New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Drug Alcohol Depend. 2011 May 1;115(1-2):120-30. doi: 10.1016/j.drugalcdep.2010.11.004. Epub 2010 Dec 8.
This study aims to estimate general and racial-ethnic specific cumulative probability of developing dependence among nicotine, alcohol, cannabis or cocaine users, and to identify predictors of transition to substance dependence.
Analyses were done for the subsample of lifetime nicotine (n=15,918), alcohol (n=28,907), cannabis (n=7389) or cocaine (n=2259) users who participated in the first and second wave of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Discrete-time survival analyses were implemented to estimate the cumulative probability of transitioning from use to dependence and to identify predictors of transition to dependence.
The cumulative probability estimate of transition to dependence was 67.5% for nicotine users, 22.7% for alcohol users, 20.9% for cocaine users, and 8.9% for cannabis users. Half of the cases of dependence on nicotine, alcohol, cannabis and cocaine were observed approximately 27, 13, 5 and 4 years after use onset, respectively. Significant racial-ethnic differences were observed in the probability of transition to dependence across the four substances. Several predictors of dependence were common across the four substances assessed.
Transition from use to dependence was highest for nicotine users, followed by cocaine, alcohol and cannabis users. Transition to cannabis or cocaine dependence occurred faster than transition to nicotine or alcohol dependence. The existence of common predictors of transition dependence across substances suggests that shared mechanisms are involved. The increased risk of transition to dependence among individuals from minorities or those with psychiatric or dependence comorbidity highlights the importance of promoting outreach and treatment of these populations.
本研究旨在估计尼古丁、酒精、大麻或可卡因使用者中普遍存在的以及特定种族的依赖累积概率，并确定向物质依赖过渡的预测因素。
对参加国家酒精与相关状况流行病学调查（NESARC）第一和第二波的终身尼古丁（n=15918）、酒精（n=28907）、大麻（n=7389）或可卡因（n=2259）使用者的子样本进行了分析。采用离散时间生存分析来估计从使用到依赖的过渡累积概率，并确定向依赖过渡的预测因素。
尼古丁使用者向依赖过渡的累积概率估计值为 67.5%，酒精使用者为 22.7%，可卡因使用者为 20.9%，大麻使用者为 8.9%。尼古丁、酒精、大麻和可卡因依赖的半数病例分别在使用后约 27、13、5 和 4 年观察到。在四种物质中，依赖过渡的概率存在显著的种族差异。几种依赖的预测因素在评估的四种物质中是共同的。
从使用到依赖的过渡在尼古丁使用者中最高，其次是可卡因、酒精和大麻使用者。向大麻或可卡因依赖的过渡比向尼古丁或酒精依赖的过渡更快。跨物质依赖过渡的共同预测因素的存在表明存在共同的机制。少数群体或有精神或依赖共病的个体向依赖过渡的风险增加，突出了向这些人群推广外联和治疗的重要性。
