Ting-Kai Li, M.D.

1
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• Ting-Kai Li, M.D.
• ??????????????
• ???????
• ??????????

2
Ting-Kai Li, M.D. ????????????????
http//www.niaaa.nih.gov/AboutNIAAA/DirectorsCorn
er/default.htm
3
?????????????????
????????????????????????????? ???????????????????
???????????, ?????????????????????????? ????????
??????????????????,?????
http//pubs_at_niaaa.nih.gov/publications/StrategicPl
an/NIAAASTRATEGICPLAN.htm
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Alcohol Use????
5
???????????

• ??( el-Guebaly N, el-Guebaly A, 1981, Int J
  Addict., 161207-21 )
• ??????????????,????????4200?,??????????
• ?? (McGovern et al., 2004, PNAS, 10117593-17598
  )
• ???7000?,????????????????????????(?????????????)
• ???2000?,?????????(????)

6
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• ???1600-1050?,??????????????????
• ???460-320?,????????????????????
• ???18???????,18-30?????,??40?????????
• ?????????????????????
• ??11??????????????????????????????????????????

7
2003?????????????(??)
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• 65????????
• ???,???????,74???????,26??????
• 73???10??????
• ??????12???,????????????

???????????????????????????????????? (NESARC
2001-2002)
9
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• ???????????????,???????????????????????,??????????
  ????,????????
• (USDA/HHS Dietary Guidelines, 2005)

?????12??????????????????????,??5?????????1.5???8
0???????

.

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• ?10????????3????????
• ?????,?????14?
• ?????4?
• ?????,?????7?
• ?????3?

???????????????????????????????????? ????
(NESARC 2003)
11
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• ???????????????????????????

????????????????(BAC)???0.08gm????????????????,??
???????????5?????????4????????????????????
12
?????????????2001-2002 ???
?????????? ??????14 (??),7 (??)??? 4 (??), 3 (??) ?????????? ??????14 (??),7 (??)??? 4 (??), 3 (??) ????,???????Odds??? ????,???????Odds???
???? 18????????????????? ????????? ???????????
??????????????????? 72 ??? (1.0) ??? (1.0)
???????? 2 7.8 12.4
?????????,?????? 14 17.0 33.0
????????,?????????? 2 31.1 82.0
?????????????????? 10 31.1 219.4
13
??????????????30??????5?????5????
??
??
???????????????,2003???????????????(NSDUH)
14
?????????????????????????
?? Corrao et al. (2004), Preventive Medicine??,
38613619
15
Odds of Co-Occurrence of Current
(12-month)??(12??)?????Odds?DSM-IV ???????????
?? Odds
?? 2.6x
???? (?????) 4.1x
???? 4.0x
??????? 7.1x
???? 36.9x
????? 6.4x
16
????????????????,?????????
?? ??? ?? ??? ?? ?????????? ?????? ?? ?????? ?????

?????? 2002 http//www.who.int/whr/2002/en/whr20
02_annex14_16.pdf
17
????
18
????????????/???????
DSM-IV ???? ICD-10 ????

A. ???????????????????????,????1-2?????????????????? A. ??????????????????
???????????????? ??????????????? ??????????? ??????????????????????????
B. ????????????? B. ??????????????
90?????????????????? ??????20???20??
(Dawson, DA. Unpublished NESARC Analysis, 2006)
19
?????????????????????

• ??NIAAA???????????????? ??? ???? (e.g.,
  Langenbucher et al., 2004 Krueger et al., 2004
  Kahler and Strong, 2006 Saha et al., 2006
  Proudfoot et al., 2006)???????
• ?????????????? (?????), ?????????????
• ?????????????????????????????????????????????(con
  tinuum)
• ?????????????????

NESARC ? 1991-1992?? NIAAA ???????????? (NLAES)
20
????(????)
21
??????? DSM-IV and ICD-10(??????7?????3?,?3/7?)
1. ?? ?? ??/?? ???
3. ????? ???
??/?? ??????/?? ???
???
4. ???? ???
?? (??ICD-10) ???
???? ???? ??????? ????
?????
22
????DSM-IV???????????2001-2002
2001-2002, DSM-IV????????? 3.8
23
???????????
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• ??????????????????????????
• ?? ? ?? ??
• ?? ??
• ????, ????????

25
???? ?????????
??60 ??,????????????
??40 ????????
26
AUD?????????????
?????
??
????
????
?? (??????)
??/??(?????)
??????? (?????)
27
????????????????
???? ????????????????????
28
??????????(???? ??????????)

• ??????? ?????,??,???
• 3-4 ?
• ??? ??????????
• 2-3 ?

???????????????
29
????????????
30
???? DSM-IV ????????????????
31
?????????????????????????
32
P ? NP??????????????????????????
Murphy JM, Gatto GJ, McBride WJ, Lumeng L, Li TK
((1989). Alcohol. 6(2)127-31.
33
???????????
34
??????????

?????,????????, ???????????

100
Abstainer
90

80
70
Low
-
risk drinker


??????,?????? ??????????????
60
PPY Population
PPY Population
50
Asymptomatic risk
40
drinker (
subclinical
dependence)

30
Partial Remission
20

10

???????30-60, ?????????? (?????????? ,????)
0
Still Dependent
lt5
5 to 9
10 to 19
20
Interval (Years)




??????


???????



????
(e.g.,
????????, ????)



????

35
???????? ????
???
Facilitated self
-
change
Behavioral and Medication
-
Prevention
??
??????????????
???????
Brief counseling
Therapy
Disease
?? ??
management
Dependence
Dependence
At
-
risk
-
None
Harmful use
(Early)
(Chronic)
?
??????
????
????
????

gt????4?,??14???

gt????3?,?? 7 ???
gt
36

• ??15????????
• ????????????(??????,????,12?)
• ?????????????,??????????????

37
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38
FDA??????????????
?? ?? ?? ?? ???? ????

Disulfiram Disulfiram Aldehyde Dehydrogenase 1949 1949 1949
??25???????????????????? ??25???????????????????? ??25???????????????????? ??25????????????????????

Naltrexone Naltrexone Mu Opioid Receptor 1994 1994 1994
Acamprosate Acamprosate Glutamate and GABA-Related 2004 2004 2004
Naltrexone Depot Naltrexone Depot Mu Opioid Receptor 2006 2006 2006

39
????????????
?? ??

Topiramate GABA/Glutamate
Valproate GABA/Glutamate
Ondansetron 5-HT3 Receptor
Nalmefene Mu Opioid Receptor
Baclofen GABAB Receptor
Antalarmin CRF1 Receptor
Rimonabant CB1 Receptor
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NIAAA?????AUD????????????
???? ??

????/?? naltrexone sertraline
????/???? valproate naltrexone
???????/?? venlafaxine (Effexor)
????/???? clozapine (Clozaril)
????/???? bupropion (Zyban)
????/????? topiramate (Topamax)
41
NIAAA ?????? ?????????
??AUDIT-C 1. ?????????? 2. ?????????,????????????
??? 3. ??????????????6????? ??????
???????(79)?????/??(81) ?????,?????????83 Bus
h etc Arch Intern Med 19981581789-1795 ????????
?????????????? www.pubs.niaaa.nih.gov/publication
s/practitioner/CliniciansGuide2005/GuideSlideShow.
htm
42
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