Zusammenfassung
Die Intensität des Suchtdrucks (Craving) wird maßgeblich mit dem Rückfallrisiko der
Alkoholabhängigkeit in Zusammenhang gebracht. Es wird angenommen, dass zumindest 3
Gruppen des Craving unterscheidbar sind, denen auf neuronaler Ebene Veränderungen
in unterschiedlichen Neurotransmittersystemen zugrunde liegen. Momentan sind in Deutschland
die Substanzen Acamprosat und Disulfiram zur Rückfallprophylaxe der Alkoholabhängigkeit
zugelassen. Im Rahmen von Therapieversuchen ist auch eine Anwendung von Naltrexon
möglich. Aktuelle Studienergebnisse zeigen jedoch, dass diese Substanzen nicht bei
allen Patienten gleichermaßen wirksam sind. Substanzen, die spezifisch auf die zugrunde
liegenden Neurotransmitterveränderungen wirken, könnten hypothetisch die Wirksamkeit
der medikamentösen Alkoholrückfallprophylaxe bei bestimmten Personengruppen erhöhen.
Deswegen werden aktuell weitere Substanzgruppen auf eine mögliche Wirksamkeit in der
Alkoholrückfallprophylaxe untersucht. Substanzen, die in präklinischen oder ersten
klinischen Studien Wirksamkeit in der Alkoholrückfallprävention gezeigt haben, sind
Baclofen, Topiramat, Odansetron, Rimonabant und Memantin.
Abstract
Many studies address the neurobiological mechanisms of alcohol craving. The study
results obtained so far show that there may be at least three subtypes of craving,
which may be linked to changes in different neurotransmitter systems. Actually in
Germany acamprosate and disulfiram are approved for clinical use for the prevention
of alcohol relapse. Also off-label therapy with naltrexone is possible. However studies
show that these substances are not effective in all patients. In the light of hypothetical
changes in different neurotransmitter systems, subtype specific therapy may be necessary
for successful prevention of alcohol relapse. Therefore new therapy options are needed
in order to treat alcohol dependent persons. Substances that seem to have efficacy
in preclinical or preliminary clinical studies are baclofen, topiramate, odansetron,
rimonabant and memantine.
Schlüsselwörter
Alkoholabhängigkeit - Alkoholentzug - Rückfallprävention - Craving - Pharmakotherapie
Key words
alcohol addiction - alcohol withdrawal - craving - relapse prevention - pharmacotherapy
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Dr. med. Annemarie Heberlein
Psychiatrische und Psychotherapeutische Klinik, Universitätsklinikum Erlangen
Schwabachanlage 6
91054 Erlangen
eMail: annemarie.heberlein@uk-erlangen.de
