Ridenour Ty A, Cottler Linda B, Compton Wilson M, Spitznagel Edward L, Cunningham-Williams Renee M
The Prevention Research Center, Human Development and Family Studies, The Pennsylvania State University, State College, PA 16801, USA.
Addiction. 2003 May;98(5):635-44. doi: 10.1046/j.1360-0443.2003.00350.x.
Recent studies suggest that a progression occurs from alcohol abuse to alcohol dependence. Although DSM-IV criteria for all substance use-related diagnoses are based largely on the alcohol dependence syndrome, progression from abuse to dependence might not generalize to other substances.
This study tested whether a progression from DSM-IV abuse to dependence occurs related to the use of cannabis, cocaine and opiates.
Retrospective data from the DSM-IV Substance Use Disorders Work Group (n = 1226) were reanalysed using McNemar's chi2, configural frequency analyses and survival analyses. Participants were men and women who were primarily African-Americans or Caucasians.
Participants were recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview-Substance Abuse Module.
For all substances, life-time dependence in the absence of life-time abuse was rare. Results were consistent with a progression occurring for alcohol and cannabis, but not for cocaine and opiates. Abuse and dependence occurred in the same year for 66% of the cocaine users who experienced both disorders (57% of users with any cocaine disorder) and 65% of the opiate users who experienced both disorders (46% of users with any opiate disorder). Because cocaine and opiate dependence in the absence of abuse were rare, it is possible that progressions in cocaine and opiate disorders occur more rapidly than cannabis and alcohol.
Research is needed to clarify the mechanisms that influence progressions of substance use disorders. Potential factors leading to between-drug variation in rate of progression of disorders are discussed.
近期研究表明，存在从酒精滥用发展为酒精依赖的过程。尽管所有与物质使用相关诊断的《精神疾病诊断与统计手册》第四版（DSM-IV）标准很大程度上基于酒精依赖综合征，但从滥用发展为依赖的情况可能并不适用于其他物质。
本研究测试了与大麻、可卡因和阿片类药物使用相关的，从DSM-IV定义的滥用发展为依赖的情况是否存在。
使用麦克尼马尔卡方检验、构型频率分析和生存分析，对DSM-IV物质使用障碍工作组的回顾性数据（n = 1226）进行重新分析。参与者为主要是非洲裔美国人或高加索人的男性和女性。
参与者从社区和临床环境中招募。测量工具为《综合国际诊断访谈-物质滥用模块》。
对于所有物质，终生未滥用却出现终生依赖的情况很罕见。结果与酒精和大麻存在从滥用发展为依赖的过程一致，但可卡因和阿片类药物并非如此。在同时经历了两种障碍的可卡因使用者中，66%（在所有有任何可卡因相关障碍的使用者中占57%）以及在同时经历了两种障碍的阿片类药物使用者中，65%（在所有有任何阿片类药物相关障碍的使用者中占46%）在同一年既出现了滥用又出现了依赖。由于不存在滥用却出现可卡因和阿片类药物依赖的情况很罕见，可卡因和阿片类药物相关障碍的发展过程可能比大麻和酒精更快。
需要开展研究以阐明影响物质使用障碍发展过程的机制。讨论了导致不同药物在障碍发展速率上存在差异的潜在因素。
