[Addicted During Pandemic? - COVID-19 and Addictive Disorders]. / Suchtkrank in der Pandemie? ­ COVID-19 und Abhängigkeitserkrankungen.

AIM: To describe changes in consumer behavior, particularly in Germany, and the population groups affected due to in-creased substance use or are at greater risk of being infected by SARS-CoV-2 and are also in danger of suffering from a more severe course of disease. METHODS: The literature search used databases from PubMed and PubPsych, along with expert opinions. RESULTS: A slight increase in daily use of alcohol and tobacco was seen, whereas the consumption of illegal drugs decreased in European countries. There was a drop in consumption among occasional users whereas among intensive users, there was an increase in consumption. Adults and children spent more time on media and internet activities during the pandemic. Anxiety, depression and stress could be the reason for the increased behavorial changes. People already suffering from an addiction were not only psychologically burdened but were also at higher risk of a SARS-CoV-2 infection or a severe progression of the disease. CONCLUSION: These results suggest possible societal trends which should be validated by larger representative surveys in the near future. Protecting risk groups and utilizing pandemic-adapted prevention measures are necessary.

[Adult attention deficit hyperactivity disorder (ADHD) with comorbid addictive disorder. Therapeutic challenges using the example of a survey of clinical practice]. / ADHS im Erwachsenenalter und komorbide Suchterkrankungen : Therapeutische Herausforderungen am Beispiel einer Praxiserhebung.

BACKGROUND: ADHD in childhood and adolescence is characterized by the symptoms hyperactivity, impulsivity, and inattentiveness; these symptoms may persist into adulthood or may manifest as restlessness, emotional instability, and disorganized behavior. In adults ADHD often occurs with increased substance use and is associated with an early onset of substance use, development of severe addiction, and decreased treatment effectiveness. METHOD: This overview will present and critically discuss current study results and evidence-based and consensus-oriented recommendations that ensure the most adequate care for patients with ADHD and addictive disorder. RESULTS AND CONCLUSIONS: For drug therapy, the current S3 guideline recommends methylphenidate, amphetamine salts, and atomoxetine, among others. Treatment of adult patients with ADHD and addiction with stimulants tends to be viewed critically; if required, long-acting medications should be used. Integrated treatment of ADHD and addiction, consisting of a combination of pharmacotherapy and psychotherapy, is recommended.

Inpatient treatment for pathological gamblers in Germany: setting, utilization, and structure.

In Germany, there are two different approaches to inpatient treatment of pathological gambling (PG): Facilities focusing on addiction or on psychosomatic illness. However, little is known about how these differences influence utilization and structure of treatment. Therefore, in our study, we analyzed all known German gambling inpatient treatment centers concerning patients' sex, age and number of comorbid disorders and evaluated an expert assessment of the treatment system, access to treatment, and structure characteristics of inpatient treatment facilities. In 2011, 2,229 pathological gamblers were treated. This amounts to 1 % of all past-year pathological gamblers. 90 % of the patients were men, 93 % had at least one comorbid disorder. Access to treatment was mostly gained via psychosocial counseling centers, but was not readily available. Facilities with addiction departments treated less pathological gamblers per year (29.3 gamblers) than facilities with psychosomatic departments (53.3 gamblers) or with both departments (76.4 gamblers). Treatment duration was significantly longer in addiction departments treating PG as secondary diagnosis only, with a low rate of gamblers on all patients, or treating few gamblers. Some facilities specialized on PG and treated more gamblers, had a higher rate of gamblers on all patients, and offered specific treatment programs. The impact of this specialization on treatment outcome is still unclear. Although treatment numbers have risen steadily for the past years, only a small fraction of affected gamblers seek inpatient treatment. Therefore, awareness to the disease and access to treatment needs to be improved.

Pathological gambling: prevalence, diagnosis, comorbidity, and intervention in Germany.

BACKGROUND: The number of pathological gamblers seeking treatment has risen continuously till the present, and the trend shows no sign of reversal. Estimates of the number of pathological gamblers in Germany range from 103,000 to 290,000, corresponding to 0.2% to 0.6% of the population. Pathological gambling often accompanies other mental disturbances. Doctors who learn that their patients suffer from such disturbances should ask targeted questions about gambling behavior to increase the chance that this problem will be detected early on. METHODS: This article is based on an analysis of secondary data obtained from the German Statutory Pension Insurance Scheme and the Federal Statistical Office and on a selective review of the literature on comorbidities and available interventions. RESULTS: The rate of inpatient treatment for pathological gambling tripled from 2000 to 2010. Most pathological gamblers are men (70%-80%). More than 90% of the patients suffer from more than one mental disturbance; 40% of them carry five different psychiatric diagnoses. Simple screening instruments for pathological gambling are easy to use in routine practice and facilitate the diagnosis. CONCLUSION: As with alcoholics, only a small fraction of pathological gamblers receives the appropriate support and treatment. Educational seminars to raise awareness among physicians and targeted measures for early detection might result in more of the affected persons getting suitable help.