Stress und stressreaktivität bei der opioidabhängigkeit- Ein überblick

Opioid dependence is a chronic relapsing disorder characterised by a compulsive search for the substance and its consumption despite the negative consequences. Moreover, opioid dependence is marked by modified functioning of the stress regulating endocrine system (i.e., hypothalamicpituitaryadrenal [HPA] axis). Specific neurobiological changes underlie the aetiopathogenesis and clinical course of opioid dependence. These adaptations result from the brain's ability to change its function and structure permanently and adapt to the requirements of the environment. Stress plays a key role in this process. Stress factors are among the decisive determinants within the multidimensional biopsychosocial approach. They frequently trigger craving (an irresistible desire for heroin) and hence maintain the disorder and the risk of relapse. According to empirical findings, maintenance treatment with methadone, and also with other opioid agonists (e.g. pharmaceutical heroin, diacetylmorphine, DAM), has a stresslowering effect as shown by normalised release of the stress hormones adrenocorticotropin (ACTH) and cortisol, as well as reduced craving, and hence seems to guard against relapses with severe health problems and negative social consequences. The heroinassisted treatment constitutes an effective alternative for those chronic heroindependent patients who initially do not profit sufficiently from abstinenceoriented treatments and methadone maintenance treatment. For patients, continuous opioid administration may serve as a protective factor in stress situations with which they could not cope sufficiently otherwise. At large, the opioid maintenance treatment can be understood as a kind of stress protection, being a precondition for a psychosocial treatment with the goal of improving the patient's long term medical and psychosocial situation.