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

描述（由申请人提供）：尽管最近在伊拉克和阿富汗战争的美国退伍军人中，包括物质使用障碍在内的精神健康问题的高发率引起了关注，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退伍军人大量使用大麻的报告，但关于这种药物及其与情感障碍（如创伤后应激障碍和重度抑郁症）之间关系的研究实际上是不存在的。关于大麻使用的自然过程和相关问题的研究很少，也没有关于退伍军人在部署后使用大麻和情感障碍的合并症的前瞻性研究。本应用程序的目的是对400名从退伍军人管理医疗中心招募的持久自由行动（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情感障碍进行首次全面的前瞻性调查。提出的纵向设计在检查大麻使用轨迹变化的理论确定预测因素方面具有特别的优势。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。拟议的研究将确定可能的机制（出于应对原因使用大麻），并调查个体差异（情感脆弱性、认知、社会心理和身体/医学因素）的调节作用，这些因素可能解释负面情绪（DSM-IV心境或焦虑障碍和/或状态负面情绪）与大麻使用/障碍之间的关系。采用按比例分配的分层抽样方法，选择相同比例的每周频繁吸食大麻者、过去一个月吸食大麻者、过去一年不频繁吸食大麻者和有终生吸食大麻史的非吸食大麻者，以检验大麻使用变化的纵向模式的异质性。这项研究有可能提供关于共同发病和成瘾性疾病发展机制的信息，这是一个临床问题，由于成瘾相关残疾和精神健康残疾的成本增加，对公共卫生产生重大影响。这项研究的结果将对同时发生药物使用和情感障碍的OEF/OIF/OND退伍军人的评估和治疗产生广泛的影响，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. PUBLIC HEALTH RELEVANCE: Many people use marijuana to cope with depression and anxiety, which leads to more severe psychiatric symptoms and worse outcomes with respect to marijuana-related problems and marijuana use disorders. Marijuana use along with co-occurring mental health problems like post-traumatic stress disorder and depression are of particular concern among the US veterans of the wars in Iraq and Afghanistan who are returning home from the war. This research will help identify individuals who are particularly vulnerable to developing comorbid substance use and affective disorders and will track changes in veterans' marijuana and other drug use over one year with the goal of ultimately improving detection and treatment of substance use disorders.