Psychotherapie bei Abhängigkeits- erkrankungen und Posttraumatischer Belastungsstörung
Abstract
Fragestellung: Die Posttraumatische Belastungsstörung (PTBS) gehört mit einer Punktprävalenz von 15 – 41 % zu den häufigsten komorbiden Störungen bei Personen mit Abhängigkeitserkrankungen. Erst in den letzten Jahren wurde verstärkt damit begonnen, traumatherapeutische Interventionen an diese Patientengruppe zu adaptieren. Die vorliegende Arbeit soll einen Überblick über den aktuellen Stand dieser Entwicklung geben, mit einem Schwerpunkt auf empirisch überprüften Therapieverfahren. Ergebnisse: Im klinischen Alltag werden alle Interventionen, die sich im Rahmen der Traumatherapie bewährt haben, auch bei Suchtkranken erfolgreich eingesetzt. Dabei steht inzwischen fest, dass Ansätze aus beiden Bereichen von Beginn der Therapie an miteinander kombiniert werden sollten. Die existierenden randomisierten kontrollierten Studien beziehen sich sämtlich auf ein stabilisierendes Therapieprogramm („Sicherheit finden“), dessen Effektivität inzwischen als belegt gelten kann. Schlussfolgerungen: Insgesamt hat sich die Behandlung Suchtkranker mit komorbider PTBS in den letzten Jahren stark entwickelt. Allerdings liegen zur Trauma-Exposition bei dieser Patientengruppe bislang kaum systematischen Befunde vor. Weitere Evaluationsstudien sollten folgen, um das gesamte Spektrum traumaspezifischer Interventionen bei Suchtkranken angemessen bewerten zu können.
Aims: The prevalence of posttraumatic stress disorder (PTSD) in patients with substance use disorders (SUD) is estimated to range from 15 % to 41 %, making it one of the most frequent co-occuring disorders in this diagnostic group. It was only in the past decade, however, that trauma-specific interventions have been adapted for use in patients with SUD. The aim of this paper is to review current literature on the treatment of PTSD in patients with SUD, with an emphasis on empirically evaluated treatments. Results: In clinical practice, all types of trauma-specific interventions have been successfully used in patients with SUD. It has become clear that interventions for both, substance use and posttraumatic symptoms, should be combined from the beginning of the treatment. All existing randomised controlled trials examined a present-focused therapy („Seeking Safety“), which is now established as effective. Conclusions: Treatment for patients with the dual diagnosis of PTSD and SUD has advanced considerably over the past decade. Trauma-focused treatments, however, have been rarely evaluated in this group of patients. More empirical research is needed to evaluate the full range of trauma-specific interventions in patients with SUD.
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