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.

ubstance use is associated with a multitude of health and social effects. The results of the Global Burden of Disease Study clearly demonstrate that alcohol and tobacco use are among the main risk factors worldwide for premature mortality and life years lost due to disease and disability (1, 2). In 2015, every third person in Western Europe reported at least one episode of heavy drinking (≥ 60 g ethanol) in the preceding 30 days, every fifth person smoked tobacco daily, and 7% of respondents stated that they had consumed cannabis in the previous 12 months (3). Prevalence rates for the use of other illegal drugs such as amphetamines (0.6%), cocaine (1.1%), and opioids (0.4%) were much lower (3). The consumption of psychoactive substances is associated with an increased risk for substance disorders. The number of individuals with a substancerelated dependence per 100 000 people was estimated to be 881 for alcohol and 425 for cannabis in Western Europe in 2015. The number of deaths caused by substance use was reported to be 78 for tobacco, 19 for alcohol, and seven for illegal drugs per 100 000 people in the population (3). The Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA) yields population-representative data on the prevalence of legal and illegal substance use, hazardous forms of use, as well as substance-related disorders according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Projected prevalence estimates for various indicators of use make it possible to quantify the current burden caused by substance use and substance-related disorders. Methods Study design and sample The 2018 ESA study population is made up of Germanspeaking individuals aged between 18 and 64 years living in private households in Germany. The sample was drawn in a two-stage selection process. In a first step, 254 municipalities (sample points) were randomly selected. In a second step, addresses were drawn from the respective population registers using a systematic random selection. Data was collected by means of written and online questionnaires or telephone interviews (mixed-method design). The adjusted sample included 9267 individuals (response rate = 41.6%). See Summary Background: Prevalence estimates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications and of substance-related disorders enable an assessment of the effects of substance use on health and society. Methods: The data used for this study were derived from the 2018 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA). The sample of the German adult population comprised 9267 persons aged 18 to 64 (response rate, 42%). Population estimates were obtained by extrapolation to a total resident population of 51 544 494 people. Results: In the 30 days prior to the survey, 71.6% of the respondents (corresponding to 36.9 million persons in the population) had consumed alcohol, and 28.0% (14.4 million) had consumed tobacco. 4.0% reported having used e-cigarettes, and ...

pioid addiction is one of the most common substance-related disorders worldwide. It is responsible for the majority of the morbidity and mortality caused by drugs in the population (1). Opioids include both synthetic (e.g. heroin, methadone, buprenorphine, fentanyl) and plant-derived substances (opiates, e.g. codeine and morphine). Opioids carry major risks of physical and pharmacological dependency (2). Intravenous use, in particular, is associated with a nonnegligible risk of communicable diseases (3) or death due to overdose or the long-term consequences of use (4). Finally, there is an increased risk of criminal behavior, specifically drug-related crime (5). Knowing how many individuals are addicted to opioids is important for setting health policy (6). In the first instance, calculations in Germany concern addiction caused by taking illegal opioid-containing substances. A preliminary national estimate for Germany as a whole in 1989, based on treatment data, gave a figure of 60 000 to 80 000 individuals who were problem users of opiates, cocaine, stimulants, or hallucinogenic drugs (7). A German expert group estimated the number of heroin users in western and eastern Germany in 1995 at 127 000 to 152 000 (8); for the same year, the number of intravenous drug users in western Germany and Berlin was estimated at a mean of 150 000 (97 000 to 204 000) on the basis of a survey among general practitioners (9). As part of estimating the number of individuals with problematic drug use in European Union countries, figures of 127 000 to 190 000 opiate users in Germany for the year 2000 were found using various methods. This calculation was based on treatment, police, and mortality data (10). Using these approaches, comparative estimates for 1990, 1995, and 2000 indicated a moderate increase in the number of opiate users (11). The aim of this study was to estimate the number of individuals addicted to opioids in Germany and its individual federal states for the calendar year 2016. Method This estimate is based on substitution treatment registry data, data from inpatient and outpatient addiction care statistics, and counts in 5 low-threshold addiction care Summary Background: Opioid addiction is one of the most common substance-related disorders worldwide, and morbidity and mortality due to opioid addiction place a heavy burden on society. Knowing the size of the population that is addicted to opioids is a prerequisite for the development and implementation of appropriate health-policy measures. Methods: Our estimate for Germany for 2016 is based on an enumeration of opioidaddicted persons who were entered in a registry of persons receiving substitution therapy, an enumeration of persons receiving outpatient and inpatient care for addiction without substitution therapy, an extrapolation to all addiction care facilities, and an estimation of the number of opioid-addicted persons who were not accounted for either in the substitution registry or in addiction care. Results: The overall estimate of the number of opioid-addict...

In the years 2006 and 2016, tobacco use was the leading global risk factor for early death and loss of life years due to disability (e1). In 1990, tobacco had occupied third place among 86 comparable risk factors. Alcohol consumption was the fourth most important risk factor in 2016 (fifth in 1990), while illegal drugs were listed in 18 th place (21 st in 1990). In the USA the prescription of painrelieving drugs has been debated in connection with the threefold increase in opioid overdoses between 2010 and 2014 (1, 2) and a related decrease in life expectancy (3).Observations of changes in the use of psychoactive substances and medications and in the occurrence of substance-related disorders enable assessment of the magnitude of the anticipated negative consequences for the population and are thus of wide-reaching importance for health policy (e2). Given the causal connection between use and negative consequences such as illness and death, trends in indicators of consumption permit conclusions regarding the future development of such consequences. In Germany, the Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey; ESA) has been conducting regular cross-sectional surveys of substance use and related disorders in the adult population (18 to 64 years) since 1995 (4).The study reported here was designed to analyze:• Trends in use of tobacco, alcohol, cannabis, and other illegal drugs together with intake of analgesics and hypnotics/sedatives• Trends in substance-related disorders as coded according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). MethodsThe data came from nine ESA surveys carried out between 1995 and 2018 (every 3 years from 1997 onwards). Owing to changes in the age range surveyed during the observation period, all analyses were restricted to the age range 18 to 59 years. (Information on the individual ESA surveys can be found in the eMethods.) The data were collected in written form or by means of a combination of paper and internet-based questionnaires or telephone interviews. (For details of the complex sampling techniques, see the eMethods.) Information was collected on consumption and patterns of use (amount) of tobacco and alcohol, the use of SummaryBackground: Changes in the use of psychoactive substances and medications and in the occurrence of substance-related disorders enable assessment of the magnitude of the anticipated negative consequences for the population.Methods: Trends were analyzed in the consumption of tobacco, alcohol, cannabis and other illegal drugs, analgesics, and hypnotics/sedatives, as well as trends in substance-related disorders, as coded according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The data were derived from nine waves of the German Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA) from 1995 to 2018. The data were collected in written form or by means of a combination of paper and internet-based questionnaires or telephone interviews.Results: The estimated prev...

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