Rose Emma Jane, Picci Giorgia, Fishbein Diana H
Program for Translational Research on Adversity and Neurodevelopment (P-TRAN), The Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA.
Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
Front Psychiatry. 2019 Jun 14;10:399. doi: 10.3389/fpsyt.2019.00399. eCollection 2019.
Studies of substance misuse prevention generally focus on characteristics that typify risk, with the assumption that the prevalence of the problem will be optimally reduced by identifying, targeting, and reducing or eliminating risk factors. However, this risk-centered approach neglects variations in individual-level and environmental characteristics that portend differential pathways that are distinguishable by timing of substance use initiation (e.g., early versus delayed), the likelihood of use escalation versus eventual desistance, and enduring abstinence, despite exposure to significant risk factors. Considering the various underpinnings of these distinct substance use trajectories is critical to a more nuanced understanding of the effects, potency, and malleability of factors that are known to increase risk confer protection. Here, we discuss three pathways relative to substance use patterns and predictors in the context of adversity, a well-known, highly significant influence on propensity for substance misuse. The first pathway is designated as "high risk" based on early onset of substance use, rapid escalation, and proneness to substance use disorders. Individuals who defy all odds and eventually exhibit adaptive developmental outcomes despite an initial maladaptive reaction to adversity, are referred to as "resilient." However, another categorization that has not been adequately characterized is "resistant." Resistant individuals include those who do not exhibit problematic substance use behaviors (e.g., early onset and escalation) and do not develop substance use disorders or other forms of psychopathology, despite significant exposure to factors that normally increase the propensity for such outcomes (e.g. trauma and/or adversity). In this paper, we apply this conceptualization of risk, resistance, and resilience for substance misuse to a more fine-grained analysis of substance use pathways and their corresponding patterns (e.g., non-use, initiation, escalation, desistance). The significance of the progression of neurocognitive functioning over the course of development is discussed as well as how this knowledge may be translated to make a science-based determination of intervention targets. This more encompassing theoretical model has direct implications for primary prevention and clinical approaches to disrupt risk pathways and to optimize long-term outcomes.
药物滥用预防研究通常聚焦于典型风险特征，并假设通过识别、针对和减少或消除风险因素，能最佳地降低该问题的发生率。然而，这种以风险为中心的方法忽视了个体层面和环境特征的差异，这些差异预示着不同的路径，这些路径可通过药物使用开始时间（例如，早期与延迟）、使用升级与最终戒断的可能性以及持久戒断来区分，尽管存在重大风险因素。考虑这些不同药物使用轨迹的各种基础，对于更细致地理解已知增加风险或提供保护的因素的影响、效力和可塑性至关重要。在此，我们在逆境背景下讨论与药物使用模式和预测因素相关的三种路径，逆境是对药物滥用倾向有重大影响的众所周知的因素。第一条路径基于药物使用的早期开始、快速升级和易患药物使用障碍而被指定为“高风险”。尽管最初对逆境有适应不良反应，但最终表现出适应性发展结果的个体被称为“有复原力的”。然而，另一种尚未得到充分描述的分类是“有抵抗力的”。有抵抗力的个体包括那些尽管大量接触通常会增加此类结果倾向的因素（例如创伤和/或逆境），但未表现出有问题的药物使用行为（例如早期开始和升级），也未发展出药物使用障碍或其他形式精神病理学的人。在本文中，我们将这种药物滥用的风险、抵抗力和复原力概念应用于对药物使用路径及其相应模式（例如，不使用、开始、升级、戒断）的更细致分析。我们还讨论了神经认知功能在发育过程中的进展的重要性，以及如何将这些知识转化为基于科学的干预目标确定。这种更全面的理论模型对初级预防和临床方法有直接影响，以破坏风险路径并优化长期结果。
