ALCOHOLISM ADDICTION – A CASE STUDY OF AN ALCOHOLIC

aWhen one realizes that no matter how much they may know about theoretical drug problems and alcohol problems, it is still possible to be staring in the face of a full on alcoholic and not know it until after the fact. Alcoholism and drug problems, much like other chronic illnesses, are not things one can identify just by looking at someone’s face. However, if one pays attention there are probably warning signs that are indicative of a substance abuse problem. However subtle the signs may be, they are usually consistent. A story, with not so subtle signs, may be in order to properly illustrate the point:

Ahmed is a 30 year old junior marketing executive. He shares an apartment with his brother and is not in a relationship. Ahmed has a very active social life. Almost every night of the week, Ahmed can be found at some sort of festivity that is at a bar, club or restaurant. At all of these occasions, liquor is present. Ahmed often
jokes about how he must look like an alcoholic because in most pictures he is holding a drink. In addition, the woman he has begun a flirtation with finds that every time she calls him he is drinking. She thinks nothing of it, since this man must just enjoy one or two social drinks. The fact that he drinks every night does not flag him as an alcoholic in her eyes. They have spoken on the phone scores of times, spent time together and been in constant communication for a two month period. In addition, he really is such a nice guy. He casually mentions that his mother has asked him to promise not to drink. They laugh about how parents often refuse to view their children as adults.
 
One night before Ahmed goes out with his new lady friend, he tells her a few stories. One included waking up one morning after a night of drinking with blood on his shirt. The caveat being he had no idea where the blood came from. On another occasion, upon being shoved by a young woman in a club after drinking for a while, Ahmed pushed her back and the woman went flying across the room. Ahmed admits that at this point, he realized he did not know what his alcohol limit was. He stated this in past tense; these events had happened about a year prior and since then, Ahmed had allegedly altered his drinking habits. This statement was made as Ahmed pulled out two small bottles of vodka. One was for himself one for his lady friend. When she declined the offer of drink he downed both bottles himself.
 
Two hours later at the club the couple had gone to Ahmed has drunk two beers and was ready for a shot of tequila. He at this point is holding his liquor well. However; once the shot of tequila comes into play Ahmed succeeds in alienating his new friend. He spills salt all over the bar then begins dancing sloppily and says more than a few insulting things to his date. By the end of the evening the young lady wants nothing more to do with him. Ahmed can’t understand why. 

 Ahmed is in a state of denial about his drinking problem. The main issues here
include the following:
An inability to stop drinking
Inability to see conflicts arising subsequent to drinking
Spending excessive money on drinking to the point of putting oneself in a financially precarious position
Jeopardizing existing relationships
Damaging potential future relationships
Does not correlate his poor decisions with the outcomes they procure
Not understanding the concern those around have for him and his poor behavior 

 Ahmed continues to drink excessively, regardless of the concern expressed by his family and friends. He holds that he does not have a problem and does not seek help. In the long term, Ahmed is never able to find a more secure job position or maintain a serious romantic relationship with any woman he meets. The issues here are many. Ahmed’s inability to stop drinking will also eventually erode his body functioning. This will result in a financial strain both on Ahmed, his family and society. The most common health risks for alcoholics include strain on the liver and kidneys.

 

Should Ahmed ever decide he wants to stop drinking, , what he may not realize is detoxification from alcohol unsupervised can be life threatening. The purpose of writing down Ahmed’s story is his experience may be able to help someone you know.  HEALTH RISKS OF CHRONIC HEAVY DRINKING

It’s no secret that alcohol consumption can cause major health problems, including cirrhosis of the liver and injuries sustained in automobile accidents. But if you think liver disease and car crashes are the only health risks posed by drinking, think again: Researchers have linked alcohol consumption to more than 60 diseases.

“Alcohol does all kinds of things in the body, and we’re not fully aware of all its effects,” says James C. Garbutt, MD, professor of psychiatry at the University of North Carolina at Chapel Hill School of Medicine and a researcher at the university’s Bowles Center for Alcohol Studies. “It’s a pretty complicated little molecule.”

DISEASES:

ANEMIA

Heavy drinking can cause the number of oxygen-carrying red blood cells to be abnormally low. This condition, known as anemia, can trigger a host of symptoms, including fatigue, shortness of breath, and lightheadedness. 

 

CANCER

“Habitual drinking increases the risk of cancer,” says Jurgen Rehm, PhD, chairman of the University of Toronto’s department of addiction policy and a senior scientist at the Centre for Addiction and Mental Health, also in Toronto. Scientists believe the increased risk comes when the body converts alcohol into acetaldehyde, a potent carcinogen. Cancer

sites linked to alcohol use include the mouth, pharynx (throat), larynx (voice box), esophagus, liver, breast, and colorectal region. Cancer risk rises even higher in heavy drinkers who also use tobacco.

 

CARDIOVASCULAR DISEASE

 Heavy drinking, especially bingeing, makes platelets more likely to clump together into blood clots, which can lead to heart attack or stroke. In a landmark study published in 2005, Harvard researchers found that binge drinking doubled the risk of death among people who initially survived a heart attack.

 

Heavy drinking can also cause cardiomyopathy, a potentially deadly condition in which the heart muscle weakens and eventually fails, as well as heart rhythm abnormalities such as atrial and ventricular fibrillation. Atrial fibrillation, in which the heart’upper chambers (atria) twitch chaotically rather than constrict rhythmically, can cause blood clots that can trigger a stroke. Ventricular fibrillation causes chaotic twitching in the heart’s main pumping chambers (ventricles). It causes rapid loss of consciousness and, in the absence of immediate treatment, sudden death.

ADDICTION INTERVENTION
PLANNING
When someone is dealing with an addiction, one of the hardest parts of

them getting help is often simply to admit that they are having a problem.

Unfortunately it is much too easy for a person to just completely deny that they

are When this problem occurs, what it often takes is someone else staging an

intervention, and that intervention being what helps the afflicted individual

realize:

That they have a problem.

That they need to seek out help.

That the help they need is available if they are willing to reach for it.

PREPARING MENTALLY FOR THE INTERVENTION
In order to ensure that your intervention is successful it is vital that you prepare

yourself for the task at hand. Taking a loved one on and forcing them to face

the true addiction that they are going through is a difficult task to say the least.

Making sure you are emotionally ready to follow through with the intervention

is essential to being successful and helping them see the truth.

 

PROFESSIONAL INTERVENTIONAL HELP

A successful intervention cannot even begin without the right help to

guide you along the way. You might think you can do this on your own but

once you get started you will find a very different story. A professional

interventionist can walk you through the steps that need to take place in

order to be successful in your attempts at intervention. They will be able

to guide you and help you make the right choices for your intervention. A

qualified interventionist has been through the procedure multiple times

and has a good idea of what will work and what will not.

 

IMPORTANT THINGS TO REMEMBER WHEN
STAGING AN INTERVENTION
Drug intervention is a vital part of treatment for any individual who is in denial

of the problems at hand. This having been said it is extremely important to be

very organized about the intervention process. This will allow you to be

prepared for any turn of events that might occur along the way. Being prepared

is the key to success. Make sure that you are extremely detailed in the planning

of the intervention. Talk with the individuals participating in the intervention so

that you are sure each person has a clear understanding of what they will be

doing during the intervention and what their role will be for the process.

Keeping everyone working together is essential.

 
UNDERSTANDING OPTION 
 

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Meet with the participants of the intervention as often as possible before the

event to practice the process and the steps. This will help relieve some of the

pressure when the real thing is upon you. It is important that the loved one you

are trying to help does not feel as though they are being judged and the best

way to accomplish that is by everyone understanding their roles.

Be prepared for what is about to happen. The loved one you are trying to help is

more than likely going to object to the entire event and even the notion that

there is anything wrong in the first place. They may initially feel violated,

disrespected and betrayed by all of those involved in the intervention. They are

likely to lash out at all those making what they see as accusations toward

them. They could be verbally abusive in an effort to divert from the subject at

hand. Being prepared for this to happen will help everyone stay on track and

stay focused on the end goal. CONSEQUENCES OF ALCOHOLISM IN INDIA

 

Alcoholism in India

Alcohol is banned in some parts of India such as Manipur and Gujarat, but it is legally consumed in the majority of states. There are believed to be 62.5 million people in India who at least occasionally drink alcohol. Unlike many western countries the consumption of alcohol in India is witnessing a dramatic rise – for instance, between 1970 and 1995 there was a 106.7% increase in the per capita (this means per individual in the population) consumption. International brewers and distillers of alcoholic beverages are keen to become popular in India, because it is potentially offers the third largest market for their product globally. India has also become one of the largest producers of alcohol – it produces 65% of alcoholic beverages in South-East Asia. Most urban areas have witnessed an explosion in the number of bars and nightclubs that have opened in recent years

 Drinking Culture in India

India is a vast sub-continent and the drinking habits vary greatly between the different those who live in the south western state of Kerala are the heaviest drinkers. People who live in this state drink an average of 8 liters per capita, and this is four times the amount of the rest of India. Other areas of the continent where people tend to drink relatively heavily include Haryana and Punjab. In some parts of India there is hardly any drinking culture to speak of – in some of these places alcohol is banned completely. In recent years there has been a noticeable rise in the number of urban males who claim to use alcohol as a means to relax. It still tends to be the poor and those who live in rural areas that are the highest consumers of alcohol. It is believed that as little as 5% of alcohol consumers are female – although this figure is higher in some states.

 

Alcohol Abuse in India
India once had a reputation as having a culture that promoted abstinence towards drugs like alcohol. Things have changed and there is now serious problems arising due to alcohol abuse – some would say that there were always problems associated with alcohol use in India but in the past it was less reported. The implications for this rise in alcohol related problems include:

 

* An increasing number of people are becoming dependent on alcohol. This makes it difficult for them to function normally within society.

* Domestic and sexual abuse is often associated with alcohol abuse.

* This type of behavior can be damaging to communities.

* Those individuals who engage in this type of behavior can begin to fail in their

ability to meet family, social, and work commitments.

* Families can suffer financially as a result of this type of substance abuse.

* Business and the economy suffer because of lost productivity with people coming to work still suffering from the effects of alcohol.

* Drink driving is responsible for many roads death

 

Underage Drinking in India

Underage drinking is becoming a problem in India. Different states will have different age limits for alcohol consumption – the age limit in those states where it is legal to drink range from 18 to 27 years old. It is common for people to begin drinking before the legal age limit. The problems of underage drinking include:

 

 

 

* For those young people who are still in adolescence, it can interfere with their

normal development if they consume alcohol. This type of behavior can particularly interfere with crucial mental development that occurs at this age.

* Underage drinking is closely related to teen suicide.

* It encourages sexual promiscuity.

* Those people who drink at an early age are far more likely to develop alcoholism.

* It can mean that these young people perform badly at school or college. This means that their opportunities in the future will be limited.

* Even those who are young can develop alcoholism and all the physical and mental problems that come with this.

 

Treatment and Prevention of Alcoholism in India
There is help for people who have developed problems with alcohol in India including:

* Alcoholism and Drug Information Centre is devoted to prevention and treatment of substance abuse in India. They are a good resource to turn to for information and advice.

* Alcoholics Anonymous has meetings in many locations in India. This fellowship uses the 12 Steps to allow the individual to develop a better life away from addiction, substance abuse and helping them deal with other social problems.

* Many people are leaving India in order to seek treatment for their alcoholism abroad. The most respected alcohol and drug abuse treatment facility in Asia is DARA rehab

Conclusion

Alcohol is not an ordinary commodity. While it carries connotations of pleasure and sociability in the minds of many, harmful consequences of its use are diverse and widespread

From a global perspective, in order to reduce the harm caused by alcohol, policies need to take into account specific situations in different societies. Average volumes consumed and patterns of drinking are two dimensions of alcohol consumption that need to be considered in efforts to reduce the burden of alcohol-related problems. Avoiding the combination of drinking and driving is an example of measures that can reduce the health burden of alcohol.

Worlwide, alcohol takes an enormous toll on lives and communities, especially in developing countries and its contribution to the overall burden of disease is expected to increase in the future. Particularly worrying trends are the increases in the average amount of alcohol consumed per person in countries such as China and India and the more harmful and risky drinking patterns among young people.

National monitoring systems need to be developed to keep track of alcohol consumption and its consequences, and to raise awareness amongst the public and policy-makers.  It is  up to to encourage debate and formulate effective public health policies that minimize the harm caused by alcohol.

 – Jayaditya

Alcoholic Family – Observation

What is Alcoholism – Alcoholism is a disease characterized by the habitual intake of alcohol. The definition of alcoholism is chronic alcohol use to the degree that it interferes with physical or mental health, or with normal social or work behavior. Alcoholism is a disease that produces both physical and psychological addiction. It is a prominent and most common problem in cases of substance abuse.

CASE STUDY – THE SINGH FAMILY LIVING IN INDIA
Karan Singh, a 38-year-old african immigrant, and his 35-year-old wife presented to a family services agency with the complaint of “family problems.” The Singh have been married for twelve years and they have two children (a son aged 6 and a daughter aged 8). They have lived in the africa for eight years. He worked as a machine worker in a factory for five years before being recently “laid off.” He presently works as a day laborer. Mrs. Singh works as a housekeeper for a family.
Mr. Karan complains that his wife has recently started “to nag” him about his drinking. He admits that during the last few months he has increased his intake of alcohol, but denies that this is a problem for him, as he drinks “only on the weekends, and never during the week.” He drinks every weekend, but is vague about the actual amount.
Mr. Singh and his wife speak of the difficulties they experience in living in the africa. Neither speaks. Mr. Singh  admits to being quite worried about his previous lay off, adding that he didn’t want to “let the family down” in his responsibilities. As a result, he works long days in order to make ends meet. His weekend drinking is, for him, his way of relaxing, which he feels that he deserves.

The following procedure must be followed to reduce, if not solve, the problem of alcoholism Step by Step :-
1. Identify and sort through the relevant facts presented by the Singhs.

2. Identify the problems, issues, concerns that arise with the Singhs.

3. Identify the positive and strengths aspects of the Singhs situation.

4. Analyze the issues in terms of knowledge presented in the training modules.

5. Use training materials to develop a list of options and an initial plan of action for social work intervention with the Singhs .

6. Identify any additional information, research knowledge, and resources that are needed to develop and select options; identify ways to gather what you need; gather what you can.

7. Develop a strategy for social work practice with the Singhs . Be sure that you have a concrete and specific strategy for how you would address alcohol-related issues with the Singhs . Consider what kinds of reactions you might expect from each of the Singhs , and develop a plan for how to respond to them. What kinds of referrals in your practice community would you make and why? What are the intervention goals?

7a. Does the Singhs ‘ original nationality matter in this case?

8. Identify methods for evaluating outcomes of your plan and next steps/revisions of the plan, depending on various possible outcomes.

9. Discuss implications for community intervention, prevention planning, social policy reform, and advocacy that are associated with the Singhs ‘ situation.
If anyone even slightly resembles the problems as faced by the Singhs’ family, the following step to step procedure should be followed along with the doctors aid for a better result.

-Deeksha Khatri

CASE STUDY :- Priya , a cocaine and alcohol ex-consumer

What is Cocaine :- Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America.
What is Alcoholism :- A chronic disease characterised by uncontrolled drinking and preoccupation with alcohol.
CASE STUDY :- Priya , a cocaine and alcohol ex-consumer
Last week, Priya entered the inpatient treatment program where you are a social worker. She is being treated for alcohol and cocaine (crack) dependence. Priya is a 32-year-old, divorced woman who is employed as an administrative assistant at a local human services program. She lives with her 11-year-old daughter, lily , in an apartment located near her job. Although she makes a relatively low salary, Priya has managed to support herself and her daughter without financial support from lily’s father. Priya was married briefly to lily’s father when she was 20, but she left him after he became physically and sexually abusive toward her. He also was an alcoholic. She had almost no contact with him for many years. Her mother, a widow, is a strong support for Priya and lily, as are two cousins, Denise and Moira. Priya reports growing up in a “normal middle class family” and states that her childhood was “good” despite her father’s occasional drinking binges, which she says were related to him celebrating a special account he had landed (he was in advertising), and her mother’s “occasional bad depressions.” She is the youngest of five children and the only girl.
Up until a month ago, Priya was regularly attending twice-weekly treatment sessions at an outpatient chemical dependency clinic, and she went to AA/NA regularly 3 times a week. She had a sponsor and they kept in touch several times a week-more, if needed. From the beginning of recovery, Priya has experienced some mild depression. She describes having little pleasure in life and feeling tired and “dragging” all of the time. Priya reports that her difficulty in standing up for herself with her boss at work is a constant stressor. She persisted with treatment and AA/NA, but has seen no major improvement in how she feels.
After Priya had been sober for about 3 months, an older boy sexually assaulted lily after school. Priya supported lily through the prosecution process; the case was tried in juvenile court and the boy returned to school 2 months later.
After Priya celebrated her 6-month sobriety anniversary, she reports that she started having a harder time getting herself up each day. Around this same time, she returned to drinking daily. She says that she then started experiencing bouts of feeling worthless, sad, guilty, hopeless, and very anxious. Her sleep problems increased, she began having nightmares, and she lost her appetite. After a month of this, she started attending AA/NA and treatment less often, instead staying home and watching TV. She started her crack use again one night after her boss got very upset with her not finishing something on time. She went to a local bar after work that day and hooked up with a guy she met there to get crack. In accompanying him to a local dealer’s house to get some crack, she was raped by several men. Priya did not return home that night (lily was at a friend’s sleepover party) and did not show up for work the next day. She does not recall where she was the rest of that night. However, later that day she admitted herself to your treatment program.
Priya reports that she began drinking regularly (several times a week) around the age of 13. She recalls having felt depressed around the same time that she began drinking heavily, although she states she has very few clear memories of that time in her life. Priya’s drinking became progressively worse over the years, although she did not begin to see it as a problem
until after she began using crack, at around age 28. She reports feeling depressed over much of her adult life, however her depression got much worse after she began using crack daily.
Priya reports having had a lot of gynecological problems during her 20s, resulting in a hysterectomy at age 27. When asked if she was ever physically or sexually abused as a child, she says no; however, she confesses (with some difficulty) that when she was 11, she had an affair with her 35-year-old uncle (father’s brother-in-law).
Now, one week into treatment, Priya reports feeling numb and tense. She talks only in women’s treatment groups and, then, only when specifically asked a question. She feels hopeless about her ability to put her life together and says that she only sees herself failing again to achieve sobriety. Of her recent rape, she says that she “only got what she deserved” for being in the wrong place with the wrong people at the wrong time. Priya reflects that she was unable to adequately protect her daughter from sexual assault, and she speculates that maybe she is an unfit mother and should give up custody of her daughter. While lily is currently staying with Priya’s mother, Priya is concerned that her ex-husband will try to get custody of lily if he hears that she is in the hospital for alcohol and drug treatment. He has been in recovery himself for two years and began demanding to see lily again about 2 months ago.
If anyone faces the same problem as Priya’s substance abuse, once should :-
1. Identify and sort through the relevant facts presented by Priya .

2. Identify the problems, issues, and concerns that arise with Priya’s situation.

2a. What are the most pressing issues that Priya should be encouraged to assess and address?

3. Identify the positive and strengths aspects of Priya’s situation.

4. Analyze the issues in terms of knowledge presented in the training modules.

5. Use training materials to develop a list of options and an initial plan of action for social work intervention with Priya . Who should be involved in the intervention for Priya ? Who should also be referred for intervention?

6. Identify any additional information, research knowledge, and resources that are needed to develop and select options; identify ways to gather what you need; gather what you can.

7. Develop a strategy for social work practice with Priya . Be sure that you have a concrete and specific strategy for how you would address alcohol issues. What are the intervention goals? Following inpatient treatment, what kinds of referrals in your practice community would you make and why?

8. Identify methods for evaluating outcomes of your plan and next steps/revisions of the plan, depending on various possible outcomes.

9. Discuss implications for community intervention, prevention planning, social policy reform, and advocacy that are associated with Priya’s situation.
If the following is taken into consideration and active steps are taken before the problem goes too deep, one can avert a lot of crises at an early hour.

– Deeksha Khatri

6 Myths the Alcohol Industry Wants You to Believe

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Message 1: Consuming alcohol is normal, common, healthy, and very responsible.

Explanation: To bring this message home, alcohol advertisements nearly always associate alcohol consumption with health, sportsmanship, physical beauty, romanticism, having friends and leisure activities.

It’s left to the social service agencies and non-profits to attempt to convey the opposite side of the coin: a dramatically heightened risk for health problems, traffic fatalities, domestic violence, loss of job, loss of marriage, suicide—you name it.

Message 2: The damage done by alcohol is caused by a small group of deviants who cannot handle alcohol.

Explanation: Indeed, the message of the industry is that ordinary citizens drink responsibly and that ‘bad’ citizens drink irresponsibly and are the cause of any and all problems associated with high alcohol consumption.

This one is insidious and unscientific. There is no evidence that alcoholics are “bad people,” or simply unwilling to stop engaging in bad behavior. For the industry, irresponsible drinkers are a major revenue source—the dream customer— even though alcohol manufacturers continue to insist that their advertising is primarily about driving home the message of responsible alcohol consumption and brand choice.

Message 3: Normal adult non-drinkers do not, in fact, exist.

Explanation: Only children under 16 years of age, pregnant women and motorists are recognized by the industry as non-drinkers.

The existence of non-drinkers is seen by the industry as a threat. Accordingly, they have subtly reinforced the message that moderate drinking is not only normal, but also good for you. Never mind that the real profits come from excessive drinking and pricing strategies that encourage it. Alcohol industry’s income hinge on the success they have in encouraging alcoholics to believe that everything’s okay, everybody drinks that way. The message becomes clearer: Drinking is mandatory—unless you’re a deviant.

Message 4: Ignore the fact that alcohol is a harmful and addictive chemical substance (ethanol) for the body.

Explanation: The industry does not draw attention to the fact that alcohol (ethanol) is a detrimental, toxic, carcinogenic and addictive substance that is foreign to the body.

Naturally, pointing out the neuroscientific parallels between alcoholism and heroin addiction is not part of the message. Alcohol is a hard drug—ask any addiction expert. Alcoholism can kill you quick.

Message 5: “Alcohol marketing is not harmful. It is simply intended to assist the consumer in selecting a certain product or brand.”

Explanation: Meanwhile, research has indisputably demonstrated that alcohol advertisements are both attractive to young people and stimulate their drinking behavior (Anderson et al., 2009: Science Group of the Alcohol and Health Forum; 2009). Yet the industry continues to flatly and publicly deny that advertising stimulates alcohol consumption (Bond et al; 2009).

Message 6: “Education about responsible use is the best method to protect society from alcohol problems.”

Explanation: Effective measures such as a higher alcohol excise-duty, establishing minimum prices, higher age limits and advertisement restrictions can reduce alcohol related harm and will therefore decrease the profits of the industry (Babor, 2003; Babor, 2010). The industry therefore does its best to persuade governments, politicians, and policy makers that the above mentioned measures would have no effect, are only symbolic in nature or are illegitimate.

A truly great dodge, because the strategy being advertised sounds so imminently sensible. Who could be against the promotion of responsible alcohol use? Irresponsible zealots and deviants, that’s who. Why should all of the happy drinkers be made to suffer for the sins of a few rotten apples?

Indeed, all of the messages, overtly or covertly, send the same signal: You should drink more. It’s good for you.

Source: http://addiction-dirkh.blogspot.in

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Did you or anybody you know ever fell for these messages?

@akritiarora

Alcohol and HIV—The Connection

National AIDS Control Organisation of India estimated that 2.39 million people live with AIDS in India. (2008–09)

11 percent of Indians were binge drinkers, against the global average of 16 percent.(WHO)

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Alcohol and HIV have an overwhelming impact on morbidity and mortality in the world’s populations both separately and together. They rank among the top 10 leading causes of death. Their dynamic interaction increases the risk for HIV infection and complicates their treatment. How this combined epidemic is expressed for individuals, their families, and their cultural contexts and the wider institutions that serve them is explored in a publication by National Center for Biotechnology Information

It helps to arrive at a more complete understanding of the role that drinking plays in the lives of individuals and communities. There are many questions that arise in context of alcohol drinking in India that this case study aids to shed light on such as-

  • Where does drinking take place?
  • What types of alcohol are drunk?
  • Are youth who begin drinking at an earlier age at greater risk, and if so, of what?
  • What are the variations in HIV and other risks related to alcohol use?
  • Are there gender differences in men and women’s perception and use of alcohol?
  • How this repertoire of individual and group behaviors is linked to HIV risk, particularly sexual risk under the influence of alcohol

During AIDS epidemic in India, international and domestic alcohol manufacturers were seeing it as an opportunity for their products to expand in Indian middle and upper middle class communities with resources to spend on leisure time activities. Alcohol production and use has a long history in India. Recently, however, the sale and consumption of new forms of alcohol containing more pure alcohol content such as “strong beers”, and associated with higher status and prestige such as “English liquors” including whiskey, scotch and brandy, has began to replace traditional beverages with lower alcohol content and more nutritional components such as tadi madi (date wine), fenny (distilled coconut or cashew wine) and toddy (palm liquor).

In 2000, two new WHO publications highlighted the growing significance of alcohol with respect to HIV risk. The WHO Eight Country Study on alcohol and HIV (2000) included a chapter on alcohol and HIV in India, followed by an historical review of secondary data sources on the history of alcohol and its association with HIV risk in India.

HIV-and-Drinking-Don't-Mix

Important discoveries found in the NCBI’s case study:

  • According to research done on mobile female sex workers and male mobile workers who are clients of these FSW in 14 districts of India, alcohol consumption is common in both, females and males prior to sex, and is linked to inconsistent condom use. In some cases men who pay for sex with women outside of brothels are much more likely to avoid condom use or to use condoms inconsistently. These results suggest the importance of focusing interventions on reducing risks associated with paid sex and informal sexual transactions that take place outside of the brothel environment.
  • HIV positive patients who consume alcohol exacerbates gaps in medication adherence, and acts as a facilitator of sexual risk behavior. This population is highly understudied in the India context and as more people become seropositive, reducing alcohol risk and unprotected sex among PLWA is increasingly important, both to reduce transmission and improve health and related outcomes.
  • Central India showed that alcohol used before sex was a significant predictor of HIV seropositivity in married men 30–39, but not in single men who were probably younger
  • On the other hand, in a study of HIV risk among clients of wine shops in Chennai reported that 89% of respondents interviewed drank before having sex and that non-protection was significantly more common among unmarried men who drank before having sex. These studies have led scholars such to conclude that one viable option for HIV prevention in the Indian context is reducing alcohol consumption prior to sex in both married and unmarried men
  • Resource poor communities in Mumbai shows conclusively that daily drinking is associated with extramarital sex, higher level drinkers have more non spousal sexual partners and use protection less with them. It suggests that moderate level drinkers also may be at risk of exposure to STI and HIV and that interventions should be tailored, with cessation the goal in the case of regular daily drinkers and reduction of frequency and amount of consumption among moderate and lower level drinkers to reduce sexual risk.
  • Poor mental health and hazardous drinking is associated with both violence and HIV risk among men.
  • Violence associated with alcohol use has been shown to have an effect on HIV and STI risk exposure, primarily through forced, “rough” or painful sex between men and vulnerable or unwilling women including spouses. The evidence is accumulating to suggest that alcohol, when linked with gender norms, disinhibits men, and focuses them on meeting their perceived sexual and other needs in marriage through the use of violence or abuse
  • Venues where alcohol is sold and consumed including wine shops, addas and bars and restaurants clearly influence, endorse, support and enable risky sexual behavior.

What can be done?

  • In India, it is unlikely that “single sector” approaches alone will be effective in combating the gender based violence, risky sexual behaviors and other consequences of pervasive alcohol use. Sensitive community-based, community-controlled approaches to mediating alcohol use and its relationship to unprotected sex and violence should be undertaken with communities, including men, women, and families affected by alcohol, community organizations, distributors, media and providers.
  • Reinforce the importance of HIV risk reduction programs for men in the general population as well as other vulnerable populations such as sex workers, truckers and injection drug users, including de-addiction of alcohol as a focus of HIV risk reduction.
  • HIV prevention interventions that involve discussion of sex are not very widely supported in India.  Such interventions should be altered  accordingly so that they can be successfully implemented, sustained and disseminated in all locations of India as a model for much needed  educational and workplace approaches to prevention.

Case Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2973998/

What do you think? Does HIV risk grows due to alcohol?

@akritiarora