In the middle of the night, with her two children sleeping on either side, Kavitha* heard a voice distinctly: “You must come down now, urgently”. She tried to say she can’t, it’s too late for her to open the door and come out of the house. But the voice was insistent. Finally, without disturbing her sleeping children, she went down the stairs, opened the front door and looked expectantly at the gate. No one was there.
Kavitha, a retired businesswoman in Thiruvananthapuram, who recovered from alcoholism nearly 20 years ago, narrates this episode from one of those days when she used to hallucinate as a result of the disorder. She had hallucinations when she would intermittently try and stop drinking. Someone would keep talking to her inside her mind, she felt. It was not her imagination, she tried to tell her family who thought there was something amiss. Luckily, she consulted a doctor who identified the voice for what it was – auditory hallucination.
Forced withdrawal has more than once driven Kavitha to want to take her own life. A risk that alcoholics in India are now facing as bars and beverage outlets have been shut due to the lockdown as part of containing the spread of coronavirus. As this story is written, several people in India, including seven in Kerala, have already taken their lives, allegedly due to lack of availability of alcohol.
Govt suggests doctors prescribe alcohol, IMA refuses
Acknowledging the problem as a grave one, Kerala Chief Minister Pinarayi Vijayan said on Wednesday that health centres would deal with the alchol withdrawal issues since most of the major hospitals are used for COVID-19 isolation treatment. A helpline has also been set up, he informed.
However, after the first suicide allegedly due to lack of alcohol was reported in the state, the Chief Minister said on Saturday that the Excise Department would begin providing liquor to those dealing with alcoholism, after a doctor prescribes it.
However, the Indian Medical Association (IMA) has said that doctors cannot do this. The decision to provide alcohol to those suffering from withdrawal syndrome as a “prescription” by a doctor is not scientific, the IMA clarified. A note released by Dr Abraham Varghese and Dr Gopakumar, the state president and the secretary of the IMA respectively, says that those suffering from alcohol withdrawal syndrome need scientific treatment.
"It can be treated with medicines at homes or hospitals. But giving them alcohol is not scientifically approved. Doctors are also not legally responsible to give such prescriptions. If they prescribe alcohol, they might even lose the license to treat anymore."
There were criticisms when the Kerala government delayed closing the bars and the Beverages Corporation (BevCo) outlets despite the increasing COVID-19 cases. It was six days ago that the bars were shut and two days later, BevCo outlets, too, closed. Several doctors had, however, warned that it would not be a good idea to close down the liquor units instantaneously since those dependent on alcohol may suffer from withdrawal syndrome, which, in turn, may lead to other issues.
Physical, mental issues of alcoholism
“A sudden withdrawal from alcohol could cause physical and mental health issues,” says Johnson K Mangalam, a professor of Philosphy who recovered from alcoholism two decades ago. He opened a de-addiction centre called ‘Punarjani’ in Thrissur, to help others like him recover without medicine or prayers and without locking them up.
According to Johnson, people watching a person going through alcoholism may not understand their actions. “There are two types of drinkers – about 80% of them are social drinkers, the others are addicted to alcohol. Few are aware of this distinction.”
On suddenly and forcefully stopping alcohol consumption, those addicted to it may show withdrawal symptoms with minor or major side effects, he says. The minor side effects include nausea, rapid heartbeat and some may also get epileptic. Major side-effects include hallucinations – audio-visual hallucinations, like the one Kavitha had experienced.
Johnson cites several examples of these. Locked up in a room, a person with alcoholism may hear the ceiling fan whirring and hallucinate it as a voice saying, ‘chathoode, chathoode’ (can’t you die, can’t you die). Another may feel there is a man hiding under the bed or a crowd is outside his window.
Kavitha, too, had narrated similar instances – she had imagined the street outside her road crowded with people and when she opened the window, there was nobody there. Another time, she thought her children next door were speaking too loudly in the middle of the night but when she went to the room, they were sleeping soundly.
“But family members or others watching such people would not understand it. They would think the person is insane and take them to a mental hospital where strong medicines are administered. The person would then be labelled a mad person and may later face social boycott,” says Johnson.
How to approach alcoholism
The professor who has been running the de-addiction centre says that he has helped at least 16,000 people recover from alcoholism in the 16 years he has run the place. But then, his method contradicts what doctors of the IMA have suggested.
“We follow the tapering method. If a person with alcoholism who comes to Punarjani used to take 10 pegs a day, we gradually bring it down to five or six pegs a day and then to four or four the next day and so on. A few days later, they can lead a normal life without drinking. Along with these reduced dosages, we also give coconut and liquid food such as porridge water or fruit juice so their physical health also improves,” explains Johnson.
He suggests that the Kerala government should also implement this method. He realises it is not easy while the state is fighting a fast-spreading virus to encounter another serious problem. “What could be done is, every ward or panchayat member should take an interest in identifying people with alcoholism in their respective regions. There will not be too many in a single ward. They should then speak to the family members and make them understand how the person needs to take smaller doses of alcohol before they could recover. A panchayat or ward member, a health worker, a doctor and if necessary, a police officer too, could be involved in this.”
He also highlights the World Health Organisation’s (WHO) recommendation that there is no medicine for alcoholism and the treatment can begin only if the person is willing.
With the number of persons with alcoholism that Kerala would have – at least a lakh, Johnson reckons – it is not possible to put them all in de-addiction centres together. “No one wants to go to de-addiction centres either, it is scary.”
They do not want to take their own lives either, Johnson says. “It is a result of their helplessness and hallucinations. If you watch them, they beg you for a drink; they don’t always turn violent like the characters shown in movies. They are in a pathetic state. It is their last cry for help and they need help.”
(* Name changed)