Background: Although awareness of the misuse of medicines is increasing, data on the extent of the problem in the European Union (EU) are lacking. Methods: In order to assess the magnitude and severity of the problem, a systematic review of the literature on the misuse of analgesics, opioid substitution medicines and sedatives/hypnotics (with the exception of benzodiazepines) was conducted using the PubMed and Web of Science databases. Relevant literature was identified between 2001 and 2011. Results: The main groups of misused medicines include opioid analgesics, methadone, buprenorphine and Z-drugs. Regional trends in medicine misuse indicate heterogeneity across the EU with respect to misused medicine types and research activities. Prevalence, high-risk populations and factors contributing to medicine misuse are discussed. Conclusion: The implications of these findings for prevention, treatment, and policy in the EU are considered.

Action programmes fostering partnerships and bringing together regional and national authorities to promote the care of depressed patients are urgently needed. In 2001 the 'Nuremberg Alliance Against Depression' was initiated as a community-based model project within the large-scale 'German Research Network on Depression and Suicidality' (Kompetenznetz 'Depression, Suizidalität'). The 'Nuremberg Alliance Against Depression' was an action programme, conducted in the city of Nuremberg (500,000 inhabitants) in 2001/2002, addressing four intervention levels (Hegerl et al. Psychol Med 2006;36:1225). Based on the positive results of the Nuremberg project (a significant reduction of suicidal behaviour by more than 20%) 18 international partners representing 16 different European countries established the 'European Alliance Against Depression' (EAAD) in 2004. Based on the four-level approach of the Nuremberg project, all regional partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international levels. This paper gives a brief overview of the background for and experiences with the EAAD. It describes the components of the programme, provides the rationale for the intervention and outlines the current status of the project. The aim of the paper is to disseminate information about the programme's potential to reduce suicidal behaviour and to provide examples of how European community-based 'best practice' models for improving the care of depressed patients and suicidal persons can be implemented using a bottom-up approach. EAAD is mentioned by the European commission as a best practice example within the Green Paper 'Improving the mental health of the population: Towards a strategy on mental health for the European Union' (European Commission 2005).

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...

Zusammenfassung Ziel: Ziel der Studie ist eine Sch?tzung der Inanspruchnahme gesundheitlicher Versorgung durch Alkoholabh?ngige. Gesch?tzt werden die Anzahl Alkoholabh?ngiger in der Allgemeinbev?lkerung, die Anzahl der Betroffenen mit einer entsprechenden Diagnose und die Anzahl derer, die das Suchhilfesystem in Anspruch nahmen. Methodik: Die Sch?tzungen beruhen auf aktuellen Daten zur Inanspruchnahme von Einrichtungen der Gesundheitsversorgung. Die Verfahren zur Hochrechnung werden ausf?hrlich beschrieben. Ergebnisse: In Deutschland wird der Anteil Alkoholabh?ngiger in der Allgemeinbev?lkerung (18?+) f?r das Jahr 2012 auf 2,8% oder 1,86 Mio. Personen gesch?tzt. Eine Abh?ngigkeitsdiagnose bei niedergelassenen ?rzten erhielten etwa 649?000 Personen (Datenjahr 2009). Damit war etwa jeder dritte Alkoholabh?ngige (35,0%) im Gesundheitssystem registriert. Etwa 297?000 Abh?ngige befanden sich im gleichen Jahr in Behandlung im Krankenhaus und/oder ambulanten/station?ren Suchthilfeeinrichtungen. Insgesamt liegt die Betreuungsquote bei etwa 16%. Der Anteil Alkoholabh?ngiger in station?rer Rehabilitationsbehandlung betr?gt 1,8%. Schlussfolgerungen: Die Sch?tzungen machen deutlich, dass zur Vermeidung von Morbidit?t und Mortalit?t im Zusammenhang mit Alkoholabh?ngigkeit erhebliche Anstrengungen notwendig sind. Als M?glichkeiten werden die Erh?hung der Erreichungsquote Alkoholabh?ngiger durch Fr?hintervention und Diversifizierung des Behandlungsangebots sowie ein Paradigmenwechsel in der Abstinenzorientierung diskutiert.