Prevalence of problem drinking and associated factors in a representative German sample of adolescents and young adults.

BACKGROUND: Alcohol use in youth is regarded as an important public health concern and in a recent survey in 35 European countries, every third student reported heavy episodic drinking. While prevalence estimates for problem drinking in adults from representative population samples are available, corresponding numbers for adolescents in Germany are currently lacking. METHODS: A representative sample of 1531 12-25 years old in Germany was investigated with a standardized questionnaire concerning problem drinking (assessed with the AUDIT-C) and psychosocial aspects (anxiety with the GAD-2, depressive symptoms with the PHQ-2 and smoking behavior). Due to missing values, we could calculate prevalence estimates, chi-square tests and logistic regression analyses for 1490 cases. RESULTS: The 1-year prevalence of problem drinking in 12-25 years old in Germany was 18.2%. Overall, 5.0% of the adolescents (aged 12-17 years) and 27.7% of the young adults (aged 18-25 years) reported problem drinking in the last year. Young adult males more often showed problem drinking than females, while no gender differences in adolescents were observed. Problem drinking was associated with male gender, higher age, smoking behavior and depressive symptoms. CONCLUSIONS: According to the study findings, problem drinking is widespread in 12-25 years old in Germany.

[Methamphetamine : Epidemiology, clinical importance and sequelae of abuse]. / Methamphetamin : Epidemiologie, klinische Bedeutung und Folgen des Gebrauchs.

Methamphetamine (also known as meth and crystal meth) is a highly psychoactive synthetic amphetamine type stimulant, which falls under the German Federal Narcotics Law. The substance is similar to other stimulants but has distinct features with respect to psychoactive effects, clinical symptoms, user characteristics and short and long-term consequences including substance-induced problems and comorbidities. The consumption and misuse of crystal meth is still limited to certain regions in Germany; however, the substance causes significant clinical and public health concerns in the affected regions and beyond due to the associated high potential for misuse and dependence, neurotoxic and neurodegenerative effects as well as many other severe health risks. The new German guidelines for methamphetamine use disorders are now available to provide clinicians with the current knowledge on effective diagnostics and treatment planning.

[Cannabis--Position Paper of the German Respiratory Society (DGP)]. / Cannabis--Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP).

In this position paper, the adverse health effects of cannabis are reviewed based on the existing scientific literature; in addition possible symptom-relieving effects on some diseases are depicted. In Germany, cannabis is the most widely used illicit drug. Approximately 600,000 adult persons show abusive or addictive cannabis consumption. In 12 to 17 year old adolescents, cannabis use increased from 2011 to 2014 from 2.8 to 6.4%, and the frequency of regular use from 0.2 to 1.5%. Currently, handling of cannabinoids is much debated in politics as well as in general public. Health aspects have to be incorporated into this debate. Besides analysing mental and neurological side effects, this position paper will mainly focus on the influences on the bronchopulmonary and cardiovascular system. There is strong evidence for the induction of chronic bronchitis. Allergic reactions including asthma are known, too. Associations with other diseases like pulmonary emphysema, lung cancer and pneumonia are not sufficiently proven, however cannot be excluded either. In connection with the use of cannabis cardiovascular events such as coronary syndromes, peripheral vascular diseases and cerebral complications have been noted. Often, the evidence is insufficient due to various reasons; most notably, the overlapping effects of tobacco and cannabis use can frequently not be separated adequately. Empirically, early beginning, high-dosed, long-lasting and regular cannabis consumption increase the risk of various psychological and physical impairments and negatively affect age-based development. Concerns therefore relate especially to children and adolescents. There is only little scientific evidence for medical benefits through cannabis as a remedy; systematic research of good quality, in particular prospective, randomised, placebo-controlled double-blinded studies are rare. The medical societies signing this position paper conclude that cannabis consumption is linked to adverse health effects which have to be taken into consideration in the debate about the social attitude towards cannabinoids. The societies agree that many aspects regarding health effects of cannabis are still uncertain and need clarification, preferably through research provided by controlled studies.

Non-destructive mobile monitoring of microbial contaminations on meat surfaces using porphyrin fluorescence intensities.

A non-destructive mobile system for meat quality monitoring was developed and investigated for the possible application along the whole production chain of fresh meat. Pork and lamb meat was stored at 5 °C for up to 20 days post mortem and measured with a fluorescence spectrometer. Additionally, the bacterial influence on the fluorescence signals was evaluated by different experimental procedures. Fluorescence of NADH and different porphyrins could be correlated to the growth of diverse bacteria and hence used for contamination monitoring. The increase of porphyrin fluorescence started after 9 days p.m. for pork and after 2 days p.m. for lamb meat. Based on the results, a mobile fluorescence system was built and compared with the laboratory system. The corrected function of the meat slices showed a root mean square error of 1156.97 r.u. and a mean absolute percentage error of 12.59%; for lamb the values were 470.81 r.u. and 15.55%, respectively. A mobile and non-invasive measurement system would improve the microbial security of fresh meat.

[Evaluation of the Family-based Familien stärken-Program for Preventing Substance Abuse and Behavior Problems in Youth]. / Evaluation des familienbasierten Programms Familien stärken zur Prävention von Sucht- und Verhaltensproblemen bei Jugendlichen.

The Strengthening Families Program was developed in the USA and is regarded as an effective family-based prevention programme for youth. The evaluation of an adapted German version was carried out as a randomised-controlled multicentre trial. 292 families were recruited, 150 followed the intervention, and 142 received a minimal intervention. Acceptance from families and programme facilitators was high. Results about the effectiveness will be reported as soon as follow-up assessments are completed.

[Acute ethanol intoxication among children and adolescents in Hamburg, Germany]. / Alkoholintoxikierte Kinder und Jugendliche in der Notfallversorgung Hamburger Krankenhäuser.

By using an anonymous postcard reporting system, data of n=358 children, adolescents, and young adults who were treated in 26 emergency departments because of acute alcohol intoxication were collected. The aim of this study was to estimate the prevalence of acute alcohol intoxications in Hamburg, compare these data with the official hospital diagnosis register, and analyze the circumstances that led to the intoxication. A total of 358 cases were reported by the postcard system. Age ranged from 11-21 years, with 64.5% being 14-17 years old. Data were collected in the municipal area of Hamburg during the calendar year of 2008. The percentage of female patients was 65.6% in the age group from 11-17 years and decreased in the age group of patients being 18 years and older. A vast majority of patients were admitted by ambulance and were reported as being a"first offender". On average, male patients showed a higher level of blood alcohol when being admitted (2.02 ‰) than female patients (1.76 ‰). The older the age group, the higher the blood alcohol level. Among drinking circumstances, the situation"drank together with friends" was most frequently reported. In comparison with the official hospital diagnosis register, prevalence was 31.6% higher. This could mean that the prevalence reported in the official hospital diagnosis register is an underestimation of the actual case numbers.

[Pathological Internet use--epidemiology, diagnostics, co-occurring disorders and treatment]. / Pathologischer Internetgebrauch--Epidemiologie, Diagnostik, komorbide Störungen und Behandlungsansätze.

In 2009, we can look back on a history of 40 years of internet use. While most consumers make use of the internet in a controlled fashion, a progressive loss of the ability to control the frequency and duration of internet activities emerges in some users. As a consequence, the excessive time devoted to internet use and the behavioural narrowing can lead to dramatic psychosocial outcomes. This phenomenon is referred to as "pathological internet use" (PIU). On behalf of the German ministry of health a systematic review of the literature since 1996 has been carried out. The main results will be presented in this review. Prevalence data on pathological internet use are limited by methodological difficulties concerning the diagnosis and the heterogeneity of diagnostical instruments. International prevalence rates range from 1.5 % to 8.2 %. Annual studies on representative samples of the German population describe their internet use and patterns of use, but information on the prevalence of PIU is missing. Diagnostical instruments are needed that show sufficient reliability and validity and allow international comparisons. Research on the Dutch "Compulsive Internet Use Scale" may close this gap. Cross-sectional studies on samples of patients report high comorbidity of PIU with psychiatric disorders, e. g. affective disorder and attention deficit hyperactivity disorder (ADHD). If PIU and these co-occurring disorders could be explained by shared risk factors or better as secondary disorders is largely unknown. The treatment currently is based on therapeutical interventions and strategies successful in the treatment of substance use disorders. Due to the lack of methodological sufficient research it is currently impossible to recommend any evidence-based treatment of PIU.

Mood, cognition and serotonin transporter availability in current and former ecstasy (MDMA) users: the longitudinal perspective.

Although 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is a known serotonergic neurotoxin in different animal species, there is to date no conclusive evidence of its neurotoxicity in humans. MDMA use was associated with impairments of psychological well-being, verbal memory and altered serotonergic functioning in a number of cross-sectional studies. Due to inherent methodological limitations, such as the notorious polydrug use of ecstasy users and lack of control of possible pre-existing differences between ecstasy users and control participants, researchers have called for well-controlled, prospective longitudinal studies to shed more light on the issue of MDMA neurotoxicity to the human brain. This longitudinal study investigated whether mood, cognition and central serotonin transporters (SERT) would deteriorate with continued MDMA use and whether or not they would recover over increasing periods of MDMA abstinence. In a repeated-measures design, 11 current and ten ex-ecstasy users, and 11 polydrug (but not MDMA) and 15 drug-naive controls participated three times within approximately two years. Both ecstasy user groups reported a polydrug use pattern besides heavy ecstasy use. Subjective reports of ecstasy use or abstinence were verified by toxicological analyses. On each trial, the participants underwent a cognitive test battery and filled in the Symptom Check List. The availability of central SERT was assessed with positron emission tomography using the McN5652 ligand for all groups at t1, and only for the ecstasy user groups on follow-ups. The factor Group yielded significant results in the SCL-90 scales Global Severity Index, Anxiety, Obsessive/compulsive and Interpersonal sensitivity, with the ex-ecstasy users reporting the highest symptom scores. There were significant Group effects in all measures of verbal memory, with the lowest performance in the group of ex-ecstasy users. The repeated-measures analyses yielded no significant Group x Time interactions in any SCL-90 scales or measures of memory performance, with the exception of AVLT 1 immediate recall. Thus the ex-ecstasy users' psychopathological symptoms and memory performance failed to improve, and the current ecstasy users' failed to deteriorate, over time relative to the other groups. While there was a significant effect of Group in all brain regions examined (except the control region white matter), the current users' SERT availability seems to have recovered in the mesencephalon, as indicated by a significant Group x Time interaction. Reduced SERT availability might be a transient effect of heavy ecstasy use, since it partially recovered as the current users reduced their MDMA use. However, this measure may not necessarily be a valid indicator of the number or integrity of serotonergic neurons. Ex-ecstasy users' verbal memory showed no sign of improvement even after over 2.5 years of abstinence and thus may represent persistent functional consequences of MDMA neurotoxicity. However, alternative causes such as pre-existing group differences cannot be completely ruled out in spite of the longitudinal design.

Mental disorders in current and former heavy ecstasy (MDMA) users.

BACKGROUND: Ecstasy use has often been found to be associated with psychopathology, yet this research has so far been based largely on subjective symptom ratings. AIMS: To investigate whether ecstasy users suffered from long-term psychopathological consequences. MEASUREMENTS: We compared the prevalence of Diagnostic and Statistical Manual version IV (DSM-IV) mental disorders in 30 current and 29 former ecstasy users, 29 polydrug and 30 drug-naive controls. Groups were approximately matched by age, gender and level of education. The current ecstasy users reported a life-time dose of an average of 821 and the former ecstasy users of 768 ecstasy tablets. FINDINGS: Ecstasy users did not significantly differ from controls in the prevalence of mental disorders, except those related to substance use. Substance-induced affective, anxiety and cognitive disorders occurred more frequently among ecstasy users than polydrug controls. The life-time prevalence of ecstasy dependence amounted to 73% in the ecstasy user groups. More than half of the former ecstasy users and nearly half of the current ecstasy users met the criteria of substance-induced cognitive disorders at the time of testing. Logistic regression analyses showed the estimated life-time doses of ecstasy to be predictive of cognitive disorders, both current and life-time. CONCLUSIONS: The motivation for ecstasy use is not likely to be self-medication of pre-existing depressive or anxiety disorders as these did not occur more frequently in the ecstasy users than in control groups or in the general population. Cognitive disorders still present after over 5 months of ecstasy abstinence may well be functional consequences of serotonergic neurotoxicity of 3,4-methylenedioxymethamphetamine (MDMA).

[AWMF-guideline: cocaine-, amphetamine-, ecstasy- and hallucinogen-related disorders]. / AWMF-Behandlungsleitlinie: Psychische und Verhaltensstörungen durch Kokain, Amphetamine, Ecstasy und Halluzinogene.

Actually, guidelines for treatment of substance-related disorders were written under the overall control of the DG-Sucht e. V. and the DGPPN e. V. This appears within the framework of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaft (AWMF). The leading objective of these guidelines is the description of the current scientifically proven and evidence-based medicine in addiction to derive recommendations to therapy. In this context, the guideline for treatment of cocaine-, amphetamine-, ecstasy-, and halluzinogen-related disorders is introduced.

Plasma amino acids in ecstasy users.

Recreational use of the illegal drug "ecstasy" has increased dramatically in recent years. We have measured 33 different plasma amino acids in ecstasy users and controls. Significant differences were found for phosphoserine, glutamate, citrulline, methionine, tyrosine and histidine. Resembling changes in the plasma amino acids have been described in acute transient polymorphous psychosis. Thus, alterations in plasma - methionine and phosphoserine or other amino acids could be involved in the psychical symptoms produced by MDMA.

Mood, cognition and serotonin transporter availability in current and former ecstasy (MDMA) users.

RATIONALE: Chronic recreational ecstasy (MDMA) use has often been reported to be associated with psychopathology, memory impairments and serotonergic alterations. However, the findings have not been consistent. OBJECTIVES: To attempt to replicate these findings, to investigate whether such alterations would be reversible and whether they could be predicted by parameters of previous drug use. METHODS: In a cross-sectional design, 30 current and 31 ex-ecstasy users with ecstasy abstinence of at least 5 months, and 29 polydrug and 30 drug-naive controls were compared on measures of psychopathology, cognitive performance and serotonin transporter availability. RESULTS: The groups did not differ significantly in age, gender distribution, education level and premorbid intelligence. The ecstasy groups did not differ significantly from polydrug controls on most of the relevant parameters of concomitant illegal drug use. Reported drug use was confirmed by hair and urine analyses. All three groups of drug users exhibited significantly elevated psychopathology compared with drug-naive controls. Only ex-ecstasy users were significantly impaired on verbal recall. Current ecstasy users showed significantly reduced distribution volume ratios of serotonin transporter availability in the mesencephalon and caudate nucleus. Regression analyses indicated that psychopathology and serotonergic alterations were best predicted by the number of ecstasy tablets taken on a typical event. CONCLUSION: The results indicate that verbal memory impairments were possibly aggravated after prolonged ecstasy abstinence while there was tentative evidence of serotonergic recovery. On the other hand, self-reported elevated psychopathology appeared to be associated with polydrug use in general and not specifically with ecstasy use.

Specific neurotoxicity of chronic use of ecstasy.

The use of the illicit drug ecstasy (mainly containing methylenedioxymethamphetamine, MDMA) is widespread among young people in western Nations. Animal experiments indicate that MDMA is a potent neurotoxin specifically affecting the serotonergic system. A few functional neuroimaging studies revealed central nervous alterations after the repeated use of ecstasy. We examined 94 ecstasy users in comparison to 27 control subjects by means of positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG). The FDG uptake rates were globally reduced in ecstasy users, most pronounced in the striatum. The uptake rates tended to be negatively correlated with the cumulative ecstasy doses. The results indicate that younger ecstasy users may be more vulnerable with regard to neurotoxicity.

Plasma concentrations of 5-HT, 5-HIAA, norepinephrine, epinephrine and dopamine in ecstasy users.

Recreational use of the synthetic methamphetamine derivative MDMA (3,4-methylenedioxymethamphetamine), the main constituent of the illegal drug "ecstasy", has increased dramatically in recent years. The reasons for ecstasy-associated cardiovascular complications like tachycardia, arrhythmias and hypertensive crises and psychiatric symptoms like psychotic episodes are not well understood. We have measured the plasma concentrations of 5-HIAA, 5-HT, norepinephrine, epinephrine and dopamine in 159 ecstasy users and controls. Ecstasy users showed elevated resting sympathetic activity, reflected in increased norepinephrine, epinephrine and dopamine levels. The levels of these catecholamines correlated positively with the cumulative dose and also with consumption during the last 30 days and 12 months. Although it is known that significant changes in 5-HT and 5-HIAA appear in the cerebrospinal fluid in ecstasy users, we could not detect alterations in serotonergic neurotransmitters in plasma in this large sample of subjects. Thus, in the drug-free interval, ecstasy users show lowered central serotonergic activity (lowered 5-HT and 5-HIAA concentrations in CSF) along with unchanged central noradrenergic and dopaminergic activity (HVA and MHPG unchanged in CSF) and elevated peripheral noradrenergic, dopaminergic and adrenergic activity along with unchanged peripheral serotonergic activity (plasma levels). We conclude, that the data presented here could argue for a noradrenergic hyperreactivity in the drug-free interval in ecstasy users resulting from previous ecstasy consumption. Also for an association with psychotic episodes and cardiovascular complications like tachycardia, arrhythmias.

[Validity of operationalized psychodynamic diagnostics]. / Validität der Operationalisierten Psychodynamischen Diagnostik (OPD) bei familientherapeutisch behandelten Drogenabhängigen im adoleszenten und jungen Erwachsenenalter1.

The paper describes results of "operationalized psychodynamic diagnostics" (OPD) with 54 adolescent and young adult drug addicts prior to outpatient family therapy. Focus of investigation is the prognostic and factorial validity of the OPD-system. Furthermore, relationships between conflicts and psychic structure are investigated. The use of the OPD-system allows a clinical description of the patient sample. Thus, adolescent drug addicts are characterized by autonomy versus dependence and self-esteem conflicts. A neurotic or sometimes borderline level is found on the structure axis. Low scores on the structure axis are significantly correlated with self-esteem conflicts. There is some evidence for the prognostic validity of the OPD I axis. However, prognostic validity of the structure and conflict axes require further research.

Long-term effects of 'ecstasy' abuse on the human brain studied by FDG PET.

The popular recreational drug, 'ecstasy', mainly contains 3,4-methylenedioxymethamphetamine (MDMA) as the psychotropic agent. MDMA is suspected of causing neurotoxic lesions to the serotonergic system as demonstrated by animal studies, examinations of human cerebrospinal fluid, and the first positron emission tomography (PET) studies using the serotonin transporter ligand [11C]-McN5652. Damage of serotonergic afferents might mediate long-lasting alterations of cerebral glucose metabolism as a secondary effect. To study a relationship between ecstasy use and long-lasting alterations, PET using 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) was performed in 93 ecstasy users and 27 subjects without any known history of illicit-drug abuse. As an index of glucose metabolism, mean normalized FDG uptake was determined in both groups using a computerized brain atlas, and was compared for a selected number of brain regions. FDG uptake was normalized in each individual by dividing local FDG uptake by the maximum FDG uptake in the individual's brain. Within the group of ecstasy users we examined the relationship between FDG uptake and cumulative ecstasy dose, time since last ecstasy ingestion at the time of PET scanning, and age at first ecstasy use, respectively. Normalized FDG uptake was reduced within the striatum and amygdala of ecstasy users when compared to controls. No statistically significant correlation of the FDG uptake and the cumulative dose of ecstasy was detected. A positive correlation was found in the cingulate between FDG uptake and the time since last ecstasy ingestion. As compared to the control group, normalized FDG uptake in the cingulate was reduced in ecstasy users who took ecstasy during the last 6 months, while it was elevated in former ecstasy users who did not consume ecstasy for more than 1 year. FDG uptake was significantly more affected in ecstasy users who started to consume ecstasy before the age of 18 years. In conclusion, ecstasy abuse causes long-lasting effects on glucose metabolism in the human brain. These effects are more severe in the case of very early abuse. However, several questions still remain to be answered, i.e. the correlation of the neuronal alterations and the history of ecstasy use (cumulative dose, and time since the last dose) and its reversibility.

Ecstasy--long-term effects on the human central nervous system revealed by positron emission tomography.

BACKGROUND: The main psychotropic agent of the popular illicit drug ecstasy is 3,4-methylenedioxymethamphetamine (MDMA). In the light of animal studies and examinations of human cerebrospinal fluid, MDMA is suspected of causing neurotoxic lesions to the serotonergic system. AIMS: To postulate a relationship between ecstasy use and lasting alterations to the cerebral glucose metabolic rate. METHOD: Positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) was performed on seven ecstasy users and seven subjects without any known history of illicit drug use. Data were compared for a limited number of brain regions. RESULTS: By comparison with the control group, the glucose metabolic uptake of the ecstasy user group was altered within the amygdala, hippocampus and Brodmann's area II. CONCLUSIONS: The results suggest the possibility that ecstasy use has lasting effects on central neuronal activity in humans.

[MDMA ("Ecstasy") use--an overview of psychiatric and medical sequelae]. / MDMA ("Ecstasy")-Konsum--ein Uberblick zu psychiatrischen und medizinischen Folgen.

Epidemiological research and Substance Abuse Warning Systems point to a sharp increase in the use of "Ecstasy" (MDMA), as well as to structural changes in the drug scene in and outside Europe. For some consumers, "Ecstasy" opens the door to the abuse of other illegal substances. Since the mid-eighties psychiatric complications and consequences of the abuse of MDMA have been reported in at least 48 cases. It is necessary to differentiate between acute psychiatric complications, which subside completely when the level of intoxication comes down, toxic psychoses and long-term psychiatric diseases as a consequence of substance abuse. The latter involve atypical and paranoid psychoses, depressions, panic disorders, depersonalisation and behavioural disorders. Convulsive seizures are among the most common problems involving the central nervous system. Furthermore, there have been reports on cerebrovascular accidents and intracranial haemorrhages. Literature reports on at least 53 cases of medical complications in abusers of MDMA, 14 of which came to a lethal end. Research still blatantly lacks prospective epidemiological and clinical studies on a sufficiently large scale to identify different developments of dependency and predictors of harmful and unhealthy consumption.

[Quantitative EEG, basic disorders and smoking in etiopathogenetically different groups of paranoid-hallucinatory psychoses--an exploratory study]. / Quantitatives EEG, Basisstörungen und Rauchen bei ätiopathogenetisch differenten Gruppen paranoid-halluzinatorischer Psychosen--eine explorative Studie.

We performed an exploratory study of quantitative EEG in aetiopathogenetically different paranoid-hallucinatory psychoses divided into the following groups: a) patients with familial psychoses (n = 12), b) patients with neuropsychological deficits (n = 16), c) patients with alcohol and drug abuse (n = 22) and d) patients with so-called sporadic psychoses (n = 12). We found a significant reduction of relative alpha power in the group with neuropsychological deficits. In the group with familial psychosis there was a significant reduction of absolute delta power and a significant increase of relative beta power and dominant beta frequency, especially for the frontal leads. Patients with drug abuse showed a reduction of absolute beta power and an increase of absolute and relative theta power. The group with sporadic psychosis showed a significant slowing of the dominant beta frequency and a significant increase of the absolute power of fast alpha rhythms. The group with sporadic psychoses showed lowered scores for the paranoid-hallucinatory basic symptom factor. The group with neuropsychological deficits showed the most visceral-somatoform basic symptoms, the highest nicotine consumption, increased dyskinesias and more perinatal complications. This group also showed the highest level of neuroleptic and antiparkinson medication. All in all, the group with neuropsychological deficits showed a complex interaction of somatic-exogenic and medical-iatrogenic factors. Furthermore, there was a significant positive correlation between paranoid-hallucinatory basic symptoms and nicotine abuse and high frequency beta waves.