Ist eine wirksame psychosoziale Behandlung von Patienten mit Suchterkrankungen und komorbiden psychischen Störungen eine unmögliche Aufgabe?

Zusammenfassung

Auf der Grundlage von Metaanalysen und umfassenden Überblicksarbeiten werden Schlussfolgerungen über eine wirksame psychosoziale Behandlung von Patienten mit einer Komorbidität von psychischen Störungen und Sucht (Doppeldiagnosen) gezogen. Dabei wird näher auf die Studienergebnisse zu schweren und zu leichten Formen von Doppeldiagnosen eingegangen. Die Heterogenität der Patienten-, Behandlungs-, Setting- und Ergebnismerkmale erschweren allgemeingültige Schlussfolgerungen über die Wirksamkeit psychosozialer Behandlungen. Integrative, gestufte Behandlungsprogramme, die störungsspezifische Interventionen kombinieren und motivierende Gesprächsführung, kognitiv-verhaltenstherapeutische Interventionen, suchtmittelreduzierende Interventionen wie Rückfallprävention oder Kontingenzmanagement und/oder Familieninterventionen enthalten, sind Kontrollgruppen (z. B. Wartegruppen, Standardbehandlungen) meistens, anderen aktiven Behandlungen (z. B. Psychoedukation) manchmal, in den 3 Ergebnisbereichen (Sucht, psychische Störung und Funktionsniveau) überlegen.

Abstract

Results on the effectiveness of psychosocial treatments for patients with a comorbidity of psychiatric and substance use disorders (dual diagnosis) will be discussed based on relevant meta-analyses and comprehensive reviews. The findings will be presented for severe (e. g., schizophrenia) and for mild to moderate (e. g., anxiety disorders) dual diagnoses. Due to the heterogeneity in patients’, treatments’, settings’, and outcomes’ characteristics it is difficult to generally conclude which psychosocial treatments are effective. 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.

Schlüsselwörter

Komorbidität - Behandlungswirksamkeit - Behandlungskomponenten - integrative Behandlungs­programme - Überblick

Key words

comorbidity - treatment effectiveness - treatment components - integrated treatment programmes - review

• Literatur

• 1 Roberts LJ, Shaner A, Eckman TA et al. Effectively treatment of stimulant-abusing schizophrenics: Mission impossible?. New Directions for Mental Health Services 1992; 53: 55-65
• 2 Chow CM, Wieman D, Cichocki B et al. Mission impossible: treating serious mental illness and substance use co-occurring disorder with integrated treatment: a meta-analysis. Mental Health and Substance Use 2012; 1: 1-19
• 3 Cleary M, Hunt GE, Matheson SL et al. Psychosocial interventions for people with both severe mental illness and substance misuse (Review). The Cochrane Collaboration; The Cochrane Library 2010
• 4 Jeffrey DP, Ley A, McLaren S et al. Psychosocial treatment programmes for people with both severe mental illness and substance misuse (Review). The Cochrane Collaboration; The Cochrane Library 2007
• 5 Cleary M, Hunt GE, Matheson S et al. Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: a systematic review. Journal of Advanced Nursing 2009; 65: 238-258
• 6 Drake RE, Mueser KT, Brunette MF et al. A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatric Rehabilitation Journal 2004; 27: 360-374
• 7 Drake RE, O’Neal EL, Wallach MA. A systematic review of psychosocial research on psychosocial interventions for people with co-occurring severe mental and substance use disorders. Journal of Substance Abuse Treatment 2008; 34: 123-138
• 8 Hesse M. Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literature. BMC Psychiatry 2009; 9: 6
• 9 Horsfall J, Cleary M, Hunt GE et al. Psychosocial treatments for people with co-occurring severe mental illnesses and substance use disorders (dual diagnosis): a review of empirical evidence. Harvard Review of Psychiatry 2009; 17: 24-34
• 10 Kelly TM, Daley DC, Douaihy AB. Treatment of substance abusing patients with comorbid psychiatric disorders. Addictive Behaviors 2012; 37: 11-24
• 11 Lubman DI, King JA, Castle DJ. Treating comorbid substance use disorders in schizophrenia. Int Rev Psychiatry 2010; 22: 191-201
• 12 Murthy P, Chand P. Treatment of dual diagnosis disorders. Current Opinion in Psychiatry 2012; 25: 194-200
• 13 Pennay A, Cameron J, Reichert T et al. A systematic review of interventions for co-occurring substance use disorder and borderline personality disorder. Journal of Substance Abuse Treatment 2011; 41: 363-373
• 14 Tiet QQ, Mausbach B. Treatments for patients with dual diagnosis: a review. Alcoholism: Clinical and Experimental Research 2007; 31: 513-536
• 15 De Witte NAJ, Crunelle CL, Sabbe B et al. Treatment for outpatients with comorbid schizophrenia and substance use disorders: a review. European Addiction Research in press
• 16 Rosenthal RN, Westreich L In: McCrady BS, Epstein EE. Hrsg Addictions. A comprehensive guidebook. New York: Oxford University Press; 1999: 439-476
• 17 Schäfer I, Schulze C, Stubenvoll M. Psychotherapie bei Abhängigkeitserkrankungen und Posttraumatischer Belastungsstörung. Sucht 2011; 57: 353-361
• 18 Baker AL, Kavanagh DJ, Kay-Lambkin FJ et al. Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems: short-term outcome. Addiction 2010; 105: 87-99
• 19 Barrowclough C, Haddock G, Wykes T et al. Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial. BMJ 2010; 341: c6325
• 20 Pfammatter M, Junghan UM, Brenner HD. Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses. Schizophrenia Bulletin 2006; 32 (Suppl. 01) S64-S80
• 21 Moggi F Hrsg 2. Aufl Bern: Huber; 2007
• 22 Miller WR, Rollnick S 3. Aufl. Freiburg: Lambertus; 2009
• 23 Osher FC, Kofoed LL. Treatment of patients with psychiatric and psychoactive substance use disorders. Hospital and Community Psychiatry 1989; 40: 1025-1035
• 24 Prochaska JO, DiClemente CC, Norcross JC. In search how people change. Applications to addictive behaviors. American Psychologist 1992; 47: 1102-1114
• 25 Haddock G, Barrowclough C, Tarrier N et al. Cognitive-behavioral therapy and motivational intervention for schizophrenia and substance misuse. British Journal of Psychiatry 2003; 183: 418-426
• 26 Bellack AS, Bennett ME, Gearon JS et al. A randomized clinical tral of a new behavioral treatment for drug abuse in people with severe and persistent mental illness. Archives of General Psychiatry 2006; 63: 426-432
• 27 Mueser KT, Glynn SM, Cather C et al. A randomized controlled trail of Family Intervention for Co-occurring Substance use and Severe Psychiatric Disorders. Schizophrenia Bulletin 2013; 39
• 28 Frank E, Swartz HA, Kupfer DJ. Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biological Psychiatry 2000; 48: 593-604
• 29 Weiss RD, Griffin ML, Greenfield SF et al. Group therapy for patients with bipolar disorder and substance dependence: results of a pilot study. The Journal of Clinical Psychiatry 2000; 61: 361-367
• 30 Najavits LM. New York: The Guilford Press; 2002
• 31 Hien DA, Cohen LR, Miele GM et al. Promising treatments for women with comorbid PTSD and substance use disorders. The American Journal of Psychiatry 2004; 161: 1426-1432
• 32 Dimeff LA, Linehan MM. Dialectical behavior therapy for substance abusers. Addiction Science and Clinical Practice 2008; 4: 39-47
• 33 Gregory RJ, Remen AL. A manual-based psychodynamic therapy for treatment-resistant borderline personality disorder. Psychotherapy 2008; 45: 15-27
• 34 Ball SA. Manualized treatment for substance abusers with personality disorders: dual focus schema therapy. Addictive Behaviors 1998; 23: 883-891
• 35 Moggi F, Brodbeck J, Költzsch K et al. One-year follow-up of dual diagnosis patients attending a 4-months integrative inpatient treatment. European Addiction Research 2002; 8: 30-37
• 36 Morrens M, Dewilde B, Sabbe B et al. Treatment outcomes of an integrated residential programme for patients with schizophrenia and substance use disorder. European Addiction Research 2011; 17: 154-163
• 37 D’Amelio R, Behrendt B, Wobrock T. Psychoedukation Schizophrenie und Sucht. Manual zur Leitung von Patienten- und Angehörigengruppen. München: Urban & Fischer; 2007
• 38 Gouzoulis-Mayfrank E. Komorbidität Psychose und Sucht. Von den Grundlagen zur Praxis. Darmstadt: Steinkopf; 2007
• 39 Moggi F, Donati R. Psychische Störungen und Sucht: Doppeldiagnosen. Göttingen: Hogrefe; 2004
• 40 Najavits LM, Schäfer I, Stubenvoll M et al. Posttraumatische Belastungsstörung und Substanzmissbrauch: Das Therapieprogramm „Sicherheit finden“. Göttingen: Hogrefe-Verlag; 2008