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  • 101. Pampel, Fred
    et al.
    Legleye, Stephane
    Goffette, Céline
    Piontek, Daniela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Khlat, Myriam
    Cohort changes in educational disparities in smoking: France, Germany and the United States2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 127, p. 41-50Article in journal (Refereed)
    Abstract [en]

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

  • 102. Pennay, Amy
    et al.
    Holmes, John
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Livingston, Michael
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Researching the decline in adolescent drinking: The need for a global and generational approach2018In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 37, p. 115-119Article in journal (Other academic)
    Abstract [en]

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

  • 103. Pfeiffer-Gerschel, Tim
    et al.
    Schneider, Franziska
    Dammer, Esther
    Braun, Barbara
    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-Universität, Hungary.
    Methamphetaminkonsum in Deutschland: Verbreitung und Problemlage2019In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 65, no 4, p. 241-249Article, review/survey (Refereed)
    Abstract [de]

    Zusammenfassung. Zielsetzung: Um ein möglichst umfassendes und differenziertes Bild der Verbreitung von Methamphetamin (MA) in Deutschland zu zeichnen, wird im vorliegenden Beitrag mittels verschiedener Datenquellen ein überblick zur Verbreitung des Konsums von MA sowie einschlägiger Straftaten in Deutschland und Europa gegeben. Ergänzend werden Angaben zur Beratungs-/Behandlungsnachfrage in Deutschland gemacht. Methodik: Es werden verfügbare aktuelle Daten zur Konsumverbreitung, Beschlagnahmungen und Straftaten sowie von repräsentativen nationalen und regionalen Bevölkerungsstudien, Abwasseranalysen, Strafverfolgung sowie Suchtberatung und -behandlung berichtet. Ergebnisse: Insgesamt zeigt sich mit Prävalenzraten von 0,6 % (Lebenszeit) und 0,2 % (letzte 12 Monate), dass der Konsum von MA in der erwachsenen Allgemeinbevölkerung eine eher untergeordnete Rolle spielt. Es finden sich in mehreren Datenquellen regionale Unterschiede, die darauf schließen lassen, dass die Verbreitung von MA in Sachsen, Thüringen und Bayern deutlich höher ist als in anderen Regionen Deutschlands. Schlussfolgerungen: Konsum und Problemlage von MA weisen regionale Schwerpunkte insbesondere in den Grenzregionen zur Tschechischen Republik auf. Aufgrund der hohen Belastung in den betroffenen Regionen wurden in den letzten Jahren zahlreiche Interventionen initiiert, die von spezifischen Programmen zur Frühintervention bis zu strukturierten Behandlungsprogrammen reichen. Die Verbesserung der Situation in betroffenen Regionen bedarf weiterer aktiver Unterstützung durch politische und soziale Maßnahmen.

  • 104. Piontek, Daniela
    et al.
    Hannemann, Tessa-Virginia
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Implementation of community-based alcohol prevention in Karlsruhe, Germany2013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 5, p. 261-268Article in journal (Refereed)
    Abstract [en]

    Aims: The present paper aims at examining the implementation fidelity of a community-based substance use prevention program in the district of Karlsruhe (Germany). Methods: Based on an inventory assessing the formal implementation of preventive activities, communities were divided into two groups with high and low implementation fidelity, respectively. A school survey was conducted to assess the visibility, knowledge and participation in the intervention in grades 9 and 10. The sample size was 892 (response rate 21.7 %). Results: Each study group was composed of 16 communities. The major focus of the prevention activities was on the components „structure“, „communication/public relation“ and „youth protection“. More students in the group with high implementation fidelity had seen the intervention slogan (58.4 % vs. 44.6 %) and knew at least one program activity (47.8 % vs. 35.8 %). Only a minority of students had direct contact to the intervention in the past year with no differences between the two groups. Conclusions: The intervention focuses on networking and the establishment of decision-making. Differences between communities with high and low implementation fidelity vanish when adolescents are asked for program exposure. Overall program reach can be considered low.

  • 105. Piontek, Daniela
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. FT Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Trends in alcohol-related mortality in East and West Germany, 1980-2014: age, period and cohort variations2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 5, p. 836-844Article in journal (Refereed)
    Abstract [en]

    Background and aims Several indicators suggest that the extent and trends of alcohol-related mortality differ between East and West Germany. Regional drinking patterns and differences in health-care systems are assumed to affect the risk of dying from an alcohol-induced disease. The study addresses two questions: (1) what are the unbiased and independent age, period and cohort effects on alcohol-related mortality trends in Germany; and (2) do these trends differ between East and West Germany? Methods Data on alcohol-related mortality for East and West Germany came from the national causes of death register for the years 1980-2014. Analyses included all deaths fully attributable to alcohol based on the International Classification of Diseases (ICD-9 and ICD-10). Gender-stratified age-period-cohort analyses were conducted using the intrinsic estimator model. Results Age effects showed a concave pattern with a peak at ages 55-64years in both regions. Incidence rate ratios (IRR) in East Germany were highest in the years 1990-1994 (men and women: IRR=1.52) and declined thereafter. In West Germany, IRR were lowest in 1980-1984 (men: IRR=0.81, women: IRR=0.75) and stabilized at approximately 1.10 since 1995-1999. Cohort effects showed continuously lower IRR for those born after 1955-1959 in the East and those born after 1945-1949 in the West. Patterns for males and females were comparable. Conclusions The results suggest that alcohol-related mortality showed different trends in East and West Germany, which can be explained partly by different drinking patterns before and changes in the health-care system after the reunification.

  • 106. Piontek, Daniela
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Bjarnason, Thoroddur
    Demetrovics, Zsolt
    Ramstedt, Mats
    Individual and country-level effects of cannabis-related perceptions on cannabis use: A multilevel study among adolescents in 32 European countries2013In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 52, no 4, p. 473-479Article in journal (Refereed)
    Abstract [en]

    Purpose. The present paper investigated individual and aggregated effects of cannabis-related perceptions and other cannabis-related indicators on 12-months cannabis use prevalence and frequency among 15-16 year olds using multilevel analysis across 32 European countries.

    Methods. Data on cannabis use, perceptions of availability, risks and friends’ use as well as socio-demographic characteristics were taken from the 2007 European School Survey Project on Alcohol and Other Drugs (ESPAD). On country-level, aggregated measures of the perceptions were used. Moreover, data on cannabis price and 12-months cannabis use prevalence in the total population were taken from the World Drug Report. The analytical sample comprised n = 86,107 students (82.5 % of the overall 2007 international database).

    Results. Strong and persistent individual-level effects were identified for perceived availability, perceived harm and the number of cannabis using friends. The effects on cannabis use prevalence and frequency were more pronounced than country-level effects. On country-level, aggregated perceived peer consumption and population prevalence were significant predictors, while price was found not related to both outcome variables. The association between perceived friends’ use and cannabis use was moderated by aggregated perceived availability.

    Conclusions. Proximal influences related to the immediate social situation seem to be more strongly associated with cannabis use than distal influences related to social contexts emphasizing the importance of personal attitudes and perceptions in substance use behaviour. Prevention programs may focus on informing adolescents about the potential risks of cannabis and on correcting misperceptions of social norms. Policy measures may target on reducing visibility of drug use.

  • 107. Piontek, Daniela
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Gomes de Matos, Elena
    Atzendorf, Josefine
    Der Epidemiologische Suchtsurvey 2015: Studiendesign und Methodik2016In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 62, no 5, p. 259-269Article in journal (Refereed)
    Abstract [en]

    Aims: The paper gives an overview on methods and study design of the 2015 Epidemiological Survey of Substance Abuse (ESA). Methods: The sampling frame of the ESA included German-speaking individuals living in private households aged 18 to 64 years. A sample was drawn from population registers using a two-stage probability design oversampling younger birth cohorts. The survey was realized using paper-and-pencil questionnaires, telephone interviews, and online questionnaires. Results: A total of 9204 individuals participated in the survey, resulting in a response rate of 52.2 %. Using redressement weights, the sample could be adjusted to the distribution of the general population according to federal state, size of the community, sex, year of birth, and school education. Survey nonrespondents showed more problematic consumption patterns than respondents. Individuals in the paper-and-pencil mode reported higher rates of substance use compared to those in the telephone and online mode. Conclusions: By using different modes of administration and weighting procedures, representativeness of the 2015 ESA data on (clinically relevant) consumption of legal and illegal substances and pharmaceuticals is ensured.

  • 108. Piontek, Daniela
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Gomes de Matos, Elena
    Pabst, Alexander
    Komorbide Substanzstörungen in der erwachsenen Allgemeinbevölkerung2013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 6, p. 347-354Article in journal (Refereed)
    Abstract [en]

    Aims: It is aimed to assess homotypic comorbidity of substance use disorders in a representative sample of the adult general population in Germany. Methods: Data from the 2012 Epidemiological Survey of Substance Abuse are used. Based on a two-stage probability sampling, a total of n = 9 084 individuals participated (net response rate 53.6 %). Substance use disorders according to DSM-IV for alcohol, tobacco, cannabis, cocaine, amphetamines, analgesics, hypnotics and tranquilizers were assessed using the Munich Composite International Diagnostic Interview (M-CIDI). Results: Multiple diagnoses (abuse and/or dependence) were prevalent in 6.6 % of the sample. The percentage of comorbid substance use disorders was highest among those with a diagnosis related to cannabis, hypnotics and cocaine. Risk factors for at least one and more than one substance use disorders were male gender, younger age, lower educational level, being single or divorced and non-German citizenship. Conclusions: A relevant proportion of the general population in Germany is affected by more than one clinical diagnosis related to substance use. Further epidemiological research is necessary to describe this population of high risk.

  • 109. Piontek, Daniela
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Rist, Fred
    Social context and the occurrence of episodic heavy drinking2013In: International Journal of Alcohol and Drug Research, ISSN 1925-7066, Vol. 2, no 2, p. 45-52Article in journal (Refereed)
    Abstract [en]

    Aims: This study aims to investigate the influence of social context variables on Episodic Heavy Drinking (EHD) among young adults. It will assess (a) whether EHD is predicted by characteristics of the specific drinking situation and drinking motives, and (b) whether the influence of drinking motives is moderated by public versus private drinking. Design/Setting: Data were collected by means of an online survey conducted at the University of Münster (Germany) in December 2008. Participants: The analytical sample consisted of 1,638 students. Instruments: Information was collected on socio-demographics, habitual drinking behavior (beverage-specific quantity and frequency within the past 30 days, EHD, drunkenness), and drinking motives (Drinking Motive Questionnaire Revised, DMQ-R). Moreover, participants described a recent drinking situation (beverage-specific quantity, drunkenness) as well as the social context related to this situation (time, place, people present, other substances used). Multivariate regression analyses were used to test the influence of context variables and their interaction with drinking motives. Findings: Drinking at a birthday or special party, during the weekend, or in a group where many people were drunk and playing drinking games increased the risk of EHD. Social and enhancement motives were associated with a higher risk for EHD, whereas conformity motives had a protective effect on heavy drinking. The effect of conformity motives was only present in public drinking situations. Conclusions: Drinking in young people is a social phenomenon related to situational influences as well as individual characteristics. In addition, there seems to be situational moderation of the impact of specific drinking motives.

  • 110. Raitasalo, Kirsimarja
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Bye, Elin K.
    Karlsson, Patrik
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Tigerstedt, Christoffer
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Raninen, Jonas
    Similar countries, similar factors? Studying the decline of heavy episodic drinking in adolescents in Finland, Norway and Sweden2021In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 116, no 1, p. 62-71Article in journal (Refereed)
    Abstract [en]

    Aims

    To (1) examine several factors associated with trends in heavy episodic drinking (HED) in Finland, Norway and Sweden, (2) investigate similarities in these associations across the countries and (3) analyse the contribution of these factors to the trend in HED and the differences across the countries.

    Design and Setting

    Observational study using five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from Finland, Norway and Sweden between 1999 and 2015.

    Participants

    A total of 18,128 male and 19,121 female 15‐ to 16‐year‐old students.

    Measurements

    Monthly HED, perceived access to alcohol, truancy, parental control, leisure time activities and daily smoking. The Cochran–Armitage test was used to examine linear time trends in HED. Logit regression models using the Karlson–Holm–Breen (KHB) method were fitted for each country separately, including all the independent variables together with time and adjusted for family status, parental education and gender.

    Findings

    In Finland, Norway and Sweden, perceived access to alcohol, truancy and daily smoking decreased significantly between 1999 and 2015 while risk perceptions, parental control and participation in sports increased in the same period. The confounding percentage of all the independent variables related to the trend in HED was 48.8%, 68.9% and 36.7% for Finland, Norway and Sweden, respectively. Decline in daily smoking (p<.001) and perceived access to alcohol (p<.001) were positively and increase in parental control (p<.001) negatively associated with the decline in HED in all three countries. Changes in truancy, going out with friends, and engaging in sports and other hobbies had little or no impact on the decline in HED or displayed no consistent results across the countries.

    Conclusions

    The decline in adolescent heavy episodic drinking in Finland, Norway and Sweden between 1999 and 2015 appears to be associated with a decline in adolescent daily smoking and perceived access to alcohol and an increase in parental control.

  • 111. Rauschert, Christian
    et al.
    Möckl, Justin
    Seitz, Nicki-Nils
    Wilms, Nicolas
    Olderbak, Sally
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    The Use of Psychoactive Substances in Germany: Findings from the Epidemiological Survey of Substance Abuse 20212022In: Deutsches Ärzteblatt International, E-ISSN 1866-0452, Vol. 119, no 31-32, p. 527-534Article in journal (Refereed)
    Abstract [en]

    Background: Monitoring the use of psychoactive substances and substance-related problems in the population allows for the assessment of prevalence and associated health and social consequences.

    Methods: The data are derived from the Epidemiological Survey of Substance Abuse (ESA) 2021 (n = 9046, 18–64 years). We estimated prevalence rates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications, as well as the prevalence rates of their problematic use (indicating dependence) using screening instruments, and extrapolated the results to the resident population (N = 51 139 451).

    Results: Alcohol was the most frequently used substance, with a 30-day prevalence of 70.5% (36.1 million people), followed by non-opioid analgesic drugs (47.4%; 24.2 million) and conventional tobacco products (22.7%; 11.6 million). E-cigarettes were used by 4.3% (2.2 million) and heat-not-burn products by 1.3% (665 000). Among illegal drugs (12-month prevalence), cannabis was the most frequently used (8.8%; 4.5 million), followed by cocaine/crack (1.6%; 818 000) and amphetamine (1.4%; 716 000). Rates of problematic use among the study participants were 17.6% for alcohol (9.0 million), 7.8% for tobacco (4.0 million), 5.7% for psychoactive medications (2.9 million), and 2.5% for cannabis (1.3 million).

    Conclusion: The consumption of psychoactive substances continues to be widespread in Germany. In view of the imminent legal changes, the high prevalence of cannabis use and its problematic use need to be taken into consideration.

  • 112. Rauschert, Christian
    et al.
    Seitz, Nicki-Nils
    Olderbak, Sally
    Pogarell, Oliver
    Dreischulte, Tobias
    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.
    Abuse of Non-opioid Analgesics in Germany: Prevalence and Associations Among Self-Medicated Users2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 864389Article in journal (Refereed)
    Abstract [en]

    Background: Abuse of non-opioid analgesics (NOA) is associated with serious health consequences. However, due to inconsistent definitions of NOA abuse, prevalence estimates for the German population are unclear.

    Objectives: This study aimed to estimate the 12-month prevalence of NOA abuse among self-medicated users of these drugs in the general German population and to identify risk factors.

    Methods: Data are from the 2015 Epidemiological Survey of Substance Abuse, a nationally representative sample with 9,204 individuals aged 18–64 years. Classification of NOA abuse was based on self-reported information according to the definition of the ICD-10-GM diagnosis F55.2 abuse of non-dependence producing substances. Multiple logistic regression was performed to examine associations between NOA abuse and sociodemographic, behavioral, and health-related variables.

    Results: The weighted 12-month prevalence of NOA abuse was 14.6% (95%-CI [13.2- 16.0]) among self-medicated users of these drugs. Extrapolation of the proportion of individuals abusing NOA to the German population aged 18 to 64 is 3,243,396 individuals or 6.4% (95%-CI [5.7- 7.1]). Inexplicable physical pain, being underweight, depression, hazardous alcohol use, daily smoking, illegal drug use, and frequent use of NOA (one or more times per week and daily use) were associated with an increased probability of NOA abuse. The use of cannabis was associated with a lower probability of NOA abuse.

    Conclusion: Abuse of NOA is highly prevalent in the German population. Against the background of increasing self-medication of NOA, healthcare providers need to be aware of potential risk factors of abuse to better identify and prevent this problem. 

  • 113. Rauschert, Christian
    et al.
    Seitz, Nicki-Nils
    Olderbak, Sally
    Pogarell, Oliver
    Dreischulte, Tobias
    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.
    Subtypes in Patients Taking Prescribed Opioid Analgesics and Their Characteristics: A Latent Class Analysis2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 918371Article in journal (Refereed)
    Abstract [en]

    Background: Owing to their pharmacological properties the use of opioid analgesics carries a risk of abuse and dependence, which are associated with a wide range of personal, social, and medical problems. Data-based approaches for identifying distinct patient subtypes at risk for prescription opioid use disorder in Germany are lacking.

    Objective: This study aimed to identify distinct subgroups of patients using prescribed opioid analgesics at risk for prescription opioid use disorder.

    Methods: Latent class analysis was applied to pooled data from the 2015 and 2021 Epidemiological Survey of Substance Abuse. Participants were aged 18–64 years and self-reported the use of prescribed opioid analgesics in the last year (n = 503). Seven class-defining variables based on behavioral, mental, and physical health characteristics commonly associated with problematic opioid use were used to identify participant subtypes. Statistical tests were performed to examine differences between the participant subtypes on sociodemographic variables and prescription opioid use disorder.

    Results: Three classes were extracted, which were labeled as poor mental health group (43.0%, n = 203), polysubstance group (10.4%, n = 50), and relatively healthy group (46.6%, n = 250). Individuals within the poor mental health group (23.2%, n = 43) and the polysubstance group (31.1%, n = 13) showed a higher prevalence of prescription opioid use disorder compared to those of the relatively healthy group.

    Conclusion: The results add further evidence to the knowledge that patients using prescribed opioid analgesics are not a homogeneous group of individuals whose needs lie in pain management alone. Rather, it becomes clear that these patients differ in their individual risk of a prescription opioid use disorder, and therefore identification of specific risks plays an important role in early prevention.

  • 114. Rehm, J.
    et al.
    Anderson, P.
    Gual, A.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Marmet, S.
    Nutt, D. J.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University of Melbourne, Australia; Turning Point Alcohol & Drug Centre, Australia.
    Samokhvalov, A. V.
    Scafato, E.
    Shield, K. D.
    Trapencieris, M.
    Wiers, R. W.
    Gmel, G.
    The tangible common denominator of substance use disorders: a reply to Commentaries to Rehm et al. (2013a)2014In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 49, no 1, p. 118-122Article in journal (Refereed)
    Abstract [en]

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

  • 115. Rehm, J.
    et al.
    Marmet, S.
    Anderson, P.
    Gual, A.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Nutt, D. J.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University of Melbourne, Australia; Turning Point Alcohol & Drug Centre, Australia.
    Samokhvalov, A. V.
    Scafato, E.
    Trapencieris, M.
    Wiers, R. W.
    Gmel, G.
    Defining Substance Use Disorders: Do We Really Need More Than Heavy Use?2013In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 48, no 6, p. 633-640Article in journal (Refereed)
    Abstract [en]

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

  • 116. Rehm, Jürgen
    et al.
    Anderson, Peter
    Prieto, Jose Angel Arbesu
    Armstrong, Iain
    Aubin, Henri-Jean
    Bachmann, Michael
    Bastus, Nuria Bastida
    Brotons, Carlos
    Burton, Robyn
    Cardoso, Manuel
    Colom, Joan
    Duprez, Daniel
    Gmel, Gerrit
    Gual, Antoni
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Kreutz, Reinhold
    Liira, Helena
    Manthey, Jakob
    Møller, Lars
    Okruhlica, L´ubomír
    Roerecke, Michael
    Scafato, Emanuele
    Schulte, Bernd
    Segura-Garcia, Lidia
    Shield, Kevin David
    Sierra, Cristina
    Vyshinskiy, Konstantin
    Wojnarand, Marcin
    Zarco, José
    Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union2017In: BMC Medicine, E-ISSN 1741-7015, Vol. 15, article id 173Article in journal (Refereed)
    Abstract [en]

    Background

    Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.

    Methods

    A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statisticalmodelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.

    Results

    Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.

    Conclusions

    The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

  • 117. Rehm, Jürgen
    et al.
    Andersson, Peter
    Barry, Joe
    Dimitrov, Plamen
    Elekes, Zsuzsanna
    Feijão, Fernanda
    Frick, Ulrich
    Gual, Antoni
    Gmel, Gerrit Jr.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Marmet, Simon
    Raninen, Jonas
    Rehm, Maximilien X.
    Scafato, Emanuel
    Shield, Kevin D.
    Trapencieris, Marcis
    Gmel, Gerhard
    Prevalence of and potential influencing factors for alcohol dependence in Europe2015In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 21, no 1, p. 6-18Article in journal (Refereed)
    Abstract [en]

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

  • 118. Rehm, Jürgen
    et al.
    Arbesu Prieto, Jose Angel
    Beier, Markus
    Duhot, Didier
    Rossi, Alessandro
    Schulte, Bernd
    Zarco, Jose
    Aubin, Henri-Jean
    Bachmann, Michael
    Grimm, Carsten
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Manthey, Jakob
    Scafato, Emanuele
    Gual, Antoni
    The role of alcohol in the management of hypertension in patients in European primary health care practices - a survey in the largest European Union countries2016In: BMC Family Practice, E-ISSN 1471-2296, Vol. 17, article id 130Article in journal (Refereed)
    Abstract [en]

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

  • 119. Rehm, Jürgen
    et al.
    Probst, Charlotte
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The addiction concept revisited2014In: Reframing addiction: policies, processes and pressures. / [ed] Peter Andersson, Gerhard Bühringer, Joan Colom, Alice Rap , 2014, p. 103-117Chapter in book (Refereed)
    Abstract [en]

    Summary: In the past 50 years, there had been quite varied definitions and operationalizations of the term addiction, and up to today, there are different underlying concepts in the two major classification systems by the World Health Organization (ICD) and by the American Psychiatric Association (DSM). This chapter reviews current and past definitions and introduces a new concept “heavy use over time” which could replace current definitions. First, heavy use over time causes the changes in the brain we currently associate with substance use disorders. Second, heavy use over time is also very closely linked to all criteria used to define such disorders in medical classification systems. Third, heavy use over time is easy to operationalize and fourth, it has been shown to associate with mortality and morbidity outcomes of dependence or other substance use disorders better than current diagnostic criteria. Finally, defining substance use disorders as heavy use over time promises to better align treatment with standard medical treatments and could play a role in reducing stigma. To summarize, heavy use over time promises to reconceptualise addictions/substance use disorders in a parsimonious and consistent matter, in line with major scientific results.

  • 120.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Greenfield, Thomas K.
    Holmes, John
    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.
    Livingston, Michael
    Pennay, Amy
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Supranational changes in drinking patterns: factors in explanatory models of substantial and parallel social change2020In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 28, no 6, p. 467-473Article in journal (Refereed)
    Abstract [en]

    Background: That there have been 'long waves' of consumption in parallel in different societies has previously been noted. Now there is a sustained drop in drinking among youth in most of Europe, Australia and North America. Can such changes be understood in a common frame? In terms of inexorable historical phenomena or forces, like Kondratieff waves? In terms of generational shifts, with a younger generation reacting against the habits of an older? Method: Such conceptual models for understanding the dynamics of social change are examined in terms of their potential contribution in explaining when and how substantial changes in levels of consumption occur roughly in concert in different societies, with particular reference to the decline in drinking and heavy drinking in current youth cohorts. Results and Conclusion: Timing tends to rule out economic change as a factor in the current widespread decline in youth drinking. The technological revolution of the electronic web and the smart phone seems a primary explanation, with the widespread change in social presentation and interaction - in habitus - between parents and children also involved. Directions for further research are suggested.

  • 121. Sassen, Monika
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Buehringer, Gerhard
    Differences in pathological gambling prevalence estimates: facts or artefacts?2011In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 20, no 4, p. e83-E99Article in journal (Refereed)
    Abstract [en]

    The paper aims at investigating whether survey methodology has recently converged to justify the common practice of comparing prevalence estimates and interpreting differences within and between countries. To this end, prevalence studies of problem (PrG) and pathological gambling (PG) published in peer-reviewed journals between 2000 and 2010 were critically reviewed. A systematic computer-based literature search was conducted within various databases and major gambling journals. In a two-step search process, a total of 39 studies reporting current prevalence data of non-clinical national samples from different countries were identified. Analyses revealed wide ranges in estimated PrG/PG rates for adults, adolescents, and college students, whereas similar estimates were reported in two studies on PrG/PG in seniors. Despite the discussion on methodological consistency in the field of gambling research, comparability of the reported estimates was found to be still highly limited by major variation between studies with regard to survey description, administration format, exclusion criteria, assessment instrument, cut-off scores, sample frame, and reference period. The interpretation of differences in PrG and PG prevalence estimates within and between countries may be improved by using valid and reliable instruments and by applying comparable survey methodology in well-defined populations.

  • 122. Schomerus, Georg
    et al.
    Bauch, Alexandra
    Elger, Bernice
    Evans-Lacko, Sara
    Frischknecht, Ulrich
    Klingemann, Harald
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Kostrzewa, Regina
    Rheinländer, Jakob
    Rummel, Christina
    Schneider, Wiebke
    Speerforck, Sven
    Stolzenburg, Susanne
    Sylvester, Elke
    Tremmel, Michael
    Vogt, Irmgard
    Williamson, Laura
    Heberlein, Annemarie
    Rumpf, Hans-Jürgen
    Das Stigma von Suchterkrankungen verstehen und überwinden2017In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 63, no 5, p. 253-259Article in journal (Refereed)
    Abstract [en]

    Stigma does harm to individuals with substance use disorders (SUD), and it increases the burden of SUDs. It presents a barrier to help seeking, results in lower treatment quality and increases social and health related consequences of SUDs. This applies to both the individual, societal and economic consequences of substance use. Moreover, stigmatizing persons with addictions is an ethical problem, since it discriminates against a certain group and infringes on their human dignity.

    Dealing with substance use disorders without stigma is possible. Eliminating the stigma of SUDs means finding better ways to deal with SUDs and to make these ways available to everyone. Instead of devaluing, marginalizing and disciplining persons with SUD, empowerment and appreciation need to be at the core of dealing with SUD in prevention, treatment and every day life.

  • 123. Schulte, Bernd
    et al.
    Jacobsen, Britta
    Kuban, Maria
    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, Sweden; ELTE Eötvös Loránd University, Hungary.
    Reimer, Jens
    Schmidt, Christiane Sybille
    Schaeffer, Dirk
    Umsetzung von Testung, Diagnostik und Behandlung der Hepatitis C in Einrichtungen der niedrigschwelligen Drogenhilfe in Deutschland – eine Querschnittsbefragung: [Implementation of testing, diagnostic and treatment of hepatitis C in low-threshold drug help facilities in Germany - a cross-sectional survey]2022In: Suchttherapie, ISSN 1439-9903, E-ISSN 1439-989X, Vol. 23, no 03, p. 121-129Article in journal (Refereed)
    Abstract [en]

    Background AIDS and drug aid facilities offer a low-threshold access for people with injecting and other forms of drug use and thus play a central role in reducing hepatitis C virus (HCV) infections in this high-risk group. The aim of this study is to describe the provision and barriers of HCV-specific measures in facilities with low-threshold services for drug users in Germany.

    Method The cross-sectional survey addressed facility structures, availability of HCV-specific measures (prevention, testing, diagnostics, therapy), structural, facility-related and patient-related barriers. The allocation of consumer paraphernalia was used as a criterion for the selection of facilities with low-threshold access for people with injecting and other forms of drug use. The data analysis was carried out descriptively by summarizing and analyzing facilities based on their characteristics.

    Results Of the 380 facilities contacted, responses from 135 facilities with low-threshold access for people with injecting and other forms of drug use were included in the analysis. Most of the facilities offer information on safer use (98.5%) and HCV-counselling (87.4 %). Around 28% of the facilities have HCV antibody or rapid tests available. 40% and 64.4% of all facilities stated that clients with a positive antibody test result or with a corresponding diagnosis (e.g. chronic HCV infection) can be referred to medical care. Insufficient funding and client-related barriers (e.g. lack of reliability) were mentioned as the main barriers to improving the implementation of HCV-specific measures.

    Conclusions While general HCV-prevention measures are an integral part of low-threshold services for drug users in Germany, the availability and uptake of HCV testing and HCV care services for people with injecting and other forms of drug use is not sufficient to significantly reduce HCV infections in this high-risk group. In addition to adequate funding, client-centered interventions are needed to improve the uptake of such offers.

  • 124. Schulte, Bernd
    et al.
    Lindemann, Christina
    Buchholz, Angela
    Rosahl, Anke
    Härter, Martin
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Kiefer, Falk
    Frischknecht, Ulrich
    Hoffmann, Sabine
    Wensing, Michel
    C'Donnell, Amy
    Manthey, Jakob
    Rehm, Jürgen
    Schäfer, Ingo
    Verthein, Uwe
    Reimer, Jens
    Tailored interventions to support the implementation of the German national guideline on screening, diagnosis and treatment of alcohol- related disorders: a project protocol2019In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 65, no 6, p. 373-381Article in journal (Refereed)
    Abstract [en]

    Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.

  • 125. Schwarz, Tanja
    et al.
    Anzenberger, Judith
    Busch, Martin
    Gmel, Gerhard
    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; University Medical Centre Hamburg-Eppendorf, Germany.
    Krausz, Michael
    Labhart, Florian
    Meyer, Maximilian
    Schaub, Michael P.
    Westenberg, Jean N.
    Uhl, Alfred
    Opioid agonist treatment in transition: A cross-country comparison between Austria, Germany and Switzerland2024In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 254, article id 111036Article in journal (Refereed)
    Abstract [en]

    Background and Aims: OAT is a well developed and successful treatment strategy for opioid dependent patients in Europe. It has significantly contributed to the fight against the HIV and HCV pandemics, leading to an increased life expectancy in this population. Building on the OAT experiences in Austria, Germany, and Switzerland and their models of care, the objective of this study is to analyse experiences and changes in patient structures to identify necessary adaptations for the system of care.

    Methods: We analysed national register-based data from patients receiving OAT during the period spanning from 2010 to 2020 in Austria, Germany (cases), and Switzerland. We examined and compared OAT policies and practice at national levels through a review of literature and publicly available policy documents.

    Results: Across these three countries, the life expectancy of OAT patients increased substantially. The mean age increased from 33.0 in 2010 to 39.1 in 2020 in Austria, from 35.6 years to 41.5 years in Germany (cases), and from 39.6 to 47.1 in Switzerland, respectively. In all three countries, the percentage of patients/cases aged 60 years and older increased more than tenfold between 2010 and 2020.

    Conclusions: Integrated support models, reliable care structures, internationally comparable high treatment coverage, flexible prescribing practices, and a wide range of available OAT medications are successful strategies. The experiences in these countries indicate that it is possible to address the complex and chronic nature of opioid dependence and its concurrent mental and physical health challenges, resulting in an increasing life expectancy of OAT patients.

  • 126. Schwarzkopf, Larissa
    et al.
    Dorscht, Lisa
    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.
    Luttenberger, Katharina
    Is bouldering-psychotherapy a cost-effective way to treat depression when compared to group cognitive behavioral therapy - results from a randomized controlled trial2021In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, no 1, article id 1162Article in journal (Refereed)
    Abstract [en]

    Background: Bouldering-Psychotherapy (BPT) has proven to effectively reduce depressive symptoms, but evidence on its cost-effectiveness is lacking. Corresponding information is paramount to support health policy decision making on a potential implementation of BPT in routine care.

    Methods: Using data from the German KuS trial BPT was compared with group Cognitive Behavioral Therapy (CBT). Severity of depression symptoms at end of the intervention was operationalized via Montgomery-Asberg Depression Rating Scale (MADRS) and Patient Health Questionnaire (PHQ-9). Adopting a societal perspective, direct medical costs and productivity loss were calculated based on standardized unit costs. To determine incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves (CEAC), adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) were obtained from 1000 simultaneous bootstrap replications.

    Results: BPT was related to improved effects (AMDs: MADRS -2.58; PHQ-9: - 1.35) at higher costs (AMD: +euro 754). No AMD was significant. ICERs amounted to euro288 per MADRS-point and euro550 per PHQ-9-point. For both effect parameters about 20% of bootstrap replications indicated dominance of BPT, and about 75% larger effects at higher costs. At hypothetical willingness to pay (WTP) thresholds of euro241 (MADRS) and euro615 (PHQ-9) per unit of change BPT had a 50% probability of being cost-effective.

    Conclusion: BPT is a promising alternate treatment strategy which - in absence of established WTP thresholds for improving symptoms of depression - cannot unambiguously be claimed cost-effective. Further studies defining subgroups that particularly benefit from BPT appear paramount to delineate recommendations for an efficient prospective roll-out to routine care.

  • 127. Simon, Roland
    et al.
    Pfeiffer-Gerschel, Tim
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Globale, europäische, nationale und regionale Langzeittrends im Drogenkonsum: Gemeinsamkeiten und Unterschiede2018In: Sucht aktuell, ISSN 1437-1650, Vol. 25, no 1, p. 10-15Article in journal (Refereed)
  • 128. Sleczka, Pavel
    et al.
    Braun, Barbara
    Piontek, Daniela
    Bühringer, Gerhard
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, München, Germany.
    DSM-5 criteria for gambling disorder: Underlying structure and applicability to specific groups of gamblers2015In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 4, no 4, p. 226-235Article in journal (Refereed)
    Abstract [en]

    Background and Aims: DSM-5 provides nine diagnostic criteria for gambling disorder. All criteria have a pre-assumed equal diagnostic impact and are applied to all individuals and groups in an equal manner. The aims of the study are to analyse the structure underlying the diagnosis and to assess whether DSM-5 is equally applicable to different groups of gamblers. 

    Methods: Data from the 2009 German Epidemiological Survey of Substance Abuse and from a study on slot machine gamblers were used. Item Response Theory analysis was applied to estimate discrimination and severity parameters of the criteria. With the use of Differential Item Functioning analysis, potential criterion biases were analysed. We analysed data from 107 participants from the general population sample and 376 participants from the slot machine gamblers' sample who answered a 19-item diagnostic questionnaire based on the DSM criteria for gambling disorder. 

    Results: A single underlying factor, the severity of gambling disorder, was identified in both samples. In the general population sample the criteria of preoccupation and chasing were least severe and showed low discriminatory power. Bailout, withdrawal and jeopardized matters criteria had highest severity and discriminatory power. The comparison of the two samples revealed two criterion biases in the preoccupation and tolerance criteria. 

    Conclusions: The structure underlying the criteria is unidimensional but the disorder is manifested differently depending on disorder severity. The assumed equal impact of each criterion lacks support in the findings. The DSM-5 criteria measure a partially different construct in slot machine gamblers than in gamblers in the general population.

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  • 129. Sleczka, Pavel
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Braun, Barbara
    Bühringer, Gerhard
    Komorbide Störungen bei pathologischen Glücksspielern: ein Überblick2013In: rausch- Wiener Zeitschrift fur Suchtterapie, ISSN 2190-443X, Vol. 2, no 3, p. 171-177Article in journal (Refereed)
  • 130. Sleczka, Pawel
    et al.
    Braun, Barbara
    Grüne, Bettina
    Bühringer, Gerhard
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Family functioning and gambling problems in young adulthood: the role of the concordance of values2018In: Addiction Research and Theory, ISSN 1058-6989, Vol. 26, no 6, p. 447-456Article in journal (Refereed)
    Abstract [en]

    Background: Although young adult men are at an elevated risk for gambling problems (GP), compared to adolescents and adults in general this group is still largely unresearched. The current study investigates whether family functioning, which is associated with reduced risk for GP in adolescence, also affects gambling in young adults, who are more independent than minors. It analyses the relationship between GP and two core components of family functioning, the effectiveness of problem-solving in the family and perceived concordance of values.

    Methods: Data came from the baseline, 12- and 24-month follow-up assessments of Munich Leisure-time Study (MLS), a longitudinal online study in young male gamblers. Young men were recruited via the Munich citizens’ registry (n = 2,693) and Facebook invites (n = 105). In total, n = 173 individuals positively screened for frequent and/or regular gambling participated in the study. The hypothesised relations between problem-solving, concordance of values and GP were investigated with a path model controlling for non-planning impulsiveness and psychological distress.

    Results: Higher concordance of family values was significantly related to less GP in cross-sectional and longitudinal analyses. It mediated the relation between the effectiveness of problem-solving and GP.

    Conclusions: While previous studies indicated good family functioning as a factor preventive of GP, the current results indicate that this association is mediated by the perceived concordance of family values. In families with effective problem-solving, common family values might facilitate recognition of and reaction to first signs of problems. Perceived discordance may lead to feelings of shame and concealment of GP.

  • 131. Sleczka, Pawel
    et al.
    Braun, Barbara
    Grüne, Bettina
    Bühringer, Gerhard
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Proactive coping and gambling disorder among young men2016In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 5, no 4, p. 639-648Article in journal (Refereed)
    Abstract [en]

    Objectives: Male sex, young age, and frequent gambling are considered as risk factors for gambling disorder (GD) and stress might be one of the triggers of gambling behavior among problem gamblers. Conversely, well-developed coping with stress might counteract gambling problems. The Proactive Coping Theory provides a promising approach for the further development of preventive and treatment measures. The objective of the study was to investigate different facets of proactive coping (PC) in young male gamblers.

    Methods: Young men from Bavaria were recruited via the Munich citizens’ registry (n = 2,588) and Facebook invitations (n  = 105). In total, 173 out of 398 individuals were positively screened for frequent gambling and/or signs of related problems and completed the baseline questionnaire of the Munich Leisure-time Study. Factors investigated include gambling problems, PC, impulsiveness, social support, and psychological distress.

    Results: Gambling problems were associated with lower levels of preventive coping as well as of adaptive reaction delay. The associations were also significant when controlled for impulsiveness and general psychological distress. Preventive coping moderated the association between social support and gambling problems.

    Discussion and conclusions: Young men with gambling problems less frequently prevent the occurrence of stressors and more often react hasty when these occur. While the investigated group reported good social support, this factor was negatively associated with GD only among individuals with good preventive coping. Preventive coping poses a useful construct for selective prevention and treatment as it can be modified in professional interventions.

  • 132. Sleczka, Pawel
    et al.
    Braun-Michl, Barbara
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Gamblers' attitudes towards money and their relationship to gambling disorder among young men2020In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 9, no 3, p. 744-755Article in journal (Refereed)
    Abstract [en]

    Background and aims: Money plays a central role in gambling, and understanding the different attitudes of gamblers towards it might benefit both prevention and treatment of gambling-related problems. This study describes the development of a new German measure of attitudes to money and the differences in these attitudes between male non-gamblers, occasional, frequent and problem gamblers. Furthermore, it investigates the cross-sectional and longitudinal associations between attitudes towards money and the severity of gambling disorder.

    Methods: An online study was conducted among 2,584 men aged 18–25 years, recruited via the Munich citizen registry. Additionally, a sample of n = 105 Facebook users was included in part of the analyses. Frequent and problem gamblers were invited to a 12-month follow-up. Apart from gambling participation and related problems, the questionnaire included items from existing scales measuring attitudes to money.

    Results: Three factors underlying a new 12-item German Scale of Money Attitudes (SMAG) were identified: success, budgeting and evil. Compared with other groups, participants reporting any gambling problems scored highest in success and lowest in budgeting. Budgeting was associated with gambling-related problems in both cross-sectional and longitudinal analyses and strengthened the relationship between associating money with success and gambling disorder.

    Discussion: For problem gamblers, money is important as a personal symbol of success. This attitude has an especially negative effect on gambling-related problems in individuals who handle money irresponsibly. Spending and winning money might play an important role in maintaining self-esteem among gamblers and thus hinder their attempts to quit.

  • 133. Sleczka, Pawel
    et al.
    Braun-Michl, Barbara
    Schwarzkopf, Larissa
    Spörrle, Matthias
    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, Munich, Germany; ELTE Eötvös Loránd University, Budapest, Hungary.
    Why do they gamble and what does it mean? Latent class analysis of gambling motives among young male gamblers2022In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 30, no 6, p. 431-440Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Motives to gamble are important in the functional analysis of problematic gambling. This study examines the possibility of classifying young male gamblers based on their motives to gamble and compares the identified groups to validate the obtained classification.

    METHOD Based on a screening survey among 2,681 young men from Bavaria, n=170 frequent or problem gamblers (Mage = 22.3 years, SD = 2.5) were recruited to participate in a survey with a 2-year follow-up. Latent class analyses (LCA) were conducted based on baseline answers to 10 items measuring five domains of gambling motives: enhancement, coping, self-gratification, and social and financial motives. The identified classes were compared regarding baseline gambling attitudes and impulsiveness as well as gambling behavior and gambling disorder (GD) criteria at baseline and follow-up.

    RESULTS Analyses revealed a four-class solution based on reported motives: ‘primarily fun-motivated gamblers’ (n=100, 58.8%), who gambled mostly for fun; ‘asset and self-gratification seekers’ (n=19, 11.2%) with a high risk of GD at baseline; ‘thrill seekers’ (n=42, 24.7%) with high impulsiveness; and ‘polymotivated coping gamblers’ (n=9, 5.3%) with a higher risk of GD than the ‘primarily fun-motivated gamblers’ in cross-sectional and longitudinal analyses.

    CONCLUSIONS The identified group differences support the validity of the classification. ‘Thrill seekers’ and ‘polymotivated coping gamblers’ correspond to the impulsive and emotionally vulnerable pathways described by Blaszczynski and Nower (2002) respectively. The two other groups appear to be subtypes of the behaviorally conditioned type. Motivation-based classification offers a promising approach to identifying individuals with an elevated risk of GD.

  • 134. Specht, Sara
    et al.
    Schwarzkopf, Larissa
    Braun-Michl, Barbara
    Seitz, Nicki-Nils
    Wildner, Manfred
    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.
    Age, period, and cohort effects on trends in outpatient addiction care utilization in the general Berlin population from 2008 to 20162022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 320Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to decompose independent effects of age, period, and cohort on trends in outpatient addiction care utilization resulting from alcohol (AUD) and illicit substances use disorders (ISUD). Decomposing trends in addiction care utilization into their independent effects by age, period, and cohort may lead to a better understanding of utilization patterns.

    Methods: Individuals seeking help in Berlin outpatient addiction care facilities between 2008 and 2016 with an age range of 18–81 years for AUD (n = 46,706) and 18–70 years for ISUD (n = 51,113) were standardized to the general Berlin population using data from the German Federal Statistical Office. Classification of utilization as AUD- (F10) or ISUD-related (F11, F12, F14, F15, F16, F18, F19) help-seeking was based on primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. Age was measured in years and period as year of data collection. Cohort was defined as the mathematical difference between period and age. Age, period, and cohort analyses were conducted using the intrinsic estimator model on AUD- and ISUD-related outpatient addiction care utilization.

    Results: Age effects on AUD-related utilization were highest in 18- to 19-year-old and in 39- to 59-year-old individuals. ISUD-related utilization declined almost continuously with increasing age. Period effects on AUD- and ISUD-related utilization were small. AUD-related utilization was highest in cohorts born from 1951 to 1986. ISUD-related utilization increased in cohorts born between 1954 and 1973 where utilization peaked, followed by a decline of the same order.

    Conclusions: Age and cohort effects were the strongest drivers of trends in AUD- and ISUD-related outpatient addiction care utilization. Onset of help-seeking in earlier phases of AUD development should be enhanced as well as help-seeking for AUD and ISUD in general. The highest cohort-related rates in the baby boomer and following cohorts for AUD and ISUD underline an increased demand for addiction care.

  • 135. Steppan, Martin
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Piontek, Daniela
    Siciliano, Valeria
    Are cannabis prevalence estimates comparable across countries and regions?: a cross cultural validation using search engine query data2013In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 24, no 1, p. 23-29Article in journal (Refereed)
    Abstract [en]

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

  • 136. Steppan, Martin
    et al.
    Piontek, Daniela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    The effect of sample selection on the distinction between alcohol abuse and dependance2014In: The international journal of alcohol and drug research, ISSN 1925-7066, Vol. 3, no 2, p. 159-168Article in journal (Refereed)
    Abstract [en]

    Aim: The effect of sample selection on the dimensionality of DSM-IV alcohol and dependence (AUD) criteria was tested applying different methods.

    Sample: Data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used. A mixed-mode design was used (self-administered questionnaires and telephone interviews), and 7,912 individuals, aged 18 to 64 years, participated. The response rate was 45%. Alcohol abuse and dependence were assessed according to DSM-IV, based on the Munich Composite International Diagnostic Interview (M-CIDI). Inter-item correlations, Confirmatory Factor Analysis (CFA), and Latent Class Analysis (LCA) were applied to the total sample (unrestricted sample, URS) and a subsample of individuals with at least one endorsed criterion (restricted sample, RS). Latent Class Factor Analysis (LCFA) was performed using the RS, including covariates (age, sex, education).

    Findings: The mean inter-item correlation was higher in the URS than in the RS. When individuals without criterion endorsement were excluded, factor analyses resulted in more dimensions. In the RS, LCA yielded an interaction between abuse, dependence and class membership. The LCFA identified two dimensions and five classes corresponding to abuse and dependence.

    Conclusions: Sample selection has a critical effect on dimensionality analyses. When individuals who do not endorse a single criterion are excluded, the bi-axial factor structure of the DSM-IV (abuse and dependence) can be supported. However, there is also evidence that a further diagnostic category should be included or that the threshold for dependence should be lowered.

  • 137. Strizek, Julian
    et al.
    Atzendorf, Josefine
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Monshouwer, Karin
    Puhm, Alexandra
    Uhl, Alfred
    Perceived problems with adolescent online gaming: National differences and correlations with substance use2020In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 9, no 3, p. 629-641Article in journal (Refereed)
    Abstract [en]

    Background: Not much is known about the correlation between gaming problems and substance use across different countries. This paper presents cross-national analyses of different gaming indicators and their relationship to substance use. Methods: Based on data from the 2015 ESPAD study, differences in the relationship between gaming and substance use across 35 countries were analysed using multi-level logistic regression, using substance use as an individual level predictor, economic wealth as a country-level predictor and a combined problem gaming indicator as the outcome. Results: Multi-level logistic regressions revealed significant correlations between individual substance use and gaming problems, which varied across countries and were moderated by economic wealth. Students who used alcohol, tobacco or cannabis and who lived in high-income countries had a smaller risk of scoring positively on a combined problem gaming indicator than students who used alcohol, tobacco or cannabis and who lived in less prosperous countries. Discussion: Different gaming indicators varied substantially across countries, with self-perceived gaming problems being more common in countries with a low prevalence of gaming. Significant cross-level effects demonstrate the need to take the societal context into account when the relationship between problem gaming and substance use is analysed. Prevention measures need to take the fact into account that patterns of substance use among problem gamers vary across countries.

  • 138. Strothmann, Benjamin
    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.
    Kriston, Levente
    Röhrig, Jeanette
    Scherbaum, Norbert
    Buchholz, Angela
    Factorial, Construct, and Predictive Validity of the Motivation for Treatment Scale in Alcohol-Use Disorder Withdrawal Treatment2023In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 29, no 6, p. 375-384Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim of the present study was to examine for the first time the factorial, construct, and predictive validity of the motivation for treatment (MfT) scale in a cohort of patients undergoing inpatient-qualified alcohol withdrawal treatment with the goal of referring patients to further treatment. The MfT scale has previously been evaluated in different settings of substance abuse treatment, revealing factorial ambiguity. To the best of our knowledge, the present study is the first study that conducted comprehensive factor analyses versus separate analyses of the factors conducted in prior studies in order to clarify the aforementioned factorial ambiguity. Methods: A total of 249 patients (mean age 45.2 years (SD = 10.3); 34.4% females) with alcohol dependence were assessed. Data were obtained from four inpatient clinics specialized in qualified alcohol withdrawal treatment in Germany. First, confirmatory factor analyses were carried out to examine the fit of the four models discussed in the literature. Second, an exploratory factor analysis was conducted. Correlations of the new factors with other motivational constructs and referral to a subsequent treatment were investigated as measures of construct and predictive validity. Results: None of the four models showed an acceptable fit to the data in confirmatory analyses. The exploratory analysis suggested to eliminate seven items because of inappropriate factor loadings and resulted in a shortened MfT scale, which consists of three factors based on 17 items. For the latent variables “problem recognition,” “desire for help,” and “treatment readiness,” satisfactory composite reliability was found with 0.82, 0.80, and 0.78, respectively. Evidence for predictive validity was found in the correlation between “treatment readiness” and referral to a subsequent treatment. Discussion/Conclusion: The new shortened MfT scale exhibited remarkable parsimony, which is desirable in settings such as withdrawal treatment, where patients frequently are cognitively or physically impaired. Despite its briefness, construct and predictive validity were better than in the original version of the MfT scale. The factorial validity of the suggested scale needs to be corroborated in further research. 

  • 139. Strupf, M.
    et al.
    Gomes de Matos, E.
    Soellner, R.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Piontek, D.
    Trinkverhalten von Personen verschiedener Herkunftsregionen in Deutschland: Ein Vergleich mit Personen ohne Migrationshintergrund2017In: Suchttherapie, ISSN 1439-9903, E-ISSN 1439-989X, Vol. 18, no 02, p. 90-97Article in journal (Refereed)
    Abstract [en]

    Aims: Individuals with migration background from different regional origins were compared to individuals without migration background concerning their alcohol consumption.

    Methods: Data came from the 2012 Epidemiological Survey of Substance Abuse (ESA; n=9 084). Individuals with migration background were clustered in 10 groups based on their geographicalorigins. Indicators of alcohol consumption comprised prevalence of abstention, average volume and prevalence of episodic heavy drinking. Statistical inference was tested by regression analyses.

    Results: Abstention rates were significantly higher in all non-European and few European groups than in the reference group without migration background. This applies particularly to individuals with Arabic-Islamic and Turkish roots. For mean consumption and prevalence of episodic heavy drinking group differences were few in number.

    Conclusions: Willingness to stay abstinent among individuals with migration background should be supported. There is no evidence of a need for specific prevention measures among last decades’ migrants in Germany. Access to established measures for migrants should be ensured.

  • 140. Thrul, Johannes
    et al.
    Pabst, Alexander
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, München, Germany.
    The impact of school nonresponse on substance use prevalence estimates – Germany as a case study2016In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 27, p. 164-172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The European School Survey Project on Alcohol and Other Drugs (ESPAD) is a survey study that collects comparable data on substance use of students aged 15-16 years old in European countries. The present study aims at investigating the impact of school refusal to participate in ESPAD on substance use prevalence estimates.

    METHODS: 

    Data came from the 2007 German ESPAD study; the sample consisted of 12,246 students in 552 schools within seven German federal states. A simulation approach was used in order to study the effects of systematic exclusion of participating schools on prevalence estimates of key ESPAD outcomes including the use of tobacco, alcohol, cannabis, and other illegal drugs.

    RESULTS: 

    The systematic exclusion of schools based on city-, school-, and class size, school environment, and schools' substance use policies resulted in significant changes in prevalence estimates in 23 of 25 examined combinations of selection criterion and outcome. Yet, these effects were small, with differences remaining below three percentage points around the original estimates.

    CONCLUSIONS: 

    This simulation approach suggests that nonparticipation of schools in surveys on students' substance use in Germany does not largely affect the validity of resulting prevalence estimates. Even a reduced number of schools may be sufficient to gain valid prevalence figures.

  • 141.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Månsson, Josefin
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Following the changes in young people’s drinking practices before and during the pandemic with a qualitative longitudinal interview material2023In: Journal of Youth Studies, ISSN 1367-6261, E-ISSN 1469-9680, p. 1-19Article in journal (Refereed)
    Abstract [en]

    The paper analyses how the Covid-19 pandemic affected young people’s alcohol-related assemblages, trajectories of becoming and identity claims in Sweden. The data is based on longitudinal qualitative interviews among heavy and moderate drinking young people (n=23; age range 15–24 years). The participants were interviewed two to three times before the Covid-19 pandemic and once at the end of it, between 2017 and 2021. The analysis draws on actor-network theory and narrative positioning approach. The analysis demonstrates how the lockdown produced trajectories of becoming boring, normal, stress-free, self-caring, self-confident and shielded. In these trajectories, drinking was positioned into relations that either increased young people’s capacities for well-being or decreased them. Due to the lockdown, some participants learnt to be moved by relations that contributed to replace drinking with competing activities, while others experienced that the lockdown made drinking a more attractive activity, turning it into a collective force that helped them to overcome isolation. The results show how drinking is a heterogeneous activity which may increase or decrease young people’s capacities for well-being, depending on what kinds of assemblages and trajectories of becoming it is embedded in.

  • 142.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Månsson, Josefin
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. La Trobe University, Melbourne, Australia.
    How Covid-19 restrictions affected young people's well-being and drinking practices: Analyzing interviews with a socio-material approach2022In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 110, article id 103895Article in journal (Refereed)
    Abstract [en]

    Background: The Covid-19 restrictions – as they made young people's practices in their everyday life visible for reflection and reformation – provide a productive opportunity to study how changing conditions affected young people's well-being and drinking practices.

    Methods: The data is based on qualitative interviews with 18- to 24-year-old Swedes (n=33) collected in the Autumn 2021. By drawing on the socio-material approach, the paper traces actants, assemblages and trajectories that moved the participants towards increased or decreased well-being during the lockdown.

    Results: The Covid-19 restrictions made the participants reorganize their everyday life practices emphatically around the home and communication technologies. The restrictions gave rise to both worsened and improved well-being trajectories. In the worsened well-being trajectories, the pandemic restrictions moved the participants towards loneliness, loss of routines, passivity, physical barriers, self-centered thoughts, negative effects of digital technology, sleep deficit, identity crisis, anxiety, depression, and stress. In the improved well-being trajectories, the Covid-19 restrictions brought about freedom to study from a distance, more time for significant others, oneself and for one's own hobbies, new productive practices at home and a better understanding of what kind of person one is. Both worsened and improved well-being trajectories were related to the aim to perform well, and in them drinking practices either diminished or increased the participants’ capacities and competencies for well-being.

    Conclusions: The results suggest that material domestic spaces, communication technologies and performance are important actants both for alcohol consumption and well-being among young people. These actants may increase or decrease young people's drinking and well-being depending on what kinds of relations become assembled.

  • 143.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    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.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Why are young people drinking less than earlier? Identifying and specifying social mechanisms with a pragmatist approach2019In: International Journal of Drug Policy, ISSN 0955-3959, Vol. 64, p. 13-20Article in journal (Refereed)
    Abstract [en]

    Recent surveys have found a strong decrease in alcohol consumption among young people and this trend has been identified in European countries, Australia and North America. Previous research suggests that the decline in alcohol consumption may be explained by changes in parenting style, increased use of social media, changes in gender identities or a health and fitness trend. We use qualitative interviews with drinking and non-drinking young people from Sweden (N = 49) to explore in what way and in what kinds of contexts these explanations may hold true and how they alone or together may explain declining alcohol consumption among young people. By using the pragmatist approach, we pay attention to what kinds of concerns, habits, practices, situations and meanings our interviewees relate to adolescents' low alcohol consumption or decline in drinking. By analyzing these matters, we aim to specify the social mechanisms that have reduced adolescents' drinking. Our paper discovers social mechanisms similar to previous studies but also a few that have previously been overlooked. We propose that the cultural position of drinking may have changed among young people so that drinking has lost its unquestioned symbolic power as a rite of passage into adulthood. There is less peer pressure to drink and more room for competing activities. This opening of a homogeneous drinking culture to the acceptance of differences may function as a social mechanism that increases the success of other social mechanisms to reduce adolescents' drinking. Furthermore, the results of the paper suggest a hypothesis of the early maturation of young people as more individualized, responsible, reflective, and adult-like actors than in earlier generations. Overall, the paper provides hypotheses for future quantitative studies to examine the prevalence and distribution of the identified social mechanisms, as well as recommends directions for developing effective interventions to support young people's healthy lifestyle choices.

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  • 144.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Criminology. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    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 München, Germany; ELTE Eötvös Loránd University Budapest, Hungary.
    How do social media-related attachments and assemblages encourage or reduce drinking among young people?2021In: Journal of Youth Studies, ISSN 1367-6261, E-ISSN 1469-9680, Vol. 24, no 4, p. 515-530Article in journal (Refereed)
    Abstract [en]

    Research shows that young people’s online practices have become a continuous, seamless and routine part of their physical and social worlds. Studies report contradictory findings on whether social media promotes intoxication-driven drinking cultures among young people or diminishes their alcohol consumption. By applying actor-network theory, our starting point is that the effects of social media depend on what kinds of concerns mediate its use. Social media alone cannot make young people drink more or less but influences their drinking in relation to specific attachments that we call here ‘assemblages’. The data consist of individual interviews among girls (n = 32) and boys (n = 24) between 15 and 19 years old from Sweden, covering topics such as alcohol use, social media habits and leisure time activities. The paper maps the variety of assemblages that mediate young people’s online practices and analyzes how young people’s drinking-related social media assemblages increase, decrease or exclude their alcohol consumption. The analysis shows that social media-related attachments seem to reduce our interviewees’ use of alcohol by providing competing activities, by transforming their drinking under the public eye, by reorganizing their party rituals to be less oriented towards drinking and by facilitating parents’ monitoring of their drinking situations.

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  • 145.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    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.
    ‘Social health’, ‘physical health’, and well-being: Analysing with bourdieusian concepts the interplay between the practices of heavy drinking and exercise among young people2021In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 91, article id 102825Article in journal (Refereed)
    Abstract [en]

    Background: The article examines the interplay between the practices of heavy drinking and exercise among young people. The comparison helps to clarify why young people are currently drinking less than earlier and how the health-related discourses and activities are modifying young people's heavy drinking practices.

    Methods: The data is based on interviews (n = 56) in Sweden among 15–17-year-olds and 18–19-year-olds. By drawing on Pierre Bourdieu's concepts of habitus, field, and capital, we examine what kinds of resources young people accumulate in the fields of heavy drinking and exercise, how these resources carry symbolic value for distinction, and what kind of health-related habitus they imply.

    Results: The analysis shows that young people's practices in the social spaces of intoxication and exercise are patterned around the ‘social health’ and ‘physical health’ approaches and shaped by gendered binaries of masculine dominance. The ‘physical health’ approach values capable, high-performative, and attractive bodies, whereas the ‘social health’ approach is oriented towards accumulating social capital. The analysis demonstrates that these approaches affect the interviewees’ everyday life practices so that the ‘physical health’ approach has more power over the ‘social health’ approach in transforming them.

    Conclusion: As the ‘physical health’ approach appears to modify young people's practices of drinking to be less oriented to intoxication or away from drinking, this may partly explain why young people are drinking less today than earlier. Compared to drinking, the physical health-related social spaces also seem to provide more powerful arenas within which to bolster one's masculine and feminine habitus. This further suggests that intoxication may have lost its symbolic power among young people as a cool activity signalling autonomy, maturity, and transgression of norms.

  • 146.
    Wennberg, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Källmen, Håkan
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    The Dimensional Structure of the Alcohol Use Disorders Identification Test2014In: Advances in Psychology Research / [ed] Alexandra M. Columbus, New York: Nova Science Publishers, Inc., 2014, p. 143-148Chapter in book (Other academic)
  • 147. Wilms, Nicolas
    et al.
    Seitz, Nicki-Nils
    Schwarzkopf, Larissa
    Olderbak, Sally
    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.
    Alcoholic Beverage Preference in Germany: An Age-Period-Cohort Analysis of Trends 1995-20182023In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 58, no 4, p. 426-435Article, review/survey (Refereed)
    Abstract [en]

    Aims: Germany is experiencing a decline in alcohol consumption but not for every alcoholic beverage type. Given the differential health impacts of alcoholic beverage type, it is important to understand the drivers of these trends. We investigated: (a) temporal trends in beverage preference and (b) the effects of age, period and cohort on these trends.

    Methods: Data came from nine waves (1995–2018; ntotal = 75,550) of the German Epidemiological Survey of Substance Abuse, a nationally representative household survey of individuals aged 18–59 years. The quantity of beer, wine, spirits and mixed drinks drank in the last 30 days was transformed into grammes of ethanol, and the beverage type preference was estimated as the proportion of total ethanol consumption. Fractional multinomial logit regression was applied to analyse the age, period and cohort effects on temporal trends of beverage preference by sex.

    Results: The preference for spirits and mixed drinks decreased with increasing age, while the preference for wine increased with no age effect on beer. There was a general decrease in the preference for beer and an increase in the preference for wine among both sexes, with an additional increase in the preference for spirits in males.

    Conclusion: Trends in beverage preference were more related to individual ageing and changes in the whole population than to cohorts. With the continued reduction in alcohol consumption, the decreasing preference for beer and the growing preference for wine suggest a positive development. Trends of an increasing preference for spirits in males are of concern.

  • 148. Wullinger, Pia M.
    et al.
    Bickl, Andreas M.
    Loy, Johanna K.
    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; Eötvöos Loránd University, Hungary.
    Schwarzkopf, Larissa
    Longitudinal associations between psychiatric comorbidity and the severity of gambling disorder: Results from a 36-month follow-up study of clients in Bavarian outpatient addiction care2023In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 12, no 2, p. 535-546Article in journal (Refereed)
    Abstract [en]

    Background and aims: Individuals with gambling disorder (GD) often suffer from psychiatric comorbidities. Previous studies demonstrated greater severity of GD among gamblers with psychiatric comorbidities. However, evidence on the association between psychiatric comorbidity and course of GD severity during and after outpatient treatment is sparse. This study analyses data from a longitudinal one-armed cohort study on outpatient addiction care clients over three years. Methods: We investigated the course of GD severity using data from 123 clients in 28 outpatient addiction care facilities in Bavaria using generalized estimation equations (GEE). We applied time* interaction analyses to examine different development profiles in participants with and without (1) affective disorders, or (2) anxiety disorders, and (3) to account for the co-occurrence of both. Results: All participants benefitted from outpatient gambling treatment. Improvement in GD severity was poorer in participants with anxiety disorders compared to participants without anxiety disorders. The co-occurrence of affective and anxiety disorders was linked to a less favourable course of GD than the presence of affective disorders alone. However, the combined occurrence of both disorders was more favourable than the presence of anxiety disorders alone. Discussion and conclusions: Our study suggests that clients with GD, with and without psychiatric comorbidities, benefit from outpatient gambling care. Psychiatric comorbidity, especially comorbid anxiety disorders, seems to be negatively associated with the course of GD within outpatient gambling care. Addressing psychiatric comorbidity within the treatment of GD and offering individualised help are required to meet the needs of this clientele.

  • 149. Wurdak, Mara
    et al.
    Ihle, Katharina
    Stürmer, Marco
    Dirnberger, Isabella
    Fischer, Uwe C.
    Funk, Tatjana
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Wolstein, Jörg
    Indikatoren für das Ausmaß jugendlichen Rauschtrinkens in Bayern2013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 4, p. 225-233Article in journal (Refereed)
    Abstract [en]

    Aims: To research whether the rising number of hospital treatments of alcohol intoxication is an indicator of an increase in risky alcohol consumption among adolescents. Methods: This was investigated within the framework of two secondary analyses (examination of crimes committed and accidents caused under the influence of alcohol among 10 – 20-year-old adolescents, as well as the alcohol blood concentration (BAC) of adolescents treated in hospital, n = 1 020) and a field study (population survey, n = 285). Results: The number of hospital treatments was positively correlated with crimes, but not with accidents under the influence of alcohol. In a city with a high prevalence of hospital treatments related to alcohol intoxication, more people would primarily call an ambulance as compared to a city with a low prevalence. The average BAC continuously declined within a two-year-period. Conclusions: The number of hospital treatments and criminal offenses committed under the influence of alcohol is indicative of an increase in risky alcohol consumption. However, the number of hospital treatments is associated with a higher sensitivity of the population and is not supported by the number of accidents under the influence of alcohol.

  • 150. Wurdak, Mara
    et al.
    Kuntsche, Emmanuel
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, München, Germany.
    Wolstein, Jörg
    Effectiveness of a brief intervention with and without booster session for adolescents hospitalized due to alcohol intoxication2016In: Journal of Substance Use, ISSN 1465-9891, E-ISSN 1475-9942, Vol. 21, no 1, p. 72-77Article in journal (Refereed)
    Abstract [en]

    Background: The Hart-am-LimiT (HaLT) project is a brief intervention program for adolescents hospitalized due to alcohol intoxication in Germany.

    Objective: To test whether a booster session has an impact on participants’ drinking behavior compared with the standard HaLT program.

    Methods: On the morning after their admission due to alcohol intoxication, 411 adolescents in the Federal State of Bavaria were interviewed between October 2008 and January 2010 and socio-demographic data and information on previous drinking behavior were recorded (t1). Eleven to 25 months (M = 16.4) after their hospital treatment, 106 adolescents completed an online questionnaire (t2).

    Results: Subgroup analysis (ANOVA with repeated measurements) indicated that adolescents who took part in the booster session did not increase episodic heavy drinking (EHD; t1: M = 1.68 EHD d; t2: 1.59 EHD d) in contrast to the non-participating group (t1: M = 1.08 d EHD; t2: 2.66 d EHD; F = 4.383, p = 0.039).

    Conclusion: Considering the study’s limitations (e.g. no randomization, low response rate, etc.), the results indicate a positive effect of a booster session following a brief intervention for adolescents who have been treated in hospital due to alcohol intoxication. Adolescents should therefore be motivated and encouraged to participate in booster sessions.

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