The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia.
Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia.
Addiction. 2022 Nov;117(11):2955-2964. doi: 10.1111/add.15991. Epub 2022 Jul 12.
Tolerance to the effects of alcohol is an important element in the diagnosis of alcohol use disorders (AUD); however, there is ongoing debate about its utility in the diagnosis AUD in adolescents and young adults. This study aimed to refine the assessment of tolerance in young adults by testing different definitions of tolerance and their associations with longitudinal AUD outcomes.
Prospective cohort study.
Australia.
A contemporary cohort of emerging adults across Australia (n = 565, mean age = 18.9, range = 18-21 at baseline).
Clinician-administered Structured Clinical Interview for DSM-IV Research Version (SCID-IV-RV) assessed for AUD criteria across five interviews, at 6-month intervals over 2.5 years. Tolerance definitions were operationalized using survey-type response (yes/no), clinician judgement (SCID-IV-RV), different initial drinking quantity and percentage increase thresholds and average heavy consumption metrics. AUD persistence was operationalized by the number of times AUD was present across the 2.5-year study period (n = 491), and new-onset AUD was operationalized as any new incidence of AUD during the follow-up period (n = 461).
The (i) SCID-IV-RV clinician judgement [odds ratio (OR) = 2.50, P = 0.005], (ii) an initial drinking quantity threshold of four to five drinks and 50% minimum increase (OR = 2.48, P = 0.007) and (iii) 50% increase only (OR = 2.40, P = 0.005) were the tolerance definitions more strongly associated with any new onset of AUD throughout the four follow-up time-points than other definitions. However, these definitions were not associated with persistent AUD (Ps > 0.05). Average heavy consumption definitions of tolerance were most strongly associated with persistent AUD (OR = 6.66, P = 0.001; OR = 4.65, P = 0.004) but not associated with new-onset AUD (Ps > 0.05).
Initial drink and percentage change thresholds appear to improve the efficacy of change-based tolerance as an indicator for new-onset alcohol use disorder diagnosis in self-report surveys of young adults. When predicting persistent alcohol use disorder, average heavy consumption-based indicators appear to be a better way to measure tolerance than self-reported change-based definitions.
对酒精作用的耐受性是酒精使用障碍（AUD）诊断的一个重要因素；然而，关于其在青少年和年轻成年人 AUD 诊断中的效用仍存在争议。本研究旨在通过测试不同的耐受性定义及其与纵向 AUD 结局的关系，来完善对年轻人耐受性的评估。
前瞻性队列研究。
澳大利亚。
来自澳大利亚的当代成年早期队列（n=565，平均年龄 18.9 岁，范围 18-21 岁，基线）。
通过临床医师管理的 DSM-IV 研究版（SCID-IV-RV），在 2.5 年的时间里，每 6 个月进行一次共 5 次访谈，评估 AUD 标准。使用调查式回答（是/否）、临床医生判断（SCID-IV-RV）、不同的初始饮酒量和百分比增加阈值以及平均大量饮酒指标来确定耐受性定义。AUD 持续性通过 2.5 年研究期间 AUD 出现的次数来表示（n=491），新发病例的 AUD 通过随访期间任何新出现的 AUD 表示（n=461）。
（i）SCID-IV-RV 临床医生判断[比值比（OR）=2.50，P=0.005]，（ii）初始饮酒量阈值为 4-5 杯和最小增加 50%（OR=2.48，P=0.007），（iii）仅增加 50%（OR=2.40，P=0.005），这些耐受性定义与整个四个随访时间点的任何新发病例 AUD 更密切相关，而其他定义则不然（Ps>0.05）。然而，这些定义与持续性 AUD 无关（Ps>0.05）。平均大量饮酒的耐受性定义与持续性 AUD 关系最密切（OR=6.66，P=0.001；OR=4.65，P=0.004），但与新发病例 AUD 无关（Ps>0.05）。
在对年轻人进行自我报告调查时，初始饮酒量和百分比变化阈值似乎提高了基于变化的耐受性作为新发病例酒精使用障碍诊断指标的有效性。当预测持续性酒精使用障碍时，基于平均大量饮酒的指标似乎是衡量耐受性的一种更好方法，而不是基于自我报告的变化定义。
