“One more drink and I’ll move on...” - it is that craving for one last shot, to escape reality that drives an alcoholic on till blackout and even death.
Drinking becomes the solution to life’s battles, the “comfort zone” and best friend. In spite of evident damage to health, social well-being and financial stability, giving up the bottle seems unthinkable.
When confronted, some alcoholics will claim that they are ‘fine’ and that they can stop whenever they want, while others believe that they cannot stop even if they try, and accept alcohol addiction as their destiny.
In most cases alcohol dependent people choose to ignore the problem and continue to dwell in denial. To them, life without liquor is ‘spiritless’, and quitting is simply not an option. Their behaviour causes them to drift away from society, leaving them helpless and alone.
Persuading such an individual- whether he or she is a family member, a friend or colleague- to step forward and seek help is a difficult task that requires commitment and understanding. “We must remember that alcoholism is a disease,” says Mr. Terrance (full name withheld), a member of Alcoholics Anonymous (AA), an international fellowship that helps people overcome alcohol addiction.
Society condemns, stigmatizes and isolates alcoholics. “Would you do the same to a cancer patient?” questions Mr. Terrance. He believes that anyone battling an alcohol problem needs “empathetic, compassionate, loving support”.
Chief Coordinator of the UN Office on Drugs and Crime project H13 Mahesh Nissanka, has worked extensively with addicts, and advocates an approach that focuses on empowering the alcoholic to help himself. A counsellor must take a supportive and not dominating role. By being friendly and tactful, an environment must be created that facilitates the alcoholic to speak, he says.
The alcoholic must come forward and admit that he needs help from a professional. Forcibly dragging a person to a hospital or police station is not ethical and ineffective, says Mr. Mahesh.
Emphasising the importance of communication, Mr. Terrance says, “The magic of AA is that they get to speak to another alcoholic." This allows an alcoholic to see his problem in a new light.
Mahesh adds that using “fear tactics” to make a person give up alcohol, for example, by a spouse threatening to leave or calling on supernatural powers for punishment, is ineffective in the long-term. “When the initial fear subsides, the craving for liquor returns,” he explains.
The behaviour of the people around an alcoholic may also indirectly encourage alcohol abuse, says Mr. Terrance. Family and friends will safeguard the alcoholic from getting into trouble. They will lend him money. If he comes home drunk, breaks furniture and vomits, they will clean it up.
People who unknowingly encourage drinking through such acts are called ‘enablers’, explains Mr. Terrance. “Let him see the mess he has created. Let him take responsibility for what he has done,” he advises. Only then will they see the true nature of alcohol. When an alcohol addict realises the gravity of the problem and willingly comes forward to receive treatment, the first step of the recovery has begun.
Even though treatment programmes vary greatly in their approach, a common goal is to let an alcoholic create a new fulfilling life free of alcohol. Some addicts may require additional medical treatment to overcome withdrawal symptoms.
Alcoholism like all other diseases has three sides-, the physical, mental and spiritual, says Mr. Terrance. A treatment is only effective if the patient is helped to overcome all three. A priest or a doctor alone cannot do this alone, explains Terrance, stressing the importance of a combined approach. “An alcohol addict can’t come back to social drinking,” he cautions, emphasising that total abstinence is required for complete recovery. “An alcoholic is someone who has lost control of his drinking- if he has one drink, he goes on till he blacks out.”
As part of the recovery programme, alcoholics are encouraged to take responsibilities in the family, stay active and get involved in hobbies and other fun activities, says Mahesh. This helps to reintegrate them to society. They are also taught to resist peer pressure and encouraged to help others quit alcohol, he adds.
Mr. Terrance also stresses the importance of on-going education to prevent relapses. Even though an alcoholic might fail to quit completely the first few times, it is important to keep trying “one day at a time”.
The CAGE Test
Developed by Dr. John Ewing, the CAGE Test comprises four simple questions widely used for alcohol abuse screening.
- Do you feel that you should Cut down on your drinking?
- Do you feel Annoyed when other people comment about your drinking habits?
- Do you ever feel bad or Guilty about your drinking?
- Do you ever need a drink (Eye opener) first thing in the morning to steady your nerves or to get rid of a hangover?
A “yes” to any one of these questions suggests possible alcohol-related problems. More than one “yes” answer means it is highly likely that the person is abusing alcohol.
Alcohol use or abuse?
Chemically known as ethyl alcohol or ethanol, alcohol robs the world of 2.5 million lives annually.
The term ‘alcohol use’ simply refers to the consumption of alcohol and does not indicate the amount taken or the extent of harm caused.
Alcohol use becomes harmful under the circumstances of drinking. Examples include, drinking and driving and drinking during pregnancy. Traffic and industrial accidents, violence and socially-inappropriate behaviour are commonly caused by alcohol use.
In contrast, ‘alcohol abuse’ or “problem drinking” refers to “a pattern of excessive drinking that results in adverse health and social consequences to the drinker, and often to those around the drinker”.
A combination of mental, social, environmental and genetic factors could lead a person from use, a common social activity, to abuse, a chronic and progressive disease.
According to the WHO, people with alcohol abuse problems:
- Use alcohol to help them change the way they feel about themselves and/or some aspects of their lives and/or to deal with painful feelings or situations.
- Experience some problems associated with their alcohol use and get complaints about it.
- Lose interest in activities and hobbies that used to bring pleasure.
- Get irritable as their usual drinking time approaches, especially if alcohol isn’t available.
- Keep alcohol in unlikely places at home, at work and in the car and drink alone or in secret
- Gulp drinks, become intoxicated intentionally.
- Resent advice from other people
- Cannot handle day-to-day matters because of alcohol.
An ‘alcoholic’ is someone who has developed alcohol dependence, a condition arising from a combination of symptoms. The WHO lists the four main symptoms as,
Craving — A strong need, or compulsion, to drink.
Impaired control — The inability to limit one’s drinking on any given occasion.
Physical dependence — Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking.
Tolerance — The need for increasing amounts of alcohol in order to feel its effects.
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