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Alcohol use has been identified in major United Nations (UN) initiatives, such as the Sustainable Development Goals and the Non-Communicable Disease Action Plan, as a major contributor to the global burden of disease. As a result, levels of alcohol use serve as an official indicator of progress towards these UN-set goals. Given current trends, UN targets for reduced alcohol consumption are unlikely to be met. Moreover, in many countries, especially in low- and middle-income countries, the alcohol-attributable burden of disease continues to increase. Pressure will need to be exerted on national and international decision-makers to arrive at more powerful and normatively persuasive instruments, such as a treaty.

<i>Aims:</i> To identify the policy implications of the magnitude and characteristics of alcohol consumption and problems, viewed globally, and to summarize conclusions on the effectiveness of the strategies available to policymakers concerned with reducing rates of alcohol problems. <i>Design/Methods/Setting:</i> This summative article draws on the findings of the articles preceding it and of reviews of the literature. <i>Findings and Conclusions:</i> Overall volume of consumption is the major factor in the prevalence of harms from drinking. Since consumption and associated problems tend to increase with economic development, policymakers in developing economies should be especially aware of the need to develop policies to minimize overall increases in alcohol consumption. Unrecorded consumption is also an important consideration for policy in many parts of the world, and poses difficulties for alcohol control policies. Drinking pattern is also an important contributing factor toward alcohol-related harm. Although some drinking patterns have been shown to produce beneficial health effects, because the net effect of alcohol on coronary disease is negative in most parts of the world, policies that promote abstinence or lower drinking overall may be the safest options. Moreover, sporadic intoxication is common in many parts of the world, and policies are unlikely to change this drinking pattern at least in the short to medium term. At the same time, because injuries comprise a large proportion of the burden of alcohol, it is appropriate to enhance these policies with targeted harm reduction strategies such as drinking and driving countermeasures and interventions focused on reducing alcohol-related violence in specific high-risk settings. Alcohol consumption is a major factor for the global burden of disease and should be considered a public health priority globally, regionally, and nationally for the vast majority of countries in the world. The need for alcohol policy is even stronger when it is taken into consideration that the burden of alcohol estimated in the WHO Global Burden of Disease project includes primarily health problems related to drinking. From the limited evidence available, however, social problems related to drinking seem to impose at least as much burden. Moreover, the burden for both social and health harms fall not only on the drinker, but also on others. There is a broad literature on policy interventions to reduce alcohol problems. Effective strategies include controls over distribution and sale, taxation, drinking-driving countermeasures, brief interventions by health workers or counselors, and selected harm reduction measures. There is a need to develop the growing literature on comparative evaluations of cost-effectiveness of such strategies. In addition, international agreements are needed to support the effectiveness of national strategies.

Since January 1994, heroin-assisted treatment for opiate addicts has been available in Switzerland. This is the first report of the long-term effects of this form of treatment. The report examines subjects who entered a study involving medical prescription of opiates (Projekt zur ärztlichen Verschreibung von Betäubungsmitteln; PROVE) in Switzerland between January 1994 and March 1995 (n = 366). Opiates were dispensed in eight treatment centres. A follow-up was conducted 6 years after treatment entry. Two groups were assessed: clients who have continuously been on heroin-assisted treatment since entry into the PROVE study or who re-entered this treatment, and ex-clients who had discontinued heroin-assisted treatment at the time of follow-up. Two kinds of comparisons were conducted. Firstly, conditions at treatment entry were compared to 6-year follow-up outcomes, and secondly, outcomes were compared between clients still on heroin-assisted treatment and those who had been discharged. It was found that 46% of the clients still alive were on heroin-assisted treatment at the time of follow-up. A comparison of the present living conditions showed very little difference between those in treatment and those who had terminated treatment. Compared to the situation at entry, the results of the follow-up showed a significant decrease in the use of illegal substances, illegal income and most other variables concerning social conditions, but they also showed an increase in unemployment and reliance on social benefits. Heroin-assisted treatment is thus efficacious in the long-term course of treatment and is still effective after termination of treatment with respect to living conditions and use of illicit substances.

Ziel: Seit Januar 1994 wird in der Schweiz die Heroin-gestützte Behandlung für Opiatabhängige angeboten. Die ersten Resultate der Begleitforschung zeigten im kurz- und mittelfristigen Verlauf eine Verbesserung der Lebensumstände der Patienten. Der vorliegende Artikel untersucht die Situation der ersten Behandlungskohorte sechs Jahre nach Eintritt und diskutiert die Langzeitwirkung dieser Behandlungsform. </P><P> Methodik und Stichprobe: In die Studie einbezogen wurden Personen, die in der Schweiz zwischen Januar 1994 und März 1995 in die Versuche für eine ärztliche Verschreibung von Betäubungsmitteln (PROVE) eingetreten sind. Sie wurden rund sechs Jahre nach Ersteintritt in Face-to-face-Interviews ausführlich zu ihrer Lebenssituation befragt. </P><P> Ergebnisse: Sowohl bei den Patient/innen, die sich noch in Behandlung befinden, als auch bei ausgetretenen Personen ist eine Verbesserung der Lebenssituation eingetreten. In früheren Untersuchungen festgestellte positive Veränderungen dauern an und zwar über die Beendigung der Heroin-gestützten Behandlung hinaus. </P><P> Schlussfolgerungen: Die Einbindung in die Heroin-gestützte Behandlung wirkt sich im Allgemeinen positiv auf den weiteren Lebensverlauf der Patient/innen aus. Handlungsbedarf besteht hauptsächlich bezüglich einer verbesserten Eingliederung in den Arbeitsmarkt. Dies könnte auch die soziale Integration, die zu einem großen Teil über die Berufstätigkeit erfolgt, erhöhen.

The aim of this narrative review is to give an overview of alcohol consumption, attributable health harm, and potential alcohol control policies to reduce this harm in five Central and Eastern European Union countries: Czech Republic, Estonia, Latvia, Lithuania, and Poland. The overall level of alcohol consumption was high, with the two highest-consuming countries in the world being situated in Central and Eastern Europe (Czech Republic, Latvia), and all five of these countries being in the top 15% of World Health Organization member states with respect to consumption. Accordingly, alcohol-attributable health harm was high. Implementation of alcohol control policies could be improved, especially the implementation of pricing policies such as taxation increases. A moderate increase of the tax share on alcohol could result in thousands of lives being saved in Central and Eastern Europe in a single year. As taxation increases not only save lives, but also increase state revenue, the implementation of this alcohol control measure should be made a priority.

Background: In many countries, the opioid agonists, buprenorphine and methadone, are licensed for maintenance treatment of opioid dependence. Many short-term studies have been performed, but little is known about long-term effects. Therefore, this study described over 6 years (1) mortality, retention and abstinence rates and (2) changes in concomitant drug use and somatic and mental health. Methods: A prevalence sample of n = 2,694 maintenance patients, recruited from a nationally representative sample of n = 223 substitution doctors, was evaluated in a 6-year prospective-longitudinal naturalistic study. At 72 months, n = 1,624 patients were assessed for outcome; 1,147 had full outcome data, 346 primary outcome data and 131 had died; 660 individuals were lost to follow-up. Results: The 6-year retention rate was 76.6%; the average mortality rate was 1.1%. During follow-up, 9.4% of patients became "abstinent" and 1.9% were referred for drug-free addiction treatment. Concomitant drug use decreased and somatic health status and social parameters improved. Conclusions: The study provides further evidence for the efficacy and safety of maintenance treatment with opioid agonists. In the long term, the number of opioid-free patients is low and most patients are more or less continuously under opioid maintenance therapy. Further implications are discussed.

Abstract Background When calculating the number of deaths attributable to alcohol consumption (i.e., the number of deaths that would not have occurred if everyone was a lifetime abstainer), alcohol consumption is most often modelled using a capped exposure distribution so that the maximum average daily consumption is 150 grams of pure alcohol. However, the effect of capping the exposure distribution on the estimated number of alcohol-attributable deaths has yet to be systematically evaluated. Thus, the aim of this article is to estimate the number of alcohol-attributable deaths by means of a capped and an uncapped gamma distribution and capped and uncapped relative risk functions using data from the European Union (EU) for 2004. Methods Sex- and disease-specific alcohol relative risks were obtained from the ongoing Global Burden of Disease, Comparative Risk Assessment Study. Adult per capita consumption estimates were obtained from the Global Information System on Alcohol and Health. Data on the prevalence of current drinkers, former drinkers, and lifetime abstainers by sex and age were obtained from various population surveys. Alcohol-attributable deaths were calculated using Alcohol-Attributable Fractions that were calculated using capped (at 150 grams of alcohol) and uncapped alcohol consumption distributions and capped and uncapped relative risk functions. Results Alcohol-attributable mortality in the EU may have been underestimated by 25.5% for men and 8.0% for women when using the capped alcohol consumption distribution and relative risk functions, amounting to the potential underestimation of over 23,000 and 1,100 deaths in 2004 in men and women respectively. Capping of the relative risk functions leads to an estimated 9,994 and 468 fewer deaths for men and for women respectively when using an uncapped gamma distribution to model alcohol consumption, accounting for slightly less than half of the potential underestimation. Conclusions Although the distribution of drinkers in the population and the exact shape of the relative risk functions at large average daily alcohol consumption levels are not known, the findings of our study stress the importance of conducting further research to focus on exposure and risk in very heavy drinkers.

Aims: Alcohol is a substantial risk factor for mortality and the burden of disease globally. In accordance with the World Health Organization's (WHO) global strategy to reduce the harmful use of alcohol, we estimated recorded, unrecorded, tourist, and total adult per capita consumption by country and WHO sub-region for 2008, and characterized the association between per capita consumption of alcohol and gross domestic product (GDP-PPP) per capita. Methods: Using data from the Global Information System on Alcohol and Health database ( World Health Organization, 2010 a) and the 2005 Global Burden of Disease study ( Institute for Health Metrics and Evaluation, 2010 ) on adult per capita consumption of alcohol, we estimated recorded adult per capita consumption for 2008 through time series analyses for 189 countries within WHO sub-regions, and then from these estimates calculated recorded adult per capita consumption estimates for each of the WHO sub-regions. Estimates for populations were obtained for 2008 from the United Nations Populations Division. 2008 GDP-PPP data by country (N = 178) were obtained from the International Monetary Fund. Results: Adult per capita consumption of alcohol in 2008 is estimated to have been 6.04 litres (95 % CI: 4.43 to 7.65). This can be broken down into 4.39 l (95 % CI: 3.72 to 4.86) of recorded per capita consumption of alcohol, 1.75 l (95 %CI: 0.25 to 3.25) of unrecorded per capita consumption of alcohol, and 0.00 l (95 %CI: 0.00 to 0.129) per capita consumption of alcohol consumed by tourists. Adult per capita consumption was highest for the European regions and lowest for the Eastern Mediterranean region. Total adult per capita consumption of alcohol showed an increase as GDP-PPP increased until approximately 15,000 international dollars of GDP-PPP per capita. Recorded consumption showed a general increase with GDP-PPP. Unrecorded consumption showed a U-shaped association with GDP-PPP per capita, with countries with the lowest and highest GDP-PPPs per capita having the lowest unrecorded adult per capita consumption of alcohol. Conclusions: In accordance with the WHO's global strategy to reduce the harmful use of alcohol, we present estimates of the recorded, unrecorded, tourist, and total adult per capita alcohol consumption for 189 countries and the 14 WHO sub-regions. Accurate and up-to-date estimates of alcohol consumption are imperative for monitoring and developing effective strategies to control the large and increasing global alcohol-attributable burden of disease and injury.

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

<b><i>Introduction:</i></b> 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. <b><i>Materials and Methods:</i></b> Data were collected between May and July 2020 (<i>n</i> = 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. <b><i>Results:</i></b> 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. <b><i>Discussion/Conclusions:</i></b> 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.

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.

Cannabis is the most widely used illicit drug worldwide, and the most commonly used illicit drug in Canada, among postsecondary student populations. This cross‐sectional study qualitatively assessed 112 high‐frequency, cannabis‐using university students in Canada: It examined their subjective expectations regarding what they anticipated their cannabis use would look like in the short‐ and mid‐term future and explored factors they saw potentially contributing to changes in their prospective drug use. Results indicated that participants believe that decisions about future cannabis use will be influenced by several contextual factors, including education and employment responsibilities, intimate relationships, and peer associations. These findings help illuminate the natural evolution of cannabis use and can guide the development of interventions for high‐frequency cannabis users in the future.