Farmer Richard F, Kosty Derek B, Seeley John R, Gau Jeff M, Duncan Susan C, Walker Denise D, Lewinsohn Peter M
Oregon Research Institute.
School of Social Work, University of Washington.
Psychol Addict Behav. 2016 Feb;30(1):82-92. doi: 10.1037/adb0000151. Epub 2016 Jan 14.
Risk factors for the development of cannabis use disorders (CUDs) have been well-researched. Comparatively little is known, however, about factors associated with the persistence of CUDs over time. This research explored whether the temporal sequencing of comorbid psychiatric disorders in relation to the onset of the index CUD episode were associated with the length of this episode. Four comprehensive diagnostic assessments were conducted between ages 16 and 30 with a large and regionally representative community sample (n = 816), among which 173 persons were diagnosed with a lifetime CUD. In separate unadjusted analyses, any internalizing disorder and any mood disorder with onset prior to that of the index CUD episode were each significantly and negatively associated with CUD duration. These effects, however, were reduced to trend level in adjusted analyses that controlled for putative confounders. Following the onset of the index CUD episode, the subsequent occurrence of any Axis I disorder, internalizing disorder, externalizing disorder, or other substance use disorder during the index CUD episode was significantly and positively associated with the duration of that episode in both unadjusted and adjusted analyses. These findings collectively suggest that the presence of internalizing-spectrum disorders prior to the onset of the index CUD episode affords some modest protection against protracted episodes, whereas the emergence of broad-spectrum psychopathology within the index CUD episode, most notably noncannabis substance use disorders, is associated with greater disorder persistence. The relevance of these findings for various motivational models of cannabis addiction is discussed.
大麻使用障碍（CUDs）发展的风险因素已得到充分研究。然而，关于CUDs随时间持续存在的相关因素，人们所知相对较少。本研究探讨了与索引CUD发作相关的共病精神障碍的时间顺序是否与该发作的持续时间有关。对一个具有广泛代表性的社区大样本（n = 816）在16至30岁之间进行了四次全面的诊断评估，其中173人被诊断为终生患有CUD。在单独的未调整分析中，任何内化障碍和在索引CUD发作之前发作的任何情绪障碍均与CUD持续时间显著负相关。然而，在控制了假定混杂因素的调整分析中，这些影响降至趋势水平。在索引CUD发作之后，在索引CUD发作期间随后出现的任何轴I障碍、内化障碍、外化障碍或其他物质使用障碍在未调整和调整分析中均与该发作的持续时间显著正相关。这些发现共同表明，在索引CUD发作之前存在内化谱系障碍可提供一定程度的保护，防止发作持续时间延长，而在索引CUD发作期间出现广泛的精神病理学，最明显的是非大麻物质使用障碍，则与更高的障碍持续性相关。讨论了这些发现与大麻成瘾各种动机模型的相关性。
