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Schwarzkopf L, Bickl A, Daniel J, Papastefanou G, Neyer MA, Gomes de Matos E, Hoch E, Olderbak S, Kraus L, Loy JK. Do breaks in online gambling affect neuropsychological arousal? Conceptual approach and lessons learned from the TESSA-pilot trial. Addict Behav Rep 2024; 19:100530. [PMID: 38327759 PMCID: PMC10848032 DOI: 10.1016/j.abrep.2024.100530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
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.
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Affiliation(s)
- Larissa Schwarzkopf
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804 München, Germany
- Department of Psychiatry and Psychotherapy, University Clinic of the Ludwig Maximilians University Munich, Nussbaumstraße 7, 80336 Munich, Germany
| | - Andreas Bickl
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804 München, Germany
| | - Joana Daniel
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804 München, Germany
| | - Georgios Papastefanou
- Bodymonitor GmbH für biometrische Wirkungsanalyse, Wolfsgrubenweg 3a, 67069 Ludwigshafen, Germany
| | - Marieke A Neyer
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804 München, Germany
| | - Elena Gomes de Matos
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804 München, Germany
- Department Psychologie, Professur für Klinische Psychologie und Psychotherapie, Charlotte-Fresenius-Universität, Infanteriestrasse 11a, 80797 Munich, Germany
| | - Eva Hoch
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804 München, Germany
- Department of Psychiatry and Psychotherapy, University Clinic of the Ludwig Maximilians University Munich, Nussbaumstraße 7, 80336 Munich, Germany
- Department Psychologie, Professur für Klinische Psychologie und Psychotherapie, Charlotte-Fresenius-Universität, Infanteriestrasse 11a, 80797 Munich, Germany
| | - Sally Olderbak
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804 München, Germany
- Department of Psychiatry and Psychotherapy, University Clinic of the Ludwig Maximilians University Munich, Nussbaumstraße 7, 80336 Munich, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804 München, Germany
- Department for Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Johanna K Loy
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstrasse 175, 80804 München, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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Lochbühler K, Rossa M, Ebert C, Morgenstern M, Arnaud N, Kraus L. [Substance use and the usage of social media, computer games, and gambling among apprentices at vocational schools]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:465-474. [PMID: 38526678 PMCID: PMC10995047 DOI: 10.1007/s00103-024-03854-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024]
Abstract
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.
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Affiliation(s)
- Kirsten Lochbühler
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, München, Deutschland
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Deutschland
| | - Monika Rossa
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, München, Deutschland
| | - Christopher Ebert
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, München, Deutschland
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Deutschland
| | | | - Nicolas Arnaud
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Ludwig Kraus
- Department of Public Health Science, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Schweden.
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn.
- Zentrum für Interdisziplinäre Suchtforschung, Universität Hamburg (ZIS), Klinik für Psychiatrie und Psychotherapie (W37), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
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Bickl AM, Kraus L, Loy JK, Kriwy P, Sleczka P, Schwarzkopf L. Development of Gambling Behaviour and Its Relationship with Perceived Social Support: A Longitudinal Study of Young Adult Male Gamblers. J Gambl Stud 2024; 40:307-332. [PMID: 37058216 PMCID: PMC10904415 DOI: 10.1007/s10899-023-10200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 04/15/2023]
Abstract
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.
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Affiliation(s)
| | - Ludwig Kraus
- IFT Institut Für Therapieforschung, Munich, Germany.
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary.
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.
| | | | - Peter Kriwy
- Institute of Sociology, Chemnitz University of Technology, Chemnitz, Germany
| | - Pawel Sleczka
- German University of Health and Sport, Ismaning, Germany
| | - Larissa Schwarzkopf
- IFT Institut Für Therapieforschung, Munich, Germany
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
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Maspero S, Delle S, Kraus L, Pogarell O, Hoch E, Bachner J, Lochbühler K. Short-term effectiveness of the national German quitline for smoking cessation: results of a randomized controlled trial. BMC Public Health 2024; 24:588. [PMID: 38395782 PMCID: PMC10893695 DOI: 10.1186/s12889-024-18104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
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.
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Affiliation(s)
- Simona Maspero
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
| | - Simone Delle
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
| | - Ludwig Kraus
- Department of Public Health Science, Centre for Social Research On Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Eva Hoch
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joachim Bachner
- Department Health and Sport Sciences, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Kirsten Lochbühler
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Munich, Germany.
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany.
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Olderbak S, Möckl J, Manthey J, Lee S, Rehm J, Hoch E, Kraus L. Trends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 2021. Addiction 2024; 119:311-321. [PMID: 37816631 DOI: 10.1111/add.16356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 08/07/2023] [Indexed: 10/12/2023]
Abstract
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).
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Affiliation(s)
| | - Justin Möckl
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Jakob Manthey
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychiatry, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Sara Lee
- IFT Institut für Therapieforschung, Munich, Germany
| | - Jürgen Rehm
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research (ZIS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Program on Substance Abuse and WHO CC, Public Health Agency of Catalonia, Barcelona, Spain
| | - Eva Hoch
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Kraus L, Loy JK, Olderbak S, Trolldal B, Ramstedt M, Svensson J, Törrönen J. Does the decline in Swedish adolescent drinking persist into early adulthood? Addiction 2024; 119:259-267. [PMID: 37726931 DOI: 10.1111/add.16342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 08/17/2023] [Indexed: 09/21/2023]
Abstract
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.
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Affiliation(s)
- Ludwig Kraus
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Centre for Mental Health and Addiction Research, IFT Institut für Therapieforschung, Munich, Germany
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Johanna K Loy
- Centre for Mental Health and Addiction Research, IFT Institut für Therapieforschung, Munich, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sally Olderbak
- Centre for Mental Health and Addiction Research, IFT Institut für Therapieforschung, Munich, Germany
| | - Björn Trolldal
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden
| | - Mats Ramstedt
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden
| | - Johan Svensson
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden
| | - Jukka Törrönen
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
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Schwarz T, Anzenberger J, Busch M, Gmel G, Kraus L, Krausz M, Labhart F, Meyer M, Schaub MP, Westenberg JN, Uhl A. Opioid agonist treatment in transition: A cross-country comparison between Austria, Germany and Switzerland. Drug Alcohol Depend 2024; 254:111036. [PMID: 38091902 DOI: 10.1016/j.drugalcdep.2023.111036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND AIMS OAT is a well developed and successful treatment strategy for opioid dependent patients in Europe. It has significantly contributed to the fight against the HIV and HCV pandemics, leading to an increased life expectancy in this population. Building on the OAT experiences in Austria, Germany, and Switzerland and their models of care, the objective of this study is to analyse experiences and changes in patient structures to identify necessary adaptations for the system of care. METHODS We analysed national register-based data from patients receiving OAT during the period spanning from 2010 to 2020 in Austria, Germany (cases), and Switzerland. We examined and compared OAT policies and practice at national levels through a review of literature and publicly available policy documents. RESULTS Across these three countries, the life expectancy of OAT patients increased substantially. The mean age increased from 33.0 in 2010 to 39.1 in 2020 in Austria, from 35.6 years to 41.5 years in Germany (cases), and from 39.6 to 47.1 in Switzerland, respectively. In all three countries, the percentage of patients/cases aged 60 years and older increased more than tenfold between 2010 and 2020. CONCLUSIONS Integrated support models, reliable care structures, internationally comparable high treatment coverage, flexible prescribing practices, and a wide range of available OAT medications are successful strategies. The experiences in these countries indicate that it is possible to address the complex and chronic nature of opioid dependence and its concurrent mental and physical health challenges, resulting in an increasing life expectancy of OAT patients.
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Affiliation(s)
- Tanja Schwarz
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria; Doctoral Programme Meduni Vienna, Medical University of Vienna, Spitalgasse 23, Vienna 1090, Austria.
| | - Judith Anzenberger
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria
| | - Martin Busch
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria
| | - Gerhard Gmel
- Addiction Switzerland, Lausanne, Switzerland; Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Mental Health and Addiction Research, Munich, Germany; Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Krausz
- University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Florian Labhart
- Psychiatric University Clinic Basel, University of Basel, Basel, Switzerland
| | - Maximilian Meyer
- Psychiatric University Clinic Basel, University of Basel, Basel, Switzerland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, Zurich, Switzerland
| | - Jean N Westenberg
- Addiction Switzerland, Lausanne, Switzerland; University of British Columbia, Faculty of Medicine, Department of Psychiatry, Vancouver, BC, Canada
| | - Alfred Uhl
- Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria; Sigmund Freud University Vienna, Vienna, Austria
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Strothmann B, Kraus L, Kriston L, Röhrig J, Scherbaum N, Buchholz A. Factorial, Construct, and Predictive Validity of the Motivation for Treatment Scale in Alcohol-Use Disorder Withdrawal Treatment. Eur Addict Res 2023; 29:375-384. [PMID: 38008078 DOI: 10.1159/000532066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/12/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION The aim of the present study was to examine for the first time the factorial, construct, and predictive validity of the motivation for treatment (MfT) scale in a cohort of patients undergoing inpatient-qualified alcohol withdrawal treatment with the goal of referring patients to further treatment. The MfT scale has previously been evaluated in different settings of substance abuse treatment, revealing factorial ambiguity. To the best of our knowledge, the present study is the first study that conducted comprehensive factor analyses versus separate analyses of the factors conducted in prior studies in order to clarify the aforementioned factorial ambiguity. METHODS A total of 249 patients (mean age 45.2 years (SD = 10.3); 34.4% females) with alcohol dependence were assessed. Data were obtained from four inpatient clinics specialized in qualified alcohol withdrawal treatment in Germany. First, confirmatory factor analyses were carried out to examine the fit of the four models discussed in the literature. Second, an exploratory factor analysis was conducted. Correlations of the new factors with other motivational constructs and referral to a subsequent treatment were investigated as measures of construct and predictive validity. RESULTS None of the four models showed an acceptable fit to the data in confirmatory analyses. The exploratory analysis suggested to eliminate seven items because of inappropriate factor loadings and resulted in a shortened MfT scale, which consists of three factors based on 17 items. For the latent variables "problem recognition," "desire for help," and "treatment readiness," satisfactory composite reliability was found with 0.82, 0.80, and 0.78, respectively. Evidence for predictive validity was found in the correlation between "treatment readiness" and referral to a subsequent treatment. DISCUSSION/CONCLUSION The new shortened MfT scale exhibited remarkable parsimony, which is desirable in settings such as withdrawal treatment, where patients frequently are cognitively or physically impaired. Despite its briefness, construct and predictive validity were better than in the original version of the MfT scale. The factorial validity of the suggested scale needs to be corroborated in further research.
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Affiliation(s)
- Benjamin Strothmann
- Department of Medical Psychology, Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Levente Kriston
- Department of Medical Psychology, Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jeanette Röhrig
- Clinic for Addiction Medicine and Addictive Behaviour, Institute for Clinical Psychology, Medical Centre Stuttgart, Stuttgart, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Angela Buchholz
- Department of Medical Psychology, Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
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Wullinger PM, Bickl AM, Loy JK, Kraus L, Schwarzkopf L. Longitudinal associations between psychiatric comorbidity and the severity of gambling disorder: Results from a 36-month follow-up study of clients in Bavarian outpatient addiction care. J Behav Addict 2023. [PMID: 37307216 DOI: 10.1556/2006.2023.00026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/05/2023] [Accepted: 05/20/2023] [Indexed: 06/14/2023] Open
Abstract
Background and aims Individuals with gambling disorder (GD) often suffer from psychiatric comorbidities. Previous studies demonstrated greater severity of GD among gamblers with psychiatric comorbidities. However, evidence on the association between psychiatric comorbidity and course of GD severity during and after outpatient treatment is sparse. This study analyses data from a longitudinal one-armed cohort study on outpatient addiction care clients over three years. Methods We investigated the course of GD severity using data from 123 clients in 28 outpatient addiction care facilities in Bavaria using generalized estimation equations (GEE). We applied time* interaction analyses to examine different development profiles in participants with and without (1) affective disorders, or (2) anxiety disorders, and (3) to account for the co-occurrence of both. Results All participants benefitted from outpatient gambling treatment. Improvement in GD severity was poorer in participants with anxiety disorders compared to participants without anxiety disorders. The co-occurrence of affective and anxiety disorders was linked to a less favourable course of GD than the presence of affective disorders alone. However, the combined occurrence of both disorders was more favourable than the presence of anxiety disorders alone. Discussion and conclusions Our study suggests that clients with GD, with and without psychiatric comorbidities, benefit from outpatient gambling care. Psychiatric comorbidity, especially comorbid anxiety disorders, seems to be negatively associated with the course of GD within outpatient gambling care. Addressing psychiatric comorbidity within the treatment of GD and offering individualised help are required to meet the needs of this clientele.
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Affiliation(s)
- Pia M Wullinger
- 1IFT Institut für Therapieforschung, Mental Health and Addition Research, Munich, Germany
| | - Andreas M Bickl
- 1IFT Institut für Therapieforschung, Mental Health and Addition Research, Munich, Germany
| | - Johanna K Loy
- 1IFT Institut für Therapieforschung, Mental Health and Addition Research, Munich, Germany
| | - Ludwig Kraus
- 1IFT Institut für Therapieforschung, Mental Health and Addition Research, Munich, Germany
- 2Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
- 3Institute of Psychology, ELTE, Eötvöos Loránd University, Budapest, Hungary
| | - Larissa Schwarzkopf
- 1IFT Institut für Therapieforschung, Mental Health and Addition Research, Munich, Germany
- 4Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany
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10
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Wilms N, Seitz NN, Schwarzkopf L, Olderbak S, Kraus L. Alcoholic Beverage Preference in Germany: An Age-Period-Cohort Analysis of Trends 1995-2018. Alcohol Alcohol 2023:7078828. [PMID: 36928123 DOI: 10.1093/alcalc/agad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 12/06/2022] [Accepted: 02/07/2023] [Indexed: 03/17/2023] Open
Abstract
AIMS Germany is experiencing a decline in alcohol consumption but not for every alcoholic beverage type. Given the differential health impacts of alcoholic beverage type, it is important to understand the drivers of these trends. We investigated: (a) temporal trends in beverage preference and (b) the effects of age, period and cohort on these trends. METHODS Data came from nine waves (1995-2018; ntotal = 75,550) of the German Epidemiological Survey of Substance Abuse, a nationally representative household survey of individuals aged 18-59 years. The quantity of beer, wine, spirits and mixed drinks drank in the last 30 days was transformed into grammes of ethanol, and the beverage type preference was estimated as the proportion of total ethanol consumption. Fractional multinomial logit regression was applied to analyse the age, period and cohort effects on temporal trends of beverage preference by sex. RESULTS The preference for spirits and mixed drinks decreased with increasing age, while the preference for wine increased with no age effect on beer. There was a general decrease in the preference for beer and an increase in the preference for wine among both sexes, with an additional increase in the preference for spirits in males. CONCLUSION Trends in beverage preference were more related to individual ageing and changes in the whole population than to cohorts. With the continued reduction in alcohol consumption, the decreasing preference for beer and the growing preference for wine suggest a positive development. Trends of an increasing preference for spirits in males are of concern.
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Affiliation(s)
- Nicolas Wilms
- IFT Institut für Therapieforschung, Munich 80804, Germany
| | | | | | - Sally Olderbak
- IFT Institut für Therapieforschung, Munich 80804, Germany.,Psychology Department, College of Science, University of Arizona, Tucson, AZ 85721, USA
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich 80804, Germany.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest 1075, Hungary.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm 10691, Sweden
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11
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Kraus L, Bickl A, Sedlacek L, Schwarzkopf L, Örnberg JC, Loy JK. 'We are not the ones to blame'. Gamblers' and providers' appraisal of self-exclusion in Germany. BMC Public Health 2023; 23:322. [PMID: 36788494 PMCID: PMC9926676 DOI: 10.1186/s12889-023-15117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
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.
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Affiliation(s)
- Ludwig Kraus
- IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstraße 175, 80804, Munich, Germany. .,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden. .,Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary.
| | - Andreas Bickl
- grid.417840.e0000 0001 1017 4547IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstraße 175, 80804 Munich, Germany
| | - Lucia Sedlacek
- grid.417840.e0000 0001 1017 4547IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstraße 175, 80804 Munich, Germany
| | - Larissa Schwarzkopf
- grid.417840.e0000 0001 1017 4547IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstraße 175, 80804 Munich, Germany
| | - Jenny Cisneros Örnberg
- grid.10548.380000 0004 1936 9377Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Johanna K. Loy
- grid.417840.e0000 0001 1017 4547IFT Institut für Therapieforschung, Centre for Mental Health and Addiction Research, Leopoldstraße 175, 80804 Munich, Germany
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12
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Pietsch B, Arnaud N, Lochbühler K, Rossa M, Kraus L, Gomes de Matos E, Grahlher K, Thomasius R, Hanewinkel R, Morgenstern M. Effects of an App-Based Intervention Program to Reduce Substance Use, Gambling, and Digital Media Use in Adolescents and Young Adults: A Multicenter, Cluster-Randomized Controlled Trial in Vocational Schools in Germany. Int J Environ Res Public Health 2023; 20:1970. [PMID: 36767337 PMCID: PMC9915308 DOI: 10.3390/ijerph20031970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Vocational students are a risk group for problematic substance use and addictive behaviors. The study aim was to evaluate the effects of an app-based intervention on tobacco, e-cigarettes, alcohol, and cannabis use as well as gambling and digital media-related behaviors in the vocational school setting. A total of 277 classes with 4591 students (mean age 19.2 years) were consecutively recruited and randomized into an intervention (IG) or waitlist control group (CG). Students from IG classes received access to an app, which encouraged a voluntary commitment to reduce or completely abstain from the use of a specific substance, gambling, or media-related habit for 2 weeks. Substance use, gambling, and digital media use were assessed before and after the intervention in both groups with a mean of 7.7 weeks between assessments. Multi-level logistic regression models were used to test group differences. Intention-to-treat-results indicated that students from IG classes had a significantly larger improvement on a general adverse health behavior measure compared to CG (OR = 1.24, p = 0.010). This difference was mainly due to a significantly higher reduction of students' social media use in the IG (OR = 1.31, p < 0.001). Results indicate that the app "Meine Zeit ohne" is feasible for the target group and seems to have a small but measurable impact on students' health behavior.
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Affiliation(s)
- Benjamin Pietsch
- IFT-Nord Institute for Therapy and Health Research, 24114 Kiel, Germany
| | - Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre, Hamburg-Eppendorf, 20251 Hamburg, Germany
| | | | - Monika Rossa
- IFT Institut für Therapieforschung, 80804 Munich, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, 80804 Munich, Germany
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, 11419 Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, 1053 Budapest, Hungary
| | | | - Kristin Grahlher
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre, Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre, Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Reiner Hanewinkel
- IFT-Nord Institute for Therapy and Health Research, 24114 Kiel, Germany
- Institute for Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein (UKSH), 24105 Kiel, Germany
| | - Matthis Morgenstern
- IFT-Nord Institute for Therapy and Health Research, 24114 Kiel, Germany
- Institute for Medical Psychology and Medical Sociology, University Medical Center Schleswig-Holstein (UKSH), 24105 Kiel, Germany
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13
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Möckl J, Lindemann C, Manthey J, Schulte B, Reimer J, Pogarell O, Kraus L. Estimating the prevalence of alcohol-related disorders and treatment utilization in Bremen 2016/2017 through routine data linkage. Front Psychiatry 2023; 14:1002526. [PMID: 36778636 PMCID: PMC9909027 DOI: 10.3389/fpsyt.2023.1002526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023] Open
Abstract
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.
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Affiliation(s)
- Justin Möckl
- Department of Epidemiology and Diagnostics, Institut für Therapieforschung (IFT), Centre for Mental Health and Addiction Research, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Christina Lindemann
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Medical Psychology, Center for Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Manthey
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Reimer
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Itzehoe, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Ludwig Kraus
- Department of Epidemiology and Diagnostics, Institut für Therapieforschung (IFT), Centre for Mental Health and Addiction Research, Munich, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, Eötvös Loránd University (ELTE), Budapest, Hungary
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14
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Törrönen J, Månsson J, Samuelsson E, Roumeliotis F, Svensson J, Kraus L, Room R. How Covid-19 restrictions affected young people's well-being and drinking practices: Analyzing interviews with a socio-material approach. Int J Drug Policy 2022; 110:103895. [PMID: 36323187 PMCID: PMC9581798 DOI: 10.1016/j.drugpo.2022.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Covid-19 restrictions - as they made young people's practices in their everyday life visible for reflection and reformation - provide a productive opportunity to study how changing conditions affected young people's well-being and drinking practices. METHODS The data is based on qualitative interviews with 18- to 24-year-old Swedes (n=33) collected in the Autumn 2021. By drawing on the socio-material approach, the paper traces actants, assemblages and trajectories that moved the participants towards increased or decreased well-being during the lockdown. RESULTS The Covid-19 restrictions made the participants reorganize their everyday life practices emphatically around the home and communication technologies. The restrictions gave rise to both worsened and improved well-being trajectories. In the worsened well-being trajectories, the pandemic restrictions moved the participants towards loneliness, loss of routines, passivity, physical barriers, self-centered thoughts, negative effects of digital technology, sleep deficit, identity crisis, anxiety, depression, and stress. In the improved well-being trajectories, the Covid-19 restrictions brought about freedom to study from a distance, more time for significant others, oneself and for one's own hobbies, new productive practices at home and a better understanding of what kind of person one is. Both worsened and improved well-being trajectories were related to the aim to perform well, and in them drinking practices either diminished or increased the participants' capacities and competencies for well-being. CONCLUSIONS The results suggest that material domestic spaces, communication technologies and performance are important actants both for alcohol consumption and well-being among young people. These actants may increase or decrease young people's drinking and well-being depending on what kinds of relations become assembled.
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Affiliation(s)
- Jukka Törrönen
- Department of Public Health Sciences, Stockholm University, Sweden,Corresponding author
| | - Josefin Månsson
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Eva Samuelsson
- Department of Public Health Sciences, Stockholm University, Sweden,Department of Social Work, Stockholm University, Stockholm, Sweden
| | | | - Johan Svensson
- Department of Public Health Sciences, Stockholm University, Sweden
| | - Ludwig Kraus
- Department of Public Health Sciences, Stockholm University, Sweden,IFT Institut für Therapieforschung, Leopoldstraße 175, 80804 München, Germany
| | - Robin Room
- Department of Public Health Sciences, Stockholm University, Sweden,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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15
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Kühnl R, Aydin D, Horn S, Olderbak S, Verthein U, Kraus L. Taking the cat-and-mouse game to the next level: different perspectives on the introduction of the German New Psychoactive Substances Act. Harm Reduct J 2022; 19:122. [PMID: 36329471 PMCID: PMC9632031 DOI: 10.1186/s12954-022-00704-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Regina Kühnl
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.,Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069, Ulm, Germany
| | - Darya Aydin
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany
| | - Sabine Horn
- Unit III.5 Criminal Law, Criminal Procedural Law and Criminal Politics, German Police University, Zum Roten Berge 18-24, 48165, Muenster, Germany
| | - Sally Olderbak
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.,Psychology Department, University of Arizona, 1503 E University Blvd., Tucson, AZ, 85721, USA
| | - Uwe Verthein
- Department of Psychiatry and Psychotherapy, Centre of Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany. .,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, 106 91, Stockholm, Sweden. .,Institute of Psychology, ELTE Eötvös Loránd University, Egyetem tér 1-3, 1053, Budapest, Hungary.
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16
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Loy J, Seitz N, Soellner R, Törrönen J, Kraus L. Entwicklungen des jugendlichen Trinkverhaltens in
Europa. Suchttherapie 2022. [DOI: 10.1055/s-0042-1755951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- J Loy
- IFT Institut für Therapieforschung,
München
| | - N Seitz
- IFT Institut für Therapieforschung,
München
| | | | | | - L Kraus
- IFT Institut für Therapieforschung,
München
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17
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Rauschert C, Möckl J, Seitz NN, Wilms N, Olderbak S, Kraus L. The Use of Psychoactive Substances in Germany. Dtsch Arztebl Int 2022; 119:527-534. [PMID: 35791270 PMCID: PMC9677535 DOI: 10.3238/arztebl.m2022.0244] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 06/01/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Monitoring the use of psychoactive substances and substance-related problems in the population allows for the assessment of prevalence and associated health and social consequences. METHODS The data are derived from the Epidemiological Survey of Substance Abuse (ESA) 2021 (n = 9046, 18-64 years). We estimated prevalence rates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications, as well as the prevalence rates of their problematic use (indicating dependence) using screening instruments, and extrapolated the results to the resident population (N = 51 139 451). RESULTS Alcohol was the most frequently used substance, with a 30-day prevalence of 70.5% (36.1 million people), followed by non-opioid analgesic drugs (47.4%; 24.2 million) and conventional tobacco products (22.7%; 11.6 million). E-cigarettes were used by 4.3% (2.2 million) and heat-not-burn products by 1.3% (665 000). Among illegal drugs (12-month prevalence), cannabis was the most frequently used (8.8%; 4.5 million), followed by cocaine/crack (1.6%; 818 000) and amphetamine (1.4%; 716 000). Rates of problematic use among the study participants were 17.6% for alcohol (9.0 million), 7.8% for tobacco (4.0 million), 5.7% for psychoactive medications (2.9 million), and 2.5% for cannabis (1.3 million). CONCLUSION The consumption of psychoactive substances continues to be widespread in Germany. In view of the imminent legal changes, the high prevalence of cannabis use and its problematic use need to be taken into consideration.
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Affiliation(s)
- Christian Rauschert
- IFT Institut für Therapieforschung, Munich,*IFT Institut für Therapieforschung Leopoldstraße 175 80804 München, Germany
| | | | | | | | - Sally Olderbak
- IFT Institut für Therapieforschung, Munich,Psychology Department, University of Arizona, Tucson, USA
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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18
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Kraus L, Möckl J, Lochbühler K, Rauschert C, Seitz NN, Olderbak S. Changes in the Use of Tobacco, Alternative Tobacco Products, and Tobacco Alternatives in Germany. Dtsch Arztebl Int 2022; 119:535-541. [PMID: 36384922 PMCID: PMC9677538 DOI: 10.3238/arztebl.m2022.0252] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/01/2022] [Accepted: 06/08/2022] [Indexed: 01/04/2023]
Abstract
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 paperpencil 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. CONCLUSION 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.
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Affiliation(s)
- Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany,Department of Public Health Sciences, Stockholm University, Sweden,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,*IFT Institut für Therapieforschung Leopoldstr. 175, 80804 Munich, Germany
| | - Justin Möckl
- IFT Institut für Therapieforschung, Munich, Germany
| | | | | | | | - Sally Olderbak
- IFT Institut für Therapieforschung, Munich, Germany,Psychology Department, University of Arizona, Tucson, USA
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19
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Specht S, Schwarzkopf L, Braun-Michl B, Seitz NN, Wildner M, Kraus L. Was macht den Unterschied? Alters-, Perioden- und Kohorteneffekte in
der Inanspruchnahme ambulanter Suchthilfeleistungen. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- S Specht
- IFT Institut für Therapieforschung, München,
Deutschland
| | - L Schwarzkopf
- IFT Institut für Therapieforschung, München,
Deutschland
- Ludwig-Maximilians-Universität, Pettenkofer School of Public
Health, München, Deutschland
| | - B Braun-Michl
- IFT Institut für Therapieforschung, München,
Deutschland
| | - N-N Seitz
- IFT Institut für Therapieforschung, München,
Deutschland
| | - M Wildner
- Ludwig-Maximilians-Universität, Pettenkofer School of Public
Health, München, Deutschland
- Bayerisches Landesamt für Gesundheit und
Lebensmittelsicherheit, Oberschleißheim, Deutschland
| | - L Kraus
- IFT Institut für Therapieforschung, München,
Deutschland
- Stockholm University, Department of Public Health Science, Centre for
Social Research on Alcohol and Drugs, Stockholm, Schweden
- ELTE Eötvös Loránd University, Institute of
Psychology, Budaoest, Ungarn
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20
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Kraus L. Ausschluss vom Glücksspiel (Spielersperre): ein zahnloser
Tiger? Suchttherapie 2022. [DOI: 10.1055/s-0042-1756005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- L Kraus
- IFT Institut für Therapieforschung,
München
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21
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Delle S, Kraus L, Maspero S, Pogarell O, Hoch E, Lochbühler K. Effectiveness of the national German quitline for smoking cessation: study protocol of a randomized controlled trial. BMC Public Health 2022; 22:1386. [PMID: 35854238 PMCID: PMC9295518 DOI: 10.1186/s12889-022-13742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
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. Trial registration The protocol for this study is registered with the German Clinical Trials Register: DRKS00025343, Date of registration: 2021/06/07, https://www.drks.de/drks_web/setLocale_EN.do
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Affiliation(s)
- Simone Delle
- IFT Institut für Therapieforschung, Munich, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | | | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Eva Hoch
- IFT Institut für Therapieforschung, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
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22
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Kraus L, Olderbak S. Commentary on Livingston et al.: Do reductions in adolescent drinking really maintain into adulthood? Addiction 2022; 117:1282-1283. [PMID: 35261098 PMCID: PMC9314098 DOI: 10.1111/add.15856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ludwig Kraus
- Department of Epidemiology and DiagnosticsIFT Institut für TherapieforschungMunichGermany
- Department of Public Health Sciences, Centre for Social Research on Alcohol and DrugsStockholm UniversityStockholmSweden
- Institute of PsychologyELTE Eötvös Loránd UniversityBudapestHungary
| | - Sally Olderbak
- Department of Epidemiology and DiagnosticsIFT Institut für TherapieforschungMunichGermany
- Psychology DepartmentUniversity of ArizonaTucsonAZUSA
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23
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Arnaud N, Weymann J, Lochbühler K, Pietsch B, Rossa M, Kraus L, Thomasius R, Hanewinkel R, Morgenstern M. Effectiveness of an app-based intervention to reduce substance use, gambling, and digital media use in vocational school students: study protocol for a randomized controlled trial. Trials 2022; 23:277. [PMID: 35395932 PMCID: PMC8990496 DOI: 10.1186/s13063-022-06231-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance-related and addictive disorders are among the most common mental disorders in adolescence and young adulthood. Vocational school students are a risk group for problematic substance use and addictive behavior. However, the availability of evidence-based prevention concepts and programs is underdeveloped in the vocational school setting. METHODS/DESIGN A two-arm cluster randomized waitlist-controlled trial will be conducted to evaluate the effectiveness of an app-based intervention to decrease substance use, gambling, and digital media use in vocational school students in Germany. Vocational students will participate in an app-based intervention that is designed to support voluntary commitment to abstain from or reduce substance or digital media use over a period of 2 weeks. The "education-as-usual" control arm will have access to the intervention after data collection is completed. One of the primary outcome measures will be the use of alcohol, nicotine, and digital media 30 days after the intervention. Several secondary outcome measures will also be included, such as cannabis consumption, gambling, symptoms of stress, physical activity, mindfulness, well-being, impulsivity and sensation seeking, and readiness to change. A total of 4500 vocational students from 225 classes will be recruited and randomized across three German federal states. DISCUSSION This study protocol describes the design of an RCT testing the effectiveness of an app-based intervention to reduce addictive behaviors in vocational school students. It is expected that this approach will be feasible for and effective in the vocational school setting and that the study provides comprehensive information on the key factors involved in temporary abstaining or reducing substance or digital media use. TRIAL REGISTRATION German Clinical Trials Register DRKS00023788 . Registered on 20 January 2021.
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Affiliation(s)
- Nicolas Arnaud
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Johanna Weymann
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Benjamin Pietsch
- IFT-Nord Institute for Therapy and Health Research, Kiel, Germany
| | - Monika Rossa
- IFT Institut für Therapieforschung, Munich, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany
| | - Rainer Thomasius
- German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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24
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Specht S, Schwarzkopf L, Braun-Michl B, Seitz NN, Wildner M, Kraus L. Age, period, and cohort effects on trends in outpatient addiction care utilization in the general Berlin population from 2008 to 2016. BMC Public Health 2022; 22:320. [PMID: 35168578 PMCID: PMC8848644 DOI: 10.1186/s12889-022-12744-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/09/2022] [Indexed: 01/12/2023] Open
Abstract
Background The aim of this study was to decompose independent effects of age, period, and cohort on trends in outpatient addiction care utilization resulting from alcohol (AUD) and illicit substances use disorders (ISUD). Decomposing trends in addiction care utilization into their independent effects by age, period, and cohort may lead to a better understanding of utilization patterns. Methods Individuals seeking help in Berlin outpatient addiction care facilities between 2008 and 2016 with an age range of 18–81 years for AUD (n = 46,706) and 18–70 years for ISUD (n = 51,113) were standardized to the general Berlin population using data from the German Federal Statistical Office. Classification of utilization as AUD- (F10) or ISUD-related (F11, F12, F14, F15, F16, F18, F19) help-seeking was based on primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. Age was measured in years and period as year of data collection. Cohort was defined as the mathematical difference between period and age. Age, period, and cohort analyses were conducted using the intrinsic estimator model on AUD- and ISUD-related outpatient addiction care utilization. Results Age effects on AUD-related utilization were highest in 18- to 19-year-old and in 39- to 59-year-old individuals. ISUD-related utilization declined almost continuously with increasing age. Period effects on AUD- and ISUD-related utilization were small. AUD-related utilization was highest in cohorts born from 1951 to 1986. ISUD-related utilization increased in cohorts born between 1954 and 1973 where utilization peaked, followed by a decline of the same order. Conclusions Age and cohort effects were the strongest drivers of trends in AUD- and ISUD-related outpatient addiction care utilization. Onset of help-seeking in earlier phases of AUD development should be enhanced as well as help-seeking for AUD and ISUD in general. The highest cohort-related rates in the baby boomer and following cohorts for AUD and ISUD underline an increased demand for addiction care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12744-6.
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Affiliation(s)
- Sara Specht
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.
| | - Larissa Schwarzkopf
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany
| | - Barbara Braun-Michl
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany
| | - Nicki-Nils Seitz
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany
| | - Manfred Wildner
- Pettenkofer School of Public Health, Ludwig-Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany.,Bavarian Health and Food Safety Authority, Veterinärstraße 2, 85764, Oberschleißheim, Germany
| | - Ludwig Kraus
- IFT Institut Für Therapieforschung, Leopoldstraße 175, 80804, Munich, Germany.,Department of Public Health Science, Centre for Social Research on Alcohol and Drugs, Stockholm University, SE-106 91, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Izabella utca 46, 1064, Budapest, Hungary
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25
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Buchholz A, Berner M, Dams J, Rosahl A, Hempleman J, König HH, Konnopka A, Kriston L, Piontek D, Reimer J, Röhrig J, Scherbaum N, Silkens A, Kraus L. Patient-centered placement matching of alcohol-dependent patients based on a standardized intake assessment: process evaluation within an exploratory randomized controlled trial. BMC Psychiatry 2022; 22:60. [PMID: 35086501 PMCID: PMC8793210 DOI: 10.1186/s12888-022-03705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the implementation of placement matching guidelines, feasibility has been concerned in previous research. Objectives of this process evaluation were to investigate whether the patient-centered matching guidelines (PCPM) are consistently applied in referral decision-making from an inpatient qualified withdrawal program to a level of care in aftercare, which factors affect whether patients actually receive matched aftercare according to PCPM, and whether its use is feasible and accepted by clinic staff. METHODS The study was conducted as process evaluation within an exploratory randomized controlled trial in four German psychiatric clinics offering a 7-to-21 day qualified withdrawal program for patients suffering from alcohol dependence, and with measurements taken during detoxification treatment and six months after the initial assessment. PCPM were used with patients in the intervention group by feeding back to them a recommendation for a level of care in aftercare that had been calculated from Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff on the treatment unit. As measurements, The MATE, the Client Socio-Demographic and Service Receipt Inventory-European Version, a documentation form, the Control Preference Scale, and the Motivation for Treatment Scale were administered. A workshop for the staff at the participating trial sites was conducted after data collection was finished. RESULTS Among 250 patients participating in the study, 165 were interviewed at follow-up, and 125 had received aftercare. Although consistency in the application of PCPM was moderate to substantial within the qualified withdrawal program (Cohen's kappa ≥ .41), it was fair from discharge to follow-up. In multifactorial multinomial regression, the number of foregoing substance abuse treatments predicted whether patients received more likely undermatched (Odds Ratio=1.27; p=.018) or overmatched (Odds Ratio=0.78; p=.054) treatment. While the implementation process during the study was evaluated critically by the staff, they stated a potential of quality assurance, more transparency and patient-centeredness in the use of PCPM. CONCLUSIONS While the use of PCPM has the potential to enhance the quality of referral decision making within treatment, it may not be sufficient to determine referral decisions for aftercare. TRIAL REGISTRATION German Clinical Trials Register DRKS00005035 . Registered 03/06/2013.
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Affiliation(s)
- Angela Buchholz
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre of Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Michael Berner
- Municipal Clinical Center of Karlsruhe, Karlsruhe, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Rosahl
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre of Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jochen Hempleman
- Outpatient Department for Addiction, LWL-Hospital Muenster, Muenster, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, Centre for Psychosocial Medicine, University Medical Centre of Hamburg-Eppendorf, 20246, Hamburg, Germany
| | | | - Jens Reimer
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Centre for Psychosocial Medicine, Health North, Bremen, Germany
| | - Jeanette Röhrig
- Clinic for Addiction Medicine and Addictive Behaviour, Institute for Clinical Psychology, Klinikum Stuttgart, Stuttgart, Germany
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behavior and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Anna Silkens
- LVR-Hospital Essen, Department of Addictive Behavior and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Germany
- Department for Public Health Sciences, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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26
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Rauschert C, Seitz NN, Olderbak S, Pogarell O, Dreischulte T, Kraus L. Abuse of Non-opioid Analgesics in Germany: Prevalence and Associations Among Self-Medicated Users. Front Psychiatry 2022; 13:864389. [PMID: 35546935 PMCID: PMC9081647 DOI: 10.3389/fpsyt.2022.864389] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Abuse of non-opioid analgesics (NOA) is associated with serious health consequences. However, due to inconsistent definitions of NOA abuse, prevalence estimates for the German population are unclear. OBJECTIVES This study aimed to estimate the 12-month prevalence of NOA abuse among self-medicated users of these drugs in the general German population and to identify risk factors. METHODS Data are from the 2015 Epidemiological Survey of Substance Abuse, a nationally representative sample with 9,204 individuals aged 18-64 years. Classification of NOA abuse was based on self-reported information according to the definition of the ICD-10-GM diagnosis F55.2 abuse of non-dependence producing substances. Multiple logistic regression was performed to examine associations between NOA abuse and sociodemographic, behavioral, and health-related variables. RESULTS The weighted 12-month prevalence of NOA abuse was 14.6% (95%-CI [13.2- 16.0]) among self-medicated users of these drugs. Extrapolation of the proportion of individuals abusing NOA to the German population aged 18 to 64 is 3,243,396 individuals or 6.4% (95%-CI [5.7- 7.1]). Inexplicable physical pain, being underweight, depression, hazardous alcohol use, daily smoking, illegal drug use, and frequent use of NOA (one or more times per week and daily use) were associated with an increased probability of NOA abuse. The use of cannabis was associated with a lower probability of NOA abuse. CONCLUSION Abuse of NOA is highly prevalent in the German population. Against the background of increasing self-medication of NOA, healthcare providers need to be aware of potential risk factors of abuse to better identify and prevent this problem.
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Affiliation(s)
- Christian Rauschert
- Department of Epidemiology and Diagnostics, IFT Institut für Therapieforschung, Munich, Germany
| | - Nicki-Nils Seitz
- Department of Epidemiology and Diagnostics, IFT Institut für Therapieforschung, Munich, Germany
| | - Sally Olderbak
- Department of Epidemiology and Diagnostics, IFT Institut für Therapieforschung, Munich, Germany.,Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tobias Dreischulte
- Department of General Practice and Family Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Ludwig Kraus
- Department of Epidemiology and Diagnostics, IFT Institut für Therapieforschung, Munich, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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27
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Kraus L, Loy JK, Bickl AM, Schwarzkopf L, Volberg RA, Rolando S, Kankainen VE, Hellman M, Rossow I, Room R, Norman T, Cisneros Örnberg J. Self-exclusion from gambling: A toothless tiger? Front Psychiatry 2022; 13:992309. [PMID: 36213894 PMCID: PMC9537465 DOI: 10.3389/fpsyt.2022.992309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Ludwig Kraus
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,IFT Institut für Therapieforschung, München, Germany.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Johanna K Loy
- IFT Institut für Therapieforschung, München, Germany
| | | | | | - Rachel A Volberg
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | - Sara Rolando
- Eclectica, Institute for Research and Training, Torino, Italy
| | - Veera E Kankainen
- University of Helsinki Centre for Research on Addiction, Control and Governance (CEACG), University of Helsinki, Helsinki, Finland
| | - Matilda Hellman
- University of Helsinki Centre for Research on Addiction, Control and Governance (CEACG), University of Helsinki, Helsinki, Finland
| | | | - Robin Room
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
| | - Thomas Norman
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia.,Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Jenny Cisneros Örnberg
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
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28
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Rauschert C, Seitz NN, Olderbak S, Pogarell O, Dreischulte T, Kraus L. Subtypes in Patients Taking Prescribed Opioid Analgesics and Their Characteristics: A Latent Class Analysis. Front Psychiatry 2022; 13:918371. [PMID: 35873263 PMCID: PMC9304960 DOI: 10.3389/fpsyt.2022.918371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Owing to their pharmacological properties the use of opioid analgesics carries a risk of abuse and dependence, which are associated with a wide range of personal, social, and medical problems. Data-based approaches for identifying distinct patient subtypes at risk for prescription opioid use disorder in Germany are lacking. OBJECTIVE This study aimed to identify distinct subgroups of patients using prescribed opioid analgesics at risk for prescription opioid use disorder. METHODS Latent class analysis was applied to pooled data from the 2015 and 2021 Epidemiological Survey of Substance Abuse. Participants were aged 18-64 years and self-reported the use of prescribed opioid analgesics in the last year (n = 503). Seven class-defining variables based on behavioral, mental, and physical health characteristics commonly associated with problematic opioid use were used to identify participant subtypes. Statistical tests were performed to examine differences between the participant subtypes on sociodemographic variables and prescription opioid use disorder. RESULTS Three classes were extracted, which were labeled as poor mental health group (43.0%, n = 203), polysubstance group (10.4%, n = 50), and relatively healthy group (46.6%, n = 250). Individuals within the poor mental health group (23.2%, n = 43) and the polysubstance group (31.1%, n = 13) showed a higher prevalence of prescription opioid use disorder compared to those of the relatively healthy group. CONCLUSION The results add further evidence to the knowledge that patients using prescribed opioid analgesics are not a homogeneous group of individuals whose needs lie in pain management alone. Rather, it becomes clear that these patients differ in their individual risk of a prescription opioid use disorder, and therefore identification of specific risks plays an important role in early prevention.
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Affiliation(s)
- Christian Rauschert
- Department of Epidemiology and Diagnostics, IFT Institut Für Therapieforschung, Munich, Germany
| | - Nicki-Nils Seitz
- Department of Epidemiology and Diagnostics, IFT Institut Für Therapieforschung, Munich, Germany
| | - Sally Olderbak
- Department of Epidemiology and Diagnostics, IFT Institut Für Therapieforschung, Munich, Germany.,Department of Psychology, University of Arizona, Tucson, AZ, United States
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Tobias Dreischulte
- Department of General Practice and Family Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Ludwig Kraus
- Department of Epidemiology and Diagnostics, IFT Institut Für Therapieforschung, Munich, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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29
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Kraus L, Uhl A, Atzendorf J, Seitz NN. Estimating the number of children in households with substance use disorders in Germany. Child Adolesc Psychiatry Ment Health 2021; 15:63. [PMID: 34740375 PMCID: PMC8571854 DOI: 10.1186/s13034-021-00415-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Ludwig Kraus
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, München, Germany. .,Department of Public Health Sciences, Centre for Social Research On Alcohol and Drugs, Stockholm University, Stockholm, Sweden. .,Institute of Psychology, ELTE Eötvös-Loránd-University, Budapest, Hungary.
| | - Alfred Uhl
- grid.502403.00000 0004 0437 2768Austrian Public Health Institute, Vienna, Austria ,grid.263618.80000 0004 0367 8888Sigmund Freud Private University, Vienna, Austria
| | - Josefine Atzendorf
- grid.462523.40000 0004 1794 2504Munich Center for the Economics of Aging (MEA), Max-Planck-Institute for Social Law and Social Policy, Munich, Germany
| | - Nicki-Nils Seitz
- grid.417840.e0000 0001 1017 4547IFT Institut für Therapieforschung, Leopoldstraße 175, 80804 München, Germany
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Loy JK, Seitz NN, Bye EK, Raitasalo K, Soellner R, Törrönen J, Kraus L. Trends in alcohol consumption among adolescents in Europe: Do changes occur in concert? Drug Alcohol Depend 2021; 228:109020. [PMID: 34537468 DOI: 10.1016/j.drugalcdep.2021.109020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/09/2021] [Accepted: 07/18/2021] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Johanna K Loy
- IFT Institut für Therapieforschung, Munich, Germany.
| | | | - Elin K Bye
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Kirsimarja Raitasalo
- Alcohol, Drugs and Tobacco Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Renate Soellner
- Department of Psychology, University of Hildesheim, Hildesheim, Germany
| | - Jukka Törrönen
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany; Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Schwarzkopf L, Dorscht L, Kraus L, Luttenberger K. Is bouldering-psychotherapy a cost-effective way to treat depression when compared to group cognitive behavioral therapy - results from a randomized controlled trial. BMC Health Serv Res 2021; 21:1162. [PMID: 34702280 PMCID: PMC8549311 DOI: 10.1186/s12913-021-07153-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bouldering-Psychotherapy (BPT) has proven to effectively reduce depressive symptoms, but evidence on its cost-effectiveness is lacking. Corresponding information is paramount to support health policy decision making on a potential implementation of BPT in routine care. METHODS Using data from the German KuS trial BPT was compared with group Cognitive Behavioral Therapy (CBT). Severity of depression symptoms at end of the intervention was operationalized via Montgomery-Asberg Depression Rating Scale (MADRS) and Patient Health Questionnaire (PHQ-9). Adopting a societal perspective, direct medical costs and productivity loss were calculated based on standardized unit costs. To determine incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves (CEAC), adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) were obtained from 1000 simultaneous bootstrap replications. RESULTS BPT was related to improved effects (AMDs: MADRS -2.58; PHQ-9: - 1.35) at higher costs (AMD: +€ 754). No AMD was significant. ICERs amounted to €288 per MADRS-point and €550 per PHQ-9-point. For both effect parameters about 20% of bootstrap replications indicated dominance of BPT, and about 75% larger effects at higher costs. At hypothetical willingness to pay (WTP) thresholds of €241 (MADRS) and €615 (PHQ-9) per unit of change BPT had a 50% probability of being cost-effective. CONCLUSION BPT is a promising alternate treatment strategy which - in absence of established WTP thresholds for improving symptoms of depression - cannot unambiguously be claimed cost-effective. Further studies defining subgroups that particularly benefit from BPT appear paramount to delineate recommendations for an efficient prospective roll-out to routine care.
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Affiliation(s)
- Larissa Schwarzkopf
- IFT Institut für Therapieforschung, Leopoldstrasse 175, 80804, Munich, Germany. .,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Lisa Dorscht
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Leopoldstrasse 175, 80804, Munich, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, 10691, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Kazinczy utca 23-27, 1075, Budapest, Hungary
| | - Katharina Luttenberger
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Specht S, Braun-Michl B, Schwarzkopf L, Piontek D, Seitz NN, Wildner M, Kraus L. Substance use disorder and the baby boom generation: Does Berlin outpatient addiction care face a sustained change? Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Specht
- IFT Institut für Therapieforschung
| | | | | | | | | | - M Wildner
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL)
- Ludwig-Maximilians-Universität München, Pettenkofer School of Public Health
| | - L Kraus
- IFT Institut für Therapieforschung
- Department of Public Health Science, Centre for Social Research on Alcohol and Drugs
- Institute of Psychology, ELTE Eötvös Loránd University
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Kilian C, Manthey J, Kraus L, Mäkelä P, Moskalewicz J, Sieroslawski J, Rehm J. A new perspective on European drinking cultures: a model-based approach to determine variations in drinking practices among 19 European countries. Addiction 2021; 116:2016-2025. [PMID: 33464658 DOI: 10.1111/add.15408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/26/2020] [Accepted: 12/30/2020] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Pia Mäkelä
- Alcohol, Drugs and Addictions Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,WHO Collaboration Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Bickl AM, Schwarzkopf L, Loy JK, Grüne B, Braun-Michl B, Sleczka P, Örnberg JC, Kraus L. Changes in gambling behaviour and related problems in clients seeking help in outpatient addiction care: Results from a 36-month follow-up study in Bavaria. J Behav Addict 2021; 10:690-700. [PMID: 34319902 PMCID: PMC8997214 DOI: 10.1556/2006.2021.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Andreas M. Bickl
- IFT Institut für Therapieforschung, München, Germany,Corresponding author. E-mail:
| | | | | | - Bettina Grüne
- German Youth Institute (DJI), Department of Youth and Youth Services, München, Germany
| | | | - Pawel Sleczka
- German University of Health and Sport, Ismaning, Germany,Seeburg Castle University, Seekirchen am Wallersee, Austria
| | - Jenny Cisneros Örnberg
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Germany,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden,Institute of Psychology, ELTE, Eötvös Loránd University, Budapest, Hungary
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Kilian C, Manthey J, Probst C, Brunborg GS, Bye EK, Ekholm O, Kraus L, Moskalewicz J, Sieroslawski J, Rehm J. Why Is Per Capita Consumption Underestimated in Alcohol Surveys? Results from 39 Surveys in 23 European Countries. Alcohol Alcohol 2021; 55:554-563. [PMID: 32491170 PMCID: PMC7427154 DOI: 10.1093/alcalc/agaa048] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/15/2020] [Accepted: 05/03/2020] [Indexed: 12/11/2022] Open
Abstract
Aims The aims of the article are (a) to estimate coverage rates (i.e. the proportion of ‘real consumption’ accounted for by a survey compared with more reliable aggregate consumption data) of the total, the recorded and the beverage-specific annual per capita consumption in 23 European countries, and (b) to investigate differences between regions, and other factors which might be associated with low coverage (prevalence of heavy episodic drinking [HED], survey methodology). Methods Survey data were derived from the Standardised European Alcohol Survey and Harmonising Alcohol-related Measures in European Surveys (number of surveys: 39, years of survey: 2008–2015, adults aged 20–64 years). Coverage rates were calculated at the aggregated level by dividing consumption estimates derived from the surveys by alcohol per capita estimates from a recent global modelling study. Fractional response regression models were used to examine the relative importance of the predictors. Results Large variation in coverage across European countries was observed (average total coverage: 36.5, 95% confidence interval [CI] [33.2; 39.8]), with lowest coverage found for spirits consumption (26.3, 95% CI [21.4; 31.3]). Regarding the second aim, the prevalence of HED was associated with wine- and spirits-specific coverage, explaining 10% in the respective variance. However, neither the consideration of regions nor survey methodology explained much of the variance in coverage estimates, regardless of the scenario. Conclusion The results reiterate that alcohol survey data should not be used to compare or estimate aggregate consumption levels, which may be better reflected by statistics on recorded or total per capita consumption.
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Affiliation(s)
- Carolin Kilian
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Centre for Interdisciplinary Addiction Research, UKE Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Probst
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,Heidelberg Institute of Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Geir S Brunborg
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Elin K Bye
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Germany.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Jacek Moskalewicz
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Janusz Sieroslawski
- Department of Studies on Alcoholism and Drug Dependence, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,WHO Collaboration Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Schwarzkopf L, Loy JK, Braun-Michl B, Grüne B, Sleczka P, Kraus L. Gambling disorder in the context of outpatient counselling and treatment: Background and design of a prospective German cohort study. Int J Methods Psychiatr Res 2021; 30:e1867. [PMID: 33439510 PMCID: PMC8170573 DOI: 10.1002/mpr.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/19/2020] [Accepted: 12/18/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The prospective naturalistic study 'Katamnese-Studie' conducted between 2014 and 2019 gathers evidence on the course of gambling disorder in German routine outpatient addiction care. This study elucidates design and methodological advantages and caveats of the study. METHODS Participants of the multi-centre cohort received written questionnaires at admission and at 6-, 12-, 24- and 36-month follow-up to assess socio-demographic data, gambling behaviour, gambling-related consequences and care offers sought. Subsequently, self-reports were linked to client-individual routine documentation for the German Addiction Care Statistical Service. Furthermore, employees of participating outpatient addiction care facilities were surveyed regarding experiences with and attitudes towards gambling disorder. Multivariate longitudinal regression models will portray changes in the severity of gambling disorder and gambling behaviour and explore associated client- and care-related factors. CONCLUSION The 'Katamnese-Studie' covers the whole spectrum of outpatient gambling care. Keeping the design-related caveats in mind (reliability of self-reports, loss-to-follow-up and issues regarding causal inference), the study is anticipated to draw a comprehensive picture of routine outpatient gambling care and key factors related to sustained remission. In the medium term, this information might support the development and subpopulation-specific adaptation of recommendations on how to structure process and content of outpatient gambling care.
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Affiliation(s)
- Larissa Schwarzkopf
- IFT Institut Fuer Therapieforschung, Munich, Germany.,Helmholtz Zentrum Muenchen, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Johanna K Loy
- IFT Institut Fuer Therapieforschung, Munich, Germany
| | | | - Bettina Grüne
- Department of Palliative Medicine, Ludwig Maximilians University Hospital, Munich, Germany
| | - Pawel Sleczka
- German University of Health and Sport, Ismaning, Germany
| | - Ludwig Kraus
- IFT Institut Fuer Therapieforschung, Munich, Germany.,Department for Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Kraus L, Loy JK, Wilms N, Starker A. [Age-specific trends in risky drinking in Germany: collectivity or polarisation?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:652-659. [PMID: 33978772 PMCID: PMC8187186 DOI: 10.1007/s00103-021-03328-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
Einleitung Nach der Collectivity-of-Drinking-Cultures-Theorie von Skog finden Veränderungen des Alkoholkonsums in allen Bevölkerungsgruppen und -schichten als parallele Verschiebungen statt. Ziele des vorliegenden Beitrags sind (1) die Darstellung zeitlicher Trends des riskanten Konsums und des episodischen Rauschtrinkens nach Altersgruppen und Geschlecht und (2) die Prüfung, ob die Trends in allen Altersgruppen parallel verlaufen („Kollektivität“) oder zwischen Altersgruppen divergieren („Polarisierung“). Methoden Datengrundlage sind 9 Erhebungen des Epidemiologischen Suchtsurveys (ESA) zwischen 1995 und 2018. Als Schwellenwert für riskanten Alkoholkonsum wurde ein täglicher Konsum von mehr als 12 g Reinalkohol bei Frauen beziehungsweise 24 g bei Männern herangezogen. Episodisches Rauschtrinken wurde als Konsum von 5 oder mehr Gläsern Alkohol (ca. 70 g Reinalkohol) an mindestens einem Tag in den letzten 30 Tagen definiert. Lineare Regressionen wurden für die Vorhersage des zeitlichen Effekts auf riskanten Konsum bzw. Rauschkonsum nach Altersgruppen (18–29, 30–39, 40–49 und 50–59 Jahre) und Geschlecht getrennt berechnet und auf Unterschiede geprüft. Ergebnisse Die Entwicklungen riskanten Alkoholkonsums nach Altersgruppen verlaufen bei Männern weitgehend parallel, bei Frauen gegenläufig. Die Trends des episodischen Rauschtrinken weisen bei beiden Geschlechtern keine parallele Entwicklung auf: Während in der jüngsten und ältesten Altersgruppe die Prävalenz im Zeitverlauf anstieg, sank sie in den übrigen Altersgruppen. Diskussion Vor dem Hintergrund einer generellen Abnahme spricht die Zunahme in den Trends risikoreichen Alkoholkonsums in bestimmten Gruppen für einen Ausbau verhaltenspräventiver Maßnahmen. Zur Fortsetzung der positiven Entwicklung und der Vermeidung einer Trendumkehr sollten zudem auf die Gesamtbevölkerung ausgerichtete Präventionsanstrengungen intensiviert werden, beispielsweise durch Erhöhung der Alkoholsteuer oder Reduktion der Verfügbarkeit von Alkohol. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03328-7) enthalten.
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Affiliation(s)
- Ludwig Kraus
- IFT Institut für Therapieforschung, Leopoldstr. 175, 80804, München, Deutschland. .,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Schweden. .,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn.
| | - Johanna K Loy
- IFT Institut für Therapieforschung, Leopoldstr. 175, 80804, München, Deutschland
| | - Nicolas Wilms
- IFT Institut für Therapieforschung, Leopoldstr. 175, 80804, München, Deutschland
| | - Anne Starker
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
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Kraus L, Seitz NN, Loy JK, Trolldal B, Törrönen J. Has beverage composition of alcohol consumption in Sweden changed over time? An age-period-cohort analysis. Drug Alcohol Rev 2021; 41:153-166. [PMID: 33942409 DOI: 10.1111/dar.13297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Ludwig Kraus
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.,IFT Institut für Therapieforschung, Munich, Germany.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | | | | | - Björn Trolldal
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,The Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden
| | - Jukka Törrönen
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Specht S, Braun-Michl B, Schwarzkopf L, Piontek D, Seitz NN, Wildner M, Kraus L. Substance use disorder and the baby boom generation: Does Berlin outpatient addiction care face a sustained change? Drug Alcohol Rev 2021; 40:979-988. [PMID: 33508892 PMCID: PMC8451895 DOI: 10.1111/dar.13245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/27/2020] [Accepted: 12/13/2020] [Indexed: 01/10/2023]
Abstract
Introduction The ageing of baby boomers is expected to confront addiction care with new challenges. This cohort had greater exposure to psychoactive substances in youth than earlier cohorts. In this study, we aimed to investigate whether Berlin addiction care is confronted with a sustained change in its clientele initiated by the baby boomers. Methods Using data from Berlin outpatient addiction care facilities, we contrasted type of primary substance use disorder and number of comorbid substance use disorders in baby boomers with an earlier and a later cohort. To isolate cohort effects, two‐level random intercept regression models were applied in the overlapping age groups of the baby boomer cohort with each of the other cohorts. Results Compared with the earlier cohort, alcohol use disorder lost importance whereas illicit substance use disorder gained importance in the baby boomers. Baby boomers presented a higher number of comorbid substance use disorders than the earlier cohort. Comparing baby boomers with the later cohort, these relationships pointed in the opposite direction. Discussion and Conclusions Outpatient addiction care faces a sustained change to more illicit and comorbid substance use disorders. With increasing life expectancy and the ageing of baby boomers marked by higher substance use than previous cohorts, older clients, who had been under‐represented in outpatient addiction care, will gain relevance. Hence, addiction care has to adapt its offers to appropriately meet the changing needs of its clientele.
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Affiliation(s)
- Sara Specht
- IFT Institut für Therapieforschung, Munich, Germany
| | | | - Larissa Schwarzkopf
- IFT Institut für Therapieforschung, Munich, Germany.,Pettenkofer School of Public Health, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Manfred Wildner
- Pettenkofer School of Public Health, Ludwig-Maximilians-University, Munich, Germany.,Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany.,Department of Public Health Science, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Raitasalo K, Kraus L, Bye EK, Karlsson P, Tigerstedt C, Törrönen J, Raninen J. Similar countries, similar factors? Studying the decline of heavy episodic drinking in adolescents in Finland, Norway and Sweden. Addiction 2021; 116:62-71. [PMID: 32285975 DOI: 10.1111/add.15089] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/09/2019] [Accepted: 04/07/2020] [Indexed: 11/30/2022]
Abstract
AIM To (i) examine several factors associated with trends in heavy episodic drinking (HED) in Finland, Norway and Sweden, (ii) investigate similarities in these associations across the countries and (iii) analyse the contribution of these factors to the trend in HED and the differences across the countries. DESIGN AND SETTING Observational study using five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from Finland, Norway and Sweden between 1999 and 2015. PARTICIPANTS A total of 18 128 male and 19 121 female 15- to 16-year-old students. MEASUREMENTS Monthly HED, perceived access to alcohol, truancy, parental control, leisure time activities and daily smoking. The Cochran-Armitage test was used to examine linear time trends in HED. Logit regression models using the Karlson-Holm-Breen (KHB) method were fitted for each country separately, including all the independent variables together with time and adjusted for family status, parental education and gender. FINDINGS In Finland, Norway and Sweden, perceived access to alcohol, truancy and daily smoking decreased significantly between 1999 and 2015 whereas risk perceptions, parental control and participation in sports increased in the same period. The confounding percentage of all the independent variables related to the trend in HED was 48.8%, 68.9% and 36.7% for Finland, Norway and Sweden, respectively. Decline in daily smoking (P < 0.001) and perceived access to alcohol (P < 0.001) were positively and increase in parental control (P < 0.001) negatively associated with the decline in HED in all three countries. Changes in truancy, going out with friends, and engaging in sports and other hobbies had little or no impact on the decline in HED or displayed no consistent results across the countries. CONCLUSIONS The decline in adolescent heavy episodic drinking in Finland, Norway and Sweden between 1999 and 2015 appears to be associated with a decline in adolescent daily smoking and perceived access to alcohol and an increase in parental control.
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Affiliation(s)
- Kirsimarja Raitasalo
- Finnish Institute for Health and Welfare, Alcohol, Drugs and Addictions Unit, Helsinki, Finland
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Germany.,Department for Public Health Sciences, Stockholm University, Stockholm, Sweden.,ELTE Eötvös Loránd University, Institute of Psychology, Budapest, Hungary
| | - Elin K Bye
- Department of Substance Use, Norwegian Institute of Public Health, Oslo, Norway
| | - Patrik Karlsson
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Christoffer Tigerstedt
- Finnish Institute for Health and Welfare, Alcohol, Drugs and Addictions Unit, Helsinki, Finland
| | - Jukka Törrönen
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Jonas Raninen
- CAN (Swedish Council for Information on Alcohol and Other Drugs), Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,School of Social Sciences, Unit of Social Work, Södertörn University, Huddinge, Sweden
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Frischknecht U, Hoffmann S, Steinhauser A, Lindemann C, Buchholz A, Manthey J, Schulte B, Rehm J, Kraus L, Verthein U, Reimer J, Kiefer F. [Screening for Problematic Alcohol Consumption - A Survey on Guideline Implementation in Transdisciplinary Health Care of a Model Region]. Gesundheitswesen 2020; 84:43-51. [PMID: 33302318 DOI: 10.1055/a-1276-0475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
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.
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Affiliation(s)
- Ulrich Frischknecht
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim.,Katholische Hochschule NRW, Deutsches Institut für Sucht- und Präventionsforschung, Köln
| | - Sabine Hoffmann
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - Alisa Steinhauser
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim
| | - Christina Lindemann
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Angela Buchholz
- Institut für Medizinische Psychologie, Universitatsklinikum Hamburg-Eppendorf, Hamburg
| | - Jakob Manthey
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Dresden
| | - Bernd Schulte
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Dresden.,Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health - Russell Street Site, Toronto.,Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto, Toronto.,WHO Collaborating Centre for Addiction and Mental Health , PAHO, Washington.,Epidemiological Research Unit, Technische Universität Dresden, Dresden.,Department of International Health Projects, Institute for Leadership and Health Management, I M Sechenov First Moscow State Medical University, Russian Federation, Moskva.,Graduate Department of Community Health and Institute of Medical Science, University of Toronto, Toronto
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München.,Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest
| | - Uwe Verthein
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Jens Reimer
- Klinikverbund Bremen, Gesundheit Nord gGmbH Klinikverbund Bremen, Bremen
| | - Falk Kiefer
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim
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Frischknecht U, Hoffmann S, Steinhauser A, Lindemann C, Buchholz A, Manthey J, Schulte B, Rehm J, Kraus L, Verthein U, Reimer J, Kiefer F. Diagnostik und Behandlung alkoholbezogener Störungen – Versorgerbefragung zur Erarbeitung von Strategien der Leitlinienimplementierung. Suchttherapie 2020. [DOI: 10.1055/a-1265-4687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Ziel der Studie Die Art und Häufigkeit durchgeführter Diagnostik, Kurzintervention und Behandlung bei PatientInnen mit bekanntem problematischen Alkoholkonsum und Alkoholkonsumstörungen durch Berufsgruppen der Gesundheitsversorgung soll erfasst werden. Diese Informationen dienen der Bedarfsabschätzung zur Entwicklung von Strategien zur weiteren Implementierung der S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“.
Methodik Schriftliche Befragung von FachärztInnen (hausärztlich allgemeinmedizinisch/internistische, gynäkologische, psychiatrische, pädiatrische, Kinder- und jugendpsychiatrische), PsychotherapeutInnen, SozialarbeiterInnen und Hebammen/Entbindungspflegern in einer Querschnittsstudie in der Modellregion Bremen.
Ergebnisse 34% der PatientInnen mit bekanntem problematischen Alkoholkonsum erhielten eine leitlinienkonforme Diagnostik, 39% eine spezifische Kurzintervention. Von den PatientInnen mit diagnostizierter alkoholbezogener Störung wurde bei 34% eine spezifische Behandlung in eigener Praxis durchgeführt und bei 37% eine Weiterbehandlung anderswo empfohlen. Validierte Instrumente zur Diagnostik alkoholbezogener Störungen fanden selten Anwendung. Kurzinterventionen beinhalteten meist informelle motivierende Gespräche. Als Postakutbehandlungen wurden überwiegend Suchtberatungen und Selbsthilfe und nur selten pharmakologische Rückfallprophylaxe durchgeführt.
Schlussfolgerungen Die Umsetzung strukturierter Diagnostik und Kurzinterventionen, sowie die zielgerichtete Empfehlung pharmakologischer Rückfallprophylaxe und ambulanter Angebote ist für eine leitliniengerechte Versorgung unzureichend. Sie sollten daher Gegenstand von Strategien zur weiteren Leitlinienimplementierung sein.
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Affiliation(s)
- Ulrich Frischknecht
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
- Katholische Hochschule NRW, Deutsches Institut für Sucht- und Präventionsforschung, Köln
| | - Sabine Hoffmann
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
| | - Alisa Steinhauser
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
| | - Christina Lindemann
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Angela Buchholz
- Institut und Poliklinik für Medizinische Psychologie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf; Hamburg
| | - Jakob Manthey
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden
| | - Bernd Schulte
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
- Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto (UofT), PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto,Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
- Graduate Department of Community Health and Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Schweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | - Uwe Verthein
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Jens Reimer
- Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
- Gesundheit Nord, Bremen
| | - Falk Kiefer
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
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Sleczka P, Braun-Michl B, Kraus L. Gamblers' attitudes towards money and their relationship to gambling disorder among young men. J Behav Addict 2020; 9:744-755. [PMID: 32692711 PMCID: PMC8943678 DOI: 10.1556/2006.2020.00042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/04/2020] [Accepted: 06/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Money plays a central role in gambling, and understanding the different attitudes of gamblers towards it might benefit both prevention and treatment of gambling-related problems. This study describes the development of a new German measure of attitudes to money and the differences in these attitudes between male non-gamblers, occasional, frequent and problem gamblers. Furthermore, it investigates the cross-sectional and longitudinal associations between attitudes towards money and the severity of gambling disorder. METHODS An online study was conducted among 2,584 men aged 18-25 years, recruited via the Munich citizen registry. Additionally, a sample of n = 105 Facebook users was included in part of the analyses. Frequent and problem gamblers were invited to a 12-month follow-up. Apart from gambling participation and related problems, the questionnaire included items from existing scales measuring attitudes to money. RESULTS Three factors underlying a new 12-item German Scale of Money Attitudes (SMAG) were identified: success, budgeting and evil. Compared with other groups, participants reporting any gambling problems scored highest in success and lowest in budgeting. Budgeting was associated with gambling-related problems in both cross-sectional and longitudinal analyses and strengthened the relationship between associating money with success and gambling disorder. DISCUSSION For problem gamblers, money is important as a personal symbol of success. This attitude has an especially negative effect on gambling-related problems in individuals who handle money irresponsibly. Spending and winning money might play an important role in maintaining self-esteem among gamblers and thus hinder their attempts to quit.
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Affiliation(s)
- Pawel Sleczka
- German University of Health and
Sport, Ismaning, Germany
| | | | - Ludwig Kraus
- IFT Institut für
Therapieforschung, Munich,
Germany
- Department of
Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm
University, Stockholm, Sweden
- Institute of
Psychology, ELTE Eötvös Loránd University, Budapest,
Hungary
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Strizek J, Atzendorf J, Kraus L, Monshouwer K, Puhm A, Uhl A. Perceived problems with adolescent online gaming: National differences and correlations with substance use. J Behav Addict 2020; 9:629-641. [PMID: 33027059 PMCID: PMC8943675 DOI: 10.1556/2006.2020.00061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/02/2020] [Accepted: 08/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Not much is known about the correlation between gaming problems and substance use across different countries. This paper presents cross-national analyses of different gaming indicators and their relationship to substance use. METHODS Based on data from the 2015 ESPAD study, differences in the relationship between gaming and substance use across 35 countries were analysed using multi-level logistic regression, using substance use as an individual level predictor, economic wealth as a country-level predictor and a combined problem gaming indicator as the outcome. RESULTS Multi-level logistic regressions revealed significant correlations between individual substance use and gaming problems, which varied across countries and were moderated by economic wealth. Students who used alcohol, tobacco or cannabis and who lived in high-income countries had a smaller risk of scoring positively on a combined problem gaming indicator than students who used alcohol, tobacco or cannabis and who lived in less prosperous countries. DISCUSSION Different gaming indicators varied substantially across countries, with self-perceived gaming problems being more common in countries with a low prevalence of gaming. Significant cross-level effects demonstrate the need to take the societal context into account when the relationship between problem gaming and substance use is analysed. Prevention measures need to take the fact into account that patterns of substance use among problem gamers vary across countries.
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Affiliation(s)
- Julian Strizek
- Austrian Public Health Institute, Vienna, Austria,Corresponding author. E-mail:
| | - Josefine Atzendorf
- Munich Center for the Economics of Aging (MEA), Max-Planck-Institute for Social Law and Social Policy, Munich, Germany
| | - Ludwig Kraus
- Institut für Therapieforschung, Munich, Germany,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | | | | | - Alfred Uhl
- Austrian Public Health Institute, Vienna, Austria,Sigmund-Freud Privat-Universität, Wien, Austria
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Abstract
Zusammenfassung. Zielsetzung: Ziel der vorliegenden Studie war, die Veränderung des Alkoholkonsums während der SARS-CoV-2 Pandemie in Deutschland zu untersuchen und mit derer anderer europäischer Länder zu vergleichen. Methodik: Analyse von soziodemographischen und sozioökonomischen Daten sowie Angaben zur Veränderung des Alkoholkonsums seit der Pandemie in einer europaweiten Onlinebefragung (n=40.064) aus 21 Ländern. Zur Anpassung an die Bevölkerungsverteilung in den Ländern erfolgte eine Gewichtung anhand von Geschlecht, Alter und Bildungsabschluss. Ergebnisse: Seit Beginn der Pandemie wurde im Mittel weniger Alkohol getrunken. Der Rückgang des Konsums ist vor allem auf eine Reduktion der Gelegenheiten zum Rauschtrinken zurückzuführen. Der Alkoholkonsum ist in Deutschland weniger stark als in anderen Europäischen Ländern zurückgegangen. Gründe dafür sind Zunahmen im Alkoholkonsum bei Frauen sowie bei Personen, die negative Auswirkungen in Beruf und Finanzen erlebt haben und bei Personen mit riskanten Konsummustern. Schlussfolgerungen: Um den negativen Folgen des in Teilgruppen verstärkten Alkoholkonsums während der Pandemie entgegenzuwirken, sollte die Verfügbarkeit von Alkohol durch eine sinnvolle Besteuerung reduziert sowie eine Ausweitung routinemäßiger Alkoholscreenings in der allgemeinärztlichen Versorgung umgesetzt werden.
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Affiliation(s)
- Jakob Manthey
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE)
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Carolin Kilian
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Schweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | - Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Kanada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Kanada
- Department of Psychiatry, University of Toronto, Toronto, Kanada
- Department of International Health Projects, Institute for Leadership and Health Management, I. M. Sechenov First Moscow State Medical University, Moskau, Russland
| | - Bernd Schulte
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE)
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Specht S, Braun-Michl B, Schwarzkopf L, Piontek D, Seitz N, Wildner M, Kraus L. Substance use disorder and the baby boomers: Does German outpatient addiction care face a change? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The aging of baby boomers is expected to confront addiction care with new challenges. This study aims to investigate if German addiction care is confronted with a sustained change in its clientele that was initiated by the baby boomers.
Methods
Using data from Berlin outpatient addiction care facilities, we contrasted type of primary substance use disorder and number of comorbid substance use disorders in baby boomers with an older (n = 6524) as well as a younger cohort (n = 15677). To isolate cohort effects, two-level random-intercept regression models were applied in the overlapping age groups of the baby boomer cohort with each other cohort.
Results
Compared to the older cohort, alcohol use disorder lost importance while illicit substances use disorder gained importance in the baby boomers. Baby boomers presented a higher number of comorbid substance use disorders than the older cohort. Comparing baby boomers with the younger cohort, these relationships pointed in the opposite direction.
Conclusions
Outpatient addiction care faces a sustained change to more illicit and comorbid substance use disorders. The addiction care system ought to adapt its services to address the changing needs of its clientele.
Key messages
Baby boomers differed in comparison to the older cohort regarding type of substance use disorder and comorbid substance use disorders. The changes set off by the baby boomers continued in the younger cohort.
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Affiliation(s)
- S Specht
- IFT Institut für Therapieforschung, Munich, Germany
| | | | | | - D Piontek
- IFT Institut für Therapieforschung, Munich, Germany
| | - N Seitz
- IFT Institut für Therapieforschung, Munich, Germany
| | - M Wildner
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
- Pettenkofer School of Public Health, Ludwig-Maximilians-University, Munich, Germany
| | - L Kraus
- IFT Institut für Therapieforschung, Munich, Germany
- Department of Public Health Science, Centre for Social Resea, Stockholm University, Stockholm, Sweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Abstract
Zusammenfassung. Hintergrund und Fragestellung: Spielersperren stellen eine effektive Maßnahme des Spielerschutzes dar. Sie bedürfen jedoch einer Anpassung an die Bedürfnisse von Personen mit Glücksspielproblemen. Studien weisen auf Defizite hinsichtlich Sperrvorgang und -dauer sowie Zugangskontrollen hin. Ziel der qualitativen Untersuchung war es, Empfehlungen für die Optimierung von Spielersperren abzuleiten. Methodik: Mit semi-strukturierten Leitfäden wurden die am Prozess einer Spielesperre beteiligten Akteure zu Regelungen der Spielersperre, persönlichen Erfahrungen und Barrieren befragt. Einbezogen wurden Glücksspielende mit und ohne Sperre sowie Angehörige, Fachkräfte, Mitarbeitende von Spielbanken, Spielhallen und der Gesellschaft für Spielerschutz und Prävention (GSP). Insgesamt wurden 20 Einzel- und sechs Gruppeninterviews geführt. Ergebnisse: Als zentrale Ansatzunkte der Optimierung wurden Sperrdauer und -umfang (übergreifendes Sperrsystem) sowie Zugangskontrollen genannt. Empfohlen wurden eine Antragstellung über Post oder Internet zur Senkung der Hemmschwelle und ein rascheres Inkrafttreten der Spielersperre. Kontrovers diskutiert wurden Sperrdauer und Optionen einer Entsperrung. Durch den Einsatz einer Spielerkarte versprachen sich die Befragten eine Verbesserung des Spielerschutzes durch Feststellung einer laufenden Spielersperre und Begrenzung von Spielzeit oder Geldeinsätzen. Diskussion: Spielersperren wurden von allen Befragten grundsätzlich positiv bewertet. Optimierungsbedarf wurde in den gesetzlichen Regelungen und Sperrkonditionen gesehen. Von einer Schließung von Gesetzeslücken sowie einer intensiven Aufklärung und Motivation von Glücksspielenden, Angehörigen und Glücksspielanbietern werden positive Effekte auf die Inanspruchnahme von Spielersperren erwartet.
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Affiliation(s)
- Johanna K. Loy
- IFT Institut für Therapieforschung, München, Deutschland
| | - Lucia Sedlacek
- IFT Institut für Therapieforschung, München, Deutschland
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Deutschland
- Department for Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Schweden
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
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Atzendorf J, Rauschert C, Seitz NN, Lochbühler K, Kraus L. The Use of Alcohol, Tobacco, Illegal Drugs and Medicines: An Estimate of Consumption and Substance-Related Disorders in Germany. Dtsch Arztebl Int 2020; 116:577-584. [PMID: 31587705 DOI: 10.3238/arztebl.2019.0577] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/03/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
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 (correspond- ing 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 anal- gesics 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.
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Affiliation(s)
- Josefine Atzendorf
- IFT Institut für Therapieforschung (Institute for Therapy Research), München; Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Schweden; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
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49
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Törrönen J, Samuelsson E, Roumeliotis F, Room R, Kraus L. 'Social health', 'physical health', and well-being: Analysing with bourdieusian concepts the interplay between the practices of heavy drinking and exercise among young people. Int J Drug Policy 2020; 91:102825. [PMID: 32593513 DOI: 10.1016/j.drugpo.2020.102825] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The article examines the interplay between the practices of heavy drinking and exercise among young people. The comparison helps to clarify why young people are currently drinking less than earlier and how the health-related discourses and activities are modifying young people's heavy drinking practices. METHODS The data is based on interviews (n = 56) in Sweden among 15-17-year-olds and 18-19-year-olds. By drawing on Pierre Bourdieu's concepts of habitus, field, and capital, we examine what kinds of resources young people accumulate in the fields of heavy drinking and exercise, how these resources carry symbolic value for distinction, and what kind of health-related habitus they imply. RESULTS The analysis shows that young people's practices in the social spaces of intoxication and exercise are patterned around the 'social health' and 'physical health' approaches and shaped by gendered binaries of masculine dominance. The 'physical health' approach values capable, high-performative, and attractive bodies, whereas the 'social health' approach is oriented towards accumulating social capital. The analysis demonstrates that these approaches affect the interviewees' everyday life practices so that the 'physical health' approach has more power over the 'social health' approach in transforming them. CONCLUSION As the 'physical health' approach appears to modify young people's practices of drinking to be less oriented to intoxication or away from drinking, this may partly explain why young people are drinking less today than earlier. Compared to drinking, the physical health-related social spaces also seem to provide more powerful arenas within which to bolster one's masculine and feminine habitus. This further suggests that intoxication may have lost its symbolic power among young people as a cool activity signalling autonomy, maturity, and transgression of norms.
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Affiliation(s)
- Jukka Törrönen
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, SE-10691 Stockholm, Sweden.
| | - Eva Samuelsson
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, SE-10691 Stockholm, Sweden; Department of Social Work, Stockholm University, SE-10691 Stockholm, Sweden
| | - Filip Roumeliotis
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, SE-10691 Stockholm, Sweden; Department of Criminology, Stockholm University, SE-10691 Stockholm, Sweden
| | - Robin Room
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, SE-10691 Stockholm, Sweden; Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC 3086 Australia
| | - Ludwig Kraus
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, SE-10691 Stockholm, Sweden; IFT Institut für Therapieforschung, Leopoldstraße 175, 80804 München, Germany; Institute of Psychology, ELTE Eötvös Loránd University, 1075 Budapest, Kazinczy utca 23-27, Hungary
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Strupp M, Kraus L, Schautzer F, Rujescu D. Retraction Note to: Menière’s disease: combined pharmacotherapy with betahistine and the MAO-B inhibitor selegiline—an observational study. J Neurol 2020; 267:1225. [DOI: 10.1007/s00415-020-09791-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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