Medical drug abuse and dependency

Doctors prescribe medications to alleviate specific symptoms and treat illnesses. That means that a prescribed medication is intended only for treatment of the illness for which it was prescribed.

Drug abuse is when a person

• takes a drug for an illness or symptoms for which it is not intended
• takes a drug at a higher dose than what was prescribed
• uses a drug for purposes other than those intended
• takes a drug for a longer period of time than prescribed

Harmful use is when physical or psychological consequences are already apparent. 

A typical indicator of abuse is if a drug has harmful effects on the psyche or the body of the person taking it, or on other persons. If drug abuse continues over a long period of time, it becomes habitual and can result in drug dependency.

It is estimated that 2.7 million people in Germany between the ages of 18 and 60 take medication in harmful quantities or are dependent on them. Since the risk of drug dependency increases with age, the overall statistics are significantly higher.

Drug dependency appears in people of all ages and social groups. Older people are particularly dependent on sedatives, and women more often than men. Approximately two-thirds of all drug-dependent women are over 65 years of age. 

However, the group of people more prone to dependency on opium-based painkillers are younger people between the ages of 20 and 40. Here, men are more often affected than women.

Mental illnesses and the concurrent use of sedatives and opioids in higher doses can also play a role in the development of a drug dependency.

The medications that are most often abused are over-the-counter painkillers such as ibuprofen or diclofenac. 

At the top of the list are also laxatives, decongestant nose sprays, diuretics, and drugs that contain alcohol.

Some medications requiring a prescription, particularly sleeping pills and sedatives belonging to the group of benzodiazepine and opium-based painkillers such as tramadol and fentanyl often lead to abuse, harmful consumption, and dependency. Z-substances also fall into this category: they are benzodiazepine-like sleeping pills and sedatives.

The way in which parents handle medication themselves can influence a child’s propensity for drug abuse. For example, children with parents who turn to medication quickly when they have common ailments such as headaches, are more prone to drug abuse. A study has shown that approx. 20 percent of 14-16 year-old girls take painkillers almost daily. These girls have grown up in a “painkiller household”.

Furthermore, many people feel overwhelmed by their private and professional lives. They are under pressure to perform and compete, and they cope by taking sleeping pills and sedatives. They take medication as a way to manage stress, and often for longer than recommended. 

The use of medication that can result in dependency is also increased by life events such as retirement, menopause, or traumatic experiences such as the death of a loved one. Long-term treatment of chronic conditions or concurrent treatment of multiple conditions can also lead to abuse and dependence.

People who visit a doctor and complain of long-standing symptoms that are difficult to diagnose are at high risk for drug dependence.

These are often psychological symptoms such as feelings of being overwhelmed or overworked, sleep disturbances, anxiety, or dejection. So called psychosomatic symptoms also frequently occur; these can only be partially explained by physical causes. Typical symptoms are physical dizziness, palpitations, or gastrointestinal problems. Such complaints are then often treated with benzodiazepine-type sleeping pills and sedatives over a long period of time.

People with chronic headaches or migraines, who regularly take over-the-counter pain medications, are at increased risk for abuse or harmful use. Regular use of opioid painkillers can also lead to drug dependency. The same applies, for example, to people who regularly resort to painkillers due to psychosomatic pain.

A dependency develops insidiously. A person’s dependency can develop gradually, first starting as normal use that turns into harmful use. 

Medical professionals define drug dependency based on six criteria. A patient must meet at least three of these within the past year.

These criteria are:

• strong desire and/or compulsion to use the drug
• loss of control over the start, amount and/or end of consumption
• physical withdrawal symptoms upon cessation or reduction of use
• need for increasingly higher doses to achieve the desired effect of the drug
• increased neglect of other pleasures or interests in favor of substance use; increased time spent obtaining the drug or recovering from the effects of use
• continued substance use despite clear physical or psychological harm of which the user is aware

Treatment for a drug addiction consists of withdrawal therapy along with psychotherapy.

One component of the therapy is not to discontinue use of the medication abruptly (if the medication is medically necessary), but to phase it out.

People with a drug addiction may be admitted as inpatients to specialized detoxification facilities. There, they receive additional medications to help with complications that may arise during withdrawal.

For example, to treat addiction to benzodiazepines or opioid painkillers, the following options may be considered:

Withdrawal from benzodiazepines

The average withdrawal period in the clinic is 3 to 6 weeks. Outpatient withdrawal, on the other hand, often lasts a few months to a year. The goal of therapy is to gradually reduce the dose. 

Withdrawal from opioid painkillers

Depending on the severity of the addiction, withdrawal takes place on an inpatient or outpatient basis. A prerequisite for successful withdrawal is adequate pain management and, if necessary, physical and relaxation therapy.

Withdrawal treatment after inpatient withdrawal

Withdrawal treatment is carried out at a specialized outpatient facility, day clinic, or inpatient facility, for example in the form of medical rehabilitation. The rehabilitation measures are financed by the German pension insurance institution.

Aftercare

Aftercare is offered by outpatient counseling and treatment centers approved for this purpose. Aftercare consists, for example, of weekly group therapy sessions to review what has been learned and maintain motivation to remain abstinent in daily life. Involving addiction self-help groups has also proven effective.

To prevent medical drug dependency from occurring, there are two things to keep in mind:

• Correct dosage: the drug should always be made available in the smallest package size and taken at the dose indicated for the condition.
• Short-term use: ideally, the medication should be taken for as short a time as necessary. Long-term drug treatment should always be carefully considered.

The telephone information service provided by the Federal Center for Health Education (BZgA) also provides support in all matters relating to addiction prevention.

Counseling centers such as the Federal Center for Health Education (BZgA) offer an online portal with information about local counseling centers.