Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
J Clin Psychiatry. 2012 May;73(5):e588-93. doi: 10.4088/JCP.11m07345.
To examine whether self-medication with drugs confers risk of comorbid mood and drug use disorders.
A longitudinal, nationally representative survey was conducted by the National Institute on Alcohol Abuse and Alcoholism. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) assessed DSM-IV-TR psychiatric disorders, self-medication, and sociodemographic variables at 2 time points. A total of 34,653 adult, US participants completed both waves of the survey. Wave 1 was conducted between 2001 and 2002, and Wave 2 interviews took place 3 years later (2004-2005). Logistic regression and population attributable fractions were calculated to obtain estimates of the association between self-medication and incident disorders.
Logistic regression analyses revealed that self-medication with drugs conferred a heightened risk of new-onset drug dependence among those with baseline mood disorders (adjusted odds ratio [AOR] = 7.65; 95% CI, 3.70-15.82; P < .001) and accounted for over 25% of incident drug dependence disorders among people with mood disorders. Among those with comorbid mood and drug use disorders at baseline, self-medication with drugs was associated with the persistence of drug abuse (AOR = 2.47; 95% CI, 1.34-4.56; P < .01), accounting for over one-fifth of the persistence of drug use disorders at 3-year follow-up.
Self-medication with drugs among individuals with mood disorders confers substantial risk of developing incident drug dependence and is associated with the persistence of comorbid mood and drug use disorders. These results clarify a pathway that may lead to the development of mood and drug use disorder comorbidity and indicate an at-risk population, with potential points of intervention for prevention of comorbidity.
研究自我用药是否会增加共患心境和药物使用障碍的风险。
美国国家酒精滥用和酒精中毒研究所进行了一项纵向、全国代表性的调查。国家酒精流行病学调查及相关条件（NESARC）在 2 个时间点评估了 DSM-IV-TR 精神障碍、自我用药和社会人口统计学变量。共有 34653 名美国成年参与者完成了调查的 2 个波次。第 1 波调查于 2001 年至 2002 年进行，第 2 波访谈于 3 年后（2004-2005 年）进行。计算逻辑回归和人群归因分数以获得自我用药与新发障碍之间的关联估计。
逻辑回归分析显示，在基线有心境障碍的人群中，药物自我用药会增加新发药物依赖的风险（调整后的优势比 [AOR] = 7.65；95%置信区间，3.70-15.82；P <.001），并解释了有心境障碍的新发药物依赖障碍人群中超过 25%的比例。在基线时共患心境和药物使用障碍的人群中，药物自我用药与药物滥用的持续存在相关（AOR = 2.47；95%置信区间，1.34-4.56；P <.01），占 3 年随访时药物使用障碍持续存在的五分之一以上。
心境障碍个体的药物自我用药会显著增加新发药物依赖的风险，并且与共患心境和药物使用障碍的持续存在相关。这些结果阐明了一条可能导致心境和药物使用障碍共病发展的途径，并表明存在一个高危人群，为预防共病提供了潜在的干预点。
