Health Care
Since 1999 psychiatric health care for addicted patients has been established, the current treatment facilities encompassing 24 inpatient beds, 20 day-clinic slots, as well as a general addiction psychiatry outpatient clinic and a substitution outpatient clinic. Added to these are special outpatient facilities, for example, those for smokers trying to quit, and consumers of ecstasy, cannabis and party drugs. A specialised clinic for pathological gamblers (games of chance, internet…) was established in 2010. Thus the basic psychiatric health care in the addiction sector available to the population of Mannheim and vicinity is fully provided with regard to outpatient care, while covering about 50% of the demand for inpatient care (the remainder of inpatients being admitted to the PZN Wiesloch (Psychiatrisches Zentrum Nord Baden / Psychiatric Center North Baden), which has assumed this task in close agreement with the CIMH).
The research priority with regard to psychiatric care for patients lies in the area of psycho- and pharmacotherapy for disorders associated with addictive substances and behavioural addictions:
- Alcohol dependency and alcohol-associated disorders (inpatient, day clinic, outpatient).
- Dependency upon analgesics and tranquilizers, and associated disorders, particularly affective and anxiety disorders (day clinic and outpatient).
- Opiate dependency (substitution outpatient facility and inpatient).
- Use disorders upon cannabis and party drugs (outpatient, day clinic, inpatient).
Research
Research at the department covers the biological and psychosocial conditions in the etiology, the course, and the treatment of substance related and behavioural addictions. Particularly the explanation of specific gene-environment interactions over the lifespan, neuroplastic changes and new treatment options are explored in studies funded by the National Genome Research Network (NGFN 2, and NGFN Plus, BMBF), the SFB 636 (FP 2&3, DFG), the SPP 1226 (DFG), and the Transalc study (ERANET/EU). A close collaboration with the pharmaceutical industry has allowed us to perform clinical trials (Mann et al. Biol. Psychiat. 2013) which were instrumental to approve a new medication (Nalmefene) for alcohol dependence through the European Medicines Agency (EMA). This goes along with a paradigm shift in the treatment of alcoholism (reduction of alcohol consumption as valid endpoint in addiction to abstinence).
The acquisition of third-party funds since 2007 sums up to about 5.7 million euro. The translational research cooperation with the Department of Psychopharmacology permits complementary addiction research in both animals and humans. This was primarily established within the “Baden-Württemberg Consortium on Addiction Research (funded by the BMBF and the state of BW between 2002 and 2008). It was again instrumental for the TRANSALC study (ERA-Net, BMBF funding) and the SFB 636 (FP 2&3) that deals with the neurobiological basis of extinction of mesolimbic cue-reactivity and the NGFN Plus focusing on glutamatergic pathways of hyperexcitability of alcohol withdrawal and learning processes. The Addiction department has become a European and transatlantic center of reference for the psychopharmacological treatment of alcohol and drug dependency and behavioural addictions. It has partnerships with the pharmaceutical industry to design and carry out studies.
The holder of the Chair was the center coordinator of the CIMH (until 2012) for a multicenter study (IMAGEN) funded for five years by the EU with 10 million euro. In a representative sample of 2,000 adolescents aged 14 years, the development, psychopathology, cognitive skills and genotype will be studied (among others by means of fMRI). Participating in the study are the CIMH Departments of Child and Adolescent Psychiatry, Addiction Medicine, Neuropsychology, Genetic Epidemiology in Psychiatry, and Psychopharmacology, as well as the Department of Child and Adolescent Psychiatry at the University of Heidelberg.
The specific expertise in diagnoses and treatment of addictions represented in the department has resulted in chairing national and international panels. The head of department was invited into the WHO group which prepares the ICD-11 diagnostics in addictions. He was nominated chair of the subcommittee on behavioural addictions. He was appointed as coordinator of S3 treatment guidelines for alcoholism and tobacco dependence in German speaking countries bringing together representatives of 50 learned societies, NGO’s, pension funds as well as patient groups. Recently he was asked to chair an expert group on behavioural addictions in Germany.
Since treatment and research are intimately linked to each other, it is guaranteed that results of this research can immediately be transferred into clinical care. For dissemination into the German speaking treatment world two treatment manuals were published recently.
