Tablet addiction: When the doctor becomes a dealer
At night, she rolls in bed for hours and ponders: about the rates for the house, the boss, her ex-husband. In the morning she feels utterly worn down and screams at the children. Immediately she is sorry. What if she makes mistakes at work now? Especially now, where are deleted anyway places? Something has to happen. She goes to the doctor. And he prescribes her first a sleeping pill.
For a few weeks, says the doctor, so that she comes to rest again. And that this may not be a permanent condition, because these tablets make dependent. I do not, "she thinks," that has never been my problem. " She takes the first pill in the evening and wakes up in the morning like newborn. 20 days later the pack is empty, she needs a new recipe. The doctor pushes it this time a bit unwillingly over the table and explains: "In the long term, but you have to come up with something else!"
Doctors promote tablet addiction by frivolous prescribing
But a few weeks later, the fears, the sleep disturbances, the irritability suddenly return. Now also abstain from sleeping pills? This is by no means possible. The doctor does not tell her that the new problems have not occurred despite, but because of the drug. And that may have already begun the entry into the addiction.
This is the story of a scandal that is repeated day after day in Germany: doctors prescribe sleep and sedatives lightly, although their addictive effects have been known for decades. An unpublished study by the Institute for Interdisciplinary Addiction and Drug Research in Hamburg now proves the whole, dramatic extent of this silent addiction. In contrast to all medical guidelines, 800,000 people in Germany permanently take so-called benzodiazepines: prescription drugs with a high search risk.
Another 130,000 are so heavily dependent on them that they will hardly be able to get away without targeted, technical help. How risky the drug is, which is marketed in dozens of drugs, proves another number: Each (or each) second, who gets a prescription for a benzodiazepine for the first time slips into the - medically prescribed - drug abuse.
Is it still true, the much cited picture of the dealers in white? Yes and no. There are far too many of them, as evidenced by the new study: Doctors who unhesitatingly pick up the prescription block when people complain of sleep disturbances or restlessness. But there are also patients who go from one practice to another, inventing fears and serious illnesses in order to get their addictive substance.
And there are all stages in between: the tacit agreement between the doctor and the patient, for example, to end the visit to the consultation as quickly as possible with a prescription. If it is still a private decree, the silent addiction virtually eludes any control by the health insurance companies. About 56 percent of benzodiazepines prescribed as sleeping pills, as the Bremen pharmacologist Gerd Glaeske found out, are now being paid by patients out of pocket. In 1993, this share was only 13.7 percent.
Women are twice as likely to be addicted as men.
For most patients the price is not a problem. Compared to other addictive drugs benzodiazepines are cheap, namely to have from 50 cents per pill. In addition, more and more prescriptions for a new type of sleep and tranquillizer are issued: So-called non-benzodiazepines are now prescribed three to four times as often as in 1993. Experts like Dr. med. Rüdiger Holzbach, who heads Lippstadt, Germany's only focal point for drug withdrawal, observes that these new drugs can be just as dependent. But this often only becomes visible after years or decades.
This is particularly bad for women - they suffer, according to the numbers of the "German main office for addiction issues", about twice as often as men at a drug dependency. And a completely new, nationwide survey of the DAK shows: One in four women in Germany (and about one in eight men) has already taken medication to improve mental capacity or mental health. Top of the list of female complaints: depressive moods, anxiety, nervousness, restlessness - all symptoms against which benzodiazepines and non-benzodiazepines are prescribed.
"For many women it is a secret that they take these medicines, they never leave the house without pills, but they do not talk about it," observes Jörg Otto, a psychologist at the Berlin-based Vivantes-Klinikum am Urban. It happens in all age groups and social strata, but many have the same motives: "For women, the desire to keep working is the consistent theme," says addiction specialist Holzbach.
More and more stress in everyday life can lead to tablet addiction
Kerstin Gerlach, a general practitioner and psychotherapist in Prenzlauer Berg in Berlin, experiences the consequences of more and more everyday stress in her practice every day. Whether students, young professionals or parents of toddlers come to her: In the foreground of the complaints are often sleep disorders, but behind the misery rolls up. The pressure to always give 160 percent in the job, the uncertainty of short-term employment contracts. In addition, the stress comes from working hours against every biorhythm, through shiftwork - because the organism no longer has a chance to come to rest. And especially the single mothers just suffer from chronic overload. "
Especially single mothers suffer from chronic overwork.
Nevertheless, she prescribed benzodiazepines to only four of her 800 patients in the last quarter. But the alternatives to the fast-acting pill challenge both sides more time and effort: "It's about reviewing lifestyle habits, learning how to relax, doing sleep advice, and often it's a mosaic of building blocks that needs to mesh."
The handle to the pill box is closer to many, also because they do not know the fatal consequences. Because the drug dependence acts outwardly rather unspectacular: the sufferers do not slide into an addiction, as they are known by junkies or alcoholics, but just suffer silently to himself. Holzbach explains her illness in countless further training courses, usually in three stages: in phase one, patients remain disciplined at the once prescribed dose.
The tablet addiction leads into a fatal downward spiral
But her body, which has become used to the drug quickly, produces the symptoms of drug withdrawal after only eight weeks: sleep disorders, irritability, fears and often a bad body feeling. Those affected do not suspect that they are suffering from the side effects of their medication, but believe that their problems have become even worse. In phase two, many are starting to increase their daily dose; they now take two to three tablets. The result: they have less and less energy, can no longer think clearly, become forgetful and emotionally dull. Only in the third phase does dependency become a massive addiction in which everything revolves around the vicious circle between procurement and withdrawal.
People who suffer from anxiety disorders in the psychiatric sense can easily get into this fatal downward spiral. According to the Göttingen psychiatrist and anxiety expert Prof. Borwin Bandelow, 58 percent of these patients are prescribed benzodiazepines by their physicians, even though there have been better and less risky treatment options for them.
By the thoughtless prescription of tranquillizers but just as those are endangered who just want to continue working, although overload and existential anxiety rob them of sleep at night. "Many of my patients say: Actually, I do not like any medications," says the addiction specialist Holzbach. And then dependency will not let her go anymore. Because with the handle to the recipe block the doctor has prescribed an additional, serious problem.
By prescription, the doctor prescribes an additional, serious problem.
Withdrawal of benzodiazepines is no pleasure. Slow grading may take months on an outpatient basis, weeks in the clinic and must be accompanied by a doctor. Well, it would be, says the addiction medicine Holzbach, if there were more groups in which those affected can share their experiences. For severe cases there is the therapy station of the LWL clinics Warstein and Lippstadt. There is no need to expect long waiting times there, just as many other addiction centers in psychiatric or psychosomatic clinics where medication-dependent help can be found.
Because many sufferers do not find their way there, mostly do not even really know what problem they have. This will probably only change a little if the silent suffering of hundreds of thousands of drug addicts in Germany is no longer kept silent.
The prescribed tablet addiction - what you need to know
How do you recognize benzodiazepines?
Dozens of tranquilizers and sleep aids (eg Valium, Tavor, Rohypnol, Diazepam) belong to the group of benzodiazepines: They contain active ingredients whose names usually end in -zepam or -zolam. If in doubt, ask the doctor or pharmacist. So-called "non-benzodiazepines" contain the active ingredients zaleplon, zolpidem or zopiclone. Whether these actually make less dependent, is controversial among experts.
How do these funds work?
The active ingredient docks on the so-called GABA receptors of the nerve cells and enhances the effect of the messenger GABA, which is released in case of excitement - the calming effect occurs very quickly and usually without any noticeable side effects. Benzodiazepines are probably very similar to an endogenous substance that has the same effect.The problem: The body gets used to the chemical very quickly, and after a few weeks, the dose would have to be increased to achieve the same effect. This creates a dependency very quickly.
How many of these pills can you take care of?
"A pack of ten is an annual dose," explains Berlin physician and psychotherapist Kerstin Gerlach. This means that benzodiazepines should only be used in acute panic attacks or in other exceptional situations. An intake over a period of more than four weeks is always questionable. This also applies to other sleep and sedatives.
Are there any drug alternatives?
Antidepressants are clearly better for the treatment of depression and anxiety disorders: some of them can also be used as sleeping pills. There are a variety of preparations that are individually very differently tolerated, but not all addictive. The disadvantage of these drugs: An effect begins after two or more weeks. Therefore, some specialists prescribe benzodiazepines to bridge the first phase of treatment.
What side effects do benzodiazepines have?
It can z. As fears, sleep disorders and mood swings occur and give the impression that the basic problem of those affected has worsened. Declining memory, apathy and loss of energy are also possible side effects. With a quick self-test, you can find out if you or your loved ones are affected.
How do you turn off the medication?
Benzodiazepines after prolonged ingestion on any case on their own set off or relatives simply "take away"! The slow tapering of the drug must be medically supported and accompanied.
Where is there advice and help?
Better not with the doctor who has prescribed the drug for years. Ask your local addiction center or addiction ambulance specialist (psychiatrist or psychosomatist) who are familiar with drug withdrawal. More information and addresses of counseling centers, self-help groups and in-patient help can be found here.
