Evidenzgrade in der Suchttherapie von alkoholbezogenen Störungen und illegalen Drogen

Zusammenfassung

Substanzbezogene Störungen sind klinisch und gesellschaftlich von hoher Bedeutung. In Deutschland sind über eine Million Menschen unterschiedlichsten Alters betroffen. Je nach Substanz und Stadium der Behandlung werden Medikamente und verschiedene Therapieverfahren eingesetzt. Durch eine Literaturrecherche wurde untersucht, zu welchen Pharmaka und Therapieverfahren aktuell randomisierte Studien zum Nachweis einer Wirksamkeit in der Suchttherapie vorliegen. Ziel war es, für jeden pharmakologischen Wirkstoff oder jedes Therapieverfahren Evidenzgrade festzulegen. Für die pharmakologische Therapie des Alkohol-, Kokain- und Opiatentzugssyndroms, sowie deren Rückfallprophylaxe bzw. Substitutionstherapie liegen Medikamente mit hohem Evidenzgrad vor. Eine Wirksamkeit ist auch für Verfahren wie die Verhaltenstherapie, das Kontingenzmanagement oder die motivierende Gesprächsführung wissenschaftlich nachgewiesen.

Abstract

Substance-related disorders are clinically and socially very important. In Germany over a million people of varying ages are affected. Depending on the substance and stage of treatment, drugs and different treatment methods are used. Through a literature search we examined the current knowledge of what drugs and therapies are used to date, and what randomised trials have been carried out to prove the efficacy of drug therapy. The aim was to define for each drug or pharmacological therapy a specific level of evidence. For the pharmacological treatment of alcohol, cocaine and opiate withdrawal syndromes and their relapses, prophylaxis or replacement therapy drugs are found to have a high level of evidence. Efficacy has been proven scientifically for processes such as behaviour therapy, contingency management or motivational interviewing.

Schlüsselwörter

Suchttherapie - substanzbezogene Störungen - Evidenzgrade

Key words

addiction treatment - substance related disorders - levels of evidence

• Literatur

• 1 Sackett DL, Rosenberg WM, Gray JA et al. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312: 71-72
• 2 Schmidt LG, Gastpar M, Falkai P et al. Evidenzbasierte Suchtmedizin. Behandlungsleitlinie Substanzbezogene Störungen. Köln: Deutscher Ärzte-Verlag; 2006
• 3 Mefert-Diete C. Daten, Zahlen und Fakten. In: Jahrbuch Sucht 2011. Deutsche Hauptstelle für Suchtfragen (DHS) e.V (Hrsg.)
• 4 Drogen- und Suchtbericht Mai 2012. Berlin: Die Drogenbeauftragte der Bundesregierung, Bundesministerium für Gesundheit; 2012 http://www.drogenbeauftragte.de
• 5 Mayo-Smith MF, Beecher LH, Fischer TL et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004; 164: 1405-1412
• 6 Diener HC, Putzki N. Alkoholdelir. In: Leitlinien für Diagnostik und Therapie in der Neurologie. Deutsche Gesellschaft für Neurologie (Hrsg.) 4.. Aufl. Stuttgart: Thieme; 2008: 860-868
• 7 Mundle G, Banger M, Mugele B et al. AWMF-Behandlungsleitlinie: Akutbehandlung alkoholbezogener Störungen. Sucht 2003; 49: 147-167
• 8 Geyer D, Batra A, Beute M et al. Postakutbehandlung alkoholbezogener Störungen. Sucht 2006; 52: 8-34
• 9 Bonnet U, Scherbaum N. Cannabisbezogene Störungen Teil II: Psychiatrische und somatische Folgestörungen und Komorbiditäten. Fortschr Neurol Psychiatr 2010; 78: 360-367
• 10 Reymann G, Gastpar M, Tretter F et al. Akutbehandlung opioidbedingter Störungen. Sucht 2002; 48: 245-264
• 11 Lobmaier P, Kornor H, Kunoe N et al. Sustained-release naltrexone for opioid dependence. Cochrane Database Syst Rev 2008; (2): CD006140
• 12 Thomasius R, Gouzoulis-Mayfrank E, Karus C et al. AWMF-Behandlungsleitlinie: Psychische und Verhaltensstörungen durch Kokain, Amphetamine, Ecstasy und Halluzinogene. Fortschr Neurol Psychiatr 2004; 72: 679-695
• 13 AWMF, Ärztliche Zentralstelle Qualitätssicherung ÄZQ (Hrsg). Das Leitlinienmanual von AWMF und ÄZQ. Systematische Evidenz-Recherche. ZaeFQ 2001; 95 (Suppl 1)
• 14 Holbrook A, Crowther R, Lotter A et al. Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal. CMAJ 1999; 160: 649-655
• 15 Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline (American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal). JAMA 1997; 278: 144-151
• 16 Ntais C, Pakos E, Kyzas P et al. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev 2005; (3): CD005063
• 17 Minozzi S, Amato L, Vecchi S et al. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev 2010; (3): CD005064
• 18 Bonnet U, Schäfer M, Richter C et al. Anticonvulsants in the treatment of alcoholism. Fortschr Neurol Psychiatr 2009; 77: 92-202
• 19 Athen D. Comparative investigation of chlormethiazole and neuroleptic agents in the treatment of alcoholic delirium. Acta Psychiatr Scand 1986; 329: 167-170
• 20 Mayo-Smith MF, Beecher LH, Fischer TL et al. Management of alcohol withdrawal delirium. An evidence-based practice guideline. Arch Intern Med 2004; 164: 1405-1412
• 21 Spies CD, Dubisz N, Neumann T et al. Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomised trial. Critical Care Medicine 1996; 24: 414-422
• 22 Adinoff B. Double-blind study of alprazolam, diazepam, clonidine, and placebo in the alcohol withdrawal syndrome: preliminary findings. Alcohol Clin Exp Res 1994; 18: 873-878
• 23 Worner TM. Propranolol versus diazepam the management of the alcohol withdrawal syndrome: double-blind controlled trial. Am J Drug Alcohol Abuse 1994; 20: 115-124
• 24 Horwitz R, Gottlieb L, Kraus M. The efficacy of atenolol in the outpatient management of the alcohol withdrawal syndrome. Results of a randomized clinical trial. Arch Intern Med 1989; 149: 1089-1093
• 25 Digranes O. Beta blocker treatment in alcohol withdrawal. A double-blind test with pindolol (Visken)/placebo. Tidsskr Nor Laegeforen 1976; 96: 226-228
• 26 Gallant DM, Bishop MP, Guerrero-Figueroa R et al. Doxepin versus diazepam: a controlled evaluation in 100 chronic alcoholic patients. J Clin Pharmacol J New Drugs 1969; 9: 57-65
• 27 Franz M, Dlabal H, Kunz S et al. Treatment of alcohol withdrawal: tiapride and carbamazepine versus clomethiazole. A pilot study. Eur Arch Psychiatry Clin Neurosci 2001; 251: 185-192
• 28 Croissant B, Loeber S, Diehl A et al. Oxcarbazepine in combination with Tiaprid in inpatient alcohol-withdrawal – a RCT. Pharmacopsychiatry 2009; 42: 175-181
• 29 Lucht M, Kuehn KU, Armbruster J et al. Alcohol withdrawal treatment in intoxicated vs non-intoxicated patients: a controlled open-label study with tiapride/carbamazepine, clomethiazole and diazepam. Alcohol Alcohol 2003; 38: 168-175
• 30 Garbutt JC, West SL, Carey TS et al. Pharmacological treatment of alcohol dependence: a review of the evidence. JAMA 1999; 281: 1318-1325
• 31 Mann K. Pharmacotherapy of alcohol dependence: a review of the clinical data. CNS Drugs 2004; 18: 485-504
• 32 Kranzler HR, Koob G, Gastfriend DR et al. Advances in the pharmacotherapy of alcoholism: challenging misconceptions. Alcohol Clin Exp Res 2006; 30: 272-281
• 33 Rösner S, Hackl-Herrwerth A, Leucht S et al. Acamprosate for alcohol dependence. Cochrane Database Syst Rev 2010; (9): CD004332
• 34 Heberlein A, Bleich S, Kornhuber J et al. Pharmakologische Therapieoptionen zur Prävention des Alkoholrückfalls. Fortschr Neurol Psychiatr 2008; 76: 421-428
• 35 Rösner S, Hackl-Herrwerth A, Leucht S et al. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev 2010; (12): CD001867
• 36 Johnson BA, Ait-Daoud N, Bowden CL et al. Oral topiramate for treatment of alcohol dependence: a randomised controlled trial. Lancet 2003; 361: 1677-1685
• 37 Anton RF, Kranzler H, Breder C et al. A randomized, multicenter, double-blind, placebo-controlled study of the efficacy and safety of aripiprazole for the treatment of alcohol dependence. J Clin Psychopharmacol 2008; 28: 5-12
• 38 Martinotti G, Di Nicola M, Di Giannantonio M et al. Aripiprazole in the treatment of patients with alcohol dependence: a double-blind, comparison trial vs. naltrexone. J Psychopharmacol 2009; 23: 123-129
• 39 Guardia J, Roncero C, Galan J et al. A double-blind, placebo-controlled, randomized pilot study comparing quetiapine with placebo, associated to naltrexone, in the treatment of alcohol-dependent patients. Addict Behav 2011; 36: 265-269
• 40 Wiesbeck GA, Weijers HG, Lesch OM et al. Flupenthixol decanoate and relapse prevention in alcoholics: results from a placebo-controlled study. Alcohol Alcohol 2001; 36: 329-334
• 41 Tiihonen J, Ryynanen OP, Kauhanen J et al. Citalopram in the treatment of alcoholism: a double-blind placebo-controlled study. Pharmacopsychiatry 1996; 29: 27-29
• 42 Kabel D, Petty F. A placebo-controlled, double-blind study of fluoxetine in severe alcohol dependence: adjunctive pharmacotherapy during and after inpatient treatment. Alcohol Clin Exp Res 1996; 20: 780-784
• 43 Pettinati HM, Volpicelli JR, Luck G et al. Double-blind clinical trial of sertraline treatment for alcohol dependence. J Clin Psychopharmacol 2001; 21: 143-153
• 44 Farren CK, Scimeca M, Wu R et al. A double-blind, placebo-controlled study of sertraline with naltrexone for alcohol dependence. Drug Alcohol Depend 2009; 99: 317-321
• 45 Addolorato G, Caputo F, Capristo E et al. Baclofen efficacy in reducing alcohol craving and intake: a preliminary double-blind randomized controlled study. Alcohol Alcohol 2002; 37: 504-508
• 46 Addolorato G, Leggio L, Ferrulli A et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet 2007; 370: 1915-1922
• 47 Garbutt JC, Kampov-Polevoy AB, Gallop R et al. Efficacy and safety of baclofen for alcohol dependence: a randomized, double-blind, placebo-controlled trial. Alcohol Clin Exp Res 2010; 34: 1849-1857
• 48 Evans SM, Levin FR, Brooks DJ et al. A pilot double-blind treatment trial of memantine for alcohol dependence. Alcohol Clin Exp Res 2007; 31: 775-782
• 49 Green AI, Tohen MF, Hamer RM et al. First episode schizophrenia-related psychosis and substance use disorders: acute response to olanzapine and haloperidol. Schizophr Res 2004; 66: 125-135
• 50 Berk M, Brook S, Trandafir AI. A comparison of olanzapine with haloperidol in cannabis-induced psychotic disorder: a double-blind randomized controlled trial. Int Clin Psychopharmacol 1999; 14: 177-180
• 51 van Nimwegen LJ, de Haan L, van Beveren NJ et al. Effect of olanzapine and risperidone on subjective well-being and craving for cannabis in patients with schizophrenia or related disorders: a double-blind randomized controlled trial. Can J Psychiatry 2008; 53: 400-405
• 52 Levin FR, McDowell D, Evans SM et al. Pharmacotherapy for marijuana dependence: a double-blind, placebo-controlled pilot study of divalproex sodium. Am J Addict 2004; 13: 21-32
• 53 Cooper ZD, Haney M. Opioid antagonism enhances marijuana's effects in heavy marijuana smokers. Psychopharmacology 2010; 211: 141-148
• 54 Carpenter KM, McDowell D, Brooks DJ et al. A preliminary trial: double-blind comparison of nefazodone, bupropion-SR, and placebo in the treatment of cannabis dependence. Am J Addict 2009; 18: 53-64
• 55 Winstock AR, Lea T, Copeland J. Lithium carbonate in the management of cannabis withdrawal in humans: an open-label study. J Psychopharmacol 2009; 23: 84-93
• 56 McRae AL, Brady KT, Carter RE. Buspirone for treatment of marijuana dependence: a pilot study. Am J Addict 2006; 15: 404
• 57 Huestis MA, Boyd SJ, Heishman SJ et al. Single and multiple doses of rimonabant antagonize acute effects of smoked cannabis in male cannabis users. Psychopharmacology 2007; 194: 505-515
• 58 Gorelick DA, Goodwin RS, Schwilke E et al. Antagonist-elicited cannabis withdrawal in humans. J Clin Psychopharmacol 2011; 31: 603-612
• 59 Cornelius JR, Chung T, Martin C et al. Cannabis withdrawal is common among treatment-seeking adolescents with cannabis dependence and major depression, and is associated with rapid relapse to dependence. Addict Behav 2008; 33: 1500-1505
• 60 Vandrey R, Haney M. Pharmacotherapy for cannabis dependence: how close are we?. CNS Drugs 2009; 23: 543-553
• 61 Haney M, Hart C, Vosburg S et al. Effects of THC and lofexidine in a human laboratory model of marijuana withdrawal and relapse. Psychopharmacology 2008; 197: 157-168
• 62 Amato L, Davoli M, Minozzi S et al. Methadone at tapered doses for the management of opioidwithdrawal. Cochrane Database Syst Rev 2005; (3): CD003409
• 63 Mattick RP, Breen C, Kimber J et al. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev 2009; (3): CD002209
• 64 Gowing L, Ali R, White J. Buprenorphine for the management of opioid withdrawal. Cochrane Database Syst Rev 2009; (3): CD002025
• 65 Gowing L, Farrell M, Ali R et al. Alpha2-adrenergic agonists for the management of opioid withdrawal. Cochrane Database Syst Rev 2009; (2): CD002024
• 66 Vogel M, Petitjean S, Borgwardt S et al. Therapie der Opioidabhängigkeit – ein Update. Schweizer Arch Neurol Psychiatr 2010; 161: 5-13
• 67 Taschner KL. A controlled comparison of clonidine and doxepin in the treatment of the opiate withdrawal syndrome. Pharmacopsychiatry 1986; 19: 91-95
• 68 Titievsky J, Seco G, Barranco M et al. Doxepin as adjunctive therapy for depressed methadone maintenance patients: a double-blind study. J Clin Psychiatry 1982; 43: 454-456
• 69 Woody GE, O'Brien CP, Rickels K. Depression and anxiety in heroin addicts: a placebo-controlled study of doxepin in combination with methadone. Am J Psychiatry 1975; 132: 447-450
• 70 Gowing L, Ali R, White JM. Opioid antagonists under heavy sedation or anaesthesia for opioid withdrawal. Cochrane Database Syst Rev 2010; (1): CD002022
• 71 Assadi SM, Radgoodarzi R, Ahmadi-Abhari SA. Baclofen for maintenance treatment of opioid dependence: a randomized double-blind placebo-controlled clinical trial. BMC Psychiatry 2003; 3: 16
• 72 Ahmadi-Abhari SA, Akhondzadeh S, Assadi SM et al. Baclofen versus clonidine in the treatment of opiates withdrawal, side-effects aspect: a double-blind randomized controlled trial. J Clin Pharm Ther 2001; 26: 67-71
• 73 Mattick RP, Kimber J, Breen C et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2008; (2): CD002207
• 74 Haasen C, Verthein U, Degkwitz P et al. Heroin-assisted treatment for opioid dependence: randomised controlled trial. Br J Psychiatry 2007; 191: 55-62
• 75 Eiroa-Orosa FJ, Haasen C, Verthein U et al. Benzodiazepine use among patients in heroin-assisted vs. methadone maintenance treatment: findings of the German randomized controlled trial. Drug Alcohol Depend 2010; 112: 226-233
• 76 Ferri M, Davoli M, Perucci CA. Heroin maintenance for chronic heroin-dependent individuals. Cochrane Database Syst Rev 2011; (12): CD003410
• 77 Ling W, Amass L, Shoptaw S et al. A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction 2005; 100: 1090-1100
• 78 Lobmaier P, Kornor H, Kunoe N et al. Sustained-release naltrexone for opioid dependence. Cochrane Database Syst Rev 2008; (2): CD006140
• 79 Minozzi S, Amato L, Vecchi S et al. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev 2011; (2): CD001333
• 80 Silva de Lima M, Farrell M, Lima Reisser AA et al. Antidepressants for cocaine dependence. Cochrane Database Syst Rev 2009; (2): CD002950
• 81 Preuss UW, Bahlmann M, Koller G et al. Die Behandlung der Kokainabhängigkeit. Intoxikation, Entzug und Rückfallprophylaxe. Fortschr Neurol Psychiatr 2000; 68: 224-238
• 82 Moeller FG, Schmitz JM, Steinberg JL et al. Citalopram combined with behavioral therapy reduces cocaine use: a double-blind, placebo-controlled trial. Am J Drug Alcohol Abuse 2007; 33: 367-378
• 83 Soares B, Lima MS, Reisser AA et al. Dopamine agonists for cocaine dependence. Cochrane Database Syst Rev 2003; (2): CD003352
• 84 Soares B, Lima Reisser AA, Farrell M et al. WITHDRAWN: Dopamine agonists for cocaine dependence. Cochrane Database Syst Rev 2010; (2): CD003352
• 85 Amato L, Minozzi S, Pani PP et al. Antipsychotic medications for cocaine dependence. Cochrane Database Syst Rev 2007; (3): CD006306
• 86 Minozzi S, Amato L, Davoli M et al. Anticonvulsants for cocaine dependence. Cochrane Database Syst Rev 2008; (2): CD006754
• 87 Pani PP, Trogu E, Vacca R et al. Disulfiram for the treatment of cocaine dependence. Cochrane Database Syst Rev 2010; (1): CD007024
• 88 Elkashef AM, Rawson RA, Anderson AL et al. Bupropion for the treatment of methamphetamine dependence. Neuropsychopharmacology 2008; 33: 1162-1170
• 89 Srisurapanont M, Jarusuraisin N, Kittirattanapaiboon P. Treatment for amphetamine withdrawal. Cochrane Database Syst Rev 2001; (4): CD003021
• 90 Shoptaw SJ, Kao U, Heinzerling K et al. Treatment for amphetamine withdrawal. Cochrane Database Syst Rev 2009; (2): CD003021
• 91 Liechti ME, Vollenweider FX. Acute psychological and physiological effects of MDMA ("Ecstasy") after haloperidol pretreatment in healthy humans. Eur Neuropsychopharmacol 2000; 10: 289-295
• 92 Liechti ME, Baumann C, Gamma A et al. Acute psychological effects of 3,4-methylenedioxymethamphetamine (MDMA, “Ecstasy”) are attenuated by the serotonin uptake inhibitor citalopram. Neuropsychopharmacology 2000; 22: 513-521
• 93 Liechti ME, Vollenweider FX. The serotonin uptake inhibitor citalopram reduces acute cardiovascular and vegetative effects of 3,4-methylenedioxymethamphetamine ('Ecstasy') in healthy volunteers. J Psychopharmacol 2000; 14: 269-274
• 94 Liechti ME. "Ecstasy" (MDMA): Pharmakologie, Toxikologie und Behandlung der akuten Intoxikation. Dtsch Med Wochenschr 2003; 128: 1361-1366
• 95 Magill M, Ray LA. Cognitive-behavioral treatment with adult alcohol and illicit drug users: a meta-analysis of randomized controlled trials. J Stud Alcohol Drugs 2009; 70: 516-527
• 96 Bottlender M, Köhler J, Soyka M. Effektivität psychosozialer Behandlungsmethoden zur medizinischen Rehabilitation alkoholabhängiger Patienten. Fortschr Neurol Psychiatr 2006; 74: 19-31
• 97 Vasilaki EI, Hosier SG, Cox WM. The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol Alcohol 2006; 41: 328-335
• 98 Project Match Research Group. Matching alcoholism treatments to client heterogeneity: Project Match posttreatment drinking outcomes. J Stud Alcohol 1997; 58: 7-29
• 99 Miller WR, Wilbourne PL. Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction 2002; 97: 265-277
• 100 Holder HD, Longabaugh R, Miller WR et al. The cost effectiveness of treatment for alcoholism: a first approximation. J Stud Alcohol 1991; 52: 517-540
• 101 Finney JW, Monahan SC. The cost effectiveness of treatment for alcoholism: a second approximation. J Stud Alcohol 1996; 57: 229-243
• 102 Tonigan JS, Toscova R, Miller WR. Meta-analysis of the literature on Alcoholics Anonymous: sample and study characteristics moderate findings. J Stud Alcohol 1996; 57: 65-72
• 103 Bottlender M, Soyka M. Prädiktion des Behandlungserfolges 24 Monate nach ambulanter Alkoholentwöhnungstherapie: Die Bedeutung von Selbsthilfegruppen. Fortschr Neurol Psychiatr 2005; 73: 150-155
• 104 Nordstrom BR, Levin FR. Treatment of cannabis use disorders: a review of the literature. Am J Addict 2007; 16: 331-342
• 105 Denis C, Lavie E, Fatseas M et al. Psychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings. Cochrane Database Syst Rev 2006; (3): CD005336
• 106 Amato L, Minozzi S, Davoli M et al. Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database Syst Rev 2008; (4): CD005031
• 107 Amato L, Minozzi S, Davoli M et al. Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database Syst Rev 2008; (4): CD004147
• 108 Carroll KM, Ball SA, Nich C et al. Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence: efficacy of contingency management and significant other involvement. Arch Gen Psychiatry 2001; 58: 755-761
• 109 Saunders B, Wilkinson C, Phillips M. The impact of a brief motivational intervention with opiate users attending a methadone programme. Addiction 1995; 90: 415-424
• 110 Rawson RA, Marinelli-Casey P, Anglin MD et al. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction 2004; 99: 708-717
• 111 Shoptaw S, Huber A, Peck J et al. Randomized, placebo-controlled trial of sertraline and contingency management for the treatment of methamphetamine dependence. Drug Alcohol Depend 2006; 85: 12-18
• 112 Carroll KM, Onken LS. Behavioral therapies for drug abuse. Am J Psychiatry 2005; 162: 1452-1460
• 113 Knapp WP, Soares BG, Farrel M et al. Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. Cochrane Database Syst Rev 2007; (3): CD003023
• 114 Carroll KM. Relapse prevention as a psychosocial treatment: A review of controlled clinical trials. Exp Clin Psychopharmacol 1996; 4: 46-54
• 115 Mercer DE, Woody G. Psychotherapie bei Kokainabhängigkeit. Suchttherapie 2002; 3: 13-17
• 116 Carroll KM, Rounsaville BJ, Gordon LT et al. Psychotherapy and pharmacotherapy for ambulatory cocaine abusers. Arch Gen Psychiatry 1994; 51: 177-187
• 117 Longabaugh R, Wirtz PW, Beattie MC et al. Matching treatment focus to patient social investment and support: 18-month follow-up results. J Consult Clin Psychol 1995; 63: 296-307
• 118 Kashner TM, Rosenheck R, Campinell AB et al. Impact of work therapy on health status among homeless, substance-dependent veterans: a randomized controlled trial. Arch Gen Psychiatry 2002; 59: 938-944
• 119 Arnold O. Musik- und Tanztherapie in der ambulanten Rehabilitation Drogenabhängiger. Musik-, Tanz- und Kunsttherapie 2003; 14: 19-31
• 120 Mays KL, Clark DL, Gordon AJ. Treating addiction with tunes: a systematic review of music therapy for the treatment of patients with addictions. Subst Abus 2008; 29: 51-59
• 121 Meyer T, Broocks A. Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription. Sports Med 2000; 30: 269-279
• 122 Kunz S, Schulz M, Lewitzky M et al. Ear acupuncture for alcohol withdrawal in comparison with aromatherapy: a randomized-controlled trial. Alcohol Clin Exp Res 2007; 31: 436-442
• 123 Gates S, Smith LA, Foxcroft DR. Auricular acupuncture for cocaine dependence. Cochrane Database Systematic Reviews 2006; (1): CD005192
• 124 Cho SH, Whang WW. Acupuncture for alcohol dependence: a systematic review. Alcohol Clin Exp Res 2009; 33: 1305-1313
• 125 Bearn J, Swami A, Stewart D et al. Auricular acupuncture as an adjunct to opiate detoxification treatment: effects on withdrawal symptoms. J Subst Abuse Treat 2009; 36: 345-349
• 126 http://www.cra-kongress.de/netzwerke/diskussion-zulassung-antabus/