Zusammenfassung
Die Mehrheit der Opiatabhängigen in Substitutionsbehandlung leidet unter weiteren
suchtmittelbezogenen Störungen. Der Beikonsum von Heroin, Alkohol, Benzodiazepinen
oder Kokain gefährdet den Erfolg der Substitutionsbehandlung. Eine Intervention zur
Behandlung des Beikonsums ist das auf lerntheoretischen Prinzipien basierende Kontingenzmanagement
(KM). Im KM wird Drogenabstinenz – verifiziert durch Urintests – kontingent und zeitnah
verstärkt. Bei Substitutionspatienten wurden u. a. geldwerte Gutscheine oder Mitgabeprivilegien
als Verstärker für suchtmittelfreie Drogen-Urinscreenings eingesetzt. Zahlreiche kontrollierte
Studien in den USA belegen einen mittelstarken durchschnittlichen Effekt auf Beikonsum-
bzw. Abstinenzraten der Substitutionspatienten. Der Effekt lässt nach Beendigung der
Intervention allerdings deutlich nach. Es wird diskutiert, wie sich KM in der deutschen
Substitutionspraxis umsetzen und mit anderen Maßnahmen zur Beikonsumreduktion wie
selektiven Entgiftungen oder kognitiv-verhaltenstherapeutischen Programmen kombinieren
lässt.
Abstract
The majority of opiate-dependent patients in substitution treatment show additional
substance-related disorders. Concomitant use of heroin, alcohol, benzodiazepines or
cocaine compromises treatment success. Concomitant drug use may be treated by using
contingency management (CM) which is based on learning theory. In CM, abstinence from
drugs, as verified by drug screenings, is reinforced directly and contingently. Reinforcers
used in CM studies with substituted patients were, amongst others, vouchers and take-home
privileges. Studies in the USA show a medium average effect of CM on drug consumption
rates and abstinence. The effects decrease markedly after the end of the intervention.
We discuss whether CM is applicable within the German substitution treatment system
and how it can be combined with other interventions such as selective detoxification
treatments or cognitive-behavioural programmes.
Schlüsselwörter
Opiatabhängigkeit - Kontingenzmanagement - komorbide substanzbezogene Störungen -
Psychotherapie
Keywords
opiate dependence - contingency management - comorbid substance-related disorders
- psychotherapy
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Prof. Norbert Scherbaum
Klinik für abhängiges Verhalten und Suchtmedizin, LVR-Klinikum Essen, Kliniken der
Universität Duisburg-Essen
Virchowstraße 174
45174 Essen
Email: norbert.scherbaum@uni-due.de
