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Themenschwerpunkt

Psychotherapie bei Abhängigkeits- erkrankungen und Posttraumatischer Belastungsstörung

Published Online:https://doi.org/10.1024/0939-5911.a000138

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.


Psychotherapy for Substance Use Disorders and Posttraumatic Stress Disorder

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.

Literatur

  • Amaro, H. , Dai, J. , Arevalo, S. , Acevedo, A. , Matsumoto, A. , Nieves, R. et al. (2007). Effects of Integrated Trauma Treatment on Outcomes in a Racially/Ethnically Diverse Sample of Women in Urban Community-based Substance Abuse Treatment. Journal of Urban Health, 84, 508 – 522. First citation in articleCrossrefGoogle Scholar

  • Aldao, A. , Nolen-Hoeksema, S. , Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217 – 237. First citation in articleCrossrefGoogle Scholar

  • American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. Washington DC: American Psychiatric Press. First citation in articleGoogle Scholar

  • Back, S. , Dansky, B. S. , Coffey, S. F. , Saladin, M. E. , Sonne, S. , Brady, K. T. (2000). Cocaine Dependence with and without Post-Traumatic Stress Disorder: A Comparison of Substance Use, Trauma History and Psychiatric Comorbidity. The American Journal on Addictions, 9, 51 – 62. First citation in articleCrossrefGoogle Scholar

  • Back, S. E. , Dansky, B. S. , Carroll, K. M. , Foa, E. B. , Brady, K. T. (2001). Exposure Therapy in the Treatment of PTSD among Cocaine-Dependent Individuals: Description of Procedures. Journal of Substance Abuse Treatment, 21, 35 – 45. First citation in articleCrossrefGoogle Scholar

  • Bischof, G. (2010) Effektivität von Psychotherapie bei Suchterkrankungen. Suchttherapie, 11, 158 – 165. First citation in articleCrossrefGoogle Scholar

  • Bisson, J. I. , Ehlers, A. , Matthews, R. , Pilling, S. , Richards, D. , Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder. Systematic review and metaanalysis. The British Journal of Psychiatry, 190, 97 – 104. First citation in articleCrossrefGoogle Scholar

  • Bottlender, M. , Köhler, J. , Soyka M., (2006) Effektivität psychosozialer Behandlungsmethoden zur medizinischen Rehabilitation alkoholabhängiger Patienten. Fortschritte der Neurologie – Psychiatrie, 74, 19 – 31 First citation in articleCrossrefGoogle Scholar

  • Bradley, R. , Greene, J. , Russ, E. , Dutra, L. , Westen, D. (2005). A Multidimensional Meta-Analysis of Psychotherapy for PTSD. American Journal of Psychiatry, 162, 214 – 227. First citation in articleCrossrefGoogle Scholar

  • Brady, K. T. , Dansky, B. S. , Back, S. E. , Foa, E. B. , Carroll, K. M. (2001). Exposure Therapy in the Treatment of PTSD among Cocaine-Dependent Individuals: Preliminary Findings. Journal of Substance Abuse Treatment, 21, 47 – 54. First citation in articleCrossrefGoogle Scholar

  • Breslau, N. , Davis, G. C. , Andreski, P. , Peterson, E. (1991). Traumatic Events and Posttraumatic Stress Disorder in an Urban Population of Young Adults. Archives of General Psychiatry, 48, 216 – 222. First citation in articleCrossrefGoogle Scholar

  • Brown, P. J. , Read, J. P. , Kahler, C. W. (2003). Comorbid Posttraumatic Stress Disorder and Substance Use Disorders: Treatment Outcomes and the Role of Coping. Washington D. C.: American Psychological Association. First citation in articleGoogle Scholar

  • Cheetham, A. , Allen, N. B. , Yucel, M. , Lubman, D. I. (2010). The role of affective dysregulation in drug addiction. Clinical Psychology Review, 30, 621 – 634. First citation in articleCrossrefGoogle Scholar

  • Coffey, S. F. , Saladin, M. E. , Drobes, D. J. , Brady, K. T. , Dansky, B. S. , Kilpatrick, D. G. (2002). Trauma and Substance Cue Reactivity in Individuals with Comorbid Posttraumatic Stress Disorder and Cocaine or Alcohol Dependence. Drug and Alcohol Dependence, 65, 115 – 127. First citation in articleCrossrefGoogle Scholar

  • Coffey, S. F. , Stasiewicz, P. R. , Hughes, P. M. , Brimo, M. L. (2006). Trauma-Focused Imaginal Exposure for Individuals with Comorbid Posttraumatic Stress Disorder and Alcohol Dependence: Revealing Mechanisms of Alcohol Craving in a Cue Reactivity Paradigm. Psychology of Addictive Behaviors, 20, 425 – 435. First citation in articleCrossrefGoogle Scholar

  • Cohen, L. R. , Hien, D. A. (2006). Treatment Outcomes for Women with Substance Abuse and PTSD Who Have Experienced Complex Trauma. Psychiatric Services, 57, 100 – 106. First citation in articleCrossrefGoogle Scholar

  • Covington, S. S. (2000). Helping Women Recover: A Comprehensive Integrated Treatment Model. Alcoholism Treatment Quarterly, 18, 99 – 111. First citation in articleCrossrefGoogle Scholar

  • Desai, R. A. , Harpaz-Rotem, I. , Najavits, L. M. , Rosenheck, R. A. (2008). Impact of the Seeking Safety Program on Clinical Outcomes among Homeless Female Veterans with Psychiatric Disorders. Psychiatric Services, 59, 996 – 1003. First citation in articleCrossrefGoogle Scholar

  • Dilling, H. , Mombour, W. , Schmidt, M. H. , Schulte-Markwort, E. (Hrsg.) (1994). Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V. Forschungskriterien. Bern: Huber. First citation in articleGoogle Scholar

  • Domino, M. , Morrissey, J. P. , Nadlicki-Patterson, T. , Chung, S. (2005). Service Costs for Women with Co-Occurring Disorders and Trauma. Journal of Substance Abuse Treatment, 28, 135 – 143. First citation in articleCrossrefGoogle Scholar

  • Donovan, B. , Padin-Rivera, E. , Kowaliw, S. (2001). ”Transcend”: Initial Outcomes from a Posttraumatic Stress Disorder/Substance Abuse Treatment Program. Journal of Traumatic Stress, 14, 757 – 772. First citation in articleCrossrefGoogle Scholar

  • Driessen, M. , Schulte, S. , Luedecke, C. , Schäfer, I. , Sutmann, F. , Ohlmeier, M. et al. (2008). Trauma and PTSD in Patients with Alcohol, Drug, or Dual Dependence: A Multi-Center Study. Alcoholism: Clinical and Experimental Research, 32, 481 – 488. First citation in articleCrossrefGoogle Scholar

  • Fallot, R. D. , Harris, M. (2002). The Trauma Recovery and Empowerment Model (Trem): Conceptual and Practical Issues in a Group Intervention for Women. Community Mental Health Journal, 38, 475 – 485. First citation in articleCrossrefGoogle Scholar

  • Flatten, G. , Hofmann, A. , Liebermann, P. , Wöller, W. , Siol, T. , Petzold, E. (2001). Posttraumatische Belastungsstörung, Leitlinie und Quellentext. Stuttgart, New York: Schattauer Verlag. First citation in articleGoogle Scholar

  • Foa, E. B. , Keane, T. M. , Friedman, M. J. , Cohen, J. (Eds.) (2008). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York: Guilford Press. First citation in articleGoogle Scholar

  • Gatz, M. , Brown, V. , Hennigan, K. , Rechberger, E. , O’Keefe, M. , Rose, T. et al. (2007). Effectiveness of an Integrated Trauma-Informed Approach to Treating Women with Co-Occurring Disorders and Histories of Trauma. Journal of Community Psychology, 35, 863 – 878. First citation in articleCrossrefGoogle Scholar

  • Haase, M. , Hofmann, A. (2006). Behandlung traumatisierter Abhängiger mit der EMDR-Methode. In I. Schäfer & M. Krausz, (Eds.), Trauma und Sucht – Konzepte, Diagnostik, Behandlung (pp. 221 – 235). Stuttgart: Klett-Cotta Verlag. First citation in articleGoogle Scholar

  • Harris, M. (1998). Trauma Recovery and Empowerment: A Clinician’s Guide for Working with Women in Groups. New York, NY: The Free Press. First citation in articleGoogle Scholar

  • Herman, J. L. (1992). Trauma and recovery. New York: Basic Books. First citation in articleGoogle Scholar

  • Hien, D. A. , Nunes, E. , Levin, F. R. , Fraser, D. (2000). Posttraumatic Stress Disorder and Short-Term Outcome in Early Methadone Treatment. Journal of Substance Abuse Treatment, 19, 31 – 37. First citation in articleCrossrefGoogle Scholar

  • Hien, D. A. , Cohen, L. R. , Miele, G. M. , Litt, L. C. , Capstick, C. (2004). Promising Treatments for Women with Comorbid PTSD and Substance Use Disorders. American Journal of Psychiatry, 161, 1426 – 1432. First citation in articleCrossrefGoogle Scholar

  • Jacobsen, L. K. , Southwick, S. M. , Kosten, T. R. (2001). Substance Use Disorders in Patients with Posttraumatic Stress Disorder: A Review of the Literature. American Journal of Psychiatry, 158, 1184 – 1190. First citation in articleCrossrefGoogle Scholar

  • Johnson, S. D. , Striley, C. , Cottler, L. B. (2006). The Association of Substance Use Disorders with Trauma Exposure and PTSD among African American Drug Users. Addictive Behaviors, 31, 2063 – 2073. First citation in articleCrossrefGoogle Scholar

  • Kessler, R. C. , Sonnega, A. , Bromet, E. , Hughes, M. , Nelson, C. B. (1995). Posttraumatic Stress Disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048 – 1060. First citation in articleCrossrefGoogle Scholar

  • Lüdecke, C. , Lottermoser, S. (2010). Besonderheiten in der Anwendung der EMDR-Methode bei Suchtkranken. In C. Lüdecke, U. Sachsse , H. Faure, (Eds.), Sucht – Bindung – Trauma (pp. 316 – 341). Stuttgart: Schattauer Verlag. First citation in articleGoogle Scholar

  • McGovern, M. P. , Lambert-Harris, C. , Acquilano, S. , Xie, H. , Alterman, A. I. , Weiss, R. D. (2009). A Cognitive Behavioral Therapy for Co-Occurring Substance Use and Posttraumatic Stress Disorders. Addictive Behaviors, 34, 892 – 897. First citation in articleCrossrefGoogle Scholar

  • Miller, D. , Guidry, L. (2001). Addictions and Trauma Recovery. Healing the Body, Mind & Spirit. New York: W. W. Norton. First citation in articleGoogle Scholar

  • Mills, K. L. , Lynskey, M. , Teesson, M. , Ross, J. , Darke, S. (2005). Post-Traumatic Stress Disorder among People with Heroin Dependence in the Australian Treatment Outcome Study (Atos): Prevalence and Correlates. Drug and Alcohol Dependence, 77, 243 – 249. First citation in articleCrossrefGoogle Scholar

  • Mueser, K. T. , Rosenberg, S. D. , Rosenberg, H. J. (2009). Posttraumatic Stress Disorder in Special Populations. A Cognitive Restructuring Program. Washington, DC: American Psychological Association. First citation in articleCrossrefGoogle Scholar

  • Najavits, L. M. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: Guilford Press. First citation in articleGoogle Scholar

  • Najavits, L. M. (2009). Posttraumatische Belastungsstörung und Substanzmissbrauch. Das Therapieprogramm ”Sicherheit finden”. Göttingen: Hogrefe Verlag. First citation in articleGoogle Scholar

  • Najavits, L. M. , Sonn, J. , Walsh, M. , Weiss, R. D. (2004). Domestic Violence in Women with PTSD and Substance Abuse. Addictive Behaviors, 29, 707 – 715. First citation in articleCrossrefGoogle Scholar

  • Najavits, L. M. , Gallop, R. J. , Weiss, R. D. (2006). Seeking Safety Therapy for Adolescent Girls with PTSD and Substance Use Disorder: A Randomized Controlled Trial. Journal of Behavioral Health Services & Research, 33, 453 – 463. First citation in articleCrossrefGoogle Scholar

  • Ouimette, P. , Moos, R. H. , Brown, P. J. (2003). Substance Use Disorder-Posttraumatic Stress Disorder Comorbdity: A Survey of Treatments and Proposed Practice Guidelines. Washington D. C.: American Psychological Association. First citation in articleGoogle Scholar

  • Ouimette, P. , Moos, R. H. , Finney, J. W. (2003). PTSD Treatment and 5-Year Remission among Patients with Substance Use and Posttraumatic Stress Disorders. Journal of Consulting and Clinical Psychology, 71, 410 – 414. First citation in articleCrossrefGoogle Scholar

  • Ouimette, P. , Goodwin, E. , Brown, P. J. (2006). Health and Well Being of Substance Use Disorder Patients with and without Posttraumatic Stress Disorder. Addictive Behaviors, 31, 1415 – 1423. First citation in articleCrossrefGoogle Scholar

  • Ouimette, P. , Coolhart, D. , Funderburk, J. S. , Wade, M. , Brown, P. J. (2007). Precipitants of First Substance Use in Recently Abstinent Substance Use Disorder Patients with PTSD. Addictive Behaviors, 32, 1719 – 1727. First citation in articleCrossrefGoogle Scholar

  • Ouimette, P. , Read, J. P. , Wade, M. , Tirone, V. (2010). Modelling Associations between Posttraumatic Stress Symptoms and Substance Use. Addictive Behaviors, 35, 64 – 67. First citation in articleCrossrefGoogle Scholar

  • Read, J. P. , Brown, P. J. , Kahler, C. W. (2004). Substance Use and Posttraumatic Stress Disorders: Symptom Interplay and Effects on Outcome. Addictive Behaviors, 29, 1665 – 1672. First citation in articleCrossrefGoogle Scholar

  • Schäfer, I. , Schultz, M. , Verthein, U. , Krausz, M. (2004). Traumatisierungen bei Suchtpatienten – Relevanz und spezifische Behandlung in der ambulanten Suchttherapie. Suchttherapie, 5, 118 – 123. First citation in articleCrossrefGoogle Scholar

  • Schäfer, I. , Reininghaus, U. , Langeland, W. , Voss, A. , Zieger, N. , Haasen, C. et al. (2007). Dissociative Symptoms in Alcohol-Dependent Patients: Associations with Childhood Trauma and Substance Abuse Characteristics. Comprehensive Psychiatry, 4, 539 – 545. First citation in articleCrossrefGoogle Scholar

  • Schäfer, I. , Najavits, L. M. (2007). Clinical Challenges in the Treatment of Patients with Posttraumatic Stress Disorder and Substance Abuse. Current Opinion in Psychiatry, 20, 614 – 618. First citation in articleCrossrefGoogle Scholar

  • Schäfer, I. , Langeland, W. , Hissbach, J. , Luedecke, C. , Ohlmeier, M. D. , Chodzinski, C. et al. (2010). Childhood Trauma and Dissociation in Patients with Alcohol Dependence, Drug Dependence, or Both-a Multi-Center Study. Drug and Alcohol Dependence, 109, 84 – 89. First citation in articleCrossrefGoogle Scholar

  • Schäfer, I. , Schulze, C. , Dilling, A. , Barghaan, D. , Bullinger, M. , Stubenvoll, M. (2010). „Sicherheit finden“ – Akzeptanz eines integrativen Therapieangebotes für Posttraumatische Störungen und Substanzmissbrauch bei Patientinnen mit Alkoholabhängigkeit. Suchttherapie, 11, 60 – 68. First citation in articleCrossrefGoogle Scholar

  • Schützwohl, M. , Maercker, A. (1999). Effects of Varying Diagnostic Criteria for Posttraumatic Stress Disorder are Endorsing the Concept of Partial PTSD. Journal of Traumatic Stress, 12, 155 – 165. First citation in articleCrossrefGoogle Scholar

  • Simpson, T. L. , Miller, W. R. (2002). Concomitance between Childhood Sexual and Physical Abuse and Substance Use Problems. Clinical Psychology Review, 22, 27 – 77. First citation in articleCrossrefGoogle Scholar

  • Stevens, S. J. , Murphy, B. S. , McKnight, K. (2003). Traumatic Stress and Gender Differences in Relationship to Substance Abuse, Mental Health, Physical Health, and HIV Risk Behavior in a Sample of Adolescents Enrolled in Drug Treatment. Child Maltreatment, 8, 46 – 57. First citation in articleCrossrefGoogle Scholar

  • Toussaint, D. W. , VanDeMark, N. R. , Bornemann, A. , Graeber, C. J. (2007). Modifications of the Trauma Recovery and Empowerment Model (TREM) for Substance-Abusing Women with Histories of Violence: Outcomes and Lessons Learned at a Colorado Substance Abuse Treatment Center. Journal of Community Psychology, 35, 879 – 894. First citation in articleCrossrefGoogle Scholar

  • Triffleman, E. (2000). Gender Differences in a Controlled Pilot Study of Psychosocial Treaments in Substance Dependent Patients with Posttraumatic Stress Disorder: Design Considerations and Outcomes. Alcoholism Treatment Quarterly, 18, 113 – 126. First citation in articleCrossrefGoogle Scholar

  • Triffleman, E. , Carroll, K. , Kellogg, S. (1999). Substance Dependence Posttraumatic Stress Disorder Therapy. An Integrated Cognitive-Behavioral Approach. Journal of Substance Abuse Treatment, 17, 3 – 14. First citation in articleCrossrefGoogle Scholar

  • Zlotnick, C. , Najavits, L. M. , Rohsenow, D. J. , Johnson, D. M. (2003). A Cognitive-Behavioral Treatment for Incarcerated Women with Substance Abuse Disorder and Posttraumatic Stress Disorder: Findings from a Pilot Study. Journal of Substance Abuse Treatment, 25, 99 – 105. First citation in articleCrossrefGoogle Scholar