Natural Course and Developmental Trajectories of Alcohol Use Disorders

描述(申请人提供)：酒精滥用和依赖障碍在普通人群中很常见，保守的估计表明，近五分之一的美国人会在一生中患上酒精使用障碍(AUD)。与急性尿毒症相关的公共卫生问题已经有了很好的记录；然而，关于急性尿毒症在普通人群中的发展和病程，在知识方面仍然存在重大差距。为了解决这些差距，拟议的研究将描述与AUDS自然过程相关的几个重要特征。这些包括与AUD相关的发育轨迹的多样性，以及AUD轨迹与常见共生疾病，如大麻使用障碍、难用药物使用障碍和反社会行为障碍共享的关系的时间和顺序。这项拟议的研究还将报告有关第一次AUD发作后复发的可能性以及第二次AUD发作后疾病复发时间的数据。还将测试一个模型，以了解AUDS的短期和长期结果，这些结果反过来又对持续恢复期后与复发相关的过程产生影响。为了实现这些研究目标，将对俄勒冈州青少年抑郁项目(OADP)的现有数据集进行分析。OADP是一项以社区为基础的多代纵向研究，从青春期到成年早期，跨越了危险酒精持续使用模式出现的高峰期。这项提案中描述的研究将解决以前的OADP出版物中没有解决的几个问题。强调了四个大的领域，这些领域整合了OADP的纵向和发展特点。(1)将导出描述与AUDS首次发病年龄相关的趋势的危险函数，并将报告关于恢复时间、复发概率和疾病复发时间的数据。(2)将根据AUDS在一生中的发展历程确定不同的人群亚组，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果。(3)将评估和记录AUDS与其他相关疾病共享的可能的单向和相互关系。(4)抑郁障碍将被评估为最初的AUDS后可能的“疤痕”，而这反过来又预测了未来复发的可能性。这项拟议研究的结果有可能为AUDS的流行病学理论提供信息，帮助开发筛查工具来确定哪些年轻人有可能患上AUDS，促进有针对性的预防计划和治疗干预的发展，并在有益的行为改变发生后降低复发的可能性。

DESCRIPTION (provided by applicant): Alcohol abuse and dependence disorders are common in the general population, with conservative estimates suggesting that almost 1 in 5 Americans will develop an alcohol use disorder (AUD) during their lifetime. The public heath concerns associated with AUDs have been well-documented; nonetheless, important gaps in knowledge remain concerning the development and course of AUDs in the general population. To address these gaps, the proposed research will describe several important features associated with the natural course of AUDs. These include the diversity of AUD-related developmental trajectories, as well as the timing and sequencing of relationships that AUD trajectories share with common co-occurring conditions, such as cannabis use disorders, hard drug use disorders, and antisocial behavior disorders. The proposed research will also report data on the probability of relapse following the first AUD episode and the time to disorder recurrence for those with a second AUD episode. A model will also be tested for understanding the short- and longer-term outcomes of AUDs that, in turn, have implications for relapse-related processes following periods of sustained recovery. 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 alcohol use, from adolescence through early adulthood. The research described in this proposal will address several issues not previously addressed in prior OADP publications. Four broad areas are emphasized that integrate OADP's longitudinal and developmental features. (1) Hazard functions that describe trends associated with the age of first onset for AUDs will be derived, and data will be reported on the time to recovery, the probability of relapse, and the time to disorder recurrence. (2) Subgroups of persons will be identified based on the developmental course of AUDs over the lifetime, and childhood risk factors and adult psychosocial outcomes associated with distinct trajectory subgroups will be reported. (3) The possible unidirectional and reciprocal relationships that AUDs share with other related disorders will be evaluated and documented. (4) Depressive disorders will be evaluated as possible "scars" following initial AUDs that, in turn, predict the likelihood of future relapse. Findings from this proposed research have the potential to inform theories of the epidemiology of AUDs, aid the development of screening tools to identify youth who are at risk for future AUDs, facilitate the development of targeted prevention programs and therapeutic interventions, and reduce the likelihood of relapse once beneficial behavior change has occurred.