Lutz Wartberg

Reversibility of ecstasy-induced reduction in serotonin transporter availability in polydrug ecstasy users

PurposeAnimal data suggest that the synthetic drug ecstasy may damage brain serotonin neurons. Previously we reported protracted reductions in the availability of the serotonin transporter (SERT), an index of integrity of the axon terminals of brain serotonergic neurons, in SERT-rich brain regions in current human ecstasy users. Comparison of current ecstasy users and former ecstasy users yielded some evidence that this reduction might be reversible. However, participant selection effects could not be ruled out. Therefore, follow-up examinations were performed in these subjects to test the following a priori hypothesis in a prospective longitudinal design that eliminates participant selection effects to a large extent: availability of the SERT increases towards normal levels when ecstasy use is stopped, and remains unchanged or is further decreased if use is continued.MethodsTwo follow-up positron emission tomography measurements using the SERT ligand [11C](+)McN5652 were completed by 15 current and nine former ecstasy users. All subjects used illicit drugs other than ecstasy, too. The time interval between repeated measurements was about 1 year. The time course of the availability of the SERT was analysed in the following SERT-rich regions: mesencephalon, putamen, caudate and thalamus.ResultsCurrent ecstasy users showed a consistent increase in the availability of the SERT in the mesencephalon during the study (Friedman test: p=0.010), which most likely was caused by a decrease in the intensity of ecstasy consumption (Spearman correlation coefficient −0.725, p=0.002). Former ecstasy users showed a consistent increase in SERT availability in the thalamus (Friedman test: p=0.006).ConclusionEcstasy-induced protracted alterations in the availability of the SERT might be reversible.

Prevalence of Pathological Internet Use in a Representative German Sample of Adolescents: Results of a Latent Profile Analysis

Background: Pathological internet use is of increasing significance in several industrial nations. Sampling and Methods: We surveyed a representative German quota sample of 1,723 adolescents (aged 14-17 years) and 1 caregiver each. We conducted a latent profile analysis to identify a high-risk group for pathological internet use. Results: Overall, 3.2% of the sample formed a profile group with pathological internet use. In contrast to other published studies, the results of the latent profile analysis were verified not only by self-assessments of the youths but also by external ratings of the caregivers. In addition to the pathological internet use, the high-risk group showed lower levels of family functioning and life satisfaction as well as more problems in family interactions. Conclusions: The results showed a considerable prevalence of pathological internet use in adolescents and emphasized the need for preventive and therapeutic approaches.

Psychopathological factors associated with problematic alcohol and problematic Internet use in a sample of adolescents in Germany

In Germany, high prevalence rates for problematic alcohol use and problematic Internet use in adolescents were reported. The objective of the present study was to identify psychopathological factors associated with these two behavior patterns. To our knowledge, this is the first investigation assessing psychopathological factors for both problematic alcohol and problematic Internet use in the same sample of adolescents. We surveyed a sample of 1444 adolescents in Germany regarding problematic alcohol use, problematic Internet use, psychopathology and psychological well-being. We conducted binary logistic regression analyses. 5.6% of the sample showed problematic alcohol use, 4.8% problematic Internet use, and 0.8% both problematic alcohol and problematic Internet use. Problematic alcohol use was higher in adolescents with problematic Internet use compared to those without problematic Internet use. Conduct problems and depressive symptoms were statistically significant associated with both problematic alcohol and problematic Internet use. Prosocial behavior was related to problematic Internet use. Male gender and less peer problems were associated with problematic alcohol use. For the first time associations between adolescent problematic alcohol and problematic Internet use due to common psychopathological factors were identified. However, in addition to shared factors, we found also specific psychopathological correlates associated with these two behavior patterns.

Brief motivational intervention for adolescents treated in emergency departments for acute alcohol intoxication – a randomized-controlled trial

BackgroundAlcohol misuse among youth is a major public health concern and numbers of adolescents admitted to the emergency department for acute alcoholic intoxication in Germany are recently growing. The emergency setting offers an opportunity to reach at-risk alcohol consuming adolescents and provide brief interventions in a potential “teachable moment”. However, studies on brief interventions targeting adolescents in emergency care are scarce and little is known about their effectiveness when delivered immediately following hospitalization for acute alcohol intoxication. In this protocol we present the HaLT-Hamburg trial evaluating a brief motivational intervention for adolescents treated in the emergency department after an episode of acute alcoholic intoxication.MethodsThe trial design is a parallel two-arm cluster randomized-controlled trial with follow-up assessment after 3 and 6 months. N = 312 participants aged 17 years and younger will be recruited Fridays to Sundays in 6 pediatric clinics over a period of 30 months. Intervention condition is a manual-based brief motivational intervention with a telephone booster after 6 weeks and a manual-guided intervention for caregivers which will be compared to treatment as usual. Primary outcomes are reduction in binge drinking episodes, quantity of alcohol use on a typical drinking day and alcohol-related problems. Secondary outcome is further treatment seeking. Linear mixed models adjusted for baseline differences will be conducted according to intention-to-treat (ITT) and completers (per-protocol) principles to examine intervention effects. We also examine quantitative and qualitative process data on feasibility, intervention delivery, implementation and receipt from intervention providers, receivers and regular emergency department staff.DiscussionThe study has a number of strengths. First, a rigorous evaluation of HaLT-Hamburg is timely because variations of the HaLT project are widely used in Germany. Second, prior research has not targeted adolescents in the presumed teachable moment following acute alcohol intoxication. Third, we included a comprehensive process evaluation to raise external validity. Fourth, the study involved important stakeholders from the start to set up organizational structures for implementation and maintaining project impact.Trial registrationCurrent Controlled Trials ISRCTN31234060 (April 30th 2012).

Gender-related consequences of Internet use perceived by parents in a representative quota sample of adolescents

Only few studies have investigated gender differences in consequences of adolescent Internet use in a general population sample. In this study, we surveyed a representative German quota sample of N=1744 adolescents aged between 14 and 17 years and their caregivers with standardised questionnaires. Parents’ reports showed significant differences between male and female youth in 8 out of 10 problem areas (summarised in a ‘difficulties index’, Cronbachs alpha=0.89) caused by adolescent Internet use. According to parents’ assessment, male adolescents neglected school obligations and friendships outside the Internet more frequently than female adolescents. Compared to girls, boys spent more time and money using the Internet, regarded media use as more important, set wrong priorities in selecting online content, and rather ran into cost traps or legal consequences. More parents of boys than of girls observed adverse effects on adolescents’ physical and mental development. Both parents and adolescents consistently reported excessive media use more frequently for boys. By conducting a multiple linear regression analysis for the full sample, approximately one-third (34%) of the variance in the ‘difficulties index’ was explained by frequency of excessive Internet use. The results highlight the importance of gender-related analyses regarding the consequences of adolescent Internet use.

Brief in Person Interventions for Adolescents and Young Adults Following Alcohol-Related Events in Emergency Care: A Systematic Review and European Evidence Synthesis

Background: Increasing numbers of youth in need of emergency medical treatment following alcohol intoxication have been a major public health concern in Europe in recent years. Brief interventions (BIs) in the emergency department (ED) could prevent future risky drinking. However, effectiveness and feasibility of this approach are currently unclear. Method: A systematic literature search on controlled trials including participants aged 12-25 years treated in an ED following an alcohol-related event was conducted. Additionally, a grey literature search was conducted to support findings from the systematic review with evidence from practice projects and uncontrolled trials. Data on effectiveness, acceptance, implementation and reach were extracted. Results: Seven randomised controlled trials (RCT), 6 practice projects, 1 non-randomised pilot study and 1 observational study were identified. Six RCTs found reductions of alcohol use for all participants. Four RCTs found effects on alcohol consumption, alcohol-related risk-behaviour or referral to treatment. Participation and referral rates varied strongly, whereas data on acceptance and implementation were rarely assessed. Conclusion: Heterogeneity of study designs and effects limit conclusions on effectiveness of BIs for young ED patients following an alcohol-related event. However, the number of practice projects in Europe indicates a need perceived by practitioners to address this population.

Neuropsychologische Defizite bei Ecstasykonsumenten

Zusammenfassung: Einleitung: Neuere Untersuchungen diskutieren vermehrt den Einfluss von Cannabis zur Erklarung neuropsychologischer Beeintrachtigungen bei Ecstasykonsumenten. Methodik: Eine nach Alter, Bildung und kumulierter Cannabis-Dosis gleich verteilte Stichprobe von 24 Konsumenten von Ecstasy und Cannabis mit geringem Beikonsum von Kokain und LSD und 24 reinen Cannabiskonsumenten wurde neuropsychologisch untersucht. Ergebnisse: Die Ecstasykonsumenten zeigen in mehreren untersuchten Bereichen (Daueraufmerksamkeit, Kurz- und Langzeitgedachtnis) deutliche Beeintrachtigungen im Vergleich zu Probanden mit reinem Cannabiskonsum. Schlussfolgerungen: Dabei konnte es sich um Auswirkungen einer neurotoxischen Schadigung durch Ecstasy oder durch kombinierte Effekte von Ecstasy und Cannabis handeln. Die Ergebnisse der vorliegenden Untersuchung sprechen gegen eine zentrale Rolle von Cannabis zur Erklarung von kognitiven Defiziten bei Ecstasykonsumenten.

Short- to Midterm Effectiveness of a Brief Motivational Intervention to Reduce Alcohol Use and Related Problems for Alcohol Intoxicated Children and Adolescents in Pediatric Emergency Departments: A Randomized Controlled Trial.

OBJECTIVES The proportion of children and adolescents receiving emergency care for acute alcohol intoxication (AAI) in Germany has sharply increased over the past years. Despite this, no randomized controlled trials (RCTs) have studied guideline- and evidence-based interventions to prevent future alcohol misuse within this population. The objective of our investigation was to evaluate the effectiveness of a brief motivational intervention (b-MI) to reduce drinking and associated problems within pediatric emergency departments (PED) in Hamburg, Germany. METHODS This stratified cluster-RCT compared a widely established but modified targeted b-MI and treatment as usual (TAU) for patients recruited and treated on Fridays, Saturdays, or Sundays from July 2011 to January 2014 for AAI in EDs of six pediatric hospitals in Hamburg, Germany. Patients under the age of 18 years and their caregivers were included in the study. Intervention was delivered by trained hospital-external staff. The intervention group (n = 141) received a single-session b-MI with a telephone booster after 6 weeks and a brief consultation for caregivers. All intervention material was manual-based. The TAU control group (n = 175) received youth-specific written information on alcohol use and contact information for community resources. Primary outcomes were changes in binge drinking frequency, number of alcoholic drinks on a typical occasion, and alcohol-related problems using the brief Rutgers Alcohol Problem Index. Outcomes were measured by research assistants not involved in intervention delivery. Baseline data were collected in person at the PED, and follow-up data were collected via telephone 3 and 6 months after baseline. Secondary outcome was postenrollment health service utilization. Analyses were based on linear mixed models and intent to treat. RESULTS A total of 86.1% (87.5%) of patients in the b-MI group and 82.4% (86.9%) in the TAU group provided valid outcome data after 3 (6) months, respectively. The differences between groups for all outcomes were statistically nonsignificant at both follow-ups (p > 0.05). After 3 months the mean change in binge drinking frequency was -1.36 (95% confidence interval [CI] = -1.81 to -0.91), a reduction of 62.1% in the b-MI group, and -1.29 (95% CI = -1.77 to -0.95), a reduction of 49.0% in the TAU group. The mean change in number of alcoholic drinks on a typical occasion was -2.24 (95% CI = -3.18 to -1.29), a reduction of 37.5% in the b-MI group, and -1.34 (95% CI = -2.54 to -0.14), a reduction of 26.4% in the TAU group. The mean change of alcohol-related problems was -6.72 (95% CI = -7.68 to -5.76), a reduction of 60.5% in the b-MI group, and -6.43 (95% CI = -7.37 to -5.49), a reduction of 58.3% in the TAU group. The differences in mean changes between groups were similar after 6 months for all outcomes. CONCLUSION This study provides new information on the effectiveness of b-MIs delivered at discharge of young AAI patients in emergency care. Both trial groups reduced alcohol use and related problems but the b-MI was not associated with significant effects. Although the intervention approach appears feasible, further considerations of improving the outcomes for this relevant target group are required.

Zusammenhänge zwischen familialen Aspekten und pathologischem Internetgebrauch bei Jugendlichen

OBJECTIVE The internet is used intensely by German adolescents for various activities both in school as well as during leisure time. Pathological internet use is currently on the increase in many industrial nations (especially in Asia, North America, and Europe). According to recent epidemiological studies, pathological internet use occurs more frequently in youths than in adults. Several studies have investigated the interdependence of family structures or interactions and pathological adolescent internet use. This article provides an overview of the available research results. METHODS We conducted a systematic literature search in the bibliographic databases PubMed, PsycINFO, and Psyndex. RESULTS We identified 15 studies (published in English or German) examining exclusively minor-aged participants. A good family functioning as well as a good communication between parents and adolescents, a positive parent-child relationship, and supportive parental monitoring proved to help prevent pathological adolescent internet use. CONCLUSIONS The described familial predictors have been replicated in some studies. Implications for future research on this subject are discussed.

Internet gaming disorder in early adolescence: Associations with parental and adolescent mental health

BACKGROUND Internet gaming disorder (IGD) has been included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, associations between IGD in early adolescence and mental health are largely unexplained. In the present study, the relation of IGD with adolescent and parental mental health was investigated for the first time. METHODS We surveyed 1095 family dyads (an adolescent aged 12-14 years and a related parent) with a standardized questionnaire for IGD as well as for adolescent and parental mental health. We conducted linear (dimensional approach) and logistic (categorical approach) regression analyses. RESULTS Both with dimensional and categorical approaches, we observed statistically significant associations between IGD and male gender, a higher degree of adolescent antisocial behavior, anger control problems, emotional distress, self-esteem problems, hyperactivity/inattention and parental anxiety (linear regression model: corrected R2=0.41, logistic regression model: Nagelkerkes R2=0.41). CONCLUSIONS IGD appears to be associated with internalizing and externalizing problems in adolescents. Moreover, the findings of the present study provide first evidence that not only adolescent but also parental mental health is relevant to IGD in early adolescence. Adolescent and parental mental health should be considered in prevention and intervention programs for IGD in adolescence.