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This year’s United Nations International Day Against Drug Abuse and Illicit Trafficking celebrated on June 26th. Every year has as it’s theme Drugs: Treatment Works, a theme that will run until next year’s June 26th celebrations when a new theme will take over.
But treatment for what? Is drug abuse a disease? But you have probably heard of alcoholics going for treatment. Treatment for what? Is drinking too much alcohol a sickness? Is using to bhang (cannabis sativa), heroin, or cocaine a sickness?
The addiction which in overwhelming numbers comes about by continued use of bhang, heroin or cocaine is what is then termed a disease. This condition then is what needs treatment. But surely alcohol is not a drug and definitely drunks are not sick people, all they need to do is stop.
Before we talk about what treatment for drug addiction is all about, we must then first ask about the drug which is causing Kenyans the most grief and yet is not looked upon as a drug capable of causing addiction with it’s attendant destruction even more effectively than heroin or bhang- alcohol!
October has been declared the inaugural National Alcohol Awareness Month in Kenya by goingomedotcom Trust a charity registered in Kenya to disseminate awareness on alcoholism and other drug abuse. The Trust has just run the 1st National Alcohol Awareness Month with the them "Alcohol and HIV" very successfully with over 20 programmes on Radio and TV as well as articles in magazines and newspapers.
Alcohol is the most abused drug on earth but even those who have quaffed it for years, literally know nothing about its effects on the body. Others, it would seem go to great lengths not to know; preferring not to have a good reason to cut down or cease their drinking.
But the effects of alcohol on the body organs are grim. Brain cells are altered, with many dying, while senses are dulled and memory function blocked. Irreversible damage is the long-term consequence.
Alcohol can also trigger bleeding in the stomach and intestines while causing deterioration of the heart muscle. In the immune system, cells, which fight infection, are prevented from functioning properly and the risk of viral or bacterial diseases is increased.
Not even the reproductive function is spared. In men, hormone levels change causing lower sex drive and enlarged breasts, while women’s menstrual cycles become irregular and their ovaries malfunction. Pregnant women run a risk of bearing deformed children as a result of Foetal Alcohol Syndrome.
But ultimately it is the liver which suffers the worst as it is responsible for filtering most of the alcohol out of the blood stream even as it breaks it down.
Because of its high, though nutrient deficient caloric content, alcohol displaces key nutrients, sometimes causing malnutrition. Excess calories are stored as fat (this is one of the signs of ‘fatty’ or alcoholic liver disease.) Eventually, the liver cells die, resulting in cirrhosis, a degeneration of the organ.
Every Onyango, Koech and Mwangi can tell you what an alcoholic is and they usually one Kiswahili word: mlevi or drunkard. But is alcoholism really the same as drunkenness?
Most Kenyans would describe a mlevi as a drunkard, irresponsible person who spends all his time in the bar, broke, unkempt, no fixed abode, a con man, shiftless, vagabond, jailbird ad infinitum! Is this then the description of an alcoholic or are these merely the manifestations of alcoholism or alcoholic behaviour?
Alcoholism as defined by the Concise Columbia Encyclopedia is a "chronic illness characterised by the habitual consumption of alcohol to a degree that interferes with your health, social work and relationships."
This is as good a description as any of the multiple definitions except that it fails to point out that if left untreated is usually ultimately fatal.
However the question still begs, is this a drunkard or an alcoholic and what indeed if any is the difference? Well there is a difference as one is willful, a behaviour while one is due to physiology in the way your body reacts to alcohol specifically the brain. Put another way, the drunkard could stop if he would, while the alcoholic would stop if he could.
But fundamentally, what causes alcoholism and why is it that the majority can drink socially but hundreds of thousands become alcoholic and end up either drinking or craving for alcohol?
Why is it that some people can drink and go home, while others come to drink in bars which then become their homes? Numerous studies have shown that due to subtle differences in an alcoholic’s brain chemistry, when he or she consumes alcohol the need for more is created. In a vicious cycle the more they drink to quench this craving the more intense the craving becomes.
This can be put into perspective by looking at a fellow driving his car blissfully along obeying all the traffic rules. Suddenly as he is waiting for the traffic light to turn green allowing him to drive on, the back seat is yanked open and a menacing looking man slides in pointing a gun to the back of the hapless fellow’s head.
"Drive!" the man barks forcing our friend to accelerate into the main road even though the lights are still red. Oncoming vehicles swerve desperately, brakes screeching, horns blaring. Luckily with several near misses our man drives off with no damage. But behind him chaos reigns as one driver ploughs into a lamppost while another one careens onto a pavement slamming sickeningly into a woman and her child sending the latter hurtling through the air to land in an untidy, motionless heap 20 feet away.
"Turn right here" instructs the gunman grinding the nose of the gun muzzle painfully into the drivers neck. Wincing the man obliges even though the street is clearly marked as a one-way street. More chaos.
This harrowing ride continues for another one hour until on the outskirts of Nairobi the final command “stop here” ends the nightmare as the gunman slips away into the convoluted labyrinth of a sprawling slum.
Later the still shaking driver is arrested and charged with the trail of mayhem left in his wake including one dead child. Was it his fault? He is later released. Two days later in a bizarre twist of fate our friend is car-jacked and the madness ensues again. Whose fault is it again? It is his car. It is he in the driver’s seat. He is the one driving. But is he in control? No!
This then is the key. Loss of control. And just as our luckless driver can never be in charge with a gun to his head, so too the alcoholic with alcohol in his system. For the alcohol ‘hijacks’ his brain. He is no longer in control. Once an alcoholic drinks anything can happen including the person drinking normally and going home.
In his now classic book Under the Influence, a guide to the myths and realities of alcoholism, Dr. James R. Milam highlights some of the more common myths which are accepted as truths.
One of them is that alcohol is an addictive drug and anyone who drinks long and hard enough will be addicted. But the reality here is that alcohol is only selectively addictive to a minority of users, namely alcoholics. These are usually between 10-15 percent of most societies who are predisposed to alcoholism and hence need to start drinking in order to trigger their disease.
Most people can drink occasionally even heavily without becoming addicted to alcohol. Others (alcoholics) will become addicted no matter how much they drink.
Another myth is that people become alcoholics because they have psychological or emotional problems, which they try to relieve by drinking. But refutes Dr. Milam, alcoholics have the same psychological and emotional problems like everyone else before they start drinking.
The addiction to alcohol then aggravates these problems, undermining and weakening the alcoholic’s ability to cope with normal problems of living.
Furthermore, the alcoholic’s emotions become inflamed, both when he drinks excessively and when he stops drinking. Thus when he is drinking and when he is abstinent, he will feel angry, fearful and depressed in exaggerated degrees.
Common too is the myth that when an alcoholic is drinking, he reveals his true personality. However, the truth of the matter is that alcohol’s effect on the brain causes severe psychological and emotional distortions of the normal personality. Sobriety reveals the person’s true personality.
But perhaps the most common myth of them all is that if only people would drink responsibly, they would not become alcoholics. Then because it is the nature of the disease (not the person), they all begin to drink irresponsibly.
Dangerous and many times fatal for the alcoholic however, is the myth that they can learn to drink ‘normally’ again and with no ill effects as long as they watch the quantity consumed. This in total ignorance of the fact that no matter what amount they start out with, sooner or later usually sooner, drinking will reactivate their addiction.
In spite of all this many Kenyan’s are still skeptic that alcoholism is a disease and this flying in the face of the World Health Organisation (WHO), the American Medical Association (AMA), the British Medical Association and others who have researched the problem of alcoholism and concluded that it is indeed a disease.
A disease is anything that interferes with the biological ability of a human being to function normally. Yet if it is a disease ‘not his fault’ why then does the alcoholic so vehemently deny his condition? This even when there is ample evidence all around him of destruction in all spheres of his life that have been caused by his drinking - why does he still deny reality?
One reason could be how it works. In Carlotta McBride, a fictional study of an alcoholic by Charles Orson Gorman, there occurs the following excerpt. “One thing about alcohol, it works. It may destroy a man’s career, ruin his marriage, turn him into a zombie unconscious in the hallway-but it works.
"On short-term, it works much faster than a psychiatrist or a priest or the love of husband for wife. Those things… they all take time. They must be developed…But alcohol is always ready to go to work at once. Then minutes, half an hour, the little formless fears are gone turned into harmless amusement. But they come back. Oh yes, and they bring reinforcements."
These can be tremors, anxiety, agitation and later hallucinations, delirium tremens (DTs) and convulsions. This then is one of the most confusing aspects of alcoholism and that is that the alcoholic becomes most sick not when he is drinking, but when he stops.
So what kind of disease is this then? In his extremely enlightening book, Alcoholism And You by Fr. Maurice Gelinas, he quotes “cunning, baffling and powerful”. These are in fact the three words Alcoholics Anonymous (AA) also use to describe the disease.
He further states that the alcoholic himself has no clear concept of what his disease is and that in any case, there as many definitions as professionals in the field who write about this disease, lecture on it or counsel alcoholics.
Fr. Gelinas, however, defines alcoholism as a disease which is chronic, progressive, of unknown origin, that affects the whole man and those around him, and whose characteristic is the loss of the ability to control one’s drinking of alcohol".
Thus chronic or permanent or incurable, can only be remitted if kept in check. Non-alcoholics generally have no difficulty in accepting whatever advice they are given to keep their disease in check.
But not so the alcoholic. Because of his befuddled (by alcohol) thinking or as AA calls it “stinking thinking”, the alcoholic will not agree that his disease is permanent and incurable. I remember how I tried time after time to "drink like everybody else", but each time it ended up on a serious bender. I tried drinking on weekends only, after 5.00 p.m., at special occasions only, once a month, not in bars, carrying little money, the list is endless. But always in the end - unmitigated disaster.
The position of the Church is more interesting. In 1804, Thomas Trotter, an Edinburgh physician wrote a paper stating his belief that habitual drunkenness was a disease. This paper created a controversy that continues to this day.
Society has since then been divided on the question: is alcoholism primarily a physiological disease or is it as was held a symptom of character inadequacy and emotional weakness? Today, this question still divides the alcoholism field.
In Under the Influence, Dr. Milam reasons that by shifting the blame from the alcoholic’s character to a ‘remote cause’ outside the alcoholics control, Trotter’s new theory confused the lines between “good” (that is will power, self control and moderation) and "evil" (weakness of character, gluttony and intemperance).
It was to take a long time before alcoholics (or inebriates as they were then described) were even given separate facilities from the insane. But still, almost one hundred years after Trotter’s essay, attitudes were even more intolerant with the American Temperance movement organising crusades against alcohol at national level. The Church insisted that the chronic inebriate was responsible for his happy state and needed its moral guidance to be reformed.
But finally after a lot of research as well as the emergence of AA, the Church was forced to modify its position such that one hundred and forty-two years after Trotter’s essay, the Presbyterian Church became the first religious Organization to acknowledge formally that alcoholism is a disease.
But to date, blame and stigma are still attached to the victim for contracting this disease, with people still insisting that alcoholism is caused by heavy drinking, which in turn is caused by defects in the drinker’s psychological, social and cultural fabric.
Closer to home, a poster distributed by Islamic Propagation Centre International in Durban, South Africa, asks that “if alcoholism is a disease, then it is only disease that is sold in bottles, is advertised in newspapers, magazines, radio and television, is contracted by the will of man, has licensed outlets to spread it, produces revenue for the government, brings violent death on the highways, has no germs or viral cause; propels one’s health to self-destruction, destroys family life and increases crime”. They end by stressing, "it is not a disease - it is Satan’s handiwork".
Fr. Gelinas puts it more succinctly. Alcoholism is &qiot;not a sin. A sin is something judged to be (a) wrong done (b) freely and (c) knowingly, with all three conditions fulfilled together. If any one of these conditions is absent, there is no sin.
Drinking in excess of what is socially acceptable or to the point of intoxication is objectively wrong. No argument.
Drunkards (given to the excessive use of alcohol: often drunk) are not necessarily alcoholic. Generally, the drinking alcoholic is a drunkard. The basic difference between the two is a matter of control: the alcoholic has lost his ability to control his drinking of alcohol (the main characteristic of the disease), while the drunkard still has the ability. If no ability to control, then no freedom of choice.
The alcoholic does not intend becoming one, any more than the syphilitic intends his disease. In both cases, there could have been, and probably were, objectively sinful acts linked to the disease but the disease, itself that is linked to the act is not a sin".
He thus concludes, "alcoholism is not a symptom of underlying problems. It is an illness by and of itself producing its own symptoms. Before the onset, of the disease alcoholism, the excessive drinking of alcoholic liquor generally is symptomatic of underlying problems
Once the line has been crossed and the alcoholic has become an alcoholic drinker, his drinking is then symptomatic of that illness.
Unfortunately, there is no way of telling if you are predisposed to alcoholism (i.e. you have the X-factor). The only way you can find out is by starting to drink and waiting for it to be triggered.
If you don’t drink ask yourself, ‘why start?’ If you do drink, are you drinking responsibly? For the alcoholic there is only one solution. Abstinence! Any alcoholic who continues drinking, the end is inevitably insanity, an institution or death!
To paraphrase Fr. Gelinas, even if you do not drink, maintain an attitude of humility; it is no credit to you that you are not an alcoholic, and will never be if you never drink, no more than it is for not being a diabetic, or epileptic or moronic.
Now that we understand alcoholism we are able to look at treatment in the next issue.
David Ogot Sr.
12th August 2004
Nairobi, Kenya
David Ogot is a freelance journalist/producer with personal experience with alcoholism. He can be reached at goinghomedotcom@yahoo.com , website: www.goinghomekenya.org .
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