In defense of addicts, one must admit there is some truth in the fact that since everyone in the world drinks liquor, one should not zero in on a few drinkers. But the fact remains that everyone who drinks is not a drunkard or an alcoholic. According to the definitions and categories spelt out by Alcoholics Anonymous and other entities, there are four types of liquor consumers. The social drinker takes a limited quantity of alcohol on social occasions, and only when specially invited to do so. Some social drinkers then graduate to becoming `planned drinkers’ who plan their booze sessions with friends and family.
Very soon liquor or alcohol in any form becomes a daily routine. Those who consume it every day as a matter of habit are called `habitual drinkers.’ When this habit turns into an obsession, an addict is born. Although different categories exist, the divisions are often blurred. For some social drinkers, liquor can become an instant obsession. While some remain at the level of social drinking all through life, others graduate to addiction much faster than their friends. Some take a long time to move from one category to another, and some become addicts in a jiffy.
According to global estimates, there are 13 addicts to every 100 social drinkers. However, the incidence is higher in India and therefore we possibly have 20 addicts to every 100 social drinkers. That means one person in five is an addict. This is not good at all. In fact it is alarming. It could be anyone. There is no criterion that decides who will fall prey to temptation. There are many who can hold out against temptation for years, while they quickly give in after years of moderate drinking. In short, it is a risky proposition, and best avoided.
Before Muktangan started, we had heard of a therapy that was part of the MBBS curriculum. It is called Disulphiram. It has nothing to do with Lord Ram, but it produces sensitivity to alcohol which results in a highly unpleasant reaction when those undergoing treatment ingest alcohol. Disulphiram blocks the oxidation of alcohol at the acetaldehyde stage. This is also called the Antabuse therapy. It interferes with the metabolism of alcohol resulting in unpleasant effects when alcohol is consumed. The idea is to create an aversion for alcohol. The tablets have a temporary effect. Their impact naturally wears off after a while. Many of our patients remain unaffected by this therapy. One of them told us how he deceived his wife by making a show of taking the tablets. Another said, “I would wait for its effect to nullify at lunch time and then take my required `dose’ in between tablets.”
Addicts shared such instances in their own distinct lingo. They would refer to the liquor bottles as ‘quarter’ or ‘khamba’ denoting the size of the bottle. We do see such empty bottles strewn all over our cities. Some take ‘hard’ stuff, which means without adding water. There is an approved lexicon of such terms used by liquor drinkers. Sunanda had picked up a lot of these terms. She would surprise the patients by using them during her counseling.
Coming to Disulphiram, it is a rather painful therapy. After some initial pathological tests, which have to show normal results, the patient is hospitalized for the first dose. Disulphiram is given to the patient along with the brand of liquor that he usually consumes. The highly unpleasant symptoms referred to as the Disulphiram-alcohol reaction, which is proportional to the dosage of both Disulphiram and alcohol, persists as long as alcohol is metabolized. The intensity of the reaction may vary with each individual. During severe reactions, there may be nausea, pain and cardiovascular collapse, convulsions and even death. That’s why we often tell patients to avoid this risky therapy and adopt the withdrawal therapy offered at Muktangan. Not only is it less time-consuming, but it provides a support system for the patient. It makes the patients a part of a larger circle which can help in the event of a relapse. No tablet can replace the attention that a family can give.
Similar to Antabuse is the Methadone Rehabilitation program which is much in vogue in Europe and America. Methadone is an analgesic known for its anti-addictive properties. Methadone acts on the same body receptors that drugs act on. Oral doses of methadone can stabilize patients. Higher doses of methadone can block the euphoric effects of heroin, morphine and similar drugs. As a result, correctly dosed methadone patients can reduce their use of harmful substances or stop it altogether. However, it is no panacea for drug addiction. In countries where Methadone was available and advocated freely, addicts got used to it. That was a very curious case of mass addiction of an anti-addictive medicine. The irony was well brought out by a patient from Holland. “It is easier to give up drugs than to give up Methadone. I wish the government would give us drugs, so that we are able to get rid of this Methadone. We can get rid of the drugs later, but as of now life is hell because of Methadone addiction.” This illogical scenario really flummoxed me.
I thought Muktangan was doing well in its de-addiction and rehabilitation programs. We never make tall claims of assuring complete sobriety. We don’t give surefire guarantees of the patient’s recovery. We merely guarantee hundred per cent co-operation and support. I am so thankful that our therapy does not include any anti-addictive medicines. Very few could have afforded that. If we had adopted the strictly ‘medical’ treatments for their body ailments, the doctor would then have become the cynosure of our rehabilitation initiative. Today, the doctors do give tablets and drugs, but they are part of a larger effort. Also, the doctors form a team which takes the help of semi-literate volunteers who can suggest alternative practical therapies. The breakthroughs achieved by these not-so-educated team members are more creditworthy than those achieved by any medicine under the sun. The sobriety that they lend to patients is more long-lasting than any drug-oriented therapy.
I wonder about the word `sober’ which denotes a drug-free existence. Though it otherwise means a staid, sedate and balanced state of mind, it gains a special connotation for those in the field of drug prevention. It has been accepted in the remotest rural areas of Maharashtra. Women with no English skills use the word with confidence. There is another word called ‘sharing,’ which is used very often by addicts and those around them. It is not the usual sharing, as we know it, but the sharing of experiences of de-addiction, which prove invaluable for others. In most AA meetings there is no formal address; just a direct sharing of personal accounts. I find this very useful and effective. I wish people in India’s public life would take a cue from such ‘sharing.’
There is another term that we use very often. It is “follow-up.” It implies a long-term bond between the patient and Muktangan which remains intact even after the person’s formal discharge. We encourage patients to keep in touch with us. It is also our way of following up on their progress and our effectiveness. Women use this word pretty frequently in our interactions. One of them called it ‘folu.’ But we understood what she meant.
Follow-up is indeed important because patients need to be monitored after they achieve sobriety, especially those who have made grand declarations of remaining sober for their entire lifetime. Some say that they will test their sobriety by going to a liquor den and not touch a drop of alcohol. While these declarations are well-meaning, often rehabilitated people are at risk of being pulled back into the world of drugs or alcohol.
There are people who visit liquor bars and yet come out unaffected. But what about the possibility of an uncontrollable urge to drink? We don’t know when the brain will send such a signal in response to the smell of liquor? Why dare unnecessarily? Instead one must count each drug-free or alcohol-free day as a blessing. That is in fact true bravery; the rest is bravado. Bravery requires a person to live life quietly, without making a big song and dance about it. In this context, our `follow-up’ is crucial. It means a lot to Muktangan because it allows us to help people remain sober. We can discourage patients from taking brash and supposedly brave decisions. Counselors can warn them against any sudden alterations in lifestyle. When rehabilitated patients decide to take huge loans for new enterprises, we tell them not to rush into new lifestyles. We ask them to take it easy and concentrate on regaining the lost social reputation. These people, who have once been thrown out of the social order, have to be doubly responsible about their decisions.
Unlike others who have social credibility, these patients can’t afford to make mistakes. Mistakes are the prerogative of those who have not erred so far. But those who have been labeled as irresponsible in the past must live life more cautiously – never in the fast lane.
It is easier for us to follow-up with the `de-addicted lot’ in Pune. We can meet them regularly. But those staying elsewhere also telephone us, sometimes at unearthly hours. Our volunteers receive long-distance phone calls every evening. The person at the other end just wants to talk to someone in Muktangan, not necessarily anyone in particular.
There is a yearning to communicate with the inmates of Muktangan. There are times when the wives of these patients advise them to go to Muktangan for recuperation: “You have been very irritated for quite some time. Why don’t you go to Muktangan?”
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