Jens Kalke

Substitution treatment with methadone in Germany: politics, programmes and results

Abstract In Germany, methadone treatment for opiate addicts has been approved only during the last few years. The development of methadone treatment took place under special political conditions. The federal system in Germany made it possible to establish methadone treatment in some states against the opposition of the German government. The result was the development of different forms of methadone therapy with different indications and treatment rules. With respect to somatic and mental health, social integration and consumption patterns, the results of German evaluation studies show an overall quite similar effect of methadone treatment programmes. The relations between the regulations of different types of programmes and treatment effects are discussed.

Learning by Doing: ‘Initiated Abstinence’, a School-Based Programme for the Prevention of Addiction

The objective of the study was to find out whether the school-based prevention programme ‘Initiated abstinence’ is suitable to induce pupils to change their consumer behavior and attitudes. The participants of the prevention programme commit themselves ‘per contract’ to abstain from or considerably reduce their consumption of at least one of their currently used substances (e.g. sweets, cigarettes) or media (TV, computer games) for a period of 2 weeks. The main goal of the programme is to sharpen their problem and health consciousness concerning addiction and pleasure seeking. The programme was evaluated by a longitudinal study. At three given times, the 12- to 15-year-old pupils of the experimental classes were interviewed by standardized self-completion questionnaires (n = 2,267). The control classes were submitted to two surveys (n = 586). The study was carried out in the areas of Innsbruck (Austria), Schleswig-Holstein (Germany) and South Tyrol (Italy). Not all pupils were able to keep their intentions submitted in their contract, but 4 of 5 pupils had at least one positive experience with the renunciation (82%). There were ‘overall effects’: The actual renunciation of the pupils was much higher than stated in their agreement. The experimental group showed significant reduction effects for pupils, who had successfully reduced or stopped use of a substance or medium. In a further step, it should be explored whether the programme is suitable also for older groups, i.e. for pupils older than 15 years. Moreover, the long-term effects of the programmes should be tested.

Methadone Therapy in Hamburg

Methadone treatment for opiate addicts as a structured form of therapy has been introduced in Hamburg in the summer of 1988. The number of patients in substitution has been increasing ever since. Since 1991 scientific follow-up research has been done. The following presents a number of selected results, which show the overall positive effects of methadone therapy. The retention rate is 91.3%, which is extremely high. The dose of methadone (10 ml levomethadone in general) depends primarily on the dose of heroin a patient was using before the beginning of substitution. The additional use of heroin, cocaine or cannabis does not have any influence on the dosage of methadone. On the whole, we can see positive developments: the patients’ health improved substantially, social reintegration started, the additional use of drugs was given up or decreased. Furthermore the conditions of substitution allow an intensive psycho– and sociotherapy. Both therapists and patients consider such additional therapies effective. Not only do they report an improvement of general well-being but also progress in psychic development as well as progress and changes in social behavior.

Regierungsmehrheit und Opposition in den bundesdeutschen Landtagen — eine quantitative Auswertung von Plenarprotokollen

Das politikwissenschaftliche Analysekonzept von Regierungsmehrheit und Opposition verortet die parlamentarische Kontrolle neu. Dieser Ansatz uberwindet den alten Dualismus zwischen Exekutive (Landesregierung) und Legislative (Parlament) und sieht stattdessen aufgrund ihrer parteipolitischen Verwobenheit eine annahernde Interessenkongruenz zwischen der Regierung und den sie tragenden Regierungsparteien. Diese Aktionseinheit wird Regierungsmehrheit genannt (Steffani 1991). Ihr steht die parlamentarische Opposition gegenuber, die aus einer oder mehreren Fraktionen bestehen kann. Der Regierungsmehrheit und der Opposition werden in der politikwissenschaftlichen Literatur unterschiedliche Parlamentsfunktionen zugeordnet, u.a. die Gesetzgebungsfunktion der Regierungsmehrheit und die Kontrollfunktion der Opposition (Kalke 2001, Hesse und Ellwein 1997).1 Regierungsmehrheit und Opposition sind damit Institutionen der Verfassungspraxis, die den politischen Gestaltungsprozess in unterschiedlicher Weise bestimmen. Danach ist es also vor allem die Opposition, die die Regierung kontrolliert, und nicht mehr das Parlament als Ganzes.

Comparative Analysis of Potential Risk Factors for at-Risk Gambling, Problem Gambling and Gambling Disorder among Current Gamblers—Results of the Austrian Representative Survey 2015

Background: The risk of developing a problem gambling behavior is distributed unequally among the population. For example, individuals who report stressful life events, show impairments of mental health or belong to a socio-economically deprived group are affected more frequently by gambling problems. The aim of our study is to investigate whether these risk factors are equally relevant for all gambling groups (social = 0 DSM-5 criteria, at risk = 1 DSM-5 criterion, problem = 2–3 DSM-5 criteria, disordered = 4–9 DSM-5 criteria). Methods: Of a total of 10,000 participants in the representative gambling survey in Austria in 2015, 4,082 individuals reported gambling during the last 12 months and were allocated to the four gambling groups according to DSM-5. With social gamblers as the reference group, relevant risk factors for the other three groups were identified by means of bi- and multivariate multinomial logistic regression. Results: Significant risk factors for gambling disorder are at-risk alcohol use (OR = 4.9), poor mental health (OR = 5.9), young age (≤26 years, OR = 2.1), a low level of formal education (OR = 2.4), having grown up with a single parent (OR = 2.5), parents with addiction problems (OR = 2.3) and belonging to the working class (OR = 2.9). Risk factors for problem gambling are parents with addiction problems (OR = 3.8), poor mental health (OR = 2.6) and a young age (OR = 2.2). With regard to at-risk gambling, only growing up with a single parent was relevant (OR = 2.4). Conclusion: Overall, the results of this study suggest, that the number and the influence of the included risk factors differ between gambling problem groups. Apparently, the development of severe gambling problems is to a lesser extent facilitated by specific risk factors than by their cumulative presence. Therefore, future prevention and treatment measures should place a particular focus on individuals who have experienced growing up in a difficult family situation, have poor mental health, suffer from substance-related problems or have a low level of formal education.

Bekanntheit und Akzeptanz der ambulanten Suchthilfe in der Bevölkerung

Hintergrund: Der Beitrag gibt die Ergebnisse einer Reprasentativbefragung zur Bekanntheit und Akzeptanz des ambulanten Suchthilfesystems im Bundesland Hessen aus der Sicht der Allgemeinbevolkerung wieder. Methodik: Es wurden im Zeitraum vom 15. Oktober bis 12. November 2007 insgesamt 5.600 Personen, die in Hessen wohnen und zwischen 17 bis 69 Jahre alt sind, telefonisch per Zufallsauswahl befragt. Bei den Auswertungen wurden sechs mogliche Einflussfaktoren systematisch berucksichtigt: Geschlecht, Alter, Region, Schulbildung, Erwerbssituation und der problematische Konsum psychoaktiver Substanzen. Ergebnisse: Die Akzeptanz der ambulanten Suchthilfe in Hessen ist sehr hoch. 91 % der Hessen wurden einem Angehorigen/Bekannten empfehlen, bei Suchtproblemen eine ambulante Suchthilfeeinrichtung aufzusuchen. Konkrete Kenntnis von einer ambulanten Suchthilfeeinrichtung in ihrem Landkreis bzw. kreisfreien Stadt haben dagegen nur 39 %. Bei Personen mit problematischem Substanzkonsum liegt dieser Anteil bei 49 %. Sch...

Cannabis in pharmacies: a proposal from Germany on how to separate the drug markets☆

The German federal state of Schleswig– Holstein suggested distributing cannabis in pharmacies under certain regulated conditions. The purpose of this suggestion was to separate the drug markets and to improve drug prevention. However, the German Federal Institute for drugs and medical products rejected this ‘cannabis project’. Given recent changes in German federal drug policy it is quite possible that the distribution of cannabis will be reconsidered at some point in the future. The ‘pharmacy scheme’ is the mostly plausible distribution model given the current political, civil, and judicial circumstances in Germany. This article will inform the judicial background, the motivations as well as the individual conditions of the ‘cannabis project’. 2. Judicial background