Goldstick Jason E, Lyons Vivian H, Myers Matthew G, Walton Maureen A, Heinze Justin E, Cunningham Rebecca M
Department of Emergency Medicine, University of Michigan, E Medical Center Drive, Ann Arbor, MI, 48109, United States; Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI, 48109-2800, United States; Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory Street, Ann Arbor, MI, 48109-2019, United States.
Harborview Injury Prevention and Research Center, University of Washington, Gerberding Hall G80 Box 351202, Seattle, WA, 98195, United States.
Drug Alcohol Depend. 2021 Apr 1;221:108605. doi: 10.1016/j.drugalcdep.2021.108605. Epub 2021 Feb 14.
The distinction between within- and between-person associations with drug use disorder (DUD) has implications for intervention targets and content. We used longitudinal data from youth entering an urban emergency department (ED) to identify factors related to changes in DUD diagnosis, with particular emphasis on alcohol use.
Research staff recruited youth age 14-24 (n = 599) reporting any past six-month drug use from a Level-1 ED; participants were assessed at baseline and four biannual follow-ups. Participants self-reported validated measurements of peer/parental behaviors, violence/crime exposure, drug use self-efficacy, and alcohol use. Research staff performed diagnostic interviews for DUD with nine substances, post-traumatic stress disorder (PTSD), and major depressive disorder (MDD). We used repeated measures logistic regression models with person-level covariate means, and person-mean-centered covariates, as separate variables, to separate within- and between-person covariate effects.
Among 2,630 assessments, 1,128 (42.9 %) were DUD diagnoses; 21.7 % were co-diagnoses with multiple drugs. Positive (aOR = 0.81, 95 %CI:[0.70, 0.94]) and negative (aOR = 1.73, 95 %CI:[1.45, 2.07]) peer behaviors related to DUD, primarily through between-person effects. Parental support (aOR = 0.92, 95 %CI:[0.83, 0.99]), community violence/crime (aOR = 1.28, 95 %CI:[1.14, 1.44]), PTSD/MDD diagnosis (aOR = 1.36, 95 %CI:[1.04, 1.79]), and alcohol use quantity (aOR = 1.06, 95 %CI:[1.02, 1.11]) were associated with DUD, showing primarily within-person effects. Other factors, such as interpersonal violence involvement (aOR = 1.47, 95 %CI:[1.21, 1.78]), showed both within- and between-person effects.
DUD is prevalent in this population, and within-person changes in DUD are predictable. Within-person effects suggest the importance of addressing escalating alcohol use, enhancing parental support, crime/violence exposure, and other mental health diagnoses as part of DUD intervention.
药物使用障碍（DUD）在个体内部和个体之间的关联差异对干预目标和内容具有重要意义。我们利用进入城市急诊科（ED）的青少年的纵向数据，以确定与DUD诊断变化相关的因素，尤其着重于酒精使用情况。
研究人员从一级急诊科招募了14至24岁（n = 599）且报告在过去六个月内有任何药物使用情况的青少年；参与者在基线时以及每半年进行的四次随访中接受评估。参与者自行报告了关于同伴/父母行为、暴力/犯罪经历、药物使用自我效能感以及酒精使用情况的有效测量数据。研究人员对九种物质的DUD、创伤后应激障碍（PTSD）和重度抑郁症（MDD）进行了诊断访谈。我们使用具有个体水平协变量均值以及以个体均值为中心的协变量作为单独变量的重复测量逻辑回归模型，以区分个体内部和个体之间的协变量效应。
在2630次评估中，有1128次（42.9%）为DUD诊断；21.7%为多种药物的共病诊断。与DUD相关的积极（调整后比值比[aOR]=0.81，95%置信区间[CI]：[0.70, 0.94]）和消极（aOR = 1.73，95%CI：[1.45, 2.07]）同伴行为，主要通过个体间效应起作用。父母支持（aOR = 0.92，95%CI：[0.83, 0.99]）、社区暴力/犯罪（aOR = 1.28，95%CI：[1.14, 1.44]）、PTSD/MDD诊断（aOR = 1.36，95%CI：[1.04, 1.79]）以及酒精使用量（aOR = 1.06，95%CI：[1.02, 1.11]）与DUD相关，主要显示出个体内部效应。其他因素，如人际暴力参与（aOR = 1.47，95%CI：[1.21, 1.78]），则显示出个体内部和个体之间的效应。
DUD在该人群中普遍存在，且个体内部DUD的变化是可预测的。个体内部效应表明，在DUD干预中，解决酒精使用量不断增加的问题、加强父母支持、减少犯罪/暴力经历以及其他心理健康诊断具有重要意义。
