The EDSP: Setting the Stage!

Abstract

Analyses of trends in the field of psychoactive substance use have shown a general increase in the frequency and severity of problems in most countries. The modern drug epidemics which started in the 1960s in industrialized countries have now spread worldwide with an enormous increase in the use of cocaine, designer drugs, other stimulants, cannabis, hallucinogens and opiates in addition to the use of multiple drugs (including alcohol). This epidemic has brought about an increase in the risk of mortality caused by substance-related risk-taking behavior, accidents, infections (including HIV and hepatitis), overdose and other physical diseases. The mental and physical disabilities and handicaps associated with substance use also seem to increase considerably. Although these trends have generally been identified in many countries around the world, knowledge about the scope and size of the problem in specific countries and regions is sparse. With the exception of fairly comprehensive and diversified monitoring systems and long-term research initiatives in the US, most other countries and particularly Germany have been fairly slow in recognizing the importance of the drug problem and designing appropriate initiatives to learn more about culture, country and region-specific characteristics of drug use and abuse, associated risk factors and consequences. Addressing these issues is a challenging and complex task, requiring concerted action on the regional, national and international level by politicians, the legal system and police, administrators, clinicians and researchers. This collaboration is essential because it is extremely unlikely that one country, region or institution alone is able to carry out the necessary basic, epidemiological and clinical research needed to provide a sound scientific basis for a rationally planned action and intervention program against the drug epidemic. Further, understanding and intervening the rapidly changing international drug distribution ‘highways’ and patterns certainly call for more intense collaborations. Examples for research areas where international collaboration is needed include (a) harmonization efforts with regard to the measurement of drug use, abuse and dependence as well as (b) monitoring strategies to allow comparison between various countries. These two issues are essential to determine to what degree knowledge and insight collected in one country can be generalized or projected to other countries. International coordination in basic science is essential not only to improve our knowledge about the neurobiology and psychology of addictive behaviors but also about the natural history of drug use over life course, the delineation of stages of involvement in different drugs (including legal drugs such as nicotine and alcohol), degrees of involvement within drug classes and between drug classes (i.e. initiation, intermittent use, regular use, dependence, remission and relapse). Such natural history research require on the one hand longitudinal studies of individuals over time, on the other cohort sequential designs, in order to identify classes of probable causes, and the time they operate in an individuals life, as well as to differentiate among age, cohort and historical changes and differences. Despite the availability of numerous cross-sectional studies in various regions, it is still difficult to put the puzzle together, due to differences in the operationalization of key constructs, different designs and instruments, making