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Evans EA, Grella CE, Upchurch DM. Gender differences in the effects of childhood adversity on alcohol, drug, and polysubstance-related disorders. Soc Psychiatry Psychiatr Epidemiol 2017; 52:901-912. [PMID: 28258335 DOI: 10.1007/s00127-017-1355-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine gender differences in the associations between childhood adversity and different types of substance use disorders and whether gender moderates these relationships. METHODS We analyzed data from 19,209 women and 13,898 men as provided by Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether gender moderates the associations between childhood adversity and DSM-IV defined lifetime occurrence of alcohol, drug, and polysubstance-related disorders. We used multinomial logistic regression, weighted to be representative of the US adult civilian, noninstitutionalized population, and we calculated predicted probabilities by gender, controlling for covariates. To test which specific moderation contrasts were statistically significant, we conducted pair-wise comparisons corrected for multiple comparisons using Bonferroni's method. RESULTS For each type of substance use disorder, risk was increased by more exposure to childhood adversity, and women had a lower risk than men. However, moderation effects revealed that with more experiences of childhood adversity, the gender gap in predicted probability for a disorder narrowed in relation to alcohol, it converged in relation to drugs such that risk among women surpassed that among men, and it widened in relation to polysubstances. CONCLUSIONS Knowledge regarding substance-specific gender differences associated with childhood adversity exposure can inform evidence-based treatments. It may also be useful for shaping other types of gender-sensitive public health initiatives to ameliorate or prevent different types of substance use disorders.
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Affiliation(s)
- Elizabeth A Evans
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), 11075 Santa Monica Blvd., 200, Los Angeles, CA, 90025, USA. .,Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E. Young Drive South, 36-071 CHS, 951772, Los Angeles, CA, 90095-1772, USA. .,Department of Veterans Affairs (VA) Health Service Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Bldg 206, Rm 250, Los Angeles, CA, 90073, USA. .,Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, 325 Arnold House, 715 North Pleasant St., Amherst, MA, 01003-9304, USA.
| | - Christine E Grella
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), 11075 Santa Monica Blvd., 200, Los Angeles, CA, 90025, USA
| | - Dawn M Upchurch
- Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E. Young Drive South, 36-071 CHS, 951772, Los Angeles, CA, 90095-1772, USA
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Evans EA, Grella CE, Washington DL, Upchurch DM. Gender and race/ethnic differences in the persistence of alcohol, drug, and poly-substance use disorders. Drug Alcohol Depend 2017; 174:128-136. [PMID: 28324815 DOI: 10.1016/j.drugalcdep.2017.01.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/09/2017] [Accepted: 01/14/2017] [Indexed: 12/13/2022]
Abstract
AIMS To examine gender and racial/ethnic differences in the effect of substance use disorder (SUD) type on SUD persistence. METHODS Data were provided by 1025 women and 1835 men from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to examine whether gender and race/ethnicity (Non-Hispanic White, Black, Hispanic) moderate the effects of DSM-IV defined past-12 month SUD type (alcohol, drug, poly-substance) on SUD persistence at 3-year follow-up, controlling for covariates. Using gender-stratified weighted binary logistic regression, we examined predictors of SUD persistence, tested an SUD type by race/ethnicity interaction term, and calculated and conducted Bonferroni corrected pairwise comparisons of predicted probabilities. RESULTS SUD persistence rates at 3-year follow-up differed for SUD type by gender by race/ethnicity sub-group, and ranged from 31% to 81%. SUD persistence rates were consistently higher among poly-substance users; patterns were mixed in relation to gender and race/ethnicity. Among women, alcohol disordered Hispanics were less likely to persist than Whites. Among men, drug disordered Hispanics were less likely to persist than Whites. Also, Black men with an alcohol or drug use disorder were less likely to persist than Whites, but Black men with a poly-substance use disorder were more likely to persist than Hispanics. CONCLUSIONS The effect of SUD type on SUD persistence varies by race/ethnicity, and the nature of these relationships is different by gender. Such knowledge could inform tailoring of SUD screening and treatment programs, potentially increasing their impact.
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Affiliation(s)
- Elizabeth A Evans
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA; Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, USA; Department of Veterans Affairs (VA) Health Service Research and Development (HSR and D) Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, USA; Department of Health Policy and Promotion, School of Public Health and Health Sciences, University of Massachusetts Amherst, USA.
| | - Christine E Grella
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Donna L Washington
- Department of Veterans Affairs (VA) Health Service Research and Development (HSR and D) Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, USA; Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, USA
| | - Dawn M Upchurch
- Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, USA
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Azh N, Nahidi F, Ozgoli G, Ardalan G. Adolescents Confusion in Receiving Health Services: A Qualitative Study. J Clin Diagn Res 2017; 11:LC01-LC06. [PMID: 28658809 DOI: 10.7860/jcdr/2017/23393.9761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 02/01/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Providing health services for adolescents requires exploration of hidden factors from the perspective of adolescents, providers, and key individuals. Understanding the process of providing health services from adolescents point of view will help receiving and continuation of services. Although many studies have been conducted in Iran on adolescents health needs, few studies have dealt with provision of these services to adolescents. AIM The present study aimed to explain the adolescents and key informants' perception of healthcare provision. MATERIALS AND METHODS The present qualitative study was conducted according to grounded theory. Data were collected using deep semi-structured individual interviews and group discussion. Participants were selected through purposive sampling followed by theoretical sampling. Participants in present study were 65 adolescents, nine youths (19-24-year-old), and 19 parents and key people involved in providing health services. Adolescents and their parents were selected from different parts of Tehran. Data collection continued until data saturation, and was analysed using Corbin-Strauss (2008) method. RESULTS Issues relating to adolescents perception of the process of providing services included health concerns, society's inappropriate behaviours, and weakness of the health services system in responding to adolescents needs, which as underlying factors contributed to adolescents confusion in receiving services and their proper coping with puberty. CONCLUSION Due to lack of education on how to manage puberty by parents, schools, society, and the health system, participating adolescents from Tehran were confused about receiving information and unable to manage puberty problems. Solving this problem requires continuity of services and interaction of family, school and community.
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Affiliation(s)
- Nezal Azh
- PhD Student, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University, Tehran, Iran
| | - Fatemeh Nahidi
- Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University, Tehran, Iran
| | - Giti Ozgoli
- Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University, Tehran, Iran
| | - Gelayol Ardalan
- Pediatrician, Ministry of Health and Medical Education, Islamic Republic of Iran, Tehran, Iran
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Kogan SM, Cho J, Oshri A, MacKillop J. The influence of substance use on depressive symptoms among young adult black men: The sensitizing effect of early adversity. Am J Addict 2017; 26:400-406. [PMID: 28426146 DOI: 10.1111/ajad.12555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/07/2017] [Accepted: 03/27/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Depressive symptoms have been identified as an important consequence of substance use. Both heavy drinking and marijuana use have acute and short-term effects on systems that regulate emotion, increasing the potential for substance use to induce problems with negative affect and irritability. We investigated the effects of alcohol and marijuana use on depressive symptoms among a sample of young Black men. We also tested the stress sensitization hypothesis that exposure to adverse childhood experiences would amplify the influence of substance use on men's depressive symptoms. METHODS Hypotheses were tested with 505 rural Black men who, at ages 19-22 years, provided data on their substance use, adverse childhood experiences, and depressive symptoms; they provided data again 18 months later. RESULTS Substance use forecasted increases in depressive symptoms; cross-lagged analyses yielded no evidence for the inverse path, depressive symptoms increasing substance use. The impact of substance use on depressive symptoms was amplified among young Black men who were exposed to adverse childhood experiences. Substance use did not significantly predict depressive symptoms when adversity was low. DISCUSSION AND CONCLUSIONS Our findings suggest that, during young adulthood, substance use increases depressive symptoms among Black men who were exposed to childhood adversity. Because childhood adversity disproportionately affects Black men, these findings inform future cross-group research designed to investigate racial disparities in the consequences of substance use. SCIENTIFIC SIGNIFICANCE Depressive symptoms may be understood as an effect as well as a cause of substance use, particularly among vulnerable young Black men. (Am J Addict 2017;26:400-406).
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Affiliation(s)
- Steven M Kogan
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia
| | - Junhan Cho
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Assaf Oshri
- Department of Human Development and Family Science, University of Georgia, Athens, Georgia
| | - James MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Wolitzky-Taylor K, Sewart A, Vrshek-Schallhorn S, Zinbarg R, Mineka S, Hammen C, Bobova L, Adam EK, Craske MG. The Effects of Childhood and Adolescent Adversity on Substance Use Disorders and Poor Health in Early Adulthood. J Youth Adolesc 2016; 46:15-27. [PMID: 27613006 DOI: 10.1007/s10964-016-0566-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 01/21/2023]
Abstract
Childhood and adolescent adversity have been shown to predict later mental and physical health outcomes. Understanding which aspects and developmental timings of adversity are important, and the mechanisms by which they have their impact may help guide intervention approaches. A large subset of adolescents (N = 457; Female 68.9 %) from the 10-year longitudinal Youth Emotion Project was examined to better understand the associations among childhood/adolescent adversity, substance use disorder, and later health quality. Adolescent (but not childhood) adversities were associated with poorer health in late adolescence/early adulthood, adolescent adversities were associated with subsequent onset of substance use disorder, and adolescent adversities continued to be associated with poorer health in late adolescence/early adulthood after accounting for the variance explained by substance use disorder onset. These associations were observed after statistically accounting for emotional disorders and socioeconomic status. Specific domains of adversity uniquely predicted substance use disorder and poorer health outcomes. In contrast with current recent research, our findings suggest the association between childhood/adolescent adversity and poorer health outcomes in late adolescence and emerging adulthood are not entirely accounted for by substance use disorder, suggesting efforts to curtail family-based adolescent adversity may have downstream health benefits.
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Affiliation(s)
- Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, 11075 Santa Monica Blvd, Suite 200, Los Angeles, CA, 90025, USA
| | - Amy Sewart
- Department of Psychology, University of California-Los Angeles, 1285 Franz Hall-Box 951563, Los Angeles, CA, 90095, USA
| | - Suzanne Vrshek-Schallhorn
- Department of Psychology, University of North Carolina-Greensboro, 296 Eberhart Building, PO Box 26170
- Greensboro, NC 27402-6170, Greensboro, NC, 27412, USA
| | - Richard Zinbarg
- Department of Psychology, Northwestern University, 2029 Sheridan Road - 102 Swift Hall, Evanston, IL, 60208-2710, USA
| | - Susan Mineka
- Department of Psychology, Northwestern University, 2029 Sheridan Road - 102 Swift Hall, Evanston, IL, 60208-2710, USA
| | - Constance Hammen
- Department of Psychology, University of California-Los Angeles, 1285 Franz Hall-Box 951563, Los Angeles, CA, 90095, USA
| | - Lyuba Bobova
- Clinical Psychology, Adler University, 17 N. Dearborn Street, Chicago, IL, 60602, USA
| | - Emma K Adam
- School of Education and Social Policy and Institute for Policy Research, Northwestern University, 2120 Campus Drive, Evanston, IL, 60208, USA
| | - Michelle G Craske
- Department of Psychology, University of California-Los Angeles, 1285 Franz Hall-Box 951563, Los Angeles, CA, 90095, USA.
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McCabe SE, Cranford JA, Boyd CJ. Stressful Events and Other Predictors of Remission from Drug Dependence in the United States: Longitudinal Results from a National Survey. J Subst Abuse Treat 2016; 71:41-47. [PMID: 27776676 DOI: 10.1016/j.jsat.2016.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/14/2016] [Accepted: 08/08/2016] [Indexed: 12/25/2022]
Abstract
This study examined stressful life events and other predictors associated with remission from DSM-IV drug dependence involving cannabis, cocaine, hallucinogens, heroin, inhalants, non-heroin opioids, sedatives, stimulants, tranquilizers, or other drugs. Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to examine the prevalence and predictors of past-year remission status. Among U.S. adults with previous (i.e., prior-to-past-year) drug dependence (n=921) at baseline (wave 1), the prevalence of past-year remission status at wave 1 was: abstinence (60.5%), asymptomatic drug use (18.8%), partial remission (7.1%), and still drug dependent (13.5%). Similarly, the prevalence of past-year remission status three years after baseline at wave 2 was: abstinence (69.1%), asymptomatic drug use (15.5%), partial remission (8.4%), and still drug dependent (7.0%). Remission three years after baseline at wave 2 was much more likely among formerly drug dependent U.S. adults who abstained from drug use at baseline (wave 1) relative to those who reported asymptomatic drug use, partial remission, or remained drug dependent. Design-based weighted multinomial logistic regression analysis showed that relative to abstinence, past-year stressful events at baseline (wave 1) predicted higher odds of partial remission and drug dependence at both waves 1 and 2. This is the first national study to examine the potential role of stressful life events associated with remission from drug dependence. Although the majority of those who reported previous drug dependence transitioned to full remission, a sizeable percentage were either still drug dependent or in partial remission. Higher levels of stressful life events appear to create barriers to remission and should remain a focus for relapse prevention programs.
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Affiliation(s)
- Sean Esteban McCabe
- Institute for Research on Women and Gender, Substance Abuse Research Center, University of Michigan, 204 S. State Street, Ann Arbor, MI 48109-1290.
| | - James A Cranford
- Addiction Research Center, Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI 48109-5740
| | - Carol J Boyd
- Institute for Research on Women and Gender, Department of Psychiatry, Nursing, and Women's Studies, University of Michigan, 204 S. State Street, Ann Arbor, MI 48109-1290
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Verplaetse TL, Smith PH, Pittman BP, Mazure CM, McKee SA. Associations of Gender, Smoking, and Stress with Transitions in Major Depression Diagnoses. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2016; 89:123-9. [PMID: 27354839 PMCID: PMC4918874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Using data from the newly available U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 3; n = 36,309), we evaluated relationships among gender, cigarette smoking status (current, former, non-smoker), life event stress (0-1 vs. 2+ events), and their impact on transitions in major depression diagnosis (MDD; new vs. absent cases; ongoing vs. remit cases). Women who were both current and former cigarette smokers with more than two stressful events had higher rates of new MDD diagnosis compared to men who were current or former smokers with two or more stressful events. Current smoking and experiencing two or more stressful events increased the odds of having an ongoing MDD diagnosis, while being a former smoker decreased these odds. Results suggest that smoking and stress are markers for depression risk in women and should help guide clinical assessment as well as gender-difference research on the biological underpinnings of these conditions.
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Affiliation(s)
- Terril L. Verplaetse
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine,To whom all correspondence should be addressed: Terril L. Verplaetse, PhD, 2 Church Street South, Suite 201, Yale University School of Medicine, New Haven, CT 06519; Fax: 203.737.4243
| | - Philip H. Smith
- Department of Community Health and Social Medicine, CUNY School of Medicine
| | - Brian P. Pittman
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine
| | - Carolyn M. Mazure
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine
| | - Sherry A. McKee
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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Abstract
Drug and alcohol use disorders account for a high and potentially preventable proportion of overall disability and mortality. This article reviews published data on the distribution of alcohol and drug abuse and dependence in the USA. Published data shows that alcohol use disorders are more prevalent than illegal drug use disorders, although the persistence of both disorders was similar over a three-year follow-up period. Significant variability exists within sex, racial/ethnic, and age groups. Men, Native Americans, and young adults, aged 18 to 25, are at a higher risk of substance dependence. Environmental correlates of disorder include early environmental factors, political environment, and social contextual factors. Systematically identifying, and measuring variability across demographic populations, will guide prevention and intervention efforts. Future research will expand understanding of the complex interplay between individual and environmental factors that serve to initiate and sustain alcohol and drug use disorders.
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Affiliation(s)
- Erin Delker
- New York State Psychiatric Institute, 722 West 168th Street, New York, NY 10032, USA
| | - Qiana Brown
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Deborah Hasin
- New York State Psychiatric Institute, 722 West 168th Street, New York, NY 10032, USA
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