Debatte zu kontrolliertem Trinken: Was wir über kontrolliertes und reduziertes Trinken wissen und was nicht

Zusammenfassung

Kontrolliertes Trinken (KT) ist und war ein kontroverses Behandlungsziel in der Behandlung von Alkoholkonsumstörungen. Angesichts der unzureichenden Erreichbarkeit betroffener Menschen durch das Suchthilfesystem positionierte sich der Dachverband der Deutschen Suchtfachgesellschaften 2019 dahingehend, dass KT eine relevante Therapieoption darstellen könnte. Der vorliegende Beitrag gibt vor dem Hintergrund des Positionspapiers der Dachgesellschaft einen Überblick zum gegenwärtigen Wissensstand hinsichtlich Möglichkeiten und Grenzen von KT in der Behandlung von Alkoholkonsumstörungen und diskutiert bedeutsame Wissensdefizite in dem Feld.

Abstract

Controlled drinking (CT) has been a controversial treatment goal in the treatment of alcohol use disorders (AUDs). In view of the inadequate reach of individuals with AUDs by the addiction treatment system, the umbrella organization of German addiction societies in 2019 pointed out that CT could represent a relevant treatment option. Against the background of the umbrella organization's position paper, this article provides an overview of the current state of evidence regarding the possibilities and limitations of CT in the treatment of alcohol use disorders and discusses significant knowledge deficits in the field.

Schlüsselwörter

Kontrolliertes Trinken - Schadensminimierung - Selbstkontroll-Training - Behandlungslücke

Keywords

controlled drinking - harm reduction - self-control-training - treatment gap

Publication History

Article published online:
12 August 2024

• Literatur

• 1 WHO, Global status report on alcohol and health 2018. 2018
• 2 Anderson B.O.. et al. Health and cancer risks associated with low levels of alcohol consumption. Lancet Public Health 2023; 8: e6-e7
• 3 Das wissenschaftliche Kuratorium der DHS. Empfehlungen zum Umgang mit Alkohol – Stellungnahme der Deutschen Hauptstelle für Suchtfragen e.V. 2023 23.02.2024; Available from https://www.dhs.de/fileadmin/user_upload/WK_der_DHS_-_Empfehlungen_zum_Umgang_mit_Alkohol.pdf
• 4 GBD 2017 Mortality Collaborators. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1684-1735
• 5 Holmes J. Is minimum unit pricing for alcohol having the intended effects on alcohol consumption in Scotland?. Addiction 2023; 118: 1609-1616
• 6 Kraus L.. et al. Inanspruchnahme gesundheitlicher Versorgung durch Alkoholabhängige. Suchttherapie 2015; 16: 18-26
• 7 Finn S.W., Bakshi A.S., Andreasson S. Alcohol Consumption, Dependence, and Treatment Barriers: Perceptions Among Nontreatment Seekers with Alcohol Dependence. Substance Use & Misuse 2014; 49: 762-769
• 8 Deutsche Gesellschaft für Psychiatrie und Psychotherapie, P.u.N.D. and Deutsche Gesellschaft für Suchtforschung und Suchttherapie e.V. (DG-SUCHT). S-3 Leitline Screening, Diagnose und Behandlung alkoholbezogener Störungen. 2020 16.02.2021]; Available from https://www.awmf.org/leitlinien/detail/ll/076-001.html
• 9 Bischof G.. et al. Stellungnahme Dachgesellschaft Sucht: Reduziertes Trinken und Schadensminderung bei der Behandlung von Alkoholkonsumstörungen Sucht 2019; 65: 115-134
• 10 Bischof G.. et al. Reduced drinking and harm reduction in the treatment of alcohol use disorders. Drugs and Alcohol Today 2021; 21: 31-44
• 11 Fan A.Z.. et al. Prevalence and Correlates of Past-Year Recovery From DSM-5 Alcohol Use Disorder: Results From National Epidemiologic Survey on Alcohol and Related Conditions-III. Alcohol Clin Exp Res 2019; 43: 2406-2420
• 12 Dawson D.A., Goldstein R.B., Grant B.F. Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up. Alcohol Clin Exp Res 2007; 31: 2036-45
• 13 Sieber M. Kontrolliertes Trinken nach stationärer Behandlung. Ergebnisse aus den Katamnesen der Forel Klinik. Bulletin der Forel-Klinik 2000; 1: 45-50
• 14 Mann K., Koerkel J. Trinkmengenreduktion: ein ergänzendes Therapieziel bei Alkoholabhängigen? [Drinking volume reduction: an additional therapy goal for alcohol dependent individuals?]. Psychopharmakotherapie 2013; 20: 193-198
• 15 Toumbourou J.W.. et al. Youth alcohol and other drug use in the United States and Australia: a cross-national comparison of three state-wide samples. Drug Alcohol Rev 2005; 24: 515-23
• 16 Charlet K., Heinz A. Harm reduction-a systematic review on effects of alcohol reduction on physical and mental symptoms. Addict Biol 2017; 22: 1119-1159
• 17 Tuchman F.R.. et al. Reductions in WHO risk drinking levels correlate with alcohol craving among individuals with alcohol use disorder. Alcohol Clin Exp Res (Hoboken) 2024; 48: 420-429
• 18 Witkiewitz K.. et al. Drinking Risk Level Reductions Associated with Improvements in Physical Health and Quality of Life Among Individuals with Alcohol Use Disorder. Alcohol Clin Exp Res 2018; 42: 2453-2465
• 19 Aldridge A.P.. et al. The Relationship Between Reductions in WHO Risk Drinking Levels During Treatment and Subsequent Healthcare Costs for the ACTIVE Workgroup. J Addict Med 2022; 16: 425-432
• 20 Witkiewitz K.. et al. Stability of Drinking Reductions and Long-term Functioning Among Patients with Alcohol Use Disorder. J Gen Intern Med 2021; 36: 404-412
• 21 Bahji A.. et al. Pharmacotherapies for Adults With Alcohol Use Disorders: A Systematic Review and Network Meta-analysis. Journal of Addiction Medicine 2022; 16: 630-638
• 22 Kotake K.. et al. Efficacy and safety of alcohol reduction pharmacotherapy according to treatment duration in patients with alcohol dependence or alcohol use disorder: A systematic review and network meta-analysis. Addiction. 2024
• 23 Miller W.R. Behavioural self-control training in the treatment of problem drinkers., in Behavioural self-management: Strategies, techniques and outcomes., R.B. Stuart, Editor. 1977. Brunner/Mazel; New York:
• 24 Al-Otaiba Z.. et al. Accounting for self-selected drinking goals in the assessment of treatment outcome. Psychol Addict Behav 2008; 22: 439-43
• 25 United Kingdom Alcohol Treatment Trial (UKATT): hypotheses, design and methods. Alcohol Alcohol 2001; 36: 11-21
• 26 Adamson S.J.. et al. Initial preference for drinking goal in the treatment of alcohol problems: II. Treatment outcomes. Alcohol Alcohol 2010; 45: 136-42
• 27 Walters G.D. Behavioral self-control training for problem drinkers: A meta-analysis of randomized control studies. Behavior Therapy 2000; 31: 135-149
• 28 Henssler J.. et al. Controlled drinking-non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression. Addiction 2021; 116: 1973-1987
• 29 Hammarberg S.I.. et al. Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial. Addiction 2024; 119: 86-101
• 30 Ingesson-Hammarberg S., Jayaram-Lindström N., Hammarberg A. Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking. Addict Sci Clin Pract 2024; 19: 12
• 31 Hemrage S.. et al. Efficacy of psychosocial interventions to reduce alcohol use in comorbid alcohol use disorder and alcohol-related liver disease: a systematic review of randomized controlled trials. Alcohol Alcohol 2023; 58: 478-484
• 32 Körkel J. Kontrolliertes Trinken bei Alkoholkonsumstörungen: Eine systematische Übersicht [Controlled drinking for alcohol consumption disorders: a systematic review]. Sucht 2015; 61: 147-174
• 33 Bischof G. Suchterkrankungen = Gehirnerkrankungen? Rausch – Wiener Zeitschrift für Suchttherapie, in press.