Was ist wirksam in forensischer Suchtbehandlung? – Ein nicht-systematischer Einblick in die Evidenzbasierung von Behandlungsansätzen und Interventionen im Kontext des § 64 StGB

Zusammenfassung

Forensische Suchtbehandlung nach § 64 Strafgesetzbuch spielt im deutschen Maßregelvollzugssystem zahlenmäßig eine immer größere Rolle. In den letzten Jahren stand die Frage der Wirksamkeit der Behandlung insgesamt im Fokus zahlreicher Studien. Seltener beschäftigte sich die Forschung jedoch mit der Evidenzbasierung einzelner Interventionen und Wirkfaktoren. Der Artikel gibt einen nicht-systematischen Einblick in den aktuellen Kenntnisstand zu spezifischen Interventionen und Wirkfaktoren in der Behandlung suchtkranker Straftäter. Im Ergebnis lässt sich die Frage, was genau wirkt, nur rudimentär beantworten. Das Konzept der Therapeutischen Gemeinschaft erscheint weitgehend empirisch belegt. Trotz schmaler Evidenzbasis können als aussichtsreiche Therapieformen am ehesten Motivational Interviewing und die Dialektisch-Behaviorale Therapie gelten. Möglicherweise liegt die Wirksamkeit forensischer Suchtbehandlung weniger in der Applikation einzelner Ansätze begründet als in Fragen des Settings und der Haltung der Behandelnden.

Abstract

Forensic addiction treatment according to Section 64 of the German Criminal Code is playing an increasingly important role in the German system of correctional institutions. In recent years, the question of the effectiveness of treatment as a whole has been the focus of numerous studies. Less frequently, however, research has addressed the evidence base of therapeutic interventions and efficacy factors. Since this article takes a non-systematic look into the current state of knowledge on specific interventions and factors that play a role in the effective treatment of addicted offenders, the question of what exactly works can only be answered in a rudimentary way. The concept of Therapeutic Community appears to be largely empirically supported. Based on such evidence as is currently available, motivational interviewing and dialectical-behavioral therapy can be considered the most promising forms of therapy. The effectiveness of forensic addiction treatment lies possibly less in the application of individual approaches than in questions of the setting and the attitude of those providing treatment.

Schlüsselwörter

Maßregelvollzug - Abhängigkeitserkrankung - Evidenzbasierte Medizin - Straftäterbehandlung - Psychotherapie

Key words

Forensic psychiatry - Addiction - offender treatment - psychotherapy - evidence-based medicine

Publication History

Received: 22 August 2022

Accepted after revision: 16 July 2023

Article published online:
22 August 2023

• Literatur

• 1 Querengässer J, Baur A. Gutachten gemäß § 64 StGB: Hinweise an forensisch-psychiatrische Sachverständige zur Prüfung der Voraussetzungen einer Unterbringung in der Entziehungsanstalt. SUCHT 2021; 67: 33-43
• 2 Cirener G. Unterbringung in einer Entziehungsanstalt, § 64 StGB. In: Cirener G, Radtke H, Rissing-van Saan R, Rönnau T, Schluckebier W (eds). Leipziger Kommentar zum Strafgesetzbuch. Band 5 §§ 56 – 68g. De Gruyter. 2022
• 3 Statistisches Bundesamt. Rechtspflege – Strafverfolgung. Fachserie 10 Reihe 3, Berichtsjahr 2021. Online-Dokument 2022 https://www.destatis.de/DE/Themen/Staat/Justiz-Rechtspflege/Publikationen/Downloads-Strafverfolgung-Strafvollzug/strafverfolgung-2100300217004.pdf?__blob=publicationFile; zugegriffen: 24.03.2023
• 4 Steinert T. § 64 StGB sollte abgeschafft werden–Pro. Psychiatrische Praxis 2017; 44: 190-191
• 5 Bezzel A, Schlögl C, Janele D. et al. Forensische Suchtbehandlung vor der Reform. Monatsschrift für Kriminologie und Strafrechtsreform 2022; 105: 65-73
• 6 Feißt M, Lewe U, Kammeier H. Plädoyer für eine Transformation der Maßregeln – Kurzfassung. Online-Dokument. 2022 https://www.dgsp-ev.de/fileadmin/user_files/dgsp/pdfs/Stellungnahmen/2022/Plaedoyer_fuer_eine_Transformation_der_Massregel_Kurzfassung.pdf; zugegriffen: 9.5.2022
• 7 Schalast N. Ergebnisse der Essener Evaluationsstudie. In: Schalast N (ed). Straffällige mit Suchtproblemen – Fakten, Erfahrungen und Ergebnisse der Essener Evaluationsstudie. Lengerich: Pabst Science Publishers; 2019: 29-150
• 8 Völlm B, Cerci D. Suchtbehandlung im Maßregelvollzug: Narrativer Review. Suchtmed 2021; 23: 90-98
• 9 Müller JL, Saimeh N, Briken P. et al. Standards für die Behandlung im Maßregelvollzug nach §§ 63 und 64 StGB. Der Nervenarzt 2017; 88: 1-29
• 10 McMurran M. What works in substance misuse treatments for offenders?. Criminal Behaviour and Mental Health 2007; 17: 225-233
• 11 Roberts AJ, Hayes AJ, Carlisle J. et al. Review of Drug and Alcohol Treatments in Prison and Community Settings, A Systematic Review Conducted on Behalf of the Prison Health Research Network. Project documentation, The University of Manchester. 2007
• 12 Perry A, Coulton S, Glanville J. et al. Interventions for drug-using offenders in the courts, secure establishments and the community. Cochrane Database of Systematic Reviews 2006; 3: CD005193
• 13 De Andrade D, Ritchie J, Rowlands M. et al. Substance use and recidivism outcomes for prison-based drug and alcohol interventions. Epidemiologic reviews 2018; 40: 121-133
• 14 Hayhurst KP, Leitner M, Davies L. et al. The effectiveness of diversion programmes for offenders using Class A drugs: a systematic review and meta-analysis. Drugs: Education, Prevention and Policy 2019; 26: 113-124
• 15 Perry AE, Neilson M, Martyn-St James M. et al. Pharmacological interventions for drug-using offenders. Cochrane Database of Systematic Reviews 2015; 6: CD010862
• 16 Perry AE, Martyn-St James M, Burns L. et al. Interventions for drug-using offenders with co-occurring mental health problems. Cochrane Database of Systematic Reviews 2019; 10: CD010901
• 17 Ritchie G, Weldon S, Freeman L. et al. Outcomes of a drug and alcohol relapse prevention programme in a population of mentally disordered offenders. Br J Forensic Pract 2011; 13: 32-43
• 18 Miles H. “A new horizon?”: evaluation of an integrated Substance Use Treatment Programme (SUTP) for mentally disordered offenders. Adv Dual Diagn 2015; 8: 90-101
• 19 McFadden D, Prior K, Barrett EL. A Substance Use Treatment Programme for mentally ill forensic patients in an Australian setting: a pilot study of feasibility, acceptability and preliminary efficacy. Int J Ment Health Addiction. 2020 [Epub ahead of print]
• 20 Beaudry G, Yu R, Perry AE. et al. Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials. The Lancet Psychiatry 2021; 8: 759-773
• 21 Magor-Blatch L, Bhullar N, Thomson B. et al. A systematic review of studies examining the effectiveness of therapeutic communities. The International Journal of Therapeutic Communities 2014; 35: 168-84
• 22 Doyle MF, Shakeshaft A, Guthrie J. et al. A systematic review of evaluations of prison-based alcohol and other drug use behavioural treatment for men. Australian and New Zealand Journal of Public Health 2019; 43: 120-130
• 23 Whitten T, Cale J, Nathan S. et al. Hospitalisation following therapeutic community drug and alcohol treatment for young people with and without a history of criminal conviction. Drug and Alcohol Dependence 2022; 231: 109280
• 24 Ashdown JD, Treharne GJ, Neha T. et al. Maori men’s experiences of rehabilitation in the Moana House therapeutic community in Aotearoa/New Zealand: A qualitative enquiry. International journal of offender therapy and comparative criminology 2019; 63: 734-751
• 25 Hill B, Williams M, Woolfenden S. et al. Healing journeys: experiences of young Aboriginal people in an urban Australian therapeutic community drug and alcohol program. Health Sociology Review 2022; 31: 193-212
• 26 Sacks JY, McKendrick KM, Hamilton Z. A randomized clinical trial of a therapeutic community treatment for female inmates: outcomes at 6 and 12 months after prison release. Journal of Addictive Diseases 2012; 31: 258-269
• 27 Sacks JY, Sacks S, Mckendrick KM. et al. Prison therapeutic community treatment for female offenders: profiles and preliminary findings for mental health and other variables (crime, substance use and HIV risk). Journal of Offender Rehabilitation 2008; 46: 233-261
• 28 McMurran M. Motivational interviewing with offenders: A systematic review. Legal and Criminological Psychology 2009; 14: 83-100
• 29 Pinto e Silva T, Cunha O, Caridade S. Motivational interview techniques and the effectiveness of intervention programs with perpetrators of intimate partner violence: a systematic review. Trauma, Violence, & Abuse 2022;
• 30 Austin KP, Williams MWM, Kilgour G. The Effectiveness of Motivational Interviewing with Offenders: An Outcome Evaluation. New Zealand Journal of Psychology 2011; 40: 55-67
• 31 Brown RA, Abrantes AM, Minami H. et al. Motivational interviewing to reduce substance use in adolescents with psychiatric comorbidity. Journal of substance abuse treatment 2015; 59: 20-29
• 32 Querengässer J, Janele D, Schlögl et al. Selbstbestimmung und forensische Suchtbehandlung - Reflexionen zum Spannungsfeld zwischen Patientenautonomie und dem Präventionsauftrag des § 64 StGB aus psychiatrischer, ethischer und normativer Sicht. Nervenarzt 2022; efirst; https://doi.org/10.1007/s00115-021-01254-2
• 33 Shaul L, Blankers M, Koeter MW. et al. The role of motivation in predicting addiction treatment entry among offenders with substance use disorders under probation supervision. International Journal of Offender Therapy and Comparative Criminology 2019; 63: 2453-2465
• 34 Oermann A. Dialektisch-behaviorale Therapie im forensischen Setting. Psychotherapie 2013; 18: 115-131
• 35 Evershed S, Tennant A, Boomer D. et al. Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: A pragmatic and non-contemporaneous comparison. Criminal Behaviour and Mental Health 2003; 13: 198-213
• 36 Rosenfeld B, Galietta M, Ivanoff A. et al. Dialectical behavior therapy for the treatment of stalking offenders. International Journal of Forensic Mental Health 2007; 6: 95-103
• 37 Rosenfeld B, Galietta M, Foellmi M. et al. Dialectical behavior therapy (DBT) for the treatment of stalking offenders: A randomized controlled study. Law and human behavior 2019; 43: 319-328
• 38 Long CG, Fulton B, Dolley O. et al. Dealing with feelings: The effectiveness of cognitive behavioural group treatment for women in secure settings. Behavioural and cognitive psychotherapy 2011; 39: 243-247
• 39 Sakdalan JA, Shaw J, Collier V. Staying in the here-and-now: A pilot study on the use of dialectical behaviour therapy group skills training for forensic clients with intellectual disability. Journal of Intellectual Disability Research 2010; 54: 568-572
• 40 Sakdalan JA, Collier V. Piloting an evidence-based group treatment programme for high risk sex offenders with intellectual disability in the New Zealand setting. New Zealand Journal of Psychology 2022; 41: 6-12
• 41 Gee J, Reed S. The HoST programme: A pilot evaluation of modified dialectical behaviour therapy with female offenders diagnosed with borderline personality disorder. European Journal of Psychotherapy & Counselling 2013; 15: 233-252
• 42 Ivanoff A, Marotta PL. DBT in forensic settings. Oxford handbook of dialectical behaviour therapy 2018; 615-644
• 43 Tomlinson MF. A theoretical and empirical review of dialectical behavior therapy within forensic psychiatric and correctional settings worldwide. International Journal of Forensic Mental Health 2018; 17: 72-95
• 44 Zimmermann P, Förster J, Reiske S. DBT-Sucht. Dialektisch-Behaviorale Therapie bei Borderline- und Substanzgebrauchsstörungen (DBT-S). Göttingen: Hogrefe; 2021
• 45 Haktanir A, Callender KA. Meta-analysis of dialectical behavior therapy (DBT) for treating substance use. Research on Education and Psychology. 2020; 4(Special Issue) 74-87
• 46 Wettermann A, Völlm B, Schläfke D. Highly Structured Treatment Programs for Addicted Offenders: Comparing the Effects of the Reasoning & Rehabilitation Program and DBT-F. Frontiers in Psychiatry 2020; 11
• 47 Ross RR, Ross RD. The R&R programme. In: Ross RR, Ross RD (eds). Thinking straight: The reasoning and rehabilitation programme for delinquency prevention and offender rehabilitation. Ottawa: AIR Training and Publications; 1995: 83-120
• 48 Wampold BE, Imel HE. (eds). The Great Psychotherapy Debate - The Evidence for What Makes Psychotherapy Work. New York: Routledge; 2015
• 49 Fontao M, Schorer L, Ross T. Therapeutische Wirkfaktoren in der Behandlung von Straftätern: ein systematisches Literaturreview. Fortschr Neurol Psychiatr 2021; 89: 483-495
• 50 Querengässer J, Hoffmann K, Bulla J. et al. Einflussfaktoren forensischer Suchttherapie aus Patienten- und Therapeutensicht. Verhaltenstherapie & Verhaltensmedizin 2017; 38: 93-106
• 51 Berthold D, Riedemann C. Überlastet, überfordert, überbelegt …Und der Wunsch nach »dem guten Patienten«". Recht & Psychiatrie 2022; 40: 225-231
• 52 McFadden D, Prior K, Miles H. et al. Genesis of change: Substance use treatment for forensic patients with mental health concerns. Drug and Alcohol Review 2022; 41: 256-259