That Germany is home to high levels of alcoholism and tobacco addiction is a well-established, if unhappy fact. What is less known is the fact that abuse of prescribed medication is also widespread.
Time to turn over a new leaf
The German Head Office for Dependency Matters, the DHS, estimates that between 1.4 and 1.9 million people in Germany are dependent on prescribed drugs, considerably more than the numbers of those addicted to cannabis, cocaine, heroin or other illegal substances. In short, levels of addiction to legal medication are topped only by a dependency on alcohol and tobacco. But while those addictions are often discussed in the media, there is relatively little public discussion about addiction to legal substances.
Addiction to medication, a women's thing?
The most abused medication are the benzodiazepines, such as valium, which are often used as tranquilizers and sleeping pills, primarily by women. According to Bruno Müller-Oerlinghausen, a doctor with the Drug Commission of the German Medical Association, that fact could be attributed to the physical changes which women undergo during the menopause, and to the reality that women are more prone to depression than men and less likely to use alcohol when the going gets tough.
The fact that problems with abuse of this medication are more frequent among females has not helped to bring it to light.
"Unfortunately it has long been considered a women's issue and has been neglected," said Karin Mohn of the DHS.
She said she hopes that a number of new measures, including increasing public awareness and improving early recognition and intervention methods, will help to reverse the trend.
Prevention is better than a cure
Johannes Lindenmeyer, a psychologist who specializes in addiction, says it is quite clearly a case of prevention being better than a cure, but adds that both doctors and patients need to change their thinking in order for the problem to be addressed in a serious way.
Therapy offers prevention
"People need psychotherapy instead of medication, but doctors don't get paid much for just talking about problems and patients generally prefer to go home with a prescription in their hands," he said. "So the doctors give medication instead of analyzing their psychological needs and assessing how their patients could benefit from such things as behavioral therapy."
In the case of insomnia for example, Lindenmeyer explains that sufferers have to learn how to get rid of the problem rather than chemically suppressing it, not least because such relief is only temporary.
"Unlike alcohol, people take addictive medicines because they have a complaint," he said. "They take it and it makes them feel better, but once that sensation has worn off, the original complaint comes back more acutely."
For example, the insomniac taking medication to induce sleep will build up a tolerance over time and have to increase the dosage over time to achieve the same effect. A psychological dependency on the drug can easily take root.
The route to dependency with some medications is incredibly fast, with users becoming addicted after just weeks of regular use. Once the addiction to medication has taken hold, it is much harder to break the cycle than with alcohol, according to Lindenmeyer.
Drug addiction claims less victims than medication dependency
"People find it harder to believe that they have an addiction problem, because they have been prescribed their medication by doctors," he said.
"By the same token, we don't have any clinics which deal specifically with medication addiction, they are put together with other addicts and feel misunderstood. All this means that the success rate of programs to break medication addiction is about ten percent lower than anti-alcoholism schemes."
Stricter controls necessary?
If the estimates of 1.4 to 1.9 million addicts are accurate, and if it is so hard to cure them once they have fallen prey to legal pharmaceuticals, should there be tighter controls on what doctors can and do prescribe? Müller-Oerlinghausen does not think so. He believes the path away from the addictive trend is to continue training doctors and informing the public about the dangers of tranquilizers.
"Over the past 10-20 years, German doctors have learnt how to use these substances in a restrictive way in order to prevent addiction," he said. "There are clear guidelines and the annual report on prescribed medicines proves that the number of tranquilizers being handed out by doctors gets smaller every year."
Nonetheless, Mohn of the DHS says there has not been much change in the estimated number of patients addicted to medication over the past few years and that the consumption of legal drugs remains a cause for concern.
"Some patients alternately pick up prescriptions from several different doctors," she said.
And with Germany's strict data protection laws, it is difficult to trace such strategy. "Controlling patients 100 percent just isn't possible," Müller-Oerlinghausen said.