Jackson Kristina M, Sher Kenneth J, Schulenberg John E
Brown University, Center for Alcohol and Addiction Studies, Providence, Rhode Island 02912, USA.
Alcohol Clin Exp Res. 2008 May;32(5):723-37. doi: 10.1111/j.1530-0277.2008.00643.x. Epub 2008 Mar 4.
Despite the prominence of comorbidity among substances and the recent attention focused on trajectory-based approaches to characterizing developmental change, little research in the substance use field has simultaneously considered both course and comorbidity.
Using nationally representative panel data from the Monitoring the Future Project (MTF; n = 32,087; 56% female; 82% Caucasian), we identified developmental courses of heavy drinking, smoking, and marijuana use using 4 waves of data spanning ages 18 to 26 in a multi-cohort young adult sample. Comorbidity was examined by cross-classifying group membership in substance use trajectories. Finally, the extent to which risk factors (sex, race, alcohol expectancies, delinquency, sensation seeking, depressive affect, religiosity, academic achievement, and parent education) accounted for combinations of comorbidity that occurred at a rate greater than chance was examined.
For each substance, we identified 4 courses of substance use that were largely consistent with those found in the literature (chronic high use, late-onset use, developmentally limited use, and low-use), with a fifth moderate smoking group. Heavy drinking, smoking, and marijuana use were each highly associated, and distinct patterns of comorbidity were evident, with greatest agreement along the diagonal. All risk factors explained comorbidity to some degree, with delinquency, sensation seeking, alcohol expectancies, and religion in particular predicting combinations of comorbidity that were characterized by early onset and chronic high use.
Cross-substance trajectory concordance was high, with parallel changes in substance use over emerging adulthood. This suggests similar developmental timing of use, perhaps due to the experience of developmental transitions that have a common influence on use of different substances. Prediction of combinations of comorbidity characterized by early onset and persistently high use suggests that to some extent, individuals use multiple substances because of a common vulnerability to each, rather than directional relations among substances (e.g., cross-tolerance, cueing).
尽管物质使用共病现象突出，且近期人们关注基于轨迹的方法来描述发育变化，但物质使用领域很少有研究同时考虑病程和共病情况。
利用来自“监测未来项目”（MTF；n = 32,087；56%为女性；82%为白种人）的具有全国代表性的面板数据，我们在一个多队列青年样本中，使用涵盖18至26岁年龄段的4波数据确定了重度饮酒、吸烟和大麻使用的发育病程。通过对物质使用轨迹中的组成员进行交叉分类来检查共病情况。最后，研究了风险因素（性别、种族、酒精预期、犯罪行为、寻求刺激、抑郁情绪、宗教信仰、学业成绩和父母教育程度）在多大程度上解释了以高于偶然概率出现的共病组合。
对于每种物质，我们确定了4种物质使用病程，这些病程在很大程度上与文献中发现的一致（慢性高使用、晚发使用、发育受限使用和低使用），还有一个中度吸烟组。重度饮酒、吸烟和大麻使用两两之间高度相关，明显存在不同的共病模式，沿对角线的一致性最高。所有风险因素在一定程度上都解释了共病情况，特别是犯罪行为、寻求刺激、酒精预期和宗教信仰能够预测以早发和慢性高使用为特征的共病组合。
跨物质轨迹一致性很高，在成年早期物质使用呈现平行变化。这表明使用的发育时间相似，可能是由于发育转型经历对不同物质的使用有共同影响。对以早发和持续高使用为特征的共病组合的预测表明，在某种程度上，个体使用多种物质是因为对每种物质都有共同的易感性，而不是物质之间的定向关系（例如，交叉耐受性、提示作用）。
