Mapping the course of AUD symtpoms : a network perspective
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Contemporary models of Alcohol Use Disorder (AUD) suggest a stage-like progression wherein certain features (i.e., symptoms) may play key roles in different stages of the disorder. For example, allostatic processes (tolerance, withdrawal) are suggested to play important role in escalation from recreational substance use to addiction, while corticostriatal- limbic neuroadaptations have been found to contribute to craving and subsequent relapses. To further elucidate the role that individual symptoms of AUD play in the development and continuation of other symptoms, the current study used data from NESARC Waves 1 and 2 (n = 34,653) to explore how each individual symptom contributes to the onset, persistence, and recurrence of each other symptom of AUD. After creating subsamples for symptom onset, persistence, and recurrence, cross-lagged panel network models were calculated using Wave 1 symptoms to predict the presence of Wave 2 symptoms. The structure of the onset, persistence, and recurrence networks had low agreement, indicating that inter-symptom relationships differed as a function of course. High frequency, low severity symptoms had the greatest effect on the course of other symptoms, while the course of low frequency, high severity symptoms were most greatly influenced by other symptoms. While broad patterns emerged regarding symptom centrality, some symptoms appeared to have uniquely important roles in the various stages of course. When findings were compared to conceptual addiction models, results were mixed, and processes from multiple theoretical models were reflected in the data. Notable limitations include the presence of only two waves of data, issues related to symptom measurement and variable selection, and analytic limitations. The findings highlight need for additional work understanding the temporal course of individual AUD symptoms.
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