Frauen und Alkoholabhängigkeit: Aktueller Forschungsstand zur Effektivität psychotherapeutischer Behandlungen als Grundlagen für Behandlungsempfehlungen

Zusammenfassung

Die neuen deutschen S3-Leitlinien „Screening, Diagnose und Behandlung alkoholbezogener Störungen“ (AWMF 076001) enthalten eine Reihe von Hinweisen auf geschlechtsspezifische Differenzen hinsichtlich des Screenings, der Diagnostik und vor allem der Behandlung alkoholbezogener Störungen. In einem Unterkapitel werden die Ergebnisse einer breit angelegten Literatursuche nach (randomisierten) kontrollierten Studien zusammengefasst mit Frauen als Studiensubjekte. Zur Behandlung von schwangeren Frauen mit leichten bis mittleren alkoholbezogenen Störungen empfehlen sich Kurzinterventionen. Für Schwangere mit schweren alkoholbezogenen Störungen sollte eine stationäre Behandlung angestrebt werden bzw. eine Begleitung durch die Schwangerschaft und die Zeit nach der Geburt durch Hausbesuche durch eine Fachkraft. Kurzeitinterventionen haben sich auch bei nicht-schwangeren Frauen mit leichten bis mittleren alkoholbezogenen Störungen bewährt. Frauen, bei denen eine Posttraumatische Belastungsstörungen sowie eine Substanzkonsum-Störung diagnostiziert worden ist, sollten eine integrierte Behandlung erhalten (wie z. B. im Programm „Sicherheit finden“). In gewissem Umfang bewährt haben sich kognitive Paartherapien sowie ambulante oder stationäre Settings mit Frauengruppen. Das gilt insbesondere für Frauen, die eine Paarbehandlung oder eine Behandlung in einer Frauengruppe wünschen. Mehr und bessere Forschungen sind dringend notwendig, um die Angebote für Frauen mit Substanzkonsum-Störungen zu verbessern.

Abstract

The new German S3-guidelines “Screening, diagnostics and treatment of alcohol-related disorders” (AWMF 076001) contain quite a number of references on gender-specific differences regarding screening, diagnostics and, especially, treatment of alcohol-related disorders. In a subchapter the results of an extensive literature search for (randomised) controlled studies which address explicitly women as study subjects are summarised. Brief interventions are recommended for the treatment of pregnant women with mild and medium severe alcohol-related disorders. Pregnant women with severe alcohol-related disorders should be referred to inpatient treatment or they should be supported with home visits by professionals during pregnancy and after delivery. Brief interventions are also effective with women who are not pregnant with mild and medium severe alcohol-related disorders. Women who are diagnosed as having a post-traumatic stress disorder and a substance abuse disorder should be offered an integrated treatment programme (e. g., the programme “seeking safety”). There is some evidence that behavioral couples therapy is effective as well as a treatment for women in outpatient or inpatient women-only settings. Behavioral couples therapy as well as treatment in women-only settings is most effective if women choose these types of treatment. More and better research studies are strongly needed to improve the treatment of women with substance use disorders.

Schlüsselwörter

Frauen - Schwangere - alkoholbezogene Störungen - Behandlungen

Key words

women - pregnant women - alcohol-related disorders - treatments

• Literatur

• 1 American Psychiatric Association (APA). Treatment of patients with substance use disorders. 2006
• 2 National Institute for Health and Clinical Excellence (NICE) . Diagnosis, assessment and management of harmful drinking and alcohol dependence (CG 115). National Institute for Health and Clinical Excellence 2011;
• 3 National Institute for Health and Clinical Excellence (NICE) . Alcohol-use disorders: preventing the development of hazardous and harmful drinking – public health guidance (PH 24). National Institute for Health and Clinical Excellence 2010;
• 4 VA/DoD clinical practice guideline for management of substance use disorders (SUD). USA: Department of Defense, Federal Government Agency, Department of Veterans Affairs; Veterans Health Administration; 2009
• 5 Eltons A, Kilts CD. The role of sex differences in the drug addiction process. In Brady KT, Back SE, Greenfield SF. Hrsg Women and addiction. A comprehensive handbook. New York: Guilford; 2009: 147-170
• 6 Becker JB, Hu M. Sex differences in drug abuse. Frontiers in Neuroendocrinology 2008; 29: 36-47
• 7 Goldstein RB. Comorbidity of substance use disorders with independent mood and anxiety disorders in women: Results from the National Epidemiological Survey on alcohol and related conditions. In Brady KT, Back SE, Greenfield SF. Hrsg Women and addiction. A comprehensive handbook. New York: Guilford; 2009: 173-192
• 8 Pettinati HM, Plebani JG. Depression and substance use disorders in women. In Brady KT, Back SE, Greenfield SF. Hrsg Women and addiction. A comprehensive handbook. New York: Guilford; 2009: 193-208
• 9 AWMF, angemeldete Leitlinie. Screening, Diagnose und Behandlung alkoholbezogener Störungen. Registernummer 076001. Abgerufen unter http://www.awmf.org/leitlinien/detail/anmeldung/1/ll/076-001.html
• 10 Stade BC, Bailey C, Dzendoletas D et al. Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy. Cochrane Database of Systematic Reviews 2009; Issue 2. Art. No.: CD004228
• 11 Chang G, Wilkings-Haug L, Berman S et al. A brief intervention for alcohol use in pregnancy: A randomized trial. Addiction 1999; 94: 1499-1508
• 12 Handmaker NS, Miller WR, Manicke M. Findings of a pilot study of motivational interviewing with pregnant drinkers. Journal of Studies on Alcohol 1999; 60: 285-287
• 13 O’Connor MJ, Whaley SE. Brief intervention for alcohol use by pregnant women. American Journal of Public Health 2007; 97: 252-258
• 14 Reynolds KD, Coombs D, Lowe J. Evaluation of a self-help program to reduce alcohol consumption among pregnant women. International Journal of Addictions 1995; 30: 427-443
• 15 Tzilos GK, Sokol RJ, Ondersma SJ. A randomized phase I trial of a brief computer-delivered intervention for alcohol use during pregnancy. Journal of Women’s Health 2011; 20: 1517-1524
• 16 Gilinsky A, Swanson V, Power K. Interventions delivered during antenatal care to reduce alcohol consumption during pregnancy: A systematic review. Addiction Research and Theory 2011; 19: 235-250
• 17 Executive Council of the Society of Obstetricians and Gynaecologists of Canada Hrsg Alcohol Use and Pregnancy Consensus Clinical Guidelines. Journal of Obstetrics and Gynaecology Canada 2010; 32 (Supplement 3) S1-S27
• 18 Lui S, Terplan M, Smith EJ. Psychosocial interventions for women enrolled in alcohol treatment during pregnancy. Cochrane Database of Systematic Reviews 2008; Issue 3. Art. No.: CD006753
• 19 National Institute for Health and Clinical Excellence (NICE). Pregnancy and complex social factors. National Institute for Health and Clinical Excellence 2010;
• 20 Miligan K, Niccols A, Sword W et al. Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: A meta-analysis. Substance Abuse, Prevention, and Policy 2010; 5: 21
• 21 Whiteside-Mansell L, Crone CC, Conners NA. The development and evaluation of an alcohol and drug prevention and treatment program for women and children. Journal of Substance Abuse Treatment 1999; 16: 265-275
• 22 Luthar SS, Suchman NE, Altomare M. Relational psychotherapy mother’s group: A randomized clinical trial for substance abusing mothers. Developmental Psychopathology 2007; 19: 243-261
• 23 Landgraf MN, Heinen F. Fetales Alkoholsyndrom. S3-Leitlinien zur Diagnostik. Stuttgart: Kohlhammer; 2013
• 24 Ernst CC, Grant TM, Streissguth AP et al. Intervention with high-risk alcohol and drug-abusing mothers: II. Three-year findings from the Seattle model of paraprofessional advocacy. Journal of Community Psychology 1999; 27: 19-38
• 25 Doggett C, Burrett SL, Osborn DA. Home visits during pregnancy and after birth for women with an alcohol or drug problem. Cochrane Database of Systematic Reviews 2005; Issue 4. Art. No.: CD004456
• 26 Turnbull C, Osborn DA. Home visits during pregnancy and after birth for women with an alcohol or drug problem. Cochrane Database of Systematic Reviews 2012; Issue 1. Art. No.: CD004456
• 27 Bartu A, Sharp J, Ludlow J et al. Postnatal home visiting for illicit drug-using mothers and their infants: A randomized controlled trial. Australian and New Zealand Journal of Obstetrics and Gynaecology 2006; 46: 419-426
• 28 Dakof GA, Quille TJ, Tejeda MJ et al. Enrolling and retaining mothers of substance-exposed infants in drug abuse treatment. Journal of Consulting and Clinical Psychology 2003; 71: 764-772
• 29 Schuler ME, Nair P, Black MM. Ongoing maternal drug use, parenting attitudes, and a home intervention: Effects on mother-child interaction at 18 months. Journal of Developmental and Behavioral Pediatrics 2002; 23: 87-94
• 30 TIP 34: Brief interventions and brief therapies for substance abuse: Treatment Improvement Protocol (TIP) Series 34. US Department of Health and Human Services. DHHS Publication No (SMA) 99-3353 1999
• 31 Ballesteros J, Gonzalez-Pinto A, Querejeta I et al. Brief interventions for hazardous drinkers delivered in primary care are equally effective in men and women. Addiction 2004; 99: 103-108
• 32 Kaner EF, Beyer F, Dickinson HO et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2007; CD004148
• 33 Bertholet N, Deappen JB, Wietlisbach V et al. Reduction of alcohol consumption by brief alcohol intervention in primary care. Archives of Internal Medicine 2005; 165: 986-995
• 34 Sullivan LE, Tetrault JM, Braithwaite RS et al. A meta-analysis of the efficacy of nonphysician brief interventions for unhealthy alcohol use: Implications for the patient-centered medical home. American Journal on Addictions 2011; 20: 343-356
• 35 Polizeiliche Kriminalstatistik 2013 Abgerufen unter https://www.google.de/search?q=Gewaltkriminalit%C3%A4t+und+Geschlecht&biw=1490&bih=643&source=lnt&tbs=cdr%3A1%2Ccd_min%3A2013%2Ccd_max%3A2014&tbm=#q=Gewaltkriminalit%C3%A4t+und+Geschlecht&tbs=cdr%3A1%2Ccd_min%3A2013%2Ccd_max%3A2014
• 36 FRA-Agentur der Europäischen Union für Grundrechte (2014). Gewalt gegen Frauen: eine EU-weite Erhebung. Abgerufen unter http://fra.europa.eu/de/press-release/2014/gewalt-gegen-frauen-sie-passiert-taglich-und-allen-kontexten
• 37 Gahleitner S. Gender-Trauma-Sucht: Stand der Forschung. Zeitschrift für Psychotraumatologie, Psychotherapiewissenschaft, Psychologische Medizin 2012; 9-20
• 38 Vogt I. Beratung von süchtigen Frauen und Männern. Weinheim: Beltz; 2004
• 39 Lüdecke C, Sachse U, Faure H Hrsg Sucht-Bindung-Trauma. Stuttgart: Schattauer; 2010
• 40 Hien DA. Trauma, posttraumatic stress disorder and addiction among women. In Brady KT, Back SE, Greenfield SF. Hrsg Women & addiction. A comprehensive handbook. New York: Guilford; 2009: 242-256
• 41 Waldrop A. Violence and victimization among women with Substance Use Disorders. In Brady KT, Back SE, Greenfield SF. Hrsg Women & addiction. A comprehensive handbook. New York: Guilford; 2009: 493-499
• 42 Vogt I, Fritz J, Kuplewatzky N. Süchtige und von Gewalt betroffene Frauen: Nutzung von formalen Hilfen und Verhaltensmuster bei Beendigung der Gewaltbeziehung. Verhaltenstherapie und psychosoziale Praxis 2014; 41
• 43 Hien DA, Cohen LR, Miele GM et al. Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry 2004; 161: 1426-1432
• 44 Hien DA, Wells EA, Jiang H et al. Multi-site randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorder. Journal of Consulting and Clinical Psychology 2009; 77: 607-619
• 45 Zlotnick C, Johnson J, Najavits LM. Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorders and PTSD. Behavioral Therapy 2009; 404: 325-336
• 46 Hien DA, Campbell ANC, Ruglass LM et al. The role of alcohol misuse on PTSD outcomes for women in community treatment: A secondary analysis of NIDA’s Women and Trauma study. Drug and Alcohol Dependence 2010; 111: 114-119
• 47 Killeen T, Hien DA, Cambell ANC et al. Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment. Journal of Substance Abuse Treatment 2008; 35: 304-311
• 48 Najavits L. Posttraumatische Belastungsstörung und Substanzmissbrauch – Das Therapieprogramm „Sicherheit finden“. Göttingen: Hogrefe; 2009
• 49 New York State Department of Health . Medical care of HIV-infected substance-using women. New York (NY): New York State Department of Health; 2009
• 50 Fals-Stewart W, Kam WKK, Kelley ML. Behavioral couple therapy. Partner-involved treatment for substance-abusing women. In Brady KT, Back SE, Greenfield SF. Hrsg Women & addiction. A comprehensive handbook. New York: Guilford; 2009: 323-338
• 51 Schumm JA, O’Farrell TJ, Muchowski P. A randomized clinical trial of behavioral couples therapy for women with alcohol dependence. Paper presented at the Annual Meeting of the Association for the Advancement of Behavioral and Cognitive Therapies, Orlando 2008
• 52 Powers MB, Vedel E, Emmelkamp PMG. Behavioral couples therapy (BCT) for alcohol and drug use disorders: A meta-analysis. Clinical Psychology Review 2008; 28: 952-962
• 53 Fals-Stewart W, Birchler GR, Kelley ML. Learning sobriety together. A randomized clinical trial examining behavioral couples therapy with alcoholic female patients. Journal of Consulting and Clinical Psychology 2006; 74: 579-591
• 54 McCrady B, Epstein EE, Cook S et al. A randomized trial of individual and couple behavioral alcohol treatment for women. Journal of Consulting and Clinical Psychology 2009; 77: 243-256
• 55 O’Farrell TJ, Clements K. Review of outcome research on marital and family therapy in treatment for alcoholism. Journal of Marital and Family Therapy 2012; 38: 122-144
• 56 McCrady BS, Epstein EE, Cook S et al. What do women want? Alcohol treatment choices, treatment entry and retention. Psychology of Addictive Behaviors 2011; 25: 521-529
• 57 Graff FS, Morgan TJ, Epstein EE et al. Engagement and retention in outpatient alcoholism treatment for women. American Journal on Addictions 2009; 18: 277-288
• 58 Greenfield SF, Pirard S. Gender-specific treatment for women with substance use disorders. In Brady KT, Back SE, Greenfield SF. Hrsg Women and addiction. A comprehensive handbook. New York: Guilford; 2009: 289-236
• 59 Dahlgren L, Wilander A. Are special treatment facilities for female alcoholics needed? A controlled 2-year follow-up study from a specialized female unit (EWA) versus a mixed male/female treatment facility. Alcoholism, Clinical and Experimental Research 1989; 13: 499-504
• 60 Gjestad R, Franck J, Lindberg S et al. Early Treatment for women with alcohol addiction (EWA) reduces mortality: A randomized controlled trial with long-term register follow-up. Alcohol and Alcoholism 2011; 46: 170-176
• 61 Greenfield SF, Trucco EM, McHugh RK et al. The women’s recovery group study: A stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling. Drug and Alcohol Dependence 2007; 90: 39-47
• 62 Kaskutas LA, Zhang L, French MT et al. Women’s programs versus mixed-gender day treatment: Results from a randomized study. Addiction 2005; 100: 60-69
• 63 Cummings AM, Gallop RJ, Greenfield SF. Self-efficacy and substance use outcomes for women in single-gender versus mixed-gender group treatment. Journal of Groups in Addiction & Recovery 2010; 5: 4-16