The Nordic countries share similarities in many social and welfare domains, but drug policies have varied over time and between countries. We wanted to compare differences in mortality and disease burden attributed to drug use over time. Using results from the Global Burden of Disease (GBD) study, we extracted age-standardized estimates of deaths, DALYs, YLLs and YLDs per 100 000 population for Denmark, Finland, Iceland, Norway, and Sweden during the years 1990 to 2019. Among males, DALY rates in 2019 were highest in Finland and lowest in Iceland. Among females, DALY rates in 2019 were highest in Iceland and lowest in Sweden. Sweden have had the highest increase in burden since 1990, from 252 DALYs to 694 among males, and from 111 to 193 among females. Norway had a peak with highest level of all countries in 2001-2004 and thereafter a strong decline. Denmark have had the most constant burden over time, 566-600 DALYs among males from 1990 to 2010 and 210-240 DALYs among females. Strict drug policies in Nordic countries have not prevented an increase in some countries, so policies need to be reviewed.

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

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

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

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

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

Background and Aims: This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective.

Design: A narrative summary of the contents of the book according to five major issues.

Findings: An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers.

Conclusion: Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best.

Background and Aims: This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective. Design: A narrative summary of the contents of the book according to five major issues. Findings: An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers. Conclusion: Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best.

This study investigated if a change to an occupation with lowerphysical workload was associated with a reduced risk of disabilitypension (DP). A change to lower physical workload was associatedwith a reduced risk of DP. Older workers had the largest decreasedrisk for musculoskeletal DP. Generally, a larger reduction in physicalworkload was associated with the greatest reduced risk of DP.

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.

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

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

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

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

Aims

This study aimed to examine perceived social norms, the effect of parental drinking on these norms, alcohol use in front of children, and how norms and consumption vary based on child age and gender of the parent.

Methods

A cross-sectional online panel survey was undertaken with n = 1000 Australian adults (including 670 parents) aged 18-59 years. The survey assessed: alcohol consumption in front of children; normative attitudes towards drinking in the presence of children; and perceived social norms.

Results

Overall, 33.9% of parents reported drinking a glass of alcohol each day or a couple of times a week, 18.2% reported getting slightly drunk and 7.8% indicated getting visibly drunk each day or a couple of times a week with their children present. In total, 37.5% reported drinking in front of their children at least weekly. Fathers were more likely to drink in front of children than mothers. Most parents deemed drinking small amounts of alcohol in front of children as acceptable but did not accept drunkenness. Respondents were less concerned about a father drinking one or two drinks in front of their children than a mother. Social expectations were not related to child age, but norms related to others' perceived behaviour were.

Conclusions

Many parents, particularly fathers consume alcohol in front of their children. There is a need to target health promotion strategies to adults and parents consuming in excess of health guidelines, and to the many parents who are consuming alcohol at higher levels in front of their children.

Introduction and Aims Parental role modelling of alcohol use is known to influence alcohol consumption in adolescence and in later life. This study aimed to assess relationships between parental status, child age and alcohol consumption, which have not been well documented. Design and Methods Data were sourced from the 2013 Australian National Drug Strategy Household Survey. Analyses were conducted for 25-55 year olds (n = 11 591) by parental status, gender and age of youngest child in the household, controlling for socio-demographic factors. Results Parents were less likely than non-parents to exceed the alcohol guideline for increased lifetime risk (18.2% vs. 24.2%) and short-term risk: at least weekly (14.2% vs. 21.2%); and at least monthly (27.5% vs. 35.9%). Fathers were just as likely to exceed the guidelines for lifetime risk as other men, but those with children aged 0-2, were less likely to exceed the guideline for short-term risk. Women were least likely to exceed the guideline for lifetime risk if they had children aged 0-2, 6-11 or 15 years and over, or the guideline for short-term risk, if they had children aged 0-2, or 15 years and over in the household. Parents were more likely to report drinking in the home. Discussion and Conclusions Parents were less likely to exceed alcohol guidelines than non-parents, especially mothers whose youngest child was an infant or in high school or older. Consistent with population rates in men, fathers were more likely to exceed alcohol guidelines than mothers, and this excess consumption warrants public health attention.

Background: Alcohol is a discretionary, energy dense, dietary component. Compared to non-drinkers, people who consume alcohol report higher total energy intake and may be at increased risk of weight gain, overweight, and obesity, which are key preventable risk factors for illness. However, accurate consumer knowledge of the energy content in alcohol is low. To inform future behaviour change interventions among drinkers, this study investigated individual characteristics associated with changing alcohol consumption due to energy-related concerns.

Methods: An online survey was undertaken with 801 Australian adult drinkers (18–59 years, 50.2% female), i.e. who consumed alcohol at least monthly. In addition to demographic and health-related characteristics, participants reported past-year alcohol consumption, past-year reductions in alcohol consumption, frequency of harm minimisation strategy use (when consuming alcohol), and frequency of changing alcohol consumption behaviours because of energy-related concerns.

Results: When prompted, 62.5% of participants reported changing alcohol consumption for energy-related reasons at least ‘sometimes’. Women, those aged 30–44 years, metropolitan residents, those with household income $80,001–120,000, and risky/more frequent drinkers had increased odds of changing consumption because of energy-related concerns, and unemployed respondents had reduced odds.

Conclusions: Results indicate that some sociodemographic groups are changing alcohol consumption for energy-related reasons, but others are not, representing an underutilised opportunity for health promotion communication. Further research should investigate whether messaging to increase awareness of alcohol energy content, including through systems-based policy actions such as nutritional/energy product labelling, would motivate reduced consumption across a broader range of drinkers.

Background: The aim of this study was to examine how gender, age and education, regional prevalence of male and female risky drinking and country-level economic gender equality are associated with harms from other people's drinking.

Methods: 24,823 adults in 10 countries were surveyed about harms from drinking by people they know and strangers. Country-level economic gender equality and regional prevalence of risky drinking along with age and gender were entered as independent variables into three-level random intercept models predicting alcohol-related harm.

Findings: At the individual level, younger respondents were consistently more likely to report harms from others' drinking, while, for women, higher education was associated with lower risk of harms from known drinkers but higher risk of harms from strangers. Regional rate of men's risky drinking was associated with known and stranger harm, while regional-level women's risky drinking was associated with harm from strangers. Gender equality was only associated with harms in models that did not include risky drinking.

Conclusions: Youth and regional levels of men's drinking were consistently associated with harm from others attributable to alcohol. Policies that decrease the risky drinking of men would be likely to reduce harms attributable to the drinking of others.

Background and aims: Survey questions on usual quantity and frequency of alcohol consumption are regularly used in screening tools to identify drinkers requiring intervention. The aim of this study was to measure age-based differences in quantity and frequency of alcohol consumption on the Alcohol Use Disorders Identification Test (AUDIT) and how this relates to the prediction of harmful or dependent drinking.

Design: Cross-sectional survey.

Setting: Australia.

Participants: Data were taken from 17 399 respondents who reported any alcohol consumption in the last year and were aged 18 and over from the 2016 National Drug Strategy Household Survey, a broadly representative cross-sectional survey on substance use.

Measurement: Respondents were asked about their frequency of consumption, usual quantity per occasion and the other items of the AUDIT.

Findings: In older drinkers, quantity per occasion [β = 0.53, 95% confidence interval (CI) = 0.43, 0.64 in 43–47-year-olds as an example] was a stronger predictor of dependence than frequency per occasion (β = 0.24, 95% CI = 0.17, 0.31). In younger drinkers the reverse was true, with frequency a stronger predictor (β = 0.54, 95% CI = 0.39, 0.69 in 23–27-year-olds) than quantity (β = 0.26, 95% CI = 0.18, 0.34 in 23–27-year-olds). Frequency of consumption was not a significant predictor of dependence in respondents aged 73 years and over (β = −0.03, 95% CI = −0.08, 0.02). Similar patterns were found when predicting harmful drinking. Despite this, as frequency of consumption increased steadily with age, the question on frequency was responsible for at least 65% of AUDIT scores in drinkers aged 53 years and over.

Conclusions: In younger drinkers, frequent drinking is more strongly linked to dependence and harmful drinking subscale scores on the Alcohol Use Disorders Identification Test (AUDIT) than quantity per occasion, yet quantity per occasion has a stronger influence on the overall AUDIT score in this group. In older drinkers, frequency of consumption is not always a significant predictor of the AUDIT dependence subscale and is a weak predictor of the harmful drinking subscale.

Introduction and Aims: Restrictions introduced to reduce the spread of COVID-19 have had major impacts on the living circumstances of Australians. This paper aims to provide insight into shifts in alcohol consumption and associated factors during the epidemic. Design and Methods: A cross-sectional convenience sample of 2307 Australians aged 18 and over who drank at least monthly was recruited through social media. Respondents were asked about their alcohol consumption and purchasing in 2019 prior to the epidemic plus similar questions about their experiences in the month prior to being surveyed between 29 April and 16 May 2020. Results: Reports of average consumption before (3.53 drinks per day [3.36, 3.71 95% confidence interval]) and during (3.52 [3.34, 3.69]) the pandemic were stable. However, young men and those who drank more outside the home in 2019 reported decreased consumption during the pandemic, and people with high levels of stress and those who bulk-bought alcohol when restrictions were announced reported an increase in consumption relative to those who did not. Discussion and Conclusions: A reported increase in consumption among those experiencing more stress suggests that some people may have been drinking to cope during the epidemic. Conversely, the reported decrease in consumption among those who drank more outside of their home in 2019 suggests that closing all on-trade sales did not result in complete substitution of on-premise drinking with home drinking in this group. Monitoring of relevant subgroups to assess long-term changes in consumption in the aftermath of the epidemic is recommended.

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

Background: In the 1920s, eight of nine Canadian provinces legalized alcohol sales, ending prohibition in favor of government control. Much has been written about the rise and fall of Prohibition in North America, but there is little work examining these events in the light of current drug policy debates. This paper attempts to fill some of these gaps.

Methods: The aims of this paper are primarily exploratory and descriptive. Following a literature review, it draws from secondary and some primary sources to explore the debate around ending alcohol prohibition (i.e. legalizing its distribution) in Ontario between 1920 and 1927. It then uses material drawn from a comprehensive search of the Canadian House of Commons debates on cannabis legalization between 2016 and 2018 to draw parallels with the debates around alcohol legalization in Ontario about 90 years earlier.

Results: While alcohol and cannabis legalization occurred in very different social and political contexts, there are similarities in both the arguments in favor of ending prohibition (ineffectiveness at preventing consumption and collateral social harms) and post-legalization debates around regulation (most notably the optimal way to replace the illicit market).

Conclusion: The Canadian cannabis legalization debates of the 2010s echo the alcohol legalization debates of the 1920s in remarkable and relevant ways. Ultimately the most striking parallel may be the extent to which the political leaders advocating for legalization emphasized that their policy was not liberalization, but more effective control.

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

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

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

This study derived a set of Australian low-risk gambling limits and explored the relative and absolute risk associated with exceeding these limits. Secondary analysis of population-representative Tasmanian and Australian Capital Territory (ACT) cross-sectional (11,597 respondents) and longitudinal studies (2027 respondents) was conducted. Balancing sensitivity and specificity, the limits were: gambling frequency of 20-30 times per year; gambling expenditure of AUD $380-$615 per year (USD $240-$388 per year); gambling expenditure comprising 0.83-1.68% of gross personal income; and two types of gambling activities per year. All limits, except number of activities, predicted subsequent harm, with limits related to gambling expenditure consistently the best-performing. Exceeding the limits generally conferred a higher degree of relative and absolute risk, with gamblers exceeding the limits being 3-20 times more likely to experience harm than those who do not, and having a 5-17% risk of experiencing harm. Only 7-12% of gamblers exceeding the limits actually experienced harm. Gambling consumption lower than the limits also conferred a considerable amount of harm. Using a relative risk method, this study derived similar limits from disparate Australian states and territories. These limits can serve as working guidelines for the consideration of researchers, clinicians, and policy makers, but need to be subject to further rigorous empirical investigation.

Background: Cannabis use is common, especially among young people, and is associated with risks for various health harms. Some jurisdictions have recently moved to legalization/regulation pursuing public health goals. Evidence-based 'Lower Risk Cannabis Use Guidelines' (LRCUG) and recommendations were previously developed to reduce modifiable risk factors of cannabis-related adverse health outcomes; related evidence has evolved substantially since. We aimed to review new scientific evidence and to develop comprehensively up-to-date LRCUG, including their recommendations, on this evidence basis.

Methods: Targeted searches for literature (since 2016) on main risk factors for cannabis-related adverse health outcomes modifiable by the user-individual were conducted. Topical areas were informed by previous LRCUG content and expanded upon current evidence. Searches preferentially focused on systematic reviews, supplemented by key individual studies. The review results were evidence-graded, topically organized and narratively summarized; recommendations were developed through an iterative scientific expert consensus development process.

Results: A substantial body of modifiable risk factors for cannabis use-related health harms were identified with varying evidence quality. Twelve substantive recommendation clusters and three precautionary statements were developed. In general, current evidence suggests that individuals can substantially reduce their risk for adverse health outcomes if they delay the onset of cannabis use until after adolescence, avoid the use of high-potency (THC) cannabis products and high-frequency/-intensity of use, and refrain from smoking-routes for administration. While young people are particularly vulnerable to cannabis-related harms, other sub-groups (e.g., pregnant women, drivers, older adults, those with co-morbidities) are advised to exercise particular caution with use-related risks. Legal/regulated cannabis products should be used where possible.

Conclusions: Cannabis use can result in adverse health outcomes, mostly among sub-groups with higher-risk use. Reducing the risk factors identified can help to reduce health harms from use. The LRCUG offer one targeted intervention component within a comprehensive public health approach for cannabis use. They require effective audience-tailoring and dissemination, regular updating as new evidence become available, and should be evaluated for their impact.

Affect Phobia Treatment (APT) is based on an integrative theory involving the use of psychodynamic principles for understanding a client’s psychological dynamics, experiential principles for engaging and working with the client’s affect, and behavioral principles of exposure and response prevention for desensitizing the client to the fear of affect. APT’s goal is "to help patients function better by resolving emotional conflict through reducing their avoidance of adaptive, activating emotions" (Osborn et al., 2014). APT has not yet been systematically employed and researched for patients with mild to moderate Alcohol Use Disorder (AUD) together with affect phobia. The present study was designed to begin this process by describing and comparing, both qualitatively and quantitatively, three illustrative, distinctive cases of APT in patients with AUD, assigned the names of "Carey," "Michelle," and "Mary." The focus was on exploring the process by which the different individual patients responded to the multifaceted APT therapy, and hence how the therapist had to adapt the therapy to each particular patient, as outlined in Stiles’ (2009) concept of "appropriate responsiveness."  Following the manual for APT, therapy included 10 weekly sessions of individual psychotherapy. This short length for a therapy like APT, a treatment which usually has no determined session length (McCullough et al., 2003), was designed to make the therapy comparable in length to other therapies for AUD, like Motivational Interviewing. During the whole study period, patients gave weekly reports of their alcohol consumption and craving. In addition, at the beginning and at the end of the study, the patients answered questionnaires measuring affect phobia and psychiatric symptoms. Role expectations and experiences of psychotherapy were also measured. All three patients completed the treatment and the measurement period. No adverse events were reported. The patients had different trajectories of change regarding alcohol consumption, craving, and symptom change. The study showed that 10-session APT was a tolerable treatment for the patients with on-going mild-to-moderate alcohol dependence, who primarily used alcohol as a way of avoiding emotions, but that the therapy worked to different degrees and in different ways for the three patients due to their different presenting patterns of psychiatric symptoms and personality characteristics. Experience in the three cases suggests the advisability of (a) flexible treatment length in accordance to a patient's needs, and (b) complementary treatment strategies beyond APT focusing on reducing alcohol consumption per se for some patients.

The composition, use, policies, and the societal position of cannabis are changing and diversifying internationally. Cannabis has emerged as an object of much controversy and is subject to varying forms of regulation. Its role and regulation are also debated in the Nordic countries. To shed light on such developments, this special issue sets out to explore how the phenomenon of cannabis, and related policies and subjectivities, are currently made, unmade, and transformed in multiple ways through discourses, practices, and materiality, and with different consequences.

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

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

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

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

Objective: This study aimed to investigate the association between alcohol consumption and the prevalence of stroke in Chinese adults aged 40 years and over.

Method: We conducted a cross-sectional analysis among 113,573 Chinese adults aged >= 40 years in the China National Stroke Prevention Project (2014-2015) to examine correlations of alcohol consumption with the prevalence of stroke. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), controlling for various confounders, e.g., gender, age, smoking, physical activity and other health conditions.

Results: Within the study population, a total of 12,753 stroke survivors were identified. The prevalence of light to moderate and of heavy alcohol consumption was 10.1% and 5.7% respectively. The multivariate logistic regression results show that light to moderate alcohol consumption was associated with reduced risk of stroke of all types [0.91 (95%CI: 0.85-0.97)] and of ischemic stroke [0.90 (0.84-0.97)]. No association was found between alcohol consumption and hemorrhagic stroke. Compared with abstainers, the adjusted ORs of all stroke were 0.83 (0.75-0.92) for those who drank 11-20 years, and no association was found between 1 and 10 years or over 20 years of drinking and risk of stroke.

Conclusions: These results indicate that light to moderate alcohol consumption may be protective against all and ischemic stroke, and heavy drinking was not significantly associated with risk of all stroke in China. No association between alcohol consumption and hemorrhagic stroke was found.

Aim: Work is an important part of most people's everyday lives and well-being. Substance use by employees is associated with several negative consequences, such as absence from work and poor work performance. The study examines the strategies through which people who have problems with substance use produce a “normal” self and avoid becoming stigmatised in the workplace. Methods: The study uses data from in-depth unstructured life story interviews, which were conducted over phone with 13 people. The participants had developed various problematic heavy substance use habits. The interviews were analysed by applying interactional analysis and by using Goffman's concepts of “normality”, “embarrassment”, “face-work”, “stigma” and “performance”. Results: The analysis identified multiple strategies the participants used to produce normality and to avoid embarrassment and stigmatisation at work. These include skilful use of drugs in order not to show withdrawal symptoms, various ways of hiding their heavy substance use, frequent change of jobs, the maintenance of a clean and professional look, and attributing the absence from work to mental or physical illness. Moreover, the participants strategically avoided social contacts in which embarrassing situations could arise. When this was not possible, they manipulated their corporeal looks by hiding such kinds of bodily marks that would connote abnormality. Conclusion: The analysis points out that maintaining normality at work does not only refer to the efforts of trying to hide the effects of the drugs on behaviours and the body. It also reveals that the participants used substances to be able to perform energetically their work tasks, and in this way present themselves as normal workers. This ambivalence in performing normality makes the work life of people who use substances challenging. 

Alcohol consumption is causally linked to several cancers but the evidence for stomach cancer is inconclusive. In our study, the association between long-term alcohol intake and risk of stomach cancer and its subtypes was evaluated. We performed a pooled analysis of data collected at baseline from 491 714 participants in the European Prospective Investigation into Cancer and Nutrition and the Melbourne Collaborative Cohort Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for incident stomach cancer in relation to lifetime alcohol intake and group-based life course intake trajectories, adjusted for potential confounders including Helicobacter pylori infection. In all, 1225 incident stomach cancers (78% noncardia) were diagnosed over 7 094 637 person-years; 984 in 382 957 study participants with lifetime alcohol intake data (5 455 507 person-years). Although lifetime alcohol intake was not associated with overall stomach cancer risk, we observed a weak positive association with noncardia cancer (HR = 1.03, 95% CI: 1.00-1.06 per 10 g/d increment), with a HR of 1.50 (95% CI: 1.08-2.09) for >= 60 g/d compared to 0.1 to 4.9 g/d. A weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) was also observed. HRs of 1.48 (95% CI: 1.10-1.99) for noncardia and 0.51 (95% CI: 0.26-1.03) for cardia cancer were observed for a life course trajectory characterized by heavy decreasing intake compared to light stable intake (P-homogeneity = .02). These associations did not differ appreciably by smoking or H pylori infection status. Limiting alcohol use during lifetime, particularly avoiding heavy use during early adulthood, might help prevent noncardia stomach cancer. Heterogeneous associations observed for cardia and noncardia cancers may indicate etiologic differences.

Objective: Drawing on a study of the range and mag-nitude of harms that alcohol caused to specific others in Australia, and on social and health agency statistics for collective costs, this article produces an analysis of the economic cost of alcohol's harm to others (AHTO) in Australia. Method: This study used a general population survey and routinely collected social response agencies' data to quantify different costs of AHTO, using methods consistent with International Guidelines for Estimating the Costs of Substance Abuse. This approach estimates costs for health care and social services, crime costs, costs of productivity loss, quality of life-year loss and other expenses, including both tangible costs (direct and indirect) and intangible costs of loss of quality of life (respondents' self-reported loss of health-related quality of life). Results: The cost of AHTO in Australia was AUD$19.81 bil-lion (95% CI [11.99, 28.34]), with tangible costs accounting for 58% of total costs ($11.45 billion, which is 0.68% of gross domestic product in 2016) and intangible costs of $8.36 billion. The costs to private individu-als or households ($18.1 billion and 89% of total costs of AHTO) are greater than the costs to the government or society because of others' drinking in Australia. Conclusions: This study presents an estimation of the economic cost of harm from others' drinking. The economic costs from others' drinking are large and of much the same magnitude as the costs that drinkers impose on themselves, as found in previous studies. Preventing harm to others from drinking is important as a public health goal for both economic and humane reasons. 

The burden of caring for drinkers is seldom articulated as a social concern, or integrated in service planning or alcohol policy. This study aims to examine prevalence and predictors of informal caregiving due to others' drinking cross-nationally by surveying 20,728 respondents (18-64 years) in 11 countries. The outcome variable was respondent-reported informal caregiving due to others' drinking, analysed by socio-demographic factors and drinking pattern using logistic regression and meta-analysis. Estimated overall prevalence of informal caregiving due to others' drinking ranged from 9% in Nigeria to 47% in Thailand. In most countries, females reported a higher rate than males of caring for children and other dependents, but males reported a higher rate of driving family or friends somewhere or picking them up. Logistic regression analysis found differences between high-income countries and low- and middle-income countries in the relationship of caregiving with employment and household composition. Respondent's own drinking was positively correlated with the prevalence of caregiving in 10 out of 11 countries. In general, younger adults and those who are themselves risky drinkers are more likely to have had caring responsibilities. Although problematic drinking is concentrated in specific subpopulations, the burden of care for others' drinking extends widely across the population.

Aim This study aims to examine the relationship between alcohol expenditure and experience of financial difficulties.

Subjects and methods Using data from Australian Household Expenditure Survey 2009-10, associations between the proportion of household expenditure spent on alcohol and experience of financial difficulties in Australian households were estimated by logistic and linear regression models.

Results A positive association was found which suggests that the households that spent a higher percentage of total expenditure on alcohol were over 1.3 times more likely to experience financial difficulties than those households in the lowest alcohol expenditure quintile, while households which had no alcohol expenditure were also more likely to report financial problems compared with the lowest alcohol spending group. The determinants analysis in subcategories suggests that having experienced three or more types of financial difficulties in the last 12 months was related to higher levels of alcohol expenditure. The study also found that households living in rented dwellings and youngest age groups are likely to spend a greater proportion than others of their weekly spending on alcohol and more likely to experience financial difficulty.

Conclusion Alcohol expenditure makes up a significant proportion of household expenditure and strongly associates with household's financial problems in Australia. Brief interventions to reduce hazardous drinking and policy controls on alcohol availability may mean that such drinkers experience fewer alcohol-related financial problems.

Aims: To model the effects of a range of alcohol pricing policies on alcohol consumption in subpopulation groups (e.g. alcohol consumption pattern, and age and income groups) in Australia.Design: We used estimated price elasticities to model the effects of proposed pricing policies on consumption for 11 beverage categories among subpopulation groups.Setting: Australia.Participants: A total of 1789 adults (16+ years) who reported they purchased and consumed alcohol in the 2013 Australian International Alcohol Control Study, an adult population survey.Measurements: Mean and percentage changes in alcohol consumption were estimated for each scenario across subgroups. The policy scenarios evaluated included: (1) increasing the excise rate 10% for all off‐premise beverages; (2) replacing the wine equalization tax with a volumetric excise rate equal to the current spirits tax rate; (3) applying a uniform excise tax rate to all beverages equal to the current sprits tax rate and a 10 or 20% increase in it; and(4) introducing a minimum unit price (MUP) on all beverages categories at $1.00, 1.30 or 1.50.Findings: The effects of different tax and MUP policies varied greatly across different subgroups. The effects of the MUP policy on alcohol consumption increased rapidly in the range from $1.00 to $1.50. Applying a uniform tax rate across all beverages equal to current spirits tax rate, or a 10 or 20% increase beyond that, could generate large reductions in overall alcohol consumption in Australia. Compared with the uniform tax rate with or without further tax increase, introducing a MUP at $1.30 or $1.50 could reduce consumption particularly among harmful drinkers and lower‐income drinkers, with comparatively smaller impacts on moderate and higher‐income drinkers.Conclusions: Both uniform excise tax and minimum unit price policies are predicted to reduce alcohol consumption in Australia. Minimum unit price policies are predicted to have a greater impact on drinking among harmful drinkers than moderate drinkers.

Introduction Alcohol use and misuse are associated with substantial health and social issues in Australia and internationally. Pricing policy is considered as one of the most effective means to reduce risky drinking and related harms. This protocol paper describes a study that will model and estimate the effects, effectiveness and cost-benefit of alcohol pricing policy initiatives in reducing risky drinking, health and social harms, and health inequalities among subpopulations in Australia.

Methods and analysis The study is a modelling and epidemiological study using data from various resources, such as survey, previous literatures and response agencies. A number of statistical procedures will be undertaken to evaluate the impact of different alcohol pricing policy initiatives on various outcomes, including alcohol consumption in population subgroups, and health and social problems, and to measure health inequalities and cost-effectiveness of those proposed pricing policies, such as a 10% tax increase on all alcohol beverages or introduction of a minimum unit price.

Ethics and dissemination The ethics approval of this study was obtained from the College Human Ethics Sub-Committee of the La Trobe University on 9 November 2017 (Ref: S17-206). While examining the heterogeneous effects of price policy across population subgroups, this study will provide the first comprehensive estimates of the likely impacts of alcohol price changes on health inequalities. The study will also provide sophisticated economic analyses of the impact of price policy changes, which is critical information for policy makers and will assist policy makers in directing resources to a more efficient alcohol strategy. Results will be made available to communities and societies, health departments and other researchers.

Gambling during the COVID-19 pandemic: experiences of risks and changes

This study uses theories of risk society to examine how gamblers have experienced the exceptional situation caused by the COVID-19 pandemic, and what are the risks they have associated with the situation. The qualitative data was gathered by the University of Helsinki and EHYT ry. Results show that the reduced availability of gambling has limited total consumption, and the risk of gambling-related harms has therefore become less pressing during the pandemic. While gambling is also a public health risk in addition to being a harmful activity, the policy measures during the COVID-19 pandemic have revealed that, at a societal level, the risk of infection was perceived as a more serious problem than the risk of gambling harms.

Introduction

Adolescence is associated with an increased inclination for risk behaviors, like gambling and heavy episodic drinking (HED). While impulsivity is a well-documented risk factor, the purpose of this study is to explore if there are variables modulating this association. The study examined the effects of impulsivity and psychological health on risk gambling and HED, and whether psychological health functions as a moderator, i.e., protective factor.

Methods

Data was extracted from the Stockholm School Survey, collected in 2014 and 2016 among students in the ninth grade of primary school (15–16 years) and second grade of upper secondary school (17–18 years) in Stockholm (n = 21,886). Impulsivity, psychological problems, risk gambling, HED, and a number of sociodemographic control variables were measured using self-report data. The statistical method was binary logistic regression.

Results

Results showed that risk gambling (3.4%) and HED (22.8%) were prevalent among Swedish pupils. Impulsivity and—to a weaker extent—psychological problems as well as several sociodemographic variables were risk factors for risk gambling and HED. Furthermore, psychological problems negatively moderated the association between impulsivity and HED among girls.

Conclusions

This study supports evidence that impulsivity represents a risk factor for risk behaviors, and—contrary to the a priori hypothesis—indicates that the association between impulsivity and HED in female students might be attenuated by the presence of psychological problems. Prevention measures should particularly address adolescents exhibiting the mentioned risk factors and aim at reducing psychological problems, but not necessarily target the adolescents showing impulsivity and psychological problems simultaneously.

The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.

The emergent and growing body of research on alcohol's harm to others (AHTO), or secondhand effects of drinking, has important implications for prevention, intervention, and policy. Those victimized by other drinkers tend to favor effective alcohol policies more than their nonvictimized peers, but often a community's impulse will be to combat AHTO by targeting and stigmatizing individual heavy drinkers, rather than taking a public health approach to reducing harm. Here we discuss opportunities and challenges in selecting ways of reducing AHTO. We make a case for adopting joint public health and individual approaches to reduce AHTO.

The co-administration of different substances is a widespread practice in the context of hard drug use. Among others, alcohol combined with certain substances produces potentially dangerous interactions. This article explores how people who combine alcohol with benzodiazepines or psychostimulants perceive these practices and how they share their perceptions in Finnish and Swedish online discussions. This is carried out by analyzing discussants’ use of metaphoric expressions. We found that the metaphors given to the use of these substance combinations reflect their pharmacological characteristics. Through that, the metaphors and meanings were different depending on the substance alcohol was combined with. Moreover, we found that, in the realities the metaphors create, the control of use was differently conceptualized. The different aspects of control could be divided into three categories that, however, were not related to any specific substances but overarched all metaphors: 1) controlling pharmacological risks, 2) controlling social appearance and 3) ignoring control. As our findings bring out, often the actual health dangers and risks of the studied substance combinations were bypassed, and the control was rather understood either as a form of socially appropriate behavior or wholly ignored.

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

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

Setting Nineteen European countries and one autonomous community.

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

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

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

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

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

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

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

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

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

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.

Background and aimsSweden 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.DesignData 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).SettingSweden.ParticipantsA total of n = 52 847 respondents (48% females) aged 16 and 30 years were included in this study.MeasurementsFor 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.FindingsThe 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.ConclusionsIn 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.

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.

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.

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.

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.