Komorbide psychische Störungen bei Opiatabhängigen

Zusammenfassung

Opiatabhängige weisen außer häufig bestehenden Abhängigkeiten von weiteren psychotropen Substanzen in der Regel zusätzliche psychische und somatische Erkrankungen und Beeinträchtigungen auf. In der Lebenszeit wie auch aktuell sind bis weit über 50% der Opiatabhängigen von komorbiden psychischen Störungen betroffen. Besonders verbreitet sind affektive und Angststörungen, Persönlichkeitsstörungen sowie posttraumatische Belastungsstörungen. Diese Störungen können allenfalls zu einem Teil als Begleit- oder Folgeerscheinung der Opiatabhängigkeit erklärt werden. Vorbestehende psychische Belastungen und frühzeitig manifestierte Störungen können vielmehr oft als wesentliche Faktoren bei der Suchtentstehung angesehen werden, z. B. im Sinne einer Selbstmedikation mit psychotropen Substanzen. Pharmakologische und psychotherapeutische Behandlungsmöglichkeiten der komorbiden psychischen Störungen sind hinsichtlich ihrer Anwendbarkeit und Wirksamkeit bei unbehandelten oder in Behandlung (z. B. Substitution) befindlichen Opiatabhängigen kaum erforscht. Zudem fehlt es an integrierten Modellen und Algorithmen für die Behandlung bei gleichzeitig bestehenden substanzbezogenen und sonstigen psychischen Störungen.

Abstract

Opiate dependents frequently show additional substance use disorders, chronic somatic illnesses and mental disorders. Lifetime prevalence and also the current rate for mental disorders exceed 50%. Most frequent are affective disorders, anxiety disorders, personality disorders and posttraumatic stress disorders. The high prevalence of comorbid mental disorders can only partly be explained as a ramification or consequence of opiate dependence. Rather, pre-existing psychological strains und mental disorders can be considered as important factors during the development of substance use disorders, for example because of self-medication with psychotropic substances. Research on pharmacological and psychotherapeutic treatments of comorbid mental disorders in opiate dependents, either within or outside substance use treatment, is sparse. Moreover, there is a lack of theoretical models and of algorithms for the integrated treatment of both substance use and other mental disorders.

Schlüsselwörter

Opiatabhängigkeit - Komorbidität - psychische Störungen - Ätiologie - Diagnostik - Behandlung

Key words

opiate dependence - comorbidity - mental disorders - etiology - treatment

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