Hellwig Sabine, Domschke Katharina
Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland.
Nervenarzt. 2023 Jul;94(7):647-654. doi: 10.1007/s00115-023-01502-7. Epub 2023 Jun 21.
Anxiety disorders are frequent, with a 12-month prevalence of 14%, tend to be chronic, and display a high comorbidity with substance abuse disorders. Anxiety and substance abuse disorders are associated with a pronounced individual as well as socioeconomic burden. This article reviews the epidemiological, etiological, and clinical aspects of the dual diagnosis of anxiety and substance abuse disorders, with a particular focus on alcohol and cannabis. The treatment comprises nonpharmacological strategies, mainly cognitive behavioral therapy combined with elements of motivational interviewing (MI) and pharmacological management with antidepressants; however, the use of selective serotonin reuptake inhibitors (SSRI)/serotonin and noradrenaline reuptake inhibitors (SNRI) is not unreservedly recommended. The use of gabapentinoids requires careful risk-benefit consideration because of their potential for abuse and dependence in substance abuse disorders. Benzodiazepines are reserved exclusively for crisis management. Rapid diagnosis and treatment initiation targeting both disorders are essential for successful treatment of comorbid anxiety and substance abuse disorders.
焦虑症很常见，12个月患病率为14%，往往呈慢性，且与物质使用障碍共病率很高。焦虑症和物质使用障碍会给个人以及社会经济带来明显负担。本文综述了焦虑症和物质使用障碍双重诊断的流行病学、病因学和临床方面，特别关注酒精和大麻。治疗包括非药物策略，主要是认知行为疗法结合动机性访谈（MI）的要素以及使用抗抑郁药进行药物管理；然而，选择性5-羟色胺再摄取抑制剂（SSRI）/5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRI）的使用并非毫无保留地被推荐。由于加巴喷丁类药物在物质使用障碍中有滥用和依赖的可能性，因此使用时需要仔细权衡风险和益处。苯二氮䓬类药物仅用于危机管理。针对这两种障碍进行快速诊断和开始治疗对于成功治疗共病的焦虑症和物质使用障碍至关重要。
