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.
The school system is an established setting for behavioural and environmental tobacco prevention activities. Most research on the effectiveness of tobacco prevention has been conducted with regard to ...behavioural approaches, knowledge about school smoking policy is lacking. This research project aimed at developing a psychometrically sound instrument to assess school smoking policy. The checklist presented here contains five scales with a total of 15 items. Its reliability was tested with 42 Bavarian schools and 607 schools from Hesse. The checklist allows to measure school smoking policy in a reliable and action-oriented manner.
Aims
To investigate age, period and cohort effects on time trends of alcohol‐related mortality in countries with different drinking habits and alcohol policies.
Design and setting
Age–period–cohort ...(APC) analyses on alcohol‐related mortality were conducted in Denmark, Finland, Norway, Sweden, France and Germany.
Participants
Cases included alcohol‐related deaths in the age range 20–84 years between 1980 and 2009.
Measurements
Mortality data were taken from national causes of death registries and covered the ICD codes alcoholic psychosis, alcohol use disorders, alcoholic liver disease and toxic effect of alcohol.
Findings
In all countries changes across age, period and cohort were found to be significant for both genders effect value with confidence interval (CI) shown in Supporting information, Table S1. Period effects pointed to an increase in alcohol‐related mortality in Denmark, Finland and Germany and a slightly decreasing trend in Sweden, while in Norway an inverse U‐shaped curve and in France a U‐shaped curve was found. Compared with the cohorts born before 1960, the risk of alcohol‐related mortality declined substantially in cohorts born in the 1960s and later. Pairwise between‐country comparisons revealed more statistically significant differences for period (P < 0.001 for all 15 comparisons by gender) than for age P < 0.001 in seven (men) and four (women) of 15 comparisons or cohort P < 0.01 in two (men) and three (women) of 15 comparisons.
Conclusions
Strong period effects suggest that temporal changes in alcohol‐related mortality in Denmark, Finland, Norway, Sweden, France and Germany between 1980 and 2009 were related to secular differences affecting the whole population and that these effects differed across countries.
The excitation function and momentum distribution of η′ mesons have been measured in photon induced reactions on 12C in the energy range of 1250–2600 MeV. The experiment was performed with tagged ...photon beams from the ELSA electron accelerator using the Crystal Barrel and TAPS detectors. The data are compared to model calculations to extract information on the sign and magnitude of the real part of the η′-nucleus potential. Within the model, the comparison indicates an attractive potential of −(37±10(stat)±10(syst)) MeV depth at normal nuclear matter density. Since the modulus of this depth is larger than the modulus of the imaginary part of the η′-nucleus potential of −(10±2.5) MeV, determined by transparency ratio measurements, a search for resolved η′-bound states appears promising.
Placement matching guidelines are promising means to optimize patient-centered care and to match patients' treatment needs. Despite considerable research regarding placement matching approaches to ...optimize alcohol abuse treatment, findings are inconclusive.
To investigate whether the use of patient-centered placement matching (PCPM) guidelines is more effective in reducing heavy drinking and costs 6 months after discharge from an inpatient alcohol withdrawal treatment compared to usual referral to aftercare. Secondary aims were to investigate whether age, gender, trial site or level of care (LOC) are moderators of efficacy and whether patients who were actually referred to the recommended LOC had better treatment outcomes compared to patients who were treated under- or overmatched.
Design. Exploratory randomized controlled trial with measurements during withdrawal treatment and 6 months after initial assessment.
Four German psychiatric clinics offering a 7-21 day inpatient qualified withdrawal program for patients suffering from alcohol dependence.
From 1,927 patients who had a primary diagnosis of alcohol dependence and did not have organized aftercare when entering withdrawal treatment, 299 were invited to participate. Of those, 250 were randomized to the intervention group (IG, n = 123) or the control group (CG, n = 127).
The PCPM were applied to patients of the IG by feeding back a recommendation to a LOC for aftercare that was calculated from the Measurements in the Addictions for Triage and Evaluation (MATE) and discussed with the staff of the treatment unit. Patients of the CG received a general feedback regarding their MATE interview on request.
The MATE, the Client Socio-Demographic and Service Receipt Inventory--European Version and the MATE-Outcomes were administered. Data were analyzed using generalized linear models.
In the intention-to-treat analysis, there were no significant differences between IG and CG regarding days of heavy drinking (incident risk ratio IRR 1.09; p = 0.640), direct (IRR 1.06; p = 0.779), indirect (IRR 0.77; p = 0.392) and total costs (IRR 0.89; p = 0.496). Furthermore, none of the investigated moderator variables affected statistically significant drinking or cost-related primary outcomes. Regardless of group allocation, patients who received matched aftercare reported significantly fewer days of heavy drinking than undermatched patients (IRR 2.09; p = 0.004). For patients who were overmatched, direct costs were significantly higher (IRR 1.79; p = 0.024), but with no additional effects on alcohol consumption compared to matched patients.
While the use of PCPM failed to affect the actual referral to aftercare, our findings suggest that treating patients on the recommended LOC may have the potential to reduce days of heavy drinking compared to undertreatment and costs compared to overtreatment.
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