Alcohol addiction: Just one more for the road

Why alcohol addiction is a serious and hidden problem in India and how to fight it

A marketing professional based in Bangalore had the reputation of being a talented multitasker. But though he would perform brilliantly at the workplace, no job held his attention for long. By the time he was into his fifth job in seven years, he was drinking incessantly and picking up fights with his bosses. Eventually, his performance suffered and his personal relationships deteriorated.

After trying to quit on his own (he tried going cold turkey and minimizing his drinking sessions), he finally sought professional help at the behest of his family. By then, the 38-year-old had been drinking for almost 10 years. “He displayed all the classical signs of alcohol dependence (drinking too much, craving for it regularly, etc.) so we put him on a rehab programme," says Vivek Benegal, additional professor of psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences (Nimhans), Bangalore. “Five years after his diagnosis and continuous treatment, he is in a far better state, and now back at work. It took him so long because he had a tendency to keep falling back to alcohol, but his family stood by him, which is crucial," adds Dr Benegal.

The numbers are huge

Alcohol is the most commonly abused substance in the world and in India, alcohol dependence is said to be at an all-time high. A 2009 paper in The Lancet pegged the growth rate in alcohol sales in India at 8% for the previous three years. It also stated that even though officially India was in the lowest alcohol-consuming group (only 21% of adult men and around 2% of women drink), up to a fifth of this group—about 14 million people—consisted of dependent drinkers requiring “help".

But how does one define dependence? Sameer Malhotra, head, mental health and behavioural sciences, Max Healthcare, New Delhi, who specializes in drug and tobacco/alcohol deaddiction, says that dependency has four main aspects to it: escalation of dosage to continue getting satisfaction, persistent craving, discomfort on non-availability, and spending a lot of time consuming or procuring it, and being under its effect (neglecting other responsibilities in the bargain).

“There are people who drink every day, and then there are some dependents who won’t drink for some time, say three months or so, to prove that they can stay off drinking, and then go and polish off two bottles on the go," says Dr Malhotra. “This type of binge drinking is in fact quite a severe form of alcohol dependence, contrary to general perception, and very harmful."

In India it’s not just how much we drink, but also how we drink that’s a cause of concern. In April, at a conference on alcohol control initiatives at the Public Health Foundation of India in Delhi, Nimhans researchers presented their findings. In this study, supported by the World Health Organization (WHO) and Union government, 8,600 households across five states (Gujarat, Maharashtra, Orissa, Sikkim and Andhra Pradesh) were surveyed. Binge drinking and the pursuit of intoxication were widespread. “We found a tendency of drinkers to consume too much," Dr Benegal, the principal investigator of the study, says.

The standard international unit (for a peg)—12g of ethanol, or 30ml of spirit—is not the standard measure poured across homes and bars in India, the study found.

“The standard ‘drink’ in India seems to range anywhere from 60ml to 270ml, apparently called double Patiala peg," says Dr Benegal. Another disturbing trend is that many more urban young Indians are taking to alcohol. Earlier this month, in a much televised exposé, around 100 schoolchildren were caught drinking at a pub in Gurgaon. “Beginning to drink early, even if it is sporadic and the amount is low, is a big-big risk factor for alcoholism at a later age," warns Dr Malhotra.

The cultural pattern

The choice of drink too veers towards the more potent spirits, the survey found. Beer and wine consumption is low, whisky, rum and vodka are preferred. “The signature pattern is to drink to intoxication," says Dr Benegal. “No hostess serves food till everyone is drunk. Our drinking is not done along with food but before it, which is extremely bad. If there is some food in the stomach before you start drinking, it helps slow down the absorption of alcohol in the body and it will not enter the bloodstream as quickly. Another issue is that many people in India do not drink openly and hence tend to drink very quickly."

At an international conference on behavioural health held at the Toranfield House behavioural health and addiction centre in Ireland in November 2011, experts highlighted the issue of rising alcohol addiction among high-profile professionals in the UK. As a case in point, they presented research that indicated doctors themselves were three times more likely to develop cirrhosis of the liver than the general population. And that alcohol abuse would be a factor for 15-24% of lawyers during their careers.

“I have seen this in my practice too," says Dr Malhotra. “The problem is that while the general image of an alcoholic is someone who is totally down and out, the fact is that most of them continue to stay in their high-profile jobs and carry on as if nothing is amiss, till it actually gets too late."

Alcoholics will also deny that there is a problem, partly because of the pleasures of addiction, and partly because of the stigma attached to coming clean and asking for help. “It often takes a watershed event such as losing a job or relationship for someone to seek help," says Dr Benegal.

Deaddict now

There are now newer and better ways to help a person shake off an alcohol problem.

Years of research have led to a better understanding of the causes of alcohol dependency, as well as the underlying susceptibility issues that lead to it.

“It is now conclusive that addiction is a primary, brain-based illness and not just a manifestation of other illnesses or traits," says Alastair Mordey, programme director, The Cabin Chiang Mai, a resident rehab centre located in Thailand which gets a lot of patients from India. “And this has paved the way towards treating people who are dependent as someone with an illness—by following a scientific methodology," he adds.

But while checking into rehab is the first step, Dr Benegal stresses the importance of continuous monitoring. “Alcohol dependence is like any other disorder, say diabetes, and needs continuous maintenance to prevent a relapse."

Dr Malhotra believes that proper detox, with medication to prevent complications and withdrawal symptoms, is imperative.

“There are three stages to the treatment," he says. “The first is acceptance and seeking help." Then begins the psycho-education of the person, which is tailored individually, and motivational counselling, which involves strengthening willpower, and social support. Finally, relapse prevention therapy and lifestyle-change counselling is done. At this stage, medication to reduce cravings, counselling to induce the fear factor (about alcohol’s ill effects), and cognitive therapy are done.

“The aim is to take one day at a time, and achieve reasonable goals," Dr Malhotra says.

The signs of alcohol abuse

® Drinking alone and secretly

® Drunken driving

® Needing to drink to function

® Trembling on waking up in the morning

® Inability to stop or reduce alcohol intake

® Continued abuse of alcohol despite family and social problems

® Spending significant time drinking and/or recovering from drinking

® Continuing to drink even after recognizing it’s a problem

® Violent episodes while or after drinking

® Becoming angry when confronted about drinking.

Experts: Alastair Mordey, programme director, The Cabin Chiang Mai (a rehab centre in Thailand), and Sameer Malhotra, head, mental health and behavioural sciences, Max Healthcare, New Delhi.

Next week: What to do if your teenager has started drinking.

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