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Nervenheilkunde 2016; 35(11): 770-776
DOI: 10.1055/s-0037-1616450
Sucht
Schattauer GmbH

Wirkfaktoren psychosozialer Behandlungen bei Sucht und komorbiden psychischen Störungen

Effective psychosocial treatment for patients with substance use disorders and co-morbid psychiatric disorders
F. Moggi
1   Universitätsklinik für Psychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz
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Publication History

eingegangen am: 04 July 2017

angenommen am: 09 August 2016

Publication Date:
10 January 2018 (online)

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Zusammenfassung

Gegenstand und Ziel: Es werden die wichtigsten Wirkfaktoren erfolgreicher psychosozialer Behandlungen von Patienten mit einer Komorbidität von psychischen Störungen und Sucht (Doppeldiagnosen) herausgearbeitet. Material und Methoden: In den wissenschaftlichen Datenbanken PubMed, PsycINFO und Web of Science wurden neuere Metaanalysen und umfassende Übersichtsarbeiten zur Wirksamkeit psychosozialer Behandlungen bei Doppeldiagnose-Patienten gesucht und aus deren Ergebnisse das vorliegende „narrative review“ erarbeitet. Dabei wird näher auf die Studienergebnisse zu schweren und zu leichten Formen von Komorbidität eingegangen. Ergebnisse: Integrative, gestufte Behandlungsprogramme, die störungsspezifische Interventionen kombinieren, sind Kontrollgruppen (z. B. Wartegruppen, Standardbehandlungen) meistens, bzw. anderen aktiven Behandlungen (z. B. Psychoedukation) manchmal in den drei Ergebnisbereichen (Sucht, psychische Störung und Funktionsniveau) überlegen. Erfolgreiche Behandlungsprogramme enthalten meist motivierende Gesprächsführung, kognitiv-verhaltenstherapeutische Interventionen, substanzkonsumbezogene Interventionen wie Rückfallprävention oder Kontingenzmanagement und/oder Familieninterventionen. Schlussfolgerung: Die Heterogenität der Patienten-, Behandlungs-, Settings- und Ergebnismerkmale erschweren allgemeingültige Schlussfolgerungen über die Wirksamkeit psychosozialer Behandlungen. Bei Patienten mit Doppeldiagnosen sind integrierte Behandlungsangebote am erfolgversprechendsten.

Summary

Objective: Results on the effectiveness of psychosocial treatments for patients with a comorbidity of psychiatric and substance use disorders (dual diagnosis patients) are presented. Material and methods: PubMed, PsycINFO, and Web of science were searched for recent meta-analyses and comprehensive reviews on the efficacy of psychosocial treatments for dual diagnosis patients. The findings are presented in this narrative review for severe (e. g., schizophrenia) and for mild to moderate (e. g., anxiety disorders) dual diagnoses. Results: Promising treatments seem to be integrative stagewise programs that comprise motivational interviewing, cognitive-behavioral interventions, substance use reducing interventions such as relapse prevention and contingency management and/or family interventions. Such programs are mostly superior to control groups (e. g., waiting list) and they are sometimes superior to other active treatments (e. g., treatment as usual) in outcomes of substance use, psychiatric disorders and social functioning. Conclusions: Due to the heterogeneity in patients’, treatments’, settings’, and outcomes’ characteristics, it is difficult to generally conclude which psychosocial treatments are effective. Integrated treatments seem to be most effective for dual diagnosis patients.

Schlüsselwörter

Komorbidität - Behandlungswirksamkeit - integrative Behandlungen - Übersicht

Keywords

Comorbidity - treatment effectiveness - integrated treatment - review
 

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