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Background: The Covid-19 restrictions – as they made young people's practices in their everyday life visible for reflection and reformation – provide a productive opportunity to study how changing conditions affected young people's well-being and drinking practices. Methods: The data is based on qualitative interviews with 18- to 24-year-old Swedes (n=33) collected in the Autumn 2021. By drawing on the socio-material approach, the paper traces actants, assemblages and trajectories that moved the participants towards increased or decreased well-being during the lockdown. Results: The Covid-19 restrictions made the participants reorganize their everyday life practices emphatically around the home and communication technologies. The restrictions gave rise to both worsened and improved well-being trajectories. In the worsened well-being trajectories, the pandemic restrictions moved the participants towards loneliness, loss of routines, passivity, physical barriers, self-centered thoughts, negative effects of digital technology, sleep deficit, identity crisis, anxiety, depression, and stress. In the improved well-being trajectories, the Covid-19 restrictions brought about freedom to study from a distance, more time for significant others, oneself and for one's own hobbies, new productive practices at home and a better understanding of what kind of person one is. Both worsened and improved well-being trajectories were related to the aim to perform well, and in them drinking practices either diminished or increased the participants’ capacities and competencies for well-being. Conclusions: The results suggest that material domestic spaces, communication technologies and performance are important actants both for alcohol consumption and well-being among young people. These actants may increase or decrease young people's drinking and well-being depending on what kinds of relations become assembled.

Adolescent alcohol consumption has been in decline across many high-income countries since the early to mid-2000s. This is a significant public health trend, with few documented examples from history where such a global downward shift in alcohol consumption has occurred primarily among the adolescent segment of the population. In this commentary we describe the nature and breadth of the trend; reflect on the environmental, social and policy factors that have been proffered; and argue that to adequately understand and support the maintenance of these trends, three important methodological considerations are needed for future research. Firstly, longitudinal panel and qualitative studies are needed to complement and inform continuing cross-sectional research. Secondly, a collaborative cross-cultural approach is needed to contextualise the international scale of the trend and thirdly, future research must be situated within a historical and generational perspective to understand declines in adolescent drinking in the context of a broader shift in adolescent behaviours., Varför dricker unga mindre än tidigare?

Aim of this study was to investigate the current health care situation for patients with co-occurring mental disorders in addiction treatment. Therefore, data from the German Substance Abuse Treatment System (N = 194,406) was analysed with regard to the prevalence of comorbid mental disorders, treatment characteristics and outcomes of patients with comorbid psychiatric diagnosis. In outpatient setting, the prevalence of comorbid diagnoses was considerably lower (4.6%) than in inpatient setting (50.7%), but mood and anxiety disorders were the most prevalent additional diagnoses in both settings. In the treatment of patients with these comorbid disorders, we found higher rates of complementary internal and external (psychiatric) treatment, more co-operations and referrals after treatment, and positive treatment process outcomes. Findings indicate that the knowledge of an additional diagnosis influences the health care provision of affected patients and can therefore be seen as the essential precondition for providing adequate and comprehensive treatment. This highlights the importance of a sufficient consideration and diagnostic assessment of mental disorders in addiction treatment to further improve the health care situation of comorbid patients.

Background: Although young adult men are at an elevated risk for gambling problems (GP), compared to adolescents and adults in general this group is still largely unresearched. The current study investigates whether family functioning, which is associated with reduced risk for GP in adolescence, also affects gambling in young adults, who are more independent than minors. It analyses the relationship between GP and two core components of family functioning, the effectiveness of problem-solving in the family and perceived concordance of values. Methods: Data came from the baseline, 12- and 24-month follow-up assessments of Munich Leisure-time Study (MLS), a longitudinal online study in young male gamblers. Young men were recruited via the Munich citizens’ registry (n = 2,693) and Facebook invites (n = 105). In total, n = 173 individuals positively screened for frequent and/or regular gambling participated in the study. The hypothesised relations between problem-solving, concordance of values and GP were investigated with a path model controlling for non-planning impulsiveness and psychological distress. Results: Higher concordance of family values was significantly related to less GP in cross-sectional and longitudinal analyses. It mediated the relation between the effectiveness of problem-solving and GP. Conclusions: While previous studies indicated good family functioning as a factor preventive of GP, the current results indicate that this association is mediated by the perceived concordance of family values. In families with effective problem-solving, common family values might facilitate recognition of and reaction to first signs of problems. Perceived discordance may lead to feelings of shame and concealment of GP.

Ziel: Es wurden Personen mit Migrationshintergrund aus verschiedenen Herkunftsregionen hinsichtlich ihres Alkoholkonsums mit Personen ohne Migrationshintergrund verglichen. Methodik: Daten des Epidemiologischen Suchtsurveys (ESA) 2012 wurden ausgewertet (n=9 084). Personen mit Migrationshintergrund wurden ihrer Herkunft entsprechend in 10 Gruppen aufgeteilt. Als Indikatoren zur Erfassung des Alkoholkonsums dienten Abstinenz, Durchschnittskonsum und episodisches Rauschtrinken. Inferenzstatistische Vergleiche erfolgten regressionsanalytisch. Ergebnisse: Alle Herkunftsgruppen außerhalb Europas und wenige innerhalb Europas wiesensignifikant höhere Abstinenzraten auf als Personen ohne Migrationshintergrund. Die höchsten Werte zeigten Personen mit einem Hintergrund aus arabisch-islamisch geprägten Ländern und der Türkei. Hinsichtlich des Durchschnittskonsums und episodischen Rauschtrinkens wurden kaum Gruppenunterschiede gefunden. Schlussfolgerungen: Die Bereitschaft unter Personen mit Migrationshintergrund zur Abstinenz sollte unterstützt werden. Ein Bedarf migrationsspezifischer Präventionsmaßnahmen auf Populationsebene ist für die Gruppe der in den zurückliegenden Jahrzehnten nach Deutschland migrierten Personen und ihre Nachkommen nicht erkennbar; die Erreichung der Personen mit Migrationshintergrund durch bestehende Maßnahmen sollte gewährleistet werden., Aims: Individuals with migration background from different regional origins were compared to individuals without migration background concerning their alcohol consumption. Methods: Data came from the 2012 Epidemiological Survey of Substance Abuse (ESA; n=9 084). Individuals with migration background were clustered in 10 groups based on their geographicalorigins. Indicators of alcohol consumption comprised prevalence of abstention, average volume and prevalence of episodic heavy drinking. Statistical inference was tested by regression analyses. Results: Abstention rates were significantly higher in all non-European and few European groups than in the reference group without migration background. This applies particularly to individuals with Arabic-Islamic and Turkish roots. For mean consumption and prevalence of episodic heavy drinking group differences were few in number. Conclusions: Willingness to stay abstinent among individuals with migration background should be supported. There is no evidence of a need for specific prevention measures among last decades’ migrants in Germany. Access to established measures for migrants should be ensured., English title: Drinking Behaviour among Individuals of Different Origins in Germany: A Comparison of Individuals with and without a Migration Background.

Aim: A drinking pattern is not only a major drinking variable, but is also one indicator of a country's drinking culture. In the present study, we examine drinking patterns within and across the neighbouring countries of Denmark and Germany. The aim of the research is to determine to what extent drinking patterns differ or are shared at the sub-national level in the two countries. Method: Data came from the German 2012 Epidemiological Survey of Substance Use (n = 9084) 18-64 years (response rate 54%), and the Centre for Alcohol and Drug Research's 2011 Danish national survey (n = 5133) 15-79 years (response rate 64%), which was reduced to a common age range, producing a final n = 4016. The drinking pattern variable included abstention, moderate drinking, heavy drinking, risky single occasion drinking (RSOD), and was investigated with bivariate statistics and gender-specific hierarchical cluster analysis. Results: For men three clusters emerged: one highlighting abstention and RSOD, moderate/heavy drinking, RSOD and RSOD + heavy drinking. For women, two clusters appeared: one highlighting abstention and moderate/heavy drinking and the other highlighting RSOD and RSDO + heavy drinking. The clusters revealed different geographical patterning: for men, a west vs. east divide; for women, a north-south gradient. Conclusions: The analysis could identify for each gender clusters representing both separate and shared drinking patterns as well as distinctive geographical placements. This new knowledge can contribute to a new understanding of the dynamics of drinking cultures and could indicate new approaches to prevention efforts and policy initiatives.

Aims 1. To quantify barriers to alcohol screening among hypertensive patients reported by primary healthcare professionals. 2. To examine whether education and screening frequency measures are associated with stigma-related barriers. Methods A web survey was conducted among 3081 primary healthcare professionals from France, Germany, Italy, Spain and the UK. Participants were asked about perceived barriers to alcohol screening as free-text response. The replies were independently categorized by two raters. Stigma-related barriers were predicted by logistic regressions with education, knowledge on alcohol as risk factor and frequency of alcohol screening. Results In France and Italy, almost half of the reported barriers were stigma-related, whereas time constraints were cited most commonly in Spain and the UK. In Germany, nearly half of respondents rated the importance of alcohol screening for hypertension as low. Perception that regular screening is inappropriate or associated with too much effort, beliefs that screening is unnecessary, and insufficient knowledge of screening tools were cited as further barriers. Professional education on alcohol use was consistently rated to be poorer than the equivalent education on hypertension, and only a minority of respondents perceived alcohol as important risk factor for hypertension. Stigma-related barriers could not be significantly predicted by education, knowledge or screening frequency in most models. Conclusions Overall, regular alcohol screening among hypertensive patients seems to be widely accepted, but further education (Germany) and structural support (Spain, UK) could contribute to increase screening rates. In France and Italy, screening uptake could be improved by addressing stigma. Short Summary Alcohol screening among hypertensive patients was largely accepted among general practitioners from five different European countries. Reported screening barriers varied between countries and included time constraints, s

Stigmatisierung schadet den Betroffenen und verstärkt Suchtprobleme. Sie ist ein Hindernis auf dem Weg zur Hilfe, führt zu schlechterer Behandlung und vergrößert die sozialen und gesundheitlichen Folgen einer Suchtkrankheit. Das gilt sowohl für die individuellen Folgen als auch für die gesellschaftlichen einschließlich der öffentlichen Gesundheitskosten. Zudem ist Stigmatisierung ein ethisches Problem, weil sie eine bestimmte Gruppe benachteiligt und die Menschenwürde der Betroffenen angreift. Ein stigmafreier Umgang mit Suchtkrankheiten ist möglich. Entstigmatisierung bedeutet, bessere Lösungen für Suchtprobleme zu finden und verfügbar zu machen. Nicht Abwertung, Ausgrenzung und Disziplinierung, sondern Wertschätzung und Befähigung (Empowerment) müssen im Zentrum von Prävention, Behandlung sowie dem alltäglichen Umgang mit Suchtkrankheiten stehen., Stigma does harm to individuals with substance use disorders (SUD), and it increases the burden of SUDs. It presents a barrier to help seeking, results in lower treatment quality and increases social and health related consequences of SUDs. This applies to both the individual, societal and economic consequences of substance use. Moreover, stigmatizing persons with addictions is an ethical problem, since it discriminates against a certain group and infringes on their human dignity. Dealing with substance use disorders without stigma is possible. Eliminating the stigma of SUDs means finding better ways to deal with SUDs and to make these ways available to everyone. Instead of devaluing, marginalizing and disciplining persons with SUD, empowerment and appreciation need to be at the core of dealing with SUD in prevention, treatment and every day life.

Background There is evidence that patients entering alcohol or drug treatment have different levels of treatment readiness and change their motivation differently over time. Nonetheless, existing studies mainly use single measures of motivation and do not consider individual differences. This study addresses 2 questions: (i) How does treatment readiness change in patients with alcohol and drug use dependence over the course of an inpatient rehabilitation treatment?; and (ii) Can changes in treatment readiness be explained by sociodemographic and substance use-related characteristics? Methods Data from 177 alcohol-dependent patients and 152 drug-dependent patients were collected in 2 inpatient rehabilitation centers in Germany. Three single-item indicators of treatment readiness were assessed weekly over the course of the treatment. Sociodemographic and substance use-related characteristics were assessed at baseline. To model developments of treatment readiness that may be different for each patient, multilevel analyses for longitudinal data were used. Results The overall effect of time on treatment readiness was not significant, indicating that average motivation across all patients did not change over the course of the treatment. However, individuals showed different initial states and different rates of change. School education, employment status, earlier substance use treatments, and craving predicted treatment readiness. Interactions with time were found for craving and marital status. Conclusions The results suggest that it is necessary to consider individual differences when evaluating treatment motivation in alcohol- and drug-dependent patients. The identification of variables predicting motivation may help to improve substance abuse treatment contents and outcomes.

Background: Alcohol is one of the least intervened risk factors in the management of hypertension at the primary care level. In order to improve alcohol interventions, a better understanding of knowledge, attitudes and clinical practice of lifestyle interventions in the management of hypertension is needed.Method: As a part of a European study (France, Germany, Italy, Spain, UK), 211 German general practitioners (GPs) were recruited in Bavaria and Hamburg and surveyed via an Internet-based questionnaire. Results were compared with the European sample (n=2870).Results: One-third of the patients seen by German GPs had hypertension (36.2%, standard deviation (SD): 14.6) and among cases with hypertension, less than half were ever screened for alcohol (4.5 out of 10 patients). The foremost reasons for not screening for alcohol were that alcohol was not considered a major risk factor for hypertension plus the lack of knowledge of appropriate alcohol screening instruments. The majority of German GPs managed patients with hazardous drinking levels themselves or in their practice (71.3%, 95% confidence interval (CI): 64.6-77.2%), but only 42.0% (95% CI: 35.2-49.0%) managed alcohol dependent patients. German screening rates were slightly lower but interventions of screened positive patients higher than the European average.Conclusions: Rates of alcohol screening in patients with hypertension in primary health care may be increased by improving GPs knowledge of alcohol as a major risk factor for hypertension, increasing GPs education on alcohol and screening instruments, and providing reimbursement. This may increase treatment of alcohol problems in patients with hypertension and reduce hypertension.

This study aims (1) to describe the context of drinking among adolescents with acute alcohol intoxication (AAI) by gender, (2) to explore temporal changes in the context of drinking and (3) to analyse the association between the context of drinking and blood alcohol concentration (BAC). A retrospective chart review of 12- to 17-year-old inpatients with AAI (n = 1441) of the years 2000 to 2006 has been conducted in five participating hospitals in Germany. Gender differences in the context of drinking were tested with t test and chi2 test. Differences over time were analysed using logistic regressions. Multivariate linear regression was used to predict BAC. Girls and boys differed in admission time, drinking situation, drinking occasion and admission context. No temporal changes in drinking situation and in admission to hospital from public locations or places were found. Higher BAC coincided with male gender and age. Moreover, BAC was higher among patients admitted to hospital from public places and lower among patients who drank for coping. Conclusion: The results suggest gender differences in the context of drinking. The context of drinking needs to be considered in the development and implementation of target group-specific prevention and intervention measures.

Background Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. Methods A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statisticalmodelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. Results Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually

Objective: This study aimed to (a) investigate the relationship between drinking location and adolescent alcohol use, (b) analyze the association of drinking culture indicators with alcohol use, and (c) explore interaction effects of drinking location and drinking culture indicators. Method: Analyses were based on the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD). The analytical sample consisted of 15-to 16-year-old students (N = 36,366; 51.6% female) from 11 countries. Alcohol volume and perceived drunkenness were used as outcomes. Drinking location was used as predictor variable. Per capita consumption and restrictions on public drinking were used as country-level predictors. Sex-stratified generalized linear models with cluster robust standard errors were applied. Results: Compared with drinking outdoors, the reported alcohol volume was lower when drinking at home and higher when drinking in multiple locations or at someone else's home. Drunkenness was highest among boys drinking at someone else's home and, compared with drinking outdoors, lower among girls drinking on premise. Per capita consumption was positively associated with alcohol volume. Among girls, the association between per capita consumption and both outcomes was stronger when drinking in multiple locations than when drinking outdoors. A ban on public drinking showed a negative effect on drinking volume and drunkenness among girls. Conclusions: The role of different drinking locations in alcohol use as well as sex differences should be considered in prevention and intervention of adolescent heavy drinking. Setting-specific prevention and intervention measures are of greater importance in medium-or high-consumption societies.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends within as well as between countries. Between 1995 and 2015, six surveys were conducted in 48 European countries. The present report differs from the earlier ESPAD reports in that it presents selected key results of the 2015 ESPAD survey rather than the full range of results and tables. The full set of data on which the current report is based, including all the usual tables in the familiar ESPAD format, is available online (http://www.espad.org). All of the tables can be downloaded in Excel format and used for further analysis. The present report provides information on the perceived availability of substances, early onset of substance use and prevalence estimates of substance use (cigarettes, alcohol, illicit drugs, inhalants, new psychoactive substances and pharmaceuticals). The descriptive information includes indicators of intensive substance use and prevalence estimates of internet use, gaming and gambling by country and gender. Secondly, overall ESPAD trends between 1995 and 2015 are presented. For selected indicators, ESPAD trends are shown based on data from 25 countries that participated in at least four (including the 2015 data collection) of the six surveys. Finally, for some indicators, country-specific trends are shown. In the 2015 ESPAD data collection, 96 043 students took part from 35 countries: Albania, Austria, Belgium (Flanders), Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroes, Finland, the former Yugoslav Republic of Macedonia, France, Georgia, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, Montenegro, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and Ukraine. For comparative reasons, the tables of the 2015 ESPAD results contain, in additio, European School Survey Project on Alcohol and Other Drugs (ESPAD)

Background: Three different conceptualizations of occupational prestige were contrasted by applying social stratification to four exemplarily selected psychoactive substances. Although these conceptualizations partly measure the same construct, it is hypothesized that the gradient of occupational inequality differs depending on the type of conceptualization. Method: Data were taken from the 2012 German Epidemiological Survey of Substance Abuse. The study sample comprised n = 9084 individuals of the general population aged 18–64 years. Use and heavy use of cigarettes, alcohol, cannabis and analgesics were stratified by (a) employment status (six groups: employed, marginally employed, apprenticeship, unemployed, retired and other), (b) occupational status (five groups: low to high) and (c) occupational social class (two groups: blue-collar and white-collar). Absolute and relative differences between occupational groups were calculated. All analyses were stratified by gender. Results: Risk for smoking was increased amongst unemployed males and blue-collar workers. Retired persons, people with low occupational status and female blue-collar workers had a diminished risk for alcohol consumption; apprentices had an increased risk. Amongst males, low occupational status and blue-collar work was associated with episodic heavy drinking. Unemployment and blue-collar work was related to cannabis use. Risk for heavy analgesics use was increased amongst unemployed women, men with low occupational status and male blue-collar workers, respectively. Conclusions: The results suggest that occupational inequality differs depending on the applied conceptualizations of occupational prestige. Consequently, they should not be used interchangeably.

Ziel: Ziel der Studie ist die Analyse von Trends des (klinisch relevanten) Konsums von Tabak, Alkohol, Cannabis und anderen illegalen Drogen sowie der Einnahme von Medikamenten zwischen 1995 und 2015. Methodik: Datengrundlage bilden acht Erhebungswellen des Epidemiologischen Suchtsurveys (ESA) aus den Jahren 1995 bis 2015. Die Befragungen erfolgten schriftlich, telefonisch oder online. Eine einheitliche Darstellung zeitlicher Trends ist für den Altersbereich 18 bis 59 Jahre möglich. Ergebnisse: Der Tabakkonsum hat in den letzten 20 Jahren abgenommen. Trenddaten des Alkoholkonsums zeigen sinkende Konsumwerte für Männer und stabile Werte für Frauen. Die Prävalenz des Rauschtrinkens ist bei Frauen seit dem Jahr 2009 angestiegen. Der Cannabiskonsum hat zwischen 2012 und 2015 bei beiden Geschlechtern zugenommen. Der wöchentliche Gebrauch von Schmerzmitteln ist angestiegen, während bei Schlaf-/Beruhigungsmitteln ein Rückgang zu verzeichnen ist. Indikatoren eines klinisch relevanten Konsums zeigen für Cannabis keine Änderungen, für Tabak einen Rückgang und für Medikamente einen Anstieg. Hinweise auf klinisch relevanten Alkoholkonsum sind bei Männern konstant geblieben und bei Frauen angestiegen. Schlussfolgerungen: Die weite Verbreitung insbesondere der legalen Substanzen legt einen dringenden Handlungsbedarf für Prävention und Intervention nahe. Als besondere Zielgruppe wurden Frauen identifiziert, bei denen der klinisch relevante Konsum von Alkohol und Medikamenten zugenommen hat., Aims: The study analyzes trends in the (clinically relevant) use of tobacco, alcohol, cannabis, other illegal drugs as well as pharmaceuticals. Methods: Data from eight waves of the Epidemiological Survey of Substance Abuse (ESA) from the years 1995 to 2015 were used. The data were collected using self-administered questionnaires, telephone interviews, or online questionnaires. A consistent analysis of trends is possible for the age range 18 to 59 years. Results: Tobacco consumption significantly declined over the past 20 years. Alcohol data showed declining consumption in males and stable consumption in females. The prevalence of episodic heavy drinking increased in females since the year 2009. Compared to the year 2012, cannabis consumption increased in both sexes. Weekly use of analgesics also increased, whereas weekly use of sedatives/hypnotics decreased. Indicators of clinically relevant use remained constant for cannabis, declined for tobacco and increased for pharmaceuticals. With regard to alcohol, males showed stable and females increased rates of clinically relevant use. Conclusions: Prevention and intervention measures need to be intensified especially with regard to the legal substances tobacco and alcohol. Trend analyses identified women as a particularly vulnerable subgroup because of an increasing prevalence of clinically relevant use of alcohol and pharmaceuticals.

Background: Even though addressing lifestyle problems is a major recommendation in most guidelines for the treatment of hypertension (HTN), alcohol problems are not routinely addressed in the management of hypertension in primary health care. Methods: Internet based survey of 3081 primary care physicians, recruited via the mailing lists of associations for general practitioners (GPs) in France, Germany, Italy, Spain and the UK. Clinical practice, attitudes, knowledge, education and training were assessed. Logistic regression to predict screening, brief intervention and treatment for alcohol dependence in the management of hypertension were assessed. Results: Overall, about one third of the interviewed GPs reported sufficient screening in cases with HTN (34.0 %, 95 % confidence interval (CI):32.1-35.8 %). One out of five GPs screened and delivered brief interventions in HTN patients with hazardous consumption (22.2 %, 95 % CI: 20.6-23.8 %) and about one in 13 GPs provided treatment for HTN patients with alcohol dependence other than advice or brief intervention (7.8 %, 95 % CI: 6.8-8.9 %). Post-graduate training and belief in their effectiveness predicted interventions. There were marked differences between countries. Conclusions: While current interventions were overall low, marked differences between countries indicate that current practices could be improved. Education and post-graduate training seems to be key in improving clinical practice of including interventions for problematic alcohol consumption and alcohol dependence in primary health care.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends within as well as between countries. Between 1995 and 2015, six surveys were conducted in 48 European countries. The present report differs from the earlier ESPAD reports in that it presents selected key results of the 2015 ESPAD survey rather than the full range of results and tables. The full set of data on which the current report is based, including all the usual tables in the familiar ESPAD format, is available online (http://www.espad.org). All of the tables can be downloaded in Excel format and used for further analysis. The present report provides information on the perceived availability of substances, early onset of substance use and prevalence estimates of substance use (cigarettes, alcohol, illicit drugs, inhalants, new psychoactive substances and pharmaceuticals). The descriptive information includes indicators of intensive substance use and prevalence estimates of internet use, gaming and gambling by country and gender. Secondly, overall ESPAD trends between 1995 and 2015 are presented. For selected indicators, ESPAD trends are shown based on data from 25 countries that participated in at least four (including the 2015 data collection) of the six surveys. Finally, for some indicators, country-specific trends are shown. In the 2015 ESPAD data collection, 96 043 students took part from 35 countries: Albania, Austria, Belgium (Flanders), Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroes, Finland, the former Yugoslav Republic of Macedonia, France, Georgia, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, Montenegro, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and Ukraine. For comparative reasons, the tables of the 2015 ESPAD results contain, in additio, European School Survey Project on Alcohol and Other Drugs (ESPAD)

Background: The long-term psychosocial development of adolescents admitted to in-patient treatment with alcohol intoxication (AIA) is largely unknown. Methods: We invited all 1603 AIAs and 641 age- and sex-matched controls, who had been hospitalized in one of five pediatric departments between 2000 and 2007, to participate in a telephone interview. 277 cases of AIA and 116 controls (mean age 24.2 years (SD 2.2); 46% female) could be studied 5-13 years (mean 8.3, SD 2.3) after the event. The control group consisted of subjects who were admitted due to conditions other than alcohol intoxication. Blood alcohol concentration on admission was systematically measured in the AIA but, owing to the retrospective study design, not in the control group. Subtle alcohol intoxication could therefore not be entirely ruled out in the control group. Long-term outcome measures included current DSM-5 alcohol use disorders (AUD), drinking patterns, illicit substance use, regular smoking, general life satisfaction, use of mental health treatment, and delinquency. Results: AIA had a significantly elevated risk to engage in problematic habitual alcohol use, to exhibit delinquent behaviors, and to use illicit substances in young adulthood compared to the control group. Severe AUD also occurred considerably more often in the AIA than the control group. Conclusions: In the majority of AIAs, further development until their mid-twenties appears to be unremarkable. However, their risk to develop severe AUD and other problematic outcomes is significantly increased. This finding calls for a diagnostic instrument distinguishing between high- and low-risk AIAs already in the emergency room.

Ziel: Die Verbreitung des Substanzkonsums in der erwachsenen Allgemeinbevölkerung Deutschlands soll anhand aktueller Daten dargestellt werden. Methodik: Datengrundlage bildete der Epidemiologische Suchtsurvey 2015, eine bundesweite Befragung in der Wohnbevölkerung von 18 bis 64 Jahren (n = 9,204; Rücklaufquote: 52.2 %). Probanden wurden zum Gebrauch von Tabak, Alkohol, illegalen Drogen und Medikamenten befragt. Ergebnisse: In den letzten 30 Tagen hatten 28.7 % der Befragten Tabakprodukte genutzt. Den Konsum von Alkohol in diesem Zeitraum berichteten 72.8 %. Hinweise auf klinisch relevanten Konsum in den letzten 12 Monaten wiesen 28.3 % (Männer) bzw. 9.6 % (Frauen) auf. Die 12-Monats-Prävalenz illegaler Drogen lag bei 6.1 % für Cannabis und bei maximal 1 % für alle anderen Substanzen. Unter Medikamenten hatten Schmerzmittel die höchste Gebrauchsprävalenz (47.1 %) sowie die geringste Prävalenz täglichen Gebrauchs unter Nutzern (8.6 %). Schlussfolgerungen: Die Ergebnisse belegen die nach wie vor hohe Verbreitung des Substanzkonsums in der Allgemeinbevölkerung. Konsumprävalenz sowie Hinweise auf klinisch relevanten Konsum sind in Bezug auf legale Substanzen, die eine hohe Verfügbarkeit charakterisiert, am häufigsten. Hinweise auf klinisch relevanten Konsum illegaler Drogen bestanden bei deutlich weniger Personen. Da es sich dabei jedoch um eine besondere Risikogruppe handelt, ist deren Erreichung durch adäquate Angebote sicherzustellen., Aims: We assess the extent of substance use among the adult general population in Germany. Method: Data come from the 2015 Epidemiological Survey of Substance Abuse, a national survey conducted among the resident population aged 18 to 64 years. With a response rate of 52.2 %, the sample size was n = 9,204. Participants were asked about their use of alcohol, tobacco, pharmaceuticals, and illicit drugs. Results: Of all respondents, 28.7 % had used tobacco products in the past 30 days, and 72.8 % had drunk alcohol. Indications of clinically relevant use within 12 months prior to the survey were found for 28.3 % of men and 9.6 % of women. Regarding illicit drugs, the 12-month prevalence was 6.1 % for cannabis and at most 1 % for all other substances. Analgesics were the class of pharmaceuticals with the highest prevalence of use (47.1 %), but the lowest prevalence of daily use among consumers of a given pharmaceutical (8.6 %). Conclusions: Results demonstrate that the use of psychoactive substances is still highly prevalent in the general population. Prevalence of use as well as indications for clinically problematic use were highest for licit substances that are highly available. Potentially clinically relevant illicit drug use affects considerably fewer individuals. However, because they comprise a specific risk population, it should be ensured that they are reached by appropriate prevention measures., English title: Substance use in the German general population: Results of the 2015 Epidemiological Survey of Substance Abuse.

Ziel: Der vorliegende Beitrag beschreibt die Methodik und das Studiendesign des Epidemiologischen Suchtsurveys (ESA) 2015. Methodik: Zielpersonen des ESA waren deutschsprachige und in Privathaushalten lebende Personen im Alter zwischen 18 und 64 Jahren. Die Ziehung der Personenstichprobe erfolgte auf Basis der Einwohnermelderegister disproportional zur Verteilung der Geburtsjahrgänge in einem zweistufigen Zufallsverfahren. Die Befragungen wurden schriftlich, telefonisch und online durchgeführt. Ergebnisse: Insgesamt konnte im ESA 2015 mit n = 9204 Teilnehmern eine Nettoausschöpfung von 52.2 % erreicht werden. Durch die verwendete Gewichtung konnte die Stichprobe hinsichtlich Bundesland, BIK-Gemeindegrößenklasse, Geschlecht, Jahrgangsgruppe und Schulbildung an die Verteilung in der Grundgesamtheit angepasst werden. Mit der Studie nicht erreichte Personen zeigten problematischere Konsummuster als Teilnehmer der Befragung. Schriftlich befragte Personen gaben häufiger Substanzkonsum an als telefonisch und online Befragte. Schlussfolgerungen: Durch den Einsatz verschiedener Befragungsmethoden und die Gewichtung der Daten konnte sichergestellt werden, dass mit dem ESA 2015 bevölkerungsrepräsentative Daten zum (klinisch relevanten) Konsum von legalen und illegalen Substanzen sowie Medikamenten vorliegen., Aims: The paper gives an overview on methods and study design of the 2015 Epidemiological Survey of Substance Abuse (ESA). Methods: The sampling frame of the ESA included German-speaking individuals living in private households aged 18 to 64 years. A sample was drawn from population registers using a two-stage probability design oversampling younger birth cohorts. The survey was realized using paper-and-pencil questionnaires, telephone interviews, and online questionnaires. Results: A total of 9204 individuals participated in the survey, resulting in a response rate of 52.2 %. Using redressement weights, the sample could be adjusted to the distribution of the general population according to federal state, size of the community, sex, year of birth, and school education. Survey nonrespondents showed more problematic consumption patterns than respondents. Individuals in the paper-and-pencil mode reported higher rates of substance use compared to those in the telephone and online mode. Conclusions: By using different modes of administration and weighting procedures, representativeness of the 2015 ESA data on (clinically relevant) consumption of legal and illegal substances and pharmaceuticals is ensured., English title: The Epidemiological Survey of Substance Abuse: Study design and methodology.

Objectives: Male sex, young age, and frequent gambling are considered as risk factors for gambling disorder (GD) and stress might be one of the triggers of gambling behavior among problem gamblers. Conversely, well-developed coping with stress might counteract gambling problems. The Proactive Coping Theory provides a promising approach for the further development of preventive and treatment measures. The objective of the study was to investigate different facets of proactive coping (PC) in young male gamblers. Methods: Young men from Bavaria were recruited via the Munich citizens’ registry (n = 2,588) and Facebook invitations (n = 105). In total, 173 out of 398 individuals were positively screened for frequent gambling and/or signs of related problems and completed the baseline questionnaire of the Munich Leisure-time Study. Factors investigated include gambling problems, PC, impulsiveness, social support, and psychological distress. Results: Gambling problems were associated with lower levels of preventive coping as well as of adaptive reaction delay. The associations were also significant when controlled for impulsiveness and general psychological distress. Preventive coping moderated the association between social support and gambling problems. Discussion and conclusions: Young men with gambling problems less frequently prevent the occurrence of stressors and more often react hasty when these occur. While the investigated group reported good social support, this factor was negatively associated with GD only among individuals with good preventive coping. Preventive coping poses a useful construct for selective prevention and treatment as it can be modified in professional interventions.

Background: Wastewater analysis is an innovative approach that allows monitoring illicit drug use at the community level. This study focused on investigating geographical differences in drug consumption by comparing epidemiological, crime and wastewater data. Methods: Wastewater samples were collected in 19 cities across Germany and Switzerland during one week, covering a population of approximately 8.1 million people. Self-report data and consumption offences for the investigated areas were used for comparison and to investigate differences between the indicators. Results: Good agreement between data sources was observed for cannabis and amphetamine-type stimulants, whereas substantial discrepancies were observed for cocaine. In Germany, an important distinction could be made between Berlin, Dortmund and Munich, where cocaine and particularly amphetamine were more prevalent, and Dresden, where methamphetamine consumption was clearly predominant. Cocaine consumption was relatively homogenous in the larger urban areas of Switzerland, although prevalence and offences data suggested a more heterogeneous picture. Conversely, marked regional differences in amphetamine and methamphetamine consumption could be highlighted. Conclusions: Combining the available data allowed for a better understanding of the geographical differences regarding prevalence, typology and amounts of substances consumed. For cannabis and amphetamine-type stimulants, the complementarity of survey, police and wastewater data could be highlighted, although notable differences could be identified when considering more stigmatised drugs (i.e. cocaine and heroin). Understanding illicit drug consumption at the national scale remains a difficult task, yet this research illustrates the added value of combining complementary data sources to obtain a more comprehensive and accurate picture of the situation.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends within as well as between countries. Between 1995 and 2015, six surveys were conducted in 48 European countries. The present report differs from the earlier ESPAD reports in that it presents selected key results of the 2015 ESPAD survey rather than the full range of results and tables. The full set of data on which the current report is based, including all the usual tables in the familiar ESPAD format, is available online (http://www.espad.org). All of the tables can be downloaded in Excel format and used for further analysis. The present report provides information on the perceived availability of substances, early onset of substance use and prevalence estimates of substance use (cigarettes, alcohol, illicit drugs, inhalants, new psychoactive substances and pharmaceuticals). The descriptive information includes indicators of intensive substance use and prevalence estimates of internet use, gaming and gambling by country and gender. Secondly, overall ESPAD trends between 1995 and 2015 are presented. For selected indicators, ESPAD trends are shown based on data from 25 countries that participated in at least four (including the 2015 data collection) of the six surveys. Finally, for some indicators, country-specific trends are shown. In the 2015 ESPAD data collection, 96 043 students took part from 35 countries: Albania, Austria, Belgium (Flanders), Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroes, Finland, the former Yugoslav Republic of Macedonia, France, Georgia, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, Montenegro, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and Ukraine. For comparative reasons, the tables of the 2015 ESPAD results contain, in additio, European School Survey Project on Alcohol and Other Drugs (ESPAD)

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends within as well as between countries. Between 1995 and 2015, six surveys were conducted in 48 European countries. The present report differs from the earlier ESPAD reports in that it presents selected key results of the 2015 ESPAD survey rather than the full range of results and tables. The full set of data on which the current report is based, including all the usual tables in the familiar ESPAD format, is available online (http://www.espad.org). All of the tables can be downloaded in Excel format and used for further analysis. The present report provides information on the perceived availability of substances, early onset of substance use and prevalence estimates of substance use (cigarettes, alcohol, illicit drugs, inhalants, new psychoactive substances and pharmaceuticals). The descriptive information includes indicators of intensive substance use and prevalence estimates of internet use, gaming and gambling by country and gender. Secondly, overall ESPAD trends between 1995 and 2015 are presented. For selected indicators, ESPAD trends are shown based on data from 25 countries that participated in at least four (including the 2015 data collection) of the six surveys. Finally, for some indicators, country-specific trends are shown. In the 2015 ESPAD data collection, 96 043 students took part from 35 countries: Albania, Austria, Belgium (Flanders), Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroes, Finland, the former Yugoslav Republic of Macedonia, France, Georgia, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, Montenegro, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and Ukraine. For comparative reasons, the tables of the 2015 ESPAD results contain, in additio, European School Survey Project on Alcohol and Other Drugs (ESPAD)

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends within as well as between countries. Between 1995 and 2015, six surveys were conducted in 48 European countries. The present report differs from the earlier ESPAD reports in that it presents selected key results of the 2015 ESPAD survey rather than the full range of results and tables. The full set of data on which the current report is based, including all the usual tables in the familiar ESPAD format, is available online (http://www.espad.org). All of the tables can be downloaded in Excel format and used for further analysis. The present report provides information on the perceived availability of substances, early onset of substance use and prevalence estimates of substance use (cigarettes, alcohol, illicit drugs, inhalants, new psychoactive substances and pharmaceuticals). The descriptive information includes indicators of intensive substance use and prevalence estimates of internet use, gaming and gambling by country and gender. Secondly, overall ESPAD trends between 1995 and 2015 are presented. For selected indicators, ESPAD trends are shown based on data from 25 countries that participated in at least four (including the 2015 data collection) of the six surveys. Finally, for some indicators, country-specific trends are shown. In the 2015 ESPAD data collection, 96 043 students took part from 35 countries: Albania, Austria, Belgium (Flanders), Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroes, Finland, the former Yugoslav Republic of Macedonia, France, Georgia, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, Montenegro, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and Ukraine. For comparative reasons, the tables of the 2015 ESPAD results contain, in additio, European School Survey Project on Alcohol and Other Drugs (ESPAD)

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends within as well as between countries. Between 1995 and 2015, six surveys were conducted in 48 European countries. The present report differs from the earlier ESPAD reports in that it presents selected key results of the 2015 ESPAD survey rather than the full range of results and tables. The full set of data on which the current report is based, including all the usual tables in the familiar ESPAD format, is available online (http://www.espad.org). All of the tables can be downloaded in Excel format and used for further analysis. The present report provides information on the perceived availability of substances, early onset of substance use and prevalence estimates of substance use (cigarettes, alcohol, illicit drugs, inhalants, new psychoactive substances and pharmaceuticals). The descriptive information includes indicators of intensive substance use and prevalence estimates of internet use, gaming and gambling by country and gender. Secondly, overall ESPAD trends between 1995 and 2015 are presented. For selected indicators, ESPAD trends are shown based on data from 25 countries that participated in at least four (including the 2015 data collection) of the six surveys. Finally, for some indicators, country-specific trends are shown. In the 2015 ESPAD data collection, 96 043 students took part from 35 countries: Albania, Austria, Belgium (Flanders), Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroes, Finland, the former Yugoslav Republic of Macedonia, France, Georgia, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, Montenegro, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and Ukraine. For comparative reasons, the tables of the 2015 ESPAD results contain, in additio, European School Survey Project on Alcohol and Other Drugs (ESPAD)

Aims: The study aims at estimating health care utilization of alcohol dependents. Estimates will be provided for the number of people with dependence in the general population, the number of people that have received the diagnosis "dependence" by a general practitioner, and number of people treated in addiction care. Methods: Estimates are based on the most recent data on health care utilization. The estimation methods are described in detail. Results: In Germany, the prevalence of alcohol dependence in the general population aged 18 years and above is estimated at 2.8 % or 1.86 million individuals in 2012. Approximately 649 000 individuals were diagnosed as, alcohol dependent" by a general practitioner indicating that about one third of the people with dependence (35.0%) were registered in the health care system (2009 data). In the same year approximately 297 000 individuals with alcohol dependence (16 %) were utilizing specialized addiction services (in-or outpatient treatment, general hospital). The rate of addicts in rehabilitation treatment was estimated at 1.8%. Conclusions: For reducing the burden of morbidity and mortality associated with alcohol dependence considerable improvements in health care utilization by addicts are required. Utilization may be increased by improving excess to early intervention, diversification of treatment offers and challenging the paradigm of abstinence-oriented treatment.

This study aimed at testing whether drinking volume and episodic heavy drinking (EHD) frequency in Germany are polarizing between consumption levels over time. Polarization is defined as a reduction in alcohol use among the majority of the population, while a subpopulation with a high intake level maintains or increases its drinking or its EHD frequency. The polarization hypothesis was tested across and within socio-economic subgroups. Analyses were based on seven cross-sectional waves of the Epidemiological Survey of Substance Abuse (ESA) conducted between 1995 and 2012 (n = 7833-9084). Overall polarization was estimated based on regression models with time by consumption level interactions; the three-way interaction with socio-economic status (SES) was consecutively introduced to test the stability of effects over socio-economic strata. Interactions were interpreted by graphical inspection. For both alcohol use indicators, declines over time were largest in the highest consumption level. This was found within all SES groups, but was most pronounced at low and least pronounced at medium SES. The results indicate no polarization but convergence between consumption levels. Socio-economic status groups differ in the magnitude of convergence which was lowest in medium SES. The overall decline was strongest for the highest consumption level of low SES.

Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

Aims: To investigate age, period and cohort effects on time trends of alcohol-related mortality in countries with different drinking habits and alcohol policies. Design and setting: Age-period-cohort (APC) analyses on alcohol-related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany. Participants: Cases included alcohol-related deaths in the age range 20-84 years between 1980 and 2009. Measurements: Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol. Findings: In all countries changes across age, period and cohort were found to be significant for both genders [effect value with confidence interval (CI) shown in Supporting information, Table S1]. Period effects pointed to an increase in alcohol-related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U-shaped curve and in France a U-shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol-related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between-country comparisons revealed more statistically significant differences for period (P<0.001 for all 15 comparisons by gender) than for age [P<0.001 in seven (men) and four (women) of 15 comparisons] or cohort [P<0.01 in two (men) and three (women) of 15 comparisons]. Conclusions: Strong period effects suggest that temporal changes in alcohol-related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.

INTRODUCTION -The analyses (1) assessed the association between social status variables and aggression when controlling for volume of alcohol consumption and episodic heavy drinking (EHD), (2) tested whether social status moderates the association between volume or EHD and verbal as well as physical aggression, and (3) investigated whether EHD moderates the effect of volume on aggression. METHODS - Swedish Alcohol Monitoring Survey (2003 to 2011); N=104,316 current drinkers; response rate: 51 to 38%. Alcohol-related aggression was defined as involvement in a quarrel or physical fight while drinking. Social status was defined as the highest education, monthly income and marital status. RESULTS -The associations between social status variables and aggression showed mixed results. Verbal aggression was associated with education in males and with marital status in both genders. Physical aggression was associated with education in both genders. No associations with aggression were found for income. With few exceptions, these associations remained significant when controlling for drinking patterns; social status did not moderate the association between drinking and aggression; EHD moderated the effect of volume on physical aggression in males. CONCLUSIONS - Groups of lower educated and non-married individuals experience verbal or physical aggression over and above different levels of consumption. Individual differences in aggression vulnerability rather than differences in aggression predisposition account for higher risks of aggression in these groups.

This study investigates the evolution of educational disparities in smoking uptake across cohorts for menand women in three countries. Nationally representative surveys of adults in France, Germany and theUnited States in 2009e2010 include retrospective measures of age of uptake that are compared for threecohorts (born 1946e1960, 1961e1975, and 1976e1992). Discrete logistic regressions and a relativemeasure of education are used to model smoking histories until age 34. The following patterns are found:a strengthening of educational disparities in the timing of uptake from older to younger cohorts; anearlier occurrence of the strengthening for men than women and for the United States than France orGermany; a faster pace of the epidemic in France than in the United States, and; a divide between thehighest level of education and the others in the United States, as opposed to a gradient across categoriesin France. Those differences in smoking disparities across cohorts, genders and countries help identifythe national and temporal circumstances that shape the size and direction of the relationship betweeneducation and health and the need for policies that target educational disparities.

Aims: In Sweden, alcohol abstention has increased over the last 20 years and consumption has recently decreased after a peak in 2004. To understand the dynamics of these trends the present study aims at estimating age, period and cohort (APC) effects on trends in alcohol use prevalence as well as overall and beverage-specific volume of drinking over the last three decades. Methods: APC analysis of seven cross-sectional surveys from 1979 to 2011 was conducted using cross-classified random effects models (CCREMs) by gender. The nationally representative samples comprised 77,598 respondents aged 16-80 years. Outcome measures were 30-day prevalence of alcohol use and overall as well as beverage-specific alcohol volume. Results: Trends in prevalence, overall and beverage-specific volume were significantly affected by APC. The period effects of prevalence and overall volume showa small decline after an increase up to the year 2005. Mean beer and wine volume levelled off after a peak in 2005 and volume of spirits drinking decreased constantly. Predicted alcohol prevalence rates in male cohorts (1945-1985) remained generally at the same level, while they declined in post-World War II female generations. Results point to high overall and beverage-specific consumption among cohorts born in the 1940s, 1950s and 1980s. Conclusions: High consuming cohorts of the 1940-1950s were key in rising consumption up to 2005. Progression through the life course of these cohorts, a decrease in prevalence and drinking volume in successive cohorts seem to have contributed to the recent downward trend in alcohol use in Sweden.

Alcohol use disorders (AUDs), and alcohol dependence (AD)in particular, are prevalent and associated with a large burdenof disability and mortality. The aim of this study wasto estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and toinvestigate potential influencing factors. The 1-year prevalenceof AD in the EU was estimated at 3.4% among people18–64 years of age in Europe (women 1.7%, men 5.2%), resultingin close to 11 million affected people. Taking into accountall people of all ages, AD, abuse and harmful use resultedin an estimate of 23 million affected people. Prevalenceof AD varied widely between European countries, andwas significantly impacted by drinking cultures and socialnorms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking,such as liver cirrhosis or injury, were moderate. Theseresults suggest a need to rethink the definition of AUDs.

In response to our suggestion to define substance use disorders via ‘heavy use over time’, theoretical and conceptual issues, measurement problems and implications for stigma and clinical practice were raised. With respect to theoretical and conceptual issues, no other criterion has been shown, which would improve the definition. Moreover, heavy use over time is shown to be highly correlated with number of criteria in current DSM-5. Measurement of heavy use over time is simple and while there will be some underestimation or misrepresentation of actual levels in clinical practice, this is not different from the status quo and measurement of current criteria. As regards to stigma, research has shown that a truly dimensional concept can help reduce stigma. In conclusion, ‘heavy use over time’ as a tangible common denominator should be seriously considered as definition for substance use disorder.

Fragestellung: Es wurde untersucht, ob auf Bundeslandebene Unterschiede im Alkohol-, Tabak- und Cannabiskonsum Jugendlicher und seiner Zeitverläufe bestehen. Methodik: Daten von 23.997 Jugendlichen aus drei Erhebungswellen (2003; 2007; 2011) der Europäischen Schülerstudie zu Alkohol und anderen Drogen (ESPAD) der 9. und 10. Klasse aus fünf Bundesländern (Bayern, Berlin, Brandenburg, Mecklenburg-Vorpommern, Thüringen) wurden deskriptiv und regressionsanalytisch ausgewertet. Ergebnisse: Länderübergreifend zeigen sich für alle drei Substanzen sinkende Konsumwerte über die Zeit. Für den Cannabiskonsum ist dieser Trend nur bis 2007 zu beobachten. Berlin weist den geringsten Alkohol- und höchsten Cannabiskonsum auf. Der Tabakkonsum ist in Brandenburg und Mecklenburg-Vorpommern am höchsten und zeigt den stärksten Rückgang in Thüringen. Schlussfolgerungen: Trotz einiger Unterschiede in den Konsumprofilen der Bundesländer sind die Trends sehr homogen. Insgesamt betrachtet sind die beobachteten Konsumparameter, die sich im europäischen Vergleich auf hohem bis mittlerem Niveau befinden, rückläufig., Aims: To examine differences between German federal states regarding adolescent consumption of alcohol, tobacco and cannabis and its time trends. Method: Data of 23,997 adolescents came from three waves (2003; 2007; 2011) of the European School Survey Project on Alcohol and Other Drugs (ESPAD) in Bavaria, Berlin, Brandenburg, Mecklenburg-Western Pomerania and Thuringia. Descriptive and regression analyses were applied. Results: Across the five federal states and three substances, consumption declined over time. For cannabis use this trend is just observed until 2007. Adolescents in Berlin show the lowest level of alcohol use and the highest level of cannabis use. Tobacco use is highest in Brandenburg and Mecklenburg-Western Pomerania and declined most strongly in Thuringia. Conclusions: Despite some differences in the federal states’ consumption patterns, most notably in Berlin, trends are very similar. Altogether, the observed consumption indicators, which on European level are high to moderate, show a declining trend.

This study investigates pathways from alcohol outcome expectancies to alcohol-related problems (ARPs), considering alcohol volume and episodic heavy drinking (EHD) as potential mediators. It is further examined whether these pathways vary by age. The population-based sample comprised 6,823 individuals aged 18 to 64 years reporting alcohol use in the past year. Direct and indirect effects of five alcohol expectancies (social assertiveness, tension reduction, sexual enhancement, cognitive impairment, aggression) and alcohol use (average daily intake, EHD) on a latent measure of ARPs (six items of the Alcohol Use Disorders Identification Test) were investigated. A multiple-group structural equation model with three age groups (18 to 24, 25 to 44, 45 to 64 years) was examined. In individuals aged 18 to 24 years, social assertiveness expectancies were positively associated with average intake and EHD, which in turn were associated with more ARPs. In addition, expectancies related to cognitive impairment and aggression were directly linked to more ARPs without mediation in this age group. In individuals aged 25 years and older, tension reduction expectancies were associated with more ARPs through increased average intake. In contrast, high scores on cognitive impairment were associated with lower average intake and in turn with fewer ARPs. Challenging expectancies of sociability in young and expectancies of relaxation in mid adulthood might help decrease high-risk drinking and subsequently ARPs. Considering negative alcohol expectancies may help to identify younger individuals at high risk for ARPs, even if they have not previously exhibited repeated excessive drinking.

Background and aims: As only a minority of pathological gamblers (PGr) presents for treatment, further knowledge about help-seeking behavior is required in order to enhance treatment utilization. The present study investigated factors associated with treatment participation in gamblers in Germany. As subclinical pathological gamblers (SPGr, fulfilling one to four DSM-IV-criteria) are target of early intervention due to high risk of transition to pathological gambling, they were subject of special interest. Methods: The study analyzed data from a general population survey (n = 234, SPGr: n = 198, PGr: n = 36) and a treatment study (n = 329, SPGr: n = 22, PGr: n = 307). A two-step weighting procedure was applied to ensure comparability of samples. Investigated factors included socio-demographic variables, gambling behavior, symptoms of pathological gambling and substance use. Results: In PGr, regular employment and non-German nationality were positively associated with being in treatment while gambling on the Internet and gaming machines and fulfilling more DSM-IV-criteria lowered the odds. In SPGr, treatment attendance was negatively associated with married status and alcohol consumption and positively associated with older age, higher stakes, more fulfilled DSM-IV criteria and regular smoking. Conclusions: In accordance to expectations more severe gambling problems and higher problem awareness and/or external pressure might facilitate treatment entry. There are groups with lower chances of being in treatment: women, ethnic minorities, and SPGr. We propose target group specific offers, use of Internet-based methods as possible adaptions and/or extensions of treatment offers that could enhance treatment attendance., AuthorCount:5

Aim: The effect of sample selection on the dimensionality of DSM-IV alcohol and dependence (AUD) criteria was tested applying different methods. Sample: Data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used. A mixed-mode design was used (self-administered questionnaires and telephone interviews), and 7,912 individuals, aged 18 to 64 years, participated. The response rate was 45%. Alcohol abuse and dependence were assessed according to DSM-IV, based on the Munich Composite International Diagnostic Interview (M-CIDI). Inter-item correlations, Confirmatory Factor Analysis (CFA), and Latent Class Analysis (LCA) were applied to the total sample (unrestricted sample, URS) and a subsample of individuals with at least one endorsed criterion (restricted sample, RS). Latent Class Factor Analysis (LCFA) was performed using the RS, including covariates (age, sex, education). Findings: The mean inter-item correlation was higher in the URS than in the RS. When individuals without criterion endorsement were excluded, factor analyses resulted in more dimensions. In the RS, LCA yielded an interaction between abuse, dependence and class membership. The LCFA identified two dimensions and five classes corresponding to abuse and dependence. Conclusions: Sample selection has a critical effect on dimensionality analyses. When individuals who do not endorse a single criterion are excluded, the bi-axial factor structure of the DSM-IV (abuse and dependence) can be supported. However, there is also evidence that a further diagnostic category should be included or that the threshold for dependence should be lowered.

AIMS - New trends in drug consumption reveal increasing polydrug use. Epidemiological indicators in the current use are based on the prevalence and the associated potential harm of a single main substance. We propose new indicators to evaluate frequency and potential harm of polydrug use. The indicators are used to compare drug use among countries based on survey data on adolescents' substance use in 38 European countries. METHODS - The approach is based on analysis of the frequency of use in the various population samples: lifetime use, twelve months use or last thirty days, depending on available data, and on the risk of harm for the substances used. Two indicators are provided: the frequency of use score (FUS) by summing the frequency of use of each substance, and the polydrug use score (PDS) that weight all the substances used by their risk. RESULTS - The indicators FUS and PDS were calculated and the distribution functions were used to characterise substance use across ESPAD countries. The analysis shows important differences in poly-substance use severity among countries presenting similar prevention policies. CONCLUSIONS - Systematic analysis of substance use and the related risk are of paramount interest. The proposed indicators are designed to better monitor and understand consequences of polydrug use and to measure the resulting risk at country or population level. The indicators may also be used to assess the effects of policy interventions., AuthorCount:7

Background: Cannabis is the most popular illicit drug in the world, but the process of its diffusion throughthe population has rarely been studied. The unfolding of the tobacco epidemic was accompanied by ashift in the educational gradient of users across generations. As a consequence, cannabis may show thesame pattern of widening social inequalities. We test the diffusion hypotheses that a positive value inolder cohorts – the more educated experimenting more – shifts to a negative one in younger cohorts –the more educated experimenting less, first for males and then females. Methods: Three nationwide subsamples (18–64 years old) of representative surveys conducted in France(n = 21,818), Germany (n = 7887) and USA (n = 37,115) in 2009–2010 recorded age at cannabis experimen-tation (i.e., first use), educational level, gender, and age. Cumulative prevalence of experimentation wasplotted for three retrospective cohorts (50–64, 35–49, 18–34 years old at data collection) and multivariatetime-discrete logistic regression was computed by gender and generation to model age at experimen-tation adjusted on age at data collection and educational level. This latter was measured according tofour categories derived from the International Standard Classification of Education (ISCED) and a relative(rather than absolute) index of education. Results: The findings demonstrate a consistent pattern of evolution of the prevalence, gender ratio andeducational gradient across generations and countries that support the hypothesis of an “epidemic” ofcannabis experimentation that mimics the epidemic of tobacco. Conclusion: We provide evidence for a cannabis epidemic model similar to the tobacco epidemic model.In the absence of clues regarding the future of cannabis use, our findings demonstrate that the gender gapis decreasing and, based on the epidemic model, suggest that we may expect widening social inequalitiesin cannabis experimentation if cannabis use decreases in the future.

Aims: The aim of the study was to explore whether the concept of heavy substance use over time can be used as definition of substance use disorder. Methods: Narrative review. Results: Heavy use over time clearly underlies the neurobiological changes associated with current thinking of substance use disorders. In addition, there is evidence that heavy use over time can explain the majority of social problems and of burden of disease (morbidity and mortality). A definition of substance use disorders via heavy use over time would avoid some of the problems of current conceptualizations, for instance the cultural specificity of concepts such as loss of control. Finally, stressing the continuum of use may avoid the high level of stigmatization currently associated with substance use disorders. Conclusion: ‘Heavy substance use over time’ seems to be a definition of substance use disorders in line with results of basic research and epidemiology. Additionally, it reduces stigmatization. This approach should thus be further explored.

Aims The objective of this paper is to present an overview of gambling in Germany, including historical development, legislative and economic changes as well as treatment options and their effectiveness. Methods The available scientific literature and research reports on gambling in Germany were reviewed to obtain relevant information on history, commercialization, legislation, treatment and research agenda. Results Gambling in Germany is characterized by compromises between protective and economic efforts. At present, gambling is illegal in Germany, and provision is subject to the state monopoly. Mere gaming machines (specific slot machines) are not classified as gambling activity, permitting commercial providers. In recent years, implementing regulations for state gambling and gaming machines have been changed. Concerning the treatment of pathological gambling, various options exist; treatment costs have been covered by health and pension insurance since 2001. Information on the effectiveness of treatment in Germany is limited. Similarly, the number of peer-reviewed publications on gambling is small. Conclusions German gambling legislation was subject to major changes in the past years. Based on the available body of research (longitudinal), studies on risk and protective factors and the aetiology of pathological gambling are needed. The effectiveness of pathological gambling treatment in Germany and the impact of gambling regulations on gambling behaviour also need to be investigated., AuthorCount:4

Aims: The paper gives an overview on design and sample selection, measures, realization and analyses of the 2012 Epidemiological Survey of Substance Abuse (ESA). Methods: A disproportional sample was drawn from population registers using a two-stage probability design oversampling younger birth cohorts. Different modes of administration were used (paper-and-pencil questionnaire, telephone interview, online questionnaire). Results: A total of 9 084 individuals aged 18 to 64 years participated in the survey (response rate 53.6 %). The redressement weight had an effectiveness of 67.6 %. Non-responders showed a lower prevalence of alcohol and cannabis use, but a higher prevalence of episodic heavy drinking and hypnotics use as well as a higher tobacco use quantity. Respondents in the telephone and internet mode had a lower rate of substance use than those in the paper-and-pencil mode. Conclusions: Contrary to the general trend of decreasing response rates, the ESA achieves increasing response rates over the past years due to the application of a mixed mode design. Selectivity effects are possible because of the exclusion of specific population subgroups and non-response effects.

Background: Prevalence estimation of cannabis use is usually based on self-report data. Although there is evidence on the reliability of this data source, its cross-cultural validity is still a major concern. External objective criteria are needed for this purpose. In this study, cannabis-related search engine query data are used as an external criterion. Methods: Data on cannabis use were taken from the 2007 European School Survey Project on Alcohol and Other Drugs (ESPAD). Provincial data came from three Italian nation-wide studies using the same methodology (2006-2008; ESPAD-Italia). Information on cannabis-related search engine query data was based on Google search volume indices (GSI). (1) Reliability analysis was conducted for GSI. (2) Latent measurement models of true cannabis prevalence were tested using perceived availability, web-based cannabis searches and self-reported prevalence as indicators. (3) Structure models were set up to test the influences of response tendencies and geographical position (latitude, longitude). In order to test the stability of the models, analyses were conducted on country level (Europe, US) and on provincial level in Italy. Results: Cannabis-related GSI were found to be highly reliable and constant over time. The overall measurement model was highly significant in both data sets. On country level, no significant effects of response bias indicators and geographical position on perceived availability, web-based cannabis searches and self-reported prevalence were found. On provincial level, latitude had a significant positive effect on availability indicating that perceived availability of cannabis in northern Italy was higher than expected from the other indicators. Conclusion: Although GSI showed weaker associations with cannabis use than perceived availability, the findings underline the external validity and usefulness of search engine query data as external criteria. The findings suggest an acceptable relative comparability, AuthorCount:4

Aims: It was aimed to estimate 12-months prevalences of i) perception of substance-related problems among alcohol, illicit drugs and prescription drug users; ii) use of several formal and informal sources of care by individuals perceiving substance-related problems; and iii) use of professional help among individuals with a substance use disorder. Factors associated with help-seeking were assessed. Methods: Data come from the 2012 Epidemiological Survey of Substance Abuse (ESA; n = 9084; 18 to 64 years; response rate 53.6 %). DSM-IV diagnoses were assessed using the M-CIDI. Regression analyses were used to assess predictors of help-seeking. Results: Between 6 % (alcohol) and 19 % (illicit drugs) of substance users reported having experienced substance related problems. Of those, 14 % (alcohol), 33 % (illicit drugs) and 59 % (prescription drugs) sought help. With the exception of income, socio-demographic variables were not associated with help-seeking. Conclusions: Results show a clear under-treatment in individuals with substance related problems. Help-seeking seems to be mainly influenced by the severity of the substance-related disorder., Ziel: Es wurden 12-Monats-Prävalenzen geschätzt bezüglich a) der Wahrnehmung substanzbezogener Probleme, b) der Inanspruchnahme verschiedener Hilfsangebote und c) der Inanspruchnahme professioneller Hilfe. Faktoren, die mit der Inanspruchnahme von Hilfe assoziiert sind, wurden analysiert. Methodik: Die Auswertung basiert auf Daten des Epidemiologischen Suchtsurveys (ESA) 2012 (n = 9084; 18 – 64 Jahre; Ausschöpfungsrate 53.6 %). Missbrauch und Abhängigkeit nach DSM-IV wurden anhand des M-CIDI erfasst. Prädiktoren der Hilfesuche wurden regressionsanalytisch getestet. Ergebnisse: Zwischen 6 % (Alkohol) und 19 % (illegale Drogen) der Konsumenten berichteten substanzbezogene Probleme. Von diesen nahmen 14 % (Alkohol), 33 % (Illegale Drogen) bzw. 59 % (Medikamente) Hilfe in Anspruch. Mit Ausnahme des Einkommens bei Alkoholkonsumenten waren soziodemografische Variablen nicht mit der Inanspruchnahme von Hilfe assoziiert. Schlussfolgerungen: Die Studie zeigt eine Unterversorgung von Personen mit substanzbezogenen Problemen. Das Hilfesuchverhalten scheint hauptsächlich durch die Schwere der substanzbezogenen Störung beeinflusst zu sein.

Aims: It is aimed to assess homotypic comorbidity of substance use disorders in a representative sample of the adult general population in Germany. Methods: Data from the 2012 Epidemiological Survey of Substance Abuse are used. Based on a two-stage probability sampling, a total of n = 9 084 individuals participated (net response rate 53.6 %). Substance use disorders according to DSM-IV for alcohol, tobacco, cannabis, cocaine, amphetamines, analgesics, hypnotics and tranquilizers were assessed using the Munich Composite International Diagnostic Interview (M-CIDI). Results: Multiple diagnoses (abuse and/or dependence) were prevalent in 6.6 % of the sample. The percentage of comorbid substance use disorders was highest among those with a diagnosis related to cannabis, hypnotics and cocaine. Risk factors for at least one and more than one substance use disorders were male gender, younger age, lower educational level, being single or divorced and non-German citizenship. Conclusions: A relevant proportion of the general population in Germany is affected by more than one clinical diagnosis related to substance use. Further epidemiological research is necessary to describe this population of high risk., Ziel: Ziel ist die Untersuchung der homotypischen Komorbidität von Störungen im Zusammenhang mit dem Konsum von legalen und illegalen Substanzen sowie Medikamenten in der erwachsenen Bevölkerung. Methodik: Die Auswertungen basieren auf Daten des Epidemiologischen Suchtsurveys 2012. In einem zweistufigen Zufallsverfahren wurde eine Stichprobe von n = 9084 Personen realisiert (Ausschöpfung 53.6 %). Substanzbezogene Störungen nach DSM-IV wurden mithilfe des Münchener Composite International Diagnostic Interview für Alkohol, Tabak, Cannabis, Kokain, Amphetamine sowie Schmerz-, Schlaf- und Beruhigungsmittel erfasst. Ergebnisse: Multiple Diagnosen (Missbrauch und/oder Abhängigkeit) lagen bei insgesamt 6.6 % der Stichprobe vor. Der Anteil komorbider Substanzstörungen war bei Störungen durch Cannabis-, Schlafmittel- und Kokainkonsum am höchsten. Als Risikofaktoren für das Auftreten mindestens einer bzw. mehr als einer Diagnose erwiesen sich männliches Geschlecht, jüngeres Alter, niedrigere Schulbildung, lediger/geschiedener Familienstand und nicht-deutsche Staatsbürgerschaft. Schlussfolgerungen: Ein nicht unerheblicher Anteil der deutschen Bevölkerung ist von multiplen Substanzstörungen betroffen. Weitere epidemiologische Studien zur Beschreibung dieser Hochrisikogruppe sind nötig.

Aims: To examine prevalences, patterns and disorders associated with the use of alcohol, tobacco, illegal drugs and prescription drugs. Methods: The sample of the 2012 Epidemiological Survey of Substance Abuse (ESA) was randomly drawn from population registers and consisted of 9 084 individuals aged 18 to 64 years. A mixed-mode design including questionnaires, telephone and Internet interviews was applied. The response rate was 53.6 %. Results: Based on the past 30 days 57.3 % of respondents reported low-risk alcohol consumption whereas 14.2 % reported risky consumption. Overall, 30.2 % reported having smoked within this period. The 12-months prevalence of illegal substance use was 4.5 % for cannabis, 0.8 % for cocaine and 0.7 % for amphetamines. Analgesics were the most prevalent prescription drugs used within the past 12 months (61.9 %). Rates of DSM-IV substance dependence were estimated at 3.4 % for alcohol, 10.8 % for tobacco, 0.5 % for cannabis, 0.2 % for cocaine, 0.1 % for amphetamines and 3.4 % for analgesics. Conclusions: The high prevalence of substance use disorders associated with alcohol and tobacco emphasize the urgency of implementing effective prevention measures. Disorders associated with prescription drugs should be given more attention., Ziel: Untersucht wurden Umfang, Konsummuster und Störungen im Zusammenhang mit dem Gebrauch von Alkohol, Tabak, illegalen Drogen und Medikamenten. Methodik: Die Stichprobe des Epidemiologischen Suchtsurveys (ESA) 2012 wurde zufällig aus den Einwohnermelderegistern gezogen und umfasste 9084 Personen im Alter zwischen 18 und 64 Jahren. Die Befragung erfolgte schriftlich, telefonisch bzw. über das Internet; die Antwortrate lag bei 53.6 %. Ergebnisse: Bezogen auf die letzten 30 Tage zeigten 57.3 % der Befragten einen risikoarmen und 14.2 % einen riskanten Alkoholkonsum. Insgesamt 30.2 % gaben an, in diesem Zeitraum geraucht zu haben. In den letzten 12 Monaten haben 4.5 % der Befragten Cannabis, 0.8 % Kokain und 0.7 % Amphetamine konsumiert. Schmerzmittel waren die am häufigsten eingenommenen Medikamente (12-Monats-Prävalenz: 61.9 %). Schätzungen zur Substanzabhängigkeit nach DSM-IV ergaben Prävalenzwerte von 3.4 % für Alkohol, 10.8 % für Tabak, 0.5 % für Cannabis, 0.2 % für Kokain, 0.1 % für Amphetamine und 3.4 % für Schmerzmittel. Schlussfolgerungen: Die hohe Verbreitung psychischer Störungen durch Alkohol und Tabak macht die Dringlichkeit der Umsetzung effizienter Präventionsmaßnahmen deutlich. Störungen im Zusammenhang mit Medikamenten sollten stärker beachtet werden.