Epidemiology of substance use and substance use disorders in Germany

The objective of this literature review was to investigate the epidemiological basis in public health and clinical treatment for four psychotropic substance groups (i.e., alcohol, tobacco, illegal drugs, and pharmaceuticals) in Germany. The following issues were addressed: (1) what impact does the consumption of these psychoactive substances have on the overall burden of diseases to the general public compared to other disorders? (2) What are the prevalences of these four substance groups regarding consumption, substance use disorders, and sequelae in Germany? (3) How many people with a substance-related diagnosis have been treated within the addiction help system? (4) What are the costs of substance-related disorders and problems? Epidemiological data, mainly representative samples in Germany about use and abuse of legal and illegal drugs, were analyzed. For cost-benefit analyses, only the most recent studies were used. Alcohol-related disorders are among the ten most common diseases with the strongest impact on the overall burden of disease. The prevalence rates of substance-related diagnoses in 2006 (based on the last 12 months for 18-64 year olds) were 7.3% for nicotine dependence, followed by alcohol dependence (2.4%), alcohol misuse (3.8%), and illegal substances (0.6%). Alcohol consumption in Germany, defined as the per capita consumption of pure alcohol, declined between 1980 and 2007. However, extreme alcohol abuse in adolescents has increased. Inpatient admissions due to acute alcohol disorders increased more in adolescents than in the general population. Particularly critical is the increasing number of 10- to 15-year-old girls. The availability of treatment to patients with pharmaceutical-related disorders and with nicotine disorders is very low. Cost-benefit studies for the consequences of consuming various substances show that netto costs regarding alcohol taxes were 316 Euro per capita of the German population between 18 and 65 years for alcohol disorders and 133 Euro for nicotine dependence. The availability of nicotine and pharmaceutical dependence assistance to patients should be improved in the primary and secondary care systems. The alcohol abuse of adolescents requires specific observation and intervention. In order to adequately plan treatment systems for addiction, an estimation of the need for help and the acceptance of the help should be explored and analyzed in scientific studies.