Purpose The Alcohol use disorder (AUD) (F10.X) is among the most common diagnoses in hospital treatments in Germany and cause around 10 billion euros direct costs every year. Treatment includes detoxification, withdrawal treatments, rehabilitation measures, and drug-based relapse prevention. Disulfiram, which causes an alcoholaversionon reaction, is used for relapse prevention. This retrospective analysis aimed to determine the therapeutic needs of patients in outpatient disulfiram treatment and identify predictors for long-term treatment success. Methods Data from 76 male and 25 female alcohol-dependent patients (mean age: 43.98 +/- 8.48 years) who participated in supervised disulfiram administration were examined. The influence of average weekly treatment duration on treatment success was determined using a single-factor analysis of variance with covariates (ANCOVA). . Results ANCOVA revealed that the lowest relapse rate occurred with a treatment duration of 70 minutes per week (divided into three 23,3-minute sessions) compared to a short weekly treatment time (20 Minutes per week, divided into three sessions; post-hoc analysis p=0.043.). Disulfiram proved particularly effective for patients with a duration of addiction of more than 20 years (p=0.038). Conclusion Supervised disulfiram administration is a valuable method for treatingAUD, especially for patients with a long history of AUD (20 years or more). Optimal treatment outcomes are achieved bya combination of medication monitoring, psychosocial support, and individualized treatment intensity adjustments.

Alkoholbezogene Störungen (F10.X) sind in Deutschland eine der häufigsten Diagnosen bei Krankenhausbehandlungen und verursachen jährlich etwa 10 Milliarden Euro direkte Kosten. Die Behandlung umfasst Entgiftung, Entzugsbehandlung, Rehabilitationsmaßnahmen und medikamentöse Rückfallprophylaxe. Disulfiram, welches eine Alkoholaversionsvreaktion auslöst, wird zur Rückfallprävention eingesetzt. Ziel der retrospektiven Analyse war es, die therapeutischen Bedürfnisse von Patienten in der ambulanten Disulfirambehandlung sowie Prädiktoren für eine erfolgreiche Therapie zu ermitteln. Untersucht wurden 76 männliche und 25 weibliche alkoholabhängige Patienten (Durchschnittsalter: 43,98±8,48 Jahre), die an der supervidierten Disulfiramvergabe teilnahmen Der Einfluss der durchschnittlichen wöchentlichen Behandlungsdauer auf den Behandlungserfolg wurde mit einer einfaktoriellen Varianzanalyse mit Kovariaten (ANCOVA) berechnet. Die Ergebnisse der ANCOVA zeigten, dass bei einer Behandlungszeit von 70 Minuten pro Woche (aufgeteilt in drei Sitzungen à 23,3 Minuten) im Vergleich zu einer kurzen wöchentlichen Behandlungszeit (20 Minuten pro Woche, aufgeteilt auf drei Sitzungen) die geringste Rückfallrate auftrat (post hoc Analyse p=0,043). Disulfiram war darüber hinaus besonders effektiv für Patienten mit einer Dauer der Abhängigkeitserkrankung von mehr als 20 Jahren (p=0,038). Die supervidierte Disulfiramvergabe stellt eine wertvolle Methode in der Behandlung von Alkoholabhängigkeit dar, besonders für Patienten mit langjähriger Abhängigkeitserkrankung. Optimale Therapieergebnisse werden durch eine Kombination aus Medikamentenüberwachung, psychosozialer Unterstützung und individueller Anpassung der Behandlungsintensität erreicht.

Purpose Parents suffering from addiction face the dual challenge of remaining abstinent and at the same time adequately fulfilling their role as parents. While there are specific offers for this target group in the rehabilitation setting, there is a complete lack of outpatient, combined therapy offers in acute treatment settings. The aim of the "STAERKE" project was therefore to develop, implement and evaluate an outpatient psychotherapy program that teaches both skills for substance use disorders to promote abstinence and elements to strengthen parenting skills. Methodology The effectiveness was evaluated in this single-group pre-post pilot study (N=48) online at six measurement points during therapy participation (at the start of the study, after 3, 6, 9, 12, and 24 weeks) and at a follow-up survey twelve weeks after the end of therapy participation to record the symptom burden of addicted parents during participation in the "STAERKE" therapy program using the following self-assessment questionnaires: Beck Depression Inventory (BDI-II), State and Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-10), Mannheim Craving Scale (MaCS). Changes in the children's behaviour were measured through parental observation using the Child Behaviour Checklist (CBCL). Results Using ANOVAs with repeated measurements, significant reductions in parental symptom burden were found: depression (BDI-II): t0-t5, N=11, p=0,011), anxiety as a personality trait (STAI-T): t0-t5, N=11, p=0,029), subjective stress experience ((PSS-10): t0-t3, N=18, p=0,001), craving ((MaCS): t0-t3, N=22, p=0,050).Significant improvements were also observed between t0 and t5 in child behavior: Thinking problems: (N=11, p=0,031), rule-breaking behavior: (N=11, p=0,014). There were no gender differences across the measurement points (p=0,951). Conclusion Despite existing limitations, this pilot study provides initial indications of the effectiveness of the therapy program. In addition, fathers and mothers appear to benefit equally from the "STAERKE" therapy program. The small number of participants limited the interpretation of the results, insufficient data return due to restrictions related to COVID-19, and the chosen quasi-experimental study design without a sufficiently large control group. Further, large randomized studies are therefore needed for a conclusive evaluation of the therapeutic effects of the program.

Suchterkrankte Eltern stehen vor der zweifachen Herausforderung, abstinent zu bleiben und zugleich die Elternrolle adäquat auszuüben. Während in der postakuten Rehabilitation vereinzelt Angebote für diese Zielgruppe existieren, fehlen ambulante, kombinierte Therapieangebote in der Akutbehandlung vollständig. Ziel des Projekts „STAERKE“ war die Entwicklung, Implementierung und Evaluation eines ambulanten Psychotherapieprogramms, das sowohl suchtmedizinische Inhalte zur Förderung der Abstinenz als auch Elemente zur Stärkung elterlicher Kompetenzen vermittelt. Die Evaluation der Wirksamkeit erfolgte in dieser Ein-Gruppen Prä-Post -Pilotstudie (N=48) online zu sechs Messzeitpunkten während der Therapieteilnahme (Studienbeginn, nach 3, 6, 9, 12, 24 Wochen) sowie zu einer Katamneseerhebung zwölf Wochen nach Ende der Therapieteilnahme zur Erfassung der Symptombelastung während der Teilnahme am „STAERKE“-Therapieprogramm anhand der Selbstbeurteilungsfragebögen Beck Depression Inventar (BDI-II),State and Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS-10), Mannheimer Craving Scale, (MaCS). Mittels ANOVAS mit Messwiederholungen wurden signifikante Reduktionen der elterlichen Symptombelastung festgestellt: Depressivität ((BDI-II): t0–t5, N=11, p=0,011), Ängstlichkeit als Persönlichkeitsmerkmal ((STAI-T): t0–t5, N=11, p=0,029), subjektives Stresserleben ((PSS-10): t0–t3, N=18, p=0,001), Craving ((MaCS): t0–t3, N=22, p=0,050). Auch kindliche Denkprobleme (p=0,031) und regelverletzendes Verhalten (p=0,014) verbesserten sich signifikant. Geschlechterunterschiede zwischen Müttern und Vätern fanden sich nicht (p=0,951). Trotz vorhandener Limitationen liefert diese Pilotstudie erste Hinweise auf die Wirksamkeit des Therapieprogramms. Zudem scheinen Väter und Mütter gleichermaßen vom „STAERKE“-Therapieprogramm zu profitieren. Limitierend auf die Interpretation der Ergebnisse wirkten sich der der unzureichende Datenrücklauf bedingt durch Einschränkungen im Zusammenhang mit der COVID-19-Pandemie sowie das gewählte quasi-experimentelle Studiendesign ohne auswertbare Kontrollgruppe aus. Zur abschließenden Bewertung der therapeutischen Effekte des Programms sind daher weitere, größere randomisierte Studien erforderlich.

Cigarette smoking is a prevalent and critical global health issue, with inconsistent findings for its effects on endogenous progesterone concentrations. This large multicentre study investigated the associations between various markers of smoking behaviour and plasma progesterone concentrations using a sex-segregating approach. We studied 747 males aged 18-65 years and 158 peri-/postmenopausal females aged 50-65 years and assessed differences in plasma progesterone concentrations between smokers and never-smokers and associations of plasma progesterone concentrations with the Fagerström Test for Nicotine Dependence (FTND) score, cigarette pack years, age at onset of regular smoking, number of cigarettes smoked daily, exhaled carbon monoxide (CO), plasma cotinine and the Questionnaire of Smoking Urges (QSU) score. In models adjusted for age, body mass index (BMI), years of education, Alcohol Use Disorder Identification Test (AUDIT) scores, intake of any medication and study centre, and after correction for multiple hypothesis testing, there were no significant differences in plasma progesterone concentrations between smokers and never-smokers, and no significant associations between any of the mentioned markers of smoking behaviour and plasma progesterone concentrations in either males or females. The results suggest that smoking behaviour has no substantial effect on plasma progesterone concentrations and is not an important confounder in studies investigating progesterone.

BackgroundCraving and altered reactivity to alcohol cues are central features of alcohol use disorder (AUD). Approved medications yield only limited effects on these facets. Oxytocin (OXY) might be a promising candidate, due to its anti-craving effects. MethodsWe conducted a randomized double-blind placebo-controlled crossover study to investigate the effects of 24 IU intranasal OXY compared to a matched Placebo (PLC) on the neural response to alcohol stimuli (primary outcome) and cue-induced alcohol craving (secondary outcome) in a validated functional magnetic resonance imaging cue-reactivity task in N=24 individuals with AUD. ResultsOXY compared to PLC increased alcohol cue-induced activation in parts of the frontal gyrus, supplementary motor area, hippocampus, parts of the temporal gyrus, fusiform gyrus, parahippocampal gyrus, precuneus, the superior parietal gyrus on a whole brain cluster-level. After OXY versus PLC administration, cue-induced craving during fMRI was rated higher after OXY application (F(1,691) = 4.370, p = .037). Interestingly, sex interacted with the treatment effect on cue-induced craving, i.e., female participants reported higher craving while males reported lower craving after OXY compared to PLC (F(1,691) = 8.914, p = .003). ConclusionsThe results provide evidence that OXY increases cue-induced neural response to alcohol stimuli in brain areas that are associated with cognitive control, context processing and social perception sensory processing and motor control. OXY increases cue-induced craving in female and reduces cue-induced craving in male non-treatment seeking individuals with AUD.Further well-powered studies are needed to investigate OXY effects on the mechanisms underlying AUD and sex-specific effects.

INTRODUCTION:Evidence suggests a role of appetite-regulating hormones in alcohol use disorder. Reductions in acylated ghrelin levels are associated with reductions in craving and cue-induced brain activity. Ghrelin levels can be physiologically decreased by glucose intake, which therefore could be a treatment reducing craving and cue-induced brain activity in patients with alcohol use disorder, potentially mediated by acylated ghrelin. MATERIAL AND METHODS:80 males and females with alcohol use disorder participated in the randomized placebo-controlled crossover study, examining glucose intake as acute treatment to reduce craving. Changes in craving and ghrelin levels were assessed at eight time points. Of these, 43 participants attended fMRI measurements examining habituation to cue-induced brain activation over time. Craving and hormone levels over time were analyzed using linear mixed modeling, brain activation habituation over time using flexible factorial models. RESULTS:Models revealed a significant interaction effect (F(1,474.607)= 13.563, p < .001) between sex and treatment on craving, with lower craving values in males (difference in means=-.540, p = .016, 95 %CI: -.976, -.103) and higher craving in females (difference in means=.815, p = .005, 95 %CI:.243, 1.387) in the glucose compared to the placebo condition. In males, we found a significant effect of treatment (F(1,313.602)= 7.811, p = .006) and a trend, but no significant effect of acylated ghrelin (F(1,301.568)= 3.574, p = .060) on craving as well as greater habituation to cue-induced brain activation after glucose compared to placebo intake in right putamen (T(1,35)= 4.77, p = .019). Individual habituation slopes significantly predicted the difference in craving before and after the alcohol task (F(2,36)= 5.234, p = .010; B= -36.018, p = .027) in males. CONCLUSIONS:Glucose intake could be a short-term treatment for males with alcohol use disorder to reduce alcohol craving and cue-induced brain activation. Sex-specific differences should be considered to gain a better understanding of the underlying mechanisms and develop treatment options for females.

Rationale Negative affect plays a prominent role in the maintenance of alcohol use disorder (AUD) and has been identified as a risk factor for relapse to alcohol. To date, however, treatment options that target negative affective states and consecutive relapse risk in AUD are insufficient. Oxytocin (OXY) might be a promising approach for addressing negative affective states and resulting motivation to use alcohol. Objectives We aimed to investigate the acute effects of 24 I.U. OXY, administered intranasally, compared to matched placebo (PLC) on central processing of negative emotional stimuli in the amygdala in individuals with AUD. Methods We conducted a randomized double-blind placebo-controlled crossover study in N = 24 individuals with AUD. Amygdala response to emotional stimuli served as primary outcome and was assessed using a validated functional magnetic resonance imaging emotion-processing task. Alcohol craving served as secondary outcome. Results OXY versus PLC attenuated right amygdala reactivity to fearful and angry emotional face stimuli during the fMRI task ( t (33) = 3.32, p FWE =0.035), while no effect of OXY on amygdala activation was observed during the presentation of geometric figures. In addition, right amygdala reactivity to fearful and angry emotional face stimuli was positively associated with alcohol craving ( r =.332, Bias corrected and accelerated 95% confidence interval [95% BCa CI]=-0.044 to 0.624, p =.042). Conclusions OXY’s effects on the neurocircuitry underlying negative affect and craving in AUD support its potential for dampening alcohol craving induced by negative affective states and implicate OXY as a potential future treatment option for AUD. Clinicaltrials registry DRKS00026218.

INTRODUCTION:There is evidence that the appetite-regulating hormone insulin plays an important role in alcohol use disorder (AUD), in the sense that there is a negative correlation between insulin and alcohol craving, meaning that an increase in insulin levels leads to a reduction in acute craving. This suggests a promising approach for the acute reduction of craving in the treatment of patients with AUD, which could be achieved via an actively induced short-term increase in insulin levels, e.g., by glucose administration, and which has not yet been investigated in the form of a randomized controlled trial. Another aspect that has not yet been investigated is the role of the insulin-responder-type of each individual, i.e., the time until the insulin peak is reached, in this relationship. METHODS:The randomized, placebo-controlled, double-blind crossover study examined a glucose intake as acute treatment to reduce craving in 80 male and female patients with AUD. Dynamics in craving and insulin levels were assessed at 8 time points on each study visit before and after alcohol cue exposure, after treatment with glucose-respective placebo solution and during the subsequent observation phase. These changes were analyzed using linear mixed models. The insulin-responder-type (fast, normal, slow) of each person was taken into account, and possible interactions with the treatment were analyzed. RESULTS:Linear mixed models revealed a significant interaction effect (F(2, 412.058) = 7.988, p < 0.001) between treatment and insulin-responder-type on craving, with lower craving values in the glucose compared to the placebo condition in the normal insulin-responder-type group (i.e., insulin peak after glucose intake within 30 to 60 min, difference in means = -0.805, p = 0.003, 95% CI: -1.428, -0.182). In the contrary, in the fast insulin-responder-type group craving values were higher in the glucose compared to the placebo condition (difference in means = 1.143, p = 0.011, 95% CI: 0.378, 1.907). Slow insulin-responders showed no differences in craving levels depending on the treatment condition (difference in means = -0.124, p = 0.694, 95% CI: -0.741, 0.493). No main effect was found in the linear mixed models for baseline-centered insulin levels (F(1, 395.337) = 2.328, p = 0.128). CONCLUSIONS:Glucose intake may reduce craving in individuals with AUD who show a normal insulin response. Further research should consider the different insulin-responder-types and peak times to better understand the underlying mechanisms of craving reduction with glucose administration in the context of insulin elevation.

Introduction Alcohol dependence (AD) is highly prevalent and has severe consequences on health and quality of life. However, the efficacy of approved pharmacotherapies such as naltrexone (NTX) remains limited, highlighting the need for novel pharmacotherapeutic approaches. Cannabidiol (CBD) is a promising candidate, which has shown potential to reduce craving and alcohol use by modulating brain circuits involved in craving and addiction. Preclinical studies suggest that CBD may enhance NTX’s therapeutic effects.Methods and analysis This is a three-armed, randomised, double-blind, placebo-controlled parallel group, multicentre phase II clinical trial. A total of 150 patients with AD will be randomised (1:1:1) to receive either 800 mg or 1200 mg CBD plus 50 mg oral NTX or placebo plus 50 mg oral NTX for 14 days. Alcohol craving will be assessed using the Obsessive Compulsive Drinking Scale (OCDS-G) where the primary endpoint is the change from baseline to the end of treatment. Secondary outcomes include craving during the entire study, quality of life, depressive symptoms, anxiety, patient-reported outcomes, neural brain activation, CBD plasma levels, time to relapse, alcohol use and treatment safety. For the comparison of each experimental group to the control group, a strata-adjusted (centre and baseline OCDS-G) van Elteren test is applied with adjustment for multiple testing by Bonferroni-Holm.Ethics and dissemination The trial has been approved by the Ethics Committee and the competent authority (ID: B_03510). All participants will provide written informed consent. An independent Data and Safety Monitoring Board will monitor safety. This trial complies with national and international regulations.Trial registration number NCT06845124; EU Trial Number: 2024-518164-12-00.

Aim: In Germany, 1.5 to 2.75 million children live in families with substance use disorders and 3.8 million live with parents with other mental illnesses. Little is known about the differences between these two groups of parents with regard to their living conditions, their subjective experience of stress and their met and unmet needs. This study compares these parameters between parents with a substance use disorder (SU parents) and parents with other mental illnesses (AP parents). Methods: The cross-sectional survey compares data from 44 parents treated by addiction medicine and 44 parents treated by general psychiatry using the chi-square test and t-test for independent samples. Results: Although the living conditions of SU parents did not differ from those of AP parents, they reported a lower global burden, depression and parental stress than AP parents. They received less support from social environment and experienced more unmet needs of their children than AP parents. Conclusion: Compared to mentally ill parents, parents suffering from a substance use disorder find it more difficult to verbalize the burden of their illness and parental responsibilities, possibly due to the anticipation of stigmatization. At the same time, resulting needs appear to be insufficiently met by the welfare system, especially in families with addiction problems. Therefore, all support services should also be open to affected family members of families with addiction problems.

BACKGROUND:According to data from the Federal Statistical Office, the diagnosis of alcohol use disorder (AUD) (F 10) is the second most common main diagnosis for hospital treatment. Those affected by this disorder are often repeatedly hospitalized at short intervals due to relapses; however, little is known about the factors that influence readmission rates after initial treatment. AIM OF THE STUDY:The aim of this retrospective analysis is to analyze the effects of treatment type (qualified withdrawal treatment (QE) versus physical detoxification) and discharge mode on the probability of readmission in alcohol-dependent patients after inpatient treatment. MATERIAL AND METHODS:Data from 981 male and female alcohol-dependent patients who completed either qualified withdrawal treatment (QE) (68% men; mean age 47.6 years) or inpatient detoxification (74% men; mean age 48.0 years) were analyzed. Predictors of regular discharge were determined separately for both types of treatment using stepwise logistic regression. RESULTS:Patients who had completed a qualified withdrawal treatment were significantly more likely to be regularly discharged. Regular completion of the qualified withdrawal treatment (QE) led to a relative reduction in the readmission rate of 25.64% within 1 year compared to a physical detoxification. CONCLUSION:In order to prevent readmission and chronic courses of alcohol use disorder (AUD), qualified withdrawal treatment should always be recommended to affected patients instead of physical detoxification. Aktuelle Daten des Statistischen Bundesamtes für das Jahr 2022 zeigen, dass die Diagnose "Psychische und Verhaltensstörungen durch Alkohol (F 10.X)" die zweithäufigste Hauptdiagnose bei Krankenhausbehandlungen darstellt [13]. Im Gesundheitssystem entstehen durch dieses Erkrankungsbild und seine somatischen und psychischen Folgeerkrankungen jährlich ca. 10 Mrd. € direkte Kosten [13]. Dieser Sachverhalt wird dadurch kontrastiert, dass die Krankenkassen die qualifizierte Entzugsbehandlung (QE) als leitliniengerechte Goldstandardtherapie [4] wiederholt infrage stellen [10].

Nach Daten des Statistischen Bundesamtes stellt die Diagnose „Psychische und Verhaltensstörungen durch Alkohol (F 10)“ die zweithäufigste Hauptdiagnose bei Krankenhausbehandlungen dar. Betroffene von dieser Erkrankung werden aufgrund von Rückfällen oft wiederholt in kurzen Abständen stationär behandelt. Dennoch ist bisher wenig bekannt, welche Faktoren Rehospitalisierungsraten nach einer initialen Behandlung beeinflussen. Ziel dieser retrospektiven Analyse ist es, die Effekte der Behandlungsart (Qualifizierte Entzugsbehandlung [QE] vs. körperliche Entgiftung) sowie des Entlassmodus auf die Wiederaufnahmewahrscheinlichkeit bei alkoholabhängigen Patienten nach einer stationären Behandlung zu analysieren. Es wurden Daten von 981 männlichen und weiblichen alkoholabhängigen Patienten, die entweder eine Qualifizierte Entzugsbehandlung (QE) (68

Zusammenfassung Die routinemäßige, tiefgreifende Charakterisierung von Patienten mit Methoden der klinischen und skalenbasierten Untersuchung, der Neuropsychologie, anhand von Biomaterialien und sensorbasierten Informationen verspricht transformative Möglichkeiten auf dem Weg zu einer personalisierten Diagnostik, Therapie und Prävention in der Psychiatrie, Psychotherapie und Psychosomatik. Die effektive Integration des zusätzlichen zeitlichen und logistischen Aufwands in den Versorgungsalltag sowie die Akzeptanz bei Patienten sind entscheidend für den Erfolg eines solchen Ansatzes, hierzu liegen jedoch bisher kaum Daten vor. Wir berichten hier über die Etablierung eines Diagnose- und Aufnahmezentrums (DAZ) am Zentralinstitut für Seelische Gesundheit (ZI) in Mannheim. Beim DAZ handelt es sich um eine den anderen Versorgungstrukturen vorgeschaltete ambulante Einheit zur klinischen und wissenschaftlichen diagnoseübergreifenden Phänotypisierung als Ausgangsbasis für eine datenunterstützte, individuelle Bahnung der weiteren Behandlungs‑, Diagnostik- oder Studienpfade. Wir beschreiben die Funktionen, Ziele und Implementierung der neu geschaffenen klinisch-wissenschaftlich translationalen Struktur, geben einen Überblick über die damit erreichten Patientenpopulationen und liefern Daten zur Akzeptanz. Die enge Verzahnung mit den nachgelagerten klinischen Prozessen ermöglicht dabei eine besser abgestimmte und bedarfsorientierte Zuweisung und einen schnelleren Beginn der störungsspezifischen Diagnostik und Therapie. Seit dem Start im April 2021 bis Ende 2022 wurden in einer Pilotphase 1021 Patienten im DAZ psychiatrisch untersucht. Die Patientenklientel entsprach dabei einer repräsentativen Stichprobe aus der Regelversorgung und die neu etablierten Prozesse wurden von Patienten als hilfreich erlebt. Zusammenfassend verknüpft das DAZ somit in hohem Maße Interessen und Bedürfnisse der Patienten mit der Erhebung wissenschaftlich relevanter Daten.

Approximately 2% of the German population suffer from psoriasis. HybridVITA has developed a mobile application (app) that enables psoriasis patients to independently document the progression of the disease and the current psychological stress at home. The HybridVITA app was created in close collaboration with user groups to ensure optimal adaptation to their needs. Two interactive workshops were held with the user groups and the technical developers of the app as a core element of the developmental process. The workshops identified the needs and suggestions for improvement of the various user groups and formulated user stories for the further development of the app using the Scrum method. The participatory approach of the workshop enabled the project team to gather valuable practical knowledge at an early stage of development. The team's awareness of potential obstacles during the early stages of the project enabled them to proactively identify and address these issues prior to implementing the app in dermatological care. We are confident that a patient-centered and participatory approach to health app development can provide valuable insights for developers.