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Zeitschrift für Gerontologie und Geriatrie

, Volume 51, Issue 7, pp 757–767 | Cite as

Altgewordene Suchtkranke

  • Dirk K. WolterEmail author
Themenschwerpunkt
  • 298 Downloads

Zusammenfassung

In den letzten 20 Jahren ist eine deutliche Zunahme von Suchterkrankungen im höheren Lebensalter zu beobachten, die sich fortsetzen wird. Dabei unterscheidet man häufig zwischen einem frühen und einem späten Beginn („early onset“ [EO] vs. late onset [LO]). Early-onset-Suchtkranke sind aufgrund konstitutioneller und psychosozialer Vorbelastungen in einer ungünstigeren Ausgangsposition und werden durch die kumulierenden medizinischen, psychischen und sozialen Folgeerscheinungen im Verlauf der Suchterkrankung weiter geschädigt. Im höheren Alter sind sie gegenüber Gleichaltrigen mit LO-Suchtproblemen im Nachteil, durch mehr und schwerere chronische Krankheiten, psychische Komorbidität, geringere persönliche und soziale Ressourcen, eher dysfunktionale Problembewältigungsstrategien sowie soziale Probleme. Ihre Therapieadhärenz ist geringer und die Behandlung wegen der Kombination aus suchttypischen Verhaltensweisen, psychischer Komorbidität, somatischen Erkrankungen sowie in vielen Fällen vorliegenden kognitiven Beeinträchtigungen schwierig. Therapieziele müssen sehr individuell formuliert werden; Abstinenz als Maximalziel ist nur selten realistisch. Auch die Behandlung muss sehr individuell und oft unkonventionell durchgeführt werden. Dieser Beitrag gibt einen Überblick über die besonderen Merkmale von Verlauf, Symptomatik und Folgeproblemen bei EO-Suchtkranken, die das höhere Lebensalter erreicht haben. Dabei werden Alkohol, Medikamente, illegale Drogen und das Rauchen, aber auch Verhaltenssüchte berücksichtigt.

Schlüsselwörter

Schadensbegrenzung Komorbidität Doppeldiagnosen Versorgungsziele Demenz 

Early onset substance abuse disorders and addictive diseases in old age

Abstract

During the past 20 years substance-related and addictive disorders in old age have markedly increased and this increase is going to continue. It is quite common to make a distinction between early onset (EO) and late onset (LO) of these disorders. EO-addicts are in a more disadvantageous position due to constitutional and psychosocial burdens and the cumulating harmful medical, mental and social consequences of addiction place them at a further disadvantage during the course of the disorder. In old age they are at a disadvantage compared to others of the same age with LO addiction problems because of more and more severe chronic medical conditions, psychiatric comorbidity, less personal and social resources, dysfunctional coping style, and social problems. They present with lower treatment adherence and the treatment is difficult due to the combination of typical addictive behavior, psychiatric comorbidity, somatic diseases and in many cases also cognitive impairment. Treatment goals must be mostly individually defined and abstinence is rarely a realistic goal. Even the treatment has to be carried out mostly individually and often unconventionally. This article gives a review of the characteristic features of the course, presentation and adverse consequences of addictive disorders in EO addicts who have reached old age. The article covers alcohol, prescription drugs, illicit drugs and smoking as well as behavioral addictions.

Keywords

Harm reduction Comorbidity Concomitant disease Goals of care Dementia 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D.K. Wolter gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

Supplementary material

391_2018_1440_MOESM1_ESM.docx (15 kb)
Online finden sich noch eine Übersicht zu den körperlichen  Alkoholfolgekrankheiten sowie zusätzliche Literatur, Tabelle e1: Körperliche Alkoholfolgekrankheiten
391_2018_1440_MOESM2_ESM.docx (30 kb)
Literatur Online-Version (e-Nummern)

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Abteilung Gerontopsychiatrie und PsychotherapieLVR-Klinik Bonn, Akademisches Lehrkrankenhaus, Universität BonnBonnDeutschland

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