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BIOSAFETY NEWS May 2002
ALCOHOLISM DIGEST
with David Ogot

"Drink no water, but use a little wine for thy stomach's sake 1 Timothy 5." But the million-shilling question here is how little is a 'little'? Where does one draw the line and say enough? When does one cross the line from social drinking and enter the murky world of alcoholism? A world shrouded in myth and half-truths.

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 any reason for not 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 is 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 high risk of bearing deformed children. But ultimately, it is the liver that suffers the worst as it filters most of the alcohol out of the bloodstream and breaks it down.

Because of its high 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 can tell you and they usually use one Kiswahili word: mlevi or drunkard. But is alcoholism really the same as drunkeness. Doesn’t a drunk willfully set out to get drunk or abuse alcohol? Does an alcoholic have control over his drinking?

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 conman, shiftless, vagabond, jailbird and 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 physical or mental health or with normal social or occupational behavior" In simple terms, this means drinking constantly until it interferes with your health, social and work relationships.

So is this a drunkard or an alcoholic? Though the effects are very similar there is a world of difference between them. 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 constantly either drinking or craving for alcohol?

Why is it that some people can drink and go home while others come to drink in the bars which then become their homes? There are several reasons advanced, ranging from physiological (body) hereditary (runs in families or particular ethnic groups), bio-chemical imbalances - too much of one thing not enough of another? Liver defects, psychological (mind and will) guilt stress, resentment and socio-cultural: peer pressure, problem drinking in the home and school. But some of these "causes" could be effect.

It could be one or a combination of several factors and that is why it is called the x-factor. But one thing we do know: alcohol does not cause alcoholism. If that were the case, anyone who drank alcohol would become alcoholic. Who then is an alcoholic?

According to Dr. Fred Owiti, of arrow Medical center, who is a consultant psychiatrist, an alcoholic is someone who is controlled by alcohol, but denies it. He goes on to state that alcoholism is a much bigger problem than other drugs in this country, baring the fact that alcohol is socially acceptable. Dr Owiti further acknowledges that there are a lot of myths and beliefs about alcohol are not based on scientific fact.

Mr. Joseph Jangima, General Manager of Ich-Ber Scientific Ltd., describes and alcoholic as "a person who is always drinking alcohol and is always drunk. He has too much alcohol in his blood and in some cases may not function well without taking alcohol. One becomes alcoholic by increasing his alcohol intake to such an extent tat he becomes addicted, or rather cannot do without alcohol.quot;

Dr. Max Okonji, who is a consultant psychiatrist at Chiromo Lane Medical center, defines an alcoholic as "a person whose dependence on alcohol has a major effect on his mental, physical and social life and he/she cannot perform in the absence of alcohol."

As to some of the myths about alcohol, he says that certain communities believe that alcohol can cure specific diseases e.g. measles. Dr. Okonji also believes that thousands of deaths, which are a direct consequence of alcohol abuse and alcoholism are wrongly laid at the feet of other causes. These include heart and liver failure, accidents and suicides.

Dr. Peter Gaku, a pharmacist and consultant for the national agency for the Campaign Against Drug Abuse (NACADA) also recently in a workshop on drug and chemical abuse training for training institutions and colleges organised by the agency emphasised this fact.

When people die and are told he died from liver failure, they don't go further and ask what caused it? Yet when you ask the doctor he will tell you it was as a "direct result of his alcohol abuse," he pointed out to some of the participants who were sceptical about the high mortality figures for Kenya.

Supporting this view on wrongly attributed deaths and myths is Ms. Joyce Fiodembo, a counselor in Nairobi, who counsels among the other abusers, alcoholics. She points out that a common myth in Kenya surrounding alcoholism is that one is demonic or is bewitched.

In his 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.

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 everyone else before they start drinking.

The addiction to alcohol then aggravates these problems, undermining and weakening the alcoholic’s ability to cope with the 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 that alcoholic's true personality.

But perhaps the most common myth of them all is that if people would only drink responsibly, they would not become alcoholics. Many responsible drinkers become alcoholics. Then because it is the nature of the disease (not the person), they begin to drink responsibly.

Dangerous and sometimes 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 amount of alcohol consumed at a sitting. But no matter what amount they start out with, sooner or later drinking will re-activate their addiction.

So having cleared the air somewhat, the burning question still is, is alcoholism a disease? Many members of the public interviewed for this article gave an emphatic no! Others though were not sure.

Mr. Mike Muchiri, a nursing officer at the Chiromo Lane Medical center in Nairobi, however, gave an equally emphatic "yes" and he is joined in this by 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.

What then is a disease? A disease is anything that interferes with the biological ability of a human being to function normally. But many Kenyans I talked to are dubious about this idea. "Anakunya kwa sababu anaipenda, si ati ni ugonjwa!" He drinks because he likes to not because it is a sickness.

The Majority of the opinions were in the same mien. Others were, "they are irresponsible, lazy." John Wambua feels they drink to forget their problems, while Louisa Nndulu thinks it’s because they are wealthy, while some is due to peer pressure.

Continued in 'It's A Thin Line between Drinking, Alcoholism' part two in Biosafety News JUNE 2002

David Ogot is a freelance journalist/producer who has personal experience with alcoholism. He can be reached at goinghomedotcom@yahoo.com or alternatively at info@goinghomedotcom.org