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Fortschr Neurol Psychiatr 2008; 76(1): 14-18
DOI: 10.1055/s-2007-980076
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Nikotinabhängigkeit als komorbide Störung bei Alkoholabhängigkeit - Epidemiologie, Ätiologie und Therapie

Nicotine Dependence as Comorbidity of Alcohol Dependence - Epidemiology, Etiology and TherapyA.  Diehl1 , N.  Scherbaum2
  • 1Zentralinstitut für Seelische Gesundheit - Klinik für Abhängiges Verhalten und Suchtmedizin (Prof. Dr. K. Mann)
  • 2Klinik für abhängiges Verhalten und Suchtmedizin, Rheinische Kliniken Essen, Kliniken der Universität Duisburg-Essen (Prof. Dr. N. Scherbaum)
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Publication History

Publication Date:
03 July 2007 (online)

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Zusammenfassung

Alkohol- und Nikotinabhängigkeit sind hoch miteinander assoziiert. Bei dieser zweifachen Abhängigkeit ist die Intensität der jeweiligen einzelnen Abhängigkeit hoch und der Verlauf ungünstiger als bei isolierter Abhängigkeit. Dies betrifft auch die Folgen der Abhängigkeiten für die körperliche Gesundheit und die kognitive Funktionstüchtigkeit. Mögliche biologische Ursachen dieser häufigen Komorbidität sind die additive belohnende Wirkung der Substanzen bei gemeinsamem Konsum, pharmakologische Interaktionen der Substanzen mit Einfluss auf Rezeptoraktivierung und Metabolisation mit Kompensation unangenehmer Alkoholnebenwirkungen durch Nikotinkonsum sowie eine gemeinsame genetische Disposition für beide Abhängigkeiten. Aus psychologischer Perspektive handelt es sich bei der Assoziation der beiden Konsumhandlungen um ein erlerntes Verhalten. Die Befürchtung, nikotinabhängige Alkoholabhängige seien an einer Nikotinentwöhnung nicht interessiert und ohnehin von einer Behandlung beider Abhängigkeiten generell überfordert, ist nicht empirisch gesichert. Allerdings sind die Erfolgsraten einer Nikotinentwöhnung bei dieser Gruppe geringer als bei Nikotinabhängigen ohne Alkoholprobleme. Bei den entsprechenden Untersuchungen wurden allerdings die üblichen therapeutischen Strategien zur Nikotinentwöhnung angewendet. Speziell auf Patienten mit Doppelabhängigkeit zugeschnittene Strategien sind wünschenswert.

Abstract

There is a high association between alcohol and nicotine dependence. Compared to one particular dependence, associated nicotine and alcohol dependence are more severe and the course is more unfavourable for each dependence. This also applies to the sequels of dependence regarding physical health and cognitive functions. Possible biological causes for this high comorbidity are 1) an additive rewarding effect by combined consumption, 2) substance interaction with an impact on receptor activation and metabolism which results in reduction of adverse acute alcohol effects, and 3) a combined genetic disposition for both addictions. From a psychological point of view the association of both acts of use is learned. There is no evidence for the commonly presumed fundamental lack of interest, motivation, and ability for smoking cessation in alcohol dependent patients. The outcome of smoking cessation programs, however, is less successful compared to smokers without alcohol problems. Respective studies have used the common therapeutic strategies for nicotine addiction. Specifically adapted strategies for patients with a dual dependence are required.

Schlüsselwörter

Nikotinabhängigkeit - Alkoholabhängigkeit - Therapie - Komorbidität - Ätiologie

Key words

Nicotine dependence - alcohol dependence - therapy - comorbidity - aetiology

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Prof. Dr. med. Norbert ScherbaumDirektor der Klinik für Abhängiges Verhalten und Suchtmedizin, Komm. Direktor der Klinik für Psychiatrie und Psychotherapie

Rheinische Kliniken Essen, Kliniken der Universität Duisburg-Essen

Virchowstr. 174

45147 Essen

Email: norbert.scherbaum@uni-due.de

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