First use and initiation of regular alcohol use has been frequently found to start in adolescence. However, only few studies have also investigated how many adolescents proceed during ages 14–24 to harmful drinking or even develop alcohol use disorders. This paper – using the EDSP baseline sample of 3,021 community respondents from the Munich area – examines the prevalence of use, abuse and dependence and investigates the dose/disorder relationship. Alcohol abuse was reported by 9.7% of respondents and alcohol dependence by 6.2%. Men were more likely to report an alcohol disorder than women, prevalence also increased in the older age cohorts. However, even among 14- to 17-year-olds a substantial proportion of respondents report high and regular consumption rates, the occurrence of abuse and dependence criteria and even a full dependence syndrome. There is however only a moderate association between average number of standard drinks consumed with the risk of developing abuse and dependence. In light of the substantial rates among adolescents and young adults the validity of DSM-IV alcohol disorder criteria is discussed.

Alkoholkonsum beginnt häufig bereits im Jugendalter. Allerdings fehlen bisher Erkenntnisse darüber, ob, wie häufig und aufgrund welcher Merkmale Jugendlichen und junge Erwachsene auch bereits klinisch definierte Mißbrauchs- und Abhängigkeitsdiagnosen entwickeln. In der vorliegenden Arbeit werden Ergebnisse einer repräsentativen Untersuchung an 3021 Jugendlichen im Alter von 14-24 Jahren vorgestellt. Neben der Prävalenz von Alkoholmißbrauch und -abhängigkeit nach DSM-IV werden Daten zur Häufigkeit und Menge des Alkoholkonsums berichtet sowie erste Symptome beschrieben. 9,7% der befragten Jugendlichen erhielten aufgrund von DSM-IV-Kriterien eine Mißbrauchsdiagnose, 6,2% eine Abhängigkeitsdiagnose. Bei männlichen Jugendlichen war die Prävalenz wesentlich höher als bei weiblichen. Die Prävalenz war in den älteren Geburtskohorten höher. Als erstes Missbrauchssymptom trat am häufigsten "Gebrauch mit körperlicher Gefährdung" (91,9%), als erstes Abhängigkeitssymptom "Toleranzentwicklung" (34,3%) auf. Erste diagnostische Kriterien einer Alkoholstörung traten zumeist deutlich vor dem 18. Lebensjahr auf. Diese Daten unterstreichen, daß Alkoholmißbrauch und -abhängigkeit bereits im Jugend- und frühen Erwachsenenalter häufig sind. / Alcohol use frequently begins in adolescence. However, only few studies have reported the prevalence of alcohol abuse disorders in adolescents. This paper reports results from a representative study in a sample of 3021 adolescents, aged 14-24 years. The Prevalence of alcohol abuse and dependence according to DSM-IV criteria, as well as the prevalence, frequency and quantity of alcohol abuse and a description of the first occuring symptoms, are presented here. Alcohol abuse was reported by 9.7% of respondents and alcohol dependence by 6.2%. Males were more likely to report an alcohol disorder than females, and the prevalence also increased in the older age cohorts. The most frequent initial symptoms were "hazardous use" (91.9%) for abuse and "tolerance" (34.3%) for dependence. First symptoms have been shown to occur long before the age of 18. These results show that even in adolescents and young adults alcohol abuse and dependence are frequent disorders.

Alkoholkonsum beginnt häufig bereits im Jugendalter. Allerdings fehlen bisher Erkenntnisse darüber, ob, wie häufig und aufgrund welcher Merkmale Jugendlichen und junge Erwachsene auch bereits klinisch definierte Mißbrauchs- und Abhängigkeitsdiagnosen entwickeln. In der vorliegenden Arbeit werden Ergebnisse einer repräsentativen Untersuchung an 3021 Jugendlichen im Alter von 14-24 Jahren vorgestellt. Neben der Prävalenz von Alkoholmißbrauch und -abhängigkeit nach DSM-IV werden Daten zur Häufigkeit und Menge des Alkoholkonsums berichtet sowie erste Symptome beschrieben. 9,7% der befragten Jugendlichen erhielten aufgrund von DSM-IV-Kriterien eine Mißbrauchsdiagnose, 6,2% eine Abhängigkeitsdiagnose. Bei männlichen Jugendlichen war die Prävalenz wesentlich höher als bei weiblichen. Die Prävalenz war in den älteren Geburtskohorten höher. Als erstes Missbrauchssymptom trat am häufigsten "Gebrauch mit körperlicher Gefährdung" (91,9%), als erstes Abhängigkeitssymptom "Toleranzentwicklung" (34,3%) auf. Erste diagnostische Kriterien einer Alkoholstörung traten zumeist deutlich vor dem 18. Lebensjahr auf. Diese Daten unterstreichen, daß Alkoholmißbrauch und -abhängigkeit bereits im Jugend- und frühen Erwachsenenalter häufig sind. / Alcohol use frequently begins in adolescence. However, only few studies have reported the prevalence of alcohol abuse disorders in adolescents. This paper reports results from a representative study in a sample of 3021 adolescents, aged 14-24 years. The Prevalence of alcohol abuse and dependence according to DSM-IV criteria, as well as the prevalence, frequency and quantity of alcohol abuse and a description of the first occuring symptoms, are presented here. Alcohol abuse was reported by 9.7% of respondents and alcohol dependence by 6.2%. Males were more likely to report an alcohol disorder than females, and the prevalence also increased in the older age cohorts. The most frequent initial symptoms were "hazardous use" (91.9%) for abuse and "tolerance" (34.3%) for dependence. First symptoms have been shown to occur long before the age of 18. These results show that even in adolescents and young adults alcohol abuse and dependence are frequent disorders.

First use and initiation of regular alcohol use has been frequently found to start in adolescence. However, only few studies have also investigated how many adolescents proceed during ages 14–24 to harmful drinking or even develop alcohol use disorders. This paper – using the EDSP baseline sample of 3,021 community respondents from the Munich area – examines the prevalence of use, abuse and dependence and investigates the dose/disorder relationship. Alcohol abuse was reported by 9.7% of respondents and alcohol dependence by 6.2%. Men were more likely to report an alcohol disorder than women, prevalence also increased in the older age cohorts. However, even among 14- to 17-year-olds a substantial proportion of respondents report high and regular consumption rates, the occurrence of abuse and dependence criteria and even a full dependence syndrome. There is however only a moderate association between average number of standard drinks consumed with the risk of developing abuse and dependence. In light of the substantial rates among adolescents and young adults the validity of DSM-IV alcohol disorder criteria is discussed.

Objective: The paper discusses conceptual, methodological and clinical issues of comorbidity from the perspective of more recent epidemiological studies. Further the potential causal and pathogenic role of temporally primary disorders for the onset of secondary disorders is evaluated. Results: The available data suggest so far that comorbidity (a) is not an artefact of assessment strategies, sampling or design features, (b) is specific in different disorders, (c) is particularly frequent in anxiety and affective disorders, (d) affects systematically the course of the comorbid conditions and (0 might be related to symptom progression models. Conclusions: Furthermore, evidence is presented that specific forms of primary anxiety disorders affect the risk for secondary depressive disorders, increase the likelihood of non-remission as well as the number of subsequent depressive episodes. / Scopo: Lo studio affronta problemi concettuali, metodologici e clinici della comorbidità, alia luce dei piu recenti studi epidemiologici. Inoltre viene valutata la causa potenziale e il ruolo patogenetico dei disturbi temporaneamente primari per la comparsa dei disturbi secondari. Risultati: I risultati disponibili fino ad oggi suggeriscono che la comorbidità (a) non è un artefatto delle strategic di valutazione, del campionamento o del disegno, (b) è specifica nei differenti disturbi, (c) e particolarmente frequente nei disturbi affettivi e d'ansia, (d) influisce sistematicamente sull'andamento delle condizioni di comorbidita è (f) potrebbe essere correlata con modelli di evoluzione dei sintomi. Conclusioni: È inoltre evidente che forme specifiche di disturbi di ansia primaria comportano il rischio di sviluppare disturbi depressivi. secondari, aumentano la probability di non remissione cosi come il numero di successivi episodi depressivi.

Objective: The paper discusses conceptual, methodological and clinical issues of comorbidity from the perspective of more recent epidemiological studies. Further the potential causal and pathogenic role of temporally primary disorders for the onset of secondary disorders is evaluated. Results: The available data suggest so far that comorbidity (a) is not an artefact of assessment strategies, sampling or design features, (b) is specific in different disorders, (c) is particularly frequent in anxiety and affective disorders, (d) affects systematically the course of the comorbid conditions and (0 might be related to symptom progression models. Conclusions: Furthermore, evidence is presented that specific forms of primary anxiety disorders affect the risk for secondary depressive disorders, increase the likelihood of non-remission as well as the number of subsequent depressive episodes. / Scopo: Lo studio affronta problemi concettuali, metodologici e clinici della comorbidità, alia luce dei piu recenti studi epidemiologici. Inoltre viene valutata la causa potenziale e il ruolo patogenetico dei disturbi temporaneamente primari per la comparsa dei disturbi secondari. Risultati: I risultati disponibili fino ad oggi suggeriscono che la comorbidità (a) non è un artefatto delle strategic di valutazione, del campionamento o del disegno, (b) è specifica nei differenti disturbi, (c) e particolarmente frequente nei disturbi affettivi e d'ansia, (d) influisce sistematicamente sull'andamento delle condizioni di comorbidita è (f) potrebbe essere correlata con modelli di evoluzione dei sintomi. Conclusioni: È inoltre evidente che forme specifiche di disturbi di ansia primaria comportano il rischio di sviluppare disturbi depressivi. secondari, aumentano la probability di non remissione cosi come il numero di successivi episodi depressivi.

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