After reviewing currently available diagnostic assessment instruments for substance use disorders this paper describes the format and structure of the Munich-Composite International Diagnostic Interview (M-CIDI) substance disorder section. In addition, the test-retest reliability of diagnoses and criteria for nicotine, alcohol, illegal and prescription drugs, is reported. Findings obtained in community sample of adolescents and young adults indicate that the substance section is acceptable for almost all types of respondents, efficient in terms of time and ease of administration as well as reliable in terms of consistency of findings over time. The test-retest reliability over a period of an average of 1 month, as examined by two independent interviewers indicates good-to-excellent kappa values for all substance disorders assessed, with significant kappa values ranging between 0.55 for drug abuse and 0.83 for alcohol abuse. There was also fairly consistently high agreement for the assessment of single DSM-IV diagnostic criteria for abuse and dependence as well as the M-CIDI quantity-frequency and time-related questions. To conclude, although – unlike previous studies – this study was conducted in a community sample and not in patients and used considerably longer time intervals of more than a month between investigations, our M-CIDI reliability findings are at least as high as those from previous studies.

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.

After reviewing currently available diagnostic assessment instruments for substance use disorders this paper describes the format and structure of the Munich-Composite International Diagnostic Interview (M-CIDI) substance disorder section. In addition, the test-retest reliability of diagnoses and criteria for nicotine, alcohol, illegal and prescription drugs, is reported. Findings obtained in community sample of adolescents and young adults indicate that the substance section is acceptable for almost all types of respondents, efficient in terms of time and ease of administration as well as reliable in terms of consistency of findings over time. The test-retest reliability over a period of an average of 1 month, as examined by two independent interviewers indicates good-to-excellent kappa values for all substance disorders assessed, with significant kappa values ranging between 0.55 for drug abuse and 0.83 for alcohol abuse. There was also fairly consistently high agreement for the assessment of single DSM-IV diagnostic criteria for abuse and dependence as well as the M-CIDI quantity-frequency and time-related questions. To conclude, although – unlike previous studies – this study was conducted in a community sample and not in patients and used considerably longer time intervals of more than a month between investigations, our M-CIDI reliability findings are at least as high as those from previous studies.

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.

Eltern mit suchterkrankten Jugendlichen leiden an einem erhöhten Elternstress (ES). Die Gründe für dieses erhöhte Stresserleben sind aktuell noch wenig erforscht. Das Hauptaugenmerk dieser Arbeit war es, potenzielle sozioökonomische Stressoren, welche einen erhöhten ES erklären, zu identifizieren. Zu diesem Zweck füllten PatientInnen und ProbandInnen im Rahmen der großangelegten DELTA-Studie neben vielen weiteren Fragebögen den Elternstressfragebogen (ESF) aus. In einem anderen Fragebogen wurden Daten zur sozioökonomischen Situation der Familien erfasst, außerdem kam der Drug Use Disorder Identification Test (DUDIT) zum Einsatz, um die Suchtstärke der ProbandInnen zu ermitteln. Insgesamt 81 PatientInnen, welche im Zeitraum von Dezember 2017 bis Oktober 2020 in der Suchtambulanz des Universitätsklinikum Dresden behandelt wurden, erfüllten die Einschlusskriterien und wurden der abschließenden Studienkohorte dieser retrospektiven Arbeit hinzugefügt. Eine parallel dazu erstellte Kontrollgruppe beinhaltete 28 ProbandInnen. Es erfolgten deskriptive und inferenzstatistische Analysen der erhobenen Daten. Mittels Varianzanalyse mit Kovariaten (ANCOVA) sollte herausgefunden werden, welche Faktoren den ES beeinflussen. Der elterliche Erwerbsstatus, Schulabschluss und das objektiv messbare Einkommen waren nicht entscheidend für den ES. Auch die Suchtstärke des betroffenen Jugendlichen scheint keinen bedeutenden Einfluss zu haben. Die Varianzanalyse mit Kovariaten (ANCOVA) zeigte einen signifikanten Zusammenhang zwischen der Höhe des ES und der subjektiv wahrgenommenen finanziellen Situation (F(3,81) = 2,9, p = ,04, η2 par = 0,123). Je schlechter die Familien ihre finanzielle Lage einschätzten, desto höher war der ES. Die Ergebnisse legen die Vermutung nahe, dass die Substanzkonsumstörung (SKS) der Kinder selbst der Auslöser für einen erhöhten ES sein könnte. Eine finanzielle Unterstützung der betroffenen Familien sowie eine Beratung zum Ressourcenmanagement scheinen zur Unterstützung der SKS-Therapie sinnvoll.:1 EINLEITUNG 7 1.1 SUBSTANZKONSUMSTÖRUNGEN BEI JUGENDLICHEN 7 1.1.1 EPIDEMIOLOGIE 8 1.1.2 DIAGNOSEKRITERIEN UND SYMPTOME EINER SUBSTANZKONSUMSTÖRUNG 9 1.1.3 PSYCHOSOZIALE UND SOMATISCHE KONSEQUENZEN BEI SUBSTANZKONSUM IM JUGENDALTER 11 1.1.4 KONSEQUENZEN FÜR DAS UMFELD 12 1.2 ELTERNSTRESS ALS MÖGLICHE KONSEQUENZ EINER SUBSTANZKONSUMSTÖRUNG IM JUGENDALTER 14 1.2.1 NEUROBIOLOGIE DES STRESSES 14 1.2.2 ELTERNSTRESS – THEORETISCHER HINTERGRUND 15 1.3 PROBLEMSTELLUNG UND ZIELE DER ARBEIT 18 2 PATIENTEN UND METHODEN 20 2.1 STICHPROBE 20 2.1.1 BILDUNG DER ANALYSESTICHPROBE 20 2.2 STUDIENDESIGN 21 2.3 INSTRUMENTE 22 2.3.1 ELTERNSTRESSFRAGEBOGEN 22 2.3.2 SOZIODEMOGRAFIE-FRAGEBOGEN 23 2.3.3 DRUG USE DISORDER IDENTIFICATION TEST (DUDIT) 24 2.4 STATISTISCHE METHODEN 25 3 ERGEBNISSE 26 3.1 PATIENTENCHARAKTERISTIKA 26 3.2 SKALENVERGLEICH MIT NORMALBEVÖLKERUNG 28 3.3 PRÄDIKTOREN FÜR ELTERNSTRESS 29 4 DISKUSSION 32 4.1 EINORDNUNG UND INTERPRETATION DER ERGEBNISSE 32 4.2 IMPLIKATIONEN FÜR THERAPIE UND FORSCHUNG 36 4.3 LIMITATIONEN 37 5 ZUSAMMENFASSUNG 39 6 SUMMARY 40

Diese Dissertation fasst drei wissenschaftliche Arbeiten (Artikel) zusammen, welche sich mit veränderten Entscheidungsprozessen bei substanzgebundenen- und substanzungebundenen Abhängigkeitserkrankungen beschäftigen. In Artikel I wurde beobachtet, dass Probanden mit Alkoholkonsumstörung (AD) und Probanden mit Glücksspielstörung (GD) eine ähnlich reduzierte Verlustaversion gegenüber gesunden Kontrollen (HC) aufweisen. Beide Gruppen zeigten jedoch unterschiedliche neuronale Korrelate dieser reduzierten Verlustaversion: Während AD-Probanden eine unterschiedliche funktionelle Aktivität im dorsal-lateralen-präfrontalen Kortex im Vergleich zu HC aufwiesen, zeigten GD-Probanden eine veränderte funktionelle Konnektivität zwischen Amygdala und orbito-frontalem Kortex (OFC) bzw. medial-präfrontalem Kortex. In den Artikeln II und III wurde untersucht, ob das Verhalten und die neuronale Aktivität bei einer Verlustaversionsaufgabe bei GD-Probanden moduliert wird, wie dies in ähnlichen Studien bei AD-Probanden beobachtet wurde. Tatsächlich konnten GD-Probanden von HC-Probanden auf Grundlage ihrer veränderten Glücksspielannahme während der Präsentation spielbezogener Hinweisreize unterschieden werden. Auf neuronaler Ebene (Artikel III) konnten GD-Probanden von HC-Probanden durch die neuronalen Korrelate der reizinduzierten Veränderungen im Spielverhalten in einem Netzwerk aus Amygdala, Nucleus Accumbens und OFC unterschieden werden. Da in den Studien der Fokus auf Glücksspielabhängigkeit lag, also auf einer Abhängigkeit, welche unabhängig von Substanzmissbrauch existiert, deuten die hier diskutierten Ergebnisse darauf hin, dass verminderte Verlustaversion, sowie erhöhte reizinduzierte Veränderungen im Entscheidungsverhalten – welches beides bekannte Phänomene von Substanzabhängigkeiten sind – nicht durch Substanzmissbrauch zustande kommen. Beide Phänomene scheinen vielmehr erlernte Merkmale oder sogar prädisponierende Faktoren von Abhängigkeitserkrankungen zu sein. / This dissertation summarizes three papers concerned with decision-making impairments in a substance-based and a non-substance-based addictive disorder. In Paper I, it was observed that subjects with alcohol use disorder (AD) and subjects with gambling disorder (GD) show similarly reduced loss aversion. Both groups, however, showed different neural correlates of this reduced loss aversion: While AD subjects showed different functional activity in dorsal-lateral-prefrontal cortex compared to healthy controls (HC), GD subjects showed different amygdala-orbital-frontal and amygdala-medial-prefrontal connectivity. Paper II and III investigated whether behavior and neural activity in a loss aversion task is modulated in GD subjects, as has been observed in similar studies in AD subjects. The data showed that GD subjects can be distinguished from HC subjects using a behavioral pattern of increased cue-induced gamble increase when gambling-related cues are presented in the background. On neural level (Paper III), GD subjects could be distinguished from HC subjects by neural correlates of cue-induced changes in gambling behavior in a network of amygdala, nucleus accumbens and orbital-frontal cortex. Since the focus of the studies was GD, an addiction that is independent of substance abuse, the results suggest that reduced loss aversion and increased cue-induced changes in gambling behaviors, two phenomena related to substance-based addictions, are not dependent on a substance of abuse but rather on learned characteristics or even on predisposing traits of addictive disorders.