Mental and behavioral disorders caused by sedatives or hypnotics
| Classification according to ICD-10 | |
|---|---|
| F13 | Mental and behavioral disorders caused by sedatives or hypnotics |
| F13.0 | Acute intoxication [acute intoxication] |
| F13.1 | Harmful use |
| F13.2 | Addiction syndrome |
| F13.3 | Withdrawal syndrome |
| F13.4 | Withdrawal syndrome with delirium |
| F13.5 | Psychotic disorder |
| F13.6 | Amnestic syndrome |
| F13.7 | Residual and delayed psychotic disorder |
| F13.8 | Other mental and behavioral disorders |
| F13.9 | Unspecified mental and behavioral disorder |
| ICD-10 online (WHO version 2019) | |
Mental and behavioral disorders caused by sedatives or hypnotics are a group of addiction disorders caused by repeated use of sedatives or hypnotics . Sleep disorders are usually the reason for prescribing hypnotics, with sedatives the aim is to calm down during the day. In Germany, abuse of illegally obtained prescription drugs has so far been mainly observed among users of illegal drugs . Overall, it can be assumed that even when admitted to inpatient treatment, abuse or dependence on medication often remains hidden behind the health crisis that prompted the admission and is not discovered or only discovered at a later point in time. An addiction syndrome is defined by the presence of at least three of the following:
- A strong desire or some kind of compulsion to use psychotropic substances.
- Decreased ability to control the beginning, the end and the amount of consumption.
- A physical withdrawal syndrome upon cessation or reduction of consumption, evidenced by substance-specific withdrawal symptoms or by ingesting the same or a closely related substance in order to alleviate or avoid withdrawal symptoms.
- Proof of tolerance. In order to produce the effects of the psychotropic substance originally achieved by lower doses, increasingly higher doses are required.
- Progressive neglect of other pleasures or interests in favor of substance use, increased expenditure of time to obtain the substance, consume it or recover from the consequences.
- Persistent substance use despite evidence of clear harmful consequences, such as B. Liver damage from excessive drinking, depressive moods as a result of heavy substance consumption or drug-related deterioration in cognitive functions. It should be established that the consumer was actually aware of the nature and extent of the harmful consequences, or at least that it can be assumed. Regular use of sedatives and sleeping pills creates many problems. The consumption of hypnotics and sedatives leads to dependence in the long run. Patients continue to take such a drug with the thought that they need the drug - instead of thinking that they might be dependent on it. Sleeping pills and sedatives only work against the symptoms, not against the causes of the symptoms.
causes
The causes that lead a person to constant consumption are in different areas of life (personal, family, social, with work, legal or in others). There are effective detox therapies . These must be accompanied by medical supervision and treatment aimed at resolving the aforementioned deep-seated issues. The use of sedatives and hypnotics is a serious public health problem these days. The drug addict may deny that he is in trouble with the psychoactive substance (illusion of control); the family also tries to hide the difficulties. There is holding on to the idea that their loved one is not a drug addict. And when he realizes his difficulties through the substance, he begins to blame others for his problems. Another event consists in manipulating or blackmailing the relatives because the addict knows the weak points of each individual. Those addicted to hypnotics or sedatives have the dominant idea: how and when will I consume again? Several authors call this irresistible desire compulsion .
consequences
Possible physical disorders include: seizures , changes in heart rate, and disorders of the central nervous system . The sedatives and hypnotics can also cause digestive and heart diseases. In very high doses they can cause acute poisoning, which can lead to death. Psychological symptoms include depression , deterioration and weakening of will. The addict literally becomes a slave to drug use and can do anything to get it. A deterioration in personal relationships takes place: the drug addict is no longer able to maintain his stability or his healthy relationships with family or friends. You may steal or cheat to get these drugs, which further worsens trust and contact in emotional relationships. Poor performance at work or studies extends to abandoning goals and plans. These drugs are used as the only solution . There are social consequences: The addict can become involved in aggression or violent conflict due to the loss of his assertiveness. Crimes such as robbery or murder can be committed while under the influence of the drug. There are also economic consequences: the consumption of sedatives and hypnotics can be very expensive and can lead the addict to devote all of his or her assets and other resources to maintaining consumption. Rehabilitation centers are not an option to help. A person can be physically, emotionally and psychologically dependent on the substance used. These addictions can result in him getting the drug in any way, which directly affects his place in society and in the family environment. These circumstances can lead to his abandonment of his family and work, as well as making legal and / or illegal substances his priority. He is unable to follow self-control, which leads to significant economic and emotional losses. For many people, drugs are an easy option because they found a false refuge from reality without realizing that they were falling into an abyss. The abuse of drugs in an accidental or compulsive manner can be viewed as an escape behavior that is sustained by its immediate consequences. The habit of use is reinforced by carrying out the drug beforehand with a pleasant effect (positive reinforcement) or as negative reinforcement such as relief from pain, anxiety, or insecurity. Secondary or social reinforcement is independent of the pharmacological effects of the sedative or hypnotic and can play an important role. Contact with these drugs can lead to a certain social status, enables treatment or entry into a certain area. Sometimes this social reinforcement extends the individual's experimental behavior until he or she appreciates the primary effect of the drug or tolerates the side effects. This is very typical of socially accepted drugs and has similarities to tobacco use. Dependence on sedatives and hypnotics is a socio-economic problem that affects us all. Sedative and hypnotic addicts are ill, need understanding, moral and emotional support from those around them, and, since some of them are very difficult to cure, the intervention of professionals.
Neurological effects
Sedatives and hypnotics disrupt the neurological and biological mechanisms, neurotransmitters, that transmit messages between the cells of the nervous system and are absorbed into specific receptors in the brain. Under normal conditions, these receptors receive the body's own substances (endorphins) that have calming properties and create a feeling of pleasure. The effects of those drugs on the brain include mental decline and hostile behavior.
statistics
In 2005, the United States recorded approximately 22,400 deaths from prescription drug use, 32% of which were opioids . In the United States, prescription drug abuse is the number one post-cannabis-related drug-related problem, with 6.2 million people abusing them in 2008, more than total cocaine, heroin, hallucinogens, MDMA (ecstasy), and inhalable drug users; According to estimates, 1.4 to 1.9 million people in Germany are dependent on pharmaceutical preparations. In Canada, in most major cities, most opioid users abuse prescription opioids such as hydromorphone, morphine, and oxycodone. In several European countries (France, Italy, Lithuania, and Poland), 10 to 18% of students use sedatives without a prescription, and INCB warns that prescription drug abuse is the most dangerous for the vulnerable group, children and adolescents, and underlines that in its report Problem of abuse of opioids sold under the trade names Oxicontin and Vicodin, which have caused deaths in young people worldwide. Because of its potential for abuse and addiction, many prescription drugs have been classified in the same category as opium or cocaine by the Drug Enforcement Administration (DEA). The most commonly used substances include: Ritalin and Dexedrin (stimulants) and the analgesics OxyContin, Demerol and Roxanol. More than 95 percent of the states that are members of the United Nations are party to the three treaties (the 1961 Single Convention on Narcotic Drugs, the 1971 Convention on Psychotropic Substances and the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances from 1988).
Benzodiazepines
As harmful use of benzodiazepines (before the introduction of ICD-10 : Abuse of benzodiazepines ) that consumption is of anxiolytic and sedative action polycyclic organic compounds referred to, which leads to physical or mental health impairment.
In the case of benzodiazepines , severe physical dependence can develop after a relatively short period of time even at therapeutic doses (i.e. when taken as intended) . This is characterized by no increase in dose, so that the WHO dependency criteria can only be applied to a limited extent.
As early as 2007, the German Medical Association pointed out in the guideline “Medicines Harmful Use and Dependence” that there is a risk of dependence with continuous use, even at low doses. This form of dependency is also called "low dose dependency" .
Possible damage to health are:
- Disturbances of the memory function ( amnestic disorders ), especially with high doses and with substances that develop rapidly (such as alprazolam , diazepam , lorazepam and flunitrazepam )
- Behavior disorders in combination with alcohol (even in small amounts),
- paradoxical effects with an increase in anxiety or sleep disorders under medication
- psychomotor slowdown with an increased risk of accidents, especially in older people and when using long-acting substances.
The general guidelines for the therapeutic use of benzodiazepines in 2008 stated that these drugs should be given with a clear indication (i.e. clearly justified), in the lowest possible dose for the shortest possible period and no longer than a few weeks in total.
It is estimated that there are around 1.5 million benzodiazepine addicts nationwide, two thirds of whom are elderly women (as of 2016).
In 2017, significantly more alprazolam was sold via darknet markets than ever before. About half of sales went to the US, about 22% to the UK, 10% to Canada, and 10% to Australia.
See also
Individual evidence
- ↑ a b c Karin Mohn, with the collaboration of Cornelia Plenter: Possibilities and deficits in the accessibility of selected target groups (socially disadvantaged women and the elderly) through measures and materials to reduce drug abuse and dependence. (PDF) Assessment based on current research results and examples from practice. German Central Office for Addiction Issues, 2007, accessed on September 26, 2019 .
- ↑ Sleeping pills and sedatives at work. (PDF) Information and help for business multipliers. German Central Office for Addiction Issues, 2007, accessed on September 26, 2019 .
- ↑ Stephanie C. Licata, James K. Rowlett: Abuse and dependence liability of benzodiazepine-type drugs: GABAA receptor modulation and beyond . In: Pharmacology Biochemistry and Behavior . tape 90 , no. 1 , July 2008, p. 74-89 , doi : 10.1016 / j.pbb.2008.01.001 .
- ↑ Drug addiction. (PDF) Addiction Medical Series Volume 5. German Central Office for Addiction Issues, 2013, accessed on September 26, 2019 .
- ↑ a b medication. (PDF) Basic information. German headquarters for addiction issues, 2004, accessed on September 26, 2019 .
- ↑ www.bundesaerztekammer.de (2007): Medicines with potential for abuse and addiction (pdf)
- ^ Mathias Berger (Ed.): Mental illnesses - clinic and therapy. 3. Edition. Elsevier, Urban & Fischer, 2008, ISBN 978-3-437-22481-2 .
- ↑ Christiane Berg: Just a brief blessing . In: PTA Forum . No. 11/2016 , 2016, ISSN 2364-2149 ( pharmazeutische-zeitung.de ): "Glaeske stressed:" benzodiazepine dependence is female. ""
- ↑ theguardian.com February 5, 2018: Xanax misuse: doctors warn of 'emerging crisis' as UK sales rise .
