Patterns of concurrent alcohol, tobacco, and cannabis use in Germany: Prevalence and correlates

Abstract

Aims: This study investigated past month patterns and risk factors of alcohol, tobacco and cannabis use by level of intensity in the German general population. Methods: Data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used. The cross-sectional random sample consisted of N ¼ 7912 adults aged 18-64 years. The response rate was 45%. Intensive use of each substance was measured applying substance-specific cut-off points: alcohol: 420/30 g pure ethanol daily for women/men; tobacco: 20 cigarettes daily; cannabis: on 6 occasions monthly. Findings: The majority of substance users reported no intensive use of any of the three substances (77.5%) and 19.4% had used one of the three substances intensively. A total of 3.1% engaged in intensive use of multiple substances with alcohol and tobacco (2.3%) as the most prevalent pattern. A higher risk for intensive use of multiple substances was found among males, older individuals and those with a substance use disorder. Conclusions: Results of this study call for an integrated view on substance use and related disorders in prevention and treatment, taking diverse use patterns and specific needs of substance abusers into account.

Measuring Concurrent Polydrug Use in General Populations: A Critical Assessment

“…Furthermore, it should be noted that the prevalence alone does not reveal the harmfulness of polydrug use; rather, additional factors such as the intensity of use or potential harms of combining different substances need to be taken into consideration [12,13]. One possibility to measure SPU in population surveys would be to include questions concerning, for instance, different combinations of substances used at the same time or in temporal proximity, frequency and motivation of such use as well as perceived harms of SPU.…”

“…Polydrug use is noted especially among problem drug users [6,7], but it needs to be recognized among the general population too due to its serious health and social consequences [8,9,10]. In the present literature, it is often claimed that polydrug use has increased during the last decades [11,12,13]. However, as far as the authors know, only a few studies have presented research evidence about prevalence trends of polydrug use among the general population [14,15,16].…”

“…However, illicit drugs are not necessarily included at all, since the use of alcohol and prescription drugs may form a pattern of polydrug use [24]. Moreover, the degree of alcohol use as a part of polydrug use can vary greatly, for example, from at least one drink during the last year [8] to hazardous drinking [22], whereas the amounts of illicit drugs used are rarely taken into consideration [13]. …”

Simultaneous Versus Concurrent Use of Alcohol and Cannabis in the National Alcohol Survey

“…We found only three general population studies of simultaneous use among adults (Höhne et al, 2014; Midanik et al, 2007; Norton and Colliver, 1988). First, an older study using the 1982 National Household Survey on Drug Abuse data (N=5,624) showed that individuals who combined cannabis and alcohol were more likely to be male and in the 18–34 age group than not (Norton and Colliver, 1988).…”

“…In the 2000 National Alcohol Survey (N=7,612), simultaneous use was related to increased social consequences, depression and alcohol dependence compared to alcohol-only users, and that simultaneous users were younger, less educated, less likely to have a partner, and had heavier drinking patterns (Midanik et al, 2007); the authors did not make direct comparisons between simultaneous and concurrent users. Most recently, an epidemiologic study of German adults (N=7,912) showed that male gender, older age, less education, and having a substance use disorder all significantly predicted multiple intensive substance use (use of cannabis, alcohol and/or tobacco above a pre-defined threshold) compared to non- or single-intensive substance use (Höhne et al, 2014). …”