Alcohol Use Disorders Across the Lifespan: Subtypes, Course, Comorbidity

描述（由申请人提供）：这是一份修订申请（1 R 01 AA 016392 - 01 A1）的修订版，该修订申请是根据NIAAA项目公告（05-088）现有酒精流行病学数据的二次分析编写的，并由BGES IRG在其2006年10月的会议上进行了审查。在这次修订中，我们试图解决最初提交的评审员提出的问题，同时保持我们最初的主要目标，即通过利用国家酒精和相关疾病流行病学调查（NESARC）研究的独特方面，包括广泛的精神病理学评估，将酒精使用障碍（AUD）的结构和过程描述为青少年晚期和成人发育的功能（包括轴I和轴II疾病），基于人群的抽样，大样本量（约43，000人），成年年龄跨度的覆盖范围和3年的纵向随访。我们的主要重点是心理测量结构和课程（例如，AUDs的发作、进展、消退和缓解/停止）作为发育（实足年龄）的函数。尽管酒精研究者越来越多地将AUDs视为发育障碍，但人们对依赖综合征的结构（从维度或类别上评估）是否随发育而变化以及各种协变量在决定生命周期沿着不同时间点的过程中所起的作用知之甚少。除了关注年龄作为从测量和预后角度理解AUD的关键支架外，我们还计划研究其他主要人口统计学（即，性别和种族/民族）和临床变量（即，轴I和轴II病理）与年龄相互作用，影响AUDs的结构和过程。我们特别感兴趣的是通过使用NESARC的人格病理学评估来扩展以前的工作，这是该数据集的一个独特方面。我们相信人格病理学在AUD的病因学和病程中起着重要但未被充分认识的作用，并计划进行广泛和系统的分析，以描绘AUD/人格障碍（轴II）共病的性质。由于轴I“临床综合征”和轴II疾病之间的高共病性，目前还不清楚现有的关于AUD与轴I疾病共病性的文献在多大程度上代表了病理学的伪影。只有通过全面和同时建模轴I和轴II病理，我们才能解决各种共病综合征与AUDs具有统计学独特关系的程度。除了研究项目的实质性目标外，我们还建议开发和完善表征酒精相关综合征的方法，并研究其随时间的稳定性。我们相信这些心理测量学研究可以为临床疾病分类学和对可能在遗传学研究中有用的新表型感兴趣的研究人员提供信息。 与公共卫生的相关性：酒精使用障碍（AUDs）是美国最普遍的心理障碍之一，对受影响的个人，他们的朋友和家人以及整个社会产生了巨大的负担。虽然主要是青春期和成年早期的疾病，但AUD在整个成年过程中代表着重大的健康挑战。拟议的研究旨在表征因素的发展和过程中的AUDs作为一个功能的成人发展阶段，以更好地了解AUDs的原因和后果的发展背景。

DESCRIPTION (provided by applicant): This is a revision of an amended application (1 R01 AA016392-01A1) written in response to NIAAA Program Announcement (05-088) Secondary Analysis of Existing Alcohol Epidemiology Data and reviewed by the BGES IRG at its October, 2006, meeting. In this revision, we have attempted to address concerns raised by the reviewers of the initial submission while maintaining our original primary goals which involve characterizing the structure and course of alcohol use disorders (AUDs) as a function of late adolescent and adult development by exploiting the unique aspects of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study which include extensive assessment of psychopathology (including both Axis I and Axis II disorders), population-based sampling, large (~43,000 individuals) sample size, coverage of the adult age span, and three-year longitudinal follow-up. Our main focus is on the psychometric structure and course (e.g., onset, progression, regression, and remission/desistence) of AUDs as a function of development (chronological age). Although alcohol researchers increasingly view AUDs as developmental disorders, little is known about whether the structure of the dependence syndrome (assessed either dimensionally or categorically) varies as a function of development and the role that various covariates play in determining course at different points along the lifespan. In addition to focusing on age as critical scaffolding for understanding AUDs from both a measurement and prognostic perspective, we plan to examine how other major demographic (i.e., sex and race/ethnicity) and clinical variables (i.e., Axis I and Axis II pathology) interact with age to affect the structure and course of AUDs. We are particularly interested in extending previous work by using the NESARC's assessment of personality pathology, a unique aspect of this data set. We believe personality pathology plays an important but under-recognized role in the etiology and course of AUDs, and plan extensive and systematic analyses to portray the nature of AUD/personality disorder (Axis II) comorbidity. Because of the high comorbidity between Axis I "clinical syndromes" and Axis II disorders, it is unclear to what extent the existing literature on AUD comorbidity with Axis I disorders represents an artifact of pathology. Only by comprehensively and simultaneously modeling both Axis I and Axis II pathology can we resolve the extent that various comorbid syndromes have a statistically unique relation with AUDs. In addition to the substantive goals of the research project, we also propose to develop and refine methodologies for characterizing alcohol-related syndromes and studying their stabilities over time. We believe these psychometric investigations can inform both clinical nosology and researchers interested in novel phenotypes that may be useful in genetic investigations. Relevance to public health: Alcohol use disorders (AUDs) are among the most prevalent psychological disorders in the Nation and produce substantial burden to affected individuals, their friends and families, and society at large. Although primarily a disorder of adolescence and early adulthood, AUDs represent significant health challenges throughout the course of adulthood. The proposed study seeks to characterize factors important in the development and course of AUDs as a function of stage of adult development in order to better understand the causes and consequences of AUDs in a developmental context.