PDF herunterladen
Suchttherapie 2000; 1(1): 8-15
DOI: 10.1055/s-2000-13133
Schwerpunktthema
© Georg Thieme Verlag Stuttgart · New York

Alkoholabhängigkeit und psychiatrische Komorbidität - ein Überblick

Alcohol Dependence and Psychiatric Comorbidity - an OverviewJens Wittfoot, Martin Driessen
  • Psychiatrische Klinik, Bielefeld
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Dezember 2000 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Zusammenfassung

Zusätzliche psychische Störungen, insbesondere Angst- und affektive Störungen, finden sich bei Alkoholabhängigen in Behandlungseinrichtungen sehr viel häufiger als bei unbehandelten Abhängigen. Im Sinne des Komorbiditätskonzepts und auf der Grundlage operationalisierter Diagnostik zeigt bereits der zeitliche Zusammenhang ein komplexes Muster simultaner und sukzessiver Komorbidität. Eindeutige Belege für eine gemeinsame hereditäre bzw. genetische Grundlage von Abhängigkeit und komorbiden Störungen existieren nicht. So fokussiert sich das Interesse derzeit auf drei Fragen: 1. Stellen Alkoholabhängigkeit und komorbide psychische Störung wechselseitig Risikofaktoren für das Auftreten der jeweils anderen Erkrankung dar? 2. Beeinflussen komorbide Störungen und/oder das Ausmaß der aktuellen Psychopathologie den Verlauf der Abhängigkeit? 3. Sind komorbide psychische Störungen therapierelevant? Während Behandlungsprogramme für Alkoholabhängige mit komorbiden psychischen Störungen in der Praxis bereits existieren, fehlen bisher Untersuchungen zum Beleg der Wirksamkeit definierter pharmako-, psycho- und sozialtherapeutischer Interventionen.

Alcohol Dependence and Psychiatric Comorbidity - an Overview

Additional psychiatric disorders, i.e. mainly anxiety and affective disorders, were more frequently found in treated than in non treated alcohol-dependent persons. Basing on the concept of comorbidity operationalized diagnostic investigations revealed a complex pattern of successive and simultaneous comorbidity. A common hereditary and/or genetic origin of substance use disorders and comorbid psychiatric disorders cannot be stated. The current interest of researches and clinicians focusses on three issues: 1. Are alcohol dependence and additional psychiatric disorders pathogenetic risk factors for each other? 2. Do comorbid psychiatric disorders and/or the degree of current psychopathology interact with the course of alcohol dependence? 3. Are comorbid disorders relevant for alcoholism treatment? While treatment programmes for comorbid alcoholics were introduced into the clinical practice, up to now, evidence is missing for the efficacy (and efficiency) of defined psychopharmacological, psychotherapeutical, and social interventions in the field.

Literatur

  • 1 Schneider K. Psychischer Befund und psychiatrische Diagnose. Leipzig; Thieme 1939
    Google Scholar
  • 2 Jaspers K. Allgemeine Psychopathologie. Berlin, Heidelberg; Springer 1948
    Google Scholar
  • 3 Feinstein A R. The pretherapeutic classification of comorbidity in chronic disease.  Am J Psychiatry. 1970;  142 1259-1264
    PubMedGoogle Scholar
  • 4 Driessen M. Psychiatrische Komorbidität bei Alkoholismus und Verlauf der Abhängigkeit. Darmstadt; Steinkopff 1999
    Google Scholar
  • 5 Kosten T, Kleber H. Differential diagnosis of psychiatric comorbidity in substance abusers.  J Subst Abuse Treat. 1988;  5 201-206
    PubMedGoogle Scholar
  • 6 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Darmstadt; Steinkopff 1999
    Google Scholar
  • 7 RachBeisel J, Scott J, Dixon L. Co-occurring severe mental illness and substance use disorders: a review of recent research.  Psychiatr Serv. 1999;  5 1427-1434
    PubMedGoogle Scholar
  • 8 Brady K T. Comorbidity of substance use and axis I psychiatric disorders. Medscape Mental Health 1998 3
    Google Scholar
  • 9 Hesselbrock M N, Meyer R E, Keener J J. Psychopathology in hospitalized alcoholics.  Arch Gen Psychiatry. 1985;  42 1050-1055
    PubMedGoogle Scholar
  • 10 Ross H E, Glaser F B, Germanson T. The prevalence of psychiatric disorders in patients with alcohol and other drug problems.  Arch Gen Psychiatry. 1988;  45 1023-1031
    CrossrefPubMedGoogle Scholar
  • 11 Herz L, Volicer R, D'Angelo N, Gadish D. Additional psychiatric illness by Diagnostic Interview Schedule in male alcoholics.  Compr Psychiatry. 1990;  3 72-79
    PubMedGoogle Scholar
  • 12 Tomasson K, Vaglum P. A nationwide representative sample of treatment-seeking alcoholics: a study of psychiatric comorbidity.  Acta Psychiatr Scand. 1995;  92 378-385
    PubMedGoogle Scholar
  • 13 Schneider U  et al. Comorbid anxiety and affective disorders on alcohol dependent patients seeking treatment: the forst multicenter study in Germany. Unveröffentlicht
    Google Scholar
  • 14 Arolt V, Driessen M. Alcoholism and psychiatric comorbidity in general hospital inpatients.  Gen Hosp Psychiatry. 1996;  18 271-277
    PubMedGoogle Scholar
  • 15 Kessler R C, Crum R M, Warner L A, Nelson C B, Schulenberg J, Anthony J C. Lifetime co-occurrance of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey.  Arch Gen Psychiatry. 1997;  54 313-321
    PubMedGoogle Scholar
  • 16 Dilling H, Weyerer S. Psychische Erkrankungen in der Bevölkerung bei Erwachsenen und Jugendlichen. In: Dilling H, Weyerer S, Castell R Psychische Erkrankungen in der Bevölkerung Stuttgart; Enke 1984: 1-121
    Google Scholar
  • 17 Fichter M M. Prävalenz von Alkoholabusus und -abhängigkeit in der Bevölkerung. In: Fichter MM Verlauf psychischer Erkrankungen in der Bevölkerung Berlin, Heidelberg, New York; Springer 1990: 72-83
    Google Scholar
  • 18 Nace E P, Davis C W, Gaspari J P. Axis II comorbidity in substance abusers.  Am J Psychiatry. 1991;  148 118-120
    PubMedGoogle Scholar
  • 19 Smyth N J. Differences in situational heavy drinking among alcoholics with and without comorbid personality disorders. VI Congress on the Treatment of Addictive Behavior 1993. Santa Fé, USA; Abstract 1993
    Google Scholar
  • 20 DeJong A J, van den Brink W, Hartefeld F M, van der Wielen E GM. Personality disorders in alcoholics and drug addicts.  Compr Psychiatry. 1993;  34 87-94
    CrossrefPubMedGoogle Scholar
  • 21 Parker J B, Meiller R M, Andrews G W. Major psychiatric disorders masquerading as alcoholism.  South Med J. 1960;  53 560-565
    PubMedGoogle Scholar
  • 22 Merikangas K, Risch N J, Weissman M M. Comorbidity and co-transmission of alcoholism, anxiety and depression.  Psychological Medicine. 1994;  24 69-80
    PubMedGoogle Scholar
  • 23 Kendler K, Heath H, Neale M, Kessler R, Eaves L. Alcoholism and major depression in women. A twin study of the causes of comorbidity.  Arch Gen Psychiatry. 1993;  5 690-698
    PubMedGoogle Scholar
  • 24 Pickens R W, Svikis D S, McGue M, LaBuda M C. Common genetic mechanisms in alcohol, drug, and mental disorder comorbidity.  Drug Alcohol Depend. 1995;  39 129-138
    PubMedGoogle Scholar
  • 25 Maier W, Merikangas K. Co-occurrence and contransmission of affective disorders and alcoholism in families.  BJP. 1996;  3 93-100
    PubMedGoogle Scholar
  • 26 Kendler K S, Davis C G, Kessler R C. The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey: a family history study.  BJP. 1997;  17 541-548
    PubMedGoogle Scholar
  • 27 Dinwiddie S H, Reich T. Genetic and family studies in psychiatric illness and alcohol and drug dependence.  J Addict Disord. 1993;  12 17-27
    PubMedGoogle Scholar
  • 28 Kaye W H, Lilenfeld L R, Plotnicov K, Merikangas K R, Nagy L, Strober M, Bulik C M, Moss H, Greeno C G. Bulimia nervosa and substance dependence: association and family transmission.  Alc Clin Exp Res. 1996;  2 878-881
    PubMedGoogle Scholar
  • 29 Kendler K S, Walters E E, Neale M C, Kessler R C, Heath A C, Eaves L J. The structure of the genetic and environmental risk factors for six major psychiatric disorders in women. Phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism.  Arch Gen Psychiatry. 1995;  52 374-383
    PubMedGoogle Scholar
  • 30 Hambrecht M, Haefner H. Führen Alkohol- oder Drogenmissbrauch zu Schizophrenie.  Nervenarzt. 1996;  67 36-45
    PubMedGoogle Scholar
  • 31 Behar D, Winokur G, Berg C J. Depression in the abstinent alcoholic.  Am J Psychiatry. 1984;  141 1105-1107
    PubMedGoogle Scholar
  • 32 Schuckit M. Alcoholic patients with secondary depression.  Am J Psychiatry. 1983;  14 711-714
    PubMedGoogle Scholar
  • 33 Schuckit M. Genetic and clinical implications of alcoholism and affective disorder.  Am J Psychiatry. 1986;  143 140-147
    PubMedGoogle Scholar
  • 34 Schuckit M A, Tipp J E, Bergman M, Reich W, Hesselbrock V M, Smith T L. Comparison of induced and independent major depressive disorders in 2,945 alcoholics.  Am J Psychiatry. 1997;  154 948-957
    PubMedGoogle Scholar
  • 35 Roy A, DeJong J, Lamparski D, George T, Linnoila M. Depression among alcoholics.  Arch Gen Psychiatry. 1991;  48 428-432
    PubMedGoogle Scholar
  • 36 Johannessen D, Cowley D, Walker R, Jensen C, Parker L. Prevalence, onset, and clinical recognition of panic states in hospitalized male alcoholics.  Am J Psychiatry. 1989;  146 1201-1203
    PubMedGoogle Scholar
  • 37 Kuefner H. Angst und Alkohol. In: Faust V Angst-Furcht-Panik Stuttgart; Hippokrates 1986: 141-147
    Google Scholar
  • 38 Wiseman E J. Alcohol dependence may be the missing link between posttraumatic stress disorder and panic.  Arch Gen Psychiatry. 1994;  51 429-430
    PubMedGoogle Scholar
  • 39 Baving L, Olbrich H. Anxiety in alcohol dependent patients.  Fortschr Neurol Psychiat. 1996;  64 83-89
    PubMedGoogle Scholar
  • 40 Roberts M C, Emsley R A, Pienaar W P, Stein D J. Anxiety disorders among abstinent alcohol-dependent patients.  Psychiatr Serv. 1999;  5 1359-1361
    PubMedGoogle Scholar
  • 41 Thevos A K, Johnston A L, Latham P K, Randall C L, Adinoff B, Malcolm R. Symptoms of anxiety in inpatient alcoholics with and without DSM-III-R anxiety diagnoses.  Alc Clin Exp Res. 1991;  15 102-105
    PubMedGoogle Scholar
  • 42 Kushner M G, Sher K J, Erickson D J. Prospective analysis of the relation between DSM-III anxiety disorders and alcohol use disorders.  Am J Psychiatry. 1999;  156 723-732
    PubMedGoogle Scholar
  • 43 Schuckit M A. Alcoholism and sociopathy. Diagnostic confusion.  J Stud Alcohol. 1973;  34 157-164
    PubMedGoogle Scholar
  • 44 Tarter R E, McBride H, Buonpane N, Schneider D U. Differentiation of alcoholics. childhood history of minimal brain dysfunction, family history, and drinking pattern.  Arch Gen Psychiatry. 1979;  34 761-768
    PubMedGoogle Scholar
  • 45 Virkkunen M. Alcoholism and antisocial personality.  Acta Psychiatr Scand. 1979;  59 493-501
    PubMedGoogle Scholar
  • 46 Rada R T. Alcoholism and sociopathy: Diagnostic and Treatment Implications. In: Kaufman E Encyclopedic Handbook of Alcoholism New York; Gardner 1982: 647-654
    Google Scholar
  • 47 Lewis C E, Rice J, Helzer J E. Diagnostic interactions between alcoholism and antisocial personality.  J Nerv Ment Dis. 1983;  171 105-113
    PubMedGoogle Scholar
  • 48 Hesslbrock M N. Childhood Behavior Problems and Adult Antisocial Personality Disorder in Alcoholism. In: Meyer RE Psychopathology and Addictive Disorders New York, London; Guilford 1986: 78-93
    Google Scholar
  • 49 Rounsaville B J, Dolinsky C S, Babor T F, Meyer R E. Psychopathology as a predictor of treament outcome in alcoholics.  Arch Gen Psychiatry. 1987;  44 505-513
    PubMedGoogle Scholar
  • 50 Alterman A I, Gerstley L J, Strohmetz D B, McKay J R. Psychiatric Heterogeneity in antisocial alcoholics: relation to familial alcoholism.  Compr Psychiatry. 1991;  32 423-430
    PubMedGoogle Scholar
  • 51 Powell B, Penick E, Nickel E, Liskow B I, Riesenmy K E, Campion S L, Brown E F. Outcomes of co-morbid alcoholic men: a 1-year follow-up.  Alc Clin Exp Res. 1992;  16 131-138
    PubMedGoogle Scholar
  • 52 McGue M, Slutske W, Taylor J, Iacono W G. Personality and substance use disorders: I. Effects of gender and alcoholism subtype.  Alc Clin Exp Res. 1997;  21 513-520
    PubMedGoogle Scholar
  • 53 von der Stein B, Podoll K. Borderline-Persönlichkeitsstörung bei Patienten mit chronischem Alkoholismus.  Sucht. 1992;  2 99-106
    PubMedGoogle Scholar
  • 54 Bartels S, Drake R E, McHugo G J. Alcohol abuse, depression, and suicidal behavior in schizophrenia.  Am J Psychiatry. 1992;  149 394-395
    PubMedGoogle Scholar
  • 55 Cuffel B J, Chase P. Remission and relapse of substance use disorders in schizophrenia.  J Nerv Ment Dis. 1994;  182 342-348
    PubMedGoogle Scholar
  • 56 Drake R E, Wallach M A. Moderate drinking among people with severe mental illness.  Hospital and Community Psychiatry. 1993;  4 1041-1046
    PubMedGoogle Scholar
  • 57 Soyka M. Sucht und Schizophrenie. Nosologische, klinische und therapeutische Fragestellungen. 1. Alkoholismus und Schizophrenie.  Fortschr Neurol Psychiat. 1994;  62 71-87
    PubMedGoogle Scholar
  • 58 Chouljian T L, Shumway M, Balancio E, Dwyer E V, Surber R, Jacobs M. Substance use among schizophrenic outpatients: prevalence, course, and relation to functional status.  Ann Clin Psychiat. 1995;  7 19-24
    PubMedGoogle Scholar
  • 59 Kozaric-Kovacic D, Folnegovic-Smalc V, Folnegovic Z, Maruic A. Influence of alcoholism on the prognosis of schizophrenic patients.  J Stud Alcohol. 1995;  56 622-627
    PubMedGoogle Scholar
  • 60 Uchtenhagen A. Schizophrenia and substance dependence.  Schw Arch Neuro Psychiat. 1995;  146 215-223
    PubMedGoogle Scholar
  • 61 Hasin D S, Tsai W Y, Endicott J, Mueller T I, Coryell W, Keller M. Five-year course of major depression: effects of comorbid alcoholism.  J Affect Disord. 1996;  41 63-70
    PubMedGoogle Scholar
  • 62 Murphy G E, Armstrong J W, Hermele S L, Fischer J R, Clendenin W W. Suicide and alcoholism: interpersonal loss confirmed as a predictor.  Arch Gen Psychiatry. 1979;  36 65-69
    PubMedGoogle Scholar
  • 63 Biro M, Selakovic-Bursic S, Kapamadzija B. The role of depressive disorder in the suicidal behavior of alcoholics.  Crisis. 1991;  12 64-68
    PubMedGoogle Scholar
  • 64 Cornelius J R, Salloum I M, Mezzich J, Cornelius M D, Fabrega H J r, Ehler J G, Ulrich R F, Thase M E, Mann J J. Disproportionate suicidality in patients with comorbid major depression and alcoholism.  Am J Psychiatry. 1995;  152 358-364
    PubMedGoogle Scholar
  • 65 Whitters A, Cadoret R, Troughton E, Widmer R. Suicide attempts in antisocial alcoholics. The Journal of Nervous and Mental Disease.  J Nerv Ment Dis. 1987;  175 626
    PubMedGoogle Scholar
  • 66 Driessen M, Veltrup C, Weber J, John U, Wetterling T, Dilling H. Psychiatric co-morbidity, suicidal behaviour and suicidal ideation in alcoholics seeking treatment.  Addiction. 1998;  93 889-894
    CrossrefPubMedGoogle Scholar
  • 67 Pirkola S P, Marttunen M J, Henriksson M M, Isometsae E T, Heikkinen M E, Loennqvist M E. Alcohol-related problems among adolescent suicides in Finland.  Alcohol & Alcoholism. 1999;  34 320-329
    PubMedGoogle Scholar
  • 68 Driessen M, Arolt V, John U, Veltrup C, Dilling H. Psychiatric comorbidity in hospitalized alcoholics after detoxification treatment.  Europ Addict Res. 1996;  2 17-23
    PubMedGoogle Scholar
  • 69 Greenfield S F, Weiss R D, Muenz L R, Vagge L M, Kelly J F, Bello L R, Michael J. The effect of depression on return to drinking: a prospective study.  Arch Gen Psychiatry. 1998;  55 259-265
    PubMedGoogle Scholar
  • 70 Kranzler H R, Del Boca F K, Rounsaville B J. Comorbid psychiatric diagnosis predicts three-year outcomes in alcoholics: a posttreatment natural history study.  J Stud Alcohol. 1996;  57 619-626
    PubMedGoogle Scholar
  • 71 Thomas S E, Thevos A K, Randall C L. Alcoholics with and without social phobia: a comparison of substance use and psychiatric variables.  J Stud Alcohol. 1999;  6 472-479
    PubMedGoogle Scholar
  • 72 Tomasson K, Vaglum P. Role of psychiatric comorbidity in the prediction of readmission for detoxification.  Compr Psychiatry. 1998;  39 129-136
    PubMedGoogle Scholar
  • 73 Holdcraft L C, Iacono W G, McGue M K. Antisocial Personality Disorder and depression in relation to alcoholism: a community-based sample.  J Stud Alcohol. 1998;  59 222-226
    PubMedGoogle Scholar
  • 74 Hoff R A, Rosenheck R A. The cost of treating substance abuse patients with and without comorbid psychiatric disorders.  Psychiatr Serv. 1999;  5 1309-1315
    PubMedGoogle Scholar
  • 75 Maynard C, Cox G B. Psychiatric hospitalization of persons with dual diagnoses: estimates from two national surveys.  Psychiatr Serv. 1998;  49 1615-1617
    PubMedGoogle Scholar
  • 76 Moggi F, Ouimette P C, Finney J W, Moos R H. Effectiveness of treatment for substance abuse and dependence for dual diagnosis patients: a model of treatment factors associated with one-year outcomes.  J Stud Alcohol. 1999;  6 856-866
    PubMedGoogle Scholar
  • 77 Moggi F, Ouimette P C, Moos R H, Finney J W. Dual diagnosis patients in substance abuse treatment: relationship of general coping and substance-spezific coping to 1-year outcomes.  Addiction. 1999;  94 1805-1816
    CrossrefPubMedGoogle Scholar
  • 78 George D T, Nutt D J, Dwyer B A, Linnoila M. Alcoholism and panic disorder: is the comorbidity more than coincidence?.  Acta Psychiatr Scand. 1990;  81 97-107
    PubMedGoogle Scholar
  • 79 Kranzler H R, Burleson J A, Brown J, Babor T F. Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics.  Alc Clin Exp Res. 1996;  2 1534-1541
    PubMedGoogle Scholar
  • 80 Lejoyeux M. Use of serotonin (5-hydroxytryptamine) reuptake inhibitors in the treatment of alcoholism.  Alcohol & Alcoholism. 1996;  Suppl. 69-75
    PubMedGoogle Scholar
  • 81 Litten R Z, Allen J, Fertig J. Pharmacotherapies for alcohol problems: a review of research with focus on developments since 1991.  Alc Clin Exp Res. 1996;  2 859-876
    PubMedGoogle Scholar
  • 82 Gorelick D A, Paredes A. Effect of fluoxetine on alcohol consumption in male alcoholics.  Alc Clin Exp Res. 1992;  16 261-265
    PubMedGoogle Scholar
  • 83 Janiri L, Gobbi G, Mannelli P, Pozzi G, Serretti A, Tempesta E. Effects of fluoxetine at antidepressant doses on short-term outcome of detoxified alcoholics.  Int Clin Psychopharmacol. 1996;  11 109-117
    PubMedGoogle Scholar
  • 84 Malcolm R, Anton R F, Randall C L, Johnston A, Brady K, Thevos A. A placebo-controlled trial of buspirone in anxious inpatient alcoholics.  Alc Clin Exp Res. 1992;  16 1007-1013
    PubMedGoogle Scholar
  • 85 Tollefson G D. Anxiety and alcoholism: a serotonin link. British Journal of Psychiatry 1991 Suppl.: 34-39
    Google Scholar

Dr. Jens Wittfoot

Psychiatrische Klinik
Krankenanstalten Gilead, Bethel

Remterweg 69-71

33617 Bielefeld

eMail: wittfoot@psychiatrie.gilead.de

      >