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'Heavy substance use over time' seems to be a definition of substance use disorders in line with results of basic research and epidemiology. Additionally, it reduces stigmatization. This approach should thus be further explored.

Alcohol use disorders (AUDs), and alcohol dependence (AD) in particular, are prevalent and associated with a large burden of disability and mortality. The aim of this study was to estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and to investigate potential influencing factors. The 1-year prevalence of AD in the EU was estimated at 3.4% among people 18-64 years of age in Europe (women 1.7%, men 5.2%), resulting in close to 11 million affected people. Taking into account all people of all ages, AD, abuse and harmful use resulted in an estimate of 23 million affected people. Prevalence of AD varied widely between European countries, and was significantly impacted by drinking cultures and social norms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking, such as liver cirrhosis or injury, were moderate. These results suggest a need to rethink the definition of AUDs.

Aims: The aim of the study was to investigate the efficacy and safety of as-needed use of nalmefene 18 mg versus placebo in reducing alcohol consumption in patients who did not reduce their alcohol consumption after an initial assessment, i.e. the pooled subgroup of patients with at least a high drinking risk level (men: >60 g/day; women: >40 g/day) at both screening and randomization from the two randomized controlled 6-month studies ESENSE 1 (NCT00811720) and ESENSE 2 (NCT00812461). Methods: Nalmefene 18 mg and placebo were taken on an as-needed basis. All the patients also received a motivational and adherence-enhancing intervention (BRENDA). The co-primary outcomes were number of heavy drinking days (HDDs) and mean total alcohol consumption (g/day) in Month 6 measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study. Results: The pooled population consisted of 667 patients: placebo n = 332; nalmefene n = 335. There was a superior effect of nalmefene compared with placebo in reducing the number of HDDs [treatment difference: −3.2 days (95% CI: −4.8; −1.6); P < 0.0001] and total alcohol consumption [treatment difference: −14.3 g/day (−20.8; −7.8); P < 0.0001] at Month 6. Improvements in clinical status and liver parameters were greater in the nalmefene group compared with the placebo group. Adverse events and adverse events leading to dropout were more common with nalmefene than placebo. Conclusion: As-needed nalmefene was efficacious in reducing alcohol consumption in patients with at least a high drinking risk level at both screening and randomization, and the effect in this subgroup was larger than in the total population.

AimsTo investigate changes in alcohol consumption during the first months of the COVID-19 pandemic in Europe as well as its associations with income and experiences of distress related to the pandemic. Design Cross-sectional on-line survey conducted between 24 April and 22 July 2020. Setting Twenty-one European countries. Participants A total of 31 964 adults reporting past-year drinking. Measurements Changes in alcohol consumption

Reduction of drinking in alcohol use disorders was associated with a marked reduction in mortality risk for those who reached abstinence or reduced drinking compared to continued heavy drinkers. Those who reached abstention showed the smallest mortality risk, lower than the risk for reduced consumption without abstinence.

The use of standard drink units (SDUs) in the measurement of individual alcohol consumption has become widely popular in recent years. However, the ethanol content of drinks varies from country to country and is usually arrived at without scientific backing. The present study was designed to establish an SDU for a predominantly wine-drinking country (Spain). Two field studies were simultaneously conducted to gather data about home and public alcohol consumption in eight regions of the country with a total of 10751 subjects. The average alcohol content of a drink was very similar for wine and beer, whereas in the case of spirits it was almost double. Relevant differences were found across regions, drinking settings and city sizes. A Spanish SDU was set at 10 g of ethanol for wine and beer, with a measure of spirits accounting for two SDUs. The use of SDUs should be encouraged in primary health care settings. However, dispersion of data suggests that, when SDU is used as a screening tool, additional information should always be obtained in borderline cases.