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Themenschwerpunkt

Wege aus der Abhängigkeit

Rückfallprädiktoren der Alkoholabhängigkeit

Published Online:August 26, 2013https://doi.org/10.1024/0939-5911.a000255

Abstract

Hintergrund: Alkohol-assoziierte Reize lösen bei alkoholabhängigen Patienten konditionierte Reaktionen aus, die zu einer erhöhten Motivation der Alkoholeinnahme führen können. Klassische Konditionierungsprozesse scheinen demnach sowohl zur Aufrechterhaltung der Abhängigkeit als auch zum Rückfallgeschehen nach Entzug beizutragen. Bildgebende Studien weisen darauf hin, dass das dopaminerge Neurotransmittersystem an assoziativen Lernvorgängen beteiligt ist und Veränderungen innerhalb dieses Systems bei entgifteten alkoholabhängigen Patienten zum Rückfall beitragen könnten. Die genauen Mechanismen in diesem Zusammenhang sind bisher jedoch ungeklärt. Zielsetzung: Ziel dieser Arbeit ist die Darstellung von motivationalen Veränderungen und deren (neuroadaptiven) Grundlagen bei Alkoholabhängigkeit. Ein genaueres Verständnis davon, welche neuronalen und motivationalen Prozesse im Rahmen des Rückfallgeschehens eine Rolle spielen, könnte sowohl pharmakologische als auch therapeutische Implikationen für die Behandlung der Alkoholabhängigkeit liefern. Methodik: Diese Arbeit umfasst eine Literaturanalyse über neuroadaptive Veränderungen bei Alkoholabhängigkeit mit besonderem Fokus auf Lernprozesse und deren Rolle beim Rückfallgeschehen. Die Literaturrecherche basiert auf Recherchen der Forschergruppe 1617 der Deutschen Forschungsgesellschaft (DFG; Learning and Habitization in Alcohol Dependence, LeAD). Schlussfolgerung: Bisher existieren keine Untersuchungen, in denen neuroadaptive Veränderungen der Alkoholabhängigkeit mit spezifischen Lerndefiziten in Zusammenhang gebracht werden. Die DFG Forschergruppe LeAD untersucht neuronale Korrelate von lernbezogenen Rückfallprädiktoren. Ein Ziel dieser Untersuchung ist es herauszufinden, warum alkoholabhängige Patienten nach ihrer Entgiftung oft nicht lernen, Alkohol durch alternative belohnende Reize und Situation zu ersetzen und welche neuronalen Grundlagen diesem Defizit zu Grunde liegen.


Leaving Addiction Behind: Predicting Relapse in Alcohol Dependence

Background: In alcohol dependence alcohol-associated stimuli elicit conditioned responses that can increase motivation to consume alcohol. Thus, an essential role for Pavlovian learning in addiction maintenance and relapse is pointed out. Studies using functional imaging implicate a fundamental involvement of the dopaminergic system in associative learning. These studies also suggest that neuroadaptive alterations within this system might contribute to relapse in alcohol addiction. However, the exact mechanism of how these processes might be related still remains unanswered. Aim: We review motivational and neuroadaptive alterations in alcohol dependence. A more precise understanding of neural and affective processes that are related to relapse can have pharmacological as well as therapeutic implications in the treatment of alcohol dependent patients. Methods: Studies reporting neuroadaptative alterations in alcohol dependence are reviewed, with a particular focus on learning processes and relapse, based on a literature search conducted in the research group 1617 funded by the Deutsche Forschungsgesellschaft (DFG; Learning and Habitization in Alcohol Dependence, LeAD) Conclusion: So far, no investigations have been conducted that examined neuroadaptive alterations in alcohol dependence as associated with learning mechanisms that could predict relapse. We describe a study design that aims to assess why detoxified patients with alcohol addiction often do not learn to substitute alcohol with alternative rewards. Moreover, we explored the neural basis of these potential learning-related alterations in alcohol dependence.

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