Validity and Psychometric Properties of the Internet Gaming Disorder Scale in Three Large Independent Samples of Children and Adolescents.

BACKGROUND: Problematic gaming has become a major health issue in children and adolescents resulting in the need for targeted valid and reliable screening instruments. This study aimed to explore the psychometric properties and criterion validity of the widely used 9-item Internet Gaming Disorder Scale (IGDS) in young gamers. METHODS: Three independent samples were drawn from socio-demographically representative cross-sectional telephone surveys collected in the years 2016 (N = 762), 2017 (N = 777), and 2018 (N = 784) and analyzed separately. RESULTS: The IGDS revealed psychometric properties suitable for screening in large samples. Cronbach's alpha was 0.563, 0.724, and 0.778. The unidimensionality assumption was challenged. At-risk and pathological gamers compared to normal gamers reported longer digital media use and more emotional symptoms and hyperactivity/inattention with clinical relevance to medium effect sizes. The comparison of at-risk and pathological gamers indicated a partial distinction between the two problematic gaming groups. CONCLUSIONS: The IGDS could be shown to be an overall suitable and valid tool to identify pathological gamers in childhood and adolescence according to the DSM-5 criteria on a population level. However, the polythetic structure limits comparability with the recent ICD-11 criteria. At-risk gamers appeared as a heterogeneous group warranting more research.

Phosphatidylethanol Reliably and Objectively Quantifies Alcohol Consumption in Adolescents and Young Adults.

BACKGROUND: Alcohol contributes to numerous annual deaths and various societal problems not just in adult, but also in adolescent, populations. Therefore, it is vital to find methods for reliably detecting alcohol use for early preventative measures. Research has shown phosphatidylethanol (PEth) to be superior to self-report instruments and indirect biomarkers for alcohol consumption in adult populations. However, the transferability onto an adolescent population has not yet been investigated. METHODS: N = 106 adolescents and young adults aged between 13 and 21 years were included. PEth analysis using high-pressure liquid chromatography-tandem mass spectrometry was performed on dried blood spot samples. Self-report questionnaires for alcohol consumption (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C, and Timeline Followback, TLFB) and drug and alcohol consumption (Detection of Alcohol and Drug Problems in Adolescents, DEP-ADO) were completed by each participant. RESULTS: AUDIT-C scores showed large correlations with PEth 16:0/18:1 (rs  = 0.732) and PEth 16:0/18:2 (rs  = 0.661) concentrations. AUDIT-C with a cutoff value ≥3 was largely correlated with PEth 16:0/18:1 (η = 0.411) and showed a medium-sized correlation with PEth 16:0/18:2 (η = 0.397) concentrations. Using an AUDIT-C cutoff value ≥5 showed large correlations with both PEth 16:0/18:1 (η = 0.510) and PEth 16:0/18:2 (η = 0.497) concentrations, respectively. ROC curves indicated higher PEth concentrations are a good model for detecting positive AUDIT-C cutoff values (AUROC range: 0.800 to 0.849). PEth concentrations showed medium to large correlations with DEP-ADO and TLFB subscales (range rs  = 0.469 to 0.746). CONCLUSION: The results suggest that PEth is a reliable and objective marker for quantifying alcohol consumption in adolescents and young adults. This could be of importance for early preventative measures against hazardous alcohol consumption, which is increasingly common at younger ages.

[Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review]. / Zum aktuellen Stand der familienbasierten Prävention und Therapie bei substanzbezogenen Störungen im Kindes- und Jugendalter: Ein Überblick.

Current State of Family-Based Prevention and Therapy of Substance-Use Disorders in Children and Adolescents: A Review Adolescence is a vulnerable period for substance use disorders (SUD) as indicated by epidemiological studies. Research demonstrates the family's role for the etiology of SUD and provides a rationale for interventions based on family-associated risk and resilience factors. In this article, we summarize published results for family-based interventions from 2008-2018. Taken together, prevention programs can be effective when they focus on the promotion of broader developmental competencies and familial resources, rather than narrowly addressing substance use. Moreover, programs could benefit from targeting youth and parents as done in the "Strengthening Families Program 10-14"; most existing programs however target parents and do not include the adolescents. Family-based treatment programs with an evidence base are Multisystemic Therapy, Functional Family Therapy, Multidimensional Family Therapy and Brief Strategic Family Therapy. Overall, the effects of family-based interventions are small-to-middle sized but vary significantly across populations. Across the field of family-based interventions, there is a need for more knowledge on effective components and differential effects. The results could be improved by translational research such as on the emerging concept of mindfulness. Moreover, there is a need for implementation research and the effectiveness of service delivery programs on the community level in Germany.

Children with Elevated Psychosocial Risk Load Benefit Most from a Family-Based Preventive Intervention: Exploratory Differential Analyses from the German "Strengthening Families Program 10-14" Adaptation Trial.

While the effectiveness of substance use prevention programs such as the Strengthening Families Program 10-14 (SFP) has been demonstrated in the USA, European SFP adaptations have not replicated these sizable effects. Following the rationale of the risk moderation hypothesis positing that elevated risk groups may benefit more from a preventive intervention than lower-risk groups, we reanalyzed evaluation data from a randomized controlled trial testing the adapted German version of SFP (SFP-D). We hypothesized a differential impact of risk status on intervention results. The study employed a minimal control condition. Of the N = 292 participating children, 73.5% qualified as at-risk because they lived in a deprived urban district, and 26.5% qualified as high risk because they additionally scored as "difficult" in the German Strengths and Difficulty Questionnaire (parents' reports using gender- and age-specific German norms). Outcomes were children's self-reports on substance use, mental health, family functioning, and quality of life. Data were analyzed with repeated measures linear mixed models and relative risk analyses. The high-risk group in the SFP-D condition achieved the best results compared with all other groups, especially in mental health and quality of life. Relative risk analyses on tobacco [alcohol] abstinence showed that an additional percentage of 29.8% [16.0%] of high-risk children in nonabstinent controls would have remained abstinent if they had participated in SFP-D. We conclude that risk load influences the impact of substance use prevention programs and discuss to what extent differential analyses can add value to prevention research.

Short- to Midterm Effectiveness of a Brief Motivational Intervention to Reduce Alcohol Use and Related Problems for Alcohol Intoxicated Children and Adolescents in Pediatric Emergency Departments: A Randomized Controlled Trial.

OBJECTIVES: The proportion of children and adolescents receiving emergency care for acute alcohol intoxication (AAI) in Germany has sharply increased over the past years. Despite this, no randomized controlled trials (RCTs) have studied guideline- and evidence-based interventions to prevent future alcohol misuse within this population. The objective of our investigation was to evaluate the effectiveness of a brief motivational intervention (b-MI) to reduce drinking and associated problems within pediatric emergency departments (PED) in Hamburg, Germany. METHODS: This stratified cluster-RCT compared a widely established but modified targeted b-MI and treatment as usual (TAU) for patients recruited and treated on Fridays, Saturdays, or Sundays from July 2011 to January 2014 for AAI in EDs of six pediatric hospitals in Hamburg, Germany. Patients under the age of 18 years and their caregivers were included in the study. Intervention was delivered by trained hospital-external staff. The intervention group (n = 141) received a single-session b-MI with a telephone booster after 6 weeks and a brief consultation for caregivers. All intervention material was manual-based. The TAU control group (n = 175) received youth-specific written information on alcohol use and contact information for community resources. Primary outcomes were changes in binge drinking frequency, number of alcoholic drinks on a typical occasion, and alcohol-related problems using the brief Rutgers Alcohol Problem Index. Outcomes were measured by research assistants not involved in intervention delivery. Baseline data were collected in person at the PED, and follow-up data were collected via telephone 3 and 6 months after baseline. Secondary outcome was postenrollment health service utilization. Analyses were based on linear mixed models and intent to treat. RESULTS: A total of 86.1% (87.5%) of patients in the b-MI group and 82.4% (86.9%) in the TAU group provided valid outcome data after 3 (6) months, respectively. The differences between groups for all outcomes were statistically nonsignificant at both follow-ups (p > 0.05). After 3 months the mean change in binge drinking frequency was -1.36 (95% confidence interval [CI] = -1.81 to -0.91), a reduction of 62.1% in the b-MI group, and -1.29 (95% CI = -1.77 to -0.95), a reduction of 49.0% in the TAU group. The mean change in number of alcoholic drinks on a typical occasion was -2.24 (95% CI = -3.18 to -1.29), a reduction of 37.5% in the b-MI group, and -1.34 (95% CI = -2.54 to -0.14), a reduction of 26.4% in the TAU group. The mean change of alcohol-related problems was -6.72 (95% CI = -7.68 to -5.76), a reduction of 60.5% in the b-MI group, and -6.43 (95% CI = -7.37 to -5.49), a reduction of 58.3% in the TAU group. The differences in mean changes between groups were similar after 6 months for all outcomes. CONCLUSION: This study provides new information on the effectiveness of b-MIs delivered at discharge of young AAI patients in emergency care. Both trial groups reduced alcohol use and related problems but the b-MI was not associated with significant effects. Although the intervention approach appears feasible, further considerations of improving the outcomes for this relevant target group are required.

[Children with Multiple Risk Factor Exposition Benefit from the German "Strengthening Families Program"]. / Kinder mit multipler Risikoexposition profitieren von der Teilnahme an "Familien stärken!"

Children with Multiple Risk Factor Exposition Benefit from the German "Strengthening Families Program" The German adaptation of the substance use-preventive family-based Strengthening Families Program 10-14 (SFP, Iowa version) was evaluated in a longitudinal two-year follow-up trial. Participants were N = 292 children with a mean age of twelve years at baseline, and N = 292 parents. We employed a multi-centric, randomized-controlled, two-armed (SFP vs. minimal control condition) study design. Following a "risk moderation hypothesis", we assumed that children with an elevated risk-exposition R(+) would benefit more than children with a low risk-exposition R(-) irrespective of the preventive intervention, and that R(+) under SFP would benefit more than R(+) under the minimal control condition. "Risk-exposition" was measured in correspondence with the Communities That Care Youth Survey-questionnaire. A total of 28 % of children were classified with an elevated risk level. Children's reports confirmed our hypothesis: R(+) report a total of eleven improvements, four of these being significantly more distinct than in the other groups (Anxiety-Depressivity, Punitive Parenting of mother, Punitive Parenting of father, Unbalanced family functioning). In three measures an improvement appears solely in R(+) under SFP (Satisfaction with family functioning, School Attachment and Peer Relationship Quality, Quality of Life). Parents' reports showed a similar tendency, but were less pronounced.

[Treatment of alcohol-related disorders in children and adolescents: Age-specific treatment recommendations from the new interdisciplinary S3-guideline]. / Behandlung alkoholbezogener Störungen bei Kindern und Jugendlichen: Altersspezifische Empfehlungen der neuen interdisziplinären S3-Leitlinie.

Objective: Alcohol-related disorders typically have an early onset. However, current treatment provisions often fail to address developmental aspects adequately. Recently, the new evidence- and interdisciplinary consensus-based German S3-guideline (National Clinical Practice Guideline) was established for the screening, diagnosis, and treatment of alcohol-related disorders in young patients. For the first time it includes population-specific recommendations. Method: For this new S3-guideline, 23 source guidelines, 28 systematic reviews, and 2,213 study reports were analyzed. An interdisciplinary consensus conference devised 174 recommendations with 14 specific recommendations for children and adolescents. Depending on the quality of evidence, they issued "must," "should," and "can" recommendations or a "clinical consensus point (CCP)." Results: For the psychotherapeutic treatment of children and adolescents with alcohol-related disorders, a "must" recommendation was devised for motivational interviewing, cognitive behavior therapy, and inclusion of family members in treatment. Recommendations for family-based therapies are heterogeneous. For psychosocial therapies (psychoeducation, parent counseling, ergotherapy, also hospital schools) a CCP was devised. Concerning pharmacological treatment, the evidence base was insufficient; only for treating comorbid disorders (ADHS) could a CCP be derived. As to differential indications, elevated risks for suicide, for treatment dropout, and for delinquency influenced by copatients should be considered (CCP). Conclusions: Numerous population-specific recommendations have been issued for the treatment of alcohol-related disorders in youths. However, urgent research requirements have been identified especially in medical drug treatment.

Evaluation of a German version of the Strengthening Families Programme 10-14: a randomised controlled trial.

BACKGROUND: The purpose of this study is to evaluate the effects of a German adaptation of the Strengthening Families Programme 10-14 (SFP 10-14; Familien Stärken). METHODS: A multi-centre randomised controlled trial comparing the German SFP version consisting of seven sessions and four booster-sessions with a minimal intervention on parenting as control condition. Outcomes comprise measures of adolescent substance use (initiation) and behaviour problems and are assessed at baseline, after programme delivery and at 6- and 18-month follow-ups. Primary outcomes were lifetime tobacco, alcohol and cannabis use at 18 months. Data of n = 292 families were analysed using baseline adjusted logistic regressions and mixed models. RESULTS: We observed reduced rates of lifetime tobacco use in analyses with follow-up respondents, but not in data using the complete intention to treat sample with multiple imputation estimates for missing data. Parents reported fewer adolescent behaviour problems in analyses with the total sample and multiple imputed data, but not in data with follow-up respondents only. There were no other significant effects of SFP 10-14. CONCLUSION: Overall the medium size effects found in previous US trials could not be replicated in a German context.

Weighing the Evidence: A Systematic Review on Long-Term Neurocognitive Effects of Cannabis Use in Abstinent Adolescents and Adults.

Findings on neurocognitive effects of sustained cannabis use are heterogeneous. Previous work has rarely taken time of abstinence into account. In this review, we focus on understanding sustained effects of cannabis, which begin when clinical symptoms of the drug have worn off after at least 14 days. We conducted a search between 2004 and 2015 and found 38 studies with such a prolonged abstinence phase. Study-design quality in terms of evidence-based medicine is similar among studies. Studies found some attention or concentration deficits in cannabis users (CU). There is evidence that chronic CU might experience sustained deficits in memory function. Findings are mixed regarding impairments in inhibition, impulsivity and decision making for CU, but there is a trend towards worse performance. Three out of four studies found evidence that motor function remains impaired even after a time of abstinence, while no impairments in visual spatial functioning can be concluded. Functional imaging demonstrates clear differences in activation patterns between CU and controls especially in hippocampal, prefrontal and cerebellar areas. Structural differences are found in cortical areas, especially the orbitofrontal region and the hippocampus. Twenty studies (57 %) reported data on outcome effects, leading to an overall effect size of r mean = .378 (CI 95 % = [.342; .453]). Heavy use is found to be more consistently associated with effects in diverse domains than early age of onset. Questions of causality-in view of scarce longitudinal studies, especially those targeting co-occurring psychiatric disorders-are discussed.

Exploring Attachment Patterns in Patients With Comorbid Borderline Personality and Substance Use Disorders.

Studies exploring attachment patterns in samples of patients with borderline personality disorder (BPD) report a combination of preoccupied and fearful-avoidant patterns. This has been interpreted as reflecting the approach-avoidance dilemma of BPD. Comorbid substance use disorders (SUD) have not been considered in these studies, despite the high proportions of SUD among BPD patients and despite the more avoidant attachment in SUD samples. This cross-sectional, naturalistic study explores attachment patterns in a sample of comorbid (BPD and SUD) patients, comparing them to two samples of patients with either SUD or BPD only. Within-group comparisons replicated findings of both preoccupied and fearful-avoidant attachment in BPD and comorbid groups. But between-group comparisons showed that comorbid patients were significantly less preoccupied (p = 0.018) and more dismissing-avoidant (p = 0.030). Although both groups were similar in several psychiatric measures, attachment patterns of the comorbid group were more similar to substance abusers than to borderline patients.

[Sustainable Transfer of the Health Network Alcohol Use in Adolescence: A Cooperation of Research, Practice and Politics]. / Nachhaltiger Transfer des Gesundheitsnetz Alkohol im Jugendalter: Eine Kooperation aus Forschung, Praxis und Politik.

OBJECTIVES: Testing the effectiveness of a brief motivational intervention in an emergency-setting for adolescents with acute alcohol intoxication in a randomized-controlled trial and sustained implementation within mental health care of Hamburg. METHODS: Modification and evaluation of an established indicated prevention program in a transdisciplinary cooperation using a pragmatic RCT-research design. CONCLUSIONS: This study contributes to the evidence base of an established prevention program which allows for broad dissemination building on existing capacities for broad dissemination.

Drinking patterns of alcohol intoxicated adolescents in the emergency department: A latent class analysis.

INTRODUCTION: The increasing number of children and adolescents in need of emergency medical treatment following acute alcohol intoxication has been a major public health concern in Europe in recent years. However, little is known about drinking habits and associated risks in this population. To our knowledge, this is the first study to examine drinking patterns and associated risks in adolescent emergency department patients following alcohol intoxication. The aim of this study is to establish a classification system for admitted adolescents METHODS: Latent class analysis was used to identify subgroups of adolescents with distinct patterns of habitual drinking as defined by the quantity of consumed alcohol on a typical drinking occasion, frequency of binge drinking and drunkenness, alcohol-related problems, prior alcohol-related hospitalizations and alcohol-related risk behaviors. Subgroup characteristics were examined with regard to sociodemographics, other substance use and psychosocial problems using analysis of variance (ANOVA) and chi-square tests. RESULTS: A total of 316 adolescents aged 12-17 treated in 6 urban emergency departments in Germany were analyzed. Five classes of drinking patterns were identified: one class representing low-risk drinking (class 1 "low-risk" (61.2%)), two classes representing risky drinking (class 2 "moderate-risk" (5.7%) and class 3 "frequent drunk" (15.8%)), as well as two classes representing high-risk drinking (class 4 "alcohol-related problems" (11.4%) and class 5 "excessive drinking" (5.1%)). Membership of classes 4 and 5 was associated with the most severe psychosocial problems, especially with regard to aggressive-dissocial behaviors. The CRAFFT-d and brief RAPI screening tools allowed identifying the two risky drinking classes and two high-risk drinking classes. CONCLUSIONS: Our findings provide the first in-depth analysis of habitual drinking in this study population and may help practitioners to better tailor interventions to patients' needs by using the identified classes as a form of classification system for admitted adolescents.

Brief motivational intervention for adolescents treated in emergency departments for acute alcohol intoxication - a randomized-controlled trial.

BACKGROUND: Alcohol misuse among youth is a major public health concern and numbers of adolescents admitted to the emergency department for acute alcoholic intoxication in Germany are recently growing. The emergency setting offers an opportunity to reach at-risk alcohol consuming adolescents and provide brief interventions in a potential "teachable moment". However, studies on brief interventions targeting adolescents in emergency care are scarce and little is known about their effectiveness when delivered immediately following hospitalization for acute alcohol intoxication. In this protocol we present the HaLT-Hamburg trial evaluating a brief motivational intervention for adolescents treated in the emergency department after an episode of acute alcoholic intoxication. METHODS: The trial design is a parallel two-arm cluster randomized-controlled trial with follow-up assessment after 3 and 6 months. N = 312 participants aged 17 years and younger will be recruited Fridays to Sundays in 6 pediatric clinics over a period of 30 months. Intervention condition is a manual-based brief motivational intervention with a telephone booster after 6 weeks and a manual-guided intervention for caregivers which will be compared to treatment as usual. Primary outcomes are reduction in binge drinking episodes, quantity of alcohol use on a typical drinking day and alcohol-related problems. Secondary outcome is further treatment seeking. Linear mixed models adjusted for baseline differences will be conducted according to intention-to-treat (ITT) and completers (per-protocol) principles to examine intervention effects. We also examine quantitative and qualitative process data on feasibility, intervention delivery, implementation and receipt from intervention providers, receivers and regular emergency department staff. DISCUSSION: The study has a number of strengths. First, a rigorous evaluation of HaLT-Hamburg is timely because variations of the HaLT project are widely used in Germany. Second, prior research has not targeted adolescents in the presumed teachable moment following acute alcohol intoxication. Third, we included a comprehensive process evaluation to raise external validity. Fourth, the study involved important stakeholders from the start to set up organizational structures for implementation and maintaining project impact. TRIAL REGISTRATION: Current Controlled Trials ISRCTN31234060 (April 30th 2012).

[Substance-related and addictive disorders in the DSM-5]. / Substanzgebrauchsstörung und nicht-substanzgebundene Süchte im DSM-5.

This paper concerns the revised classification of Substance-Related and Addictive Disorders in the fifth edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In DSM-5, substance use disorders are diagnosed on a continuum of severity specified by explicit operationalized diagnostic criteria. "Gambling disorder" is the only behavioral addiction added to the DSM. Furthermore, preliminary criteria for "Caffeine Use Disorder" and "Internet Gaming Disorder" have now been defined in the manual. Adopting the DSM-5 criteria catalogue within the German treatment system for children and adolescents with substance use disorders or at risk for developing substance use disorders would be of great significance. Since the diagnostic threshold is lower, more patients would be eligible for treatment. Thus, early intervention in the area of substance use disorders should be strengthened, a development that appears to be highly desirable from the perspective of child and adolescent psychiatry. The current Section III diagnoses, with their now comprehensive diagnostic criteria, facilitate more internationally compatible research.

Implementing and evaluating the German adaptation of the "Strengthening Families Program 10 - 14"- a randomized-controlled multicentre study.

BACKGROUND: Substance use problems in childhood and adolescence can severely impact youth's physical and mental well-being. When substance use is initiated early, the risk for moving from hazardous substance use to substance use disorders (SUD) is particularly high to developmentally induced biological and psychological vulnerability towards chronic trajectories in youth. Thus, risk factors for developing SUD should be addressed early in life by adequate preventive measures reaching out to children, adolescents, and their families. The study described in this protocol will test the effectiveness of the German adaptation of the Strengthening Families Program for Parents and Youth 10-14 (SFP 10-14) aimed at ten to 14 year old adolescents and their caregivers. METHODS/DESIGN: The study is conducted in four large German cities by counselling centres in the areas of youth welfare, social work and addiction aid. The effectiveness of the manualised group programme "Familien Stärken" consisting of seven sessions and four booster-sessions is tested among N = 288 children and participating parents in a multicentre randomised controlled trial with standardised assessment instruments. The control condition receives a minimal 2-hour intervention on parenting delivered in a school setting. Data are collected shortly before and after as well as six and 18 months after the intervention. We expect to replicate the favourable effects of the SFP 10-14 programme in the United States in the area of substance use initiation, family functioning and individual psychosocial adjustment. DISCUSSION: The trial is expected to contribute to the growing literature on family-based preventive interventions, their effectiveness and feasibility. It is in line with several other current European efforts aimed at strengthening families against the detrimental effects of substance abuse in youth. The results of these trials will expand our knowledge on adapting evidence-based interventions and delivering them in diverse cultures and settings. TRIAL REGISTRATION: Current Controlled Trials ISRCTN90251787.

Selective prevention programs for children from substance-affected families: a comprehensive systematic review.

Children from substance-affected families show an elevated risk for developing own substance-related or other mental disorders. Therefore, they are an important target group for preventive efforts. So far, such programs for children of substance-involved parents have not been reviewed together. We conducted a comprehensive systematic review to identify and summarize evaluations of selective preventive interventions in childhood and adolescence targeted at this specific group. From the overall search result of 375 articles, 339 were excluded, 36 full texts were reviewed. From these, nine eligible programs documented in 13 studies were identified comprising four school-based interventions (study 1-6), one community-based intervention (study 7-8), and four family-based interventions (study 9-13). Studies' levels of evidence were rated in accordance with the Scottish Intercollegiate Guidelines Network (SIGN) methodology, and their quality was ranked according to a score adapted from the area of meta-analytic family therapy research and consisting of 15 study design quality criteria. Studies varied in program format, structure, content, and participants. They also varied in outcome measures, results, and study design quality. We found seven RCT's, two well designed controlled or quasi-experimental studies, three well-designed descriptive studies, and one qualitative study. There was preliminary evidence for the effectiveness of the programs, especially when their duration was longer than ten weeks and when they involved children's, parenting, and family skills training components. Outcomes proximal to the intervention, such as program-related knowledge, coping-skills, and family relations, showed better results than more distal outcomes such as self-worth and substance use initiation, the latter due to the comparably young age of participants and sparse longitudinal data. However, because of the small overall number of studies found, all conclusions must remain tentative. More evaluations are needed and their quality must be improved. New research should focus on the differential impact of program components and delivery mechanisms. It should also explore long-term effects on children substance use, delinquency, mental health, physical health and school performance. To broaden the field, new approaches to prevention should be tested in diverse cultural and contextual settings.

[Psychopathology and achievement motivation in adolescents with pathological internet use]. / Psychische Befindlichkeit und Leistungsmotivation bei Jugendlichen mit pathologischem Internetgebrauch.

In Germany, the internet is used by 69.4% of the population or 49 million people, and 100% of adolescents (between 14 to 19 years of age) spend time in the internet at least occasionally. An excessive use of the internet may lead to negative psychosocial consequences and changes in behaviour. This phenomenon is named "pathological internet use". Until now, there are only few studies published that investigate mental well being in German adolescents with pathological internet use. 16 participants of an outpatient treatment program for pathological internet use and 16 healthy adolescents were compared on self-reported levels of psychopathology (SPS-J), achievement motivation (FLM 7-13) and personal experience of attention deficit (FEDA). There were no differences in age, gender, intelligence or education between the two groups. Pathological internet users exhibited significantly elevated scores on self-esteem problems and the summary score of the SPS-J and significantly lower scores on FLM 7-13-dimensions "achievement ambition" and "perseverance/diligence" compared to controls. The results revealed that adolescents with pathological internet use report a higher level of psychopathology and lower levels of achievement motivation and drive. These findings should be taken into account when conceptualizing treatments for pathological internet users.

Binge drinking in childhood and adolescence: epidemiology, consequences, and interventions.

BACKGROUND: Episodic excessive alcohol consumption ("binge drinking") among children and adolescents has become a serious public health problem in Germany and is associated with a variety of risks. METHODS: Selective literature search of the Ovid Medline database from 1998 to 2008. RESULTS: Episodic excessive alcohol consumption is associated not only with somatic complications, but also with traffic accidents and other types of accident, violent behavior, and suicide. The more frequently a child or adolescent drinks to excess, and the younger he or she is, the greater is the risk of developing an alcohol-related disorder (alcohol misuse or dependence syndrome). In the USA, brief motivational interventions have been shown to have a small to medium-sized beneficial effect in reducing further binge drinking and its complications. CONCLUSIONS: The intervention HaLT ("Stop," also an acronym for Hart am Limit--"near the limit") is performed in a number of regions in Germany. Further types of brief motivating intervention should be developed and evaluated to prevent the development of alcohol-related disorders, where indicated, in children and adolescents that engage in binge drinking.

Heroin as an attachment substitute? Differences in attachment representations between opioid, ecstasy and cannabis abusers.

Earlier studies indicated a relation between fearful-avoidant attachment and substance abuse. This study compares attachment representations (Family Attachment Interview; Bartholomew & Horowitz, 1991) of three groups of substance abusers and non-clinical controls. Heroin abusers (N = 22) were mainly fearful-avoidant, ecstasy abusers (N = 31) were preoccupied, fearful-avoidant and dismissing-avoidant, cannabis abusers (N = 19) were mainly dismissing and secure, and controls (N = 22) were mainly secure. Groups did differ in their level of psychosocial functioning (GAF) (cannabis > ecstasy > opioids). Differences in attachment prevailed when GAF was controlled. Based on the self-medication hypothesis we understand the preferences for specific substances to be influenced by specific attachment strategies. Heroin seems to be used as an emotional substitute for lacking coping strategies. Cannabis seems to be used to support existing deactivating and distancing strategies. Ecstasy abuse was related to insecure attachment but not to a specific attachment strategy.

Insecure family bases and adolescent drug abuse: a new approach to family patterns of attachment.

A new approach to assessing family attachment patterns is presented, using a composite measure of individual attachment representations based on the Bartholomew Attachment Interview. A cluster analysis yielded three different patterns in a sample of N = 37 families with a drug dependent adolescent (age 14 - 25) and both biological parents. A "triangulated" pattern (mothers: preoccupied; fathers: dismissing; adolescents: fearful) was found in 65% of the sample. A total of 19% showed an "insecure" pattern (mothers, fathers, and adolescents: fearful) and 16% a "near-secure" pattern (mothers and adolescents: secure; fathers preoccupied). Preliminary comparisons between these groups indicate differences in comorbid psychiatric disorders, in individual and family functioning, but not in addiction severity. There is a trend towards differences in outcome of family therapy. Implications for treatment and further research are discussed.