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Mohamed MS, Rukh G, Vadlin S, Olofsdotter S, Åslund C, Schiöth HB, Nilsson KW. Differential change in alcohol consumption during the COVID-19 pandemic: the role of loneliness, socialization, and mental well-being. Front Psychiatry 2024; 15:1236410. [PMID: 38495906 PMCID: PMC10940434 DOI: 10.3389/fpsyt.2024.1236410] [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: 06/07/2023] [Accepted: 02/07/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction The COVID-19 pandemic led to a surge in mental health issues and psychological distress, disruption to work/studying conditions, and social isolation particularly among young adults. Changes in these factors are differentially associated with alcohol use. Moreover, the relationship between these factors are bidirectional and may have fluctuated throughout the different phases of the pandemic. However, studies focusing on young adults had conflicting results, short follow-up periods, and lacked comprehensive data to describe underlying mechanisms. Methods 1067 young adults participated in repetitive measures termed wave 4 (2021) of the Survey of Adolescent Life in Västmanland Cohort "SALVe" Cohort. Of these, 889 also completed pre-pandemic measurements termed wave 3 (2018). Participants completed the Alcohol Use Disorders Identification Test (AUDIT) to evaluate alcohol consumption and harmful use. Cross-sectional associations between perceived changes in alcohol use and shift in individual, mental health, and work environment factors were examined using Chi-square tests. Logistic regression was utilized to identify pre-pandemic predictors of harmful consumption during the pandemic. Results Harmful consumption decreased only in females following the COVID-19 pandemic. Participants who reported increased feelings of depression, anxiety, and loneliness were more likely to increase their alcohol use. Interestingly, the subgroup who felt less lonely and met their friends more often, as well as those who continued working/studying from their regular workplace also had an increased likelihood of higher consumption. Only pre-pandemic ADHD and delinquency symptoms predicted harmful alcohol consumption following the pandemic. Conclusion Females reduced harmful alcohol consumption during the COVID-19 pandemic. While those who suffered the burden of social isolation and distress were more likely to increase their alcohol use, young adults who felt less lonely and met their friends more often also had a similar outcome. The relationship between loneliness and alcohol consumption among young adults is influenced by the social factors that may be facilitated by drinking.
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Affiliation(s)
- Mohamed S. Mohamed
- Center for Clinical Research, Uppsala University, Västmanland County Hospital Västerås, Västerås, Sweden
- Functional Pharmacology and Neuroscience, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Gull Rukh
- Functional Pharmacology and Neuroscience, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sofia Vadlin
- Center for Clinical Research, Uppsala University, Västmanland County Hospital Västerås, Västerås, Sweden
| | - Susanne Olofsdotter
- Center for Clinical Research, Uppsala University, Västmanland County Hospital Västerås, Västerås, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Cecilia Åslund
- Center for Clinical Research, Uppsala University, Västmanland County Hospital Västerås, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Helgi B. Schiöth
- Functional Pharmacology and Neuroscience, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kent W. Nilsson
- Center for Clinical Research, Uppsala University, Västmanland County Hospital Västerås, Västerås, Sweden
- School of Health, Care and Social Welfare, Division of Public Health Sciences, Mälardalen University, Västerås, Sweden
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Bhattarai D, Upadhyaya S, Banstola H, Pant SB. Alcohol Withdrawal Presenting with Cut Throat Injury during COVID-19 Lockdown: Case Reports from Nepal. Case Rep Psychiatry 2023; 2023:5514321. [PMID: 37928320 PMCID: PMC10624550 DOI: 10.1155/2023/5514321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/06/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023] Open
Abstract
Background The relationship between alcohol dependence and suicidal tendency is well recognized. Self-harm by cut throat is an uncommon but is potentially life-threatening when attempted. We present a description and discussion of a series of three cases of alcohol dependence syndrome who presented with self-inflicted cut throat wounds during the lockdown period from 24th March to 7th July 2020 due to the COVID-19 pandemic at the largest tertiary care hospital in Nepal. Case description. During the three and a half months of COVID-19 lockdown, we had three cases of alcohol dependence syndrome presenting to emergency services with a self-inflicted cut throat injury. Two cases were diagnosed as having alcohol withdrawal delirium and one case as alcohol-induced psychotic disorder (alcoholic hallucinosis) as per the international classification of mental and behavioral disorders diagnostic criteria for research. All three cases were alcohol dependent for more than a decade, but with no prior self-harm attempts. Necessary surgical interventions were done by the Department of Otorhinolaryngology, and in liaison with the Department of Psychiatry, appropriate psychiatric management was done. All three cases had uneventful outcomes in regard to wound care and mental disorder. Conclusion Suicidal precautions should be taken in alcohol dependence during phases of consumption and abstinence. Screening for alcohol dependence and withdrawal should be a standard process in all self-harm cases that present to the emergency department during a crisis.
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Affiliation(s)
- Dipesh Bhattarai
- Department of Psychiatry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Shreeram Upadhyaya
- Department of Psychiatry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Hemanta Banstola
- Department of General Practice and Emergency Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sagun Ballav Pant
- Department of Psychiatry, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Mapanga W, Craig A, Mtintsilana A, Dlamini SN, Du Toit J, Ware LJ, Norris SA. The Effects of COVID-19 Pandemic Lockdowns on Alcohol Consumption and Tobacco Smoking Behaviour in South Africa: A National Survey. Eur Addict Res 2023; 29:127-140. [PMID: 36934716 PMCID: PMC10627113 DOI: 10.1159/000528484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/29/2022] [Indexed: 03/21/2023]
Abstract
INTRODUCTION During the first phase of the coronavirus (COVID-19) pandemic lockdowns in South Africa (SA), both alcohol and tobacco were considered non-essential goods and their sales were initially prohibited and further restricted to certain days and timeframes. This study investigates self-reported changes in alcohol consumption and tobacco smoking behaviour in the general population during the COVID-19 pandemic lockdowns in SA. METHODS A cross-sectional national survey was conducted in October 2021 (before the Omicron wave 4 and while SA was in low-level lockdown) among 3,402 nationally representative respondents (weighted to 39,640,674) aged 18 years and older. Alcohol consumption and tobacco use were assessed from the beginning of the lockdown towards the end of March 2020 until October 2021 using the WHO-AUDIT and the US Centre for Disease Control (CDC) Global Adult Tobacco Survey questionnaires, respectively. RESULTS Among those that drank alcohol (33.2%), 31.4% were classified as having a drinking problem that could be hazardous or harmful and 18.9% had severe alcohol use disorder during the COVID-19 lockdowns. Twenty-two per cent (22.0%) of those that reported alcohol consumption reported that the COVID-19 pandemic lockdowns changed their alcohol consumption habits, with 38.1% reporting a decreased intake or quitting altogether. Among the one in five respondents (19.2%) who had ever smoked, most reported smoking at the time of the survey (82.6%) with many classified as light smokers (87.8%; ≤10 cigarettes/day). Almost a third (27.2%) of those smoking reported that the COVID-19 pandemic lockdowns had changed their use of tobacco products or vaping, with 60.0% reporting a reduction/quitting tobacco use. Given that sales were restricted this indicates that people could still get hold of tobacco products. Heavy smoking was associated with older age (p = 0.02), those classified as wealthy (p < 0.001), those who started or increased tobacco smoking during the pandemic lockdowns (p = 0.01) and residential provinces (p = 0.04). CONCLUSION Given restrictions on the sale of alcohol and tobacco in SA between 27 March and August 17, 2020, during the pandemic, respondents reported an overall decline in alcohol consumption and tobacco use which might suggest that the regulatory restrictive strategies on sales had some effect but may be inadequate, especially during times where individuals are likely to experience high-stress levels. These changes in alcohol consumption and tobacco use were different from what was reported in several European countries, possibly due to differences in the restrictions imposed in SA when compared to these European countries.
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Affiliation(s)
- Witness Mapanga
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashleigh Craig
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Asanda Mtintsilana
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siphiwe N. Dlamini
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justin Du Toit
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa J. Ware
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK
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Aslam A, Kwo PY. Epidemiology and Disease Burden of Alcohol Associated Liver Disease. J Clin Exp Hepatol 2023; 13:88-102. [PMID: 36647400 PMCID: PMC9840073 DOI: 10.1016/j.jceh.2022.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 09/06/2022] [Indexed: 01/19/2023] Open
Abstract
Consumption of alcohol in excess leads to substantial medical, economic, and societal burdens. Approximately 5.3% of all global deaths may be attributed to alcohol consumption. Moreover, the burden of alcohol associated liver disease (ALD) accounts for 5.1% of all disease and injury worldwide. Alcohol use disorder (AUD) affects men more than women globally with significant years of life loss to disability in low, middle and well-developed countries. Precise data on global estimates of alcohol related steatosis, alcohol related hepatitis, and alcohol related cirrhosis have been challenging to obtain. In the United States (US), alcohol related steatosis has been estimated at 4.3% based on NHANES data which has remained stable over 14 years. However, alcohol-related fibrotic liver disease has increased over the same period. In those with AUD, the prevalence of alcohol related hepatitis has been estimated at 10-35%. Globally, the prevalence of alcohol-associated cirrhosis has been estimated at 23.6 million individuals for compensated cirrhosis and 2.46 million for those with decompensated cirrhosis. The contribution of ALD to global mortality and disease burden of liver related deaths is substantial. In 2016 liver disease related to AUD contributed to 50% of the estimated liver disease deaths for age groups 15 years and above. Data from the US report high cost burdens associated with those admitted with alcohol-related liver complications. Finally, the recent COVID-19 pandemic has been associated with marked increase in alcohol consumption worldwide and will likely increase the burden of ALD.
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Key Words
- AAPC, Average annual percentage change
- ABIC, Age, Serum bilirubin, INR and serum Creatinine
- ABV, Alcohol by volume
- ALD, Alcohol-associated liver disease
- AUD, Alcohol use disorder
- BAC, Blood alcohol concentration
- CDC, Centers for Disease Control and Prevention
- COVID-19, Coronavirus disease 2019
- GAHS, Glasgow alcoholic hepatitis score
- HE, Hepatic encephalopathy
- HRS, Hepatorenal syndrome
- ICD-10, International Classification of Diseases, 10th Edition
- MDF, Maddrey's Discriminant Function
- MELD, Model of end-stage liver disease
- MRI, Magnetic resonance imaging
- NHANES, National Health and Nutrition Examination Survey
- NIAAA, National Institute of Alcohol Abuse and Alcoholism
- NIS, National inpatient sample
- NSDUH, Annual National Survey on Drug Use and Health
- SAMHSA, Substance Abuse and Mental Health Services Administration
- US, United States
- USG, Ultrasonography
- WHO, World Health Organization
- YLD, Years of life lost to disability
- alcohol
- alcohol use disorder
- alcoholic cirrhosis
- alcoholic hepatitis
- alcoholic steatosis
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Affiliation(s)
- Aysha Aslam
- Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA 94063, USA
| | - Paul Y. Kwo
- Stanford University School of Medicine, 430 Broadway, Pavilion C, 3rd Floor, Redwood City, CA 94063, USA
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Schulz P, Shabbir R, Ramakrishnan S, Asrani SK. Acute Alcohol-Associated Hepatitis in the COVID-19 Pandemic — a Structured Review. CURRENT TRANSPLANTATION REPORTS 2022; 9:227-239. [DOI: 10.1007/s40472-022-00387-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/22/2022]
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Hultgren BA, Smith‐LeCavalier KN, Canning JR, Jaffe AE, Kim IS, Cegielski VI, Garcia TA, Larimer ME. College students' virtual and in-person drinking contexts during the COVID-19 pandemic. Alcohol Clin Exp Res 2022; 46:2089-2102. [PMID: 36454103 PMCID: PMC9720698 DOI: 10.1111/acer.14947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The COVID-19 pandemic has resulted in pronounced changes for college students, including shifts in living situations and engagement in virtual environments. Although college drinking decreased at the onset of the pandemic, a nuanced understanding of pandemic-related changes in drinking contexts and the risks conferred by each context on alcohol use and related consequences have yet to be assessed. METHODS Secondary data analyses were conducted on screening data from a large parent clinical trial assessing a college student drinking intervention (N = 1669). Participants across six cohorts (from Spring 2020 to Summer 2021) reported on the frequency of drinking in each context (i.e., outside the home, home alone, home with others in-person, and home with others virtually), typical amount of drinking, and seven alcohol-related consequence subscales. RESULTS Descriptive statistics and negative binomial regressions indicated that the proportion and frequency of drinking at home virtually with others decreased, while drinking outside the home increased from Spring 2020 to Summer 2021. Limited differences were observed in the proportion or frequency of individuals drinking at home alone or at home with others in-person. Negative binomial and logistic regressions indicated that the frequency of drinking outside the home was most consistently associated with more alcohol-related consequences (i.e., six of the seven subscales). However, drinking at home was not without risks; drinking home alone was associated with abuse/dependence, personal, social, hangover, and social media consequences; drinking home with others virtually was associated with abuse/dependence and social consequences; drinking home with others in-person was associated with drunk texting/dialing. CONCLUSION The proportion and frequency of drinking in certain contexts changed during the COVID-19 pandemic, although drinking outside the home represented the highest risk drinking context across the pandemic. Future prevention and intervention efforts may benefit from considering approaches specific to different drinking contexts.
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Affiliation(s)
- Brittney A. Hultgren
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashingtonUSA
| | | | | | - Anna E. Jaffe
- Department of PsychologyUniversity of Nebraska‐LincolnLincolnNebraskaUSA
| | - Isabel S. Kim
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashingtonUSA
| | | | | | - Mary E. Larimer
- Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleWashingtonUSA
- Department of PsychologyUniversity of WashingtonSeattleWashingtonUSA
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Sharma P, Kamath C, Kurani S, Pazdernik V, Kremers HM, St Sauver J, Croarkin P, Geske J, Prasad K, Patten C, Holland A. Longitudinal Correlates of Increased Alcohol Use Among Adolescents and Young Adults During the COVID-19 Pandemic. Alcohol Alcohol 2022; 57:648-655. [PMID: 35511126 PMCID: PMC9383764 DOI: 10.1093/alcalc/agac024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS The objective of this study is to longitudinally assess sociodemographic and psychological correlates of increased alcohol use during the coronavirus disease of 2019 (COVID-19) period among adolescents and young adults. METHODS Pre-COVID period is defined as the 1-year period on or before 31 March 2020, and during-COVID period is defined as the period from 1st April 2020 to 30 March 2021. Univariable logistic regression models are used to evaluate the association of demographic characteristics, Area Deprivation Index (ADI), rurality, changes in Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) scale severity, and the risk of increased alcohol consumption (binge drinking, number of drinks and drinking regularity) from pre-COVID to during-COVID period. RESULTS AND CONCLUSION Our study found that worsened anxiety symptoms, older age, being in college and current cigarette smoking status were associated with increased alcohol use among youth during the pandemic year. Socioeconomic position (measured by ADI) and rural status were not found to be associated with increased alcohol use among adolescents and young adults.
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Affiliation(s)
- Pravesh Sharma
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA.,Department Psychiatry and Psychology, Mayo Clinic Health System, 1221 Whipple St., Eau Claire, WI, 54703, USA
| | - Celia Kamath
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA.,Department of Quantitative Health Sciences, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA.,Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA
| | - Shaheen Kurani
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA
| | - Vanessa Pazdernik
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA
| | - Hilal Maradit Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA
| | - Jennifer St Sauver
- Department of Quantitative Health Sciences, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA
| | - Paul Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA
| | - Jennifer Geske
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA
| | - Kavita Prasad
- Department of Integrative Medicine, Zumbro Valley Health Center, 343 Woodlake Dr, Rochester, MN 55904, USA
| | - Christi Patten
- Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA.,Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55906, USA
| | - Ashely Holland
- Department Psychiatry and Psychology, Mayo Clinic Health System, 1221 Whipple St., Eau Claire, WI, 54703, USA
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Bloomfield K, Kilian C, Manthey J, Rehm J, Brummer J, Grittner U. Changes in Alcohol Use in Denmark during the Initial Months of the COVID-19 Pandemic: Further Evidence of Polarization of Drinking Responses. Eur Addict Res 2022; 28:297-308. [PMID: 35545059 PMCID: PMC9254281 DOI: 10.1159/000524379] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/18/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The year 2020 was marked by the COVID-19 pandemic. Policy responses to COVID-19 affected social and economic life and the availability of alcohol. Previous research has shown an overall small decrease in alcohol use in Denmark in the first months of the pandemic. The present paper focused on identifying which subgroups of individuals had decreased or increased their consumption. MATERIALS AND METHODS Data were collected between May and July 2020 (n = 2,566 respondents, convenience sample). Weights were applied to reflect the actual Danish general population. Variables included the pre-pandemic alcohol consumption, change in alcohol consumption in the past month, socio-demographics, and reported economic consequences. Responses to a single item assessing changes in alcohol consumption in the past month were classified as no change, increase, or decrease in consumption. Regression models investigated how changes in consumption were linked to pre-pandemic drinking levels, socio-demographics (gender, age groups, education), and reported economic consequences. RESULTS While 39% of participants reported decreased consumption levels and 34% had stable levels, 27% increased consumption. Characteristics associated with changes in consumption were associated with both increases and decreases in consumption: younger people, those with higher consumption levels before the pandemic, and those with lower education more often both reported increases as well as decreases in consumption. DISCUSSION/CONCLUSIONS We confirmed that more people decreased rather than increased their alcohol consumption in the first few months of the pandemic in Denmark. Characteristics associated with changes in consumption such as younger age, higher consumption levels, and lower education demonstrated a polarization of drinking since these were associated with both increases and decreases in consumption. Public health authorities should monitor alcohol use and other health behaviours for increased risks during the pandemic.
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Affiliation(s)
- Kim Bloomfield
- Centre for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark,Institute of Biometry and Clinical Epidemiology, Charité − Universitätsmedizin Berlin, Berlin, Germany,Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark,Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - 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,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 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
| | - Julie Brummer
- Centre for Alcohol and Drug Research, Aarhus University, Copenhagen, Denmark
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité − Universitätsmedizin Berlin, Berlin, Germany,Berlin Institute of Health, Berlin, Germany,*Ulrike Grittner,
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