兩波資料指出對五種次類型的後續研究
出處：WebMD醫學新聞
December 9, 2008 (佛羅里達州波卡雷登) — 研究者表示，兩次國家酒癮與相關流行病學(NESARC)社區調查的新發現改變了醫師對酒癮的瞭解。
美國成癮精神病學會第19屆年會暨研討會中，國家酒精濫用與酒癮研究中心的Howard B. Moss醫師指出，運用NESARC的資料定義了五種酒癮者的次類型，最新的兩批資料指出有關恢復、緩解與治療的曙光。
Moss醫師表示，資料顯示半數以上的酒癮者是青年人，這不只是中年人的疾病；此外，半數酒癮者有這類的家族病史。
Moss醫師向Medscape Psychiatry表示，在進行該研究調查的榮民事務醫院中，半數以上的酒癮者年紀為20多歲，而不是40歲的中年人。
該資料也發現，有酒癮的年輕成人傾向不會尋求治療，恢復率與完全緩解率最低。他表示，這些年輕酒癮者就好像沒有被我們治療物質濫用的雷達偵測到。
NESARC是一個具有美國社區代表性的抽樣調查，第一波調查在2001至2002年間、第二波在2004至2005年間。
目前的分析聚焦在1,484名符合精神疾病診斷與統計手冊第四版(DSM-IV)之酒癮規範的調查對象，研究對象的平均年紀為32歲，68%是男性、71%為白人。
根據年紀、飲酒量、家族酒癮史與共病症，研究者定義了五種酒癮次類型：
* 年輕成人次類型(31.5%的美國酒癮者) — 這些人在開始飲酒後三年內變成有酒癮，他們的其他物質濫用與家族酒癮史的比率低。
* 年輕反社會次類型(21.1%的美國酒癮者) — 這些人在開始飲酒後三年內變成有酒癮，不過，他們傾向有反社會的人格特質、多種精神共病症、其他物質濫用問題以及家族酒癮史。
* 功能性次類型(19.4%的美國酒癮者) — 這些中年人一般有良好教育和好工作，有酒癮約18年。
* 中產家庭次類型(18.8%的美國酒癮者) —這些中年人一般有酒癮約15年，他們有好幾代有家族酒癮史與多種共病症。
* 慢性嚴重次類型(9.2%的美國酒癮者) —這些中年人飲酒量最多，有酒癮約13年。傾向有好幾代有家族酒癮史，且其他精神方面異常比率最高。
慢性嚴重次類型中約有40%的人曾考慮過尋求幫助，而年輕成人次類型只有5%尋求幫助。
Moss醫師表示，最多人的是年輕人這一類型，且很少人對其飲酒行為尋求任何協助。這將促使成癮治療專家把這些年輕酒癮者納入健康照護治療體系，以便幫助他們獲得某種程度的恢復。
最初的調查後三3年，約有30%的年輕飲酒者與功能性次類型者、40%的中產家庭次類型與年輕反社會次類型飲酒者、 65%慢性嚴重次類型飲酒者仍然有酒癮，這5組的整體緩解率約有13%至19%。
Moss醫師表示，使用這些次類型進行NESARC資料的後續研究將有助於設計未來的酒癮研究模式，幫助確認需要介入的高風險族群，以及評估治療策略。
此研討會由國家酒精濫用與酒癮研究中心贊助。Moss醫師報告沒有相關資金上的往來。
美國成癮精神病學會(American Academy of Addiction Psychiatry)第19屆年會暨研討會：研討會 I。發表於2008年12月4日。
AAAP 2008: NESARC Findings Changing Understanding of Alcoholism
Medscape Medical News
December 9, 2008 (Boca Raton, Florida) — New findings from 2 waves of the National Epidemiological Study on Alcohol and Related Conditions (NESARC) community survey are changing clinicians' understanding of alcohol dependence, researchers say.
Presented here at the American Academy of Addiction Psychiatry 19th Annual Meeting and Symposium, Howard B. Moss, MD, from the National Institute on Alcohol Abuse and Alcoholism, in Bethesda, Maryland, described how NESARC data identified 5 subtypes of alcohol-dependent drinkers and the more recent wave 2 data shed light on recovery, remission, and treatment seeking.
The data show that rather than being solely a disease of middle-aged men, more than half of alcohol-dependent individuals are young adults. In addition, only half of alcoholics have a family history of the disease, said Dr. Moss
"Slightly more than half of alcohol-dependent individuals are 20-somethings, not 40-year-old men in Veterans Affairs hospitals, for which much research has been obtained," Dr. Moss told Medscape Psychiatry.
The data also revealed that young adult alcohol-dependent individuals tend not to seek treatment and have the lowest rates of recovery and full remission from alcoholism. "These young adult drinkers are flying below the radar for those of us who treat substance abuse," he said.
NESARC is a nationally representative sample of community-dwelling adults in the United States who were surveyed in wave 1 in 2001–2002 and in wave 2 in 2004–2005.
The current analysis focused on 1484 survey respondents who met criteria for alcohol dependence from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV). Respondents had a mean age of 32 years, 68% were male, and 71% were white.
Based on factors including age, alcohol consumption, family history of alcoholism, and comorbidities, the researchers identified 5 subgroups of alcoholism:
"Young-adult" subtype (31.5% of US alcoholics) — These individuals become dependent on alcohol within 3 years of drinking onset. They had low rates of abuse of other substances and family alcoholism.
"Young-antisocial" subtype (21.1% of US alcoholics) — These individuals become dependent on alcohol within 3 years of drinking onset. However, they tended to have antisocial personality disorder, multiple psychiatric comorbidities, problems with other types of substance abuse, and a family history of alcoholism.
"Functional" subtype (19.4% of US alcoholics) — These middle-aged individuals were typically well-educated with good jobs and had been dependent on alcohol for about 18 years.
"Intermediate-familial" subtype (18.8% of US alcoholics) — These middle-aged individuals had typically been dependent on alcohol for about 15 years. They also had a multigenerational family history of alcoholism and multiple comorbidities.
"Chronic-severe" subtype (9.2% of US alcoholics) — These middle-aged individuals consumed the most alcohol, had been dependent on alcohol for about 13 years, and also tended to have a multigenerational family history of alcoholism and the highest rates of other psychiatric disorders.
About 40% of the individuals in the chronic-severe subgroup had sought help for their drinking in the previous year, compared with only about 5% of those in the young-adult subgroup.
"Individuals in the largest subtype, the young adults, very rarely seek any assistance for their drinking behavior," said Dr. Moss. "The challenge for addiction professionals is to actually get these younger alcohol-dependent individuals into the healthcare treatment system so that we can help them with pursuing some degree of recovery," he added.
Three years after the initial survey, about 30% of drinkers in the young-adult and functional subgroups, about 40% of drinkers in the intermediate-familial and young-antisocial subgroups, and 65% of drinkers in the chronic-severe subgroups were still dependent on alcohol. Full remission had been attained by about 13% to 19% of individuals in the 5 subgroups.
Further study of NESARC data using this subgroup approach will be useful for designing future alcoholism research studies, to help identify high-risk groups in need of prevention efforts, and to evaluate treatment strategies, said Dr. Moss
The symposium was sponsored by the National Institute on Alcohol Abuse and Alcoholism. Dr. Moss reports having no financial disclosures.
American Academy of Addiction Psychiatry (AAAP) 19th Annual Meeting and Symposium: Symposium I. Presented December 4, 2008.
[ 本帖最後由 goodcat1111 於 2008-12-23 10:31 編輯 ] |
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