Eight million people in Germany have an addiction. But what does addiction and dependence mean, for example on alcohol, drugs, medication? And what can you do to get out? Answers from Martin Voss, specialist in psychiatry and psychotherapy, and Alexander Stoll, chief physician in withdrawal therapy.
What is an addiction?
There are six criteria in the ICD-10 medical classification list published by the World Health Organization (WHO). An addiction disorder occurs when at least three of these are identified:
What can be signals by which relatives or those affected can recognize that risky consumption is turning into an addiction?
“You don’t get an addiction overnight,” says Martin Voss, who is a senior physician in the Addiction Medicine Center at the Clinic for Psychiatry and Psychotherapy in the <a href="http://www.world-today-news.com/debts-loans-and-unpaid-bills-among-users-of-semi-inpatient-and-inpatient-psychiatric-treatment-in-berlin/" title="Debts, loans and unpaid bills among users of semi-inpatient and inpatient psychiatric treatment in Berlin“>St. Hedwig Hospital in Berlin. Addiction develops gradually and has precursors. A warning signal and symptom of a consumption disorder is the increasing consumption itself, according to Alexander Stoll, head physician at the Vivantes Weaning Therapy Hartmut Spittler Specialist Clinic at the Auguste Viktoria Clinic in Berlin: “More is consumed and never less.”
The spiral of addiction turns in such a way that the side effects of consumption become increasingly apparent. So: loss of control, development of tolerance or neglect of relationships and other activities in favor of consumption.
According to Voss, these are the decisive categories for an addiction disorder. Ultimately, the quantity itself does not play such a decisive role in the diagnosis.
Why do you become addicted in the first place?
Voss compares it to a hostile takeover that takes place in the brain: the substance causes certain areas of the brain to change massively. The focus is primarily on the so-called reward system. “This is what responds to any stimuli that we experience as positive, such as good food or beautiful things that we enjoy or sexuality.”
Addictive substances directly or indirectly stimulate the reward system, “to an extent that we do not get through our behavior or other stimulation.” Cocaine, for example, leads directly to a release of the neurotransmitter dopamine – to an extent that not even an orgasm can achieve.
“Once you have done it several times, it becomes difficult to do without it,” says Martin Voss. “You get more and more used to it and eventually become dependent.” If you don’t take the substance, withdrawal symptoms occur. And these can also be non-specific symptoms. Maybe the cycle is going crazy. Or nervousness, restlessness and depressive symptoms occur.
People who use party drugs have a strong hangover that goes away when they start using again. “That’s the trap you fall into,” says Voss. At some point they become automatic processes that you can hardly influence anymore.”
This is the so-called hostile takeover: “Then at some point it’s just a matter of preventing withdrawal symptoms and functioning,” says Martin Voss. “People consume and go to work because without consumption they would no longer be able to go to work.”
It is often said that addiction has many faces. “If you look at a ward like ours with 24 beds for detoxification from alcohol and other substances, who is here, it’s a complete cross-section of society,” says Voss. “All ages and all social classes are affected here.”
What happens during withdrawal in a clinic?
Many clinics offer so-called qualified withdrawal. On the one hand, this involves detoxification and alleviating withdrawal symptoms, including through medication. Because: “Withdrawal from alcohol, opiates and benzodiazepines is physically demanding and can be accompanied by complications such as an epileptic seizure,” says Alexander Stoll. “That’s why these withdrawals should definitely be accompanied by a doctor.”
Relaxation procedures as well as medically and psychologically guided group therapies are usually also offered, in which knowledge about the illness and how to deal with it is conveyed. In addition: individual discussions with doctors and psychologists or social workers.
On the other hand, the course is also set for follow-up treatment, i.e. long-term or withdrawal therapy in specialized rehabilitation clinics, “which only accept patients who have already detoxified,” says Voss. “That’s up to six months of therapy in which you learn to live without the substance again.”
Good to know: Various facilities, especially addiction counseling centers, offer outpatient withdrawal therapies.
Many facilities are overloaded. What else can you do urgently?
There are self-help groups for many addictions. They are a low-threshold option. “If there are bottlenecks in professional help and waiting times arise, I clearly recommend visiting self-help groups in the respective region free of charge,” says Stoll. “Even if you are still using and not clean, most groups allow entry. Every affected person can immediately benefit from such a strong community.”
The German Central Office for Addiction Issues (DHS) offers a search for local and regional contact points on its website: https://www.dhs.de/service/suchthilfekatalog.
Information about various addictions and how to overcome them can be found on the website of the Federal Ministry of Health (BMG):
