European Addiction Research

<b><i>Background:</i></b> The <i>International Collaboration on ADHD and Substance Abuse</i> (ICASA) is a network of 28 centers from 16 countries initiated to investigate the link between attention deficit-hyperactivity disorder (ADHD) and substance use disorder (SUD). In this article, we present the mission, the results of finished studies, and the current and future research projects of ICASA. Methods: During the past 10 years, 3 cross-sectional studies were conducted: two International ADHD in Substance use disorders Prevalence (IASP-1 and IASP-2) studies, directed at the screening, diagnosis, and the prevalence of adult ADHD in treatment-seeking patients with SUD, and the Continuous performance test for ADHD in SUD Patients (CASP) study, testing a novel continuous performance test in SUD patients with and without adult ADHD. Recently, the prospective International Naturalistic Cohort Study of ADHD and Substance Use Disorders (INCAS) was initiated, directed at treatment provision and treatment outcome in SUD patients with adult ADHD. <b><i>Results:</i></b> The IASP studies have shown that approximately 1 in 6 adult treatment-seeking SUD patients also have ADHD. In addition, those SUD patients with adult ADHD compared to SUD patients without ADHD report more childhood trauma exposure, slower infant development, greater problems controlling their temperament, and lower educational attainment. Comorbid patients also reported more risk-taking behavior, and a higher rate of other psychiatric disorders compared to SUD patients without ADHD. Screening, diagnosis, and treatment of this patient group are possible even before abstinence has been achieved. The results of the CASP study are reported separately in this special issue. <b><i>Conclusions:</i></b> The ICASA research to date has demonstrated a high prevalence of comorbid ADHD and SUD, associated with elevated rates of additional comorbidities and risk factors for adverse outcomes. More research is needed to find the best way to treat these patients, which is the main topic of the ongoing INCAS study.

<i>Background:</i> Several experimental laboratory studies have shown that subjective craving for alcohol increases as a result of low-to-moderate levels of alcohol consumption. Less is known about alcohol prime effects on relatively automatic appetitive motivational processes such as attentional bias (AB). Also, it is not known whether the effects from laboratory studies can be generalized to real-life drinking environments, and whether effects change after higher alcohol doses than those that have been administered in lab studies. <i>Method:</i> In two pubs, we investigated alcohol prime dose effects in self-reported craving and AB, measured by a modified Flicker Paradigm. We included an opportunistic sample of 72 social drinkers who had been drinking various amounts of alcohol. <i>Results:</i> Self-reported craving was positively predicted by dose of alcohol consumed, from one up to 16 drinks. In contrast, AB was negatively predicted by dose consumed in participants who had been binge drinking. <i>Conclusion:</i> This field study validates earlier experimental research on alcohol prime effects in a real drinking situation. Further, it demonstrates prime effects up to much higher alcohol doses than in previous lab studies.

<i>Background/Aims:</i> Cannabis use is a growing challenge for public health, calling for adequate instruments to identify problematic consumption patterns. The Cannabis Use Disorders Identification Test (CUDIT) is a 10-item questionnaire used for screening cannabis abuse and dependency. The present study evaluated that screening instrument. <i>Methods:</i> In a representative population sample of 5,025 Swiss adolescents and young adults, 593 current cannabis users replied to the CUDIT. Internal consistency was examined by means of Cronbach’s alpha and confirmatory factor analysis. In addition, the CUDIT was compared to accepted concepts of problematic cannabis use (e.g. using cannabis and driving). ROC analyses were used to test the CUDIT’s discriminative ability and to determine an appropriate cut-off. <i>Results:</i> Two items (‘injuries’ and ‘hours being stoned’) had loadings below 0.5 on the unidimensional construct and correlated lower than 0.4 with the total CUDIT score. All concepts of problematic cannabis use were related to CUDIT scores. An ideal cut-off between six and eight points was found. <i>Conclusions:</i> Although the CUDIT seems to be a promising instrument to identify problematic cannabis use, there is a need to revise some of its items.

<b><i>Background:</i></b> Smoking cessation during pregnancy and preventing relapse postpartum is a pivotal public health priority. <b><i>Objectives:</i></b> This study examined the risk and protective indicators of women who (a) smoke before pregnancy, (b) smoke during the entire pregnancy, (c) successfully quit smoking during pregnancy, and (d) relapse postpartum. <b><i>Method:</i></b> This paper reports secondary analyses of the Dutch population-based Monitor on Substance Use and Pregnancy (2016). A representative sample of mothers of young children (<i>n</i> = 1,858) completed questionnaires at youth health care centers. Bivariate and multivariate logistic regression analyses were conducted. <b><i>Results:</i></b> Main results showed that women’s smoking around pregnancy was strongly associated with the partner’s smoking status before pregnancy, partner’s change in smoking during pregnancy, and partner’s change in smoking postpartum. Women’s educational level and cannabis use before pregnancy were also related with women’s smoking before and during pregnancy. Women’s intensity of alcohol use before pregnancy was ambiguously related with women’s smoking before and during pregnancy. <b><i>Conclusions:</i></b> One of the key findings of this study suggests that it is essential that partners quit smoking before pregnancy and do not smoke during pregnancy. If partners continue smoking during pregnancy, they should quit smoking postpartum. Health care professionals can play an important role in addressing partners’ smoking and giving them evidence-based cessation support before, during, and after pregnancy.

<i>Objective:</i> Desire thinking is a voluntary cognitive process involving verbal and imaginary elaboration of a desired target. Recent research has highlighted the role of desire thinking in predicting addictive behaviours independent of other psychological constructs including negative affect and craving. The goal of this research project was to explore the role of desire thinking across the continuum of drinking behaviour. <i>Methods:</i> A sample of alcohol-dependent drinkers (n = 43), problem drinkers (n = 59), and social drinkers (n = 68) completed self-report instruments of desire thinking, negative affect, craving and drinking behaviour. <i>Results:</i> Analyses revealed that alcohol-dependent drinkers and problem drinkers scored higher than social drinkers on imaginal prefiguration, and that alcohol-dependent drinkers scored higher than problem drinkers who in turn scored higher than social drinkers on verbal perseveration. A multi-group discriminant analysis showed that craving, imaginal prefiguration and verbal perseveration loaded on a first function whilst age loaded on a second function. The variables correctly classified 75.9% of cases. <i>Conclusions:</i> The findings suggest that desire thinking may be a risk factor across the continuum of drinking behaviour and that treatment may benefit from specifically targeting this cognitive process.

<b><i>Background/Aims:</i></b> Little is known about the association of binge drinking with impulsivity related to trait- or state-like aspects of behavior. The aim of the present study was therefore to investigate whether binge drinkers show an impairment of inhibitory control in comparison to non-binge drinkers when confronted with alcohol-associated or control stimuli, and whether this is reflected in self-reported impulsivity. <b><i>Methods:</i></b> A go/no-go task with pictures of alcoholic and nonalcoholic beverages as well as control stimuli was administered to binge drinkers and a gender-matched group of non-binge drinkers. All participants also completed the Barratt Impulsiveness Scale (BIS-11). <b><i>Results:</i></b> We found an alcohol-specific impairment of response inhibition for binge drinkers only, while the groups did not differ with regard to overall response inhibition to the experimental stimuli or self-reported impulsiveness (BIS-11). In addition, the number of commission errors in response to alcohol-associated stimuli was the only significant predictor of binge drinking. <b><i>Conclusion:</i></b> The findings of the present study suggest that when young adults have established binge drinking as a common drinking pattern, impairment of inhibition in response to alcoholic stimuli is the only significant predictor of binge drinking, but not general impulsive behavior. i 2014 S. Karger AG, Basel

<i>Aims:</i> To make quantitative estimates on a global basis of exposure of disease-relevant dimensions of alcohol consumption, i.e. average volume of alcohol consumption and patterns of drinking. <i>Design:</i> Secondary data analysis. <i>Measurements:</i> Level of average volume of drinking was estimated by a triangulation of data on per capita consumption and from general population surveys. Patterns of drinking were measured by an index composed of several indicators for heavy drinking occasions, an indicator of drinking with meals and an indicator of public drinking. Average volume of consumption was assessed by sex and age within each country, and patterns of drinking only by country; estimates for the global subregions were derived from the population-weighted average of the countries. For more than 90% of the world population, per capita consumption was known, and for more than 80% of the world population, survey data were available. <i>Findings:</i> On the country level, average volume of alcohol consumption and patterns of drinking were independent. There was marked variation between WHO subregions on both dimensions. Average volume of drinking was highest in established market economies in Western Europe and the former Socialist economies in the Eastern part of Europe and in North America, and lowest in the Eastern Mediterranean region and parts of Southeast Asia including India. Patterns were most detrimental in the former Socialist economies in the Eastern part of Europe, in Middle and South America and parts of Africa. Patterns were least detrimental in Western Europe and in developed countries in the Western Pacific region (e.g., Japan). <i>Conclusions:</i> Although exposure to alcohol varies considerably between regions, the overall exposure by volume is quite high and patterns are relatively detrimental. The predictions for the future are not favorable, both with respect to average volume and to patterns of drinking.

<i>Objective: </i>To conduct an overview of alcohol-related health consequences and to estimate relative risk for chronic consequences and attributable fractions for acute consequences. <i>Methods: </i>Identification of alcohol-related consequences was performed by means of reviewing and evaluating large-scale epidemiological studies and reviews on alcohol and health, including epidemiological contributions to major social cost studies. Relative risks and alcohol-attributable fractions were drawn from the international literature and risk estimates were updated, whenever possible, by means of meta-analytical techniques. <i>Results:</i> More than 60 health consequences were identified for which a causal link between alcohol consumption and outcome can be assumed. <i>Conclusions: </i>Future research on alcohol-related health consequences should focus on standardization of exposure measures and take into consideration both average volume of consumption and patterns of drinking.

<i>Aim:</i> The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. <i>Design, Setting, Participants:</i> Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. <i>Measurements:</i> Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. <i>Findings:</i> The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. <i>Conclusions:</i> The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.