User:Noble Attempt/sandbox/Abuse of non-psychoactive substances

Abuse of non-psychoactive substances (ICD-10 F55.-) refers to the improper use of certain drugs, food supplements, herbal medicines or other substances that are not considered to have substance-related dependency potential or cause psychoactive changes. Addiction to these substances is therefore the result of an obsessive-compulsive disorder or a behavioral disorder, leading to potential psychological and social consequences. However, the harmful effects of the substances can also cause physical damage. There is either no medical need to take these substances, or they are taken more frequently or in higher doses than necessary. Affected people can have a strong craving for the substance and sometimes insist on continuing to take it despite the damage that occurs.

Conceptual definition

While laypeople often talk about drug or pharmaceutical abuse, abusiveness, addiction, or dependence in regards to non-psychoactive substances, these terms do not adequately describe the actual nature of the phenomenon, since the substances abused in these cases are not necessarily drugs (e.g. vitamins). In addition, terms such as abuse, abusiveness or addiction are avoided today due to their negative connotations in order to respect the diverse causes of substance use.

As a result, the harmful use of non-psychoactive substances is distinguished from the dependency syndrome caused by psychoactive substances. Likewise, possible complications when stopping the substances do not fall under the term withdrawal syndrome as related to psychotropic substances. This classification also does not include damage caused by taking medication prescribed by a doctor, nor damage from drug side effects or treatment errors. Any possible benefit of this type of self-medication is less important than the harmful effects; if medical care were provided, the substances would therefore not be used or would only be used in smaller doses.

Examples

Both psychological and social factors on the part of those affected in addition problematic prescribing behavior on the part of doctors can potentially play a role. Social expectations of success, the need to function, and an increase in multiple health problems that may overlap can lead to problematic consumption.

Antacids

Long-term use of antacids containing aluminum may increase the risk of developing osteoporosis. In vitro studies have found a potential for acid rebound to occur due to antacid overuse that can lead to a trend of increased frequency or amount of dosage to mitigate increasing acid reflux. However, although the significance of this finding has been called into question.

Laxatives

The intended use of laxatives is to be taken temporarily to cleanse the intestines before X-ray examinations or surgical interventions; to achieve soft stools in the case of anal fissures and painful hemorrhoids; or after rectal-anal interventions or to treat constipation caused by medication (e.g. opiates for cancer pain or substitution treatment for opiate addiction). Aside from these applications, there is improper use. In medicine today it is assumed that no relevant physical habituation effect occurs from laxatives. The possible side effect of hypokalemia only occurs rarely and only when overdosed amounts are taken.

Painkillers

The improper use of painkillers is often a form of harmful use of non-addictive substances. However, there is evidence that the painkiller paracetamol is able to relieve not only physical pain, but also psychological suffering caused by social exclusion or rejection (so-called social pain ) .  There is therefore the possibility of a dependency syndrome caused by psychotropic substances , which must be taken into account in the differential diagnosis .

Worldwide, approximately 60 million people take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). It is estimated that half of the people who regularly take these drugs may develop erosions and ulcers in the stomach and duodenum. The risk of ulcer-related bleeding and perforation is increased threefold. When taking indomethacin, the maximum risk is reached after just 14 days of use; the relative risk is 2.25. With other NSAIDs, the maximum risk of complications is reached after about 50 days of use, although the relative risk is lower.

If over-the-counter painkillers are taken regularly (on more than half of the days of a month), a drug-induced chronic headache can occur after just a few weeks, but usually only after years (on average after 4.7 years). With triptans, this time is shortened to 1.7 years.

Other drugs with psychotropic effects

The harmful use of non-addictive substances also includes the inappropriate use of medications with psychotropic effects such as antidementia drugs , stimulants and antidepressants .  Here too, the possibility of a dependency syndrome caused by psychotropic substances must be taken into account in the differential diagnosis .

Frequency

According to the 2008 Drug and Addiction Report, an estimated 1.5 million people in Germany are “drug dependent”, while other studies  put the figure at 1.9 million people. Approximately the same number can be classified as being at medium to high risk of developing “drug dependence”. However, 80% of cases involve dependence on benzodiazepines [  which have a high potential for dependence and are therefore more likely to be attributed to a dependence syndrome caused by psychotropic substances .

One problem in recording prevalence figures is the diversity of harmful use of non-addictive substances. Of the approximately 10,000 most commonly prescribed drugs, approximately 4 to 5% have the potential for problematic use and the development of dependence.  However, this does not record whether it is a dependence syndrome caused by psychotropic substances or harmful use of non-addictive substances. These figures do not take into account the harmful use of substances that are not medications.