Die Behandlung der Kokainabhängigkeit

Zusammenfassung:

Es wird ein Überblick über die Behandlung des Kokainentzuges, der Kokainintoxikation und der Rückfallprophylaxe der Kokainabhängigkeit gegeben. Derzeit nehmen in Deutschland rund 25 % der polizeilich auffälligen Erstkonsumenten von Drogen Kokain. Weit größere Ausmaße hat die Kokainabhängigkeit in den USA angenommen. Der Entzug von Kokain kann in drei Phasen eingeteilt werden, wobei die psychische Symptomatik im Vordergrund steht. Lebensgefahr kann bei einer Kokainintoxikation bestehen, häufig im Zusammenhang mit dem Beigebrauch anderer Substanzen. Im Langzeitverlauf besteht bei Kokainabhängigen eine hohe Rückfallgefahr. In Therapieevaluationsstudien wird im Zusammenhang mit Rückfällen häufig ein intensiver Drang nach Kokain (Craving) bei Abhängigen berichtet. Empfehlungen für die Behandlung der Kokainintoxikation, des Kokainentzuges und zur Rückfallprophylaxe der Kokainabhängigkeit werden gegeben. Verschiedene medikamentöse Strategien, die in klinischen Studien und Anwendungsbeobachtungen mit Antidepressiva, Antikonvulsiva, dopaminergen und serotonergen Substanzen gewonnen wurden sowie psychotherapeutische Ansätze zur Behandlung und zur Rückfallprophylaxe der Kokainabhängigkeit werden in diesem Artikel beschrieben und bewertet. Außerdem wird ein Überblick über neuartige, experimentelle Behandlungsformen gegeben.

The aim of this review article is to evaluate the treatment of cocaine-withdrawal, cocaine-intoxication and long-term relapse prevention of cocaine-addicts. Some 25 % of police recognized first time drug users in Germany consume cocaine. However, there is an increasing number of cocaine-abusers and -addicts in the USA. The withdrawal of cocaine can be divided into three phases dominated mainly by psychiatric symptoms. Lifethreatening condition can occur in cocaine-intoxication mainly in combination with other drug-use. A high risk of relapse is seen in follow-up trials of cocaine-addicts. Intensive craving, high cocaine- and substance-abuse is reported regularely in cocaine-addicts after detoxification therapy. Recommendations in the treatment of cocaine-intoxication, withdrawal and long-term relapse prevention are made. The use of antidepressives, anticonvulsants, dopaminergic and serotonergic medications as well as behavioural, psychoanalytical and combined therapies and their efficacy in clinical and trails is evaluated. A short review of new experimental therapies in the treatment of cocaine-dependence is shown.

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