title: Economic crisis and changes in drug use in the Spanish economically active population.
abstract: OBJECTIVE
  To examine changes in the use of alcohol, cannabis and hypnotics/sedatives between two periods (before and during Spain's economic crisis), and to identify differences in the change between employed and unemployed individuals.
  
  
  METHODS
  Using cross-sectional data from four editions of the Spanish Household Survey on Alcohol and Drugs, we selected economically active individuals aged 16-64 years (total sample = 62 440) and defined two periods, pre-crisis [period 1 (P1) = 2005-07] and crisis (P2 = 2009-11). Poisson regression models with robust variance were fitted to obtain prevalence ratios (PR) of heavy and binge drinking and multinomial regression models to obtain relative risk ratios (RRR) of cannabis and hypnotic/sedative use between the two periods, also considering the interaction between period and employment status.
  
  
  RESULTS
  While the prevalence of alcohol use remained stable, heavy drinking declined in P2 in men both overall [PR = 0.73; 95% confidence interval (CI) = 0.67-0.79] and in the two age groups (16-34 and 35-64 years), and also in women overall (PR = 0.86; 95% CI = 0.75-0.99) and in the older age group. In contrast, binge drinking increased overall in P2 in men (PR = 1.17; 95% CI = 1.12-1.22) and in women (PR = 1.62; 95% CI = 1.49-1.76), and in both age groups. No differences in the change were observed between employed and unemployed individuals. Overall cannabis use remained stable in P2, but unemployed men and women of the older age group were more likely to have increased sporadic use compared to their employed counterparts (RRR = 2.24; 95% CI = 1.36-3.68 and RRR = 3.21; 95% CI = 1.30-7.93, respectively). Hypnotic/sedative use remained stable in P2 in men, but unemployed men were less likely to have increased heavy use in P2 compared with employed men (RRR = 0.69; 95% CI = 0.49-0.97). In women, heavy use increased in P2 overall and in the older age group, irrespective of employment status.
  
  
  CONCLUSIONS
  During a period of economic recession in Spain, heavy drinking decreased and binge drinking increased. Sporadic cannabis use increased among older unemployed men and women. Heavy use of hypnotics/sedatives increased among employed men while older women increased use irrespective of employment status.
authors.affiliation: Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.|Centre for Research in Occupational Health, Pompeu Fabra University, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Colell
authors.affiliation: Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.|CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Sánchez-Niubò
authors.affiliation: The University of Texas School of Public Health, Houston, TX, USA.|Centre for Research in Occupational Health, Pompeu Fabra University, Barcelona, Spain.|CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: George L
authors.initials: GL
authors.lastname: Delclos
authors.affiliation: Centre for Research in Occupational Health, Pompeu Fabra University, Barcelona, Spain.|CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Benavides
authors.affiliation: Drug Abuse Epidemiology Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Domingo-Salvany
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D057172:Economic Recession / Q000706:statistics & numerical data*; D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Alcohol use; Spain; cannabis use; economic recession; hypnotics and sedatives; unemployment