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Sandisiwe Mahlangu
Do you enjoy a drink every now and then? Many do, often when socialising with friends and family.

Drinking alcohol is widely and socially accepted and associated with relaxation and pleasure. Some people drink alcohol without experiencing harmful effects. Drinking alcohol can be beneficial or harmful depending on your age, health status, situation and, of course, how much you drink.

However, a growing number of people experience physical, social and psychological harmful effects of alcohol. Drinking alcohol is associated with a risk of developing health problems like alcohol dependence, liver cirrhosis, cancers and injuries.

For some people, it takes quite a few drinks to get a buzz or feel relaxed. Often they are unaware that being able to ‘hold your liquor’ isn’t protection from alcohol problems but instead a reason for caution. They tend to drink more, socialise with people who drink a lot and develop a tolerance for alcohol. As a result they have an increased risk for developing alcoholism.

The abuse of alcohol worldwide is a problem which compromises both individual and social development. Alcoholism/ Alcohol Dependence Syndrome/ Alcohol Use Disorder is a chronic disorder marked by excessive and usually compulsive drinking of alcohol leading to psychological and physical dependence or addiction.

An alcoholic is a woman or man who suffers from alcoholism- they have a distinct physical desire to consume alcohol beyond their capacity to control it, regardless of all rules of common sense.

Denial is ubiquitous meaning it is universal in alcoholism. Almost all alcoholics deny they have a problem with drinking or rationalise it one way or another. They are often quick to lay blame for their drinking habit on situations or other people. Upon close enquiry, however, one sees that drinking is in large part autonomous. Although stressful events may be followed by increased alcohol consumption, the alcoholic is also intoxicated during the good times or simply the neutral times of life.

Most alcoholics make attempts to control their drinking and although they succeed at times, the successes will generally be short-lived. This loss of control was at one point considered the hallmark of the alcoholic.

However, it may be just as fair to say that the hallmark is rather a sense of a need to control. Normal people do not experience a need to control their drinking; they simply stop without giving it a second thought.

In a full blown case of alcoholism, drinking has become a primary need in an individual’s life, to the detriment or neglect of almost all other activities. The urge to drink may be experienced as a craving, an imperious need or a compulsion. At times, however, when the alcoholic is off guard, it may merely sneak up insidiously and the alcoholic may begin drinking without knowing why.

When alcoholics do drink, most eventually become intoxicated. It is this recurrent intoxication that eventually ruins their lives. The equivalent of intoxication in everyday speech is ‘drunkenness’. Friends are lost, health deteriorates, marriages are broken, children are abused and jobs terminated. Yet despite these consequences, the alcoholic continues to drink.

Many undergo a change in personality. Previously upstanding individuals may find themselves lying, cheating, stealing and engaging in all manner of deceit to protect or cover up their drinking. Shame and remorse the morning after may be intense. Many alcoholics progressively isolate themselves to drink undisturbed.

An alcoholic may hole up in a motel for days or a week, drinking continuously. Most of them become more irritable, they have a heightened sensitivity to anything vaguely critical. Many alcoholics appear quite grandiose, yet on closer inspection one sees that their self-esteem has slipped away from them.

Many alcoholics also display an alcohol withdrawal syndrome when they either reduce or temporarily cease consumption. Awakening with the ‘shakes’ and with the strong urge for relief, drinking is a common occurrence. Many eventually succumb to the ‘morning drink’ to reduce their withdrawal symptoms.

Excessive use of other intoxicants is common among alcoholics. Marijuana, cocaine and opioids may be preferred. For most alcoholics, however, these substances are merely ancillary. Alcohol remains the ‘drug of choice’.

When the body and the brain are regularly subjected to alcohol over a long period of time certain changes occur which help them adapt to the presence of alcohol. In people who drink large amounts of alcohol on a regular basis, the liver adapts to breaking down the alcohol more rapidly than it does in people who rarely drink. The liver does this by large amounts of the enzymes which breakdown alcohol. Because the liver has become more efficient at breaking down alcohol, drinkers need to drink more alcohol in order to get the same effect. This is the role the liver plays in the development of alcohol tolerance.

Alcohol is strongly associated with a wide range of mental health problems. Depression, anxiety, drug misuse, nicotine dependence and self-harm are commonly associated with excessive alcohol consumption. Some suicides are attributable to alcohol and some people who engage in deliberate self-harm are alcohol dependent.

Employee alcohol use causes a variety of problems in business and economic productivity. It reduces productivity, impairs job performance, increases health care costs and can threaten public safety. Sickness absence associated with harmful use of alcohol and alcohol dependence entails a substantial cost to employees and social security systems.

There is ample evidence that people with alcohol dependence and problem drinkers have higher rates of sickness absence than other employees.

Alcohol is implicated in relationship breakdown, domestic violence and poor parenting, including child neglect and abuse. It is estimated that over a million children are affected by parental alcohol misuse. Alcohol also contributes to unsafe sex and unplanned pregnancies, financial problems and homelessness.

It is well established that drinking can severely impair the individual’s functioning in various social roles. Alcohol misuse is associated with many negative consequences both for the drinker’s partner as well as the children. Maternal alcohol consumption during pregnancy can result in foetal alcohol syndrome in children.

Parental drinking is correlated with child abuse and impacts a child’s environment in many social, psychological and economic ways. Drinking can impair performance as a parent, as a spouse or partner and a contributor to household functioning. Time spent while drinking often competes with the time needed to carry on family life.

Drinking also costs money and can impact upon resources particularly of a poor family, leaving other members destitute. Implicit in the habitual drinker’s potential impact on family life is the fact that the drinking and its consequences can result in substantial mental health problems of family members. They may have feelings of anxiety, fear, and depression.

Living with an active alcoholic is lonely, devastating and confusing. Equally destructive is growing up with an alcoholic or living with a family member who grew up in alcoholism but didn’t seek help. The loss of self-esteem causes family members to doubt their own capabilities and even their senses when people feel compelled to deny that they heard yelling, witnessed fighting or suffered abuse.

Keeping the secret of our abuse can be overwhelming yet it is not allowed to talk about it in the family or outside. Families are taught not to discuss what goes on in the house with anyone else. Doing so is regarded as a violation to the family and a sign of disloyalty.

If the alcoholic is or has been on treatment, the family needs to understand that treatment arrests the addiction but does not cure it. Recovery is an ongoing, daily process for alcoholics and their family members.

The primary goal of alcohol addiction treatment is a lifelong commitment to abstinence from alcohol. With good health, a strong support system and motivation, complete recovery is possible. Alcoholism can often go undiagnosed despite the fact that alcohol is the most frequently used drug worldwide.

Treatment for alcoholism typically can only begin when the alcoholic accepts the problem exists and is motivated to stop drinking. Treatment happens in three levels namely detoxification, rehabilitation and maintenance of sobriety or soberness, each providing an integral step in the process of successfully giving up alcohol.

Treatment for alcoholism does not prescribe an easy cure for chemical dependency, but gives the individual all the tools with which to build a life based on promoting sobriety day to day. Since alcoholism affects almost every area of an individual’s life, the changes which will be made while sometimes slow at first will be all encompassing. After completing detox and rehab, the maintenance of sobriety will be intrinsically connected to the willingness, openness and honesty put into living one’s life by a new set of principles and values.

There is no single defining treatment appropriate for everyone and generating treatment settings, interventions and services to an individual’s particular problem and need is critical to his/her ultimate success in returning to productive functioning in the family, workplace and society.

What is most important to remember is that treatment and long term sobriety are about discovering how to accept help and manage life’s challenges without needing to escape or finding a quick fix. This new way of living will provide new meaning and direction and those with rich participation in recovery will achieve freedom and serenity.

Poor nutrition goes with heavy drinking and alcoholism. Alcoholics are often deficient in Vitamins A, B complex and C, folic acid, magnesium, selenium, zinc as well as essential fatty acids and antioxidants. Restoring such nutrients by providing thiamine (Vitamin B-1) and a multivitamin can aid recovery and are important in all detox programmes.

To learn to live without alcohol, one must avoid people and places that make drinking the norm and find new non- drinking friends.
Join a self-help group like Alcoholic Anonymous. Alcoholic Anonymous can be contacted on 0772 594 709 when in Harare and 0784223075 for Bulawayo. Enlist the help of friends and family.

An alcoholic can also visit the nearest health centre where they can be assisted or referred for further specialist help to a psychiatrist.
Replace your negative dependence on alcohol with positive dependences such as a new hobby or self-development clubs like Toastmasters (0775 401 935).

Start exercising. Exercising releases chemicals in the brain that provide a ‘natural high’. Even a walk after dinner can be tranquilising.

Sandisiwe Mahlangu is a Psychiatric mental health nurse. Contact details: Cell: 0774782282. Email: [email protected]