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Pathogenese der Komorbidität von ADHS und Substanzabhängigkeit – Klinische Implikationen für die medikamentöse Behandlung

Published Online:October 22, 2015https://doi.org/10.1024/0939-5911.a000386

Abstract

Zusammenfassung.Zielsetzung: Die Pathogenese der Komorbidität der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) und Substanzabhängigkeit hat große klinische Relevanz, da nach klinisch-epidemiologischer Erfahrung bei ADHS-Patienten einerseits häufig eine komorbide Substanzabhängigkeit vorliegt, andererseits sich daraus erhebliche Konsequenzen für das therapeutische und diagnostische Procedere ergeben. Zusammenhänge von ADHS und Substanzstörungen: Neben der „Dopaminmangelhypothese“ bei ADHS sind unter anderem das Konzept des „Sensation-Seekings“ (Zuckerman, 1979) und die „Selbstmedikations-Hypothese“ (Khantzian, 1985) auch im Zusammenhang mit anderen komorbiden Störungen von Belang. Schlussfolgerungen für die Praxis: Die Diagnostik von ADHS-Patienten sollte Substanzstörungen und andere psychische Komorbiditäten berücksichtigen. Klinische Implikationen für die Pharmakotherapie lassen sich insbesondere aus der „Dopaminmangelhypothese“ und den beobachteten depressiven Symptomen bei ADHS-Patienten ableiten: neben der möglichen Behandlung mit Methylphenidat wird daher vorgeschlagen, den therapeutischen Wert von selektiven Dopamin- oder Noradrenalin-Wiederaufnahme-Hemmern und darüber hinaus insbesondere auch psychotherapeutische Behandlungsverfahren zu nutzen.


Pathogenesis of the Comorbidity of ADHD and Substance Use Disorders – A Clinical Perspective and Implications for Pharmacotherapy

Abstract.Aim: An understanding of the pathogenesis of the comorbidity of attention deficit/hyperactivity disorder (ADHD) and substance use disorders is clinically relevant. According to clinical-epidemiological expertise, ADHD patients often show a comorbid substance dependence, resulting in significant consequences for therapeutic and diagnostic procedures. Relationship of ADHD and substance use disorders: In addition to the “dopamine-deficiency hypothesis” for ADHD, the concept of “sensation-seeking” (Zuckerman, 1979) and the “self-medication hypothesis” (Khantzian, 1985) are relevant for understanding the comorbidity of ADHD and substance use disorders. Clinical implications: Diagnostic routines of ADHD patients should consider substance use disorders and other psychiatric comorbidities. The “dopamine-deficiency hypothesis” and the observed depressive symptoms in ADHD patients support clinical pharmacological implications: Besides the possible treatment with methylphenidate the therapeutic value of substances such as SSRI and SNRI should be considered – as well as a psychotherapy.

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