I know I am supposed to link articles rather than post them here, but this article wasn't in English. I translated it for a friend who was suffering from Bipolar who was addicted to sleeping pills, and found that her bipolarism always got worse when she stopped taking sleeping pills.

I hope it helps any of you that receive regular medication for depression, anxiety or bipolarism to think critically about long-term use of medication which affects the brain.
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Article in original German under: http://www.sd-sargans.ch/1999/referat2.htm

Prescription Dependency?

Addicted to Pills Who are the Guilty Ones?

Dissertation A service in cooperation with the professional German magazine SuchtMagazin

Addicted to pills Who are the guilty ones? Are the drugs guilty themselves? Or maybe the government authorities that allow their prescription? Are the pharmaceutical companies responsible? What about doctors, chemists and medical insurance companies? Or could it be that the patient is guilty himself?

By Hans Weiss

Before I get into the guilt question, I would like to describe the problem we are discussing here first. What is medication addiction?
I could, for example, be addicted to medication without anyone ever noticing it around me. Medication addiction cant be smelled, and doesnt necessarily leave needle tracks on your limbs. The eye pupils are not unusually enlarged or conspicuously small. Moreover, your behaviour is not necessarily conspicuous. Even in medical and laboratory check-ups finding traces of medication addiction are hard without a hint in the right direction.

What exactly is medication addiction?

The typical person who is addicted to medication or better put: the typical medication addict, for the greater part women** - is non-conspicuous, orderly, and conforms to society. Maybe they are even very orderly and neat, and especially try to fit in and please others. That means they are not usually human derelicts. They are not like homeless junkies, and not zombies. Could it be then, that we are discussing an apparent problem here that is being hyped by over-critical addiction experts? I dont think so. The subversive fact about medication addiction is that it goes un-noticed for a very long time. Usually, it first gets noticed when a combination of tranquillisers and sleeping pills cause an injury or an accident.

I have researched the definitions being issued from a number of competent authorities, such as the German Institute against Addiction Substances or the WHO. I have to admit, that I have my problems with their definitions. Theyre stated in such a technical and highly contrived manner that you can hardly apply them practically. To put it bluntly you could say: a person is addicted to medication, if he feels the irresistible compulsion to take a particular medication. This irresistible compulsion can be felt physically as well as psychologically. By the way addiction is often used interchangeably with abuse. For experts, though, these expressions are not interchangeable. Abuse precedes addiction.

Important, but not Everything Decisive Factors

Often it is maintained that a typical sign of medication addiction is the increasing dosage required, because the body builds up a resistance to the effects of the medication through habitual use. This is absolutely true for some pain killing substances, such as opiates (e.g. codeine, morphine, opium, heroine) or barbiturates. But this does not necessarily apply for the active ingredients that are commonly found in most medications, such as benzodiazepine, which is the base ingredient for tranquillisers and sleeping pills. These kinds of substances can be taken for years, without ever having to increase the dosage.

Withdrawal symptoms that occur shortly after the getting off these substances are not necessarily a sign that we are talking about an addictive substance. There are medications that are not considered addictive, but still cause withdrawal symptoms when patients go off them. Sometimes the withdrawal symptoms are worse then the original symptoms that caused a medical professional to prescribe them in the first place. An example is the high blood pressure medication Clonidine, which can actually cause blood pressure to skyrocket when patients stop taking it from one day to the next.
The problem with medication addiction often starts because neither the patients nor the doctors are aware that an addiction exists. If I am supposed to believe field literature, then a medication addiction can only be diagnosed through a patient doctor dialogue, in which the patient talks to his or her doctor or with friends or acquaintances.
The pre-requisite for this, of course, is that the patient as at least some knowledge about which preparations and substances cause addiction, and that the patients are willing, and open to take about medications they use.

An Example

I have, during my collaboration for the book Bitter Pills (in German Bittere Pillen) come across a number of medication abuses in my circle of friends and acquaintances, quite by accident. It happens a lot more than you would think.

Heres an example: a successful dramatic producer, who has managed, among other projects, the Burg Theatre in Vienna, numerous German theatres, including the Schauspielhaus in Zurich, has been complaining of common headaches, ever since I have known her. As it so often is in the theatre world, alcohol is often drunk, and she rationalised her headaches with the drinking that goes along with the theatre life. At some point, I nailed her down and asked him specific questions. I found out that he had been taking medication everyday for headaches for years, and she had always been taking medication that either contained caffeine or codeine. She had tried to stop taking them now and again, because she always suspected that they werent healthy, but whenever she quit them her headaches got worse in fact so bad that she just kept on taking the medication.

She didnt just take over-the-counter stuff; she also took prescription painkillers, and had never had problems getting a prescription from her doctor. Whenever she needed a re-fill she just went to her doctors office and told the receptionist that she was here for a re-fill. It had become a matter or routine.

I gave my friend some information about addictive painkillers and the address of a doctor who specialises in treating medication addiction. Since then, she has never taken pain pills for headaches since then, and she only sometimes has headaches from drinking. She still drinks as much as she did before, and maybe too much, but thats another story.

How many kinds of medication addiction are there?

Before I get to the guilt question, I would like to give you a rough sketch of the problem about the statistics of medication addiction. The statistics in field literature vary greatly from year to year, and from author to author they even vary within single magazine articles so much that I can only give you a rough idea.

According to the latest statistics, which appeared in 1998 in the Annual German Book of Addiction published by the German National Society Against Addiction, alcohol holds first place for addictive substances (1.7 million addicts in Germany); medication holds second place (1.5 million addicts), and then there follows a big gap before third place comes with narcotics (250,000 to 300,000 addicts). If we compare the number of medication addicts to the population of Germany, then about 2% of all Germans are addicted to medication.
Whats it like in Switzerland? Well, I dont have exact figures for Switzerland, but I am going to guess it isnt much different than Germany. Its estimated that about 150,000 Swiss are addicted to medication. But you have to be careful about these numbers! Ill quote the Annual German Book of Addiction from 1998 from the German National Society Against Addiction once more: About 6 to 8% of all prescribed medication is potentially addictive. The same author who wrote in a book on preventive medicine, which also appeared in 1998, that about 5% of all prescribed medication is potentially addictive.

So whats the real figure? Five percent? Six percent? Eight percent? We should keep in mind that: When were talking about medication addiction and statistics are thrown into the picture, that theyre relative and not absolute.

Mothers Little Helpers

And now back to the main question of my article: Who is really guilty? Is it the medication itself? Lets take a look at prescription medications first. Benzodiazepine is the biggest problem concerning medication addiction at the moment. This is a group of active ingredients, which are usually found in tranquillisers and sleeping pills. Famous medications such as Valium or Librium contain them, but in the meantime there are dozens of medications available on the market, which contain them, too [ed. note: including Imovane and Zopiclone].

Benzodiazepine ingredients were introduced to the market in 1960, probably in the U.S.A. They became popular there, and soon were known by their nickname Mothers Little Helpers. The advertising industry targeted women. The first publication about abuse came about four years after the drugs were introduced to the market, which was in 1964. Because of alarming widespread use and because of the addiction danger, the American food and drug control authorities placed restrictions on them in the 70s. After that the consumption subsided.

In Germany, however, the addiction danger only came into public debate at the beginning of the 80s. I would like to remind you that just a few years ago Benzodiazepine was a major ingredient in numerous medications, which were used to treat a number of ailments: such as menopause, angina pectoris or depression.
In collaboration with the first edition of Bitter Pills (German: Bittere Pillen) in 1983, I recall receiving a lot of flak from doctors, because we warned patients about the potential addiction danger. Since then this topic has finally received public attention from serious field publications as well as the mainstream press. These warnings and appellations have finally brought about the result that their consumption has declined.

It would be fair to guess that about 800,000 to around 1.2 million Germans are addicted to Benzodiazepine medications right now. In any case the number of addicts is much higher than narcotic addicts.
Other prescription medications that can be addictive

Another important addictive medication is codeine, which is often found in numerous pain, migraine and cough syrups. Often times it is completely useless and superficial. Codeine can easily become abusive because of its euphoric affect. Used by itself, it is often prescribed as a substitute therapy for drug addicts.

There is a special problem in Germany and Austria I dont know if its true for Switzerland with opiate painkillers (e.g. Tramal, Valoron N and others). Ill spare you the long list of medications, because the amount of them that are prescribed is not as high as by

Benzodiazepine medications. These medications are usually only used for patients that suffer from intense pain or are seriously ill. But the problem here is not that they are being prescribed too much; they are in fact seldom prescribed. The reason for this is because doctors often fear that the patients will become addicted, and the strict laws pertaining to the prescription of such drugs. In this case the problem with these drugs is not abuse its the lack of providing them in the first place.

Even over-the-counter medications can (or are supposed to?) be addictive

There are also over-the-counter medications that have a hidden abuse or addiction potential: In Germany approximately one third of every medication sold is an over-the-counter medication. As far as were concerned here, these are painkiller combo-drugs, which usually contain caffeine.

The favourite and most often consumed medication in Germany is Thomapyrin. 21 million packages of this are swallowed every year. This medication is also available in Austria and Switzerland. Experts believe that Thomapyrin is the number one medication in Germany because its doped with an invigorating drug that can easily lead to abuse and addiction caffeine. Whoever takes Thomapyrin for long periods of time, will experience withdrawal headaches when they go cold turkey. This in turn, only sends the consumers back to using the drug again, because its supposed to be good for headaches. The results can be devastating, because Thomapyrin is a combination of two different kinds of painkillers: acetylsalicylic acid and Paracetamol, and it is believed that yearlong abuse of these painkillers can cause kidney damage. And loss of kidney functions would eventually mean kidney dialysis.

In Germany, not only Thomapyrin contains caffeine, but a whole series of other over-the-counter drugs also contain caffeine/pain-killer dual ingredients, and about 40 million packages of these medications are sold every year.

The consequences: Experts believe that around 10 to 15 percent of all kidney dialysis patients contracted their condition through yearlong combo painkiller abuse. Only about 4,500 to 6,500 cases can actually prove this.

From laxatives to nose drops

There are numerous other over-the-counter medications that can be abused. Whether or not they become addictive is unsure. In any case they are listed in the German registry of potential addictive substances:

Laxatives such as Dulcolax (contains Bisacodyl) or Bekunis (contains senna leaf extract). These medications are fine for using for brief periods of time. The danger lies in the continual use of them, because the continual use can cause damage to the intestinal cell walls and intestinal flora, and it can cause intestinal impairment, as well as making haemorrhoids worse. Laxatives are often abused to lose weight. Usually it is women who abuse them.

Alcoholic medications such as Klosterfrau Melissengeist (contains 79% pure alcohol) or the cold syrup Vick Medinight (18% pure alcohol), which also contains psychoactive ingredients such as Dextromethorphane, Doxylamine and Ephedrine.

Numerous nose drops and sprays, which are often used longer than a week, which can actually cause a medication-induced runny nose. Otrivin, Nasivin and the rest of them. As a reaction to the continual, yearlong use, the mucous tissue in the nose swells up after discontinuing use, so that the patient always grabs the bottle again and again. You can only get around the addiction, when you find out that the nose drops are causing the problem in the first place.

A friend of mine, a politician in the German Green Party, with whom of which I shared an apartment with for a whole week, took a medication for a runny nose on a daily basis. He had the feeling that he wouldnt be able to breath properly without taking it first. Of course this medication has instructions but who bothers to read the instructions? Nobody really understands what they write in them anyway, its only written for doctors and chemists. Besides: Who really gives a damn what they write there? Alone the side effects and reasons why you shouldnt take them would make anybody in their right mind through the pills in the rubbish bin.

My friend has finally stopped taking nose drops. He still has trouble breathing through his nose, but thats probably due to the yearlong abuse of nose drops in the first place.

Target Group Women

Are maybe the patients themselves guilty of their own medication addiction? Are there kinds of patients that are especially susceptible to medication addition or abuse?

To state it shortly, I can say that medication addiction is mainly a problem for women and senior citizens. Why women? Because women are still traditionally expected to keep the family together, and offer emotional support to the husband and children. But women often dont have anyone that they can turn to in an emotional crisis. They often feel isolated, and introverted. They suffer from more from fear and anxiety than men do, and often suffer from exhaustion and depression more than men do. When men have psychological problems, they usually reach for the bottle. When women have psychological problems they consult a doctor. Accordingly they often receive typical diagnosis like vegetive dystony or chronic depression. And the classic reaction in the medicinal world to this problem is to prescribe psycho-pharmaceutical sedatives, sleeping pills and anti-depression medications.

These kinds of medications are real wonders and Im not being cynical here. You can swallow them without anyone really noticing them. And they are very effective. They let your cares go away, and make you happy again, and finally let you get to sleep; they let you get through the day as if you really didnt take pills at all sort of like sunglasses for your psyche just like in the advertisements for tranquillisers years ago. The fatal part about swallowing medications is that it can easily become a nasty habit. Without you really noticing it, it can become addictive.

Target Group Senior Citizens

Medication addiction is especially a problem with older people. From several studies, we know that the medication addiction tends to increase with the older generation. Experts in Germany estimate that almost every woman over the age of 50 is a potential addict. Because women live an average of seven to eight years longer than men, the amount of medication that women consume in their lifetimes is about three times that of men.

On of the reasons why medication addiction is more common amongst older people is because more medications are prescribed for older people than for younger people. And at a later age it is considered normal to consume daily medication, often for the rest of the patients life. Thats why its not so apparent when certain medications become addictive. Older people who are a little confused receive Benzodiazepine medications. Older people who get crotchety receive Benzodiazepine medications. Older people who cant see the sense in living any longer receive Benzodiazepine medications. Older people who have problems falling asleep, well, you know the rest.

Now back to our question: are the patients themselves guilty? I do believe that there is a certain amount of guilt that can be found with the patient. Some patients think they have to swallow pills for every little ache and pain they get. Some of them are looking for instant solutions to lifelong problems like getting rid of it with a pill, for instance instead of trying to make some changes in their lives, like getting away from the medication addiction.

The Government Authorities

Now lets address the government authorities. Are the government food and drug authorities guilty of this problem?

A radical way to dramatically reduce medication addiction would be to simply remove all potentially addictive substances from the market. But using this argument, you might as well make cars and driving illegal, because they are potentially dangerous too, and that would ultimately reduce the number of deaths and injuries every year, even thought we would have to forego all of the advantages that motor vehicles offer us.

Thats the same thing with potentially addictive medications. They have their advantages and their dangers, which we have to weigh when we take them. The important factor is whether or not the practical uses of a medication outweigh the risks. In the case of barbiturates, for example, the risk of becoming addictive is much higher than the actual good these drugs do. This is why the use of these types of medications should be limited.

This is where the government authorities could do something. Its up to them to evaluate what should be done here to regulate the market. In Germany, independent scientists and field publications have been accusing the government food and drug authorities for years that theyre nothing but puppets for the pharmaceutical industry. Some critics go even further and accuse the government authorities of rubber-stamping industrys demands at the expense of the consumer.

Heres a concrete example for our topic: independent pain-killer medication experts have been demanding for years that medications like Thomapyrin should have to have a prescription, because of the addiction potential this medication has. I dont believe that thats going to be happening anytime soon, because the pharmaceutical lobby in Germany and everywhere else on the planet for that matter is very influential.

The Medication Producers

Lets come to the next subject: Are pharmaceutical companies guilty for the shear numbers of medication addicts? Fifteen years ago, I wouldnt have hesitated to say, Yes! The pharmaceuticals companies are the main culprits. They are un-ethical, and only worry about their profits; they play down the side effects, they dont properly inform their patients or their doctors, and the influence the prescribing habits of doctors in ethically questionable manner.

I still think that this is pretty much true, depending on how serious or how large a pharmaceutical company is or what their long-term plans are. Despite this, my answer is different today than fifteen years ago. Back then leftists tended to think that all corporations and industrial companies were basically evil. Maybe that hasnt changed too much today, but maybe I have changed. Pharmaceutical companies produce and market products just like other companies do. Its up to our society to make sure that the marketing and sale of these products follows certain laws and codes. In the case of pharmaceutical companies, they should be strict laws.
Individual Responsibility is Required

But you cant put the whole blame on the pharmaceutical companies, though. I would like to use a quote from an interview that the CEO of the German National Association of Pharmaceutical Companies to the Frankfurt Allgemeinen Zeitung newspaper. Professor Vogel was answering the question of whether the pharmaceutical industry feels a responsibility for the two million people in Germany who are addicted to medication. Certainly we do, he said, adding, I believe that we were playing down the side effects in our advertising campaigns. Our advertising was giving people the impression that no matter how many problems you were having, all you had to do was take a couple of pills and they would go away. This was detrimental. I often thought that doctors would have long banded together to protest this, but nothing happened.

Well, I couldnt have said it better myself. Just to illustrate the criticism that Professor Vogel mentioned, there is a very good example for a medical journal. Its about an advertisement from a Swiss company for a medication containing benzodiazepine: A sixteen old girl. Her boyfriend has just dumped her for another girl. To help her get over her heartbreak, just take so-and-so milligrams of this medication.

And the Doctors?

Maybe its the doctors fault. Are the maybe responsible for prescribing us too much medication? When I thumb through the medical journals touching on this subject, then it almost looks like we have finally found the guilty party here. Before I name a couple of examples, I would like to concede one thing: This is not about doctors in general, but about a small group of doctors the black sheep of the family.

The evidence: Studies were conducted by the collaborating experts for the book entitled Bitter Pills (German: Bittere Pillen), such as Professor Jrg Remien, pharmacologist in Munich. He researched all of the prescriptions summated to one public insurance company in Germany in 1993, to see if mediation addiction is supported through prescription, and he found out that nearly 40 percent of all medications that contain benzodiazepine were being prescribed for a period of time longer than three months at a time which meant they were being prescribed longer than their recommended period of intake. Besides this the recommended dosage was usually being exceeded.

Prescribed Addiction

Why are so many doctors doing this? Is it just ignorance? Is it indifference? Are they doing it for profit? I think that it has a lot to do with the business conditions that most doctors offices have. The more patients a doctor has, the more he earns. Patients who are addicted to medication mean cooperative problem-free patients for the longest time. They dont cost a lot of time, and make it easy for the doctor to write regular bills to the insurance company. Then, theres always the danger that if a doctor actually refuses to prescribe the medication an addictive patient is demanding, that that patient will go elsewhere until he finds a doctor that will prescribe it. And patients who go elsewhere mean less income for the doctor. Its not that hard in Germany for a medication addict to find a doctor who will prescribe the medication he wants.

Another explanation for the indifference in which doctors prescribe medications that are potentially addictive is their ignorance. This assertion doesnt sound really serious. But I know its true based on my own experience, because I used to be a pharmaceutical consultant at the beginning of the 80s in Vienna for journalistic reasons. I was appalled by the fact of how little doctors actually knew about the medications that they prescribed. Even today, I can still imagine how many doctors there are who never go to informative seminars, and the bulk of their information is based on publications provided by the pharmaceutical company or medical consultants.
In most cases only sanctions will help

I think the doctors will always have the biggest influence on whether or not someone will stop remaining addicted to medication.

If patients trust their doctors, then they will be able to convince their patients when its better to stop taking a particular medication. In order to do that they, of course, will need a good background in medication, a sense of responsibility and a touch of sensitivity or a background in psychology. Basically, there is no reason why tranquillisers and sleeping pills shouldnt be prescribed, provided that they are doled out in the proper doses, and they are not prescribed for a period longer than three months.

In a trial experiment to dampen medication addiction, which was commenced in 1983 by the Hamburg Association of Medical Professionals, they were able to prove that it isnt enough to just appeal to doctors professional responsibilities; that it isnt enough to inform and educate doctors about the potential addiction dangers of medication, but only with decisive sanctions where they able to achieve the desired results, and have medication prescription practices radically changed. The Hamburg Association of Medical Professionals indicted medical professionals in 60 cases for violating existing prescription codes. It was a shocking result to find out that more often than not, most of these medical professionals were already addicts themselves, who continued to write lots of prescriptions for questionable medications, in order to provide themselves with the products. In approximately 30 cases the doctors lost their licenses to practice medicine.

And the chemists?

Its not pure coincidence that in every pharmaceutical product advertisement in Germany, you will hear or see the statement: Ask your doctor or your chemist! Whoever sells medication is at least directly partially responsible. German chemists pride themselves in their role as medication consultants. This not only applies for prescription medications; it also applies for over-the-counter drugs.
Chemists often lose themselves in the conflict of interests here, just like doctors often have. Should they feel compelled to discourage patients from taking a particular medication? If they discourage someone from taking one kind of medication say because a patient has suspiciously purchased this medication time and time again, and appears to be addicted to this particular medication and risk losing the patient as a regular customer.

That decision depends on the individual chemist, and whether their professional ethics will outweigh their profit interests. I am sure that there are black sheep here too, just like with the doctors too many black sheep, I might add.

Cultural Influences

Lets take a look as some of the suspects that still need to be examined. Is maybe society guilty? Are cultural influences turning us into addicts? It is common knowledge that there are many more countries that swallow many more pills than in Germany, Austria and Switzerland. In France, for example, the average French person swallows two and a half times the amount of medication than in Germany or Austria. Even the Japanese belong to the massive pill-swallowing peoples of the world.

It would be interesting to find out if the general increase in use of medication actually causes addiction in itself. Im not sure, be there are some indications that the general acceptance to swallowing pills as a means of solving problems affects medication addiction positively.

Certainly it would be interesting to find out if our society has been becoming more susceptible to medication addiction within the past decades.

And the alternative medications?

At least we are certain that the total consumption of medication is not increasing in Germany and Austria. In fact in Germany it is decreasing. But there also isnt a definite trend that Germans are keeping clear of conventional medication, or what they commonly call chemical drugs and moving in the direction of alternative or herbal medications. Most of these types of medication are used as co-remedies, in addition to the regular medication. Usually this is done without thinking about it, and in a volume that I find mind-boggling. Alternative and herbal medications have the reputation which is basically not true, and this can be proved to be soothing and harmless and supposedly dont have any side effects. At least medication addition hardly plays a role here, except for maybe herbal laxatives.

According to my experience, alternative medicine is more focused on consuming medication than conventional medicine is, which is often polemically ridiculed as school medicine. As far as I am concerned alternative patients are far less critical about medication than so-called school medicine patients. Alternative patients will take almost any kind of herbal medicine without ever finding out if its recommended, or if it should have been prescribed by a doctor.
My opinion is thats the best road to medication addiction, or at least the road that makes medication addiction easier. Any situation that fosters the idea of immediately taking some pill to get rid of every ache and pain, or taking medication as a means of prevention, is always a potential medication addiction situation, and only makes it harder for a patient to quit.

Its less a danger that someone will actually become physically addicted, but more psychologically; or that it cuts a path through the grass to facilitate addiction for other substances, such as ecstasy, alcohol or narcotics.

Closing Remarks

To close this article, just a few thoughts about the possibilities to reduce the number of medication addicts, or at least a way to prevent us from having so many addicts.

Laws pertaining to drugs and medication can be changed rapidly and efficiently. This would be the fastest way to curtail the number of addicts, such as some over-the-counter drugs under prescription, or applying some of them to the present narcotic control laws. But there is a danger that lawmakers will over-do it, and make doctors too cautious about prescribing medication that does good in small dosages. We already see this happening with heavy-duty painkillers, and doctors reluctance to prescribe them, except for people who are practically terminally ill.

Information will have to play a very important role not just for the doctors and chemists, but also for patients and consumers. Sometimes its just a matter, that many people just dont know that some medications are potentially addictive. A good idea for making this mainstream knowledge would be to set up an potential abuse encyclopaedia or an early warning encyclopaedia, that would be available to the public, so that you could check or information about certain drugs, and get statistical information about how easily it is to become addicted to certain medications. Of course these encyclopaedias would have to be updated from time to time.
Poor track records for some medications could be recorded and corrected earlier. Medical insurance companies could provide the necessary feedback to accomplish this. At the moment, they arent providing pharmaceutical companies with any data. In Austria, though, this would take some doing, because public insurance companies are slow-to-react bureaucratic organisations that are more concerned about managing money than anything else. They are hardly interested in the medication they are reimbursing, or the possible addiction that is accompanying it.

A preventive measure that could be endorsed by society is probably child rearing and education. Teaching children that nice little pills make nasty pains go away immediately fosters the problem in the first place. The paediatrician will need to be responsible in this case, to help recognise family behaviours and correct them if needed, especially when it comes to re-filling prescriptions.
Once again this admonishes the important roll that doctors play especially when it comes to fostering as well as preventing medication addiction.

Important Sources:

Yearbook of Addiction 98, published by the German National Institution Against Addiction, Neuland Publishing, Geesthacht 1997
Yearbook of Addiction 99, Geesthacht 1998
Medication Dependency; Information for Doctors, published by the German National Institute Against Addiction, 3. Edition, Hamm 1991
Gerd Glaeske, Medication Abuse and Medication Dependency in: Preventative Medicine, Springer Loseblattsysteme, Stand: September 1998
Kurt Langbein, Hans-Peter Martin, Hans Weiss: Bitter Pills Advantages and Risks of Medication, Published 1999 2001, Cologne 1999
* Dr. phil. Hans Weiss is a psychologist, and co-author (Bitter Pilles) and author. He lives in Vienna. This article is based on a dissertation, which the author presented on March 25, 1999 to the Sarganserlnder Symposium for Addiction in reference to the topic medication addiction. It was edited by Martin Hafen.
** For reasons of expedience the following was used in the female gender (in the original language).