1. CO-MORBITITY RESEARCH IN ADDICTION SCIENCE International Round Table ICAA MEETING MAGDEBURG May 23 rd, 2008 DR. THOMAS LEGL KUR UND GESUNDHEITSZENTRUM KNAPPENHOF ICAA-INTERNATIONAL COUNCIL ON ALCOHOL AND ADDICTIONS EURO-TC

2. OVERALL SITUATION 37 % Substance Dependents additionally suffer from affective disorder, schizophrenia spectrum psychosis, anxiety and/or personality disorder37 % Substance Dependents additionally suffer from affective disorder, schizophrenia spectrum psychosis, anxiety and/or personality disorder In general psychiatric hospitals as well as addiction treatment centers do not offer appropriate service for this clienteleIn general psychiatric hospitals as well as addiction treatment centers do not offer appropriate service for this clientele “Come-go-come back” effect“Come-go-come back” effect Increased risk for suicide and suicide attemptsIncreased risk for suicide and suicide attempts Need for special approach offering treatment for substance dependence plus the additional psychiatric disease Need for special approach offering treatment for substance dependence plus the additional psychiatric disease

3. Co-morbidity - Flow Pattern Psychiatric Hospital Outpatient Facility TC Substitution Programme High Co-morbitity Low Co-morbitity High Co-Morbitity Low Co-morbitity

4. INTEGRATIVE ASPECTS Small group of dual diagnoses patients can achieve high profit from integration into a TC programSmall group of dual diagnoses patients can achieve high profit from integration into a TC program Need for special structure within the system with main differences in vocational therapyNeed for special structure within the system with main differences in vocational therapy Adapted psychotherapeutic approach with increased inclusion of family membersAdapted psychotherapeutic approach with increased inclusion of family members Orientation towards “non-dual diagnoses” patientsOrientation towards “non-dual diagnoses” patients Helpful psycho-dynamics for all TC membersHelpful psycho-dynamics for all TC members Positive influence on self-centered behavior of the addictPositive influence on self-centered behavior of the addict

5. EVALUATION Results – I: Clinical Observations (N=35)  Positive long-term effects on psychopathology with 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 psychiatric disordersImproved understanding of mechanisms of both psychiatric disorders decreased rate of re-hospitalization at Psychiatric Hospitals Reduction of psychotropic medication Improved medical status (e.g. hepatitis C)

6. EVALUATION Results – II: Clinical observations – ongoing study (N=35)  Positive effects on social stabilization by 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 drug useDecreased risk for relapse to uncontrolled drug use Employment by re-integration at the labor marketEmployment by re-integration at the labor market Establishing of residential communitiesEstablishing of residential communities

7. CASE STUDY MALE PATIENT - 34 YEARS OLD Homelessness emotional physical PROCESS OF INDIVIDUATION Ecstasy Cannabis Designer Drugs High expectations of performance SCHIZOPHRENIA SPECTRUM PSYCHOSIS NARCISITIC PERSONALITY DISORDER Drug abuse as self medication Desire of control and security „Superman – Syndrom“ Clear Structure Multiprofessional team Stable medication, Placebo High role expectation

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