Alkoholbezogene Störungen im Alter - Aktueller Stand zu Diagnostik und Therapie

Zusammenfassung

Aufgrund des demografischen Wandels und der veränderten Konsumgewohnheiten der jetzt alternden Kohorte ist mit einem Anstieg der Prävalenz alkoholbezogener Störungen im Alter zu rechnen. Konservative Schätzungen gehen für Deutschland von 400 000 alkoholabhängigen Personen älter als 60 Jahre und über 2 Millionen mit riskantem Alkoholkonsum aus. Zum Verlauf der Suchterkrankung, aktuellen Konsummustern, psychischer und somatischer Komorbidität ist bei den älteren Suchtkranken wenig bekannt. Im Kontrast zu den hohen Zahlen von Betroffenen sind ältere Alkoholkranke in ambulanten wie stationären Suchthilfeeinrichtungen deutlich unterrepräsentiert. Im folgenden Artikel wird der aktuelle Stand zu Diagnostik und evidenzbasierter Therapie alkoholbezogener Störungen im Alter referiert. Dabei werden im psychotherapeutischen Teil die Methoden der Kurzintervention und der Kognitiven Verhaltenstherapie, im pharmakologischen Teil die Substanzen Disulfiram, Acamprosat und Naltrexon kritisch bewertet. Daraus abgeleitet werden erste Empfehlungen zum therapeutischen Vorgehen ausgesprochen.

Abstract

Due to demographic trends and an aging cohort, which has higher rates of substance abuse than any previous generation, an increase in numbers of elderly alcohol abusers is predicted. The number of older alcohol dependent adults in Germany has been estimated to 400 000, the prevalence of risky use up to 2 million. Despite this reported high prevalence, patients over age 60 are seldom seen attending in- or outpatient treatment programs for alcohol dependence. In addition, little is known about this growing population of older adults with alcohol-related disease, e. g. regarding course of alcohol addiction, consumption patterns, somatic and mental comorbid disorders. This article shows the state of research in this area and reviews clinically-relevant concepts related to identifying, assessing and treating older adults with alcohol-related disability. Emphasis will be placed on the psychotherapy-methods of brief interventions and cognitive-behavioral therapy and on the pharmacological approaches for treating alcohol dependence with disulfiram, acamprosate and naltrexone.

Schlüsselwörter

Alkoholabhängigkeit - Alter - Psychotherapie - KOALA - Pharmakotherapie

Key words

alcohol dependence - older adult - psychotherapy - KOALA - pharmacotherapy

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