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Übersichtsarbeit

Trauma und Sucht: Implikationen für die Psychotherapie

Published Online:August 20, 2012https://doi.org/10.1024/0939-5911.a000191

Abstract

Ziel: Die vorliegende narrative Übersichtsarbeit geht der Frage nach, welche Rolle traumatische Lebenserfahrungen und damit assoziierte Traumafolgestörungen bezüglich der Ätiologie und Pathogenese von Suchterkrankungen spielen und welche Implikationen sich daraus für die therapeutische Praxis ableiten. Ergebnisse: Die aktuelle empirische Befundlage belegt ein gehäuftes gemeinsames Auftreten von traumatischen Erfahrungen und substanzbezogenen Störungen sowie eine erhöhte Komorbidität von Posttraumatischer Belastungsstörung und Suchterkrankungen. Befunde aus Interview- und Fragebogenstudien sowie aus experimentellen Untersuchungen mit komorbiden Patienten zeigen, dass Betroffene psychotrope Substanzen als Selbstmedikation einsetzen, um ihre traumabedingte Symptomatik zu lindern. Es entsteht ein komplexes, sich gegenseitig aufrechterhaltendes Wechselspiel zwischen Traumafolge- und Suchtsymptomatik, welches die Behandlung deutlich erschwert. Schlussfolgerungen: Zur Unterbrechung dieses Wechselspiels erscheint ersten Befunden zufolge ein von Beginn an integrativer, traumafokussierter Behandlungsansatz besonders geeignet. Auch wenn diesbezüglich erste erfolgsversprechende traumakonfrontative Therapieansätze entwickelt wurden, stehen größere prospektive Untersuchungen sowie randomisiert kontrollierte Therapiestudien diesbezüglich noch aus und sollten einen Schwerpunkt zukünftiger Forschung auf diesem Gebiet bilden.


Trauma and Addiction: Implications for Psychotherapy

Aim: This narrative review focuses on the question of how traumatic life experiences and trauma-related disorders are implicated in the etiology and pathogenesis of addiction and the resulting implications for psychotherapy. Results: Current empirical evidence shows numerous co-occurrence of traumatic experiences and substance use disorders as well as an increased comorbidity of post-traumatic stress disorder and addiction. Findings from various clinical studies with patients suffering from trauma and substance related disorders point out that these individuals use psychotropic substances as a self-medication to alleviate trauma-related symptoms. This often results in a complex interaction between trauma sequelae and addiction symptoms whereby both conditions mutually sustain each other. Conclusions: This has important implications for the treatment of addiction. Preliminary evidence shows that, rather than focusing on the symptoms of addiction only, integrated approaches with a trauma focus should be applied in order to interrupt the vicious circle between trauma and substance use disorders. So far, first promising trauma focused treatment approaches have been developed, but there is still a paucity of large-scale prospective surveys as well as randomized controlled trials. Such empirical studies should be a priority for future research on this topic.

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