Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
JAMA Psychiatry. 2013 Jul;70(7):718-26. doi: 10.1001/jamapsychiatry.2013.1098.
Mood disorders and alcohol dependence frequently co-occur. Etiologic theories concerning the comorbidity often focus on drinking to self-medicate or cope with affective symptoms. However, there have been few, if any, prospective studies in population-based samples of alcohol self-medication of mood symptoms with the occurrence of alcohol dependence. Furthermore, it is not known whether these associations are affected by treatment or symptom severity.
To evaluate the hypothesis that alcohol self-medication of mood symptoms increases the probability of subsequent onset and the persistence or chronicity of alcohol dependence.
Prospective study using face-to-face interviews-the National Epidemiologic Survey on Alcohol and Related Conditions.
Nationally representative survey of the US population.
Drinkers at risk for alcohol dependence among the 43 093 adults surveyed in 2001 and 2002 (wave 1); 34 653 of whom were reinterviewed in 2004 and 2005 (wave 2).
Association of alcohol self-medication of mood symptoms with incident and persistent DSM-IV alcohol dependence using logistic regression and the propensity score method of inverse probability of treatment weighting.
The report of alcohol self-medication of mood symptoms was associated with an increased odds of incident alcohol dependence at follow-up (adjusted odds ratio [AOR], 3.10; 95% CI, 1.55-6.19; P = .002) and persistence of dependence (AOR, 3.45; 95% CI, 2.35-5.08; P < .001). The population-attributable fraction was 11.9% (95% CI, 6.7%-16.9%) for incident dependence and 30.6% (95% CI, 24.8%-36.0%) for persistent dependence. Stratified analyses were conducted by age, sex, race/ethnicity, mood symptom severity, and treatment history for mood symptoms.
Drinking to alleviate mood symptoms is associated with the development of alcohol dependence and its persistence once dependence develops. These associations occur among individuals with subthreshold mood symptoms, with DSM-IV affective disorders, and for those who have received treatment. Drinking to self-medicate mood symptoms may be a potential target for prevention and early intervention efforts aimed at reducing the occurrence of alcohol dependence.
情绪障碍和酒精依赖经常同时发生。关于这种共病的病因理论通常集中在通过饮酒来自我治疗或应对情绪症状。然而，在基于人群的酒精自我治疗情绪症状与酒精依赖发生的样本中，很少有（如果有的话）前瞻性研究。此外，尚不清楚这些关联是否受治疗或症状严重程度的影响。
评估以下假设，即酒精自我治疗情绪症状会增加随后发生酒精依赖的可能性，以及增加酒精依赖的持续性或慢性程度。
使用面对面访谈的前瞻性研究-国家酒精和相关条件流行病学调查。
美国全国代表性的调查人群。
2001 年和 2002 年接受调查的有酒精依赖风险的 43093 名成年人中的饮酒者（第 1 波）；其中 34653 人在 2004 年和 2005 年（第 2 波）接受了重新访谈。
使用逻辑回归和逆概率治疗加权的倾向评分方法，将酒精自我治疗情绪症状与新发和持续性 DSM-IV 酒精依赖的关联作为主要结局进行评估。
在随访时，报告酒精自我治疗情绪症状与发生酒精依赖的几率增加有关（调整后的优势比 [AOR]，3.10；95%CI，1.55-6.19；P=0.002），且与依赖的持续性有关（AOR，3.45；95%CI，2.35-5.08；P<0.001）。在人群中，新发依赖的归因分数为 11.9%（95%CI，6.7%-16.9%），持续性依赖的归因分数为 30.6%（95%CI，24.8%-36.0%）。分层分析按年龄、性别、种族/民族、情绪症状严重程度和情绪症状的治疗史进行。
饮酒以缓解情绪症状与酒精依赖的发展以及依赖一旦发生后的持续性有关。这些关联发生在有亚临床情绪症状、DSM-IV 情感障碍以及接受过治疗的个体中。饮酒自我治疗情绪症状可能是预防和早期干预努力的一个潜在目标，旨在减少酒精依赖的发生。
