ÖZEL GRUPLARDA ALKOL VE MADDE KULLANIM BOZUKLUKLARI VE TEDAVİSİ

Ozel_Gruplarda_Alkol_ve_Madde_Kullanimi_Bozukluklari_ve_Tedavisi_kapak

TRAVMA VE ALKOL MADDE KULLANIM BOZUKLUKLARI

Cansu Çoban

Ankara Etlik Şehir Hastanesi, Psikiyatri Kliniği, Ankara, Türkiye

Çoban C. Travma ve Alkol Madde Kullanım Bozuklukları. Doğan Bulut S, editör. Özel Gruplarda Alkol ve Madde Kullanım Bozuklukları ve Tedavisi. 1. Baskı. Ankara: Türkiye Klinikleri; 2025. p.115-127.

ÖZET

Alkol-madde kullanım bozukluğu (AMKB) iş, sağlık ve sosyal yaşamda olumsuz sonuçları olmasına rağmen alkol-madde kullanımını sürdürme ile karakterize kronik ve tekrarlayıcı bir hastalıktır. Sıklıkla diğer ruhsal bozukluklarla bir arada görülür. Travma ile ilişkili bozukluklar AMKB’ye sıklıkla eşlik eder. Travma sonrası stres bozukluğu (TSSB) korkutucu bir şekilde ölüm ve ağır yaralanmayla karşılaşma veya cinsel saldırıya uğrama sonrasında başlayan yeniden yaşantılama, kaçınma, biliş ve duyguların olumsuz yönde etkilenmesi ve aşırı uyarılmışlık semptomları ile kendini gösteren bir sendromdur. TSSB’si olan birçok kişi belirtileri yatıştırmak için alkol veya madde kullanabilmektedir. TSSB’nin AMKB riskini artırdığı bilinmektedir. Bununla birlikte madde kullanım bozukluğu olan bireylerin de aşırı doz uygulama, arkadaşın ölümüne tanık olma, şiddete maruz kalma, cinsel saldırıya uğrama gibi travma veya stresli bir yaşam olayına maruz kalma riski artmıştır. Ayrıca AMKB olan bireylerde yoksunluk semptomları nedeniyle aşırı uyarılmanın eşlik etmesi, duygusal işlemlemenin olumsuz etkilenmesi gibi nedenlerle TSSB duyarlılığı da artmıştır. TSSB’nin AMKB riskini artırdığı gibi AMKB’nin de TSSB risk ve sıklığını artırdığı gösterilmiştir. İstismar, ihmal gibi olumsuz çocukluk çağı olayları eş tanılı AMKB ve TSSB için ortak risk faktörü olarak tanımlanmıştır. Ergenlik veya yetişkinlikte maruziyete kıyasla çocukluk çağında travma maruziyetinin olması TSSB ve AMKB’nin seyrinin daha olumsuz olmasına neden olmaktadır.

TSSB veya AMKB birbirinden bağımsız olarak ortaya çıktığında diğer ruhsal hastalık riskinin artması, bilişsel bozulma, işlevsellikte bozulma ile ilişkili olduğu bilinmektedir. TSSB ve AMKB eş tanılarının olması TSSB ve AMKB semptom şiddetinin, diğer psikiyatrik ek tanı riskinin artmasına, gidişin daha olumsuz seyretmesine ve yaşam kalitesinin daha düşük olmasına neden olmaktadır. Kişinin yaşam kalitesi ve işlevselliğini artırmak için eş tanılı TSSB ve AMKB’nin tedavisi büyük önem arz etmekte, tedavi ile ilgili birtakım güçlükleri de beraberinde getirmektedir. TSSB veya AMKB tedavisinde etkinliği gösterilmiş ve yaygın olarak kullanılan tedavi yaklaşımları mevcuttur. Tedavinin başından itibaren her iki bozukluğun tedavisi beraber ele alınmalıdır. Ancak eş tanılı AMKB ve TSSB için güncel bir tedavi kılavuzu bulunmamaktadır. Eş tanılı TSSB ve AMKB’si olan bireylerde farmakolojik tedavileri inceleyen az sayıda mevcut çalışmaların çoğu serotonerjik, noradrenerjik, opioiderjik, GABAerjik ve glutamaterjik sistemlere odaklanmıştır. TSSB ve AMKB için ayrı ayrı etkili psikoterapi uygulamaları pratikte uygulanmakla birlikte eş tanılı durumların tedavisinde daha kapsamlı yaklaşımlara ihtiyaç vardır. Bu bağlamda entegre-bütünleşik psikoterapilerin geliştirilme ihtiyacı gündeme gelmiştir. Güven arayışı terapisi ve bütünleşik maruz kalma terapileri sıklıkla uygulanan ve etkinliği gösterilmiş bilişsel davranışçı temelli bütünleşik terapilerdir.

Anahtar Kelimeler: Travma; Travma sonrası stres bozukluğu; Alkol kullanım bozukluğu; Madde kullanım bozukluğu

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