RESUMO
OBJECTIVE: To evaluate the accuracy of detecting 16-year-old male (n = 465) and female (n = 162) youths who subsequently manifest opioid use disorder (OUD) at 25 years of age. We hypothesized that the combined measures of 2 components of etiology, heritable risk, and substance use, accurately detect youths who develop OUD. STUDY DESIGN: Heritable risk was measured by the transmissible liability index (TLI). Severity of the prodrome presaging OUD was quantified by the revised Drug Use Screening Inventory containing the consumption frequency index (CFI) documenting substance use events during the past month and the overall problem density (OPD) score indicating co-occurring biopsychosocial problems. Diagnosis of OUD was formulated by a clinical committee based on results of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition in conjunction with medical and social history records. RESULTS: Bivariate analysis shows that the TLI, CFI, and OPD scores at 16 years of age predict OUD at 25 years. Multivariate modeling indicates that the TLI combined with the CFI predict OUD with 86% accuracy (sensitivity = 87%; specificity = 62%). The TLI and CFI at 16 years of age mediate the association between parental substance use disorder and OUD in offspring at 25 years of age, indicating that these measures respectively evaluate risk and prodrome. CONCLUSIONS: These results demonstrate the feasibility of identifying youths requiring intervention to prevent OUD.
Assuntos
Diagnóstico Precoce , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Pais , Medição de Risco/métodos , Sensibilidade e Especificidade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This longitudinal investigation examined the hypothesis that subjective experience during consumption of preferred drugs mediates the association of transmissible risk for substance use disorder (SUD) measured in childhood and adolescence, and SUD diagnosis in adulthood. Transmissible risk denotes the psychological characteristics having intergenerational continuity between parents and their biological children. METHODS: The transmissible liability index (TLI) was administered to four hundred eighty-three 10 to 12-year-old boys (baseline). Follow-up evaluations were conducted when the boys attained 12-14, 16, 19, and 22 years of age, using age-specific versions of the TLI. Frequency of consumption of the participants' three most preferred drugs, affect on an ordinary day, affect while under influence of the preferred substances, and presence/absence of current SUD were assessed at 22 years of age. RESULTS: Consumption frequency of preferred drugs among boys mediates the association of transmissible risk during childhood, and adolescence and SUD diagnosis in adulthood. Severity of negative affect on a drug-free day predicts frequency of consumption of preferred drugs, which, in turn, predicts severity of negative affect during the drug use event. Neither affect on a drug-free day nor affect during the drug use event mediates the association of transmissible risk and SUD. CONCLUSIONS: Affect on drug-free days, and while under influence of preferred substances, covary with consumption frequency; however, affect is not related to transmissible SUD risk or SUD outcome.