Longitudinal Changes in Recovery from Drug Use Disorders: A National Study

 描述(由申请人提供)：这项名为“药物使用障碍恢复的纵向变化：国家研究”的项目建议使用两波具有全国代表性的纵向数据来检查药物使用障碍(DUDS)的过程以及从DUDS中恢复的纵向变化，包括复发(即任何DUD标准的复发)和完全缓解(即没有任何DUD标准的复发)的比率和相关性。到目前为止，基于美国具有全国代表性的研究，对DUDS完全缓解的稳定性的了解有限，因为大多数研究仅专注于酒精使用障碍(AUD)和治疗样本。在过去20年里，在美国参加药物滥用治疗计划的人中观察到的主要滥用药物发生了显著变化，报告酒精为主要滥用药物的药物滥用治疗入院患者的百分比从1993年的57%下降到2010年的41%，而大麻、鸦片类药物和兴奋剂的药物滥用治疗入院患者的比例从1993年的约22%上升到2010年的47%。虽然在普通人群中对AUDS的病程和从AUDS中恢复进行了很好的调查，但还没有全国性的代表性研究研究DUDS和从DUDS中恢复的纵向模式随时间的变化，以及涉及单个药物类别(例如，镇静剂、镇静剂、阿片类药物、兴奋剂、致幻剂、大麻、可卡因、海洛因和吸入剂)的DUDS与涉及多个药物类别的DUDS之间的潜在差异。为了解决这些差距，我们建议对全国酒精及相关疾病流行病学调查(NESARC)进行二次分析，这是一项对居住在美国的34,653名18岁或以上的非制度化成年人进行的两波纵向流行病学调查。NESARC是唯一一项具有足够样本量来评估药物类别、年龄、性别和种族/民族之间潜在差异的大规模全国代表性研究，以满足我们研究的目的：(1)评估从哑巴中恢复的流行率(即，第1波(基线)和第2波(3年后)的特定药物DUDS和涉及多种药物类别的DUDS)；(2)确定第一波(基线)的哑巴恢复状态是否与第二波(3年后)重新面谈的可能性有关，并检查有关第二波的哑巴恢复状态的推论对潜在的不同自然减退的敏感性；(3)检查与复发和完全缓解相关的多个发育领域的预测因素；以及(4)调查药物滥用、治疗利用和残疾对第一波和第二波哑巴恢复的影响。这些问题包括：可获得具有全国代表性的大样本非住院成年人；大量哑巴患者；纳入与发展有关的复发预测指标；以及纳入关于残疾、治疗利用、哑巴和其他精神疾病的可靠衡量标准。

 DESCRIPTION (provided by applicant): This project "Longitudinal Changes in Recovery from Drug Use Disorders: A National Study" proposes to use two waves of nationally representative longitudinal data to examine the course of drug use disorders (DUDs) along with longitudinal changes in recovery from DUDs, including rates and correlates of relapse (i.e., recurrence of any DUD criteria) and full remission (i.e., no recurrence of any DUD criteria). To date, there is limited knowledge on the stability of full remission from DUDs based on nationally representative studies in the U.S. because the majority of research has focused solely on alcohol use disorders (AUDs) and treatment samples. There has been a significant shift in primary drugs of abuse observed in those entering drug abuse treatment programs in the U.S. over the past two decades with the percentage of drug abuse treatment admissions reporting alcohol as the primary drug of abuse decreasing from 57% in 1993 to 41% in 2010, while the percentage of drug abuse treatment admissions for marijuana, opiates, and stimulants increased from approximately 22% in 1993 to 47% in 2010. While the course of AUDs and recovery from AUDs has been well-investigated in the general population, no nationally representative studies have examined the longitudinal patterns of DUDs and recovery from DUDs over time and potential differences between DUDs involving individual drug classes (e.g., sedative, tranquilizer, opioid, stimulant, hallucinogen, cannabis, cocaine, heroin, and inhalant) o DUDs involving multiple drug classes. In order to address these gaps, we propose a secondary analysis of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a two-wave longitudinal and epidemiological survey of a nationally representative sample of 34,653 non-institutionalized adults, 18 years of age or older residing in the U.S. The NESARC represents the only large-scale nationally representative study that has a sufficient sample size to assess potential differences in drug classes, age, gender, and race/ethnicity, to meet our study purpose which aims to: (1) assess the prevalence of recovery from DUDs (i.e., drug-specific DUDs and DUDs involving multiple drug classes) at Wave 1 (baseline) and Wave 2 (3 years later); (2) determine whether DUD recovery status at Wave 1 (baseline) is associated with the likelihood of reinterview at Wave 2 (3 years later), and examine the sensitivity of inferences regarding DUD recovery status at Wave 2 to potential differential attrition; (3) examine the predictors from multiple developmental domains associated with relapse and full remission; and (4) investigate the effects of drug abuse treatment utilization and disability on recovery from DUDs at Waves 1 and 2. The proposed project takes advantage of the unique opportunities afforded by the NESARC. These include: the availability of a large nationally representative sample of non-institutionalized adults; large numbers of individuals with DUD; the inclusion of developmentally relevant predictors associated with relapse; and the inclusion of reliable measures of disability, treatment utilization, DUDs and other psychiatric disorders.