Substance Abuse & Treatment Gaps in Asians, Pacific Islanders & Multiple-race Ind

描述(由申请人提供)：与RFA-MD-12-003的目标一致，本申请建议解决已确定的少数群体之间的健康差距：亚裔美国人(AAs)、太平洋岛民(PI)和多种族个人(MRS)。AAS、PI和MRS是研究最少、最不为人所知的少数群体，尤其是在物质问题和治疗需求方面。由于缺乏关于使用酒精和9类毒品的发生率和流行率的人口数据，以及每一组与物质相关的疾病的模式和规模以及治疗需求，因此几乎不可能制定以证据为基础的方案和政策，以解决这些增长最快和服务不足的人口与物质有关的负担。利用最大的全国药物使用和疾病研究(全国药物使用和健康调查，NSDUH)和美国最大的精神科电子病历数据库(MindLinc)，拟议的团队将检查每个群体的药物滥用和治疗差距。研究的目的包括：(A)检查酒精和九种主要药物类别的首次使用(开始)的发生率和决定因素，包括发生率趋势、开始使用的风险期和最近开始使用的相关因素；(B)确定多物质使用和物质障碍的模式、顺序和相关性；(C)调查药物滥用治疗使用的流行率、模式和相关因素，包括接受服务的地点、接受治疗的主要滥用药物以及认为的未得到满足的治疗需求和治疗使用障碍；(D)阐明共病障碍的综合模式及其时间关联；以及(E)确定获得精神治疗的途径，包括进入治疗的环境、进入治疗的原发障碍(物质障碍与非物质障碍)、治疗模式和治疗反应。针对每个目标的分析将检查不同种族群体之间的差异，以衡量健康差异的程度(AA、PI、MRS与白人)，并在每个群体内为每个特定人口提供深入的知识库。这些发现将确定开始饮酒或吸毒的高风险期和高危亚群，以促进针对初级预防计划的目标。他们还将指定显示多物质使用、药物障碍和其他精神障碍几率增加的亚组，以便他们可以成为有针对性的干预措施，以减少严重后果。该领域将更好地了解AAs、PIs和MRS之间未得到满足的治疗需求和治疗使用障碍。鉴于《患者保护和平价医疗法案》，及时需要这样一个全面的知识库来指导循证研究、干预和政策制定，以减少与药物使用相关的负担和成本。这些群体最大的国家数据档案将得到纵向收集的治疗数据的补充，以更全面地了解这些未被研究的群体的药物滥用治疗需求。这个项目是研究AAs、PIs和MRS之间物质问题的分布、相关性、过程、后果和治疗差距的第一步，也是具有成本效益的一步。

DESCRIPTION (provided by applicant): Consistent with the goal of RFA-MD-12-003, this application proposes to address health disparities among the identified minority groups: Asian Americans (AAs), Pacific Islanders (PIs), and multiple-race individuals (MRs). AAs, PIs, and MRs are among the most understudied and the least known minority populations, especially for substance problems and treatment needs. The lack of population-based data on the incidence and prevalence of use of alcohol and 9 drug classes as well as the patterns and magnitude of substance-related disorders and treatment needs for each group make it almost impossible to develop evidence-based programs and policies to address substance-related burdens for these fastest-growing and underserved populations. Capitalizing on the largest national studies of substance use and disorders (National Survey on Drug Use and Health, NSDUH) and the largest psychiatric electronic medical record data repository (MindLinc) in the US, the proposed team will examine substance abuse and treatment gaps for each group. Study aims include to (a) examine the incidence and determinants of first use (onset) of alcohol and nine major drug classes, including incidence trends, risk periods for initiation, and correlates of recent initiatin; (b) determine the patterns, sequences, and correlates of polysubstance use and substance disorders; (c) investigate the prevalence, patterns, and correlates of substance abuse treatment use, including the location of services received, the primary abused substance for receiving treatment, and perceived unmet needs for and barriers to treatment use; (d) elucidate comprehensive patterns of comorbid disorders and their temporal associations; and (e) determine pathways to psychiatric treatment, including treatment entry settings, primary disorders for treatment entry (substance vs. non-substance disorders), modes of treatment, and treatment responses. Analyses for each aim will examine differences across racial groups to gauge the extent of health disparities (AAs, PIs, MRs vs. whites) and within each group to provide an in-depth knowledge base for each specific population. The findings will identify the heightened risk periods for initiating alcohol or drug use and at-risk subgroups to facilitate targeting primary prevention programs. They also will specify subgroups showing elevated odds of polysubstance use, drug disorders, and other mental disorders, so they can be targeted for focused interventions to reduce serious consequences. The field will understand better the unmet needs for and barriers to treatment use among AAs, PIs, and MRs. Given the Patient Protection and Affordable Care Act, such a comprehensive knowledge base is timely needed to guide evidence-based research, intervention, policymaking to reduce burdens and costs associated with substance use. The largest national data files for these groups will be complemented by longitudinally collected treatment data to provide a fuller picture of substance abuse treatment needs for these understudied groups. This project constitutes an initial and cost-effective step to study the distributions, correlates, courses, consequences, and treatment gaps of substance problems among AAs, PIs, and MRs.