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Suchttherapie 2014; 15(01): 9-15
DOI: 10.1055/s-0033-1358693
Schwerpunktthema
© Georg Thieme Verlag KG Stuttgart · New York

Ist eine wirksame psychosoziale Behandlung von Patienten mit Suchterkrankungen und komorbiden psychischen Störungen eine unmögliche Aufgabe?

Effective Psychosocial Treatment for Patients with Substance Use Disorders and Comorbid Psychiatric Disorders: A Mission Impossible?
F. Moggi
1   Universitätsklinik und Poliklinik für Psychiatrie Bern, Schweiz & Department für Psychologie, Universität Fribourg, Schweiz
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Publication History

Publication Date:
09 December 2013 (online)

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Zusammenfassung

Auf der Grundlage von Metaanalysen und umfassenden Überblicksarbeiten werden Schlussfolgerungen über eine wirksame psychosoziale Behandlung von Patienten mit einer Komorbidität von psychischen Störungen und Sucht (Doppeldiagnosen) gezogen. Dabei wird näher auf die Studienergebnisse zu schweren und zu leichten Formen von Doppeldiagnosen eingegangen. Die Heterogenität der Patienten-, Behandlungs-, Setting- und Ergebnismerkmale erschweren allgemeingültige Schlussfolgerungen über die Wirksamkeit psychosozialer Behandlungen. Integrative, gestufte Behandlungsprogramme, die störungsspezifische Interventionen kombinieren und motivierende Gesprächsführung, kognitiv-verhaltenstherapeutische Interventionen, suchtmittelreduzierende Interventionen wie Rückfallprävention oder Kontingenzmanagement und/oder Familieninterventionen enthalten, sind Kontrollgruppen (z. B. Wartegruppen, Standardbehandlungen) meistens, anderen aktiven Behandlungen (z. B. Psychoedukation) manchmal, in den 3 Ergebnisbereichen (Sucht, psychische Störung und Funktionsniveau) überlegen.

Abstract

Results on the effectiveness of psychosocial treatments for patients with a comorbidity of psychiatric and substance use disorders (dual diagnosis) will be discussed based on relevant meta-analyses and comprehensive reviews. The findings will be presented for severe (e. g., schizophrenia) and for mild to moderate (e. g., anxiety disorders) dual diagnoses. Due to the heterogeneity in patients’, treatments’, settings’, and outcomes’ characteristics it is difficult to generally conclude which psychosocial treatments are effective. Promising treatments seem to be integrative stagewise programs that comprise motivational interviewing, cognitive-behavioral interventions, substance use reducing interventions such as relapse prevention and contingency management and/or family interventions. Such programs are mostly superior to control groups (e. g., waiting list) and they are sometimes superior to other active treatments (e. g., treatment as usual) in outcomes of substance use, psychiatric disorders and social functioning.

Schlüsselwörter

Komorbidität - Behandlungswirksamkeit - Behandlungskomponenten - integrative Behandlungs­programme - Überblick

Key words

comorbidity - treatment effectiveness - treatment components - integrated treatment programmes - review
 

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