Drug addiction

Julia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.

More about the experts All content is checked by medical journalists.

With drug addiction, those affected develop an almost uncontrollable desire for a certain drug. Such a dependency can develop, for example, with long-term use or too high a dosage of a drug. Above all, painkillers, sedatives and sleeping pills have a high potential for addiction. In the event of addiction, their withdrawal leads to physical and psychological withdrawal symptoms. A drug addiction usually occurs gradually and is often only discovered late. Read everything you need to know about drug addiction here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F11F19

Brief overview

Description: physical and psychological dependence on a drug, often sedatives, sleeping pills, painkillers, stimulants
Symptoms: Loss of control over time and duration of consumption, strong desire for the addictive substance, neglect of interests and tasks, physical and psychological withdrawal symptoms
Causes: Permanent prescription of addictive drugs by the doctor, improper use of a drug, severe emotional stress
Diagnosis: Criteria include withdrawal symptoms, loss of control, development of tolerance, high procurement costs, neglect of tasks and interests, concealment of consumption, prolonged use,
Treatment: withdrawal, outpatient or inpatient therapy, behavioral individual and group sessions
Prognosis: gradual progression, addiction often goes unnoticed for a long time, coping possible with therapeutic help

Drug Addiction: Description

In general, the term “addiction” is associated with alcohol or drug addiction. But drugs can also be addictive. According to experts, drug addiction is actually a fairly common problem. After stopping the respective preparation, those affected develop physical or psychological withdrawal symptoms or both.

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 drug addicts. Two thirds of them are women. Regardless of gender, older people are more often affected than younger people. Experts believe that far more people suffer from drug addiction than is known. Often the addiction is not recognized. Thus, the number of unreported cases is probably high.

Differentiation between drug abuse and drug addiction

Doctors differentiated between drug addiction and drug abuse. Medication abuse always occurs when drugs are used in a way other than that intended by the prescribing doctor. This is the case when a drug is used for too long, in too high a dosage or without medical necessity. Drug abuse is often the first step on the path to drug addiction. One speaks of drug addiction only if the drugs consumed affect the psyche (psychotropic drugs).

Differentiation between physical and psychological dependence

If people with a drug addiction stop taking the drug in question for a certain period of time or take it in too low a dose, withdrawal symptoms can occur. In the case of physical dependence, physical withdrawal symptoms such as headache, nausea, inner restlessness and, depending on the active ingredient, a variety of other complaints occur after stopping the drug. The psychological dependence manifests itself primarily in a strong desire ("craving") for the drug. Withdrawal from the drug has no physical effects, but it is still difficult for those affected to endure. He feels that he absolutely needs the drug and would like to experience the often mood-enhancing effects again.

Drug Addiction: Symptoms

The symptoms of drug addiction occur when the person concerned no longer takes the corresponding medication for a certain period of time or takes it in too low a dose. There are then both physical and psychological withdrawal symptoms.

In the case of some drugs, the improperly used active ingredient can itself cause symptoms. For example, some drugs can cause profound personality changes when used in excess.

The drugs with the highest potential for addiction are the following substance groups:

Sleeping pills and sedatives such as benzodiazepines
Stimulants and appetite suppressants (stimulants), for example amphetamines
Pain relievers and narcotics such as opioids

Drug addiction: sleeping pills and sedatives

The doctor often prescribes benzodiazepines for anxiety disorders, sleep disorders or signs of stress. Benzodiazepines are drugs that can be obtained from pharmacies on a prescription. They have an anxiety-relieving, relaxing and calming effect and are also known as tranquilizers (Latin: tranquillare = to calm down). Sleeping pills can be a great relief, especially in acute stressful situations. With both drug groups, however, it is true that too long use can lead to drug addiction. Sleeping pills and sedatives should therefore generally not be taken for more than four weeks.

Symptoms: If sleeping pills and sedatives are taken over a long period of time, they have an enormous potential for addiction. They are both physically and mentally addictive. There is also 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 due to the abuse of sleeping pills and tranquilizers are poor performance, flattening of interests and gradual changes in personality. In addition, there are severe withdrawal symptoms such as weakness, dizziness, tremors, inner restlessness, sleep disorders, nausea, headaches, tremors, anxiety, irritability and seizures. In addition, a so-called reversal of effects can occur. This means that those affected no longer react tiredly and calmly to the drug, but on the contrary over-excited and euphoric.

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 drowsiness (narcolepsy) and attention deficit hyperactivity disorder (ADHD). If those affected take the medication according to the doctor's instructions, drug addiction usually does not develop. However, it does happen that athletes, for example, gain access to stimulants such as amphetamines in order to be more efficient. Appetite suppressant stimulants, on the other hand, are not infrequently used by anorexics. With prolonged use there is a high risk of becoming dependent.

Symptoms: Symptoms of withdrawal are tiredness, psychomotor slowdown, restlessness, sleep disorders and severe depression and even suicidal tendencies.

Drug addiction: painkillers and narcotics

The so-called opioids are used as very effective pain relievers and narcotics (analgesics), especially for very severe and chronic pain. These morphine derivatives also have a mood-enhancing effect.

Symptoms: If the dose or duration of use is incorrect, opioids lead to psychological and physical dependence and the development of tolerance. Your potential for addiction 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 and tremors, sleep disorders, 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, as they do not affect the psyche. However, if misused, these drugs can also be addictive and cause great harm. The following drugs are often misused:

Nasal drops and sprays with decongestant effects

Many patients' bodies get used to the drugs after just five to seven days. If you stop using the drops, your nasal mucous membrane will swell up again immediately. It's very uncomfortable. Since those affected believe that it is another runny nose that is causing their breathing problems, they keep using 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 colonize and form foul-smelling crusts - what is known as a smelly nose.

Laxatives

The intestines quickly get used to the effects of many chemical or herbal laxatives. After discontinuation of the preparations, severe constipation then sets in. The person concerned then resorts to laxatives again. In this situation too, excessive use can lead to a vicious circle that causes 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 referred to as anabolic steroids (from the Greek on ana "to" and balllein "to throw"). The misuse of these hormones is extremely dangerous: since they also stimulate the heart muscle to grow excessively, the risk of sudden cardiac death is increased.

Steroids are broken down in the liver, which, if used in excess, can lead to liver damage and even liver cancer. Other symptoms that can occur with anabolic steroid abuse are increased sweat production, shortness of breath, skin problems (steroid acne), increased blood pressure, increased intraocular pressure, hair loss, prostate growth, breast formation in men (gynecomastia), headache and depression. What is particularly annoying for those affected is that the muscles often lose size again without continuous use of the anabolic steroids.

Female sex hormones such as estrogens are also occasionally misused. They have a reputation for slowing down the aging process (anti-aging effect). However, this effect has so far been controversial. What seems certain, however, is 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 pharmaceutical preparations (including homeopathic medicines), alcohol serves as a carrier substance or preservative for the respective active ingredients. The ethanol content of such drugs is often underestimated. For healthy people, the alcohol content in medication is usually safe. However, people with liver dysfunction, epilepsy or an alcohol problem should better avoid drugs containing alcohol. Otherwise there may be severe interactions between drugs containing alcohol and other drugs. For example, opioids are enhanced in their effects by alcohol. The long-term use of drugs containing alcohol can also make people dependent on alcohol 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 drugs with addictive potential too carelessly, the patient can slide into drug addiction. Often, however, it is the patient himself who uses a medicinal product improperly, for example because he or she 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 often prescribe painkillers or sleeping pills to relieve your symptoms. Particularly at risk are people who suffer from diffuse, difficult-to-understand symptoms that cannot be remedied for a long time. In these cases, the doctors often do not know what else to help the patient than to continue to prescribe painkillers and sedatives. The risk of drug addiction is then often either overlooked or even accepted.

The danger of iatrogenic drug addiction exists above all if the doctor cannot make a causal diagnosis, but rather uses the drugs to treat the symptoms purely on the basis of symptoms. This is particularly problematic if physical symptoms such as insomnia, headaches or other complaints are an expression of a mental disorder such as depression or anxiety disorder.

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 tablets. However, there is little chance of success, especially with psychological triggers, through purely symptomatic pharmacotherapy. If the symptoms do not go away, some patients increase the dose without consulting their doctor. They fail to realize that the symptoms are not adequately treated by the drug treatment and that the drugs themselves can even make them worse. In this case one speaks of a high dose dependency.

Long-term prescribing of some psychotropic drugs is particularly dangerous. Due to the extensive educational work on drug addiction, it is now common practice to prescribe risky drugs for a few weeks at the most. 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 if there is a low dose dependency. A low dose dependency in drug addiction is when the patient is addicted to the active ingredient even though he is only taking a low dose. The dose is then 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 about the drugs becoming less effective. This phenomenon is especially known with some sedatives (benzodiazepines).

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

Experts suspect that personal and social backgrounds in particular can be a decisive factor in the development of drug addiction. For example, it has an impact when someone learns in childhood to safely take medication for a headache or other malaise. On the one hand, the widespread attitude plays a role in coping with any complaint by swallowing a pill. On the other hand, the pressure to perform and competitive in society means that many people suppress pain and illness because they do not want to show weakness to those around them. Some people also need the medication in order to withstand the psychological pressure of the performance-oriented society at all.

Science has long 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 “the 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 drugs and other substances. Girls are particularly susceptible to drug abuse with the onset of menstruation. They often take pain relievers, sometimes even preventively, for example for period pain, but also for stress-related tension headaches. According to the German headquarters for addiction issues, studies in schools found that 20 percent of pubescent girls take pills almost every day.

A person's genetic makeup could also play a role. To clarify this, family and twin studies were carried out. So far, however, the genetic studies on drug addiction have not yielded any clear findings.

Gender differences

When there are problems in their 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. The “stronger sex”, on the other hand, takes refuge in alcohol significantly more frequently in stressful situations. There are, however, other gender-specific differences in drug consumption: Overall, women are more often undergoing medical treatment than men and therefore also take more drugs. Women are also prescribed psychotropic drugs or sleeping pills and sedatives much more often than men.

Age as a risk factor

Many drug groups that harbor the risk of drug addiction are prescribed more frequently with increasing age. These include, for example, pain relievers and various psychoactive substances (especially benzodiazepines). The consumption of psychotropic drugs is particularly high among seniors who live in old people's and nursing homes.

As people get older, they generally take more medication than they did when they were younger - not least because the number of diseases increases with age. If a person suffers from diabetes, cataracts, insomnia and high blood pressure at the same time and is in some cases cared for by several doctors, the list of prescribed medications grows, in some cases dramatically. This not only increases the risk of abuse and addiction, but is also associated with other health risks: For example, there may be unpredictable interactions as well as ingestion errors because the many tablets overwhelm the patient.

The correct dosage is also a source of danger: changes in 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 a lower dose of many drugs than people of younger age. However, this is not always sufficiently taken into account, so that many elderly patients receive too high a dose.

Drug abuse for intoxication purposes

In these cases, those affected are not concerned with alleviating medical complaints. 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 medication from a doctor with a prescription, they try to obtain these medication illegally, for example from foreign pharmacies or through falsified prescriptions. Usually they also consume other substances, such as alcohol or cocaine, to increase the intoxication. By combining them with other active ingredients, the effects of certain drugs can be increased or decreased again. The combination with alcohol in particular harbors unpredictable risks. If alcohol is taken together with benzodiazepines, the effect is not only intensified, it also leads to cross-tolerance in the long term. This means that tolerance effects with respect to one substance also lead to tolerance towards the other substance. Alcohol addicts therefore need a higher dose of benzodiazepines in order to feel an effect.

Drug Addiction: Investigations and Diagnosis

Drug addiction is sometimes referred to as "secret addiction" because it is often hidden from outsiders. It is also not always clear to patients that they are drug addicts. In contrast to alcohol addicts, for example, there is no obvious evidence of an addiction. Even when symptoms such as fatigue or headache occur, they are rarely associated with medication use. Some people, on the other hand, are well aware of their drug addiction, but suppress it or close themselves off to urgently needed treatment.

The medical examination

The first point of contact if you suspect drug addiction is usually your family doctor. But even doctors usually notice drug addiction late. Often it only becomes apparent when the drug is discontinued and the withdrawal symptoms set in. In order to identify drug addiction early on, the family doctor can ask the following questions, for example:

Do you regularly take medication to calm down or relieve pain, anxiety or sleep disorders? If so, how often?
Do you feel you need these drugs urgently?
Do you have the impression that the effect wears off after a while?
Have you ever tried to stop taking 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 a psychological specialist. The psychologist can determine whether, in addition to drug addiction, there is also a mental disorder that requires treatment.

The diagnosis of drug addiction

The doctor only makes a diagnosis of dependency if the person concerned is taking medication that has an effect on the psyche (psychotropic medication). These include sleeping pills, stimulants, and pain relievers. The most commonly prescribed and consumed group of psychotropic drugs are the benzodiazepines, which have a calming effect.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the diagnosis of drug dependency (drug addiction) requires substance use that leads to impairment and suffering in a clinically significant manner. In addition, at least three of the following criteria must apply to the diagnosis of "drug addiction":

Development of tolerance, which is shown by increasing the dose or reducing the effect with the same dose
Withdrawal symptoms on 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
It takes a lot of time to get the medication
Restriction or abandonment of other work and leisure activities
Ingestion despite awareness of the negative effects

Drug addiction: treatment

If those affected notice the undesirable effects of a drug or if they do not take the drug permanently according to the doctor's prescription, they should seek help urgently. The earlier drug addiction is detected, the easier it is to stop taking the drug. But also those affected who have been taking medication for a long time can be helped with therapeutic and medical guidance. Older people should not shy away from treating drug addiction either, 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 the guidance of a doctor. The dose reduction and ultimately 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 (for example in a hospital) or on a partial inpatient basis (for example in a day clinic).

Stabilization phase

After withdrawal, the patient has to learn to use alternative calming methods instead of medication in times of stress or inner 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. To do this, it is necessary to make the person affected understand that the medication no longer reduces the symptoms, but creates these and other problems and is therefore harmful.

Treatment of comorbid mental illnesses

The treatment of possible psychological concomitant diseases is just as important as the actual therapy for drug addiction. Mental disorders such as depression or anxiety disorders are often the basis for drug addiction. Since the patient has so far only tried to alleviate his symptoms with tablets, 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 fear management training, the therapist strengthens the patient's confidence in their own coping strategies. 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 insidiously. Patients complain to the doctor about fears, 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 identified and treated appropriately, symptoms will reappear after a while. The person concerned tries to get this under control by increasing the dose of the medication, without knowing that he is actually exacerbating the symptoms.

Since taking medication is often viewed in society as a health-promoting behavior, drug addiction can go undetected for many years or even decades. It is not easy for the drug addicts themselves or their friends and family members to notice the disease. The consequences of drug addiction only become apparent on closer inspection. Especially with a low dose dependency, those affected are still fully socially and professionally involved.

If there is a long-term drug addiction to psychotropic drugs, the withdrawal is psychologically and physically very stressful. Hence, drug addiction cessation should never be done without professional help. Withdrawal symptoms occur individually and differently depending on the active ingredient. That can be after ten days or after six weeks. Experts estimate that when taking benzodiazepines, after a period of three months, 25 percent of patients will experience withdrawal symptoms. After a year this rate increases to 80 percent. However, drug addiction can still be successfully treated after some time through outpatient or inpatient therapies. The earlier drug addiction is recognized, the better the chances of recovery.

Tags: medicinal herbal home remedies Diagnosis teeth