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Originalarbeit

Alkohol in Opioidsubstitution – zwischen therapeutischem Risiko, Patientenwohl und Public Health

Published Online:February 25, 2013https://doi.org/10.1024/0939-5911.a000225

Abstract

Fragestellung: Ausprägung des Alkoholkonsums und des Zusammenhangs der Intensität des Alkoholkonsums mit der Einsicht in die Notwendigkeit einer Trinkmengenreduktion bzw. der Therapiebereitschaft unter opioid-substituierten Patienten. Methodik: Standardisierte, mündliche Erhebung von Selbstangaben in einer naturalistischen Behandlungs-Kohorte in opioid gestützter Behandlung (n = 140) in einem Setting mit minimalen Behandlungsrestriktionen hinsichtlich weiterer Substanzstörungen. Ergebnisse: Der Anteil mit unproblematischem Konsum lag bei 62 %. 23 % zeigten einen riskanten (AUDIT 8 – 15), 15 % einen schädlichen oder abhängigen Alkoholkonsum (AUDIT ≥16). Die AUDIT-Risiko-Levels waren positiv mit Konsum von Opioiden und Benzodiazepinen und negativ mit sozialer Integration assoziiert. Alle Patienten mit AUDIT-Score ≥16 und 47 % der riskant Trinkenden zeigten Problembewusstsein. 62 % der Patienten mit AUDIT ≥16 äußerten Therapiebereitschaft. Kontrollverlust bei Männern und Schuldgefühle bei Frauen waren die häufigsten Konsequenzen des Trinkens. Schlussfolgerungen: Übermässiger Alkoholkonsum ist ein vordringliches Problem in der Substitutionstherapie. Routinemäßiges Alkohol-Screening bei Beginn und während der Behandlung ist empfehlenswert. Problematischer Alkoholkonsum sollte im Sinne einer Komplikation unter umfassender, individueller Nutzen-Risiken-Abwägung in die Behandlung einbezogen werden. Der Integration geeigneter therapeutischer Angebote sollte hohe Priorität eingeräumt werden.


Alcohol in Opioid Maintanance Treatment – Between Therapeutic Risk, Individual Wellbeing, and Public Health

Aims: To detect the extent of alcohol consumption and its interrelations with patients’ demand for reduction and willingness to be treated in opioid maintenance therapy (OMT). Method: Standardized oral self-reports from a naturalistic treatment cohort (n = 140) in a OMT-setting with minimal restrictions concerning co-morbid substance use disorders. Results: 62 % were abstinent or showed low-risk drinking, 23 % showed hazardous drinking (AUDIT 8 – 15), and 15 % harmful drinking or dependence (AUDIT ≥16). AUDIT-risk-levels were positively associated with illicit opioid and benzodiazepine consumption, and negatively with social integration. All patients with AUDIT ≥16 and 47 % of hazardous drinkers acknowledged a demand for reduction. 62 % of patients with AUDIT ≥16 expressed willingness to be treated. Loss of control was the most frequent mentioned consequence of drinking in man, and feelings of guilt in woman. Conclusions: Problematic alcohol consumption is a major problem in OMT. Routine alcohol screening at beginning and during treatment is advisable. Problematic alcohol use should be integrated as a complication in OMT, accounting for a comprehensive risk-benefit-weighting of the individual case. High priority should be given to the integration of appropriate therapeutic offers in OMT.

Literatur

  • Anglin, M. D. , Almog, I. J. , Fisher, D. G. , Peters, K. R. (1989). Alcohol use by heroin addicts: evidence for an inverse relationship. A study of methadone maintenance and drug-free treatment samples. The American Journal of Drug and Alcohol Abuse, 15, 191 – 207. First citation in articleCrossref, Google Scholar

  • Babor T. F., Higgins-Biddle J. C. , Saunders J. B, , Monteiro, M. G. (2001). AUDIT- The Alcohol Use Disorders Identification Test: Guidelines for use in Primary Care. Geneva: World Health Organisation Department of Mental Health and Substance Dependence. First citation in articleGoogle Scholar

  • Best, D. , Man, L. H. , Zador, D. , Darke, S. , Bird, S. , Strang, J. et al. (2000). Overdosing on opiates: Part 1 – Causes. Drug and Alcohol Findings, 4, 4 – 20. First citation in articleGoogle Scholar

  • Bundesamt für Gesundheit. (2009). Substitutionsgestützte Behandlung bei Opioidabhängigkeit: Empfehlungen des Bundesamtes für Gesundheit (BAG), der Schweizerischen Gesellschaft für Suchtmedizin (SSAM), der Vereinigung der Kantonsärztinnen und Kantonsärzte (VKS). Bern: Bundesamt für Gesundheit (BAG). First citation in articleGoogle Scholar

  • Bundesärztekammer. (2010). Hintergründe und Inhalte der Richtlinien-Novelle substitutionsgestützte Behandlung Opiatabhängiger. Deutsches Ärzteblatt, 107, 511 – 516. First citation in articleGoogle Scholar

  • Chatham, L. R. , Rowan-Szal, G. A. , Joe, G. W. , Brown, B. S. , Simpson, D. D. (1995). Heavy drinking in a population of methadone-maintained clients. Journal of Studies on Alcohol, 56, 417 – 422. First citation in articleCrossref, Google Scholar

  • Davoli, M. , Bargagli, A. M. , Perucci, C. A. , Schifano, P. , Belleudi, V. , Hickman, M. et al. (2007). Risk of fatal overdose during and after specialist drug treatment: The VEdeTTE study, a national multi-site prospective cohort study. Addiction, 102, 1954 – 1959. First citation in articleCrossref, Google Scholar

  • Dobler-Mikola, A. , Hattenschwiler, J. , Meili, D. , Beck, T. , Boni, E. , Modestin, J. (2005). Patterns of heroin, cocaine, and alcohol abuse during long-term methadone maintenance treatment. Journal of Substance Abuse Treatment, 29, 259 – 265. First citation in articleCrossref, Google Scholar

  • el-Bassel, N. , Schilling, R. F. , Turnbull, J. E. , Su, K. H. (1993). Correlates of alcohol use among methadone patients. Alcoholism: Clinical and Experimental Research, 17, 681 – 686. First citation in articleCrossref, Google Scholar

  • Fairbank, J. A. , Dunteman, G. H. , Condelli, W. S. (1993). Do methadone patients substitute other drugs for heroin? Predicting substance use at 1-year follow-up. The American Journal of Drug and Alcohol Abuse, 19, 465 – 474. First citation in articleCrossref, Google Scholar

  • Gibson, A. , Randall, D. , Degenhardt, L. (2011). The increasing mortality burden of liver disease among opioid-dependent people: Cohort study. Addiction, 106, 2186 – 2192. First citation in articleCrossref, Google Scholar

  • Gossop, M. , Marsden, J. , Stewart, D. (2002). Dual dependence: Assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems. Addiction, 97, 169 – 178. First citation in articleCrossref, Google Scholar

  • Gossop, M. , Marsden, J. , Stewart, D. , Kidd, T. (2003). The National Treatment Outcome Research Study (NTORS): 4 – 5 year follow-up results. Addiction, 98, 291 – 303. First citation in articleCrossref, Google Scholar

  • Hakkinen, M. , Launiainen, T. , Vuori, E. , Ojanpera, I. (2012). Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning. European Journal of Clinical Pharmacology, 68, 301 – 309. First citation in articleCrossref, Google Scholar

  • Hillebrand, J. , Marsden, J. , Finch, E. , Strang, J. (2001). Excessive alcohol consumption and drinking expectations among clients in methadone maintenance. Journal of Substance Abuse Treatment, 21, 155 – 160. First citation in articleCrossref, Google Scholar

  • Hser, Y. I. , Hoffman, V. , Grella, C. E. , Anglin, M. D. (2001). A 33-year follow-up of narcotics addicts. Archives of General Psychiatry, 58, 503 – 508. First citation in articleCrossref, Google Scholar

  • Körkel, J. , Bahle, F. (2007). Damit Alkohol nicht zur Sucht wird – kontrolliert trinken: 10 Schritte für einen bewussteren Umgang mit Alkohol. Stuttgart: Trias. First citation in articleGoogle Scholar

  • Körkel, J. , Waldvogel, D. (2008). What shall we do with the drunken drug addict? Eine Studie zum Alkoholkonsum Drogenabhängiger. Suchttherapie, 9, 72 – 79. First citation in articleCrossref, Google Scholar

  • Kunstmann, W. (2012). Substitution international – welche Regelungen und Realitäten bestehen in anderen Ländern? [Abstract]. Suchtmedizin in Forschung und Praxis, 14, 120. First citation in articleGoogle Scholar

  • Laberke, P. J. , Bartsch, C. (2010). Trends in methadone-related deaths in Zurich. International Journal of Legal Medicine, 124, 381 – 385. First citation in articleCrossref, Google Scholar

  • Lees, R. , Williams, T. , Henderson, G. , Hickman, M. , Lingford, H. (2010). Interaction between alcohol and opioids in opioid-dependent subjects. European Neuropsychopharmacology, 20, S73–S74. First citation in articleCrossref, Google Scholar

  • Lesch, O. , Walter, H. (2009). Alkohol und Tabak: Medizinische und soziologische Aspekte von Gebrauch, Missbrauch und Abhängigkeit. Wien, New York: Springer. First citation in articleGoogle Scholar

  • Lieb, B. , Specka, M. , Sick, I. , Bonnet, U. , Scherbaum, N. (2005). Alkoholkonsum in Methadonsubstitution – keine Suchtverlagerung. Suchttherapie, 6, 206 – 207. First citation in articleCrossref, Google Scholar

  • Marsden, J. , Gossop, M. , Stewart, D. , Best, A. M. , Farrell, M. , Lehmann, P. et al. (1998). The Maudsley Addiction Profile (MAP): A brief instrument for assessing treatment outcome. Addiction, 93, 1857 – 1867. First citation in articleCrossref, Google Scholar

  • Mattick, R. P. , Breen, C. , Kimber, J. , Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD002209.pub2 First citation in articleGoogle Scholar

  • McCusker, M. (2001). Influence of hepatitis C status on alcohol consumption in opiate users in treatment. Addiction, 96, 1007 – 1014. First citation in articleCrossref, Google Scholar

  • Meyers, R. , Smith, J. E. (2009). CRA-Manual zur Behandlung von Alkoholabhängigkeit: Erfolgreicher behandeln durch positive Verstärkung. (3. Aufl.) Bonn: Psychiatrieverlag. First citation in articleGoogle Scholar

  • Moss, H. B. , Chen, C. M. , Yi, H. Y. (2007). Subtypes of alcohol dependence in a nationally representative sample. Drug and Alcohol Dependence, 91, 149 – 158. First citation in articleCrossref, Google Scholar

  • Moyer, A. , Finney, J. W. , Swearingen, C. E. , Vergun, P. (2002). Brief interventions for alcohol problems: A meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction, 97, 279 – 292. First citation in articleCrossref, Google Scholar

  • Neuefeind, W. (2001). Arzthaftungsrecht. Ein Überblick für Rechtsanwender, Ärzte und Patienten. (3. überarbeitete und ergänzte Aufl.) Marburg: Tectum. First citation in articleGoogle Scholar

  • Nyamathi, A. , Cohen, A. , Marfisee, M. , Shoptaw, S. , Greengold, B. , de Castro, V. et al. (2009). Correlates of alcohol use among methadone-maintained adults. Drug and Alcohol Dependence, 101, 124 – 127. First citation in articleCrossref, Google Scholar

  • Passarino, G. , Ciccone, G. , Siragusa, R. , Tappero, P. , Mollo, F. (2005). Histopathological findings in 851 autopsies of drug addicts, with toxicologic and virologic correlations. The American Journal of Forensic Medicine and Pathology, 26, 106 – 116. First citation in articleGoogle Scholar

  • Pirnay, S. , Borron, S. W. , Giudicelli, C. P. , Tourneau, J. , Baud, F. J. , Ricordel, I. (2004). A critical review of the causes of death among post-mortem toxicological investigations: analysis of 34 buprenorphine-associated and 35 methadone-associated deaths. Addiction, 99, 978 – 988. First citation in articleCrossref, Google Scholar

  • Rumpf, H. J. , Meyer, C. , Hapke, U. , Bischof, G. , John, U. (2000). Inanspruchnahme suchtspezifischer Hilfen von Alkoholabhängigen und -mißbrauchern: Ergebnisse der TACOS-Bevölkerungsstudie. SUCHT, 46, 9 – 17. First citation in articleLink, Google Scholar

  • Ryder, N. , Cullen, W. , Barry, J. , Bury, G. , Keenan, E. , Smyth, B. P. (2009). Prevalence of problem alcohol use among patients attending primary care for methadone treatment. BMC Family Practice, 10, 42. First citation in articleCrossref, Google Scholar

  • Salamina, G. , Diecidue, R. , Vigna-Taglianti, F. , Jarre, P. , Schifano, P. , Bargagli, A. M. et al. (2010). Effectiveness of therapies for heroin addiction in retaining patients in treatment: Results from the VEdeTTE study. Substance Use & Misuse, 45, 2076 – 2092. First citation in articleCrossref, Google Scholar

  • Senbanjo, R. , Wolff, K. , Marshall, J. (2007). Excessive alcohol consumption is associated with reduced quality of life among methadone patients. Addiction, 102, 257 – 263. First citation in articleCrossref, Google Scholar

  • Srivastava, A. , Kahan, M. , Ross, S. (2008). The effect of methadone maintenance treatment on alcohol consumption: A systematic review. Journal of Substance Abuse Treatment, 34, 215 – 223. First citation in articleCrossref, Google Scholar

  • Stenbacka, M. , Beck, O. , Leifman, A. , Romelsjo, A. , Helander, A. (2007). Problem drinking in relation to treatment outcome among opiate addicts in methadone maintenance treatment. Drug and Alcohol Review, 26, 55 – 63. First citation in articleCrossref, Google Scholar

  • Stinson, F. S. , Grant, B. F. , Dawson, D. A. , June Ruan, W. , Huang, B. , Saha, T. (2006). Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States. Alcohol Research & Health, 29, 94 – 106. First citation in articleGoogle Scholar

  • World Health Organization. (2009). Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. Geneva: WHO Press. First citation in articleGoogle Scholar