ALCOHOLISM IN SAMOA: A DISEASE

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By Puletini Tuala

APIA, Samoa (December 14, 1999 – Samoa Observer)---Whether in jammed urban Apia or the spacious remote villages of Savaii, the scene can be remarkably similar: The husband comes home drunk again, perhaps without his paycheck or having lost his job, or just had too much of a wonderful time; the wife crying amidst the shouting; the children cringing in fear.

Neighbors overhearing the ruckus condemn the man. "Why doesn't he stop his drinking or at least control it?"

They might be surprised to learn that is exactly what he's been trying to do -- and failing repeatedly. Somehow he just can't seem to stop or limit his drinks. Even when he doesn't want to, he gets drunk.

And as his drinking is getting more and more out of control, he is becoming increasingly frightened and overwhelmed by feeling of guilt and remorse at the damage he is doing to himself, his family and others. Yet, despite it all, he cannot seem to stop or control his drinking.

What has happened is that the drinking of this particular person has become different from others. Of those who drink alcoholic beverages, he is perhaps one out of thirteen whose drinking becomes compulsive and addictive. He no longer has real control over his drinking. His willpower is rendered inoperative despite what he knows it is doing to him. He is an alcoholic.

Most people still consider it as a moral problem -- a lack of will power or perhaps just the sign of a bad person.

"If he really wanted to, he could control his drinking." But for the alcoholic, this is simply not true. Once he takes one alcoholic drink, i.e., alcohol goes into the system, the addiction is triggered and he loses control. An overwhelming compulsion to continue drinking sets in against which his willpower and "good intentions" are powerless.

The alcoholic's drinking is no longer essentially a moral problem but a medical problem. The active alcoholic is not necessarily a "bad" person but a very sick person. He/she is a person with an extremely serious disease, which will affect him/her physically, psychologically, emotionally and spiritually in a very adverse manner.

Alcoholism has been classified as a disease by the World Health Organization (WHO), the American Medical Association (AMA) and many other medical associations.

Some definitions are:

* "An alcoholic is a person who is powerless to stop drinking once he or she has started and whose drinking seriously alters normal living patterns," according to the National Council on Alcoholism.

*"Alcoholism is a physical compulsion to drink coupled with a mental obsession about it," according to Alcoholics Anonymous.

In other words, an alcoholic is a person who at some time in his drinking reaches a point where he no longer can control it. Once he starts to drink he is never sure he'll be able to stop. For the majority of people, alcoholic drinks like beer, wines, etc., may be a way to help them relax and enjoy social functions. But for the minority who become alcoholics, such drinks become like a poison to them.

There has been a good deal of research in recent years on the disease of alcoholism and from it can be seen that for a person to become an alcoholic, several factors must be present: First, drinking must be socially acceptable so that the person can -- and does -- drink. In some societies (e.g. a strict Muslim society) drinking alcohol is not allowed and so there is little alcoholism in such a society.

However, in most of the Pacific societies, drinking is not only acceptable but in some groups or in some business circles there is actually pressure on members to drink, even when they may not want to. It also is becoming apparent that for a person to become an alcoholic there must be a physical factor in his or her body. Scientists are studying the phenomena (enzyme imbalance? endorphins?) trying to precisely determine what it is.

However, it is apparent that some people's bodies do not metabolize alcohol like the rest of mankind. For example, in the beginning they may have a tremendous capacity and be able to drink much more than other people. Later on, they may start to drink first thing in the morning whereas most people's bodies would reject alcohol then.

And once the disease of alcoholism is present and alcohol is ingested in the body, the craving and addiction for more is activated. This physical disposition is still not completely understood but it is recognizable, and while it seems there is hereditary factor, this is not true in every case. For instance a family where there is an alcoholic parent, one of the children may also become an alcoholic while another does not.

Along with the environmental and physical factors there will undoubtedly be some psychological or emotional strains triggering drinking. For instance, most alcoholics while still drinking do not seem to cope very well with life. They have remained emotionally immature and when problems and tensions arise in life, they will often seek to escape in drink.

A potential alcoholic may drink to avoid responsibility, boredom or problems, or he may drink to celebrate or just feel good. Any excuse will do. But if he keeps at it, drinking will eventually become his number one problem. He is usually as manipulative and very dependent person. He has to be in order to continue drinking the way he does. For example, the alcoholic husband will ask his wife to telephone the boss and say he has the flu and cannot go to work when in reality he is just drunk or suffering from a hangover. An active alcoholic may also suffer from a sort of free-floating anxiety and he finds it hard to tolerate any type of pain, physical or emotional.

Impatience, hypersensitivity and a tendency toward excessive perfectionism may also increase the tension that causes the alcoholic to seek relief in the bottle. More often than not the alcoholic is a sensitive and talented person. Unfortunately this great potential stagnates as the disease worsens and he will begin to lie and cheat to continue drinking, finding his whole sense of morality and the spiritual deteriorating and wasting away.

For the average alcoholic, after some years of heavy drinking (although this is relative to each person) in which alcohol becomes more and more the center of his life, he will pass a point where he loses control of his drinking again. Moreover, from now on the disease will become progressively worse. If he continues to drink it will lead to extreme loneliness, paranoia, despair, ruined health and an obsession with alcohol. For the person who becomes an alcoholic, one of three things will happen: he will either die, go insane -- or recover.

If the alcoholic is to recover (not be 'cured' since he can never go back to drinking again) he must eventually want it for himself -- not just because his wife or boss want him to stop or because of some other outside pressure. He has to 'surrender' -- no more big plans, etc., but just recognize his drinking as the most serious problem in his/her life (and probably the cause of most of his/her other problems) and be willing to do whatever is necessary to stop drinking and get his life together.

In recovery he first has to dry out-sot drinking and get the alcohol out of his system. Seeing a doctor and possibly being hospitalized may be necessary if his/her condition is bad cirrhosis of the liver or some other series ailment has devalued. With a good diet and some exercise he/she will probably recover his/her health after a little while. Once he feels better the old temptation may come back, i.e., that he can now have just a few drinks. This is suicide; he has lost his ability to stop at a few drinks and his next bout with drinking will be worse than that one he just passed through. The progression, if he continues to drink, can lead to his death or insanity.

What is necessary after he dries out is that he begins to look at whatever is causing him to pick up that first drink, which triggers his compulsion. He has to begin facing the challenges and tensions in his life, and work them through without trying to escape from them in the bottle. In other words he has to start growing up. Occasionally an alcoholic may benefit from some ongoing professional help a psychiatrist or a psychologist but most find that once they stop drinking and attain some quality sobriety their problems tend to be manageable.

Psychological insights may be very helpful to an alcoholic in understanding what lies at the root of his tensions but worldwide experience shows that something more than such understanding is necessary for one to actually stop drinking permanently and stay sober.

Another misunderstanding that can be fatal is that by prayer alone the alcoholic can quit drinking and maintain a lasting and fulfilling sobriety. Again, common experience shows this to be false. The alcoholic has a disease and as with any other illness, he should pray and ask God's help and grace and then take the ordinary and appropriate means to get well. For instance, if a person has a kidney disease, he or she should ask God's help and then take the appropriate medicine. For the person with the disease alcoholism, he should pray and then take appropriate "medicine" for alcoholism which, by worldwide consensus, is Alcoholic Anonymous.

Alcoholic Anonymous, or AA, describes itself as, "a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problems and help others to recover from alcoholism." It is not a religious program though it is a spiritual program. It seems to combine basic good spirituality and psychology. Its members strive not to drink today -- no long-term tension producing promises. Just a day at a time. They work on a program of twelve steps for personal recovery. These are:

1. We admit we were powerless over alcohol, that our lives had become unmanageable.

2. Came to believe that a power greater than ourselves could restore us to sanity.

3. Made a decision to turn our lives and our will over to the care of God, as we understood Him.

4. Made a seating and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and become willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us ands the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Alcoholics Anonymous has perhaps two million members throughout the world but it is relatively new in Samoa. Nevertheless there are individuals who have attempted from time to time to establish this group. [The telephone number for contact is 26156]. For the person who is concerned whether his drinking has become alcoholic, there are test available, such as the following. Do you:

1. need a drink 'the morning after?

2. like to drink alone?

3. lose time from work due to drinking?

4. need a drink at a definite time daily?

5. have a loss of memory while or after drinking [a blackout]

6. find yourself [or others] hard to get along with?

7. find your efficiency or ambition decreasing?

8. drink to relieve shyness, fear or inadequacy?

9. find your drinking is harming or worrying your family or those close to you?

10. find yourself more moody, jealous or irritable after drinking?

These yes answers may well mean alcoholism. If there are four yes answers alcoholism is almost certain to be present and that reality should be faced.

For those close to an actively drinking alcoholic it is well to remember that they are dealing with a very sick person. It doesn't help to criticize, nag or just try to force an alcoholic to stop drinking. What may be needed is a personal crisis or shock to get him to want help. And so, he should not be 'bailed' out of trouble, have things covered up for him, etc. This only enables him to continue drinking and not face the results of what his drinking is bringing about.

To allow this is to allow him to continue his slow suicide. A deeper love and concern will allow him to suffer the results of his drinking [jailing, loss of job, etc.] in the hope he will 'hit bottom' and become so sick of what his drinking is causing in his life that he will seek help. True, this is very difficult and may result in suffering for the family; it also involves the risk that he may not seek help-- a risk much like that taken by the father of the prodigal son in the gospel parable.

In the case where an alcoholic's drinking has become intolerable, a constructive intervention may be necessary. He himself is in denial regarding his disease, so others may have to make decisions for him. In such a case, the family or others close to the alcoholic confront him and tell him that he either accepts help and stops drinking [in AA or in an alcoholic rehabilitation program geared to AA]-- or sanctions become effective [e.g., the family leaves him; he loses hi job; whatever].

Such an intervention requires preparation and perhaps some outside help-- and the conditions must be strictly adhered to. A great help in these matters is Al Anon, a group similar to AA but consisting of the spouses and others whose problem is not alcohol but the alcoholic, and who help each other through their 12 steps program to work through the problems involved in relating with an alcoholic and so live fulfilling and happy lives. If, in any of this, an alcoholic rehabilitation program seems advisable, there has been one group meeting every Tuesday evening in Apia, or the contact number in Apia, 26156.

For the alcoholic to whom life had seemed impossible without his 'crutch' of alcohol, it often comes as a tremendous relief in recovery to find that he is not the moral leper he had felt himself to be, but a person with a disease-- about which he can do something and recover. To meet other recovered alcoholics and to see them living full, joyous and even deeply spiritual lives can offer a great hope to a man or woman who may have been living in despair for years. His talents, sensitivity and perfectionist tendencies, no longer impeded by drink, often make the recovered alcoholic better than average in his field of work.

Recovery for one who has lived long in a hell not of his own choosing can mean a whole life with much peace, joy and meaning in which Jesus' words and gift are deeply understood and appreciated-- "I have come that Samoa pooled with Aussies you may have life, and have it to the full." [John 10.10].

And, as a wonderful bonus, the recovered alcoholic will be able to share this new life-- his experience, strength and hope-- with others who still suffer from the ravages and despair of the disease of alcoholism.

Puletini Tuala is the Director of Satiamai-[Alcohol Awareness/Family Recovery; HIV/AIDS Awareness/Education]

For additional reports from the Samoa Observer, go to PACIFIC ISLANDS REPORT News/Information Links: Newspapers/Samoa Observer.

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