Sunday, April 18, 2010

Chang’aa deaths: Time for proactive approach

Sunday Nation 18 April 2010

The use of alcohol is indeed as old as human society itself, and has been chronicled innumerably in both religious and secular literature worldwide. In some regions such as the Middle East, alcohol was used with meals in place of water which was a scarce commodity in those areas.

Like many foods and beverages, alcohol has an effect on the nervous system that is experienced by the individual as a pleasurable sensation, and this increases the probability of continued use. Alcohol is also useful in facilitating social interaction, and all over the world it was a key ingredient in all sorts of social events.

One may therefore wonder why alcohol use causes so many problems for some people, to the extent that every year we have episodes such as that which occurred last week in Nairobi’s Shauri Moyo area. In this incident, many young men took a lethal brew they thought was chang’aa, but which in reality was a concoction containing ethanol and the poisonous chemical methanol, which was responsible for the deaths of many and blindness in others.

The answer to this conundrum lies in the fact that as far as alcohol is concerned, there seem to be two groups of people – those who are able to take alcohol safely and those who are not. It is currently impossible to identify with any degree of certainty into which category one falls before they taste an alcoholic beverage.

It is only after one starts using alcohol that we can clearly see a difference in the pattern of use that identifies those that are unable to safely drink alcohol. These individuals may develop various patterns of harmful use, including alcohol abuse, alcohol dependence and other alcohol related conditions.

People with alcohol abuse may not drink large quantities of alcohol daily but whenever they drink, they often engage in activities that pose a danger to themselves or to others. Such activities include driving while drunk, fighting, breaking the law, destruction of property and other antisocial acts. They may also experience problems in important areas of functioning such as work, home or in relationships, but continue drinking nonetheless.

Alcohol dependence, on the other hand, involves drinking more than four or five standard alcoholic drinks daily, and neglecting important responsibilities due to being hung-over or drunk. People with this condition often develop withdrawal symptoms whenever they reduce their alcohol intake, and need larger amounts of alcohol to achieve the original effect. Once they start drinking, they have difficulties stopping, and will continue drinking until they run out of money or alcohol, or lose consciousness.

Both groups described above are at high risk of developing other alcohol-related disorders such as memory problems, psychotic disorders, depression and other mood disorders, anxiety disorders, sleep disorders and even sexual problems. Other problems include liver disease, cancers, stomach ulcers and nutritional deficiencies.

The importance of treating alcohol related disorders seriously cannot be overstated. The approach must be multi-dimensional, and must avoid knee-jerk reactions such as the brief “crackdowns” that inevitably follow alcohol-related disasters every so often.

The government is very quick to react whenever such tragedies occur, but is otherwise lethargic in enforcing laws that are already in the statute books. A more sustainable approach to the alcohol use problems would lie in the establishment of more treatment centres and training of more personnel in management of substance related disorders.

The lack of proper policy framework and an oversight mechanism has resulted in the mushrooming of so-called rehabilitation centres, some of which are just glorified places of worship with nothing in the way of professional evaluation and treatment services.

Further, the government needs to re-evaluate its policy on alcohol use with a view to establishing a standards oversight mechanism to regulate all brewers, instead of criminalising some alcoholic brews. The current view that alcohol is a source of revenue to the exchequer only serves to raise prices of safe alcohol, driving the poor to consume unsafe home-made brews that so often end in tragedy.

Measures to control the age at which young people first taste alcohol would also reduce the likelihood of alcohol related disorders, and these should target homes, schools and institutions of higher learning. It is a fact that the later in life one is exposed to alcohol, the less likely they are to develop alcohol dependence and related disorders.

We must recognise that it is highly unlikely that we can completely eradicate the use of alcohol in our society. The best we can do is to regulate it so that it does not result in unnecessary death and injury. We must address the issue proactively if we hope to prevent what is becoming an annual “Kwona Mbee” phenomenon.

Dr Lukoye Atwoli is a consultant psychiatrist and lecturer at Moi University’s School of Medicine

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