Zielsetzung: Die Gültigkeit des Modells der Stadien der Veränderung von Prochaska und DiClemente für die stationäre Alkoholentwöhnungstherapie empirisch zu prüfen. Methoden: Reliabilität, Faktorstruktur und Konstruktvalidität der Veränderungsstadienskala (VSS) wurden an Alkoholpatienten querschnittlich (N = 265) und längsschnittlich (N = 108) untersucht. Ergebnisse: Die Reliabilität der VSS fiel befriedigend aus mit Ausnahme der Skala «Precontemplation», die sich auf nicht motivierte Patienten bezieht. Die faktorielle Validität war insbesondere für die Skalen «Contemplation» und «Maintenance» unzureichend. Clusteranalysen ergaben eine nicht modellkonforme Drei-Cluster-Lösung einschließlich «uninvolvierter » Patienten. VSS-Werte waren durchgängig mit der Therapiemotivation korreliert. Prädiktive Validität (Behandlungsdauer, Rückfallvorhersage) konnte nicht belegt werden. Schlussfolgerungen: Der Ansatz bestätigt seinen heuristischen Wert, kann aber noch nicht valide für praktische Entscheidungen in der Alkoholentwöhnungsbehandlung herangezogen werden. Spezifische Modelle für verschiedene Behandlungsgruppen und -settings scheinen Erfolg versprechender. / Aim: The validity of the ”Stages of Change” approach was tested in alcohol inpatient long-term treatment. Methods: Reliability, factor structure, and construct validity of the University of Rhode Island Change Assessment Scale (URICA, German version) was examined using cross-sectional (N = 265) and longitudinal data (N = 108). Results: Scale reliability proved to be satisfying, except for the precontemplation scale. Factorial validity was insufficient for the contemplation and the maintenance scale. Cluster analyses revealed a threecluster solution not in accordance with the model and included a cluster of ”uninvolved patients”. URICA-scores were correlated with therapy motivation, but predictive validity with respect to duration of treatment and prediction of relapse was not confirmed. Conclusions: The model proved to be of heuristic value but is not yet a valid basis for practical decisions. Models which are directed more specifically towards a particular treatment group or setting are expected to be more successful. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Dysfunktionale Lernvorgänge (wie z.B. Pawlowsche Konditionierung) können bei Patienten mit Alkoholabhängigkeit das Rückfallrisiko erhöhen, was innerhalb der vorliegenden Arbeit mittels drei Studien untersucht wurde.

Background: Human and animal work suggests a shift from goal-directed to habitual decision-making in addiction. However, the evidence for this in human alcohol dependence is as yet inconclusive. Methods: Twenty-six healthy controls and 26 recently detoxified alcohol-dependent patients underwent behavioral testing with a 2-step task designed to disentangle goal-directed and habitual response patterns. Results: Alcohol-dependent patients showed less evidence of goal-directed choices than healthy controls, particularly after losses. There was no difference in the strength of the habitual component. The group differences did not survive controlling for performance on the Digit Symbol Substitution Task. Conclusion: Chronic alcohol use appears to selectively impair goal-directed function, rather than promoting habitual responding. It appears to do so particularly after nonrewards, and this may be mediated by the effects of alcohol on more general cognitive functions subserved by the prefrontal cortex.

Background: Pavlovian processes are thought to play an important role in the development, maintenance and relapse of alcohol dependence, possibly by influencing and usurping ongoing thought and behavior. The influence of pavlovian stimuli on ongoing behavior is paradigmatically measured by pavlovian-to-instrumental transfer (PIT) tasks. These involve multiple stages and are complex. Whether increased PIT is involved in human alcohol dependence is uncertain. We therefore aimed to establish and validate a modified PIT paradigm that would be robust, consistent and tolerated by healthy controls as well as by patients suffering from alcohol dependence, and to explore whether alcohol dependence is associated with enhanced PIT. Methods: Thirty-two recently detoxified alcohol-dependent patients and 32 age- and gender-matched healthy controls performed a PIT task with instrumental go/no-go approach behaviors. The task involved both pavlovian stimuli associated with monetary rewards and losses, and images of drinks. Results: Both patients and healthy controls showed a robust and temporally stable PIT effect. Strengths of PIT effects to drug-related and monetary conditioned stimuli were highly correlated. Patients more frequently showed a PIT effect, and the effect was stronger in response to aversively conditioned CSs (conditioned suppression), but there was no group difference in response to appetitive CSs. Conclusion: The implementation of PIT has favorably robust properties in chronic alcohol-dependent patients and in healthy controls. It shows internal consistency between monetary and drug-related cues. The findings support an association of alcohol dependence with an increased propensity towards PIT.

Objective: Some adolescents and young adults who do not fulfill criteria for DSM-IV alcohol abuse (AA) report symptoms of DSM-IV alcohol dependence (AD) below the diagnostic threshold (diagnostic orphans, DOs; 1 or 2 symptoms). Contemporarily, little is known on the long-term stability, risk of progression to AD, impairment, and drinking patterns possibly associated with this status in the first decades of life. Aim: (1) To identify prevalence rates of the DO status from adolescence to early adulthood. To investigate (2) stability and variability of the DO status over time and (3) associations between DO status, drinking patterns and impairment in comparison to subjects with AA, with AD, or without any symptoms. Method: N = 2039 community subjects (aged 14–24 years at baseline) were assessed at baseline and at about four and ten years after baseline. DSM-IV AUD diagnoses were obtained with the DIA-X/M-CIDI. Results: About 11–12% of the sample was classified as DOs at all waves. Over a period of ten years, 18% of DOs were stable in their diagnosis and additional 10% progressed to AD. DOs were comparable to subjects with AA in drinking patterns, impairment and stability of diagnostic status. DOs progressed to AD significantly more often than AA. AD was associated with highest levels in all outcomes of interest. Conclusions: The DO status in adolescence and early adulthood is associated with considerable stability, risk of progression and problematic alcohol intake. In consequence, it can be meaningful for the timely identification of early stages of clinically relevant alcohol problems. For subjects with DO status early specific interventions are required.

Reduction of long-term mortality risk, an important clinical outcome for people in alcohol dependence treatment, can rarely be established in randomized controlled trials (RCTs). We calculated the reduction in all-cause mortality risk using data from short-term (6 and 12 months) double-blind RCTs comparing as-needed nalmefene treatment to placebo, and mortality risks from meta-analyses on all-cause-mortality risk by reduction of drinking in people with alcohol dependence. A reduction in drinking in the RCTs was defined by shifts in drinking risk levels established by the European Medicines Agency. Results showed that the reduction of drinking in the nalmefene group was associated with a reduction in mortality risk by 8% (95% CI: 2%, 13%) when compared to the placebo group. Sensitivity analyses confirmed a significant effect. Thus comparing the difference between nalmefene and placebo in reduction in drinking levels with results on all-cause mortality risk from meta-analyses indicated a clinically relevant reduction in mortality risk. Given the high mortality risk of people with alcohol dependence, abstinence or a reduction in drinking have been shown to reduce mortality risk and should be considered treatment goals.

Background Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition. Method A total of 3021 community subjects (97.7% lifetime AU) aged 14–24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI. Results Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition. Conclusions Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.

Die Alkoholsucht ist ein global verbreitetes Phänomen und kennzeichnet sich durch eine Transition von kontrolliertem zu zwanghaftem Alkoholkonsum.Die Tendenz, einem neutralen Reiz eine Anreizwirkung zuzuschreiben, ist individuell unterschiedlich und stellt einen Risikofaktor für die Entwicklung einer Abhängigkeit dar.Zur Entwicklung spezifischer Präventionsstrategien ist ein besseres Verständnis der Zusammenhänge zwischen der Anreizsalienz und Alkoholabhängigkeit erforderlich.Der Übergang von mäßigem zu zwanghaftem Alkoholkonsum wurde durch das Modell des Alkoholentzugseffekts simuliert, das den menschlichen Alkoholrückfall nachahmt.Die Ratten erhielten freiwilligen Zugang zu verschieden Alkohollösungen mit wiederholten Deprivations- und Alkoholphasen.Die Ratten durchliefen zusätzlich den Pavlovian Conditioned Approach getestet, welcher die individuellen Tendenzen auf einen bedingten Reiz/Belohnung quantifiziert.Während des letzten ADE-Zyklus wurde mit Geschmacksverfälschung zwanghaftes Trinken ermittelt.Nach der Identifizierung zuverlässiger Prädiktoren für Suchtverhalten wurde präventive Neurostimulation durchgeführt, um die Tendenz der Tiere alkoholbezogenen Reizen eine motivationale Bedeutung beizumessen, zu beeinflussen, und die Manifestation eines Abhängigkeitsverhaltens zu verhindern. Weibchen tranken mehr Alkohol als Männchen und zeigten ST Verhalten im PavCA, während Männchen GT aufwiesen.Die Anwendung von transkranieller Gleichstromstimulation während PavCA führte zu mehr GT-Verhalten bei stimulierten Ratten.Frühe tDCS während des Trinkens hatte keinen Einfluss auf das akute und das Langzeit-Trinken. Die Ergebnisse zeigen eine komplexere Beziehung zwischen Anreizsalienz und Alkoholsucht und unterstreichen,individuelle Unterschiede und beide Geschlechter in der präklinischen Forschung zu berücksichtigen. / The consequences of alcohol dependence cause the global deaths of million people yearly.The ability of the environment can trigger dependent behavior and promote drinking.The tendency to attribute incentive salience to cues differs between subjects.By forming a cue-alcohol association, neutral cues receive motivational value,thereby predicting the likelihood of alcohol reward occurrence,known as Pavlovian learning.Understanding the relationship between incentive salience and alcohol addiction help inform treatment strategies.We study the relationship between incentive salience and alcohol addiction.The transition from moderate to compulsive alcohol intake can be captured by the alcohol deprivation effect rat model (mimics alcohol relapse in humans).Rats were given voluntary access to alcohol solutions with repeated abstinence/reintroduction phases.Further,rats were tested in the PavCA,which quantifies individual tendency toward a conditional cue and the reward, thus allowing to trace the process of attributing incentive salience to rewardcues.During the final ADE cycle,rats underwent a bitter taste adulteration test to assess for compulsive-like behavior.After identifying reliable predictors of addictive behavior,preventive tDCS was performed to influence the tendency of animals to attach motivational importance to alcohol-related stimuli,and to prevent the manifestation of alcohol addictive behavior.Females drank more alcohol than males and exhibited more ST behavior in the PavCA, whereas males showed GT behavior.PavCA phenotypes emerged early and remained stable.The application of tDCS during PavCA results in high GT numbers in stimulated rats.Early tDCS on drinking does not affect acute or long-term drinking.Our findings indicate a complex relationship between incentive salience and alcohol addiction and emphasize the importance of considering individual differences and both sexes in preclinical research.

Lässt sich Persönlichkeit als Risikofaktor bei Personen mit Alkoholabhängigkeit verstehen? Dies ist die Leitfrage der Studie. In einem Querschnittsdesign werden insgesamt 297 alkoholabhängige Personen untersucht. Es wird eine umfassende Persönlichkeitsdiagnostik (TPF, SKID-II, DITS-40) durchgeführt. In unterschiedlichen Bereichen des Suchtverhaltens (Suchtverlauf, Trinkmenge, Abstinenzverhalten, Rückfall) werden Hochrisikogruppen gebildet und mit der jeweils übrigen Stichprobe mittels binär logistischer Regression verglichen. Die Einflussvariablen der logistischen Modelle werden als Risikofaktoren für Hochrisikoverhalten gedeutet. Es zeigt sich, dass Persönlichkeitsvariablen in vielen Bereichen des Suchtverhaltens eine wichtige Rolle spielen. Insbesondere gilt dies für den Suchtverlauf vor der ersten Entgiftungsbehandlung, die Trinkmenge und das Rückfallverhalten. Für den Suchtverlauf nach der ersten Entgiftungsbehandlung und das Abstinenzverhalten gilt dies weitaus weniger. Insgesamt wird Hochrisikoverhalten in unterschiedlichen Bereichen des Suchtverhaltens stark durch Persönlichkeitsvariablen geprägt. Hierauf sollte in der Praxis jede Therapie adäquat reagieren. / Is it possible to consider personality as a risk factor in people who are alcohol dependent? This is the main question to be addressed in this project. A total of 297 alcohol dependent people are tested in a cross-sectional design. A comprehensive personality diagnosis is undertaken (TPF, SKID-II, DITS-40). In various aspects of alcohol abuse (history of abuse, amount consumed, abstinence behaviour, relapse) high-risk groups are formed and compared with the rest of the sample in each case by means of binary logistic regression. The influencing variables of the logistic models are interpreted as risk factors for high risk behaviour. What this shows is that personality variables play a major role in many areas of abusive behaviour. This applies especially to the history of abuse before the first detoxification treatment, the amount consumed an the relapse behaviour. This applies to a far lesser extent to the history of abuse after the first detoxification treatment and abstinence behaviour. Overall, high-risk behaviour in various aspects of alcohol abuse is strongly influenced by personality. Every therapy should have the appropriate answer to this in practise.

Untersucht wurde in dieser Studie retrospektiv, ob sich alkoholabhängige Personen mit (n = 42) und ohne (n = 35) komorbide affektive Pathologie hinsichtlich kortikaler und subkortikaler Veränderungen unterscheiden. 3-Tesla MRT-Aufnahmen dieser Patienten, die zwischen 2008 und 2012 eine qualifizierte stationäre Entgiftungsbehandlung erhielten, wurden hierzu herangezogen. Mittels FreeSurfer erfolgten Kortexdickebestimmungen und Segmentierungen neuroanatomischer Strukturen; die statistische Auswertung erfolgte mittels IBM SPSS. Die Ergebnisse zeigen in der Gruppe der nur alkoholabhängigen Personen ein höheres Maß zerebraler Atrophien für das gesamte Gehirn. In keiner Hirnregion wies die Gruppe der Komorbiden geringere kortikale Volumen auf. Kein Gruppenunterschied konnte festgestellt werden für die Abhängigkeitsschweremarker „Dauer der Alkoholabhängigkeit“ und „mittlere tägliche Konsummenge“.