Firstpost Podcast: Dr Aiswarya Rao looks at the dark side of forced detox during coronavirus lockdown
In this episode, Dr Aiswarya explains what constitutes alcohol abuse, and the dark side of the forced detox in the lockdown.
The lockdown has all of us missing some things that may not necessarily add nutritional value to our lives. Of them, alcohol tops the list for quite a few. But when recreational use bleeds into dependence it can become a dangerous situation to navigate for addicts.
In this episode, Dr Aiswarya Rao explains what constitutes alcohol abuse, and the dark side of forced detox in the lockdown. In conversation with Dr Aiswarya is Dr Poorna Chandrika, the director of the Institute of Mental Health, Chennai.
As we approach the end of the initial 21-day lockdown, we are looking at a lot of uncertainties. Many non-essential supplies are dwindling. One item that has been completely out of reach for people is alcohol. A lot of us have been wondering how people are taking this sudden prohibition. It is all the more difficult for people who are dependent on alcohol. We continue to hear everyday in the news, about people consuming substitutes for alcohol like shoe polish, varnish etc which ultimately lead to their deaths. We heard a news that West Bengal had planned to home deliver alcohol, much to the delight of Bengalis and everyone’s envy, but that turned out to be fake news.
I am Dr Aiswarya Rao, a paediatrician and public health consultant and today I am in conversation with Dr Poorna Chandrika, the director of Institute of Mental Health, Chennai about the ramifications for people who are alcohol dependent during this COVID lockdown.
A: Good afternoon madam! And thank you for talking to us today. I know you are very busy with all the duties that you have, especially in the shadow of the COVID-19 response. So, for our listeners today I wanted to talk to you to help our listeners understand the issues around alcohol dependence, especially during this complete lockdown, when the sale of alcohol is prohibited.What is the difference between alcohol abuse and recreational use of alcohol?
P: First of all, let me thank you for giving me this opportunity to interact with people, with your viewers and inform them about what we as mental health professionals are doing, and what people can help themselves and approach us during this period of lockdown. Thanks a lot!
A: It's our pleasure...
P: Recreational use of alcohol and abuse of alcohol is the question? Abuse includes the continuous use of the substance, despite the significant problems caused by it. But at the same time it wont amount to dependence. And the recreational use of alcohol, is a grey area, wherein it goes on and on. Certain cultures, even one drink will be seen as abuse, whereas in some cultures and areas it will be like OK, continue. Whatever it is, it will lead to problematic drinking, in some certain vulnerable individuals. That is the reason we always say do not experiment with drugs.
A: So you are saying, it all depends on the cultural context...
P: Not only cultural context, it is a bio-psycho-socio model. It depends on the genetics, it depends on the vulnerability of the individual, depends on the environmental factors, depends on the other various factors surrounding the individual.
A: Generally speaking how much alcohol intake qualifies for dependence or abuse, given somebody like a male, in Chennai, today?
P: One unit is 10 ml of ethanol. So as per the NICE Guidelines, we say that not more than 14 units should be consumed per week on a regular basis. And it is like the unit should be spread across the day. Not more than that for a man or a woman. Its like 14 units when consumed per week, then it amounts to too much alcohol.
A: What are the symptoms of someone who is dependent on alcohol?
P: Yes! This is one question we that will plague everyone. Because we see such a huge amount of crowd in front of TASMAC on weekends, before festivals and any occasion and we always wonder whether these persons are dependent on alcohol. Yes, there are certain fixed guidelines and criteria that these persons are dependent on alcohol, so for that we always say, first of all, that the increase priority given for the substance.
And another one criteria that is very important is they will not be able to cut down on the strong desire and compulsion for a drink, and they can’t control that once they start. They just go on and on and on… and if suppose it stops suddenly, like right now, then they go through certain symptoms. Like tremors and like, and any alcohol dependent person if we ask them, they will say we started with 90 ml I had this intoxication, but now even though I drink around 2 fulls or 3 fulls, I am not getting the same desired effect as before. That is also one of the signs of dependence.
The difficulty in controlling the substance and whatever happens, they will neglect the family, and sometimes, they might miss certain occasions. That’s because the alcohol takes precedence over everything else. The other is that even if alcohol is continued, , when others try to stop it or cut it down, they know its causes harm, they know that it causes jaundice, it will lead to seizures, even though they will continue to use the alcohol. These are all the criteria that this person is dependent on not only on alcohol, but any new substances.
A: Especially now that we are having the complete lockdown, what do you think that people who are dependent on alcohol are doing, and what do you think? Is alcohol available in the black market? In your experience, what are some of the things that you are seeing in your OP now?
P: I have a question of how the people are reacting to it and how different people are reacting to this lockdown. There are some people who are anticipated that this will lead to this much of days off, and they are stocked up. So surprise element in this situation of this further two weeks which might happen, which was announced by the government, which will lead to other surprises. After the black market, I think it is for the legal department and the police to say, how much it is going on. But from news reports, what we are seeing is Tamil Nadu, there is some looting of shops
A: Looting of shops, we are seeing it every day...
P: There is a certain percentage of people, who are taking this in a very good sense. Personally, I met someone who said after this lockdown, there is no stock, so I have no other option than to stop. And now right now, they are running their life better. He was very much happy that he was able to be off the substance over this many days.
A: So, it actually helped someone who is motivated to stop, to stop...
P: It actually helps someone who is motivated to stop, and it helps people who are not motivated to stop, because they have no other option before them.
A: So that is one additional good thing of the lockdown...
P: Ya, that is there. And I always say, that we must use this opportunity and people should use this opportunity to stop, because there are periods, when they go on penance and fasting and stop. Like when they go to...
P: temples and church and they don’t take alcohol for 40 days and when they return some people, they just quit it. This can also be taken as an opportunity where they can stop and quit alcohol. And definitely they wouldn’t have done that in the past. In future it will be very good for them.
A: That is one of the positive stories coming out of this lockdown experience., Isn’t it madam?
P: Yes! Definitely, definitely.
A: Also, the news is filled with stories about something related to alcohol dependence, I mean we are hearing about how people are resorting to consuming substitute substances for alcohol, for those who are extremely dependent. So what are some of the substitutes and have you seen something like that ma’am?
P: In our OPD we still have not come across someone who has suffered, because they might report to the causality of other hospitals. But I always take every opportunity to say when I talk to media or when I talk to anyone, to tell them that no substitutes come for alcohol and please do not use it, because it is very dangerous to life and please do not go near and don’t get carried away by false WhatsApp messages that says this is the substitute for that, and that is the substitute for this. Don’t drink and loose your life. Please don’t go near. That is one this I always tell again and again.
A: I think your message is useful right now for people who are thinking of consuming substitutes. What are some of the social and family problems, if the family has someone who is alcohol dependent.
P: Yes, this is one of the high time for anyone with someone who is alcohol dependent and not so very motivated to quit alcohol. These sort of persons life can become difficult for the partner who is with them and for the children with the person, and yes, they tend to be violent and fight, because the person will be irritable due to withdrawal effect, and its about the other person who is not understanding.
I think some chances it is better to put away from this person and when the place is too small, 24/7 you have to keep looking at someone who is having mood swings. It is a lot of stress. And that leads to unwanted things in the family. So I think if the partner is understanding, taking into account that this is the moment that it is better to avoid nasty confrontation, especially in front of the children, so if that can be taken into account, then the violence and the….It is not putting the blame on anyone, but staying away from someone who is irritable and he is a little bit understanding, and give them a very healthy diet. They might experience mild sleep abnormalities in the initial days.
But of course only 5 percent to 10 percent of the people will have complicated withdrawal. Just the first 7 to 10 days. See, all said and done, if suppose the lockdown effects on alcohol goes higher the OP should have been crowded, it is not so. It is only the 5 percent who will experience the complications. The rest of the persons can be managed by outpatient or community detoxification. But these things are not happening. So they must be managing by themselves.
A: So your OP is not getting crowded...
P: And then when it is severe…no, no, Actually, even before lockdown, daily we used to have around 5 to 8 alcohol dependent patients coming for treatment. So now also we are seeing 3 to 5 people coming daily to the OPD. So I don’t find that much of a difference. But of course, they will come to us if the complications are very severe. That is the one of the reasons they come to us even when there is no lockdown, even if they are not motivated. Because of other complications.
A: And yours is a tertiary centre, so only the most complicated cases will arrive at your OP...
P: And another reason is we run an exclusive, we are the one tertiary psychiatric hospital exclusive for mental health needs. And we are open 24/7 in Chennai. And so the rest of the hospitals also due to corona needs, to the pandemic needs, whereas we cater to the mental health problems, so we tend to get steady stream of persons, not only due to alcohol, but also other psychiatric problems if the person is aggressive, if the person is relapsed. So, everyone is brought in 24/7
A: Yeah, I was just going to ask you also that ma’am. About other people, non-alcohol related psychiatric care and admissions. What’s happening and how are you addressing this?
P: First of all let me start with alcohol dependence itself. So, if they want, if they come here, they can be admitted. If with an attender, because it’s a pandemic time. We have an exclusive ward wherein they can be admitted without an attender. But since just for extra precautions, we tend to ask for the partner or whoever accompanies for a few days before we keep them alone in our de-addiction unit.
And, as per the counselling aspect of people who are staying at home still need help, still have some doubts in their mind, or whether their family members have a doubt as to whether they should bring this person to the hospital or not, whether it is just a normal behaviour. Whatever issue or concern they have can be addressed through mental health professionals all over Tamilnadu. And the landline number of IMH is there. And the district mental health program team is functioning all over Tamil Nadu 24/7 Every team consists of a Psychiatrist, Psychologist and a Social Worker. So if they contact 104 control room, and which ever district is there, that can be given, and if they contact the District Collector’s office also the numbers will be given. It is available everywhere and people should make use of these numbers and they can address their queries to us and address the queries to the psychologist, which is uncomplicated. If they need and have some concern that can be addressed by counselling, it can be done over the phone. And if treatment is required, they will be directed to the nearest treatment centre in their particular district. Or in the PHC. Wherever it is feasible or closer enough. Because the drugs for alcohol are available everywhere. So, they can be directed to us also. So I just want to take this opportunity to reiterate again to make use of this opportunity to get treatment.
A: And this is a nation wide number ma’am?
P: This is a state-wide number. 104 is a state-wide number. And also all over the social media, even if we get it from IMA also the numbers have been given. And landline number also is available. So you can just call us. I will tell our Institute of Mental Health number at the end of the show. So that they can call. We have on call psychiatrist, and a psychologist. So, any issue can be addressed.
As for the other complaints, we ourselves were curious to know as to what brings people out of their houses during the pandemic. Because in spite of all the safety measures and all the precautions that are being told, what brings them to the hospital during this pandemic period. We are actually doing a data-base to see who comes. And do we get all the routine cases. Because people are worried if I stop the medication it will lead to relapse of all the other conditions. Like schizophrenia, mood disorders. So they do come and get medications from us. For their regular reviews. And there are certain persons, in other hospitals because of the pandemic, they need medications, they are directed to us. There are some private hospitals which are not functioning, and because of that, private hospital patients also come to us. So, all the other issues, relapses are common now because they stopped the medication. And of course, among all the other mental health disorders, alcohol patients also keep coming to us. And we get a query and we do admit people.
We were brought in a patient who had wandered from Pune and turned up at IMH. And they attender came, and they stayed and after 10 days we discharged them and they went back. We informed the health authorities also regarding this. So that they may be followed up.
A: That is very interesting ma’am. Also just wanted to know, is pandemic related anxiety higher and such symptoms are they coming and seeking help from your OP?
P: Higher anxiety, pandemic related anxiety is, I won’t say higher. But everyone does express it. I won’t say high. Just like you and me they also have their concerns. So, we tell them about the facts, that this, this this helps and that does not help. These are the practices that we can follow. And first of all accentuating the situation. And spend some time in doing whatever you want to do. All the regular ones that we keep telling. Read books. You need not do too much of TV. Lesser amount of TV at the right time and proper information. Proper governmental information. So, we keep telling them and this is something that we deal it on a regular basis. Some calls do keep coming. And we address them. We can’t say that we get exclusive psychiatric calls, we do get some general calls also. And which also we direct to the specific authorities.
A: So general counselling is able to alleviate a lot of the anxiety is what you are telling me...
P: Yeah, it alleviates the anxiety. Yes, definitely.
Actually we are getting a call from Bengal, it comes to my office. He wants to come from Bengal. So I told him that this is not the time and no one will allow you also. So we said we will direct you to the Bengal state mental health helpline.
A: So that is the efficiency with which your helplines are functioning...
P: Thanks a lot. I will just share the IMH landline number.
This is our helpline of Institute of Mental Health, which runs 24/7. We have a psychiatrist, and psychologist on call. And depending on the nature of the call, the person who is attending the phone will direct the call to the Psychiatrist, and Psychologist on duty. And as per the need of the individual the issue will be addressed. Our number is 044-26425585. Again, I repeat, 044-26425585.
So please make use of this helpline. Hopefully we get wider publicity through this interview. So that everyone starts receiving and we are able to help as many people as we can during this time of crisis. Thank you for giving me this opportunity.
A: So nice to hear about the work. IMH has always done good work and you are continuing the good work and thank you for helping our listeners and me to understand what is happening, especially during this lockdown. It was very nice talking to you. Thank you for your service...
That was Dr Poorna Chandrika, director, Institute of Mental Health in Chennai talking to us. The message is loud and clear. When in need of mental health services whether for alcohol dependency related services or anxiety related to the COVID pandemic news from all over, please reach out to mental health professionals. Call the respective state helplines wherever you are. 104 is the number in many states. Do not handle this yourself. Ask for help. There is professionals waiting to help you.
I am Dr Aiswarya Rao and I will see you with another edition of a COVID-19-related podcast soon. Thank you for listening.
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