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Background and aims: Sweden has experienced a substantial decrease in adolescent drinking over the past decades. Whether the reduction persists into early adulthood remains unclear. Using survey data, the present study aimed to determine whether reductions in indicators of alcohol use observed among adolescents remain in early adulthood and whether changes in alcohol intake are consistent among light/moderate and heavy drinkers. Design: Data from the Swedish monthly Alcohol Monitoring Survey (2001–20) were used to construct five 5‐year birth cohorts (1978–82, 1983–87, 1988–92, 1993–97 and 1998–2002). Setting: Sweden. Participants: A total of n = 52 847 respondents (48% females) aged 16 and 30 years were included in this study. Measurements For both males and females, temporal changes in the prevalence of any drinking, the prevalence of heavy episodic drinking (HED) and total alcohol intake in the past 30 days in centilitres were analysed. Findings The prevalence of any drinking in more recent cohorts remained low until young people came into their early (females) and mid‐ (males) 20s. Male cohorts differed in the prevalence of HED across age, with the later cohorts showing lower odds than earlier cohorts (odds ratios between 0.54 and 0.66). Among females, no systematic differences between cohorts across age could be observed. Later male birth cohorts in light/moderate drinkers had lower alcohol intake than earlier cohorts (correlation coefficients between −0.09 and −0.54). No statistically significant cohort effects were found for male heavy drinkers. Although differences in alcohol intake among females diminished as age increased, the cohorts did not differ systematically in their level of alcohol intake. Conclusions: In Sweden, the reduced uptake of drinking in adolescents appears to fade as people move into adulthood. Observed reductions in alcohol intake among light and moderate drinkers appear to persist into adulthood. More recent male cohorts show a lower prevalence rate of heavy episodic drinking. [ABSTRACT FROM AUTHOR]

Aims: To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates. Design: Repeated waves of the Epidemiological Survey on Substance Abuse, a cross‐sectional survey conducted between 1995 and 2021 with a two‐stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on‐line. Setting: Germany. Participants/cases: German‐speaking participants aged between 18 and 59 years living in Germany who self‐reported on their cannabis use in the past 12 months (n = 78 678). With the application of a weighting scheme, the data are nationally representative. Measurements Questions on the frequency of cannabis use in the past 12 months and self‐reported changes in frequency of use due to the COVID‐19 pandemic. Findings The prevalence of past 12‐month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past‐year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID‐19 pandemic. Extrapolating from these models, the prevalence of 12‐month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear. Conclusions: Trends from 1995 to 2021 suggest that the prevalence of past 12‐month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German‐speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year). [ABSTRACT FROM AUTHOR]

Aims Germany is experiencing a decline in alcohol consumption but not for every alcoholic beverage type. Given the differential health impacts of alcoholic beverage type, it is important to understand the drivers of these trends. We investigated: (a) temporal trends in beverage preference and (b) the effects of age, period and cohort on these trends. Methods Data came from nine waves (1995–2018; n total = 75,550) of the German Epidemiological Survey of Substance Abuse, a nationally representative household survey of individuals aged 18–59 years. The quantity of beer, wine, spirits and mixed drinks drank in the last 30 days was transformed into grammes of ethanol, and the beverage type preference was estimated as the proportion of total ethanol consumption. Fractional multinomial logit regression was applied to analyse the age, period and cohort effects on temporal trends of beverage preference by sex. Results The preference for spirits and mixed drinks decreased with increasing age, while the preference for wine increased with no age effect on beer. There was a general decrease in the preference for beer and an increase in the preference for wine among both sexes, with an additional increase in the preference for spirits in males. Conclusion Trends in beverage preference were more related to individual ageing and changes in the whole population than to cohorts. With the continued reduction in alcohol consumption, the decreasing preference for beer and the growing preference for wine suggest a positive development. Trends of an increasing preference for spirits in males are of concern. [ABSTRACT FROM AUTHOR]

Older individuals are not only more sensitive to the impact of alcohol but also face significant health risks from alcohol–drug interactions. To alter current drinking patterns, it is crucial to understand the motives for abstention of adults in late middle age. We hypothesized that, for adults in late middle age, socio-demographic characteristics and health-related factors predict alcohol abstinence; and that current motives for abstention vary between subgroups of abstainers. Data on adults aged 50–64 years (n = 2,308) came from the German Epidemiological Survey of Substance Abuse (ESA). Logistic regression was used to examine the association between different types of abstinence and socio-demographic and health-related variables. Low income, low education and poor self-rated physical health predicted 12-month abstinence. Men with a chronic disease had a 9.5 % chance to be abstinent, whilst it was 17.7 % for women. Main motives for older lifetime abstainers were 'dislike of taste or smell', 'loss of control' and 'family constraints'. For 12-month abstainers, it was 'loss of control', 'health constraints' and 'dislike of taste or smell'. Poor health in middle-aged drinkers offers an opportunity to recommend reduction or cessation of alcohol use by explaining the negative health effects from alcohol. Future research investigating abstention needs to differentiate between lifetime and 12-month abstainers. [ABSTRACT FROM AUTHOR]

Background and aims: In recent decades, alcohol drinking in the European Union has been characterized by increasing homogenization of levels of drinking coupled with an overall decrease. This study examined whether we can still distinguish distinct practices of drinking by addressing two research questions: (1) are drinking practices still characterized by the choice of a certain alcoholic beverage; and (2) how do drinking practices vary across countries? Design Cross‐sectional study: latent‐class analyses of drinking variables and fractional response regression analyses of individual characteristics for individual‐level class endorsement probabilities, respectively. Setting: Nineteen European countries and one autonomous community. Participants: A total of 27 170 past‐year drinkers aged 18–65 years in 2015. Measurements Data were collected through the Standardized European Alcohol Survey included frequency of past‐year drinking, pure alcohol intake per drink day, occurrence of monthly risky single‐occasion drinking and preferred beverage, together with socio‐demographic data. Findings Three latent classes were identified: (1) light to moderate drinking without risky single‐occasion drinking [prevalence: 68.0%, 95% confidence interval (CI) = 66.7–69.3], (2) infrequent heavy drinking (prevalence: 12.6%, 95% CI = 11.5–13.7) and (3) regular drinking with at least monthly risky single‐occasion drinking (prevalence: 19.4%, 95% CI = 18.1–20.9). Drinking classes differed considerably in beverage preference, with women reporting a generally higher share of wine and men of beer drinking. Light to moderate drinking without risky single‐occasion drinking was the predominant drinking practice in all locations except for Lithuania, where infrequent heavy drinking (class 2) was equally popular. Socio‐demographic factors and individual alcohol harm experiences (rapid alcohol on‐line screen) explained up to 20.5% of the variability in class endorsement. Conclusions: Beverage preference appears to remain a decisive indicator for distinguishing Europeans' drinking practices. In most European countries, multiple drinking practices appear to be present. [ABSTRACT FROM AUTHOR]

Aim: To (i) examine several factors associated with trends in heavy episodic drinking (HED) in Finland, Norway and Sweden, (ii) investigate similarities in these associations across the countries and (iii) analyse the contribution of these factors to the trend in HED and the differences across the countries. Design and Setting: Observational study using five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from Finland, Norway and Sweden between 1999 and 2015. Participants: A total of 18 128 male and 19 121 female 15‐ to 16‐year‐old students. Measurements: Monthly HED, perceived access to alcohol, truancy, parental control, leisure time activities and daily smoking. The Cochran–Armitage test was used to examine linear time trends in HED. Logit regression models using the Karlson–Holm–Breen (KHB) method were fitted for each country separately, including all the independent variables together with time and adjusted for family status, parental education and gender. Findings In Finland, Norway and Sweden, perceived access to alcohol, truancy and daily smoking decreased significantly between 1999 and 2015 whereas risk perceptions, parental control and participation in sports increased in the same period. The confounding percentage of all the independent variables related to the trend in HED was 48.8%, 68.9% and 36.7% for Finland, Norway and Sweden, respectively. Decline in daily smoking (P < 0.001) and perceived access to alcohol (P < 0.001) were positively and increase in parental control (P < 0.001) negatively associated with the decline in HED in all three countries. Changes in truancy, going out with friends, and engaging in sports and other hobbies had little or no impact on the decline in HED or displayed no consistent results across the countries. Conclusions: The decline in adolescent heavy episodic drinking in Finland, Norway and Sweden between 1999 and 2015 appears to be associated with a decline in adolescent daily smoking and perceived access to alcohol and an increase in parental control. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

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. [ABSTRACT FROM AUTHOR]

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 comprisedn = 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. [ABSTRACT FROM AUTHOR]

Background: The Hart-am-LimiT (HaLT) project is a brief intervention program for adolescents hospitalized due to alcohol intoxication in Germany. Objective: To test whether a booster session has an impact on participants’ drinking behavior compared with the standard HaLT program. Methods: On the morning after their admission due to alcohol intoxication, 411 adolescents in the Federal State of Bavaria were interviewed between October 2008 and January 2010 and socio-demographic data and information on previous drinking behavior were recorded (t1). Eleven to 25 months (M = 16.4) after their hospital treatment, 106 adolescents completed an online questionnaire (t2). Results: Subgroup analysis (ANOVA with repeated measurements) indicated that adolescents who took part in the booster session did not increase episodic heavy drinking (EHD;t1:M = 1.68 EHD d;t2: 1.59 EHD d) in contrast to the non-participating group (t1:M = 1.08 d EHD;t2: 2.66 d EHD;F = 4.383,p = 0.039). Conclusion: Considering the study’s limitations (e.g. no randomization, low response rate, etc.), the results indicate a positive effect of a booster session following a brief intervention for adolescents who have been treated in hospital due to alcohol intoxication. Adolescents should therefore be motivated and encouraged to participate in booster sessions. [ABSTRACT FROM PUBLISHER]

Aims: 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. Method: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 show a 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. [ABSTRACT FROM AUTHOR]

Aims: This study investigated past month patterns and risk factors of alcohol, tobacco and cannabis use by level of intensity in the German general population. Methods: Data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used. The cross-sectional random sample consisted of N = 7912 adults aged 18-64 years. The response rate was 45%. Intensive use of each substance was measured applying substance-specific cut-off points: alcohol: >20/30 g pure ethanol daily for women/men; tobacco: ≥20 cigarettes daily; cannabis: on ≥6 occasions monthly. Findings: The majority of substance users reported no intensive use of any of the three substances (77.5%) and 19.4% had used one of the three substances intensively. A total of 3.1% engaged in intensive use of multiple substances with alcohol and tobacco (2.3%) as the most prevalent pattern. A higher risk for intensive use of multiple substances was found among males, older individuals and those with a substance use disorder. Conclusions: Results of this study call for an integrated view on substance use and related disorders in prevention and treatment, taking diverse use patterns and specific needs of substance abusers into account. [ABSTRACT FROM AUTHOR]

Background In order to better understand trends in cannabis use, this study estimates independent and nonconfounded age, period and cohort effects on 12-month cannabis use prevalence and frequency. Methods Data from seven waves of the German Epidemiological Survey of Substance Abuse (ESA) conducted between 1990 and 2009 were used. The total sample included 29 836 men and 34 877 women aged 18-65 years. Cross-classified random effects models were conducted to estimate fixed effects of age and random effects of periods and birth cohorts. Analyses were stratified by gender. Results With regard to 12-month prevalence, substantial age variations were identified with a peak of cannabis use in young adulthood. The overall effects of periods and birth cohorts were not significant. With regard to frequency of use, there were no significant influences of either variable. The results were largely identical for men and women. Conclusions This study identified little variation in trend data of current cannabis use. When confounding influences of period and ageing are controlled, the widely reported increases in cannabis consumption in recent birth cohorts cannot be demonstrated. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To test age differences in the prevalence of DSM-IV alcohol dependence (AD) diagnostic criteria in the adult general population while controlling for drinking behaviour. Design and setting Cross-sectional data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used, applying a two-stage probability sampling design. The survey used self-administered questionnaires and telephone interviews (mixed-mode design; 45% response rate). Participants The analytical sample consisted of n = 6984 individuals aged 18-64 years reporting alcohol consumption within the previous year. Measurements Age effects on individual AD criteria were estimated using logistic regression models, adjusting for eight mutually exclusive drinking groups (defined in terms of average daily alcohol intake and episodic heavy drinking) and socio-economic variables. Findings When controlling for drinking behaviour, 18-24-year-olds were more likely to meet the criteria 'tolerance', 'larger/longer' and 'time spent' relative to older age groups. In contrast, the likelihood of experiencing 'withdrawal' symptoms increased with age. There was no significant age effect on the diagnosis of AD. Conclusions Age differences in the prevalence of specific alcohol dependence diagnostic criteria such as 'tolerance', 'drinking larger amount or for longer than intended' and 'time spent recovering' cannot be fully explained by differences in drinking behaviour. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]