Is it a disease or choice?
Alcohol drinking is a popular activity in Kenya. Many social events are incomplete till alcohol is poured and shared. Direct alcohol marketing and adverts depict glamorous, youthful and good looking models endearing viewers to be like them. Indirectly, alcohol companies influence movies and TV programmes to show drinking as appealing and sophisticated. Drunkenness is portrayed as funny and humorous; we seldom see movie actors experience hangovers (except in a comical way), injuries and deaths from accidents, legal, financial and health problems.
Many alcohol users ultimately get addicted or dependent on alcohol. This is characterised by cravings for alcohol and an inability to stop drinking despite attempts and knowledge of negative consequences. In the past, alcohol dependence was viewed as a weakness or the individual was seen as being morally defective. Today, the World Health Organisation recognises alcoholism as a disease based on the belief that alcoholism is a condition of primary biological causation and it has a predictable natural history.
What is a standard drink?
One standard drink is equal to 10 grammes of pure alcohol. The liver can only metabolise on standard drink per hour. The 500ml beer bottle has two standard measures of alcohol. A 200ml bottle of spirits has six standard measures of alcohol. A 750ml bottle of wine has 7.5 standard measures of alcohol. Low risk alcohol use stipulates 11 standard drinks per week for women and 17 standard drinks per week for men.
Diagnosing Addiction
The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and the International Classification of Diseases (ICD), 10th Edition outline dependence to include seven symptoms. If three or more of the symptoms are patterns in a person’s life for a year or more, that person is diagnosed as being addicted or dependent to alcohol.
Tolerance: The need to drink more to get same effect or diminished effect with same amount. One needs more of the same drink than before to reach the same intoxication level. The same amount of alcohol drank before fails to intoxicate the person as it did before. W
Withdrawal: Physical/emotional withdrawal symptoms, or drinking/using more to relieve or avoid withdrawal symptoms. The withdrawal symptoms are the opposite of those of acuteintoxication – they include sweating, nausea, tremors, great anxiety, agitation and depression. They are experienced 6-48 hours after consumption. The symptoms are relieved or avoided by taking more alcohol. Many drinkers do not wait for the withdrawal symptoms, they replenish before the symptoms set in.
Loss of control: The person drinks more alcohol and for a longer period than he intended to. The person’s family may criticise his drinking and the time spent or outright state that he or she needs to cut down on the alcohol.
Attempts to control: The person reports a persistent desire or efforts to cut down or control alcohol drinking. This may include making rules for self about when, where, what to drink, and so on. Needless to say, these attempts are futile.
Time spent on use: The person spends a great deal of time in activities necessary to get alcohol, drink it and recover from it. For example, a person may travel far to get to his friends who have promised him a drink and when he gets there, he drinks for many hours.
Sacrifices made for use: The person gives up or neglects important family, social, occupational and recreational activities that conflict with his drinking. A person’s family and marital responsibilities such as intimacy with spouse and children are affected. A person may miss work, church and family occasions such as births, weddings and funerals because he is drinking at the time.
Continued use despite known negative effects: The person continues to drink alcohol despite knowledge of having persistent physical or psychological problem that is caused or made worse by drinking. For instance, a person continues drinking despite a doctor’s warning about the effect of his drinking on his medical condition such as ulcers. He or she may continue to drink despite having experienced problems with law enforcement agencies.
Addiction
A first time alcohol user will either spit it out in disgust or ultimately like the fact that it either gives pleasure or reduces unpleasant feelings. As time goes by, a person discovers that taking alcohol may help deal with a difficult situation. For example, a shy man may feel more confident to talk to a girl after a drink. This is because alcohol is a downer, or a depressant. It sedates the central nervous system leading to impaired speech, vision, coordination, and concentration. It reduces one’s sense of judgment and inhibitions and makes one speak and act courageously and confidently. As alcohol use continues, tolerance starts to increase. One needs more of the drug to get the same effect. During this phase, a user starts experiencing blackouts, begins to hide from others the amount they’re drinking; downs the drink faster and strictly for the effect and will experience their first loss of control and physical withdrawal.
Gradually, the loss of control progresses, and a person can’t be sure how much he or she will drink or use once they get started. If there are snide comments about the drinking, persons at this phase may quit for a while to prove they aren’t really dependent. They soon return to uncontrolled drinking when they attempt moderate use. They will often hide and lie about their drinking. They experience physical and psychological problems – family, friends and colleagues can see that their health and personalities are negatively affected. Social and occupational functioning is affected: life is characterized by conflicts, disruptions, health, financial and legal challenges. Still, the person continues to drink, as they are now alcohol addicts or alcoholics. A functioning alcoholic is a person who is able to maintain a respectable and good profile life, with a good family, home and friends. They maintain the balancing act, though that does not dissipate the effects and consequences of drinking.
In the chronic stage, the person’s life is comes apart. A person loses hold on the family and home, loses the job, has serious health challenges, and has encounters with the law. Sadly, some people die of clinical complications, accidents and suicide. Others decide to do whatever it takes to change – a recovery programme. The alcoholic MUST be willing and ready to get therapy. Oftentimes, treatment fails because it is family members and employers who coerce a person to check into a rehab.
Treatment for alcoholism
The 12-steps treatment programme guides people to change their behaviours and stop substance abuse and patterns of thought and behavior that lead to addiction. Alcoholics Anonymous uses the 12-Steps, welcomes all to join, and provides suggestions, not requirements for participation. The rational recovery treatment approach is useful for people who either can’t accept the 12-Step programmes’ views on a higher power or opt for a self-help approach to recovery. It is based on rational-emotive therapy (RET), the idea that all dysfunctional behaviour is due to mistaken beliefs, thus correcting those beliefs will correct the behaviours. Faith-based programmes are run by churches, mosques and other faith communities. The inpatient or residential treatment is the most popular and intensive. It lasts between several weeks to months depending on progress of recovery. Clients receive both medical and psychiatric/psychological treatment for co-dependent problems such as depression, suicidality, trauma etc.
Alcohol dependence negatively impacts on a person’s health, family, work, financial and social life. The common opinion is that people with alcohol dependence or addiction are weaklings and unable to pull their act together Alcoholism is not a respecter of social class or intellectualism. Anyone is prone to alcoholism. We all know of family members or friends struggling with the criteria outlined above. With this greater understanding, we can make a difference to someone with alcohol dependence and addiction.
On this, we have a choice.
