Stressreagibilität bei Alkoholabhängigen unter Berücksichtigung von Abstinenzdauer und Krankheitsschwere

Zusammenfassung

Hintergrund Bei der Entstehung und Aufrechterhaltung von Alkoholabhängigkeit spielt Stress als Risikofaktor eine wichtige Rolle. Die Berücksichtigung von Stressreaktions- und Stressverarbeitungsmechanismen bei Alkoholabhängigen ist für die Aufrechterhaltung von Abstinenz im Alltag von Relevanz. Ebenso wichtig ist die Berücksichtigung von Krankheitsschwere, die ihrerseits Einfluss auf die Abstinenz insbesondere auf das Verlangen nach Alkohol ausübt. In zahlreichen Studien wurde die Abstinenzdauer, nicht aber die Krankheitsschwere ausreichend berücksichtigt.

Ziel Untersucht wird, ob neben der Abstinenzdauer auch die Schwere der Alkoholabhängigkeit einen Einfluss auf die Stressreagibilität und Stressverarbeitung hat. Zudem soll geprüft werden bei welchen Patienten sich der Einfluss zeigt. Die Ergebnisse könnten mehr Klarheit in der komplexen bidirektionalen Beziehung zwischen Alkoholabhängigkeit und Stress bringen, aber auch für die Behandlung von Betroffenen nützlich sein.

Methoden Im Querschnittsdesign wurden 64 Alkoholabhängige und 30 gesunde Probanden untersucht. Die Patientenstichprobe wurde nach Abstinenzdauer von 7 und 70 Tagen in jeweils zwei Gruppen aufgeteilt. Ebenso nach Krankheitsschwere in leicht-mittelschwer und schwer. Mit Trierer Sozial Stresstest (TSST) wurden alle Probanden akutem Stress ausgesetzt. Erhoben wurden Parameter wie Cortisol im Speichel, elektrodermale Aktivität (EDA), Puls, suchtspezifische Variablen (Schwere der Abhängigkeit, Trinkdauer, Trinkmenge, Suchtdruck, Leberenzyme, familiäre Vorgeschichte, Anzahl Therapien, Rauchen, uvm.), psychopathologische Variablen (Angst, Depression, kritische Lebensereignisse, Persönlichkeitsstörungen), akute und chronische Stressverarbeitung, sowie Alltagsbelastungen.

Ergebnisse Schwerkranke Patienten reagieren schwächer und etwas verzögert auf Stress, zeigen dafür aber eine verlängerte Stressreaktion im Vergleich zu leicht-mittelschwerkranken und Gesunden. Dies ist unabhängig von der Abstinenzdauer (7 oder 70 Tage). Schwerkranke zeigten stärkere Flucht- und Vermeidungsreaktionen, starkes Bedürfnis nach sozialer Unterstützung und die intensive gedankliche Weitebeschäftigung als akute Stressbewältigungsstile. Als Zeichen chronischer Stressbelastung wurden erhöhte Werte in Bereichen Mangel an sozialer Anerkennung, soziale Spannungen und Isolation festgestellt. Außerdem zeigten Schwerkranke stärkere familiäre Vorbelastung, stärkeren Suchtdruck, höhere Ängstlichkeit, längere Trinkdauer und mehr einschneidende Lebensereignisse als Leicht-mittelschwerkranke.

Schlussfolgerungen Für eine differenzierte Beurteilung von Stressreagibilität und Stressverarbeitung bei Alkoholabhängigkeit scheint neben Abstinenzdauer auch die Krankheitsschwere eine wichtige Rolle zu spielen. Weitere Anstrengungen sind nötig, um die Ergebnisse in die Behandlungsprogramme zu implementieren.

Abstract

Background Stress increases the risk of developing and maintaining alcohol addiction. Mechanism for reacting to, and coping with, stress in persons with alcohol addiction are an important factor enabling them to maintain abstinence in everyday life. Also of Relevance for abstinence, and in particular craving for alcohol, is the severity of the dependence. Numerous studies have focused on the duration of abstinence, but not on the severity of the disease.

Objective This study investigates if, in addition to abstinence duration, also the severity of the alcohol addiction influences stress responsiveness and ability to cope with stress. Another objective is to ascertain in which patients such an influence can be found. The results can shed light on the complex bidirectional relationship between alcoholism and stress, but are also potentially useful in treating patients with this disease.

Methods In a cross-sectional design, 64 alcohol-dependent patients and 30 healthy controls were examined. The alcoholics sample was divided in two groups according to a duration of abstinence of seven days and, 70 days. Each group was further divided in a subgroup of individuals with mild to moderate alcohol addiction and in a subgroup of patients with severe alcohol addiction (A7-severe and A70-severe). Using the Trierer Social Stress Test (TSST), all participants were subjected to acute stress. Parameters measured were salivary cortisol, skin conductance -response, heart rate, addiction-related variables (addiction severity, duration of alcohol abuse, drinking quantity, craving, liver enzymes, family history of alcoholism, number of therapies, smoking), psychopathological variables (anxiety, depression, live events, personality disorders), acute and long-term stress coping, and level of strain on everyday life.

Results In patients with severe addiction, the reaction to stress is weaker and slightly retarded, but also of a longer duration than that patients with mild and moderate addiction and of healthy controls. This is independent of the length of abstinence (7 days and 70 days). In severely ill patients, strategies for coping with acute stress differed from those of the other groups in that they consisted in stronger flight and avoidance responses, a stronger need for social support, and a more intense mental preoccupation. Increased levels of social tension, lack of social recognition, and isolation indicated chronic stress. Patients with severe alcohol addiction also showed a more pronounced familial predisposition, stronger craving, increased anxiety, a longer history of alcohol abuse, and a higher frequency of incisive life events than patients with mild to moderate alcohol addiction.

Conclusions The results indicate that a more differentiated evaluation of stress responsiveness and stress coping in persons with an alcohol addiction not only length of abstinence, but also severity of disease have to be taken into account. Further research is necessary to adjust treatment accordingly.

Schlüsselwörter

Alkoholabhängigkeit - Stress - Abstinenzdauer - Krankheitsschwere - Cortisol - EDA - Puls - TSST

Key words

alcohol addiction - stress - abstinence duration - disease severity - cortisol - conductance - heart rate - TSST

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