ALCOHOLISM
Meaning of Alcoholism
It was the Swedish doctor Magnus Huss who used the term “Alcoholism” in the year 1849 for the first time to denote a disease which is the result of excessive consumption of alcohol. Since then, the concept of “alcoholism” has become a popular expression to signify cases of excessive drinking.
Alcoholism, or an addiction to alcohol, is often seen as a stereotyped, non-medical condition and which is basically a human weakness that has been widespread as a social evil in India. Although alcoholism does not invariably lead to personal disorganization, it is undoubtedly an important cause of personal disorganization. Drinking alcohol within a moderate quantity is absolutely fine. In fact, wine and beer have a lot of positive impacts on one’s health. But, when drinking alcohol begins to impact one’s life in a negative way, it might be a symptom of alcoholism.
According to the Global status report on alcohol and health 2018 released by the World Health Organization (WHO) per capita, alcohol consumption in India increased two folds between 2005 and 2016. It is found that in India, Indians consumed 2.4 litres of alcohol in 2005, which increased to 4.3 litres in 2010 and scaled up to 5.7 litres in 2016 per adult per year. Some researcher estimates that by 2030 half of all adults will drink alcohol, and almost a quarter (23 per cent) will binge drink at least once a month.
Definition of Alcoholism
According to Jonson defined “Alcoholism is a condition in which the individual has lost control over his alcohol intake in that he is constantly unable to refrain from drinking once he begins.”
Keller and Efron put it as “Alcoholism is characterized by the repeated drinking of alcoholic beverage to an extent that exceeds customary use or compliance with the social customs of the community and that interferes with the drinker’s health or his social or economic functioning.”
Clinebell defines “An alcoholic is one whose drinking interferes frequently or continuously with any of his important life adjustments and interpersonal relationships.”
Seldon Bacon defines alcoholism as “a disease characterized by a compulsion to drink in order to face the ordinary life problems.”
Collins Dictionary of sociology: Alcoholism refers to “To the consumption of alcohol to excess; leading to psychological and physical dependency and addiction.”
Types of Drinkers or Alcoholics
Different writers have given different classifications of the types of drinkers. We may mention here three such classifications.
According to G. R. Madan and C. B. Mamoria, there are two types of drinkers. They are as follows:
Moderate Drinkers: There are the drinkers who take liquor in quantity they can tolerate. These drinkers are not “drunkards” for they have some control over their habits.
Problem Drinkers: These are the drinkers who take liquor in quantities they cannot tolerate or withstand. For them, drinking has become their routine.
As Dr. Durfee points out, problem drinker is one whose “health is endangered, peace of mind affected, home life made unhappy, business jeopardized and reputation clouded, drinking becomes a routine matter”.
Don Cahalan has spoken of a five-fold classification of alcohol drinkers on the basis of the frequency of drinking and not the quantity of alcohol consumed. It is mentioned below.
Rare Users: Those who desire alcoholic drink very rarely, say, once or twice a year.
Infrequent Users: Those who drink infrequently are called “infrequent users”. Such persons drink once or twice in 2-3 months, that is, less than once a month.
Light Drinkers: Those who drink relatively frequently in comparison with the drinkers of previous category. Such persons drink once or twice a month.
Moderate Drinkers: Those who have control over drinking, but slowly becoming habituated to it for they consume alcohol three or four times a month.
Heavy Drinkers: Those who drink every day or consume alcohol several times a day. They are actually alcoholics. They can even be called “hard-core” drinkers.
Marshall B. Clinard in his “Sociology of Deviant Behaviour” has mentioned about four types of drinkers taking into consideration the type of drinking and the quantity of drinking.
Moderate Drinkers: Those who are not drunkards or habituated to it. They drink occasionally at parties, sometimes due to the pressure of their companions or to special social circumstances. Drinking of these people cannot be considered a problem nor a great weakness from the point of view of modern norms.
Excessive drinkers: Some are habituated to drinking. These people drink excessively and experience the compulsion of drinking again and again though they have not become the slaves to drinking; they often lose control over their drinking. Even at this stage, these people have sufficient mental stamina to take a firm decision to have control over their drinking.
Morbid drinkers: These are the people who drink excessively and also frequently for they have become the slaves of drinking. They drink for various purposes say, to forget family problems, to run away mentally from the personal economic crises, to overcome physical inabilities and so on. Their excessive drinking may even make them become diseased.
Alcoholics or continuous drinkers: Drinking habit reaches its climax in these persons. They consider drinking as their great ideal in life. They believe that they cannot live or survive without drinking. Day in and day out they think of only drinking. Drinking habit overrules them and in the real sense of the word, they become alcoholics or drunkards. They lose their physical, mental and moral health and finally become the victims of drinking.
Causes of Drinking
According to the Global status report on alcohol and health 2018 recorded alcohol users in India per capita (15+) of age consumption (in litres of pure alcohol) by types of an alcoholic beverage are spirits (93%), beer (7%) and wine (1%) respectively.
Different reasons can be accounted for by various writers such as Caltin, Starling, Bonger and Janet, which may be summarized below.
Misery Drinking: Men drink because they are miserable because life holds no joy for them nor any other prospect other than a dreary and unending round of toil. In such a life scheme drinking is blessed with palliative medicine.
Occupational Factor: Men drink because their occupation has completely exhausted them. They look forward to the respite that intoxication affords after the heat of the blast furnace or the stench of the stockyards.
Bad Housing and Lack of Recreational Facilities: Men drink, because their houses are so cold, dark and sordid, that they cannot stay there for a long time. The failure of the community to satisfy the emotions in a safe and healthy manner also leads to such cravings.
Ignorance: Men who do heavy manual work have long been deluded by the belief that alcohol furnishes added strength and vigour with which they can pursue their labour. This illusory feeling of physical vitality after the consumption of alcohol is the cause of drunkenness.
Inherent Nervous Defects: There are born drunkards whose neurological heritage is such that they are unable to face reality. In their desperate effort to flee the world, these unhappy persons become hopeless alcoholics.
God’s Curse or Gift: Some persons believe that men drink because they are steeped in original sin. Others maintain with equal conviction that men drink because the Lord intended that they should have occasional movements of pleasant oblivion from this vale of tears and placed the grapes on earth for that particular purpose.
For companionship and Fun: Men drink for companionship, for fun, for conceivability for what the Germans call Gemutlichkeit, a compound of all three.
Fashion: Drinking to excess is a “perversion of the hard instinct”, brought about by the pathetic attempt of one individual to enter into rapport with his fellows.
For Business Reasons: Men drink for business reasons in the capacity of either potential customers or sellers. The great game of “entertaining the visiting buyer” falls into this category.
Sudden success in Business: Many cases of drinking arise after apparent success in Business or professional life.
Urbanization: The urbanization and mechanization of life along with material mindedness which modern civilization has brought, has also been responsible for the increase in drinking.
Social Inadequacy: There are certain persons who are unable to face the hard realities of life and start drinking to overcome their social inadequacy temporarily which later on takes the form of habitual drinking.
The victim of these crises may take his first drink as an experimental method of dispelling the gloom which envelops him. He is usually rewarded by a given feeling of warmth and well-being in the early stages of intoxication and depression follows after some time. In order to perpetuate this pleasant relaxation, the novice tries to experiment again and again and gradually becomes an alcoholic.
Consequences of Alcoholism
Alcohol has now become a common word in Indian society. With the impact of globalization, urbanization, industrialization, media influence and changing lifestyles, alcohol has entered the lives of Indians in a big and unrestricted manner.
The consequences of alcoholism can be understood better on the following below –
Personal misery: The drinker thinks that alcohol will reduce his tension, guilt, anxiety and frustration. But, the fact is that it reduces his operational efficiency to below the minimum level necessary for social existence or even for a bare existence. A drinker harbours the mistaken notion that alcohol can make association and interpersonal activity easier in society. But in reality, alcohol breaks down an individual’s participation in association and thus socially weakens the individual. It impairs socially valuable ideas.
Failure of Health: The human organisms are many and varied. Depending upon the quantity of alcohol intake and the frequency with which it is consumed, for example, spirit, beer, wine etc., it does not cause serious or harmful to the health of the person. Nor periodic dose is permanently injurious mechanism. It is only when acute drinking which carries a train of ill effects. It leads to nerve degeneration, liver cirrhosis, chronic gastritis, high blood pressure and a host of other diseases. Thus, he cannot pursue any work seriously.
Inducement to crime: Alcoholism has a tendency to close kin with crime. It has been found that there is a close relationship between drinking and crime. Either partially or completely intoxication can lure too many types of crime such as arson, stabbing, manslaughter, assaults and sex offences.
Increase accident proneness: Studies have revealed that drink is closely related to the increasing number of accidents which take a heavy toll on human life. Thus, there is a direct ratio between alcohol and an increase in accident proneness. According to the latest data compiled by the National Crime Records Bureau (NCRB), drunk-driving was responsible for only 7,061 a mere 1.5% of the 4,64,674 road accidents in India in 2015. Significantly, however, the share of drunk driving accidents was significantly lower than this national average in states that are fully or partially dry.
Alcohol makes family relations miserable: Alcohol has been a traditional enemy of love and marriage because it often leads to promiscuity and breach of moral standards of the spouses. It can lead to family unhappiness, moral degradation, divorce and family disorganization and juvenile delinquency are the resultant consequences.
Economic loss: the effects of alcoholism are far-reaching. It disturbs the normal course of community life. Drinking affects the business, the office efficiency and factory productiveness also. Absenteeism, low output and poor judgement leading to work-related accidents cost the government crores of rupees.
Harmful effects of Liquor
The use of liquor and other intoxicants is harmful to every progressive and growing individual and society. It is harmful in as much as it intellectually impoverishes, morally softens and spiritually damns the person addicted to it.
The wastage of national wealth: It has been estimated that successful enforcement of the prohibition policy would increase the purchasing capacity of people by ₹ 140 crores; of this ₹ 44 crores will be invested for productive purpose. It is obvious; therefore, that prohibition would save the country from huge wastage of national wealth.
Low standards of health: The consumption of liquor leads to deterioration of health. This may happen due to any of two following reasons:
Liquor is narcotic and leads to nervous degeneration, liver cirrhosis, high blood pressure and a host of other diseases.
Money spent on liquor reduces one’s resources and may not leave one with sufficient funds to buy nutritious food.
Lowering of efficiency: With the fall in the standards of bodily health and mental agility, the fall in efficiency is but a cordially. The alcoholic is whimsical and incapable of sustained attention, concentration and putting in long hours of work.
Mental imbalance: A man under the influence of liquor has no control over his will and is fickle-minded. He is unable to think and work constructively. His own vision and thinking get barred if intoxication is strong.
Increase in poverty: In India, villagers and labourers drink in spite of their poverty. This obviously increases their poverty though it may provide them with temporary well-being and euphoria.
Individual disorganization: The consumption of liquor makes a man wayward inhabits and whimsical in moods. He also loses all control over his will and his desire to grow and progress becomes feeble. He grows careless and indifferent and feels little difference between morality and immorality. All this produces personality disintegration.
Family disorganization: More homes are broken due to drinking than any other single cause. This is easy to understand. As the moral sense of man is destroyed and his inhibitions removed due to alcoholism, prostitution and adultery are the normal consequences. An alcoholic shows little respect to his wife or children. This leads to constant family tension and divorce.
Increase in Crime: Under the influence of liquor, people act in unsocial ways as their inhibitions are removed. This includes murder, rape and other crimes. Moreover, in order to meet the expenses of drink a man may take to gambling or even theft.
Social disorganization: All the above factors lead to social disorganization.
Measures to control Alcoholism
Alcoholism has been one of the earliest habits of man. Attempts have also been made from the times immemorial to control it. Over the years this habit has grown into a social evil posing a big challenge to public health. It has become necessary for the people vested with the authority to introduce various measures to control its practice in some way or the other. Let us now discuss the ways and means of controlling alcoholism.
Not a removal but control of Alcoholic Drinks: The practice of alcoholism which has been associated with human life for centuries, cannot be removed immediately. No country has been successful in this regard so far. Kautilya, the author of “Arthashastra”, had recognized this fact long ago and hence suggested that provision should be made to establish “liquor houses” (“panagrihas”) on the outskirts of the towns. He was also of the opinion that men’s weakness towards alcohol could never be completely suppressed, but only controlled. Since all drinkers are not alcoholics, it is more appropriate to make provision for drinking under vigilance and control, than to make a futile attempt to remove it once and for all.
Drinking as a Habit of Physical Labourers and Workers: ‘Liquor shops’ are often regarded as “poor men’s clubs”. It has been observed that labourers who are engaged in tight hard work want to have some relaxation after their toil. To forget the boredom of work and to relax and refresh, they want to consume alcohol which they believe will be of great help. Thus, it is necessary to provide good entertainment facilities at an affordable cost for the labour class to discourage them from resorting to alcohol.
Welfare of people is more important than increasing Revenue through the sale of Alcohol: The Government should take appropriate legal and administrative steps to introduce prohibition on the sale of liquor. If the supply is not there, one can expect the demand to die down at least gradually. In the Indian context, many state governments are not prepared to introduce prohibition for the simple reason that they get a lot of income for the state treasury by way of tax imposed on the sale of liquor. It is difficult to have control over the consumption of alcohol in a nation like India if the state governments are not taking initiative in imposing prohibition. They must understand that promoting people’s welfare is the primary duty of the Government. They must make alternative arrangements to collect revenue for the state to make good the loss which they are said to incur due to the introduction of prohibition.
Making campaign against Alcoholic drinks and creating Awareness about its Evil effects: It is necessary to launch a campaign against the evil of alcoholism to make the people know about its harmful effects. Government alone cannot do it effectively. Government, non-government organization, private individuals of great repute, religious, political and social leaders should launch a combined campaign against alcoholism.
Modern means of mass media such as radio, television, advertisement, newspaper, cinema, etc., can also play an effective role in impressing upon the people about the disastrous effects of the ugly practice of alcoholism.
Introduction of prohibition Act: Several nations have tried to stop the practice of taking alcohol by introducing prohibition acts. But the experience of these nations has revealed that legislation alone cannot do any magic here. America, Russia and France, for example, have tried with legislative enactments to stop the practice of taking drinks. Different states in India also have experimented with such legislations. Neither in India nor elsewhere, these legislations have been a total success. This does not mean that legislation in this regard is useless and ineffective. It only means that the legislation has not been implemented honestly and effectively.
In a nation like India where millions of poor people have become the victims of the ugly practice of alcoholism, the introduction of legislation against it is a must. Educated public and non-government organizations must give their full cooperation to the Government to implement the legislation.
Need for widespread campaign Against Drinking: Educated and well-informed people who have a strong concern must take initiative in launching campaigns against the practice of drinking. Some such efforts made by some individuals with strong determination have fetched positive results. For example, women of Nellur District of Andhra Pradesh launched such a campaign in their district in 1990s which later on was spread to the whole of Andhra Pradesh. The Telegu Desam Party which supported this campaign was voted to power in 1994 and the party introduced prohibition soon after assuming power.
Treatment of Alcoholics
Treatments for alcoholism vary, but the overall goal in treatment is total abstinence since those that abstain have better success rates than those that don’t. Treatment should also, include replacing addictive patterns with satisfying, time-filling, behaviours which are able to fill the void in daily activities when drinking has stopped. Because alcoholism is so difficult to treat, most doctors will choose to treat alcoholism as a chronic disease that includes relapses and remission periods. Alcohol dependence is treatable; there have been many successful treatment programmers to overcome alcohol dependence.
There are various kinds of programmes for different degrees of drinking, Psychotherapy, environment therapy, behaviour therapy, and medical therapy are suggested and used for different types of drinkers.
Following are the major and common therapies being used worldwide in the de-addiction and treatment process of Alcohol Use Disorders (ADS).
Detoxification: For alcohol dependence, the first step is ‘detoxification’. The individual with alcohol addiction needs immediate medical care and medical intervention. In this process usually, tranquillizers are used for treating withdrawal symptoms like convulsions and hallucinations. High potency vitamins and fluid-electrolyte balance are also used in their physical rehabilitation.
Behavior Therapy: The most commonly used behaviour therapy is aversion therapy. In this process, sub-threshold electric shock or an emetic, like apomorphine are usually used. Many other methods (covert sensitization, relaxation techniques, assertiveness training, self-control skill, positive reinforcement) have been used alone or in combination with aversive therapy.
Family Therapy: Involving the family of the individual with alcohol addiction in his treatment and rehabilitation enhances the better recovery. The family members do not preach; nor do they blame or condemn the alcoholic. They minimize their harsh reaction and behaviour toward the individual with alcohol addiction.
Alcoholics Anonymous (AA): AA is one of the most effective social therapies being available which uses group interaction as a major method. It is an internationally recognized and well-accepted organization of ex-alcoholics which started in the United States in the early 1940s and today has millions of persons as its members. In India, the branches exist in all the metropolitan cities across all state. Alcoholics Anonymous (AA) is an organization, a group of people concerned, affected and suffering from alcohol addiction to share their experiences, strength and hope with each other that they may solve their common problem (i.e., alcoholism) and help others recover from alcoholism.
Residential De-addiction centers: The centers have been developed in some cities as alternatives to hospital treatment. Each centre has around 10-20 residents. Here, not only does counselling take place in a supportive environment but residents are made to follow certain anti-drinking rules too.
Counselling and Psychotherapy: Re-socialization is reinforced through counselling and other psychotherapy. Both group and individual counselling and psychotherapy take place during the treatment process of alcohol dependence.
Group Therapy: Dealing with social life and life after addiction get discussed among the group. In the same group process how the member will look at their social and personal life after getting discharged from the treatment center was also get shared among the members of the center.
Alcohol abuse will begin to start impacting one’s life at work, at home, in social life and even in personal relationships. Besides this, there are many other diseases that follow as by-products of an indulgent drinking disorder, such as cancer, and damage to the liver, brain and other organs. The ideal way to combat alcoholism or to help anyone dealing with alcoholism is to de-stigmatize the condition and seek medical help. The mindset toward alcohol abuse as one that can be willfully controlled is not true. It is as much a medical disorder like any other disease and needs to be treated likewise. Therefore, alcoholism is a very real and serious disease that requires medical treatment and those suffering will require lifelong care and support. It is estimated that globally, alcohol consumption is set to increase from 5.9 litres of pure alcohol a year per adult in 1990 to 7.6 litres in 2030.
References
Rao, C. N. (2015). Indian Social Problems A Sociological Perspectives. New Delhi: S. Chand & Company Pvt. Ltd.
Madan, G. R. (2001). Indian Social Problems (Vol. Volume 1). New Delhi: Allied Publishers Pvt. Limited. P. 154-157
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