Madde Kullanım Bozukluğu Tanılı Ergenlerde Kokain Kullanım Bozukluğu Gelişimi ile ilişkili Faktörler: Kesitsel bir Regresyon Analizi

Abstract

Amaç: Bu çalışma, Madde Kullanım Bozukluğu (MKB) tanısıyla tedavi başvurusu yapmış ergenlerde, Kokain Kullanım Bozukluğu (KKB) gelişimiyle ilişkili bireysel, davranışsal ve zamansal belirleyicileri ortaya koymayı amaçlamaktadır. Yöntemler: Kesitsel ve retrospektif tasarımla yürütülen bu çalışmaya, Nisan 2019– Şubat 2024 tarihleri arasında MKB tanısıyla takip edilen ve en az bir kez kokain kullanmış 87 ergen dâhil edilmiştir. DSM-5’e göre KKB tanısı alanlar “KKB grubu” (n = 31), yalnızca kokain deneyimi olanlar ise “KKB olmayan grup” (n = 56) olarak sınıflandırılmıştır. Grup karşılaştırmaları Ki-kare/Fisher’s Exact ve Mann–Whitney U testleriyle yapılmış; ikili analizlerde anlamlı bulunan değişkenler Backward LR yöntemiyle çok değişkenli lojistik regresyona alınmıştır. Bulgular: KKB grubu, kokainle daha erken yaşta tanışmış (medyan = 15) ve ilk madde deneyiminden kokain kullanımına daha kısa sürede geçmiştir (medyan = 2 yıl). Ayrıca, hayat boyu MKB tanı sayısı KKB grubunda belirgin olarak daha yüksektir (p < 0,01). Buna karşın, ilk maddeyle tanışma yaşı ve hayat boyu toplam madde sayısı açısından anlamlı fark saptanmamıştır. Tercih maddeleri incelendiğinde, yalnızca esrar tercihi farklılık göstermiş; esrarı tercih maddesi olarak bildirenlerde KKB olasılığı anlamlı ölçüde daha düşük bulunmuştur (p = 0,002). Lojistik regresyon analizinde, dört değişken KKB ile bağımsız ilişkili kalmıştır: daha yüksek hayat boyu MKB tanı sayısı (OR = 1,81), daha erken kokainle tanışma yaşı (OR = 0,61), daha kısa geçiş süresi (OR = 0,69) ve esrar tercihi (OR = 0,13). Sonuç: Ergenlerde KKB gelişiminin özellikle kokainle karşılaşma zamanlaması, kullanım hızındaki artış ve birikimli bağımlılık yüküyle ilişkili olduğunu; bu göstergelerin erken müdahalede önemli olduğunu ortaya koymaktadır.

Keywords

• Ergen
• Madde kullanım bozukluğu
• Kokain kullanım bozukluğu
• Erken başlangıç
• Lojistik regresyon

Factors Associated with the Development of Cocaine Use Disorder in Adolescents with Substance Use Disorder: A Cross-Sectional Regression Analysis

Abstract

Objective: This study aimed to identify individual, behavioral, and temporal determinants associated with the development of Cocaine Use Disorder(CUD) among adolescents presenting for treatment with a Substance Use Disorder(SUD) diagnosis. Methods: This cross-sectional and retrospective study included 87 adolescents who had been followed with a SUD diagnosis and had used cocaine at least once between April 2019 and February 2024. According to DSM-5 criteria, adolescents diagnosed with CUD formed the “CUD group” (n = 31), while those with cocaine experimentation only formed the “non-CUD group” (n = 56). Group comparisons used Chi-square/Fisher’s Exact tests and Mann–Whitney U tests. Variables that were significant in bivariate analyses were entered into a multivariable logistic regression model using the Backward LR method. Results: The CUD group encountered cocaine at a younger age (median = 15) and transitioned more rapidly from first substance use to cocaine (median = 2 years). They also had higher lifetime SUD diagnosis counts (p < 0,01). In contrast, no significant differences emerged in age at first substance use or total number of substances used. Among preferred substances, only cannabis preference differed; adolescents reporting cannabis as a preferred substance had a markedly lower likelihood of CUD (p = 0,002). Logistic regression identified four independent predictors: higher lifetime SUD diagnosis count (OR = 1,81), younger age at cocaine initiation (OR = 0,61), shorter transition time (OR = 0,69), and cannabis preference (OR = 0,13). Conclusion: CUD development in adolescents is closely linked to cocaine exposure timing, accelerated use trajectories, and cumulative dependence burden.

Keywords

• Adolescent
• Substance use disorder
• Cocaine use disorder
• Early onset
• Logistic regression.

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