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Drug addiction: signs, therapy

by Josephine Andrews
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In the case of drug addiction , those affected develop an almost uncontrollable craving for a specific drug. Such a dependency can develop, for example, with long-term use or too high a dose of a drug. Painkillers, sedatives and sleeping pills in particular have a high potential for addiction. Discontinuation leads to physical and psychological withdrawal symptoms in the event of dependence. Drug addiction usually sets in insidiously and is often only discovered at a late stage. Read everything you need to know about drug addiction here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

F11 F19

quick overview

  • Description : physical and psychological dependence on a drug, often tranquilizers, sleeping pills, painkillers, stimulants
  • Symptoms: loss of control over the timing and duration of consumption, strong desire for the addictive substance, neglect of interests and tasks, physical and psychological withdrawal symptoms
  • Causes: Long-term prescription of addictive drugs by the doctor, misuse of a drug, severe mental stress
  • Diagnosis: Criteria include withdrawal symptoms, loss of control, development of tolerance, high cost of procurement, neglect of tasks and interests, concealment of consumption, prolonged use,
  • Treatment: withdrawal, outpatient or inpatient therapy, behavioral therapy individual and group sessions
  • Prognosis: creeping course, addiction often goes unnoticed for a long time, can be overcome with therapeutic help

Drug addiction: description

In general, the term “addiction” is more associated with alcohol or drug addiction. But medication can also be addictive. In fact, according to experts, drug addiction is a fairly common problem. Those affected develop physical or psychological withdrawal symptoms or both after stopping the respective preparation.

Who Does Drug Addiction Affect?

Drug addiction can be found in all social classes. According to estimates, around 1.4 to 1.9 million people in Germany are dependent on medication. Two thirds of them are women. Regardless of gender, older people are affected more often than younger people. Experts assume that far more people suffer from drug addiction than is known. The dependency is often not recognized. So the number of unreported cases is probably high.

Distinction between drug abuse and drug addiction

Doctors differentiate between drug addiction and drug abuse. Drug abuse occurs when drugs are used in ways other than intended by the prescribing physician. This is the case when a drug is used for too long, in too high a dose or without medical necessity. Drug abuse is often the first step in drug addiction. However, one speaks of drug addiction only when the drugs consumed affect the psyche (psychotropic drugs).

Distinction between physical and psychological dependence

If people with a drug addiction stop taking the drug in question for a certain period of time, or if the dosage is too low, withdrawal symptoms can occur. In the case of physical dependence , after stopping the drug, physical withdrawal symptoms such as headaches, nausea, inner restlessness and, depending on the active ingredient, a variety of other symptoms occur. Psychological dependence primarily manifests itself in a strong desire (“craving”) for the drug . While stopping the drug has no physical effects, it is still difficult for the sufferer to endure. He feels he desperately needs the drug and wants to relive the often mood-enhancing effects.

Drug addiction: symptoms

The symptoms of drug addiction appear when the person concerned stops taking the corresponding medication for a certain period of time or takes the dose too low. Both physical and psychological withdrawal symptoms then set in.

With some medications, the misused active ingredient itself can cause symptoms. For example, overuse of some medications can cause profound personality changes.

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

  • Sleeping pills and tranquilizers, such as benzodiazepines
  • Stimulants and appetite suppressants (stimulants), for example amphetamines
  • Painkillers and narcotics, such as opioids

Drug addiction: sleeping pills and tranquilizers

For anxiety disorders, sleep disorders or signs of stress, the doctor often prescribes benzodiazepines. Benzodiazepines are drugs that are available in pharmacies with a prescription. They have an anxiolytic, relaxing and calming effect and are also referred to as tranquilizers (Latin: tranquillare = to calm down). Sleeping pills can be a great relief, especially in acute stressful situations. With both groups of active substances, however, it is true that prolonged use can lead to drug addiction. Sleeping pills and sedatives should therefore not be taken for longer than four weeks.

Symptoms: If sleeping pills and sedatives are taken over a longer period of time, they have an enormous potential for addiction. They are both physically and psychologically addicting. In addition, there is an increase in tolerance. This means that the dose has to be increased more and more in order to achieve the same effect. Typical symptoms of drug addiction through the abuse of sleeping pills and tranquilizers are loss of performance, flattening of interests and gradual personality changes. In addition, there are severe withdrawal symptoms such as weakness, dizziness, tremors, inner restlessness, insomnia, nausea, headaches, tremors, anxiety, irritability and seizures. In addition, a so-called reversal of effect can occur. This means that those affected no longer feel tired and calm after the remedy,

Drug addiction: stimulants and appetite suppressants (psychostimulants)

The so-called psychostimulants are drugs that increase drive and suppress appetite. They suppress tiredness and feelings of hunger and increase performance and concentration. Stimulants are used in patients with narcolepsy and attention deficit hyperactivity disorder (ADHD). If those affected take the medication as prescribed by the doctor, they usually do not develop a drug addiction. However, it does happen that athletes, for example, gain access to stimulants such as amphetamines in order to be more efficient. Appetite-suppressing stimulants, on the other hand, are not infrequently taken by anorexics. If you take it for a long time, there is a high risk of becoming dependent.

Symptoms: Symptoms of withdrawal are tiredness, psychomotor retardation, restlessness, sleep disorders and severe depression up to a suicidal tendency.

Drug addiction: painkillers and narcotics

So-called opioids are used as very effective painkillers and narcotics (analgesics), especially in the case of very severe and chronic pain. These morphine derivatives also have a mood-elevating effect.

Symptoms: Opioids lead to psychological and physical dependence and the development of tolerance if the dose is incorrect or the duration of use is incorrect. Your addiction potential is high. It must therefore be taken under strict medical supervision. If the painkillers are taken very frequently, the medication can cause a persistent headache (“ medication-induced headache ”). Withdrawal symptoms also include headaches, tremors, insomnia, restlessness, tension, bad mood and impaired consciousness.

Symptoms of drug abuse

Apart from the active ingredients mentioned above, there are other classes of substances that do not cause classic drug addiction because they do not affect the psyche. However, these drugs can also become addictive and cause great harm if misused. The following drugs are commonly misused:

nasal drops and sprays with a decongestant effect

After just five to seven days, the bodies of many patients have become accustomed to the medication. If you stop taking the drops, your nasal mucosa will immediately swell up again. This is very uncomfortable. Since people believe that it is another cold that is causing their breathing problems, they continue to use the nose drops or nasal spray. This can result in a vicious circle. Long-term use can severely damage the mucous membrane of the nose. In extreme cases, bacteria settle and form foul-smelling crusts – a so-called stinky nose develops.

laxatives

The intestine quickly gets used to the effects of many chemical or herbal laxatives. Severe constipation then sets in after discontinuation of the preparations. The person concerned then resorts to laxatives again. In this situation, too, excessive use can lead to a vicious circle, which induces those affected to take laxatives again and again. Laxatives are often misused by people with eating disorders who want to use laxatives to regulate their weight.

growth and sex hormones

Growth and sex hormones are popular doping agents in competitive sports and among bodybuilders. For example, steroids such as the male sex hormone testosterone and its synthetic derivatives as well as the growth hormone HGH (growth hormone ) support the build-up of muscle mass. Such substances are called anabolic steroids (from the Greek on ana “on” and ballein “to 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 when used in excess can lead to liver damage and even liver cancer. Other symptoms that can occur with anabolic steroid abuse are increased sweating, shortness of breath, skin problems (steroid acne), increased blood pressure, increased intraocular pressure, hair loss , prostate growth, breast formation in men (gynecomastia), headaches and depression. It is particularly annoying for those affected that the muscles often lose size again without continuous intake of anabolic steroids.

Female sex hormones such as estrogens are also occasionally misused. They have the reputation of slowing down the aging process (anti-aging effect). So far, however, this effect has been disputed. On the other hand, it seems certain that the excessive use of female sex hormones increases the risk of certain types of cancer such as breast cancer or cervical cancer.

Medicines containing alcohol

In many liquid medicinal preparations (including homeopathic medicines), alcohol is used 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 harmless. However, people with liver dysfunction, epilepsy or an alcohol problem should avoid taking medicines containing alcohol. Otherwise there can be serious interactions between the alcohol-containing medication and other medicines. For example, the effects of opioids are increased by alcohol. The long-term use of medicines containing alcohol can also make alcohol dependent or trigger a relapse in “dry” alcoholics.

Drug addiction: causes and risk factors

Drug addiction usually begins when a doctor prescribes a prescription drug. If he prescribes drugs with potential for addiction too carelessly, the patient can slip into a drug addiction. However, it is often the patient himself who misuses a drug, for example because he appreciates its psychological effects.

Drug addiction caused by the doctor (iatrogenic drug addiction)

Most often, drug addiction begins with the prescription of drugs by the doctor. Older people in particular often come to the practice with sleep problems and chronic pain. The doctor will then often prescribe painkillers or sleeping pills to relieve the symptoms. Particularly at risk are people who suffer from diffuse, difficult to pin down symptoms for a long time, which cannot be remedied. In these cases, doctors often do not know what to do other than continue to prescribe painkillers and tranquilizers. The risk of drug addiction is then often either overlooked or even accepted.

The danger of an iatrogenic addiction to medicines therefore exists above all when the doctor cannot make a causal diagnosis, but instead carries out a purely symptomatic treatment with the medicines. This is particularly problematic when physical symptoms such as sleep disorders, headaches or other complaints are an expression of a mental disorder such as depression or anxiety.

If these hidden causes of drug addiction are not treated, the risk of addiction for the patient is very high: He tries to reduce his symptoms with the help of the pills. However, there is little chance of success with purely symptomatic pharmacotherapy, especially in the case of psychological triggers. If the symptoms do not go away, some patients increase the dose without consulting their doctor. They do not realize that the symptoms are not being adequately treated with medication and can even be made worse by the medication itself. In this case one speaks of a high dose dependency .

A long-term prescription of some psychotropic drugs is particularly dangerous. Due to the large amount of educational work on the subject of drug addiction, it is now common to prescribe risky drugs for a maximum of a few weeks. However, some patients circumvent this safety measure by constantly changing doctors.

However, not all psychotropic drugs are addictive. Antidepressants are not addictive. They should and often have to be taken for months and years.

A pill addiction is not easy to recognize even for the doctor. This is especially true when there is low-dose dependency. Low-dose dependency in drug addiction is when the patient is addicted to the drug even though they are only taking a small dose. The dose is still within the medically prescribed range, but the patient becomes dependent if he takes the medication over a long period of time. A warning sign of low-dose dependency is when the patient complains that the medication is wearing off. This phenomenon is particularly common with some sedatives (benzodiazepines).

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

Experts suspect that the personal and social background in particular can be a decisive factor in the development of drug addiction. For example, it has an influence if someone learns in childhood to safely take medication for headaches or other illnesses. On the one hand, the widespread attitude of overcoming every ailment by swallowing a pill plays a role. On the other hand, the pressure to perform and compete in society means that many people suppress pain and illness because they don’t want to show weakness in those around them. Some people also need the medication to withstand the mental pressure of the performance-oriented society at all.

For a long time, science has also been concerned with the question of whether there is a certain personality structure that makes a person particularly susceptible to drug addiction. So far, one cannot assume that there is “one addict personality”.

However, a high level of impulsiveness and curiosity about the effects of remedies seem to have an influence. Young people in particular are experimenting with the effects of medicines and other substances. Girls are particularly vulnerable to drug abuse when menstruation begins. They often take painkillers, sometimes even as a preventive measure, for example against menstrual pain but also stress-related tension headaches. According to the German Central Office for Addiction Questions, studies in schools found that 20 percent of pubescent girls take pills almost every day.

A person’s genetic make-up could also play a role. To clarify this, family and twin studies were conducted. So far, however, genetic studies on drug addiction have not produced any clear findings.

gender differences

When it comes to problems at work and family, worries or crises, women resort to medication more often than men, which is why there are twice as many cases of drug addiction among them. The “stronger sex”, on the other hand, takes refuge in alcohol much more frequently in stressful situations. However, there are other gender-specific differences in drug consumption: women are treated by a doctor more often than men and therefore take more drugs. Women are also prescribed psychotropic drugs or sleeping pills and tranquilizers much more often than men.

risk factor age

Many groups of drugs that harbor the risk of drug addiction are prescribed more frequently with increasing age. These include, for example, painkillers and various psychoactive substances (especially benzodiazepines). The consumption of psychotropic drugs is particularly high among seniors living in retirement and nursing homes.

Older people generally take more medication than when they were younger – not least because the number of illnesses increases with age. If a person suffers from diabetes, cataracts, insomnia and high blood pressure at the same time and is sometimes being looked after by several doctors, the list of prescribed medication sometimes grows drastically. This not only increases the risk of abuse and addiction, but is also associated with other health hazards: there can be unforeseeable interactions and errors in administration because the many tablets overwhelm the patient.

The correct dosage is also a source of danger: changed metabolic functions and organ disorders (e.g. impaired kidney function) in old age cause the body to break down some drugs more slowly. Therefore, seniors should take lower doses of many medications than younger people. However, this is not always sufficiently taken into account, so that many older patients receive a dose that is too high.

Drug abuse for intoxicating purposes

In these cases, those affected are not concerned with alleviating medical symptoms. 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 medicines with a doctor’s prescription, they try to obtain these medicines illegally, for example from pharmacies abroad or by counterfeiting prescriptions. They usually also consume other substances, such as alcohol or cocaine, to increase the intoxication. The combination with other active ingredients can increase or decrease the effects of certain drugs. In particular, the combination with alcohol harbors unforeseeable risks. If alcohol is taken together with benzodiazepines, the effect not only increases acutely, there is also long-term cross-tolerance. This means that tolerance effects with regard to one substance also lead to tolerance towards the other substance. Alcohol addicts therefore require higher doses of benzodiazepines to feel an effect.

Drug Addiction: Investigations and Diagnosis

Drug addiction is sometimes referred to as a “secret addiction” because it often remains hidden from outsiders. Patients are also not always aware that they are drug addicts. Unlike, for example, with alcohol addicts, there is no obvious evidence of addiction. Even when symptoms such as fatigue or headaches do occur, they are rarely associated with medication use. Some people, on the other hand, are well aware of their drug addiction, but they repress it or close themselves off to urgently needed treatment.

The medical examination

The first point of contact when a drug addiction is suspected is usually the general practitioner. But doctors often notice drug addiction too late. It often only becomes apparent when the drug is stopped and the withdrawal symptoms set in. In order to recognize a drug addiction early on, the general practitioner can ask the following questions, for example:

  • Do you regularly take medication to calm down or for pain, anxiety or sleep disorders? If yes, how often?
  • Do you feel you need these medicines urgently?
  • Do you have the impression that the effect has worn off after a while?
  • Have you ever tried to come off the medication?
  • Have you noticed any side effects?
  • Have you ever increased the dose?

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

The diagnosis of drug dependence

The doctor only makes a dependency diagnosis if the person concerned is taking medication that affects the psyche (psychotropic medication). These include sleeping pills, stimulants and painkillers. The most commonly prescribed and used psychotropic drug group are the benzodiazepines, which have a sedative effect.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a substance use that leads to clinically significant impairments and suffering must be present for the diagnosis of drug dependence (drug addiction). In addition, at least three of the following criteria must apply for the diagnosis “drug addiction”:

  • Development of tolerance, which is shown by an increase in dose or a reduced 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 increased amounts
  • Persistent desire or unsuccessful attempts to control intake
  • A lot of time is required to obtain the medication
  • Restriction or abandonment of other professional and leisure activities
  • Ingestion despite awareness of the negative effects

Drug Addiction: Treatment

If those affected notice undesirable effects of a medication or do not take the medication according to the doctor’s prescription for a long time, they should seek help as a matter of urgency. The earlier drug addiction is identified, the easier it is to stop taking the drug. But those affected who have been taking medication for a long time can also be helped with therapeutic and medical guidance. Even older people should not shy away from treatment for drug addiction, as successful therapy can significantly improve their quality of life.

Withdrawal

Treating drug addiction takes time. As a rule, the drug should not be discontinued overnight. Instead, the dose is gradually reduced under medical guidance. The dose reduction and ultimately the complete discontinuation can trigger both psychological and physical withdrawal symptoms. In particular, if serious withdrawal symptoms are to be expected, this withdrawal must be carried out on an inpatient basis (e.g. in a hospital) or on a part-time basis (e.g. in a day clinic).

stabilization phase

After withdrawal, the patient must learn to use alternative sedation methods instead of medication when stressed or tense. 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. To do this, it is necessary to make the person concerned understand that the drugs no longer reduce the symptoms that occur, but create these and other problems and are therefore harmful.

The treatment of psychiatric comorbidities

Just as important as the actual therapy for drug addiction is the treatment of any accompanying mental illnesses. Psychological disorders such as depression or anxiety disorders are often the cause of drug addiction. Since the patient has so far only tried to alleviate his symptoms with pills, it is important to provide him with psychotherapeutic coping mechanisms. A common problem is the patient’s fear of not being able to cope without the medication. With the help of anxiety management training, the therapist strengthens the patient’s confidence in their own coping strategies. In individual and group therapies, the affected person has the opportunity to work on other psychological problems that are related to the drug addiction.

Drug addiction: course of the disease and prognosis

Drug addiction usually develops gradually. Patients complain to the doctor about anxiety, sleep disorders, other psychological complaints or pain. The doctor therefore first prescribes a drug that initially at least partially achieves the desired effect. However, if an underlying mental disorder is not recognized and treated appropriately, the symptoms will reappear after some time. The person concerned tries to get this under control by increasing the dose of the medication, without knowing that this is actually making the symptoms worse.

Since drug use is often seen as a health-promoting behavior in society, drug addiction can go undetected for many years or even decades. It is not easy for drug addicts themselves, nor for their friends and family members to notice the condition. The consequences of drug addiction only become apparent on closer inspection. Especially in the case of low-dose dependency, those affected continue to be fully involved socially and professionally.

If there is a drug addiction to psychotropic drugs over a long period of time, the withdrawal is very stressful both mentally and physically. Therefore, drug addiction cessation should never be attempted without professional help. Withdrawal symptoms occur individually and vary depending on the active ingredient. This can be after ten days or even after six weeks. Experts assume that when taking benzodiazepines after a period of three months, 25 percent of patients will experience withdrawal symptoms. After a year, that rate increases to 80 percent. With outpatient or inpatient therapies, however, drug addiction can still be successfully treated after some time. The sooner the drug addictionis recognized, the better the chances of recovery.

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