Marijuana use, problems, and cannabis use disorders in OIF/OEF/OND veterans

描述（由申请人提供）：尽管最近关注伊拉克和阿富汗战争中美国退伍军人的高精神健康问题率，包括物质使用障碍，但大多数报告都集中在过度饮酒和相关问题上。虽然临床医生面临着越来越多的报告，大量和有问题的大麻使用的退伍军人，研究这种药物及其与情感障碍（例如，创伤后应激障碍和严重抑郁症）几乎不存在。关于大麻使用的自然过程和相关问题的研究很少，也没有关于部署后退伍军人使用大麻和情感障碍的共病性的前瞻性研究。该应用程序的目标是对400名持久自由行动（OEF），伊拉克自由行动（OIF）和新黎明行动（OND）退伍军人的大麻使用轨迹，相关问题，大麻使用障碍和伴随的情感障碍进行首次全面的前瞻性调查。拟议的纵向设计是一个特殊的力量，在研究理论上确定的预测变化的大麻使用轨迹。大麻使用和滥用、酒精和其他药物使用障碍的变化（一年内的升级和降级）和稳定性将使用潜在过渡分析进行检查，纵向关联将使用潜在增长曲线模型进行检查。拟议的研究将确定假定的机制（使用大麻应对的原因），并调查个体差异（情绪脆弱性，认知，心理社会和身体/医疗因素）的调节作用，可能解释负面影响（DSM-IV情绪或焦虑症和/或状态负面情感）和大麻使用/障碍之间的关系。使用分层抽样与比例分配，一个相等的比例，经常每周大麻用户，过去一个月的用户，不经常过去一年的用户和非用户与大麻使用的终身历史将被选择，以允许异质性检查纵向模式的变化大麻使用。这项研究有可能产生的机制，共同发病和成瘾性疾病的发展，临床问题，对公共卫生产生重大影响，由于成瘾相关的和心理健康残疾的成本增加的基础信息。这项研究的结果将对OEF/OIF/OND退伍军人的评估和治疗产生广泛的影响，这些退伍军人同时患有物质使用和情感障碍，并最终为他们提供更高的生活质量。

DESCRIPTION (provided by applicant): Despite the recent attention to high rates of mental health problems including substance use disorders among the US veterans of the wars in Iraq and Afghanistan, most of the reports have been focused on excessive alcohol use and related problems. While clinicians are confronted with increasing reports of heavy and problematic marijuana use among the veterans, research on this drug and its association with affective disorders (e.g., post-traumatic stress disorder and major depressive disorder) is virtually nonexistent. There is a paucity of studies on the natural course of marijuana use and associated problems and there are no prospective studies on the comorbidity of cannabis use and affective disorders among veterans following deployment. The goal of this application is to conduct the first comprehensive prospective investigation of the trajectories of marijuana use, related problems, cannabis use disorders and concomitant affective disorders among 400 Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans recruited from the Veterans Administration Medical Center post-deployment. The proposed longitudinal design is a particular strength in examining theoretically-determined predictors of change in marijuana use trajectories. Change (escalation and de-escalation over one year) and stability in marijuana use and abuse, alcohol, and other drug use disorders will be examined using latent transition analysis, and longitudinal associations will be examined using latent growth curve modeling. The proposed study will identify putative mechanisms (using marijuana for coping reasons) and investigate the moderating effects of individual differences (emotional vulnerability, cognitive, psychosocial, and physical/medical factors) that may explicate the relationship between negative affect (DSM-IV mood or anxiety disorder and/or state negative affectivity) and marijuana use/disorders. Using stratified sampling with proportional allocation, an equal proportion of frequent weekly marijuana users, past month users, infrequent past year users and non-users with lifetime history of marijuana use will be selected to allow for heterogeneity in examining longitudinal patterns of change in marijuana use. This study has the potential to yield information about the mechanisms that underlie the development of co morbidity and addictive disorders, a clinical problem that has substantial impact on public health due to increasing costs of addiction-related and mental health disability. Findings from this study will have wide-ranging implications for the assessment and treatment of OEF/OIF/OND veterans with co-occurring substance use and affective disorders and ultimately for providing them with a higher quality of life.