Alcohol use disorders (AUDs) are prevalent in U.S. society and associated with much disability, comorbidity and harm to individuals, their families and society. Thus, understanding the risk factors for the occurrence and persistence of AUDs is vital for prevention and intervention. Because AUDs are complex disorders, key risk factors must be investigated in an integrated manner. One such risk factor is adverse childhood/adolescent experiences (ACEs): maltreatment in the form of emotional or physical abuse or neglect, or sexual abuse. Studies suggest that these experiences affect normal development and are associated with later drinking and AUDs. However, many questions remain about these relationships. Another key risk factor is personality psychopathology, persistent maladaptive behaviors, emotions and cognitions from early adulthood, included in DSM-IV as ten Personality Disorders (PDs). Unfortunately, these are also prevalent in our society. Prior smaller studies suggest that ACEs are related to PDs or their symptoms, while other such studies suggest that PDs or PD symptoms are related to AUDs. However, the joint impact of these two key risk factors on AUDs has not been studied. Further, aside from antisocial PD, large epidemiologic studies have never previously addressed how the full range of DSM-IV PDs relates to AUDs. Finally, risk factors for occurrence can differ from factors affecting prognosis. Very little is known about how ACEs and the full range of PDs affect the persistence of AUDs. To examine these issues, this study will combine an unprecedented set of resources. Responding to PAR-08-005, extramural and intramural investigators will collaborate in analysis of data from 34,653 participants in Waves 1 (2001- 2002) and 2 (3 years later) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). These participants were assessed for major DSM-IV Axis I disorders, all DSM-IV Axis II PDs, different types of ACEs, and many additional important covariates. Groundwork will consist of thoroughly investigating the relationship of ACEs to PDs and the structure of PD symptomatology, about which there are many questions. The findings from this groundwork will then inform investigation of how ACEs and PDs relate to the occurrence and persistence of AUDs, controlling for Axis I disorders, family history of alcoholism, and other important covariates.
The new knowledge from this study will be vital for (1) better identification of individuals at high risk for AUDs;(2) education of clinicians working with patients with alcohol use disorders, potentially stimulating new treatment development;(3) development of DSM-V;(4) developing more refined studies of etiology incorporating biological (e.g., genetic) variation in the search for causes of AUDs and their persistence.
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