drug addiction

Drug addiction: description

Generally, the term “addiction” is more associated with alcohol or drug addiction. But even drugs can be addictive. According to experts, drug addiction is even a fairly common problem. The persons affected develop physical or mental withdrawal symptoms or both after discontinuation of the respective preparation.

Who concerns drug addiction?

Drug addiction can be found in all social classes. In Germany, about 1.4 to 1.9 million people are estimated to be dependent on drugs. Two thirds of them are women. Regardless of gender, older people are more affected than younger people. Experts believe that far more people suffer from drug addiction than is known. Often the dependency is not recognized. Thus, the dark figure is probably high.

Distinction drug abuse and drug addiction

Doctors distinguished between drug addiction and drug abuse. One Prescription drug abuse is always present when medicines other than those prescribed by the prescribing physician are used. This is the case when a drug is used too long, in too high a dosage or without medical necessity. Drug abuse is often the first step in drug addiction. From one drug addiction One speaks only if the drugs used affect the psyche (psychotropic drugs).

Distinction between physical and psychological dependence

If people with a drug addiction take the appropriate drug for a certain period of time or in too low dosage, withdrawal symptoms may occur. At a physical dependence occur after discontinuation of the drug, physical withdrawal symptoms such as headache, nausea, inner restlessness and depending on the drug a variety of other complaints. The mental dependence Expresses itself primarily in a strong desire (“craving”) for the drug. Although the discontinuation of the drug has no physical effects, it is still difficult for the person affected to endure. He has the feeling that he absolutely needs the medication and wants to experience the often mood-enhancing effect again.

Drug addiction: symptoms

The symptoms of drug addiction occur when the person takes the appropriate medication for a certain period of time no longer or in too low a dose. It then sets off both physical and mental withdrawal symptoms.

For some medications, the misused drug itself can cause symptoms. For example, some drugs can cause profound changes in personality when used excessively.

The drugs with the highest addictive potential are the following substance groups:

• Sleep aids and sedatives, for example benzodiazepines
• Stimulants and appetite suppressants (for example, amphetamines)
• Painkillers and anesthetics, for example opioids

Drug addiction: sleep and sedatives

For anxiety disorders, sleep disorders or stress symptoms, the doctor often prescribes benzodiazepines. Benzodiazepines are medicines that are available by prescription in the pharmacy. They have an anxiety-relieving, relaxing and soothing effect and are also known as tranquilizers (Latin: tranquillare = calm). Sleep aids can be a great relief especially in acute stress situations. For both groups of active ingredients, however, a too long application can lead to drug addiction. Sleep and sedatives should therefore not be taken for more than four weeks.

symptoms: Sleeping and sedatives are taken over a longer period of time, they have an enormous addictive potential. They make you physically as well as mentally dependent. In addition, there is a tolerance increase. This means that the dose must be continually increased to achieve the same effect. Typical symptoms of drug abuse due to abuse of sleep aids and tranquillizers are performance losses, flattening of interests and a gradual change in personality. There are also severe withdrawal symptoms such as weakness, dizziness, tremors, inner restlessness, sleep disorders, nausea, headache, tremors, anxiety, irritability and seizures. In addition, a so-called effect reversal can occur. This means that those affected no longer feel tired and calm, but on the contrary, over-excited and euphoric.

Drug addiction: stimulants and appetite suppressants (psychostimulants)

The so-called psychostimulants are drugs that increase the drive and appetite suppressing. They suppress fatigue and feelings of hunger and increase performance and concentration. Stimulants are used in patients with narcotic addiction (Narcolepsy) and Attention Deficit Hyperactivity Disorder (ADHD). If sufferers take the medication according to the doctor’s instructions, drug addiction generally does not develop. It happens, however, that, for example, athletes gain access to stimulants such as amphetamines in order to be more efficient. Appetizing stimulants in turn are often taken by anorexics. Prolonged intake is a high risk to become dependent.

symptoms: Symptoms of withdrawal include fatigue, psychomotor slowdown, restlessness, sleep disorders as well as severe depression and suicidal tendencies.

Drug addiction: painkillers and narcotics

As very effective painkillers and narcotics (analgesics) the so-called opioids are used especially for very severe and chronic pain. These morphine derivatives also have a mood-lifting effect.

symptoms: Opioids lead to mental and physical dependence as well as a development of tolerance in case of wrong dose or wrong duration of use. Your addictive potential is high. The intake must therefore be under strict medical control. If the painkillers are taken very often, the drugs can produce a persistent headache (“drug-induced headache”). The withdrawal symptoms also include headaches and tremors, sleep disturbances, restlessness, tension, bad mood and disturbances of consciousness.

Symptoms of drug abuse

Apart from the above-mentioned drugs, there are other substance classes that do not cause classic drug addiction, as they do not affect the psyche. However, these drugs can also be addictive in abuse and cause great damage. The following medications are often misused:

Nasal drops and sprays with a decongestant effect

After just five to seven days, the body of many patients has become accustomed to the means. Put the drops off, swells her nasal mucosa again immediately. That is very unpleasant. Because those affected believe that it is a renewed runny nose that causes their breathing problems, they continue to use the nasal drops or nasal spray. This can lead to a vicious circle. Continuous use can severely damage the mucous membrane of the nose. In extreme cases, bacteria settle on, which form foul smelling crusts – it creates a so-called stink nose.

Laxatives (laxatives)

The intestine gets used to the effects of many chemical or plant laxatives quickly. After discontinuation of the preparations then sets in a heavy constipation. The affected then attacks again laxatives. Even in this situation, excessive use can develop a vicious cycle that causes sufferers to repeatedly take laxatives. Laxatives are often misused by people with eating disorders who want to regulate their weight with laxatives.

Growth and sex hormones

Growth and sex hormones are popular doping agents in competitive sports as well as bodybuilders. Steorides such as the male sex hormone testosterone and its synthetic derivatives as well as the growth hormone HGH (Growth Hormone) support the development of muscle mass. Such substances are referred to as anabolic steroids (from Greek on ana “on” and ballein “throw”). The misuse of these hormones is extremely dangerous: Since they also stimulate the heart muscle to overgrow, the risk of sudden cardiac death is increased.

Steroids are broken down in the liver, which, if used too much, can lead to liver damage or liver cancer. Other symptoms associated with anabolic steroids include increased sweating, shortness of breath, skin problems (steroid acne), increased blood pressure, increased intraocular pressure, hair loss, prostate growth, meninges (gynecomastia), headache, and depression. It is particularly annoying for those affected that the muscles often lose their size again without continuous anabolic steroids.

Even female sex hormones such as estrogens are occasionally used abusively. They have a reputation for slowing down the aging process (anti-aging effect). However, this effect is still controversial. On the other hand, it seems certain that overuse of female sex hormones increases the risk of certain cancers, such as breast cancer or cervical cancer.

Alcohol-containing medicines

In many liquid pharmaceutical preparations (also in homeopathic remedies) alcohol serves as a carrier or preservative for the respective active ingredients. The ethanol content of such drugs is often underestimated. For healthy people, the alcohol content in medicines is usually without hesitation. However, people with hepatic dysfunction, epilepsy, or alcohol problems should abstain from using alcohol-based medicines. Otherwise it can lead to heavy interactions between the alcoholic drugs and other medicines. For example, opioids are enhanced in their effect by alcohol. The long-term use of alcohol-containing drugs can also make alcohol dependent or trigger a relapse in “dry” alcoholics.

Drug addiction: causes and risk factors

A drug addiction usually begins with the prescription of a prescription drug by a doctor. If he prescribes negligible drugs with addictive potential, the patient may slip into drug addiction. Often, however, it is the patient himself who uses an abusive medicine, for example, because he values ​​their psychological effect.

Doctor’s drug addiction (iatrogenic drug addiction)

The most common drug addiction begins with the prescription of drugs by the doctor. Especially the elderly often come to sleep with sleep problems and chronic pain. The doctor then prescribes you pain relief or sleeping pills often to alleviate the symptoms. Particularly at risk are people who for a long time suffer from diffuse, elusive symptoms that can not be resolved. In these cases, doctors often know how to help the patient rather than continue to prescribe painkillers and sedatives. The danger of drug addiction is then often either overlooked or even accepted.

The danger of an iatrogenic drug addiction exists therefore above all if the doctor can not make a causal diagnosis, but with the medicines performs a purely symptomatic treatment. This is especially problematic when physical symptoms such as sleep disorders, headaches or other complaints are expressions of a mental disorder, such as depression or anxiety disorder.

If these hidden causes of drug addiction are not treated, the search risk for the patient is very high: he tries to reduce his symptoms with the help of the tablets. However, there is little chance of success in the case of psychological triggers with purely symptomatic pharmacotherapy. If the symptoms do not recede, some patients increase the dose without consulting the doctor. They do not realize that the symptoms are not sufficiently treated by the drug treatment and can even be exacerbated by the drugs themselves. In this case one speaks of one High dose dependence.

Particularly dangerous is a long-term prescription of some psychotropic drugs. Due to the many educational work on drug addiction, it is common today to prescribe risky drugs for a few weeks at the most. However, some patients bypass this safety measure by constantly changing the doctor.

However, not all psychotropic drugs are dependent. Antidepressants have no addictive potential. They should and must often be taken for months and years.

A tablet addiction is not easy to recognize even for the doctor. This is especially true if one Low dose dependence is present. A low-dose dependency in drug addiction is when the patient is addicted to the drug, although he takes only a small dose. The dose is then still within the medically prescribed range, yet the patient becomes dependent if he takes the medication over a long period of time. A low-dose dependency warning sign is when the patient complains about the lessening effect of the medication. This phenomenon is especially known for some tranquilizers (benzodiazepines).

Individual factors: learning experiences, sociocultural factors, age and gender

Experts suspect that above all the personal and social backgrounds can be a decisive factor for the emergence of drug addiction. For example, it has an influence when someone learns in childhood to take medication for headaches or other malaise without hesitation. First, the widespread attitude plays a role in overcoming any complaint by swallowing a pill. On the other hand, the competitive and competitive pressure in society causes many people to suppress pain and illnesses because they do not want to show their environment any weaknesses. Some people also need the medication to be able to withstand the psychological pressure of the performance-oriented society.

Science has also long been concerned with the question of whether there is a particular personality structure that makes a person particularly vulnerable to drug addiction. So far, one can not assume that there is “one addictive personality”.

However, high impulsivity and curiosity about the effects of remedies seem to have an impact. Especially young people experiment with the effects of drugs and other substances. Girls are particularly susceptible to drug abuse at the onset of menstruation. They frequently take, sometimes even preventively, painkillers, for example, against periodic pains, but also stress-related tension-type headaches. According to the German Department for Addiction, it has been found in school examinations that 20 percent of pubescent girls take tablets almost daily.

The genetic makeup of a human could also play a role. To clarify this, family and twin studies were conducted. So far, however, the genetic studies on drug addiction revealed no clear findings.

Sex differences

For problems in job and family, worries or crises, women resort to medication more often than men, which is why they have twice as many cases of drug addiction. In contrast, the “strong sex” escapes significantly more frequently into the alcohol in the stress situation. However, there are other gender-specific differences in drug use: Women are more often in medical treatment than men and therefore also take more medication. In addition, women are much more likely to be prescribed psychotropic drugs or sleeping pills and tranquillizers than men.

Risk factor age

Many drug groups that harbor the risk of drug addiction are more commonly prescribed with increasing age. These include, for example, analgesics and various psychoactive substances (especially benzodiazepines). Particularly high is the consumption of psychotropic drugs in seniors who live in retirement and nursing homes.

At an older age, people generally take more medication than in younger years – not least because with the years of life and the number of diseases increases. If a person at the same time suffers from diabetes, cataracts, insomnia and high blood pressure and is sometimes cared for by several doctors, the list of prescribed drugs grows in part drastically. This not only increases the risk of abuse and addiction, but is also associated with other health hazards: It can lead to unpredictable interactions and revenue errors, because the many tablets overwhelm the patient.

One source of danger is also the correct dosage: Altered metabolic functions as well as organ disturbances (for example, impaired kidney function) in old age cause the body to break down some drugs more slowly. Therefore, for many medications, seniors should take a lower dose than people of younger age. However, this is not always taken into account sufficiently, so that many elderly patients receive too high a dose.

Drug abuse for intoxication

In these cases, those affected are not concerned with relieving medical ailments. Rather, they want to achieve a pleasant feeling of intoxication through the medication – for example, some strong painkillers (opioids). If the addicts do not receive the drugs from a prescription from the doctor, they will try to obtain these drugs illegally, for example, through pharmacies from abroad or through prescription counterfeiting. In most cases, they also consume other substances, such as alcohol or cocaine, to increase the state of intoxication. By combining with other drugs, the effects of certain drugs can be increased or decreased again. In particular, the combination with alcohol carries unpredictable risks. If alcohol is taken together with benzodiazepines, the effect is not only acutely intensified, but in the long term it also leads to cross-tolerance. This means that tolerance effects with respect to one substance also lead to a tolerance to the other substance. Alcohol addicts therefore need a higher dose of benzodiazepines to feel an effect.

Drug addiction: examinations and diagnosis

The drug addiction is sometimes referred to as a “secret addiction” because it often remains hidden from outsiders. The patient is also not always aware that they are addicted to medication. Unlike alcoholics, for example, there are no obvious signs of addiction. Even when symptoms such as tiredness or headache occur, they are rarely associated with medication. Some people, on the other hand, are well aware of their drug addiction, but they crowd this out or shut down the much needed treatment.

The medical examination

The first point of contact for suspected drug addiction is usually the family doctor. But even doctors are usually late for drug addiction. Often, it only comes to light when the drug is discontinued and use the withdrawal symptoms. To detect a drug addiction early, the family doctor can, for example, ask the following questions:

• Do you regularly take medications for calming or for pain, anxiety or sleep disorders? If so, how often?
• Do you feel that you urgently need these medicines?
• Do you have the impression that the effect has diminished after some time?
• Have you ever tried to stop the medication?
• Did you notice any side effects?
• Have you ever raised the dose?

If the suspicion of drug addiction is confirmed, the patient is referred to a psychological specialist care. The psychologist can determine whether in addition to drug addiction is also a mental disorder requiring treatment.

The diagnosis drug dependence

The doctor only makes a diagnosis of dependency if the person concerned uses medications that have an effect on the psyche (psychotropic drugs). These include sleeping, stimulating and painkillers. The most prescribed and consumed psychotropic drug group are the benzodiazepines, which have a calming effect.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), substance use must be used to diagnose drug addiction (drug addiction), leading to impairments and distress in clinically meaningful ways. In addition, at least three of the following criteria must apply to the diagnosis “drug addiction”:

• Development of tolerance, which manifests itself by increasing the dose or decreasing the effect at the same dose
• Withdrawal symptoms upon discontinuation or dose reduction of the drug
• Frequent intake over a longer period of time or in an increased amount
• Continuing desire or unsuccessful attempts to control ingestion
• High time spent on the procurement of the drugs
• Restriction or abandonment of other activities in work and leisure
• Ingestion, despite awareness about the negative effects

Drug addiction: treatment

If sufferers detect unwanted effects of a drug or permanently take the medication according to the prescriptions of the medical prescription, they should urgently seek help. The earlier a drug addiction is detected, the easier it is to discontinue the drug. But also sufferers, who take medication for a long time, can be helped with therapeutic and medical guidance. Even older people should not shy away from treating drug addiction, as successful treatment can significantly improve the quality of life.

Withdrawal

The treatment of drug addiction takes time. As a rule, the remedy must not be discontinued overnight. Instead, the dose is gradually reduced under medical supervision. Dose reduction and ultimately complete withdrawal can trigger both mental and physical withdrawal symptoms. In particular, if severe withdrawal symptoms are expected, this withdrawal must be performed inpatient (for example, in the hospital) or semi-stationary (for example, in a day clinic).

stabilization phase

After the withdrawal, the patient must learn to use alternative sedation methods instead of medication during stress or tension. Such procedures can be learned but require regular practice and professional guidance. An important prerequisite for the successful treatment of drug addiction is the willingness of the patient to actively participate. For this it is necessary to make it clear to the person concerned that the drugs no longer reduce the symptoms that occur, but generate these and other problems and are thus harmful.

The treatment of mental comorbidities

Just as important as the actual therapy of drug addiction is the treatment of possible psychic comorbidities. Often mental disorders, such as depression or anxiety disorders are the basis of drug addiction. Since the patient has so far only tried to relieve his symptoms with tablets, it is important to provide him with psychotherapeutic coping mechanisms. A common problem is the fear of the patient, without being able to cope with the medication. Through anxiety management training, the therapist strengthens the patient’s confidence in their own coping skills. In individual and group therapies, the person concerned has the opportunity to work on other psychological problems related to drug addiction.

Drug addiction: disease course and prognosis

A drug addiction usually arises creeping. The patients complain to the doctor about fears, sleep disorders, other mental complaints or pain. The doctor therefore prescribes a drug for them, which at least partially achieves the desired effect for the time being. However, if an underlying mental disorder is not recognized and not treated appropriately, symptoms reappear after some time. The person concerned tries to control them with an increase in the dose of the drugs, without knowing that he is even exacerbating the symptoms.

Drug addiction can often go undetected for many years or even decades, as drug intake is often considered to promote good health in society. It is not easy for the drug addicts themselves or their friends and family members to notice the disease. The consequences of drug addiction are only visible on closer inspection. Especially with a low-dose dependency, those affected continue to be socially and professionally fully involved.

If drug addiction to psychotropic drugs is present for a long time, the withdrawal is psychologically and physically very stressful. Therefore, the cessation of drug addiction should never be done without professional help. Withdrawal symptoms are different depending on the active ingredient. This can be after ten days or even after six weeks. Experts believe that when taking benzodiazepines after a period of three months in 25 percent of patients use withdrawal symptoms. After one year, this rate rises to 80 percent. Outpatient or inpatient therapies can also be used to successfully treat drug addiction after some time. The sooner the drug addiction is recognized, the better are the chances of recovery.