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  • 1. Amundsen, Ellen J.
    et al.
    Bretteville-Jensen, Anne L.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT, Institut für Therapiforschung, Germany.
    Estimating incidence of problem drug use using the Horwitz-Thompson estimator - A new approach applied to people who inject drugs in Oslo 1985-20082016In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 27, p. 36-42Article in journal (Refereed)
    Abstract [en]

    Background: The trend in the number of new problem drug users per year (incidence) is the most important measure for studying the diffusion of problem drug use. Due to sparse data sources and complicated statistical models, estimation of incidence of problem drug use is challenging. The aim of this study is to widen the palette of available methods and data types for estimating incidence of problem drug use over time, and for identifying the trends. Methods: This study presents a new method of incidence estimation, applied to people who inject drugs (PWID) in Oslo. The method took into account the transition between different phases of drug use progression - active use, temporary cessation, and permanent cessation. The Horwitz-Thompson estimator was applied. Data included 16 cross-sectional samples of problem drug users who reported their onset of injecting drug use. We explored variation in results for selected probable scenarios of parameter variation for disease progression, as well as the stability of the results based on fewer years of cross-sectional samples. Results: The method yielded incidence estimates of problem drug use, over time. When applied to people in Oslo who inject drugs, we found a significant reduction of incidence of 63% from 1985 to 2008. This downward trend was also present when the estimates were based on fewer surveys (five) and in the results of sensitivity analysis for likely scenarios of disease progression. Conclusion: This new method, which incorporates temporarily inactive problem drug users, may become a useful tool for estimating the incidence of problem drug use over time. The method may be less data intensive than other methods based on first entry to treatment and may be generalized to other groups of substance users. Further studies on drug use progression would improve the validity of the results.

  • 2. Atzendorf, Josefine
    et al.
    Apfelbacher, Christian
    Gomes de Matos, Elena
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Piontek, Daniela
    Patterns of multiple lifestyle risk factors and their link to mental health in the German adult population: a cross-sectional study2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 12, article id e022184Article in journal (Refereed)
    Abstract [en]

    Objectives Lifestyle risk factors, such as drinking or unhealthy diet, can expotentiate detrimental health effects. Therefore, it is important to investigate multiple lifestyle risk factors instead of single ones. The study aims at: (1) identifying patterns of lifestyle risk factors within the adult general population in Germany and (2) examining associations between the extracted patterns and external factors.

    Design Cross-sectional study.

    Setting General German adult population (aged 18–64 years).

    Participants Participants of the 2015 Epidemiological Survey of Substance Abuse (n=9204).

    Primary outcome measures Lifestyle risk factors (daily smoking, at-risk alcohol consumption, unhealthy diet, low physical activity, weekly use of pharmaceuticals, as well as consumption of cannabis and other illicit drugs).

    Results A latent class analysis was applied to identify patterns of lifestyle risk factors, and a multinomial logistic regression was carried out to examine associations between the extracted classes and external factors. A total of four classes were extracted which can be described as healthy lifestyle (58.5%), drinking lifestyle (24.4%), smoking lifestyle (15.4%) and a cumulate risk factors lifestyle (1.7%). Individuals who were male, at younger age and single as well as individuals with various mental health problems were more likely to show multiple lifestyle risk factors.

    Conclusions Healthcare professionals should be aware of correlations between different lifestyle risk factors as well as between lifestyle risk groups and mental health. Health promotion strategies should further focus especially on younger and single men.

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

  • 3. Atzendorf, Josefine
    et al.
    Aschenbrenner, Annika Berit
    de Matos, Elena Gomes
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. FT Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Kroeger, Christoph
    Delle, Simone
    Piontek, Daniela
    E-Zigaretten: Einschätzung vonGesundheitsgefahren undNutzung zur Tabakentwöhnung2018In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, ISSN 1436-9990, Vol. 61, no 11, p. 1415-1421Article in journal (Refereed)
    Abstract [de]

    BackgroundThe perception that e-cigarettes are less harmful than traditional tobacco products can influence the consumption of e-cigarettes.ObjectivesThree questions were examined: (1)How do different population groups perceive health risks of e-cigarettes? (2)Do sociodemographic variables explain differences in the risk assessment of e-cigarettes? (3)Does the perception of health risks predict the use of e-cigarettes for smoking cessation?MethodsData came from the 2015 Epidemiological Survey of Substance Abuse (ESA) with asample size of n=9204 participants, aged 18 to 64years (response rate 52.2%). Data were collected by telephone, online, or by written questionnaires. Assessments of risk perception of e-cigarettes and conventional cigarettes (more harmful, just as harmful, less harmful, do not know) were compared. Descriptive statistics and logistic regressions were performed.ResultsIndividuals with lower education rated e-cigarettes as more harmful. Older people and women perceived e-cigarettes as just as harmful. Smokers considered e-cigarettes to be more harmful than or just as harmful as conventional tobacco products. The likelihood of using e-cigarettes for smoking cessation was higher if people thought they were less harmful than conventional cigarettes.ConclusionsOnly one-third of the population knows that e-cigarettes are less harmful to health than conventional cigarettes. The perception of health risks is related to the usage of e-cigarettes for smoking cessation.

  • 4. Atzendorf, Josefine
    et al.
    Gomes de Matos, Elena
    Kröger, Christoph
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Piontek, Daniela
    Die Nutzung von E-Zigaretten in der deutschen Bevölkerung – Ergebnisse des Epidemiologischen Suchtsurvey 20152019In: Das Gesundheitswesen, ISSN 0941-3790, E-ISSN 1439-4421, Vol. 81, no 02, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Aim Estimates of e-cigarette consumption in Germany vary considerably. The use of e-cigarettes for tobacco cessation is critically discussed. Based on current data, the distribution of the consumption of e-cigarettes and their use in the adult general population of Germany will be presented.

    Methods The 2015 Epidemiological Survey of Substance Abuse, a nationwide survey of 18 to 64 year-old people in Germany (n=9,204, response rate: 52,2%), was used as data basis.

    Results E-cigarettes were known to most of the respondents (85,3%, 43,5 Mio.), whereas only 2,9% (1,5 Mio.) used e-cigarettes in the last 30 days. Higher risk of consuming e-cigarettes was seen in younger people (OR=0,95, 95%-KI=(0,93; 0,97)), men (OR=1,45, 95%-KI=(1,02; 2,07)) and smokers (OR=12,53, 95%-KI=(8,71; 18,03)). About a third of smokers and ex-smokers of conventional cigarettes (36,6%) who consumed e-cigarettes used these for tobacco cessation of which one fifth (21,3%) was able to quit smoking.

    Conclusion E-cigarette users seem to be more likely to be male, younger and smokers of conventional cigarettes. In addition to curiosity, the change in smoking behavior is an important motive for consumption. The results indicate that the use of e-cigarettes can contribute to tobacco cessation, the majority of users, however, continue to consume conventional and/or e-cigarettes.

  • 5. Atzendorf, Josefine
    et al.
    Rauschert, Christian
    Seitz, Nicki-Nils
    Lochbuehler, Kirsten
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung Germany; Eötvös Loránd University, Hungary.
    The Use of Alcohol, Tobacco, Illegal Drugs and Medicines An Estimate of Consumption and Substance-Related Disorders in Germany2019In: Deutsches Ärzteblatt International, ISSN 1866-0452, E-ISSN 1866-0452, Vol. 116, no 35-36, p. 577-+Article in journal (Refereed)
    Abstract [en]

    Background: Prevalence estimates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications and of substance-related disorders enable an assessment of the effects of substance use on health and society. Methods: The data used for this study were derived from the 2018 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA). The sample of the German adult population comprised 9267 persons aged 18 to 64 (response rate, 42%). Population estimates were obtained by extrapolation to a total resident population of 51 544 494 people. Results: In the 30 days prior to the survey, 71.6% of the respondents (corresponding to 36.9 million persons in the population) had consumed alcohol, and 28.0% (14.4 million) had consumed tobacco. 4.0% reported having used e-cigarettes, and 0.8% reported having used heat-not-burn products. Among illegal drugs, cannabis was the most commonly used, with a 12-month prevalence of 7.1% (3.7 million), followed by amphetamines (1.2%: 619 000). The prevalence of the use of analgesics without a prescription (31.4%) was markedly higher than that of the use of prescribed analgesics (17.5%, 26.0 million); however, analgesics were taken daily less commonly than other types of medication. 13.5% of the sample (7.0 million) had at least one dependence diagnosis (12-month prevalence). Conclusion: Substance use and the consumption of psychoactive medications are widespread in the German population. Substance-related disorders are a major burden to society, with legal substances causing greater burden than illegal substances.

  • 6. Been, Frederic
    et al.
    Bifisma, Lubertus
    Benaglia, Lisa
    Berset, Jean-Daniel
    Botero-Coy, Ana M.
    Castiglioni, Sara
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Zobel, Frank
    Schaub, Michael P.
    Buecheli, Alexander
    Hernandez, Felix
    Delemont, Olivier
    Esseiva, Pierre
    Ort, Christoph
    Assessing geographical differences in illicit drug consumption-A comparison of results from epidemiological and wastewater data in Germany and Switzerland2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 161, p. 189-199Article in journal (Refereed)
    Abstract [en]

    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.

  • 7. Bloomfield, Kim
    et al.
    Grittner, Ulrike
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Piontek, Daniela
    Drinking patterns at the sub-national level: What do they tell us about drinking cultures in European countries?2017In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 34, no 4, p. 342-352Article in journal (Refereed)
    Abstract [en]

    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.

  • 8. Bloomfield, Kim
    et al.
    Hope, Ann
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Alcohol survey measures for Europe: A literature review2013In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 20, no 5, p. 348-360Article, review/survey (Refereed)
    Abstract [en]

    This article reports the results of a purposive review of the different alcohol survey instruments currently used in survey research. The review was conducted to support the development of a standardized comparative survey methodology for Europe. It examines various types of instruments used to measure alcohol consumption, risky drinking, alcohol abuse and dependence, social consequences and third-party harm. The review of literature provides several insights for a European comparative survey. The beverage-specific quantity-frequency measure is recommended for use across countries. A reference period of 1 year for alcohol consumption is considered important if one is to link associated problems with alcohol intake. With regard to risky drinking, objective measures based on the quantity of approximately 60-70 g of ethanol per drinking occasion are preferable to subjective measures of drunkenness. In choosing an instrument for measuring abuse and dependence, the key issue is to decide whether the instrument is to serve as a screening or diagnostic tool. In the case of screening, the Alcohol Use Disorders Identification Test or the Rapid Alcohol Problem Screen-4 appears more appropriate. But if one desires to approximate a diagnostic category, then the Composite International Diagnostic Interview or another operationalization of ICD-10/DSM-IV criteria would be the better choice. Due to a lack of validated scales for social consequences and third-party harm, no recommendations are justified.

  • 9. Braun, B.
    et al.
    Ludwig, M.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Inst Therapieforsch.
    Kroher, M.
    Buehringer, G.
    Outpatient Addiction Care for Pathological Gamblers in Bavaria: Do Treatment Services Meet Clients' Needs?2013In: SUCHTTHERAPIE, ISSN 1439-9903, Vol. 14, no 1, p. 37-45Article in journal (Refereed)
    Abstract [en]

    Aim: Examination of pathological gamblers (PG) in outpatient services and analysis of the fit of clientele characteristics and healthcare situation. Methods: From April 2009 to March 2011 a total of 461 patients at 36 outpatient addiction care facilities in Bavaria, Germany, was examined consecutively. Data including sotio-demographic variables, psychological state (i.a. SCL-90, BDI) and counselling were collected. Results: The majority of patients were male (88.8%) with a mean age of 36 years. Most patients (81.4%) reported gambling on and preferring (74.7%) gaming machines within the past 12 months. A total of 93% fulfilled diagnostic criteria for PG and had a high severity of psychological strain (50.5 %) and depressive symptoms (47.4%). About half of the patients (51.8%) had less than 6 treatment contacts, 70.2% terminated prematurely. Conclusions: Given the high psychosocial burden, these results indicate a gap between objective need and actual treatment characteristics, particularly regarding the diagnostic process, premature treatment termination and rare conduit to other services. Possibilities of further development of outpatient health care structures are discussed.

  • 10. Braun, Barbara
    et al.
    Behrendt, Silke
    Piontek, Daniela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Germany.
    Bühringer, Gerhard
    Therapie alkoholbezogener Störungen im Alter: Ergebnisse der deutschen Stichprobe der randomisiert-kontrollierten ELDERLY-Studie bis zum 12-Monats-Follow-up2019In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 65, no 2, p. 101-114Article in journal (Refereed)
    Abstract [en]

    Treatment of alcohol use disorder in higher ages: Results of the German sample of the randomized-controlled ELDERLY study up to 12 months follow-up

    Aim: The demographic change implicates a higher number of older persons with alcohol related problems, for which therapeutic care is insufficient up to now. Within the international randomized-controlled ELDERLY study two versions of an outpatient psychotherapeutic treatment for persons aged 60 years or older having an alcohol use disorder according to DSM-5 (AUD) were tested in three countries. Methods: After baseline, the randomized treatment groups were reassessed after 1, 3, 6 and 12 months. Changes (time and group) regarding drinking quantity, number of abstinent days, number of days with binge drinking, and number of days with low-risk consumption as well as number of fulfilled criteria for AUD were evaluated. Complete case- and intention-to-treat analyses for the German subsample are presented (n=203). Results: Both treatment groups showed stably up to 12 months after baseline higher abstinence rates (18 %; t0: 4 %), rates of persons without any days of risky use (45 %, t0: 4 %) and without binge drinking days (68 %; t0: 15 %). Also, a reduction in drinking quantity (median of 27 g pure alcohol per drinking day; t0: 58 g) and number of fulfilled AUD criteria (median of 2; t0: 5) was observed. Conclusion: The improvements with regard to drinking behavior and symptoms of AUD remained steady despite the relatively short treatment duration. Motivational interventions, especially personalized feedback of drinking behavior, evoke changes in drinking behavior in older persons with alcohol related disorders. Therapeutic nihilism is misplaced; rather is it necessary to consider special needs of this target group to implement tailored help offers.

  • 11. Braun, Barbara
    et al.
    Ludwig, Monika
    Sleczka, Pawel
    Buehringer, Gerhard
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Gamblers seeking treatment: Who does and who doesn't?2014In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 3, no 3, p. 189-198Article in journal (Refereed)
    Abstract [en]

    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.

  • 12. Buchholz, Angela
    et al.
    Friedrichs, Anke
    Berner, Michael
    Koenig, Hans-Helmut
    Konnopka, Alexander
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kriston, Levente
    Kuefner, Heinrich
    Piontek, Daniela
    Rist, Fred
    Roehrig, Jeanette
    Placement matching of alcohol-dependent patients based on a standardized intake assessment: rationale and design of a randomized controlled trial2014In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 14, p. 286-Article in journal (Refereed)
    Abstract [en]

    Background: Despite considerable research on substance-abuse placement matching, evidence is still inconclusive. The aims of this exploratory trial are to evaluate (a) the effects of following matching guidelines on health-care costs and heavy drinking, and (b) factors affecting the implementation of matching guidelines in the treatment of alcohol-dependent patients. Methods: A total of 286 alcohol-dependent patients entering one of four participating detoxification units and having no arrangements for further treatment will be recruited. During the first week of treatment, all patients will be administered Measurements in the Addictions for Triage and Evaluation (MATE), European Quality of Life-Five Dimensions health status questionnaire (EQ-5D), and the Client Socio-Demographic and Service Receipt Inventory-European Version (CSSRI-EU). Patients who are randomly allocated to the intervention group will receive feedback regarding their assessment results, including clear recommendations for subsequent treatment. Patients of the control group will receive treatment as usual and, if requested, global feedback regarding their assessment results, but no recommendations for subsequent treatment. At discharge, treatment outcome and referral decisions will be recorded. Six months after discharge, patients will be administered MATE-Outcome, EQ-5D, and CSSRI-EU during a telephone interview. Discussion: This trial will provide evidence on the effects and costs of using placement-matching guidelines based on a standardized assessment with structured feedback in the treatment of alcohol-dependent patients. A process evaluation will be conducted to facilitate better understanding of the relationship between the use of guidelines, outcomes, and potential mediating variables.

  • 13. Dams, Judith
    et al.
    Buchholz, Angela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institute for Therapeutic Research Munich, Germany; ELTE Eötvös Loránd University, Hungary.
    Reimer, Jens
    Scherbaum, Norbert
    Konnopka, Alexander
    König, Hans-Helmut
    Excess costs of alcohol-dependent patients in German psychiatric care compared with matched non-alcohol-dependent individuals from the general population: a secondary analysis of two datasets2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e020563Article in journal (Refereed)
    Abstract [en]

    Objectives Heavy alcohol use can cause somatic and mental diseases, affects patients' social life and is associated with social isolation, unemployment and reduced quality of life. Therefore, societal costs of alcohol dependence are expected to be high. The aim of this study was to estimate excess costs of patients with alcohol dependence diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria compared with individuals without alcohol dependence in Germany. Design In a secondary analysis, baseline data of patients with alcohol dependence enrolled in a randomised controlled trial (German Clinical Trials Register DRS00005035) were compared with data collected via a telephone survey from individuals without alcohol dependence and that had been matched by entropy balancing. Health service use was evaluated retrospectively for a 6-month period. Settings Four German psychiatric university clinics (patients with alcohol dependence) and the German general adult population (individuals without alcohol dependence). Participants n=236adult patients with alcohol dependence and n=4687adult individuals without alcohol dependence. Primary and secondary outcome measures The excess costs of health service use, absenteeism and unemployment of patients with alcohol dependence were calculated and compared with individuals without alcohol dependence. In subgroup analyses, the associations between excess cost and gender, comorbidities and the duration of disease were investigated. Results Total 6-month excess costs of Euro11839 (95% CI Euro11 529 to Euro12 147) were caused by direct excess costs of Euro4349 (95% CI Euro4129 to Euro4566) and indirect costs of Euro7490 (95% CI Euro5124 to Euro9856). In particular, costs of inpatient treatment, formal long-term care, absenteeism and unemployment were high. Conclusions Alcohol dependence causes substantial direct and indirect excess costs. Cost-effective interventions to prevent and treat alcohol dependence are urgently needed. Trial registration number DRKS00005035.

  • 14. Dauber, Hanna
    et al.
    Braun, Barbara
    Pfeiffer-Gerschel, Tim
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Pogarell, Oliver
    Co-occurring Mental Disorders in Substance Abuse Treatment: the Current Health Care Situation in Germany2018In: International Journal of Mental Health and Addiction, ISSN 1557-1874, E-ISSN 1557-1882, Vol. 16, no 1, p. 66-80Article in journal (Refereed)
    Abstract [en]

    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.

  • 15. Dauber, Hanna
    et al.
    Pogarell, Oliver
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös-Loránd-University, Hungary.
    Braun, Barbara
    Older adults in treatment for alcohol use disorders: service utilisation, patient characteristics and treatment outcomes2018In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 13, article id 40Article in journal (Refereed)
    Abstract [en]

    Background In western countries demographic changes are leading to an ageing society. Consequently, the number of older adults with alcohol use disorders (AUDs) will rise and the demand of treatment is likely to increase. However, thus far not many older adults with an AUD are seeking treatment and little is known about the efficacy of treatment for older adults. The present study aimed at determining the proportion of older adults with an AUD in addiction treatment, particular characteristics and treatment outcomes of this clientele.

    Methods Using data of 10,860 patients with an AUD aged 60 and over that are documented within the national German addiction care system we conducted exploratory analyses with regard to prevalence, sociodemographic, disorder- and treatment-related variables.

    Results Overall, we found a low proportion of older patients in treatment due to AUDs, but highly positive treatment outcomes. With regard to sociodemographic and disorder-related characteristics, older females and late-onset patients in particular constitute a unique clientele.

    Conclusions The low service utilisation on the one hand but good treatment prognosis on the other emphasise the need to promote treatment seeking among older adults with AUDs. In this context, the special characteristics we found among older patients may contribute to better reach this population and to improve provisions of targeted treatment approaches.

  • 16. de Matos, Elena Gomes
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Pabst, Alexander
    Piontek, Daniela
    Does a Change Over All Equal a Change in All? Testing for Polarized Alcohol Use Within and Across Socio-Economic Groups in Germany2015In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 50, no 6, p. 700-707Article in journal (Refereed)
    Abstract [en]

    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.

  • 17. Friedrichs, A.
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Inst Therapieforsch, Munich, Germany.
    Berner, M.
    Schippers, G.
    Broekman, T.
    Rist, F.
    Piontek, D.
    Roehrlg, J.
    Buchholz, A.
    Adaptation of Dutch Allocation Guideline for Patients after Alcohol Detoxification - Results of a Delphi Survey2013In: SUCHTTHERAPIE, ISSN 1439-9903, Vol. 14, no 4, p. 148-154Article in journal (Refereed)
    Abstract [en]

    Aim of the study: In the Netherlands, guidelines for the allocation of patients with alcohol related disorders to different levels of care have been implemented and evaluated nationwide. These guidelines cannot be used in the German health care system without adaptation, but with modifications they may prove useful. Aim of this study was therefore to develop an adaptation of those allocation guidelines to the German system. Methods: Using the Delphi-technique, experts in substance use treatment discussed existing addiction treatment services and indication criteria relevant for allocation in 3 rounds. The results of this process were integrated by means of a concluding consensus conference. Results: The Dutch allocation guideline was adapted for treatment decisions following detoxification treatment of alcohol dependent patients. Conclusions: The consented guideline can support the allocation of patients with alcohol-related disorders. The guideline is currently evaluated in a randomized controlled trial.

  • 18. Friedrichs, Anke
    et al.
    Silkens, Anna
    Reimer, Jens
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institute for Therapeutic Research Munich, Germany.
    Scherbaum, Norbert
    Piontek, Daniela
    Röhrig, Jeanette
    Hempleman, Jochen
    Härter, Martin
    Buchholz, Angela
    Role preferences of patients with alcohol use disorders2018In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 84, p. 248-254Article in journal (Refereed)
    Abstract [en]

    Aims

    Shared decision making (SDM) is increasingly demanded in medical decision making. SDM acknowledges patients' role preferences in decision making processes. There has been limited research on SDM and role preferences in substance use disorders; results are promising. Aim of this study was to investigate role preferences of patients with alcohol use disorders (AUD), and to identify predictors of these preferences.

    Method

    Cross-sectional data collected from June 2013 to May 2014 in four detoxification wards in Germany during a randomised controlled trial (RCT, Registration Code O1GY1114) was analysed. Of the 250 patients with AUD who were included in the RCT, data from 242 patients [65% male; mean age = 45.2 years (sd = 10.3)] were analysed. Participants' role preferences were assessed with the Control Preference Scale. Potential correlates were drawn from instruments used in the RCT; multinomial logistic regression was used.

    Results

    90% (n = 217) of the AUD patients preferred an active or shared role in decision-making, 10% (n = 25) preferred a passive role. Patients' desire for help was associated with their role preference (OR = 3.087, p = .05). The model's goodness of fit was Nagelkerke's R-2 = 0.153 [chi(2) (24) = 25.206, p = .395].

    Conclusions

    Patients' preference for an active role in decision-making underscores the importance of involving patients in their treatment planning. Patients' desire for help seems to be an important determinant of paternalistic decision making. However, further research is needed to determine whether patients' role preferences are related to their behavior during their treatment referral and recovery.

  • 19. Gomes de Matos, Elena
    et al.
    Atzendorf, Josefine
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Piontek, Daniela
    Substanzkonsum in der Allgemeinbevölkerung in Deutschland. Ergebnisse des Epidemiologischen Suchtsurveys 20152016In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 62, no 5, p. 271-281Article in journal (Refereed)
    Abstract [en]

    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.

  • 20. Gomes de Matos, Elena
    et al.
    Hannemann, Tessa-Virginia
    Atzendorf, Josefine
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institute for Therapy Research, Germany.
    Piontek, Daniela
    The Consumption of New Psychoactive Substances and Methamphetamine Analysis of Data From 6 German Federal States2018In: Deutsches Ärzteblatt International, ISSN 1866-0452, E-ISSN 1866-0452, Vol. 115, no 4, p. 49-55Article in journal (Refereed)
    Abstract [en]

    Background: The abuse of new psychoactive substances (NPS) and methamphet amine has severe adverse effects. Here we provide the first report of regional patterns in NPS and methamphetamine consumption in Germany, on the basis of epidemiologic data from six federal states (Bavaria, Hamburg, Hesse, North Rhine-Westphalia, Saxony, and Thuringia). Methods: Data were derived from the 2015 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey) and supplemented with additional cases from the federal states that were studied. The numbers of persons included in the representative samples of persons aged 18 to 64 in each state were 1916 (Bavaria), 1125 (Hamburg), 1151 (Hesse), 2008 (North Rhine-Westphalia), 1897 (Saxony), and 1543 (Thuringia). Potential risk factors for the lifetime prevalence of consumption were studied by logistic regression. Results: The lifetime prevalence of methamphetamine consumption in the individual states ranged from 0.3% (North Rhine-Westphalia) to 2.0% (Saxony). Thuringia and Saxony displayed values that were significantly higher than average. For NPS, the figures ranged from 2.2% (Bavaria) to 3.9% (Hamburg), but multivariate analysis revealed no statistically significant differences between the states. Higher age and higher educational level were associated with lower consumption of NPS and methamphetamine, while smoking and cannabis use were each associated with higher consumption. Conclusion: NPS consumption is equally widespread in all of the federal states studied. Methamphetamine is rarely consumed; its consumption appears to be higher in Saxony and Thuringia. The risk factor analysis reported here should be interpreted cautiously in view of the low case numbers with respect to consumption.

  • 21. Gomes de Matos, Elena
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institute for Therapeutic Research, Germany.
    Hannemann, Tessa-Virginia
    Soellner, Renate
    Piontek, Daniela
    Cross-cultural variation in the association between family's socioeconomic status and adolescent alcohol use2017In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 36, no 6, p. 797-804Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims. This study estimates cross-country variation in socioeconomic disparities in adolescent alcohol use and identifies country-level characteristics associated with these disparities. Design and Methods. The association between socioeconomic status (family wealth and parental education) and alcohol use (lifetime use and episodic heavy drinking) of 15- to 16-year-olds from 32 European countries was investigated. Country-level characteristics were national income, income inequality and per capita alcohol consumption. Multilevel modelling was applied. Results. Across countries, lifetime use was lower in wealthy than in less wealthy families (odds ratio [OR]((girls))=0.95, OR(boys)=0.94). The risk of episodic heavy drinking, in contrast, was higher for children from wealthier families (OR(girls)=1.04, OR(boys)=1.08) and lower when parents were highly educated (ORs=0.95-0.98). Socioeconomic disparities varied substantially between countries. National wealth and income inequality were associated with cross-country variation of disparities in lifetime use in few comparisons, such that among girls, the (negative) effect of family wealth was greatest in countries with unequally distributed income (OR=0.86). Among boys, the (negative) effect of family wealth was greatest in low-income countries (OR=1.00), and the (positive) effect of mothers' education was greatest in countries with high income inequality (OR=1.11). Discussion and Conclusions. Socioeconomic disparities in adolescent alcohol use vary across European countries. Broad country-level indicators can explain this variation only to a limited extent, but results point towards slightly greater socioeconomic disparities in drinking in countries of low national income and countries with a high income inequality. [Gomes de Matos E, Kraus L, Hannemann T-V, Soellner R, Piontek D. Cross-cultural variation in the association between family's socioeconomic status and adolescent alcohol use.

  • 22. Gomes de Matos, Elena
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Pabst, Alexander
    Piontek, Daniela
    Problembewusstsein und Inanspruchnahme von Hilfe bei substanzbezogenen Problemen2013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 6, p. 355-366Article in journal (Refereed)
    Abstract [en]

    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.

  • 23. Gomes de Matos, Elena
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Pabst, Alexander
    Piontek, Daniela
    Trends im Substanzkonsum Jugendlicher: gibt es regionale Unterschiede?2014In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 60, no 3, p. 163-172Article in journal (Refereed)
    Abstract [en]

    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.

  • 24. Gross, Cornelius
    et al.
    Reis, Olaf
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Piontek, Daniela
    Zimmermann, Ulrich S.
    Long-term outcomes after adolescent in-patient treatment due to alcohol intoxication: A control group study2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 162, p. 116-123Article in journal (Refereed)
    Abstract [en]

    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.

  • 25. Groß, Cornelius
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Munich, Germany.
    Piontek, Daniela
    Reis, Olaf
    Zimmermann, Ulrich S.
    Prediction of long-term outcomes in young adults with a history of adolescent alcohol-related hospitalization2016In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 51, no 1, p. 47-53Article in journal (Refereed)
    Abstract [en]

    Aims: Empirical data concerning the long-term psychosocial development of adolescents admitted to inpatient treatment with alcohol intoxication (AIA) are lacking. The aim of this study was to identify the factors that, at the time of admission, predict future substance use, alcohol use disorders (AUD), mental health treatment, delinquency and life satisfaction.

    Methods: We identified 1603 cases of AIA treated between 2000 and 2007 in one of five pediatric departments in Germany. These former patients were invited to participate in a telephone interview. Medical records were retrospectively analyzed extracting potential variables predicting long-term outcomes.

    Results: Interviews were conducted with 277 individuals, 5–13 [mean 8.3 (SD 2.3)] years after treatment, with a response rate of 22.7%; of these, 44.8% were female. Mean age at the interview was 24.4 (SD 2.2) years. Logistic and linear regression models revealed that being male, using illicit substances and truancy or runaway behavior in adolescence predicted binge drinking, alcohol dependence, use of illicit substances and poor general life satisfaction in young adulthood, explaining between 13 and 24% of the variance for the different outcome variables.

    Conclusions: This naturalistic study confirms that known risk factors for the development of AUD also apply to AIA. This finding facilitates targeted prevention efforts for those cases of AIA who need more than the standard brief intervention for aftercare.

  • 26. Grüne, Bettina
    et al.
    Piontek, Daniela
    Pogarell, Oliver
    Grübl, Armin
    Groß, Cornelius
    Reis, Olaf
    Zimmermann, Ulrich S.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Acute alcohol intoxication among adolescents - the role of the context of drinking2017In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 176, no 1, p. 31-39Article in journal (Refereed)
    Abstract [en]

    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.

  • 27. Grüne, Bettina
    et al.
    Piontek, Daniela
    Sleczka, Pawel
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Pogarell, Oliver
    Drinking Location and Drinking Culture and Their Association With Alcohol Use Among Girls and Boys in Europe2017In: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, Vol. 78, no 4, p. 549-557Article in journal (Refereed)
    Abstract [en]

    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.

  • 28. Gyepesi, Aron
    et al.
    Urban, Robert
    Farkas, Judit
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Semmelweis University.
    Piontek, Daniela
    Paksi, Borbala
    Horvath, Gergely
    Magi, Anna
    Eisinger, Andrea
    Pilling, Janos
    Koekoenyei, Gyoengyi
    Kun, Bernadette
    Demetrovics, Zsolt
    Psychometric Properties of the Cannabis Abuse Screening Test in Hungarian Samples of Adolescents and Young Adults2014In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 20, no 3, p. 119-128Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of our study was to analyze psychometric properties of the Cannabis Abuse Screening Test (CAST). Methods: Our sample comprised Hungarian high school (n = 476; male 56.3%; mean age 19.0 years, SD = 0.65 years) and college students (n = 439; male 65.1%; mean age 23.9 years, SD = 1.56 years) who reported cannabis use in the past year. The sample covered the five biggest universities of Hungary. Besides the CAST, participants responded to the Munich-Composite International Diagnostic Interview. Factor structure was analyzed by a confirmatory factor analysis. Receiver operating characteristic curve analysis was made to assess cut-off scores. Data collection took place in 2010. Results: CAST proved to be a reliable (Cronbach's alpha 0.71 and 0.76) one-dimensional measure. Regarding both cannabis dependence and cannabis use disorders, a cut-off of 2 points proved to be ideal in both samples, resulting in optimal specificity, negative predictive values and accuracy, but less than optimal positive predictive values (dependence) and low sensitivity (cannabis use disorder). Discussion and Conclusions: In line with former results, the CAST proved to be an adequate measure for the screening of cannabis-related problems among adolescents and young adults in an Eastern European country where this scale has not been studied before. (C) 2013 S. Karger AG, Basel

  • 29. Hannemann, Tessa-Virginia
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). SIFT Institut für Therapieforschung, Germany.
    Piontek, Daniela
    Consumption Patterns of Nightlife Attendees in Munich: A Latent-Class Analysis2017In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 52, no 11, p. 1511-1521Article in journal (Refereed)
    Abstract [en]

    Background: The affinity for substance use among patrons of nightclubs has been well established. With novel psychoactive substances (NPS) quickly emerging on the European drug market, trends, and patterns of use are potentially changing. Objectives: (1) The detection of subgroups of consumers in the electronic dance music scene of a major German metropolitan city, (2) describing the consumption patterns of these subgroups, (3) exploring the prevalence and type of NPS consumption in this population at nightlife events in Munich. Methods: A total of 1571 patrons answered questions regarding their own substance use and the emergence of NPS as well as their experience with these substances. A latent class analysis was employed to detect consumption patterns within the sample. Results: A four class model was determined reflecting different consumption patterns: the conservative class (34.9%) whose substance was limited to cannabis; the traditional class (36.6%) which especially consumed traditional club drugs; the psychedelic class (17.5%) which, in addition to traditional club drugs also consumed psychedelic drugs; and an unselective class (10.9%) which displayed the greatest likelihood of consumption of all assessed drugs. Smoking mixtures and methylone were the new substances mentioned most often, the number of substances mentioned differed between latent classes. Conclusion: Specific strategies are needed to reduce harm in those displaying the riskiest substance use. Although NPS use is still a fringe phenomenon its prevalence is greater in this subpopulation than in the general population, especially among users in the high-risk unselective class.

  • 30. Hanschmidt, Franz
    et al.
    Manthey, Jakob
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Scafato, Emanuele
    Gual, Antoni
    Grimm, Carsten
    Rehm, Jürgen
    Barriers to Alcohol Screening Among Hypertensive Patients and the Role of Stigma: Lessons for the Implementation of Screening and Brief Interventions in European Primary Care Settings2017In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 52, no 2, p. 572-579Article in journal (Refereed)
    Abstract [en]

    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, stigma and underrated importance of alcohol. Results did not indicate a positive impact of education and screening frequency on perception of stigma as barrier to screening.

  • 31. Höhne, Brigit
    et al.
    Pabst, Alexander
    Hannemann, Tessa-Virginia
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Patterns of concurrent alcohol, tobacco, and cannabis use in Germany: prevalence and correlates2014In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 21, no 2, p. 102-109Article in journal (Refereed)
    Abstract [en]

    Aims: This study investigated past month patternsand risk factors of alcohol, tobacco and cannabis useby level of intensity in the German generalpopulation. Methods: Data from the 2006 GermanEpidemiological Survey of Substance Abuse (ESA)were used. The cross-sectional random sampleconsisted of N¼7912 adults aged 18–64 years. Theresponse rate was 45%. Intensive use of eachsubstance was measured applying substance-specificcut-off points: alcohol: 420/30 g pure ethanol dailyfor women/men; tobacco: 20 cigarettes daily;cannabis: on 6 occasions monthly. Findings: The majority of substance users reportedno intensive use of any of the three substances(77.5%) and 19.4% had used one of the threesubstances intensively. A total of 3.1% engaged inintensive use of multiple substances with alcohol andtobacco (2.3%) as the most prevalent pattern. Ahigher risk for intensive use of multiple substanceswas found among males, older individuals and thosewith a substance use disorder. Conclusions: Results of this study call for anintegrated view on substance use and relateddisorders in prevention and treatment, takingdiverse use patterns and specific needs of substanceabusers into account.

  • 32.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Starker Konsum oder Substanzstörung? Überlegungen zum Suchtkonzept2013In: SuchtMagazin, ISSN 1422-2221, no 6, p. 12-15Article in journal (Refereed)
  • 33.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Eriksson Tinghög, Mimmi
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Lindell, Annette
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Pabst, Alexander
    Piontek, Daniela
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University of Melbourne, Australia; Turning Point Alcohol and Drug Centre, Australia.
    Age, Period and Cohort Effects on Time Trends in Alcohol Consumption in the Swedish Adult Population 1979-20112015In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 50, no 3, p. 319-327Article in journal (Refereed)
    Abstract [en]

    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.

  • 34.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Hannemann, Tessa-Virginia
    Piontek, Daniela
    Awolin, Mareike
    Effects of community-based prevention on alcohol consumption in adolescents2013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 5, p. 269-277Article in journal (Refereed)
    Abstract [en]

    Aims: The present paper aims at evaluating the effectiveness of the community-based substance use prevention program “Wegschauen ist keine Lösung”. Methods: Communities of the district of Karlsruhe were divided into a group with high (HIG) and low (LIG) program implementation fidelity. In 2011, a school survey was conducted among 892 adolescents in grades 9 and 10 of regular schools in the district of Karlsruhe. The Bavarian sample of the 2011 European School Survey Project on Alcohol and other Drugs (ESPAD) was used as external comparison group (n=1635). Results: Only few differences were found between HIG and LIG with regard to alcohol consumption and negative consequences. Compared to the external ESPAD comparison group, students in Karlsruhe showed lower 30-day prevalence of alcohol use (66.0 vs. 80.5 %), lower consumption quantity (17.17 vs. 34.91 grams of ethanol per drinking day) and lower frequency of use (0.75 vs. 1.21 days within the last week). Conclusions: Considering restrictions of the limited study design there are indications of possible positive effects of the project “Wegschauen ist keine Lösung”. However, for methodological sound evaluations of community-based prevention programs pre-post studies with clearly defined control conditions are needed.

  • 35.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institute for Therapy Research, Germany.
    Hay, Gordon
    Richardson, Clive
    Yargic, Ilhan
    Ilhan, Mustafa Necmi
    Ay, Pinar
    Karasahin, Füsun
    Pinarci, Mustafa
    Tuncoglu, Tolga
    Piontek, Daniela
    Schulte, Bernd
    Estimating high‐risk cannabis and opiate use in Ankara, Istanbul and Izmir2017In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 36, no 5, p. 626-632Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims. Information on high-risk drug use in Turkey, particularly at the regional level, is lacking. The present analysis aims at estimating high-risk cannabis use (HRCU) and high-risk opiate use (HROU) in the cities of Ankara, Istanbul and Izmir. Design and Methods. Capture–recapture and multiplier methods were applied based on treatment and police data stratified by age and gender in the years 2009 and 2010. Case definitions refer to ICD-10 cannabis (F.12) and opiate (F.11) disorder diagnoses from outpatient and inpatient treatment records and illegal possession of these drugs as recorded by the police. Results. High-risk cannabis use was estimated at 28 500 (8.5 per 1000; 95% confidence interval 7.3–10.3) and 33 400 (11.9 per 1000; 95% confidence interval 10.7–13.5) in Ankara and Izmir, respectively. Using multipliers based on capture–recapture estimates for Izmir, HRCU in Istanbul was estimated up to 166 000 (18.0 per 1000; range: 2.8–18.0). Capture–recapture estimates of HROU resulted in 4800 (1.4 per 1000; 95% confidence interval 0.9–1.9) in Ankara and multipliers based on these gave estimates up to 20 000 (2.2 per 1000; range: 0.9-2.2) in Istanbul. HROU in Izmir was not estimated due to the low absolute numbers of opiate users. Discussion and Conclusions. While HRCU prevalence in both Ankara and Izmir was considerably lower in comparison to an estimate for Berlin, the rate for Istanbul was only slightly lower. Compared with the majority of European cities, HROU in these three Turkish cities may be considered rather low. [Kraus L, Hay G, Richardson C, Yargic I, Ilhan N M, Ay P, Karasahin F, Pinarci M, Tuncoglu T, Piontek D, Schulte B Estimating high-risk cannabis and opiate use in Ankara, Istanbul and Izmir Drug Alcohol Rev 2016;00:000-000]

  • 36.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Hibell, Björn
    Whence and whither: strengths and future challenges of ESPAD2014In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, no 4, p. 319-322Article in journal (Refereed)
  • 37.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Nociar, Alojz
    ESPAD Report 2015: Results from the European School Survey Project on Alcohol and Other Drugs2016Report (Refereed)
    Abstract [en]

    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 addition to country-specific estimates, an average across all participating countries as well as prevalence estimates for two non-ESPAD countries: Spain and the United States. The instruments used in the Spanish and US surveys overlap to a large degree with the ESPAD questionnaire, and the methodology used in all three surveys allows for rough comparisons across the countries.

  • 38.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, München, Germany.
    Pabst, Alexander
    Piontek, Daniela
    Gmel, Gerrit
    Shield, Kevin D.
    Frick, Hannah
    Rehm, Juergen
    Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany2015In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 21, no 5, p. 262-272Article in journal (Refereed)
    Abstract [en]

    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.

  • 39.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Piontek, Daniela
    Repräsentative Bevölkerungsbefragungen zum Substanzkonsum sind alternativlos. [There are no alternatives to general population surveys on substance use]2016In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 62, no 5, p. 257-258Article in journal (Other academic)
  • 40.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Deutschland.
    Piontek, Daniela
    Wie evidenz-basiert kann kommunale Suchtprävention sein? [Is there an Evidence Base for Community Prevention?]2013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 5, p. 247-248Article in journal (Other academic)
  • 41.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Piontek, Daniela
    Atzendorf, Josefine
    Gomes de Matos, Elena
    Zeitliche Entwicklungen im Substanzkonsum in der deutschen Allgemeinbevölkerung: Ein Rückblick auf zwei Dekaden2016In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 62, no 5, p. 283-294Article in journal (Refereed)
    Abstract [en]

    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.

  • 42.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Piontek, Daniela
    Pabst, Alexander
    Gomes de Matos, Elena
    Studiendesign und Methodik des Epidemiologischen Suchtsurveys 20122013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 6, p. 309-320Article in journal (Refereed)
    Abstract [en]

    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.

  • 43.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, München, Germany.
    Piontek, Daniela
    Pfeiffer-Gerschel, Tim
    Rehm, Jürgen
    Inanspruchnahme gesundheitlicher Versorgung durch Alkoholabhängige [Health care utilization of perople with alcohol dependence]2015In: Suchttherapie, ISSN 1439-9903, E-ISSN 1439-989X, Vol. 16, no 1, p. 18-26Article in journal (Refereed)
    Abstract [en]

    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.

  • 44.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Livingston, Michael
    Pennay, Amy
    Holmes, John
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Long waves of consumption or a unique social generation? Exploring recent declines in youth drinking2019In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392Article in journal (Refereed)
    Abstract [en]

    Background: There is growing evidence for recent declines in adolescent alcohol use in the Western world. While these changes have been subject to scientific debate, the reasons for this downward trend are not yet understood.Method: We consider broader theoretical framings that might be useful in understanding declines in youth drinking. In particular, we reflect on the historical observations of ‘long waves of alcohol consumption’, the ‘Total Consumption Model’, and the ‘Theory of Social Generations’. Based on this, we explore some of the main hypotheses that are presently discussed as possible explanations for changes in youth drinking.Results: We suggest there may have been a change in the social position of alcohol as a social reaction to the negative effects of alcohol, but also emphasize the importance of changes in technology, social norms, family relationships and gender identity, as well as trends in health, fitness, wellbeing and lifestyle behavior. As a result of the interplay of these factors, the ‘devaluation’ of alcohol and the use of it may have contributed to the decrease in youth drinking.Conclusions: For interrupting the recurrent cycle of the ‘long waves of alcohol consumption’, we need to take advantage of the present change in sentiment and “lock in” these changes by new control measures. The model of change presented here hinges on the assumption that the observed change in the position the present young generation takes on alcohol proceeds through the life course, eventually reducing alcohol use in the whole population.

  • 45.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Schulte, Bernd
    Manthey, Jakob
    Rehm, Juergen
    Alcohol screening and alcohol interventions among patients with hypertension in primary health care: an empirical survey of German general practitioners2017In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 25, no 4, p. 285-292Article in journal (Refereed)
    Abstract [en]

    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.

  • 46.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary .
    Seitz, Nicki-Nils
    Piontek, Daniela
    Molinaro, Sabrina
    Siciliano, Valeria
    Guttormsson, Ulf
    Arpa, Sharon
    Monshouwer, Karin
    Leifman, Hakan
    Vicente, Julian
    Griffiths, Paul
    Clancy, Luke
    Feijao, Fernanda
    Florescu, Silvia
    Lambrecht, Patrick
    Nociar, Alojz
    Raitasalo, Kirsimarja
    Spilka, Stanislas
    Vyshinskiy, Konstantin
    Hibell, Bjorn
    'Are The Times A-Changin'? Trends in adolescent substance use in Europe2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 7, p. 1317-1332Article in journal (Refereed)
    Abstract [en]

    Aims To estimate temporal trends in adolescents' current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. Design and Setting Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. Participants A total of 223 814 male and 211 712 female 15-16-year-old students. Measurements Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi-level mixed-effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. Findings Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. Conclusions Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence.

  • 47.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Seitz, Nicki-Nils
    Schulte, Bernd
    Cremer-Schaeffer, Peter
    Braun, Barbara
    Verthein, Uwe
    Pfeiffer-Gerschel, Tim
    Estimation of the Number of People With Opioid Addiction in Germany2019In: Deutsches Ärzteblatt International, ISSN 1866-0452, E-ISSN 1866-0452, Vol. 116, no 9, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Background: Opioid addiction is one of the most common substance-related disorders worldwide, and morbidity and mortality due to opioid addiction place a heavy burden on society. Knowing the size of the population that is addicted to opioids is a prerequisite for the development and implementation of appropriate health-policy measures.

    Methods: Our estimate for Germany for 2016 is based on an enumeration of opioid-addicted persons who were entered in a registry of persons receiving substitution therapy, an enumeration of persons receiving outpatient and inpatient care for addiction without substitution therapy, an extrapolation to all addiction care facilities, and an estimation of the number of opioid-addicted persons who were not accounted for either in the substitution registry or in addiction care.

    Results: The overall estimate of the number of opioid-addicted persons in Germany in 2016 was 166 294 persons (lower and upper bounds: 164 794 and 167 794), including 123 988 men (122 968 to 125 007) and 42 307 women (41 826 to 42 787). The estimates for each German federal state per 1000 inhabitants ranged from 0.1 in Brandenburg to 3.0 in North Rhine-Westphalia and 5.5 in Bremen. The average value across Germany was 3.1 per 1000 inhabitants.

    Conclusion: Comparisons with earlier estimates suggest that the number of persons addicted to opioids in Germany has hardly changed over the past 20 years. Despite methodological limitations, this estimate can be considered highly valid. Nearly all persons who are addicted to opioids are in contact with the addiction care system.

  • 48.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Seitz, Nicki-Nils
    Shield, Kevin D.
    Gmel, Gerrit
    Rehm, Jürgen
    Quantifying harms to others due to alcohol consumption in Germany: a register-based study2019In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 17, article id 59Article in journal (Refereed)
    Abstract [en]

    Background: The consumption of alcohol increases the risk of drinkers harming others. The extent of alcohol's morbidity and mortality harms to others in Germany in 2014 was estimated for (1) fetal alcohol syndrome (FAS) or fetal alcohol spectrum disorders (FASD) among newborns, (2) road traffic fatalities, and (3) interpersonal violence-related deaths. Methods: The incidences of FAS and FASD were estimated by means of a meta-analytical approach, combining data on alcohol use during pregnancy and the risk relationship between alcohol consumption during pregnancy and FAS/FASD. In order to estimate alcohol-attributable road traffic fatalities and interpersonal violence due to the drinking of others, an attributable fraction methodology was applied to cause-of-death statistics for road traffic and interpersonal violence-related deaths. Results: For 2014, the incidences of FAS and FASD were estimated at 41 children per 10,000 live births (95% CI 24; 63) and 177 children per 10,000 live births (95% CI 135; 320), or 2930 (95% CI 1720; 4500) and 12,650 (95% CI 9650; 23,310) children, respectively. Furthermore, alcohol was estimated to be responsible for 1214 (95% CI 1141; 1287) third-party road traffic fatalities and 55 (95% CI 46; 64) deaths from interpersonal violence, representing 45.1% of all third-party road traffic fatalities and 14.9% of all interpersonal violence deaths. Conclusion: These study's estimates indicate there is a substantial degree of health harm to third parties caused by alcohol in Germany. While more research on harms to others caused by alcohol is needed to provide comprehensive estimates, the results indicate a need for effective prevention.

  • 49.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Tryggvesson, Kalle
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Pabst, Alexander
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Involvement in alcohol-related verbal or physical aggression. Does social status matter?2015In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 32, no 5, p. 449-463Article in journal (Refereed)
    Abstract [en]

    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.

  • 50.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Östhus, Ståle
    Amundsen, Ellen J.
    Piontek, Daniela
    Harkonen, Janne
    Legleye, Stephane
    Bloomfield, Kim
    Makela, Pia
    Landberg, Jonas
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Changes in mortality due to major alcohol-related diseases in four Nordic countries, France and Germany between 1980 and 2009: a comparative age-period-cohort analysis2015In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 9, p. 1443-1452Article in journal (Refereed)
    Abstract [en]

    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.

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