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Just under 2.5 million people die annually due to alcohol use. This global estimate, however, excludes most of the health burden borne by others than the alcohol user. Alcohol's harm to others includes a multitude of conditions, such as trauma from traffic crashes, fetal disorders due to prenatal exposure to alcohol, as well as interpersonal and intimate partner violence. While alcohol's causal role in these conditions is well-established, alcohol's harm to others' contribution to the overall health burden of alcohol remains unknown. This knowledge gap leads to a situation in which alcohol policy and prevention strategies largely focus on the reduction of alcohol's detrimental health harms on the alcohol users, neglecting affected others and population groups most vulnerable to these harms, including women and children. In this article, we seek to elucidate why estimates for alcohol's harm to others are lacking and offer guidance for future research. We also argue that a full assessment of the alcohol health burden that includes the harm caused by others' alcohol use would enhance the visibility and public awareness of such harms, and advancing the evaluation of policy interventions to mitigate them. Chaque annee, un peu moins de 2,5 millions de deces sont lies a la consommation d'alcool. Cette estimation globale ne tient cependant pas compte de l'impact sur la sante de l'entourage des consommateurs d'alcool. Les mefaits de l'alcool sur les autres ont une multitude de consequences, parmi lesquelles des traumatismes dus aux accidents de la circulation, des anomalies fatales liees a une exposition prenatale a l'alcool, ainsi que des actes de violence interpersonnelle et entre partenaires. Bien que le role causal de l'alcool dans ces problematiques soit bien etabli, les repercussions de tels mefaits sur la sante dans son ensemble restent a determiner. Des lacunes qui aboutissent souvent a une situation dans laquelle les politiques et strategies de prevention se concentrent principalement sur la diminution des effets nefastes de l'alcool sur la sante des consommateurs eux-memes, negligeant les personnes qui les entourent et les categories de population les plus vulnerables, en particulier les femmes et les enfants. Dans cet article, nous tentons d'expliquer pourquoi il n'existe aucune estimation concernant les mefaits de l'alcool sur les autres et prodiguons des conseils pour de futures recherches. Nous plaidons aussi pour une analyse complete de la charge sanitaire imputable a l'alcool incluant les mefaits de l'alcool sur les autres, afin d'ameliorer la visibility et de mieux sensibiliser l'opinion publique a ces problematiques, mais aussi de faire progresser l'evaluation des interventions politiques entreprises pour y remedier. Cerca de 2,5 millones de personas mueren cada ano por el consumo de alcohol. Sin embargo, esta estimacion global excluye la mayor parte de la carga sanitaria que soportan personas que no son consumidores de alcohol. Los danos del alcohol a terceros incluyen multitud de afecciones, como los traumatismos por accidentes de trafico, los trastornos fetales debidos a la exposicion prenatal al alcohol, y la violencia interpersonal y de pareja. Aunque se sabe que el alcohol influye en estas afecciones, se desconoce la contribucion de los danos del alcohol a terceros a la carga sanitaria global que supone el alcohol. Esta falta de conocimiento conduce a una situacion en la que las estrategias de politica y de prevencion del alcohol se centran en gran medida en la reduccion de los danos perjudiciales del alcohol para la salud de los consumidores de alcohol, dejando de lado a los demas afectados y a los grupos de poblacion mas vulnerables a estos danos, incluidas las mujeres y los ninos. En este articulo, tratamos de dilucidar por que faltan estimaciones sobre los danos del alcohol en otras personas y ofrecemos orientaciones para futuras investigaciones. Tambien argumentamos que una evaluacion completa de la carga sanitaria del alcohol que incluya los danos causados por el consumo de alcohol de otras personas mejoraria la visibilidad y la concienciacion publica de esos danos, y haria avanzar la evaluacion de las intervenciones politicas para mitigarlos. [phrase omitted], Introduction Just under 2.5 million people die annually due to alcohol use. (1) This global estimate, however, excludes most of the health burden borne by others than the alcohol user. [...]

Introduction: The use of high‐potency cannabis products is associated with an increased risk of mental disorders. This study investigates whether the rising THC concentration in Germany is associated with an increase in cannabis‐related diagnoses. Methods: The number of insured persons with at least one cannabis‐related ICD‐10 F12 diagnosis (e.g., harmful use, dependence) in outpatient care was provided by statutory health insurance funds between 2009 and 2021. The dependent variable is the ratio of (a) the number of insured persons with at least one F12 diagnosis to (b) all insured persons who have used cannabis in the last year. Information on THC concentration in cannabis flower was provided by law enforcement agencies. Using generalised mixed linear models, the dependent variable was predicted by the median THC concentration in cannabis flower. Results: The regression results show that an increase in THC concentration by one percentage point is significantly associated with an increase in the proportion of diagnoses (women: +0.17; men: +0.42). THC concentration positively predicted the proportion of diagnoses in all 16 federal states for men and in 15 federal states for women. Discussion and Conclusions: Compared to low‐potency products, using high‐potency products may pose additional health risks, which may be particularly pronounced in men. Acknowledging the limitations of the ecological study design and uncertainties inherent to the analysed data, further investigations on the sex‐specific impact of THC exposure are required. Limiting the THC concentration in cannabis products and closely monitoring THC consumption in the population appears necessary. [ABSTRACT FROM AUTHOR]

Aims: Our study aimed to a) describe the distribution of hospital discharges with primary and secondary alcohol‐specific diagnoses by sex and age group, and b) describe how the number of hospital discharges with primary and secondary alcohol‐specific diagnoses have changed across different diagnostic groups (categorized by primary International Classification of Diseases, 10th Revision [ICD‐10] diagnosis) over time. Design: Retrospective cross‐sectional analysis. Setting: German hospital settings between 2012 and 2021. Participants: All persons aged 15–69 admitted to hospitals as registered in a nationwide data set. Measurements We counted a) the number of all hospital discharges and b) the number of hospital discharges with at least one alcohol‐specific secondary diagnosis (secondary alcohol‐specific diagnosis) by year, sex, age group, and diagnostic group. One diagnostic group included all primary alcohol‐specific diagnoses, while 13 additional groups aligned with ICD‐10 chapters (e.g., neoplasms). Alcohol‐involvement was defined as either a primary or secondary alcohol‐specific diagnosis. Findings Of 95 417 204 recorded hospital discharges between 2012 and 2021, 3 828 917 discharges (4.0%; 2 913 903 men (6.4%); 915 014 women (1.8%)) involved either a primary or at least one secondary diagnosis related to alcohol. Of all alcohol‐involved hospital discharges, 56.8% (1 654 736 discharges) had no primary but only a secondary alcohol‐specific diagnosis. Secondary alcohol‐specific diagnoses were particularly prevalent in hospital discharges due to injuries. With rising age, alcohol‐involvement in hospital discharges due to digestive or cardiovascular diseases increased. Between 2012 and 2021, the rate of alcohol‐involved hospital discharges has decreased more in younger as compared with older adults (average change between 2012 and 2021: 15–24: −55%; 25–34: −41%; 35–44: −23%; 45–54: −31%; 55–64: −21%; 65–69: −8%). Conclusions: The number of alcohol‐involved hospital discharges in Germany from 2012 to 2021 more than doubles (from 1 654 736 to 3 828 917) when including secondary alcohol‐specific diagnoses. More pronounced declines among younger adults may be attributed to unequal changes in alcohol consumption patterns across the population and to the hazardous effects of long‐term alcohol use. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to assess: (i) trends in alcohol‐specific — that is, fully attributable — morbidity and mortality in the German adult population aged 15–69 between 2000 and 2021; and (ii) changes in alcohol‐attributable disease burden — that is, fully and partially alcohol‐attributable categories — for 2006, 2012, 2018 and 2021. Methods: Morbidity data was pulled from hospitalisation and rehabilitation statistics and mortality data was pulled from the causes of death registry. Alcohol use, adjusted for unrecorded consumption, was estimated using the Epidemiological Survey of Substance Abuse and triangulated with per capita consumption from annual sales data. For major disease categories, alcohol‐attributable fractions were estimated for males and females by age groups (15–29, 30–49, 50–69 years) using the comparative risk assessment methodology. Results: For males and females, the age‐standardised rate of alcohol‐specific morbidity peaked in 2012 and decreased thereafter showing a steep decline from 2019 to 2021. The rates of alcohol‐specific mortality decreased constantly from 2000 to 2019 but increased from 2019 to 2021. Compared to 2006 the age‐standardised alcohol‐attributable morbidity and mortality rates in males and females were lower in 2021. For both sexes, the age‐standardised alcohol‐attributable morbidity and mortality rates and the proportions of morbidity/mortality rates relative to all‐cause morbidity/mortality decreased between 2006 and 2021. Discussion: The declines in alcohol‐attributable morbidity and mortality are in line with decreases in consumption and signal that the importance of alcohol in health service utilisation and mortality has weakened. Sex ratios in morbidity and mortality do not indicate a strong converging trend. [ABSTRACT FROM AUTHOR]

Background and aims: Previously identified national drinking patterns in Europe lack comparability and might be no longer be valid due to changes in economic conditions and policy frameworks. We aimed to identify the most recent alcohol drinking patterns in Europe based on comparable alcohol exposure indicators using a data‐driven approach, as well as identifying temporal changes and establishing empirical links between these patterns and indicators of alcohol‐related harm. Design: Data from the World Health Organization's monitoring system on alcohol exposure indicators were used. Repeated cross‐sectional hierarchical cluster analyses were applied. Differences in alcohol‐attributable harm between clusters of countries were analyzed via linear regression. Setting: European Union countries, plus Iceland, Norway and Ukraine, for 2000, 2010, 2015 and 2019. Participants/Cases: Observations consisted of annual country data, at four different time points for alcohol exposure. Harm indicators were only included for 2019. Measurements Alcohol exposure indicators included alcohol per capita consumption (APC), beverage‐specific consumption and prevalence of drinking status indicators (lifetime abstainers, current drinkers, former drinkers and heavy episodic drinking). Alcohol‐attributable harm was measured using age‐standardized alcohol‐attributable Disability‐Adjusted Life Years (DALYs) lost and deaths per 100 000 people. Findings The same six clusters were identified in 2019, 2015 and 2010, mainly characterized by type of alcoholic beverage and prevalence drinking status indicators, with geographical interpretation. Two‐thirds of the countries remained in the same cluster over time, with one additional cluster identified in 2000, characterized by low APC. The most recent drinking patterns were shown to be significantly associated with alcohol‐attributable deaths and DALY rates. Compared with wine‐drinking countries, the mortality rate per 100 000 people was significantly higher in Eastern Europe with high spirits and 'other' beverage consumption [ β^ = 90, 95% confidence interval (CI) = 55–126], and in Eastern Europe with high lifetime abstainers and high spirits consumption (β^ = 42, 95% CI = 4–78). Conclusions: European drinking patterns appear to be clustered by level of beverage‐specific consumption, with heavy episodic drinkers, current drinkers and lifetime abstainers being distinguishing factors between clusters. Despite the overall stability of the clusters over time, some countries shifted between drinking patterns from 2000 to 2019. Overall, patterns of drinking in the European Union seem to be stable and partly determined by geographical proximity. [ABSTRACT FROM AUTHOR]

Objective To validate a Russian-language version of the World Health Organization's Alcohol Use Disorders Identification Test (AUDIT). Methods We invited 2173 patients from 21 rural and urban primary health-care centres in nine Russian regions to participate in the study (143 declined and eight were excluded). In a standardized interview, patients who had consumed alcohol in the past 12 months provided information on their sociodemographic characteristics and completed the Russian AUDIT, the Kessler Psychological Distress Scale and the Composite International Diagnostic Interview to identify problem drinking and alcohol use disorders. We assessed the feasibility of administering the test, its internal consistency and its ability to predict hazardous drinking and alcohol use disorders in primary health care in the Russian Federation. Findings Of the 2022 patients included in the study, 1497 were current drinkers with Russian AUDIT scores. The test was internally consistent with good psychometric properties (Cronbach's a : 0.842) and accurately predicted alcohol use disorders and other outcomes (area under the curve > 75%). A three-item short form of the test correlated well with the full instrument and had similar predictive power (area under the curve > 80%). We determined sex-specific thresholds for all outcomes, as non- specific thresholds resulted in few women being identified. Conclusion With the validated Russian AUDIT, there is no longer a barrier to introducing screening and brief interventions into primary health care in the Russian Federation to supplement successful alcohol control policies. Objectif Valider une version russe du test AUDIT (Alcohol Use Disorders Identification Test) de l'Organisation mondiale de la Sante. Methodes Nous avons invite 2173 patients originaires de 21 centres de soins de sante primaires repartis dans neuf regions du pays, tant en milieu rural qu'urbain, a participer a cette etude (143 ont refuse et huit ont ete exclus). Lors de chaque entretien standardise, les patients ayant consomme de l'alcool au cours des 12 derniers mois ont fourni des informations sur leurs caracteristiques sociodemographiques et complete l'AUDIT russe, l'Echelle de detresse psychologique de Kessler ainsi que le Questionnaire composite international pour le diagnostic afin d'identifier les problemes de boisson et les troubles lies a l'abus d'alcool. Nous avons evalue la faisabilite du test, sa coherence interne et sa capacite a predire toute consommation dangereuse ou trouble lie a l'abus d'alcool dans le cadre des soins de sante primaires en Federation de Russie. Resultats Sur les 2022 patients inclus dans l'etude, 1497 se sont vus octroyer un score par l'AUDIT russe. Le test a fait preuve de coherence interne et affiche de bonnes proprietes psychometriques (Cronbach a: 0,842). Il a egalement predit avec justesse les troubles lies a l'abus d'alcool, mais aussi d'autres consequences (aire sous la courbe > 75%). Une version plus courte du test, comportant seulement trois elements, s'est bien accordee avec l'instrument complet et offrait une valeur predictive similaire (aire sous la courbe > 80%). Pour l'ensemble des observations, nous avons determine des seuils en fonction du genre car dans le cas contraire, le nombre de femmes identifiees etait peu eleve. Conclusion Grace a la validation du test AUDIT russe, aucun obstacle ne subsiste en matiere de depistage et d'intervention rapide dans les centres de soins de sante primaires de la Federation de Russie. Ces derniers peuvent ainsi s'ajouter aux politiques efficaces de lutte contre l'alcoolisme. Objetivo Validar una version en ruso del Test de Identificacion de Trastornos debidos al Consumo de Alcohol (AUDIT, por sus siglas en ingles) de la Organizacion Mundial de la Salud. Metodos Invitamos a participar en el estudio a 2.173 pacientes de 21 centros de atencion primaria rurales y urbanos de nueve regiones rusas (143 se negaron y ocho fueron excluidos). En una entrevista estandarizada, los pacientes que habian consumido alcohol en los ultimos 12 meses proporcionaron informacion sobre sus caracteristicas sociodemograficas y completaron el AUDIT ruso, la Escala de malestar psicologico de Kessler y la Entrevista Diagnostica Internacional Compuesta para identificar el consumo problematico de alcohol y los trastornos por consumo de alcohol. Se evaluo la viabilidad de la administracion de la prueba, su consistencia interna y su capacidad para predecir el consumo peligroso de alcohol y los trastornos por consumo de alcohol en los centros de atencion primaria de la Federacion Rusa. Resultados De los 2.022 pacientes incluidos en el estudio, 1.497 eran consumidores de alcohol con puntuaciones en el AUDIT. La prueba demostro consistencia interna con buenas propiedades psicometricas (Cronbach a : 0,842). Tambien predijo con precision los trastornos por abuso de alcohol, pero tambien otras consecuencias (area bajo la curva > 75%). Una version mas corta de la prueba con solo tres items se correlaciono bien con el instrumento completo y ofrecio un valor predictivo similar (area bajo la curva > 80%). Se determinaron umbrales especificos por sexo para todos los resultados, ya que los umbrales no especificos identificaron a pocas mujeres. Conclusion Con la validacion del AUDIT ruso, ya no existe ningun obstaculo para el cribado y la intervencion temprana en los centros de atencion primaria de la Federacion Rusa. Estas pueden anadirse a las politicas eficaces de control del consumo de alcohol., Introduction In September 2018, the World Health Organization (WHO) released SAFER, a new initiative and technical package outlining five high-impact strategies that can help governments to reduce the harmful use [...]

Background: In Germany, most individuals with alcohol dependence are recognized by the health care system and about 16% per year receive addiction-specific care. This paper aimed to analyze the prevalence and treatment utilization rate of people with alcohol dependence by type of addiction-specific care in the federal state of Bremen using routine and survey data. Methods: The number of individuals with alcohol dependence was estimated using data from the 2018 Epidemiological Survey of Substance Abuse (ESA). Furthermore, linked routine data of two statutory health insurances (SHIs), the German pension insurance (GPI), and the communal hospital group Gesundheit Nord - Bremen Hospital Group (GeNo), from 2016/2017, were analyzed. Based on SHI data, the administrative prevalence of various alcohol-related diagnoses according to the International Classification of Diseases (ICD-10), in various treatment settings, was extrapolated to the total population of Bremen. Based on all routine data sources, treatment and care services for individuals with alcohol dependence were also extrapolated to Bremen's total population. Care services included outpatient addiction care visits and addiction-specific treatments, [i.e., qualified withdrawal treatment (QWT), outpatient pharmacotherapy as relapse prevention, and rehabilitation treatment]. Results: Of the survey-estimated 15,792 individuals with alcohol dependence in Bremen, 72.6% (n = 11,467) had a diagnosis documented with an ICD-10 code for alcohol dependence (F10.2) or withdrawal symptoms (F10.3-F10.4). One in ten individuals with alcohol dependence (n = 1,689) used one or more addiction-specific care services during the observation period. Specifically, 4.3% (n = 675) received outpatient addiction care, 4.7% (n = 736) initiated QWT, 0.8% (n = 133) received pharmacotherapy, and 3.9% (n = 614) underwent rehabilitation treatment. The share of seeking addiction-specific treatment after diagnosis was highest among younger and male patients. Conclusion: Although more than half of the individuals with alcohol dependence are documented in the health system, utilization rates of addiction-specific treatments are low. These low utilization rates suggest that there are existing barriers to transferring patients with alcohol dependence into addiction-specific care. Strengthening primary medical care provision in dealing with alcohol-related disorders and improving networking within the addiction support system appear to be particularly appropriate. [ABSTRACT FROM AUTHOR]

Abstract:Aim: Alcohol use is causing a considerable health burden for individuals and society in Germany. To reduce the burden from alcohol use, ensuring optimal treatment for those who are in need, is key. With this data-linkage study, we aim to provide a comprehensive description of healthcare service use among individuals with alcohol use disorders (AUD) in Hamburg, the second-largest German city. Methods: The study population is defined as adults living in Hamburg, currently insured by one of two statutory health insurance funds and with at least one alcohol-specific ICD-10 code between 2016 and 2021. Additionally, we will obtain data from pension funds and the Hamburg basic data monitoring system of outpatient addiction aid. By using unique identifiers, individual register data from these three sources will be linked. Hypotheses and qualitative analyses are presented in the form of research questions to analyse administrative prevalence rates, patient trajectories and predictors of treatment success as well as to estimate the impact of prototypical care pathways and the COVID-19 pandemic on utilization of alcohol-specific healthcare services. Discussion: The study 'Patient Routes of People with Alcohol Use Disorders in Germany' (PRAGMA) will be the first to provide an in-depth understanding of treatment provision for people with AUD in Germany. Following up a heterogeneous sample of people with AUD for six years will provide a unique opportunity to compare current with recommended care pathways as well to identify options for care improvements. [ABSTRACT FROM AUTHOR]

Die Säule 1 der Cannabislegalisierung sieht eine Entkriminalisierung des Besitzes sowie die Legalisierung des privaten und gemeinschaftlichen Cannabisanbaus für Erwachsene vor. Kritiker:innen befürchten, dass das Gesetzesvorhaben zu einem Anstieg des Konsums führen könnte. Daten aus Kanada, den USA und Uruguay zeigen tatsächlich, dass eine Zunahme der Konsumprävalenz sowie dadurch bedingter Probleme durch eine Cannabislegalisierung langfristig zu erwarten wäre. Dafür verantwortlich sind jedoch vermutlich Mechanismen kommerzieller Märkte, die in Deutschland so nicht vorgesehen sind. Die Säule 1 der Cannabislegalisierung erscheint daher als ein geeigneter Mittelweg zwischen Prohibition und Kommerzialisierung. [ABSTRACT FROM AUTHOR]