Alcohol is the most widely used psychoactive drug on earth and continues to be responsible for a substantial burden of death and disability. Mitigating these harms is an important focus of any healthful society. Population-level alcohol policy strategies may be employed to decrease these harms and improve population health. To assist towards these goals, this dissertation has two research objectives relating to the estimation and mitigation of alcohol harms: (1) to complete a series of studies regarding the Alcohol Total Consumption Model (TCM) and (2) to specify and test a novel alcohol health harms estimator and alcohol policy scenario modeler, the International Model of Alcohol Harms and Policies (InterMAHP). The TCM is an important theory in alcohol studies and connects alcohol policies, per capita alcohol consumption and alcohol-attributable (AA) harms in a unified social theory. In brief, policies are expected to reflect on population-level consumption, which in turn is the most important predictor of alcohol harms. The TCM theorizes that change should flow directionally through the model – a policy expected to decrease consumption would be predicted to decrease alcohol harms. This theory has been critical towards informing alcohol control policies in the past five decades. In this dissertation, a series of studies were conducted to test the assumptions of the TCM, to test their continued viability. Study A is a comprehensive systematic review and series of meta-analyses that established the link between alcohol policies influencing day/hours of sale and outlet density and per capita consumption. Study B is a primary research study that examined the direct effect of a changed alcohol policy on alcohol-related ED visits, in the context of Saskatchewan. Studies C and D establish the link between alcohol consumption and AA mortality and morbidity through mathematical specification of InterMAHP. Next, the model was applied to the exemplar of AA mortality in Canada in 2016. Last, Study E extended InterMAHP functionalities to include modeling changes in AA harms expected from potential or realized per capita consumption changes resulting from policy change. An application was provided in the context of Québec. The results of this dissertation research provide some support, in a modern context, to the relationships defined in the TCM. The findings suggest that the TCM continues to be a largely appropriate conceptual model in consideration of alcohol policy-making. InterMAHP provides global alcohol researchers with a novel model towards estimating the health harms of alcohol. / Graduate / 2020-04-09

Objective: We present the prevalence and incidence rates of alcohol, nicotine, and illicit substance use, abuse, and dependence in a sample of German adolescents and young adults. Patterns of onset, cohort trends, and use of various substance classes are also analyzed. Method: A prospective longitudinal epidemiological study with a representative sample of adolescents and young adults (n = 3,021; baseline age range = 14–24 years) was conducted in Munich, Germany. Participants were assessed between 1995 and 1999 with the Munich-Composite International Diagnostic Interview. Results: Cumulative lifetime incidence (up to age 28) of any substance abuse or dependence was 43.8%, and 12-month prevalence of any substance abuse or dependence was 24.4%. The lifetime incidence of nicotine dependence was most frequent (24.8%), followed by alcohol abuse (19.3%) and alcohol dependence (9.2%); 61.7% endorsed the regular use of a substance for at least one circumscribed period during their lifetime. Age-specific incidence rates and age at onset of substance use disorders differed by age cohorts. Furthermore, nicotine dependence was significantly associated with illicit substance use disorders (HR = 2.6, 95% CI 1.7–4.0). An interactive relationship between age, age at onset of nicotine dependence, and subsequent onset of illicit substance use disorders was found. Conclusions: Since the baseline investigation in 1995, high incidence rates of substance use disorders and substance use have been observed in this young German sample. Especially younger cohorts report significantly earlier ages at onset of abuse and dependence. There also seems to be a trend towards a secondary age at onset peak of nicotine dependence after the onset of illicit drug use disorders. Further investigations are needed to study these patterns in younger samples. However, results emphasize the need for a combined prevention of illicit drugs and nicotine dependence. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.