SLEEPING AGENTS To the doctor or to the dealer?

SLEEPING AGENTS To the doctor or to the dealer?

Millions of women in Germany suffer from anxiety and sleep disorders. Far too many doctors carelessly and irresponsibly prescribe them sleeping pills that are addictive. The story of a scandal.
At night, she tosses and turns in bed for hours, brooding about the house payments, her boss, her ex-husband. In the morning, she feels completely demoralized and yells at the children. Immediately she feels sorry. What if she now makes mistakes at work, too? Especially now, when jobs are being cut anyway? Something has to be done. She goes to the doctor. And he first prescribes her a sleeping pill.

For a few weeks, the doctor says, so that she can get some rest. And that this must not become a permanent condition, because these tablets are addictive. "Addictive? Not me," she thinks, "That's never been my problem." She takes the first pill in the evening and wakes up in the morning as if reborn. 20 days later, the pack is empty, she needs a new prescription. The doctor slides it across the table a bit reluctantly this time, explaining, "In the long run, though, you'll have to come up with something else!"

Entering an addiction
But a few weeks later, the anxiety, insomnia, the irritability are suddenly back. Now to give up the sleeping pill, too? There's no way she can do that. The doctor doesn't tell her that the new problems have arisen not despite the drug, but because of it. And that this may be the beginning of her addiction.

This is the story of a scandal that is repeated day after day in Germany: doctors carelessly prescribe sleeping pills and tranquilizers even though their addictive effects have been known for decades. An as-yet-unpublished study by the Institute for Interdisciplinary Addiction and Drug Research in Hamburg now demonstrates the full, dramatic extent of this silent addiction. 800,000 people in Germany - against all medical guidelines - permanently take so-called benzodiazepines: prescription drugs with a high risk of addiction.

A further 130,000 are so severely dependent on it that they will hardly be able to get off it without targeted, specialist help. Another figure shows just how risky the active ingredient is, which is marketed in dozens of preparations: every (or every) second person who receives a prescription for a benzodiazepine for the first time slips into - medically prescribed - drug abuse.

Sleeping pills are prescribed too quickly
So is it still true, the oft-cited image of dealers in white? Yes and no. There are far too many of them, as the study shows: doctors who reach for the prescription pad without hesitation when people complain of sleep disorders or restlessness. But some patients run from one practice to another, who invent fears and serious illnesses to get their hands on their addictive substance.

And there are all levels in between the tacit agreement between doctor and patient, for example, to end the visit to the consultation as quickly as possible with a prescription. If this is also a private prescription, the silent addiction virtually escapes any control by the health insurance companies. Over 56 percent of benzodiazepines prescribed as sleeping pills are now paid for by patients out of their own pockets, according to the Bremen pharmacologist Gerd Glaeske. In 1993, this share was only 13.7 percent.

For most patients, the price is not a problem. Compared to other addictive drugs, benzodiazepines are cheap, starting at 50 cents per pill. Also, more and more prescriptions are being written for a new type of sleeping pills and tranquilizers: So-called non-benzodiazepines are prescribed three to four times as often today as they were in 1993. Experts such as Dr. Rüdiger Holzbach, who heads Germany's only center for drug withdrawal in Lippstadt, observe that these newer drugs can be just as addictive. However, this often only becomes visible after years or decades.

Women particularly affected
This is particularly bad for women - according to figures from the "Deutsche Hauptstelle für Suchtfragen" (German Central Office for Addiction Issues), they suffer from drug dependency about twice as often as men. And a brand new, nationwide survey by the DAK shows: One in four women in Germany (and about one in eight men) have already taken medication to improve their mental performance or psychological state. At the top of the list of female complaints: depressive moods, anxiety, nervousness, restlessness - all symptoms for which benzodiazepines and non-benzodiazepines are prescribed.

"For many women, it's kind of a secret that they take these medications. They never leave home without pills, but they don't talk about it," observes Jörg Otto, a psychologist at Berlin's Vivantes Hospital on Urban. It happens in all age groups and social classes, but many have the same motives: "With women, the desire to continue to function is the consistent theme," knows addiction physician Holzbach.

Kerstin Gerlach, a general practitioner and psychotherapist in Prenzlauer Berg in Berlin, experiences the consequences of increasing stress in everyday life every day in her practice. Whether students, young professionals, or parents of small children come to her: Sleep disorders are often at the forefront of the complaints, but behind them, misery rolls up. The pressure to always give 160 percent at work, the uncertainty caused by short-term employment contracts. Also, there is the stress caused by working hours that go against every biorhythm, by shift work - the organism no longer has a chance to rest. And single mothers in particular simply suffer from chronic overwork."

Alternatives require time
Nevertheless, the doctor prescribed benzodiazepines to only four of her 800 patients in the last quarter. But the alternatives to the fast-acting pill demand more time and effort from both sides: "It's a matter of reviewing lifestyle habits, learning relaxation techniques, conducting sleep counseling. It's often a whole mosaic of building blocks that have to mesh together."

Reaching for the pillbox is closer to many, partly because they don't know the fatal consequences. For drug addiction appears rather unspectacular on the surface: those affected do not slide into an addiction, as is known from junkies or alcoholics, but simply suffer silently. As Holzbach explains to his colleagues in countless training courses, their illness usually takes place in three stages: In stage one, patients stay disciplined to the dose once prescribed.

But their bodies, which quickly become accustomed to the drug, produce the symptoms of drug withdrawal after just eight weeks: sleep disturbances, irritability, anxiety, and often a bad body feeling. Sufferers, however, have no idea that they are suffering from the side effects of their drugs; instead, they believe their problems have gotten worse. In phase two, many start 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 feel emotionally dull. It is not until the third phase that dependence turns into a massive addiction, in which everything revolves around the vicious circle between procurement and withdrawal.

Fatal downward spiral
People suffering from anxiety disorders in the psychiatric sense can also easily fall into this fatal downward spiral. According to Prof. Borwin Bandelow, a psychiatrist and anxiety expert from Göttingen, 58 percent of these patients are prescribed benzodiazepines by their doctors, even though better and less risky forms of treatment have long been available for them.

The unquestioning prescription of tranquilizers, however, puts just as much at risk those who simply want to continue functioning, even though overwork and existential fears rob them of sleep at night. "Very many of my female patients say, 'Actually, I don't like medication at all,'" Holzbach, an addiction physician, tells us. And then the addiction doesn't let them go. Because by reaching for the prescription pad, the doctor has prescribed them an additional, severe problem.

Withdrawal from benzodiazepines is no pleasure. Slowly weaning them off can take months in an outpatient setting, weeks in a clinic, and must be accompanied by a doctor. According to Holzbach, an addiction specialist, it would be good if there were more groups where those affected could share their experiences. For severe cases, there is the therapy ward of the LWL clinics in Warstein and Lippstadt. You don't have to expect long waiting times there any more than in many other addiction wards in psychiatric or psychosomatic clinics where drug addicts find help.

Many of those affected do not find their way there and usually do not even really know what their problem is. This will probably only change when the silent suffering of hundreds of thousands of drug addicts in Germany is no longer hushed up.


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