Estimating the prevalence of alcohol-related disorders and treatment utilization in Bremen 2016/2017 through routine data linkage

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.

German Guidelines on Screening, Diagnosis, and Treatment of Alcohol Use Disorders: Update 2021

INTRODUCTION

Alcohol consumption in Germany is associated with considerable health and economic consequences. In addition to prevention, the early detection and differential treatment of those affected play an important role. The guideline "Screening, Diagnosis, and Treatment of Alcohol Use Disorders" forms the basis of this care for people suffering from alcohol use disorders. Regular updates integrate the current state of research evidence and clinical expertise.

METHODS

Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology and the German Society for Addiction Research and Addiction Therapy e.V. (DG-Sucht), the 2019-2020 S3 guideline on alcohol was revised by eight working groups. Thirty-five professional societies participated in a structured consensus process to deliberate the recommendations. Potential conflicts of interest were examined in advance, documented, and taken into account during the voting on the recommendations.

RESULTS

The guideline provides recommendations on screening and brief interventions for different groups of people, as well as on treatment of individuals in the acute and post-acute phases of withdrawal. Special emphasis was placed on the treatment of comorbid somatic and psychological disorders. In addition, recommendations for specific groups of people (e.g., children and adolescents, pregnant women) have been made and adapted to the German care landscape.

Age, period, and cohort effects on trends in outpatient addiction care utilization in the general Berlin population from 2008 to 2016

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.

S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“

Zusammenfassung. Zielsetzung: Alkoholkonsum ist in Deutschland mit erheblichen gesundheitlichen und wirtschaftlichen Folgen assoziiert. Neben der Prävention spielen die Früherkennung und differentielle Behandlung von Betroffenen eine bedeutende Rolle. Die Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“ bildet die Grundlage für die Versorgung betroffener Personen. Die regelmäßigen Updates implementieren evidenzbasiert den aktuellen Forschungsstand von Literatur und klinischer Expertise. Methodik: Unter Federführung der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und der Deutschen Gesellschaft für Suchtforschung und Suchttherapie e. V. (DG-Sucht) wurde die S3-Leitlinie Alkohol von 2019–2020 in acht Arbeitsgruppen überarbeitet. Am strukturierten Konsensprozess zur Beratung der Empfehlungen beteiligten sich 35 Fachgesellschaften. Potentielle Interessenskonflikte wurden im Vorfeld erfragt, dokumentiert und in der Abstimmung der Empfehlungen berücksichtigt.: Die Leitlinie gibt Empfehlungen zu Screening und Kurzintervention für verschiedene Personengruppen, sowie zur Behandlung von Betroffenen in der akuten und postakuten Phase des Entzugs. Besondere Bedeutung kommt der Behandlung von komorbiden somatischen und psychischen Störungen zu. Außerdem wurden Empfehlungen für bestimmte Personengruppen (z. B. Kinder und Jugendliche, Schwangere) ausgesprochen und auf die deutsche Versorgungslandschaft adapiert.

German Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders

Evidence-based strategies for screening, diagnosing and treating alcohol use disorders (AUD) are instrumental in the early and better management of individuals at risk for or suffering from AUD. However, existing guidelines vary and may be biased by conflicts of interests. Unbiased recommendations can be achieved only if sufficient detail is provided on the composition and representativeness of author groups, methodological rigor, handling of potential conflicts of interest and financing. This paper presents the first evidence-based guidelines for AUD from German-speaking countries. These guidelines are based on the work of delegates from a representative sample of 46 scientific societies (mostly medical) from Austria, Germany and Switzerland dealing with AUD. It also included patients and relatives. Recommendations were derived from a standardised hierarchical process involving quality controls drawn from existing guidelines, de novo literature searches and/or expert experience. Potential conflicts of interest were assessed yearly and led to exclusion from voting in specific areas. An overall cost of more than 400,000€ (for alcohol and tobacco guidelines) were exclusively covered by the participating societies and academic institutions. More than 100 recommendations on screening, diagnostics and treatment of AUD are outlined in this paper, and their scientific background is given in the online supplementary material. Tables of aggregated study synopses (in English) and the full version of guidelines (in German) are available (see "Links").

Zeitliche Entwicklungen im Substanzkonsum in der deutschen Allgemeinbevölkerung

Zusammenfassung. Ziel: Ziel der Studie ist die Analyse von Trends des (klinisch relevanten) Konsums von Tabak, Alkohol, Cannabis und anderen illegalen Drogen sowie der Einnahme von Medikamenten zwischen 1995 und 2015. Methodik: Datengrundlage bilden acht Erhebungswellen des Epidemiologischen Suchtsurveys (ESA) aus den Jahren 1995 bis 2015. Die Befragungen erfolgten schriftlich, telefonisch oder online. Eine einheitliche Darstellung zeitlicher Trends ist für den Altersbereich 18 bis 59 Jahre möglich. Ergebnisse: Der Tabakkonsum hat in den letzten 20 Jahren abgenommen. Trenddaten des Alkoholkonsums zeigen sinkende Konsumwerte für Männer und stabile Werte für Frauen. Die Prävalenz des Rauschtrinkens ist bei Frauen seit dem Jahr 2009 angestiegen. Der Cannabiskonsum hat zwischen 2012 und 2015 bei beiden Geschlechtern zugenommen. Der wöchentliche Gebrauch von Schmerzmitteln ist angestiegen, während bei Schlaf-/Beruhigungsmitteln ein Rückgang zu verzeichnen ist. Indikatoren eines klinisch relevanten Konsums zeigen für Cannabis keine Änderungen, für Tabak einen Rückgang und für Medikamente einen Anstieg. Hinweise auf klinisch relevanten Alkoholkonsum sind bei Männern konstant geblieben und bei Frauen angestiegen. Schlussfolgerungen: Die weite Verbreitung insbesondere der legalen Substanzen legt einen dringenden Handlungsbedarf für Prävention und Intervention nahe. Als besondere Zielgruppe wurden Frauen identifiziert, bei denen der klinisch relevante Konsum von Alkohol und Medikamenten zugenommen hat.

Treatment outcome, treatment retention, and their predictors among clients of five outpatient alcohol treatment centres in Switzerland

Background

Few studies have reported on the outcomes of outpatient alcohol treatment or the factors associated with effective treatment. We investigated treatment outcome, treatment retention, and their predictors in clients receiving outpatient treatment for alcohol misuse.

Methods

Naturalistic, longitudinal multi-centre study in Switzerland that included 858 clients receiving outpatient treatment for alcohol misuse. Assessments were conducted at treatment admission, discharge, and 6- and 12-month follow-ups. Non-problem drinking was used as an indicator of positive treatment outcome.

Results

Clients admitted to outpatient alcohol treatment were highly heterogeneous in terms of pre-treatment alcohol use and drinking goals. 45 % of clients exhibiting problem drinking at the beginning of treatment showed non-problem drinking at discharge, and 41 % and 43 % showed non-problem drinking at the 6- and 12-month follow-up, respectively; 51 % were discharged regularly and 43 % were discharged irregularly. Non-problem drinking at the 12-month follow-up was more likely in clients with a higher life satisfaction, those with lower alcohol use, those aiming for alcohol abstinence, and those who had been admitted for the first time to a treatment institution, whereas it was less likely in clients with a higher educational level. Treatment retention was higher among older clients, clients with a higher life satisfaction, and clients who subsisted on their own income.

Conclusion

Irregular discharge is high in outpatient alcohol treatment; nevertheless, a substantial portion of clients can achieve and maintain non-problem drinking by a 12-month follow-up.

Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany

AIMS

Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany.

METHODS

The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated.

RESULTS

Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased.

CONCLUSIONS

The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.