Introduction Alcohol consumption poses a significant health risk, contributing to 10% of deaths in the WHO European Region. To combat this, the WHO recommends the implementation of its € best buy' policies - three cost-effective alcohol policies that include higher taxes, restricted availability and marketing bans. While evidence links alcohol marketing to increased consumption, the effectiveness of marketing bans in decreasing alcohol use remains inconclusive. Lithuania's 2018 comprehensive alcohol marketing ban offers a unique opportunity to measure the impact of this particular € best buy' control policy. Methods and analysis We will analyse repeated cross-sectional measures of alcohol use among 15-year-old and 16-year-old adolescents from Lithuania and other five European Union countries (Estonia, France, Italy, Latvia and Poland). Data from the European School Survey Project on Alcohol and Other Drugs collected between 2003 and 2019 will be used, as well as longitudinal alcohol policy data meticulously gathered through official records, supplemented by relevant literature and consultations with national authorities. Although all six countries introduced best buy alcohol policies - primarily via excise tax increases implemented at different times - only Lithuania implemented a full marketing ban. Generalised linear mixed models will be employed to assess the impact of national alcohol marketing restrictions on alcohol consumption, controlling for participant characteristics, social behaviours and country-level variables such as other alcohol control policies evaluated through a partial Bridging the Gap (BtG) scale. Sensitivity analyses will explore different outcome time periods and model specifications. Ethics and dissemination The Research Ethics Board of the primary recipient of the grant has approved the secondary data analyses as outlined in the grant proposal (CAMH REB 050/2020 delegated review, renewed annually). The study results will be published in a peer-reviewed journal, presented at conferences, and shared with policymakers. Author(s) (or their employer(s)) 2025.

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

Background  Alcohol use disorder (AUD) is conceptualized as a dimensional phenomenon in the DSM-5, but electronic health records (EHRs) rely on binary AUD definitions according to the ICD-10. The present study classifies AUD severity levels using EHR data and tests whether increasing AUD severity levels are linked with increased comorbidity.

Methods  Billing data from two German statutory health insurance companies in Hamburg included n = 21,954 adults diagnosed with alcohol-specific conditions between 2017 and 2021. Based on ICD-10 alcohol-specific diagnoses, patients were classified into five AUD severity levels: 1 (F10.0, T51.0 or T51.9); 2 (F10.1); 3 (F10.2); 4 (F10.3/4); 5 (K70 + or one of the following diagnoses: K70.0-4, K70.9, K85.2, K85.20, K86.0, 10.5-9, E24.4, G31.2, G62.1, G72.1, I42.6, K29.2). Generalized estimating equation regression models for count data (Poisson distribution) were used to assess associations with the Elixhauser Comorbidity Score (ECS).

Results  Across the study period, the annual prevalence of any AUD diagnosis varied between 2.7% and 2.9%. A dose-response relationship was observed between AUD severity and ECS, indicating that individuals with higher AUD severity experience more comorbid conditions, particularly cardiovascular and liver diseases.

Conclusions  The proposal to define AUD severity levels based on ICD-10 diagnoses allows for a more nuanced analysis of AUD in EHR data.

Background: A variety of treatment options for people with alcohol use disorder (AUD) exist. Surveys estimate that 1 in 10 people with AUD utilise treatment, but real-world treatment pathways remain covert. This data-linkage study seeks to characterise treatment utilisation patterns to identify gaps in treatment access and delivery in Germany. Methods: Linking individual-level data from three sources (statutory health insurance, pension funds, outpatient addiction care services) identified seven alcohol-related treatment types delivered in outpatient (brief psychiatric consultation; formal psychotherapy; pharmacotherapy; low-threshold counselling), inpatient (standard, somatic inpatient treatment; intensive inpatient treatment with somatic and psychosocial care), or either of the two settings (long-term rehabilitation treatment) during 2016 to 2021. For patients with a new AUD diagnosis (ICD-10: F10.1-9), treatment utilisation over 24 months was recorded and patterns were identified using latent class analyses. Results: Of n=9,491 patients with a new AUD diagnosis, 30% utilised at least one alcohol-related treatment type. Treatment utilisation was associated with younger age, female sex, unemployment, German nationality and lower physical comorbidity. Among treatment entrants, nearly half received only brief psychiatric consultation. A similar share of patients utilised standard or intensive inpatient treatment, the latter occasionally followed by rehabilitation treatment. Formal psychotherapy, low-threshold counselling and pharmacotherapy were rarely utilised and were mostly used in conjunction with other treatments. Conclusions: The real-world utilisation of alcohol-related treatments contrasts with existing guidelines, as most patients with diagnosed AUD do not receive adequate care. Structural and social barriers should be minimised to ensure healthcare provision for those affected.

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

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

Zielsetzung: Alkoholkonsum stellt eine erhebliche gesundheitliche Belastung für den Einzelnen und die Gesellschaft in Deutschland dar. Um diese Belastung zu reduzieren, ist die Sicherstellung einer optimalen Behandlung für diejenigen, die sie benötigen, von zentraler Bedeutung. Ziel dieser Data-Linkage-Studie ist eine umfassende Beschreibung der Inanspruchnahme von Gesundheitsleistungen durch Personen mit Alkoholkonsumstörungen in Hamburg. Methoden: Die Studienpopulation ist definiert als in Hamburg lebende Erwachsene, die aktuell bei einer von zwei gesetzlichen Krankenkassen versichert sind und in den Jahren 2016 bis 2021 mindestens eine alkoholspezifische ICD-10-Diagnose aufwiesen. Zusätzlich werden Daten der Rentenversicherungsträger und des Hamburger Basisdatenmonitorings der ambulanten Suchthilfe genutzt. Mittels eineindeutiger Identifikatoren werden die individuellen Registerdaten aus den drei Quellen miteinander verknüpft. In Form von Forschungsfragen werden Hypothesen und qualitative Analysen vorgestellt, um administrative Prävalenzraten, Patient_innenwege und Prädiktoren für einen Behandlungserfolg zu untersuchen sowie die Auswirkungen prototypischer Versorgungspfade und der COVID-19-Pandemie auf die Inanspruchnahme von alkoholspezifischen Gesundheitsleistungen abzuschätzen. Diskussion: Mit der Studie „Patient_innenwege von Menschen mit einer Alkoholabhängigkeit in Deutschland“ (PRAGMA) wird erstmals ein umfassendes Verständnis der Behandlungsangebote für Menschen mit Alkoholkonsumstörungen in Deutschland bereitgestellt. Die Nachverfolgung einer heterogenen Stichprobe von Menschen mit Alkoholkonsumstörungen über sechs Jahre hinweg bietet die einzigartige Möglichkeit, die tatsächlichen mit den empfohlenen Behandlungspfaden zu vergleichen und Möglichkeiten zur Verbesserung der Versorgung zu identifizieren.

Background Although many individuals with alcohol dependence (AD) are recognized in the German healthcare system, only a few utilize addiction-specific treatment services. Those who enter treatment are not well characterized regarding their prospective pathways through the highly fragmented German healthcare system. This paper aims to (1) identify typical care pathways of patients with AD and their adherence to treatment guidelines and (2) explore the characteristics of these patients using routine data from different healthcare sectors.

Methods We linked routinely collected register data of individuals with a documented alcohol-related diagnosis in the federal state of Bremen, Germany, in 2016/2017 and their addiction-specific health care: two statutory health insurance funds (outpatient pharmacotherapy for relapse prevention and inpatient episodes due to AD with and without qualified withdrawal treatment (QWT)), the German Pension Insurance (rehabilitation treatment) and a group of communal hospitals (outpatient addiction care). Individual care pathways of five different daily states of utilized addiction-specific treatment following an index inpatient admission due to AD were analyzed using state sequence analysis and cluster analysis. The follow-up time was 307 days (10 months). Individuals of the clustered pathways were compared concerning current treatment recommendations (1: QWT followed by postacute treatment; 2: time between QWT and rehabilitation). Patients’ characteristics not considered during the cluster analysis (sex, age, nationality, comorbidity, and outpatient addiction care) were then compared using a multinomial logistic regression.

Results The analysis of 518 individual sequences resulted in the identification of four pathway clusters differing in their utilization of acute and postacute treatment. Most did not utilize subsequent addiction-specific treatment after their index inpatient episode (n = 276) or had several inpatient episodes or QWT without postacute treatment (n = 205). Two small clusters contained pathways either starting rehabilitation (n = 26) or pharmacotherapy after the index episode (n = 11). Overall, only 9.3% utilized postacute treatment as recommended.

Conclusions A concern besides the generally low utilization of addiction-specific treatment is the implementation of postacute treatments for individuals after QWT.

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

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

Results: Of the survey-estimated 15,792 individuals with alcohol dependence in Bremen, 72.6% (n = 11,467) had a diagnosis documented with an ICD-10 code for alcohol dependence (F10.2) or withdrawal symptoms (F10.3–F10.4). One in ten individuals with alcohol dependence (n = 1,689) used one or more addiction-specific care services during the observation period. Specifically, 4.3% (n = 675) received outpatient addiction care, 4.7% (n = 736) initiated QWT, 0.8% (n = 133) received pharmacotherapy, and 3.9% (n = 614) underwent rehabilitation treatment. The share of seeking addiction-specific treatment after diagnosis was highest among younger and male patients.

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

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

Introduction: Mandatory breaks have been discussed as a harm reduction strategy in the context of gambling for several years, but their effectiveness remains unclear. The TESSA pilot study examines the association of physiological arousal (PA) and mandatory breaks during gambling with an aim to conceptualize the framework for a subsequent randomized controlled trial.

Material and methods: In a one-armed experimental pilot study 28 participants engaged in a simulated online slot game with mandatory breaks. PA, disentangled into fear, anger, joy, attraction, balance, and retraction, was continuously monitored via skin conductivity and skin temperature. The occurrence of PA in distinct phases (phase 1: initiation, phase 2: pre-break, phase 3: post-break) was contrasted by multilevel logistic regression.

Results: Fear and attraction did not change. Compared to phase 1, anger (OR = 0.698; p = 0.015) and joy (OR = 0.714; p = 0.032) were less likely in phase 2, with joy also being less likely in phase 3 (OR = 0.690; p = 0.023). Balance was more likely in phase 2 (OR = 5.073; p < 0.0001) than in phase 1 and less likely in phase 3 (OR = 0.348; p < 0.0001) whilst retraction declined from phase to phase.

Discussion: Mandatory breaks appear suited to offset changes in PA response evolving during gambling, but a sustained effect on initial PA levels should not to be expected. However, to sensitively judge the role of breaks additional framework conditions that impact on gambling behavior (e. g. wins/losses) should be considered.