Excessive alcohol consumption in young men: is there an association with their earlier family situation? A baseline-analysis of the C-SURF-study (Cohort Study on Substance Use Risk Factors).

AIMS: To determine whether parental factors earlier in life (parenting, single parent family, parental substance use problem) are associated with patterns of alcohol consumption among young men in Switzerland. METHODS: This analysis of a population based sample from the Cohort Study on Substance Use Risk Factors (C-SURF) included 5,990 young men (mean age 19.51 years), all attending a mandatory recruitment process for the army. These conscripts reported on parental monitoring and rule-setting, parental behaviour and family structure. The alcohol use pattern was assessed through abstention, risky single occasion drinking (RSOD), volume drinking and dependence. Furthermore, the impact of age, family socio-economic status, educational level of the parents, language region and civil status was analysed. RESULTS: A parental substance use problem was positively associated with volume drinking and alcohol dependence in young Swiss men. Active parenting corresponded negatively with RSOD, volume drinking and alcohol dependence. Single parent family was not associated with a different alcohol consumption pattern compared to standard family. CONCLUSION: Parental influences earlier in life such as active parenting (monitoring, rule-setting and knowing the whereabouts) and perceived parental substance use problem are associated with alcohol drinking behaviour in young male adults. Therefore, health professionals should stress the importance of active parenting and parental substance use prevention in alcohol prevention strategies.

Contextual determinants of alcohol consumption changes and preventive alcohol policies: a 12-country European study in progress.

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

Trends in drug consumption and risk of transmission of HIV and hepatitis C virus among injecting drug users in Switzerland, 1993-2006

As a part of the HIV behavioural surveillance system in Switzerland, repeated cross-sectional surveys were conducted in 1993, 1994, 1996, 2000 and 2006 among attenders of all low threshold facilities (LTFs) with needle exchange programmes and/or supervised drug consumption rooms for injection or inhalation in Switzerland. Data were collected in each LTF over five consecutive days, using a questionnaire that was partly completed by an interviewer and partly self administered. The questionnaire was structured around three topics: socio-demographic characteristics, drug consumption, health and risk/preventive behaviour. Analysis was restricted to attenders who had injected drugs during their lifetime (IDUs). Between 1993 and 2006, the median age of IDUs rose by 10 years. IDUs are severely marginalised and their social situation has improved little. The borrowing of used injection equipment (syringe or needle already used by other person) in the last six months decreased (16.5% in 1993, 8.9% in 2006) but stayed stable at around 10% over the past three surveys. Other risk behaviour, such as sharing spoons, cotton or water, was reported more frequently, although also showed a decreasing trend. The reported prevalence of HIV remained fairly stable at around 10% between 1993 and 2006; reported levels of hepatitis C virus (HCV) prevalence were high (56.4% in 2006). In conclusion, the overall decrease in the practice of injection has reduced the potential for transmission of infections. However as HCV prevalence is high this is of particular concern, as the current behaviour of IDUs indicates a potential for further spreading of the infection. Another noteworthy trend is the significant decrease in condom use in the case of paid sex.

Patterns in the situated activity of substance use in the careers of elite doping athletes

Objectives This article presents a psychological approach to substance use in sport using a dynamic and situated activity framework. The aim was to analyze the various relationships between activity and the consumption of substances during the sporting life course of athletes who recognized doping violation. Design Data were collected from secondary sources and biographical and self-confrontational interviews to build traces of the past activity. Method Twelve doping athletes or those admitting to having used banned substances volunteered to participate. The data were coded and compared to identify typical activities and their intrinsic dynamics. Results Six activities were identified: "Agree to use," "Drop out of a non-viable state," Return to a former state," "Prevent a potential deficiency," "Maintain an acquired state," and "Balance the sporting life with substance use," comprising 11 patterns. Conclusions The athletes' activity embedded substance use in reciprocal relationships that consisted of freezing, exploring and exploiting fields of possible actions created and offered by the situation dynamics. Recommendations for situated and dynamic prevention are provided.

Plasma and urine profiles of Delta9-tetrahydrocannabinol and its metabolites 11-hydroxy-Delta9-tetrahydrocannabinol and 11-nor-9-carboxy-Delta9-tetrahydrocannabinol after cannabis smoking by male volunteers to estimate recent consumption by athletes.

Since 2004, cannabis has been prohibited by the World Anti-Doping Agency for all sports competitions. In the years since then, about half of all positive doping cases in Switzerland have been related to cannabis consumption. In doping urine analysis, the target analyte is 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THC-COOH), the cutoff being 15 ng/mL. However, the wide urinary detection window of the long-term metabolite of Delta(9)-tetrahydrocannabinol (THC) does not allow a conclusion to be drawn regarding the time of consumption or the impact on the physical performance. The purpose of the present study on light cannabis smokers was to evaluate target analytes with shorter urinary excretion times. Twelve male volunteers smoked a cannabis cigarette standardized to 70 mg THC per cigarette. Plasma and urine were collected up to 8 h and 11 days, respectively. Total THC, 11-hydroxy-Delta(9)-tetrahydrocannabinol (THC-OH), and THC-COOH were determined after hydrolysis followed by solid-phase extraction and gas chromatography/mass spectrometry. The limits of quantitation were 0.1-1.0 ng/mL. Eight puffs delivered a mean THC dose of 45 mg. Plasma levels of total THC, THC-OH, and THC-COOH were measured in the ranges 0.2-59.1, 0.1-3.9, and 0.4-16.4 ng/mL, respectively. Peak concentrations were observed at 5, 5-20, and 20-180 min. Urine levels were measured in the ranges 0.1-1.3, 0.1-14.4, and 0.5-38.2 ng/mL, peaking at 2, 2, and 6-24 h, respectively. The times of the last detectable levels were 2-8, 6-96, and 48-120 h. Besides high to very high THC-COOH levels (245 +/- 1,111 ng/mL), THC (3 +/- 8 ng/mL) and THC-OH (51 +/- 246 ng/mL) were found in 65 and 98% of cannabis-positive athletes' urine samples, respectively. In conclusion, in addition to THC-COOH, the pharmacologically active THC and THC-OH should be used as target analytes for doping urine analysis. In the case of light cannabis use, this may allow the estimation of more recent consumption, probably influencing performance during competitions. However, it is not possible to discriminate the intention of cannabis use, i.e., for recreational or doping purposes. Additionally, pharmacokinetic data of female volunteers are needed to interpret cannabis-positive doping cases of female athletes.

Do Swiss adolescents perceive the negative effects of their illegal substance use?

This study explores adolescents' perceptions of adverse consequences linked to their illegal psychoactive substance (IPS) use, as they are often thought to minimise them. From a Swiss nationally representative sample of 8740 adolescents aged 16 to 20 pursuing post-mandatory education, 2515 participants reported IPS use in the past month on a self-administered anonymous questionnaire. The percentages of participants reporting problems in four areas (individual, school, relationships and sexual) were assessed, depending on the type of IPS consumption over the last 30 days: occasional cannabis users: ≤2 times; regular cannabis users: ≥3 times; and poly-consumers: cannabis plus at least one other substance used. The percentages varied significantly across these three groups with 26.9% of occasional users, 53.8% of regular users, and 73.3% of poly-consumers reporting at least one problem. Compared to occasional cannabis users, poly-consumers were more likely to report problems in all four categories [relative risk ratio (RRR): 3.38 to 5.44], while regular cannabis users often reported only school and relationship problems [RRR: 2.43 to 3.23]. Thus, many adolescents seem to perceive the negative effects of their IPS use, with heavier consumption being associated with increasing problems. Physicians should feel confident questioning adolescents on the adverse consequences of their IPS consumption, as they are likely to be responsive on this issue.

Beverage preferences and associated drinking patterns, consequences and other substance use behaviours.

BACKGROUND: Studies about beverage preferences in a country in which wine drinking is relatively widespread (like Switzerland) are scarce. Therefore, the main aims of the present study were to examine the associations between beverage preferences and drinking patterns, alcohol-related consequences and the use of other substances among Swiss young men. METHODS: The analytical sample consisted of 5399 Swiss men who participated in the Cohort Study on Substance Use Risk Factors (C-SURF) and had been drinking alcohol over the preceding 12 months. Logistic regression analyses were conducted to study the associations between preference for a particular beverage and (i) drinking patterns, (ii) negative alcohol-related consequences and (iii) the (at-risk) use of cigarettes, cannabis and other illicit drugs. RESULTS: Preference for beer was associated with risky drinking patterns and, comparable with a preference for strong alcohol, with the use of illicit substances (cannabis and other illicit drugs). In contrast, a preference for wine was associated with low-risk alcohol consumption and a reduced likelihood of experiencing at least four negative alcohol-related consequences or of daily cigarette smoking. Furthermore, the likelihood of negative outcomes (alcohol-related consequences; use of other substances) increased among people with risky drinking behaviours, independent of beverage preference. CONCLUSIONS: In our survey, beer preference was associated with risky drinking patterns and illicit drug use. Alcohol polices to prevent large quantities of alcohol consumption, especially of cheaper spirits like beer, should be considered to reduce total alcohol consumption and the negative consequences associated with these beverage types.

Cannabis use as a means of socialization?: new consumption patterns among heavy users

Purpose: After tobacco and alcohol, cannabis is the most used substance among adolescents in Switzerland. Our aim is to assess whether cannabis use has become an ordinary means of socialization. We hypothesize that cannabis consumption has become a normative, although still illegal, behavior. Methods: As part of a larger qualitative study aimed at assessing new ways [patterns] of cannabis consumption, 16 daily cannabis consumers (11 males) and 2 former heavy consumers (both females), aged 15 to 20 years, participated in interviews and focus groups. Data were transcribed verbatim and analyzed using Atlas.ti qualitative analysis software. Results: Most consumers define the beginning of their consumption as a moment when they made new friends. They commonly use cannabis in group settings, which encourages the belief that all adolescents use cannabis. Thus, cannabis is mainly identified as an everyday social act. Joints are smoked like cigarettes: at all times of the day, during or after school or work with peers, often starting at lunch break, and mostly in public places. Friends offer a joint in a group setting, much like beer in a bar, as a means of making contact. Consumption invariably increases while socializing on vacation: "During vacation, we smoke up to 10-15 joints a day; at the end we're just dead." Additionally, in order to obtain cannabis, consumers have to be part of the right networks; they generally have several dealers to assure their supply, buy and sell themselves, or practice group-buying. As a result, all friends or acquaintances of consumers are themselves cannabis users. For instance, 4 boys, who say they are best friends, always smoke together and that, in order to quit, "All four of us should say to ourselves, 'Okay, now, let's all stop smoking'. That would be the only solution. . .but it would be impossible!" The 2 former consumers state that when they started using cannabis, "I found myself little by little in a vicious circle where I saw only people who also smoked". When they quit, they separated from their group of friends: "Either you make new friends who don't smoke or you smoke." Conclusions: Discussions with consumers demonstrate a normative facet of cannabis consumption as part of teenage socialization. Consequently, cannabis consumers develop a significant dependency since a majority of their friends use cannabis and their consumption involves most of their daily social life. Our study highlights the need for clear messages about the harmful aspects of using this substance while also suggesting that cessation efforts should include helping users separate from their consumption milieu. Sources of Support: Dept. of Public Health of the canton of Vaud.

Secular trends in legal and illegal substance use among 16 to 20 year old adolescents in Switzerland.

BACKGROUND: Data targeting trends in legal and illegal substance use by adolescents are scarce. Using the data from two similar large national surveys run in 1993 and 2002, this paper assesses secular trends in rates of substance use among 16-20-year-old Swiss adolescents. METHODS: Self-reported regular use of tobacco, alcohol misuse, regular cannabis use (01 occasion over last 30 days) and lifetime use of psychoactive medication, LSD, ecstasy, cocaine and heroine were assessed through identical questions using an anonymous self-administered questionnaire. 9268 (1993) and 7428 (2002) high school students and apprentices were included in the analyses. RESULTS: There is a higher proportion of regular smokers among apprentices than among students (p <0.001). Between 1993 and 2002 the increase in regular tobacco consumption was significant among both female and male apprentices (p <0.001) but not among students. Between 1993 and 2002 alcohol misuse significantly increased in all four groups (p <0.001). It is more prevalent among males than among females (p <0.001) and higher among apprentices than among students (p <0.001). Regular use of cannabis has increased in the four groups (p <0.0001). It is higher among males than among females (p <0.001), while it is largely the same among students and apprentices. While the increase in ecstasy use is highly significant in all four groups (p <0.001), the increase in LSD and cocaine use is significant among apprentices only (p <0.001). Use of LSD, ecstasy and cocaine is more prevalent among males than among females (<0.001) and higher among apprentices than among students (p <0.001). CONCLUSION: The secular increase in psychoactive substance use among older Swiss adolescents calls for the implementation of effective strategies both from individual and public health viewpoints.

Cannabis and tobacco use: where are the boundaries? A qualitative study on cannabis consumption modes among adolescents.

The purpose of this article is to identify tobacco and cannabis co-consumptions and consumers' perceptions of each substance. A qualitative research including 22 youths (14 males) aged 15-21 years in seven individual interviews and five focus groups. Discussions were recorded, transcribed verbatim and transferred to Atlas.ti software for narrative analysis. The main consumption mode is cannabis cigarettes which always mix cannabis and tobacco. Participants perceive cannabis much more positively than tobacco, which is considered unnatural, harmful and addictive. Future consumption forecasts thus more often exclude tobacco smoking than cannabis consumption. A substitution phenomenon often takes place between both substances. Given the co-consumption of tobacco and cannabis, in helping youths quit or decrease their consumptions, both substances should be taken into account in a global approach. Cannabis consumers should be made aware of their tobacco use while consuming cannabis and the risk of inducing nicotine addiction through cannabis use, despite the perceived disconnect between the two substances. Prevention programs should correct made-up ideas about cannabis consumption and convey a clear message about its harmful consequences. Our findings support the growing evidence which suggests that nicotine dependence and cigarette smoking may be induced by cannabis consumption.

Consommation d'alcool et de benzodiozépines au troisième âge [Consumption of alcohol and benzodiazepines in the elderly]

In Switzerland, 9.1% of the general population accept regular consumption of BZD. In 65-74 years age group, 2% of cases display a high-risk alcohol consumption. Moderate risk consumption is present in 5% of cases. For the BZD, the cognitive difficulties settle in an insidious way; for alcohol, the daily consumption of fairly high quantities may lead to cognitive deterioration. At early stages, alcohol abusers show preserved neuropsychological performances. Gradually, the deficits will affect the remaining cognitive functions and become irreversible. This review indicates that the chronic consumption of alcohol and BZD in old age is at the origin of major clinical difficulties that need ad hoc training both for psychiatrists and general practitioners.

First consumption ever of multiple substances: applying an expert-based taxonomy to a Swiss national sample of adolescents.

The use of multiple legal and illegal substances by adolescents is a growing concern in all countries, but since no consensus about a taxonomy did emerge yet, it is difficult to understand the different patterns of consumption and to implement tailored prevention and treatment programs directed towards specific subgroups of the adolescent population. Using data from a Swiss survey on adolescent health, we analyzed the age at which ten legal and illegal substances were consumed for the first time ever by applying a method combining the strength of both automatic clustering and use of substance experts. Results were then compared to 30 socio-economic factors to establish the usefulness of and to validate our taxonomy. We also analyzed the succession of substance first use for each group. The final taxonomy consists of eight groups ranging from non-consumers to heavy drug addicts. All but four socio-economic factors were significantly associated with the taxonomy, the strongest associations being observed with health, behavior, and sexuality factors. Numerous factors influence adolescents in their decision to first try substances or to use them on a regular basis, and no factor alone can be considered as an absolute marker of problematic behavior regarding substance use. Different processes of experimentation with substances are associated with different behaviors, therefore focusing on only one substance or only one factor is not efficient. Prevention and treatment programs can then be tailored to address specific issues related to different youth subgroups.

Parental monitoring: a way to decrease substance use among Swiss adolescents?

The objective of this research was to determine whether the level of parental monitoring is associated with substance use among adolescents in Switzerland, and to assess whether this effect remains when these adolescents have consuming peers. For this purpose, we used a nationally representative sample from the Swiss participation in the 2007 European School Project on Alcohol and Other Drugs survey, which included 7,611 adolescents in public schools (8th-10th grades). Four levels of parental control were created and four substances (tobacco, alcohol, cannabis, and ecstasy) were analyzed. All significant variables at the bivariate level were included in the multivariate analysis. Most adolescents had a high level of parental monitoring and that was associated with younger age, females, high socioeconomic status, intact family structure, and satisfactory relationships with mother, father, and peers. Overall, substance use decreased as parental monitoring increased and high parental monitoring decreased as having consuming peers increased. Results remained essentially the same when the variable "having consuming peers" was added to the analysis. Conclusion: parental monitoring is associated to positive effects on adolescent substance use with a reduction of consumption and a lower probability of having consuming peers, which seems to protect adolescents against potentially negative peer influence. Encouraging parents to monitor their adolescents' activities and friendships by establishing rules about what is allowed or not is a way to limit the negative influence of consuming peers on adolescent substance use.

Parental monitoring: an easy way to decrease adolescent substance use?

Objective: To examine whether the level of parental monitoring is associated with substance use among Swiss adolescents, and to assess whether this effect remains when these adolescents have consuming peers. Methods: Nationally representative sample from the Swiss participation in the 2007 European School Project on Alcohol and Other Drugs (ESPAD) survey, which included 7611 adolescents issued from public schools (8th-10th grades). Four levels of parental control were created and four substances (tobacco, alcohol, cannabis and ecstasy) were analyzed. All significant variables at the bivariate level were included in the multivariate analysis. Results: Most adolescents had a high level of parental monitoring and that was associated with younger age, being female, high socioeconomic status, intact family structure and a satisfactory relationship with mother, father and peers. Globally, substance use decreased as parental monitoring increased and high parental monitoring decreased having consuming peers. Results remained essentially the same when consuming peers were added in the analysis. Conclusions: Parental monitoring has positive effects on adolescent substance use with a reduction of consumption and a lower association with consuming peers, which seems to protect adolescents against their potential negative influence. Encouraging parents to monitor their adolescents' activities and friendships by establishing rules about what is allowed or not are simple ways to limit the negative influence of consuming peers on adolescent substance use.