寻求治疗与未寻求治疗的酒精依赖研究参与者之间的差异：一项探索性分析。
Differences Between Treatment-Seeking and Nontreatment-Seeking Alcohol-Dependent Research Participants: An Exploratory Analysis.
作者信息
Rohn Matthew C H, Lee Mary R, Kleuter Samuel B, Schwandt Melanie L, Falk Daniel E, Leggio Lorenzo
机构信息
Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland.
Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.
出版信息
Alcohol Clin Exp Res. 2017 Feb;41(2):414-420. doi: 10.1111/acer.13304.
BACKGROUND
Alcoholism is a chronic relapsing disorder with complex behavioral and functional heterogeneity. To date, attempts to characterize subgroups of alcohol-dependent (AD) individuals have largely been focused on categorical distinctions based on behaviors such as ability to abstain, age of onset, and drinking motives, but these have failed to yield predictors of treatment response and disease course. The distinction between AD individuals who are or are not interested in treatment holds significant implications for interpreting results of human laboratory studies with nontreatment seekers and clinical trials with treatment-seeking AD patients. However, despite their crucial role in alcohol-related research, these 2 groups are poorly defined. In this exploratory analysis, we attempt to better define the phenotypic differences between these 2 experimentally relevant populations.
METHODS
We analyzed data from AD individuals who participated in screening protocols to evaluate their suitability for participation in either treatment or nontreatment research studies at NIAAA. Scores on individual measures from a battery of behavioral, neuropsychological, and blood laboratory measures were compared between those who presented seeking treatment for AD and those who were not seeking treatment. Differences in each measure were assessed between the 2 groups. In addition, we explored whether significant differences were apparent when drinking behavior was used as a covariate.
RESULTS
Treatment seekers manifested more impairment compared to nontreatment seekers on a wide variety of measures in the following categories: alcohol drinking, personality, impulsivity, trauma/stress, cognition, aggression, mood, and liver enzyme tests. Treatment seekers endorsed a greater number of AD criteria. Several measures including elevations in liver enzyme tests remained significantly different between the 2 groups when average daily alcohol consumption per drinking day was used as a covariate.
CONCLUSIONS
Treatment-seeking, compared to nontreatment-seeking AD subjects who present for alcohol-related research studies, differ in characteristics beyond the quantity of alcohol consumption. Implications of these differences with respect to clinical research for treatments of AD are discussed.
背景
酒精成瘾是一种具有复杂行为和功能异质性的慢性复发性疾病。迄今为止，对酒精依赖（AD）个体亚组进行特征描述的尝试主要集中在基于诸如戒酒能力、发病年龄和饮酒动机等行为的分类区分上，但这些方法未能产生治疗反应和疾病进程的预测指标。对治疗感兴趣或不感兴趣的AD个体之间的区分，对于解释针对非治疗寻求者的人体实验室研究结果以及针对治疗寻求型AD患者的临床试验结果具有重要意义。然而，尽管这两组在酒精相关研究中起着关键作用，但它们的定义却很模糊。在这项探索性分析中，我们试图更好地界定这两个与实验相关的人群之间的表型差异。
方法
我们分析了参与筛查方案的AD个体的数据，以评估他们是否适合参与美国国立酒精滥用与酒精中毒研究所（NIAAA）的治疗或非治疗研究。比较了那些因AD寻求治疗者和未寻求治疗者在一系列行为、神经心理学和血液实验室测量中的个体测量得分。评估了两组之间每项测量的差异。此外，我们探讨了将饮酒行为作为协变量时，是否存在显著差异。
结果
在以下类别中的多种测量指标上，与未寻求治疗者相比，寻求治疗者表现出更多的损伤：饮酒、人格、冲动性、创伤/压力、认知、攻击性、情绪和肝酶测试。寻求治疗者认可更多的AD标准。当将每个饮酒日的平均每日酒精消费量作为协变量时，包括肝酶测试升高在内的几项测量指标在两组之间仍存在显著差异。
结论
与因酒精相关研究前来就诊的未寻求治疗的AD受试者相比，寻求治疗者在饮酒量之外的特征上存在差异。讨论了这些差异对AD治疗临床研究的影响。
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