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Alcoholism the scourge of hundreds of thousands of homes in Kenya, killing countless of its citizens, yet a disease which though everybody seems able to quantify its moral, social, economic consequences, none seem able to define.

The myths and stories which surround it are myriad and as assorted as the different brand names though basically there are only two types of alcohol methyl alcohol (methanol) and ethyl alcohol (ethanol) with methanol when added to your kumi-kumi causing blindness, coma, even death and ethanol the one in your beers, wines and spirits.

To understand the disease, one must understand the substance alcohol, an oddball combination of food, chemical and drug capable of creating exquisite pain or pleasure. Ethanol is made by fermentation i.e. yeast, a fungus with a hunger for sugars found in food grains, fruits, berries and other plant materials, eats them and releases an enzyme which converts the sugars into alcohol

Because yeast expires when alcohol concentration reaches 13 or 14 percent, natural fermentation stops at this point. Distillation which was discovered in Arabia is the art which continues the process where the yeast leaves off ('alcohol' is derived from the Arabic 'alkuhl' meaning essence.) The percentage of alcohol in distilled liquors is commonly expressed in degrees 'proof' rather than as a percentage of pure alcohol. This measure developed in the seventeenth century from the English custom of 'proving' that an alcoholic drink was of sufficient strength by mixing it with gunpowder and attempting to ignite it. If the drink contained 49 percent alcohol by weight or 57 percent by volume it could be ignited.

Proof is approximately double the percentage of pure alcohol. Thus 100 proof whiskey is 50 percent pure alcohol; an 86 proof whiskey is 43 percent alcohol.

Since alcohol is a derivative of sugar, and sugars can be absorbed directly into the bloodstream without any chemical change, i.e. without digestion it is absorbed directly into the bloodstream. Once in the body, it is carried to wherever the blood goes and thus in a healthy person weighing about 70 KGs, the blood circulates throughout the body in about 30 seconds. That means that within thirty seconds the alcohol will have passed throughout your fingers, heart, liver, brain, earlobes, -everywhere! You now have alcohol in your body. Let us begin our journey into alcoholism.

With all the stories that abound and the dozens of articles that have been written, none seems to answer clearly the seemingly simple question namely, what is alcoholism? Yet every Onyango, Koech and Mwangi can tell you what an alcoholic is and they usually use one word, mlevi! kiswahili for drunkard. So just what definition falls under mlevi?

Well there is drunkard, irresponsible, a person who spends all his time in the bar, broke, unkempt, no fixed abode, a conman, shiftless, vagabond, jailbird ad infinitum and they all fall under mlevi. So is this an alcoholic or are these merely manifestations of alcoholism or alcoholic behavior?

Alcoholism as defined by The Concise Columbia Encyclopedia is "a chronic illness characterized 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 you drink all the time until it interferes with your health and social and work relationships. Thus you become a mlevi.

Yet what causes it and why is it that the vast majority can drink socially once in a while but yet for the minority they become alcoholic such that they constantly think about and crave alcohol? Why is 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 imbalance - 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 soon. But some of these 'causes' could be effect. We do not know.

But one thing we do know. ALCOHOL DOES NOT CAUSE ALCOHOLISM. If that were the case anyone who drank alcohol would became alcoholic. So where are we? Let us first then try to define 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 drugs in this country bar the fact that alcohol is socially acceptable. Dr Owiti further acknowledges that there are a lot of myths and beliefs about alcohol not based on scientific fact.

Mr. Joseph Jangima, General Manager of Dutote Promotions an, advertising, marketing and public relations firm in Nairobi says an alcoholic "is 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 that he becomes addicted, or rather cannot do without alcohol."

Dr Max Okonji who is a consultant psychiatrist at the Chiromo Lane Medical Center defines an alcoholic as "a person whose dependence on alcohol has 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 some diseases e.g. measles. Dr.Okonji believes that thousands of deaths as a result of alcoholism are wrongly attributed to other causes such as heart failure, liver failure, accidents etc. Supporting this view on wrongly attributed deaths and myths, is Ms. Joyce Fiodembo a counselor in Nairobi who also counsels among others, alcoholics. She points out that a common myth about 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 gives some of the myths as;

• Myth; alcohol is an addictive drug and anyone who drinks long and hard enough will become addicted.
• Reality; Alcohol is only selectively addictive to a minority of its 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. Myth; people become alcoholics because they have psychological or emotional problems which they try to relieve by drinking.
• Reality; Alcoholics have the same psychological and emotional problems like everyone else before they start drinking. The only thing is the addiction to alcohol aggravates these problems. Alcoholism he says undermines and weakens the alcoholic's ability to cope with the normal problems of living. Furthermore the alcoholics 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.
• Myth; when an alcoholic is drinking he reveals his true personality.
• Reality; Alcohol's effect on the brain causes severe psychological and emotional distortions of the normal personality. Sobriety reveals the alcoholic’s true personality.
• Myth; if people would only drink responsibly, they would not become alcoholics.
• Reality; many responsible drinkers become alcoholics. Then because it is the nature of the disease (not the person) they begin to drink irresponsibly
• Myth; some alcoholics can learn to drink normally and can continue to drink with no ill effects as long as they limit the amount.
• Reality; alcoholics can never safely return to drinking because drinking in any amount will sooner or later re-activate their addiction.

Okay, so we have cleared up the air a bit or have we? We have learnt some myths and some realities, but what is alcoholism? Is for example a disease? Ted Nugi a form two student gives an emphatic no. So does Luisa Nndulu a student at a leading secretarial college in Nairobi. And many others agree with them. Yet Sarah a student at a church school says yes: a lone voice in the wilderness among the youth, as well as .Joseph Jangima, yes. "I strongly believe it is a disease." while John K Wambua does not seem to be sure as he says, "it is not, but it can be."

Mr. Mike Muchiri a nursing officer at the Chiromo Lane Medical Center in Nairobi also gives an emphatic yes and he is joined in this by the World Health Organization (WHO), the American Medical Association, (AMA), the British Medical Association and others who have researched the problem of alcoholism and all have come to the same conclusion: alcoholism is a disease.

So what is a disease? A disease is anything that interferes with the ability of a human being to function normally. But almost everybody the writer talked to in the cause of researching this article scoffed at the idea that alcoholism is a disease. "Anakunywa kwa saababu anaeipenda, si ati ni ugonjwa!" He drinks because he likes to, not that it is a sickness. Most other opinions were in the same mien. They are irresponsible, lazy. John Wambua feels they drink to try and forget their problems, while Luisa Nndulu thinks it is because some are wealthy and others due to be peer pressure.

But why then if its 'because he wants to', or 'he does it to irritate others' does he vehemently deny it, kicking, screaming and spitting, mimi si mlevi (I am not a alcoholic) even when there is ample evidence in the problems drinking has created in all spheres of his life and everybody else around seems to aware except him. Even when he knows the hangovers (withdrawal symptoms) will be terrible why does he persist?

One reason could be how it works. In 'Carlotta McBride', a fictional study of an alcoholic by Charles Orson Gorman, there is the following excerpt "one thing about alcohol, it works. It may destroy a mans 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 a husband or 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 or turned into harmless amusement. But they come back. Oh yes, and they bring reinforcements."

These reinforcements can be tremors, anxiety, agitation and later hallucinations, delirium tremens (DTs) and convulsions, but yet one of the most confusing aspects of alcoholism is that the alcoholic is most sick not when he drinks, but when he stops drinking.

So what kind of a disease is this? In his extremely enlightening book, 'Alcoholism And You' by Fr.Maurice Gelinas (White Fathers) he quotes 'cunning, baffling, powerful'. The three words that the A.A use to describe alcoholism. He further states, that the alcoholic himself has no clear concept of what his disease is and that in any case there are as many definitions as professionals in this field who write about this disease, lecture on it, or counsel alcoholics. Fr. Gelinas who first went to Uganda in 1943 and served in various capacities and was later recalled His Eminence Cardinal Nsubuga, Archbishop of Kampala from the United States to have him the lay the groundwork for a program on alcoholism, a field in which he had acquired some experience personally and vicariously.

His definition, "alcoholism is 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 A.A. calls it "stinking thinking" the alcoholic will not agree that his disease is permanent and incurable. As Fr. Gelinas goes on to say he may again and again try to "drink like everybody else" and each time end up drunk. Once an alcoholic - an alcoholic until death do us part. So it is not that he drinks again and again in different ways (weekends only, end of month only, only at functions) that he is trying to stop, but instead a futile attempt on his part to find the 'magic formula' which if he follows will show 'them' he can 'drink like everybody else'.

So what opinion then of this hapless fellow? Well Luisa Nndulu says they spend their nights in gutters, Joseph Jangima says they are a nuisance, while Sarah feels they need help and Ted Nugi feels they should be discouraged from drinking as "they degrade the community".

And what of the church? In 1804 Thomas trotter, an Edinburgh physician wrote a paper stating his belief that habitual drunkenness was a disease, which created a controversy, which continues to the present day. Society has since then been devided on the question: Is alcoholism primarily a physiological disease or is as was held a symptom of character inadequacy and emotional weakness? Today this still basically devides the alcoholism field.

In 'Under The Influence' Dr.Milam says that by shifting the blame from the alcoholics character to a "remote cause" outside the alcoholics control, Trotters new theory confused the lines between "good" (that is, will power, self control, and moderation) and "evil" (that is weakness of character, gluttony, and intemperance).

And it was to take along 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 Trotters essay attitudes were even more intolerant with the Temperance movement organizing crusades against alcohol at national level. The church insisted that the chronic inebriate was responsible for his unhappy state and needed the churches moral guidance to be reformed.

But finally after a lot of research as well as the emergence of A.A the church was finally forced to modify its position such that one hundred and forty-two years after Trotters essay, the Presbyterian Church became the first religious organization to acknowledge formally alcoholism as a disease. But to date, blame and stigma are still attached to 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 drinkers psychological, social and cultural fabric.

Fr. Gelinas of the White Fathers put it more succinctly. Alcoholism is "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.

1. Drinking in excess of what is socially acceptable or to the point of intoxication is objectively wrong. No argument.
2. 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 this disease), while the drunkard still has the ability. If no ability to control, then no freedom of choice.
3. 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 those acts is not a sin."

He thus concludes, "alcoholism is NOT A SYMPTOM of underlying problems. It is an illness in and by 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 drinker has become an alcoholic drinker, his drinking is then symptomatic of that illness."

So that about sums it up except that when you now accept you are alcoholic and decide to go for treatment, will your insurance policy cover you? No! Why? The insurance companies do not recognize alcoholism as a disease. "In fact once we know you are alcoholic, we will not issue you a policy period!" one employee of a leading Kenyan insurance company, (name withheld) told this writer. Speaking on condition of anonymity he defined alcoholism in insurance terms as "when one exceeds five pints of beer daily".

He went on to say that if a prospective client was discovered to be alcoholic he would not be given any kind of cover. This was "because of the inherent rise in alcoholics." When asked if there were any policies which would cover an alcoholics stay in a rehabilitation center as he was treated or pay for his stay in a medical facility for detoxification, he replied I am "not aware".

So where do you stand? Whether you drink alcohol or not, this questionnaire might prove useful to you. There are others but they are variants of this one and the one from the National Council on Alcoholism (New York, USA) This one is the John Hopkins University Hospital (Baltimore, Maryland, USA) version which is also used by AA great Britain though with theirs the questions are in a different order.

1. Do you lose time from work due to drinking?
2. Is drinking making your home life unhappy?
3. Do you drink because you are shy with other people?
4. Is drinking affecting your reputation?
5. Have you ever felt remorse after drinking?
6. Did you get into financial difficulties as a result of drinking?
7. Do you turn to lower companions in an inferior environment when drinking?
8. Does your drinking make you careless of your family’s welfare?
9. Has your ambition decreased since drinking?
10. Do you crave a drink at a definite time daily?
11. Do you want a drink the next morning?
12. Does drinking cause you to have difficulty sleeping?
13. Has your efficiency decreased since drinking?
14. Is drinking jeopardising your job or business?
15. Do you drink to escape from worries or troubles?
16. Do you drink alone?
17. Have you ever had a complete loss of memory as a result of drinking?
18. Has your doctor ever treated you for drinking?
19. Do you drink to build up your self-confidence?

Scoring.
If you have answered YES to any one of the questions, there is a definite warning that you may be an alcoholic.
If you answer YES to any two, the chances are that you are an alcoholic.
If you answer YES to three or more, you are definitely an alcoholic.

Can an alcoholic, can you ever safetly drink again after stopping for some time even years? No! For even though the alcoholic has stopped drinking the disease still progresses and should he resume, he will be even worse off than when he stopped not taking up from where he left off. And for any alcoholic who continues drinking, the end is inevitably INSANITY, an INSTITUTION or DEATH!

But as Fr.Gelinas says in his book 'Alcoholism and You' "if you do not drink, other than serving to recapitulate all that you have read on alcoholism, the questions may help you to develop 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."

David Ogot snr
25th. August 2001

An extremely condensed version of this story entitled 'What is Alcoholism' appeared in The Saturday Nation newspaper of September 8 - 14th, 2001
A slightly different and condensed version appeared in Biosafety News May 2002 entitled 'Its A Thin Line Between Drinking, Alcoholism Pt. I and in Biosafety News June 2002 entitled 'It's A Thin Line between Drinking, Alcoholism Pt. II A condensed version of this article was printed in two parts in The People On Sunday newspaper July 6th 2003 (Pt. I) under the heading 'Understanding What Makes An Alcoholic' and subsequently in The People On Sunday newspaper July 13, 2003 (Pt. II) under the heading 'What Sort Of Disease Is This Alcoholism'

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