Addiction of sleeping pills.
Addiction to or dependency ?
There is often a confusion between two concepts : addiction and dependence.
It is the increase of the tolerance of the organism to a specific substance. The body adapts to the action of a particular drug and becomes less sensitive. The maintenance of the effects of the drug then implies an increase in the amount absorbed. Addiction is different from addiction, in which events occur only at the stop of the treatment.
Addiction is frequently observed with alcohol. It is rare with the drugs, even those against anxiety, insomnia or pain.
We distinguish two types of dependence : physical dependence (the body adapts to treatment and the judgment of the latter leads to physical symptoms called withdrawal reactions) and psychic dependence (fear of what could happen without treatment). The withdrawal reactions (nervousness, fatigue, insomnia, tremor, concentration difficulties, etc) are more intense when the treatment was long, with high dosages. The symptoms of the disease being treated can also recur. The mental dependence, when it is strong, can encourage the patient to extend his treatment for fear of the consequences of a judgment, thereby increasing the possibility of physical dependence.
What are the drugs that can cause addiction ?
The phenomena of dependence are recognized mainly with the drugs of the anxiety, and sleep disorders (benzodiazepines), as well as certain pain medications. Some neuroleptics and antidepressants may also lead to withdrawal reactions.
The medicines of anxiety, and insomnia
The medicines of anxiety and sleep disorders are often involved in problems of drug dependence. To avoid this problem, it is important to respect the dosage and the conditions recommended by the doctor. The treatment should not last more than a few weeks(usually between four and six weeks). It must then be re-evaluated by the physician based on the situation and effects of any psychological treatment. The stop of the processing is done by gradual reduction of doses.
Remember, taking a drug for anxiety or insomnia implies that one does not drink alcohol. The combination of these two substances can lead to disorders of behavior, memory, and increase the risk of accidents.
The addiction to vasoconstrictors
Some people become addicted to drugs vasoconstrictors in spray designed to relieve the symptoms of rhinitis (decongestant nasal cavities). For this reason, these medicines are available only with a prescription. If this situation applies to you, talk to your doctor. Other drugs, less likely to cause dependence, exist that allow you to gradually move to these vasoconstrictors.
Medicines for depression
Unlike medicines for anxiety or sleep disorders, antidepressants most commonly used are no risk of real addiction. It must simply comply with the doctor's prescription and do not stop treatment too early or abruptly, to avoid relapses and the symptoms associated with the discontinuation of treatment. Some of the older antidepressants that are prescribed in the forms of depression that are resistant to the most common treatment, can still cause of the phenomena of dependence.
To avoid the symptoms associated with the discontinuation of treatment for depression, doses of antidepressant medications are reduced progressively over a period of one to several months to avoid a withdrawal syndrome. Indeed, adverse effects, transients are occasionally observed if treatment is stopped suddenly : anxiety, irritability, nightmares, insomnia, nausea, dizziness, etc, These side effects appear within two to thirty days following the cessation of treatment. If such symptoms occur, the doctor may choose to return temporarily to the treatment at full dose, and then to put in place a timetable of stopping treatment even more progressive.
Some medicines for moderate to severe pain, or even severe, may be at the origin of addiction.
Codeine and dihydrocodeine
Medicines containing codeine or dihydrocodeine should be used with caution and with the agreement of the doctor. In the long term, they can cause a physical dependence, especially codeine.
The headache by abuse of painkillers
The headache by abuse of painkillers are characterized by the repetition of headaches due to the overuse of pain medications. Everything happens as if each intake of analgesic was followed by a rebound of the headache. These unrelenting headaches account for 15% to 20% of consultations in specialised centres in the treatment of headaches. The mechanisms of this phenomenon are not elucidated. The treatment is to wean gradually, people who suffer from it.
Tramadol is not a derivative of morphine, but a molecule of the original that acts on receptors in the brain sensitive to morphine, as well as on the receptors for other chemical messengers in the brain (serotonin and norepinephrine). Long-term use, high dose, expose them to a risk of dependence.
The use of morphine today is no longer reserved for extreme cases or for palliative care. On the contrary, its use is required in all situations where the pain of lesser power are insufficient, subject to the condition that the cause of the pain has been identified. However, in the context of pain of non-malignant, its use should be of a duration as short as possible and be the subject of a "moral contract of use" between the patient and the prescribing physician. Today, cases of dependence to morphine are extremely rare.
Prevent drug dependence
In most cases, a few simple measures can help avoid becoming addicted to a drug.
The case of sleeping pills
A regular intake of drug sleep aid over a long period induces a significant risk of addiction. The product then loses its effectiveness and the dose must be increased to obtain the same effect. In addition, if it happens that the person treated does not have her medication, it will have a lot of difficulties to find the sleep : she became psychologically dependent.
For these reasons, a treatment sleeping drug should not be taken over a period of more than four to six weeks. After twenty days of use of a sleeping aid, the percentage of sleep (the one that really rests) decreases, and the risks of addiction and dependency increase.
The case of anti-anxiety medications
For the anti-anxiety medication, like all medications, it is important to respect the dosage and the conditions recommended by the doctor. As a general rule, the treatment is initiated by gradual increase of the dosage. The objective is to identify the minimum effective dose to limit side effects, and the risk of addiction. Older people are often sensitive to lower doses. Attention, it is unnecessary and dangerous to take simultaneously two anxiolytics.
Treatment with an anxiolytic should not last more than a few weeks (usually between four and six weeks). It must then be re-evaluated by the physician based on the situation and the effects of psychological treatment (which is always recommended). The stop of the processing is done by gradual reduction of doses.
The case of medication against the pain
In the case of chronic pain (osteoarthritis for example), taking painkillers at regular intervals, helps soothe the pain more effectively that a decision taken at the request, "when it hurts". In addition, it is recommended not to use analgesics more than five days without medical advice. Please do not hesitate to contact your doctor if the prescribed treatment does not relieve enough of the pain.
How to stop a treatment ?
The minimum duration of a treatment varies according to disease. The decision to stop treatment should be taken jointly by the doctor and his patient. Together, they make the point about the evolution of the disease, the absence of relapse and adverse effects of treatment. If the conditions seem to be met to consider it, the doctor will stop the treatment.
The arrest of a long-term treatment must sometimes be done gradually, reducing the doses by increments successive. It is often the case for drugs that might cause a physical addiction (drugs, sleeping pills, anti-anxiety medications, etc). The arrest of a long-term treatment is commenced preferably when the conditions are favourable (holidays, absence of other health problems, for example). In all cases, that judgment should be done gradually. Indeed, a gradual decrease in the daily dosage allows you to quickly re-establish an effective dosage in the event of a relapse. In addition, this reduction in stages allows you to limit the events related to a physical dependence that would have been able to install.