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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] [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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Kiefer F, Batra A, Petersen KU, Ardern IS, Tananska D, Bischof G, Funke W, Lindenmeyer J, Mueller S, Preuss UW, Schäfer M, Thomasius R, Veltrup C, Weissinger V, Wodarz N, Wurst FM, Hoffmann S. German Guidelines on Screening, Diagnosis, and Treatment of Alcohol Use Disorders: Update 2021. Eur Addict Res 2022; 28:309-322. [PMID: 35439764 DOI: 10.1159/000522335] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/28/2022] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Falk Kiefer
- Central Institute of Mental Health, Department of Addictive Behaviour and Addiction Medicine, Mannheim, Germany
- Chair in Addiction Research, Medical Faculty Mannheim/Heidelberg University, University of Heidelberg, Heidelberg, Germany
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Kay Uwe Petersen
- Department of Psychiatry and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Isabel Sophie Ardern
- Central Institute of Mental Health, Department of Addictive Behaviour and Addiction Medicine, Mannheim, Germany
| | - Daniela Tananska
- Central Institute of Mental Health, Department of Addictive Behaviour and Addiction Medicine, Mannheim, Germany
| | - Gallus Bischof
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Wilma Funke
- MEDIAN clinic Wied, Rhineland-Palatinate, Germany
| | | | - Sebastian Mueller
- Center of Alcohol Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrich W Preuss
- Vitos clinic for psychiatry an psychotherapy Herborn, Herborn, Germany
| | - Martin Schäfer
- Department of Psychiatry and Psychotherapy, Psychosomatic and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany
| | - Rainer Thomasius
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | | | - Norbert Wodarz
- Clinical Addiction Medicine Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Friedrich M Wurst
- Medical Faculty, Psychiatry and Psychotherapy, University of Basel, Basel, Switzerland
| | - Sabine Hoffmann
- Central Institute of Mental Health, Department of Addictive Behaviour and Addiction Medicine, Mannheim, Germany
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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] [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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Kiefer F, Batra A, Bischof G, Funke W, Lindenmeyer J, Mueller S, Preuss UW, Schäfer M, Thomasius R, Veltrup C, Weissinger V, Wodarz N, Wurst FM, AUD L, Hoffmann S. S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“. SUCHT 2021. [DOI: 10.1024/0939-5911/a000704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Falk Kiefer
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim
- Lehrstuhl für Suchtforschung, Ruprecht-Karls-Universität Heidelberg
| | - Anil Batra
- Sektion Suchtmedizin des Universitätsklinikums Tübingen, Tübingen
| | - Gallus Bischof
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck
| | | | | | | | | | - Martin Schäfer
- Klinik für Psychiatrie, Psychotherapie, Psychosomatik und Suchtmedizin, Ev. Kliniken Essen-Mitte
| | - Rainer Thomasius
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf
| | | | | | | | | | | | - Sabine Hoffmann
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim
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Mann K, Batra A, Fauth-Bühler M, Hoch E. German Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders. Eur Addict Res 2017; 23:45-60. [PMID: 28178695 DOI: 10.1159/000455841] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
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").
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Affiliation(s)
- Karl Mann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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Kraus L, Piontek D, Atzendorf J, Matos EGD. Zeitliche Entwicklungen im Substanzkonsum in der deutschen Allgemeinbevölkerung. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2016. [DOI: 10.1024/0939-5911/a000446] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Ludwig Kraus
- IFT Institut für Therapieforschung, München
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm
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Haug S, Schaub MP. Treatment outcome, treatment retention, and their predictors among clients of five outpatient alcohol treatment centres in Switzerland. BMC Public Health 2016; 16:581. [PMID: 27422382 PMCID: PMC4947295 DOI: 10.1186/s12889-016-3294-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/12/2016] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Severin Haug
- Swiss Research Institute for Public Health and Addiction, Zurich University, Konradstrasse 32, CH- 8031, Zurich, Switzerland.
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, Zurich University, Konradstrasse 32, CH- 8031, Zurich, Switzerland
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Kraus L, Pabst A, Piontek D, Gmel G, Shield KD, Frick H, Rehm J. Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany. Eur Addict Res 2015; 21:262-72. [PMID: 25967383 DOI: 10.1159/000381672] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 03/14/2015] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Ludwig Kraus
- IFT Institut für Therapieforschung, München, Germany
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