title: Trajectories of Lifetime Comorbid Alcohol and Other Drug Use Disorders Through Midlife.
abstract: OBJECTIVE
  Very few studies have examined the developmental nature of comorbid alcohol use disorders and drug use disorders (AUD-DUD). The current study sought to extend our understanding of the nature of AUD-DUD comorbidity by characterizing the developmental course of AUD-DUD comorbidity, determining the degree to which the two disorders occur during the same period, and eliciting differences in AUD-DUD trajectories over the life course.
  
  
  METHODS
  Vietnam-era male veterans and matched civilians provided retrospective accounts of alcohol- and other drug-related experiences spanning 25 years. Concurrent growth mixture modeling was used to describe the course of AUD-DUD lifetime comorbidity.
  
  
  RESULTS
  Five trajectories were identified based on the probabilities of diagnosing with AUD-DUD: substance switching (increasing AUD, decreasing DUD); young adult (both AUD and DUD decreasing rapidly after young adulthood); severe nonchronic (both AUD and DUD decreasing slowly in the third decade of life); severe chronic alcohol-severe nonchronic drug (AUD remains high and DUD decreases in the fourth decade); and young adult alcohol-severe chronic drug (decreasing AUD in the second decade and DUD remains high).
  
  
  CONCLUSIONS
  For the majority of this sample, substance use disorders continued or worsened through adulthood, indicating a problem that extends far beyond young adulthood. Demographic characteristics differed among the trajectories; however, psychiatric diagnoses did not differ except for the number of years with diagnoses of antisocial personality disorder. Subthreshold symptoms in adulthood may be present for a significant period before diagnosis, making this period important for intervention and prevention. Integration of efforts into healthcare, employment, and public policy will help target those at highest risk.
authors.affiliation: Family Research Center, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Upah
authors.affiliation: Family Research Center, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California.
authors.forename: Theodore
authors.initials: T
authors.lastname: Jacob
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Rumi Kato
authors.initials: RK
authors.lastname: Price
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology*; D000987:Antisocial Personality Disorder / Q000453:epidemiology; D015897:Comorbidity; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult