beitrag_sucht

(Volks-)Krankheit Sucht


Suchterkrankungen gehören zu den häufigsten Diagnosen in Europa. Auch die Gene spielen bei ihrer Entwicklung eine Rolle – doch man kann durch frühe Prävention und umfassende Aufklärung gegensteuern.
Ein Artikel von Natalie Zettl

Prinzipiell kann man nach fast allem süchtig werden: nach Medikamenten, Sport, Arbeit – und sogar nach Shopping. Die häufigsten Süchte im Bundesland Salzburg sind jedoch nach wie vor Alkohol und Drogen, wie der aktuelle Suchtbericht des Landes** zeigt.

Foto: wildpixel - istockphoto.com

Foto: wildpixel – istockphoto.com

Süchtig?
Den Begriff „Sucht“ zu definieren, fällt schwer: Zwar gibt es eine allgemein gültige Definition der WHO, die Sucht als „Zustand periodischer oder chronischer Vergiftung, hervorgerufen durch den wiederholten Gebrauch einer natürlichen oder synthetischen Droge“ sieht – diese lässt jedoch „Verhaltenssüchte“ wie Kaufsucht und Spielsucht außer Acht. Diesbezüglich geht die WHO-Definition von Abhängigkeit etwas weiter: Sie beschreibt diese als „seelischen, eventuell auch körperlichen Zustand, der dadurch charakterisiert ist, dass ein Mensch trotz körperlicher, seelischer oder sozialer Nachteile ein unüberwindbares Verlangen nach einer bestimmten Substanz oder einem bestimmten Verhalten empfindet, das er nicht mehr steuern kann und von dem er beherrscht wird.“
In der Praxis geht die Tendenz jedoch immer mehr weg von strengen Definitionen, hin zur Betrachtung des Einzelfalls. Sucht beginnt dort, wo sich eine Toleranz-entwicklung gegenüber der Substanz aufbaut, der Süchtige also immer mehr konsumieren oder tun muss, um den gewünschten Effekt zu erreichen. Es entwickelt sich ein sogenanntes „Craving“, also eine Art Heißhunger, bei dem der Süchtige langsam die Kontrolle verliert. Oft bemerkt das soziale Umfeld die Sucht noch vor dem Betroffenen selbst. Zu den Risikogruppen gehören Menschen mit einer emotionalen Traumatisierung, die sich in einer für sie schwierigen Lebenssituation befinden.
Üblicherweise gliedert sich eine Suchterkrankung in drei Phasen: In der Einleitungsphase finden die ersten Kontakte mit dem Suchtmittel statt, die der Betroffene ausschließlich positiv erlebt. Es folgt die kritische Phase, in der sich der Süchtige langsam an das Suchtmittel gewöhnt.
Spricht ihn jemand aus seinem sozialen Umfeld auf die Problematik an, reagiert er gereizt oder weicht aus – unter anderem, weil sich hinsichtlich der Entgleisung seines Konsums ein Bewusstsein bei dem Betroffenen zu bilden beginnt. In dieser Phase kann und will der Erkrankte nicht mehr aus der Sucht aussteigen.
In der folgenden chronischen Phase kommt es zum absoluten Kontrollverlust. Nun will man aussteigen, kann es aber nicht mehr – zu-mindest nicht aus eigener Kraft.

Foto: Willi - stock.adobe.com

Foto: Willi – stock.adobe.com

Erbgut als Teilursache
Lange Zeit gingen Forscher davon aus, dass eine Sucht in erster Linie durch psychologische Faktoren bedingt ist. Die aktuelle Forschung deutet jedoch darauf hin, dass auch die Epigenetik eine Rolle spielt: Eine Studie der Fudan University in Shanghai legt nahe, dass epigenetische Anlagerungen am Erbgut den Hirnstoffwechsel im Belohnungssystem beeinflussen und so nachhaltig zu einem suchtanfälligeren Verhalten führen können. Dies scheint sogar über mehrere Generationen hinweg der Fall zu sein: Bei einem Versuch mit Ratten im Jahr 2017 entdeckten chinesische Forscher einen epigenetischen Zusammenhang zwischen dem Suchtverhalten des Vaters und der Suchtanfälligkeit der Nachkommen. Inzwischen geht man davon aus, dass ca. 50 Prozent der Suchtanfälligkeit einer epigenetischen Anlage entspringen. Ein erblich erhöhtes Suchtrisiko bedeutet allerdings nicht, dass man zwangs-läufig süchtig wird

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Dem entgegenzuwirken, ist möglich – durch ein erfülltes, ausgeglichenes Leben, in dem sowohl Arbeit als auch Freizeit Platz haben. Denn: Oft sei das Abrutschen in eine Abhängigkeit die versteckte Suche nach einer Abkürzung zum Glück, so Caroline Weinlich, psychologische Leiterin der Suchthilfe Klinik Salzburg. „Man darf aber nicht vergessen, dass – genau wie im Straßenverkehr – die Suche nach einer Abkürzung die Gefahr eines sehr langen und mühsamen Umwegs beinhaltet.“

Kontrollierter Konsum?
Je nach Sucht unterscheidet sich der Weg in ein gesundes Leben. Kompletter Verzicht auf das, was süchtig macht, ist nicht in allen Fällen möglich: Es geht in diesen Fällen darum, das Verhalten wieder in kontrollierte, gesunde Bahnen zu lenken. Diese Tendenz ist beispielsweise bei Alkoholabhängigkeit bemerkbar – denn nicht alle schaffen den kompletten Verzicht. Das Konzept des kontrollierten Konsums wurde von dem deutschen Forscher Joachim Körkel bereits in den 90er-Jahren entwickelt, als Gegenbewegung zur Abstinenz. Unumstritten war es nie: Einerseits wissen Experten aus Erfahrung, dass bereits kontrollierter Konsum für die meisten Alkoholiker eine große Herausforderung darstellt und deswegen rein abstinenzorientierte Einrichtungen oft zu hochschwellig sind. Andererseits funktioniert kontrolliertes Trinken in vielen Fällen nicht und ist somit meist nur eine Übergangsbemühung auf dem Weg zur Abstinenz. Sie erfordert ein hohes Maß an Disziplin: Beim kontrollierten Trinken müssen Alkoholiker ihre Trinkhäufigkeit und die Trinkmenge für die folgende Woche planen und mittels Trinktagebuch überprüfen. Es muss feste Abstinenztage geben, an denen überhaupt kein Alkohol konsumiert wird. So entwickelt sich ein Bewusstsein über das tatsächliche Ausmaß der eigenen Abhängigkeit, das die Basis für die Behandlungsmotivation bildet. Kontrolliertes Trinken soll in manchen Fällen auch als früher Ausweg fungieren, um schlimme Folgen wie Jobverlust, Partnerverlust und körperliche Auswirkungen zu verhindern.
Dazu Caroline Weinlich: „Lange Zeit war diese Behandlungsform ein Tabuthema. Aktuell findet ein Paradigmenwechsel statt, was uns in der Praxis durchaus zu Gute kommt.“ Um möglichst individuell vorgehen zu können, wird es in Zukunft eine ambulante Behandlung in der Suchthilfe Klinik Salzburg geben, die zieloffen geführt wird. Damit es gar nicht so weit kommt, muss Prävention betrieben werden: Das Land Salzburg setzt dabei auf regionale Initiativen: Beispielsweise bietet Akzente Salzburg (die Fachstelle des Landes) Beratungen, Infomaterial und weitere Unterstützung für Schulen und Ausbildungsstätten an.

Sucht in Salzburg**

Im Oktober 2019 wurde der aktuelle Suchtbericht des Landes Salzburg veröffentlicht.
In Betreuung befanden sich:

  • wegen Alkoholsucht: 659 männliche und 295 weibliche Personen
  • wegen Drogensucht: 471 männliche und 145 weibliche Personen
  • wegen Spielsucht: 31 männliche und 3 weibliche Personen

In den Gebirgsgauen zeichnet sich indes ein neuer Trend ab: Zunehmend greifen vor allem junge Männer zwischen 20 und 24 Jahren zu Marihuana.

** Land Salzburg: Suchtbericht des Landes Salzburg 2018, Download unter www.salzburg.gv.at/soziales_/Documents/Suchtbericht2018.pdf

Adressen für Betroffene und Angehörige 

Drogen

Drogenberatung (Suchthilfe) Stadt Salzburg
Saint-Julien-Straße 9a

5020 Salzburg
Tel. +43 (0) 662 / 87 96 82
drogenberatung@suchthilfe-salzburg.at

Alkohol und andere Süchte

Beratung durch den Psychosozialen Dienst des Landes
Salzburg Zentralraum (Salzburg Stadt, Flachgau, Tennengau)

Fanny-von-Lehnert-Straße 1
5020 Salzburg
Tel. +43 (0) 662 / 80 42 35 99
psds@salzburg.gv.at


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