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DOI: 10.1055/s-0042-106076
Verbessert eine intensivierte ambulante Behandlung das Outcome von schwer alkoholabhängigen Patienten? Eine Pilotstudie
Does Intensified Outpatient Treatment Improve the Outcome of Severely Alcohol Addicted Patients? A Pilot StudyPublication History
Publication Date:
09 June 2016 (online)
Zusammenfassung
Ziel der Studie: Disulfiram ist zur Senkung der Rückfallrate bei Alkoholabhängigen nur wirksam, wenn es mit mehrmals wöchentlichen Kontakten verknüpft ist. Es stellt sich daher die Frage, ob eine intensivierte ambulante Behandlung auch ohne Disulfiram wirkt, bzw. ob es bestimmte Patientengruppen gibt, die von einer solchen Therapie profitieren.
Methodik: In einer nicht-randomisierten Verlaufsbeobachtung konnten sich Alkoholabhängige nach abgeschlossener stationärer Entzugsbehandlung für die intensivierte Behandlung (IB, 3x/Woche ärztliche Kurzkontakte) oder die reguläre Behandlung (RB, 1 ärztlicher Kontakt alle 2 Wochen) entscheiden. Zur regulären Behandlung gehört das Angebot einer rückfallprophylaktischen Medikation mit Naltrexon: dies wurde auch bei IB angeboten. Bei Einschluss wurden Alkoholkonsum und -verlangen, soziobiografische Daten, Vorbehandlungen und Ängstlichkeit erfasst. Anschließend wurde über 3 Monate das Konsummuster erhoben.
Ergebnisse: 75 Patienten (41 RB, 34 IB) wurden eingeschlossen. Patienten in IB waren häufiger Frauen und wiesen mehr Vorbehandlungen, eine schwerere Abhängigkeit und stärkere Ängstlichkeit auf. Die Konsummengen nahmen bis zum Endpunkt der Studie nach 3 Monaten in beiden Gruppen signifikant ab, ohne Unterschiede zwischen den einzelnen Gruppen.
Schlussfolgerung: Der neue Therapieansatz IB ist durchführbar, ergänzt die bisherigen Behandlungsmöglichkeiten und scheint hilfreich zu sein für schwer Alkoholabhängige (vor allem Frauen), für die eine Behandlung mit Disulfiram nicht in Frage kommt.
Abstract
Aim of the study: Disulfiram is an effective treatment for reducing relapse rates in alcohol addicts only in combination with high frequency therapeutic contacts (3 per week). Without this intensified treatment, disulfiram shows no effect. This raises the question, whether an intensified treatment is possible without administration of disulfiram, and which patient group might benefit the most from it.
Methods: In this non-randomized, prospective observational study, detoxified alcohol addicts could choose between the new intensified treatment (IT, 3x/week short therapeutic contacts) and the regular treatment (RT, 1 contact every 2 weeks). Standard relapse-preventive medication (naltrexone) was offered in both groups. At baseline, consumption patterns, sociodemographic data, previous treatments, craving, anxiety and severity of alcohol dependence were assessed. During a follow-up period of 3 months, consumption patterns were collected.
Results: 75 patients (41 RT, 34 IT) were included. Patients in IT were more often female and were characterized by more previous treatments, higher severity of dependence, and higher rate of anxiety. Total alcohol consumption decreased over 3 months significantly in both groups, without significant differences between groups.
Conclusion: IT compliments existing treatment options and seems to be helpful, mainly in combination with naltrexone, for patients with severe alcohol dependence (especially women), who are not suitable for disulfiram treatment.
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Literatur
- 1 Kiefer F, Mann K. New achievements and pharmacotherapeutic approaches in the treatment of alcohol dependence. Eur J Pharmacol 2005; 526: 163-171
- 2 Loeber S, Mann K. Entwicklung einer evidenzbasierten Psychotherapie bei Alkoholismus. Nervenarzt 2006; 77: 558-566
- 3 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“. 2015
- 4 Kiefer F, Helwig H, Tarnaske T et al. Pharmacological relapse prevention of alcoholism: clinical predictors of outcome. Eur Addict Res 2005; 11: 83-91
- 5 Drinkmann A, Lettl B. Die Akzeptanz von kontrolliertem Konsum als Behandlungsziel unter Suchthilfefachkräften in Bayern. Suchttherapie 2015; 16: 82-89
- 6 Bach P, Vollstädt-Klein S, Kirsch M et al. Increased mesolimbic cue-reactivity in carriers of the muopioid-receptor gene OPRM1 A118G polymorphism predicts drinking outcome: A functional imaging study in alcohol dependent subjects. Eur Neuropsychopharmacol 2015;
- 7 Diehl A, Ulmer L, Mutschler J et al. Why is disulfiram superior to acamprosate in the routine clinical setting? A retrospective long-term study in 353 alcohol-dependent patients. Alcohol Alcohol 2010; 45: 271-277
- 8 Mutschler J, Grosshans M, Koopmann A et al. Supervised disulfiram in relapse prevention in alcohol-dependent patients suffering from comorbid borderline personality disorder – a case series. Alcohol Alcohol 2010; 45: 146-150
- 9 Krampe H, Stawicki S, Hoehe MR et al. Outpatient Long-term Intensive Therapy for Alcoholics (OLITA): a successful biopsychosocial approach to the treatment of alcoholism. Dialogues Clin Neurosci 2007; 9: 399-412
- 10 Mutschler J, Grosshans M, Koopmann A et al. Urinary ethylglucuronide assessment in patients treated with disulfiram: a tool to improve verification of abstention and safety. Clin Neuropharmacol 2010; 33: 285-287
- 11 Kaiser KA, Affuso O, Beasley TM et al. Getting carried away: a note showing baseline observation carried forward (BOCF) results can be calculated from published complete-cases results. Int J Obes (Lond) 2012; 36: 886-889
- 12 Miller WR, Del Boca FK. Measurement of drinking behavior using the Form 90 family of instruments. J Stud Alcohol Suppl 1994; 12: 112-118
- 13 Skinner HA, Horn JL. Alcohol Dependence Scale (ADS) user's guide. Toronto: Addiction Research Foundation; 1984
- 14 Anton RF, Moak DH, Latham P. The Obsessive Compulsive Drinking Scale: a self-rated instrument for the quantification of thoughts about alcohol and drinking behavior. Alcohol Clin Exp Res 1995; 19: 92-99
- 15 Beck AT, Steer RA, Brown GK. BDI-II, Beck depression inventory: manual. 2. Aufl. San Antonio, Tex., Boston: Psychological Corp.; Harcourt Brace; 1996
- 16 Spielberger CD. Manual for the state-trait anxiety inventory. Palo Alto, California (USA): Consulting Psychologists Press; 1983
- 17 Laux L (Hrsg.) Das State-Trait-Angstinventar: STAI; theoretische Grundlagen und Handanweisung. Weinheim: Beltz Test; 1981
- 18 Driessen M, Meier S, Hill A et al. The course of anxiety, depression and drinking behaviours after completed detoxification in alcoholics with and without comorbid anxiety and depressive disorders. Alcohol Alcohol 2001; 36: 249-255
- 19 Curran GM, Flynn HA, Kirchner J et al. Depression after alcohol treatment as a risk factor for relapse among male veterans. J Subst Abuse Treat 2000; 19: 259-265
- 20 Burns L, Teesson M, O'Neill K. The impact of comorbid anxiety and depression on alcohol treatment outcomes. Addiction 2005; 100: 787-796
- 21 Koopmann A, Lemenager T, Wolf ND et al. The impact of atrial natriuretic peptide on anxiety, stress and craving in patients with alcohol dependence. Alcohol Alcoholism 2014; 49: 282-286
- 22 Willinger U, Lenzinger E, Hornik K et al. Anxiety as a predictor of relapse in detoxified alcohol-dependent patients. Alcohol Alcoholism 2002; 37: 609-612
- 23 Schellekens AF, de Jong CA, Buitelaar JK et al. Co-morbid anxiety disorders predict early relapse after inpatient alcohol treatment. Eur Psychiatry 2015; 30: 128-136
- 24 Adamson SJ, Sellman JD, Frampton CM. Patient predictors of alcohol treatment outcome: a systematic review. J Subst Abuse Treat 2009; 36: 75-86
- 25 Jonas DE, Amick HR, Feltner C et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA 2014; 311: 1889-1900
- 26 Pettinati HM, Silverman BL, Battisti JJ et al. Efficacy of extended-release naltrexone in patients with relatively higher severity of alcohol dependence. Alcohol Clin Exp Res 2011; 35: 1804-1811
- 27 Berner MM, Wahl S, Brueck R et al. The place of additional individual psychotherapy in the treatment of alcoholism: a randomized controlled study in nonresponders to anticraving medication-results of the PREDICT study. Alcohol Clin Exp Res 2014; 38: 1118-1125
- 28 Bertholet N, Daeppen JB, Wietlisbach V et al. Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Arch Intern Med 2005; 165: 986-995
- 29 Drisko JW. Common Factors in Psychotherapy Outcome: Meta-Analytic Findings and Their Implications for Practice and Research. Fam Soc 2004; 85: 81-90