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Psychotropic Substances

Psychotropic Substances are herbal, synthetic or semi-synthetic substances that influence the human psyche via the central nerves. In particular, perception, thinking, feeling and acting are changed. Psychotropic substances not only include illegal drugs such as amphetamines, ecstasy or cocaine, but also luxury goods such as alcohol, tobacco and caffeine.

The globally valid ICD-10 classification distinguishes the following psychotropic substances:

  • alcohol
  • opiate
  • Cannabinoids
  • Sedatives and sleeping pills
  • cocaine
  • Hallucinogens
  • tobacco
  • volatile solvents
  • other substances, including caffeine

Special text: sleeping pills

A distinction must be made between the consumption of psychotropic substances and substance-related dependence. There is a dependence on psychotropic substances if at least three of the following points apply:

  • Compulsive desire for the substance, possibly accompanied by a change in personality
  • Decreased control over consumption
  • Persistent consumption despite negative effects on psyche, body or social life
  • Neglect of hobbies, interests and social contacts in favor of substance use
  • Development of physical tolerance towards the substance
  • Withdrawal symptoms when abstaining from consumption

Whether the consumption of psychotropic substances is tolerated or prohibited varies according to society, epoch and substance. Even within the EU there is no consensus on what an illegal drug is and whether or why cannabis should be banned. In terms of harmfulness, the so-called stimulants are not inferior to illegal drugs: the approximately 1500 drug deaths in Germany every year are a shockingly high number. They are exceeded by a ten times higher number of deaths from alcohol consumption and up to 75 times higher number of deaths from long-term nicotine consumption. Experience in many countries shows that preventive medicine is more effective than the prohibition of substances dangerous to health and the criminalization of their consumption in the case of tobacco and alcohol is their massive taxation - experience in many countries shows. This also avoids the problem of procurement crime from the outset.

Around 300,000 people in Germany are dependent on illegal drugs such as heroin, LSD and cocaine, men twice as often as women. A selection of illegal drugs are discussed in more detail below. For more information, see the separate articles on alcohol, cannabis, and nicotine addiction.

opiate

Substances obtained from the dried juice of the opium poppy, among which among others opium, Morphine, heroin, Codeine and Methadone belong. Opiates are produced almost exclusively in the Middle East with Afghanistan as the center. There or in the target country, opiates are processed into heroin. Heroin has the highest addiction potential among drugs with pronounced psychological and physical dependence and rapid development of tolerance.

Semi-synthetic or synthetic opiate are also known as opioids. Doctors use them as a highly effective means of treating severe pain. To prevent abuse, they are subject to the Narcotics Prescription Ordinance (BtM-VV). Used in appropriate doses for severe pain, but opiates are not addictive.

Effect and complaints

  • Feeling of ecstasy and comforting warmth
  • Feeling of happiness (euphoria)
  • Quick change of mood
  • Pathological drowsiness, tiredness
  • Slow pulse
  • Weight loss, constipation, nausea and vomiting
  • Narrow pupils
  • Slurred (diffuse) language.

cocaine

cocaine (Coke) is obtained from the coca leaves, which are mainly grown in South America and are mainly chewed there. In the 19th century, the active ingredient of the coca plant was extracted and converted into the water-soluble cocaine hydrochloride.

Cocaine is an intoxicant that leads to strong psychological dependence and is traditionally sniffed, but can also be injected and smoked. By adding chemicals like baking soda it becomes so-called Crack produced, which has the same effect as cocaine, but is many times more intense. Crack has the highest potential for addiction. The drug can lead to addiction even after initial consumption.

Effect and complaints

  • With acute cocaine effects (kick): Euphoric mood, feeling of happiness, urge to talk and disinhibition, lack of criticism, megalomania, subjective increase in creativity and performance, reduced feeling of hunger and thirst, reduced need for sleep, dilated pupils, high blood pressure and tachycardia (rapid cardiac arrhythmias)
  • In the intoxicated stage: hallucinations with paranoia
  • In the "depressive" stage (withdrawal): Violent fears and depressive mood.
  • The use of cocaine increases the risk of acute coronary syndrome and also makes the disease worse. Heart attacks are much more severe in patients who use cocaine than in those who abstain from cocaine. Your risk of dying from a heart attack is ten times higher.

Designer drugs

Designer drugs: Synthetically manufactured drugs that make you euphoric and seem to blow away tiredness, but quickly create psychological dependence. These drugs include, among others:

LSD (Lysergic acid diethylamide, acid): One of the most powerful hallucinogens, related to the body's own hormone serotonin, which affects digestion, heart rate and blood pressure. The duration of the effect (“trip”) is about 8–12 hours. A desired change in perception occurs in a state of complete alertness (intensification, illusion, hallucination).

Amphetamines (speed),Crystal meth (metamphetamine) , Meth, Yaba, Crystal Speed, Ice: Strongly stimulating drugs, popular as "party drugs", pick-me-ups or appetite suppressants. It is usually a powder that is sniffed through the nose or swallowed dissolved in liquid. Amphetamines work similarly to cocaine by releasing norepinephrine and dopamine. This results in decreased sleep, hunger and thirst, euphoric states and increased self-confidence for 6–8 hours.

Crystal meth is particularly dangerous. Like snuff, the active ingredient metamphetamine can be snorted, smoked, injected intravenously and swallowed. Smoking (ice) and injections are particularly dangerous, acute poisoning from overdosing is common. Signs of overdose are fever, sweating, dry mouth, dizziness, tremors, anxiety, and circulatory collapse with a drop in blood pressure and even death.

Oral intake through crystal meth beads (bobbles) is less risky, but rather uncommon in Central Europe. Crystal Speed ​​works for 20 to 30 hours, is extremely addictive and, if overdosed, causes cerebral haemorrhage and cardiac arrest. The euphoric active phase is followed by a phase of lethargy and depression-like moodiness (hangover, "coming down"). The long-term consequences are skin ulcers, organ bleeding and psychoses.

Ecstasy (XTC): Mixture of synthetic drugs, the main component being MDMA - an amphetamine - the effect lasts for about 4–6 hours. The drug mix has been spreading from the United States for about 25 years and is one of the most commonly used hard drugs today. Ingestion leads to symptoms typical of amphetamines.

Leading complaints (of all designer drugs)

  • Psychological complaints such as restlessness, nervousness, disinhibition, euphoria, hallucinations and paranoia, fear and panic
  • Physical complaints such as loss of appetite, increased blood pressure and cardiovascular failure.
An acute risk is dehydration (desiccosis) and heart failure. Long-term consumption can lead to permanent impairment of consciousness and perception. Ecstasy is not a harmless "party drug".

The diagnosis is usually confirmed through the analysis of blood, urine or hair samples, but also through information provided by the person concerned himself or by people close to him.

Primary aim of the treatment of the Drug addiction (Substance abuse) is permanent abstinence. There are several phases to get there:

In the motivation phase, the patient is contacted and motivated, e. B. through advice centers, doctors, family, friends.

In the detoxification phase, physical withdrawal takes place, which - depending on the substance - is characterized by nausea, diarrhea, freezing, sweating, dizziness and palpitations, high blood pressure, convulsions and hallucinations. Because of these severe withdrawal symptoms, detoxification is usually carried out on an inpatient basis and takes 1–6 weeks. With regard to the administration of medication during detoxification, a distinction is made between cold turkey with the administration of psychotropic drugs, muscle-relaxing medication and anti-epileptic drugs and warm withdrawal with drug substitution by tranquilizers, codeine or methadone, which is mainly practiced in the rehab facilities. Retarded morphine has also been approved for warm withdrawal for heroin addicts since April 2015. In studies, it showed fewer side effects than methadone. In addition, addicts treated with morphine found it easier to give up heroin.

After detoxification, the addiction is treated psychologically (weaning phase), initially mostly in specialized long-term facilities, later also on an outpatient or partial inpatient basis. The focus is on building new goals in life and achieving a new self-image. In order to stay addiction-free in the long term, further professional support from psychotherapy or self-help organizations makes sense.

Unfortunately, relapses are common. The motivation for therapy of addicts is often moderate and fluctuating. Repeated use of opiates is very likely within the first few months, with around 75% of drug addicts relapsing six months after drug withdrawal.

Newer approaches to addiction counseling distance themselves from the term “relapse”. Treatment goals are negotiable between the therapist and the patient; between the extremes of "either - or" further goals are conceivable: occasional consumption, controlled consumption, healthy consumption, no consumption ...

The pioneers of the self-help organizations come from the addiction scene; there are suitable self-help groups in larger cities for practically every addiction disease.

Relatives should be aware of their role as “co-dependent”. This means that behaviors of family members - such as B. Cover-up, excessive understanding, or accusations - keep the addictive mechanisms in place. Self-help groups also offer help here.

  • www.dhs.de - Website of the German Central Office for Addiction Issues. V., Hamm: With information on drugs, projects, facts and figures as well as a search mask for rehab facilities.

Authors

Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 14:14