A3 ALICE RAP – WP 7-9 (2011-2016)
PI: Prof. Jürgen Rehm, Prof. Gerhard Bühringer
Staff: Dr. Silke Behrendt, Dr. Sarah Forberger, Dipl.-Psych. Maria Neumann, Dipl.-Psych. Charlotte Probst
Funding: European Commission
Duration: 04/2011 – 03/2016
Background: ALICE RAP is a Europe wide project of 107 researchers and 71 research institutions from 25 European countries to analyse the place and challenges of addictions and lifestyles to the cohesion, organization and functioning of contemporary European society. Through integrated multidisciplinary research, a wide range of factors will be studied through a foresight approach to inform a redesign of effective addictions governance (for further information see: www.alicerap.eu).
Work area 2/ Work package 5 – Counting addiction (Prof. Jürgen Rehm)
Objectives: WP 5 will give an epidemiological overview of addictions related to alcohol, tobacco, illegal drug use, gambling, and gaming for 31 countries. The following estimates will be undertaken by country, sex and age: prevalence of dependence, incidence of dependence, prevalence of abuse (DSM)/harmful use (ICD) and mortality, years of life lost and burden of disease attributable to addiction and to substance use.
Methods: The revised DISMOD III tool will be used to systematically integrate all epidemiological exposure data available from different countries. Epidemiological data will be combined with risk relation data to estimate substance-attributable mortality, years of life lost due to mortality and disability, and burden of disease due to addiction and substance use based on methods developed by the ongoing Comparative Risk Assessment of the Global Disease Burden study. Data will be systematically gathered from 31 countries by local experts via systematic assessment. Data will include but not be limited to unpublished data from governmental surveys or data in local data-banks that are accessible from government websites or relevant departments.
Work area 3/Work packages 7-9 – Determinants of addiction (Prof. Gerhard Bühringer)
Objectives: Each work package (WP) has four main objectives: 1. to develop agreed definitions for transitions focused in the respective WP, that is WP 7: risky use and risky gambling, WP 8 harmful substance use and harmful gambling (including substance use disorders according to DSM IV and ICD 10) and WP 9: reductions in harmful substance use and gambling; 2. to synthesise evidence held in each discipline about the predictors of each transition; 3. to produce a synthesis report as an up-to-date comprehensive review on the determinants of the respective transition from a multidisciplinary perspective and 4. to develop multidisciplinary logic models that can form the basis for future research.
Methods: The work within the WPs has been structured into tasks. These include a start-up meeting at which the team agreed on terms and methods and an expert paper about the determinants of each transition in each of the partners’ disciplines. These papers provided an overview on identified determinants of each transition within particular disciplines. Where possible, determinants for different age groups were considered. Assisted by the partners, a science writer used the expert papers and the findings from expert meetings and skype conferences to generate a final synthesis report and logic models and a logic model report. Additionally, in collaboration with WP5, evidence for quantitative transition probabilities for the transition from risky substance use/gambling to harmful substance use/gambling will be identified. The results are used to explore implications for the EU addiction research and policy.
Contribution of the institute: Prof. Bühringer is scientific leader of work package 8. Beyond this, Prof. Dr. Bühringer and associated staff produce expert papers from psychology for each work package and contributed to each synthesis report and logic models via discussion in expert meetings, comments and feedback on the reports and writing parts of the report (implications for future research).
Publications
Gavens, L., Holmes, J., Buehringer, G., McLeod, J., Neumann, M., Lingford-Hughes, A., Hock, E.S., Meier, P. S. (2017). Interdisciplinary working in public health research: a proposed good practice checklist. J Public Health (Oxf), 1-8. doi:10.1093/pubmed/fdx027
Gell, L., Holmes, J., Bühringer, G., Allamani, A., Bjerge, B., Forberger, S., . . . Neumann, M., Room, R. (2016). Methods. In L. Gell, G. Bühringer, J. McLeod, S. Forberger, J. Holmes, A. Lingford-Hughes, & M. H. Meier (Eds.), What determines harm from addictive substances and behaviours? Oxford: Oxford University Press.
Gell, L., McLeod, J., Holmes, J., Allamani, A., Baumberg, B., Bjerge, B., . . . Neumann, M., Withington, P. (2016). Determinants of harmful substance use and harmful gambling. In L. Gell, G. Bühringer, J. McLeod, S. Forberger, J. Holmes, A. Lingford-Hughes, & M. H. Meier (Eds.), What determines harm from addictive substances and behaviours? Oxford: Oxford University Press.
McLeod, J., Gell, L., Holmes, J., Allamani, A., Baumberg, B., Bjerge, B., . . . Neumann, M., Withington, P. (2016). Determinants of transitions from harmful to low-risk substance use and gambling. In L. Gell, G. Bühringer, J. McLeod, S. Forberger, J. Holmes, A. Lingford-Hughes, & M. H. Meier (Eds.), What determines harm from addictive substances and behaviours? (pp. 113-156). Oxford: Oxford University Press.
McLeod, J., Gell, L., Holmes, J., Allamani, A., Bjerge, B., Buehringer, G., . . . Neumann, M., Weirs, R. (2016). Determinants of risky substance use and risky gambling. In L. Gell, G. Bühringer, J. McLeod, S. Forberger, J. Holmes, A. Lingford-Hughes, & M. H. Meier (Eds.), What determines harm from addictive substances and behaviours? Oxford: Oxford University Press.
Gell, L., McLeod, J., Holmes, J., Everson-Hock, E., Buehringer, G., Lingford-Hughes, A., Neumann, M., & Meier, P. (2014). Reflections and best practice recommendations for interdisciplinary working: a case study on the identification of the determinants of addiction from the Addiction and Lifestyles In Contemporary Europe Reframing Addictions Project (ALICE RAP). The Lancet, 384, S13.
Work area 4/ Work package 10 – Revenues, profits and participants (sub-study on prison interviews) (Prof. Jürgen Rehm, Prof. Gerhard Bühringer)
Objectives: Work package 10 has four main objectives: 1. to calculate retail expenditures on addictive goods (illicit drugs, gambling, alcohol and tobacco) in Member States and estimate what share of these markets are attributable to those who are addicted; 2. to improve understanding of suppliers in the illicit drug trade, 3. to improve understanding of the costs and profits associated with the illegal drug trade, and 4. to improve understanding of public-sector corruption in the provision of addictive substances. Methods: The estimation of illicit drug markets will build on RAND, Europe’s recent report for the EC. For gambling a framework for understanding how revenues are generated from addicts in the gambling industry will be developed. Using expenditure surveys and gambling prevalence surveys in the UK, this work will provide quantitative estimates of one Member State to illustrate how the model could be used for all Member States with relevant data. For alcohol and tobacco, LSE and RAND will systematically review studies which analyze expenditure information and quantity consumed in Member States. These demand-side estimates will be compared with information about EU production, exports, and imports and incorporate information about unrecorded alcohol consumption. Given the hidden nature of illicit markets, a major contribution will be to conduct prison-based interviews with convicted drug dealers at all levels of the supply-chain in Germany, Slovenia, and Italy. At TU Dresden the prison based interviews for Germany were conducted.
Publication Tzvetkova, M., Pardal, M., Disley, E., Rena, A., Talic, S., & Forberger, S. (2016). Strategies for a risky business: How drug dealers manage customers, suppliers and competitors in Italy, Slovenia and Germany. International Journal of Drug Policy, 31, 90-98. doi: 10.1016/j.drugpo.2016.04.012
Work area 5 / Work package 13.1 – Theoretical overview of governance views (Prof. Dr. Gerhard Bühringer)
Objectives: This part of work package 13 will be achieved through in depth and systematic reviews of the published literature on governance views and as they apply to governance of addictions. An historical perspective (and thus linking with WP1.1) will be taken, using the laboratory of Europe to look at different governance views. Stakeholders´ perspectives will be captured through three expert meetings and colloquia ensuring a very wide range of representatives and capturing some of the broader related governance issues including trade, control, commerce, agriculture, health, international bodies, and users. Topics for inclusion in the publication will include: Introduction to governance and governance of addictions; History of governance of addictions (Europe and global); Conceptual models for governance approaches, Application of concepts to differing governance views across Europe, Governance and health: a public good; Trade and governance; Private sector governance; Civil society and governance; Partnerships and governance; Governance of illegal issues; Governance of communications and the Internet; and What do we learn from an analysis of the governance view. Methods: Book publication with chapter authors, edited by Peter Anderson, Gerhard Bühringer, and Jean Collins.
Publication: Anderson, P., Bühringer, G., & Colom, J. (Eds.). (2014). Reframing addiction: policies, processes and pressures. The ALICE RAP project.
Work area 3 / Work packages 7-9 – Transition probabilities between different stages of substance use
PI: Prof. Jürgen Rehm
Funding: Alice Rap
Duration: 04/2013 - 03/2016
Objectives: Substance use disorders are usually preceded by a history of use initiation, periods of low-risk use, and risky patterns of use. Aim of the study was to contribute to our understanding of transition probabilities (TPs) between such patterns of use and respective influential factors. Methods: Panel data from three waves assessing a sample of German adolescents and young adults (N=3,021 at baseline) were used to calculate annual TPs for nicotine and alcohol use, taking a few important covariates into account. Use states were abstinence, use, risky use (for alcohol only), and harmful use and as covariates we considered age, gender, socioeconomic status (for alcohol only) and mental comorbidity. Age- and gender-specific TPs were used to simulate the prevalence of drinking states over the ages 14 to 30. For alcohol a four-state Markov model was fit and annual TPs and hazard ratios (HRs) were calculated based on that. Results: For nicotine the TPs were highest (≥80%) for staying in one state. TPs for going back to abstinence or use were higher in younger age groups (13-17) and very low in older age groups (>17, <10%). In older age groups (>17) TPs for becoming a user or harmful user were very low (<5%). For alcohol the highest TPs (≥70%) were found for staying in one state (abstinence, use, risky use) and for transitioning from harmful use to use. Lowest TPs were found between abstinence and risky or harmful use and between risky and harmful use (≤6%). Gender was found to influence transitions between abstinence and use, socioeconomic status was found to influence transitions between use and risky or harmful use. With one exception TPs decreased with increasing age.
Conclusion: German adolescents and young adults tend to be stable in the drinking states of abstinence, use of alcohol, risky single-occasion drinking and frequent risky single-occasion drinking. Females are less likely to transition to riskier states and more likely to transition back from frequent risky single-occasion drinking, higher age is associated with lower hazard of transitioning and participants of higher socio-economic status are less likely to transition from 'use of alcohol' to 'risky single-occasion drinking'.
Publication: Probst, C., Moyo, D., Purshouse, R., & Rehm, J. (2015). Transition probabilities for four states of alcohol use in adolescence and young adulthood: What factors matter when? Addiction, 110(8), 1272-1280. doi:10.1111/add.12985