Change search
Refine search result
123 1 - 50 of 150
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 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, 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.
    Apfelbacher, Christian
    Gomes de Matos, Elena
    Lochbühler, Kirsten
    Piontek, Daniela
    Seitz, Nicki-Nils
    Kraus, Ludwig
    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; LTE Eötvös Loránd University, Hungary.
    Do smoking, nutrition, alcohol use, and physical activity vary between regions in Germany?-results of a cross-sectional study2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 277Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies on lifestyle risk factors mainly focused on age- or gender-specific differences. However, lifestyle risk factors also vary across regions. Aim of the present study was to examine the extent to which prevalence rates of SNAP (smoking, nutrition, alcohol consumption, physical activity) vary between East and West Germany or North and South Germany.

    Methods: Data came from the population-representative 2015 Epidemiological Survey of Substance Abuse (ESA) comprising 9204 subjects aged 18 to 64 years. To assess an east-west or south-north gradient, two binary logistic regression models were carried out for each SNAP factor.

    Results: The logistic regression models revealed statistically significant differences with higher rates of at-risk alcohol consumption and lower rates of unhealthy nutrition in East Germany compared to West Germany. Significant differences between North and South Germany were found for at-risk alcohol consumption with higher rates of at-risk alcohol consumption in South Germany. Daily smoking and low physical activity were equally distributed across regions.

    Conclusions: The implementation of measures reducing at-risk alcohol consumption in Germany should take the identified east-west and south-north gradient into account. Since the prevalence of unhealthy nutrition was generally high, prevention and intervention measures should focus on Germany as a whole instead of specific regions.

  • 4. 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.

  • 5. 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.

  • 6. Atzendorf, Josefine
    et al.
    Rauschert, Christian
    Seitz, Nicki-Nils
    Lochbühler, Kirsten
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). 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, E-ISSN 1866-0452, Vol. 116, no 35-36, p. 577-584Article 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.

    Download full text (pdf)
    fulltext
  • 7. 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.

  • 8. Bickl, Andreas M.
    et al.
    Kraus, Ludwig
    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 University, Hungary.
    Loy, Johanna K.
    Kriwy, Peter
    Sleczka, Pawel
    Schwarzkopf, Larissa
    Development of Gambling Behaviour and Its Relationship with Perceived Social Support: A Longitudinal Study of Young Adult Male Gamblers2024In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 40, no 1, p. 307-332Article in journal (Refereed)
    Abstract [en]

    Young adult men who gamble frequently face an elevated risk of developing gambling-related problems. So far, little is known about how changing levels of perceived social support interact with the course of gambling behaviour and gambling-related problems in this population. Using data from a prospective single-arm cohort study (Munich Leisure Time Study), we applied hierarchical linear models to investigate the longitudinal association of changes in perceived emotional and social support (hereafter PESS; operationalized as ENRICHD Social Support Instrument score) with gambling intensity, gambling frequency, and fulfilled criteria for gambling disorder. Pooling data from three time points (baseline, 12-month and 24-month follow-ups) to assess two 1-year intervals, these models disentangle the associations of (a) “level of PESS” (cross-sectional, between participants) and (b) “changes in individual PESS” (longitudinally, within-participants). Among the 169 study participants, higher levels of PESS were associated with fewer gambling-related problems (− 0.12 criteria met; p = 0.014). Furthermore, increasing individual PESS was associated with lower gambling frequency (− 0.25 gambling days; p = 0.060) and intensity (− 0.11 gambling hours; p = 0.006), and fewer gambling-related problems (− 0.19 problems; p < 0.001). The results suggest a mitigating influence of PESS on gambling behaviour and gambling-related problems. Increasing individual PESS appears more decisive for this pathway than high initial levels of PESS. Treatment and prevention strategies that activate and reinforce beneficial social resources in people with gambling-related problems are recommended and promising.

  • 9. Bickl, Andreas M.
    et al.
    Schwarzkopf, Larissa
    Loy, Johanna K.
    Grüne, Bettina
    Braun-Michl, Barbara
    Sleczka, Pawel
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kraus, Ludwig
    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 University, Hungary.
    Changes in gambling behaviour and related problems in clients seeking help in outpatient addiction care: Results from a 36-month follow-up study in Bavaria2021In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 10, no 3, p. 690-700Article in journal (Refereed)
    Abstract [en]

    Background and aim: Evidence on the course of gambling disorder (GD) in clients seeking help from outpatient addiction care facilities is sparse. To close this knowledge gap, this longitudinal one-armed cohort study portrays the development of GD in help-seeking clients over a 3-year timeframe.

    Methods: We investigated changes in severity of GD as well as in gambling frequency and intensity in 145 gamblers in outpatient treatment in Bavaria using generalized estimation equations (GEEs). To investigate potentially different trajectories between study participants with and without migration background (MB), additional analyses were applied with time*migration interaction. All analyses were adjusted for age, gender, education, electronic gambling machine (EGM) gambling, MB, GD, related help sought before and treatment status.

    Results: Within the entire study population, improvements in severity of GD (reduction of 39.2%), gambling intensity (reduction of 75.6%) and gambling frequency (reduction of 77.0%) were observed between baseline and 36 months of follow-up. The declines were most pronounced between baseline and follow-up 1 and stabilized thereafter. Participants with MB improved consistently less than participants without MB.

    Discussion and conclusion: Our study suggests that severity of GD and gambling patterns improve in the context of outpatient treatment. The beneficial results furthermore persist for 36 months after treatment termination. As clients with MB seem to profit less than clients without MB, improvements in outpatient gambling services to the specific needs of this clientele are required.

  • 10. 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.

  • 11. 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.

    Download full text (pdf)
    fulltext
  • 12. 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.

  • 13. 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.

  • 14. 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.

  • 15. Buchholz, Angela
    et al.
    Berner, Michael
    Dams, Judith
    Rosahl, Anke
    Hempleman, Jochen
    König, Hans-Helmut
    Konnopka, Alexander
    Kriston, Levente
    Piontek, Daniela
    Reimer, Jens
    Röhrig, Jeanette
    Scherbaum, Norbert
    Silkens, Anna
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Patient-centered placement matching of alcohol-dependent patients based on a standardized intake assessment: process evaluation within an exploratory randomized controlled trial2022In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 22, no 1, article id 60Article in journal (Refereed)
    Abstract [en]

    Background: In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff.

    Methods: The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory—European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished.

    Results: Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen’s kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM.

    Conclusions: While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare.

    Trial Registration: German Clinical Trials Register DRKS00005035. Registered 03/06/2013.

  • 16. Buchholz, Angela
    et al.
    Dams, Judith
    Rosahl, Anke
    Hempleman, Jochen
    Koenig, Hans-Helmut
    Konnopka, Alexander
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary .
    Kriston, Levente
    Piontek, Daniela
    Reimer, Jens
    Roehrig, Jeanette
    Scherbaum, Norbert
    Silkens, Anna
    Berner, Michael
    Patient-Centered Placement Matching of Alcohol-Dependent Patients Based on a Standardized Intake Assessment: Primary Outcomes of an Exploratory Randomized Controlled Trial2020In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 26, no 3, p. 109-121Article in journal (Refereed)
    Abstract [en]

    Background: Placement matching guidelines are promising means to optimize patient-centered care and to match patients' treatment needs. Despite considerable research regarding placement matching approaches to optimize alcohol abuse treatment, findings are inconclusive. Objectives: To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usual referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under- or overmatched. Methods: Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment. Setting. Four German psychiatric clinics offering a 7-21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence. Participants. From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127). Intervention. The PCPM were applied to patients of the IG by feeding back a recommendation to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request. Measurements. The MATE, the Client Socio-Demographic and Service Receipt Inventory--European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models. Results: In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio [IRR] 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients. Conclusions: While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.

  • 17. 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, 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.

  • 18. Carr, Sinclair
    et al.
    Lindemann, Christina
    Kraus, Ludwig
    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; ELTE Eötvös Loránd University, Hungary.
    Rehm, Jürgen
    Schulte, Bernd
    Manthey, Jakob
    Alcohol Consumption Levels and Health Care Utilization in Germany. Results from the GEDA 2014/2015-EHIS Study2022In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 68, no 3, p. 151-160Article in journal (Refereed)
    Abstract [en]

    Aims: Due to large inconsistencies in previous studies, it remains unclear how alcohol use is related to health care utilization. The aim of this study was to examine associations between alcohol drinking status with utilization of outpatient and inpatient health care services in Germany. Methodology: Survey data of the GEDA 2014/2015-EHIS study with n = 23,561 German adults were analyzed (response rate: 27 %). Respondents were categorized as lifetime abstainers, former drinkers, and non-weekly drinkers, as well as weekly low-risk drinkers and risky drinkers. Outpatient services included GP, specialist, and hospital visits; inpatient services included hospital overnight stays in the last 12 months. For both settings, binary logistic regression models were applied, adjusted for possible confounders. Results: For specialist visits, elevated odds were found among former drinkers (odds ratio (OR) = 1.93, 95 % confidence interval (95 % CI) = 1.50-2.49), non-weekly drinkers (OR = 1.24, 95 % CI = 1.05-1.47), weekly low-risk drinkers (OR = 1.39, 95 % CI = 1.17-1.67), and risky drinkers (OR = 1.28, 95 % CI = 1.04-1.57) compared to lifetime abstainers. In contrast, lower odds for inpatient service use were found among non-weekly drinkers (OR = 0.76, 95 % CI = 0.62-0.93), low-risk drinkers (OR = 0.66, 95 % CI = 0.53-0.81), and risky drinkers (OR = 0.65, 95 % CI = 0.51-0.84). No differences were observed for GP and outpatient hospital visits. Conclusions: While the increased odds of consulting a specialist are consistent with higher health care needs among former and current drinkers, the lower use of inpatient care among current drinkers is contrary to known health risks associated with alcohol consumption and evidence from hospitalized populations. The findings also highlight the need to differentiate between lifetime abstainers and former drinkers in their use of health services.

  • 19. 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, 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.

  • 20. 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.

  • 21. 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, 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.

  • 22. Delle, Simone
    et al.
    Kraus, Ludwig
    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; ELTE Eötvös Loránd University, Hungary.
    Maspero, Simona
    Pogarell, Oliver
    Hoch, Eva
    Lochbühler, Kirsten
    Effectiveness of the national German quitline for smoking cessation: study protocol of a randomized controlled trial2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, article id 1386Article in journal (Refereed)
    Abstract [en]

    Background: Despite the decline in cigarette smoking prevalence during nearly the past two decades, tobacco use is still widespread in the German adult population, accounting for 125,000 deaths each year and causing tremendous social costs. To accelerate the reduction in tobacco smoking prevalence, evidence-based smoking cessation methods are pivotal to a national tobacco control strategy. The present study aims to evaluate the effectiveness of the national German Smokers Quitline offering cessation support to smokers.

    Methods: A total sample of 910 daily smokers, who are motivated to quit, will be recruited via an online access panel and randomly assigned to either the intervention (telephone counselling) or control condition. In the intervention group, participants will receive up to six proactive phone calls during an intervention period of approximately six weeks. The provided treatment will combine the principles of motivational interviewing and those of the cognitive behavioural approach to treating substance use. Participants in the control condition will receive a self-help brochure to support smoking cessation. Data collection will take place at baseline as well as three (post assessment) and twelve months (follow-up assessment) after baseline assessment. Primary outcome measures will include the seven-day point prevalence abstinence at 3-month and 12-month assessments as well as prolonged abstinence (abstinence over the 12 month period). Secondary outcome measures will include a change in smoking-related cognitions and coping strategies among all participants. Among non-abstainers, treatment success indicators such as a reduction in number of cigarettes smoked per day and changes in the number and duration of quit attempts after intervention start will be assessed. It is expected that after both three and twelve months, smoking cessation rates will be higher in the telephone counselling condition compared to the control condition.

    Discussion: The results will provide insights into the effectiveness of proactive telephone counselling by the national German Smokers Quitline.

  • 23. Delle, Simone
    et al.
    Seitz, Nicki-Nils
    Atzendorf, Josefine
    Mühlig, Stephan
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Motives for not drinking alcohol: why adults in late middle age abstain2022In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 30, no 2, p. 126-133Article in journal (Refereed)
    Abstract [en]

    Background: Older individuals are not only more sensitive to the impact of alcohol but also face significant health risks from alcohol-drug interactions. To alter current drinking patterns, it is crucial to understand the motives for abstention of adults in late middle age.

    Objectives: We hypothesized that, for adults in late middle age, socio-demographic characteristics and health-related factors predict alcohol abstinence; and that current motives for abstention vary between subgroups of abstainers.

    Method: Data on adults aged 50-64 years (n = 2,308) came from the German Epidemiological Survey of Substance Abuse (ESA). Logistic regression was used to examine the association between different types of abstinence and socio-demographic and health-related variables.

    Results: Low income, low education and poor self-rated physical health predicted 12-month abstinence. Men with a chronic disease had a 9.5 % chance to be abstinent, whilst it was 17.7 % for women. Main motives for older lifetime abstainers were 'dislike of taste or smell', 'loss of control' and 'family constraints'. For 12-month abstainers, it was 'loss of control', 'health constraints' and 'dislike of taste or smell'.

    Conclusion: Poor health in middle-aged drinkers offers an opportunity to recommend reduction or cessation of alcohol use by explaining the negative health effects from alcohol. Future research investigating abstention needs to differentiate between lifetime and 12-month abstainers.

  • 24. 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.

  • 25. 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.

  • 26. Frischknecht, Ulrich
    et al.
    Hoffmann, Sabine
    Steinhauser, Alisa
    Lindemann, Christina
    Buchholz, Angela
    Manthey, Jakob
    Schulte, Bernd
    Rehm, Jürgen
    Kraus, Ludwig
    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; ELTE Eötvös Loránd University, Hungary.
    Verthein, Uwe
    Reimer, Jens
    Kiefer, Falk
    Screening auf problematischen Alkoholkonsum – Erhebung zur Umsetzung der S3-Leitlinienempfehlungen in der transdisziplinären Versorgung einer Modellregion: [Screening for Problematic Alcohol Consumption – A Survey on Guideline Implementation in Transdisciplinary Health Care of a Model Region]2022In: Das Gesundheitswesen, ISSN 0941-3790, E-ISSN 1439-4421, Vol. 84, no 01, p. 43-51Article in journal (Refereed)
    Abstract [en]

    Aim Recording the frequency of screenings for problematic alcohol consumption by professionals involved in the health care of respective patients. The German S3-guideline screening, diagnosis and treatment of alcohol-related disorders recommends the use of questionnaire-based screenings for all patients in all settings.

    Methods Cross-sectional survey on screening frequency among general practitioners, gynecologists, psychiatrists, child- and adolescent therapists, psychotherapists, social workers and midwives. Logistic regression was used to explore how healthcare professionals' attributes were associated with the implementation of screenings.

    Results With response rates of about 20%, health care professionals reported using screening instruments for an average of 6.9% of all patients during the previous four weeks. Most of the time, custom-made questions were used instead of the recommended instruments (AUDIT, AUDIT-C). Higher screening rates were reported for patients with newly diagnosed hypertension (21.2%), alcohol-related disorders (43.3%) and mental disorders (39.3%). Knowledge of the guideline was associated with implementation of screenings (OR=4.67; 95% KI 1.94-11.25, p<0.001).

    Conclusions Comprehensive screening for problematic alcohol use with questionnaire-based instruments in accordance with guidelines is far from being routinely implemented in the studied health care settings. Measures to increase the knowledge of the guidelines are necessary in order to increase the frequency of alcohol screening in health care. 

  • 27. 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.

  • 28. 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, 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.

  • 29. 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.

  • 30. 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
    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.

  • 31. 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
    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.

  • 32. 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.

  • 33. 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.

  • 34. 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.

  • 35. 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.

  • 36. 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.

  • 37. 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

  • 38. 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.

  • 39. 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.

  • 40. 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). IFT Institut für Therapiforschung, Germany.
    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 patterns and risk factors of alcohol, tobacco and cannabis use by level of intensity in the German general population.

    Methods: Data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used. The cross-sectional random sample consisted of N = 7912 adults aged 18–64 years. The response rate was 45%. Intensive use of each substance was measured applying substance-specific cut-off points: alcohol: >20/30 g pure ethanol daily for women/men; tobacco: ≥20 cigarettes daily; cannabis: on ≥6 occasions monthly.

    Findings: The majority of substance users reported no intensive use of any of the three substances (77.5%) and 19.4% had used one of the three substances intensively. A total of 3.1% engaged in intensive use of multiple substances with alcohol and tobacco (2.3%) as the most prevalent pattern. A higher risk for intensive use of multiple substances was found among males, older individuals and those with a substance use disorder.

    Conclusions: Results of this study call for an integrated view on substance use and related disorders in prevention and treatment, taking diverse use patterns and specific needs of substance abusers into account.

  • 41. Kilian, Carolin
    et al.
    Manthey, Jakob
    Kraus, Ludwig
    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; ELTE Eötvös Loránd University, Hungary.
    Mäkelä, Pia
    Moskalewicz, Jacek
    Sieroslawski, Janusz
    Rehm, Jürgen
    A new perspective on European drinking cultures: a model-based approach to determine variations in drinking practices among 19 European countries2021In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 116, no 8, p. 2016-2025Article in journal (Refereed)
    Abstract [en]

    Background and aims In recent decades, alcohol drinking in the European Union has been characterized by increasing homogenization of levels of drinking coupled with an overall decrease. This study examined whether we can still distinguish distinct practices of drinking by addressing two research questions: (1) are drinking practices still characterized by the choice of a certain alcoholic beverage; and (2) how do drinking practices vary across countries?

    Design Cross-sectional study: latent-class analyses of drinking variables and fractional response regression analyses of individual characteristics for individual-level class endorsement probabilities, respectively.

    Setting Nineteen European countries and one autonomous community.

    Participants A total of 27 170 past-year drinkers aged 18-65 years in 2015.

    Measurements Data were collected through the Standardized European Alcohol Survey included frequency of past-year drinking, pure alcohol intake per drink day, occurrence of monthly risky single-occasion drinking and preferred beverage, together with socio-demographic data.

    Findings Three latent classes were identified: (1) light to moderate drinking without risky single-occasion drinking [prevalence: 68.0%, 95% confidence interval (CI) = 66.7-69.3], (2) infrequent heavy drinking (prevalence: 12.6%, 95% CI = 11.5-13.7) and (3) regular drinking with at least monthly risky single-occasion drinking (prevalence: 19.4%, 95% CI = 18.1-20.9). Drinking classes differed considerably in beverage preference, with women reporting a generally higher share of wine and men of beer drinking. Light to moderate drinking without risky single-occasion drinking was the predominant drinking practice in all locations except for Lithuania, where infrequent heavy drinking (class 2) was equally popular. Socio-demographic factors and individual alcohol harm experiences (rapid alcohol on-line screen) explained up to 20.5% of the variability in class endorsement.

    Conclusions Beverage preference appears to remain a decisive indicator for distinguishing Europeans' drinking practices. In most European countries, multiple drinking practices appear to be present.

  • 42. Kilian, Carolin
    et al.
    Manthey, Jakob
    Probst, Charlotte
    Brunborg, Geir S.
    Bye, Elin K.
    Ekholm, Ola
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Moskalewicz, Jacek
    Sieroslawski, Janusz
    Rehm, Jürgen
    Why Is Per Capita Consumption Underestimated in Alcohol Surveys? Results from 39 Surveys in 23 European Countries2020In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 55, no 5, p. 554-563Article in journal (Refereed)
    Abstract [en]

    Aims: The aims of the article are (a) to estimate coverage rates (i.e. the proportion of ‘real consumption’ accounted for by a survey compared with more reliable aggregate consumption data) of the total, the recorded and the beverage-specific annual per capita consumption in 23 European countries, and (b) to investigate differences between regions, and other factors which might be associated with low coverage (prevalence of heavy episodic drinking [HED], survey methodology).

    Methods: Survey data were derived from the Standardised European Alcohol Survey and Harmonising Alcohol-related Measures in European Surveys (number of surveys: 39, years of survey: 2008–2015, adults aged 20–64 years). Coverage rates were calculated at the aggregated level by dividing consumption estimates derived from the surveys by alcohol per capita estimates from a recent global modelling study. Fractional response regression models were used to examine the relative importance of the predictors.

    Results: Large variation in coverage across European countries was observed (average total coverage: 36.5, 95% confidence interval [CI] [33.2; 39.8]), with lowest coverage found for spirits consumption (26.3, 95% CI [21.4; 31.3]). Regarding the second aim, the prevalence of HED was associated with wine- and spirits-specific coverage, explaining 10% in the respective variance. However, neither the consideration of regions nor survey methodology explained much of the variance in coverage estimates, regardless of the scenario.

    Conclusion: The results reiterate that alcohol survey data should not be used to compare or estimate aggregate consumption levels, which may be better reflected by statistics on recorded or total per capita consumption.

  • 43. Kilian, Carolin
    et al.
    Manthey, Jakob
    Rehm, Jürgen
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Deutschland; ELTE Eötvös Loránd University, Ungarn.
    Alcohol Policy in Germany: Missed Opportunities to Lower Alcohol's Health Burden2023In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 69, no 4, p. 163-171Article in journal (Refereed)
    Abstract [en]

    Upon the release of the third edition of the book Alcohol: no ordinary commodity, the authors evaluated the implementation of cost-effective alcohol policies in Germany. Method: Current legal regulations and practices addressing four policy areas were reviewed: (1) pricing and taxation policies; (2) regulating physical availability; (3) restrictions of alcohol marketing; and (4) drink-driving countermeasures. Results: Compared to other European countries, excise duties on alcoholic beverages and particularly on beer and wine are low and barely lower alcohol affordability. With few exceptions, alcoholic beverages can be purchased at any time and various retail venues (e. g., grocery stores, petrol stations). Restrictions on alcohol marketing are limited to youth protection and the portrayal of 'abusive' alcohol use. The recommended countermeasures to prevent driving under the influence of alcohol have been largely implemented. Conclusion: Cost-effective alcohol policies are insufficiently implemented in Germany, despite their potential to substantially lower the alcohol-related health burden.

  • 44.
    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)
  • 45.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Atzendorf, Josefine
    Schiele, Caroline
    Lochbühler, Kirsten
    Substanzbezogene Störungen: Ein gesellschaftliches Problem2019In: Kerbe - Forum für soziale Psychiatrie, ISSN 0724-5165, Vol. 37, no 1, p. 9-12Article in journal (Other (popular science, discussion, etc.))
  • 46.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Centre for Mental Health and Addiction Research, Germany; Eötvös Loránd University, Hungary.
    Bickl, Andreas
    Sedlacek, Lucia
    Schwarzkopf, Larissa
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Loy, Johanna K.
    'We are not the ones to blame'. Gamblers' and providers' appraisal of self-exclusion in Germany2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 322Article in journal (Refereed)
    Abstract [en]

    Background Given low utilization by individuals experiencing gambling problems the potential of self-exclusion (SE) might be not fully exploited in Germany. This paper aims to gain insight into different actors’ perceptions and reflections on the problems and difficulties in the process of self-exclusion to delineate which specific attitudes hamper a successful implementation of SE.

    Methods 13 individual and four group interviews with individuals experiencing gambling problems and governmental or commercial gambling providers were examined. A Grounded Theory Approach was used to portray the opinions of these different actors on existing regulations of SE and to delineate potentially diverging interests between the distinct groups.

    Results The interviewees agreed on the usefulness of SE and consented that it is important to early recognize individuals experiencing gambling problems. They also considered the present practice insufficient but for different reasons. Individuals experiencing gambling problems and providers particularly disagreed on addressing individuals experiencing gambling problems. While individuals experiencing gambling problems stated that they had hardly ever been approached, providers argued that help offers were mostly rejected. Especially commercial providers also regarded insufficient German language skills and rapid fluctuation of guests as strong barriers to approaching individuals experiencing gambling problems. Interviewees from governmental venues furthermore suspected that commercial providers took addressing individuals experiencing gambling problems less seriously.

    Conclusion Our results emphasize the dilemma of conflicting interests in both individuals experiencing gambling problems and providers. Rather than acting against the economic interests of employers, venue staff blame individuals experiencing gambling problems for lack of problem recognition. Conversely, individuals experiencing gambling problems blame the providers for not offering help. To address individuals experiencing gambling problems appropriate staff training is required, and SE regulations need to be controlled by an independent body rather than by the providers themselves.

  • 47.
    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.

  • 48.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Hannemann, T. -V
    Pabst, A.
    Mueller, S.
    Kronthaler, F.
    Gruebl, A.
    Stuermer, M.
    Wolstein, J.
    Inpatient Treatment of Adolescents with Acute Alcohol Intoxication: The Tip of the Iceberg?2013In: Das Gesundheitswesen, ISSN 0941-3790, E-ISSN 1439-4421, Vol. 75, no 7, p. 456-464Article in journal (Refereed)
    Abstract [en]

    Aims: This study assessed whether (i) adolescents treated in hospital for acute alcohol intoxication show different habitual drinking patterns from adolescents of the general population and whether (ii) predictors for repeated treatment can be identified. Methods: A sample of adolescents who had undergone inpatient treatment for intoxication (clinical sample) comprised n = 482 under 18-year-old subjects, who had additionally been surveyed within the context of the project Hart am Limit (HaLT) between 2008 and 2010 (mean age: 15.1 years, 44.4% girls). The population sample consisted of n = 1 994 Bavarian students who had taken part in the European School Survey Project on Alcohol and other Drugs (ESPAD) in 2007 (mean age: 15.7 years; 54.4% girls). Results: Within the clinical sample, gender differences in age, level of education and motivation to get drunk were found. Adolescents of the clinical sample were on average younger and had a higher level of education than adolescents in the general population sample. Although students in the clinical sample drank alcohol less often (2.8 vs. 5.0 times within the past 30 days), they drank more alcohol per occasion (36.4 g vs. 22.3 g pure alcohol per drinking day). Assessments by a third-party show that the risk of repeated inpatient treatment due to alcohol intoxication is positively associated with perceived psychosocial stress and negatively associated with perceived family support. Conclusions: A hospitalisation due to alcohol intoxication does not sufficiently indicate alarming habitual drinking behaviour. The risk of hospitalisation seems to depend on the drinking context and other factors of the drinking situation. Nevertheless, a sub-group of adolescents, who seem to display an elevated risk for intoxications, could be identified. It is for this sub-group, that supportive measures must be made available.

  • 49.
    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.

  • 50.
    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]

123 1 - 50 of 150
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf