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Positionspapier

Können Alkoholabhängige ihre Trinkmengen durch eine Kombination von Medikamenten und Kurzinterventionen dauerhaft reduzieren?

Published Online:February 13, 2015https://doi.org/10.1024/0939-5911.a000346

Abstract

Hintergrund: Die traditionelle Behandlung von Alkoholabhängigen in Deutschland ist erfolgreich, allerdings nehmen sie nur rund 10 Prozent der Betroffenen wahr. Ein Grund hierfür liegt in der Forderung nach lebenslanger Abstinenz. Fragestellung: Es fragt sich daher, ob eine Erniedrigung dieser sehr hohen Eingangsschwelle zu einer stärkeren Nachfrage führt. Weiter ist zu fragen, ob alternative Angebote zum Beispiel mit dem Therapieziel der Konsumreduktion empirisch hinreichend belegt sind, um auch für den Bereich der Alkoholtherapie einen Schaden minimierenden Ansatz in Deutschland einzuführen. Ergebnisse: Eine amerikanische und eine englische Studie (Project MATCH und UKATT) belegen, dass mittels Psychotherapie eine Trinkmengenreduktion bei Alkoholabhängigen über längere Zeiträume möglich ist. Gleiches gilt für Medikamente wie zum Beispiel den Opioidmodulator Nalmefen. Bei rund 2400 in Europa behandelten Patienten zeigte sich ein stabiler Rückgang des Konsums bereits in der Kontrollgruppe (Kurzintervention plus Plazebo). Dieser Rückgang war signifikant stärker in der Gruppe ‚Nalmefen plus Kurzintervention‘. Die Substanz wurde von der europäischen Zulassungsbehörde (EMA) 2013 zugelassen und wurde 2014 in Deutschland eingeführt. Schlussfolgerungen: Im vorliegenden Positionspapier wird skizziert wie Alkoholabhängigen wesentlich schneller und in größerem Umfang als bisher Hilfen angeboten werden können. Damit ist die Hoffnung verbunden, dass sich Hausärzte zu einem stärkeren Engagement für Alkoholpatienten entschließen und so mehr Patienten für das Hilfesystem gewonnen werden.


The potential of brief interventions and medication in reducing alcohol consumption in alcohol dependent individuals

Background: The traditional methods of treatment of alcoholism in Germany are successful but reach only about 10% of the alcohol-dependent patients. One reason seems to lie in the treatment goal of obtaining total abstinence, a rather high threshold especially for treatment-naïve patients in the early phases of their addiction. Aims: This article reviews the evidence for a reduction of alcohol consumption as a new treatment paradigm that could represent a strategy of harm-reduction in alcoholism. Results: Two large psychotherapy trials in the United States (Project MATCH) and in the UK (UKATT) showed that alcohol reduction can be achieved and maintained in patients carrying a dependence diagnosis. Medications such as the opioid modulator Nalmefene have been tested and in some 2400 patients proved to provide a stable reduction even in the control group with placebo plus brief intervention. This effect was significantly stronger in the patients randomized to Nalmefene plus brief intervention. On this basis the European Medicines Agency approved Nalmefene for the treatment of alcohol-dependent patients, and it was introduced into the German market in 2014. Conclusions: With this new option available general practitioners can become more engaged in the treatment of alcoholism, especially in patients in the early phases of dependence.

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