Kontingenzmanagement in der Substitutionsbehandlung Opiatabhängiger

Zusammenfassung

Die Mehrheit der Opiatabhängigen in Substitutionsbehandlung leidet unter weiteren suchtmittelbezogenen Störungen. Der Beikonsum von Heroin, Alkohol, Benzodiazepinen oder Kokain gefährdet den Erfolg der Substitutionsbehandlung. Eine Intervention zur Behandlung des Beikonsums ist das auf lerntheoretischen Prinzipien basierende Kontingenzmanagement (KM). Im KM wird Drogenabstinenz – verifiziert durch Urintests – kontingent und zeitnah verstärkt. Bei Substitutionspatienten wurden u. a. geldwerte Gutscheine oder Mitgabeprivilegien als Verstärker für suchtmittelfreie Drogen-Urinscreenings eingesetzt. Zahlreiche kontrollierte Studien in den USA belegen einen mittelstarken durchschnittlichen Effekt auf Beikonsum- bzw. Abstinenzraten der Substitutionspatienten. Der Effekt lässt nach Beendigung der Intervention allerdings deutlich nach. Es wird diskutiert, wie sich KM in der deutschen Substitutionspraxis umsetzen und mit anderen Maßnahmen zur Beikonsumreduktion wie selektiven Entgiftungen oder kognitiv-verhaltenstherapeutischen Programmen kombinieren lässt.

Abstract

The majority of opiate-dependent patients in substitution treatment show additional substance-related disorders. Concomitant use of heroin, alcohol, benzodiazepines or cocaine compromises treatment success. Concomitant drug use may be treated by using contingency management (CM) which is based on learning theory. In CM, abstinence from drugs, as verified by drug screenings, is reinforced directly and contingently. Reinforcers used in CM studies with substituted patients were, amongst others, vouchers and take-home privileges. Studies in the USA show a medium average effect of CM on drug consumption rates and abstinence. The effects decrease markedly after the end of the intervention. We discuss whether CM is applicable within the German substitution treatment system and how it can be combined with other interventions such as selective detoxification treatments or cognitive-behavioural programmes.

Schlüsselwörter

Opiatabhängigkeit - Kontingenzmanagement - komorbide substanzbezogene Störungen - Psychotherapie

Keywords

opiate dependence - contingency management - comorbid substance-related disorders - psychotherapy

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