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异：亚裔美国人（AA）、太平洋岛民（PI）和多种族个体（MR）。AAs，PI和MR是研究最不足和最不为人知的少数群体，特别是物质问题和治疗需求。由于缺乏关于使用酒精和9类毒品的发生率和流行率以及每个群体的物质相关疾病和治疗需求的模式和程度的基于人口的数据，因此几乎不可能制定循证方案和政策来解决这些增长最快和服务不足的人口的物质相关负担。利用美国最大的药物使用和疾病国家研究（国家药物使用和健康调查，NSDUH）和美国最大的精神病电子病历数据库（MindLinc），拟议的团队将检查每个群体的药物滥用和治疗差距。研究目的包括：（a）检查酒精和九种主要毒品首次使用（发作）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）确定多种物质使用和物质障碍的模式、顺序和相关因素;（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，以及感知到的未满足的治疗需求和障碍;（d）阐明共病障碍的综合模式及其时间关联;（e）确定精神病治疗途径，包括治疗进入设置、治疗进入的原发性障碍（物质与非物质障碍）、治疗模式和治疗反应。对每个目标的分析将检查种族群体之间的差异，以衡量健康差异的程度（AA，PI，MR与白人），并在每个群体内为每个特定人群提供深入的知识基础。研究结果将确定开始使用酒精或药物的高风险期以及风险亚组，以促进针对初级预防计划。他们还将指定显示多种物质使用，药物障碍和其他精神障碍几率升高的亚组，因此可以针对这些亚组进行重点干预，以减少严重后果。该领域将更好地了解未满足的需求和障碍，以治疗使用之间的AA，PI和MR鉴于患者保护和平价医疗法案，这样一个全面的知识库是及时需要指导循证研究，干预，决策，以减少负担和费用与物质使用相关。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，以便更全面地了解这些研究不足的群体的药物滥用治疗需要。该项目构成了一个初步的和具有成本效益的步骤，研究的分布，相关性，课程，后果和治疗差距的物质问题之间的AA，PI和MR。

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.