Original article
Psychoactive substance use in Germany
Findings from the Epidemiological Survey of Substance Abuse (ESA) in 2024
Dtsch Arztebl Int 2025; 122: 625. DOI: 10.3238/arztebl.m2025.0157
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For technical reasons, the English full text will be published approximately two weeks after the German print edition has been published.
IFT Institut für Therapieforschung, München: Dr. phil. Sally Olderbak, Dipl. Stat. Regina Hollweck, Eva-Maria Krowartz, M. Sc., Dr. rer. biol. hum. Justin Möckl, Prof. Dr. rer. nat. habil. Eva Hoch
Abteilung für Klinische Psychologie und Psychotherapie, Charlotte Fresenius Hochschule, München: Dr. phil. Sally Olderbak, Prof. Dr. rer. nat. habil. Eva Hoch
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, Klinikum LMU München: Dr. phil. Sally Olderbak, Eva-Maria Krowartz, M. Sc., Prof. Dr. rer. nat. habil. Eva Hoch
Abteilung für Klinische Psychologie und Psychotherapie, Charlotte Fresenius Hochschule, München: Dr. phil. Sally Olderbak, Prof. Dr. rer. nat. habil. Eva Hoch
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, Klinikum LMU München: Dr. phil. Sally Olderbak, Eva-Maria Krowartz, M. Sc., Prof. Dr. rer. nat. habil. Eva Hoch
| 1. | Peacock A, Leung J, Larney S, et al.: Global statistics on alcohol, tobacco and illicit drug use: 2017 status report. Addiction 2018; 113: 1905–26 CrossRef MEDLINE |
| 2. | Starker A, Olderbak S, Möckl J, et al.: Tabak- und Nikotinprodukte – Zahlen und Fakten zum Konsum. DHS Jahrbuch Sucht 2025. Lengerich: Deutsche Hauptstelle für Suchtfragen e.V. 2025. |
| 3. | Kraus L, Möckl J, Manthey J, Rovira P, Olderbak S, Rehm J: Trends in alcohol-attributable morbidity and mortality in Germany from 2000 to 2021: A modelling study. Drug Alcohol Rev 2024; 43: 1662–75 CrossRef MEDLINE |
| 4. | Bundeskriminalamt: Bundeslagebild Rauschgiftkriminalität 2023. Wiesbaden: Bundeskriminalamt 2024. |
| 5. | Organisation for Economic Co-operation and Development (OECD): Health at a Glance: Europe 2022. Paris: OECD 2022. |
| 6. | Deutsche Hauptstelle für Suchtfragen e.V. (DHS). Tabak – Zahlen, Daten, Fakten. www.dhs.de/suechte/tabak/zahlen-daten-fakten (last accessed on 15 Septermber 2025). |
| 7. | Starker AHJ: Tabak – Zahlen und Fakten zum Konsum. DHS Jahrbuch Sucht 2024. Lengerich: Deutsche Hauptstelle für Suchtfragen e. V. 2024. |
| 8. | Deutsches Krebsforschungszentrum (eds.): Passivrauchen – ein unterschätztes Gesundheitsrisiko. Heidelberg: 2005. |
| 9. | World Health Organization: Guidelines for controlling and monitoring the tobacco epidemic. Geneva: WHO 1998. |
| 10. | Seitz H, Bühringer G, Mann K: Grenzwerte für den Konsum alkoholischer Getränke. In: Deutsche Hauptstelle für Suchtfragen (editor), Jahrbuch Sucht 2008. Geesthacht: Neuland 2008; p. 205–9. |
| 11. | Burger M, Brönstrup A, Pietrzik K: Derivation of tolerable upper alcohol intake levels in Germany: A systematic review of risks and benefits of moderate alcohol consumption. Prev Med 2004; 39: 111–27 CrossRef MEDLINE |
| 12. | Bundesministerium für Gesundheit (BMG): Fragen und Antworten zum Cannabisgesetz 2024. www.bundesgesundheitsministerium.de/themen/cannabis/faq-cannabisgesetz.html (last accessed on 15 May 2025). |
| 13. | Wittchen HU, Beloch E, Garczynski E, et al.: Münchener Composite International Diagnostic Interview (M-CIDI), Paper-pencil 2.2, 2/95. München: Max-Planck-Institut für Psychiatrie, Klinisches Institut 1995. |
| 14. | Statistisches Bundesamt (Destatis) (2023). GENESIS-Online. www-genesis.destatis.de/ (Datenlizenz: dl-de/by-2–0) (last accessed on 1 August 2025). |
| 15. | Heeringa SG, West BT, Berglund PA: Applied survey data analysis. New York: Chapman and Hall/CRC 2017. |
| 16. | StataCorp. Stata Statistical Software: Release 15.1. College Station, TX: StataCorp LLC2017. |
| 17. | Hoch E, Krowartz EM, Hollweck R, Möckl J, Olderbak S: Cannabis consumption before and after partial legalization in Germany: Early trends, consumption patterns, and motives. Dtsch Arztebl Int 2025; 122. DOI: 10.3238/arztebl.m2025.0161 (in press). |
| 18. | Rauschert C, Möckl J, Seitz NN, Wilms N, Olderbak S, Kraus L: The use of psychoactive substances in Germany—findings from the Epidemiological Survey of Substance Abuse 2021. Dtsch Arztebl Int 2022; 119: 527–34 CrossRef VOLLTEXT |
| 19. | Eurostat. File: Daily smokers of cigarettes among persons aged 15 and over, 2019 HLTH2022.png: European Union. 2019. www.ec.europa.eu/eurostat/statistics-explained/index.php?title=File:Daily_smokers_of_cigarettes_among_persons_aged_15_and_over,_2019_HLTH2022.png (last accessed on 24 July 2025). |
| 20. | Inoue-Choi M, Christensen CH, Rostron BL, et al.: Dose-response association of low-intensity and nondaily smoking with mortality in the United States. JAMA Netw Open 2020; 3: e206436 CrossRef MEDLINE PubMed Central |
| 21. | Inoue-Choi M, Hartge P, Liao LM, Caporaso N, Freedman ND: Association between long-term low-intensity cigarette smoking and incidence of smoking-related cancer in the national institutes of health-AARP cohort. Int J Cancer 2018; 142: 271–80 CrossRef MEDLINE PubMed Central |
| 22. | Inoue-Choi M, Liao LM, Reyes-Guzman C, Hartge P, Caporaso N, Freedman ND: Association of long-term, low-intensity smoking with all-cause and cause-specific mortality in the National Institutes of Health-AARP diet and health study. JAMA Intern Med 2017; 177: 87–95 CrossRef MEDLINE PubMed Central |
| 23. | Heinrich-Heine-Universität Düsseldorf: DEBRA – Deutsche Befragung zum Rauchverhalten: Rauchstoppversuch 2024. www.debra-study.info/ (last accessed on 31 July 2025). |
| 24. | World Health Organization (WHO): Fact sheet Alcohol 2024. www.who.int/news-room/fact-sheets/detail/alcohol (last accessed on 31 July 2025). |
| 25. | World Health Organization (WHO): No level of alcohol consumption is safe for our health. 2022. www.who.int/europe/de/news/item/28-12-2022-no-level-of-alcohol-consumption-is-safe-for-our-health (last accessed on 7 August 2025). |
| 26. | Manthey J, Freeman TP, Kilian C, López-Pelayo H, Rehm J: Public health monitoring of cannabis use in Europe: Prevalence of use, cannabis potency, and treatment rates. Lancet Reg Health Eur 2021; 10: 100227 CrossRef MEDLINE PubMed Central |
| 27. | Olderbak S, Mockl J, Manthey J, et al.: Trends and projection in the proportion of (heavy) cannabis use in Germany from 1995 to 2021. Addiction 2023; 119: 311–21 CrossRef MEDLINE |
| 28. | European Union Drugs Agency (EUDA): Kokain – die aktuelle Situation in Europa. Europäischer Drogenbericht 2024: Trends und Entwicklungen. Luxemburg: Amt für Veröffentlichungen der Europäischen Union 2024. |
| 29. | Bindu S, Mazumder S, Bandyopadhyay U: Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem Pharmacol 2020; 180: 114147 CrossRef MEDLINE PubMed Central |
| 30. | Fendrick AM, Pan DE, Johnson GE: OTC analgesics and drug interactions: clinical implications. Osteopath Med Prim Care 2008; 2: 2 CrossRef MEDLINE PubMed Central |
| 31. | Salk RH, Hyde JS, Abramson LY: Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychol Bull 2017; 143: 783–822 CrossRef MEDLINE PubMed Central |
| 32. | Tourangeau R, Yan T: Sensitive questions in surveys. Psychol Bull 2007; 133: 859–83 CrossRef MEDLINE |
| 33. | Krumpal I: Determinants of social desirability bias in sensitive surveys: a literature review. Qual Quant 2013; 47: 2025–47 CrossRef |
| 34. | Schraepler J-P: Respondent behavior in panel studies. A case study for income nonresponse by means of the German Socio-Economic Panel (SOEP). Sociol Methods Res 2004. 33: 118–56 CrossRef |
| 35. | Spitzer S: Biases in health expectancies due to educational differences in survey participation of older Europeans: It‘s worth weighting for. Eur J Health Econ 2020; 21: 573–605 CrossRef MEDLINE PubMed Central |