University of Michigan, Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, and Institute for Research on Women and Gender, 426 N. Ingalls St., Ann Arbor, MI 48109, USA.
University of Michigan, Survey Research Center, Institute for Social Research, P.O. Box 1248, Ann Arbor, MI 48106, USA.
J Subst Abuse Treat. 2018 Oct;93:38-48. doi: 10.1016/j.jsat.2018.07.012. Epub 2018 Jul 25.
This study examined demographic and psychosocial correlates associated with persistence/recurrence of and remission from at least one of ten DSM-5 substance use disorders (SUDs) and three substance-specific SUDs (i.e., alcohol, cannabis, and prescription opioids). Data were collected from structured diagnostic interviews and national prevalence estimates were derived from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. An estimated 25.4% of the U.S. population had at least one prior-to-past-year (prior) SUD. Among individuals with any prior SUDs, the prevalence of past-year substance use and DSM-5 symptomology was as follows: abstinence (14.2%), asymptomatic use (36.9%), symptomatic use (10.9%), and persistent/recurrent SUD (38.1%). Among individuals with prior SUDs, design-based multinomial logistic regression analysis revealed that young adulthood, higher educational attainment, higher personal income, never having been married, being divorced/separated/widowed, lack of lifetime substance use treatment, and stressful life events predicted significantly greater odds of past-year persistent/recurrent SUDs, relative to abstinence. In addition, remission from a prior tobacco use disorder decreased the probability of past-year persistent/recurrent SUD, relative to abstinence. Stressful life events were the only common correlates across the aggregation of all SUDs and each substance-specific SUD, but differences were found for specific stressful life events between drug classes. Nearly half (49%) of adults with prior DSM-5 SUDs continued to report past-year symptomatic substance use, while only one in seven individuals were abstinent. The findings suggest the value of examining remission associated with both substance-specific SUDs and aggregation of SUDs based on the shared and unique correlates of persistent/recurrent SUDs; this is especially true for stressful life events, which could be useful targets for enhancing clinical care and interventions.
本研究考察了与十种 DSM-5 物质使用障碍（SUD）和三种特定物质 SUD（即酒精、大麻和处方阿片类药物）中至少一种持续/复发和缓解相关的人口统计学和心理社会因素。数据来自结构化诊断访谈，全国患病率估计值来自 2012-2013 年全国酒精和相关条件流行病学调查。美国约有 25.4%的人口过去一年（过去）至少有一种 SUD。在有任何既往 SUD 的个体中，过去一年物质使用和 DSM-5 症状表现如下：戒断（14.2%）、无症状使用（36.9%）、症状性使用（10.9%）和持续/复发 SUD（38.1%）。在有既往 SUD 的个体中，基于设计的多项逻辑回归分析显示，青年期、较高的教育程度、较高的个人收入、从未结婚、离婚/分居/丧偶、没有接受过终生物质使用治疗以及生活压力事件与过去一年持续/复发 SUD 的几率显著更高，而非戒断。此外，与戒断相比，既往烟草使用障碍的缓解降低了过去一年持续/复发 SUD 的可能性。生活压力事件是所有 SUD 聚集和每种特定物质 SUD 的唯一共同相关因素，但在不同药物类别之间发现了特定生活压力事件的差异。近一半（49%）有既往 DSM-5 SUD 的成年人仍报告过去一年有症状性物质使用，而只有七分之一的人戒断。这些发现表明，基于持续/复发 SUD 的共同和独特相关因素，检查特定物质 SUD 和 SUD 聚集缓解的相关性是有价值的；对于生活压力事件尤其如此，它可能是增强临床护理和干预的有用目标。
