title: [Silent abuse].
abstract: The rate of "silent abuse" is probably underestimated by the current esteem of 1:200 in the general population. Because of the criterion of "silent inconspicuousness" most of the patients concerned elude statistical records. So much the more, however, they need medical attention. It is a highly urgent problem, involving individual as well as social medicine, and carrying the risk of massive damage to health, shortening of life expectancy and loss of ability to enjoy creativity and pleasure. The presenting symptoms are mainly headache, sleep disturbances and vegetative manifestations. The (over-)medication in use consists mainly of analgesics, tranquillizers and narcotics. The etiological background is made up (usually in close interdependency) of depression, external circumstances and neurotic development as well as a distinct type of personality (to be understood as the result of interaction between genetic and psychodynamic factors). Especially, there appears a personality structure according to the present ideal picture of achievement and order. Therefore, even from the medical point of view, hardly ever to be regarded as deviant or in need of therapy. In some cases out of this constellation arises a further enhancement of the mechanisms of abuse. Among rational objective measures we can propose: Increased information of the public and further special education of medical people, especially referring to rational therapy of depression and pain without the use of analgesics, furthermore, rational psychotherapeutic guidance; attempts at more specified and follow-up care of disaccustomed abusers; intensified public relation work in cooperation between medical doctors and politicians.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D000437:Alcoholism / Q000175:diagnosis; D000701:Analgesics, Opioid; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000150:complications; D006261:Headache / Q000188:drug therapy; D006801:Humans; D010146:Pain / Q000188:drug therapy; D011619:Psychotropic Drugs; D012917:Social Adjustment; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation
chemical_list: D000701:Analgesics, Opioid; D011619:Psychotropic Drugs
vernacular_title: Der stille Abusus.