Nervenheilkunde 2019; 38(09): 657-661
DOI: 10.1055/a-0979-0610
Schwerpunkt
© Georg Thieme Verlag KG Stuttgart · New York

ADHS und Sucht

ADHD and addiction
Martin D. Ohlmeier
1   Klinik für Psychiatrie und Psychotherapie, Klinikum Kassel
› Author Affiliations
Further Information

Publication History

Publication Date:
02 September 2019 (online)

ZUSAMMENFASSUNG

Gegenstand und Ziel: Abhängigkeitserkrankungen sind bei Erwachsenen mit einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) häufig. Insbesondere Abhängigkeit von Cannabis, Amphetaminen und Alkohol haben sowohl für die differenzialdiagnostische Einschätzung als auch für den differenzialtherapeutischen Entscheidungsprozess eine hohe klinische Relevanz. Eine wichtige Rolle in der Pathophysiologie der Komorbidität spielt neben der „Selbstbehandlungshypothese“ und der „Dopaminmangelhypothese“ die oftmals bestehende erhöhte Risikobereitschaft bei ADHS-Patienten im Sinne eines „Sensation-Seekings“.

Material und Methoden: In dem Artikel wird eine Übersicht über die Epidemiologie, Pathophysiologie sowie die sich daraus ergebenden klinischen Implikationen der ADHS und komorbiden Abhängigkeitserkrankungen gegeben.

Ergebnisse, Schlussfolgerungen: Bei Erwachsenen mit ADHS ist die Komorbidität mit Abhängigkeitserkrankung häufig, insbesondere Cannabis, Amphetamine und Alkohol betreffend. In der Ätiopathogenese hat die „Selbstmedikationshypothese“ im Kontext der „Dopaminmangelhypothese“ eine wichtige Bedeutung. Auch die erhöhte Risikobereitschaft der betroffenen ADHS-Patienten hat im Sinne des „Sensation-Seekings“ eine große klinische Relevanz. Die Behandlung mit Psychostimulanzien ist bei Vorliegen einer komorbiden Suchterkrankung kritisch abzuwägen, da sie selbst ein Abhängigkeitspotenzial besitzen. Alternativ können Noradrenalin- und Dopamin-Wiederaufnahmehemmer eingesetzt werden. Weitere wissenschaftliche Untersuchungen hinsichtlich geeigneter Behandlungsmethoden erscheinen notwendig.

ABSTRACT

Objective: Substance abuse or substance dependence are common in adults with attention deficit/hyperactivity disorder (ADHD). In particular, dependence on cannabis, amphetamines and alcohol have a high clinical relevance for both the differential diagnostic assessment and the differential therapeutic decision-making process. In addition to the “self-treatment hypothesis” and the “dopamine-deficiency hypothesis” an important role in the pathophysiology of comorbidity plays an often-elevated risk-taking behavior in ADHD-patients in the sense of sensation seeking.

Material and methods: The article reviews the epidemiology, pathophysiology and clinical implications of ADHD and comorbid addictive disorders.

Results and Conclusions: In adults with ADHD, comorbidity of substance use disorder is common, especially with regard to cannabis, amphetamines and alcohol. In the etiopathogenesis, the “self-medication hypothesis” in the context of the “dopamine deficiency hypothesis” has an important meaning. The increased risk-taking of the affected ADHD patients also has great clinical relevance in the sense of sensation seeking. The treatment with psychostimulants should be critically weighed in the presence of a comorbid addiction disease, since they themselves have a dependency potential. Alternatively, noradrenaline and dopamine reuptake inhibitors can be used. Further scientific investigations regarding suitable treatment methods seem necessary.

 
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