Alcoholism: the killer disease under the radar
Health Minister says it will be a priority next year
By Oluatoyin Alleyne
Stabroek News
December 23, 2006
It is one of the taboo issues in Guyana, but alcoholism impacts seriously on family life by reducing disposable income, fuelling domestic abuse and causing deaths on the road through persons driving under the influence.
In an economy in which rum production is a key industry, the number of addicts is thought to be in the thousands - the majority without access to professional help.
People turn to alcohol to numb the pain of harsh economic and social conditions and personal problems. The irony is that apart from a temporary release from reality, alcohol intensifies the factors that would have led to its use in the first place.
Minister of Health Dr Leslie Ramsammy estimates that alcohol use and abuse cost the health sector some $500M. "That is a good example of how much it affects us," the minister said. But as he pointed out, along with many in civil society and other areas, alcohol abuse affects every sector of the country.
Counsellor at Help and Shelter, Karen Gomes, told Stabroek News that alcoholism is a factor in more that 70% of the abuse cases that come to the attention of the shelter.
And substance abuse counsellor, Clarence Young had this to say: "It (alcoholism) is a significant problem and it is widely the most abused substance worldwide."
Because of the seriousness of alcoholism, which has fuelled suicides as well, Dr Ramsammy said that next year it will be one of the priority areas that the health ministry will be addressing. Further, next year would see a resolution at the World Health Assembly (WHA) addressing alcoholism; the minister said they have been working on the issue behind the scenes. The WHA will identify alcoholism as needing global action and countries signing the resolutions would have to take action in the area.
He said his ministry is expanding the treatment scope as part of its substance abuse programme, and in addition to using the services offered by the Salvation Army, it would also be looking at having treatment provided at the Georgetown and New Amsterdam hospitals. "Our primary health care setting [will be used for] introducing more counselling and more treatment programmes for alcohol and other substance abuse," the minister said.
He said there would be a programme that would see various stakeholders being involved including the manufacturers and distributors of alcoholic beverages. The minister said they would also need to have non-governmental organisations (NGO) working on the issue.
"We are not asking people to stop drinking; we are saying if you don't drink responsibly this is what would happen…"
Dr Ramsammy pointed out that the majority of road accidents in Guyana are alcohol related and that is another indication of the seriousness of the issue.
He said that alcohol consumption is not synonymous with alcoholism, but there are too many alcoholics in the country. "But even [among] those who are not alcoholics, who can control their drinking, [there] is a problem… the fact is that people drink and drive, people drink and go to work and so they are walking accidents and it decreases productivity at workplaces."
He said even though some people claim they can drink all night and work the next day, science has shown that a person who drank the night before would be less productive the next day. "There are too many young people who are drinking and the laws are so weak… There are young children who are going to the stores and buying alcohol and tobacco products and there are laws against this but they are so old and so ineffective. So these are issues." He said no one should think that alcohol abuse and alcohol consumption are small issues as they are important and should be dealt with.
The minister made mention of his war on tobacco which has seen a reduction in its use; he said he would like to see a complete ban of that product.
"We need to have a national approach to it, we need to treat people… the law needs to ensure that it takes it [alcohol abuse] into consideration…" The minister noted that in the US a person who is caught drinking and driving is not only fined, but needs to go to a treatment centre.
He said some of these issues would be addressed in the Health Protection and Promotion Bill that will be tabled in Parliament. However, the minister said that would not be the only place where the issues would be addressed since there needs to be a generalised approach.
Alcohol hub
Herstelling, located just a few miles outside of Georgetown on the East Bank Demerara, could be considered a hub for liquor bars; the village has no less than 20 of these establishments, commonly called "rum shops".
An early morning visit by Stabroek News to the village saw almost half of them already open and quite a few patrons consuming alcoholic beverages. The village mirrors many others in the country; young men could be found 'liming' (sitting at the road corners) from early in the morning, many of them are unemployed. One villager said they are part of the reason why rum shops are thriving.
But according to another villager who has spent almost all of his 55 years in the village, the problem is not a new one. He grew up knowing that alcohol drinking was a big thing in the village. However, he said, over the years rum shops have been popping up all over the village and this not only encourages dangerous drinking patterns, but makes the area unsafe with the numerous intoxicated individuals walking the streets day and night.
"It is a big problem, the rum drinking and the many rum shops in the area. But what we go do? It will be like fighting the devil and you know no matter how much you fight the devil he coming back," one villager said. He said he thought about forming a group to come up with some mechanism to deal with the issue but it was difficult to get people on board. He pointed out that many of the older men, and in some cases women, also consume a lot of alcohol and as such they are not willing to do anything about the issue. "I ent have no problem if a person tek a lil drink on the weekends and so on but the problem come when is every day whole day de young and old drinking," the man said.
"You can't have people drinking rum whole day… no matter if it is the old and young. Look, you see what ah talking about," the man said indicating a man walking down the street with two bottles in his hand, one containing coca cola and the other rum. According the resident, that particular man consumes alcohol on a daily basis along with his wife even though they have children.
It is amazing, one resident pointed out, that so many men appear to be unemployed as they sit at the street corners all day and yet they still have money to buy alcohol. He said this raises another problem as he feels it is the urge for the alcohol among the unemployed that is driving the increase in crime, particularly breaking and entering people's homes.
"Dem drinking every day and in de night dem breaking and entering people home and thieving, and even in de day dem doing it when people gone out," the man said.
Licensing
Another resident pointed out that the deep-seated alcoholism in the village has also increased the incidence of domestic violence and violence on the whole. "In de night dem does deh cussing up one another and you could hear dem knocking cutlass on de road and posts threatening one another. It is terrible, dem is a nuisance," the man said.
Two other residents were concerned with the number of unlicensed rum shops in the area. "Nuff a dem ent license to sell alcohol but dem doing it and I feel that the authority should look into this thing. If dem enforce de rule then I know dat nuff a dem rum shops will have to close down. But you does have people come in here and taking bribe," one of the men said. The other said it was obvious that some of the shops don't have licences as they are popping up all over the place and could be referred to as nothing more than "bottom house" operations.
They called on the Guyana Revenue Authority to send officers into the village to ensure that the shop owners are licensed. Even as villagers spoke to Stabroek News a few men, who appeared to be intoxicated, overheard some parts of the conversations and hurled abuse at the residents and the reporter. "You see, this is what we does have to go through on a daily basis and in de night we does have to be watchman because we ent want dem breaking in we home," one man said.
One man posited that Herstelling was not an isolated case; there are other such villages throughout the country but he conceded that the village must top the list as the one with the most rum shops.
One of the men, who now lives in the United States, said he is concerned with parents sending their children to purchase alcohol from a very young age as he said this encourages children to drink. He was upset that even though Guyana has laws against such acts they are not enforced as it is an accepted practice throughout the country for children to purchase alcoholic beverages and cigarettes.
Some residents also called for the rum shops to close their doors at a decent hour as the noise emanating from them made it difficult for many of them to sleep. "Dem does have the music up and people drinking and cussing up, how can people sleep? And when you call de police dem does come sometimes but as soon as dem gone de music back up again. Dem shops dem dah should close down man, is hard fuh people in hay," the man said.
The shop owners say they are making a legitimate "living" and don't believe they are doing anything wrong. But most of them when approached by this newspaper, declined to comment on the issue. One who spoke said he does not sell alcohol to children. Another said that no one was forcing people to drink and he was just providing them with what they wanted.
As this reporter drove around the village young men could be seen sitting at the road corners and underneath houses; some were in rum shops. Older men were also in the rum shops and a few had rum bottles in their hands.
Recovering addicts
Mark (not his real name) started imbibing alcohol since he was a young child; he said he was given alcohol by adults. Stabroek News caught up with the man at the Salvation Army rehabilitation centre where he was being treated. According to him, after he leaves the institution at the end of the six-month period he would not be touching alcohol again, he said it almost ended his life.
Mark related that he lost both of his parents when he was just a child and had to be brought up by an older sibling. He was forced to leave school at the primary school level and was soon making his own way by doing odd jobs around his community.
The 32-year-old man said that because he was earning his own money, he soon started drinking and no one could have told him anything because he felt he was a "big man".
He said that by the time he became an adult he was scorned in the village because of his drinking habit. Many times he would drink and sleep on the road or in drains instead of going home. At one point in his life he developed a trade as a mechanic and had a "very good job" but his drinking habit saw his boss having to let him go even though he was a good worker when he was sober. The man recalled that many times he did not eat for days. "As soon as I wake up is rum and it was rum before I sleep. My sister dem use to beg me to stop drinking and when she cook and give me food to eat I use to just throw it away because I want the rum," Mark said.
He stated that at one point he was almost sleeping on the street as his siblings did not want him around because of his attitude. And because of his drinking habits Mark has been unable to develop a steady relationship with a woman. He recalled having one such relationship which dissolved soon after because of "rum." He showed this newspaper several scars about his body from wounds sustained because of his drinking problem.
Mark had to literally fall and hit his head to "come to my senses." He said not so long ago while in a drunken stupor he fell to the road and hit his head, disfiguring part of his face. He was taken to the hospital by his sister and the injuries sobered him up. He agreed to access treatment and his old boss has promised to give him his job back once he leaves the institution and remains sober.
Unlike Mark, Kevin (not his real name), who was also at the Salvation Army, does not see himself as having a drinking problem. He declared quickly that he did not drink rum but he drank other alcoholic beverages which sometimes led to him forgetting important things. His stay at the institution was being funded by his mother, who, according to him, was very concerned when she returned to Guyana to find that he had no fixed place of abode.
Kevin is also a deportee, but he would not say why he was deported. According to him, he is a clothing vendor. His drinking habit has resulted in his stock disappearing or being stolen from him when he is in a drunken state.
Kevin's denial of having an alcohol problem, one counsellor said, means that he may very well return to his old ways when he leaves the institution.
No economic barrier
Trinidadian Clarence Young was a counsellor with Guyana's first structured substance abuse programme at Prasad's Hospital which commenced in 1996. He said the programme, the result of a co-ordinated effort between himself and a doctor, dealt with more cocaine and marijuana abuse than alcohol. Persons would visit the hospital seeking help while others were referred by other medical practitioners.
According to Young, dealing with alcoholism is always challenging because it is actually a legal substance and people justify the use of it because it is legal. However, he pointed out that no one takes into account the serious implications of alcohol abuse which includes health care costs, social ills, spousal and children abuse and criminality.
Young said one of the things he found significant during his years at the hospital was the wide cross-section of persons who visited the institution for help; from the medical field, legal field or common labourers.
"It had no economic barrier, from the very wealthy to the very poor who depended on someone else to pay their hospital fees," he said.
Young, who is now the co-ordinator of the Phoenix Recovery Project at Sparendaam, East Coast Demerara which deals with substance abuse, said that over the years he has seen the incidence of alcoholism in women rise, as well as in young people.
Driving home the seriousness of the issue, Young recalled that once a 21-year-old young man went to the hospital on a stretcher and was never able to access their help because of the number of medical problems he had: loss of sight and speech and loss of control of his organs, and he died while receiving treatment for those. He said the man's family reported that he drank no less than three bottles of High Wine a day (High Wine has 69% alcohol content) and when he collapsed he was rushed to the hospital. But it was for his medical problems that he was rushed to the institution and not to seek help for his alcohol abuse.
Young described working at Prasad's Hospital as a challenge because many persons were of the opinion that they could be given medication and their addiction would just go away; unaware that to receive help they had to change their behaviour.
"It is not as simple as stop using the alcohol but rather it is about changing your entire lifestyle. Treatment modification is very important to help the client with coping skills." He pointed out that the alcohol becomes a crutch and as such the addicted person depends on it for their every movement.
He said what is very important is the after care and the persons would need constant support as the disease doesn't go away and all it takes is one drink to get that person to return to his/her old ways.
Young noted that alcoholism is a huge problem in Guyana. He said he has visited all ten geographical regions of Guyana and has found that alcohol abuse is a problem in all of the regions. He said that in interior locations it is industrial alcohol that is abused not the types sold on the coast. According to him there is a socio-cultural relation between alcoholism and the sugar and rice industries which contributed greatly to the problem. He said often when workers finish labouring in the sugar and rice fields, and even in the offices, they would stop at the rum shop before going home. Upon arrival home some of them would become very abusive to their spouses and children both verbally and physically. And the availability of the substance impacts heavily on its abuse. Young also commented on the fact that adults send children to purchase the substance.
"Even though there are laws in place against such actions it is not enforced and children will say to themselves, 'if daddy or mommy could use it then it is okay for me to use it'. They sometimes would take a little sip of it before taking it home to their parents," he said.
He feels that it is necessary to have a comprehensive drug demand programme with special emphasis on primary prevention targeting persons who are yet to start abusing the different substances. He also recommended that there needs to be more treatment programmes available in Guyana.
He said he has seen significant relapses during his work adding that some individuals have to make several attempts before they finally overcome their addiction. Some never do. But Young said he is not daunted as he is satisfied whenever he assists one person to get his/her life back in order. "It is worth the while and it is something I would continue doing."
Disease
Ralph Turpin, counsellor for three years at the Salvation Army said that alcoholism is a disease which is fuelled by obsession and compulsion.
"No matter how hard the person tries not to use, they are compelled to use it. No matter how hard they try not to think about it the thought continues being in their minds and they continue drinking."
He said the disease needs to be arrested and this could be done by removing the person to a controlled and therapeutic environment where they cannot access the alcohol. He said during the counselling sessions the addict learns skills on how to cope without the alcohol; how to avoid situations that could trigger a relapse and how to recognise such situations. The duration of the programme is four to six months and the persons remain in the compound every day; if they are required to leave, they would be accompanied by someone.
The normal routine would see the addicts going every morning at 5 am for exercise. They then return to the Kingston location and begin their daily chores. After breakfast, they would join the 'huddle' and read from the Just for Today book, which is specially designed for recovery from substance abuse. This is followed by sessions at 9 am that deal with anger management. He said though there have been cases of persons returning to the alcohol time and time again he is happy with his work if just one person is helped.
(See Wednesday's edition for article on alcohol-fuelled domestic abuse.)