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Biomedical subjects

Bridget F Grant

Publications and source records attributed to Bridget F Grant.

At least 19 recordsLinked to original sources
PubMed2007

Impact of age at first drink on stress-reactive drinking.

BACKGROUND: Although recent data from animal models indicate that adolescent ethanol exposure increases self-administered ethanol intake in adult rats, the impact of age at first drink on the association between stress and drinking has not been studied in humans. METHODS: Data collected in the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to estimate the extent to which age at first drink modified the association between stress and average daily volume (ADV) of ethanol intake in a sample of 26,946 past-year drinkers. Successive models estimated the magnitude and significance of the interaction between age at first drink (ages 14 or younger, 15-17, and 18 or older) and number of stressors (out of 12 past-year negative life events) after (1) adjusting for sociodemographic characteristics, (2) additionally adjusting for family history of alcoholism, comorbid psychopathology, adolescent, and past-year tobacco and illicit drug use, and (3) additionally adjusting for all other significant interactions with number of stressors. RESULTS: Even after adjusting for a wide range of confounders and their interactions with stress, initiation of drinking at ages 14 and younger increased the association between the number of stressors and ADV of ethanol consumption by 8% (p=0.014), when considering the full range of 12 potential stressors. In fact, the positive association between stress and consumption was significant only for this group of drinkers with early adolescent exposure to ethanol. Within this group, ADV of consumption increased by an average of 7% with each additional stressor experienced, although the exact percentage increase varied as a function of other covariates that had significant interactions with stress. When a reduced set of 4 stressors was considered, the magnitudes of the associations were mostly unchanged, but the modifying effect of age at first drink fell short of statistical significance (p=0.309) in the fully adjusted model. CONCLUSIONS: The findings of this study are consistent with the argument that early-onset drinking may increase stress-reactive ethanol consumption; however, these findings need to be replicated in an experimental human study in order to control fully the direction of the relationship between stress and consumption.

Adolescent↗
PubMed2007

The impact of partner alcohol problems on women's physical and mental health.

OBJECTIVE: The purpose of this study was to examine the association between partner alcohol problems and selected physical and mental health outcomes among married or cohabiting women, before and after adjusting for potential confounders, and to compare these associations with those reflecting the impact of the women's own alcohol-use disorders (AUDs). METHOD: This analysis is based on data from the Wave 1 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional, retrospective survey of a nationally representative sample of U.S. adults 18 years of age and older. The analytic sample consisted of 11,683 married or cohabiting women. Classification of their own AUDs was based on self-report of symptoms operationalizing the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for alcohol abuse or dependence. Current partner alcohol problems were identified by the women after an explanation that recapitulated the essence of these criteria. Physical health measures included criminal victimization of any type, injury, emergency-department and hospital visits, self-reported fair or poor health, and Short Form-12 Health Survey Questionnaire, Version 2 (SF-12v2), -based physical quality of life. Mental health measures included DSM-IV mood and anxiety disorders, number of past-year stressors, and SF-12v2-based mental/psychological quality of life. All measures refer to the 12 months immediately preceding the interview. Associations were tested using bivariate and multivariate logistic and linear regression models. RESULTS: At the bivariate level, women whose partners had alcohol problems were more likely to experience victimization, injury, mood disorders, anxiety disorders, and being in fair or poor health than women whose partners did not have alcohol problems (odds ratio [OR]: 1.7-4.5). They also experienced more life stressors and had lower mental/psychological quality-of-life scores. All but one of these differences remained significant after adjusting for potential confounders, which included the significantly greater rates of substance use and AUDs among women whose partners had alcohol problems. Although the magnitudes of the ORs decreased after adjustment (adjusted OR [AOR]: 2.1-3.4), they generally exceeded the AORs associated with the women's own AUDs. CONCLUSIONS: Partner alcohol problems pose diverse health threats for women that go beyond their well-documented association with domestic violence. Mood, anxiety, stress, general health, and quality-of-life problems should be addressed by groups that provide couples' treatment or counseling to female partners of alcoholics.

Adolescent↗
PubMed2006

Gambling level and psychiatric and medical disorders in older adults: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: This study examined the association between gambling level and psychiatric and medical disorders in a nationally representative sample of older adults. METHOD: Data on 10,563 U.S. older adults (age 60 or older) were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS: A total 28.74% of older adults were lifetime recreational gamblers and 0.85% were lifetime disordered gamblers. Compared with older adults without a history of regular gambling, recreational gamblers had significantly elevated rates of alcohol (30.1% versus 12.8%), nicotine (16.9% versus 8.0%), mood (12.6% versus 11.0%), anxiety (15.0% versus 11.6%), and personality disorders (11.3% versus 7.3%) and obesity (25.6% versus 20.8%), but were less likely to have past-year diagnoses of arteriosclerosis (4.7% versus 6.0%) or cirrhosis (0.2% versus 0.4%). Disordered gamblers were significantly more likely than older adults without a history of regular gambling to have alcohol (53.2% versus 12.8%), nicotine (43.2% versus 8.0%), drug (4.6% versus 0.7%), mood (39.5% versus 11.0%), anxiety (34.5% versus 11.6%), and personality (43.0% versus 7.3%) disorders, and to have past-year diagnoses of arthritis (60.2% versus 44.3%) or angina (22.7% versus 8.8%). These results remained significant even after controlling for demographic, psychiatric, and behavioral risk factors. CONCLUSIONS: Lifetime recreational gamblers were more likely than nonregular gamblers to have psychiatric disorders but were less likely to have some medical conditions. Lifetime disordered gamblers had a range of lifetime psychiatric disorders and were more likely than nonregular gamblers to have past-year diagnoses of angina and arthritis.

Adaptation, Psychological↗
PubMed2006

DSM-IV alcohol dependence: a categorical or dimensional phenotype?

BACKGROUND: Etiologic research on complex disorders including alcohol dependence requires informative phenotypes. Information is lost when categorical variables represent inherently dimensional conditions. We investigated the validity of DSM-IV alcohol dependence as a dimensional phenotype by examining evidence for linearity and thresholds in associations with validating variables. METHOD: Current drinkers in the National Longitudinal Alcohol Epidemiologic Survey (NLAES) (n=18352) and National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) (n=20836) were analyzed. Validating variables included family alcoholism, early-onset drinking, and alcohol treatment. Logistic or Poisson regression modeled the relationships between the validating variables and dependence in categorical, dimensional or hybrid forms, with severity defined as number of current DSM-IV alcohol-dependence criteria. Wald tests assessed differences between models. RESULTS: No evidence was found for boundaries between categories. Instead, the association of alcohol dependence with the validating variables generally increased in linear fashion as the number of alcohol-dependence criteria increased. For NLAES models of family alcoholism, early-onset drinking and treatment, the lines had zero intercepts, with slopes of 0.18, 0.27, 0.70, respectively. For NESARC models of family history and early-onset drinking, the zero intercept lines had slopes of 0.20, 0.33, and 0.77, respectively. Wald tests indicated that models representing alcohol dependence as a dimensional linear predictor best described the association between dependence criteria and the validating variables. CONCLUSIONS: The sample sizes allowed strong tests. Diagnoses are necessary for clinical decision-making, but a dimensional alcohol-dependence indicator should provide more information for research purposes.

Adult↗
PubMed2006

Cannabis use disorders in the USA: prevalence, correlates and co-morbidity.

BACKGROUND: The purpose of this study was to present 12-month and lifetime estimates of the prevalence, sociodemographic and clinical correlates, and psychiatric co-morbidity of DSM-IV cannabis abuse and dependence. METHOD: Data were derived from a large nationally representative survey (n=43093) of US adults. RESULTS: The prevalence of 12-month and lifetime DSM-IV cannabis abuse (1.1% and 7.2%) exceeded the corresponding rates of cannabis dependence (0.3% and 1.3%). Being male, Native American, widowed/separated/divorced, and residing in the West increased the odds whereas being Black, Asian or Hispanic decreased the odds of cannabis abuse and dependence. Cannabis dependence was significantly associated with low income. Ages of onset for both cannabis use disorders occurred in adolescence and the majority of individuals with these disorders remained untreated. Co-morbidity was high between cannabis use disorders and other Axis I and II disorders. CONCLUSIONS: Cannabis use disorders continue to present a widespread and serious personal and public health problem. Native Americans were found to have high rates of cannabis use disorders, warranting closer attention to the mental health needs of this subgroup. Associations between cannabis abuse and dependence and Axis I and II disorders were strong, signaling the need for more comprehensive assessment of individuals with cannabis use disorders. Further controlled treatment studies are needed, especially among co-morbid individuals, in view of growing evidence of the adverse personal, medical and societal impacts of cannabis use disorders in the USA.

Adolescent↗
PubMed2006

DSM-IV alcohol dependence and abuse: further evidence of validity in the general population.

BACKGROUND: In order to understand the validity of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) alcohol abuse and dependence diagnoses, studies are needed in both clinical and general population samples. The purpose of this study was to examine the construct and criterion-oriented validity of DSM-IV alcohol dependence and abuse in the general population with respect to factor structure and their relationship to family history of alcoholism, treatment utilization, and psychiatric comorbidity. METHODS: This analysis is based on data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), in which nationally representative data were collected in personal interviews conducted with one randomly selected adult in each sample household or group quarters. A subset (n=26,946) of the NESARC sample (total n=43,093) who reported drinking one or more drinks during the year preceding the interview formed the basis of analyses. Latent variable modeling was used to assess the concurrent validity of DSM-IV alcohol abuse and dependence symptom items. RESULTS: The latent variable modeling yielded one major factor related to alcohol dependence, a second factor related to alcohol abuse and a third smaller factor defined by tolerance. The validity of alcohol dependence in general population samples was further supported by statistically significant associations with family history of alcoholism, treatment utilization, and psychiatric and medical comorbidities. CONCLUSIONS: The factor structure and relationship to external criterion variables observed in the study provide support for the further validity of DSM-IV alcohol dependence in the general population, whereas support for the validity of DSM-IV abuse was equivocal.

Adolescent↗
PubMed2006

Race-ethnicity and the prevalence and co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol and drug use disorders and Axis I and II disorders: United States, 2001 to 2002.

The objective of this study was to compare the current prevalence and co-occurrence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol and drug use disorders and mood, anxiety, and personality disorders among whites, blacks, Native Americans, Asians, and Hispanics in a large representative sample of the US population. Striking mental health disparities were observed in the prevalences of psychiatric disorders, especially among Native Americans. Disparities in psychiatric comorbidity differed from those associated with prevalence. Most significantly, the association between alcohol disorders and personality disorders was significantly greater among Asians relative to whites, blacks, and Native Americans, despite lower prevalences of these disorders among Asians. Taken together, the results of this study highlight the need of future studies that help unravel the risk factors underlying the disparities in both prevalence and comorbidity of psychiatric disorders observed among race-ethnic groups in the United States.

Adult↗
PubMed2006

Sex differences in subclinical and DSM-IV pathological gambling: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND: To examine sex differences in DSM-IV subclinical and pathological gambling in nationally representative data of the US population. METHOD: Data come from a large (n = 43093) representative sample of the adult US population. RESULTS: The lifetime prevalence rate of DSM-IV pathological gambling was 0.64% (95% CI 0.50-0.78) for men and 0.23% (95% CI 0.17-0.29) for women, whereas the lifetime prevalence of subclinical pathological gambling was 6.79% (95% CI 6.32-7.26) for men and 3.26% (95% CI 2.93-3.59) for women. For subclinical pathological gambling, men were significantly (p < 0.01) more likely than women to have smoked more than two packs of cigarettes a day, to be classified as heavy drinkers and to have lifetime diagnoses of alcohol and drug use disorders. Women with subclinical and pathological gambling were significantly more likely than men to have lifetime mood and anxiety disorders. With respect to pathological gambling, women had later ages of onset of the disorder, and were significantly more likely than men to report gambling to relieve depressed mood and to prefer casino gambling. Rates of treatment-seeking for DSM-IV pathological gambling were low for both men and women. CONCLUSIONS: There are important sex differences in the prevalence, symptom pattern, sociodemographic and clinical correlates and course of DSM-IV subclinical and pathological gambling. Results underscore the need to investigate sex differences in the social determinants, neurobiology and treatment response of DSM-IV subclinical and pathological gambling.

Adolescent↗
PubMed2006

Race/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND: Very few large national epidemiologic surveys have examined the prevalence of psychiatric disorders among Asians and Native Americans due to small sample sizes. Very little is also known about the co-occurrences between substance use disorders and mood and anxiety disorders among these two minority groups and how their rates compare to Whites, Blacks, and Hispanics. METHOD: Analyses were based on a large (n = 43093) nationally representative survey of the adult (18+ years), U.S. population supplemented by a group quarters sampling frame. Prevalences and associations of major DSM-IV mood, anxiety and substance use disorders were examined among all major race/ethnic subgroups of the population. RESULTS: Twelve-month rates of most mood, anxiety and substance use disorders were generally greatest among Native Americans and lowest among Asians. For most race/ethnic subgroups, alcohol and drug dependence, but not abuse, were significantly associated with mood disorders. With few exceptions, there were no significant associations between alcohol and drug abuse and anxiety disorders. In contrast, alcohol dependence was associated with most anxiety disorders among Whites, Blacks and Asians, but not among Native Americans. CONCLUSIONS: The 12-month prevalence of substance use, mood, and anxiety disorders varied greatly across the five major race/ethnic subgroups of the population. Twelve-month co-occurrence of substance use disorders and mood and anxiety disorders was pervasive among all race/ethnic subgroups. Future research is also needed to understand race/ethnic differentials in prevalence and co-occurrence of these disorders with a particular focus on factors that may give rise to them.

Adult↗
PubMed2006

Lack of remorse in antisocial personality disorder: sociodemographic correlates, symptomatic presentation, and comorbidity with Axis I and Axis II disorders in the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: The purpose of this study was to compare sociodemographic and family history correlates, symptomatic presentation, and comorbidity with Axis I and Axis II disorders, in an epidemiologic sample of adults with DSM-IV antisocial personality disorder (ASPD) who lacked, vs those who did not lack, remorse. METHODS: This study is based on a nationally representative sample of adults. Lifetime prevalences of each ASPD diagnostic criterion and each comorbid mood, anxiety, substance use, and personality disorder were estimated. Logistic regression was used to examine associations of lack of remorse with ASPD symptom patterns and comorbid disorders. Diagnoses were made using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: Among the 1422 respondents with ASPD, 728 (51%) lacked remorse. Respondents who lacked remorse were younger and more often reported a family history of drug problems than those who did not. More often than remorse-positive respondents, those who were remorse-negative met diagnostic criteria involving violence against persons and less often met criteria involving offenses against property. Remorse was not associated with cruelty to animals, nor with most nonviolent antisocial behaviors. Remorse-negative respondents endorsed more total lifetime violent behaviors than those who were remorse-positive. Lack of remorse was not associated with any lifetime comorbid Axis I or Axis II disorder. Patterns of findings were generally similar between men and women. CONCLUSIONS: Lack of remorse appears to identify at best a modestly more symptomatically severe and violent form of ASPD in nonclinical populations.

Adolescent↗
PubMed2006

Toward an alcohol use disorder continuum using item response theory: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND: Item response theory (IRT) was used to determine whether the DSM-IV diagnostic criteria for alcohol abuse and dependence are arrayed along a continuum of severity. METHOD: Data came from a large nationally representative sample of the US population, 18 years and older. A two-parameter logistic IRT model was used to determine the severity and discrimination of each DSM-IV criterion. Differential criterion functioning (DCF) was also assessed across subgroups of the population defined by sex, age and race-ethnicity. RESULTS: All DSM-IV alcohol abuse and dependence criteria, except alcohol-related legal problems, formed a continuum of alcohol use disorder severity. Abuse and dependence criteria did not consistently tap the mildest or more severe end of the continuum respectively, and several criteria were identified as potentially redundant. The drinking in larger amounts or for longer than intended dependence criterion had the greatest discrimination and lowest severity than any other criterion. Although several criteria were found to function differentially between subgroups defined in terms of sex and age, there was evidence that the generalizability and validity of the criterion forming the continuum remained intact at the test score level. CONCLUSIONS: DSM-IV diagnostic criteria for alcohol abuse and dependence form a continuum of severity, calling into question the abuse-dependence distinction in the DSM-IV and the interpretation of abuse as a milder disorder than dependence. The criteria tapped the more severe end of the alcohol use disorder continuum, highlighting the need to identify other criteria capturing the mild to intermediate range of the severity. The drinking larger amounts or longer than intended dependence criterion may be a bridging criterion between drinking patterns that incur risk of alcohol use disorder at the milder end of the continuum, with tolerance, withdrawal, impaired control and serious social and occupational dysfunction at the more severe end of the alcohol use disorder continuum. Future IRT and other dimensional analyses hold great promise in informing revisions to categorical classifications and constructing new dimensional classifications of alcohol use disorders based on the DSM and the ICD.

Adult↗
PubMed2006

Antisocial personality disorder with childhood- vs. adolescence-onset conduct disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

This study, based on a nationally representative, epidemiologic sample (N = 43,093, response rate 81%), compared sociodemographic and family history correlates, antisocial personality disorder (ASPD) symptom patterns, and Axis I and Axis II comorbidity, among adults with DSM-IV ASPD who reported onset of conduct disorder (CD) in childhood ( or =age 10). Prevalence of each ASPD diagnostic criterion and comorbid lifetime disorder was estimated. Logistic regression was used to examine associations of childhood-onset CD with ASPD symptom patterns and comorbid disorders. Among the 1422 respondents with ASPD, 447 reported childhood-onset CD. Childhood-onset respondents were more likely than adolescence-onset respondents to endorse CD criteria involving aggression against persons, animals, and property before age 15, and to endorse more childhood criteria and lifetime violent behaviors. Childhood-onset respondents displayed significantly elevated odds of lifetime social phobia, generalized anxiety disorder, drug dependence, and paranoid, schizoid, and avoidant personality disorders, but significantly decreased odds for lifetime tobacco dependence. Childhood-onset CD appears to identify a more polysymptomatic and violent form of ASPD, associated with greater lifetime comorbidity for selected Axis I and Axis II disorders, in nonclinical populations.

Adolescent↗
PubMed2006

Estimating the effect of help-seeking on achieving recovery from alcohol dependence.

AIMS: To investigate the effect of help-seeking on the likelihood of recovery from Diagnostic and Statistical Manual version IV (DSM-IV) alcohol dependence, specifically examining the impact of model selection, factors that moderate the effect of help-seeking and distinctions between the effects of 12-Step participation and formal treatment. DESIGN: This analysis is based on data from the Wave 1 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional, retrospective survey of a nationally representative sample of US adults 18 years of age and over. The analytical sample consisted of 4422 individuals with prior-to-past-year (PPY) onset of DSM-IV alcohol dependence. METHODS: Logistic regression, proportional hazards and time-dependent proportional hazards models were used to estimate the effects of help-seeking on three outcomes: (1) any recovery from alcohol dependence, which required full remission of all symptoms of alcohol abuse and dependence and excluded asymptomatic drinkers whose alcohol consumption exceeded low-risk drinking guidelines; (2) non-abstinent recovery (NR), representing low-risk asymptomatic drinkers; and (3) abstinent recovery (AR), representing abstainers. FINDINGS: Only one-quarter of individuals with PPY-onset alcohol dependence had ever sought help for alcohol problems, including 3.1% who had participated in 12-Step programs only, 5.4% who had received formal treatment only and 17.0% with both 12-Step and formal treatment. Based on the most appropriate model, help-seeking increased the likelihood of any recovery [hazard rate ratio (HRR) = 2.38], NR (HRR = 1.50) and AR (HRR = 4.01). The impact of help-seeking on AR did not show any significant variation across the exposure period but was modified by severity among other factors. Individuals who participated in 12-Step programs in addition to formal treatment had almost twice the chance of recovery and more than more than twice the chance of AR compared with those who received formal treatment alone. CONCLUSIONS: Help-seeking plays a significant role in the achievement of abstinent recovery from alcohol dependence, with 12-Step participation playing a major role. Appropriate model selection is critical to assessing the impact of help-seeking.

Adolescent↗
PubMed2006

Characteristics of nosologically informative data sets that address key diagnostic issues facing the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) and International Classification of Diseases, eleventh edition (ICD-11) substance use disorders workgroups.

AIMS: Over the past two decades, many nosological issues have been addressed by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) substance use disorders workgroups. Even with those efforts, there are key issues that have not been resolved and must be revisited, or addressed de novo, by the workgroups. These lingering points are broad, due to the array of substances classified under the diagnostic umbrella of substance use disorders. They include substantive issues ranging from dimensional approaches, similar criteria for each substance, cut-points and thresholds, distinct abuse and dependence classifications, new criteria and drugs, to less substantive ones, such as the adjectives used to describe the severity of the behaviors. RESULTS: This paper describes the characteristics of the data sets that will be needed to resolve the key nosological issues. Ten points are described: (1) data must be true to nomenclature under study; (2) flexible regarding rearrangements of scoring algorithms; (3-4) able to assess substances individually and retain former versions of the criteria; (5) not rely on shortened versions; (6) utilize samples that are generalizable; (7) make diagnoses with transparent algorithms; (8) combine mixed methods for corroborating data; (9) utilize assessments that collect reliable and valid diagnoses and criteria; and (10) stretch the limits by allowing for new discoveries. CONCLUSIONS: This paper describes each of these and gives examples of the limitations and strengths of data for the purpose of defining a useful, unified concept of addictive behaviors.

Algorithms↗
PubMed2006

Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002.

OBJECTIVE: The authors examined changes in the prevalence of major depression in the United States between 1991-1992 and 2001-2002 and sought to determine whether changes in depression rates were associated with changes in rates of comorbid substance use disorder. METHOD: Data were drawn from two large (Ns exceeding 42,000) cross-sectional surveys of representative samples of the U.S. population conducted 10 years apart. Both surveys used face-to-face interviews, the same diagnostic criteria, and consistent assessment instruments. Rates of past-year major depressive episode in the total samples and among subjects with and without co-occurring substance use disorders in major demographic groups were compared. RESULTS: From 1991-1992 to 2001-2002, the prevalence of major depression among U.S. adults increased from 3.33% to 7.06%. Increases were statistically significant for whites, blacks, and Hispanics and for all age groups. For Hispanic men overall and Hispanic women 18-29 years of age, rates increased but not significantly. The hypothesis that increases in the rates of depression could be explained by concomitant increases in co-occurring substance use disorders was supported only for black men 18-29 years of age. CONCLUSIONS: Rates of major depression rose markedly over the past decade in the United States, and increases were noted for most sociodemographic subgroups of the population. If the prevalence continues to increase at the rate it did during the past decade, the demand for services will increase dramatically in the coming years.

Adult↗
PubMed2006

Maturing out of alcohol dependence: the impact of transitional life events.

OBJECTIVE: The purpose of this study was to investigate the effects of transitional life events related to education, employment, and family formation on the likelihood of recovery from alcohol dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), distinguishing the short- and long-term effects of these events and potential effect modification by treatment history, gender, and severity of dependence. METHOD: This analysis is based on data from the Wave 1 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional, retrospective survey of a nationally representative sample of U.S. adults 18 years of age and older. The analytic sample consisted of 4,422 individuals with prior-to-past-year (PPY) onset of DSM-IV alcohol dependence. Time-dependent proportional hazards models were used to estimate the effects of completing school, starting full-time work, getting married, becoming separated/divorced/widowed, and becoming a parent on the outcomes of nonabstinent recovery (NR; e.g., low-risk asymptomatic drinking) and abstinent recovery (AR). RESULTS: Entry into and exit from a first marriage each increased the likelihood of NR during the first 3 years after those events occurred (hazard rate ratio [HRR] = 1.37 and 1.76, respectively). However, individuals who were still dependent 3 or more years after those events occurred had a decreased likelihood of subsequent NR (HRR = 0.70 for both events), as did those who were still dependent 3 or more years after completing schooling (HRR = 0.54). The likelihood of AR was more than doubled in the 3 years after first becoming a parent (HRR = 2.22) but was decreased among individuals still dependent 3 or more years after starting full-time work. For the outcome of NR, all of the negative effects associated with still being dependent 3 or more years after the occurrence of key life events were more strongly negative among individuals with less severe cases of dependence. CONCLUSIONS: Transitional life events demonstrate many effects on recovery, including both direct effects consistent with role socialization and associations more reflective of selectivity than causation. Taken as a whole, these events appear to contribute to (but by no means fully explain) the high rates of recovery from alcohol dependence that have been observed even in the absence of treatment.

Adult↗
PubMed2006

Nativity and DSM-IV psychiatric disorders among Puerto Ricans, Cuban Americans, and non-Latino Whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: This study examined the risk of lifetime substance use disorders and mood and anxiety disorders between Island-born Puerto Ricans, foreign-born Cuban Americans, and foreign-born non-Latino whites and their U.S.-born counterparts. METHOD: Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093) were used to derive lifetime prevalence rates of specific DSM-IV psychiatric disorders by subethnicity and nativity group. Logistic regression models were constructed to detect variation in the odds of each psychiatric disorder across groups. RESULTS: A protective effect of foreign-born nativity in risk for psychiatric disorders was present for all groups but varied according to the assessed disorder. For non-Latino whites, the effect was observed for most specific psychiatric disorders, whereas, for Puerto Ricans and Cuban Americans, the effect was only evident for specific substance use disorders. CONCLUSION: The protective effect of nativity against psychiatric morbidity found in other studies among Mexican Americans and non-Latino whites does not entirely generalize to Puerto Ricans and Cuban Americans and may not generalize to individuals of other origins. The results of this study are discussed in terms of potential mechanisms involved in variations in the risk of specific psychiatric disorders among groups defined by nativity and race-ethnicity and the importance of identifying specific cultural components that may serve as risk and protective factors of psychiatric morbidity.

Adolescent↗