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Kokain gilt als attraktive Leistungsdroge unserer Zeit. Zu erschwinglichen Preisen und nahezu überall verfügbar, täuscht es den Konsumenten lange Zeit ein Gefühl von Vitalität, Selbstsicherheit und Euphorie vor. Nicht wenige werden von der Droge abhängig - teilweise mit gravierenden körperlichen und seelischen Folgen. Das vorliegende Buch gibt einen allgemeinverständlichen Überblick über den aktuellen Wissensstand zum Thema Kokainabhängigkeit. Es informiert über die Wirkung des Kokains, körperliche und psychische Konsequenzen des Konsums und der Abhängigkeit, die Diagnostik der Kokainabhängigkeit sowie die neuesten Möglichkeiten der Behandlung.

Kokain ist eine zunehmend weit verbreitete illegale Droge, die im Unterschied z.B. zu Heroin und Nikotin gesellschaftlich positiv konnotiert ist. Sie gilt als muntermachend, leistungssteigernd und als "Aphrodisiakum" , ist preiswert und in grossen Mengen leicht zu beschaffen. Sie verfügt über ein hohes Abhängigkeitspotential und ihr Konsum führt zu körperlichen und psychischen Gesundheitsschäden, die schwer therapierbar sind. Der Autor dieses in einer interdisziplinär konzipierten Reihe erschienenen Buches ist Schweizer Suchtexperte (zuletzt "Alkohol und Partnerschaft", Pabst Science Publishers, 2012; hier nicht besprochen). Er wird seinem Anspruch, sowohl einem breiten Publikum als auch Fachleuten und Studierenden fundiert und umfassend alle Aspekte der Kokainabhängigkeit verständlich zu vermitteln, in hervorragender Weise gerecht. Übersichtlich strukturiert werden die kurzen Kapitel mit Merk- und Definitionskästchen, Grafiken und Fallbeispielen aufgelockert. Ausführliches Literaturverzeichnis und Register. Trotz des stolzen Preises überall empfohlen. Aktuell kein vergleichbarer Titel bekannt. (2S)

Das praxisnahe Werk behandelt u. a. folgende Themen: Wirkung von Rauschdrogen, Folgen chronischen Konsums, Missbrauch und Abhängigkeit (biologische, psychologische, soziale Faktoren), Aufgaben und Ausstattung von Einrichtungen der Suchtkrankenhilfe. Dargestellt werden die gesamten professionellen Interventionsverfahren, ebenso die Behandlungsmethodik von Begleiterkrankungen und bei besonderen Problemgruppen. Beispiele und spezielle Behandlungsfragen, die auch Kosten-Nutzen-Gesichtspunkte, Drogenpolitik und Ausbildungsfragen einschließen, runden das Werk ab.

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.

BACKGROUND/AIMS: Switzerland's drug policy model has always been unique and progressive, but there is a Need to reassess this system in a rapidly changing world. The IMPROVE study was conducted to gain understanding of the attitudes and beliefs towards opioid maintenance therapy (OMT) in Switzerland with regards to quality and Access to treatment. To obtain a "real-world" view on OMT, the study approached its goals from two different angles: from the perspectives of the OMT patients and of the physicians who treat patients with maintenance therapy. The IMPROVE study collected a large body of data on OMT in Switzerland. This paper presents a small subset of the dataset, focusing on the research design and methodology, the profile of the participants and the responses to several key questions addressed by the questionnaires. METHODS: IMPROVE was an observational, questionnaire-based cross-sectional study on OMT conducted in Switzerland. Respondents consisted of OMT patients and treating physicians from various regions of the country. Data were collected using questionnaires in German and French. Physicians were interviewed by phone with a computer-based questionnaire. Patients self-completed a paper-based questionnaire at the physicians' Offices or OMT treatment centres. RESULTS: A total of 200 physicians and 207 patients participated in the study. Liquid methadone and methadone tablets or capsules were the medications most commonly prescribed by physicians (60% and 20% of patient load, respectively) whereas buprenorphine use was less frequent. Patients (88%) and physicians (83%) were generally satisfied with the OMT currently offered. The current political framework and lack of training or information were cited as determining factors that deter physicians from engaging in OMT. About 31% of OMT physicians interviewed were ≥60 years old, indicating an ageing population. Diversion and misuse were considered a significant problem in Switzerland by 45% of the physicians. CONCLUSION: The subset of IMPROVE data presented gives a present-day, real-life overview of the OMT landscape in Switzerland. It represents a valuable resource for policy makers, key opinion leaders and drug addiction researchers and will be a useful basis for improving the current Swiss OMT model.

<i>Background:</i> To assess the long-term course of the feasibility and safety of orally administered heroin [diacetylmorphine (DAM)] tablets in substitution treatment of severely addicted opioid users. <i>Design:</i> Open-label, prospective cohort study with 2 non-randomly assigned treatment arms: DAM tablets only (n = 128) or DAM tablets combined with injected DAM and/or other opioids (n = 237). The average duration of the observation period was 62 months. Study endpoints were the time to discharge from treatment and the number of serious adverse events. <i>Results:</i> Both patient groups had a higher than 70% retention rate after the first 48 months of treatment, with similar long-term retention rates (after 8 years both groups had retention over 50%). The physician-verified rate of serious adverse events was 0.01 events per application year among the exclusively oral substitution group (intention-to-treat analysis) during the last year of observation, and 0.005 events per application year in the other group. <i>Conclusions:</i> Because of their feasibility and safety over years, DAM tablets may be a valuable long-term therapeutic alternative.

<i>Background/Aim:</i> Heroin dependence is a chronic relapsing disorder characterized by the compulsion to seek and use heroin. Stress and craving are seen as key factors for heroin use. Moreover, altered hypothalamic-pituitary-adrenal (HPA) axis function has been frequently reported. However, the acute effects of diacetylmorphine (DAM) on HPA axis activity and craving have not been investigated in a controlled study. The present randomized controlled study examined whether DAM administration differs from placebo (saline) administration with regard to HPA axis response and heroin craving. <i>Methods:</i> In a crossover experiment, 28 DAM-maintained heroin-dependent patients were first injected with DAM and then saline, or the converse. Plasma adrenocorticotropic hormone (ACTH) and cortisol in saliva and serum were measured at baseline and 20 and 60 min after both injections. Heroin craving was measured at baseline and 60 min after both injections, by means of the Heroin Craving Questionnaire. <i>Results:</i> Compared to saline, DAM administration induced a significant decrease in plasma ACTH (p < 0.01), serum cortisol (p < 0.0001) and saliva cortisol (p < 0.01), as well as in craving (p < 0.0001), over time. <i>Conclusion:</i> Since acute DAM administration suppresses the stress response, DAM-assisted treatment may be an effective alternative to methadone maintenance in stress-sensitive heroin-dependent patients.

<b><i>Aims:</i></b> Posttraumatic stress disorder (PTSD) is a significant comorbidity in substance use disorders (SUDs). While most studies have addressed trauma/PTSD in abstinent patients, little is known about trauma/PTSD in early detoxification treatment. The current study therefore addresses the systematic evaluation of trauma/PTSD in early inpatient detoxification. <b><i>Methods:</i></b> A cross-sectional survey was accomplished in three German-speaking clinics (<i>n</i> = 134) specialized in inpatient detoxification and motivation treatment. All measures are based on self-report using trauma-specific questionnaires and measures for general psychopathological burden. <b><i>Results:</i></b> Participation rate was 60.1% and patients did not show clinically obvious psychological distress during or after assessment. DSM-IV traumatic events were reported by 66.4%. Of the total sample, 38.1% screened positive for PTSD, and 14.9% screened positive for subsyndromal PTSD. PTSD patients reported significantly more childhood adversities and significantly higher scores in depression and ­general psychopathology compared to subsyndromal PTSD and SUD-only patients. <b><i>Conclusions:</i></b> Early and systematic evaluation of PTSD in SUD inpatient detoxification treatment is largely safe and yields important information for individual treatment. The high PTSD-rate and the high symptom load in SUD patients during inpatient detoxification treatment highlight the need for a more stringent address of trauma/PTSD in early SUD treatment.

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.