Alcoholism in Sikkim a growing concern despite rehabs seeking better solutions

Alcoholism in Sikkim a growing concern despite rehabs seeking better solutions
Image Credit: Northwestern Medicine

    A popular social media post that went viral said: 

    It is true that alcohol doesn’t help me enjoy life but if I went running, a pair of running shoes might help.

    Similarly, many have pondered upon the etymology and even conducted research on the word. 

    "The word “alcohol” is said to come from the Arabic term “Al-khul” which means “BODY-EATING SPIRIT” (also, is the origin of the term” ghoul”).

    In alchemy, alcohol is used to extract the soul essence of an entity. Hence its’ use in extracting essences for essential oils, and the sterilization of medical instruments. By consuming alcohol into the body, it in effect extracts the very essence of the soul, allowing the body to be more susceptible to neighbouring entities most of which are of low frequencies. (why do you think we call certain alcoholic beverages “SPIRITS”). That is why people who consume excessive amounts of alcohol often blackout, not remembering what happened. This happens when the good soul (we were sent herewith) leaves because the living conditions are too polluted and too traumatic to tolerate. The good soul jettisons the body, staying connected on a tether, and a dark entity takes the body for a joy ride around the block, often in a hedonistic and self-serving illogical rampage. Our bodies are cars for spirits. If one leaves, another can take the car for a ride."

    The etymological roots of alcohol do suggest that there is, in fact, a correlation between alcohol being a body eating spirit, a spirit that is of the chemical kind. It doesn’t just eat the body but also slowly chews away the mind as there is almost four-decade worth of studies that suggest that alcohol abuse isn’t just a social evil but is more complex than that.

    According to the United States’ National Institute on Drug Abuse, "about half of all people who have one condition also have the other." A comorbidity condition is when the conditions occur simultaneously; professionals refer to the diagnosis as a co-occurring disorder, comorbidity or dual diagnosis. This co-occurring condition isn’t just a social nuisance but a serious disease that needs to be taken into cognizance like other mental health issues which have been now becoming an issue of table talk. In Sikkim, alcohol is a household item, Sikkimese culture has accepted this substance as a widely-used beverage for guests as well as for trivial and special affairs. 

    Psychiatry is a complex field about diagnostic assessment. Blood tests and lab procedures don't provide conclusive diagnoses for psychiatric illness. Co-occurring disorders can be especially problematic to diagnose because the presence of one disorder can interfere with the diagnosis of the other. For example, a person with an alcohol or other drug dependence is likely to manifest problems with depression or anxiety.

    Likewise, a person seeking medical care for depression or anxiety may downplay or deny his or her alcohol use. Conducting a comprehensive evaluation is of paramount importance because effective treatment of co-occurring disorders is diagnosis driven.

    Dr Satish Rasaily from Sikkim, a Senior Psychiatrist, Mental Health Activist, IMA Dr Ramachandra N Moorthy Awardee in Psychiatry 2018, and currently the HOD/ Addiction Medicine Specialist and Nodal Officer, Centre for Addiction Medicine explains this. “There is a bi-directional relationship between mental illness and substance abuse, people with psychiatric illnesses or mental disorders are very vulnerable to take drugs or abuse substances and in the same way people who abuse substances or take drugs are also prone to developmental disorders, so this is a bi-directional relationship. 

    Rather than thinking in terms of cause-and-effect, it's helpful to view the co-occurring nature of these conditions. Mental illnesses can contribute to substance use disorders, and substance use disorders can contribute to the development of mental illnesses. For example, individuals might drink because they're depressed (to alleviate symptoms of mental health disorders). On the other hand, excessive drinking could stimulate symptoms of depression or anxiety. (Hazelden Betty Ford Foundation, March 2015).

    Since 1956, the American Medical Association (AMA) has identified alcoholism as a disease characterized by compulsive decision-making, impulsive behaviour and relapse. The AMA's disease theory of alcoholism is based on the following criteria:

    -Biological in nature (illness exists in and of itself)

    -Does not go away or heal on its own.

    -Exhibits observable signs or symptoms.

    -Is progressive (can get worse—even fatal—if left untreated).

    -It has a predictable timeline of development and recovery.

    In 1980, the American Psychiatric Association identified substance use disorder as a primary mental health disorder in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the authoritative guide to the diagnosis of mental health disorders in the United States. In earlier versions of the DSM, alcoholism was categorized as a subset of personality disorders. Like other chronic diseases, addiction often involves cycles of relapse and remission. mild, moderate or severe "alcohol use disorder," the term doctors and clinicians now use instead of alcoholism, alcoholic or alcohol abuse. ( Hazelden Betty Ford Foundation, March 2015).

    Dr Satish Rasaily says, “Alcohol addiction is a complex disease with physical, psychological, biological, and social components. The usage of alcohol over long periods of time harm the person’s mental biology, it distorts the brain’s “wiring”. Some people can drink alcohol and even overindulge, and it doesn’t become an issue. For others, drinking can turn into a severe problem that needs medical and psychological attention.”

    He adds, “Any substance be it drugs or alcohol when it gets into your body, it acts in your brain and changes the way you think, feel, and behave. This is the actual definition of what these substances are: it is a chemical when ingested or injected acts on your brain and changes your thoughts, feelings, emotions, and behaviour.” 

    When asked about why some people become addicted to alcohol or other drugs while other people don't, Dr Rashaily clarified that multiple factors come into play, including age, genetics, biology, environment and social influences. He also informed that when addiction first transpires in a person it makes them feel good, that is the chemical tweaking the brain to feel a little different, this aspect applies across the board, alcohol affects the brain's reward centre. Eating good, watching good movies, having some revelation, getting rewards makes the brain release bursts of dopamine, a feel-good chemical in the brain that that urges people to "do it again!"

    According to research by biological psychologists, individuals who are more susceptible to addiction as well those who are genetically susceptible to certain mental health disorders likely have lower levels of dopamine in their brains. These biological differences in brain chemistry are not choices.

    Dr Rasaily adds, “There are different factors that play into one being addicted to substance abuse and that is personality, we know that there are a lot of kids in schools but those who have a rage issue, are violent, and have a tendency to be really harmfully naughty go on to become the ones who indulge in addiction in comparison to kids who are the compassionate, kind, and have healthy behaviours. The other factor is the environment, there are many triggers that cause people to become mentally affected, like social cues, economic factors, familial issues etc.”

    Similarly, Aruna Pariyar, representative of Sanjeevani Rehab says, “Anxiety and mental issues are underlying in the people that come to us, there is a root cause for people to cling onto substances, these aren’t many of the cases, in fact, these cases are rather rare but there’s always a root cause to why people go on and abuse substances.”

    When a patient is dealing with issues related to both alcohol addiction and mental health disorder, it is necessary to receive medical treatment for both problems at the same time. In the whole of North East India, there’s only one centre for this kind of holistic treatment that is CAM.

    “There are two things to consider, either for first-time patients or for people who have been to rehabilitation, there are two points, one is lapse and the other relapses, the lapse is to let loose for a short period of time where a patient uses a substance for either a week or so, there’s not much impact on social, economic or physical aspects of the person while they lapse. The other more serious thing is a relapse, where a person cuts free and goes on using and abusing for a longer period of time, it is very important for family and friends to recognise the lapse and seek help,” Dr Rasaily shares.

    He informs that in the past, it was believed that addiction should be treated first and the mental health issue should be treated second. It is now found that it is nearly impossible for Dual Diagnosis patients to avoid relapse in early recovery when they weren’t receiving treatment for their mental health symptoms.

    He adds that patients originally turned to alcohol to self-medicate their mental health issues, to get away from their responsibilities or to satiate their loneliness, and these untreated symptoms can serve as a trigger for relapse without effective medical and psychotherapeutic intervention. He also informed that it is very important for family and friends to be supportive of these people and help them get sobriety not only from alcohol but of the mind as well.  

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