Pharmakologische Rückfallprophylaxe bei Alkoholabhängigkeit

Zusammenfassung

Die medikamentöse Rückfallprophylaxe der Alkoholabhängigkeit hat mit detaillierterem Verständnis der neurobiologischen Grundlagen zunehmend an Bedeutung gewonnen. So genannte Anticraving Substanzen steigern in Kombination mit psychotherapeutischen/psychosozialen Maßnahmen die bislang erreichten Behandlungserfolge beträchtlich. Besonders sind der NMDA-Rezeptormodulator Acamprosat und der Opiat-Rezeptor Antagonist Naltrexon zu nennen, deren Effekte in der Rückfallprophylaxe in zahlreichen Studien nachgewiesen werden konnten. Für Naltrexon fehlt allerdings in Deutschland die Zulassung in dieser Indikation. Werden die zur Abstinenz motivierten Patienten nach Entgiftung ein Jahr mit Acamprosat rückfallprophylaktisch behandelt, kommt es zu einer Verdoppelung der Abstinenzrate, die die eigentliche Behandlungszeit überdauert. In aktuellen Studien werden besonders geeignete Untergruppen von Patienten („responder”) identifiziert, um dann gezielt behandelt in Zukunft den Erfolg der medikamentösen Rückfallprophylaxe weiter zu steigern.

Summary

Better understanding of the neurobiological substrates of alcohol dependence has been accompanied with an increasing role of pharmacological relapse prevention. In combination with psychosocial treatment substances which reduce alcohol craving improve maintenance of abstinence. Especially the NMDA receptor modulator acamprosate and the opiate receptor antagonist naltrexone showed an effect in numerous trials. In Germany, however, naltrexone has not been approved in this indication up to now. The administration of the medication starts immediately after detoxification and should last for 12 months. The medical treatment, however, is not a replacement for a psychosocial treatment of the alcohol dependence. Compared with placebo treatment, approximately twice as many patients remain abstinent under acamprosate one year after the end of the treatment period. Current studies try to identify particular subgroups of patients responding to pharmacological relapse prevention. A specific application of these substances will optimise the outcome of rehabilitation programmes for alcohol dependent patients.

Keywords

alcohol dependence - relapse prevention - craving - naltrexone - acamprosate

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