Auf der Basis aktueller Erkenntnisse aus Forschung und Praxis liefert das vorliegende Manual einen Leitfaden und Instrumente für die kognitive Verhaltenstherapie von Kokainabhängigen. Neben vielen Beispielen und Tipps vermittelt es kognitiv-behaviorale Therapiegrundsätze und Interventionen, die schrittweise eingeführt und praxisnah erörtert werden. Besonderes Augenmerk gilt dabei der störungsspezifischen Verhaltensanalyse, dem Erlernen und Üben neuer Fertigkeiten sowie dem Erarbeiten von Problemlösungsstrategien. Biographische Informationen Die Autoren sind ein multidisziplinäres Fachteam des Bereichs Abhängigkeitserkrankungen der Universitären Psychiatrischen Klinken Basel unter der Regie seines Ärztlichen Leiters, Prof. Dr. med. Gerhard Wiesbeck. Kenneth Dürsteler-MacFarland ist Klinischer Psychologe, Johannes Strasser ist Oberarzt und Facharzt für Psychiatrie und Psychotherapie, Otto Schmid ist Pflegerischer Leiter der Abteilung Janus.
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Preclinical study results suggest that neurotrophic peptides like nerve growth factor (NGF) and vascular endothelial growth factor A (VEGF-A) may be associated with symptoms of addictive behavior like withdrawal symptoms and rewarding effects. We investigated alterations in NGF and VEGF-A serum levels in opiate-dependent patients (25 male patients), who received diamorphine (DAM, heroin) treatment within a structured opiate maintenance program, and compared the results with the NGF and VEGF-A serum levels of healthy controls (23 male controls). NGF and VEGF-A serum levels were assessed before and after DAM administration twice a day (in the morning (16 h after last application – t1) and in the afternoon (7 h after last application – t3)) in order to detect a possible immediate or summative (in the afternoon) heroin effect on these two neuropeptides. Moreover, we investigated possible associations between the serum levels of these neurotrophic growth factors and psychometric dimensions of addictive behavior, e.g. craving, withdrawal, depression. Whereas there was no direct effect of DAM application on the serum levels of both neurotrophic growth factors neither in the morning nor in the afternoon, the NGF serum levels of the patient group were found to be significantly increased at all four time points of investigation compared with the healthy controls. In contrast, VEGF-A serum levels did not differ significantly in the patient and control groups. We found a significant positive association between the NGF serum levels and several items of the short opiate withdrawal scale as well as a negative association between self-reported mood (measured by visual analogue scale) and mood before heroin application (in the morning as in the afternoon). Moreover, we found a significant positive association between the NGF serum levels (t1 and t3) and the self-reported craving for methadone. In contrast, we found a negative association between the VEGF-A serum levels and avoidance, anxiety, suicide intentions of the SCL-90 as well as a positive association between the VEGF-A serum levels and the subscales of the heroin craving questionnaire measuring the rewarding effects of heroin. In conclusion, the results of this pilot study show that there might be an association between symptoms of opiate dependence and withdrawal and serum levels of VEGF-A and NGF.
