February 18 – National Day to Combat Alcoholism
Don't let alcohol kill your enjoyment of life
February 18 – National Day to Combat Alcoholism
Data from the latest National Survey on Alcohol and Other Drugs (II Lenad), carried out by UNIFESP, in São Paulo, reveal the worrying dimension of the problem in the Brazilian population: about 12 million adults said they consume alcoholic beverages once a week or more. The 2013 study also showed that 8% of people admitted that alcohol use had a detrimental effect on their work, while 4.9% reported having already lost their job due to alcohol consumption.
February 18 – National Day to Combat Alcoholism
February 18 is a very important date, as it is the date of awareness of the entire population about the damage and diseases that excessive consumption of alcoholic beverages can cause.
But remember: awareness day is every day!
The use of psychoactive substances accompanies the history of humanity. In the case of alcohol, it appears related to religious, cultural and social rituals. Advertisements and easy access contribute to the increase in the consumption of the drink, with a glorification of the substance, leveraged by the influence and economic power of the main alcoholic beverage manufacturers.
If today it is still not possible for alcohol to be completely eliminated from society, it is increasingly necessary to further clarify the population in relation to its effects and how to make a responsible consumption.
Alcohol is a drug with depressant effects on the central nervous system and leads to sedation, impairment in motor coordination and disinhibition of behavior, modifying the individual's ability to judge. Alcohol dependence is a chronic and multifactorial disease.
Interview about Alcoholism on CBN São Paulo Radio, with experts
On February 17, 2021, Radio CBN São Paulo received for an interview about alcoholism doctors Clarice Sandi Madruga and Camila Ribeiro de Sene, in addition to Maria (not her real name). Maria's report shows how alcohol interferes in the life of an addict and gives us a clear and real vision of how important prevention and awareness of the population are. Follow in full how the article was aired from 2:40 pm and can be accessed on the CBN website (https://cbn.globoradio.globo.com/programas/cbn-sao-paulo/CBN-SAO-PAULO.htm).
Interviewed:
Maria* – 51 years old, recovering alcoholic woman (*fictitious name)
Dr. Clarice Madruga – Psychologist, PhD in psychiatry and researcher at the Department of Psychiatry at Unifesp.
Dr. Camila Ribeiro de Sene – Psychologist and President of the Alcoholics Anonymous Group of Brazil (AA)
CBN: An alcoholic is a person who drinks more than 3 glasses of draft beer, 3 glasses of wine or 2 shots of whiskey a day at least 4 times a week, according to the WHO. Is it correct to refer to the addict, the alcohol-dependent person as an alcoholic or has this nomenclature already changed?
Dr. Camila R. de Sene: This nomenclature has been changing according to the interpretations that science itself gives. In AA, we use "alcoholic" to express the person who has problems with alcohol use and dependence. Remembering that this terminology is used exactly to demystify, to bring more information and remove some of the prejudice about this disease, which is extremely important, especially when it comes to the alcoholic, this human being who suffers and needs treatment and who needs, as it is in Alcoholics Anonymous, to have his identity preserved so that he can seek treatment in a more expressive way, interacting with society in a respectful way to his person. In AA, the expression we use is exactly to ensure the anonymity of these people who are highly judged, especially women.
CBN: Okay, so I should refer to alcohol-dependent people as alcoholics, right?
Dr. Camila R. de Sene: Yes, I think that Dr. Clarice, as a scientist, can bring this terminology. We talked about substance use disorder, in this case, alcohol, and I believe that for us, members of AA, it is important to emphasize especially this look free of all this cultural and social belief that is stimulated in relation to alcohol.
CBN: Clarice, do you want to talk?
Dr. Clarice Madruga: I would like to, I think it's a very cool topic to be able to talk about terminology and I think Camila put it very well. The way we call things in society can be linked to a stigma and we are from a population that already suffers from stigma, which already has a very great difficulty in having an identity separate from the disorder it has and this ends up mixing. "Alcoholics" is a very A.A. community thing that uses that term. Then this will really change according to the group you refer to: in academia we use the term "chemical dependent", "dependent with Alcohol Dependence Syndrome", which is the name in the health area, clinical. In society, in general, alcoholism is the most used term. The alcoholic is very characteristic of this spectrum of AA, which has such a cool community and makes this movement for the recognition of the problem, to be able to talk about the subject without stigma. In Brazil, it's not so much, but outside of here you can't even call a person a "drug user" because it was offensive since it's an individual who uses drugs.
CBN: You end up dehumanizing the individual, don't you?
Dr. Clarice Madruga: Exactly, so I think this reflection is important. And thinking like this: within science we call it a drug addict or a dependent with alcohol dependence syndrome and, in society, "alcoholism" is still a more neutral term because it does not put you in a specific group and does not carry the strong stigma as the "alcoholic". I always recommend that, when in doubt, use the term alcoholism because it is more neutral.
CBN: Great, so now that we know how to speak correctly, let's move on. I have said here some measures given by the World Health Organization for a person to be considered addicted or alcoholic. More than 3 glasses of Chopp, 3 glasses of wine or 2 shots of Whiskey per day. What do you think of this limit, Camila?
Dr. Camila R. de Sene: For us in AA, one dose is a lot. The person who has problems with the compulsion to consume alcoholic beverages, a drink, a drink, a sip, will awaken and enhance all this compulsive behavior of drinking without measures. So in AA, we talk about avoiding the first drink. So, abstinence is the basis of recovery in AA.
Dr. Clarice Madruga: Once diagnosed, isn't it Camila? I think I'm concerned about this definition of doses because one of the things that I think is most relevant for an internship even long before this recognition and this attitude that exists within the AA group, is the issue of having a diagnosis and understanding that there is a disorder. It is very important to understand that alcoholism is not related to doses, I think this definition is related to abusive use and associated with having the disorder. But when we talk about diagnosis, which only a mental health professional will be able to determine, then it is important that we understand that it goes far beyond the dose. In fact, the amount of consumption comes totally in the background because what we understand as being a disorder, be it alcoholism or any other, it is more being determined by how much that behavior, symptom affects the person's life. I see many saying that "Wow, I'm drinking so many drinks every Friday and I'm moving away from this WHO definition", but when we look at the diagnostic criteria, yes, this is harmful, it causes impacts that may be irreversible, but not necessarily, this is a psychiatric diagnosis where the person would be diagnosed with alcoholism because to investigate whether it affects biological, psychologically and socially. So the questions for the diagnosis are related to work, family, justice.
CBN: It's always linked to how alcohol interferes with life, isn't it?
Dr. Camila R. de Sene: In AA, I think it is important to emphasize, there is no such diagnosis. To be part of the brotherhood, all you need is the desire to stop drinking. So, what we observed: these people who come to the AA meeting room, they have identified their behavior, their social, emotional, work impairments or they have even been to a doctor, so this issue of diagnosis is very close to science. In AA, we don't do that, so people who get there may or may not be diagnosed, but they identify these inappropriate behaviors and want to recover from the disease of alcoholism. We have in AA, a questionnaire with 12 questions close to this clinical inventory that is done, especially if the person, in their daily life, shows signs of a problem.
CBN: For instance?
Dr. Camila R. de Sene: If she has already missed work, if she has realized that life could be better without drinking, if she has tried to replace one drink with another, if a family member has already given any indication of her problem...
CBN: I found the questions here: Have you ever tried to stop drinking for a week or more, but only managed to stop drinking for a few days? Have you taken a drink in the morning in the last 12 months? Ever changed the type of drink in the hope that it could stop you from getting drunk? Has your drinking ever caused you problems at home? Did you try to get extra amounts of drinks at parties where doses were limited?
Dr. Camila R. de Sene: It is very similar to the DSM criteria, very similar to the diagnostic criteria in that it shows the impact on life.
CBN: When Clarice talks about a bio-psycho-social phenomenon, we know that there is no simple answer to the question. How do listeners arrive, for example: "What are the signs that I'm becoming dependent on drinking?" and for that, I wanted to hear Maria since she is here to tell her story. Maria, when did you taste alcohol and, from then on, what was your relationship established with drinking?
Mary: Hi, the first time I had contact, I was 13 years old. I was very sad because I had lost my father a few months ago and I went at Christmas to my paternal grandparents' house and on that day, I drank secretly and drank a lot. People didn't realize that I was drinking and I felt very sick. Then my uncontrolled consumption began.
CBN: And what do you call "uncontrolled consumption"? What relationship did you establish with drinking? Why did he drink? In what situations did you drink and what did you look for in alcohol?
Mary: Look, I started using alcohol for everything in my life. For celebrations when I was happy and to calm down when I was sad. So if I had a problem, I was sad, anxious... for everything! Alcohol became a crutch for all occasions, I used it a lot.
CBN: And what was your routine, your life like, Maria? Was it "partying"? As I said, in the beginning, in general, socializations have alcohol. It is a socially accepted drug, in fact even socially demanded sometimes.
Mary: Look, the impression I have is that I lost a lot of my life because of alcoholism because as I started using it very early, I became a relatively different person from the other people I lived with. So I didn't become a "partygoer", I became a very withdrawn person. I didn't like clubs, nightclubs, my focus was always drinking. Go out drinking. I didn't have much fun because I could go out to enjoy nature, but even in nature, I was always getting drunk to "have fun". So I ended up creating a very big dependence on alcohol and that got in the way a lot. At my 15th birthday party, I got drunk, at 2 pm I was drinking cachaça and at 6 pm I was already completely drunk. And my family didn't know how to control me at that time. So, I didn't live my adolescence, the beginning of adulthood, I always had my life very disrupted by this disease of alcoholism.
CBN: Did you know, at the age of 15, that you had this problem? Because I have an impression that every alcoholic is sure to be in control of drinking and that he can stop drinking whenever he wants. How was it with you?
Mary: I had no idea that this could be a problem. I only started to question and quit drinking at the age of 51. Before, it was very normal to drink, get drunk, drink drinks, because it was very socially accepted and I never questioned my use until I almost died, so I looked for AA. But until then, it never crossed my mind that alcohol could bring me this damage.
CBN: Do you want to tell this episode and why did you seek help?
Mary: I was afraid of dying because 7 and a half years before, I had many physical, affective, emotional, cognitive, relational problems, I had many health defects and I looked for a psychiatrist about 8 years ago. And I started taking psychotropic medication because I didn't talk about my problem with alcohol, since I wasn't aware of it. So, his diagnosis was that I had Bipolar Affective Disorder. I had anxiety crises that started to be at very high levels, I went through depressive episodes and had horrible headaches that wouldn't even let me walk and I took medication for anxiety, depression and a codeine-based medication for headaches and all of these were always in my bag, it was a very difficult situation. And even so, I continued to drink and I started to have very strong reactions of hypoglycemic crises. I always had that with the drink but they passed quickly and didn't affect me much, but they became more present and worse, so I was afraid of dying. I spent around 12 hours with hypoglycemic crises without being able to speak and if I could, I asked for a candy. So what led me to AA were my hypoglycemic crises and why this could lead to my death. I didn't know that all the other things were also related to alcohol, so I discovered a number of other things that brought me back and started to have a normal life. I was very strange, aggressive, I couldn't relate, uncontrolled and nowadays, I can be a person more within this "standard of normality of society" because I am no longer under the effect of a substance that made me sick and this brought me an incredible quality of life.
CBN: Mary, did you have relapses?
Mary: None, thank God!
CBN: Was it tempting?
Mary: Not for me, because my state was already so chaotic and when I met the program that works on my abstinence and the difficulties I have in my life, it was like a lifeline. I, experiencing this program and attending the meetings, reading A.A. literature and learning what happened to other alcoholics, feeling those wonderful things of being sober, I no longer felt like drinking. I flee from alcohol as the Devil flees from the cross. I am aware that I have a disease and that if I do not take the first sip, I can keep the disease under control and I will no longer suffer from the destruction that alcohol has caused in my life.
CBN: Clarice, doctors say that alcoholism has no cure and that even after years without drinking, yes, the alcoholic can drink again. These are the relapses. How does this happen?
Dr. Clarice Madruga: So, Maria's story is beautiful, thank you very much Maria. I think your answer is in one of the points of her account. The first has to do with biology: chemical dependency is a disease that generates changes in the brain. When she tells how alcohol is related to pleasure, it also has to do with how the drug works in our brain. We make a joke that the substance "hijacks" our pleasure circuit and that's exactly what happens chemically. That's why there is this behavior of stopping doing activities that give me pleasure to start drinking. This has to do with a biological modification of the brain because, in order to adapt to the continuous entry of that substance, it literally changes, and that whole area of the brain of worldly pleasures, those that make us happy daily, begins to function as a function of the substance. These are chemical and morphological changes to account for the entry of the substance and this is related to the craving, the desire to use it that is so great. Then intolerance happens due to physiological changes in the brain. Tolerance marks the brain. And there is a very important component, which is: how much early use makes changes in morphology that are permanent. I can't help but hit this key because we are in a country that absurdly trivializes early use. I hear from parents who would rather have their children drink at home with them than outside on the street, driving drunk and messing up. Of course, on the street he can do worse things, but the consumption of an adolescent under 22 or 23 years old, according to biology, generates a physical, morphological impact and modifies the way the brain grows, you make that individual vulnerable to develop alcohol dependence and to a series of other psychological disorders and other substances. We are talking about an organ that takes a long time to develop and that alcohol even acts on the regeneration capacity of this organ when used too early. The action of alcohol is Machiavellian and I think this is such an important issue because parents only look at exposure in the world and do not look at the physiological impact of their children's most important organ. That is why we focus on preventing alcoholism. Parents cannot trivialize this consumption, it needs to be at least postponed and the help and vigilance of the family is very important to avoid these problems.
CBN: Camila, with the pandemic, the meetings of bodies were suspended and it took a while for this to go online. I would really like to know how this was for AA and if the demand for help increased during the pandemic.
Dr. Camila R. de Sene: Studies have revealed this information about the increase in alcohol consumption in the pandemic. While we are talking here, see the importance of this work for communication and prevention, I am connected to our committees and we have already had more than 20 calls in one of the AA areas talking about our meeting.
CBN: How does the person get in touch?
Dr. Camila R. de Sene: We have a helpline: (11) 3229-3611 but the most viable access is our official website: www.aa.org.br, which has a tab that gives access to our virtual meetings. As soon as the decree to close our meeting rooms was decreed, we had to think of strategies to continue with them. As Maria said in her speech, I think the most important thing was the part that she began to feel human in the face of her disease from the fact that she recognizes herself with other people with the same problem. So, in AA, this identification is possible, because it is an alcoholic talking to another alcoholic telling his stories, difficulties, his resources to remain sober, to maintain his behavior and rescuing his hope, his family, his work, his dignity. And for the time she tells us, I believe she came to us through one of our platforms. Since March 25, 2020, we have already instituted our virtual meetings and, since then, we have noticed several important data. First: the number of people accessing our platform, seeking information about our activities, and second: the number of women. Before, we had made an inventory in 2018 with around 18% of women and, today, there are almost 40%. There was a much higher incidence by women.
CBN: Is there a reason for this?
Dr. Camila R. de Sene: We have some hypotheses... The platform made access possible. Anyone can be in your home and access our meetings. But women, due to their chores, their routine and especially for fear of not being anonymous since they are more judged by society, they ended up accessing more through the internet where their identity is more protected.
Dr. Clarice Madruga: I would like to comment that there are fewer women who "drink" statistically, but among those who drink abusively, a woman is much more likely to develop alcoholism. So, I think it is important to emphasize that women's difficulty in adhering to treatments has always been more difficult due to sex hormones, which make us so special but hinder us in this matter.
