Similar diagnostic criteria as for alcoholism apply for addiction to medication (e.g. sedatives, hypnotic and analgesic drugs). However, also patients who need a pharmaceutical preparation for medical reasons, may feel dependent. On the other hand, this may also be used to justify improper use. There is only a very fine line between a healing and an addictive substance. Furthermore, low doses can also make dependent, e.g. in the case of benzodiazepines.
The number of people addicted to medication in Germany is estimated to be between 1.4 and 1.9 million (2007); sedatives are taken by elderly people for an extended period which is quite problematic. 5% of medicines have an own addictive potential. The main players are benzodiazepines and the “Z substances“. They often go along with multiple dependence, mostly opioid dependence. Besides, a cross-tolerance exists between benzodiazepines, barbiturates, alcohol and clomethiazole. Substance abuse is also found for non-steroidal anti-rheumatic drugs (NSAR) such as Diclofenac, Ibuprofen and Propyphenazone. Drug habituation is also possible for mixed analgesics, e.g. acetylic salicic acid, paracetamol and caffeine (Thomapyrin intensive etc.).
Below is a brief overview of used substances:
- Benzodiazepines are: e.g. Rohypnol, Tavor, Diazepam, Adumbran, Lexotanil, Rivotril
- Benzodiazepine analogues or Z-substances are: e.g. Zopiclon, Zolpidem and Zaleplon (Sonata)
- Opiates are: e.g. Morphine, Hydromorphon, Oxycodon and Fentanyl. Even heroin and polamidone are opiates
- Opioid analgesics are: e.g. Tilidine, Tramadol, Buprenorphin and Codeine
Specific groups with a particular risk of becoming addicted are hard to define because no clear indicators can be identified. Many people feel overwhelmed in their relationship and work environment, which is reinforced by the competitive pressure of an achievement-oriented society. People take medicines as a means of coping with external stress and internal tension, especially when the work and life are out of balance, when relaxation is lacking or recreation fails.
Conditions which often go along with a dependency from medicinal substances are depressive syndrome, anxiety disorders, personality disorders, chronic pain syndrome and a preexisting addictive syndrome.
Because these medicines are often prescribed by doctors, patients are not even aware of a problem. According to the Pharmacists’ Professional Code (Apothekenbetriebsordnung), pharmacists are obligated by law to refuse to issue of a medication if abuse is suspected. It must in any case be assumed that there is a considerable number of undetected cases. This is also due to the fact that the condition usually is not apparent or only becomes apparent at an advanced stage of the disease; for a long time, people affected by the condition may be very well integrated in their social environment, be performance-oriented and appear adjusted.
Withdrawal usually takes longer than in the case of alcohol. For some medicines, the body can build up depots of up to 2-3 weeks so that withdrawal symptoms may only appear after this period of time. The withdrawal of medicinal substances requires a highly customized therapy plan which is set up together with the patient.
In the case of benzodiazepines, for example, we lower the dose by fractions and give accompanying medication with seizure prophylaxis in the form of an anti-epileptic drug and with close monitoring of the patient’s cardiopulmonary and metabolic situation. Our concept allows for sufficient and comprehensive psychotherapeutic support during detox and in the weaning stage. The treatment approach also includes mental, psychosomatic and physical comorbidities.
Patients learn to feel their own body again, to sense and express feelings and needs in a more differentiated manner, to process conflicts and to find new, more adequate problem solutions. The therapy will reduce the tendency to perceive inner pain as physical pain and to take pain killers instead of feeling sadness and anger.