Prevention Research Center , Pacific Institute for Research and Evaluation, Berkeley, California.
Department of Behavioral and Community Health Sciences , Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Alcohol Clin Exp Res. 2019 Feb;43(2):299-308. doi: 10.1111/acer.13940. Epub 2019 Jan 20.
Survey-based estimates of the prevalence of alcohol abuse, dependence, and disorders in the United States rely upon self-reports of drinking patterns (e.g., binge drinking), social problems (e.g., trouble at work), physiological responses to use (e.g., tolerance), and desistance from use (e.g., withdrawal). Diagnostic criteria derived from these reports enable prevalence estimates of abuse and dependence, but moderating structural relationships among symptom groups may lead some light and moderate drinkers to appear to exhibit an alcohol use disorder (AUD).
A dynamic model of drinking and problems predicts that symptoms of dependence will moderate relationships between drinking measures and symptoms of abuse. Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions data on DSM-IV diagnoses of abuse and dependence were used to test predictions from this model and assess whether moderating effects were observed among lighter and heavier drinkers (those who drink 1 to 3 vs. 4 or more drinks on average). A dose-response model that accounts for other known sources of risk heterogeneity related to drinking and problems enabled us to test these predictions.
As expected from previous work, symptoms of abuse and dependence and dependence criteria were nonlinearly related to drinking patterns; more symptom reports appeared and criteria were met among less frequent drinkers who drank more on each occasion and this pattern of dose-response was substantially moderated among heavier drinkers. Controlling for these effects, relationships between drinking and symptoms of abuse were moderated among respondents who met more dependence criteria. These effects were observed among both lighter and heavier drinkers.
Moderating relationships observed between measures of drinking, abuse, and dependence criteria among lighter and heavier drinkers suggest that the same etiologic forces are at play among all drinking groups. Greater symptoms of dependence among lighter drinkers may lead to greater reports of symptoms of abuse and an AUD diagnosis.
基于调查的美国酗酒、依赖和障碍的患病率估计依赖于饮酒模式的自我报告（例如，狂饮）、社交问题（例如，工作中的麻烦）、使用的生理反应（例如，耐受性）和使用的中止（例如，戒断）。从这些报告中得出的诊断标准可以估计滥用和依赖的患病率，但症状群体之间的调节结构关系可能会导致一些轻度和中度饮酒者表现出酒精使用障碍（AUD）。
饮酒和问题的动态模型预测，依赖症状将调节饮酒量与滥用症状之间的关系。使用第 1 波国家酒精流行病学调查和相关条件数据，对 DSM-IV 诊断的滥用和依赖进行了测试，以检验该模型的预测，并评估在轻度和重度饮酒者（分别为 1 至 3 次和 4 次或更多次饮酒者）中是否观察到调节效应。一种剂量反应模型考虑了与饮酒和问题相关的其他已知风险异质性来源，使我们能够测试这些预测。
正如先前的工作所预期的那样，滥用和依赖症状以及依赖标准与饮酒模式呈非线性关系；在每次饮酒量较少但饮酒量较多的不频繁饮酒者中，出现了更多的症状报告并符合标准，这种剂量反应模式在重度饮酒者中受到很大调节。在控制了这些影响后，在符合更多依赖标准的受访者中，饮酒与滥用症状之间的关系得到了调节。这些效应在轻度和重度饮酒者中均观察到。
在轻度和重度饮酒者中观察到的饮酒、滥用和依赖标准之间的调节关系表明，所有饮酒群体中都存在相同的病因力。轻度饮酒者的依赖症状更严重可能会导致更多的滥用症状报告和 AUD 诊断。
