Natural Course of Cannabis Use Disorders from Childhood Through Early Adulthood

描述（由申请人提供）：在许多国家，大麻是使用最广泛的非法药物。在美国，青少年和成年早期是开始使用大麻和发展大麻使用障碍（CUD）的特别关键时期。例如，最近对高中青年的一项调查表明，五分之二以上的12年级学生使用过大麻。同样，根据最近的一项全国性调查的结果，研究人员估计，240万12岁或以上的美国居民在前一年开始使用大麻，在同一12个月期间，约有430万居民（占美国人口的1.7%）滥用或依赖大麻。尽管CUD作为一个公共卫生问题的重要性，重要的知识差距仍然是关于一般人群中CUD的发展和过程。为了解决这些差距，拟议的研究将记录与CUD的自然过程相关的几个重要特征。为了实现这些研究目标，现有的数据集从俄勒冈州青少年抑郁症项目（OADP）将进行分析。OADP是一项以社区为基础的多代纵向研究，涵盖从青少年到成年早期出现持续危险大麻使用模式的高峰期。 本申请中描述的研究将解决先前OADP出版物中未涉及的几个大麻相关主题。强调了五个广泛的领域，这些领域整合了OADP的纵向和发展特征。(1)将报告OADP样本中CUD的患病率，还将提供描述从初始CUD发作恢复的时间、复发概率和疾病复发时间的风险函数。(2)将根据一生中CUD的发展过程确定人员亚组，并报告与不同轨迹亚组相关的儿童风险因素和成人心理社会结局。(3)将对父母传播CUD风险进行评价和记录。(4)儿童和青少年的精神危险因素，以后的CUD将进行评估与比例风险函数和逻辑回归方法。(5)比例风险建模和逻辑回归方法将用于评价CUD发作的精神结局。这项拟议研究的结果有可能为CUD的流行病学理论提供信息，帮助开发筛查工具以识别未来有CUD风险的青少年，促进有针对性的预防计划和治疗干预措施的制定，并减少复发的可能性一旦发生有益的行为改变。 公共卫生相关性：拟议的研究与国家药物滥用研究所（NIDA）的两个战略目标一致。(1)通过确定滥用模式和相关的心理社会风险因素，包括家庭因素，预防开始使用大麻和发展大麻使用障碍。(2)评估其他精神疾病对CUD发展的潜在影响。

DESCRIPTION (provided by applicant): In many countries cannabis is the most widely used illicit drug. In the United States, adolescence and early adulthood are particularly critical periods for the initiation of cannabis use and the development of cannabis use disorders (CUDs). A recent survey of high school youth, for example, indicated that more than 2 out of 5 12th grade students have used cannabis. Similarly, based on findings from a recent national survey, researchers estimated that 2.4 million U.S. residents aged 12 years or older initiated cannabis during the prior year, and that during the same 12-month period about 4.3 million residents (or 1.7% of the U.S. population) either abused or were dependent on cannabis. Despite the importance of CUDs as a public health concern, important gaps in knowledge remain concerning the development and course of CUDs in the general population. To address these gaps, the proposed research will document several important features associated with the natural course of CUDs. To accomplish these research aims, an existing data set from the Oregon Adolescent Depression Project (OADP) will be analyzed. The OADP is a community-based and multi- generational longitudinal study that spans the peak period for the emergence of sustained patterns of hazardous cannabis use, from adolescence through early adulthood. The research described in this application will address several cannabis-related topics not previously addressed in prior OADP publications. Five broad areas are emphasized that integrate OADP's longitudinal and developmental features. (1) The prevalence of CUDs in the OADP sample will be reported, and hazards functions that describe the time to recovery from the initial CUDs episode, the probability of relapse, and the time to disorder recurrence will also be provided. (2) Subgroups of persons will be identified based on the developmental course of CUDs over the lifetime, and childhood risk factors and adult psychosocial outcomes associated with distinct trajectory subgroups will be reported. (3) The parental transmission of CUD risk will be evaluated and documented. (4) Childhood and adolescent psychiatric risk factors for later CUDs will be evaluated with proportional hazards functions and logistic regression approaches. (5) Proportional hazards modeling and logistic regression approaches will be used to evaluate the psychiatric outcomes of CUD episodes. Findings from this proposed research have the potential to inform theories of the epidemiology of CUDs, aid the development of screening tools to identify youth who are at risk for future CUDs, facilitate the development of targeted prevention programs and therapeutic interventions, and reduce the likelihood of relapse once beneficial behavior change has occurred. PUBLIC HEALTH RELEVANCE: The proposed research is consistent with two strategic goals of the National Institute on Drug Abuse (NIDA). (1) To prevent the initiation of cannabis use and the development of cannabis use disorders (CUDs) by identifying patterns of abuse and associated psychosocial risk factors, including family factors. (2) To evaluate the potential influence of other psychiatric disorders in the development of CUDs.