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Das Rupert Mayer Haus der Caritas steht fur eine Reihe von Einrichtungen, die im letzten Drittel des 20. Jahrhunderts im Bereich der zunachst noch kirchlichen Obdachlosenfursorge geschaffen wurden und die im Laufe der Jahrzehnte einen Prozess der fachlichen Professionalisierung und Differenzierung durchlaufen haben und auf diesem Weg zu Brennpunkten urbaner Sozialpsychiatrie geworden sind. In diesem Artikel wird speziell die Weiterentwicklung des Betreuungskonzepts fur Alkoholkranke und Wohnungslose thematisiert sowie die fachlichen Bezugnahmen (Typologie nach Lesch) und speziell die Schritte der Evaluierung (Fragebogen) dokumentiert. Paradigmatisch lasst sich in der „sozialpsychiatrischen“ Praxis die Hinwendung vom passiven Einrichtungsbewohner zum aktiven Mitarbeiter in Gesundheitsfragen mitvollziehen.

Forschungsergebnisse belegen mehrfach, was Praktiker immer gewusst haben: Alkohol- und Tabakabhangigkeit treten in der psychosozialen Praxis gemeinsam auf.

Studies have repeatedly supported the assumption of general practitioners that alcohol and tobacco occur together in psychosocial practice.

The diagnostic systems typically used in psychiatric hospitals are designed to define homogenous groups of patients whose specific aetiology leads to certain symptoms. From this aetiology, a therapy that is most effective for this disease group should be planned. For a diagnosis of a disease the following should be provided: By defining a disease, its aetiology is also automatically defined. In addictions, smoking and drinking are often only secondary phenomena. The aetiology of abuse and the causes of addiction have always been seen as two different constructs.

As alcohol and tobacco consumption often occur concomitantly, scientific and therapeutic interest in both substances has significantly increased over the past years. The concomitant use has clearly more damaging effects than alcohol or tobacco use by itself. In practice, patients have often mentioned that they were able to quit the consumption of one substance without difficulty, but at the same increased the consumption of the other (e. g. if the patients managed to quit smoking, their alcohol consumption significantly increased). Our knowledge about dependencies is permanently expanding and basic research keeps improving explainations of the functioning of specific brain circuits. Therefore it is very important for us to deliver findings that clinical practitioners can apply in therapy or during consultations with tobacco and alcohol dependents.

85% of all adults in central Europe drink alcohol more or less regularly and this is why the question “do you drink alcohol” is almost always answered with “yes”. But this answer does not provide any information about the interaction of psycho-social-biological problems caused by alcohol and therefore this question should be avoided. Abusers and dependents know their problem, which they experience as failure, and for which they often feel guilt or shame. Antoine de Saint-Exupery has brilliantly described this situation in the 12th chapter of his book “The Little Prince” (1943), Fig. 75.

Many addictive drugs are primarily made up of herbal substances and are certainly older than humanity. Other addictive drugs are derived from fermented fruits or distilled grains. Addictive drugs are pharmacologically effective substances and therefore comply with the accepted pharmacological rules. They have been applied by mankind for thousands of years and a range of diseases have been treated with addictive drugs. It has been known for more than 2000 years that viruses can be driven away by using smoke (fire or tobacco smoke) and alcohol. Only 150 years ago, contaminated water in Europe caused severe bodily discomfort (sometimes even with lethal consequences). Yet, these adverse health effects were in no case observable when alcohol was consumed in small amounts.

As already emphasized in the last chapter, it has long been known that alcohol dependents are not a homogenous group. Studies that have used the DMS-IV in order to categorize alcohol dependents into groups were able to show that the majority of patients either have a second axis-I or an axis-II diagnosis or both an axis-I and an axis-II diagnosis.

Psychological, social, biological and genetic causes are assumed to play a role in all psychological disorders but only little of this aetiological thinking has led to practical approaches that can be realized in therapy. This has also been the case in the field of addiction where the need to define psychological, biological, sociological and aetiological factors has repeatedly been posited.