Cocaine treatment demands in 10 western European countries: observed trends between 2011 and 2018.

AIMS: To describe cocaine treatment demand in 10 western European countries and to examine the size, direction and temporality of recent trends in the proportion of cocaine users among all clients entering treatment. DESIGN: Aggregated data collected through the European Union standardized treatment demand monitoring system (TDI) between 2011 and 2018 were used. SETTING: Belgium, England, France, Germany, Ireland, Italy, Luxembourg, Spain, Switzerland and the Netherlands. PARTICIPANTS: In total, more than 700 000 cocaine treatment records were analysed. Clients in treatment for cocaine as primary drug were predominantly male (85%), with an average age of 35 years. MEASUREMENTS: Number of treatment episodes for substance use and for cocaine as primary or secondary drug were collected year- and country-wise. When available, powder cocaine and crack and patients with and without previous treatment were differentiated. FINDINGS: Among the participating countries the share of cocaine as primary drug in treatment demand ranged between 4.7% [95% confidence interval (CI) = 4.6-4.9%] in Germany and 43.1% in Spain (95% CI = 42.6-43.5%). The general trend analysis showed a decreasing proportion of cocaine-related treatment entrants between 2011 and 2014 among all subgroups followed by a strong increase in 2015. The increase appeared stronger than for powder cocaine. Seven of 10 countries observed a recent significant increase in the proportion of treatment entrants reporting cocaine as the primary substance: Belgium [annual percentage change (APC) = 9.6%, P < 0.01], England (APC = 14.9%, P < 0.05), France (APC = 21.8%, P < 0.01), Ireland (APC = 28.2%, P < 0.01), Italy (APC = 7.8%, P < 0.01), Spain (APC = 7.0%, P < 0.05) and Switzerland (APC = 12.0%, P < 0.05). Trends were similar when looking at cocaine reported as primary or adjunctive substance. CONCLUSIONS: Despite substantial country-specific variation regarding cocaine prevalence and treatment demand, there has been an overall significant increase since 2015 in the share of cocaine-related treatment demand in western Europe.

Social roles among recruits in Switzerland: Do social roles relate to alcohol use and does role change have an impact?

INTRODUCTION: Young men are likely to report high levels of alcohol use. Previous studies found a reduction in alcohol use when adopting adult social roles. This study examines the frequency of parenthood, partnership and stable employment among young men in Switzerland. It tests whether the alcohol use of those with adult social roles differs from those without and whether changes in social roles relate to changes in alcohol use. METHODS: Data was available from 5025 men (20.0 years) at baseline (August 2010 to November 2011) and 15 months later. Changes in social roles and their impact on alcohol use were examined in multiple regression models. RESULTS: At baseline, 15.8% had a job and 4.9% a stable partner, and 1.5% had a child or were expecting one (30.5%, 6.1% and 2.2% at follow-up). Having a partner was associated with a significant decrease in annual frequency of drinking and weekly risky single-occasion drinking (RSOD) at follow-up. A higher number of social roles at follow-up was associated with a significant decrease in weekly RSOD. Apart from a significant decrease in weekly RSOD among those remaining in a stable partnership, role development was not found to have significant effects on alcohol use between baseline and follow-up. CONCLUSIONS: In Switzerland, an early engagement in permanent social roles is uncommon. Nevertheless, holding single or multiple social roles was commonly associated with reduced alcohol use, although not always significantly so. In western European countries, the engagement in adult social roles is postponed to later ages.

Regional abundance of on-premise outlets and drinking patterns among Swiss young men: district level analyses and geographic adjustments.

INTRODUCTION AND AIMS: This study investigated the associations of alcohol outlet density with specific alcohol outcomes (consumption and consequences) among young men in Switzerland and assessed the possible geographically related variations. DESIGN AND METHODS: Alcohol consumption and drinking consequences were measured in a 2010-2011 study assessing substance use risk factors (Cohort Study on Substance Use Risk Factors) among 5519 young Swiss men. Outlet density was based on the number of on- and off-premise outlets in the district of residence. Linear regression models were run separately for drinking level, heavy episodic drinking (HED) and drinking consequences. Geographically weighted regression models were estimated when variations were recorded at the district level. RESULTS: No consistent association was found between outlet density and drinking consequences. A positive association between drinking level and HED with on-premise outlet density was found. Geographically weighted regressions were run for drinking level and HED. The predicted values for HED were higher in the southwest part of Switzerland (French-speaking part). DISCUSSION AND CONCLUSIONS: Among Swiss young men, the density of outlets and, in particular, the abundance of bars, clubs and other on-premise outlets was associated with drinking level and HED, even when drinking consequences were not significantly affected. These findings support the idea that outlet density needs to be considered when developing and implementing regional-based prevention initiatives.

Influence from friends to drink more or drink less: a cross-national comparison.

Drinking habits are socially patterned and social networks influence individuals' drinking behaviors. Previous studies have focused primarily upon the influence from family members to drink less. Those studies that have focused upon peer influence have been largely confined to social norms among adolescent and college-age drinkers. By contrast, based in adult populations, this article examines exhortations from friends not only to reduce alcohol consumption but also to increase it. Survey data in 15 countries that participate in the Gender, Alcohol and Culture: An International Study project (GENACIS) were used to test whether there were country and gender differences concerning the influence to drink less or to drink more by friends and examine if this was affected by the drinking behavior. The findings revealed that those influenced to drink less had more heavy episodic drinking (HED) occasions than those who did not report such influence. By contrast, influence to drink more, originating mainly from same-sex friends, may be more the result of social situations that encourage all drinkers, regardless of their frequency of HED occasions. At the country level, influence to drink less for both sexes decreased with the proportion of drinkers in a country. Similarly, influence to drink less for both sexes also decreased in countries where gender roles were more egalitarian. Thus, in countries where alcohol use is more widespread and fewer differences are observed between male and female gender role expectations, fewer people were influenced to drink less. These findings have implications for social and behavioral strategies designed to reduce alcohol-related harm across a wide range of cultures.