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Dossier: Strong mind

One pill leads to another – addicted to prescription drugs

When you feel you can’t cope without medication: addiction is harmful to health and impacts on your quality of life. You also have to be careful with some prescription drugs. Drug addiction can catch you unawares: What are the first signs and how can you stop it?

Text: Julie Freudiger; photo: iStock

Addiction has many faces. It’s not only drugs, alcohol and tobacco that can be addictive, but also prescription medicines, and it often creeps in and goes unnoticed, because medicines are readily available and considered unproblematic. According to estimates, around 400,000 people in Switzerland take medication every day with a potential risk of addiction. That is alarming. Above all, sleeping pills and sedatives from the group of benzodiazepines, also called “benzos” or Z drugs, and strong pain medication containing opioids put patients at risk of developing an addiction if they are not taken properly.

Dependence on benzodiazepines is third only to nicotine and alcohol dependence in Switzerland. Medication used to treat attention deficit hyperactivity disorder, for example ritalin, can also be addictive and should only be used to treat ADHD. The same applies to cough medicines with the active ingredients codeine or dextromethorphan, which are deliberately overdosed and abused.

“Addiction is an illness that can be prevented and, above all, cured.”

At what point is a person addicted? 

Of course, not all medicines are addictive, even if they are used over a longer period of time. Although many medicines, such as antidepressants, may lead to physical dependence, this is a long way from addiction. The body or mind gets used to the effect and reacts if intake is stopped abruptly. 

So, what is addiction? “An addiction is a medically diagnosable disease, it has nothing to do with lack of willpower,” explains Domenic Schnoz, head of the Zurich Centre for the Prevention of Substance Abuse (ZFPS) “Addiction is an illness that can be prevented and, above all, cured.” For a diagnosis of addiction, at least three of the following six symptoms must have been indicated within the last twelve months: 

  • Strong desire or wish to take the medication.
  • Developed a tolerance to the medication, i.e. when the dose or frequency of intake has to be increased to achieve the same effect.
  • Physical effects of withdrawal as soon as you stop taking the medication or reduce the dose.
  • Little control over the timing and frequency of consumption.
  • Neglect other activities in favour of consumption, obtaining the substance or recovering from consumption.
  • Clearly visible harm as a result of taking the medication. 

However, only a professional can actually diagnose addiction, because the common perception of addiction is often different to the medical diagnosis, explains Schnoz. “Being an addict doesn’t necessarily mean suffering shakes in the morning and immediately grasping for a glass of wine.” 

“Patients also have a responsibility. They have to ask questions, gather information and consider alternatives.”

How prescription drug addiction develops

A person is most at risk of developing an addiction if they take prescription medicines without a medical prescription or if they don’t follow the doctor’s instructions – they either increase the dosage, take it for longer than recommended or without medical necessity. Prescription drug abuse can be life-threatening, especially if taken with alcohol or other substances.

Even if doctors monitor the intake of medication, addiction can occur, although the risk is much lower. Low-dose dependence, for example, is difficult to detect because the dose has never been increased and the withdrawal symptoms are similar to the original symptoms. A patient may therefore experience restlessness and anxiety again after stopping the sleeping pills and sedatives. What then look like symptoms are actually withdrawal symptoms. 

In order to prevent drug dependence, everyone involved has to play a part. “The doctor has to be careful when prescribing medicines and provide support while the patient is taking the medication. But patients also have a responsibility: They have to ask questions, gather information and consider alternatives,” says addiction expert Schnoz. In case of doubt, they should seek a second opinion. First and foremost: Prescription medicines may only be prescribed by the doctor providing treatment and must be coordinated with any other medicines the patient may be taking.

Alternatives and withdrawal

If you suspect that you or a friend or relative of yours is addicted to prescription drugs, you should seek professional help. Going cold turkey on your own isn’t a good idea. First, it’s almost impossible to do on willpower alone and, second, it can have serious and life-threatening repercussions. The type of therapy depends on personal prerequisites and preferences. Options include withdrawal supported by your family doctor at home, outpatient treatment in an appropriate facility or an inpatient stay in a clinic. 

Medication can be an important part of treatment, but it is not the solution to every problem. Sleeping pills and sedatives in particular are usually intended for use in crises and not for long-term use. However, Schnoz points out that alternatives to drug treatment are not one-size-fits-all solutions.

“You have to find out what works for you, be it behavioural therapy, physiotherapy or alternative medicine For example, when it comes to pain management, there are cases where behavioural therapy can be more effective than medication.” Getting more exercise day-to-day, adjusting your lifestyle, sitting less and buying a new mattress are all ways that may help to reduce pain. And sleeping pills and sedatives tend to relieve the symptoms, but they don’t tackle the root of the problem and aren’t really a permanent solution. It is important to address the problem at all levels and to ensure that patients are offered long-term support.

When your nose is running, it can seriously affect your quality of life. Many people turn to nasal sprays for relief. But there’s a catch: Your nose quickly gets used to the effect of the spray and it can cause rebound congestion.

After the effect has worn off, the nasal mucous membranes swell even more than before. This can cause chronic congestion, the mucous membranes dry out and become cracked, often leading to frequent nose bleeds. In the worst case scenario, it can result in a condition called atrophic rhinitis or ozaena, with the dryness of the nasal mucosa leading to the build-up of bacteria that cause a foul smell. As the patient’s sense of smell is damaged, the smell is usually first noticed by other people.

Alternatives include sprays with sea salt solutions or essential oils, and nasal douches. If you’ve already got used to using nasal sprays, your nose will need a “detox”. 

  • Stop straight away: Going cold turkey takes an awful lot of willpower and the risk of relapse is high.
  • Gradual reduction: Once you’ve used half the nasal spray, fill it up with a saline solution. When the bottle is half empty again, fill it up once more with the saline solution. Continue in this way until the bottle only contains saline solution.
  • 1-nostril therapy: get one nostril used to doing without the spray, then start on the other one. 

If your symptoms are severe, you should contact your doctor for advice.