CO-MORBITITY CO-MORBITITY RESEARCH IN RESEARCH IN

ADDICTION SCIENCEADDICTION SCIENCE International Round TableInternational Round Table

ICAA MEETING MAGDEBURGMay 23 rd, 2008

DR. THOMAS LEGL•KUR UND GESUNDHEITSZENTRUM

KNAPPENHOF•ICAA-INTERNATIONAL COUNCIL ON

ALCOHOL AND ADDICTIONS•EURO-TC

OVERALL SITUATIONOVERALL SITUATION• 37 % Substance Dependents additionally 37 % Substance Dependents additionally

suffer from affective disorder, schizophrenia suffer from affective disorder, schizophrenia spectrum psychosis, anxiety and/or spectrum psychosis, anxiety and/or personality disorderpersonality disorder

• In general psychiatric hospitals as well as In general psychiatric hospitals as well as addiction treatment centers do not offer addiction treatment centers do not offer appropriate service for this clienteleappropriate service for this clientele

• ““Come-go-come back” effectCome-go-come back” effect• Increased risk for suicide and suicide Increased risk for suicide and suicide

attemptsattempts• Need for special approach offering Need for special approach offering

treatment for substance dependencetreatment for substance dependence plus plus the additional psychiatric diseasethe additional psychiatric disease

Co-morbidity - Flow Co-morbidity - Flow PatternPattern

Psychiatric Hospital

OutpatientFacility

TCSubstitutionProgramme

High Co-morbitity Low Co-

morbitity

High Co-Morbitity

Low Co-morbitity

INTEGRATIVE ASPECTSINTEGRATIVE ASPECTS

• Small group of dual diagnoses patients can Small group of dual diagnoses patients can achieve high profit from integration into a TC achieve high profit from integration into a TC programprogram

• Need for special structure within the system Need for special structure within the system with main differences in vocational therapy with main differences in vocational therapy

• Adapted psychotherapeutic approach with Adapted psychotherapeutic approach with increased inclusion of family members increased inclusion of family members

• Orientation towards “non-dual diagnoses” Orientation towards “non-dual diagnoses” patientspatients

• Helpful psycho-dynamics for all TC membersHelpful psycho-dynamics for all TC members• Positive influence on self-centered behavior of Positive influence on self-centered behavior of

the addict the addict

EVALUATIONEVALUATIONResults – I:Results – I:Clinical Observations (N=35)Clinical Observations (N=35)

Positive long-term effects on Positive long-term effects on psychopathologypsychopathology

with a reduction ofwith a reduction of• Positive and negative symptomatologyPositive and negative symptomatology• Self-mutilation and agressionSelf-mutilation and agression• Suicidal impulses and suicide attemptsSuicidal impulses and suicide attempts• Anxiety and stressAnxiety and stress• Improved understanding of mechanisms of both Improved understanding of mechanisms of both

psychiatric disorderspsychiatric disorders• decreased rate of re-hospitalization at Psychiatric Hospitals• Reduction of psychotropic medication• Improved medical status (e.g. hepatitis C)

EVALUATIONEVALUATIONResults – II:Results – II:Clinical observations – ongoing study (N=35)Clinical observations – ongoing study (N=35)

Positive effects on social stabilizationPositive effects on social stabilization by by the improvement of the improvement of

• Social skills and competenceSocial skills and competence• Creating satisfying relationshipsCreating satisfying relationships• Social interactionSocial interaction• Crisis managementCrisis management• Decreased risk for relapse to uncontrolled Decreased risk for relapse to uncontrolled

drug usedrug use• Employment by re-integration at the labor Employment by re-integration at the labor

marketmarket• Establishing of residential communitiesEstablishing of residential communities

CASE STUDYCASE STUDYMALE PATIENT - 34 YEARS OLDMALE PATIENT - 34 YEARS OLD

HomelessnessHomelessness

emotional physicalemotional physical

PROCESS OF PROCESS OF INDIVIDUATIONINDIVIDUATION

Ecstasy

Cannabis

Designer Drugs

High expectations of performance

SCHIZOPHRENIA SPECTRUM PSYCHOSISSCHIZOPHRENIA SPECTRUM PSYCHOSISNARCISITIC PERSONALITY DISORDERNARCISITIC PERSONALITY DISORDER

Drug abuse as self medicationDesire of control and security

„Superman – Syndrom“

Clear Structure

Multiprofessional team

Stable medication, Placebo

High role expectation

THANK YOU THANK YOU

FOR YOUR FOR YOUR

ATTENTIONATTENTION