Drug use patterns and drug-related disorders of cocaine users in a sample of the general population in Germany.

AIMS: The prevalence of cocaine use is still very low in Germany, but rates have been increasing over the past few decades. Patterns of drug consumption and related adverse consequences in individuals who have used cocaine were investigated in order to distinguish different types of cocaine users. METHODS: Data come from two national representative surveys on substance abuse in the German general population conducted in 1997 and 2000 using self- administered questionnaires. Overall response rates were 65 and 51%, respectively. The two samples were pooled (n = 16,159) and latent cluster analysis was conducted using a sub-sample of 272 lifetime cocaine users. RESULTS: Three clusters were derived: the majority belonged to the group of mainly unproblematic users (UPG, 80%), the second group comprised non-amphetamine poly-problem drug users (NAPPG, 12%), and a small group was composed of poly-problem drug users (PPG, 8%). Comparisons of sociodemographic characteristics, consumption patterns and age of onset for licit and illicit drug use revealed significant differences between the groups. CONCLUSIONS: The majority of cocaine users in the general population are experimental or occasional users of licit and illicit drugs. Rather than being a major drug, cocaine is one of many other licit and illicit drugs. Cocaine use as part of predominantly poly-drug use behaviour is strongly associated with substance-related disorders.

Screening for alcohol-related problems in the general population using CAGE and DSM-IV: characteristics of congruently and incongruently identified participants.

This study examines the role of age, gender, and drinking patterns in inconsistent identification of alcohol-related problems by CAGE and DSM-IV criteria. Data come from a nationally representative sample of the noninstitutionalized German general adult population (N=8020) surveyed through self-administered questionnaires in 1997. Current drinkers who were classified positive for a DSM-IV (abuse or dependence) and/or CAGE diagnosis (n=942) were included in the descriptive analysis and multinomial logistic regression. Among current drinkers with at least one positive classification, only 31.7% were "congruently" classified; that is, they were consistently identified by corresponding CAGE and DSM-IV criteria. Analyses on item level support findings of incongruence on scale level. Overall, we found that younger age groups were more likely to meet DSM criteria without reporting CAGE items. For older age groups, the reverse seems to be true. Women were found to respond more readily to CAGE items whereas men seem to respond more readily to DSM criteria. Intensive drinking patterns more often lead to congruent classification, yet surprisingly, participants with less intensive drinking patterns were found more often to be CAGE positive than to fulfil DSM abuse criteria. Moreover, binge drinkers with alcohol-related problems were neither more likely to receive a DSM nor a CAGE diagnosis. We conclude that heightened awareness is needed when employing the studied instruments in certain groups.

Changes in prevalence of problem opiate use in Germany between 1990 and 2000.

OBJECTIVES: Estimates of opiate use are calculated for the years 1990/1991, 1995 and 2000 in order to explore the development of problem opiate use in Germany in the preceding decade. METHODS: The estimates stem from multiplier methods which extrapolate from a sample (benchmark) of known drug users to the total population by multiplying the benchmark by an appropriate factor that accounts for the unknown population. Data came from the German treatment monitoring system, police and mortality statistics. RESULTS: The population estimates for 2000 resulted in 166,300-197,500 problem opiate users based on treatment data, 153,000-190,000 heroin users from police data, and 126,900-169,200 (current) injectors from mortality data. Recalculated estimates for 1990/1991 and 1995 derived from the same data sources were found to be somewhat lower. DISCUSSION: The reported estimates between 1990 and 2000 point at a moderate increase of problem opiate users in the 1990s. The population estimates based on the multiplier method using three different data sources may be considered consistent for the highly overlapping target groups of (current) injectors, problem heroin and problem opiate users. Nevertheless, some of the applied multipliers are based on small-scale studies, raising the question of representativeness. National prevalence estimates may be improved by using other techniques such as multivariate indicator, capture-recapture, or dynamic models.

Estimating prevalence of problem drug use at national level in countries of the European Union and Norway.

OBJECTIVES: This paper will present the most recent estimates for problematic drug use in European Member States and explore the problems of comparability. METHODS: Estimates of problematic drug use, derived according to agreed guidelines, were collected from all EU countries and Norway. Methods included multipliers based on treatment, police, mortality or AIDS/HIV data, the capture-recapture method and the multivariate indicator method. Prevalence estimates were transformed into rates per 1000 population aged 15-64 years. RESULTS: Target populations varied according to data selection. Estimates for six partially overlapping types of drug use could be identified: 'problem opiate use', 'problem opiate or cocaine use', 'problem amphetamine or opiate use', 'problem drug use', '(current) injecting' and 'life-time injecting'. Rates of injectors ranged from 2.6 in Germany to 4.8 in Luxembourg; rates in Austria, Denmark, Finland, Portugal and the United Kingdom fell within this range. For problem opiate use, a group of high prevalence countries were found with average rates exceeding six cases (Italy, Luxembourg, Spain and the United Kingdom) and a group with lower prevalence with average rates close to three cases (Austria, Germany, Ireland, the Netherlands). Rates obtained for France (problem opiate or cocaine use), Finland and Sweden (problem amphetamine or opiate use) are not directly comparable and fall between these rates. CONCLUSIONS: Cross-national comparisons should be made with care and estimated target populations may vary greatly between countries. For estimating various forms of problem drug use at national level, a multi-method approach is recommended.

A comparison of drinking patterns and alcohol-use-related problems in the United States and Germany, 1995.

Distinct drinking habits are seen in the United States and Germany. Using 1995 national surveys, we examined alcohol consumption patterns, demographic correlates, and relationships between consumption and problems. Although differing in design (Germany: mail survey; United States: face-to-face interviews), both surveys shared measures that permitted comparisons. Drinking volume and pattern were assessed and the CAGE screening test for alcohol-use-related problems was used. Germany has larger prevalence of current drinking, higher levels of consumption, and more heavy drinkers. However, at matched volume levels, more Americans reported alcohol-use-related problems. Sociodemographic correlates of heavier consumption also varied between countries. Results support the role of cultural traditions in the expression and recognition of alcohol-use-related problems.