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This supplement includes a collection of papers that aim at estimating the relationship between per capita alcohol consumption and various forms of mortality, including mortality from liver cirrhosis, accidents, suicide, homicide, ischaemic heart disease, and total mortality. The papers apply a uniform methodological protocol, and they are all based on time series data covering the post-war period in the present EU countries and Norway. In this paper we discuss various methodological and analytical issues that are common to these papers. We argue that analysis of time series data is the most feasible approach for assessing the aggregate health consequences of changes in population drinking. We further discuss how aggregate data may also be useful for judging the plausibility of individual-level relationships, particularly those prone to be confounded by selection effects. The aggregation of linear and curvilinear risk curves is treated as well as various methods for dealing with the time-lag problem. With regard to estimation techniques we find country specific analyses preferable to pooled cross-sectional/time series models since the latter incorporate the dubious element of geographical co-variation, and conceal potentially interesting variations in alcohol effects. The approach taken in the papers at hand is instead to pool the country specific results into three groups of countries that represent different drinking cultures; traditional wine countries of southern Europe, beer countries of central Europe and the British Isles and spirits countries of northern Europe. The findings of the papers reinforce the central tenet of the public health perspective that overall consumption is an important determinant of alcohol-related harm rates. However, there is a variation across country groups in alcohol effects, particularly those on violent deaths, that indicates the potential importance of drinking patterns. There is no support for the notion that increases in per capita consumption have any cardioprotective effects at the population level. [ABSTRACT FROM AUTHOR]

Background and aims: Estimated alcohol consumption from national self‐report surveys is often only 30–40% of official estimates based on sales or taxation data. Global burden of disease (GBD) estimates for alcohol adjust survey estimates up to 80% of total per capita consumption. This assumes that cohort studies needed to estimate relative risks for disease suffer less from under‐reporting than typical national surveys. However, there is limited evidence on which to base that assumption. This paper aims to assess the extent of underestimation of alcohol consumption in cohort studies concerning alcohol and mortality compared with official total consumption estimates. Design Comparisons of estimated per capita consumption from a comprehensive sample of cohort studies against official estimates by country and year. Participants: A total of 1 876 046 participants in 40 cohort studies from 18 countries on alcohol use and all‐cause mortality identified by systematic review. Measurements Alcohol consumption data from the cohort studies were converted into usual grams of ethanol per day and then to total age 15+ per capita consumption. Matched estimates were sourced from the World Health Organization (WHO) Global Health Observatory. Findings The cohort studies had mean coverages of age 15+ per capita alcohol consumption of 61.71% (ranging from 29.19% for Russia to 96.53% for Japan), after weighting estimates by sample size for within‐country estimates and by number of studies per country for the overall estimate. Regional estimates were higher for the United States (66.22%) and lower for western European countries (55.35%). Conclusions: Underestimation of alcohol consumption in cohort studies is less than in typical population surveys. Because some under‐coverage is caused by under‐sampling heavier drinkers, the current practice of uplifting survey estimates to 80% of total population consumption in global burden of disease studies appears to be appropriate. [ABSTRACT FROM AUTHOR]

The relationship between cannabis and psychosis and schizophrenia has tested the field of addiction for decades, and in some ways serves as measure of our ability to provide a credible contribution to public health. As cannabis is used widely, many people are interested in the risks the drug poses to mental health. This paper focuses upon a seminal study examining this, the trajectory of subsequent research findings and what this has meant for understanding and communicating risk factor information. These studies provided evidence of a dose-response relationship between cannabis and psychosis, and that for those individuals with schizophrenia cannabis exacerbated their symptoms. The findings fit with a multi-causal model in which vulnerability interacts with a precipitating agent to produce a disease outcome. Even though this is a common model in epidemiology, it has proved difficult to communicate it in this case. This may be because at a population level the increased risk is weak and the vulnerabilities relatively rare. It may also be because people bring strongly held preconceptions to interpreting a complex multi-causal phenomenon. [ABSTRACT FROM AUTHOR]

Background and aims Prohibitions on producing, distributing and selling cannabis are loosening in various jurisdictions around the world. This paper describes the diversification of cannabis supply laws and discusses the challenges to and opportunities for learning from these changes. Methods We document changes in cannabis supply laws that de jure legalized cannabis production for medical and/or non-medical purposes (excluding industrial hemp) in Australasia, Europe, North America and South America. We also highlight challenges to evaluating these legal changes based on our experiences studying cannabis laws and policies in the United States. Findings As of August 2016, two countries have passed laws to legalize large-scale cannabis production for non-medical purposes at the national (Uruguay) or subnational level (four US states). At least nine other countries legally allow (or will soon allow) cannabis to be supplied for medicinal purposes. Most of the changes in cannabis supply laws have occurred since 2010. The data available in most countries are inadequate for rigorously evaluating the changes in cannabis supply laws. Conclusion The evidence base for assessing changes in cannabis supply laws remains weak. Efforts should focus upon collecting information about quantities consumed and market transactions as well as validating self-report surveys. [ABSTRACT FROM AUTHOR]

Aim A central task for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is to produce an annual report of the latest data available on drug demand and drug supply in Europe. This paper is intended to facilitate a better understanding of, and easier access to, the main quantitative European level data sets available in 2015. Methods The European reporting system formally covers all 28 European Union (EU) Member States, Norway and Turkey and incorporates multiple indicators alongside an early warning system (EWS) on uncontrolled new psychoactive substances (NPS). While epidemiological information is based largely on registries, surveys and other routine data reported annually, the EWS collects case-based data on an ongoing basis. The 2015 reporting exercise is centred primarily on a set of standardized reporting tools. Results The most recent data provided by European countries are presented, including data on drug use, drug-related morbidity and mortality, treatment demand, drug markets and new psychoactive substances, with data tables provided and methodological information. A number of key results are highlighted for illustrative purposes. Drug prevalence estimates from national surveys since 2012 (last year prevalence of use among the 15-34 age band) range from 0.4% in Turkey to 22.1% in France for cannabis, from 0.2% in Greece and Romania to 4.2% in the United Kingdom for cocaine, from 0.1% in Italy and Turkey to 3% in the Czech Republic and the United Kingdom for ecstasy, and from 0.1% or less in Romania, Italy and Portugal to 2.5% in Estonia for amphetamine. Declining trends in new HIV detections among people who inject drugs are illustrated, in addition to presentation of a breakdown of NPS reported to the EU early warning system, which have risen exponentially from fewer than 20 a year between 2005 and 2008, to 101 reported in 2014. Conclusions Structured information is now available on patterns and trends in drug consumption in Europe, which permits triangulation of data from different sources and consideration of methodological limitations. Opioid drugs continue to place a burden on the drug treatment system, although both new heroin entrants and injecting show declines. More than 450 new psychoactive substances are now monitored by the European early warning system with 31 new synthetic cathinones and 30 new synthetic cannabinoid receptor agonists notified in 2014. [ABSTRACT FROM AUTHOR]

Alcohol is a major risk factor for burden of disease and injury in Europe, and contributes markedly to between region differences in life expectancy. Monitoring and surveillance systems have shown to be a key factor in implementing effective policies. The aim of this paper is to propose a system of indicators for alcohol consumption and attributable harm which can be used as an over-time monitoring tool at the country level as well as for comparisons between countries. A systematic research in electronic data bases was conducted but most of the information was derived from ongoing international efforts to establish alcohol monitoring and surveillance systems. European Union. Countries. Exposure to alcohol, mortality, burden of disease. Adult per capita alcohol consumption, prevalence of abstention, and frequency of drinking more than 60g pure alcohol in one occasion are proposed as a minimal set of alcohol exposure indicators, which can quickly be implemented in all EU countries. With respect to health harm indicators, the best minimal choice which can be implemented quickly in all countries of the EU would be alcohol-attributable years of life lost due to premature death. In addition, country specific indicators could be added, when alcohol places specific burden on specific diseases. National and European Union-wide monitoring systems for alcohol exposure and attributable harm to inform public health-related policy decisions could be implemented easily. The establishement of such monitoring systems would follow the recent World Assembly resolution for a global strategy to reduce alcohol-related harm. [ABSTRACT FROM AUTHOR]

Reducing alcohol-related harm in young people is a major priority across Europe. Much alcohol use and associated harm in young people occurs in public drinking environments. This review aims to identity environmental factors in drinking establishements that are associated with increased alcohol consumption and associated harm and to understand the extent of study in this area across Europe. A systematic literature search identified studies that had explored associations between physical, staffing and social factors in drinking environments and increased alcohol use or alcohol-related harm. Fifty-three papers were identified, covering 34 studies implemented in nine countries. Most studies had been implemented in non-European countries and many had collected data more than a decade prior to the review. The majority had used observational research techniques. Throughout the studies, a wide range of physical, staffing and social factors had been associated with higher levels of alcohol use and related harm in drinking environments. Factors that appeared particularly important in contributing to alcohol-related problems included a permissive environment, cheap alcohol availability, poor cleanliness, crowding, loud music, a focus on dancing and poor staff practice. However, findings were not always consistent across studies. Drinking establishments, their management and the behaviours of the young people who use them vary widely across Europe. While international research shows that environmental factors in drinking settings can have an important influence on alcohol-related harm, there is currently a scarcity of knowledge on the relevance and impacts of such factors in modern European settings. Developing this knowledge will support the implementation of strategies to create drinking environments in Europe that are less conducive to risky drinking and alcohol-related harm. [ABSTRACT FROM AUTHOR]

Objective To estimate access, activity and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia. Methods Two data sets (‘regional’ and ‘high-coverage sites’) were used to estimate NSP provision (availability/number of sites), NSP utilization (syringes distributed/year), needle and syringe distribution (needles/syringes distributed/IDU/year), IDU reached (number/percentage of IDU contacted/year), regular reach (five or more contacts/month) and syringe coverage (percentage of injections/IDU/year administrable with new injecting equipment). Results Regional data set: results from 213 sites in 25 countries suggested that Czech Republic, Poland, Russia and Ukraine had > 10 NSP during 2001/2. Czech Republic, Kazakhstan, Latvia, Russia, Slovakia and Ukraine had ≥ 10 000 IDU in contact with NSP. Ten countries reached ≥ 10% of the estimated IDU population. The 25 countries distributed ∼ 17 million syringes/needles. Eight countries distributed > 0.5 million syringes/year. Syringe coverage (assuming 400 injections/IDU/year) was < 5% in 19 countries, 5–15% in five and > 15% in Macedonia. Overall syringe coverage was 1.2% and when assuming 700 injections/IDU/year it decreased to 0.7%. Syringe coverage for the IDU population in contact with NSP was ≤ 15% in 10 countries, 15–60% in 11 and > 60% in Croatia, Macedonia, Moldova and Tajikistan. Overall syringe coverage for the population in contact with NSP was 9.8%. High-coverage data set: Soligorsk, Pskov and Sumy's NSP reached 92.3%, 92.2% and 73.3% of their estimated IDU population, respectively (regular reach: 0.2%, 1.8% and 22.7%). The distribution levels were 47.2, 51.7 and 94.2 syringes/IDU/year, respectively. Conclusion The evidence suggests suboptimal levels of NSP implementation, programme activity and coverage. This paper provides a baseline for development of indicators that could be used to monitor NSP. Strategies to increase coverage that may go beyond NSP are urgently required, as is research into understanding how NSP can contribute to better syringe coverage among IDU. [ABSTRACT FROM AUTHOR]

Aim. To test the relationship between alcohol consumption and all-cause mortality. Design. Data: Yearly mortality rates and per capita consumption from 25 European countries between 1982 and 1990. Statistical models. This paper employs time-series cross-sectional data to model the relationships between alcohol consumption and all-cause mortality. The data are derived from 25 European countries in the 1980s. The statistical analyses controlling cross-sectional correlation and timewise autoregression were used to implement the econometric modelling. Findings. Increases (decreases) in the per capita consumption of 1 litre of pure alcohol were associated with increases (decreases) of 1.3% in all-cause mortality rates. The beverage-specific analyses indicated a significant relationship between consumption of beer and all-cause mortality only. Conclusion. The data show that per capita alcohol consumption, according to reported levels in Europe, is related to all-cause mortality and is thus of relevance to public health. [ABSTRACT FROM AUTHOR]

Background and Aims: Excessive cannabis use may lead to lower educational attainment. However, this association may be due to confounders and reverse causality. We tested the potential causal relationship between cannabis use disorder (CUD) or life‐time cannabis use (LCU) and educational attainment. Design: Bidirectional two‐sample Mendelian randomization (MR) study was conducted. Our primary method was inverse‐variance weighted (IVW) MR, with a series of sensitivity analyses. Multivariable MR (MVMR) was performed to estimate any direct effect independent of intelligence, smoking initiation or attention deficit hyperactivity disorder (ADHD). Setting and participants: European ancestry individuals. The sample sizes of the genome‐wide association study ranged from 55 374 to 632 802 participants. Measurements Genetic variants of CUD, LCU or educational attainment. Findings Using univariable MR, we found evidence of a potential causal effect of genetic liability to CUD on a lower educational attainment [MR, 95% confidence interval (CI)inverse variance weighted (IVW) = −1.2 month (−1.9 month, −0.5 month); P = 0.0008]. However, we found no evidence of an effect of genetic liability to LCU on educational attainment [MR, 95% CIIVW = 0.5 month (−1.5 month, 2.6 month), P = 0.6032]. Reverse direction analysis suggested that genetic liability to higher educational attainment had a potential causal effect on lower risk of CUD [odds ratio (OR), 95% CIIVW = 0.39 (0.29, 0.52), P = 1.69 × 10−10]. We also found evidence of potential causal effect from genetic liability to higher educational attainment to higher risk of LCU [OR, 95% CIIVW = 1.35 (1.11, 1.66), P = 0.0033]. Conclusions: Genetic liability to cannabis use disorder may lead to lower educational attainment. Genetic liability to higher educational attainment may also lead to higher life‐time cannabis use risk and lower cannabis use disorder risk. However, the bidirectional effect between cannabis use disorder and educational attainment may be due to shared risk factors (e.g. attention‐deficit hyperactivity disorder). [ABSTRACT FROM AUTHOR]

Within the European Community (EG) drinking patterns in the southern countries can be characterised by daily consumption of wine at meals, and in the northern countries by less frequent consumption of beer outside meals. Yet, as in past decades in the southern countries beer consumption and in the northern countries wine consumption strongly increased, the question is whether the distinction in drinking patterns still applies. This paper (1) describes for each country of the EC total alcohol consumption, (2) examines the frequency and the context of consumption of the new beverage type and (3) analyses whether subpopulations, defined by sex, age and educational level, differ in the adoption of the new beverage type. In all countries wine is consumed more often at meals compared to beer. Older people consume wine in greater numbers and more frequently than younger people, who consume beer in greater numbers. People of higher educational level consume the new beverage type more often compared to people of lower educational level, who consume the traditional beverage type more frequently. Finally, males and females differ less in the frequency of consumption of the new beverage type than in the frequency of the traditional beverage type. [ABSTRACT FROM AUTHOR]

The author reflects on a paper by researcher Kim and colleagues that discusses drink driving in Hong Kong. He argues that random breath testing would help to build up the cohort of drivers with those who comply with the law and those who are discouraged by a single offence. He states that road safety is connected with the long-term damage that alcohol can cause; hence it is important to deal with this issue.

Background and aims: Graph theoretic analysis of structural covariance networks (SCN) provides an assessment of brain organization that has not yet been applied to alcohol dependence (AD). We estimated whether SCN differences are present in adults with AD and heavy‐drinking adolescents at age 19 and age 14, prior to substantial exposure to alcohol. Design Cross‐sectional sample of adults and a cohort of adolescents. Correlation matrices for cortical thicknesses across 68 regions were summarized with graph theoretic metrics. Setting and participants: A total of 745 adults with AD and 979 non‐dependent controls from 24 sites curated by the Enhancing NeuroImaging Genetics through Meta Analysis (ENIGMA)–Addiction consortium, and 297 hazardous drinking adolescents and 594 controls at ages 19 and 14 from the IMAGEN study, all from Europe. Measurements Metrics of network segregation (modularity, clustering coefficient and local efficiency) and integration (average shortest path length and global efficiency). Findings The younger AD adults had lower network segregation and higher integration relative to non‐dependent controls. Compared with controls, the hazardous drinkers at age 19 showed lower modularity [area‐under‐the‐curve (AUC) difference = −0.0142, 95% confidence interval (CI) = −0.1333, 0.0092; P‐value = 0.017], clustering coefficient (AUC difference = −0.0164, 95% CI = −0.1456, 0.0043; P‐value = 0.008) and local efficiency (AUC difference = −0.0141, 95% CI = −0.0097, 0.0034; P‐value = 0.010), as well as lower average shortest path length (AUC difference = −0.0405, 95% CI = −0.0392, 0.0096; P‐value = 0.021) and higher global efficiency (AUC difference = 0.0044, 95% CI = −0.0011, 0.0043; P‐value = 0.023). The same pattern was present at age 14 with lower clustering coefficient (AUC difference = −0.0131, 95% CI = −0.1304, 0.0033; P‐value = 0.024), lower average shortest path length (AUC difference = −0.0362, 95% CI = −0.0334, 0.0118; P‐value = 0.019) and higher global efficiency (AUC difference = 0.0035, 95% CI = −0.0011, 0.0038; P‐value = 0.048). Conclusions: Cross‐sectional analyses indicate that a specific structural covariance network profile is an early marker of alcohol dependence in adults. Similar effects in a cohort of heavy‐drinking adolescents, observed at age 19 and prior to substantial alcohol exposure at age 14, suggest that this pattern may be a pre‐existing risk factor for problematic drinking. [ABSTRACT FROM AUTHOR]

The article offers news briefs related to addiction as of 2016. The unregulated cannabidiol (CBD) market in Great Britain has been halted by the UK Medicines and Healthcare Products Regulatory Agency (MHRA). The public is supporting minimum unit pricing (MUP) for alcohol products in Great Britain. A World Health Organization (WHO) report has found that the alcohol-attributable mortality burden has increased slightly in Europe since 1990.

The author reflects on the relationship between alcohol consumption and liver cirrhosis mortality in Eastern Europe. He asserts that a 1-liter increase in per capita alcohol consumption is estimated to generate three to four additional liver cirrhosis deaths per 100, 000 for men and one death for women. He likewise stresses that alcohol use triggers liver cirrhosis mortality as well as reduce the life span and productivity of emerging economies.

Aims. To evaluate the effects of changes in aggregate alcohol consumption on fatal motor vehicle traffic accidents, accidental falls, and other accidents in 14 western European countries after 1950, and to compare traditional beer, wine and spirits countries. Design, setting and participants. The countries were sorted into three groups. Gender-specific, age-adjusted annual mortality rates (15-69 years) were analysed in relation to per capita alcohol consumption, utilizing the Box-Jenkins technique for time series analysis. All series were differenced to remove long-term trends. The results of the analyses of individual countries were pooled within each group of countries to increase the statistical power. Measurements. Overall accident mortality data for 5-year age groups were converted to age-adjusted mortality rates for the age group 15-69 years, using a European standard population. Data on per capita alcohol consumption were converted to consumption per inhabitant 15 years and older. Findings. For male accidental falls, the analyses uncovered a statistically significant association with alcohol consumption in northern and central Europe, but not in southern Europe. Among females the association was insignificant in all regions. For male traffic accidents, significant relationships were uncovered in central and southern Europe, but not in northern Europe. Among females the effect was significant only in central Europe. For the remaining fatal accidents a significant relationship was found for north European males only. Conclusion. The association between aggregate alcohol consumption and rates of fatal accidents is mainly due to traffic accidents in central and southern Europe, and to falls and other accidents in northern Europe. [ABSTRACT FROM AUTHOR]

The article focuses on the development of a comprehensive alcohol policy in Europe. It mentions the Alcohol Measures for Public Health Research Alliance (AMPHORA) project, a plan that aims to push through with researches pertinent to alcohol policy in the European Union (EU). According to the author, a previous research indicates how unevenly research about the effects of alcohol taxes and prices is spread within the EU. He adds that AMPHORA proposes diverse projects including technical work for checking contamination on unrecorded alcohols and an analysis of alcohol's role in the Global Burden of Diseases and alcohol consumption. Another project mentioned is one that evaluates the need of alcohol treatment services and intervention in EU countries including Austria, Germany and Italy.

Discusses the differences and similarities in European transformational processes on alcohol related issues. Two perspective on alcohol and European transformation; Systematic comparison of alcohol between Eastern and Western Europe; Alcohol between state, markets and civil society.

The article offers news briefs related to public health. The European Commission is looking for stong response to various synthetic substances, which replicate the established drugs effect such as cocaine and ectasy. The economic implications of alcohol pricing in Great Britain, which intends to form a briefing note "Alcohol Pricing and Taxation Policies," published by the Institute of Fiscal Studies (IFS). Voters had approved the Initiative 1183 that takes U.S. free of alcohol business.

Background and Aims: Adaptations with different modes of delivery and target addictions have found highly divergent rates of success for Community Reinforcement Approach and Family Training (CRAFT). This study aims to clarify which (1) treatment components and (2) participant characteristics contribute to rates of identified patient (IP) treatment entry. Method: Systematic review of CRAFT evaluation studies of all designs (controlled and uncontrolled) with data synthesis and narrative analysis of addiction treatment services and university research departments in North America and Europe. Results: A total of 691 concerned significant others (CSOs), predominately female spouses/parents, participating in 20 distinct treatment conditions from 14 studies. The main outcome of IP treatment entry rate reported by CSOs up to 12 months after starting CRAFT with key predictors/correlates including IP addiction, IP–CSO relationship, CRAFT modality and integration of treatment for IP. Meta‐analysis found CRAFT to be twice as effective as controls/comparison groups. Multi‐modality treatment, including both individual and group sessions, yielded the highest IP treatment entry rates (77 and 86%), with progressively lower rates for individual (12.5–71%), group (60%) and self‐directed workbook (13.3–40%) modalities. While all five studies targeting gambling addiction had consistently low rates (12.5–23%), other treatment components, including therapist training, treatment fidelity and integrating treatment for the IP, were implicated. Conclusions: Adaptations of Community Reinforcement Approach and Family Training for different delivery modalities and addictions have yielded widely varying rates of treatment engagement for the identified patient, with those offering the most comprehensive support to the concerned significant other, including individual and group sessions, having highest levels of engagement success. [ABSTRACT FROM AUTHOR]

Commentary to: Understanding and learning from the diversification of cannabis supply laws [ABSTRACT FROM AUTHOR]

Background and Aims: The impact of tobacco control on European older adults has not been studied, despite evidence that smoking cessation at old age can bring significant life expectancy gains. Our aim was to evaluate the impact of tobacco control policies on smoking among older adults in Europe from 2004 to 2013. Design We used longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE, aged 50+ years) from four waves from 2004 to 2013. We used logistic regression models with clustered standard errors to determine whether the implementation of tobacco control policies was associated with changes in smoking status. Furthermore, we studied whether these associations varied by socio‐demographic characteristics. Regression coefficients were converted to changes the probability of smoking [marginal effects (ME)]. Measurements Smoking status was the dependent variable, and the Tobacco Control Scale (TCS) was the explanatory variable, overall and by its main policy components (pricing and smoke‐free policies). Covariates included age, sex, education and country and wave fixed‐effects. Findings A 10‐point increase in TCS was associated with a lower probability of smoking by 1.6 percentage points [95% confidence interval (CI) = −3.208, −0.056] for those aged 50–65, but not for older Europeans. Among those with primary school or no education, the associated drop was of 1.5 percentage points (95% CI = –2.751, −0.253). By contrast, no significant relation between TCS and smoking was observed among those with high education. Higher TCS scores for pricing (ME = –0.636, 95% CI = –0.998, −0.275) and smoke‐free policies (ME = –0.243, 95% CI = –0.445, −0.041) were associated with a significantly lower probability of smoking (P = 0.001 and P = 0.018, respectively). Conclusion: Increases in tobacco taxes and smoke‐free policies are significantly related with a reduction in smoking among European older adults, suggesting potential health gains for this rising share of the population. These policies may be more effective among the lowest educated. [ABSTRACT FROM AUTHOR]

Aims: To quantify changes in (i) potency (concentration of Δ9‐tetrahydrocannabinol; %THC), (ii) price (euros/g of cannabis) and (iii) value (mg THC/euro) of cannabis resin and herbal cannabis in Europe. Design Repeated cross‐sectional study. Setting and participants: Data collected from 28 European Union (EU) member states, Norway and Turkey by the European Monitoring Centre for Drugs and Drug Addiction. Measurements Outcome variables were potency, price and value for cannabis resin and herbal cannabis in Europe, 2006–16. Inflation was estimated using the Harmonised Indices of Consumer Prices. Mixed‐effects linear regression models were used to estimate linear and quadratic time trends, with a random intercept and slope fitted to account for variation across countries. Findings Resin potency increased from a mean [95% confidence interval (CI)] of 8.14% THC (6.89, 9.49) in 2006 to 17.22 (15.23, 19.25) in 2016. Resin price increased from 8.21 euros/g (7.54, 8.97) to 12.27 (10.62, 14.16). Resin increased in value, from 11.00 mg THC per euro (8.60, 13.62) to 16.39 (13.68, 19.05). Quadratic time trends for resin potency and value indicated minimal change from 2006 to 2011, followed by marked increases from 2011 to 2016. Herbal cannabis potency increased from 5.00% THC (3.91, 6.23) to 10.22 (9.01, 11.47). Herbal price increased from 7.36 euros/g (6.22, 8.53) to 12.22 (10.59, 14.03). The value of herbal cannabis did not change from 12.65 mg of THC per euro (10.18, 15.34) to 12.72 (10.73, 14.73). All price trends persisted after adjusting for inflation. Conclusions: European cannabis resin and herbal cannabis increased in potency and price from 2006 to 2016. Cannabis resin (but not herbal cannabis) increased in the quantity of Δ9‐tetrahydrocannabinol per euro spent. Marked increases in resin potency and value from 2011 to 2016 are consistent with the emergence of new resin production techniques in European and neighbouring drug markets. [ABSTRACT FROM AUTHOR]

Background: The US National Institutes of Mental Health Research Domain Criteria (RDoC) seek to stimulate research into biologically validated neuropsychological dimensions across mental illness symptoms and diagnoses. The RDoC framework comprises 39 functional constructs designed to be revised and refined, with the overall goal of improving diagnostic validity and treatments. This study aimed to reach a consensus among experts in the addiction field on the 'primary' RDoC constructs most relevant to substance and behavioural addictions. Methods: Forty‐four addiction experts were recruited from Australia, Asia, Europe and the Americas. The Delphi technique was used to determine a consensus as to the degree of importance of each construct in understanding the essential dimensions underpinning addictive behaviours. Expert opinions were canvassed online over three rounds (97% completion rate), with each consecutive round offering feedback for experts to review their opinions. Results: Seven constructs were endorsed by ≥ 80% of experts as 'primary' to the understanding of addictive behaviour: five from the Positive Valence System (reward valuation, expectancy, action selection, reward learning, habit); one from the Cognitive Control System (response selection/inhibition); and one expert‐initiated construct (compulsivity). These constructs were rated to be related differentially to stages of the addiction cycle, with some linked more closely to addiction onset and others more to chronicity. Experts agreed that these neuropsychological dimensions apply across a range of addictions. Conclusions: The study offers a novel and neuropsychologically informed theoretical framework, as well as a cogent step forward to test transdiagnostic concepts in addiction research, with direct implications for assessment, diagnosis, staging of disorder, and treatment. [ABSTRACT FROM AUTHOR]

Commentary to: Can new psychoactive substances be regulated effectively? An assessment of the British Psychoactive Substances Bill [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Although generally prohibited by national regulations, underage gambling has become popular in Europe, with relevant cross‐country prevalence variability. This study aimed to estimate the prevalence of underage gambling in Europe stratified by type of game and on‐/off‐line mode and to examine the association with individual and family characteristics and substance use. Design: Our study used data from the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross‐sectional study, a survey using self‐administered anonymous questionnaires. Setting: Thirty‐three European countries. Participants: Sixteen‐year‐old‐year‐old students (n = 93 875; F = 50.8%). Measurements: The primary outcome measure was prevalence of past‐year gambling activity. Key predictors comprised individual behaviours, substance use and parenting (regulation, monitoring and caring). Findings: A total of 22.6% of 16‐year‐old students in Europe gambled in the past year: 16.2% on‐line, 18.5% off‐line. High prevalence variability was observed throughout countries both for mode and types of game. With the exception of cannabis, substance use shows a higher association with gambling, particularly binge drinking [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.39–1.53), life‐time use of inhalants (OR = 1.57, 95% CI = 1.47–1.68) and other substances (OR = 1.78, 95% CI = 1.65–1.92)]. Among life habits, the following showed a positive association: truancy at school (OR = 1.26, 95% CI = 1.18–1.35), going out at night (OR = 1.32, 95% CI = 1.26–1.38), participating in sports (OR = 1.30, 95% CI = 1.24–1.37). A negative association was found with reading books for leisure (OR = 0.82%, 95% CI = 0.79–0.86), parents’ monitoring of Saturday night activities (OR = 0.81, 95% CI = 0.77–0.86) and restrictions on money provided by parents as a gift (OR = 0.89, 95% CI = 0.84–0.94). Conclusions: Underage gambling in Europe appears to be associated positively with alcohol, tobacco and other substance use (but not cannabis), as well as with other individual behaviours such as truancy, going out at night and active participation in sports, and is associated negatively with reading for pleasure, parental monitoring of evening activities and parental restriction of money. [ABSTRACT FROM AUTHOR]

Abstract: Aims: This review provides an up‐to‐date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Methods: Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation. Results: In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8, 0.77, 0.37 and 0.35% for past‐year cannabis, amphetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age‐standardized prevalence of alcohol dependence was 843.2 per 100 000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High‐income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability‐adjusted life‐years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance‐attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age‐standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe; attributable age‐standardized tobacco mortality rates and DALYs were highest in Oceania. Conclusions: In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability‐adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low‐ and middle‐income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden. [ABSTRACT FROM AUTHOR]

Aims: To estimate temporal trends in adolescents’ current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. Design and Setting: Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. Participants: A total of 223 814 male and 211 712 female 15–16‐year‐old students. Measurements: Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi‐level mixed‐effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. Findings: Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. Conclusions: Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence. [ABSTRACT FROM AUTHOR]

The author discusses the prohibition of alcohol advertising in Europe. Topics discussed include the impact of alcohol in an individual's social and physical welbeing, the level of alcohol consumption among college students who are engaged in sports, and the adverse effects of alcohol in society and health.

Aims This study investigates the link between personal income and smoking among adolescents, and aims to answer the following questions: (i) to what extent is personal income related to smoking, independent of family socio-economic status (SES) and (ii) does the association between personal income and smoking apply to different subpopulations? Design Cross-sectional study. Setting Six cities from European countries (Amersfoort, the Netherlands; Coimbra, Portugal; Hannover, Germany; Latina, Italy; Namur, Belgium; Tampere, Finland) in 2013. Participants A school-based sample of 10 794 adolescents aged 14-17 years. Measurements We modelled smoking experimentation, weekly smoking, daily smoking and (among daily smokers) smoking intensity as function of personal income, adjusting for age, sex, family SES, parental smoking and country. We tested interactions between personal income and covariates. Stratification analyses were performed for the variables for which interactions were significant. Findings Adolescents in the highest income quintile were more likely to be smoking experimenters [odds ratio (OR) = 1.87; P < 0.01], weekly smokers (OR = 3.51; P < 0.01) and daily smokers (OR = 4.55; P < 0.01) than those in the lowest quintile. They also consumed more cigarettes per month (β = 0.79; P < 0.01). Adjusting for family SES did not modify the significance of relationships, and increased the magnitude of the association for daily smoking. None of the interactions between covariates and personal income was significant for smoking measures. For the intensity of smoking, the interaction was significant for SES. The stratified analysis showed a non-significant association between smoking intensity and personal income among the oldest adolescents and those with the lowest SES background, while significant among younger and higher SES backgrounds. Conclusion In the Netherlands, Portugal, Germany, Italy, Belgium and Finland, adolescents' personal income is related positively to smoking behaviours independent of family socio-economic status (SES). However, among low socio-economic status adolescent daily smokers, the association between the intensity of smoking and personal income is weaker. [ABSTRACT FROM AUTHOR]

Background and Aims Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts. Methods The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization. Results The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men. Conclusions If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men, and some of the current European guidelines would require downward revision. [ABSTRACT FROM AUTHOR]

Background and aims Barriers linked to drug control systems are considered to contribute to inequitable access to controlled medicines, leaving millions of people in pain and suffering. Most studies focus on access to opioids for the treatment of severe (cancer) pain. This study aims to identify specific access barriers for patients with opioid dependence in legislation and regulations of 11 central and eastern European countries. Methods This study builds on a previous analysis of legislation and regulations as part of the EU 7th Framework Access To Opioid Medication in Europe (ATOME) project. An in-depth analysis was undertaken to determine specific barriers for patients with opioid dependence in need of opioid analgesics or opioid agonist therapy (OAT). For each country, the number and nature of specific potential barriers for these patients were assessed according to eight categories: prescribing; dispensing; manufacturing; usage; trade and distribution; affordability; penalties; and other. An additional keyword search was conducted to minimize the omission of barriers. Barriers in an additional category, language, were recorded qualitatively. Countries included Bulgaria, Cyprus, Estonia, Greece, Hungary, Latvia, Lithuania, Serbia, Slovakia, Slovenia and Turkey. Results Ten of the 11 countries (all except Estonia) showed specific potential barriers in their legislation and regulations. The total number of barriers varied from two (Slovenia) to 46 (Lithuania); the number of categories varied from one (Slovenia) to five (Lithuania). Most specific potential barriers were shown in the categories 'prescribing', 'usage' and 'other'. The total number in a single category varied from one to 18 (Lithuania, prescribing). Individual differences between countries in the same specific potential barrier were shown; for example, variation in minimum age criteria for admission to OAT ranging from 15 (Lithuania, in special cases) to 20 years (Greece). All countries had stigmatizing language in their legislation. Conclusions Patients with opioid dependence are likely to experience specific barriers to accessing opioids in addition to those experienced by other non-dependent patients. [ABSTRACT FROM AUTHOR]

The article explores what addiction specialists in the United States might learn from Europe regarding their response to problems relating to opioid addiction and overdose. Particular focus is given to the use of illicitly manufactured opioids, which have been a major contributor to the overdose death epidemic in both Europe and the United States. Other topics discussed include methodologies for harm reduction, government regulation of prescription drugs, and how most opioid-related deaths occur in those who are either uninsured, unemployed or have a low income.

Background and aims This is the first study to examine the effect of alcohol marketing exposure on adolescents' drinking in a cross-national context. The aim was to examine reciprocal processes between exposure to a wide range of alcohol marketing types and adolescent drinking, controlled for non-alcohol branded media exposure. Design Prospective observational study (11-12- and 14-17-month intervals), using a three-wave autoregressive cross-lagged model. Setting School-based sample in 181 state-funded schools in Germany, Italy, Netherlands, Poland. Participants A total of 9075 eligible respondents participated in the survey (mean age 14 years, 49.5% male. Measurements Adolescents reported their frequency of past-month drinking and binge drinking. Alcohol marketing exposure was measured by a latent variable with 13 items measuring exposure to online alcohol marketing, televised alcohol advertising, alcohol sport sponsorship, music event/festival sponsorship, ownership alcohol-branded promotional items, reception of free samples and exposure to price offers. Confounders were age, gender, education, country, internet use, exposure to non-alcohol sponsored football championships and television programmes without alcohol commercials. Findings The analyses showed one-directional long-term effects of alcohol marketing exposure on drinking (exposure T1 on drinking T2: β = 0.420 (0.058), P < 0.001, 95% confidence interval (CI) = 0.324-0.515; exposure T2 on drinking T3: β = 0.200 (0.044), P < 0.001, 95% CI = 0.127-0.272; drinking T1 and drinking T2 on exposure: P > 0.05). Similar results were found in the binge drinking model (exposure T1 on binge T2: β = 0.409 (0.054), P < 0.001, 95% CI = 0.320-0.499; exposure T2 on binge T3: β = 0.168 (0.050), P = 0.001, 95% CI = 0.086-0.250; binge T1 and binge T2 on exposure: P > 0.05). Conclusions There appears to be a one-way effect of alcohol marketing exposure on adolescents' alcohol use over time, which cannot be explained by either previous drinking or exposure to non-alcohol-branded marketing. [ABSTRACT FROM AUTHOR]

This section offers news briefs on relating to addiction as of June 2016. It announces the implementation of the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules 2014 in India. It reports the prescription drug monitoring to be introduced in Victoria to prevent overdoses, as well as the ruling by the Texas Supreme Court upholding a state Supreme Court decision to impose a special tax on cigarette makers.

This article presents an editorial in which the authors comment on the legal aspects of cannabis use in Europe. They discuss the inconsistencies associated with punishments related to the use of cannabis as well as other psychoactive substances, citing data from the European Monitoring Centre for Drugs and Drug Addiction.

The article focuses on the developments of the state of drug budgeting studies in Europe. It is indicated that the European Union action plans on drugs consults member states and the European Commission, with the cooperation of European Monitoring Centre on Drugs and Drug Abuse, to consider an action to estimate the drug-related expenditures.

Aims The extent of variation attributable to regional differences for the efficacy of brief intervention (BI) to reduce hazardous and harmful alcohol consumption is unclear. The primary aim of this study was to determine overall efficacy of BI at 6- and 12-month follow-up in primary health care (PHC) and emergency department (ED) studies. The secondary aim was to examine whether variance in study outcome can be explained by the geographical region in which trials have taken place (European versus non-European). Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) published before August 2014 was undertaken. Twenty RCTs conducted in PHC settings with a total of 8226 participants (European = 4564/non-European = 3662) and eight RCTs conducted in ED settings with a total of 4799 participants (European = 2465/non-European = 2334) were eligible. Primary outcome measure was reduction in grams of alcohol consumed per week for BI and control groups at 6- and 12-month follow-up. An inverse variance model was applied to measure the effect of treatment in mean differences for BI and control groups at 6- and 12-month follow-up. Variance between study outcomes was explored using subgroup analysis of European versus non-European countries. Results For PHC trials at 6-month follow-up, statistically significant benefits of BI were indicated [mean difference (MD) = −21.98 g/week; 95% confidence interval (CI) = −37.40 to −6.57; P = 0.005]. At 12-month follow-up, statistically significant benefit of BI was evident (MD = −30.86 g/week; 95% CI = −46.49 to −15.23; P = 0.0001). For ED trials at 6-month follow-up, statistically significant benefits of BI were indicated (MD = −17.97 g/week; 95% CI = −29.69 to −6.24; P = 0.003). At 12-month follow-up, statistically significant benefit in favour of BI was evident (MD = −18.21 g/week; 95% CI = −26.71 to −9.70; P < 0.0001). No statistically significant differences were detected in subgroup analyses of outcomes for European versus non-European studies. Conclusions Brief intervention (BI) to reduce alcohol consumption is associated with reducing grams of alcohol consumed per week among hazardous and harmful drinkers at 6- and 12-month follow-up in primary health care and emergency department trials. The geographical region in which trials are undertaken does not appear to explain the variance in trial outcomes for reducing alcohol consumption. [ABSTRACT FROM AUTHOR]

Aims To determine the efficacy of acamprosate and naltrexone in the treatment of those who are alcohol-dependent in reducing lapse/relapse to alcohol consumption and treatment discontinuation, and to examine whether a proportion of the variance in study outcome can be explained by the country in which the trials have taken place. Method A systematic review and meta-analysis of randomized controlled trials published before September 2013 was conducted. The primary outcome measures were the efficacy of acamprosate or naltrexone in reducing lapse/relapse compared to placebo in the treatment of alcohol dependence and treatment discontinuation. Twenty-two randomized controlled trials (RCTs) of the efficacy of acamprosate met inclusion criteria for the meta-analysis, with a total of 2649 participants in the acamprosate group and 2587 in the placebo group. Twenty-seven RCTs of the efficacy of naltrexone met inclusion criteria for the meta-analysis, with a total of 2253 participants in the naltrexone group and 1946 in the placebo group. A random-effects model using a Mantel-Haenszel method was applied to conduct the meta-analysis. Variance in study outcomes was explored using subgroup analysis of Europe versus the rest of the world (ROW). Results The risk of returning to any drinking at 6 months was significantly lower for acamprosate [risk ratio (RR) = 0.83, 95% confidence interval (CI) = 0.78-0.89]. There was little difference in the risk of participants discontinuing treatment for any reason (RR = 0.91, 95% CI = 0.83-1.00) or due to adverse events (RR = 1.30, 95% CI = 0.96-1.75) for the acamprosate compared to placebo groups. The risk of individuals returning to any drinking at approximately 3 months was reduced significantly for the naltrexone group (RR = 0.92, 95% CI = 0.86-1.00), as was the risk of individuals relapsing to heavy drinking at 3 months (RR = 0.85, 95% CI = 0.78-0.93). There was no significant difference between naltrexone and placebo for the risk of individuals discontinuing treatment for any reason (RR = 0.94, 95% CI = 0.84-1.05). There was a significantly greater risk of participants in the naltrexone group discontinuing treatment due to adverse events compared to placebo (RR = 1.72, 95% CI = 1.10-2.70). Subgroup analysis by country (Europe versus ROW) revealed no difference in risk between acamprosate and placebo for the outcomes returning to any drinking at 6 months and discontinuing treatment due to adverse events. For the outcome discontinuation of treatment for any reason, there was a significant difference in RR between Europe and the ROW (χ2 = 11.65, P <0.001) for acamprosate. Acamprosate was associated with a reduction in risk of discontinuing treatment for Europe (RR = 0.86, 95% CI = 0.79-0.95), but an increase in risk of discontinuing treatment for ROW (RR = 1.23, 95% CI = 1.03-1.48). Conclusions Both acamprosate and naltrexone appear to reduce the risk of individuals returning to drinking alcohol in those who are alcohol-dependent. The country in which a randomized control trial (RCT) for the efficacy of acamprosate and naltrexone is completed does not appear to explain the variance in trial outcomes for returning to drinking alcohol or discontinuing drinking due to adverse effects. However, the country in which the RCT of acamprosate are completed may be important for explaining the variance between studies for the outcome 'discontinuing treatment for any reason'. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To examine the role of national wealth in the association between family affluence and adolescent weekly smoking, early smoking behaviour and weekly smoking among former experimenters. Design and Participants Data were used from the Health Behaviour in School-aged Children ( HBSC) study conducted in 2005/2006 in 35 countries from Europe and North America that comprises 60 490 students aged 15 years. Multi-level logistic regression was conducted using Markov chain Monte Carlo methods ( MCMC) to explore whether associations between family affluence and smoking outcomes were dependent upon national wealth. Measurement Family Affluence Scale ( FAS) as an indicator for the socio-economic position of students. Current weekly smoking behaviour is defined as at least weekly smoking (dichotomous). Early smoking behaviour is measured by smoking more than a first puff before age 13 years (dichotomous). Weekly smoking among former experimenters is restricted to those who had tried a first puff in the past. Findings The logistic multi-level models indicated an association of family affluence with current weekly smoking [odds ratio ( OR) = 1.088; 95% credible interval ( CrI) = 1.055-1.121, P < 0.001], early smoking behaviour ( OR = 1.066; CrI = 1.028-1.104, P < 0.001) and smoking among former experimenters ( OR = 1.100; CrI = 1.071-1.130; P < 0.001). Gross domestic product ( GDP) per capita was associated positively and significantly with the relationship between family affluence and current weekly smoking ( OR = 1.005; CrI = 1.003-1.007; P < 0.001), early smoking behaviour ( OR = 1.003; CrI = 1.000-1.005; P = 0.012) and smoking among former experimenters ( OR = 1.004; CrI = 1.002-1.006; P < 0.001). The association of family affluence and smoking outcomes was significantly stronger for girls. Conclusions The difference in smoking prevalence between rich and poor is greater in more affluent countries. [ABSTRACT FROM AUTHOR]

Aims To investigate the association between having a favourite alcohol advertisement and binge drinking among European adolescents. Design Data were obtained from a longitudinal observational study on relationships between smoking and drinking and film tobacco and alcohol exposures. Setting State-funded schools. Participants Baseline survey of 12 464 German, Italian, Polish and Scottish adolescents (mean age 13.5 years), of whom 10 259 (82%) were followed-up 12 months later. Measurements Pupils were asked the brand of their favourite alcohol advertisement at baseline. Multi-level mixed-effects logistic regressions assessed relationships between having a favourite alcohol advertisement ('alcohol marketing receptivity') and (i) binge drinking at baseline; and (ii) initiating binge drinking during follow-up among a subsample of 7438 baseline never binge drinkers. Findings Life-time binge drinking prevalence at baseline was 29.9% and 25.9% initiated binge drinking during follow-up. Almost one-third of the baseline sample (32.1%) and 22.6% of the follow-up sample of never-bingers named a branded favourite alcohol advertisement, with high between-country variation in brand named. After controlling for age, gender, family affluence, school performance, TV screen time, personality characteristics and drinking behaviour of peers, parents and siblings, alcohol marketing receptivity was related significantly to both binge drinking at baseline [adjusted odds ratio ( AOR) = 2.13, 95% confidence interval ( CI) = 1.92, 2.36] and binge drinking initiation in longitudinal analysis ( AOR = 1.45, 95% CI = 1.26, 1.66). There was no evidence for effect heterogeneity across countries. Conclusions Among European adolescents naming a favourite alcohol advertisement was associated with increased likelihood of initiating binge drinking during 1-year follow-up, suggesting a relationship between alcohol marketing receptivity and adolescent binge drinking. [ABSTRACT FROM AUTHOR]

Aims To estimate the role of family and socio-economic indicators of welfare state in accounting for probable problem gambling during adolescence in a representative sample of students living in nine European countries. Design Data from the 2011 European School Survey Project on Alcohol and Other Drugs ( ESPAD) Study were used for cross-sectional analyses of adolescent probable problem gambling. Setting Representative surveys in nine European countries. Participants A total of 31 236 16-year-old students. Measurements Respondents' probable problem gambling, socio-demographic characteristics and parenting (regulation, monitoring and caring) were measured individually. Indicators of wealth (gross domestic product per capita, GDP), expenditure on public health (% GDP) and benefit in kind for families/children (% GDP) were obtained from national public databases. Findings Students who perceived more parental caring [odds ratio ( OR) = 0.92, 95% confidence interval ( CI) = 0.85-0.98] and monitoring ( OR = 0.57, 95% CI = 0.53-0.62) reported less involvement in probable problem gambling. Moreover, students who perceived stronger parental regulation ( OR = 1.16, 95% CI = 1.09-1.23) were more likely to be possible problematic gamblers. At the country level, expenditure on public health was associated negatively with probable problem gambling ( OR = 0.87, 95% CI = 0.78-0.97), whereas GDP per capita ( OR = 1, 95% CI = 1.00-1.00) and the benefits in kind for families/children ( OR = 1.16, 95% CI = 0.89-1.51) showed no association with probable problem gambling. Conclusions Family characteristics and expenditure on public health may play a key role in explaining probable problem gambling among adolescents in Europe. [ABSTRACT FROM AUTHOR]

Aims To analyse the association between alcohol advertising restrictions and the prevalence of hazardous drinking among people aged 50-64 years in 16 European countries, taking into account both individual and contextual-level factors (alcohol taxation, availability, etc.). Design Cross-sectional study based on SHARE project surveys. Setting and Participants A total of 27 773 subjects, aged 50-64 years, from 16 European countries who participated in wave 4 of the SHARE ( Survey of Health, Ageing and Retirement in Europe) project. Measurements We estimated the prevalence of hazardous drinking (through adaptation of the SHARE questions to the scheme used by the Alcohol Use Disorders Identification Test Consumption ( AUDIT- C) for each country. To determine whether the degree of advertising restrictions was associated with prevalence of hazardous drinking, we fitted robust variance multi-level Poisson models, adjusting for various individual and contextual variables. Prevalence ratios ( PR) and their 95% confidence intervals (95% CI) were obtained. Findings The observed prevalence of hazardous drinking was 24.1%, varying by sex and country. Countries with greater advertising restrictions had lower prevalence of hazardous drinking: 30.6% (95% CI = 29.3-31.8) in countries with no restrictions, 20.3% (95% CI = 19.3-21.2) in countries with some restrictions and 14.4% (95% CI = 11.9-16.8) in those with greatest restrictions. The PR found (with respect to countries with greatest restrictions) were 1.36 (95% CI = 0.90-2.06) for countries with some restrictions and 1.95 (95% CI = 1.31-2.91) for those with no advertising restrictions. Conclusions The extent of advertising restrictions in European countries is associated inversely with prevalence of hazardous drinking in people aged 50-64 years. [ABSTRACT FROM AUTHOR]

Commentary to: Can new psychoactive substances be regulated effectively? An assessment of the British Psychoactive Substances Bill [ABSTRACT FROM AUTHOR]

Aims To determine comorbidity patterns in treatment-seeking substance use disorder ( SUD) patients with and without adult attention deficit hyperactivity disorder ( ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence ( IASP) study. Setting Forty-seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment-seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV ( CAADID), the presence of antisocial personality disorder ( ASPD), major depression ( MD) and (hypo)manic episode ( HME) was assessed with the Mini International Neuropsychiatric Interview- Plus ( MINI Plus), and the presence of borderline personality disorder ( BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II ( SCID II). Findings The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio ( OR) = 2.8, 95% confidence interval ( CI) = 1.8-4.2], BPD ( OR = 7.0, 95% CI = 3.1-15.6 for alcohol; OR = 3.4, 95% CI = 1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse ( OR = 4.1, 95% CI = 2.1-7.8) and HME ( OR = 4.3, 95% CI = 2.1-8.7) were all more prevalent in ADHD+ compared with ADHD− patients ( P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype ( P < 0.01), increased HME and ASPD in the hyperactive/impulsive ( P < 0.01) and combined subtypes ( P < 0.001) and increased BPD in all subtypes ( P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD. Conclusions Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders. [ABSTRACT FROM AUTHOR]

Aims To investigate the prevalence of pathological internet use ( PIU) and maladaptive internet use ( MIU) among adolescents in 11 European countries in relation to demographic, social factors and internet accessibility. Design Cross-sectional survey. Setting The 7th Framework European Union ( EU) funded project, Saving and Empowering Young Lives in Europe ( SEYLE), is a randomized controlled trial ( RCT) evaluating interventions for risk behaviours among adolescents in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the coordinating centre. Participants A total of 11 956 adolescents (female/male: 6731/5225; mean age: 14.9 ± 0.89) recruited from randomly selected schools within the 11 study sites. Measurements Internet users were classified by gender into three categories: adaptive, maladaptive and pathological, based on their score in the Young Diagnostic Questionnaire for Internet Addiction ( YDQ). Findings The overall prevalence of PIU was 4.4%; it was higher among males than females (5.2% versus 3.8%) and differed between countries (χ2 = 309.98; d.f. = 20; P < 0.001). PIU correlated significantly with mean hours online and male gender. The highest-ranked online activities were watching videos, frequenting chatrooms and social networking; significantly higher rates of playing single-user games were found in males and social networking in females. Living in metropolitan areas was associated with PIU. Students not living with a biological parent, low parental involvement and parental unemployment showed the highest relative risks of both MIU and PIU. Conclusions Across a range of countries in Europe, using the Young Diagnostic Questionnaire for Internet Addiction yields a prevalence of 'pathological internet use' of 4.4% among adolescents, but varies by country and gender; adolescents lacking emotional and psychological support are at highest risk. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To investigate whether differences in gender-income equity at country level explain national differences in the links between alcohol use, and the combination of motherhood and paid labour. Design Cross-sectional data in 16 established market economies participating in the Gender, Alcohol and Culture: An International Study (GenACIS) study. Setting Population surveys. Participants A total of 12 454 mothers (aged 25-49 years). Measurements Alcohol use was assessed as the quantity per drinking day. Paid labour, having a partner, gender-income ratio at country level and the interaction between individual and country characteristics were regressed on alcohol consumed per drinking day using multi-level modelling. Findings Mothers with a partner who were in paid labour reported consuming more alcohol on drinking days than partnered housewives. In countries with high gender-income equity, mothers with a partner who were in paid labour drank less alcohol per occasion, while alcohol use was higher among working partnered mothers living in countries with lower income equity. Conclusion In countries which facilitate working mothers, daily alcohol use decreases as female social roles increase; in contrast, in countries where there are fewer incentives for mothers to remain in work, the protective effect of being a working mother (with partner) on alcohol use is weaker. These data suggest that a country's investment in measures to improve the compatibility of motherhood and paid labour may reduce women's alcohol use. [ABSTRACT FROM AUTHOR]

Some European countries with high levels of unrecorded alcohol consumption have anomalously high rates of death attributable to liver cirrhosis. Hepatotoxic compounds in illegally produced spirits may be partly responsible. Based on a review of the evidence on the chemical composition and potential harm from unrecorded alcohol, the Alcohol Measures for Public Health Research Alliance (AMPHORA) project's methodology for identifying, analysing and toxicologically evaluating such alcohols is provided. A computer-assisted literature review concentrated on unrecorded alcohol. Additionally, we refer to our work in the capacity of governmental alcohol control authority and a number of pilot studies. The risk-oriented identification of substances resulted in the following compounds probably posing a public health risk in unrecorded alcohol: ethanol, methanol, acetaldehyde, higher alcohols, heavy metals, ethyl carbamate, biologically active flavourings (e.g. coumarin) and diethyl phthalate. Suggestions on a sampling strategy for identifying unrecorded alcohol that may be most prone to contamination include using probable distribution points such as local farmers and flea markets for selling surrogate alcohol (including denatured alcohol) to focusing on lower socio-economic status or alcohol-dependent individuals, and selecting home-produced fruit spirits prone to ethyl carbamate contamination. Standardized guidelines for the chemical and toxicological evaluation of unrecorded alcohol that will be used in a European-wide sampling and are applicable globally are provided. These toxicological guidelines may also be used by alcohol control laboratories for recorded alcohol products, and form a scientific foundation for establishing legislative limits. [ABSTRACT FROM AUTHOR]

To describe three aspects of the epidemiology of alcohol-attributable deaths in Europe, dose, demography and place, and to illustrate how such knowledge can better be used to inform alcohol policy formulation and implementation. epidemiological and population health modeling. Europe. Based on country-specific aggregate statistics. Exposure: country-specific adult per capita consumption triangulated with survey data; outcomes: mortality statistics. The absolute risk of dying from an alcohol-attributable disease and injury (accounting for a protective effect for ischaemic diseases) increases with increasing daily alcohol consumption beyond 10g alcohol per day, the first data point. Over 2/3 of all alcohol-attributable deaths occurring amongst the 20-64 year old population of the European Union (minus Cyprus and Malta) occur in the 45-64 year olds. About 25% of the difference in life expectancy between western and eastern Europe for men aged 20-64 years in 2002 can be attributed to alcohol, largely, but not exclusively, as a result of differences in heavy episodic drinking patterns. Any reduction in the dose of alcohol consumed, at least down to 10g/day, will reduce the annual and lifetime risk of an alcohol-related death. There is a need for alcohol policy to focus on measures in reducing alcohol consumption, throughout middle age, with immediacy of impact. Policy should strive to reduce alcohol-related health inequalities, with the specific recommendations for policy depending on the cost-effectiveness of interventions related to the epidemiological profile of the country or region under consideration. Fortunately, there are evidence-based policy options that reduce the amount of alcohol consumed and many alcohol-related harms with immediate effect, that reduce the risk of an alcohol-related death in middle age, and that would help to close the health gap between eastern and western Europe. [ABSTRACT FROM AUTHOR]