Studienlage zur Behandlung der Cannabisabhängigkeit

Epidemiological studies show that the prevalence of cannabis use in Germany is approaching that of countries known for their high consumption rate, such as Australia and some parts of the USA. In these countries, the resulting cannabis-related psychosocial damage has led to mainly psychotherapeutic treatment studies (conducted in the past ten years) that will be introduced here. According to these studies, the optimal treatment of cannabis-dependent adults would be a short intervention which consists of a combination of motivational-enhancement and cognitive-behavioural elements as well as individual case-counselling (c. f. "Marihuana Treatment Project"). In parallel to a clear consume-reduction over time, these interventions were associated with abstinence rates between 15 % and 22 % also in longer follow-ups (greater than 12 months). Additionally, an approximately 50 % reduction of cannabis-related problems was described. Without any specific treatment, however, abstinence rates were found to be only between 0 % and 9 %, also without any change in prominent social problems. A similar though less obvious trend occurred in a large multisite study regarding the specific treatment of young people, in which besides motivational and cognitive-behavioural also milieu and family therapeutic interventions were tested (c. f. "Cannabis Youth Treatment"). Unfortunately, there exists no controlled treatment study up to now that considered a relevant psychiatric co-morbidity, which usually accompany cannabis-dependence. Whether the interventions above can be recommended and implemented under German conditions should be further investigated, especially considering the growing number of cannabis-consumers seeking treatment.

Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany

The goals of this study were to describe demographic variables, drinking history, and the 6-month prevalence of Axis I comorbidity among alcohol-dependent subjects in GERMANY: The variables: amount of alcohol consumption, age at onset of the first alcohol consumed, age at onset of daily alcohol consumption, age at onset of withdrawal symptoms and number of detoxifications were related to the different comorbid disorders and gender. In this study, 556 patients from 25 alcohol treatment centres were enrolled between 1 January 1999 and 30 April 1999. After a minimum of 10 days of sobriety patients who fulfilled ICD-10 and DSM-IV criteria of alcohol dependence were interviewed for data collection using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule) and a standardized psychosocial interview. The 6-month prevalence of comorbid Axis I disorders was 53.1%. Among the patients with comorbidity, affective and anxiety disorders were most frequent. Comorbid stress disorder was associated with an early start of drinking, an early beginning of withdrawal symptoms, highest number of detoxifications, and the highest amount of alcohol consumed. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid disorder. The data do not answer the question of the pathogenesis of comorbid disorders and alcoholism, but indicate that stress disorders in alcoholic patients and anxiety disorders in female alcoholics influence the course and severity of alcoholism.

The effects of tetrahydrocannabinol on the recognition of emotionally charged words: an analysis using event-related brain potentials

The effects of synthetic tetrahydrocannabinol (THC) on event-related brain potentials (ERPs) were assessed in 19 healthy male volunteers while they performed a visual continuous word recognition task. The study used a double-blind cross-over design. Specifically, word lists were manipulated to contain an equal number of emotionally neutral, negative, and positive words. Most words were repeated after several intervening items with the subject's task to classify each word as old (previously seen) or new. Behaviorally, a decrease in recognition rate was observed under THC but no influence of the emotional charge of a word on recognition rate was seen. The ERPs showed a typical difference between old and new words taking the form of an enhanced positivity for old words beginning 250 ms poststimulus. The effects of THC were confined to the positive words, for which an enhancement of the positivity to the old words was seen. This effect was interpreted in terms of a congruity of the drug-induced mood state and the material to be recognized. The dissociation between ERPs and behavioral indices suggested that the former primarily reflect implicit memory processes.