Epidemiological Survey on Substance Abuse in Germany 2024 (ESA)

The Epidemiological Survey on Addiction (ESA) is a representative population study that has been conducted regularly since 1980 to assess the use of psychoactive substances and substance-related problems in the general German population. The sample (N=46,876) of German-speaking individuals aged 18 to 85 from private households was drawn disproportionately to the distribution of birth cohorts in a two-stage selection process. In the first step, 253 municipalities within Germany were selected at random. In a second step, addresses were drawn from the resident registration records via a systematic random selection. The surveys were conducted using a combination of methods, including written and internet-based questionnaires as well as telephone interviews. To compensate for disproportionate selection probabilities, post-stratification weights were calculated to align the data with the distribution of the German population. Data collection took place between August and December 2024 and was conducted by Ipsos Public Affairs, Berlin. The response rate was 22%. The study assessed 30-day, 12-month, and lifetime prevalence of use of tobacco (tobacco products as well as water pipes (shishas), heat-not-burn products (tobacco heaters), and e-cigarettes), alcohol, illicit drugs, and medications. The Munich Composite International Diagnostic Interview (M-CIDI) was used to assess abuse and dependence according to DSM-IV criteria, as well as the severity of the disorder according to DSM-5 criteria, for conventional tobacco products, alcohol, cannabis, cocaine, amphetamines, analgesics, and hypnotics and sedatives. For conventional tobacco products, only dependence according to DSM-IV was assessed. Additionally, a range of sociodemographic data, physical and mental health status, mental disorders, and modules on the focus topic of cannabis were collected. The study assessed 30-day, 12-month, and lifetime prevalence of use of tobacco (tobacco products as well as water pipes (shishas), heat-not-burn products (tobacco heaters), and e-cigarettes), alcohol, illicit drugs, and medications. Additionally, a range of sociodemographic data, physical and mental health status, mental disorders, and modules on the focus topic of cannabis were collected. Physical and mental health status: Self-assessment of current physical health; self-assessment of current mental well-being; over the past 12 months: physical complaints or pain without a clear explanation, anxiety attacks/panic attacks, frequent worries, severe anxiety in social situations, severe anxiety regarding public places, public transportation, or stores, unfounded severe anxiety in various situations, e.g., using elevators, tunnels, airplanes, as well as fear of heights or severe weather, sadness or low mood, loss of interest, fatigue or lack of energy, feeling unusually happy, overexcited, or irritable, stressful traumatic events or disasters, psychiatric, psychological, or psychotherapeutic treatment, or a mental or psychosomatic diagnosis. Medications: Use of medications in the past 12 months (opioid pain relievers, non-opioid pain relievers, sleep aids, sedatives, benzodiazepines, stimulants, appetite suppressants, antidepressants, antipsychotics, anabolic steroids, cannabinoids); none of these medications were taken; Frequency of medication use in the past 30 days; medications prescribed by a doctor; use of painkillers (opioid-based/non-opioid-based) or sleeping pills or sedatives in the past 12 months; significant problems related to the use of these medications; being under the influence of medication in situations with an increased risk of injury; unintentionally injured after taking medication; legal problems related to medication; criticism from family or friends regarding medication use; relationship ended due to medication use; financial difficulties due to medication use; physically assaulted or injured someone while under the influence of medication; taken medication in larger quantities or for a longer period than prescribed or originally intended; symptoms or discomfort when stopping a specific medication or reducing the dose; continuing to take the same or a similar medication to avoid symptoms or discomfort when stopping a specific medication or reducing the dose; requiring higher doses of a specific medication to achieve the desired effect, or a decrease in the medication’s effectiveness with prolonged use of the same amount; repeatedly tried unsuccessfully to reduce or stop taking certain medications; spending a lot of time obtaining certain medications (e.g., visiting multiple doctors) or recovering from their effects; restricting or giving up important activities, such as your job or spending time with friends or relatives, because of taking certain medications; Taking medications despite knowing that doing so is harmful; experiencing a strong craving or urge for medications that you could not resist; having such a strong craving for medications that you could not think of anything else. Questions about drugs (especially cannabis) and other substances: Use of cannabis or synthetic cannabinoids in the past 12 months; methods of use; type and amount of cannabis used on a typical day of use; sources of cannabis; membership in a cannabis cultivation club; number of memberships; driving after using cannabis; amount of marijuana and hashish used; mixing cannabis with tobacco; reasons for cannabis use; if cannabis, heroin, or amphetamines were used in the past 12 months: significant problems at work, school, or with household responsibilities related to using these drugs; being under the influence of drugs in situations with an increased risk of injury; unintentionally injured after using drugs; legal problems related to drugs; criticism from family or friends regarding drugs; relationship ended due to drug use; financial difficulties due to drug use; physically assaulted or injured someone while under the influence of drugs; used more drugs than before to achieve the same effect or noticed that the same amount had a lesser effect than before; discomfort when reducing the amount; taking drugs to prevent or avoid such discomfort; taking more drugs or using them for a longer period than originally intended; making several unsuccessful attempts to reduce or stop drug use entirely; Spending a lot of time obtaining, taking, or recovering from the effects of drugs; restricting or giving up important activities, such as work or spending time with friends or relatives, because of drugs; health problems caused by drug use; continued drug use despite these health problems; emotional or psychological problems caused by drug use; continued drug use despite psychological problems; a strong craving or urge for drugs that could not be resisted; a craving for drugs so strong that one could think of nothing else. Demography: Gender; age groups; year of birth; country of birth; length of residence in Germany (year of arrival); German or other citizenship; other citizenship; parents’ country of birth (Germany or another country, migration background); height in centimeters; weight in kilograms; marital status; living with a partner in the household; number of children; number of children living permanently or part-time in the household; number of people in the household (household size); number of people in the household under 14 years of age; highest general education qualification; intended general education qualification; highest vocational training qualification; employment status; group affiliation if not employed; previously employed full-time or part-time; occupational status; respondent is the primary earner in the household; occupational status of the primary earner; net household income (categorized); chronic illnesses; driver’s license. The following were additionally coded: Serial number; point number; West/East; weighting factors; location size (BIK10 and political municipality size class); ID of the residents’ registration offices by federal state; educational level (ISCED); survey method of the interview.