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  • 51.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Hibell, Björn
    Whence and whither: strengths and future challenges of ESPAD2014In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, no 4, p. 319-322Article in journal (Other academic)
  • 52.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Loy, Johanna K. K.
    Bickl, Andreas M. M.
    Schwarzkopf, Larissa
    Volberg, Rachel A. A.
    Rolando, Sara
    Kankainen, Veera E. E.
    Hellman, Matilda
    Rossow, Ingeborg
    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, Melbourne, Australia.
    Norman, Thomas
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Self-exclusion from gambling: A toothless tiger?2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 992309Article in journal (Refereed)
    Abstract [en]

    While there is evidence for self-exclusion (SE) as an individual-level harm reduction intervention, its effects on reducing harm from gambling at the population level remain unclear. Based on a review of national legal frameworks and SE programs, including their utilization and enforcement in selected high-income societies, the present analysis aims to explore the reach and strengths of SE in the protection of gamblers in these jurisdictions. It places particular emphasis on SE programs' potential to prevent and minimize gambling harm at the population level. The overview examined SE in Finland, Germany, Italy, Massachusetts (USA), Norway, Sweden, and Victoria (Australia). These jurisdictions differ considerably in how gambling is regulated as well as in how SE is implemented and enforced. The reach and extent of enforcement of SE apparently vary with the polity's general policy balance between reducing gambling problems and increasing gambling revenue. But in any case, though SE may benefit individual gamblers and those around them, it does not appear to be capable of significantly reducing gambling harm at the population level. To render SE programs an effective measure that prevents gamblers and those linked to them from financial, social, and psychological harm, utilization needs to be substantially increased by reforming legal regulations and exclusion conditions.

  • 53.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Loy, Johanna K.
    Olderbak, Sally
    Trolldal, Björn
    Ramstedt, Mats
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; The Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden.
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). The Swedish Council for Information on Alcohol and Other Drugs (CAN), Sweden.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Does the decline in Swedish adolescent drinking persist into early adulthood?2024In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 119, no 2, p. 259-267Article in journal (Refereed)
    Abstract [en]

    Background and aims: Sweden has experienced a substantial decrease in adolescent drinking over the past decades. Whether the reduction persists into early adulthood remains unclear. Using survey data, the present study aimed to determine whether reductions in indicators of alcohol use observed among adolescents remain in early adulthood and whether changes in alcohol intake are consistent among light/moderate and heavy drinkers.

    Design: Data from the Swedish monthly Alcohol Monitoring Survey (2001–20) were used to construct five 5-year birth cohorts (1978–82, 1983–87, 1988–92, 1993–97 and 1998–2002).

    Setting: Sweden.

    Participants: A total of n = 52 847 respondents (48% females) aged 16 and 30 years were included in this study.

    Measurements: For both males and females, temporal changes in the prevalence of any drinking, the prevalence of heavy episodic drinking (HED) and total alcohol intake in the past 30 days in centilitres were analysed.

    Findings: The prevalence of any drinking in more recent cohorts remained low until young people came into their early (females) and mid- (males) 20s. Male cohorts differed in the prevalence of HED across age, with the later cohorts showing lower odds than earlier cohorts (odds ratios between 0.54 and 0.66). Among females, no systematic differences between cohorts across age could be observed. Later male birth cohorts in light/moderate drinkers had lower alcohol intake than earlier cohorts (correlation coefficients between −0.09 and −0.54). No statistically significant cohort effects were found for male heavy drinkers. Although differences in alcohol intake among females diminished as age increased, the cohorts did not differ systematically in their level of alcohol intake.

    Conclusions: In Sweden, the reduced uptake of drinking in adolescents appears to fade as people move into adulthood. Observed reductions in alcohol intake among light and moderate drinkers appear to persist into adulthood. More recent male cohorts show a lower prevalence rate of heavy episodic drinking.

  • 54.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Loy, Johanna K.
    Wilms, Nicolas
    Starker, Anne
    Altersspezifische Trends des risikoreichen Alkoholkonsums in Deutschland: Parallele oder unterschiedliche Verläufe?2021In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, ISSN 1436-9990, Vol. 64, p. 652-659Article in journal (Refereed)
    Abstract [en]

    Introduction

    According to Skog’s collectivity of drinking cultures theory, changes in alcohol consumption in all groups and strata of the population take place as parallel displacement in the distribution of consumption. The aims of the present paper are (1) to illustrate temporal trends in risky drinking and episodic heavy drinking by age and gender and (2) to examine whether the trends are parallel in all age groups (“collectivity”) or diverge between age groups (“polarisation”).

    Methods

    The data are based on nine surveys of the Epidemiological Survey of Addiction (ESA) between 1995 and 2018. Risky drinking was defined as daily consumption of more than 12 g (for women) or 24 g (for men) of pure alcohol and episodic heavy drinking as consumption of five or more glasses of alcohol (about 70 g pure alcohol) on at least one day in the past 30 days. Linear regressions were calculated separately for age groups (18–29, 30–39, 40–49, and 50–59 years) and gender to predict the temporal effect on risky drinking or episodic heavy drinking and to test trends for differences.

    Results

    The temporal changes of risky drinking by age group show soft collectivity among men and polarisation among women. Trends in episodic heavy drinking indicate polarisation for both genders; while the prevalence increased in the youngest and oldest age groups, it decreased in all other age groups.

    Discussion

    In light of a general decrease, the increasing trends in risky drinking in specific groups indicate the need for strengthening behavioural prevention. For the positive development to continue and to avoid a trend reversal, public health measures such as alcohol tax increases and reductions of alcohol availability need to be intensified.

  • 55.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; LTE Eötvös Loránd University, Hungary.
    Möckl, Justin
    Lochbühler, Kirsten
    Rauschert, Christian
    Seitz, Nicki-Nils
    Olderbak, Sally
    Changes in the use of tobacco, alternative tobacco products, and tobacco alternatives in Germany2022In: Deutsches Ärzteblatt International, E-ISSN 1866-0452, Vol. 119, no 31-32, p. 535-541Article in journal (Refereed)
    Abstract [en]

    Background: Due to the increasing use of alternative tobacco products (waterpipes, heat-not-burn) and tobacco alternatives (e-cigarettes), we studied recent changes in the prevalence of conventional tobacco use and alternative products.

    Methods: Data come from ten waves of the Epidemiological Survey of Substance Abuse (ESA) from 1995 to 2021, with representative samples collected via paper-pencil questionnaires, telephone interviews, or online. We compared the prevalence of conventional tobacco use and alternative products by gender and age (18–24, 25–39, 40–59 years).

    Results: In all age groups, the use of conventional tobacco products decreased. The prevalence of the exclusive use of one of the three alternative products differed statistically significantly between age groups and in 2021 was higher for ages 18–24 (females: 11.1%, males: 12.4%) compared to ages 25–39 (females: 2.9%; males: 4.9%) and ages 40–59 (females: 1.4%; males: 2.0%). The use of alternative products was mainly due to the exclusive use of waterpipes among individuals aged 18 to 24 and 25 to 39 and the exclusive use of e-cigarettes among individuals aged 40 to 59.

    Conclusions: The higher prevalence of alternative product use among young adults implies a turning point that needs to be considered in prevention. Because of the addictive potential of these products, young adults can be expected to maintain their use into middle and older adulthood. There is a need to monitor the use of alternative products, identify the risks associated with them, and develop effective prevention and cessation interventions for adults.

  • 56.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Nociar, Alojz
    ESPAD Report 2015: Results from the European School Survey Project on Alcohol and Other Drugs2016Report (Refereed)
    Abstract [en]

    The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15- to 16-year-old students in order to monitor trends within as well as between countries. Between 1995 and 2015, six surveys were conducted in 48 European countries. The present report differs from the earlier ESPAD reports in that it presents selected key results of the 2015 ESPAD survey rather than the full range of results and tables. The full set of data on which the current report is based, including all the usual tables in the familiar ESPAD format, is available online (http://www.espad.org). All of the tables can be downloaded in Excel format and used for further analysis.

    The present report provides information on the perceived availability of substances, early onset of substance use and prevalence estimates of substance use (cigarettes, alcohol, illicit drugs, inhalants, new psychoactive substances and pharmaceuticals). The descriptive information includes indicators of intensive substance use and prevalence estimates of internet use, gaming and gambling by country and gender. Secondly, overall ESPAD trends between 1995 and 2015 are presented. For selected indicators, ESPAD trends are shown based on data from 25 countries that participated in at least four (including the 2015 data collection) of the six surveys. Finally, for some indicators, country-specific trends are shown.

    In the 2015 ESPAD data collection, 96 043 students took part from 35 countries: Albania, Austria, Belgium (Flanders), Bulgaria, Croatia, Cyprus, the Czech Republic, Denmark, Estonia, the Faroes, Finland, the former Yugoslav Republic of Macedonia, France, Georgia, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Malta, Moldova, Monaco, Montenegro, the Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Sweden and Ukraine. For comparative reasons, the tables of the 2015 ESPAD results contain, in addition to country-specific estimates, an average across all participating countries as well as prevalence estimates for two non-ESPAD countries: Spain and the United States. The instruments used in the Spanish and US surveys overlap to a large degree with the ESPAD questionnaire, and the methodology used in all three surveys allows for rough comparisons across the countries.

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  • 57.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; LTE Eötvös Loránd University, Hungary.
    Olderbak, Sally
    Commentary on Livingston et al.: Do reductions in adolescent drinking really maintain into adulthood?2022In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 117, no 5, p. 1282-1283Article in journal (Other academic)
  • 58.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Pabst, Alexander
    Piontek, Daniela
    Gmel, Gerrit
    Shield, Kevin D.
    Frick, Hannah
    Rehm, Juergen
    Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany2015In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 21, no 5, p. 262-272Article in journal (Refereed)
    Abstract [en]

    Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

  • 59.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Piontek, Daniela
    Repräsentative Bevölkerungsbefragungen zum Substanzkonsum sind alternativlos. [There are no alternatives to general population surveys on substance use]2016In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 62, no 5, p. 257-258Article in journal (Other academic)
  • 60.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Deutschland.
    Piontek, Daniela
    Wie evidenz-basiert kann kommunale Suchtprävention sein? [Is there an Evidence Base for Community Prevention?]2013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 5, p. 247-248Article in journal (Other academic)
  • 61.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Piontek, Daniela
    Atzendorf, Josefine
    Gomes de Matos, Elena
    Zeitliche Entwicklungen im Substanzkonsum in der deutschen Allgemeinbevölkerung: Ein Rückblick auf zwei Dekaden2016In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 62, no 5, p. 283-294Article in journal (Refereed)
    Abstract [en]

    Aims: The study analyzes trends in the (clinically relevant) use of tobacco, alcohol, cannabis, other illegal drugs as well as pharmaceuticals. Methods: Data from eight waves of the Epidemiological Survey of Substance Abuse (ESA) from the years 1995 to 2015 were used. The data were collected using self-administered questionnaires, telephone interviews, or online questionnaires. A consistent analysis of trends is possible for the age range 18 to 59 years. Results: Tobacco consumption significantly declined over the past 20 years. Alcohol data showed declining consumption in males and stable consumption in females. The prevalence of episodic heavy drinking increased in females since the year 2009. Compared to the year 2012, cannabis consumption increased in both sexes. Weekly use of analgesics also increased, whereas weekly use of sedatives/hypnotics decreased. Indicators of clinically relevant use remained constant for cannabis, declined for tobacco and increased for pharmaceuticals. With regard to alcohol, males showed stable and females increased rates of clinically relevant use. Conclusions: Prevention and intervention measures need to be intensified especially with regard to the legal substances tobacco and alcohol. Trend analyses identified women as a particularly vulnerable subgroup because of an increasing prevalence of clinically relevant use of alcohol and pharmaceuticals.

  • 62.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Piontek, Daniela
    Pabst, Alexander
    Gomes de Matos, Elena
    Studiendesign und Methodik des Epidemiologischen Suchtsurveys 20122013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 6, p. 309-320Article in journal (Refereed)
    Abstract [en]

    Aims: The paper gives an overview on design and sample selection, measures, realization and analyses of the 2012 Epidemiological Survey of Substance Abuse (ESA). Methods: A disproportional sample was drawn from population registers using a two-stage probability design oversampling younger birth cohorts. Different modes of administration were used (paper-and-pencil questionnaire, telephone interview, online questionnaire). Results: A total of 9 084 individuals aged 18 to 64 years participated in the survey (response rate 53.6 %). The redressement weight had an effectiveness of 67.6 %. Non-responders showed a lower prevalence of alcohol and cannabis use, but a higher prevalence of episodic heavy drinking and hypnotics use as well as a higher tobacco use quantity. Respondents in the telephone and internet mode had a lower rate of substance use than those in the paper-and-pencil mode. Conclusions: Contrary to the general trend of decreasing response rates, the ESA achieves increasing response rates over the past years due to the application of a mixed mode design. Selectivity effects are possible because of the exclusion of specific population subgroups and non-response effects.

  • 63.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Piontek, Daniela
    Pfeiffer-Gerschel, Tim
    Rehm, Jürgen
    Inanspruchnahme gesundheitlicher Versorgung durch Alkoholabhängige [Health care utilization of perople with alcohol dependence]2015In: Suchttherapie, ISSN 1439-9903, E-ISSN 1439-989X, Vol. 16, no 1, p. 18-26Article in journal (Refereed)
    Abstract [en]

    Aims: The study aims at estimating health care utilization of alcohol dependents. Estimates will be provided for the number of people with dependence in the general population, the number of people that have received the diagnosis "dependence" by a general practitioner, and number of people treated in addiction care. Methods: Estimates are based on the most recent data on health care utilization. The estimation methods are described in detail. Results: In Germany, the prevalence of alcohol dependence in the general population aged 18 years and above is estimated at 2.8 % or 1.86 million individuals in 2012. Approximately 649 000 individuals were diagnosed as, alcohol dependent" by a general practitioner indicating that about one third of the people with dependence (35.0%) were registered in the health care system (2009 data). In the same year approximately 297 000 individuals with alcohol dependence (16 %) were utilizing specialized addiction services (in-or outpatient treatment, general hospital). The rate of addicts in rehabilitation treatment was estimated at 1.8%. Conclusions: For reducing the burden of morbidity and mortality associated with alcohol dependence considerable improvements in health care utilization by addicts are required. Utilization may be increased by improving excess to early intervention, diversification of treatment offers and challenging the paradigm of abstinence-oriented treatment.

  • 64.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Livingston, Michael
    Pennay, Amy
    Holmes, John
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Long waves of consumption or a unique social generation? Exploring recent declines in youth drinking2020In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 28, no 3, p. 183-193Article in journal (Refereed)
    Abstract [en]

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

  • 65.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Schulte, Bernd
    Manthey, Jakob
    Rehm, Juergen
    Alcohol screening and alcohol interventions among patients with hypertension in primary health care: an empirical survey of German general practitioners2017In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 25, no 4, p. 285-292Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol is one of the least intervened risk factors in the management of hypertension at the primary care level. In order to improve alcohol interventions, a better understanding of knowledge, attitudes and clinical practice of lifestyle interventions in the management of hypertension is needed.Method: As a part of a European study (France, Germany, Italy, Spain, UK), 211 German general practitioners (GPs) were recruited in Bavaria and Hamburg and surveyed via an Internet-based questionnaire. Results were compared with the European sample (n=2870).Results: One-third of the patients seen by German GPs had hypertension (36.2%, standard deviation (SD): 14.6) and among cases with hypertension, less than half were ever screened for alcohol (4.5 out of 10 patients). The foremost reasons for not screening for alcohol were that alcohol was not considered a major risk factor for hypertension plus the lack of knowledge of appropriate alcohol screening instruments. The majority of German GPs managed patients with hazardous drinking levels themselves or in their practice (71.3%, 95% confidence interval (CI): 64.6-77.2%), but only 42.0% (95% CI: 35.2-49.0%) managed alcohol dependent patients. German screening rates were slightly lower but interventions of screened positive patients higher than the European average.Conclusions: Rates of alcohol screening in patients with hypertension in primary health care may be increased by improving GPs knowledge of alcohol as a major risk factor for hypertension, increasing GPs education on alcohol and screening instruments, and providing reimbursement. This may increase treatment of alcohol problems in patients with hypertension and reduce hypertension.

  • 66.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Sedlacek, Lucia
    Loy, Johanna
    Gonzales-Diaz, Katya
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Spiel, Satz und Sucht! Vom Spielen und Sperren2019In: Suchttherapie, ISSN 1439-9903, E-ISSN 1439-989X, Vol. 20, no 3, p. 117-119Article in journal (Other academic)
    Abstract [de]

    Spielersperren können als präventive Schutzmaßnahme oder schadensbegrenzende Intervention bei problematischem und pathologischem Glücksspielen eingesetzt werden. Dennoch fallen die Nutzungszahlen in Deutschland äußerst gering aus. Neben Interessenskonflikten, Angst vor Stigmatisierung und anderen negative Einflussfaktoren trägt die Abwesenheit einer fördernden gesetzlichen Regulation in Deutschland hierzu bei.

  • 67.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Seitz, Nicki-Nils
    Loy, Johanna Katharina
    Trolldal, Björn
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Has beverage composition of alcohol consumption in Sweden changed over time? An age-period-cohort analysis2022In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 41, no 1, p. 153-166Article in journal (Refereed)
    Abstract [en]

    Introduction. In recent years, beverage composition of total alcohol consumption has changed substantially in Sweden. As beverage choice is strongly associated with drinking practices, our paper aims to analyse trends in beverage composition of alcohol consumption by age, period and cohort. Methods. Age-period-cohort (APC) analysis was conducted using monthly data from the Swedish Alcohol Monitoring Survey (2003-2018). The sample consisted of n = 260 633 respondents aged 16-80 years. APC analysis was conducted on drinkers only (n = 193 954; 96 211 males, 97 743 females). Beverage composition was defined as the beverage-specific proportion of total intake in litre ethanol. Fractional multinomial logit regression was applied to estimate the independent effects of age, period and cohort on trends in beverage composition. Results. Regression models revealed statistically significant effects of age on all beverages except for medium-strength beer and spirits in males. Controlling for age and cohort, decreasing trends were found over time for medium-strength beer and spirits. The proportion of regular beer increased statistically significantly in males and the proportion of wine in females, whereas the trends for the opposite sex remained stable in each case. Predictions for cohorts showed statistically significant decreasing trends for medium-strength beer in males, lower proportions for regular beer and higher proportions for spirits in the youngest cohorts. Discussion and Conclusions. The increasing proportion of wine drinking, which is associated with less risky drinking practices, may decrease alcohol-related morbidity and mortality. Increasing proportions of spirits in the youngest cohorts raises concerns of a possible revival in spirits consumption among the youngest.

  • 68.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary .
    Seitz, Nicki-Nils
    Piontek, Daniela
    Molinaro, Sabrina
    Siciliano, Valeria
    Guttormsson, Ulf
    Arpa, Sharon
    Monshouwer, Karin
    Leifman, Hakan
    Vicente, Julian
    Griffiths, Paul
    Clancy, Luke
    Feijao, Fernanda
    Florescu, Silvia
    Lambrecht, Patrick
    Nociar, Alojz
    Raitasalo, Kirsimarja
    Spilka, Stanislas
    Vyshinskiy, Konstantin
    Hibell, Bjorn
    'Are The Times A-Changin'? Trends in adolescent substance use in Europe2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 7, p. 1317-1332Article in journal (Refereed)
    Abstract [en]

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

  • 69.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Seitz, Nicki-Nils
    Schulte, Bernd
    Cremer-Schaeffer, Peter
    Braun, Barbara
    Verthein, Uwe
    Pfeiffer-Gerschel, Tim
    Estimation of the Number of People With Opioid Addiction in Germany2019In: Deutsches Ärzteblatt International, E-ISSN 1866-0452, Vol. 116, no 9, p. 137-143Article in journal (Refereed)
    Abstract [en]

    Background: Opioid addiction is one of the most common substance-related disorders worldwide, and morbidity and mortality due to opioid addiction place a heavy burden on society. Knowing the size of the population that is addicted to opioids is a prerequisite for the development and implementation of appropriate health-policy measures.Methods: Our estimate for Germany for 2016 is based on an enumeration of opioid-addicted persons who were entered in a registry of persons receiving substitution therapy, an enumeration of persons receiving outpatient and inpatient care for addiction without substitution therapy, an extrapolation to all addiction care facilities, and an estimation of the number of opioid-addicted persons who were not accounted for either in the substitution registry or in addiction care.Results: The overall estimate of the number of opioid-addicted persons in Germany in 2016 was 166 294 persons (lower and upper bounds: 164 794 and 167 794), including 123 988 men (122 968 to 125 007) and 42 307 women (41 826 to 42 787). The estimates for each German federal state per 1000 inhabitants ranged from 0.1 in Brandenburg to 3.0 in North Rhine-Westphalia and 5.5 in Bremen. The average value across Germany was 3.1 per 1000 inhabitants.Conclusion: Comparisons with earlier estimates suggest that the number of persons addicted to opioids in Germany has hardly changed over the past 20 years. Despite methodological limitations, this estimate can be considered highly valid. Nearly all persons who are addicted to opioids are in contact with the addiction care system.

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  • 70.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Seitz, Nicki-Nils
    Shield, Kevin D.
    Gmel, Gerrit
    Rehm, Jürgen
    Quantifying harms to others due to alcohol consumption in Germany: a register-based study2019In: BMC Medicine, E-ISSN 1741-7015, Vol. 17, article id 59Article in journal (Refereed)
    Abstract [en]

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

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  • 71.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Tryggvesson, Kalle
    Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Pabst, Alexander
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Involvement in alcohol-related verbal or physical aggression. Does social status matter?2015In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 32, no 5, p. 449-463Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION -The analyses (1) assessed the association between social status variables and aggression when controlling for volume of alcohol consumption and episodic heavy drinking (EHD), (2) tested whether social status moderates the association between volume or EHD and verbal as well as physical aggression, and (3) investigated whether EHD moderates the effect of volume on aggression. METHODS - Swedish Alcohol Monitoring Survey (2003 to 2011); N=104,316 current drinkers; response rate: 51 to 38%. Alcohol-related aggression was defined as involvement in a quarrel or physical fight while drinking. Social status was defined as the highest education, monthly income and marital status. RESULTS -The associations between social status variables and aggression showed mixed results. Verbal aggression was associated with education in males and with marital status in both genders. Physical aggression was associated with education in both genders. No associations with aggression were found for income. With few exceptions, these associations remained significant when controlling for drinking patterns; social status did not moderate the association between drinking and aggression; EHD moderated the effect of volume on physical aggression in males. CONCLUSIONS - Groups of lower educated and non-married individuals experience verbal or physical aggression over and above different levels of consumption. Individual differences in aggression vulnerability rather than differences in aggression predisposition account for higher risks of aggression in these groups.

  • 72.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös-Loránd-University, Hungary.
    Uhl, Alfred
    Atzendorf, Josefine
    Seitz, Nicki-Nils
    Estimating the number of children in households with substance use disorders in Germany2021In: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 15, no 1, article id 63Article in journal (Refereed)
    Abstract [en]

    Background Parental substance misuse is reported to endanger the health and psychological development of children and adolescents. The aim of the present study was to address conceptual and methodological problems in estimating the number of children affected by parental substance misuse (CaPSM) and offer a novel approach based on survey data.

    Methods Data came from the 2018 German Epidemiological Survey of Substance Abuse (ESA) among 18- to 64-year-olds (n = 9267) and from population statistics. DSM-IV diagnostic criteria were used to assess substance use disorder (SUD) related to tobacco, alcohol, cannabis, cocaine or amphetamine. Based on the number of household members, the number of children below age 18 years and the information on SUD status of the respondent living in this household, the number of children currently living in households with at least one member with SUD was estimated.

    Results In 2018, there were 13,597,428 children younger than 18 years living in Germany. Of these, 6.9-12.3% (935,522-1,673,103) were estimated to currently live in households where at least one adult had a tobacco use disorder, 5.1-9.2% (688,111-1,257,345) in households where at least one adult had an alcohol use disorder and 0.6-1.2% (87,817-158,401) in households where at least one adult had a disorder related to the use of illicit drugs. The total number of children currently living with SUD adults in their household was estimated at 11.2-20.2% (1,521,495-2,751,796).

    Conclusions Available estimates are difficult to interpret and to compare due to a lack of clear case definitions and methodological approaches with various biases and limitations. Future estimates need to provide precise case definitions and standard approaches.

  • 73.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Östhus, Ståle
    Amundsen, Ellen J.
    Piontek, Daniela
    Harkonen, Janne
    Legleye, Stephane
    Bloomfield, Kim
    Makela, Pia
    Landberg, Jonas
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Changes in mortality due to major alcohol-related diseases in four Nordic countries, France and Germany between 1980 and 2009: a comparative age-period-cohort analysis2015In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 9, p. 1443-1452Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate age, period and cohort effects on time trends of alcohol-related mortality in countries with different drinking habits and alcohol policies.

    Design and setting: Age-period-cohort (APC) analyses on alcohol-related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany.

    Participants: Cases included alcohol-related deaths in the age range 20-84 years between 1980 and 2009.

    Measurements: Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol.

    Findings: In all countries changes across age, period and cohort were found to be significant for both genders [effect value with confidence interval (CI) shown in Supporting information, Table S1]. Period effects pointed to an increase in alcohol-related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U-shaped curve and in France a U-shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol-related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between-country comparisons revealed more statistically significant differences for period (P<0.001 for all 15 comparisons by gender) than for age [P<0.001 in seven (men) and four (women) of 15 comparisons] or cohort [P<0.01 in two (men) and three (women) of 15 comparisons].

    Conclusions: Strong period effects suggest that temporal changes in alcohol-related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.

  • 74. Kuttler, H.
    et al.
    Bitzer, E.M.
    Pradel, H.
    Reis, O.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Piontek, D.
    Zimmerman, U.S.
    Groβ, C.
    Alkoholintoxikation im Jugendalter: Risiko- und Schutzfaktoren für Entwicklungsgefährdungen2014In: Suchttherapie, ISSN 1439-9903, E-ISSN 1439-989X, Vol. 15, no 1, p. 4-5Article in journal (Refereed)
  • 75. Kühnl, Regina
    et al.
    Aydin, Darya
    Horn, Sabine
    Olderbak, Sally
    Verthein, Uwe
    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.
    Taking the cat-and-mouse game to the next level: different perspectives on the introduction of the German New Psychoactive Substances Act2022In: Harm Reduction Journal, E-ISSN 1477-7517, Vol. 19, no 1, article id 122Article in journal (Refereed)
    Abstract [en]

    Background: To counteract the spread of new psychoactive substances (NPS) and to prevent the emergence of novel substances, specifically designed as a response to the legal control of individual substances, a new law was introduced in Germany in 2016: the New Psychoactive Substances Act (NpSG). The NpSG combines a generic approach with the waiver of criminal liability for the acquisition and possession of NPS for personal use, which is a novelty in German narcotics law. The present study aimed at exploring the impact of the introduction of the NpSG from three different perspectives—NPS users, staff of addiction care facilities, and members of law enforcement authorities—to better understand the dynamics surrounding such a change in legislation and to contribute to the body of international experience in dealing with NPS.

    Methods: Semi-structured narrative interviews were conducted with a total of 193 representatives of the three different groups affected by the law. These interviews included questions on perceived changes associated with the introduction of the NpSG as well as questions on opinions regarding legal and criminal policy issues. The analysis was carried out using qualitative content analysis according to Mayring.

    Results: Most interviewees welcomed the non-criminalisation approach of the NpSG but also noticed that, in practice, not much has changed for users. Nevertheless, the changes in legislation have had an impact on the market. For example, novel substances have emerged circumventing the new legislation. According to users, this has led some to reduce NPS use and others to adopt more hazardous consumption patterns. Overall, most respondents did not expect the introduction of the NpSG to bring any significant changes.

    Conclusions: Although the idea of non-criminalisation inherent to the NpSG is appreciated and the generic approach has been well implemented in the law, thus covering a wide range of substances, the introduction of the law—perhaps for that very reason—has also had unintended and negative consequences, taking the cat-and-mouse game to the next level. To end the game, or at least to defuse the game situation, a combination of different strategies will be necessary, with legislation always playing a key role.

  • 76. Legleye, Stephane
    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
    Phan, Olivier
    Jouanne, Celine
    Validation of the cannabis abuse screening test in a sample of cannabis inpatients2012In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 18, no 4, p. 193-200Article in journal (Refereed)
    Abstract [en]

    The present study aims at validating the Cannabis Abuse Screening Test (CAST) in a clinical sample of adolescent and young adult cannabis users seeking treatment. Applying a classical test theory approach using DSM-IV diagnoses as gold standard, two versions of the CAST questionnaire are compared. The sample consisted of 140 subjects aged 15-26 years (mean 18.9) recruited from two cannabis treatment centers. Gold standard diagnoses were assessed using the Adolescent Diagnostic Interview-Light. Internal structure and consistency of the CAST were assessed by principal component analysis and Cronbach's alpha. Optimal thresholds were defined using receiver operating characteristic analysis. Both the binary and the full test version revealed unidimensional structures with moderate to satisfactory internal consistency (alpha = 0.66 and 0.73). Screening properties were unsatisfactory when the CAST was compared against cannabis dependence. With regard to cannabis use disorders, both test versions yielded comparable and good sensitivity and specificity at cut-off 3 (binary: 92.2%, 66.7%) and 6 (full: 93.0%, 66.7%). Overall, the full CAST may be used for screening cannabis use disorders in clinical settings. Further research may use validation methods that do without gold standard.

  • 77. Legleye, Stephane
    et al.
    Piontek, Daniela
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Inst Therapieforsch, Munich.
    Morand, Elisabeth
    Falissard, Bruno
    A validation of the Cannabis Abuse Screening Test (CAST) using a latent class analysis of the DSM-IV among adolescents2013In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 22, no 1, p. 16-26Article in journal (Refereed)
    Abstract [en]

    This paper explored the latent class structure of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) (assessed with the Munich Composite International Diagnostic Interview). Secondly, the screening properties of the Cannabis Abuse Screening Test (CAST) in adolescents were assessed with classical test theory using the latent class structure as empirical gold standard. The sample comprised 3266 French cannabis users aged 17 to 19 from the general population. Three latent classes of cannabis users were identified reflecting a continuum of problem severity: non-symptomatic, moderate and severe. Gender-specific analyses showed the best model fit, although results were almost identical in the total sample. The latent classes were good predictors of daily cannabis use, number of joints per day and age of first experimentation. The CAST showed good screening properties for the moderate/severe class (area under receiver operating characteristic curve>0.85) and very good for the severe class (0.90). It was more sensitive for boys, more specific for girls. Although structural equivalence across gender was rejected, results suggest small gender differences in the latent structure of the DSM-IV. The performance of the CAST in screening for the latent class structure was good and superior to those obtained with the classical DSM-IV diagnoses.

  • 78. Legleye, Stephane
    et al.
    Piontek, Daniela
    Pampel, Fred
    Goffette, Céline
    Khlat, Myriam
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Is there a cannabis epidemic model? Evidence from France, Germany and USA2014In: International Journal of Drug Policy, ISSN 0955-3959, Vol. 25, no 6, p. 1103-1112Article in journal (Refereed)
    Abstract [en]

    Background: Cannabis is the most popular illicit drug in the world, but the process of its diffusion throughthe population has rarely been studied. The unfolding of the tobacco epidemic was accompanied by ashift in the educational gradient of users across generations. As a consequence, cannabis may show thesame pattern of widening social inequalities. We test the diffusion hypotheses that a positive value inolder cohorts – the more educated experimenting more – shifts to a negative one in younger cohorts –the more educated experimenting less, first for males and then females. Methods: Three nationwide subsamples (18–64 years old) of representative surveys conducted in France(n = 21,818), Germany (n = 7887) and USA (n = 37,115) in 2009–2010 recorded age at cannabis experimen-tation (i.e., first use), educational level, gender, and age. Cumulative prevalence of experimentation wasplotted for three retrospective cohorts (50–64, 35–49, 18–34 years old at data collection) and multivariatetime-discrete logistic regression was computed by gender and generation to model age at experimen-tation adjusted on age at data collection and educational level. This latter was measured according tofour categories derived from the International Standard Classification of Education (ISCED) and a relative(rather than absolute) index of education. Results: The findings demonstrate a consistent pattern of evolution of the prevalence, gender ratio andeducational gradient across generations and countries that support the hypothesis of an “epidemic” ofcannabis experimentation that mimics the epidemic of tobacco. Conclusion: We provide evidence for a cannabis epidemic model similar to the tobacco epidemic model.In the absence of clues regarding the future of cannabis use, our findings demonstrate that the gender gapis decreasing and, based on the epidemic model, suggest that we may expect widening social inequalitiesin cannabis experimentation if cannabis use decreases in the future.

  • 79. Legleye, Stéphane
    et al.
    Guignard, Romain
    Richard, Jean-Baptiste
    Ludwig, Kraus
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Munich, Germany.
    Pabst, Alexander
    Beck, Francois
    Properties of the Cannabis Abuse Screening Test (CAST) in the general population2015In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 24, no 2, p. 170-183Article in journal (Refereed)
    Abstract [en]

    This paper explores the DSM-IV latent structure of cannabis users (especially its invariance towards gender and age) and assesses the psychometric properties of the Cannabis Abuse Screening Test (CAST) by confrontation with the theoretical diagnoses [dependence and cannabis use disorders (CUD)] and the latent class structure of the DSM-IV. The random sample comprised 550 French cannabis smokers aged 15-62 years interviewed by telephone. DSM-IV diagnoses were assessed with the Munich Composite International Diagnostic Interview. Internal structures of both instruments were assessed using factor analysis and latent class analysis. Optimal CAST cutoffs were determined by sensitivity, specificity and area under the receiver operating curve (AUC). CAST and DSM-IV were unidimensional (Cronbach's =0.742 and 0.752, respectively), although a two-factor solution showed a better fit for the CAST. CAST cutoffs for screening CUD and dependence were three (AUC=0.851) and five (AUC=0.868), respectively. DSM-IV latent class structure varied only marginally in age and gender. Three classes of cannabis smokers were determined, ordered along a continuum of symptoms: non-symptomatic (61.1%), moderate (32.9%) and severe (6.0%). CAST cutoff scores for screening moderate/severe and severe were, respectively, three (AUC=0.869) and eight (AUC=0.952). Results are compared to those obtained in previous CAST studies and discussed in line with the DSM-5.

  • 80. Lochbuehler, Kirsten
    et al.
    Rossa, Monika
    Ebert, Christopher
    Morgenstern, Matthis
    Arnaud, Nicolas
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). ELTE Eötvös Loránd University, Hungary ; Hamburg University, Germany.
    Substance use and the usage of social media, computer games, and gambling among apprentices at vocational schools: [Substanzkonsum und nutzung von sozialen medien, computerspielen und glücksspielen unter auszubildenden an beruflichen schulen]2024In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, ISSN 1436-9990, E-ISSN 1437-1588, Vol. 67, no 4, p. 465-474Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the current study was to assess the prevalence of the (problematic) consumption of alcohol, tobacco, and cannabis as well as the (problematic) use of social media, e‑products, computer games, and gambling among apprentices. Method: Cross-sectional survey of 4591 apprentices at 17 vocational schools from Bavaria, Schleswig-Holstein, and Hamburg. Data was collected using questionnaires between March 2021 and April 2022. The primary endpoints were the 30-day prevalence and the problematic consumption and usage behavior of the mentioned substances/behaviors using screening instruments. Results: Among the assessed substances/behaviors, social media were used most frequently by the apprentices with a 30-day prevalence of 97.7%, followed by alcohol (64.3%) and computer games (55.8%). Cigarettes were consumed by 35.1%, e‑products by 17.9%, and cannabis by 15.4% of the apprentices. Of the apprentices, 12.2% reported having gambled in the past 30 days. Rates of problematic use were 47.4% for alcohol, 18.0% for tobacco, 6.2% for e‑products, and 1.6% for cannabis. Problematic use of social media was indicated by 45.0% of the apprentices, of gambling by 2.2%, and of computer games by 0.7%. Discussion: These results suggest that apprentices constitute a risk group for problematic substance use, indicating increased need for intervention. In particular, secondary prevention efforts in the areas of alcohol and social media should be taken into consideration due to their widespread prevalence in the vocational school setting.

  • 81. Loy, Johanna K.
    et al.
    Grüne, Bettina
    Braun, Barbara
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Help-seeking behaviour of problem gamblers: a narrative review2018In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 64, no 5-6, p. 259-272Article, review/survey (Refereed)
    Abstract [en]

    Background: There is evidence for low rates of help-seeking among problem gamblers. Identifying reasons for and barriers to seeking help is essential for improving help supply and gamblers’ treatment utilisation. The present study examines treatment utilisation of problem or pathological gamblers and reviews the evidence related to motives for and barriers to seeking help. Methods: The databases Medline, PsycInfo, and PubMed were searched for English-, Swedish- and German-language studies published between 2000 and 2017. Furthermore relevant references of included studies were analysed. Results: After exclusion of non-relevant publications 34 journal articles and seven reports covering the prevalence of help-seeking among gamblers or self-reported reasons for/barriers to help-seeking were maintained. The proportion of problem gamblers seeking help was less than 10 % in most studies. Problem severity was found positively associated with treatment attendance. Financial issues, negative emotions and crises were identified as main motives for seeking treatment. Main barriers to seeking treatment were shame, problem denial and lack of treatment availability. The results were similar across the examined studies. Conclusion: Low rates of treatment utilisation by problem gamblers strongly indicate that treatment providers and the society should strive to eliminate structural barriers that hinder gamblers to seek help. To better match problem gamblers´ needs, low-threshold early intervention, increasing knowledge of treatment options and efforts to reduce stigmatisation are important strategies to enhance access to help offers.

  • 82. Loy, Johanna K.
    et al.
    Sedlacek, Lucia
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Optimierungsbedarf von Spielersperren Ergebnisse der VeSpA-Interviewstudie2020In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 66, no 4, p. 223-235Article in journal (Refereed)
    Abstract [en]

    Background and research question: Exclusion programs are effective prevention measures for gamblers. However, they need to be adapted to better fit the needs of problem gamblers and to improve gambler protection. Studies point at deficits in terms of exclusion procedure and duration as well as access controls. The aim of the qualitative study was to derive recommendations for optimizing exclusion programs. Methods: Actors involved in the process of exclusion programs were individually or in groups interviewed with semi-structured guidelines about rules and conditions of exclusion programs, personal experiences and perceived barriers. Included were gamblers who were or were not excluded, relatives, addiction care personnel, and staff members of casinos, gambling halls and the “Gesellschaft für Spielerschutz und Prävention (GSP)”. A total of 20 individual and 6 group interviews were conducted. Results: The central points of optimization included duration, extent of exclusion and access controls. The interviewees requested a nationwide and cross-game exclusion program as well as stricter access controls. Applications via post or Internet to lower barriers and quicker inception of gambling exclusion were recommended. Controversially discussed were temporal limits, length of exclusion and minimum duration. The use of a gambling card could improve gambler protection by identifying gambling exclusion and limiting gambling time or stake. Discussion: In general, exclusion programs were positively rated by all respondents. Legal regulations and exclusion conditions need to be reformed. Closing legislative loopholes, intensifying information and motivation of gamblers, relatives and gambling providers may positively affect utilization of gambling exclusion.

  • 83. Loy, Johanna K.
    et al.
    Seitz, Nicki-Nils
    Bye, Elin K.
    Dietze, Paul
    Kilian, Carolin
    Manthey, Jakob
    Raitasalo, Kirsimarja
    Soellner, Renate
    Trolldal, Björn
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE, Eötvös Loránd University, Hungary.
    Changes in Alcoholic Beverage Choice and Risky Drinking among Adolescents in Europe 1999-20192021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 20, article id 10933Article in journal (Refereed)
    Abstract [en]

    This paper explores trends in beverage preference in adolescents, identifies related regional differences, and examines cluster differences in key drinking measures. Data were obtained from the European School Survey Project on Alcohol and Other Drugs (ESPAD), covering 24 European countries between 1999 and 2019. Trends in the distribution of alcoholic beverages on the participants’ most recent drinking occasion were analysed by sex and country using fractional multinomial logit regression. Clusters of countries based on trends and predicted beverage proportions were compared regarding the prevalence of drinkers, mean alcohol volume and prevalence of heavy drinking. Four distinct clusters each among girls and boys emerged. Among girls, there was not one type of beverage that was preferred across clusters, but the proportion of cider/alcopops strongly increased over time in most clusters. Among boys, the proportion of beer decreased, but was dominant across time in all clusters. Only northern European countries formed a geographically defined region with the highest prevalence of heavy drinking and average alcohol volume in both genders. Adolescent beverage preferences are associated with mean alcohol volume and heavy drinking at a country-level. Future approaches to drinking cultures need to take subpopulations such as adolescents into account.

  • 84. Loy, Johanna K.
    et al.
    Seitz, Nicki-Nils
    Bye, Elin K.
    Raitasalo, Kirsimarja
    Soellner, Renate
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Trends in alcohol consumption among adolescents in Europe: Do changes occur in concert?2021In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 228, article id 109020Article in journal (Refereed)
    Abstract [en]

    Objective: The present paper extends the scope of testing Skog's theory on the 'collectivity of drinking culture' to adolescent alcohol use in 26 European countries. The aim was to 1) examine whether changes in adolescent alcohol use are consistent across different consumption levels, and 2) explore whether trends in heavy and light drinkers diverged or converged.

    Method: Data came from six waves of the cross-sectional European School Survey Project on Alcohol and other Drugs (ESPAD) between 1999 and 2019. The sample consisted of n = 452,935 students aged 15-16 years. Trends in alcohol volume across consumption levels including abstainers were estimated by quantile regression models (50th, 80th, 90th and 95th percentile). Countries were classified according to trends showing (soft/hard) collectivity or (soft/hard) polarisation. Trends in heavy drinkers were compared with the population trend.

    Results: Trends in alcohol consumption at different levels across 26 European countries in the period 1999-2019 were not homogeneous. Collective changes were found in 15 (14 soft/1 hard), and polarised trends in 11 countries (5 soft/6 hard). Collectivity was generally associated with a declining trend. In 18 countries, trends in heavy and light drinkers diverged.

    Conclusion: Accepting some variation in the strength of changes across consumption levels, changes in many European countries occurred in the same direction. Yet, diverging trends at different consumption levels in most countries indicate a less beneficial change in heavy compared with light drinkers, implying that in addition to universal population-level strategies, intervention strategies targeting specific risk groups are needed to prevent alcohol-related harm.

  • 85. Ludwig, Monika
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Müller, Stefanie
    Braun, Barbara
    Bühringer, Gerhard
    Has gambling changed after major amendments of gambling regulations in Germany? A propensity score analysis2012In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 1, no 4, p. 151-161Article in journal (Refereed)
    Abstract [en]

    Aims: This study examined changes in general population gambling in the light of two major amendments of the German gambling regulation, the Fifth Amendment of the German Gambling Ordinance (AGO) for commercial amusement machines with prizes (AWP) and the State Treaty on Gambling (STG) for gambling activities subject to the state monopoly. Methods: Applying cross-sectional data from the 2006 and 2009 Epidemiological Survey of Substance Abuse (ESA), propensity-score-matched samples of 7,970 subjects and 3,624 12-month gamblers aged 18-64 years were used for analyses. Logistic regression was employed to examine changes in gambling controlling for possible confounding variables. Results: Overall participation in state gambling activities, participation in lotto as well as TV lottery decreased and gambling on Internet card games increased. No changes were found for any other gambling activity, 12-month prevalence of any gambling and pathological gambling. While weekly gambling declined, overall multiple gambling increased. Effects were similar in the total sample and among current gamblers. Conclusions: Prohibiting specific gambling activities, e. g., Internet gambling, seem to be insufficient approaches to change gambling behavior. Supply reduction might need to be enhanced by changes in game characteristics and implementation of early intervention measures. However, long-term consequences are uncertain and further monitoring is needed.

  • 86. Ludwig, Monika
    et al.
    Kräplin, Anja
    Braun, Barbara
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Gambling experiences, problems, research and policy: gambling in Germany2013In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 108, no 9, p. 1554-1561Article in journal (Refereed)
    Abstract [en]

    Aims The objective of this paper is to present an overview of gambling in Germany, including historical development, legislative and economic changes as well as treatment options and their effectiveness. Methods The available scientific literature and research reports on gambling in Germany were reviewed to obtain relevant information on history, commercialization, legislation, treatment and research agenda. Results Gambling in Germany is characterized by compromises between protective and economic efforts. At present, gambling is illegal in Germany, and provision is subject to the state monopoly. Mere gaming machines (specific slot machines) are not classified as gambling activity, permitting commercial providers. In recent years, implementing regulations for state gambling and gaming machines have been changed. Concerning the treatment of pathological gambling, various options exist; treatment costs have been covered by health and pension insurance since 2001. Information on the effectiveness of treatment in Germany is limited. Similarly, the number of peer-reviewed publications on gambling is small. Conclusions German gambling legislation was subject to major changes in the past years. Based on the available body of research (longitudinal), studies on risk and protective factors and the aetiology of pathological gambling are needed. The effectiveness of pathological gambling treatment in Germany and the impact of gambling regulations on gambling behaviour also need to be investigated.

  • 87. Mamone, Alessia
    et al.
    Fabi, Francesco
    Colasante, Emanuela
    Siciliano, Valeria
    Molinaro, Sabrina
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Rossi, Carla
    New indicators to compare and evaluate harmful drug use among adolescents in 38 European countries2014In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, no 4, p. 343-358Article in journal (Refereed)
    Abstract [en]

    AIMS - New trends in drug consumption reveal increasing polydrug use. Epidemiological indicators in the current use are based on the prevalence and the associated potential harm of a single main substance. We propose new indicators to evaluate frequency and potential harm of polydrug use. The indicators are used to compare drug use among countries based on survey data on adolescents' substance use in 38 European countries. METHODS - The approach is based on analysis of the frequency of use in the various population samples: lifetime use, twelve months use or last thirty days, depending on available data, and on the risk of harm for the substances used. Two indicators are provided: the frequency of use score (FUS) by summing the frequency of use of each substance, and the polydrug use score (PDS) that weight all the substances used by their risk. RESULTS - The indicators FUS and PDS were calculated and the distribution functions were used to characterise substance use across ESPAD countries. The analysis shows important differences in poly-substance use severity among countries presenting similar prevention policies. CONCLUSIONS - Systematic analysis of substance use and the related risk are of paramount interest. The proposed indicators are designed to better monitor and understand consequences of polydrug use and to measure the resulting risk at country or population level. The indicators may also be used to assess the effects of policy interventions.

  • 88. Manthey, Jakob
    et al.
    Kilian, Carolin
    Schomerus, Georg
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Rehm, Jürgen
    Schulte, Bernd
    Alcohol Use in Germany and Europe during the SARS-CoV-2 Pandemic2020In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 66, no 5, p. 247-258Article in journal (Refereed)
    Abstract [de]

    Aims: The aim of this study was to examine changes in alcohol consumption during the Sars-CoV-2 pandemic in Germany in comparison to changes in other European countries. Method: Analyses of sociodemographic and socio-economic data, as well as reports on alcohol use changes since the pandemic collected through a European online survey (N=40,064) in 21 countries. Weights based on gender, age and education were applied to account for sample bias. Results: Since the beginning of the pandemic, alcohol consumption has decreased on average. The decline is primarily due to a reduction in heavy episodic drinking occasions. As compared to other European countries, alcohol consumption in Germany has declined less sharply. This is mainly due to an increase in alcohol consumption among women as well as among people who report negative impacts on jobs and finances and among people with risky consumption patterns. Conclusion: In order to counter negative consequences of increased alcohol consumption in sub-groups during the pandemic, cutting the availability of alcohol through reasonable taxation and fostering alcohol screening activities in primary health care settings is needed.

  • 89. Manthey, Jakob
    et al.
    Lindemann, Christina
    Verthein, Uwe
    Frischknecht, Ulrich
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Reimer, Jens
    Grün, Annett
    Kiefer, Falk
    Schulte, Bernd
    Rehm, Jürgen
    Versorgung von Personen mit riskantem Alkoholkonsum und schwerer Alkoholkonsumstörung in Bremen: bedarfsgerecht und leitlinienkonform?2020In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, ISSN 1436-9990, Vol. 63, p. 122-130Article in journal (Refereed)
    Abstract [en]

    Background: Early detection of risky alcohol use and severe alcohol use disorders (AUDs) is crucial to avoid adverse health consequences. The German “Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders” recommend to routinely screen patients for hazardous alcohol use and to subsequently conduct brief interventions, for example in primary healthcare. For severe AUDs, provision of withdrawal treatment is recommended in inpatient settings if complications are anticipated.

    Objectives: To estimate the proportion of people with hazardous alcohol use or severe AUDs receiving healthcare as stipulated by the guidelines.

    Materials and methods: The prevalence of hazardous use (female ≥12 g; male ≥24 g) and severe AUDs (female ≥60 g; male ≥90 g) was estimated using per capita consumption of pure alcohol. Treatment rates were estimated using survey data (for hazardous use) and inpatient admissions (for severe AUDs). All estimates refer to the adult population (15 years or older) of the federal state of Bremen for 2016.

    Results: Physicians screened 2.9% of all people with hazardous alcohol use and conducted brief interventions with 1.4%. Among people with severe AUDs, 7.1% received inpatient treatment. Among people with severe AUDs who required inpatient treatment, 14.1% received withdrawal treatment in inpatient settings. Treatment rates below average were registered among 21- to 39-year-olds.

    Conclusions: In Bremen, provision of guideline-conform healthcare for hazardous alcohol use and severe AUDs is insufficient, especially among 21- to 39-year-olds.

  • 90. Maron, Julian
    et al.
    Gomes de Matos, Elena
    Piontek, Daniela
    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.
    Pogarell, Oliver
    Exploring socio-economic inequalities in the use of medicines: is the relation mediated by health status?2019In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 169, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Objectives: This study evaluated mediating effects of the health status on the association between socio-economic status (SES) and medicine use. It was hypothesized that more privileged people show a reduced use of medicines, as compared with the underprivileged, because of their superior health status. It was further hypothesized that people may apply medication based on their type of health complaint (ill physical versus mental status).

    Study design: Data were taken from the 2012 German Epidemiological Survey of Substance Abuse, a nationally representative cross-sectional study of n = 9084 individuals of the German general population aged 18-64 years.

    Methods: Direct and indirect effects of SES on weekly use of analgesics and sedatives/hypnotics were examined by applying generalized structural equation modeling. Self-rated physical and mental health statuses were considered as potential mediators. SES was measured by using educational level as a proxy. All analyses were gender-stratified.

    Results: Among men, both physical and mental health mediated the path from SES to the use of analgesics and sedatives/hypnotics, respectively, with a stronger effect of physical health on analgesic use and mental health on sedative/hypnotic use. These effects were only partially found among women.

    Conclusions: Social inequalities in health seem to have substantial impact on the prevalence of medicine use. Identification and elimination of the reasons for poor health among people of low SES may, therefore, not only help to reduce health inequalities directly. A decline in the use of medicines would also result in less side-effects and a reduced number of people with medicine-related misuse and addiction.

  • 91. Maron, Julian
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Pogarell, Oliver
    Gomes de Matos, Elena
    Piontek, Daniela
    Occupational inequalities in psychoactive substance use: A question of conceptualization?2016In: Addiction Research and Theory, ISSN 1058-6989, Vol. 24, no 3, p. 186-198Article in journal (Refereed)
    Abstract [en]

    Background: Three different conceptualizations of occupational prestige were contrasted by applying social stratification to four exemplarily selected psychoactive substances. Although these conceptualizations partly measure the same construct, it is hypothesized that the gradient of occupational inequality differs depending on the type of conceptualization. Method: Data were taken from the 2012 German Epidemiological Survey of Substance Abuse. The study sample comprised n = 9084 individuals of the general population aged 18–64 years. Use and heavy use of cigarettes, alcohol, cannabis and analgesics were stratified by (a) employment status (six groups: employed, marginally employed, apprenticeship, unemployed, retired and other), (b) occupational status (five groups: low to high) and (c) occupational social class (two groups: blue-collar and white-collar). Absolute and relative differences between occupational groups were calculated. All analyses were stratified by gender. Results: Risk for smoking was increased amongst unemployed males and blue-collar workers. Retired persons, people with low occupational status and female blue-collar workers had a diminished risk for alcohol consumption; apprentices had an increased risk. Amongst males, low occupational status and blue-collar work was associated with episodic heavy drinking. Unemployment and blue-collar work was related to cannabis use. Risk for heavy analgesics use was increased amongst unemployed women, men with low occupational status and male blue-collar workers, respectively. Conclusions: The results suggest that occupational inequality differs depending on the applied conceptualizations of occupational prestige. Consequently, they should not be used interchangeably.

  • 92. Maspero, Simona
    et al.
    Delle, Simone
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University Medical Center Hamburg-Eppendorf, Germany.
    Pogarell, Oliver
    Hoch, Eva
    Bachner, Joachim
    Lochbühler, Kirsten
    Short-term effectiveness of the national German quitline for smoking cessation: results of a randomized controlled trial2024In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, no 1, article id 588Article in journal (Refereed)
    Abstract [en]

    Background

    The objective of the present study was to examine the short-term effectiveness of the national German quitline for smoking cessation.

    Methods

    A parallel-group, two-arm, superiority, randomized controlled trial with data collection at baseline and post-intervention (three months from baseline) was conducted. Individuals were randomized to either the intervention group, receiving up to six telephone counselling calls, or the control group, receiving an active control intervention (self-help brochure). The primary outcome was the seven-day point prevalence abstinence at post-assessment. Secondary outcomes included changes in smoking-related cognitions and coping strategies from pre- to post-assessment, the perceived effectiveness of intervention components, and the satisfaction with the intervention.

    Results

    A total of n = 905 adult daily smokers were assigned to either the intervention group (n = 477) or the control group (n = 428). Intention-to-treat analyses demonstrated that individuals allocated to the telephone counselling condition were more likely to achieve seven-day point prevalence abstinence at post-assessment compared to those allocated to the self-help brochure condition (41.1% vs. 23.1%; OR = 2.3, 95% CI [1.7, 3.1]). Participants who received the allocated intervention in both study groups displayed significant improvements in smoking-related cognitions and coping strategies with the intervention group showing greater enhancements than the control group. This pattern was also found regarding the perceived effectiveness of intervention components and the satisfaction with the intervention.

    Conclusion

    The present study provides first empirical evidence on the short-term effectiveness of the national German quitline for smoking cessation, highlighting its potential as an effective public health intervention to reduce the burden of disease associated with smoking.

    Trial registration

    This study is registered in the German Clinical Trials Register (DRKS00025343). Date of registration: 2021/06/07.

  • 93. Molinaro, Sabrina
    et al.
    Benedetti, Elisa
    Scalese, Marco
    Bastiani, Luca
    Fortunato, Loredana
    Cerrai, Sonia
    Canale, Natale
    Chomynova, Pavla
    Elekes, Zsuzsanna
    Feijao, Fernanda
    Fotiou, Anastasios
    Kokkevi, Anna
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Rupsiene, Liudmila
    Monshouwer, Karin
    Nociar, Alojz
    Strizek, Julian
    Lazar, Tanja Urdih
    Prevalence of youth gambling and potential influence of substance use and other risk factors throughout 33 European countries: first results from the 2015 ESPAD study2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 10, p. 1862-1873Article in journal (Refereed)
    Abstract [en]

    Background and aims

    Although generally prohibited by national regulations, underage gambling has become popular in Europe, with relevant cross‐country prevalence variability. This study aimed to estimate the prevalence of underage gambling in Europe stratified by type of game and on‐/off‐line mode and to examine the association with individual and family characteristics and substance use.

    Design

    Our study used data from the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross‐sectional study, a survey using self‐administered anonymous questionnaires.

    Setting

    Thirty‐three European countries.

    Participants

    Sixteen‐year‐old‐year‐old students (n = 93 875; F = 50.8%).

    Measurements

    The primary outcome measure was prevalence of past‐year gambling activity. Key predictors comprised individual behaviours, substance use and parenting (regulation, monitoring and caring).

    Findings

    A total of 22.6% of 16‐year‐old students in Europe gambled in the past year: 16.2% on‐line, 18.5% off‐line. High prevalence variability was observed throughout countries both for mode and types of game. With the exception of cannabis, substance use shows a higher association with gambling, particularly binge drinking [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.39–1.53), life‐time use of inhalants (OR = 1.57, 95% CI = 1.47–1.68) and other substances (OR = 1.78, 95% CI = 1.65–1.92)]. Among life habits, the following showed a positive association: truancy at school (OR = 1.26, 95% CI = 1.18–1.35), going out at night (OR = 1.32, 95% CI = 1.26–1.38), participating in sports (OR = 1.30, 95% CI = 1.24–1.37). A negative association was found with reading books for leisure (OR = 0.82%, 95% CI = 0.79–0.86), parents’ monitoring of Saturday night activities (OR = 0.81, 95% CI = 0.77–0.86) and restrictions on money provided by parents as a gift (OR = 0.89, 95% CI = 0.84–0.94).

    Conclusions

    Underage gambling in Europe appears to be associated positively with alcohol, tobacco and other substance use (but not cannabis), as well as with other individual behaviours such as truancy, going out at night and active participation in sports, and is associated negatively with reading for pleasure, parental monitoring of evening activities and parental restriction of money.

  • 94. Motka, Franziska
    et al.
    Grüne, Bettina
    Braun, Barbara
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; Eötvös Loránd University, Hungary.
    Spielersperren in Deutschland: Stand der gesetzlichen Glücksspielregelungen und ihre Umsetzung2019In: Suchttherapie, ISSN 1439-9903, E-ISSN 1439-989X, Vol. 20, no 2, p. 100-109Article in journal (Refereed)
    Abstract [en]

    The exclusion of gamblers is a measure of gambler protection. This paper aims at giving an overview of the current legal regulations for the exclusion of gamblers in Germany and its Federal States as well as its utilisation in Bavaria, one of the largest Federal States. Whereas exclusions for state-provided gambling are regulated nationwide by the State Treaty on Gambling, exclusions for commercially provided gambling are organised by each federal state separately. Due to the inconsistent legal basis for the exclusion of gamblers, excluded gamblers are able to circumvent their exclusion by using other forms of gambling or gambling venues. These factors should be addressed in the counselling or therapeutic context to facilitate abstinence of gambling. For a broad utilisation of exclusions, structural changes in the present organisation of exclusions are needed. A comprehensive exclusion system for both state-provided as well as commercially provided gambling is necessary. Furthermore, the acceptance of exclusions could be increased by reducing barriers and the introduction of transparent criteria for the revokement of exclusions.

  • 95. Motka, Franziska
    et al.
    Grüne, Bettina
    Sleczka, Pawel
    Braun, Barbara
    Cisneros Örnberg, Jenny
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Who uses self-exclusion to regulate problem gambling? A systematic literature review2018In: Journal of Behavioral Addictions, ISSN 2062-5871, E-ISSN 2063-5303, Vol. 7, no 4, p. 903-916Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Self-exclusion programs offer an intervention for individuals with problem gambling behavior. However, these programs are insufficiently used. This review describes sociodemographic features and gambling behavior of self-excluders as well as goals and motives for initiating self-exclusion from terrestrial and online gambling. In addition, use of further professional help and barriers to self-exclusion are examined.METHODS: Based on systematic literature search and quality assessment, n = 16 original studies (13 quantitative, 2 qualitative, and 1 mixed method) published between 1997 and 2017 in English or German language were analyzed. Results are presented for online and terrestrial gambling separately.RESULTS: Online self-excluders were on average 10 years younger than terrestrial self-excluders. Self-exclusion was mainly motivated by financial problems, followed by feelings of losing control and problems with significant others. Financial problems and significant others were less important for online than for terrestrial gamblers. Main barriers for self-exclusion were complicated enrollment processes, lack of complete exclusion from all venues, little support from venue staff, and lack of adequate information on self-exclusion programs. Both self-excluders from terrestrial and online gambling had negative attitudes toward the need of professional addiction care.CONCLUSION: To exploit the full potential of self-exclusion as a measure of gambler protection, its acceptance and its utilization need to be increased by target-group-specific information addressing financial issues and the role of significant others, simplifying the administrative processes, facilitating self-exclusion at an early stage of the gambling career, offering self-determined exclusion durations, and promoting additional use of professional addiction care.

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  • 96. Möckl, Justin
    et al.
    Lindemann, Christina
    Manthey, Jakob
    Schulte, Bernd
    Reimer, Jens
    Pogarell, Oliver
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Centre for Mental Health and Addiction Research, Germany; Eötvös Loránd University (ELTE), Hungary.
    Estimating the prevalence of alcohol-related disorders and treatment utilization in Bremen 2016/2017 through routine data linkage2023In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 14, article id 1002526Article in journal (Refereed)
    Abstract [en]

    Background: In Germany, most individuals with alcohol dependence are recognized by the health care system and about 16% per year receive addiction-specific care. This paper aimed to analyze the prevalence and treatment utilization rate of people with alcohol dependence by type of addiction-specific care in the federal state of Bremen using routine and survey data.

    Methods: The number of individuals with alcohol dependence was estimated using data from the 2018 Epidemiological Survey of Substance Abuse (ESA). Furthermore, linked routine data of two statutory health insurances (SHIs), the German pension insurance (GPI), and the communal hospital group Gesundheit Nord – Bremen Hospital Group (GeNo), from 2016/2017, were analyzed. Based on SHI data, the administrative prevalence of various alcohol-related diagnoses according to the International Classification of Diseases (ICD-10), in various treatment settings, was extrapolated to the total population of Bremen. Based on all routine data sources, treatment and care services for individuals with alcohol dependence were also extrapolated to Bremen’s total population. Care services included outpatient addiction care visits and addiction-specific treatments, [i.e., qualified withdrawal treatment (QWT), outpatient pharmacotherapy as relapse prevention, and rehabilitation treatment].

    Results: Of the survey-estimated 15,792 individuals with alcohol dependence in Bremen, 72.4% (n = 11,427) had a diagnosis documented with an ICD-10 code for alcohol dependence (F10.2) or withdrawal state (F10.3–4). One in 10 individuals with alcohol dependence (n = 1,577) used one or more addiction-specific care services during the observation period. Specifically, 3.7% (n = 675) received outpatient addiction care, 3.9% (n = 736) initiated QWT, 0.8% (n = 133) received pharmacotherapy, and 2.6% (n = 405) underwent rehabilitation treatment. The share of seeking addiction-specific treatment after diagnosis was highest among younger and male patients.

    Conclusion: Although more than half of the individuals with alcohol dependence are documented in the health system, utilization rates of addiction-specific treatments are low. These low utilization rates suggest that there are existing barriers to transferring patients with alcohol dependence into addiction-specific care. Strengthening primary medical care provision in dealing with alcohol-related disorders and improving networking within the addiction support system appear to be particularly appropriate.

  • 97. Olderbak, Sally
    et al.
    Möckl, Justin
    Manthey, Jakob
    Lee, Sara
    Rehm, Jürgen
    Hoch, Eva
    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.
    Trends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 20212024In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 119, no 2, p. 311-321Article in journal (Refereed)
    Abstract [en]

    Aims: To measure the current trends of cannabis use in Germany, measure trends in the proportion of heavy cannabis users and estimate future cannabis use rates.

    Design: Repeated waves of the Epidemiological Survey on Substance Abuse, a cross-sectional survey conducted between 1995 and 2021 with a two-stage participant selection strategy where respondents completed a survey on substance use delivered through the post, over the telephone or on-line.

    Setting: Germany.

    Participants/cases: German-speaking participants aged between 18 and 59 years living in Germany who self-reported on their cannabis use in the past 12 months (n = 78 678). With the application of a weighting scheme, the data are nationally representative.

    Measurements: Questions on the frequency of cannabis use in the past 12 months and self-reported changes in frequency of use due to the COVID-19 pandemic.

    Findings: The prevalence of past 12-month cannabis users increased from 4.4% [95% confidence interval (CI) = 3.7, 5.1] in 1995 to 10.0% (95% CI = 8.9, 11.3) in 2021. Modeling these trends revealed a significant increase that accelerated over the past decade. The proportion of heavy cannabis users [cannabis use (almost) daily or at least 200 times per year] among past-year users has remained steady from 1995 (11.4%, 95% CI = 7.7, 16.5) to 2018 (9.5%, 95% CI = 7.6, 11.9), but significantly increased to 15.7% (95% CI = 13.1, 18.8) in 2021 during the COVID-19 pandemic. Extrapolating from these models, the prevalence of 12-month cannabis users in 2024 is expected to range between 10.4 and 15.0%, while the proportion of heavy cannabis users is unclear.

    Conclusions: Trends from 1995 to 2021 suggest that the prevalence of past 12-month cannabis users in Germany will continue to increase, with expected rates between 10.4 and 15.0% for the German-speaking adult population, and that at least one in 10 cannabis users will continue to use cannabis heavily (almost daily or 200 + times in the past year).

  • 98. Pabst, Alexander
    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
    Piontek, Daniela
    Substanzkonsum und substanzbezogene Störungen in Deutschland im Jahr 20122013In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 59, no 6, p. 321-331Article in journal (Refereed)
    Abstract [en]

    Aims: To examine prevalences, patterns and disorders associated with the use of alcohol, tobacco, illegal drugs and prescription drugs. Methods: The sample of the 2012 Epidemiological Survey of Substance Abuse (ESA) was randomly drawn from population registers and consisted of 9 084 individuals aged 18 to 64 years. A mixed-mode design including questionnaires, telephone and Internet interviews was applied. The response rate was 53.6 %. Results: Based on the past 30 days 57.3 % of respondents reported low-risk alcohol consumption whereas 14.2 % reported risky consumption. Overall, 30.2 % reported having smoked within this period. The 12-months prevalence of illegal substance use was 4.5 % for cannabis, 0.8 % for cocaine and 0.7 % for amphetamines. Analgesics were the most prevalent prescription drugs used within the past 12 months (61.9 %). Rates of DSM-IV substance dependence were estimated at 3.4 % for alcohol, 10.8 % for tobacco, 0.5 % for cannabis, 0.2 % for cocaine, 0.1 % for amphetamines and 3.4 % for analgesics. Conclusions: The high prevalence of substance use disorders associated with alcohol and tobacco emphasize the urgency of implementing effective prevention measures. Disorders associated with prescription drugs should be given more attention.

  • 99. Pabst, Alexander
    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
    Mueller, Stefanie
    Demmel, Ralf
    Direct and indirect effects of alcohol expectancies on alcohol-related problems2014In: Psychology of Addictive Behaviors, ISSN 0893-164X, E-ISSN 1939-1501, Vol. 28, no 1, p. 20-30Article in journal (Refereed)
    Abstract [en]

    This study investigates pathways from alcohol outcome expectancies to alcohol-related problems (ARPs), considering alcohol volume and episodic heavy drinking (EHD) as potential mediators. It is further examined whether these pathways vary by age. The population-based sample comprised 6,823 individuals aged 18 to 64 years reporting alcohol use in the past year. Direct and indirect effects of five alcohol expectancies (social assertiveness, tension reduction, sexual enhancement, cognitive impairment, aggression) and alcohol use (average daily intake, EHD) on a latent measure of ARPs (six items of the Alcohol Use Disorders Identification Test) were investigated. A multiple-group structural equation model with three age groups (18 to 24, 25 to 44, 45 to 64 years) was examined. In individuals aged 18 to 24 years, social assertiveness expectancies were positively associated with average intake and EHD, which in turn were associated with more ARPs. In addition, expectancies related to cognitive impairment and aggression were directly linked to more ARPs without mediation in this age group. In individuals aged 25 years and older, tension reduction expectancies were associated with more ARPs through increased average intake. In contrast, high scores on cognitive impairment were associated with lower average intake and in turn with fewer ARPs. Challenging expectancies of sociability in young and expectancies of relaxation in mid adulthood might help decrease high-risk drinking and subsequently ARPs. Considering negative alcohol expectancies may help to identify younger individuals at high risk for ARPs, even if they have not previously exhibited repeated excessive drinking.

  • 100. Pabst, Alexander
    et al.
    van der Auwera, Sandra
    Piontek, Daniela
    Baumeister, Sebastian E.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. IFT Institut für Therapieforschung, Germany; ELTE Eötvös Loránd University, Hungary.
    Decomposing social inequalities in alcohol consumption in Germany 1995-2015: an age-period-cohort analysis2019In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 114, no 8, p. 1359-1368Article in journal (Refereed)
    Abstract [en]

    Background and aims Previous research indicates that compared with individuals with lower socio-economic status (SES), individuals in higher SES groups are more often drinkers but those who drink report drinking smaller amounts more frequently. We aimed to decompose trends in self-reported alcohol consumption in Germany into age, period and birth cohort effects and examine whether these effects varied by SES. Design Age-period-cohort (APC) analysis using data from eight waves of the cross-sectional German Epidemiological Survey of Substance Abuse (ESA) collected between 1995 and 2015. Setting Germany. Participants The analytical sample included n=65821 individuals aged 18-64years reporting alcohol use within the last 30days. Measurements Alcohol measures included drinking prevalence, alcohol volume and prevalence of episodic heavy drinking (EHD). Educational attainment was used as an indicator of SES. A series of generalized linear and logistic regression models, including both main and interaction effects of age, period and cohort with SES, were estimated. Findings Regression models revealed significant interactions between APC effects and SES on two alcohol consumption measures. Higher SES was consistently associated with drinking prevalence across age (P<0.001), period (P=0.016) and cohort (P=0.016), and with volume of drinking in younger cohorts (P=0.002) and 50+-year-olds (P=0.001). Model results were inconclusive as to whether or not APC effects on EHD prevalence differed by SES. Conclusions In Germany, there are positive associations between socio-economic status and alcohol consumption during the life-course, over time and among birth cohorts. Three groups appear vulnerable to risky drinking: high socio-economic status young birth cohorts who drink high average quantities, low socio-economic status young birth cohorts who show a risky drinking pattern and high socio-economic status adults in their 50s and older who increase their drinking volume beyond that age.

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