Abstract: Background: With the increasing availability of digital media, the prevalence of problematic digital media use (PDMU) has risen, with children and adolescents being particularly affected. Mindfulness is discussed in relation to PDMU as a protective factor and as a key mechanism underlying mindfulness-based interventions (MBI’s). Given the high prevalence rates and the lack of age-specific research, this review provides an overview of studies examining the role of mindfulness and MBI’s in the context of PDMU in children and adolescents. Methods: Systematic literature search in four databases (PubMed, Embase, Cochrane, and Web of Science). Identified studies were independently screened by two authors. Results: Of the 93 articles identified, 16 studies were included in the review. The findings can be summarized into four main points: (1) mindfulness is negatively associated with PDMU; (2) mindfulness may attenuate the effects of risk factors on PDMU; (3) mindfulness is part of mediation models involving direct and indirect associations with PDMU and other outcomes; and (4) MBI’s show promise for reducing media-related symptoms. Conclusion: Despite the high need for preventive approaches, there is a lack of studies specifically targeting PDMU in children and adolescents. The current evidence on MBI’s is limited but promising. Future research should develop age-appropriate adaptations and systematically evaluate their effectiveness.
Abstract: Aims: This study develops a series of questions to measure unlicensed gambling among people who regularly gamble. We also report the results of an exploratory analysis on the profile of people who have gambled with unlicensed providers in Great Britain. Methods: We analyse data from a representative survey of people who live in Great Britain and gamble regularly (N=1,322). The questionnaire used four separate questions to measure different aspects of unlicensed gambling. We analyse the characteristics of people who report unlicensed gambling with bivariate analysis and regression models. Results: 5.7 % of participants reported any unlicensed gambling. Unlicensed gambling was associated with higher overall gambling involvement. The odds of engaging in unlicensed gambling were significantly higher among those who regularly gambled at land-based casinos or on gambling machines. Cryptocurrency gambling was the most common reason for unlicensed gambling use (54.7 %), followed by self-exclusion (50.7 %). Conclusions: People who gamble with unlicensed websites, do so for many reasons. In many cases, harms and gambling involvement generated within the regulated market can create demand for unlicensed gambling. When asked directly, people are unlikely to recognise whether they gamble with regulated or unlicensed providers. Our methodology was able to mitigate some of this uncertainty by combining four different questions to measure unlicensed gambling.
Zusammenfassung: Zielsetzung: Die Hausarztpraxis bietet großes Potenzial, um Menschen bei der Tabakentwöhnung zu unterstützen. Diese Studie pilotierte die Wirksamkeit des Angebots kostenfreier Pharmakotherapie im Rahmen hausärztlicher Kurzberatung zum Rauchstopp. Methodik: In einer cluster-randomisierten kontrollierten Pilotstudie (cRCT) wurden 2023 – 2024 insgesamt 26 Hausarztpraxen aus dem Forschungspraxennetz HAFO.NRW randomisiert. Alle Patient_innen erhielten eine hausärztliche Kurzberatung zum Rauchstopp nach der ABC-Methode. Nur in der Interventionsgruppe wurde Pharmakotherapie zur Tabakentwöhnung kostenfrei angeboten. Der Primärendpunkt war die selbstberichtete Tabakabstinenz nach 12 Wochen, biochemisch validiert durch eine Kohlenmonoxid-Messung (CO-Messung) in der Hausarztpraxis. Ergebnisse: Es wurden 129 Patient_innen aus 13 Interventions- und 100 Patient_innen aus 11 Kontrollpraxen eingeschlossen (2 Kontrollpraxen schieden aus). Für 58.1 % (n=25) der 43 selbstberichteten Abstinenzfälle lagen CO-Werte vor. Die Odds Ratio für die CO-validierte Abstinenz betrug in der Interventions- vs. Kontrollgruppe 1.07, 95 %KI [0.25 – 4.58], und für die selbstberichtete Abstinenz 1.46, 95 % KI [0.50 – 4.26]. In der Interventionsgruppe hatten mehr Patient_innen einen Rauchstoppversuch unternommen (92.4 % vs. 81.5 % in der Kontrollgruppe) und Nikotinersatz zur Unterstützung genutzt (81.4 % vs. 56.1 %). In der Kontrollgruppe hatten mehr Patient_innen E-Zigaretten zur Unterstützung genutzt (27.3 % vs. 17.6 % in der Interventionsgruppe). Schlussfolgerung: Die Ergebnisse deuten an, dass das Angebot kostenfreier Pharmakotherapie im Rahmen hausärztlicher Kurzberatung deren Nutzung fördern und den Rauchstopp steigern könnte. Mögliche Effekte sollten in einer konfirmatorischen Studie näher untersucht werden.
Abstract: Aims: To support more effective harm reduction policies, this study examines the regulation and implementation of gambling self-exclusion systems in 30 European countries. We map and compare existing self-exclusion policies in terms of scope, provisions and administration. Methods: We conducted a comparative policy review of legal texts, regulatory documents, and official websites, using web scraping and the Vixio Gambling Compliance database. Data were collected between June and September 2025. Results: Of the 30 countries, 24 (80 %) had self-exclusion registers, administrated by public authorities (19), licensed industry actors (2), or monopoly operators (3). Among these 24 countries, 20 (83 %) offered temporary self-exclusion with minimum durations ranging from 24 hours to 3 years. Permanent or indefinite self-exclusion was available in 18 countries (75 %), with revocation allowed after 3 months to 4.5 years. Half of countries with registers mandated marketing bans during self-exclusion. Conclusions: The results indicate that public sector administered self-exclusion registers are a popular policy solution, although their implementation details and provisions vary. The study therefore recommends increased collaboration towards establishing an EU-wide self-exclusion register. This measure should be supported by further research on what optimal self-exclusion durations are and how more uniform regulations can be effectively enforced.
Abstract: Aims: This study (a) evaluates re-hospitalisation among alcohol use disorder (AUD) patients receiving different treatments and (b) simulates avoided re-hospitalisation if more patients received rehabilitation treatment. Methods: Electronic health records (2016 – 21) from patients living in Hamburg were obtained from two statutory health insurances (AOK Rheinland/Hamburg, DAK – Gesundheit) and pension funds (Deutsche Rentenversicherung Nord, Deutsche Rentenversicherung Bund). Analysed were patients receiving either (1) inpatient alcohol treatment (IAT, n = 306), (2) qualified withdrawal treatment (QWT) only ( n = 487), or (3) QWT with rehabilitation ( n = 101) after first outpatient F10.2-F10.4 diagnosis. Using weighted regression modelling, we compared re-hospitalisation during 12-months follow-up. Results: Patients entering QWT with rehabilitation had higher odds of not being re-hospitalised from any (OR: 1.84, 95 % CI [1.15, 2.95]) or alcohol-specific causes (OR: 1.87, 95 % CI [1.13, 3.10]) within 12-months follow-up compared to those with QWT only. There was no statistically significant difference in receiving IAT versus QWT only. If every second patient were to receive rehabilitation treatment, the number of patients without any all-cause re-hospitalisation during follow-up could have been increased from 45.8 % (95 % CI [42.6, 48.9]) to 50.7 % (95 % CI [47.5, 53.9]). Conclusions: Rehabilitation treatment seems critical to achieving measurable health improvements in AUD patients.
Zusammenfassung: Zielsetzung: Ziel des Projektes ist die Evaluation der technischen Spielerschutzmaßnahmen von Online-Glücksspiel, die der Glücksspielstaatsvertrag 2021 vorgibt. Methodik: Das Forschungsprojekt gliedert sich in insgesamt drei Forschungsstränge, aufgeteilt auf zwei Module. Modul 1 besteht aus zwei onlinebasierten Teilmodulen. In Modul 1a werden Mitglieder eines Online-Panels mit insgesamt N = 5000 Teilnehmenden zu drei Zeitpunkten im Längsschnitt differenziert zu ihrem Glücksspielverhalten, Online-Spielerschutzmaßnahmen, Inanspruchnahme von optionalen Limitierungssystemen und des Suchthilfesystems befragt. Verschiedene psychometrische Instrumente ergänzen diese Inhalte. Die Teilnehmenden teilen sich in die Zielgruppe der Online-Glücksspielenden (n = 3000) sowie zwei Kontrollgruppen (rein terrestrisch Glücksspielende und Menschen ohne Glücksspielkontakt in ihrem Leben; je n = 1000) auf. Flankierend wird in Modul 1b der Kundenstamm von Anbietern von Online-Glücksspielen per E-Mail direkt zu einer Online-Befragung eingeladen. In Modul 2 werden mit einem erheblich verdichteten Fragebogen Personen im Querschnitt befragt, die aufgrund von durch Online-Glücksspiele ausgelösten Problemen das Suchthilfesystem aufgesucht haben. Schlussfolgerungen: Die Ergebnisse können im Rahmen der vorgeschriebenen Gesamtevaluation für eine evidenzbasierte Fortschreibung des Staatsvertrages genutzt werden, die dem Public-Health-Ziel einer Stärkung des Spielerschutzes bzw. der Suchtprävention dient.
Zusammenfassung: Hintergrund: Die Anzahl opiatsubstituierter Patienten ist in den vergangenen Jahren angestiegen. Auch in der Behandlung suchtmittelabhängiger Straftäter im Maßregelvollzug scheint eine substitutionsgestützte Behandlung zunehmend an Bedeutung zu gewinnen. Hinsichtlich ihrer Bedeutung für psychotherapeutische Behandlungsmaßnahmen bestehen aber häufig noch Bedenken. Ziel/Methode: Die vorliegende Untersuchung betrachtet deshalb n = 171 nicht substituierte und n = 27 substituierte Untergebrachte gem. § 64 StGB im Hinblick auf Unterschiede in soziodemografischen und therapierelevanten Variablen. Ergebnisse: Es konnte gezeigt werden, dass Patienten, die in der Unterbringung gemäß § 64 StGB eine Opiatsubstitution erhalten, im Durchschnitt älter sind und fast doppelt so viele Bundeszentralregister (BZR)-Einträge und eine mehr als doppelt so lange Hafterfahrung aufweisen. Sie wurden zudem im erkennenden Verfahren durch das Gericht häufiger als erheblich vermindert schuldfähig beurteilt (§ 21 StGB) und beschreiben sich als weniger zufrieden mit ihrem Leben, erregbarer und mit mehr körperlichen Beschwerden, dabei introvertierter und zurückgezogener. Schlussfolgerungen: Die Autoren empfehlen deshalb, einen langfristigen Aufbau einer therapeutischen Beziehung zur Verbesserung der Bindungs- und Beziehungsfähigkeit und eine Unterstützung beim (Wieder-) Aufbau sozialer Bindungen außerhalb der Klinik. Es zeichnen sich jedoch, unabhängig von der Substitution selbst, in der Gruppe substituierter Patienten therapeutische Hindernisse, ein erhöhter Behandlungsbedarf und erschwerte Möglichkeiten der Reduktion des Risikos zukünftiger Delinquenz ab.
Zusammenfassung: Zielsetzung: Während die Alkoholindustrie öffentlich für einen „verantwortungsvollen“ Alkoholkonsum wirbt, deuten Studienergebnisse aus anderen Ländern darauf hin, dass mehr als die Hälfte ihres Umsatzes auf Personen mit schädlichem Alkoholkonsum zurückzuführen ist. In dieser Studie untersuchen wir, ob dies auch auf Deutschland zutrifft. Methodik: Daten zur allgemeinen erwachsenen Bevölkerung (18–64 Jahre) stammen aus vier Quellen: 1) Epidemiologischer Suchtsurvey (2018, 2021), 2) Einkommens- und Verbrauchsstichprobe (2018), 3) Bevölkerungsstatistik (2018) und 4) Branchenstatistik zum Alkoholumsatz (2018). Wir berechneten die Bevölkerungs-, Alkoholkonsum- und Umsatzanteile für drei Alkoholkonsumkategorien (d. h. niedrig riskanter, riskanter, hochriskanter Konsum), wobei wir die getränkespezifischen Konsummengen und Ausgaben nach Geschlecht, Alter, Einkommen und Alkoholkonsumkategorie berücksichtigten. Ergebnisse: Dreizehn Prozent der in Deutschland lebenden erwachsenen Bevölkerung war in den letzten 12 Monaten abstinent. Die Mehrheit (71.9 %, 95 % Konfidenzintervall [KI] [71.2 %–72.7 %]) der Erwachsenen trank niedrig riskant, 12.9 % (95 % KI [12.3 %–13.5 %]) riskant und 2.0 % (95 % KI [1.7 %–2.2 %]) hochriskant. Personen mit riskantem und hochriskantem Alkoholkonsum konsumierten mehr als die Hälfte des verkauften Alkohols und generierten einen Umsatz von 5.71 Mrd. € – die Hälfte des Gesamtalkoholumsatzes in Deutschland . Schlussfolgerung: Die Hälfte des Alkoholumsatzes wird in Deutschland durch riskanten und hochriskanten Alkoholkonsum erwirtschaftet. Dies veranschaulicht den Konflikt zwischen dem selbsterklärten Engagement der Industrie zur Prävention von Gesundheitsschäden und ihren kommerziellen Interessen.
The social or health effects of gambling problems (GP) affect not only the individuals who gamble, but also their social environment (affected others, AO). This article examines the type and intensity of harms to AO in Germany. Method: The data base is a cross-sectional survey of the population in Germany (16-70 years) on the topic of gambling, which was conducted by telephone or online. Only people without own GP (according to DSM-5) were included in the present analyses (n=12,030). The type and intensity of harms to AO were assessed using the GHS-10-AO instrument and evaluated by means of a descriptive analysis of socio-demographic variables. Results: Overall, 3.2 % (n=348) of respondents stated that they knew at least one person with GP in their immediate social environment. Of these AO, almost half (47.6 %) reported to be affected by 1 to 3 different harms, 15.7 % reported 4 to 6, and 9.6 % reported 7 or more harms. Women are significantly more frequently and more intensely affected by GP in their social environment than men. Conclusions: The findings presented indicate that harms to AO represent a relevant public health problem. Practice and research should focus more on a needs-based prevention-and help-system for this target group in the future.
Background: The number of patients receiving opiate substitutions has increased in recent years. Substitution-supported treatment also appears to be becoming increasingly important in the treatment of drug-dependent offenders in the penal system. However, there are often still concerns regarding their importance for psychotherapeutic treatment measures. Aim/Method: The present study therefore looks at n = 171 non-substituted and n = 27 substituted inmates in accordance with sec. 64 of the German Criminal Code regarding differences in socio-demographic and therapy-relevant variables. Results: It was shown that patients who receive opiate substitution in accommodation in accordance with sec. 64 of the Criminal Code are, on average, older and have almost twice as many BZR (Federal Central Register) entries and more than twice as long of a prison experience. They were also more frequently found to be of significantly diminished criminal responsibility (& sect; 21 StGB) by the court in the presiding proceedings and described themselves as less satisfied with their lives, more excitable, with more physical complaints, but also more introverted and withdrawn. Conclusions: The authors therefore recommend a long-term development of a therapeutic relationship to improve bonding and relationship skills and support in (re-)building social bonds outside of the clinic. Regardless of substitution status, the group of substituted patients exhibits therapeutic challenges, a heightened need for treatment, and reduced opportunities for mitigating the risk of future delinquent behavior.
Aims: According to the German State Treaty on Gambling, gambling advertising must not be excessive. However, what counts as excessive is not defined, nor are there any frameworks for classifying advertising. The present study therefore quantifies and classifies gambling advertising during a specific sports event. Methodology: 11 matches of the 2024 European Football Championship were analyzed with respect to frequency and type of gambling advertising. Besides, the social media accounts of 10 sports betting providers were examined. The Meta Ad Library was used to analyze paid-for advertisements. Results: A high volume of gambling advertising is prevalent (n = 5,914), especially during TV broadcasts, where it mostly appears on pitchside hoardings without age restrictions or warnings. On social media (n = 2,645), gambling providers mainly rely on content marketing for organic advertising (1,542), whereas paid-for advertisements (1,103) are more direct and targeted towards a younger audience. Conclusions: Due to the high advertising volume and the room for improvement regarding the implementation of social responsibility measures, it remains uncertain whether the objectives of the Treaty, aimed at protecting the population from gambling-related harm, can be fully achieved. The scope, content, and strategies of these advertisements raise concerns, particularly about the risks for children and adolescents.
Background: Previous studies have reported a positive association between gambling and suicide. Unlike other addictive behaviors like drugs or alcohol use disorders, there are no routine prompts for death investigators to capture whether gambling was a factor in a suicide death. This study was designed to understand how gambling suicides are investigated and ways to improve detection. Methods: Semi-structured interviews were conducted in Australia with 32 people who had either 1) survived a gambling suicide attempt, 2) been bereaved by gambling suicide, or 3) professionals who worked in areas aligned to this topic. Transcripts were analyzed using reflexive thematic analysis. Interpretation was considered in the context of the authors' experiences identifying suicides in Australian mortality datasets. Results: Identifying gambling suicides is challenging due to the ways information is gathered, weighted, and reported during death investigations. This is compounded by the stigma and shame associated with gambling which can work to conceal gambling-related harms, and limit data available to death investigators. Conclusions: Advancing awareness of gambling as a driver of suicide is needed to improve surveillance. Policy options available to regulators include establishing centralized gambling transaction datasets. Giving death investigators access to data related to gambling engagement of people who have died unexpectedly would enable them investigate gambling in these deaths efficiently and comprehensively. This information could be used to inform the design of interventional support to users of gambling products.
Background: The basis of the threshold approach, which originally stems from alcohol-research, is the direct connection between consumption patterns and harms to health.Aim: This position paper addresses the question of the usefulness of transferring this concept to the gambling sector, including opportunities and challenges for practice and research. Initial empirical findings on lower-risk consumption thresholds indicate that both time and money spent on gambling, as well as the number of gambling forms used, appear to be relevant dimensions of consumption. Discussion: To develop thresholds that are practicable and effective in terms of prevention, various methodological and conceptual considerations need to be addressed in future research. These primarily relate to the statistical processing of available (consumption) data, the degree of differentiation of the thresholds (e.g., across all gambling forms vs. within specific gambling forms), the continuous review and further development of the thresholds, and the translation of research results into everyday language. Conclusions: Overall, the threshold concept has the potential to support the evidence-based addiction prevention in the gambling sector. The authors believe that valid lower-risk gambling thresholds can therefore make an important public health contribution in the fight against addiction.
Background: Drug-related deaths associated with opioids are the leading cause of death related to illicit substances.Take-Home Naloxone (THN) as a nasal spray for people who use opioids (PWUO) could prevent fatalities. However, it has not yet been widely implemented in Germany. This article consolidates findings from the two pilot projects, BayTHN and NALtrain, to provide an overview of THN in Germany and formulates recommendations for its broader implementation. Method: Since 2018 within two observational studies, initially with BayTHN and additionally with NALtrain from 2021 onwards, PWUO have received standardized overdose education followed by access to THN. Results: Across both projects, 1020 staff members were trained to provide THN. With additionally 595 PWUO documented by the Bavarian State Ministry of Health, Care and Prevention (StMGP) at least 2,664 PWUO were reached with THN (1.6 % of PWUO in Germany), and 203 THN administrations were documented. Conclusion: For THN to reach its full harm reduction potential, at least 30 % of PWUO (50,000 PWUO) should be reached. THN has already been successfully implemented in various settings in Germany, but not nationwide. The reluctance of physicians to prescribe THN and the lack of funding for overdose education and THN in most federal states remain key barriers to a broader implementation.
