SMOKING ALCOHOL DRUGS

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Title
SMOKING ALCOHOL DRUGS
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A. A. Tradition
ifcw k Developed
By BILL W.

A Tour of the
Historical Events
That Led to Our Unique
Twelve Traditions

C!

7.
This pamphlet tells the story of the

alcoholics ANONYMOUS is a fellowship of men and
women who share iheir experience, strength and
hope with each other that they may solve their
common problem and help others to recover from
alcoholism.

• The only requirement for membership is a de­
sire to stop drinking. There are no dues or fees for
A.A. membership; we are self-supporting through
our own contributions.
• A.A. is not allied with any sect, denomination,
politics, organization or institution; does not wish
to engage in any controversy; neither endorses nor
opposes any causes.
• Our primary purpose is to stay sober and help
other alcoholics to achieve sobriety.

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emergence and development of the prin­
ciples believed essential to A.A. unity
and survival.
Bill W.’s foreword presents in their
original form the “Twelve Points to As­
sure Our Future.” In all but the Second
Tradition, the original language has
been modified or shortened.
There are two pieces by Bill W. on
the Anonymity Traditions, one written
when the Fellowship was eleven years
old; the other nine years later. Together
they buttress our best known—and per­
haps least understood—Traditions,
Eleven and Twelve.

Foreword
by Bill W.
•
Copyright 1955
Alcoholics Anonymous Publishing, Inc.
(Now known as Alcoholics Anonymous
World Services, Inc.)

Alcoholics Anonymous World Services, Inc.
Mail address: Box 459
Grand Central Station
New York, N.Y. 10017

100M—3/75 (S)

—1955
*
—

How shall we A.A.’s best preserve our unity?
That is the subject of this booklet.
When an alcoholic applies the Twelve Steps of
our recovery program to his personal life, his dis­
integration stops and his unification begins. The
Power which now holds him together in one piece
overcomes those forces which had rent him apart.
Exactly the same principle applies to each A.A.
group and to Alcoholics Anonymous as a whole.
So long as the ties which bind us together prove
far stronger than those forces which would divide
us if they could, all will be well. We shall be secure
as a movement; our essential unity will remain a
certainty.

PRINTED IN U.S.A.

• Originally published in The A.A. Grapevine.

3

If, as A.A. members, we can each refuse public
prestige and renounce any desire for personal
power; if, as a movement, we insist on remaining
poor, so avoiding disputes about extensive prop­
erty and its management; if we steadfastly decline
all political, sectarian, or other alliances, we shall
avoid internal division and public notoriety; if,
as a movement, we remain a spiritual entity con­
cerned only with carrying our message to fellow
sufferers without charge or obligation; then only
can we most effectively complete our mission. It is
becoming ever so clear that we ought never accept
even the most alluring temporary benefits if these
should consist of considerable sums of money, or
could involve us in controversial alliances and
endorsements, or might tempt some of us to accept,
as A.A. members, personal publicity by press or
radio. Unity is so vital to us A.A.’s that we cannot
risk those attitudes and practices which have some­
times demoralized other forms of human society.
Thus far we have succeeded because we have been
different. May we continue to be so!
But A.A. unity cannot automatically preserve
itself. Like personal recovery, we shall always have
to work to maintain it. Here, too, we surely need
honesty, humility, open-mindedness, unselfishness,
and, above all—vigilance. So we who are older in
A.A. beg you who are newer to ponder carefully
the experience we have already had of trying to
work and live together. We would like each A.A.
to become just as much aware of those disturbing
tendencies which endanger us as a whole as he is
conscious of those personal defects which threaten
his own sobriety and peace of mind. For wholtA'j
movements have, before now, gone on benders, tool"
The "Twelve Points of A.A. Tradition” repro­
duced herein is our first attempt to state sound
principles of group conduct and public relations.
As one of the originators of A.A., I was asked to
publish these “Points,” together with supporting
articles, serially in our principal monthly journal,
The A.A. Grapevine. Many A.A.’s already feel that
these Twelve Traditions are sound enough to be­
come the basic guide and protection for A.A. as a
whole; that we ought to apply them as seriously to
our group life as we do the Twelve Recovery Steps
to ourselves individually. Of this, it will take time
to tell.

May we never forget that without permanent
unity we can offer little lasting relief to those
scores of thousands yet to join us in their quest
for freedom.

4

Nobody invented Alcoholics Anonymous. It grew.
Trial-and-error has produced a rich experience.
Little by little we have been adopting the lessons
of that experience, first as policy and then as tra­
dition. That process still goes on and we hope it
never stops. Should we ever harden too much, the
letter might crush that spirit. We could victimize
ourselves by petty rules and prohibitions; we could
imagine that we had said the last word. We might
even be asking alcoholics to accept our rigid ideas
or stay away. May we never stifle progress like that!

Yet the lessons of our experience count for a
great deal. We now have had years of vast acquaint­
ance with the problem of living and working to­
gether. If we can succeed in this adventure—and
keep succeeding—then, and only then, will our fu­
ture be secure.
Since personal calamity holds us in bondage no
more, our most challenging concern has become
the future of Alcoholics Anonymous; how to pre­
serve among us A.A.’s such a powerful unity that
neither weakness of persons nor the strain and
strife of these troubled times can harm our com­
mon cause. We know that Alcoholics Anonymous
must continue to live. Else, save few exceptions,
we and our brother alcoholics throughout the
world will surely resume the hopeless journey to
oblivion.

Almost any A.A. can tell you what our group
problems are. Fundamentally they have to do with
our relations, one with the other, and with the
world outside. They involve relations of the A.A.
Ik to his group, the relation of his group to Alcoholics
" Anonymous as a whole, and the place of Alcoholics
Anonymous in that troubled sea called modern so­
ciety, where all of humankind must presently ship­
wreck or find haven. Terribly relevant is the prob­
lem of our basic structure and our attitude toward
those ever-pressing questions of leadership, money,
and authority. The future may well depend on how
we feel and act about things that are controversial
and how we regard our public relations. Our final
destiny will almost surely hang upon what we pres­
ently decide to do with these danger-fraught issues!
Now comes the crux of our discussion. It is this:
Have we yet acquired sufficient experience to state
clear-cut policies on these, our chief concerns; can
we now declare general principles which could
grow into vital traditions—traditions sustained in
the heart of each A.A. by his own deep conviction
and by the common consent of his fellows? That is
the question. Though full answers to all our per­

5

plexities may never be found, I’m sure we have
come at last to a vantage point whence we can dis­
cern the main outlines of a body of tradition which,
God willing, can stand as an effective guard against
all the ravages of time and circumstance.
Acting upon the persistent urge of old A.A.
friends, and upon the conviction that general agree­
ment and consent among our members are now
possible, I shall venture to place in words these
suggestions for An Alcoholics Anonymous Tradi­
tion of Relations—Twelve Points to Assure Our
Future:
Our A.A. experience has taught us that:
I.—Each member of Alcoholics Anonymous is
but a small part of a great whole. A.A. must
continue to live or most of us will surely die.
Hence our common welfare comes first. But indi­
vidual welfare follows close afterward.

(Our common welfare should come first; per­
sonal recovery depends upon A.A. unity.)
2.—For our group purpose there is but one ulti­
mate authority—a loving God as He may express
Himself in our group conscience.

(For our group purpose there is but one
ultimate authority—a loving God as He may
express Himself in our group conscience. Our
leaders are but trusted servants; they do not
govern.)
3.—Our membership ought to include all who
suffer alcoholism. Hence we may refuse none who
wish to recover. Nor ought A.A. membership ever^ki
depend upon money or conformity. Any two 01™/
three alcoholics gathered together for sobriety may
call themselves an A.A. group, provided that, as a
group, they have no other affiliation.

(The only requirement for A.A. membership
is a desire to stop drinking.)
4.—With respect to its own affairs, each A.A.
group should be responsible to no other authority
than its own conscience. But when its plans con­
cern the welfare of neighboring groups also, those
groups ought to be consulted. And no group, re­
gional committee, or individual should ever take
any action that might greatly affect A.A. as a
whole without conferring with the trustees of The
Alcoholic Foundation.
*
On such issues our common
welfare is paramount.
• Now known as The General Service Board of A.A.,

(Each group should be autonomous except
in matters affecting other groups or A.A. as a
whole.)

5.—Each Alcoholics Anonymous group ought to
be a spiritual entity having but one primary pur­
pose—that of carrying its message to the alcoholic
who still suffers.
(Each group has but one primary purpose—
to carry its message to the alcoholic who still
suffers )

6.—Problems of money, property, and authority
may easily divert us from our primary spiritual
aim. We think, therefore, that any considerable
property of genuine use to A.A. should be sep­
arately incorporated and managed, thus dividing
the material from the spiritual. An A.A. group, as
such, should never go into business. Secondary
aids to A.A., such as clubs or hospitals which re­
quire much property or administration, ought to
be incorporated and so set apart that, if necessary,
they can be freely discarded by the groups. Hence
such facilities ought not use the A.A. name. Their
management should be the sole responsibility of
those people who financially support them. For
clubs, A.A. managers are usually preferred. But
hospitals, as well as other places of recuperation,
ought to be well outside A.A.—and medically
supervised. While an A.A. group may cooperate
with anyone, such cooperation ought never go so
far as affiliation or endorsement, actual or implied.
An A.A. group can bind itself to no one.
(An A.A. group ought never endorse, finance

k or lend the A.A. name to any related facility
" or outside enterprise lest problems of money,
property and prestige divert us from our pri­
mary purpose.)

7.—The A.A. groups themselves ought to be
fully supported by the voluntary contributions of
their own members. We think that each group
should soon achieve this ideal; that any public
solicitation of funds using the name of Alcoholics
Anonymous is highly dangerous, whether by groups,
clubs, hospitals, or other outside agencies; that ac­
ceptance of large gifts from any source, or of con­
tributions carrying any obligations whatever, is
unwise. Then too, we view with much concern
those A.A. treasuries which continue, beyond pru­
dent reserves, to accumulate funds for no stated
A.A. purpose. Experience has often warned us that
nothing can so surely destroy our spiritual heritage
as futile disputes over property, money, and au­
thority.
7

(Every A.A. group ought to be fully selfsupporting, declining outside contributions.)
8.—Alcoholics Anonymous should remain forever
nonprofessional. We define professionalism as the
occupation of counseling alcoholics for fees or hire.
But we may employ alcoholics where they are go­
ing to perform those services for which we might
otherwise have to engage nonalcoholics. Such spe­
cial services may be well recompensed. But our
usual A.A. Twelfth Step work is never to be paid
for.

(Alcoholics Anonymous should remain for­
ever nonprofessional, but our service centers
may employ special workers.)

9.—Each A.A. group needs the least possible
organization. Rotating leadership is the best. The
small group may elect its secretary, the large group
its rotating committee, and the groups of a large
metropolitan area their central or intergroup com­
mittee, which often employs a full-time secretary.
The trustees of The Alcoholic Foundation are, in
effect, our A.A. General Service Committee. They
are the custodians of our A.A. tradition and the
receivers of voluntary A.A. contributions by which
we maintain our A.A. General Service Office at
New York. They are authorized by the groups to
handle our overall public relations and they guar­
antee the integrity of our principal journal, The
A.A. Grapevine. All such representatives are to be
guided in the spirit of service, for true leaders in
A.A. are but trusted and experienced servants of
the whole. They derive no real authority from their
titles; they do not govern. Universal respect is tha|
key to their usefulness.
"
(A.A., as such, ought never be organized; but
we may create service boards or committees
directly responsible to those they serve.)

10.—No A.A. group or member should ever, in
such a way as to implicate A.A., express any
opinion on outside controversial issues—particu­
larly those of politics, alcohol reform, or sectarian
religion. The Alcoholics Anonymous groups oppose
no one. Concerning such matters they can express
no views whatever.
(Alcoholics Anonymous has no opinion on
outside issues; hence the A.A. name ought
never be drawn into public controversy.)

11-—Our relations with the general public
should be characterized by personal anonymity.
We think A.A. ought to avoid sensational adver­
tising. Our names and pictures as A.A. members
8

ought not be broadcast, filmed, or publicly printed.
Our public relations should be guided by the prin­
ciple of attraction rather than promotion. There
is never need to praise ourselves. We feel it better
to let our friends recommend us.
(Our public relations policy is based on at­
traction rather than promotion; we need always
maintain personal anonymity at the level of
press, radio and films.)

12.—And finally, we of Alcoholics Anonymous
believe that the principle of anonymity has an
immense spiritual significance. It reminds us that
we are to place principles before personalities;
that we are actually to practice a genuine humil­
ity. This to the end that our great blessings may
never spoil us; that we shall forever live in thank­
ful contemplation of Him Who presides over us
all.
(Anonymity is the spiritual foundation of
all our traditions, ever reminding us to place
principles before personalities.)

WHO IS A MEMBER OF
ALCOHOLICS ANONYMOUS?
—1946—
(Tradition Three grew out of this piece by
Bill W. in The A.A. Grapevine)

The first edition of the book “Alcoholics Anon­
ymous” makes this brief statement about member­
ship: "The only requirement for membership is
an honest desire to stop drinking. We are not
allied with any particular faith, sect, or denomina- I
tion nor do we oppose anyone. We simply wish to
be helpful to those who are afflicted.” This ex­
pressed our feelings as of 1939, the year our book
was published.
Since that day all kinds of experiments with
membership have been tried. The number of mem­
bership rules which have been made (and mostly
broken!) are legion. Two or three years ago the
General Office asked the groups to list their mem­
bership rules and send them in. After they arrived
we set them all down. They took a great many
sheets of paper. A little reflection upon these many
rules brought us to an astonishing conclusion. If
all of these edicts had been in force everywhere at
once it would have been practically impossible for
any alcoholic to have ever joined Alcoholics Anon­
ymous. About nine-tenths of our oldest and best
members could never have got by!

In some cases we would have been too discour­
aged by the demands made upon us. Most of the
early members of A.A. would have been throwi^
out because they slipped too much, because theirmorals were too bad, because they had mental as
well as alcoholic difficulties. Or, believe it or not,
because they did not come from the so-called
better classes of society. We oldsters could have
been excluded for our failure to read the book
"Alcoholics Anonymous" or the refusal of our
sponsor to vouch for us as a candidate. And so on
ad infinitum. The way our "worthy" alcoholics have
sometimes tried to judge the "less worthy” is, as
we look back on it, rather comical. Imagine, if
you can, one alcoholic judging another!
At one time or another most A.A. groups go
on rule-making benders. Naturally enough, too,
as a group commences to grow rapidly it is con­
fronted with many alarming problems. Panhandlers
begin to panhandle. Members get drunk and
sometimes get others drunk with them. Those with
10

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mental difficulties throw depressions or break out
into paranoid denunciations of fellow members.
Gossips gossip and righteously denounce the local
Wolves and Red Riding Hoods. Newcomers argue
that they aren’t alcoholics at all, but keep coming
around anyway. "Slippees” trade on the fair name
of A.A. in order to get themselves jobs. Others
refuse to accept all the Twelve Steps of the re­
covery program. Some go still further, saying that
the "God business" is bunk and quite unnecessary.
Under these conditions our conservative program­
abiding members get scared. These appalling conditions must be controlled, they think, else A.A.
will surely go to rack and ruin. They view with
alarm for the good of the movement!

At this point the group enters the rule and
regulation phase. Charters, bylaws and membership
rules are excitedly passed and authority is granted
committees to filter out undesirables and discipline
the evildoers. Then the Group Elders, now clothed
with authority, commence to get busy. Recalcitrants
arc cast into the outer darkness; respectable busy­
bodies throw stones at the sinners. As for the socalled sinners, they either insist on staying around,
or else they form a new group of their own. Or
maybe they join a more congenial and less intol­
erant crowd in their neighborhood. The elders
soon discover that the rules and regulations aren’t
working very well. Most attempts at enforcement
generate such waves of dissension and intolerance
in the group that this condition is presently recog­
nized to be worse for the group life than the very
worst that the worst ever did.
After a time fear and intolerance subside. The
^Jjgroup survives unscathed. Everybody has learned
a great deal. So it is that few of us are any longer
afraid of what any newcomer can do to our A.A.
reputation or effectiveness. Those who slip, those
who panhandle, those who scandalize, those with
mental twists, those who rebel at the program,
those who trade on the A.A. reputation—all such
persons seldom harm an A.A. group for long. Some
of these have become our most respected and best
loved. Some have remained to try our patience,
sober nevertheless. Others have drifted away. We
have begun to regard these not as menaces, but
rather as our teachers. They oblige us to cultivate
patience, tolerance, and humility. We finally see
that they are only people sicker than the rest of us,
that we who condemn them are the Pharisees whose
false righteousness does our group the deeper spir­
itual damage.

Every older A.A. shudders when he remembers
11

HOSPITALS AND A.A.

the names of persons he once condemned; people
he confidently predicted would never sober up;
persons he was sure ought to be thrown out of
A.A. for the good of the movement. Now that
some of these very persons have been sober for
years, and may be numbered among his best
friends, the old-timer thinks to himself, "What if
everybody had judged these people as I once did?
What if A.A. had slammed its door in their faces?
Where would they be now?"
That is why we all judge the newcomer less and
less. If alcohol is an uncontrollable problem to him
and he wishes to do something about it, that is
enough for us. We care not whether his case is
severe or light, whether his morals are good or bad,
whether he has other complications or not. Our
A.A. door stands wide open, and if he passes
through it and commences to do anything at all
about his problem, he is considered a member of
Alcoholics Anonymous. He signs nothing, agrees
to nothing, promises nothing. We demand noth­
ing. He joins us on his own say-so. Nowadays, in
most groups, he doesn’t even have to admit he is
an alcoholic. He can join A.A. on the mere suspi­
cion that he may be one, that he may already
show the fatal symptoms of our malady.

(Excerpts from Bill W.'s "Adequate
Hospitalization" article in The A.A.
Grapevine in 1947 . . . background
for Tradition Six)

.
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Of course this is not the universal state of affairs
throughout A.A. Membership rules still exist. If a
member persists in coming to meetings drunk he
may be led outside; we may ask someone to take
him away. But in most groups he can come back
next day, if sober. Though he may be thrown out
of a club, nobody thinks of throwing him out of
A.A. He is a member as long as he says he is./y
While this broad concept of A.A. membership isv
not yet unanimous, it does represent the main cur­
rent of A.A. thought today. We do not wish to
deny anyone his chance to recover from alcoholism.
We wish to be just as inclusive as we can, never
exclusive.

Perhaps this trend signifies something much
deeper than a mere change of attitude on the
question of membership. Perhaps it means that
we are losing all fear of those violent emotional
storms which sometimes cross our alcoholic world;
perhaps it bespeaks our confidence that every storm
will be followed by a calm; a calm which is more
understanding, more compassionate, more tolerant
than any we ever knew before.

I)
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Many sanitariums and private hospitals are nec­
essarily too high priced for the average alcoholic.
Public hospitals being too few, asylums and reli­
gious institutions too seldom available, the average group has been hard put to find spots where
prospective members can be hospitalized a few
days at modest expense.
This urgency has tempted some A.A. groups to
set up drying-out places of their own, hiring A.A.
managers, nurses, and securing the services of a
visiting physician. Where this has been done under
the direct auspices of an A.A. group it has almost
always backfired. It has put the group into busi­
ness, a kind of business about which few A.A.’s
know anything at all. Too many clashing person­
alities, too many cooks spoiling the broth, usually
bring about the abandonment of such attempts.
We have been obliged to see that an A.A. group is
primarily a spiritual entity; that, as a group the less
business it has to transact, the better. While on this
theme it ought to be noted that practically all
group schemes to finance or guarantee hospital bills
for fellow members have failed also. Not only do
many such loans go unpaid, there is always the
controversial question in the group as to which
prospects deserve them in the first place.

In still other instances A.A. groups, driven by
their acute need for medical aid, have started
public money-raising campaigns to set up "A.A.
hospitals” in their communities. These efforts
almost invariably come to naught. Not only do
these groups intend to go into tire hospital busi­
ness, they intend to finance their ventures by
soliciting the public in the name of Alcoholics
Anonymous. Instantly all sorts of doubts are gen­
erated; the projects bog down. Conservative A.A.’s
realize that business ventures or solicitations carry­
ing the A.A. endorsement are truly dangerous to
us all. Were this practice to become general the lid
would be off. Promoters, A.A. and otherwise, would
have a field day.

This search for reasonably priced and under­
standing medical treatment has brought into being
still another class of facilities. These are rest farms
12

18

and drying-out places operated by individual A.A.’s
under suitable medical supervision. These setups
have proved far more satisfactory than groupdirected projects. As might be expected their success
is in exact proportion to the managerial ability
and good faith of the A.A. in charge. If he is
able and conscientious, a very good result is pos­
sible; if neither, the place folds up. Not being a
group project and not bearing the A.A. name,
these ventures can be taken or left alone. The
operation of such establishments is'always beset
with peculiar difficulties. It is difficult for the A.A.
manager to charge high enough rates to make the
venture include a fair living for himself. If he
does, people are apt to say that he is professional­
izing, or "making money out of A.A.” Nonsense
though this may often be, it is a severe handicap
nevertheless.
Yet, in spite of the headaches encountered, a
good number of these farms and sobering-up spots
are in active operation and can seemingly continue
just as long as they are tactfully managed, do not
carry the A.A. name, and do not publicly solicit
funds as A.A. enterprises. When a place has an
A.A. in charge we sometimes do take thoughtless
advantage of the fact. We dump alcoholics into it
just to get them off our hands; we promise to pay
bills and do not. Any A.A. who can successfully
manage one of these "drunk emporiums” ought to
be congratulated. It is a hard and often thankless
job though it may bring him deep spiritual satis­
faction. Perhaps this is the reason so many A.A.’s
wish to try itl

CLUBS IN A.A.
ARE THEY WITH US
TO STAY?
—1947
*
—
(More background for Tradition Six)

The club idea has become part of A.A. life.
Scores of these hospitable havens can report years
of useful service; new ones are being started
monthly. Were a vote taken tomorrow on the de­
sirability of clubs a sizable majority of A.A.’s
would record a resounding “yes." There would be
thousands who would testify that they might have
had a harder time staying sober in their first
months of A.A. without clubs and that in any case,
they would always wish for the easy contacts and
warm friendships which clubs afford.
Being the majority view, we might suppose that
a blanket endorsement for clubs; we might think
we couldn’t get along without them. We might
conceive them as a central A.A. institution—a sort
of "Thirteenth Step" of our recovery program with­
out which the other Twelve Steps wouldn't work.
At times club enthusiasts will act as though they
really believed we could handle our alcoholic prob­
lems by club life alone. They are apt to depend
upon clubs rather than upon the A.A. program.
But we have A.A.’s, rather a strong minority, too,
who want no part of clubs. Not only, they assert,
does the social life of a club often divert the atten­
tions of members from the program, they claim
-that clubs are an actual drag on A.A. progress.
They point to the danger of clubs degenerating
into mere hangouts, even "joints"; they stress the
bickerings that do arise over questions of money,
management, and personal authority; they are
afraid of "incidents" that might give us unfavorable
publicity. In short, they "view with alarm.” Thumbs
down on clubs, they say.

Toward a middle ground, for several years now,
we have been feeling our way. Despite alarms it is
quite settled that A.A.’s who need and want clubs
ought to have them. So the real concern is not
whether we shall have clubs. It is how we shall en­
hance them as assets, how we may diminish their
known liabilities; how we shall be sure, in the long
future, that their liabilities do not exceed their
assets.
Originally published in The A.A. Grapevine.

15

Of our four largest A.A. centers, two are clubminded and two are not. I happen to live in one
which is. The very first A.A. club was started in
New York. Though our experience here may not
have been the best, it is the one 1 know. So, by way
of portraying the principles and problems we need
to discuss, I shall use it, as an average illustration of
club evolution, rather than as a model setup.
When A.A. was very young we met in homes.
People came miles, not only for the A.A. meeting
itself, but to sit hours afterward at coffee, cake, and
eager, intimate talk Alcoholics and their families
had been lonely too long.
Then homes became too small. We couldn't bear
to break up into many little meetings, so we looked
for a larger place. We lodged first in the workshop
of a tailoring establishment, then in a rented room
at Steinway Hall. This kept us together during the
meeting hour. Afterward we held forth at a cafe­
teria, but something was missing. It was the home
atmosphere; a restaurant didn’t have enough of it.
Let’s have a club, someone said.

So we had a club. We took over an interesting
place, the former Artists and Illustrators Club on
West 24th Street. What excitement! A couple of
older members signed the lease. We painted and
we scrubbed. We had a home. Wonderful memories
of days and nights at that first club will always
linger.

But, it must be admitted, not all those memories
are ecstatic. Growth brought headaches; growing
pains, we call them now. How serious they seemed
then! ’’Dictators" ran amuck; drunks fell on th^v
floor or disturbed the meetings; "steering commit
tees” tried to nominate their friends to succeed
them and found to their dismay that even sober
drunks couldn’t be "steered." Sometimes we could
scarcely get up the rent; card players were imper­
vious to any suggestion that they talk to new people
(nowadays, most clubs have abandoned card play­
ing altogether); lady secretaries got in each other’s
hair. A corporation was formed to take over the
clubroom lease so we then had “officials." Should
these “directors" run the club or would it be the
A.A. rotating committee?
Such were our problems. We found the use of
money, the need for a certain amount of club orga­
nization, and the crowded intimacy of the place
created situations we hadn’t anticipated. Club life
still had great joys. But it had liabilities too, that
was for sure. Was it worth all the risk and trouble?
The answer was "yes," for the 24th Street Club kept
16

right on going, and is today occupied by the A.A.
seamen. We have, besides, three more clubs in
*
this area; a fourth is contemplated.
Our first club was known, of course, as an “A.A.
clubhouse.” The corporation holding its lease was
titled “Alcoholics Anonymous of New York, Inc."
Only later did we realize we had incorporated the
whole of New York State, a mistake recently recti­
fied. Of course our incorporation should have cov­
ered "24th Street” only. Throughout the country
most clubs have started like ours did. At first we
regarded them as central A.A. institutions. But
later experience invariably brings a shift in their
status. A shift much to be desired, we now think.
For example, the early Manhattan A.A. club
had members from every section of the metropol­
itan area, including New Jersey. After a while
dozens of groups sprang up in our suburban dis­
tricts. They got themselves more convenient meet­
ing places. Our Jersey friends secured a club of
their own. So these outlying groups originally
spawned from the Manhattan clubhouse began to
acquire hundreds of members who were not tied
to Manhattan either by convenience, inclination,
or old-time sentiment. They had their own local
A.A. friends, their own convenient gathering places.
They weren’t interested in Manhattan.

This irked New Yorkers not a little. Since we
had nurtured them, why shouldn’t they be inter­
ested? We were puzzled why they refused to con­
sider the Manhattan club the A.A. center for the
metropolitan area. Wasn’t the club running a cenferal meeting with speakers from other groups?
’Didn’t we maintain a paid secretary who sat in the
New York clubhouse taking telephone calls for
assistance and making hospital arrangements for
all groups in the area? Of course, we thought, our
outlying groups ought financially to support the
Manhattan club; dutiful children should look after
their "parents." But our parental pleas were of no
use. Though many outlying A.A. members person­
ally contributed to the 24th Street Club, nary a
cent did their respective groups ever send in.
Then we took another tack. If the outlying
groups would not support the club, they at least
might want to pay the salary of its secretary. She
was really doing an “area” job. Surely this was a
reasonable request. But it never got anywhere.
They just couldn’t mentally separate the "area
• The building was later torn down.

17

secretary" from the Manhattan club. So, for a long
time, our area needs, our common A.A. problem,
and our club management were tied into a trying
financial and psychological snarl.

to later headaches. Public solicitation is, of course,
extremely dangerous. Complete self-support of
clubs and everything else connected with A.A. is
becoming our universal practice.

This tangle slowly commenced to unravel, as we
began to get the idea that clubs ought to be
strictly the business of those individuals who spe­
cially want clubs, and who are willing to pay for
them. We begin to see that club management is
a large business proposition which ought to be
separately incorporated under another name—
"Alanon," for example; that the “directors" of a
club corporation ought to look after club business
only; that an A.A. group, as such, should never
get into active management of a business project.
Hectic experience has since taught us that if an
A.A. rotating committee tries to boss the club
corporation or if the corporation tries to run the
A.A. affairs of those groups who may meet at the
club, there is difficulty at once. The only way we
have found to cure this is to separate the material
from the spiritual. If an A.A. group wishes to use
a given club, let them pay rent or split the meeting
take with the club management. To a small group
opening its first clubroom, this procedure may
seem silly because, for the moment, the group
members will also be club members. Nevertheless
separation by early incorporation is recommended
because it will save much confusion later on as
other groups start forming in the area.

Club evolution is also telling us this: in none
but small communities are clubs likely to remain
the principal centers of A.A. activity. Originally
starting as the main center of a city, many a club
moves to larger and larger quarters thinking to re­
tain the central meeting for its area within its own
walls. Finally, however, circumstances defeat this
purpose.

Questions are often asked: "Who elects the busi­
ness directors of a club?” "Does club membership
differ from A.A. membership?" "How are clubs-,
supported and financed?” As practices vary, vf'
don’t quite know the answers yet. The most rea­
sonable suggestions seem these: any A.A. member
ought to feel free to enjoy the ordinary privileges
of an A.A. club whether he makes a regular vol­
untary contribution or not. If he contributes reg­
ularly, he should, in addition, be entitled to vote
in the business meetings which elect the business
directors of his club corporation. This would open
all clubs to all A.A.’s. But it would limit their
business conduct to those interested enough to con­
tribute regularly. In this connection, we might re­
mind ourselves that in A.A. we have no fees or
compulsory dues. But it ought to be added, of
course, that since clubs are becoming separate and
private ventures, they can be run on other lines
if their members insist.
Acceptance of large sums from any source to
buy, build, or finance clubs almost invariably leads
18

Circumstance number one is that the growing
A.A. will burst the walls of any clubhouse. Sooner
or later the principal or central meeting has to be
moved into a larger auditorium. The club can't
hold it. This is a fact which ought to be soberly
contemplated whenever we think of buying or
building large clubhouses. A second circumstance
seems sure to leave most clubs in an “off center"
position, especially in large cities. That is our
strong tendency toward central or intergroup com­
mittee management of the common A.A. problems
of metropolitan areas. Every area, sooner or later,
realizes that such concerns as intergroup meetings,
hospital arrangements, local public relations, a cen­
tral office for interviews and information, are
things in which every A.A. is interested, whether he
has any use for clubs or not. These being strictly
A.A. matters, a central or intergroup committee
has to be elected and financed to look after them.
Groups of an area will usually support with
group funds these truly central activities. Even
'though the club is still large enough for inter­
group meetings and these meetings are still held,
the center of gravity for the area will continue to
shift to the intergroup committee and its central
activities. The club is left definitely outside, where,
in the opinion of many, it should be. Actively sup­
ported and managed by those who want clubs,
they can be "taken or left alone.”

If you have a CLUB problem, write also for
the free service bulletin "A.A. Guidelines
on CLUBS."

DANGERS IN LINKING A.A.
TO OTHER PROJECTS
—1947
*
—
(Dangers which Traditions Six and Eight
recognize)

Our A.A. experience has been raising the fol­
lowing set of important, but as yet unresolved,
questions. First, should A.A. as a whole enter the
outside fields of hospitalization, research and noncontroversial alcohol education? Second, is an A.A.
member, acting strictly as an individual, justified
in bringing his special experience and knowledge
into such enterprises? And thirdly, if an A.A. mem­
ber does take up these phases of the total alcohol
problem, under what conditions should he work?
With respect to these questions, almost any
opinion can be heard among our groups. Generally
speaking, there are three schools of thought: the
“do everything" school; the “do something” school;
and the "do nothing" school.
We have A.A.’s so fearful we may become en­
tangled, or somewhat exploited, that they would
keep us a strictly closed corporation. They would
exert the strongest possible pressure to prevent all
A.A.’s, whether as individuals or groups, from
doing anything at all about the total alcohol
problem, except, of course, their straight A.A.
work. They see the specter of the Washingtonian
movement among alcoholics of a hundred yearly
ago which fell into disunity partly because its
*
members publicly took up cudgels for abolition,
prohibition—and whatnot. These A.A.’s believe
that we must preserve our isolation at any cost;
that we must keep absolutely to ourselves if we
would avoid like perils.

Then we have the A.A. who would have us “do
everything” for the total alcohol problem—any
time, any place and any wayl In his enthusiasm,
he not only thinks his beloved A.A. a “cure-all" for
drunks, but he also thinks we have the answer
for everybody and everything touching alcohol. He
strongly feels that A.A. ought to place its name
and financial credit squarely behind any first-rate
research, hospital or educational project. Seeing
that A.A. now makes the headlines, he argues that
• Originally published in The A.A. Grapevine.

20

we should freely loan out our huge goodwill. Says
he, "Why shouldn’t we A.A.’s stand right up in
public and be counted? Millions could be raised
easily for good works in alcohol." The judgment
of this enthusiast is sometimes beclouded by the
fact he wants to make a career. But with most who
enthuse so carelessly, I’m sure it’s more often a
case of sheer exuberance plus, in many instances,
a deep sense of social responsibility.
So we have with us the enthusiasts and the ultracautious; the “do everythings" and the “do noth­
ings.” But the average A.A. is not so worried about
these phenomena as he used to be. He knows that
out of the heat and smoke there will soon come
light. Presently there will issue an enlightened
policy, palatable to everyone. Tested by time, that
policy, if sound, will become A.A. tradition.
Sometimes I’ve feared that A.A. would never
bring forth a workable policy. Nor was my fear
abated as my own views swung with complete in­
consistency from one extreme to the other. But I
should have had more faith. We are commencing
to have enough of the strong light of experience
to see more surely; to be able to say with more
certainty what we can and what we surely cannot
do about causes such as education, research and
the like.
For example, we can say quite emphatically that
neither A.A. as a whole nor any A.A. group ought
to enter any activity other than straight A.A. As
groups, we cannot endorse, finance or form an
alliance with any other cause, however good; we
bfannot link the A.A. name to other enterprises
”in the alcohol field to the extent that the public
gets the impression we have abandoned our sole
aim. We must discourage our members and our
friends in these fields from stressing the A.A. name
in their publicity or appeals for funds. To act
otherwise will certainly imperil our unity, and to
maintain our unity is surely our greatest obligation
—to our brother alcoholics and the public at large.
Experience, we think, has already made these prin­
ciples self-evident.

Though we now come to more debatable ground,
we must earnestly ask ourselves whether any of us,
as individuals, ought to carry our special experience
into other phases of the alcohol problem. Do we
not owe this much to society, and can it be done
without involving A.A. as a whole?

To my mind, the "do nothing” policy has be­
come unthinkable, partly because I’m sure that

COMMUhhjy

AL73 Cdl

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BAAJGAtO.iE-■560 00^

our members can work in other noncontroversial
alcohol activities without jeopardizing A.A., if
they observe a few simple precautions, and partly
because I have developed a deep conviction that
to do less would be to deprive the whole of so­
ciety of the immensely valuable contributions we
could almost certainly make. Though we are A.A.’s,
and A.A. must come first, we are also citizens of
the world. Besides, we are, like our good friends
the physicians, honor-bound to share all we know
with all men.
Therefore it seems to me that some of us must
heed the call from other fields. And those who do
need only remember first and last they are A.A.’s;
that in their new activities they are individuals
only. This means that they will respect the prin­
ciple of anonymity in the press; that if they do ap­
pear before the general public they will not de­
scribe themselves as A.A.’s; that they will refrain
from emphasizing their A.A. status in appeals for
money or publicity.
These simple principles of conduct, if conscien­
tiously applied, could soon dispel all fears, reason­
able and unreasonable, which many A.A.’s now
entertain. On such a basis A.A. as a whole could
remain uncommitted yet friendly to any noncon­
troversial cause seeking to write a brighter page in
the dark annals of alcoholism.
Briefly summarizing, I’m rather sure our policy
with respect to “outside" projects will turn out to
be this: A.A. does not sponsor projects in other
fields. But, if these projects are constructive and
noncontroversial in character, A.A. members are|f'
free to engage in them without criticism if they'
act as individuals only, and are careful of the
A.A. name. Perhaps that’s it. Shall we try it?

MONEY
—1946
*
—
(What led up to the writing of
Tradition Seven)
In Alcoholics Anonymous, does money make the
mare go or is it the root of all evil? We are in the
process of solving that riddle. Nobody pretends to
have the complete answer. Where the proper use
of money ends—and its misuse begins—is the point
in "spiritual space” we are all seeking. Few group
problems are giving thoughtful A.A.’s more con­
cern than this. Everyone is asking, “What shall be
our attitude toward voluntary contributions, paid
workers, professionalism, and outside donations?"
In the first years of A.A. we had no money prob­
lems. We met in homes where our womenfolk
made sandwiches and coffee. If an individual A.A.
wished to grubstake a fellow alcoholic, he did so.
It was purely his own affair. We had no group
funds, hence no group money troubles. And it
must be recorded that many an old-time A.A.
wishes we could now return to those early days of
halcyon simplicity. Knowing that quarrels over
material things have crushed the spirit of many a
good undertaking, it is often thought that too
much money may prove an evil for us too.
It’s small use yearning for the impossible. Money
has entered our picture and we are definitely com­
mitted to its sparing use. No one would seriously
think of abolishing our meeting places and clubs
Bbr the sake of avoiding money altogether. Ex­
perience has shown that we very much need these
facilities, so we must accept whatever risk there is
in them.
But how shall we keep these risks to a minimum;
how shall we traditionally limit the use of money
so that it may never topple the spiritual foundation
upon which each A.A. life so completely depends?
That is our real problem today. So let us look to­
gether at the main phases of our financial situa­
tion, seeking to discover what is essential, what is
nonessential, what is legitimate and harmless, and
what may be dangerous or unnecessary.
Suppose we begin with voluntary contributions.
Each A.A. finds himself dropping money in "the
hat” to pay the rent of a meeting place, a club,
or the maintenance of his local or national head­
quarters. Though not all of us believe in clubs,
• Originally published in The A.A. Grapevine.

23

and while a few A.A.'s see no necessity for any
local or national offices, it can be said fairly that
the vast majority of us believe that these services
are basically necessary. Provided such facilities are
efficiently handled, and their funds properly ac­
counted for, we are only too glad to pledge them
our regular support, with the full understanding,
of course, that such contributions are in no wise a
condition of our A.A. membership. These partic­
ular uses of our money are now generally accepted
and, with some qualifications, there is little worry
of dire long-range consequences.

Yet some concern does remain, arising mostly in
connection with our clubs, local offices and the
General Office. Because these places customarily
employ paid workers, and because their operation
implies a certain amount of business manage­
ment, it is sometimes felt that we may get bogged
down with a heavy officialdom or, still worse, a
downright professionalization of A.A. Though it
must be said that these doubts are not always un­
reasonable, we have already had enough experi­
ence to relieve them in large part.
To begin with it seems most certain that we
need never be overwhelmed by our clubs, local
offices or by the General Office at New York City.
These are places of service; they cannot really
control or govern A.A. If any of them were to
become inefficient or overbearing the remedy is
simple enough. The average A.A. would stop his
financial support until conditions were changed.
As our A.A. membership does not depend on fees
or dues, we can always "take our special facilities^
or leave them alone.” These services must always?
serve us well or go out of business. Because no one
is compelled to support them, they can never dic­
tate, nor can they stray from the main body of
A.A. tradition for very long.

In direct line with the principle of "taking our
facilities or leaving them alone” there is an en­
couraging tendency to incorporate all such special
functions separately if they involve any great
amount of money, property or management. More
and more, the A.A. groups are realizing that they
are spiritual entities, not business organizations.
Of course the smaller club rooms or meeting places
often remain unincorporated because their busi­
ness aspect is only nominal. But as large growth
takes place it is usually found wise to incorporate
and so set the club apart from surrounding groups.
Support of the club then becomes an individual
matter rather than a group matter. If, however, the
24

club also provides a central office secretary serving
the surrounding area, it seems only fair that group
treasuries in that area should shoulder this par­
ticular expense because such a secretary serves all
groups, even though the club itself may not. Our
evolution in large A.A. centers is beginning to
indicate most clearly that while it is a proper func­
tion of a cluster of groups, or their central com­
mittee, to support a paid secretary for their area,
it is not a group or central committee function to
support clubs financially. Not all A.A.’s care for
clubs. Therefore club support has to come mainly
h from those individual A.A.’s who need or like
clubs, which, by the way, is the majority. But the
majority ought not to try to coerce the minority
into supporting clubs they do not want or need.
Of course clubs also get a certain amount of help
from meetings held in them. Where central meet­
ings for an area take place in a club it is custo­
mary to divide the collections between the club
and the central committee for the area, heavily
favoring the club of course, because the club is
providing the meeting place. The same arrange­
ment may be entered into between the club and
any particular group which wishes to use the club
whether for meeting or entertainment. Generally
speaking, the board of directors of a club looks
after the financial management and the social life
of the place. But strictly A.A. matters remain the
function of the surrounding groups themselves.
This division of activity is by no means the rule
everywhere: it is offered as a suggestion only, much
in keeping, however, with the present trend.
A large club or central office usually means one
or more paid workers. What about them—are they
professionalizing A.A.? About this, there is a hot
debate every time a club or central committee gets
large enough to require paid help. On this sub­
ject we have all done a pile of fuzzy thinking. And
I would be one of the first to plead guilty to that
charge.

The reason for our fuzzy thinking is the usual
one—it is fear. To each one of us, the ideal of
A.A., however short we may be of it personally, is
a thing of beauty and perfection. It is a power
greater than ourselves which has lifted us out of
the quicksand and set us safe on shore. The slight­
est thought of marring our ideal, much less barter­
ing it for gold, is to most of us unthinkable. So we
are constantly on the alert against the rise, within
A.A., of a paid class of practitioners or mission­
aries. In A.A., where each of us is a goodwill prac­
25

titioner and missionary in his own right, there is
no need for anyone to be paid for simple Twelfth
Step work—a purely spiritual undertaking. While
I suppose fear of any kind ought to be deplored,
I must confess that I am rather glad that we exer­
cise such great vigilance in this critical matter.

ogists or psychiatrists. But they certainly ought
never to use their A.A. connection publicly or in
such a way as to make people feel that A.A. has
such a special class within its own ranks. That is
where we all must draw the line.

Yet there is a principle upon which I believe we
can honestly solve our dilemma. It is this: a janitor
can sweep the floor, a cook can boil the beef, a
steward can eject a troublesome drunk, a secretary
can manage an office, an editor can get out a news­
paper—all, I am sure, without professionalizing
A.A. If we didn’t do these jobs ourselves we would
have to hire nonalcoholics to do them for us. We
would not ask any nonalcoholic to do these things
full-time without pay. So why should some of us,
who are earning good livings ourselves in the
outside world, expect other A.A.’s to be full-time
caretakers, cooks or secretaries? Why should these
A.A.’s work for nothing at jobs which the rest of
us could not or would not attempt ourselves? Or
why, for that matter, should they be any the less
well paid than for similar labor elsewhere? And
what difference should it make if, in the course of
their duties, they do some Twelfth Step work be­
sides? Clearly the principle seems to be that we
may pay well for special services—but never for
straight Twelfth Step work.

(a)
That the use of money in A.A. is a matter of
the gravest importance. Where its use ends and
its misuse begins is the point we should vigilantly
watch.

To sum up—we have observed:

£'

How then, could A.A. be professionalized? Quite
simply. I might, for example, hire an office and
hang on the door a sign reading: “Bill W.—Alco­
holics Anonymous Therapist. Charges $10.00 per
hour." That would be face-to-face treatment of^_
alcoholism for a fee. And I would surely be trad-'
ing on the name of Alcoholics Anonymous, a pure­
ly amateur organization, to enlarge my professional
practice. That would be professionalizing A.A.—
and howl It would be quite legal, but hardly
ethical.
Now does this mean we should criticize therapists
as a class—even A.A.’s who might choose to go
into that field? Not at all. The point is that no
one ought to advertise himself as an A.A. therapist.
As we are strictly amateur there can be no such
thing. That would be a distortion of the facts
which none of us could afford to try. As the tennis
player has to drop his amateur status when he turns
professional so should A.A.’s who become therapists
cease publishing their A.A. connection. While I
ou t if many A.A.’s ever go into the field of alcoo therapy, none ought to feel excluded, espeCla y if they are trained social workers, psychol­
26

(b)
That A.A. is already committed to a qualified
use of money, because we would not think of
abolishing our offices, meeting places and clubs
simply for the sake of avoiding finances altogether.
(c)
That our real problem today consists in set­
ting intelligent and traditional limits upon our
use of money, thus keeping its disruptive tendency
at the minimum.

(d)
That the voluntary contributions or pledges
of A.A. members should be our principal and
eventually our sole support; that this kind of
self-support would always prevent; our clubs and
offices from getting out of hand, because their
funds could readily be cut off whenever they failed
to serve us well.
(e)
That we have found it generally wise to
separately incorporate those special facilities
which require much money or management; that
an A.A. group is a spiritual entity, not a business
concern.
(f)
That we must, at all costs, avoid the profes­
sionalization of A.A.; that simple Twelfth Step
work is never to be paid for; that A.A.’s going into
alcohol therapy should never trade on their A.A.
connection; that there is not, and can never be,
any such thing as an “A.A. therapist.”

(g)
That A.A. members may, however, be em­
ployed by us as full-time workers, provided they
have legitimate duties over and beyond normal
Twelfth Step work. We may, for example, surely
engage secretaries, stewards and cooks without
making them professional A.A.’s.
Continuing now the discussion of professional­
ism: A.A.’s frequently consult local committees or
The Alcoholic Foundation
*
saying they have been
offered positions in related fields. Hospitals want
A.A. nurses and doctors, clinics ask for A.A.’s who
• Now known as The General Service Board of A.A.,
Inc.

27

are social workers, universities ask for A.A.’s to
work in the field of alcohol education on a non.
controversial basis and industry wants us to recom­
mend A.A.’s as personnel officers. Can we, acting
as individuals, accept such offers? Most of us see no
reason why we cannot.
It comes down to this. Have we A.A.’s the right
to deny society the benefit of our special knowl­
edge of the alcohol problem? Are we to tell so­
ciety, even though we might make superior
nurses, doctors, social workers or educators in
the field of alcohol that we cannot undertake such
missions for fear of professionalizing A.A.? That
would certainly be farfetched, even ridiculous.
Surely no A.A. should be barred from such em­
ployment because of his membership with us. He
needs only to avoid "A.A. therapy" and any action
or word which might hurt A.A. as a whole. Aside
from this he ought to be just as employable as the
nonalcoholic who would otherwise get the job
and perhaps not do it half as well. In fact, I be­
lieve we still have a few A.A. bartenders. Though
bartending, for obvious reasons, is not a specially
recommended occupation, I have never heard any­
one point out that these few members are pro­
fessionalizing A.A. on account of their very special
knowledge of barrooms!

Years ago we used to think A.A. should have its
own hospitals, rest homes and farms. Nowadays
we are equally convinced we should have nothing
of the sort. Even our clubs, well inside A.A., are
somewhat set apart. And in the judgment of prac­
tically all, places of hospitalization or rest should
be well outside A.A.—and medically supervised. (
Hospitalization is most definitely the job of the
doctor, backed, of course, by private or community
aid. It is not a function of A.A. in the sense of
management or ownership. Everywhere we co­
operate with hospitals. Many afford us special
privileges and working arrangements. Some con­
sult us. Others employ A.A. nurses or attendants.
Relationships such as these almost always work
well. But none of these institutions are known as
"A.A. hospitals."
Now what about donations or payments to A.A.
from outside sources? There was a time some years
ago when we desperately needed a little outside
aid. This we received. And we shall never cease
being grateful to these devoted friends whose con­
tributions made possible The Alcoholic Founda­
tion, the book "Alcoholics Anonymous” and our
General Office. Heaven has surely reserved a spe­

28

cial place for every one of them. They met a great
need, for in those days we A.A.’s were very few
and very insolvent!
But times have changed. Alcoholics Anonymous
now has thousands
*
of members whose combined
earnings each year amount to untold millions of
dollars. Hence a very powerful feeling is spreading
among us that A.A. ought to be self-supporting.
Since most members feel they owe their very lives
to the movement, they think we A.A.’s ought to
pay its very modest expenses. And isn’t it high time,
they ask, that we commence to revise the prevalent
idea that an alcoholic is always a person who must
be helped—usually with money? Let us A.A.’s,
they say, be no longer takers from society. Instead
let us be givers. We are not helpless now. Neither
are we penniless any more. Were it possible to
publish tomorrow that every A.A. group has be­
come fully self-supporting, it is probable that noth­
ing could create more goodwill for us than such a
declaration. Let our generous public devote its
funds to alcohol research, hospitalization or educa­
tion. These fields really need money. But we do
not. We are no longer poor. We can, and we
should, pay our own way.
Of course, it can hardly be counted an excep­
tion to the principle of self-support if a non­
alcoholic friend comes to a meeting and drops a
dollar in the hat.
But it is not these small tokens of regard which
concern us. It is the large contributions, espe­
cially those that may carry future obligations,
which should give us pause. Then too, there is
evidence that wealthy people are setting aside
sums for A.A. in their wills under the impression
we could use a great deal of money if we had it.
Shouldn’t we discourage them? And already there
have been a few alarming attempts at the public
solicitation of money in the name of Alcoholics
Anonymous. Few A.A.’s will fail to imagine where
such a course would lead us. Every now and then
we are offered money from so-called "wet" or
"dry” sources. Obviously dangerous, this. For we
must stay out of that ill-starred controversy. Now
and then the parents of an alcoholic, out of sheer
gratitude, wish to donate heavily. Is this wise?
Would it be good for the alcoholic himself? Per­
haps a wealthy A.A. wishes to make a large gift.
Would it be good for him, or for us, if he did so?
Might we not feel in his debt and might he not,
especially if a newcomer, begin to think he had
• Estimated membership in 1974: 725,000.

29

bought a ticket to a happy destination, sobriety?

In no case have we ever been able to question
the true generosity of these givers. But is it wise
to take their gifts? Although there may be rare
exceptions, I share the opinion of most older
A.A.’s that acceptance of large donations from
any source whatever is very questionable and
almost always a hazardous policy. True, the strug­
gling club may badly need a friendly gift or loan.
Even so, it might be better in the long run to pay
as we go. We must never let any immediate advan­
tage, however attractive, blind us to the possibility
that we may be creating a disastrous precedent for
the future. Strife over money and property has too
often wrecked better societies than we tempera­
mental alcoholics!
It is with the deepest gratitude and satisfaction
that I can now tell you of a recent resolution
passed by our over-all service committee, the
trustees of The Alcoholic Foundation, who are
the custodians of our national A.A. funds. As a
matter of policy, they have just gone on record
that they will decline all gifts carrying the slightest
obligation, expressed or implied. And further, that
The Alcoholic Foundation will accept no earnings
which may be tendered from any commercial
source. As most readers know, we have been ap­
proached of late by several motion picture concerns
about the possibility of an A.A. film. Naturally
money has been discussed. But our trustees, very
rightly I think, take the position that A.A. has
nothing to sell; that we all wish to avoid even the
suggestion of commerce, and that in any case A.A.,
generally speaking, is now self-supporting.

To my mind, this is a decision of enormous
importance to our future—a very long step in the
right direction. When such an attitude about
money becomes universal through A.A., we shall
have finally steered clear of that golden, alluring,
but very treacherous reef called Materialism.

In the years that lie just ahead Alcoholics Anon­
ymous faces a supreme test—the great ordeal of
its own prosperity and success. I think it will prove
the greatest trial of all. Can we but weather that,
the waves of time and circumstances may beat
upon us in vain. Our destiny will be secure!

30

A.A.’s Position in the
Field of Alcoholism
(This statement of A.A.'s policies in relation to
the public and to other organizations has been
affirmed and reaffirmed by the General Service
Conference. It appears also in "How A.A. Mem­
bers Cooperate," a useful pamphlet on the appli­
cation of our Traditions to A.A. life.)
alcoholics anonymous is a worldwide fellowship

of men and women who help each other to main­
tain sobriety and who offer to share their recovery
experience freely with others who may have a
drinking problem. The A.A. program consists ba­
sically of Twelve Steps designed for personal re­
covery from alcoholism.
fellowship functions through more than
22,000 local groups in
countries. Hundreds of
thousands of alcoholics have achieved sobriety in
A.A., but members recognize that their program
is not always effective with all alcoholics and that
some may require professional counseling or treat­
ment.

the

a.a. is concerned solely with the personal recovery
and continued sobriety of individual alcoholics
who turn to the Fellowship for help. The move­
ment does not engage in the field of alcoholism
research, or medical or psychiatric treatment, and
does not endorse any causes—although A.A. mem­
bers often participate in other activities as in­
dividuals.
the movement has adopted a policy of "coopera­

tion but nonaffHiation" with other organizations
concerned with the problem of alcoholism.
alcoholics anonymous is self-supporting through

its own groups and members and declines con­
tributions from outside sources. A.A. members pre­
serve personal anonymity at the level of press, films
and broadcast media.

31

WILL A.A. EVER HAVE A
PERSONAL GOVERNMENT?
—1947
*
—
(Today Tradition Nine says: A.A., as such,
ought never be organized; but we may cre­
ate service boards or committees directly
responsible to those they serve.)
The answer to this question is almost surely
“no." That is the clear verdict of our experience.

To begin with, each A.A. has been an individual
who, because of his alcoholism, could seldom
govern himself. Nor could any other human being
govern the alcoholic’s obsession to drink, his drive
to have things his own way. Time out of mind,
families, friends, employers, doctors, clergymen,
and judges have tried their hand at disciplining
alcoholics. Almost without exception the failure
to accomplish anything by coercion has been
complete. Yet we alcoholics can be led, we can be
inspired: coming into A.A. we can, and we gladly
do, yield to the will of God. Hence it is not
strange that the only real authority to be found
in A.A. is that of spiritual principle. It is never
personal authority.
Our unreasonable individualism (egocentricity
if you like) was, of course, the main reason we
all failed in life and betook ourselves to alcohol.
When we couldn’t coerce others into conformity
with our own plans and desires, we drank. When
others tried to coerce us, we also drank. Though (
now sober, we still have a strong hangover of
these early traits which caused us to resist au­
thority. Therein probably hangs a clue to our
lack of personal government in A.A.: no fees, no
dues, no rules and regulations, no demand that
alcoholics conform to A.A. principles, no one set
in personal authority over anyone else. Though
no sterling virtue, our aversion to obedience does
pretty well guarantee us freedom from personal
domination of any kind.
Still it is a fact that most of us do follow, in
our personal lives, the Twelve Suggested Steps
to recovery. But we do this from choice. We prefer
recovery to death. Then, little by little, we per­
ceive the spiritual basis of life is the best. We con­
form because we want to.
• Originally published in The A.A. Grapevine.

32

Likewise, most A.A. groups become willing to
follow the "Twelve Points of Tradition to Assure
Our Future." The groups are willing to avoid
controversy over outside issues such as political
reform or religion; they stick to their single pur­
pose of helping alcoholics to recover; they in­
creasingly rely on self-support rather than outside
charity. More and more do they insist on modesty
and anonymity in their public relations. The A.A.
groups follow these other traditional principles
for the very same reason that the individual A.A.
follows the Twelve Steps to recovery. Groups
see they would disintegrate if they didn’t and they
soon discover that adherence to our tradition and
experience is the foundation for a happier and
more effective group life.

Nowhere in A.A. is there to be seen any con­
stituted human authority that can compel an A.A.
group to do anything. Some A.A. groups, for ex­
ample, elect their leaders. But even with such a
mandate each leader soon discovers that while he
can always guide by example or persuasion he
can never boss, else at election time he may find
himself passed by.
The majority of A.A. groups do not even
choose leaders. They prefer rotating committees to
handle their simple affairs. These committees are
invariably regarded as servants—they have only
the authorization to serve, never to command.
Each committee carries out what it believes to be
the wishes of its group. That is all. Though A.A.
committees used to try to discipline wayward mem­
bers, though they have sometimes composed mi­
nute rules and regulations and now and then have
set themselves up as judges of other people’s per­
sonal morals, I know of no case where any of these
seemingly worthy strivings had any lasting effect—
except, perhaps, the election of a brand-new com­
mittee!

Surely I can make these assertions with the
greatest of confidence. For in my own turn I, too,
have tried a hand at governing A.A. Each time I
have strenuously tried it I have been shouted
down.

After struggling a few years to run the A.A.
movement I had to give it up—it simply didn’t
work. Heavy-handed assertion of my personal
authority always created confusion and resistance.
If I took sides in a controversy, I was joyfully
quoted by some, while others murmured, “And
just who does this dictator think he is?" If I
sharply criticized, I usually got double criticism

33

on the return bounce. Personal power always
failed. I can see my older A.A. friends smiling.
They are recalling those times when they, too,
felt a mighty call to "save the A.A. movement"
from something or other. But their days of play­
ing "Pharisee" are now over. So those little maxims
"Easy Does It" and "Live and Let Live” have
come to be deeply meaningful and significant to
them and to me. In such fashion each of us learns
that, in A.A., one can be a servant only.
Here at the General Office we have long known
that we can merely supply certain indispensable
services. We can supply information and liter­
ature; we can usually tell how the majority of
A.A.’s feel about our current problems; we can
assist new groups to start, giving advice if asked;
we can look after the over-all A.A. public rela­
tions; we can sometimes mediate difficulties. Sim­
ilarly, the editors of our monthly journal, The
A.A. Grapevine, believe themselves simply a mir­
ror of current A.A. life and thought. Serving
purely as such, they cannot rule or propagandize.
So. also, the trustees of The Alcoholic Foundation
(our A.A. general service committee) know them­
selves to be simple custodians, custodians who
guarantee the effectiveness of the A.A. General
Office and The A.A. Grapevine and who are the
repository of our general funds and Traditions—
caretakers only.
It is most clearly apparent that, even here at the
very center of A.A., there can only exist a center
of service—custodians, editors, secretaries and the
like—each, to be sure, with a special vital func­
tion, but none of them with any authority to
govern Alcoholics Anonymous.

That such centers of service, international, na­
tional, metropolitan area or local, will be sufficient
for the future, I can have no doubt. So long
as we avoid any menacing accumulation of wealth
or the growth of personal government at these
centers, we cannot go astray. While wealth and
authority lie at the foundation of many a noble
institution, we of A.A. now apprehend, and
thoroughly well, that these things are not for us.
Have we not found that one man’s meat is often
another man’s poison?
Shall we not do well if, instead, we can cling
in some part to the brotherly ideals of the early
Franciscans? Let all of us A.A.’s, whether we be
trustees, editors, secretaries, janitors or cooks—
or just members—ever recall the unimportance
of wealth and authority as compared with the
vast import of our brotherhood, love and service.
34

ANONYMITY
—1946
*
—
(One of the first articles on our
vital Anonymity Traditions)
In the years that lie ahead the principle of
anonymity will undoubtedly become a part of
our vital tradition. Even today we sense its prac­
tical value. But more important still, we are
beginning to feel that the word “anonymous”
has for us an immense spiritual significance.
Subtly but powerfully it reminds us that we are
always to place principles before personalities;
that we have renounced personal glorification in
public; that our movement not only preaches but
actually practices a true humility. That the prac­
tice of anonymity in our public relations has al­
ready had a profound effect upon us, and upon
our millions of friends in the outside world, there
can hardly be doubt. Anonymity is already a cor­
nerstone of our public relations policy.
How this idea first originated and subsequently
took hold of us is an interesting bit of A.A.
history. In the years before the publication of
the book "Alcoholics Anonymous," we had no
name. Nameless, formless, our essential principles
of recovery still under debate and test, we were
just a group of drinkers groping our way along
what we hoped would be the road to freedom.
Once we became sure that our feet were set
on the right track we decided upon a book in
which we could tell other alcoholics the good
news. As the book took form we inscribed in it
the essence of our experience. It was the product
of thousands of hours of discussion. It truly rep­
resented the collective voice, heart and conscience
of those of us who had pioneered the first four
years of A.A.
As the day of publication approached we racked
our brains to find a suitable name for the volume.
We must have considered at least two hundred
titles. Thinking up titles and voting upon them
at meetings became one of our main activities. A
great welter of discussion and argument finally
narrowed our choice to a single pair of names.
Should we call our new book “The Way Out" or
should we call it "Alcoholics Anonymous”? That
was the final question. A last-minute vote was
taken by the Akron and New York Groups. By
a narrow majority the verdict was for naming our
• Originally published in The A.A. Grapevine.

85

book “The Way Out." Just before we went to
print somebody suggested there might be other
books having the same title. One of our early lone
members (dear old Fitz M., who then lived in
Washington) went over to the Library of Congress
to investigate. He found exactly twelve books al­
ready titled “The Way Out.” When this informa­
tion was passed around, we shivered at the pos­
sibility of being the “Thirteenth Way Out.” So
“Alcoholics Anonymous" became first choice. That’s
how we got a name for our book of experience, a
name for our movement and, as we are now be­
ginning to see, a tradition of the greatest spiritual
import. God does move in mysterious ways His
wonders to perform!

In the book “Alcoholics Anonymous” there are
only three references to the principle of anonymity.
The foreword of our first edition states: “Being
mostly business or professional folk some of us
could not carry on our occupations if known” and
“When writing or speaking publicly about alco­
holism, we urge each of our Fellowship to omit
his personal name, designating himself instead as
‘a member of Alcoholics Anonymous,’ ” and then,
“very earnestly we ask the press also to observe
this request for otherwise we shall be greatly
handicapped.”
Since the publication of “Alcoholics Anon­
ymous" in 1939 hundreds of A.A. groups have
been formed. Every one of them asks these ques­
tions: “Just how anonymous are we supposed to
be?” and “After all, what good is this principle of
anonymity anyway?" To a great extent each group
has settled upon its own interpretation. Naturally
enough wide differences of opinion remain among
us. Just what our anonymity means and just how
far it ought to go are unsettled questions.

Though we no longer fear the stigma of alco­
holism as we once did, we still find individuals
who are extremely sensitive about their connec­
tion with us. A few come in under assumed
names. Others swear us to the deepest secrecy. They
fear their connection with Alcoholics Anonymous
may ruin their business or social position. At the
other end of the scale of opinion we have the in­
dividual who declares that anonymity is a lot of
childish nonsense. He feels it his bounden duty
to cry his membership in Alcoholics Anonymous
from the housetops. He points out that our A.A.
Fellowship contains people of renown, some of
national importance. Why, he asks, shouldn’t we
capitalize on their personal prestige just as any
other organization would?

36

In between these extremes the shades of opinion
are legion. Some groups, especially newer ones,
conduct themselves like secret societies. They do
not wish their activities known even to friends.
Nor do they propose to have preachers, doctors, or
even their wives at any of their meetings. As
for inviting in newspaper reporters—perish the
thought!
Other groups feel that their communities should
know all about Alcoholics Anonymous. Though
they print no names, they do seize every oppor­
tunity to advertise the activities of their group.
They occasionally hold public or semipublic
meetings where A.A.’s appear on the platform by
name. Doctors, clergymen and public officials are
frequently invited to speak at such gatherings.
Here and there a few A.A.’s have dropped their
anonymity completely. Their names, pictures and
personal activities have appeared in the public
print. As A.A.’s they have sometimes signed their
names to articles telling of their membership.
So while it is quite evident that most of us be­
lieve in anonymity, our practice of the principle
does vary a great deal. And, indeed, we must
realize that the future safety and effectiveness of
Alcoholics Anonymous may depend upon its
preservation.

The vital question is: Just where shall we fix
this point where personalities fade out and an­
onymity begins?
As a matter of fact, few of us are anonymous
so far as our daily contacts go. We have dropped
anonymity at this level because we think our
friends and associates ought to know about Alco­
holics Anonymous and what it has done for us.
We also wish to lose the fear of admitting that
we are alcoholics. Though we earnestly request
reporters not to disclose our identities, we fre­
quently speak before semipublic gatherings under
our right names. We wish to impress audiences
that our alcoholism is a sickness we no longer
fear to discuss before anyone. So far, so good.

If, however, we venture beyond this limit we
shall surely lose the principle of anonymity for­
ever. If every A.A. felt free to publish his own
name, picture and story we would soon be launched
upon a vast orgy of personal publicity which
obviously could have no limit whatever. Isn’t this
where, by the strongest kind of tradition, we must
draw the line?

1.
Therefore, it should be the privilege of each
A.A. to cloak himself with as much personal
37

anonymity as he desires. His fellow A.A.’s should
respect his wishes and help guard whatever status
he wants to assume.

2.
Conversely, the individual A.A. ought to re­
spect the feeling of his local group about an­
onymity. If members of his group wish to be less
conspicuous in their locality than he does, he
ought to go along with them unless they change
their views.
3.
It ought to be a worldwide policy that no
member of Alcoholics Anonymous shall ever feel
free to publish, in connection with any A.A. ac­
tivity, his name or picture in mediums of public
circulation. This would not, however, restrict the
use of his name in other public activities provided,
of course, he does not disclose his A.A. member­
ship.
If these suggestions, or variations of them, are
to be adopted as a general policy, every A.A. will
want to know more about our experience so far.
He will surely wish to know how most of our
older members are thinking on the subject of an­
onymity at the present time. It will be the pur­
pose of this piece to bring everybody up-to-date
on our collective experience.

Firstly, I believe most of us would agree that
the general idea of anonymity is sound, because
it encourages alcoholics and the families of alco­
holics to approach us for help. Still fearful of
being stigmatized, they regard our anonymity as
an assurance their problems will be kept confiden­
tial; that the alcoholic skeleton in the family
closet will not wander in the streets.

Secondly, the policy of anonymity is a protec­
tion to our cause. It prevents our founders or
leaders, so-called, from becoming household
names who might at any time get drunk and
give A.A. a black eye. No one need say that
couldn’t happen here. It could.
Thirdly, almost every newspaper reporter who
covers us complains, at first, of the difficulty of
writing his story without names. But he quickly
forgets this difficulty when he realizes that here
is a group of people who care nothing for per­
sonal gain. Probably it is the first time in his life
he has ever reported an organization which wants
no personal publicity. Cynic though he may be,
this obvious sincerity instantly transforms him into
a friend of A.A. Therefore his piece is a friendly
piece, never a routine job. It is enthusiastic writ­
ing because the reporter feels that way himself.

38

People often ask how Alcoholics Anonymous has
been able to secure such an incredible amount
of excellent publicity. The answer seems to be
that practically everyone who writes about us be­
comes an A.A. convert, sometimes a zealot. Is not
our policy of anonymity mainly responsible for
this phenomenon?
Fourthly, why does the general public regard
us so favorably? Is it simply because we are bring­
ing recovery to lots of alcoholics? No, this can
hardly be the whole story. However impressed he
may be by our recoveries, John Q. Public is
even more interested in our way of life. Weary
of pressure selling, spectacular promotion and
shouting public characters, he is refreshed by our
quietness, modesty and anonymity. It well may
be that he feels a great spiritual power is being
generated on this account—that something new
has come into his own life.
If anonymity has already done these things for
us, we surely ought to continue it as a general
policy. So very valuable to us now, it may become
an incalculable asset for the future. In a spiritual
sense, anonymity amounts to the renunciation of
personal prestige as an instrument of general pol­
icy. I am confident that we shall do well to preserve
this powerful principle; that we should resolve
never to let go of it.

Now what about its application? Since we ad­
vertise anonymity to every newcomer, we ought,
of course, to preserve a new member’s anonymity
so long as he wishes it preserved—because, when
he read our publicity and came to us, we con^Uracted to do exactly that. And even if he wants
come in under an assumed name, we should
assure him he can. If he wishes us to refrain from
discussing his case with anyone, even other A.A.
members, we ought to respect that wish too. While
most newcomers do not care a rap who knows
about their alcoholism, there are others who care
very much. Let us guard them in every way until
they get over that feeling.
Then comes the problem of the newcomer who
wishes to drop his anonymity too fast. He rushes
to all his friends with the glad news of A.A. If
his group does not caution him he may rush to
a newspaper office or a microphone to tell the
wide world all about himself. He is also likely
to tell everyone the innermost details of his per­
sonal life, soon to find that, in this respect, he has
altogether too much publicity! We ought to
suggest to him that he take things easy; that he
first get on his own feet before talking about A.A.

39

to all and sundry; that no one thinks of publiciz­
ing A.A. without being sure of the approval of
his own group.

us as a group of alcoholics who no longer fear
to let our friends know that we have been very
sick people.

Then there is the problem of group anonymity.
Like the individual, it is probable that the group
ought to feel its way along cautiously until it
gains strength and experience. There should not
be too much haste to bring in outsiders or to set
up public meetings. Yet this early conservatism
can be overdone. Some groups go on, year after
year, shunning all publicity or any meetings ex­
cept those for alcoholics only. Such groups are apt
to grow slowly. They become stale because they
are not taking in fresh blood fast enough. In their
anxiety to maintain secrecy they forget their
obligation to other alcoholics in their communities
who have not heard that A.A. has come to town.
But this unreasonable caution eventually breaks
down. Little by little some meetings are opened
to families and close friends. Clergymen and
doctors may now and then be invited. Finally the
group enlists the aid of the local newspaper.

In practice then, the principle of anonymity
seems to come down to this: with one very im­
portant exception, the question of how far each
individual or group shall go in dropping an­
onymity is left strictly to the individual or group
concerned. The exception is: that all groups or
individuals, when writing or speaking for publica­
tion as members of Alcoholics Anonymous, feel
bound never to disclose their true names. It is
at this point of publication that we feel we should
draw the line on anonymity. We ought not dis­
close ourselves to the general public through the
media of the press, in pictures or on the radio.

Any who would drop their anonymity must
reflect that they may set a precedent which could
eventually destroy a valuable principle. We must
never let any immediate advantage shake us in
our determination to keep intact such a really
vital tradition.

In most places, but not all, it is customary for
A.A.’s to use their own names when speaking
before public or semipublic gatherings. This is
done to impress audiences that we no longer fear
the stigma of alcoholism. If, however, newspaper
reporters are present they are earnestly requested
not to use the names of any of the alcoholic
speakers on the program. This preserves the
principle of anonymity so far as the general pub­
lic is concerned and at the same time represents

Great modesty and humility are needed by
every A.A. for his own permanent recovery. If
these virtues are such vital needs to the individual,
so must they be to A.A. as a whole. This prin­
ciple of anonymity before the general public can,
if we take it seriously enough, guarantee the
Alcoholics Anonymous movement these sterling
attributes forever. Our public relations policy
should mainly rest upon the principle of attraction
and seldom, if ever, upon promotion.

WHY ALCOHOLICS
ANONYMOUS
IS ANONYMOUS
—1955
*
—
As never before, the struggle for power, im­
portance and wealth is tearing civilization apart.
Man against man, family against family, group
against group, nation against nation.
Nearly all those engaged in this fierce com­
petition declare that their aim is peace and justice
for themselves, their neighbors and their nations
. . . give us power and we shall have justice;
• Originally published in The A.A. Grapevine.

40

(How Bill W. felt about
anonymity 20 years after
A.A. was formed)
give us fame and we shall set a great example;
give us money and we shall be comfortable and
happy. People throughout the world deeply be­
lieve that, and act accordingly. On this appalling
dry bender, society seems to be staggering down
a dead end road. The stop sign is clearly marked.
It says “Disaster."

What has this got to do with anonymity, and
Alcoholics Anonymous?

COMMUNITY HEALTH CEL^
1 loor) J .. Marks Road^
BANGAt.O.<u • t5uo uul

We of A.A. ought to know. Nearly every one
of us has traversed this identical dead-end path.
Powered by alcohol and self-justification, many
of us have pursued the phantoms of self-impor­
tance and money right up to the disaster stop
sign. Then came A.A. We faced about and found
ourselves on a new highroad where the direction
signs said never a word about power, fame or
wealth. The new signs read, "This way to sanity
and serenity—the price is self-sacrifice. ”
Our new book, "Twelve Steps and Twelve
Traditions,” states that "Anonymity is the greatest
protection our Society can ever have.” It says also
that "The spiritual substance of anonymity is sac­
rifice.”

When the first A.A. group took form, we soon
learned a lot more of this. We found that each
of us had to make willing sacrifices for the group
itself, sacrifices for the common welfare. The
group, in turn, found that it had to give up many
of its own rights for the protection and welfare
of each member, and for A.A. as a whole. These
sacrifices had to be made or A.A. couldn’t con­
tinue to exist.

(

Let’s turn to A.A.’s twenty years of experience
and see how we arrived at that belief, now ex­
pressed in our Traditions Eleven and Twelve.

At the beginning we sacrificed alcohol. We
had to, or it would have killed us. But we couldn’t
get rid of alcohol unless we made other sacrifices.
Big shot-ism and phony thinking had to go. We
had to toss self-justification, self-pity, and anger
right out the window. We had to quit the crazy
contest for personal prestige and big bank bal­
ances. We had to take personal responsibility for
our sorry state and quit blaming others for it.
Were these sacrifices? Yes, they were. To gain
enough humility and self-respect to stay alive at
all we had to give up what had really been our
dearest possession—our ambitions and our il­
legitimate pride.
But even this was not enough. Sacrifice had to^"'
go much further. Other people had to benefit too.
So we took on some Twelfth Step work; we began
to carry the A.A. message. We sacrificed time,
energy and our own money to do this. We
couldn’t keep what we had unless we gave it away.

Did we demand that our new prospects give
us anything? Were we asking them for power
over their lives, for fame for our good work or
for a cent of their money? No, we were not. We
found that if we demanded any of these things
our Twelfth Step work went flat. So these nature
desires had to be sacrificed; otherwise, our pros­
pects received little or no sobriety. Nor, indeed,
did we.
Thus we learned that sacrifice had to bring
a double benefit, or else little at all. We began
to know about the kind of giving of ourselves
that had no price tag on it.
42

"

Out of these experiences and realizations, the
Twelve Traditions of Alcoholics Anonymous began
to take shape and substance.
Gradually we saw that the unity, the effective­
ness—yes, even the survival—of A.A. would always
depend upon our continued willingness to sacrifice
our personal ambitions and desires for the com­
mon safety and welfare. Just as sacrifice meant
survival for the individual, so did sacrifice mean
unity and survival for the group and for A.A.’s
entire Fellowship.

Viewed in this light, A.A.’s Twelve Traditions
are little else than a list of sacrifices which the
experience of twenty years has taught us that
we must make, individually and collectively, if
A.A. itself is to stay alive and healthy.
In our Twelve Traditions we have set our faces
against nearly every trend in the outside world.

We have denied ourselves personal government,
professionalism and the right to say who our
members shall be. We have abandoned do-goodism, reform and paternalism. We refuse charitable
money and prefer to pay our own way. We will
^hcooperate with practically everybody, yet we de­
cline to marry our Society to anyone. We abstain
from public controversy and will not quarrel
among ourselves about those things that so rip so­
ciety asunder—religion, politics and reform. We
have but one purpose: to carry the A.A. message
to the sick alcoholic who wants it.
We take these attitudes not at all because we
claim special virtue or wisdom; we do these things
because hard experience has told us that we
must—if A.A. is to survive in the distraught
world of today. We also give up rights and make
sacrifices because we ought to—and, better yet,
because we want to. A.A. is a power greater
than any of us; it must go on living or else un­
counted thousands of our kind will surely die.
This we know.
Now where does anonymity fit into this pic43

ture? What is anonymity anyhow? Why do we
think it is the greatest single protection that A.A.
can ever have? Why is it our greatest symbol
of personal sacrifice, the spiritual key to all our
Traditions and to our whole way of life?
The following fragment of A.A. history will re­
veal, I deeply hope, the answer we all seek.

Years ago a noted ballplayer sobered up through
A.A. Because his comeback was so spectacular, he
got a tremendous personal ovation in the press
and Alcoholics Anonymous got much of the
credit. His full name and picture, as a member of
A.A., were seen by millions of fans. It did us
plenty of good; alcoholics flocked in. We loved
this. I was specially excited because it gave me
ideas.
Soon I was on the road, happily handing out
personal interviews and pictures. To my delight,
I found I could hit the front pages, just as he
could. Besides, he couldn't hold his publicity pace,
but I could hold mine. I only needed to keep trav­
eling and talking. The local A.A. groups and
newspapers did the rest. I was astonished when
recently I looked at those old newspaper stories.
For two or three years I guess I was A.A.'s number
one anonymity-breaker.
So I can’t blame any A.A. who has grabbed the
spotlight since. I set the main example myself,
years ago.

At the time, this looked like the thing to do.
Thus justified, I ate it up. What a bang it gave
me when I read those two-column spreads about
"Bill the Broker,” full name and picture, the guy
who was saving drunks by the thousands!
Then this fair sky began to be a little overcast.
Murmurs were heard from A.A. skeptics who said,
This guy Bill is hogging the big time. Dr. Bob
isn t getting his share." Or, again, "Suppose all
this publicity goes to Bill’s head and he gets drunk
on us?"

This stung. How could they persecute me when
I was doing so much good? I told my critics that
this was America and didn’t they know I had the
right of free speech? And wasn’t this country and
every other run by big-name leaders? Anonymity
was maybe okay for the average A.A. But co­
founders ought to be exceptions. The public cer­
tainly had a right to know who we were.
Real A.A. power-drivers (prestige-hungry peo­
ple, folks just like me) weren’t long in catching
on. They were going to be exceptions too. They
44

said that anonymity before the general public
was just for timid people: all the braver and
bolder souls, like themselves, should stand right
up before the flashbulbs and be counted. This
kind of courage would soon do away with the
stigma on alcoholics. The public would right away
see what fine citizens recovered drunks could make.
So more and more members broke their anonym­
ity, all for the good of A.A. What if a drunk
was photographed with the Governor? Both he and
the Governor deserved the honor, didn’t they?
Thus we zoomed along, down the dead-end road!
The next anonymity-breaking development
looked even rosier. A close A.A. friend of mine
wanted to go in for alcohol education. A depart­
ment of a great university interested in alcoholism
wanted her to go out and tell the general public
that alcoholics were sick people, and that plenty
could be done about it. My friend was a crack
public speaker and writer. Could she tell the gen­
eral public that she was an A.A. member? Well,
why not? By using the name Alcoholics Anonymous
she’d get fine publicity for a good brand of alco­
hol education and for A.A. too. I thought it an
excellent idea and therefore gave my blessing.
A.A. was already getting to be a famous and
valuable name. Backed by our name and her own
great ability, the results were immediate. In noth­
ing flat her own full name and picture, plus ex­
cellent accounts of her educational project, and of
A.A., landed in nearly every large paper in North
America. The public understanding of alcoholism
increased, the stigma on drunks lessened, and A.A.
got new members. Surely there could be nothing
wrong with that.

But there was. For the sake of this short-term
benefit, we were taking on a future liability of
huge and menacing proportions.

Presently an A.A. member began to publish
a crusading magazine devoted to the cause of
Prohibition. He thought Alcoholics Anonymous
ought to help make the world bone-dry. He dis­
closed himself as an A.A. member and freely used
the A.A. name to attack the evils of whiskey and
those who made it and drank it. He pointed out
that he too was an "educator,” and that his brand
of education was the "right kind." As for putting
A.A. into public controversy, he thought that was
exactly where we should be. So he busily used
A.A.’s name to do just that. Of course, he broke
his anonymity to help his cherished cause along.

45

That was followed by a proposal from a liquor­
trade association that an A.A. member take on
a job of “education.” People were to be told that
too much alcohol was bad for anyone and that
certain people—the alcoholics—shouldn’t drink
at all. What could be the matter with this?

The catch was that our A.A. friend had to
break his anonymity; every piece of publicity and
literature was to carry his full name as a member
of Alcoholics Anonymous. This of course would
be bound to create the definite public impression
that A.A. favored "education,” liquor-trade style.
Though these two developments never hap­
pened to get far, their implications were neverthe­
less terrific. They spelled it right out for us. By
hiring out to another cause, and then declaring
his A.A. membership to the whole public, it was in
the power of an A.A. to marry Alcoholics Anon­
ymous to practically any enterprise or controversy
at all, good or bad. The more valuable the A.A.
name became, the greater the temptation would be.

Further proof of this was not long in showing
up. Another member started to put us into the
advertising business. He had been commissioned
by a life insurance company to deliver a series
of twelve "lectures” on Alcoholics Anonymous
over a national radio hookup. This would of
course advertise life insurance and Alcoholics
Anonymous—and naturally our friend himself—
all in one good-looking package.
At A.A. Headquarters, we read the proposed
lectures. They were about 50% A.A. and 50%
our friend’s personal religious convictions. Thisxcould create a false public view of us. Religious’..
prejudice against A.A. would be aroused. So we
objected.
Our friend shot back a hot letter saying that
he felt "inspired” to give these lectures, and that
we had no business to interfere with his right of
free speech. Even though he was going to get a
fee for his work, he had nothing in mind except
the welfare of A.A. And if we didn't know what
was good for us, that was too bad! We and A.A.’s
Board of Trustees could go plumb to the devil.
The lectures were going on the air.
This was a poser. Just by breaking anonymity
and so using the A.A. name for his own purposes,
our friend could take over our public relations,
get us into religious trouble, put us into the aavertising business and, for all these good works,
the insurance company would pay him a hand­

some fee.

46

Did this mean that any misguided member
could thus endanger our Society any time or any
place simply by breaking anonymity and telling
himself how much good he was going to do for us?
We envisioned every A.A. advertising man looking
up a commercial sponsor, using the A.A. name to
sell everything from pretzels to prune juice.
Something had to be done. We wrote our friend
that A.A. had a right to free speech too. We
wouldn’t oppose him publicly, but we could and
would guarantee that his sponsor would receive
several thousand letters of objection from A.A.
members if the program went on the radio. Our
friend abandoned the project.

But our anonymity dike continued to leak.
A.A. members began to take us into politics. They
began to tell state legislative committees—pub­
licly, of course—just what A.A. wanted in the way
of rehabilitation, money and enlightened legisla­
tion.

Thus, by full name and often by pictures, some
of us became lobbyists. Other members sat on
benches with police court judges, advising which
drunks in the lineup should go to A.A. and which
to jail.

Then came money complications involving
broken anonymity. By this time, most members
felt we ought to stop soliciting funds publicly for
A.A. purposes. But the educational enterprise of
my university-sponsored friend had meanwhile
mushroomed. She had a perfectly proper and
legitimate need for money and plenty of it. There­
fore, she asked the public for it, putting on drives

to this end. Since she was an A.A. member and
continued to say so, many contributors were con­
fused. They thought A.A. was in the educational
field or else they thought A.A. itself was raising
money when indeed it was not and didn’t want to.

So A.A.’s name was used to solicit funds at the
very moment we were trying to tell people that
A.A. wanted no outside money.
Seeing what happened, my friend, wonderful
member that she is, tried to resume her anonymity.
Because she had been so thoroughly publicized,
this has been a hard job. It has taken her years.
But she has made the sacrifice, and I here want to
record my deep thanks on behalf of us all.

This precedent set in motion all sorts of public
solicitations by A.A.’s for money—money for drying-out farms, Twelfth Step enterprises, A.A.
47

boardinghouses, clubs, and the like—powered
largely by anonymity-breaking.
We were next startled to learn that we had
been drawn into partisan politics, this time for
the benefit of a single individual. Running for
public office, a member splashed his political ad­
vertising with the fact that he was an A.A. and,
by inference, sober as a judgel A.A. being popular
in his state, he thought it would help him win on
election day.
Probably the best story in this class tells how
the A.A. name was used to back up a libel law­
suit. A member, whose name and professional at­
tainments are known on three continents, got
hold of a letter which she thought damaged her
professional reputation. She felt something should
be done about this and so did her lawyer, also an
A.A. They assumed that both the public and
A.A. would be rightfully angry if the facts were
known. Forthwith, several newspapers headlined
how Alcoholics Anonymous was rooting for one
of its lady members—name in full, of course—to
win her suit for libel. Shortly after this, a noted
radio commentator told a listening audience, esti­
mated at twelve million people, the same thing.
This again proved that the A.A. name could be
used for purely personal purposes . . . this time
on a nationwide scale.
The old files at A.A. Headquarters reveal many
scores of such experiences with broken anonymity.
Most of them point up the same lessons.
They tell us that we alcoholics are the biggest
rationalizers in the world; that fortified with th/~
excuse we are doing great things for A.A. we can
*,through broken anonymity, resume our old and
disastrous pursuit of personal power and prestige,
public honors, and money—the same implacable
urges that when frustrated once caused us to drink;
the same forces that are today ripping the globe
apart at its seams. Moreover, they make clear that
enough spectacular anonymity-breakers could
someday carry our whole Society down into that
ruinous dead end with them.

So we are certain that if such forces ever rule
our Fellowship, we will perish too, just as other
societies have perished throughout human history.
Let us not suppose for a moment that we recov­
ered alcoholics are so much better or stronger
than other folks; or that, because in twenty years
nothing has ever happened to A.A., nothing ever
can.

Our really great hope lies in the fact that our
48

total experience, as alcoholics and as A.A. mem­
bers, has at last taught us the immense power of
these forces for self-destruction. These hard-won
lessons have made us entirely willing to undertake
every personal sacrifice necessary for the preserva­
tion of our treasured Fellowship.

This is why we see anonymity at the general
public level as our chief protection against our­
selves, the guardian of all our Traditions and the
greatest symbol of self-sacrifice that we know.
Of course no A.A. need be anonymous to fam­
ily, friends, or neighbors. Disclosure there is
usually right and good. Nor is there any special
danger when we speak at group or semipublic
A.A. meetings, provided press reports reveal first
names only.
But before the general public—press, radio,
films, television and the like—the revelation of full
names and pictures is the point of peril. This is
the main escape hatch for the fearful destructive
forces that still lie latent in us all. Here the lid
can and must stay down.
We now fully realize that 100% personal an­
onymity before the public is just as vital to the
life of A.A. as 100% sobriety is to the life of each
and every member.
I say all this with what earnestness I can; I say
this because I know what the temptation of fame
and money really is. I can say this because I was
once a breaker of anonymity myself. I thank
God that years ago the voice of experience and
the urging of wise friends took me out of the
perilous path into which I might have led our
lentire Society. Thus I learned that the tem­
porary or seeming good can often be the deadly
enemy of the permanent best. When it comes to
survival for A.A., nothing short of our very best
will be good enough.
We want to maintain 100% anonymity for still
another potent reason, one often overlooked. In­
stead of securing us more publicity, repeated self­
serving anonymity breaks could severely damage
the wonderful relation we now enjoy with press
and public alike. We could wind up with a poor
press and little public confidence at all.

For many years, news channels all over the
world have showered A.A. with enthusiastic pub­
licity, a never-ending stream of it, far out of pro­
portion to the news values involved. Editors tell
us why this is. They give us extra space and time
because their confidence in A.A. is complete. The
very foundation of that high confidence is, they

49

A.A. PUBLICATIONS
say, our continual insistence on personal anonym­
ity at the press level.
Never before had news outlets and public rela­
tions experts heard of a society that absolutely
refused personally to advertise its leaders or mem­
bers. To them, this strange and refreshing novelty
has always been proof positive that A.A. is on the
square; that nobody has an angle.
This, they tell us, is the prime reason for their
great goodwill. This is why, in season and out,
they continue to carry the A.A. message of recov­
ery to the whole world.
If, through enough anonymity lapses, we finally
caused the press, the public and our alcoholic
prospects themselves to wonder about our mo­
tives, we’d surely lose this priceless asset and,
along with it, countless prospective members.
For a long time now, both Dr. Bob and I have
done everything possible to maintain the Tradi­
tion of anonymity. Just before he died, some of
Dr. Bob’s friends suggested that there should be
a suitable monument or mausoleum erected in
honor of him and his wife, Anne, something be­
fitting a founder. Dr. Bob declined, with thanks.
Telling me about this a little later, he grinned
and said, “For heaven’s sake, Bill, why don’t you
and I get buried like other folks?”

Last summer I visited the Akron cemetery where
Bob and Anne lie. Their simple stone says never
a word about Alcoholics Anonymous. This made
me so glad I cried. Did this wonderful couple carry
personal anonymity too far when they so firmly
refused to use the words “Alcoholics Anonymous,”
even on their own burial stone?
For one, I don’t think so. I think that this
great and final example of self-effacement will
prove of more permanent worth to A.A. than
could any spectacular public notoriety or fine
mausoleum.
We don’t have to go to Akron, Ohio, to see
Dr. Bob’s memorial. Dr. Bob’s real monument
is visible throughout the length and breadth of
A.A. Let us look again at its true inscription . . .
one word only, which we A.A.’s have written. That
word is “sacrifice.”

Complete order forms available at
Box 459, Grand Central Station, New York, N.Y. 10017
BOOKS
ALCOHOLICS ANONYMOUS
(605 pages)
ALCOHOLICS ANONYMOUS COMES OF AGE
(335 pages)
TWELVE STEPS AND TWELVE TRADITIONS
(190 pages)
TWELVE STEPS AND TWELVE TRADITIONS
(Pocket-size edition)
(190 pages)
AS BILL SEES IT
(formerly THE A.A. WAY OF LIFE)
(346 pages)
BOOKLET
CAME TO BELIEVE
(128 pages)
PAMPHLETS
A.A.—44 QUESTIONS AND ANSWERS
A.A. TRADITION—HOW IT DEVELOPED
A CLERGYMAN ASKS ABOUT A.A.
THREE TALKS TO MEDICAL SOCIETIES
—BY BILL W.
ALCOHOLICS ANONYMOUS AND
THE MEDICAL PROFESSION
A.A. IN YOUR COMMUNITY
IS A.A. FOR YOU?
IS A.A. FOR YOU?—SHORT AND SIMPLE
THIS IS A.A.
QUESTIONS AND ANSWERS ON SPONSORSHIP
A.A. FOR THE WOMAN
A.A. AND THE ALCOHOLIC EMPLOYEE
THE JACK ALEXANDER ARTICLE
LETTER TO A WOMAN ALCOHOLIC
YOUNG PEOPLE AND A.A.
A.A. AND THE ARMED SERVICES
THE A.A. MEMBER AND DRUG ABUSE
THE ALCOHOLIC HUSBAND
THE ALCOHOLIC WIFE
INSIDE AA..
THE A.A. GROUP
THE G.S.R.
MEMO TO AN INMATE
THE TWELVE TRADITIONS ILLUSTRATED
LET'S BE FRIENDLY WITH OUR FRIENDS
BACKGROUND INFORMATION ON A A.
HOW A.A. MEMBERS COOPERATE
ALCOHOLISM IS A MANAGEMENT PROBLEM
... A.A. SUGGESTS ONE SOLUTION
A.A. IN PRISONS
A.A. IN HOSPITALS
PROFILE OF AN A.A. MEETING
IF YOU ARE A PROFESSIONAL . . .
A MEMBER'S-EYE VIEW OF
ALCOHOLICS ANONYMOUS
PROBLEMS OTHER THAN ALCOHOL
UNDERSTANDING ANONYMITY
CO-FOUNDERS OF A.A.
SPEAKING AT NON-A.A. MEETINGS
A BRIEF GUIDE TO A.A.
WHAT HAPPENED TO JOE
IT HAPPENED TO-ALICE
(Last two.ate fuU-CQlor, comic-book-style pamphlets)

PERIODICAL: THE A.A. GRAPEVINE
* • ‘ (Monthly)
•

GENERAL SERVICE-OFFICE of' ALCOHOLfCS^ONYMOUS

A

Declaration of Unity
This we owe to A.A.’s future:
To place our common welfare first;
To keep our fellowship united.
For on A.A. unity depend our lives,
And the lives of those to come.

This is A A. General Service
Conference-approved literattire

I am responsible ... t
When anyone, anywhere,
reaches out for help, I want
the hand of A.A. always to be there.
And for that: I am responsible.

SOCIAL ASPECTS OF ALCOHOLISM
BY
Mrs. Lalitg Shatti, M.S.W., D.P.S.W.1
2
The recognition of the role of socio—psychological factors in causing and

maintaining alcoholism has brought a change in the disease notion of alcoholism
as a physical entity.

’Problem drinking'

Recently thihas been an acceptance of the term

instead of 'Alcoholism'.

It is argued that problem drinking

'

places emphasis upon behaviour rather than on the person and thus avoids the
more permanent label alcoholism, which tends to be attached to thepperson.

This

shift is mainly due to the fact that the popular aporoaches like-constititional,
psychological and sociological, cannot help to understand and treat alcoholism

independent of each other.
Two facets of Social Aspects -

The workers who strongly ahdere to the constititional anproch do not give
any importance to the social factors in understanding the etiology of alcoholism.

Most of them, of course, agree that alcoholism could be an exogeneous stress on

the family and social milien of the alcoholic.
century, Knight

During the third decade of this

(1937) and Chassell (1938) stressed the importance of understanding

the total family in order to understand individual drinking behaviour.
(1976) comments,

Meeks

'drinking may indicate stress or dysfunction in a social system,

may be secondary to dysfunction in a social system', seems to be quite appropriate.

He is of the opinion that 'some alcohol problems may reside as much as in social
structures and processes as in people'.

Socio-cultural theory of Alcoholism Most of the epidemiological surveys have, demonstrated that the incidence

of drinking have a significant association with age, sex, social status, elj/nicity,

degree of urbanization, quality of marital and family life.

These are all

On the other hand,

in the field of

sociological and demographic variables.

psychological research no unique personality type or a unique nosological

group have shown definite correlation with alcoholism (Roebuck & Kessler, 1972).

Therefore, as pointed out by Cahalan etal (1969),

'Whether a person drinks at

all is primarily a sociological and anthropological variable rather than a

psychological one', needs a very special consideration.

1. Paper presented at Seminar on Alcoholism organised by the
Deot. of Psychiatry, St. John's Medical College & Hospital
and ndian Psychiatry Society, Karnataka State Branch, on
6-6-1983.
2. Department of Community Medicine, St. John's Medical College,
Bangalore - 34

2

Twentieth century is the age of positivism and anxiety.' The technological

advancements in the European and Western Society have brought a severe degree of
monotomy in life.

This, has affect J the youth very much.

He finds himself

as an empty shell - his family as an-empty shell - his whole system as an
empty shell.

He is in’constant search of relations and significant others.

He. is despt oately searching meaning of life.

acculturation of society.

This is an indication of

Whenever a society is undergoing acculturation the

culturally !nduced tensions will reach to an untolerable level.

lead to ex:, sential doubts.

These tensions

Roebuck & Kessler (1972) believe that 'the choide of

alcohol to relieve these is determined by (1) attitudes towards alcohol and
(2) the availability of substitute means of satisfaction or tension release.
A similar -..view is expressed'by Cahalan (1970) .-and he contended that higher

rates of problem drinking in'lower socio economic group might--be due. to fewer
opport uniti s for recreation and tension release.
Family of a '.cohulics -

The bi iovioural scientists believe that Alcoholics'
is one of t

family of orientation

very important factors in understanding the problem of alcoholism.

In this record several attempts have been made to explain the various socio-

psychologiral tenets of family life.

Float of the work in this yield is based

on the general system theory wherein the family has been considered as an

open syste:.

The expression of 'abusive drinking' as per the family system,

is considered as- a sign of stress within the family.

Often it is seen

drinking i . a family starts c.s n -'.'bstitute in the absence of usual coping
• intact families j
mechanisms.
The other view with regard to the abusive' drinking/is that it

maintainstno family as a system.

Alcoholism brings stability rather than

disruption tn the interactional behaviour in certain families.
(1954)

Jackson

rep ;rted the following seven stages in the adjustment of the family

to alcoholism.

1. Attempts to deny the problem
2. Attempts to eleminate the problem
3.

Disorganization

4.

Attempts to reorganize inspite of the problem

5.

Efforts to escape the problem

6.

Reorganization of the family

7.

Recovery and reorganization of the whole family.

Parent ch-ld relations in the families of alcoholics Wittman (1’. 39) has given an account bf the parent child relationship.

According to her the alcoholics have oversolicitors mother and a comparatively
.3

3

stern, fobidding father; the later, the person who inspired and awe or fear

and who displayed inconsistant tendencies of severity and indulgence, thus

producing in the child a feeling of insecurity and helpless dependance.

Shiela Daniel also found that alcoholic parents were not consistant in their
actions towards children.

Parental drinking attitudes -

Jackson and Connor (1957) have shown that alcoholics came more frequently
from houses in which one parent drank - usually the father.

With regard to

the families of alcoholism in the Indian set up according to Bhatti (1982)
Channabasavanna & Bhatti (1981) and Channabasavanna and Bhatti (1983) most
of the alcoholics belong to anomic families. According to them majority of the

cases came from the families having unhealthy communications, poor concern and
lack of leadership.

The individual members have their own way of life, style

of interaction and personal convictions which are often idiosyncratic.

They

are highly individualistic and do not bother about other family members.
They hardly have any discussion and no common ways are adopted to achieve the

In extreme cases, except living under common roof the family

family goals.

members have nothing else in common.

These are called the anomic families.

Anomic families contribute heaily for alcoholism and drug addiction.

In such families, the individual self is given the highest importance by

the family as such.

Often in such families regular leader of the family moves

out quite frequently and in his/her absence some other family member accepts the
leadership.

Such acceptance of leadership is always to fill the gao.

Therefore

the leader is quite mild, non-commital, highly indecisive, rarely enters into

any kind of discussion and leaves everything to others; such a leader pretends
to be a broad minded leader.

Also in such families due to the permanent incspn.?j

incapacitation or the death of the actual leader, some member of

is forced to accept the leadership.

confusing in these families.
overadherence.

the family

The patterns of communications are quite

There is always an atmosphere of imposition and

When the leader conveys the messages they are interpreted in

comparison with the way the messages were being conveyed by the original
leader.

At times the messages are quite contradictory.

The messages reflect

more often the covert meaning which remains a guess work for the receiver.

In such families the leader does not posses the role of a leader, still
plays the role of a leader.

The roles are allocated but not accepted.

patterns of reinforcement are usually temporary in nature.

use of negative patterns of reinforcement.

In crisis,

The

Such families make

such families turn

to governmental and voluntary agencies1.

,4

5
Schematic analysis of family system of alcoholics

Type of family

-Anomic type

Type of self

-Individual self

Type of leadership

-Marginal and/or stop-gap
leadership

Type of communication

-Messages without any meaning and
misinterpretation of the messages

Type of role

-Cognitive discrepancy and
discrepancy of role

Tyne of reinforcement

-Through coercion and punishment

Type of social support systen i -Tertiary social support system
Social class and alcoholism

In general survey results indicate that percentage of drinkers increase withal
increasing social status.

On the other hand rates of heavy drinking, heavy

escape drinking and problem drinking among drinkers are highest in lower
status groups.

The middle and lower upoer class might be expected to have high rate of

alcoholism because of the tensions and insecurity brought about by high speed of
living, industrial and commercial activity-and high pressures in life.

The

lower classes would be expected to have high rates because of their supposed

lack of controls on drinking.

One problem that confronts researchers who study

the association between drinking patterns and social class is the matter of
social class criteria.

Sociologists utilise different methoddLogies and criteria

in the stratification area.

The four most frequently used indicators of

social class are income, education, occupation and some combination of these.

4

Cahalan etal (1969) found that heavy escape drinkers had relatively lower j_ncomes,

Ipl.': :

problem

drinking related, to age, sex and urbanization.

Men in all

age groups have a higher frequency of drinking problems than do women.

Cahalan holds that role differences between men and women explain men’s heavier
drinking.

The frequency of drinking problems in the aggregate among men was

found to be highest among those in their twenties, significantly lower among

those in their

thirties and forties, and tapering off among those in their

fifties. The degree of urbanization is related in certain ways to drinking

behaviour,

depending upon two variables - age and socialstatus.

I would like to reitrate that the

Tn conslusion,

research in the field have established

that the etiology of alcohol abuse and aocoholism is multifactorial.

equally, it is proved beyond doubt that the management outcome is always
better when the family of an alcoholic has participated actively in the

treatment programme-well that is the relevance of social factors in alcoholism.

.5

5

:

Refcrences;1.

Bhatti R.S.,

family Therapy in Alcoholism paper presented at
the International Consultation on Christian
Response to the Alcohol and Drug Problem - 1982
Whitefield
(in press)

2.

Cahalan, Don

Problem Drinkers - San Francisco,
Jossey - Bass - 1970.

3. Cahalan, Don, Cisin, Ira,
and Crossley, Helen fl

H,
American Drinking Practices, New Burnswick,
Rustgers Centre of Alcohol Studies - 1969.

N.J.

4. Channabasavanna S .Fl
Bhatti R S .

The families of drugs abusers and their
contribution in the psychosocial tratment of
addicts - oaper presented at the 3rd Conference
of Drug Addicition, 1981, New Delhi

5. Channabasavanna, S
Bhatti R s

Family Thesapy of Alcohol addicts - paper
presented at the 35th Annual Conference of
Psychiatry, 1983, Bowbay (in press)

m

6. Chassel.J

Family Constellation in the etilogy of
essential alcoholism, Psychiatry 1938

7 .' Jackson 3.K

The adjustment of the family to the crisis.of
alcoholism. Quarterly Journal of studies on
Alcohol - 1959.

8. Jackson, Joan K and
Conner, Ralpha

Attitudes of parents of alcoholics, moderate
drinkers, and nondrinkers toward drinking.
Quarterly Journal of studies on Alcohol V-14; December 1953.

9. Knight R

The dynamics and treatment of chronic alcohol
addiction, Bulletin ofthe Flenninger
clinic, 1. 1937.

10. Meeks D.E

Family Therapy in Alcoholism Interdisciplinary
Approaches to an Enduring Problem, Eds. RE,
Tarter, AA, Sngerman, Addison - Wesley
Publishing Company, Massachusetts 1976.

11.

Roebuck J B
Kessler. R G ,

The etiology of Alcoholism Constititional,
Psychological and Sociological Approaches
Charles C Thomas Publisher Springfield Uthois
USA- 1972

12. Shiela Daniel

Impact of Alcoholism on wives and children.
Paper presented at the International
Consultation on Christian Response to the
Alcohol and Drug Problem 1982 - Whitefield
(in oress)

13. Whittman, Mary Phyllis

Developmental Characteristics and Personalities
of Chronie Alcoholics. Journal of Abnormal
and Social Psychology 34. July 1939.

erty of movement, bilateral resting tremor of the feet,
generalized cogwheel rigidity, and a stooped, somewhat
shuffling gait with loss of associated movements. Within
five days all clinical signs of parkinsonism disappeared.
A CT scan showed mild to moderate generalized cere­
bral atrophy. An electroencephalogram (EEG) was normal.
Liver function studies showed minimal elevation of biliru­
bin and serum glutamic-oxaloacetic transaminase (SGOT),
and the patient had mild hepatomegaly. Parkinsonian fea­
tures had been noted on two previous admissions.

Parkinsonism Provoked
by Alcoholism
P. L. Carlen, MD, FRCP(C),’+t§
M. A. Lee, MD, FRCP(C),’t§
M. Jacob, MD, FRCP(C),
t
*
and O. Livshits, MD
t
*

Seven chronic alcoholics, aged 53 to 70, demonstrated
transient signs of parkinsonism provoked by alcohol
withdrawal or chronic severe intoxication. All showed
improvement or recovery when they abstained or de­
creased their alcohol intake for several days to weeks.
Animal studies have demonstrated impaired striatal
dopaminergic function during severe ethanol intoxica­
tion or withdrawal. Chronic alcoholism apparently can
exacerbate or uncover latent central dopaminergic
deficiency.
Carlen PL, Lee MA, Jacob M, Livshits O:
Parkinsonism provoked by alcoholism.
Ann Neurol 9:84 ■S', 1981

Acute alcohol intoxication has been reported to trig­
ger akathisia, dystonia, and cogwheeling in young
adults taking neuroleptics [7], suggesting that alcohol
can impair central dopaminergic mechanisms in hu­
mans. During the past three years we have observed
transient parkinsonism during alcohol withdrawal or
chronic severe alcohol intoxication in seven chronic
alcoholics. Parkinsonism provoked by alcoholism has
not previously been reported.
Patient 1
A 53-year-old man widi a ten-year history of alcohol abuse
(24 beers and several glasses of wine daily) entered the
hospital for alcohol withdrawal. He had been admitted for
alcohol withdrawal two and three years previously and
had had documented alcoholic liver disease for seven years.
One day after admission he was noted to have marked pov-

From the Departments of ’Medicine and tPhysiology, University
of Toronto, the ^Addiction Research Foundation Clinical Insti­
tute, and the SPlayfair Neuroscience Unit, Toronto Western Hos­
pital, Toronto, Ont, Canada.

Received May 1, 1980, and in revised form June 27. Accepted for
publication July 5, 1980.
Address reprint requests to P. L. Carlen, MD, FRCP(C), Univer­
sity of Toronto, 33 Russell St, Toronto, Ont, Canada M5S 251.

Patient 2
A 56-year-old man had drunk 3 to 4 quarts of gin per week
for the past twenty years. A month perior to admission he
had increased his intake to 1 bottle of gin daily. Two weeks
before admission he was noted to have a slow gait and
tremor at rest. His wife, a nurse, related that during two
prior drinking episodes the patient had shown similar signs
of parkinsonism, which resolved with abstinence.
Examination showed an emotionally depressed man with
slowed speech, resting tremor, and cogwheeling rigidity of
the right arm. He had a postural tremor in both arms. His
gait was wide based and he was generally bradykinedc. He
had palmomental and snout reflexes. Three days later, it
was noted that he had no parkinsonian tremor and his cog­
wheel rigidity had decreased. Nine days after admission, no
rigidity was noted and his bradykinedc gait had greatly im­
proved. Investigadons in the hospital showed no biochemi­
cal evidence of liver disease. An EEG showed minimal ab­
normalities.

Patient 3
A 62-year-old woman who had been drinking up to 24
beers daily for twenty years had a one-year history of resting
tremor in the arms which was reportedly increased during
alcohol withdrawal. She was noted to have a shuffling gait,
cogwheel rigidity and resting tremor in the arms, an ex­
pressionless and flat facies, emotional lability, and de­
creased insight into her condition. She was diffusely
bradykinetic.
Four days after this visit, having maintained abstinence,
she was admitted to the hospital with an unsteady, shuffling
gait. Her parkinsonian signs had decreased. She had no
evidence of liver disease. CT scan showed moderate
ventricular and sulcal atrophy, and bilateral basal ganglia
calcification. She was reassessed six weeks later and osten­
sibly had not used alcohol. Signs of parkinsonism were
still present but were further diminished.
Patient 4
A 64-year-old man had drunk heavily for thirty years, in­
cluding a quart of whiskey per day and 24 beers per week
for the previous four months. Admission was prompted by
a seizure. During the first 48 hours in the hospital the pa­
tient experienced withdrawal symptoms, including a pos­
tural tremor that was controlled with chlordiazepoxide. On
the third day after admission he was noted to have a bilat­
eral pill-rolling tremor of the upper extremities with a fre­
quency of 3 to 5 per second. He had masked facies, pos­
itive glabellar tap, cogwheel rigidity of the arms, and

Reprinted from Annals of Neurology, Vol 9. No 1, January 1981. Published by Little. Bn»wn and Company, Boston, MA. Copyright © 1981 by the American Neurological Assoccuion, all nghrs reserved.

84

0364-5134/81/010084-03501.25 © 1980 by the American Neurological Association

bradykinesia. His posture was stooped, and he had a
shuffling gait with loss of arm swing. Gradually over the
next week, all clinical signs of parkinsonism resolved. A CT
scan demonstrated mild to moderate generalized cerebral
atrophy. The EEG showed mild, generalized slowing, and
liver enzymes were modestly elevated.
Six and twelve months previously, during brief periods
of alcohol withdrawal, he had noted a marked tremor which
was quite different from the pill-rolling tremor of the pres­
ent admission. However, he had also noted a slowness and
stiffness of movement during the first days of each with­
drawal episode.

Patient 5
A 66-year-old woman who had averaged 6 to 8 beers per
day since the age of 30 had a long history of tremor (prob­
ably of the postural or benign essential type) which was
decreased with alcohol intake and increased during with­
drawal. For two years prior to admission she had com­
plained of a pill-rolling tremor, particularly in the right
hand, which increased and gradually spread to both arms.
Six months before admission the patient noticed increased
abnormal involuntary movements of the tongue and lips.
There was no history of tranquilizer use.
On admission, two days after her last drink, the patient
was noted to have masked facies and a slowed, stiff gait
without associated arm swinging. Her gait was also ataxic.
The glabellar tap response was positive. She had a coarse
flexion-extension tremor of her fingers, greatest on the
right side, which decreased during voluntary movements.
Cogwheel rigidity was present in both arms. She had con­
stant lip smacking and repeated protrusions of her tongue.
Generalized hyperreflexia was present, but her plantar re­
flexes were flexor. She was disoriented to place and date
and had impaired recent memory. There was no biochemi­
cal evidence of liver disease. CT scan showed marked corti­
cal and generalized cerebral atrophy. Two weeks after ad­
mission the patient was started on Sinemet because of the
signs of parkinsonism. She improved after one week.
Sinemet was discontinued, and four weeks later she had a
normal gait, no rigidity, and almost no lingual-oral dys­
kinesia.
Patient 6
A 70-year-old man had abused alcohol since the age of 18,
particularly in the past ten years. Two years previously he
had been diagnosed as having alcoholic liver disease on the
basis of abnormal liver function studies, mild hepato­
megaly, and an abnormal liver scan. He was admitted with
severe alcohol withdrawal symptoms. His posture was
stooped, and he walked in short, shuffling, unsteady steps
with loss of arm swing. Over three weeks in the hospital his
gait improved but did not return to normal. A second ad­
mission four months later was for severe alcohol with­
drawal symptoms. Nine days after admission, neurological
consultation showed impaired fine motor movements,
bradykinesia, rigidity, stooped posture, and a shuffling gait
with loss of arm swing. A CT scan demonstrated moderate
cerebral atrophy. EEG showed mild generalized slowing.
Over the next two weeks his gait again improved but was

not completely normal. The patient had first noted a
shuffling gait two years previously and had been aware of a
deterioration of gait during previous episodes of alcohol
withdrawal.
Patient 7
For several months a 70-year-old woman had complained
of a progressive shuffling, slowed gait and impaired mem­
ory. Her husband had noted increased bradykinesia after
several drinks, which decreased by the next morning. She
had averaged at least 8 oz of vodka daily for many years.
Examination revealed impairment in orientation, recent
memory, calculation, and general knowledge. She had a
slowed gait with loss of associated swinging of the left arm,
resting tremor of the left arm, and decreased facial expres­
sion. She also demonstrated bilateral postural tremor and
mild intention tremor of the left arm, impaired tandem
gait, and mild proximal muscle weakness. Liver function
tests were normal. CT scan showed moderate diffuse cere­
bral atrophy.
Reexamination three months later, after she had reduced
her alcohol intake, demonstrated no resting tremor, a fluid
gait with associated arm swinging, and more expression to
her face. The signs of dementia and cerebellar dysfunction
had also diminished'.

Discussion
Although alcoholism-induced Parkinson disease has
not to our knowledge been reported previously, this
usually transient syndrome must not be rare. Our pa­
tients were all in the appropriate age range to de­
velop idiopathic Parkinson disease. None were re­
ceiving neuroleptic drugs. Patients 1, 2, and 4 had a
history of two prior parkinsonian episodes before
admission. Patients 2 and 5 had a history of parkinso­
nian tremor, and Patient 6 had shown a mild
shufflling gait one to two years prior to admission
(Table). Patients 1, 3, 4, and 6 developed their par­
kinsonism during the first few days of alcohol with­
drawal, Patients 2, 5, and 7 only during heavy drink­
ing; Patient 3 had both modes of presentation. Pa­
tient 5 also developed a lingual-oral dyskinesia while
drinking. Three patients demonstrated a withdrawal
syndrome along with their parkinsonism.
This syndrome differs from the chronic progres­
sive acquired hepatocerebral degeneration syndrome
described in chronic alcoholics with severe liver dis­
ease and portal-systemic shunting [9]. Most of those
patients have extrapyramidal neurological signs other
than parkinsonism. Although three of our patients
had mildly elevated liver enzymes and two had mod­
erate hepatomegaly, none had other signs of liver
disease and none had a history of hepatic encepha­
lopathy, which was present in 80% of the series of
Victor et al [9].
The effects of ethanol on dopamine metabolism in
the basal ganglia may help to explain the syndrome

Case Report: Carlen et al: Alcohol-induced Parkinsonism

85

Parkinsonism Provoked by Alcoholism

Parkinsonism
Provoked during:
Patient No.,
Age (yr),
and Sex

Alcohol
With­
drawal

Chronic
Intoxi­
cation

Liver
Abnor­
malities

CT Scan

Recovery

1. 53, M
2. 56, M

+
-

+

Mild
None

Atrophy
Not done

Full, 5 days
Almost complete, 2
wk
Partial, 6 wk

3. 62, F

+

+

None

4. 64, M
5. 66, F

+

-

—
+

Mild
None

Atrophy and basal
ganglia calcification
Atrophy
Atrophy

6. 70, M

+

-

Mild

Atrophy

Full, 1 wk
Parkinsonism: full, 6
wk; dyskinesia:
partial, 6 wk
Partial, 7 wk

7. 70, F

—

+

None

Atrophy

Almost complete

we observed. A subhypnotic dose of ethanol reduces
dopamine turnover in the substantia nigra and cau­
date nucleus in rats [1]. Increased striatal dopamine
release is seen in acutely intoxicated rats with
blood alcohol levels under 300 mg/dl; decreased
striatal release occurs with higher blood alcohol
levels [4]. Striatal dopamine release is also reduced
■during the first few days of ethanol withdrawal [4].
In mice, ethanol withdrawal is associated with di­
minished responsiveness of striatal dopamine-sensi­
tive adenylate cyclase activity [8].
These biochemical changes, if present in humans,
could help to explain why four of our seven patients
seemed to develop or greatly augment their signs of
parkinsonism during alcohol withdrawal. The reason
why other patients developed parkinsonism during
prolonged drinking episodes could be related to
higher blood ethanol levels, periods of relative with­
drawal, or other factors. We propose that our pa­
tients had underlying parkinsonian pathology, the
effects of which were intensified by chronic alcohol
intoxication and withdrawal. All the patients im­
proved with maintained abstinence. The six who had
CT scans showed cerebral atrophy, an expected
finding in chronic alcholics [2, 3, 5, 6]. Patient 3 also
had bilateral basal ganglia calcification. These findings
indicate that one should wait a few weeks before
starting antiparkinsonian medication in recently ab­
stinent alcoholics with newly diagnosed mild parkin­
sonism. Alcohol abuse would be expected to be det­
rimental to parkinsonian patients.
References
1. Bacopoulos NG, BhatnagerRK, Van Orden LS III:The effects
of subhypnodc doses of ethanol on regional catecholamine
turnover. Epilepsia 8:1-20, 1967

86

Annals of Neurology

Vol 9

No 1 January 1981

Other
Comments
Two prior episodes
Two prior episodes

Pill-rolling tremor for
1 yr
Two prior episodes
Pill-rolling tremor for
2 yr, lingual-oral
dyskinesia for 6 mo
Two-year history of
mild shuffling gait

2. Carlen PL, Wilkinson DA: Alcoholic brain damage and revers­
ible deficits. Acta Psychiatr Scand (in press)
3. Courville O: The Effects of Alcohol on the Nervous System
of Man. Los Angeles, San Lucas Press, 1966, pp 1-102
4. Darden JH, Hunt WA: Reduction of striatal dopamine release
during an ethanol withdrawal syndrome. J Neurochem
29:1143-1145, 1977
5. Horvath TB: Clinical spectrum and epidemiological features of
alcoholic dementia. In Rankin JB (ed): Alcohol, Drugs and
Brain Damage. Toronto, Alcoholism and Drug Addiction Re­
search Foundation of Ontario, 1975, pp 1-16
6. Lee K, Moller L, Hardt F, Aksel H, Jensen E: Alcohol-induced
brain damage and liver damage in young males. Lancet 2:759761, 1979
7. Lutz EG: Neuroleptic-induced akathisia and dystonia triggered
by alcohol. JAMA 236:2422-2423, 1976
8. Tabakoff B, Hoffman PL: Alterations in receptors controlling
dopamine synthesis after chronic ethanol ingestion. J Neu­
rochem 31:1223-1229, 1978
9. Victor H, Adams RD, Cole M: The acquired (non-Wilsonian)
type of chronic hepatocerebral degeneration. Medicine (Balti­
more) 44:345-396, 1965

io - To - Drags "

Youth is Love
Hope, Beauty & Rhythm

Drugs Bring Dejection
Depression, Despair
and Death I

Let's Get Together
to fight
the Drug Menace

CREST - Centre for Research Education Service and
Training for Family Life Promotion
14 High Street,

Bangalore-560 .005

Bangalore Tur! CM UJ.

"Yes to Life, No to Drugs"

FIXTURES

CREST is actively involved in Preventive Counselling in the
field of Drug Addiction.
Post Box 5038
Race Ceurse Road
Bangalore-560 001.

Telex : 845 2555 HORS IN
Telegram : " HORSES"
Telephone : Off. 72391/2/3
Sec. 71379
19th
20th

Day
Day

21st
22nd
23 rd
24th
25th
26th

Day
Day
Day
Day
Day
Day

27th
18th

Day
Day

Saturday
Saturday

4th
11th

February
February

1989
1989

CHIEF MINISTER'S TROPHY

Saturday
Saturday
Friday
Saturday
Friday
Sunday

18th
25th
10th
11th
17th
19th

February
February
March
March
March
March

1989
1989
1989
1989
1989
1989

March
March

1989
1989

GOVERNOR'S TROPHY
Fridey
Saturday

24th
25th

Preventive Counselling is giving correct and adequate
knowledge of how Drugs act and their harmful effects, develo­
ping positive attitudes needed for a healthy personality which
needs no props eg. Drugs or Alcohol, and encouraging people
especially youth to seek help and advice whenever emotionally
upset or depressed.
We have conducted many Seminars on the subject "Yes to
Life, No to Drugs".

A survey involving 3000 youth in Karnataka was under­
taken and questions on all aspects of life were asked. In the
section of Drugs, we found that 60% youth took Drugs regularly,
and 3% had tried it at least once.

Crest participated in a programme 'Yes to Life, No to
Drugs' over A.I R. which was broadcast every Thursday and
carried on for several weeks. This
programme included
parents, students, educators, journalists and rehabilitated
persons.

BANGALORE ST. LEGER
(The above dates are subject to alteration)

tSendb lt6 ‘'Beat cLOir>heo

to &ebt

We have programmes in colleges which include a questionaire on Drug Addiction followed by a time of discussions, and
we screen a very effective video film "Mannas" which shows
a young student from a good family background succumbing to
this problem due to peer pressure.

We have programmes for Youth groups for various clubs.
Associations etc , where we deal with this major problem of
Drug Addiction.
THANK YOU DONORS

S.

V. Rangaswamy & Co.

Hugh de Nazareth
and Cardoza Clinic Bangalore.

Drug Addiction is very closely related to Smoking and
Alcoholism. Since the latter two are socially acceptable and
addictive, the problem is immense.

SMOKING—NICOTINE— The Man-Made Monster

Cigarettes contain tobacco which has an alkaloid called
nicotine. It is a poison and is used widely as an ingredient in
insecticides. In cigarettes, it is found to act as a stimulant.
Habitual and frequent smoking is harmful to the body.

Besides the poision Nicotine there is Carbon Monoxide
present in a concentration 400 times the amount considered
safe, and hydrogen cyanide 160 times. Cigarette smoke also
contains a radio active compound plutonium 210. (One drop or
70 mgs of nicotine will cause the death of a man in a few
minutes).

1.
4

Narcotics

2. Sedatives

3. Tranquilizers

Stimulants and 5. Hallucinogens.

Medically defined narcotics are drugs which produce
insensibility or stupor due to their depressing effect on the
central nervous system.

Included in this definition are opium, opium derivates
(morphine, codeine, heroin) and synthetic opiates (methadone
and meperidine). All other drugs susceptible to abuse are non­
narcotics.

ALCOHOLISM :

Many of these drugs have important legitimate applica­
tions. Narcotic, Sedatives, tranquilizing and stimulating drugs
are essential to the practice of modern medicine and research.

By pharmacological definition, alcohol is a drug and may be
classified as a sedative, tranquilizer, hypnotic or anaesthetic.
It is the only drug whose-self-induced intoxication is socially
acceptable.

To the abuser, these drugs produce a change in his emo­
tional responses or reactions. The abuser may feel intoxi­
cated, relaxed, happy or detached from a world that is painful.
hostile or unacceptable to him.

Persons with alcoholism are those excessive drinkers
whose dependence upon alcohol has attained such a degree
that it shows a noticeable mental disturbance, or an interfe­
rence with their bodily and mental health, their-inter-personal
relations, and their smooth social functioning, or who show the
early signs of such development.

With repeated use, many drugs cause physical dependence.
This is an adaptation where by the body learns to live with the
drug, tolerates ever-increasing doses and reacts with certain
withdrawal symptoms when deprived of it.

Alcohol is an important and etiologic factor in suicide, auto­
mobile accidents, and injuries and deaths due to violence. The
health problems for which alcohol is responsible are only part of
the total social damage which includes family disorganization,
crime and loss of productivity.

Drugs of abuse and their effects :
Substances with abuse potential range from simple kitchen
spices to highly sophisticated drugs. All these substances
may be divided into 5 categories.

Withdrawal symptoms disappear as the body once again
adjusts to being without the drug or if the drug is re-introduced.
Tolerance represents the body's ability to adapt to the presence
of a foreign substance. Tolerance does not develop for all
drugs or all individuals, but with drugs such as morphine,
addicts have been known to build up great tolerance very
quickly. The abuser is enslaved by his habit of psychic or
psychological dependence present in most cases of drug abuse.
The abuser feels he cannot function normally without the drug.
It helps him to escape from reality from his problems and frus­

trations. The drug seems to provide the answer to everything
including disenchantment and boredom.

3

2

WHY DO PEOPLE TAKE DRUGS—LET'S TALK ABOUT IT

Tranquilizers
Can be used to counteract tension and anxiety without
producing sleep or significantly impairing mental and physical
function. Major tranquilizers are those with anti-psychotic

The following reasons are generally given by addicts
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

Experimentation or curiosity or adventure
Peer pressure—Friends pressing to try
Search for an identity.
Escape from reality and demanding situations
Rebellion-protest against social values
Family disharmony
Boredom, depression
Dependency after medical use
Media Influence
Rock culture, films, hero-worship

Addiction :

activity.

|

Minor tranquilizers are used in the treatment of emotional
disorders characterized by anxiety and tension. Many are used
as muscle relaxants.

Stimulants
These drugs directly stimulate the central nervous system.
Examples are caffeine (coffee, tea, cola etc.) Amphetamine
is also potent. Cocaine is a dangerous stimulant.

Has been defined as a state of periodic or chronic intoxi­
cation produced by the repeated consumption of a drug and
involves tolerance, psychological dependence, physical depen­
dence and an overwhelming compulsion to continue using the
drug with detrimental effects.

Hallucinogens

Habituation :

They have no general clinical medical use but are being
used as drugs of abuse.

Is the condition resulting from repeated consumption, with
some psychological dependence, but no physical dependence
or compulsion.

Distortions of perception, dream images and hallucinations
are characteristic effects of a group of drugs called hallucino­
gens, psychotomimetics, dysteptics or psychedelics. They
include mescaline and LSD. (Lysergicacid Diethylamide)

Marihuana (Cannabis) :
There is no medical use for marihuana.

Drug dependence :

Is a more general, term and is described as a state arising
from repeated administration of a drug on a continuous basis
(e.g. Drug dependence of the morphine or barbiturate type).
Depressants or Sedatives

Include a variety of old . and
common are the barbiturates.
4

new drugs.

The most

Leisure Hours and Drugs

88 percent of student addicts in Madras study in colleges
which have attached hostels.This obviously means that greater
care should be taken by hostel wardens and college authorities
to ensure that the spare time of students is gainfully employed.
Drug addiction is more frequent among those students who
have idle time aud spare money. The survey reveals that 54 per
5

cent of the addicts get more than 15 hours of leisure time per
week and that 30 per cent even have 40 hours of leisure time per
week.

The survey estimates that on an average, students get ,
between 600 to 1000 hours free time very year, not counting i
the two months of vacation. The survey suggests that parents. I.
academic authorities and the government should take note of
this and try to see that this time is more usefully spent, /
perhaps by way of social work or compulsory sports.
J

Withdrawals: When the drug-abuser stops taking drugs,
he goes through a period of severe physical withdrawal
symptoms.

1.

Hallucinations : Hearing sounds and voices and seeing
horrible and nightmarish visions which are not there.
This is due to malfunctioning of his central nervous system.
3. Temperature fluctuation

2.

Vomiting

4.

Continous sweating

5.

Goose-pimples, i.e. cold shivers and jitters,

6.

Body pain and severe pain in the joints.

7.

Constipation

9.

Loss of memory

8.

Sleeplessness
10.

Loss of reasoning powers.

Treatment

Tha treatment consists in hospitalisation and sealing of all
the parts of entry of the drug. This operation is a formidable
task. The drug dependent is cunning, and knows how to
deceive. Invariably he manages to obtain his drug surreptiously
and thus defeats the purpose of treatment. Evidence of the
withdrawal syndrome is an indication that the patient is not
obtaining tbe drug. Unfortunately some drugs do not produce
a withdrawal syndrome. However close observation of the
drug dependent during the withdrawal phase shows him to be
restless, sleepless and suffering from loss of appetite. These

The withdrawal symptoms are covered up, by the admini­
stration of a blanket of tranquilisers and hypnotics. The
general nutrition of the patient requires attention. Vitamins
galore must be the order of the day, as these patients are
generally severely depleted of vitamins and nutrients, as they
usually restrict their food intake while taking a drug which
satisfies them completely.

Role of the family
The real treatment starts after the withdrawal phase, when
psychotherapy individually or in a group aid in rebuilding the
personality of the drug dependent. The family members should
be taken into confidence, for without their aid nothing may be
achieved.
The family members contribute in no small measure
to creating and perpetuating the drug dependence

Inspite of every effort on part of the therapist a bulk of
therapy comes to no avail as mentioned already. Nevertheless
an air of optimism should prevail, and efforts to rehabilitate
the drug dependent should continue. The drug addicts need
constant attention, affection & reassurance. Drug-Abusers are
physically and psychologically dependent on drugs They are sick
people. They need intensive treatment and rehabilitation. When
the drug-abuser hits rock-bottom,i.e , when he has nowhere to
go, when he is on his own resources which are nil and no one is
going to help him anymore and when he realises that he has
reached a point of no return and utterly helpless-that is the
time when he is ready for therapy and rehabilitation. Let us
all unite to stop Drug addiction'.which is threatening our youth’s
progress, their Health & their Happiness.

Let us all say " No to Drugs "

symptoms are enough to prove that he is off his drug.

6

7

CREST
Centre

for Research,

Training for

Education, Service

Familq Life Promotion

and

dedicates

this section to the greatest treasure of India her YOUTH J

Maq u/e the educators and

to our task

of

parents be true

giving them

a

wholesome

healthq and spiritualIq strong formation.

8

CREATING RESPECT FOR LIFE
Report of III National Conference

“Yes To Life”
Presented by Asian Secretariat
“ RESPECT FOR LIFE "
C/o CREST, 14 High Street
Bangalore-560 005

Organizing President :

Prof. Ninan Thomas
Mar Ivanios College

Programme Director

Dr. Marie Mignon Mascarenhas
Asian Secretariat

:

Mother Teresa (seen with me) once invited my
husband & me to join her in addressing a gathering
after which she said •• Let us go around and meet

with people - you speak to the head & i will speak

THIRD National Conference on
“Creating Respect for Life”
"Everytime a child is born it shows
that God still has faith in Man"

to the heart " M. M- Mascarenhas

—Tagore

The III National Conference on 'Creating Respect for Life'
was held in Trivandrum from January 12-15th 1989. Topics &
Workshops & Films & Slides focussed on various topics like
"The Meaning of Life"—"Population Explosion — A Hoax?’,
Human Sexuality & Sex Education, Masculinity & Femininity,
Abortion, Suicide & Euthanasia
Also, the Dangers of Sex
Determination, Female Foeticide & Infanticide & Abortion
Education, its complications & Counselling, women in India &
their problems etc etc,.

100-delegates from 11 states actively, participatied in
this Conference. The Conference was directed by Dr. Marie
Mignon Mascarenhas of the International Federation for the
Right to Life & expert speakers included Dr. John lype, Mrs.
Phyllis Farias, Frs. Abello. Kackanath & Daniel & Mrs. Mary
Zaccariah & Lillian D'Mcrais.
Order & Read the Premier Book on

FAMILY

"FAMILY LIFE & VALUE EDUCATION"

With Chapters on "Changing Family Patterns
Adolescence. Sex Education, Marriage Preparation,
Chemical Escapism, Counselling Mental Health " etc. etc
Pages 285 with Illustrations

From:

CREST,

(Rs. 35/-)

14 HighStreet, Bangalore-560 005

Elections for the new National Association were held & Mr.
Hugh De Nazareth of Eangalore was elected President. The
Secretariat address is "National Association, Respect for Life",
c/o Good Shepherd Provincialate, Museum Road, Rangalore560 025
The Organising President Prof. Ninan Thomas of Mar
Ivanios College was assisted by a team of staff & students.

His Excellency Archbishop Mar Gregorius addre­
ssed the delegates & gave his full encouragement to
improving the quality of life in its fullest form & as
God meant it to be. All the lay people appreciated his
wonderful support and help.

Four Resolutions as follows

were discussed & adopted

unanimously :—

1.

That Human Life from its conception to natural death will

child by

abortion-nor the

old,

the

mentally retarded

or

cancer patients-for each one of them have been created by the
same loving hand of God for greater things-to love and to
be loved-a child of God-my brother, my sister.

be fully respected without discrimination of age, sex,

colour or race.
2.

Seminars be held for Parents, Teachers & Students on
Family Life Education & Human Sexuality are an urgent

This brings you my prayers and wishes, and those of our
sisters and the poor for a very happy Christmas. May the
Christ Child fill you with His peace, love and joy and may the
New Year 1989 be full of God's grace and blessing".

necessity.
3.

4.

Resolved, that because we are aware of the need for
Responsible Parenthood, we strongly oppose the violation
of the most basic right, the 'Right to Life' by the practice
of abortion. Further resolved that we shall encourage
natural means of exercising responsible parenthood.
This National Conference on Respect for Lite strongly con­
demns the practice of giving & accepting dowry as a social
evil which disrespects women.

Anita's Journey into Life a Colouring Educational Book for
children (9-12) was released, as also the Malayalam Booklet
on'Respect for Life'to commemorate 1989, the Internati­
onal Year of the Female Child.

Conference Programme
January 12th :

Inaugural & Keynote Address

PANEL I "THE MEANING OF LIFE" from
Philosophical & Theological Aspects.

Scientific,

FILMS WORKSHOP on'HOW TO CREATE RESPECT FOR
LIFE'
Opening of
LAXMI BAI

Exhibition on

'LIFE' by Princess GOWRI

Evening—Vedio Films will be screened DAILY

January 13th :
Literature 8i details of membership can be obtained
from the National Secretariat. Please help us to help
"LIFE" by becoming a member. Dont wait I
Mother Teresa's Message to the Conference
"I thank you for your kind invitation to attend the III
National Conference on "Creating Respect for Life" in Trivan­
drum from 12th to 15th January. I am sorry to disappoint
you, but it will not be possible for me to attend this confer­
ence as I have some prior engagements. I know you will under­
stand and I wish the Conference every success and blessing.
You know how important "Respect for life." is to me. No one
has the right to destroy or kill or murder-neither the unborn
2

PANEL II .'POPULATION EXPLOSION-HOAX OR REALITY?
from Demographic, Social & Health Aspects
FILMS, WORKSHOP on ' POPULATION ISSUES"

PANEL III "DESTROYING LIFE" from Foeticide-Abortion
infanticide. Suicide & Euthanasia.

WORKSHOP on "ABORTION" NETWORKING
January 14th :

PANEL IV "HUMAN SEXUALITY" from
Psychological, & Celibate Aspects.
3

the Physical.

Creating Respect for the Handicapped—2 Reports South &

EXCERPTS of Papers are printed

North East

(Full text available from Secretariat)

FILMS PANEL V

'■MASCULINITY & FEMININITY"

WORKSHOP on "SEX EDUCATION"

Inaugural :

"The Springtime of Your Life" Slide Show.
The Conference began with an Invocation sung by Miss
Annamary Thomas. Prof. Ninan Thomas the Organising Presi­
dent then welcomed the gathering.

Elections - National,
January 15th :

PANEL V

"WOMEN IN

INDIA",

from social. Religious

& Cultural Aspects.

"LIFE A GIFT TO RESPECT"

Passing of Resolutions Et

Valedictory Function - Conclusion.

The Conference was then inaugurated by the lighting of a
lamp by Father Thomas Kotharathim, Principal of Mar Ivanios
College, who addressed the gathering. The Precious Feet
symbol was then pinned on to the Guests & Prof. Ninan
Thomas.

The Keynote Address was delivered by the Programme
Director, Dr. Marie M. Mascarenhas, Board member of the
International Federation for the Right to Life.
Keynote Address

Creating Respect for Life

"In our Lives only God is UNCHANGING LOVE
AND ETERNAL UFE’'—Usha Gaba, Asha & Ramesh

Parmanand— FRIENDS of CREST.

In 1989, the century of anxiety and tension,
in India
and the world at large the word "respect" like "discipline"
seems to be outdated. We live in an age of great technological
triumphs, and yet even a country like America admits to
malnutrition and increasing deaths due to the diseases of
"civilization" which now includes AIDS.
Man has landed on the moon and yet the hearts of men and

CREST is a voluntary trust dedicated to Family

Life promotion through Research in Youth Prob­
lems Education to all concerned. Counselling and
Training.

Also has excellent Publications.

For Programmes & Publications.write to :
Director, Crest, 14 High Street. Bangalore-560 005.

4

women seem to get harder and more apart for no solution seems
in sight to rising adolescent pregnancy, divorce, loneliness,
mental illness and abortion. Modern culture reflects many
tensions and contradictions. Too often today the vision of
reality is fragmented. At times experience is mediated by
forces over which people have no control. Sometimes there is
not even an awareness of these forces. The temptation grows to
relativize moral principles and to priviledge process over truth.
This has grave consequences for the moral life as well as for the
intellectual life of individuals and of society.
5

Modern culture is marked by pluralism of attitudes, points
of view and insights. The situation rightly requires mutual
understanding. It means that society must respect those who
have a different outlook from their own. But pluralism does
not exist for its own sake. It is directed to the fullness of
truth. The respect for persons which pluralisation
rightly envisions does not justify the view that the
ultimate question about human life and destiny have
no final answers or that all beliefs are of equal value,
provided that none is asserted as absolutely true and
normative. Truth is not served in this way. It is not
true to say or believe that there is no absolute right or wrong
and that we must accept the shades of grey in between. The
ideal may be difficult to reach, but the Truth can never be in
between.
To Love is to move from "death into Life", to Live
is to grow into the stature of the truth, and we must
aspire to grow into that stature.

Prior to 1930, all Christian denominations condemned
artificial contraception. The Church of England at its Lambeth
Conference in 1930 suggested that the use of artificial contra­
ception by married couples might be morally licit in some
difficult situations. Over the next three decades, many
Churches dropped their moral condemnation & some even
suggested that artificial contraception may be a positive good.
By the end of the 1960s, Western society came to believe that
the artificial methods of birth control constituted an outstanding
contribution to modern medicine.

With this evolution of social & religious attitudes, often
referred to as the Contraceptive Mentality, new expressions
entered the public debate, such as "children should be planned",
"every child a wanted child" & a woman's right to control her
own body". The child was now perceived in a new light — a

non-person, an intruder, an inconvenience, a human product,
even as an evil I

6

The acceptance of abortion is the outcome of this change
in attitude so that now both contraception & abortion are widely
held as cultural norms.

"We Indians are in danger of losing our respect for human
life. It is happening step by step. Our attitude to human life
is becoming coarsened and desensitized."
A new attitudinal & behavioural change is occurring so
that a new sexually permissive society is being moulded.
Indeed, sexuality is being promoted as a recreational pastime
a manifestation of the pleasure instinct, an irresistable biolo­
gical drive, a passing love affair without deeper meaning or
commitment. At times it is projected as an experiment in
mutual sharingS caring, what is described as "relational sex".
But it has no roots so that it merely leads to a form of serial
polygamy.
Some of the results of these are seen in increasing :

Divorce : The attitude to male-female relationships does
not foster the deeper meaning & nuances of married love which
underpin the concept of an indissoluble and faithful union. The
liberalization of divorce laws was inevitable in this social
climate.
Infertility: The sexually transmitted diseases & the con­
traceptive practices including abortion are having a devastating
effect on female fertility, a medical problem that opened up
the field of modern reproductive technology. So devastating is
this complication that society now turns a campassionate ear
to the pleas for in vitro fertilization, without coming to grips
with the ethical, social, legal & economic consequences of
such procedures. We are now being invaded by the "new
religion" of Secular Humanism :

1.
2.

which is —

the promotion of abortion;
aggressive birth control programmes;
7

3.
4.

This sacredness of human life is present not only in
sacred texts of various religions, but also in the religious psyche
of the vast majority of the followers of different religions. This
was evident in a survey conducted by Dr. Karkal when an over­
whelming proportion of Hindus—90.34%, Muslims—94.61%,
Christians-94.07%, Sikhs-96.07%, Parsis-87.31% and Jains92.79% opted for standard or even extraordinary medical care in
the case of terminally ill patients.

recreational sex;
the availability of pornographic material;

5.

the legalization of cannabis use;

6.

the legalization of euthanasia;

7.

the liberalization of divorce;

8.

the legalization of homosexual acts.

Science can be used to enhance human freedom but
separated from ethics, man becomes continually exposed
to grave risks. Love for the human person comes from
a vision of man's truth, dignity and incomparable pre­
ciousness. This truth and dignity are eternal and hence
human life is to be perceived as a value in itself, a
value which is not dependent on the usefulness or
comfort or success that accompanies it. That life from
the moment of conception or fertilisation till natural death is
sacred is an old Indian belief. But how gravely has it been
obscured by genetic engineering now under the guise of 'gene­
therapy' ? And the exploitation that goes on under the name
of research ? And that this exploitation takes place in the
poorer people through medical experimentation by doctors, is to
me the gravest form of social injustice.
Medical Research must and should go on, but it must always
be guided by respect for the individual, his/her good, and their
basic right of life. It must never be commercialized or taken
undue advantage of.
Problem areas like the correct interpretation of 'quality of
life’, 'selective breeding', 'female foeticide', amniocentesis
and chorionic villus biopsy', breeding out undesirable characteri­
stics, tissue transplants, 'donor gametes'. In vitro fertilisation
(IVF) embryo transfer, hormonal implants, surrogacy, eugenics
and euthanasia must be confronted and a Christian and Humane
Ethics arrived at.
Alternative technology can be developed for e.g.

Tubal

Ovum Transfer as an alternative to the highly expensive, largely
unsuccessful, and emotionally traumatising, process, of IVF.
8

This is in India the country which gave light to the two
greatest persons of the century—Mahatma Gandhi and Mother
Teresa. And so we must ask ourselves what does the National
Association of Respect for Life aim to do in this Conference
and after it through its Secretariat and its branches or local and
regional chapters? it aims to promote that truth that belief in
our culture which has been hidden and obscured and lies dormant
and needs to be awakened for Man's good and our country's
good, for what is good for individual man can never be bad for
his family and for the country. In the ultimate analysis it is
the people who make their nation and this with God's
help and yours is our stated objectives.

“Teenagers Guide”-an illustrated
book for all Educators and youth
giving them sound values & cor­
rect information for a healthy
personality — (Rs.25)
From CREST.

^.et o c^.elp eack other to

The First Talk of the Conference
was on the Philosophical
Point of View
—by Fr. Lawrence Abello of Calcutta

I want to develop a concept of Respect For Life-that
does not demand religious belief. In other words we should
be able to explain the foundation of respect for life of a human
being, a foundation, that will be understandable by a secular

humanist.
The first consideration regards truth. A truth such as a
square is not a circle is obvious to all-no reasonable person
can disagree with that. This is a truth known by metaphysical
evidence.
The next level of truth is known by physical
evidence, such as the shape of the earth. Here we already
have disagreement. For instance in Calcutta one often sees
the inscription on the walls "the sun revolves around the earth
once a year". The people who write that belong to the "flat
earth society" whose members believe the earth is flat. Here
we must make a distinction-there is every evidence, though
we can never judge another's conscience, that these people are
very sincere and find much fulfillment when they write this
at 2.00 a.m. while I am sleeping. It is not a question judging
another's sincerity or holiness but of judging the truth of their
beliefs, where truth is understood as conformity of onb's
concept's to reality.

Keeping in mind the nature of truth we now address the
issue of Respect for Life. This I shall do very concretely by
the study of 3 cases. (2 are given in this excerpt)

Case 1 :
Ram was hit by a taxi and left handicapped for life. He is
working in a store owned by a rich entrepreneur who has
10

shaved the scale weight to be 800 gms. instead of 1 kg. as
marked. The clients are the very poorest people whose
children are suffering brain damage due to malnutrition. The
owner has told Ram to use this false weight or lose his job
So Ram must steal from the poorest people or see himself, his
wife and 5 children, starve to death. Suppose, as is some­
times the case that the only alternatives are to steal or starve
what should Ram do ? Most audiences will be divided-some
say steal, some starve-My aim is that it is unfair on my part
to ask them for an answer which is guess work and is not the
result of a studied solution. If I were to ask somebody-How
do I go there ? The person cannot answer if I do not know
where I want to go or if I am not going anywhere. So it is
with Life-if we have not examined whether there is a goal or a
destination of one's life (or even if there is a purpose at all)
then how can I know whether stealing or starving is the way
to reach that destination.

In the dilemma of stealing or starving many people would
say the purposes of life is to survive. Now we have postulated
life's purpose and it is obvious that the right way to reach that
purpose is to steal.
However, anyone who would resolve
major questions, such as stealing or starving on the basis of
survival, which includes money, reputation etc., is totally
ignoring any reference to a destiny beyond this life. If such a
person is consistent, which often people are not, that person
should be a materialist or secular humanist who believes that
each individual goes to dust (zero) Then I would ask Ram
whether his life has meaning. His answer that when he dies
he will be happy to have passed on his life to his children and
he is ready to go to dust.

My further question is : Ram have you helped your children
by prolonging their lives if human beings merely go to dust ?"
His aim is that they will pass on lives to his grand children.
However, scientifically and philosophically not to speak of
faith we know his lineage will come to an end with a finite
number of dependants- all of whom go to zero. Ram has not
given me an answer about the meaning of life if we are going
to zero. The only meaning human beings would have is to serve
11

a super power, to develop the universe much as animals and
computers seen human beings.
Case 2 :
Shanthi a 25 year old teacher is from a good family in
Calcutta. She spends her free time and extra salary to
educate and feed the poorer children, who are brain damaged
because of malnutrition both before and after birth. I asked her
why she does that ? Her answer is that she does not believe
in God and does not believe there is a destiny beyond for
human beings. She adds that she does it to help the children
to develop both physically and intellectually inspite of these
mental handicaps. She feels good about doing it and that is
justification enough. My further Question, are you really helping
the children if those children are going to zero ? Why not give
them a painless poison like Warfarin which causes digestion
of ones own blood due to internal haemorrhage and bring about
a most painless death ? Why prolong their lives of alloyed joys
and sufferings but mostly sufferings, if they are going to zero
anyway ? She interjects "How could I kill the children". My
answer is that your beliefs do not square with your behaviour.
You believe people go to nothing and yet you Respect Life.
But you have not answered my questions to show me how you
are helping the children.
Shanthi you remind me of a flat
earther who flies around the world both from East to West and
North to South and returns from his journeys saying the earth
is flat. He has not explained how he can square his beliefs

with his behaviour.
There are millions of children put to death by their parents
through abortion. The most basic reason for this is two fold ;
either ignorance about the fact that the child before birth is
fully a human being with an eternal destiny or the error that a
suffering child is better off dead. People think a suffering
child is better off dead because, once again they reduce a
human being to an animal level. In other words the most basic
cause for the human life in general and abortion in particular is

a spiritual bankruptcy in society.
To study
'proximate causes of abortion we turn to history.
12

the more
In the 5th

century B.C. the Greeks had widespread contraception which
led to a very high abortion rate-so high that the birth rate
went negative. Keep in mind that their birth rate had to be
very high-something like 8 children per couple-due to high
mortality brought
about especially by
epidemics the
Hippocratic oath against abortion was drawn up in 450 B.C.
The Greek population diminished to the extent that the Romans
overran the empire. The Romans went through exactly the
same syndrome. In 130 A D. Soranos of Ephesus, living in
Rome, wrote a work-describing -13 ways the Romans were
practising contraception.

Clearly there is a connection between contraception and
abortion and this connection is confirmed once again by the
Syndrome in modern societies. Every country in today's world
that has contraception invariably has also turned to abortion.
Now what is the philosophic connection-Let us take an
example. Suppose you have somebody that is very overweight,
there is nothing wrong in controlling his weight. Likewise
there is nothing wrong in controlling the number of children,
especially in Today's World in which the Life expectancy has
increased dramatically-due principally to the control of
epidemics. However the fat man should diet to control his
weight
i.e. avoid high calorie foods and choose the low or
non-calorie foods. Instead of dieting, there are people who
have their healthy intestine ' mutilated so that it cannot
assimilate most of the calories. Others control their weight by
taking pills to destroy the excess calories in the system. After
a sumptuous meal the Romans made themselves vomit in order
to eat more. The consequence of these unnatural ways to
control one's weight, involves a deliberate destruction of
God’s Gifts of our bodies and minds. The sexual Act is designed
by God for 2 reasons.

a)

To ensure race preservation

b)

for conjugality i.e. to express the total self gift of love
that husband and wife have made to each other in
marriage. If one destroys deliberately the race-preser­
vation meaning (procreative meaning) by contraception and
also destroys the conjugality meaning because contracep­
tion is an act done to self-then sex becomes only pleasure.
Hence the need to reflect on Life, its true purpose & ulti­
mate destiny.
13

India's Population Problem
A Myth or Reality ?
—Dr. M. M. Mascarenhas
India, the subcontinent with surplus food for 3 years—
Increased Primary School Education by 300%-with the Richest
Human resourses and land and sea wealth, has more than
enough to "'develop'' its people. Mahatma Gandhi said
"There is enough for everyman's need but not for every­

man's greed".
True and authentic development has been prevented by the
Population Control programmes thrust on India by the West by
Funding agencies and International Organisations who have
misled our people.
We do not want "development" if it means "Divorce,
Drugs, Depression and Disillusion which is what the West is
exporting to us." India has been giving her best brains
to the West for their benefit in Medicine, Space Technology
and Education. How has the West repaid us ?
We want to grow into our own cultural heritage imbibing
the best from the world and yet not being swept off our feet
into believing that we are poor, underdeveloped and to be
pitied.

Read how in Gandhiji's country of "non violence"-female
foeticide, Infanticide and crimes against women are increasingShatter your belief that India has a population problem. Read
the full text of the paper by Dr. M.M. Mascarenhas author of
Population Education for Quality of Life (2nd Edition by Oxford
Publishing Co ) and also "Feminism Hijacked down the Slippery
Slope" by Ms. Mary Paul and Dr. M.M. Mascarenhas.

Available from the National Secretariat

*

*

*

‘Destroying Life’
This was an important panel-as it came to the crux of the
Conference. Dr. JOHN lYPE-spoke on 'ABORTION'

He discussed various cases of abortion, and then tackled
the very important question. When dies life begin ? This is
answered by people in various ways. The ultra modern
Theologians say after 14 days, others 3 months but from
science we do know that life begins from the time of concep­
tion or fertilisation. Dr. lype then discussed the different
methods of Abortion and also spoke of the effect of Abortion
on the mother. Through the talk he gave us much food for
thought. To mention a few of his thoughts-A 'union' of the
unborn, 'Once there is no respect for the unborn then there is
no respect for anyone'-'lt is easy to scrape the baby from the
womb but it is not esay to scrape the baby from the mind of
the mother.'
He concluded by ~saying-‘It is not sufficient to make lip
sympathy. Let us Act.'

This was followed by a talk on "Suicide" by Dr. Mercy
Abraham of the Dept, of Psychology University of
Trivandrum. She began by saying that the theme of the
conference is unique. It embodies all of our values and beliefs
What is Suicide 7 Taking away ones life prematurely
at a most inappropriate time. She emphatically said, one
does not have the right to take away one's life.
She discussed the types of suicide-and said that though
there are a number of people who commit suicide & die it is ten
times that number who attempt suicide, and that was difinitely a
cry for help, and it was for us to lend a patient hearing, to be
sensitive to the cry of help, in other words, to listen.

“God always forgives. Man sometimes forgives, Nature never
forgives.”
14

15

percent chance of enabling her to survive. Without surgery
she will die in a few hours. Is such surgery proportionate or
disproportionate? In other words, is the family morally obliged
to request such surgery which would merely prolong the
agony of dying? If the surgery merely prolongs the dying state,
refusing such surgery is to accept our mortal condition and to
allow nature ie. God to take its course ?

— Fr. Lawrence Abello S.J.

Euthanasia is any deliberate act or omission which by
its nature, directly results in the death of a human being.
The person is killed either by interfering with life processes
or by denying essentials which could be assimilated without
medical means. Death of the born person is brought about for
the alleged good of the one killed or of society. Now we
shall explain the terms of the definition.
BY ITS NATURE : The deliberate act of omission is
of such a nature as to cause death. Thus, administering a
normal dose of a sedative is not euthanasia even though it may
accelerate death because a normal dose does not, by its
nature, cause death.

DIRECTLY : the death of the person is the intent of the
lethal action because the person is killed as a means to an end.
If the person is killed by denying essentials like food, drink or
air, the person should have been able to assimilate these
essentials WITHOUT MEDICAL AIDS. The reason for making
this restriction is that withdrawing or not administering essen­
tials that can only be assimilated WITH MEDICAL MEANS
(life suport systems; and which merely prolong the dying state
is not immoral. Wc need not use "exrtaordinary" means to
prolong life.

Withdrawing or administering essentials which can only be
assimilated with’medical means is not always immoral. This
can be illustrated by the following example. Suppose that a
dying man has to be fed every hour with an eye dropper. His
wife, who alone can tend to him, finally is so exhausted that
she fails to feed him for several hours during which period the
the man dies. Since the man could not assimilate essentials
without medical aids, witholding these essentials is not
euthanasia and, in fact it is not immoral in this case as the life
support system (feeding by an eye dropper) was merely pro­
longing the dying state. For instance, a teenager is brought
into the emergency centre of a hospital. She has suffered ex­
tensive brain damage from a car accident. The doctor's prog­
nosis is that very extensive cerebral surgery might have a ten
16

)

One must beware of euphemisms like ' mercy killing" and
"putting to sleep” which those wishing to legalize euthanasia
will use. Likewise, as in the case of abortion, they will
reso t to sophistry by appealing to the hardest cases. Thus
they will pull at heart strings by presenting the case of an
intensely suffering, moaning patient who, before becoming a
"vegetable" expressed the desire "to die with dignity", or
"to be put to sleep" and not merely to be allowed to die. This
is a false compassion based on a completely secular philosophy
of life. True compassion requires that one take into account
the dying person's eternal destiny as the overriding considera­
tion. A good end (alleviating temporal suffering) does not
justify an intrinsically evil means (euthanasia). One may not
play God.

Which is worse ? To blind or to abort the child ? Seen in
terms of the real purpose of life, which is to pilgrimage to­
wards eternal destiny-killing is much worse than blinding.
The blind child can still walk, think, love, be loved and strive
towards fulfilment. The dead child can neither hear, see, walk,
love, be loved or do anything else, to prepare for the life
beyond the right to life, is the foundation of all rights.
I can live without seeing but I certainly cannot see without
living. So abortion is the worst possible crime which is the
reason why any Catholic who is an accomplice in an abortion
is excommunicated.
Once a mother, abandoned by her husband and in tears
about how to feed her children, wanted an abortion. To make
her appreciate what she wanted to do the nurse pointed out to
her that, to save money she "should kill her 12 year old
daughter rather than the youngest one”. After all, by killing
the one in the womb she would save almost nothing for the
next 2 years, whereas the biggest one is costing her the most
to maintain. So, going beyond emotions, one sees how
unreasonable abortion really is.
17

Celibacy as an Expression of

'Human Sexuality”

Sexuality

— Mrs. Phyllis Farias

"Sex is a sacred expression of one's innermost

feelings”

Mrs. Phyllis Farias spoke on "The Need for Sex
Education for Children". She said-Todays youth are bomba­
rded with pornography with the result that the true meaning and
essence of human sexuality is lost. Children are beset with
doubts & anxieties, but do not find the correct door to tap atParents and teachers are themselves inhibited and can not deal
with the topic or at times the facts are distorted. The overall
effect of this distortion cum concealment attitude is to make

the child ignorant, deceitful or timid.
Looking at the consequences of a lack of Sex Education-to
name a few-irresponsible sexual relationships, poor sexual
hygiene, difficulties in conjugal life, sexual preversions, sexual
diseases, and abortion, one is firmly convinced that Sex Educa­
tion is absolutely necessary
But this education would have
to start with the parents, on the help they could give their
child. Problems arise because of a lack never an excess of

— Fr A. Kackanath of Trivandrum

Celibacy comes from the Latin word 'caelebs' which means
’alone' Celibacy in the Christian sense does not mean 'living
alone', or being simply 'unmarried'. It is also distinct from
being a single' person, bachelor or spinster. Celibate person
is unmarried and intends to remain so, bound by a vow or
promise to remain chaste.

How is Celibacy an expression of Sexuality ? We must
see therefore the deepest meaning of sexuality in Christian
understanding. Chastity is of 2 types. Celibate Chastity when
the celibate does not use ’Genitality’ and Conjugal Chastity
when the celebates husband and wife are faithful and loyal
and use gentitality for procreation and to bring love and life
into the world.
Christian Understanding of Sexuality I

Sexual difference has been determined by the Creator and
sexuality is a gift of God.

accurate knowledge about their sexuality.

"Sexuality is not genitality" — "Sex Education is like
It protects youth from the harmful media.

Relationship of man and woman reflects something of
God’s love, in its free giving of itself.

Vaccination"

This talk was followed by a slide programme on Human

Man and woman are to complete each other through
communication with the partner of the opposite sex.

Sexuality.
Mrs. Edith Kharshung and Mrs Mary Dora Blah
of Shillong spoke very feelingly on the deteriorating state
of values in the Youth. "The bow and arrow" symbol of
bravery is used for gambling. Women once venerated are
facing increasing violence

18

In the partnership of man and woman there is no subordi­
nation or superiority.
The total surrender in the sexual act is termed by the
'knowing'. In this interpersonal relationship the partners
reveal themselves in their deepest personal sphere of intimacy.
19

God communicates the power of procreation to man

With the proclamation of the Kingdom of God, the eschectological condition of man is emphasized to such an extent,
that sexuality and its fulfilment in marriage no longer appears
as the only normal way for man in this world. The way of
virginity appears beside it as a genuine possibility.

We also had two very dedicated young people-Mrs.
Shanthi Baliah and Miss Uma Kanagala - from Holy Cross
College-Trichy speak to us on creating "Respect for Handi­
capped People". They said that the problems handicapped
people face are not only those caused by their disability but
also those caused by a hostile world which threatens their very
existence as human beings, and questions their right to life
and happiness

Sexuality in itself includes the most basic urges of man
for Love, Companionship, Mutual support and enjoyment, and
procreation.

Anthropology views man and his sexuality in its entirety.
Sexuality plays an important role in the growth of personality ■
Through the love of the partner, one goes beyond the limit of the
partnership and reaches God. Sexuality grows from 'eras' to
'philia and from 'philia' to agape'. Th'ough total self giving
one receives knowledge and completion. So the aim of Sexuality
enhances the development of the whole person and a celibate
person can and should be wholly sexual.

Ways of creating respect for the handicapped

I.

Using appropriate language when referring to the handicapped
Sensibility to word usage is very important so that individua­
lity and dignity are not lost.

2.

Following an Ecological approach to deviant behaviour — A
person is handicapped by social attitudes.

3.

Treating handicapped people respectfully in mass media.

4.

Through deinstitutionalization—Institutions have become
dumping grounds for the "human rubbish" that society does
not want. These institutions deprive the handicapped indi­
viduals of belongingness to a family, social contact etc.,

PANEL 5 was a continuation of "Human Sexuality" with

emphasis on Masculinity and Femininity.
A young man
from Bangalore-Mr. C.N. Lakshmikanth spoke on Masculi­
nity. He spoke of the conflict a young student faces between
traditional ideas and the attitudes to sex in the West. He spoke
about the true attributes of Masculinity-and the youth's attitudes
to women, and sex. He also spoke from conviction that he
would only follow the Natural Family Planning Method when he
married and would never advocate abortion even in the case of
rape. A real man is never brutal to anyone.

Femininity-Dr. Sr. Pius a Psychiatrist spoke to the
young post graduate students of Mar Ivanios College. Later,
she addressed the gathering-and spoke on Femininity - mainly

from the cases she has dealt with.

5.

Through integrating in regular schools.

6.

Through mainstreaming in vocational centers.

Mrs. Mary Zaccharias of Alleppey and Mrs. Lillian
D'Morais of Cochin dealt feeling with the topic of "Women
of India" Mrs D'Morias spoke from her personal experience
in helping young women with their problem and the destitute in
homes, and was a shining example of what a woman can do.

On all the days-movies were screened and videos shown
after conference hours. Some of the films screened were :
The Beginninig of Human Reproduction life.
Abortion-a woman's decision
The Silent Scream, the Answer etc.

Fr. Rufus Pereira of Bombay dealt powerfully and
beautifully with Youth-their problems and the need for
faith formation. Youth yearn for Love and Faith.

"Educate a man and you educate an individual, educate a
woman and you educate a generation”

20

21

Workshops
Workshops were conducted everyday on different topics.
The following are some of the questions and recommendations.

Workshop - 1 — Creating Respect for Life
1.

2.

What is the most effective means to solve India's popula­
tion ?

3.

Would you advocate family planning to reduce population ?
If so - Why ?
If not - Why ?

4.

Do you really think abortion has brought down the popula­
tion of India ?

What strategies can you plan and use in your locality to

promote respect for life ?
Recommendations :

2.
3.

What role does the media play in craating respect for life?

1.

There is a threat of population explosion but by education
of the people - the so called all problem will look after
itself.

2.

The media, have to play their role for educating the masses
on family size, nutrition, health, etc.

3.

Natural family planning methods should be popularised - as
artificial methods are not safe. Also N.F.P. brings
about a good value system and understanding between
husband and wife.

What are the different ways by which one can support and

help, children and women in trouble ?

4.

How would you create respect for life of the handicapped,

old and infirm ?

Recommendations :
1.

Create an awareness in schools and colleges by conducting
Moral Science Class, seminars, workshops, etc.

2.

Circulate private audio-visual aids like 'The Silent Scream'
to educate and create an awareness.

3.

Every school and college should have Counselling Centersin order to give a helping hand.

4.

The handicapped and old need love and understanding not
pity. They should be taught to use their abilities to the
maximum.

4.

Abortion has not drastically brought down the population -

legalisation of abortion should be condemned as a means
of population control.

Workshop -3 — Abortion and Human Sexuality

Workshop - 2 — Population :

1-

2-

It is sacred'.

Does society give

What role do you think you can play

What are the benefits of educating our children in human

sexuality rather than in contraception ?

Questions :

1.

'Sex is created by God.
sex its due respect?
in this area ?

Is it true that there is a threat of population explosion in
our country ? why and how ?
22

3-

What are the evil effects of pornography films - and books,

°bscene language in the life of people ?

23

4.

Enumerate the effects of abortion on the mother.

5.

In India female foetus abortions are more in number. Do
you think there will be social implications of promoting
one sex at the expense of the other. Will this not result
in a lower respect for women.

Recommendations :

1.

Seminars to be held for Parents first - before speaking to
teenagers.

2.

We should fight against pornographic films and literature by writing letters etc.

3.

Sex Education should be given in schools and colleges with
moral values - it should not be only a biology class.

4.

Teachers
students.

5.

Abortion - has far reaching effects on the mother - women
who go for an abortion should be told facts about how the
abortion is conducted, and its after effects.

6.

Abortion should never be allowed - even in case of rape Abortion is taking away innocent life.

should be motivated

and

trained

to

guide

flank Uou /
To all who helped make this Conference a Success.
To Ms. Phyllis Farias and Ms. Mary Paul for editing the
the texts and organizing the Exhibition.

Become on active Member of the National Asso­
ciation of Respect for Life.
24

Alcoholism

Dr. C . M. Fr anci s
Director
St.Martha's Hosoital
BANGALCRE -560009
Drinking ihas been in existence from time immenorial but it was not
much of a problem. Fermented juices were taken nonast nnallyj the alcohol content
was low. Drunkennes were isolated and socially looked down upon in our counntry.
Today, alcoholism is a major problem in the country. There are at least
3 minion alcoholics in India. It is a problem for the individual (causing
many diseases like cirolosis of liver and being a risk factor for other major
diseases such as heart disease), the family (broken or unhappy families) and
the society (crimes, fights, accidents and loss of productivity). It was because
of the realization that alcoholism is a major problem that prohibition became a
major policy of our Independence movement.

The problem of alcohol abuse is both urban and rural. The Indian Council
of Medical Research study covering a number of urban centres including Bangalore
found that 20% of urban consumers of alcohol are total 1 y dependent on it.
Problem drinking is very high in industries, varying between 5 and 15%.
With the large number of large scale industries in the public and private sectors
in Bangalore, the problem is one of high concern. The economic costs of alcoholism
are very substantial. In the developed countries, the Employees Assistance Programme
for Alcoholism has been introduced successfully. It augurs well that the
managements and trade unions in Bangalore are now seized of the problem.

Who is an alcoholic ?
A person who has become physically, physiologically or psychologically
dependent on alcohol is an alcoholic; There is a compelling urge or craving for
alcohol. The body adapts itself to alcohol. There is tolerance. There is
dependence. Withdrawal produces symptoms which can be severe. Alcoholism is an
illness, manifested by behavioural and clinical disorders. It is generally progressive
but can be arrested.

Factors leading to alcohol abuse
Any type of person can become an alcoholic. Some people are more prone
to become problem drinkers - alcoholic personality ? childhood delinquency ?

2
familial ? genetic ? Certain factors can precipitate alcohol abuse - stress,
loss of job, death of abuse, sudden improvement in income. A pre-existing
psychiatric problem like depression may lead to alcohol abuse.

Alcohol causes aggressive, silly bdiaviour. There is unsteadiness of
gait and slurred speech. Difficulty is experienced in carrying out even simple
tasks. Vision is impaired as also hearing. -Alcohol can cause acute drowsiness;
deep sleep and coma.
Early identification of problem drinkers
It is necessary to identify the "hidden alcoholic". Management is hopefully
much easier at that stage than after the person has become a chronic alcoholic.
There are many indicators available. No single indicator is absolute. But a
composite group of indicators can be useful. Among them are psychological, clinical
and laboratory manifestations.
1.

Psychological
(i)
The first one is a history, including drinking habits - frequencyy and
quantity (how often ? how much?) Usually the person gives a reliable
answer to the frequency but the quantity is often unreliable. Heavy
drinking (about 60 g/day of ethanol) indicates problem drinking.

(ii)

Increased tolerance to alcohol.
to get tlie same effect.

(iii)

Drinking quickly, gulping the first drinks, skipping meals while
drinking.

(iv)

Concern or worry about drinking but unable to step or reduce drinking,
The family also gets worried about the drinking.

(v)

(vi)

Intellectual impairment. To a keen observer who knows the person well,
this may be the .first indicator.
Work impairment is an indicator.

(vii)

Accident prone ,at the workplace and elsewhere

The person needs more and more alcohol

Absence from work
Change in friends, ieeping cbnpany with heavy drinkers

(viii)

(ix)
2.

Clinical
(i)
(ii)
(iii)
(iv)
(v)
(vi)

3.

Hand tremor may be one of the earliest symptoms.
Alcoholic fetor by day
Bausea and vomiting in the morning.
Signs and symptoms of acute or chronic pancreatitis
Hepatomegaly and evidence of impairment of liver functions
Scars on the body (due to accidents and fights).

Laboratory

There are many markers which can point to alcoholism.

(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)

Gamma gluttamyl transpetidase (GGT)
Serum glutamic ozaloaxetic transaminase (SGOT)
" alkaline phosphatase
" glutamic pyruvic transaminase (SGPT)
Mean corpuscular volume (MCV)
Serum high density lipoprotein cholesterol (HDL -C)
Abnormal transferrin
Random blood alcohol level

Chronic alcoholism

Chronic alcoholisn is indicated by
1.1. high/frequent consumption of alcohol
2. withdrawal symptoms; black outs
3. physical vidaice

2.1.
2.
3.

battered children/wife
psychosomatic complaints, depression or anxiety in spouse
divorce/separation

3.1.
2.
3.
4.

impaired work performance
loss of sense of responsibility
absenteeism
prone to accidents

4.1.
2.

liver disease - cirhosis of liver
malnutrition

.. 4 ..

Counselling.

Good counselling can be effective. It must emphasis responsibility;
personal health, work and interp er snel relationships.
Educational material:

Good educational material, appropriate to the level of the person must
be mace available. Good literature must be produced as also audiovisuals.
Relaxation methods can help to allay tension and anxiety and coirtribute to
better treatnentw

Family therapy: Drinkijg behaviour 'night serve as an adaptive function for the
individual or the family. Alcoholism could be a symptom of larger family problems.
Family members can and should provide support to wean away the problem drinker.
There sis also need to help tho family. Counselling of the family members is needed.?

Group therapy
Interaction with others who are also dependent on alcohol can help.
Members of the group share and discuss their problems.
One successful group therapy was through Alcoholic Anonymous, founded
in 1935 ty Bill W, who was an alcoholic (real name: William Giffith Wilson).
It arose iron a long talk for hours with another alcoholic: Dr.Robert Smith. By
talking together and sharing their weaknesses in giving up drinking, the two men
found that the urge to drink passed off. Alcoholics anonymous has grown to at
least a million members throughout the world.

Combining family and groups can be helpful. Multiple couples group therapy
is to be tried. The difficulty is in finding couples and groups coup arable in
age, education, socio-economic status and severity of alcoholism.
ftork therapy is worth trying as part of the total treatment.
Detoxification: During the acute stage, there is need for hospitalization.
If there are complications, they must be treated. Management of the acute alcohol
intoxication and the concomitant withdrawal syndrane will depend on

.. 6 ..

(i) patient's condition
(ii) nutritional status
(iii) severity of alcohol dependence, and
(iv) overs! 1 medical evaluation.

Treatment of complications

The most important and direct morbidity caused by alcohol is cirrhosis
of the liver. Mortality due to cirrhosis in different countries is closely
related to the amount of alcohol consumed, irrespective of th© type of beverage. The
risk factor for development of cirrhosis is given by the product of the average
daily consumption of alcchol multiplied by the period of consumption at that level.
Fatty degeneration of liver and alcoholic hepatitis may be seen.
Pancreatitis (acute and chronic) can be caused by alcohol. Gastritis is another
clinical manifestation. Anaemia and clotting disorde s can occur. Neurological
diseases affecting central and peripheral nervous system may be seen. The heart may
be affected by cardiomyopathy. Vitamin deficiencies may occur.
Pharmacotherapy

Treatment with drugs does not ha.e an important place in the management of
alcoholism. In the initial stages, there may be a pice for anxiolytic drugs and
antidepressants. So also drugs are useful to control withdrawal symptoms.
One drug which is useful is disulfiram (antabuse). It causes an aversion reaction
when alcbhol is tsken. Disculfiram blocks the oxidation of alcohol at the
accetaldelyde stage, raising its ancentration in Hie blood by 5-1o times, and causes
reaction. 125 - 250 mg of the drug is administered per day or once in 3 days, (the
effect often lasts for a week). Taking as little as 7 ml of alcchol can bring about
the reaction. Care should be taken as the side-effects and contra-indications are
many and the reaction can be severe.

Disulfiram action was discovered accidentally, Two Danish scientists took
■the drug themselves to assess its safety as a vermifuge. While on disulfiram, they

M 7 .•
went to a cocktail party with disastrous results.
be useful in preventing alcohol consumption.

They inferred that the drug might

Other drugs like calcium carbamide and metronidazole and other aversion
techniques ere being tried.
Research

Research is needed if we are to solve our problems in the future. "If you do
not think of the future, you cannot have one”. There are many areas of research.
1.

Survey of alcohol use - licit and illicit
- youth; different socio-economic groups
- employed persons
- industries
- extent of alcoholism in the population

2.

Control measures

3.

Preventing alcohol abure
- factors giverning use of alcohol.
Identifying the problem
drinker - development of markers of alcohol consumption

4.

5.

- legal
- educational
- social
-limiting use of alcohol
- limiting problems arcusing out of use of alcohol.
- cause of spread of alcoholism.

Adverse effects of
alodial use - individual
- family
- society
- at the work place

6.

Mechanism of tolerance to alcohol

7.

Drihieing and accidents •» on the roads
- in the factory

.. 8 ..

3

3,

Alcohol ana diseases

9.

Treatment

!0i

Follow-up

- liver
- cardiac
- neurological
- psychiatric
- psychological.
- pharmacological
- individual
•c family
- group
- low cost interventions

- Evaluation of recovery
- Prevention of relapses
- Employee assistance programmes

The International Journal of the Addictions, 16(4), 749-758, 1981

Clinical Note

Phencyclidine Ingestion: Drug Abuse

and Psychosis
Moire S. Jacob,
*
MD, FRCP(C)
Peter L. Carlen, MD, FRCP(C)
Clinical Institute
Addiction Research Foundation;

Department of Medicine
University of Toronto
Toronto, Ontario, Canada M5S 2S1

Joan A. Marshman, PhD
Addiction Research Foundation;

Faculty of Pharmacy
University of Toronto
Toronto, Ontario, Canada M5S 2S1

Edward M. Sellers, MD, PhD, FRCP(C)
Clinical Institute
Addiction Research Foundation;
Departments of Medicine and Pharmacology
University of Toronto
Toronto, Ontario, Canada M5S 2S1

♦To whom requests for reprints should be addressed at Addiction Research Foundation,
33 Russell St., Toronto; Ontario, Canada M5S 2S1.
749

Copyright © 1981 by Marcel Dekker, Inc.

750

JACOB ET AL.

Abstract
Phencyclidine (PCP) is a popular illicit drug often misrepresented as
some other hallucinogenic substance and distributed in widely varying
dosage forms and strengths. Users of hallucinogenic drugs may present
with unintentional PCP overdoses. Toxicological laboratory analyses
are essential to establish the diagnosis. In nine admitted overdose
patients, the consciousness level ranged from alert to comatose on
presentation, and all she wed a prolonged recovery phase with agitation
and toxic psychosis. Sa . ere behavior disorder, paranoid ideation, and
amnesia for the entire period of in-hospital stay are characteristic.
In very high dose patients, shallow respiratory excursions and periods
of apnoea and cyanosis coincided with generalized extensor spasm and
spasm of neck muscles. Excessive bronchial secretions, gross ataxia,
opisthotonic posturing, and grimacing occur. PCP toxic psychosis
should be considered in drug-abusing patients presenting with schizo­
phrenic-like symptoms, psychosis, or other bizarre behavior, whether
or not they admit to taking PCP.

INTRODUCTION
Phencyclidine is a drug better known as PCP, a designation which is derived
from its chemical name l-(l-phenylcyclohexyl)piperidine. It is structurally
related to the clinically useful anaesthetic agent ketamine and was introduced
into clinical trials in the late 1950s as an intravenous anaesthetic with potent
analgesic activity (Greifenstein and DeVault, 1958; Luby et al., 1959; Meyer
et al., 1959). Despite the findings that it was an effective anaesthetic agent for
superficial surgery (Greifenstein and DeVault, 1958), clinical testing was dis­
continued in 1965 because of a high incidence of adverse effects including a
complex spectrum of sensory and cognitive effects characterized by alteration
in body image with feelings of depersonalization, delusional and illusional
experiences, a sense of isolation sometimes associated with intensification of
dependency feelings, disorganization of thought, drowsiness, apathy, and
euphoria. Repetitive motor behavior, anxiety, and depression were encountered
occasionally. The duration of these effects after PCP anaesthesia ranged from
a few hours to 4 d, and patients generally experienced amnesia for events which
occurred after they regained consciousness (Greifenstein and DeVault, 1958).
The effects of an acute dose of PCP have been likened to a sensory deprivation
syndrome (Luby et al., 1959;Meyer et al., 1959).
In 1967 a PCP-containing tablet known as the “PeaCe Pill” appeared in
San Francisco and within a year this drug was widely available in the eastern
United States under the name “hog” (Londgren et al., 1969). Since that time

751

PHENCYCLIDINE INGESTION

it has become a common drug on the illicit market throughout North America,
being found frequently in material alleged to contain some other drug(s) (Baselt
et al., 1972; Brown and Malone, 1973; Marshman and Gibbins, 1970; Schnoll
and Vogel, 1971). The drug is therefore often ingested unintentionally.
During the past 4 years our Emergency Department has seen numerous mild
PCP intoxications. Patients presenting with mild impairment were observed in a
quiet room in the Emergency Department and the “talking down approach” was
very effective in controlling the manifestations of toxic psychosis. Diazepam
(10 mg orally) was used to sedate some patients. The majority of patients were
discharged. The minority of patients who did not respond over a period of 8 h
to the above management were admitted. The nine admitted patients comprising
this report can present (to the unsuspecting physician) a bewildering clinical
picture easily misdiagnosed as a primary psychosis. The clinical characteristics
and course of nine patients admitted for PCP overdose are presented in Tables 1,
2, and 3. PCP was detected qualitatively by gas chromatographic analysis in the
urine and/or blood of all nine patients (Marshman et al., 1976), although only
three patients reported use of this drug.

CASE REPORTS
Patient 2
A 33-year-old male allegedly took tetrahydrocannabinol (THC), 1 g, 2 d
prior to presenting in a catatonic, mute state at another hospital’s Emergency
Department. On examination at the time of transfer to the Clinical Institute, he
was found to be alert with roving eye movements but showed no nystagmus,
normal pupils, decreased response to pain sensation, catatonic rigidity, increased
deep tendon reflexes, and flexor plantar responses. His heart rate was 88/min,
blood pressure was 140/90 mmHg, respiratory rate and temperature were
normal, and he showed excessive salivation. The catatonic mute state lasted 4 h
and was followed by a period characterized by staring into space, making click­
ing noises with his tongue, echolalia, inappropriate monosyllabic answers, and
euphoria. He was confused, disorientated, agitated, and hallucinating; he fre­
quently assumed bizarre postures and showed a short attention span and
profound sleep disturbance. Urine and blood samples on admission were positive
only for PCP. He was given diazepam (10 mg) intravenously, q6h.
By the sixth day he was orientated in time and place and his mental state
had improved significantly. At the end of 9 d in hospital he had completely
recovered and showed no evidence of toxic psychosis. He was amnesic for the
entire period of in-hospital stay. Urine and blood remained positive for PCP

for nine consecutive days.

753

PHENCYCLIDINE INGESTION

Clinical Histories of Nine Cases of Phencyclidine Toxic Psychosis

5
17/M
Amphetamine,
heroin, LSD,
PCP

PCP (6 tablets)

18/F
LSD, THC,
marijuana,
hashish,
mescaline

7
18/M
LSD, ampheta­
mine, heroin,
marijuana,
PCP

Mescaline
(5-7 g)

Cocaine,
THC (31 tablets) THC
amphetamine

9
20/M
18/M
LSD, ampheta­
Marijuana, LSD,
mine, heroin,
mescaline,
opium,
THC
marijuana

bronchial secretions required frequent suctioning. Chlorpromazine (100 mg)
orally, q6h, was given to control his psychotic behavior.
On the fifth day he was depressed and suicidal and over the next 2 to 3 d
he continued to be destructive and irrational. Thereafter, gradual improvement
was noted. By the tenth day his speech was slow and deliberate and although
he was unable to initiate conversation, he was polite and cooperative. On the
twelfth day he had completely recovered, showing no evident psychotic signs
and chlorpromazine was discontinued. He remains amnesic to the entire period
of toxic psychosis.

DISCUSSION
The wide discrepancy between the patients’ description of drugs abused
and his/her actual street drug use is consistent with the findings of various
street drug analysis programs. For example, during the period 1971-1976 PCP
was the drug most commonly encountered in the street drug analysis program
of the Addiction Research Foundation of Ontario. The samples had been volun­
tarily submitted to the Ontario Addiction Research Foundation for qualitative
analysis by people not associated with law enforcement. Approximately 22%
of all drug-containing samples (N = 294) examined by the laboratory contained
PCP; of these, 26% were combinations of PCP with some other drugs, commonly

754

JACOB ET AL.

Table 2

Clinical Manifestations of Nine Cases of Phencyclidine Toxic Psychosis
Patient
Agitation
Confusion and disorientation
Hallucinations
Delusions
Staring into space
Short attention span
Alterations in communicative ability:
Difficulty in verbalizing
Slurred speech
Echolalia
Catatonic mute state
Behavior disorder
Paranoid ideation
Depression
Amnesia for period of psychosis

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LSD. Only 11% of the PCP-containing samples were alleged by the submitting
physician (or patient) to contain PCP; the remainder were described as THC,
mescaline (or peyote), MDA (i.e., methylene-dioxyamphetamine), LSD, psilo­
cybin, cocaine, and less frequently as some other drug or drug combination.
Tablets, powders, and capsules in a wide range of colors were the most fre­
quently encountered dosage forms, and in some cases it was evident that
capsules intended for legitimate pharmaceutical preparations had been diverted
or emptied of their original contents and PCP had been introduced for street
sale. Some of the street drug preparations had the form of yellow brown gummy
materials or crystalline chunks, forms which suggest “illicit” synthesis. Occasion­
ally the drug was encountered in solutions or in admixture with mushroom
material (either decaying or dried) or green leaf material, sometimes marijuana.
Quantiative assays of a random sample of these products revealed PCP contents
ranging from 2.2 to 9.9 mg for tablets and 0.4 to 81.0 mg for capsules.
With widespread availability and the variation in dose level of PCP, it is not
surprising that the recent literature contains several clinical reports of acute
states of intoxication associated with nonmedical ingestion of the drug, involving
not only teenagers and adults (Burns et al., 1975; Eastman and Cohen, 1975;
Kessler et al., 1974; Liden et al., 1975a, 1975b; Lin et al., 1975; Marshman et.
al., 1976; Reed et al., 1972; Reynolds, 1971; Stein, 1973; Tong et al., 1975)
but also young children whose ingestion of the drug was accidental (Burns et al.,
1975; Liden et al., 1975a, 1975b; Lin et al., 1975). Despite the “street” impres­
sion that PCP is a benign recreational chemical, several recent reports of PCPassociated deaths confirm its status as a drug of substantial risk (Burns et al.,

Table 3
Abnormal Physical Signs in Nine Cases of Phencyclidine Overdose

Patient
Level of consciousness on admission
Intermittent apnoea and cyanosis
Excessive bronchial secretions
Blood pressure on admission
Nystagmus
Visual disturbance
Ataxia
Catatonic signs
Neck rigidity
Generalized rigidity and opisthotonic
posturing
Grimacing and trismus
Athetotic movements
Decreased response to pain
Autonomic changes:
Hypersalivation
Lacrimation

1
Drowsy
+

2
Alert

3
Alert
+

4
Alert

5
Alert

6
Coma
+

7
Coma

140/100
+

140/90

140/90

. 130/90

130/90

190/100
+

130/90
+

+
+

+

+

+

+

8
Coma
+
+
150/100

9
Coma

140/90
+
+
+

+
+

+
+

+

+

+

+

+

+
+

+

+
+
+

+

+

+

+

756

JACOB ET AL.

1975; Eastman and Cohen, 1975; Kessler et al., 1974; Lin et al., 1975; Reed
et al., 1972; Reynolds, 1971). The clinical manifestations of PCP toxic psychosis
seen in our patients (Table 2) are consistent with previous reports (Burns et al.,
1975; Liden et al., 1975b; Stein, 1973; Tong et al., 1975). The abnormal physi­
cal findings (Table 3) in all nine cases are typical of intoxication with moderate­
ly high (Patients 1-5) to very high (Patients 6-9) doses of PCP.
When present, coma lasted 4-6 h, and two of these patients had shallow
respirations during the period of coma. Periods of apnoea and cyanosis occurred
which coincided with neck muscle spasms (including laryngeal spasms) and
generalized extensor spasms. Pooling of excessive bronchial secretions inter­
fered with normal ventilation in unconscious patients, but in alert patients
these secretions were easily expectorated and constant spitting was a charac­
teristic feature.
Even in the presence of a normal respiratory rate, PCP overdose patients
must be closely watched in the first 12-18 h for apnoea and cyanosis which
may be associated with localized or generalized muscle spasm. Unless the history
suggests very recent ingestion of a large number of tablets or capsules, gastric
lavage is contraindicated in the alert patient as it may induce laryngeal spasm
and aspiration of emesis. Respiratory acidosis, which occurred in two of the
nine cases, was treated by adequate ventilation and by frequent suction of
excessive secretions. Intubation and ventilatory assistance were not indicated
in any of our cases.
Nystagmus, transient photopsia and blurred vision, gross ataxia, and other
motor system abnormalities (Table 3) observed in these patients were consistent
with previous reports (Burns et al., 1975; Eastman and Cohen, 1975; Liden et
al., 1975a, 1975b; Stein, 1973; Tong et al., 1975). Opisthotonic posturing and
generalized rigidity were present in three patients who were comatose, but
seizures did not occur (cf. Burns et al., 1975; Liden et al., 1975a). Although
opisthotonus has been previously noted in an adult patient (Liden et al., 1975a),
it has been more commonly reported in children (Burns et al., 1975; Liden et
al., 1975a, 1975b). Decreased response to pain was observed in most patients
during the alert state.
Our treatment approach in all patients support the observations that inter­
action with staff causes exacerbation of the drug-induced problems (Stein,
1973; Tong et al., 1975) and that avoiding even minimal stimuli to the patient
lessens severity of the toxic psychosis. Patients uncontrolled by symptomatic
treatment should receive medication. Oral or intravenous diazepam was useful
in reducing agitation and muscle spasm in Patients 2, 4, 6, and 7. Chlorproma­
zine was used in the management of more severely psychotic cases (Patients 5,
8, and 9).
Phencyclidine is a commonly available street drug frequently mislabeled as
some other substance and marketed in a wide range of doses. The staff in

PHENCYCLIDINE INGESTION

Emergency Departments should be trained to consider PCP toxicity in patients
presenting with schizophrenic-like symptoms, delirium, psychosis, or in fact in
a young drug user with any form of bizarre behavior. The slow recovery is
largely the result of slow elimination of PCP (half-life approximately 15 h)
(Marshamn et al., 1976). Toxicological laboratory findings were particularly
valuable in facilitating diagnosis when the patient presented with psychosis
and/or abnormal neurological and systemic manifestations.

ACKNOWLEDGMENTS
We are indebted to Miss Naomi Hunchuck and Miss Cathy Van Der Giessen
for their help in the preparation of this article.

REFERENCES
BASELT, R.C., CASARETT, L.J., and WINN, N.E. Illicit drugs: Chemical identity versus
alleged identity. Drug Forum 1: 263-267,1972.
BROWN, J.K., and MALONE, M.H. Qualitative analytical results of a street drug monitoring
program-A new aspect of toxicology. Proc. West. Pharmacol. Soc. 16: 134-137, 1973.
BURNS, R.S., et al. Phencyclidine-States of acute intoxication and fatalities. West. J.
Med. 123: 345-349, 1975.
EASTMAN, J.W., and COHEN, S.N. Hypertensive crisis and death associated with phency­
clidine poisoning. J. Am. Med. Assoc. 231:1270-1271, 1975.
GREIFENSTEIN, F.E., and De VAULT, M. A study of 1-aryl-cycro-hexyl-amine for
anesthesia. Anesth. Analg. 37: 283-294,1958.
KESSLER, G.F., et al. Phencyclidine and fatal status ep'depticus. N. EngL J. Med. 291:
979,1974.
LIDEN, C.B., LOVEJOY, F.H., and COSTELLO, C.E. Phencyclidine-Nine cases of poison­
ing. J. Am. Med. Assoc. 234: 513-516, 1975a.
LIDEN, C.B., LOVEJOY, F.H., and COSTELLO, C.E. Phencyclidine (Sernylan) poisoning.
Ped. Pharmacol. Therap. 83: 844-845,1975b.
LIN, D.C.K., et al. Quantification of phencyclidine in body fluids by gas chromatography
chemical ionization mass spectrometry and identification of two metabolites. Biomed.
MassSpectrom. 2: 206-214,1975.
LINDGREN, J.E., et al. The chemical identity of “hog”-A new hallucinogen. Am. J.
Pharm. 141: 86-90, 1969.
LUBY, E.D., et al. Study of a new schizophrenomimetic drug—Sernyl. A MA. Arch. Neur.
Psychol. 81: 363-369, 1959.
MARSHMAN, J.A., and GIBBINS, R.J. A note on the composition of illicit drugs. Ont.
Med. Rev. 37: 429-430,441,1970.
MARSHMAN, J.A., RAMSAY, M.P., and SELLERS, E.M. Quantitation of phencyclidine
in biological fluids and application to human overdose. ToxicoL Appl. Pharmacol. 35:
129-136, 1976.
MEYER, J.S., GREIFENSTEIN, F.E., and De VAULT, M. A new drug causing symptoms
of sensory deprivation. Neurological, electroencephalographic and pharmacological
effects of Sernyl. Z Nerv. Ment. Dis. 129: 54-61, 1959.
REED, D., CRAVEY, R.H., and SEDGEWICK, P.R. A fatal case involving phencyclidine.
Bull. Int. Assoc. Forensic Tox. 8: 7, 1972.

758

JACOB ET AL.

REYNOLDS, P.C. Phencyclidine poison. Bull. Int. Assoc. Forensic Tox.7: 12-13,1971.
SCHNOLL, S.H., and VOGEL, W.J. Analysis of “street drugs.” N. Engl. J.Med. 284: 791,
1971.
STEIN, J.I. Phencyclidine induced psychosis. The need to avoid unnecessary sensory influx.
Mil. Med. 138: 590-591,1973.
TONG, T.G., et al. Phencyclidine poisoning. J. Am. Med. Assoc. 234: 512-513, 1975.

6'-I
BArX'00r)St-Ivl^kSR0ad

BA^GAuoaE.5<i0001
ALCOHOLISM & DRUG ADDICTION
- THE CHURCH'S RESPONSIBILITY

(REV. J.D. SOLOMON)

’This paper is a summary of the presentations
made by very competent leaders at the conference on the
above theme held in Madras during 1-3 March 1988, under
the auspices of the CSI Council for Healing Ministry.
The first section, 'church's response' is rather a
statement on the church's understanding of, and attitude
to the problem. The nature of the problem is an
expression of the understanding of what 'alcoholism
and addiction' mean in reality, so that our approach
can also be realistic. The causes indicate the areas
wherein, and levels at which the community must have
preventive and therapeutic involvement. The last
section, 'plan of action' is the recommendations of the
conference for immediate implementation by the dioceses..
The section on treatment is not included in this report.
Though not one and the same, alcoholism and
addiction are used here almost as synonyms.

THE CHURCH'S RESPONSE:
We acknowledge that alcoholism and drug
addiction are assuming alarming proportions affecting
the physical, psychological, socio-economic and
spiritual well-being of the individual. Addiction
destroys not only the individual, but also his/her own
family and the community at various level. The
church recognises the fact that the epidemic spread
of addiction could destroy all progress and cut at the
very root of human welfare.

Having recognised the frightening spread
of the burning problem throughout the world, the church
has the responsibility of combating this devastating
trend.
There is an interplay of various factors
that lead to problem drinking and an industrial
society tends to provide potential situations that
facilitate such an interaction. The sole responsibility
of a person becoming alcoholic may ultimately rest on
the individual himself; but a fuller understanding of
the nature of the problem warrants the recognition of
various socio-economic-cultural forces. Hence the
church's attitude can never be judgmental but more
acceptive, compassionate, constructive and reformative.

1

- 2The church should encourage total abstinence.
We would urge all church leaders, including the laity, to
set an example to the flock in this regard.

From the Biblical point-of-view all of
God's creation is good, but with the possibility of
turning into evil at human hand. Alcohol and drugs
are human products. Up to a degree these human
products can be put to positive use, as in the case
of medicine, for example. But abusive practice brings
in evil. It ultimately distorts the human personality
and destroys the image of God in man and his tremendous
potentialities. Not only the individual, but his
community and society at large also suffer from the
destruction. This is going quite contrary to the will
of a Father who is involved in bringing His Kingdom
here on earth.

A

Hence we urge the church to face the issue
as in a crisis and exercise its Ministry of bringing
life, hope and liberation to the unfortunate victims
and their families. The church must use all its
spiritual resources, as well as medical, psychological
and social-work skills through preventive, therapeutic
rehabilitative actions, thus communicate and witness to
the Abundant Life offered in Jesus Christ. The church
must mobilise all its resources and engage in appropriate
planning, education, prevention and treatment. While
a minimum of competent institutional facilities has to
be developed, our congregations must be equipped for
the larger and wider role of building up a wholesome
society, functioning basically as Healing, Caring and
Prophetic Community and thus participate in the Holy
Spirit with the Father in making His Kingdom a reality.
£
NATURE OF THE PROBLEM:

From indegenous literature and the Bible
(Genesis 9:20 - 21) it is to be understood that excessive
drinking is not anything new or modern. From time immemorial
intoxication was not unknown in almost every rate and
hence it may be said that 'Alcoholism' is an age-old
problem. Yet the alarming proportion in which it is
spreading today, like an epidemic, calls for immediate
actions. It has become a global phenomenon. Behind
almost every murder, crime, burglary, rape and many
physical illness the influence of alcohol is observed.
It is now spreading into all sections of society, even
into the remote villages and different age-groups,
destroying many individuals, families and even community.
Alcoholism leads to the personphysical,emotional
.3/-

- 3 -

socio-economic and spiritual destruction. The growing
number on absenteeism in schools, colleges, factories
and institutions is an indication of the powerful
influence of problem drinking. The percentage of
drug-addicts even among school children is increasing.
The wasting of economic resources on the substance ruins
the whole family and the worst affected are the women
and children of the lower-income group.
•Alcoholism is a suicide
,
*
said Melanie Klein,
as it leads to a total personality destruction. Chronic
cases lead to such psychiatric problems like Delerium,
dementia, paranoia and even psychosis. An alcoholic
lives in a world of sever tension and self-torture.
Loss of self-esteem, feeling of intense torture, sense
of powerlessness and alienation from everyone close to
him lead to a total emotional deprivation.
He is almost
a loner suffering from a sense of self-condemnation and
guilt. Frequent breaking of repeated promises makes him
more and more guilty. Full of anger, hostility and
resentment, he may turn to aggressive attacks or sometimes
drift into a dreadful silence. Employing intellectual
arguments he may want to rationalise his own actions.

’Denial
*
is a very common defence-mechanism
an alcoholic would resort to and that is a safety-valve
from his total mental breakdown. His own actions are
justified and the whole blame is thrown on someone else.
Suspicion (of the spouse) is often presented as an
excuse for excessive drinking.
These actions are usually looked upon by the
society as ’bad
,
*
or’wicked
*
or 'evil
*
behaviour of an
Alcoholic.
In fact, alcoholism is a-disease, expressed
in such symptoms as described above. It is an illness
which has to be treated and can be treated, and
prevented.
It is also to be understood as a health
problem.
Alcoholism is not only a personal but
also familial problem. The family also begins to
loose hope and behave neurotically, but without the
use of alcohol. The whole network of relationship
between the husband and wife, parents and children
and between the siblings is disrupted. The family
suffers from a sense of social ostracism and would
want to contain the total mysery, as far as possible,
within the family itself, upto the breaking point,for
fear of the stigma.

..v-

- 4 THE CAUSES - FACTORS THAT
CONTRIBUTE TO THE DISEASE:

There is no one, single, clearly identified
cause that contribute to the development of problem­
drinking. Living under the same potentially depriving
and frustrating environment, one may end up on alcoholism
while another living under the same situation need not.
So thefcauses are multi-factorial; there is an interplay
of more than one factor, sociological, biological,
psychological and environmental. The problem can be
identified symptom-wise, but prognosis is never clear.
The causes are so complex and often include the
following:

1. Change in the sociological pattern, a fast
changing society amounting to severe
competition and confusion of roles and
conflict of values; restrictive parents
and freedom-loving children; conflicting
parental authority producing confusion and
anxiety among the children; lack of
recreational facility, not only to the
young, and opportunities for creative use
of leisure.
2. Easy availability of substance; increase in
the supply resulting in an increasing demand.
The alluring effect of mass-communication
and advertisement. Transnational companies
competing each other in production,
distribution, and marketing; subtle influence
of drug-pushers; growth of illicit brewing
as a cottage industry; governments finding
it impossible to check on production and
enforce existing law, wanting the support
of big barrel guns.

3.

Genetic factors are seen to play a part
in some instances.
4. Personality factors; alcoholism is an
anti-developmental activity. Non-conforming
personality seems to drift into more easily.

Psychological factors: lack of love,sense
of insecurity, feeling of inadea.uacy,
depression andffrustration; disorganisation
and depression within the family; a
dominant spouse.
6. No particular socio-economic group is more
prone to addiction. The neo-rich seems to
want to imitate those up in the social ladder;
sudden economic growth and possession of power.
5.

..5/-

- 5 -

7.

Certain groups seem to be more vulnerable
to addiction, the last born or first born;
persons with early parental loss; young
or middle-aged; men more than women (8:1
in India, 3:1 in the West).

Findings of a study identifies the following factors
which lead to addiction:

Pleasure
Peer-pressure
Curiosity
Drifting away from God/religion
Imitation of friend or adult
Initiation by a friend, a 'well-wisher'.

Alcohol is an answer, an alcoholic has
found for his pent-up emotional tensions, continuous
deprivation and uncertain future.

Any attempt to counteract the onslaughts
of these influences has to be inclusive and eclectic.
CHURCH'S PLAN OF ACTION:
Intervention;

Approach the alcoholic as a person with an
illness and avoid branding him as a sinner. Reach
out to him as a brother with a health problem; Accept
him as he is. An alcoholic cannot accept himself.
Listen to him patiently and creatively, communicating
forgiveness and hope and be optimistic.
Remember
that time, patience, training and various skills are
needed, along with prayer. Persons involved in
fighting against alcohol and addiction are confronting
a formidable destructive force and hence must build-up
one's own spiritual resources. Intervening in the
life of ar^'alcoholic and his family is a great
privilege, but difficult and responsible. Atmost
respectability has to be maintained.
Interview:

After a few interviews with the alcoholic
by an understanding individual or a small group, he
might express a desire to undergo a treatment process.
Let us remember that motivation cannot be thrust down
on anybody from outside. Sometime it is the inescapable
crisit that one has finally come to that motivates him
to hope for a change. Very often early indentification
and treatment facilitate better results.

..6/-

- 6 -

Treatment;

When he has committed himself to undergo
treatment for modification, he can be guided to a
centre, where total treatment is accepted. The medical
aspect of the treatment called ’Detoxification’ for
a period of 2 - 3 weeks is entirely under professional
hands. It is a time when the family members need
a lot of support.
Recovery & Rehabilitation:
What goes on during this period - the
longer one - is most important. Many experts think
that treatment really starts at this stage. Voluntary
groups, self-help groups, Alcoholic Anonymous are of
tremendous help. Personality and attitudinal change
occurs during this time. The consequences, economic,
social etc., have to be rectified. Gradually his
self-esteem and hope is regained and is now launching
out as though into a new world. His leisure and
new-found energy has to be directed and utilised; he
must be kept engaged. A supportive group can increase
family resources to cope up with the changed situation,
encouraging communication and mutual sharing. Keep
the pastoral|concern to continue even at times of
relapse and failures.

Prevention:
strengthen each family to provide mutual
love and Christian nurture. Help to
build-up the self-esteem of each person,
each child. Keep open the communication
channels, and uphold higher values in
life.
the church is a larger family that should
enrich the functioning of single families,
where family goals are strengthened and
reinforced and family resources supplemented.
Opportunities for expression, entertainment,
mental health and emotional maturity should
be offered in any church. Never become
stagnant, but keep on remodelling. Help
the your to develop resistance to temptations
and will-power to make better choices and
responsible use of freedom.
share the same goals with the Sunday School,
Youth Fellowship, Women’s Fellowship and Men's
Fellowship. Encourage neighbourhood groups,
Koinonia (prayer, Bible study and action) groups;
encourage and enjoy being a therapeutic group.
Increase positive pastime activities such as,

..7/-

- 7 -

play groups, summer camps, excursions, hyking,
hunting, fishing, sports and games, literary
clubs,dinner parties and Bible-study clubs.
-

reach out to the vulnerable group through schools
colleges, Y.M.C.A. and similar organisations.
Prepare and distribute educational literature
on the subject and collect stores of recovering
alcoholics, stories about their conversions and
new-birth.

-

from the local congregation spread to the
district/area and the diocese.

Awareness building:
*

this can be done within and outside the church.
Collect correct information, scientific facts
and figures on alcohol and drugs and their
long-term ill-effects on individuals and
society and desseminate such information.

*

organise study conferences.

*

make use of the Pulpit.

*

make use of the available audio-visual
material. Prepare rnew relevant visual
aids as teaching material; employ drama,
stories and charts.

*

help to change the hostile attitude of the
society and create a healthy one instead;
counteract the subtle massive destructive
profit-oriented advertisement campaign.

*

mobilise public support for promoting proper
laws by the government.

TRAINING:

Recruit volunteers from different professions
and age-groups and train them in,

-

providing necessary skills and attitude
and understanding;
- provide short-term medical training for such
Doctors and Nurses;
- offer short-term counselling courses;

-

develop Biblical perspectives and
spiritual resources;
The Council for Healing Ministry initially
will provide training in all the above areas
with a view to develop 2-3 treatment centres
in each region incorporating hospitals
and congregations.

01'6^6
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30

B J THE LONG RUN

We drank for hap. iness and become unhappy.

we drank for joy and became miserable.
we drank for sociability and became argumentative.

We drank for friendship and made enemies.
we drank for sloop and woke up without sleep.
we drank for strength and felt '..oak.
we drank to fool hotter, and acquired health problems.

lie drank for relaxation and got tho shakes.
we drank for bravery and

became afraid.

we drank for confidence and became doubtful.
We drank to make conversation easier and slurred our speech.

we drank to foci heavenly and ended up feeling like hell.

Vie drank to forget and were forever haunted.
we drank for freedom and became slaves.
we drank to forget problems and saw them multiply.
we drank to cope with life.

AND :I1ERE ARE WE NOW?

31

P A R T - II
ALCO55OL EDUCATION IN A COMMUNITY (SLUM AREA)

CHAPTER. I
INTRODUCTION 8

Alcohol a. use &£■ widespread in slums.
tude and dimensions of tho problem

If tho magni­

of alcohol abuse could b©

assessed, it may be found to be a major public health and

social problem.
blished that

After extensive research it has now been esta­

"addiction is a disease".

it is a very serious

disease because it affects the
- Physical

- tlcntal

- hocJal and
- ...piritual well being
of people who abuse alcohol and become addicts.

There is also

the danger of many young people falling a prey to the ’disease’

due to the environment.

The question before the health education specialists
is

"what can ba done to tackle the problem of alcohol abuse

through education? "

To plan, impionent and evaluate anjX edu­

cational programme on alcohol abuse in a community setting —
that too in a slum area, is a challenging job because of®

32

1.
2.

The very nature and magnitude o£ trie problem.
Hostility one will confront from the vested interests

(it is left to one’s guess on who ar® they?J)
3.

People affected and. interested ask a difficult questions

° vhy can’t you cure th© root cause of the

disease (availability of alcohol) rather
spending your time and energy going on

treating the disease? °
The health workers of wofnen voice (a voluntary association)

working in tho slums of Bangalore identified ’alcohol abuse0
as a major problem affecting income, health and family & social

life of the people.

The women and children were the worst

affected because of alcohol abuse by th© husband/father.

The

workers wanted to tackle this problem on their own but in vain.
Then the women’s voice got in touch with the De^artoent of

Health Education seeking a programme to tackle the problem.
The Department was contemplating on working out an educational

programme for the wor.icn’s voice and give its expertise help.
My Supervisory field Training Placement at NIMHAN5

at this juncture, gave mo an opportunity to work out an educa­

tional programme in a slum area as a pilot project with the

support of the Jo. artment of Health Education and vomen’s Voice

33

ABOUT WOMEN'.J V- ICE
*

Women’s voice was established in the ye >r 1980,
and was registered under the Karnataka societies Registra­
tion Act in the year 1982, with the primary aim o£ working
towards the integrated development of all women, especially

among the poorer women from the slums and the unorganised
sector of work.
The women’s Voice Organises, supports and develop

activities and programmes for the promotion of poorer sections

in general and women in particular in Bangalore City,

The

work has gained momentum, to tho level, that the women of
these sections participate fully in the activities and take

an active leadership in the field of education, health and
employment aspiring to work towards a better tomorrow.
The v,omen’s Voice educates women through cegular

meetings, discussions, seminars, conferences, leadership

training prorrames and also through cultural madia, audio
visual aids t. train and equip literates as wall as illeterat©
women in different aspects of life particularly in the field

of education, corxiunity health, self employment, legal edu­
cation, child c*>re

etc,,

OBJECTIVES

To work out an educational programme on alcohol

to be implemented in slum areas by the .-.omen’s Voice with

tho espertia© ©f th© department of Health Education, mimhass.

■

CHAPTER .11

DIAGNOSTIC PHASE
*
On 24th May 1990, a ra sting was hold at too
women’s Voice Lffice, st.Mark’s Road, bangalore —560 012

with the 11 health workers.

The health workers are women

from the Community (slums) with no or low educational
level.

Their technical knowledge on health is due to the

training given to than

and through orientation by their

health co-ordinator and medical consultant during period!Vsi_

£<K»o2l?fcPN.

cal meetings and field vlsits^^Vhe Organising secretary
of women’s Voice and their Medical Consultant, and Health

Co-ordinator and I participated.
The meeting focussed cn various aspects of the
problem of alcohol abuse such ass
- who drinks?

— why people drink?
- what they drink?
- what are the main occupations & income levels?
— How much is spent on alcohol?

- s hot are the other problems in the £snily?
- i hat too women in the area feel about it?

It was agreed to start in one slum in the first instance .

Ramanna Gardens (slum) was selected for working out an
educational pro xarnmo on alc-hol .

35

I

prepared a Community diagnosis schedule to

collect information from two female health workers of the

aananna Gardens (Ages 35 and

A copy of the sche­

27 ).

dule is given in Annczure.IV.
Un 2Uth f.ay 1990, I made my first visit to Ramanna
Gardens along with my co-trainee.

subsequently, Z made

visits to the slum on a regular basis.
ASOUT RAMAhlHA GAilUJSNU

(SLUM) 5

LOCATION 8

Ramanna Gardens (slum) is situated

6 krao from

IJIMHANS

and 1 km from the Corporation office.

Zt is in

between

J.C.Road, iJew Mission Road and Lalbagh Road.

A spot map is given in Annexure.V
*
HOUSES & SAIIIT^RY C IJhlTIGNSi

There are 264 houses and

tiie population is about 1600.

People live in very insani­

tary conditions.

The so called houses are continuous

without any space in between,

bpace inside the house varies

from 30 sq.ft., to 30 sq.ft..

Houses have a single door

and no windows.

Height of some houses are less than 5 ft.,

The lanes between the houses are narrow and the width varies

from 3 ft., to 5 ft..

HXSTOaX8

The slum is rectaied to be 40 years old.

People

from Tamilnadu, crninly from parts of North Arcot, South
Arcot and Salem Districts who camo for construction work

of Vidhona Soudhu settled here and the slum came into

exis­

tence.

PEOPLEo

in about 25 fami­

Kost of the people apeak Tamil,

lies, they speak Kannada, Telugu and Urdu.

Mai work as

construction workers, headloaders, cartpullers, vendor®,

drivers, painters etc., women (not all women work) work as
construction workers, house servants, vegetable vendors,

flower vendors, Agarbathi makers, etc.,

people ere Harijans.

have a few years of schooling.

level was P.U.C.,
Rs.40/-

to

Majority of the

Most of the people are illsberates or

The maximum educational

The daily income of males vary from

Rs,80/-

according to nature of work.

working women earn anywhere between Rs.10/-

to

The

Rs.40/~

per day.
INSTITUTIONS AMD C;<3ARISATXGNS»

The following arc func­

tioning organisations:

1.

Dalit Harijana -eva sangha

2.

Karnataka *
s
People

3.

Ramanna Gardens People’s Social v&lfara Association
(Youths Assccisticn)

Social welfare Association.

4.

Ono Anganwadi

5.

Christian Children’s Fund Centre

:;r

ALCOHOL ABUSE IN THE SLUM!

Alcohol abuse is drinking that impairs one’s
ability to function.

From the Community health survey it was found that ateewt J'f

about 70 - 80% of the families have an alcohol abuser.
During group discussions with women it was found that
there vjore alcoholic abusers in 1? out of 23 families®

Some women were also alcoholics.

It was also revealed

that invariably 50% of the income of such abusers was spent

on alcoholic drinks (mostly arrack/illicit arrack).

-\

33

CHAPTER. Ill
PLANNING PHASE-.

On studying various factors it was found that

ths >.'.wn°s Voice had the necessary workers already

working in the ccranunity and with the ©srenunity and

Department of Health Education, KIMHANS could train, give

consultancy services etc.,

a on alcohol Education.

Exper­

tise of NIlWUJS combined with the field organisation of
women’s Voice was thought to ba a judicious combination

to implement an Alcohol Education Programme in the alumso
On discussion with the i.ooien’s Voice and in consul­
tation with the Department of Health Education, it was
decided to impart a training programme for the Health

workers of the '.omen’s Voice in order to strengthen them
on ’alcohol education’•

33

CHAPTER .IM
IMPI.BMB0TATXOIJ

Th® following leoaon plan was prepared for the training.
It was discussed with th® Professor and finalised

after

necessary additions#
WESSON
s Alcohol and addiction

2o

TOPIC

2O

trainees

3.

TRAINER (BY iHGM) «D.H.E., Trainee on S.F.T.,

4o

DURATION

a On® hour thirty minutes.

5.

OBJECTIVE

s After the training session, the health
workers will be tell.

(TO
WHOM)

a Health workers of the Wtanen
*o

Voice.

~ Alcohol content in beer, toddy,
arrack. brandy, whisky and rua<>
- Some facts on alcohol like absorption,
detoxification, affects, hangover.

- Addiction and addiction is a disease,
- Throe phases of th© disease.
- Regular oxcersive intake of alcohol
affects physical and mental health.

40

- The disease of addiction requires
medical and psychological treatment.

G, EDUCATIONAL
METHOD.

s Lecture •*

7c EDUCATIONAL
AIDS,

s (i)
(ii)

cxsn —

discussion.

Trsnsporanoies,

Video film

(iii) Poster dasigns.
8. CONTENTS

(a) Introductions

The problem of alcoholism is wide­

spread in the slums®

The individual’s physical

and mental health a his family and society suffer.
There is the danger of youngsters picking up th©
habit bccuas© of the environment.

Sine© addiction

is a disease, it should b® understood properly

as one v.iiich requires medical ©nd psychological
treatment and support from tho family and society.
(b)

Subject Matters

Types of drinks and
alcohol constant®

Dear, Teddy, Arrack, vine,
i-hisi^, Brandy, Susu

8% ,
40%,

Absorption

8% ,
40%,

55%,
40%,

15%,

s Alcohol is directly absorbed
into th® blood-stream through
the walls of the otesaach and
the intoetines. It does not

41

a require digestion. It circulates
throughout the body.
totoxi fication

a Alcohol is a drug that roast be
changed into a non-harraful subs=
tence. 'Ulis vital function
called detoxification is perforated
by tiic liver. Tn© liver changes
alcohol at the rate of one trance
per hour, nothing will speed
up ti-sls rat®. tSien alcohol con=
sumption;/ cstcceds this rate., th©
alcohol overload continues to
circulate impairing brain centres,
intoxication results.

Some Facts

a Alcohol has no nutrients.
It is not a stlmulatot as many
people think. It is a depressant
and siowsdown the activity of the
brain.

Alcohol enters the bleed stream
faster and quicker ifs
(!) the person drinks rapidly
or ’gulps®.
(il) alcohol is mixed with soda
instead of water.

Uli) alcohol is drunk ©a an empty
stomach.

Combining alcohol with common
medicines will lead to adverse
effects.

cw

s

Addiction to alcohol affects badly
-physical and mental health

-occupation

—income
-finally
-society
Drinking and driving is dangerous®

Hangover

8

Iha sick feeling (geadach®, upset
stomach, nausea, unusual thirst)
after drinkingj
-Drinking black coffee or buttermilk

-Pouring cold water cn oae°s head

-Taking raw eggs,

-Rubbing Xewn on one’s head etc®,

will not cvorcosno hangover®

Only

passage of time and rest will give

relief®
Varnish, painty paint remover etc®,
contain i-ksthyl alcohol® It is
poisonous and its consumption will
load to blindness and daath also®
Black cuts

a The addict walks, talks and does
many tilings when he is drinking®

43

a Zoster ho forgota all that ho did
under the influence of alcohol.
Zromediate effects
of drinking.

a Removal of worry ©r tension -Exhl1 oration^ Loss of
Emotional depression -Quarrelsome argumentative -Znco-ordlnation, con­
fusion -vseplng -or Giggly -Drowsy <=
Loss of consciausnesso

•Tolerance

j

The inwcperisnced drinker recaivesla
a more powarful reaction to a given
amount of alcohol than does the
experienced drinker. This process
of adapting, gradually to the pres­
ence of alcohol is called '’developed
*
tolerance
’.

Kithdrax;al

t The addict experiences symptoms like
fits, convulsions etc., whoa he
suddenly stops taking alcohol.

Denial

t then a person takes alcohol excess­
ively several problems arise (There
are clearly visibl® to others)• Yet,
the parson continues to oay that h®
has no problem at all. This is
called denial.

vfl»y?

s Protect themselves from th© feeling
fflf hurst, sad or guilty and also to
continue with drinking.

44

Forms

« (1) dimple denial
(11) Blaming others

(ill) Minimising
(iv) rationalising
(v)

Diverting

(vi)

Initiating fights and quarrels
(becoming aggressive and
hostile)»

Physical ©nd Psychological depen­
dence is addictiono
Addiction is not moral weakness
*

Addiction is not ladk of will power
Addiction is not a crime
Addiction is not a sin.

ADDICTION IS A DISEASE;
And it requires medical and psychological treatment.

.Abstinence is the only method to control addiction
*

Treat­

ment will help in controlling addiction.

The diEsease
1.

Early Phase

of •addiction’ goes through^ 3 phases
*

a increased tolerance
pro-occupation
Avoids any talk about alcohol
Blackouts.

4S

2. Middle Phase

a loses control ©vox quantity,
time and place.
keeps on giving reasons for
drinking.

Grandiose behaviour.

Stops for soma days to prove
he has control but gees back
to excessive drinking.
changes his drink, place of
drinking, time®

3. Chronic Phase

3 keeps stock.

stoal^ lies, borrow or goes
to any extent to buy alcohol.
drinks continuously without
caring £©r any o®o or anything•

experiences withdrawal symptoras
like fits, convulsions etc.,
when he suddenly stops taking
alcohol.
Regular excessive uro of alcohol affects stosnach, in tea-

tines, Brain, -pinalcord, Liver, Pancreas, Lungs, Skin,

Heart, all parts of the boe&a
Gcrrsnunity and fondly could help in early identification^

of the disease,

i'reoztment becomes easier if help is

sought in the early phase.

46

-Addiction is a disease which affects both the addict

and his family.
'-'The addicts faniily takes on various roles to cope with
the situation -roles like protector, controller, blames,

etc., and ends up deeply affected and emotionally baroken.
-Preaching, punishing, bribing, threatening, asking for

promises, emotional appeals, etc., will not work.

—Boforo tiie disease gets worse, the addict and th© family
should go for treatment.

—The family members of the addict need understanding

and help.

During treatment, they get emotional help

and guidance.

As a result, they ar© able to menage

their lives better and support tho addict in his recovery.

9.

8 By asking questions.

BVaLWafilCUl

In respect of educational aids the following were

available in the 'Jopartmente

1.
2.

A video film on drinking and driving (2 minutes duration)

A video film on the successful exporiences of an ex­
alcoholic on treatment (particular part -3 minutes
duration).

3.

Poster designs.

4.

Development of i'ransperancics
It was conceived that the content of the training could

IB

bettor be woven in a story as close to the real life
situation in slums as possible and initiate participa­

tion and discussions on the subject matter and give the

message along \dth the story.

were developed.

For this transperancies

script for developing the transparencies

how the messages are woven in a story are given below.

As most participants are semi or illiterate and

over school ago,formal learning methods were not used.
Stories can bo a medium for learning and information

can be communicated in way that is relevant t© the parti™
cipants life.

ALCOHOL

4- Pe/?4--TH.

Intemperance in the use of alcohol creates many problems in modern
*
society

These problems may be divided into 3 categories - psychologic,

medical i sociologic

The main psychologic problem is why a person drinks excessively, often

with full knowledge that such action will result in physical injury to
himself and irreparable harm to his family.

The medical problem embraces all aspects of alcoholic habituation as well
as the diseases which result from overindulgence from alcohol

The sociologic problem comprises the effects of sustained inebriety on
the family and community.

The various problems caused by excessive drinking cannot be separated from
one another

z

I

fcttu

It requires feaiilae. projection of the imagination to conceive of the havoc
wrought by alcohol

in terms of decreased .^^productivity, accidents,

\ crime, mental and physical disease and disruption of family life.

1971 in the USA an estimated 7 million men and women - 7% ofjadult

population manifested the behavior of alcohol abuse

and alcoholism)
*

Gast're-Jnt estinal Tract - morning nausea and vomiting
— gast fsrit is

- peptic ulcer

- Nailery- Weiss Syndrome(upper GT bleeding)
- alcoholic hepatitis

- cirrhosis
- alcohol intoxication - drunkeness, coma, excitement

(patjplogic intoxication)

ffWatfOLcA HEALTH

XodLu o£

tLc- me^c-4 o-g-^ecZ;
Et.hyA .aXc.Qb£l :-3r <a|^ -Xtt VOAxou-f

-■

1. Gastro Intestinal Tract - High concentrations (rtiore than15%) produce
irritation of the mucous membrane.Cone'above 20% reduces enzymatic
action of gastric and intestinal juices. ZlkLa jus^ju-LLs
njeux-^cro^ ♦ irerTx\li.^Y) i gjg'-S-CSAXVg, po-fXCcc..

,1>> oorlu^

Iks

C|,

2. Central Nervous Systemf^Depresses the CNS in descending order.fS'Removes
inhibition; producing mood surings and uncontrolled emotional outbursts .
bLLeiSaJy"jdo silly and harmless antics, but can become viciouSj^Btl antisocial
or reckless.
Alcohol is incriminated in one out of five crimes of
violence^. BLcocI a.i-c,£>0<_of cusvTcrjuytJtjaJlIicivn
"XKca->^ 2X3"^ *
aruacaXCi-P -<-U.e~h—dXai-Q-S 'Cf—a
r>uu-&-fe
<2-c_oXgL-Q-U-£3-. .
— Alcohol reduces visual ©acurity and interferes with muscular coordination
— hence even moderate drinking is considered dangerous to public and
individual safety — more so if the individual also takes other depressants
like sedatjjofes, tranquiliza®! or analgesics .— Mith increasing quantities

the individual loses all,

SPnse of Proportion‘d.difficulty in speech, unsteadiness of gait and complete
loss of self control are likely to follow
- very large quantities can cause unconsciousness
- Death occurs due to depression of vital medullary centres, mainly the
respiratory centre

°j-e-

4^^

/

SomeCNS effects^probably due to substances(ethyl
*
acetate, isoamyl
alcohol and butanol) ©ther than ethynol present in these beverages.
— In epilept icS.alcohol may cause convulsions

3. Cardio Vascular System — Habitual heavy spirit
*
drinking over taany
years causes direct
injury to the heart muscle causing "alcoholic myocardio­
pathy".

— Even a small amount of alcohol has been shown to depress the myocardial
function in patients with coronary or valvular heart disease - hence
prescription of alchol bo these patients as a "tonic" or "coronary dilator"

is irrational and unwise

(UcoW

y,

A. Liver -^produces a fatty liver , ultimately developing into cirhosis
of the liver due to - i) stimulation of synthesis of fatty acids'by
liver ii) mobilisation of fat from periferal tissues iii) diminished

food intake and deficiency of certain vitamins due to gastritis
-<3>
5,
Has a variable effect on the metabolism of drugs due to effect on the
microsomel enzyme system
6.

7.

8.

Has an erroneous reputation as a sexual stimulant. As Shakespeare
quoted in
’Macbeth
*J
"Lechery, Sir, it provoketh and unprovoketh/ it
provoketh the desire but it taketh away the performance"

Map produce prostatic congestion resulting in acute urinary retention
Large doses damage muscle, causing alcoholic myopathy
Chronic alcoholioal suffer from various dietary deficiencies

— Blood alcohoT concent rat ion’more than 80mg%greatly3.ricreases~th ‘e“fiak'

o-f- driving- accidentsu-vae-cAe^
/0- Chronic alcoholism - repeated infection of alcohol can lead to addiction.
fn addicts, the normal feeling of wall being depends on the continuous
availability of
the drug molecules xmixWwxhM xrcd in the body fluids and
tissues, and there is such an intense craving that the desire to drink
remains the only interest in life. Sudden withdrawal of alcohol may
lead to delirium tremens.
In addition the alcohol addict is liable to
other neuropsychiatric syndromes e.g. Korsakoffs psychosis, hallucinosis,
suicidal tendencies, and Wernickes enceplalopathy.
Generally there are
also nutritional deficiencies e.g. polyneuritis, anaemia, edema.

2

Delirium t_re.irien.3_ — restlessness, insomnia,tremors, hallucinations,
delirium and even convulsiorrC'Rum Fits")

Methyl alcohol - poisoning usually results from ingestion of methylated
*
spirits

or adulterated wines

Symptoms - (due to CNS depression and acidosis)
— headache, ventigo, nausea, severe abdominal pain, dyspnoea,
restlessness

— coma can develop very rapidly, followed by death

- death usually preceded by blindness
- However total blindness could occur with as little as 15 ml of
methyl alcohol, while 70-100 ml is fatal.

MH 0-4.0
COMMUNITY HEALTH CELL
47/1,(First FlooDSt. Marks fioad
3ANGAL0RE-560001

A CLERGYMAN ASKS ABOUT A.A.
Many clergyman are already familiar with the Fellowship

of Alcoholics Anonymous and withthe programme of Twelve Suggested

Steps for recovery from alcoholism.

They know A.A. as a

nonsectarian, nondenominational ally in their own efforts to help
p-oblem drinkers. They know that religious leaders of major

faiths have endorsed the AA program and that clergyman have them­

selves found in AA the answers to personal drinking problems.
Thousands now sober in AA owe their personal recoveries

to spiritual advisors who directed them to a local AA group or
who describes the recovery program from the pulpit or in writings.

Esperience indicates, however, that some clergyman still have only

fragmentary information about AA. Others are totally unfamiliar
with the recovery program and a few appear to have erroneous conc­

epts of the Fellowship and how it functions.
The purpose of this pamphlet,, which reproduces questions about
AA that are frequently asked by clergymanm is twofold.

First, the Society wishes to record its debt to the many members

of the clergy who have been and who continue to be so understanding
and so helpful. Second, it is hoped that the material on the

following pages will provide a useful introduction to AA for those

clergyman who have not yet had occasion to become familiar with
the Fellowship.
Finally, it is suggested that this pamphlet may also be
helpful to AA members by helping them interpret to interested

clergyman the Fellowship's unique accumulation of personal

experience in the recovery of alcoholics.

Historical Note
What was later to become known as the Fellowship of Alcoholic

Anonymous came into being in Akron, Ohio in 1935. It was founded
by two men publicly identified only as Bill W., a former New York
..2/

2)

stock broker, gnd Dr.Bob S., an Akron Surgeon. Both had long

histories of irresponsible drinking and had been eegarded as
'hopeless1 alcoholics.

.

,

In the fall of 1934' Bill., hospitalised for alcoholism,
experienced a sudden spiritual 'awakening' that seemed to free
him of the desire to drink. He tried to persuade other alcoholics
that they could experience the same transformation, but none
recovered.

z

The following spring, in Akron, after the collapse of a

business venture, Bill was seriously tempted to drink again.

Fearful of the inevitable consequences of taking 'the first

drink' Bill recalled that he had had no desire for liquor during
thepreceding months while he had been working with alcoholics in
New York. In desperation, he sought a similar contact in Akron.
A series of telephone calls, of which the first was to an

understanding and cooperative clergyman, led to Dr.Bob. The latter

impressed by Bill's recovery story.and by the opportunity to share
his own problem with an admitted alcoholic,achieves sobriety
shortly thereafter.
More important, the two men discovered that their own

sobriety was strenghened when they offered to share it with others
stressing their own practical experience as recovered alcoholics .

By the fall of 1935 a small group of sober alcoholics was meeting
regularly in Akron.
Bill returned to the East where a number o‘f other groups
soon were formed. Dr.Bob, remaining in Akron, continued to be a

bulwark of the new movement until his death in 1950.
The young society remained nameless until 1939 when the

book' 'alcoholics anonymous' recorded the recovery experience of
about 100 members, most of them in Akron, Cleveland, New York and

Philadelphia. Rapid growth began in the- Nineteen-forties when
the recovery programme first attracted

widespread attention in

the United States and Canada snd in a few countries overseas. An
international service office was established in New York city in

this period to handle the growing volume of inquiries about the

recovery programme and to assist the new groups that were forming
daily.
Today the movement has an estimated 4,00,000 members a

majority of them are affiliated with over 14,000 local groups in
....3/

3

more than 90 countries around the world. It is believed that

women comprise at least one-fourth of the membership.
1.

What is Alcoholics Anonymous?

Perhaps the best brief description of AA is contained in
the two paragraphs definition that is read at many group
meetings;

'Alcoholic's Anonymous is a fellowship of men and women who

. share their experience, strength and hope with each other
that they may solve their common problem and
recover from alcoholism.

help others to

The only requirement for membership is a desire to stop
drinking. There are no dues or fees for AA membership; we

are self-supporting through our own contributions. AA is
not allied with any sect, denomination, politics, organisa­

tion, or institution; does not wish to engage in any contro­
versy, neither endorses nor opposes any causes. Our primary

purpose is to stay sober and help other alcoholics to achieve
sobriety'.

2.

Why should a clergyman be interested in AA?
Because AA members may be able to help a clergyman to help
another alcoholic and because many alcoholics look to their

clergyman for guidance both before and after becoming int­
erested in AA.

3.

How can AA help?
AA can help in only one way, by making available to the
clergyman the practical experience t5f alcoholics who have

learned to live without alcohol in any form. AA cannot usu­
ally help in situations where an alcoholic does not want help

or feels that he can stop drinking without outside help. The
best a clergyman can do in such cases is to let the alcoholic
know that help is available when the alcoholic is ready to

admit that he needs and wants it.
Many clergyamn ask AA members to meet with alcoholics to

describe the AA recovery program.

4.

How do alcoholics attain sobriety in AA?
AA members follow to the best of their ability a program
...4/

4
of Twelve suggested Steps. In these steps the first members

recorded the principles and practices through which they had

attained sobriety.

The Steps, which include elements found

in the spiritual teaching of many faiths, are suggested only; they
are not mandatory.Their acceptance by alcoholics is undoubtedly
due to the fact that they are not theoretical or dogmatic in tone;
they simply state the actual experience of men and' women who have

been able to solve their own problem of alcoholism.

Members are also encouraged to attend meetings, at which
they can share their experience with each other and with newcomers,

and to study the AA program as it is described and interpreted
in AA literature.

5.

What are the twelve suggested steps of AA?

These are the steps through which an estimated 400,000 men

and women have achieved sobriety in the fellowship of

Alcoholics Anonymous:
1.

We admitted we were powerless over alcohol

that our

lives had become urmanageable.

2.

Came to believe that a Power grreaterthan ourselves

3.

Made a decision to tumour will and our Ivies over to

4.

Made a searching and fearless moral inventory of

5.

Admitted to God, to ourselves, and to another human being

6.

Were entirely ready to havd God remove all these

7.

Humble asked Him to remove our shortcomings.

could restore us to sanity

the care of God, as we understood Him.

ourselves.
the exact nature of our. wrongs.

defects of character.
8.

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

9.

Made direct amends to such people wherever possible

10.

Continued to take personal inventory and-

except when to do-so would injure them or others.
when we

were wrong, promptly admitted it.

11.

Sought through prayer and meditation to improve our
eonscious sontact with God as we understood Him, praying
only for knowledge of His will for us and the power

to carry that out.

5/

12.

- 5 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.

6.

Is AA a Temperance Society?

No, The Fellowship takes no position on the so-called
temperance,question. Collectively, its members neither 'app­

rove' nor disapprove the use of alcohol by others. They have

simply learned from experience that theycannot handle alcohol

themselves. Recognising this face, they concentrate on
staying sober themselves and on helping other alcoholism
who express interest in the AA recovery program.

(As

individuals, not speaking for the Fellowship as a whole,

members are, ofcourse free to express personal view points

on the temperance question). >
7.

Is AA a Religious Society?

’

No. AA is not a religious society or movement in the

denominational sense although the recovery program includes
suggestions that reflect the insights of many spiritual

leaders. AA memberdhip includes men and women of a variety

of faiths, some who had no formal faith where they first
turned to the Fellowship and some who continue to profess

not to have any.

Members frequently describe AA as a

'spiritual' program.

They do not mean that it is in anyway sectarian or denonim-

ational.

8.

Is AA an Evangelical Movement?

No, not in any sense of the term. The Fellowship does
not actively recruit adherents to a formal body of beliefs

and the 'message' which it promulgates is of direct interest
only to those concerned with the problem of alcoholism.

9.

Boes AA regard alcoholism as a sin?

As aFellowship, AA is committed to no theological concept of
alcoholism. AA members may be said to be more concerned with

coping with the problem of alcoholism than defining it.

Within thesociety, there is, ofcourse, complete freedom for
the individual to express his own view points on this question
..6/

-

b

-

Most members regard alcoholism as an illness that cannot be

cured but can be arrested by alcoholics who honestly

attempt to practice the Twelve Suggested Steps in all their
affairs.
10.

What part do meetings play in the AA program?
AA meetings evolved naturally out of the early members'

desire to share their experience and problems with each
other and with new comers who sought a path to sobriety.

In time two basic types of meetings developed:

'Open1

meetings for alcoholics and (in seme areas) anyone int­
erested in the problem of alcoholism, and 'closed' meetings

for alcoholics only.
A typical program at an open meeting will have a chairman,

or leader, and two or three speakers who review their own
experience as 'practicing' alcoholics and who may describe

what their AA sobriety has meant to them. Simple refresh­

ments and coffee are usually served after the programmed
part of the meeting and most members linger for a period

of informal visiting.
Non-alcoholics attending an AA meeting for the first
time are often surprised to note the gaiety and levity
with which members describe their drinking experience.

Some personal stories may be recounted in rather informal

language, and there may be a distinctly non religious tone
to an occasional talk. Others may be characterised by
impressive expressions of spirituality and personal

religious beliefs.
The important thing to remember is that each speaker speaks
only for himself and not for AA as a movement.What all
AA speakers have in common, however, is the desire to

strengthen their own sobriety by sharing it with others.
Most members believe that regular attendance at meetings

is essential to the maintenance of sobriety. New comers

are encouraged to attend one or more meetings a week.
Closed meetings, for alcoholics only, give members an

opportunity to share their experience more intimately and
perhaps give special help and encouragement to members who

are having difficulty adjusting to a life without alcohol.

..7/

7

11.

Are clergyman welcome at AA meetings?

Clergymen are most welcome, at Aa public meetings and
^in come areas) at 'open1 meetings. Local groups will
gladly advise on the local custom.

'Closed' meetings are

traditionally limited to alcoholics.
12.

Does AA have a formal creed?

No. AA members are not asked to accept any formal creed
or statement of beliefs beyond the admission that they
have a drinking problem and want help.

Members are free to interpret the AA recovery program,

as expressed in the Twelve Suggested Steps, in any manner
they choose.

The unifying belief of the membership might be said to
be the faith that a recovered alcoholic, by sharing his or

her experience, can be uniquely effective in helping

other problem drinkers. AA members do not believe that they
have the only answer to the complex problem of alcoholism,
but most would probably agree that the answer they have

found is the only one that seems to work for them.

13.

Does AA have basic literature?

There are four basic texts describing the AA program

of recovery from alcoholism and the international Fellow­
ship based on this program:

1.

"Alcoholics Zmonymous", also known as "The Big Book"
describes the principles through which the first members

achieved sobriety and contains personal histories of

36 recovered alcoholics.
2.

"Twelve Steps and' Twelve Traditions" by Bill W., the

surviving co-founder of the movement, consists of inter­

pretive essays on the Steps for personal recovery and on
the Traditions recommended to assure survival of AA groups.

3.

"Alcoholics Anonymous comes of Age" by aill W., is an

informal history of the Society's first two decades.
4.

"The AA Way of Life" by Bill W., is a collection of .

meditative selections by AA's co-founder.
14.

Do Mt. members recognise the authority of a supreme being?
When an alcoholic turns to AA for help, he is not asked

about his personal religious beliefs. He is asked only:

...8/

8
'Do you want to stop drinking?.?

An affirmative answer to

this question is the only requirement for membership

Reliance upon a Higher Power is, however, central to
the success of most men.

and women who have achieved sob­

riety in AA. To many members, this Higher Power is a
personal God, to whom they turn for help in achieving and
maintaining . sobriety.
Early in the development of AA it was recognised that
many alcoholics are not prepared to accept the concept of

a personal Deity when they come to the Fellowship for help.
Accordingly, the first members told these newcomers, in
effects

'We have learned from experience that we need the

help of a Power greater than ourselves if we are to stay

sober- We believe

all men, if they are honest, will

recognise their lack of pwber to solve certain problems

on their own. We know, for example that when we were
drinking we had become powerless over alcohol, and that
we relied.upon it to solve our problems. We suggest that

you find a substitute for this destructive power, alcohol

and turn to a Higher Power, regardless of the name by which
you may identify that Power. We suggest that you turn your
will and your .life over to God, as you understand Him".
Some clergymen may be shocked to learn that an agnostic

or atheist may join the Fellowship, or to hear anAA member
say:

'I cant accept that 'God concept'; I put my faith

in the AA

group; that's my Higher Power and it keeps me

sober'.
The answer, if any is required, is that the spiritual

perceptions of most members deepen the longer they are in
AA and attempt to follow the Twelve Suggested Steps. Many

who have approached AA as professed agnostics or atheists
have turned ior returned), with strong faith born of a
personal experience of Divine guidance, to the established

communions.
15.

What do members mean by the 'Spiritual Side' of
AA Program?.

Most members use this phrase to describe what they bel­

ieve are the spiritual implications of the Twelve Sugg­
ested Steps. When they first come to Aa, many alcoholics
...9/

9

find that they are able to achieve sobriety even though they

may have distinct reservations about the need to rely upon

a personal Deity for help. These members apparently become sober
sober through a combination of factors - admission that they

are alcoholics and need help, the benefits of 'group therapy'

the personal interest of older members etc., that do not
include surrender of personal will to a Higher Power.
Others find that sobriety is attained more easily and sustai­
ned more serenely if they re-orient their lives spiritually

from the beginning, with speial reference to the spiritual

'disciples' suggested in the Twelve Steps. These members

believe that the so-called 'spiritual side' of the AA program

is the most helpful factor contributing to their rehabilita­
tion.
16.

What is meant by "the Group Conscience" in AA?

In matters affecting them‘as members of a local group,
or of AA as a Fellowship, most of AA's believe that they can
find their most reliable guidance in a wisdom that transaends

personal or factional desires and judgements.
■ They believe that this wisdom materialises when they still
their own voices, seek only what is good for AA and for

still-suffering alcoholics, and rely upon the will of a

Higher Power.

17.

How is Prayer used in the AA .Program?
There are two specific references to prayer in the

Twleve Suggested Steps, as recorded by the founders of the
movement.

The Seventh Step reads;

'(We) humble asked Him to remove our shortcomings".
And the Eleventh Stop notes;

"(We) 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 and the power to carry
that out".
At most AA meetings, all in attendance are invited to close

the gathering by reciting the Lord's Prayer. Participation,

ofcourse, is voluntary.

...10/

10

Many members

find spiritual strength in the following

lines which in recent years have come to be known as ‘the
AA Prayer1 :

God grant me the serenity to accept the things
I cannot change,
The courage to change the things I can,
And the wisdom to know the difference".

This prayer is also recited at AA meetings in seme areas.
18.

Why do AA members insist on personal anonymity at the

public level?
There are two reasons. One is quite*
practical; the other
might be termed spiritual.

The practical reason is that many alcoholics might hesitate

to approach AA for help if they did not have assurance that

their anonymity would be protected.

The second reason has been expressed in the Twlefth of the
Traditions which reflect AA's experience as a movement:
And finally, we of Alcoholics Anonymous believe that the

principle of anonymity has an immense spiritual significance
It reminds us that we are to place principles before personaliti
ities; that we are actually to practice a genuine humility.

This to the end that our great blessings may never speil

us; that we shall forever live in thankful contemplation
of Him who pxxis presides overfall.
In actual practice, most of AA members do not mind if their
friends learn that they have achieved sobriety within the

Fellowship, Traditionally, all AA's are careful to respect
fellow members! anonymity.

19.

May Agnostics or Atheists become members of AA?
AA does not inquire into an alcoholic's religious beliefs- or

lack of them - when he turns to the

Fellowship for help.

Some alcoholics profess to he agnostics or atheists when
they join AA. Although no formal inquiry has ever been made on

this subject, letters and reports reaching AA's General

Service Office suggest that many of these members eventually

affilitate with an establishment communion.
20.

Does AA sponsor spiritual "Retreats"?

No.

In some areas individuals ®ho are members of AA may

arrange retreats for alcoholics who wish to discuss or

mediate on spiritual problems. It is however incorrect to
identify or publicize these or similar ventures as AA affairs.

21.

Are some AA groups limited to members of a single faith?

As a Fellowship, AA welcomes alcoholics of all faiths and
"

whose who pfofess no faith. Locally, ofcourse, each AA group
is autonomous in all matters not affecting the welfare of the

society as a whole. Although no information on the religious
composition of local groups has ever been sought by the
General Service office, it is possible that all members of some

some groups may be members of the same faith. Such groups would not

would not be considered typical of "traditional" AA.,however

It is also understandable that, in groups where various
faiths are represented, alcoholics who share the same comm­

union may be drawn together outside AA for religious exercises

distinctive to their faith.
So long as they do not jeopardize the integrity of the Twelve

Steps recovery program, these groupings would not be consid­
ered to violate AA tradition. In this connection, it ma y be

noted that AA groups are frequently formed for young pe ople

for 'beginners in AA1 or for members who share common p_rof—

essional or business interests.
22.

How is AA organised? Who runs it?
AA has always attempted to keep formal organisation to a

minimum. There §re no rules or regulations in the Fellowship
no government in the

usual sense of the term and no hierarchy

of officers.

12/

12 -

Traditionally, any two or more alcoholics meeting together
for purposes of sobriety may consider themselves an AA group,

provided that, as a group, they are self-supporting and have
no outside affilitation.

Local groups generally select committees to handl? essential
group activities and services.Group representatives parti­

cipate in the work of area committees Which are concerned with
with problems of interest to a number'of groups. In North

America, delegates from 80 odd AA areas meet annually to rssxesw

review the movement's world service activities and

problems. Similar meetings are developing overseas.
No one 'runs' the movement and no individual speaks for the
movement at any level of its sdrvice program

Custodial responsibility for supervising AA's movement
wide service agencies has been entrusted by the groups to

a General Service Board.of Trustees which meets quarterly.
The board is made up of AA members and non-alcoholic

friehds of the Fellowship.

In the words of A. A's Second Traditions
'For our group purpose there is but one ultimate authority
a loving God as He may express Himself in our group conscience'
23.

How are AA's activitied and service financed?
AA is entirely self-supporting. It is a-well established

AA.Tradition that funds are not,under any circumstances, acc­

epted from outside sources.
There are no dues or fees in AA Expenses of a local group tox

(rent of meeting quarters, refreshments,literature etc.)
are defrayed by voluntary contributions, usually are group
meetings.
Most groups also contribute to the support of area.wide

activities (sponsorship of services to alcoholics in prisons
and hospitals, for example) and to the support of the move­
ment's General Service Office in New York. This Office

provides a number of services world-wide that local AA units
are not in a position to offer. The General Service Office also
derives a portion of its income fran sale of Conferenceapproved literature to the groups. A substantial amount

of literature is also distributed throughout the world
without charge each year.

..13/

-

13

-

Individual members may, if they wish, contribute directly
to the support of AA's world services (Such an individual
gift may not exceed $ 200 in any year ) .

24.

What afe the Twelve Sfctjapx Traditions' of ZxA?
Over the years, by a process of trial and error, the

Fellowship learned that the survival of effective groups was

linked closely to the observance of certain basic principles.

These principles related to the conduct of

group's internal

affairs, relations between groups and relations with the

outside world.
These twelve principles, or Traditions,many of which reflect

the spritiupl orientation of the movement, were first reduced
to writing, as AA entered its second decade. Later, at the
Fellowship's first international gathering in 1950, they
were accepted by the members as 'guides' to assure the sur­
vival of the Society's service structure.

The Traditions are not formally binding on the groups.

Members in some areas occasionally (and usually temporarily)
deviate from them.But the overwhelming majority of AA groups

throughout the world today pxfjsx prefer to conduct their
affairs and their relations with the general public in the
traditional AA manner.

25.

Does AA support Church Programs in the field of alcoholism?

Since its founding, AA has taken the position that the
Fellowship has only one thing to offer; the personal exper­
ience of recovered alcoholics, to be shared (flreely with other
men and women who seek release from the compulsion to drink.

Accordingly, although it cooperates with many agencies con­

cerned with the problem of alcoholism, AA has traditionally
avoided direct involvement in other programs in the field
AA undertakes no formal research, for example, but makes

information on its own recovery program available to all who

seek it. AA sponsors no educational programs but answers
many inquiries on AA from educators.
AA traditionally has never beenidentified or associated with

private or .tax-supported proposals, programs, propaganda
or public fund raising in any area of alcoholism prevention
or control

.14/

14

Individual members are, ofcourse, free to make their

per - ■

sonal experience as recovered alcoholics available wherever

it can be useful, An increasing number of members are active
in progrrams sponsored by non AA agencies. It cannot be
stressed too strongly that they participate in these prog­

rams as individuals, not as members, or representatives, of

?,lcoholics Anonymous.
26.

Are any clergymen members of AA?

Yes. Zilcoholism is no respecter of persons, whatever their
position, profession or vocation in life may be. A number
of alcoholic clergymen representing various faiths have

achieved sobriety in AA and participate actively in the

Fellowship's programe. There are a few groups composed .•

exclusively of clergymen.
27.

How

,

may a clergyman cooperate effectively with ZiA?

There are several ways; by becoming familiar withAA's

suggested recovery program through attendance at open
meetings and through reading movement literature, by

recognising the spiritual (though non denominational)
aspects of this program, by calling on /AA for help while

appreciating the limitations of the work of AA members in
the field of alcoholism, and by being patient with the human
failings of individual members.
One clergymen who has worked with many problem drinkers

believes that it is essential to be acquainted personally
with active AA members in the community; thus when AA help
is desired, an alcoholic can quickly be placed in the care

of a member who will take special interest in the newcomer
and help the latter to 'get a good' start' toward recovery

in AA. Another clergyman stresses the importance of coun­
selling with the family of an alcoholic after the latter
joins AA.

Because the sobriety of an AA member is strengthened

when he has an opportunity to work with other alcoholics
a clergyman indirectly helps aS whenever he calls upon a

member to share that sobriety with another alcoholic.

15/

15
23.

•

How mo■

an interested clergyman establish contact with AA?

In man^ areas

an AA .listing appears in the local telephone

directory. A- call to the number listed will normally produce
a prompt response to any inquiry. Doctors,law-enforcement

officials, newspaper editors or reports and welfare officials
may alsobe.able to provide information on AA locally.

Literature .on. the AA program

and specific directions for

getting in., touch with a local group may also be obtained by

writing -to the General Service Office of AA P 0 Box 459
Grand Central Post Office, New York N Y 20017. Both the
General Service Office and local AZi. members will be happy

to work with clergyman who may be interested in seeing new
AA groups formed in their communities.

29.

What can a clergyman tell an alcoholic who expresses interest

in AA?

Clergyman who have worked closely with AA would undoubtedly
agree that the following points deserve emphasis:

First, try to impress upon the alcoholic that AA can'
probably help him only if he is sincere in his desire to stop
drinking. Going to AA simply to please his spiritual adviser

his wife or his employer may not be adequate motivation, to
enable him to achieve sobriety in.Z-xA.

Second, urge the alcoholic to keep an open rpind on AA
if the recovery program does not appear to make sense to him

the first time he is exposed to it. He may change his first
impression of ZiZ-i if he will continue to attend meetings
over a reasonable period.

Third, stress that AA has just one primary prop purpose
to help the problem drinker to -fcttain and maintain sobriety
through sharing the personal experience of recovered

alcoholics.

Fourth, remind the alcoholic that AA membership literally
embraces a cross section of society. The newcomer will meet

all types of people in AA from all backgrounds and walks of
life. Whatever their difference, whether the newcomer is

attracted to all of them or not,, let him remember that they

share' his problem - alcoholism and are doing something const­
ructive to solve that problcip.
..16/

16
Fifth, assure the alcoholic that, in line with AA tradition-.
his personal anonymity

will be respected and that his

problem will not be disclosed outside the Fellowship without
his consent.
Finally, the alcoholic should understand thatm according

to the best available medical evidence, he can never hope
to drink normally again. He has two alternatives; progressive
deterioration if he continues to drink, or a new and promising

way of life if he will stop using alcohol in any form. In
AA he will find literally thousands of men and women who

will help him hake the transition to this new life by sharing

their experience with him.

|

A Closing Note Although it is not a religious society, alcoholics
Anonymous is deeply indebted to the clergymen of many faiths who

have befriended the Fellowship since its founding more than a
generation ago.
The heart of that friendship has been understanding and

tolerance - understanding of AA's capacities and limitations as a
Fellowship, tolerance of the failings of a society of fallible

men and women whose spiritual aspirations are higher than their
human abilities.

It would be unrealistic to assume that all AA members are
spiritually inspired. Many are not committed to a formal body of

religious doctrine, But all AA members - including those of no
communion-can bear personal witness to the transforming power of

faith, to the unlimited possibility of redeeming the human condition
however lowly, through an infusion of human love, brotherly care and
non human spiritual Power

As it has been so often inth

in the future continue to be the

the past AA hopes that it can

helpful ally of all clergyman

who share a concern for the condition of the alcoholic who would
take the first step toward freedom from alcohol.

4^
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■

CHILDREN OF ALCOHOLICS

Alcoholism is a family disease which affects not only the

alcoholic, but also each and every member -of the family living

with him. It affects the children with the same intensity with
which it does the spouse, or even more. Adults can- choose
their spouses; so also they have the option to leave them.

Children have neither the choicd nor the mobility to enter

into or exit from the parent-child relationship. While' the
|

spouse feels trapped • the child is really trapped. The spouse
is emotionally helpless, whereas the .child is emotionally
and situationally helpless.
When does-, a child lose his childhood? - When‘he lives with an

alcoholic parent. To others, he looks like any other child,
dresses like any other child, and walks about like any other
child until they get close enough to notice that edge of

sadness in his eyes, or the worried look on his brow.
He behaves like a child'' - but he is not really enjoying; he

just drags along. He does not have the same spontaneity which
the other kids have. But nobody really notices it. Even if
they do, they probably do not understand.

The fact remains that he never feels like a child. He has
never known what a child feels like. Any normal child is an

innocent, beautiful delicate being - bubbling with energy,
offering and receiving love easily; mischieyious, playful,

1

doing work for approval or for reward/ but always doing as

little as necessary. The most important fact is that he is
always care free.

In contrast, the child of an alcoholic is not a care free

little one - he is often a withdrawn child who never gives
trouble to anybody. He hides himself in a corner. Though he

does not really want to be hiding, he always instinctively

hides in a shell, hoping to be noticed sometimes or the other.
But he is powerless to do anything about it.

Children in families with alcoholism syndrome are generally
igm-fed because all attention is directed either towards the

alcoholic parent or towards his alcoholism. The self-centered,
uncooperative, destructive behaviour of the alcoholic collects
in totality all that the child longs for - attention. At the

Same time, the child learns not to rock the boat, not to
develop any desires or needs, not to make demands. These chil­
dren lose their identity - as a matter of fact, they never

had an opportunity to form one. They are subject to situational
reinforcement and are always trying to please people.

Children of alcoholics as a group, have a higher incidence of
emotional problems like anxiety, stress and depression. They

also have lots of school problems - difficulty in concentra­
tion, conduct problems, and truancy. They experience all

sorts of adjustmental problems.

2

In addition to emotional and adjustmental problems, severe

medical disorders have also been associated with the children
of alcoholics - Fetal Alcohol Syndrome, Hyper Active Child
Syndrome and a Predisposition to Alcoholism.

'The Fetal Alcohol Syndrome'1 is a disorder that sometimes
occurs in babies born to alcoholic mothers. It-results in

physical malformation and intellectual impairment of the
baby.

'The Hyper Active Child Syndrome' becomes noticeable when
the child is about three years old. It is characterised by

inattention, lack of concentration, impulsivity and hyper
active behaviour. These children can easily be distracted, and

as a result they experience all sorts of problems at school.

Children of alcoholics show
*

an increased predisposition to

abuse of alcohol or other drugs when they enter adulthood.
PROBLEMS FACED BY THE -CHILDREN OF ALCOHOLICS s

Lack of Role-Models
No child is born with standards for evaluating behaviour,
social skills or moral values. They learn from what they see.
In an alcoholic family, they see nothing but guilt, justifi­
cation, denial, aggression and repetitive negative behaviour.

The child has no other experience except possibly being scol­
ded or getting beaten. There is no yard stick to define any

situation.

3

The alcoholic father is sometimes very loving and warm. He
displays everything that one expects a father tc be — caring,

interested, promising all the things, that the child wants.

The child feels that he is being loved.
But at other times, the same father is entirely different.
Those are the moments when he is drunk. He does not come at

all; the child waits- and is worried. When he comes home, he
picks up a big fight, and the child is scared. The child
does not know what to do. He is uncertain of what is going tc
happen next, and he feels desperate. The father has forgotten

11 the premises he made. The child feels strange.

The behaviour of the father teaches the child that anger means
violence and that violence and love go together; the child

has no opportunity to learn that only tenderness and love go

together. If the child rejects violence as a coping mechanism,
he is not able ‘to find anything to replace it with. He has

not learnt any other method to handle anger and he has rejected

the only means he has learnt. So there is a gap in the child's
behaviour. This gap inevitably gets filled by passivity and

helplessness.

Lying:.
Children of alcoholics lie when it would .be just as easy to
tell the truth.

<

I

4

Lying is basic to the family system,. affected by alcohol-ism. It .

starts as a denial of unpleasant realities, cover-ups, broken .

promises and inconsistencies.
Spouses of alcoholics live, with lies and ultimately start
telling them.- They lie to cover up’ alcoholism and protect the

dignity of the' family. Their lying' is goal oriented and begins1

with the intention to do good. Lying becomes an adaptive res­
ponse. The child hears lots of promises frdrti his alcoholic
father. All these turn out to.be lies. Therefore the child

learns-that it is-alright totteli

. ,

lies. It will make.his life,

much more comfortable. The value of truth totally loses its
meaning.

If they are confronted with truth, they become genuinely con­
fused, both by the disapproval and by the concept of truth.

Their lying'does ndt lead to any guilt because they really see
nothing wrong with lies. In fact, they are more likely to feel
guilty telling the truth’ if that truth affects someone impor­

tant to them. The paradoxical message'creates • nly a confusion

and not a' desire for honesty.
Denial;

Denial takes various shapes - denial of problems leads to.
denial of the feelings produced by those problems.
Honesty, when applied ill traumatic situations, will often cause

discomfort and uproar. Therefore these children learn to

5

minimise , discount and rationalise for fear of the consequen­
ces, which are likely to follow if they speak the truth. Often

when the child speaks the truth, he is told that what he sees

and reports are not accurate.

"Your father is not drunk. Your father is only
depressed. He is sick due to viral fever."

The parental rationalising and discounting serve as a perfect
role model for the child to begin his own rationalising,

discounting and denial process.
ti

The suppression of anger is used to avoid a fight; the supp­

ression of hopes to avoid disappointment; the suppression of
i
'■
affection to avoid rejection.

Loss of self-esteem;
This child does not feel worthy. It has a very low self-esteem.
In order to measure self-esteem, one needs the sense of *
.
'self

This child, unfortunately does not even have one. He determines
what he is <by the inputs of the significant' people around him.

These are normally negative feed backs

and he internalises

these messages. Sometimes the child gets double messages, one

contradicting the other. He does not know which part is true *

so he sometimes picks up one part and sometimes the other.

No matter what the child does, it is not good enough. There is
always somebody to■find fault. The child is unable to believe

6

that he is capable of doing anything right, no matter how hard

he tries. In short, he feels totally incapable, unworthy and
low.
Depression:
It is a depression arising out of 'deprivation'. Parental

attention is never focused on the child. It is always focused
elsewhere. There is actually nobody with whom the child can

share his problems. Even the non-alcoholic mother is often

not available or too exhausted and depressed to interact with
him. The child suffers alone. He learns that when he has a

need, there will be nobody for him.

Not only is there the absence of someone to share his problems
which is very vital-to a healthy childhood development, but

also there is extreme anxiety caused when he undertakes a task
which requires skill, knowledge and experience much beyond
his ability. These children develop pseudo-maturity that covers

the unmet but undiminished needs of childhood.
The enormity.of.both the task and its results, the inability to

change things, and the inescapability of the situation are the

causes for. chronic depression. This depression inevitably leads
to feelings of helplessness, self-pity, self-hatred, isolation

and incompetence.

7

Fear:
The children of alcoholics are often treated with the same
cool formality and distance with which adults treat each other.

There are no cuddles and hugs and the child learns to regard
physical warmth with suspicion while simulatenously it craves

for it. Beneath the mask of self control, is a lonely, frigh­
tened child, hungry for caring, warmth and love.

Unable to cope with the enormous problems surrounding them

and their family, they are forced to take up certain roles
which are either thrust on them, or assumed by them voluntarily.

*Children raised in■dysfunctional homes/typically play one or
more roles within the- family structure. These roles may be

identified as The Responsible Child, The Adjuster, The Placatpr and The Acting Out Child, with the adoption of each role,

there are invariably negative consequences - Most people easily
recognise the strengths of the first three roles, but fail to

look at the deficits of each role.
Let us analyse how these children are thrust into adult roles.
* This classification of roles has been made by Claudia Black
who has been responsible for family programming in 25 alcoho­
lism - treatment centres, in the U.S.A. She has done extensive
research on the children raised in dysfunctional families,
and is a world - wide lecturer and trainer, on the subject of
'Children of Alcoholics'.

8

Responsible child •
The responsible child generally takes over the responsibility

of the parents. This child provides stability to the family
and makes life easier for the parents by looking after the
other siblings.

This child is very organised and goal-oriented. He is an ;dapt
at planning and manipulating others to get things accomplished.

He always ensures that others allow him to be in a leadership
position. He is often independent and self-reliant, capable
of achievements and accomplishments. But because these accom­
plishments are made not out of choice, but out of a necessity

to survive, there is usually a price paid for this 'early

maturity1.

For example, the child acts as a parent, takes on household

responsibilities and takes care of the younger children. This
child cooks and feeds the younger ones in the family and even

looks after the father, when he comes back home drunk.

i
To an outsider, this child will seem to be a
child. But the truth of the matter is, they '

■ do not see

the whole picture. These children nurture and help the adults
(the alcoholic father or the non-alcoholic.mother) who are

playing the roles of incapacitated children. Though these

children are not treated with distance, they never come to
know what emotional and physical dependence means. Their only

9

source of physical contact with the parent may be picking up
their drunken father, washing off his vomits, changing his

soiled clothing, or carrying him to the bed.
Deprived of the nuturing, help and guidance which they despe­

rately need and legitimately deserve, they are totally denied
their own childhood, and are given all sorts of impossible

tasks. Being loved is confused with being desperately needed,

warmth is confused with care taking, spontaneity is confused

with irrationality, and intimacy is confused with being smo­

thered.
Adjusting child;
The adjusting child learns to adjust and to handle any situa­

tion. This child does not

think about the situation nor

does it outwardly show any emotion as a result of it.

The adjusting child finds it easier not to question, think

about, or respond in any way to what is occuring in his life.
Adjusters do not attempt to change, prevent or alleviate any
situation. They simply adjust - that is, do what they are

being told. They 1-ta' ch themselves emotionally, physically
and socially as much as possible.

For example, the child would have been promised new clothes
for a function. Later on, when the father finds an excuse

for not purchasing new dresses, the child simply accepts
the excuse and adjusts to the situation. The child has

10

learnt that the best way to maintain peace in the family is by
responding to the instructions of others without any questions.
They learn that the expression of any feeling is wrong, and

will be met with disapproval, hostility

or rejection. In

order to avo.id this sort of a punishment, they learn to
suppress their feelings.
They are often confused with being 'well-adjusted'

in the

real sense of the term or being unaffected by the family chaos.
The adoption of artificial benavicur is not conducive to full
emotional development, no matter how good it looks.

Such children when they grow up, become the victims of mani­

pulation of people around. They cannot assert themselves
even while being aware of being manipulated. They, therefore,

get victimised in many ways at home, in their place of work
and in other social inter -auctions.
The Placating child;
The 'placator
*

goes one step beyond the 'adjuster1. He anti­

cipates the problems of others around, and tries to help them

out, unmindful of getting hurt in that process.
This child is always busy taking care of everyone else's
emotional needs. It assists its brother in .not feeling hurt

or disappointed. This child intervenes and ensures that none
of the children are tco frightened after a 'screaming scene'

11

at home. This is a warm, sensitive, listening, caring child who
shows a tremendous capacity to help others. F:r the placator,
the essence of survival' lies in taking away the fears, sadness

and guilt of others.

Acting Out Childs
Some children in,alcoholic homes become very angry at a very
early age.. They are.confused and scared,.and they act out their
confusion in ways that get them a lot of negative attention.

They normally get into trouble at home, school and even with
their neighbours. These kids keep shouting ‘there is something
wrong everywhere
*
. These children end up as rebels, - show

delinquent behaviour, throw temper tantrums, and drop out
from school.
Three unwritten laws in the home of alcoholics;

The children of alcoholics are governed by three unwritten

laws -

(1) Don't Talk
(2)

Don't Trust

(3)

Don't Peel

Don't'Salk;
These children never share or talk freely about anything
which happens at home. Any chaotic situation at home like

12

shouting, crying, or even physical abuse will never be dis­
cussed with friends, teachers, or relatives.
The next day was Meena's English Exams. When

she w's about to go to sleep, her father
entered the house thoroughly intoxicated. He

had been run over by a cycle and was injured
Meena's mother was upset and started shouting
at the drunken father.

Meena was panic - stricken. She immediately
cleaned her father's wound, fed him, and put

him to sleep. She sat up th'- wh-a.1. night

attending to the needs of her father.

Her eyes were red, swollen and droopy. When
she entered the school, her most intimate
friend, Renu asked her,

'Meena' ! Are you not well? You look very

dull and sickly today. What is wrong with
you? ■ .

Meena automatically replied,

' I am quite

alright. I studied till midnight. My eyes are
puffy because I didn't, have a good sleep'.

13

She walked away desperately, even though in her heart of hearts
she wanted to cling to Renu, wanted to open out and say,

'Oh'.

It is so terrible at home... I am not really sure what is

wrong, but I know that something is-.drastically wrong. Please...
Please help mel.

She wanted someone to understand without her having to tell
them; but she knew no one will.

Meena is alone with her pain. She does not share her problems
with anyone. Though her memory is painful, she feels that
sharing the real problem will be worse. It will amount to

letting down her family.

'I will not talk or disclose. Let me suffer my pain all alone'.
Den't Trust:

Children of alcoholics never develop trust because the beha­

viour of their parents is inconsistent and unpredictable.
They always see only lies and broken promises. There is
absolutely no visible model of trust. There is no comprehen­

sion of trust as a value. On the other hand, trust is always
seen as a trick or a trap.
The parents never provide physical, emotional or psychological
support to their children. They never de- what they promise to

do.

14

Rekha's father had all along made so many
promises.

'I will take you for a movie on Saturday!'
11 will buy you a new dress!*

'Today I will come home early for dinner.
We will all eat together!'

'I will clear all your doubts, in physics
today'. ’

But none cf these things ever happen - All only Lies. The dec­

laration next morning will always 'be 'I will do it not now;
but later!'.
The 'later' never comes. Therefore/the message to this child
is,

'forget it - do not believe any one - do not trust any­

body !' .

Don't Feel;
These children do not have a model for the identification of

feelings. Parents suppress their feelings, and cease to
discuss them and the children have no opportunity to develop
an adequate vocabulary of ‘feeling words' to describe their
emotions.
There is no model whatsoever for appropriate emotional exp­
ression, and there is an implied negative judgement on the

15

feelings themselves. Often, as the tension increases at home,
the implied judgement becomes overt. Children are instructed

not to talk about their fathers drinking, not to talk about
the problems or the consequences that it causes. Direct

reprimands for expression of feelings is also common.
These reproofs are always proceeded by an emotional eruption

and they serve not only to restrict the expression of the

child's feelings, but also to label the feelings as wrong,
inappropriate and destructive. Initially, the child learns

that expressing the feelings is wrong and eventually ends up
believing that having feelings itself is wrong.

/ohn joyfully said,

'I have'got the highest marks in English. My
teacher was very happy1'.

The already upset, confused, grief stricken

mother showed no sign of happiness. She did
not acknowledge his efforts or performance.

Instead, she shouted,

'You are unaware of

the struggle I am gcing through because of
your 'blessed' father. Do T have any time

at all to think about you, your school, or
your exams?"

The child instinctively learns that he cannot share his

feelings with either his alcoholic father or his tired mother.

16

They learn that expression of feelings will be met with dis­

approval, hostility or rejection. In order to avoid what they
can _nly view as punishment, they learn to suppress their
feelings.

We must remember that the alcoholism syndrcme produces only
particular kinds of behaviours, and not particular kinds of

people.
-

The children of alcoholics get so absorbed in other
people's problems, that they do not have the time to iden­

tify or solve their own.
They care so deeply, and often so destructively, about

the problems of people surrounding them, that they always
forget how to care about themselves.

-

They feel responsible for so much because the people around

them feel responsible for so little.
-

The children of alcoholics are pathetic victims of alco­
holism. They do not drink, but are victimised by alcohol.

They go through the pain and agony without the anesthetising

effect of alcohol.
-

These children are victims struggling desperately to get

away from their hurt and confusion. These innocent victims

need enormous amount of understanding, comfort, care,

information and above all, supportive psychological treat­
ment .

17

DRINKING PROBLEMS

DEFINITIONS
(1)

"Must stop but can't".

(2)

(a)

(3)

excess for that community;

(b)

causing harmful effects - physical, psychological, social.

(a)

Alcohol dependency syndrome - physical condition with morning

shakes and/or morning vomiting, eased with drink.

Hallucinations,

delirium tremens, possibly fits.
(b)

Alcohol-related disabilities
(i)

physical - many, affecting all physical systems.

Effects

on brain - see separate sheet, include alcoholic blackouts,
. memory loss, Wernicke Korsakoff syndromes, dementia;
(ii)

psychological - preoccupation with drink, problem-solving

with drink, suicide 50 times expected;
(iii)

social - family, work, home accidents, traffic accidents,

police problems.

CAUSES - multifactorial, including:(1)

Overall increased alcohol consumption in a country is associated

with increase in alcohol associated problems.
(2)

Increase in total consumed is related to increase in disposable

income.
(3)

Community controls - licencing laws, social attitudes, e.g.

young people.
(A)

Life-style, e.g. job (barmen, services, salesmen, doctors),

young single men, divorced, separated and unmarried older men.
(5)

Parental example - extremes of parental attitude to drink

associated with problem drinking in children.

(6)

Lack of support from family, community agencies.

Loss of work

and relationships, i.e. no reason to stop drinking.

(7)

Genetic - conflicting evidence.

(8)

Personality - can affect any kind of personality.

DETECTION

Health staff are poor at this due to failure to enquire and also
negative attitudes.

General Practitioners detect less than one quarter.

At least 20% of patients in Accident and Emergency Departments, General

Contd

-2-

Drinking Problems (contd)

Medical and Surgical Wards, have drink problems which are not recognised.

(1)

High association with peptic ulcers, gastritis, anxiety and

depression, accidents in the home and elsewhere, particular jobs -

see above.
(2)

History-taking - ask last drink, how many today and in the last

week.
(3)

Physical examination - breath, injected conjunctiva, heptomegaly,

unexplained trauma or forgetfulness.

(4)

Blood tests - macrocytosis (MCV > 94), raised SGOT and raised

gamma glutamyl transpeptidase.

(5)

Limited value.

Questionnaires, e.g. CAGE, MAST.

SAFE DRINKING

No agreed safe limit.

College of Psychiatrists recommend a maximum

of eight units for men per day (four pints of beer or eight single spirits

or one standard bottle of wine) and six units for women.

Recent survey of

workers with problem drinkers recommended a maximum for the male of
seven units per day, female three units.

six to

One unit = 9G ethanol.

EFFECTS OF TREATMENT

Rand Report of 45 treatment centres with 2,000 clients found 70%
improved with treatment.

Follow-up of untreated controls found that 50%

had improved.
Edwards & Orford compared intensive specialised and prolonged treatment

with the effects of one or two counselling sessions with patient and spouse
and found the outcome of each was the same.

Conclusion - no specific form or length of treatment was associated
with success.

Being in treatment appears to be the most important factor -

presumably related to motivation for change.
provided by a high powered specialist.

Counselling - need not be

Effective treatment can be provided

by volunteers and primary care team members.
Measures are especially effective when the person is well motivated

and there are helpful marriage and/or work factors.

Agreement between

management and unions that detection of drinking leads to threat of loss
of job unless agrees treatment shown to be highly effective.

Contd

Drinking Problems (contd)

-3-

Controlled drinking - possible, i.e. abstinence not always necessary.
See separate sheet on sensible drinking.

COMMUNITY RESPONSES TO ALCOHOL CONTROL

(1)

Reduction of availability - production, distribution, price,

promotion.

(2)

Reduction of demand - information, norms, encouragement

constraints already present in community.

(1)

Proven Useful Methods

(a)

increased price;

(b)

increased minimum drinking age;

(c)

increased probability of detection and punishment of

drinking and driving.

(2)

Possibly effective not proven

(a)

education children and adults in effects of alcohol;

(b)

education health professionals in physical, psychological

and social effects.

(3)

Evidence of effectiveness conflicting
(a)

controls of production;

(b)

reduction of distribution of alcohol;

(c)

regulation of advertising;

(d)

production of beers with reduced alcohol content.

Summary - need for national response, possibly with national

co-ordinating group for alcoholism.

The World Health Organisation is

collecting information on effective community responses and is available
for advice.

HGE/IT, 1985

Answers to our Drug Quiz

What is Marijuana?
Marijuana (Grass, Pot, Weed) is the
common name Tor a crude drug made
from the plant ‘Cannabis Sativa'. The
main mind altering (Psychoactive) ingre­
dient in Marijuana is THC (delta-9-tetra-.
hydrocannabinol) but more than 400 other
chemicals also are in the plant.
The
amount of THC in the marijuana deter­
mines how strong its effects will be. The
strength of today's marijuana is as much
as ten times greater than the marijuana
used in the early J97O’s.
Hashish or
hash, is made by taking the resin from
the leaves and flowers of the marijuana
plant and pressing it into cakes or slabs.

How well Did you Do ?
1.

TRUE: Brown sugar is a crude form
of heroin which is catching on very
fast with the young people.

2.

TRUE AND FALSE : Some times
these pillsand capsules arc prescribed
by medical doctors, but many times
they arc used to get a ‘high’. They
are called ‘uppers’ or ‘downers’ by
the user.

3.

Effects of Marijuana :
Some immediate physical effects of
marijuana include a faster heart beat and
pulse rate, bloodshot eyes and a dry
mouth and throat. Studies of marijuana’s
mental effects show that the drug can
impair or reduce short term memory, alter
sense of time, and reduce ability to do
things which require concentration. Long
term regular users of marijuana may
become psychologically dependent. In
addiction, when young people start using
marijuanaregularly.theyoften lose interest
and are not motivated to do their school
work. The drug can become the most
important aspect of their lives. Research
studies suggest that the use of marijuana
during pregnancy may result in premature
babies and in low birth weights. Studies
suggest that it is likely that marijuana may '
cause cancer if used for a number of
years.

4.

5.

6.

False :

In all but few cases the
drug being given to cancer patients to
control nausea from chromotheraphy
is a marijuana chemical called Delta9-THC.Saying that the cancer patients
use marijuana rather than THC is like
saying that someone with a strep
infection is using mould rather than
penicillin.
TRUE: Infact bubble bubble can
also be made out of a tube or pen and
a container. Addicts who are used to
bubble bubble carry it with them as
handy device. Marijuana and Heroin
are mostly used for hubble bubble.

FALSE : According to the National
Institute of Health, chewing tabacco
is a major factor in cancer of the
tongue, gums and checks.
TRUE: a) Balls or cubes of hashish
which is usually smoked in a joint or
pot. b) Strip of Aluminium foil
used for chasing Brown Sugar.
c) Strips of paper used for chasing
Brown Sugar.
d) Chaser used for
inhaling the smoke of the Brown
Sugar with the help of lighted paper
strips or tissue papers.

What is Cocaine?

Effects of L.S.D :

Cocaine is a drug extracted from the
leaves of the coca plant which grows in
South America.
Cocaine appears in
several different forms.
Cocitine hydro­

The physical effects include dilated
pupils, higher body temperature, increases
heart rate and blood pressure, sweating,
loss of appetite, sleeplessness, dry mouth
and tremors. The person’s sense of time
changes. The user feels of hearing colours
and seeing sounds which can cause panic.
Heavy users sometimes develop signs of
organic brain damage.

chloride is the most available form of
drug and is used medically as a local
anesthetic.
It is usually a (fine white
crystal-like powder although: at timcs.it
comes in larger pieces whiih on the

And Parents Can Heip.

What is Heroin?

luffed or snorte

Effects of Cocaine :
Some immediate effects include dila­
ted pupils and increases bloo&l pressure,
heart rate breathing rate and body
temperature. The user may Have a sense
of well being and feel more energetic or
alert and less hungry. Pcopl|e who use
high doses of cocaine over a ibng period
of time may become paranojd. People
can
become dependent oh cocaine.
Though few people realize it I over dose
deaths can occur when the drug is injected
smoked or snorted.

Heroin is made out of poppy plant.
First it is collected by scraping the opium
atrd made Io gum opium, then opium is
made to morphine by a chemical process
and synthesized from morphine into
Heroin. Pure heroin is a white powder
with a bitter taste. Illicit Heroin may
vary in color from while to dark brown
because of impurities left from the manu­
facturing process or the presense of
additives such as food colouring, cocoa
or brown sugar. Brown Sugar which is
mainly used by the teenagers contains
only 10% of heroin.
Recently a test
made on Brown Sugar contained 50% ol
rat poison and other additives.

Effects of Heroin :

What is L.S.D.?
(lysergic acid diethylt^l)
L.S.D. is manufactured from lysergic
acid and is one of the most pc tent mood­
changing chemicals. It is odourless,
colourless and tasteless. L.S.D. is sold
on the street in tablets, capsules or occa­
sionally in liquid form.
Itj is usually

taken by mouth but sonictimes injected.
Often it is added to absorbenrpaper such
as blotter paper and divided (into small
decorated squares, with . each
representing one dose.

Dmg Abuse Cao
B® Prevented

square

Euphoria, drowsiness,, respiratory
depression, constricted pupils and nausea.

Effects of Over Dose :
Slow and shallow breathing, clammy
skin, convulsions, coma and possible
death.

Withdraw! Syndrome :
Watery eyes, running nose, yawning,
Joss of appetite irritability, tremors
chills, sweating cramps and nausea.

a.

Discuss with other parents what
happening in the school and neigl
bourhood.

b.

Equip yourself with informationabc
drug abuse, particularly marijuar
and heroin and effects of such abus<

c.

Co-operate with other patents in dru
prevention.

If you are interested in your chil
this information may help you.

The first drug does the damage
Produced in co-operation with
33 Damadem,
Tivim Bardez,
Goa - 403502.

Published by .
Salsangam
Bethany Ashram
Ramwadi
Pune -411014

c-

i&b 1-Udif-

-

What do you know
about Drugs?

Covering up for Drugs :
Are Papaya stems
Hubble Bubble.

jke this true or false quiz to
see how much you really
know about kids and
Drugs.
(See Answers Inside)

Children are discovering a
new ‘High’ that can be
dangerous :
Brown Sugar.

Chewing tabacco won’t hurt yon.

Until you find drugs or drug para­
phernalia you won’t know any thing. It
is possible of course, to detect the smell
of alcohol or signs of being under the
influence. But you may not be able to
detect the use of pills or cannabis (pot)
unless you find materials like dried leaves,
the end of joint, rolling paper etc. Often
teenagers use incense in a room to mark
the sn^koj^kinabis. Room deodorisers
are o^B ^Bd for the same purpose.
Some will admit to taking alcohol to
cover signs of cannabis intoxication. If
your teenager is using cannabis, his eyes
are likely to be blood shot and his com­
plexion pale.

Arc these pills and capsules really
prescribed by Medical Doctors.

Other Tell - Talc Signs

Arc these figures related while using
drugs.
Marijuana is being used to treat
cancer patients’ nausea.

3.

used to make

Depression; not going to school; has he
dropped out of sports or other active
pastimes?;
Continual sniffles;
red
watering eyes ; has his thinking become
muddled; does he seem over active?;
has he become impulsive ? ; A low tolerance^^rustMion ; gets unusually upset
if thi^B don^^o his way or right for

Docs he wear sun - glasses at odd
times? This could be just a fad, or
it could be to cover dilated pupils of
the eyes because of cannabis, or
constricted pupils from heroin use

Ask yourself the following Questions '•
1.

Has he suddenly become different to
his usual way of behaving and rela­
ting to the family?

I
,

2.

Have a closer look at his friends.
Has he dropped long standing pals
for strangers ?

'

3. - Has he lost weight.

I

4.

Does he make unusual efforts to
cover his arms ?

5-

Arc you finding blood on his shirts?

6.

Are the bed clothes being burnt
through his falling asleep intoxicated ?

If you observe any of this signs, It
might be a good idea to search his room,
belongings places around the house for
Drugs and Drug Paraphernalia. Get to
know more about his friends, where he
goes and what he does.
If you suspect
anything don't blame him immediately.
Take advice from people who know about
Drugs.

4.

Is he now comming home far later
than usual.

5.

From being reasonably active and
capable at sport, study, work, has
he changed to being indifferent or
abandoned them?

6.

Has he become vague, withdrawn,
irritable, aggressive?

The First Drug Does
The Damage

Ask yourself if Drugs are Involved
and find out.

him; does not. immediately get what he
wants.

Just For Today - No Drugs

Some Important Indicators arc :

1.

I Can’t Do It Alone.....
.... But I Alone Can Do It.

Does he hang around with known
drug users?

Are things vanishing from the home
that could be sold ?

ST. JOHN'S MEDICAL COLLEGE, BANGALORE

DEPARTMENT OF COMMUNITY HEALTH
GRITO - IFCU WORKSHOP

on.
ALCOHOL and DRUG ABUSE

PROGRAMME
9.00am - 9.15am

Registration

9.15am - 10.30am

Presentation of Results of GRITO
study (Magnitude and Factors relevant
to urban situation)

10.30am - 10.45am
10.45am - 12.00pm

COFFEE BREAK

Group discussion - 5 Groups.
1) Factors related to Family & Peers
2) Socio-economic Factors.
3) Implications on Individual
4) Implications on Family
5) Implications on Community

Facilitators: Dr. Tanya Machado
Dr. R. Galgali
Dr. Maya Abreu
Mrs.Phyllis Farias
Dr. Reynold Washington
12.00pm - 1.15pm

1.15pm - 2.00pm

2.00pm - 3.15pm

3.15pm - 3.30pm
3.30pm - 4.30pm

Presentation of Group discussion

LUNCH
Group Discussion on
ACTIVITIES FOR DEMAND REDUCTION
(Functionally homogenous groups)
COFFEE

Plenary Session
Chairperson: Dr. Dara S. Amar

CULTURE AND DRUG ABUSE
IN ASIAN SETTING

The
ubiquity
of
drug
use
is
an
established
fact.
The
escalating large scale abuse of drugs however, is a
contemporary
phenomenon
that
has assumed menacing
overtones.
Understanding
what
constitutes use and abuse of drugs and the response of
the
society
to
drug taking behaviour cannot be
divorced
from
the
socio-cultural milieu in which such behaviour occurs.
Similarly,
any
programme
aimed
at demand reduction
should
develop
from
within the cultural context. This philosophy has
shaped
the present study.
.. . .
The
major
objectives of this study were to
understand
the
historical
social and cultural factors related to drug
use
and
abuse in India, to monitor the trends in drug abuse, to determine
the
epidemiological and social cultural characteristics of
drug
addicts
and
to
identify
and
evaluate
the
existing
demand
reduction programmes for prevention of drug abuse, rehabilitation
of
addicts
and to
develop modules for
personnel
involved
in
prevention and intervention.
Using a multidisciplinary approach, information was
obtained
from
as
varied ejnd as diverse sources as
possible.
Techniques
employed
were
a historical, sociocultural study,
collation
of
existing
information, interviews with addicts, analysis of. case
histories (medical records), interviews with key persons such
as
psychiatrists,
counsellors, principals of schools and
colleges,
wardens of hostels, police, etc. House to house survey were
also
carried out in a village, slum and an urban area.

An
ethnohistorical
study reveals that India
is
an
unique
example of culturally sanctioned, yet with inbuiltsocial controls
that
limited
and
prevented misuse. But in
the
1980s,
social
political and economic changes resulted in an upsurge of illicit
drug trafficking, increase in drug abuse and drug related
crimes
in
India.
An overview of laws related to
drug
control
reveal
inadequacies in the law and its enforcement.

Case
studies and interviews with addidts reveal
that
drugs
are
abused
mostly
by younger, male,
single
persons,
either
student
or
unemployed.
Peer
pressure
is
the
major
reason
initiating
youth
to drugs and drop out
rate
from
deaddiction
programmes
is
high.
The
most
abused
drug
in
Bangalore
is
cannabis,
but polydrug abuse is also common.
Extensive
contact
with other drug users, lack of religious afffiliation,
inability
to
use leisure constructively and easy availability of drugs
in
Bangalore were the major sustaining factors in drug abuse.

Community
surveys
using
open
ended
interview
schedules
yielded
richdata ragarding community beliefs and practices.
The
drug
users
from
rural
areas
were
generally
older,
male,
uneducated
and employed. Use of drugs was in social
gatherings,
occasional,
limited
and
was for socio
religious
reasons.
In
slums,
drug users were younger, unemployed or in unskilled
jobs
and were given to poly drug abuse. In urban areas, students
from
affluent
background
were the main users. Thus
drugs
are
used
variously
as
social
lubricants, as
an
escape
from
poverty,
hardships and boredom and as a part of socioreligious activities.
The
psychiatrists
interviewed
in this
study,
treated
on
an
average 10-15 addicts per year. Principals and teachers
admitted
drugs
to
be
a problem but had not faced much of
it
in
their
colleges.
A
majority
of police officers
interviewed
did
not
consider
drug abuse as a priority for them, but opined that
the
police
force
is
not sufficiently equipped to
deal
with
this
problem.

Both
formal and informal methods of dealing with drug
abuse
exist
in
our
culture. Most
of
the
institutionalized
formal
methods use western models of treating addicts, with little or no
attention
to
the sociocultural ethos. Coming to
the
issue
of
prevention
of
drug abuse, practically everyone
emphasized
the
importance
of
family
and
peers
in
both
drug
use
and
its
prevention.
Awareness
programmes, skills
training,
structured
leisure
activities,
strict
enforcement
of
laws
and
better
rehabi1itation
and
after
care
facilities
are
considered
as
essential.
Drug
abuse is a multifactorial phenomenon
with
individuals
using drugs in a variety of ways for a variety of reasons and
in
a
varriety
of contexts.
Any
intervention/prevention
designed
should be sensitive to this socio-cultural reality.

Organizing primary health
care services to combat drug
and alcohol abuse

A number of principles must be borne in mind when health sen-ices are
being developed to deal with drug- and alcohol-related problems in the
community:
• Medical science and technology are appropriate for treating individual
diseases, but are not sufficient to reduce and prevent drug- and alcoholrelated problems.
• Drug- and alcohol-related problems have to be dealt with through
primary health care, with emphasis on decentralized care for the
promotion of health and the prevention ofdisea.se. active participation
of the family and community, use of non-specialized primary health
care workers, and collaboration with personnel in other governmental
and nongovernmental sectors.
• The whole health sector should be structured to support decentraliza­
tion. through delegation of knowledge and skills to primary health care
workers and to the people themselves, to promote health for ail and
general well-being.
• Mental health care and the skills to deal w ith drug- and alcohol-related
problems should be essential components of primary health care.
carried out in the course of everyday activities.
• Primarv health care workers should be trained in simple but eifective
techniques to combat drug- and alcohol-related problems, including
mobilizing community action, stimulating self-help groups, providing
health education, and encouraging healthy life-styles. They should be
trained in skills such as interviewing, counselling, maintaining social
support, crisis intervention, and providing guidance about the use of
leisure time.

Functions of primary health care services
The functions of the primary health care sen-ice in relation to drug and
alcohol abuse can be considered within a framework of three levels of
:

'o r'
<
J

and

DOCUMENTATION
<
UNIT

'
J

RESPONDING TO DRUG AND ALCOHOL PROBLEMS IN THE COMMUNITY

prevention:
Primary prevention aims to avoid the appearance of new cases of

drug and alcohol abuse, by reducing the consumption of drugs and
alcohol through health promotion.
Secondary prevention attempts to detect cases early, and to treat
them before serious complications cause disability.
Tertiary prevention aims to avoid further disabilities, and to
reintegrate into society individuals who have been harmed by severe
drug and alcohol problems.

The PHC worker will be involved at all of these levels.

Primary prevention
The primary health care service is in a position to meet people's needs and
to deliver health care to individuals or families at their homes or
workplaces. It would be quite unrealistic to expect the primary health
care worker to develop complex or specialized activities. However, the
PHC worker can provide a very cost-effective service by using relatively
simple skills of listening, communication, and counselling. In order to
develop primary health care sendees directed towards drug and alcohol
problems, PHC workers will have to undertake the interrelated activities
described below.

Identify drugs currently used in the community
The PHC worker should learn about the drugs in use locally, as well as the
consequences of excessive use. It must be emphasized that information has
to be quite detailed. It may be, for example, that a local home brew is
mixed with cheap alcohols that are extremely toxic.

Identify the ways in which drugs and alcohol are used in the
community

The ways in which drugs are used in a community tend to change
frequently. Minor tranquillizers might be used secretly by certain groups,
who buy them from a friendly pharmacist or get them through medical
prescriptions. Alcohol is supplied without restrictions in many countries,
but it will not be easy to find the places where very young children drink
cheap alcoholic beverages. There may also be open-air places where
children meet to sniff gasoline or glue, under the guise of playing or
chatting.
30

ORGANIZING PRIMARY HEALTH CARE SERVICES

Teenagers and young adults use drugs, or combinations of drugs,
according to the fashion. It is also important to detect any intravenous use
of drugs, because of the associated infections.

Information and education to promote health
PHC workers are in a position to disseminate relevant information on
drugs and alcohol to the community. They can put up posters in the places
where most people are likely to see them. They can also distribute reading
matter to special groups or organizations, such as parents’ organizations.
Finally, PHC workers might be invited to conferences on drug- and
alcohol-related problems in schools, sporting associations, mothers’ clubs.
etc. More important than information dissemination is the education of
people through a two-way process of communication and interaction. For
example, it is quite natural to talk about drug and alcohol problems with
pregnant women or young mothers. Most of the time, it will be possible to
educate people about the prevention of drug and alcohol abuse without
specifying that there is a special programme to combat such problems.

Integrating primary health care work with that of other groups

The PHC worker should work with groups, such as schoolteachers, police,
district commissioners, churches, clubs, volunteers, and traditional heal­
ers. If the PHC worker is able to develop good interpersonal and
leadership skills, he or she will find it much easier to mobilize the
community and organize specific voluntary groups to deal with drug- and
alcohol-related problems.

Secondary prevention
Identify the immediate effects of drug and alcohol abuse
As the ways of taking drugs change, so do their effects. Whether a drug is
harmful or not depends upon the following factors:
• the user: his or her nutrition, other diseases, etc.
• the drug: its purity, dosage, combination with other drugs, etc.
• the environment: for example, the influence of children who sniff glue
together, prisoners who learn to inject heroin, young students who
drink at weekend parties.

The effects will be different when drugs are taken in combination: for
example, it has become a common practice in Andean cities to smoke, or
31

RESPONDING TO DRUG AND ALCOHOL PROBLEMS IN THE COMMUNITY

sniff, cocaine in order to reverse the effects of alcohol, and to drink alcohol
to control anxiety or paranoia provoked by cocaine use. Some people may
react ven- badly even to small quantities of drugs and alcohol; on the other
hand, tolerant and dependent abusers are often able to take enormous
quantities without showing signs of intoxication.

Identify harmful use and high-risk groups

With some drugs and alcohol, it is often difficult to draw a line between
safe and harmful use. For example, to drink 1 or 2 litres of beer may be
relatively safe, but this amount could become harmful if taken daily for
several years. Celebrating the New Year with three or four drinks could be
extremely dangerous if the drinker drives afterwards. Some people stand a
very high risk of harming themselves, or others, if they use drugs or
alcohol: for example, pregnant women, car drivers, people operating
machinery, and those who already have a serious drug- or alcohol-related

Drinking and driving are a dangerous combination.
32

ORGANIZING PRIMARY HEALTH CARE SERVICES

problem. Others at risk include those with a mental illness or taking
medication. Use of illegal drugs is almost always harmful, not onlv because
of the threat to health, but also because of the potential social, legal, and
economic consequences. A brief intervention can be very useful with a
person in a high-risk group. Such brief interventions are dealt with in
Chapter 5 of this manual, and might involve a discussion of the benefits of
reducing consumption, as well as of ways of coping without the drug or
alcohol.

Tertiary prevention
Identify and manage patients with acute conditions that must be
treated without delay
Some acute conditions related to drug and alcohol abuse appear suddenly
as emergency problems. The most dramatic are delirium tremens, epi­
leptic fits, confused or agitated behaviour, paranoia, suicide attempts, and
the taking of an overdose. When faced with any of these life-threatening
conditions, the PHC worker may need to give emergency medication; he
or she will therefore need appropriate training and close links with
specialist workers.

Identify and manage patients with drug and alcohol problems who
must be referred to other services
Some conditions associated with drug and alcohol abuse should ideally be
handled in a hospital; for example, epilepsy, liver cirrhosis, peptic ulcer,
lung infections, acquired immunodeficiency syndrome 'AIDS,, hepatitis.
There are also some psychiatric conditions that should be referred to a
specialist sen-ice, and some patients requiring detoxification who should
be seen by a hospital sen-ice. The PHC worker has to learn which patients
to refer, and to whom.

Identify and alleviate family problems related to drugs and alcohol
Besides damaging the brain and the body, drugs and alcohol modify the
functioning and control of emotions, desires, thoughts, and perceptions,
and also disrupt social and family relationships. The patient may be
alienated from all social contact, a vicious circle being established with the
patient becoming more and more hostile, and the family more and more
unresponsive. Jealousy, violence, unusual patterns of eating and sleeping,
fears of being poisoned, and so on, may provoke adverse reactions in other
33

RESPONDING TO DRUG AND ALCOHOL PROBLEMS IN THE COMMUNITY

members of the family. The PHC worker should be able to question family
members about these problems, and help them to cope with the emotional
turmoil. Chapter 5 covers simple interventions to help families deal with
problems and cope with crises.

Helping social rehabilitation

Former drug abusers are fragile beings who have passed through a
difficult stage. They need help to readjust to social life and its constraints.
The PHC worker should attempt to improve the social relationships of
former drug and alcohol abusers, and perhaps introduce them to com­
munity self-help and voluntary groups.

Functions of the second level of health care
The second level of health care is usually based at a district hospital. The
hospital is staffed by specialists in a range of areas who will see patients
suffering from the consequences of drug and alcohol abuse. Registered
nurses, social workers, and administrators will all have to deal with such
patients. Some training will be necessary for these personnel, so that they
can use their knowledge and skills to develop a service to deal with drugand alcohol-related problems. The functions of this service are described
below.

Treating patients referred from primary care

The characteristics of patients vary from one community to another,
according to the drugs used, and to their background. Sometimes,
guidelines for treating the most common clinical conditions are useful. As
an illustration, Table 3 provides an outline of a treatment programme for
alcohol withdrawal symptoms in severely dependent patients.

Referral back to primary level

Recovered patients should be sent back to the PHC worker with clear,
written indications as regards:

• diagnosis (somatic, neurological, and psychiatric), with comments on
expected risks and complications;
• treatment given in the hospital, and the maintenance medication that
has to be continued at home, specifying the doses and any expected
side-effects;
34

ORGANIZING PRIMARY HEALTH CARE SERVICES

Table 3. Treatment of alcohol-related syndromes In hospital

Syndrome

Expected
complications

Suggested investigations and
treatment

Dependence

Withdrawal symptoms

• Mild sedatives (chlordiazepoxide
20 mg orally. 3 times daily)
• Vitamin B complex (1 tablet,
3 times daily)
• Careful physical, neurological.
and psychiatric examination
• Laboratory tests: blood, liver, urine
• If no complications: discharge in
10 days

Delirium
tremens

Epileptic fit
Fever
Pneumonia
Death

• Diazepam (10 mg. intravenously.
every 6 hours)
• Vitamin Bl. thiamine, intramus­
cularly. every 12 hours
o Glucose and saline solutions.
2000 ml. intravenously,
every 2<t hours
• Check temperature, state of
consciousness, every 3 hours
a Antibiotics if necessary
• Complete phys cal examination.
Do not discharge before 15
days.

Alcoholic
coma

Fractured skull
Suodural haematoma
Bronchial aspiration
Death

• X-rays: skull, lungs
• Laboratory tests: blood, lumoar
tap
• Check vital signs and reflexes
every hour

■•V

•

£

’A •

*
• i \
i

I
I
A
'

•

• suggestions for psychosocial interventions, especially ways of support­
ing or influencing the family;
• indications for future referral, if necessary.

‘ fffl
' ji

Supplying essential medication

Workers at the primary care level need to have a stock of essential
medicines and to know how to use them. Some of these medications must
be taken by patients regularly for long periods (e.g., anticonvulsive pills;.
Other medications have to be given for only a few weeks (e.g., antidepres­
sants, after a suicide attempt). Finally, some medications are necessary for
treating emergencies (e.g., chlorpromazine for paranoid agitation in­
duced by cocaine). Second-level personnel should train PHC workers in

i

i
I]

■■ n

z ■ *

iE

N
-

35

1
■ ■■■

' '_ _ _______ _________ _ ___ ___ ------------- -------- —■————-

RESPONDING TO DRUG AND ALCOHOL PROBLEMS IN THE COMMUNITY

the administration of these medications and the prevention of side-effects.
as well as in the maintenance of the stock of medicines.
Training PHC workers

First-level health care personnel will usually receive practical training at
the district hospital; supervising this training is a key function of the
professionals in the hospital. They should also pay frequent and regular
visits to primary health care sendees for the purposes of supendsion and
consultation.

The changing role of specialists
The role of specialist psychologists, psychiatrists, social workers, and other
professionals in a decentralized system is to support the primary health
care sendee by carrying out the following functions:
• They act as educators and agents of social change for the health and
other sectors, with regard to drug- and alcohol-related problems, and
should attempt to stimulate public awareness of the situation.
• They are consultants for the most difficult cases referred from the
primary level; they should avoid being inundated with individual
patients who can be dealt with by less qualified staff members.
• They should visit primary health care facilities on a regular basis as
consultants and supendsors, and should encourage preventive and
curative interventions, as well as simple research.
• They should decide upon the skills and knowledge to be transferred to
the lower levels of the sendee, and prepare the schedules for in-sendee
training.
• They should coordinate and evaluate the whole system, analysing the
information collected, and disseminating the results as appropriate.

PHC workers should have a stock of essential medicines.

ORGANIZING PRIMARY HEALTH CARE SERVICES

• They should participate in the development and monitoring of national
policies and programmes, particularly those aspects related to financial
support and to the employment and placement of former dependent
persons.
• They should act as advocates to generate public support and advise
local and national authorities, the heads of other sectors, and the mass
media on matters related to drugs and alcohol.

New role for the specialist

• Educate, facilitate, and stimulate
• Consult on difficult cases
• Support and motivate PHC workers
• Transfer skills
• Coordinate and evaluate
• Plan and monitor national policies
• Become advocate and advisor.

Coordination with other sectors
To ensure coordination between the various sectors involved, it will be
useful to form a community action team CAT) with representatives from
health and other sectors. The members of these teams should be drawn
from sectors and groups with a stake in community development. CAT
members should be in close contact with members of the community,
seeking answers to questions such as:
• What does the community identify as its drug and alcohol problems?
• Who is vulnerable in the community?
• What does the community believe should be done?
The CAT should collect background information on social definitions,
perceptions, and responses connected with drug and alcohol problems, as
well as on attitudes and the degree of awareness regarding drinking habits
and drug use.
It is important that, in all of this, the PHC workers should not see
themselves as lone individuals seeking to involve the community. Partner­
ship between health workers, government agencies, social services, and
voluntary groups is vital in dealing with drug- and alcohol-related
problems in the community. Such problems can never be adequately
managed by one person, or sector, working in isolation.
37

RESPONDING TO DRUG AND ALCOHOL PROBLEMS IN THE COMMUNITY

The CAT should coordinate the actions of various interested parties,
including health professionals and associations, researchers, law-makers,
law-enforcement agents, educators, and community groups, such as
women’s and youth organizations and churches. Strategies and decisions
to develop drug and alcohol programmes should be negotiated by the
CAT, or other community committees, which should function at all levels
of the health system.
Intersectoral collaboration might also be established using the "gate­
keeper" approach: this involves, first, finding out from other sector
personnel what they need to know in order to decide whether to
collaborate with a health programme. This step stimulates the initial
interest. The next move is to find the information they require and pass it
on to the other sector, which will then be more likely to act.
Government agencies are usually organized vertically, with repres­
entation at all levels but, because of their bureaucratic structure, they
often do not develop horizontal collaboration. On the other hand.
nongovernmental organizations may be preoccupied with managing their
budgets and are often reluctant to develop a partnership for fear of losing
their freedom of action. Despite these barriers, the potential of other
sectors should be tapped, using the "gatekeeper" technique or another
approach, to support drug and alcohol programmes at the community
level. Negative attitudes need to be changed across all sectors.

WHO 91189

The CAT should coordinate the activities of the various interested parties.
38

ORGANIZING PRIMARY HEALTH CARE SERVICES

Intersectoral collaboration should be a constant process that must be
kept alive by the CAT; the team should organize regular meetings,
interactions, and task assignments with community representatives,
anticipating as far as possible any likely obstacles and problems.

Evaluation and monitoring
If sendees for dealing with drug- and alcohol-related problems are
organized according to the principles mentioned on page 29 — that is to say,
decentralized senices, with active participation of the community, and
undertaken by nonspecialized health workers—it will be important to
demonstrate their effectiveness in achieving targets, as well as their
efficiency in the use of resources. In addition, health workers, especially
those who are not specialized and who work at the community level,
need to keep track of what they are doing through feedback from
supenisors.
In order to meet these needs, a process of data collection and
monitoring is required. Data must be relevant to the everyday work of the
PHC worker, and the source of information should be the individual
health workers.
Personal contact in the transfer ofinformation is important in order to
clarify the relevance of the data, reinforce the motivation for data
collection, and give timely feedback. This process can become the basis
for continuing in-service training and support for the PHC worker.
Indicators of these activities or of the performance of a team have to be
clear and simple. Examples are:

• number of cases per week, and the types of drugs used;
• frequency of visits to families and individuals;
• proportion of cases referred;
• number of contacts with other sectors;
• number of people identified as being at risk;
• number of meetings with self-help groups;
• type and quantity of medications used.

It is also necessary to assess the sendee and the programme, and to
evaluate its management and its relevance to the needs of the community.
Information for this evaluation is not always quantitative. Sometimes it
will be necessary to carry out formal research. Such research undertakings
need not be expensive and can be done as part of a training programme for
health workers.
39

RESPONDING TO DRUG AND ALCOHOL PROBLEMS IN THE COMMUNITY

Indicators should be clear and simple, and related to the targets of the programme.

Information on the way in which services operate should be simple and
relevant to possible improvements. Such information could be collected
by asking questions such as:

• Is there a logical structure for referral and supervision?
• What mechanisms are used to engage other sectors?
• Are drug and alcohol abusers helped in peripheral centres and in the
community?

• Are there registries and systems for data collection?
• Does a community action team meet regularly?
40

t

•

ORGANIZING PRIMARY HEALTH CARE SERVICES

Other types of indicator will be needed to show the impact of the
programme and its advantages, as reflected in savings in other areas, for
example:
• reduction in re-admission rates;
• savings in costs of specialized hospital treatment:
• reductions in incidence and prevalence of drug- and alcohol-related
problems.
All this must be accomplished with continuing support and discussion,
so that the health workers understand the relevance of the data collection
and monitoring.

Training
Training is at the core of decentralization. The delegation of skills and
functions means that nonspecialized personnel need to be trained to
deliver health care at the peripheral centres and within families and
homes. Most of the training should be based on an apprenticeship system.
using the attitudes and behaviour of senior personnel and professionals as
models. Traditionally, psychosocial and interpersonal skills have been
regarded as either inherent and intuitive, or acquired only after a long
period of trial and error. This supposition is wrong and needs to be
changed.
Effective delegation of skills can be achieved through direct practical
training, using a variety of teaching methods, e.g.. small group discus­
sions, supervised in-service work, and imitative learning. Essential skills to
( be taught include:
• interviewing skills;
• ability to listen and to be empathic;
• interpersonal skills needed for counselling, guiding and persuading;
• relaxation, meditation, and culture-specific skills, such as acupuncture,
prayer, hypnotism, incantation, and the use of medicinal herbs;
• the management of essential medications;
• the detection of behavioural symptoms;
• a complete approach to problems, incorporating biological, psycho­
logical, and sociological points of view;
• recognition of the importance of working with other people in the
community, outside the health sector;
• ability to understand and deal with local community fears, beliefs,
taboos and attitudes.
The learning of these skills is different from the process of acquiring
information and psychomotor skills; it depends on having examples to
41

RESPONDING TO DRUG AND ALCOHOL PROBLEMS IN THE COMMUNITY

imitate, and on frank discussion of what is being done. The aim is to
change attitudes by constantly reinforcing positive opinions and points of
view. These attitudinal and behavioural changes have to be instilled and
shaped from the ver}- beginning of training and continually reinforced.

Budget
Sen ices will operate effectively only if the resources are appropriately
assigned. This does not imply extensive financial outlay. On the contrary.
an effective alcohol and drug sen-ice can reduce overall health costs.
Drug and alcohol sen-ices do not demand expensive methods, but
rather the deployment of simple skills to the primary health care workers.
broadening their approach, and improving their efficiency. The following
activities will need to be funded:

• training activities:
• supen-ision and support from higher levels;
• appropriate means of transport;
• support of coordinating groups (most of them voluntary . e.g., the
CAT:
• provision of essential medication;
• establishment of key. multidisciplinary staff members, such as a co­
ordinator or community nurse.
In summary, the primary health care worker deals with drug and
alcohol problems within the primary health care setting, but works within
the wider community and looks .to the hospital specialist for support. This
may appear to be too much work for a primary level worker. It should be
remembered, however, that the system described here is an ideal to be
worked towards. The PHC worker should attempt to obtain help from
both the community and specialist workers to work out effective ways of
providing a primary health care alcohol and drug senice within the
community.

42

MH 7-^6

JAG R A N S'

PAN TOMI ME THEATRE FOR CONS CI O US NES S RAI S IN G
The pre-requisite for development is liberation.from all oppressive structures
and attitudes. Such work should lead to the total liberation of men and women.
There should be development of the people themselves so that they may
understand the issues in a situation and become aware of their own responsibilities.

Jagran's pantomime is meant to educate as well as entertain. The method of
work is one that allows the audience to feel part of the act and to become
involved in it . The contents are taken from true life situations. This makes it
easier for people to place themselves in the act and for them to understand
their own situation more clearly. The aim of such an approach is to move people
from apathy into awareness and then finally into action. Jagran has been working
consistently over the past several years, as a dedicated group. The fact that it
continues to use the medium of pantomime as its vehicle for communication speaks
for itself.

ITEM-

CONCERN.

TIME

1.

Drug Addiction

Inhibitions, lack of
communications, pressures of the
community - eventually pushes
young people into the traps of drug
peddlars wh
*
like falcons annhilate
those weaker than themselves .

20 mins

2.

Black Marketeer

Poor people rise against black
marketing in their slum colonies.

20 mins.

3.

Dowry

Humiliation to a point and. beyond
brings out the strength of a young
woman to stand firm against dowry
demanding sharks.

20 mins

4.

Monster of
Malnutrition.

Balanced diet to fight anaemia

20 mins.

DIRECTOR

ALOKE ROY
E-7/10-B, Vasant Vihar,
New Delhi-110057,
Tele: 601141.

symposium : ■ SUICIDE
(organised by Lions Club l&'1' October 1974)

HOTS £:
1.

Causes of suicide

Source: Dr. S.S. Jayaram

Schizophrenia
Depression
Personality disorders
-< alc'oholics
- drug addicts
- psychopaths
4. Depressive neurotics
5. Unbearable physical disease
6. Diseases/conditions producing social ostracism - leprosy
- leukaderma
- sterility
7. Old, poor'and helpless
’
- socio economic disasters
8. Social disorders
1.
2.
3.

- multiplicity of factors '
- psycho-socit1 problem
NATURAL HISTORY C7 dUIClf
*;
1.

Occurrence of problems

2.

Tries to communicate with friends or relatives - the inner conflict

- behavioural changes
- c/o depression
- buys tablets, dalf etc
- threatens suicide

State ---- of Counselling (time gained)
3.

Attempts suicide - successful

4.

If unsuccessful —~ time lag and may again attempt —repeated

2.

Hindu view on suicide

Source: Mr. Tandaveshwara

- Karma theory
- unnatural impressions or predispositions (samskaras) due to artificial
and sudden end of this existence carries into next existence
- no solution to problem ---- since there is merely postponement of
.•■orking out of ’karma’ into another corporeal existence.

3.

Christian view on suicide

Source: Fr. Herman D’aour.a

Suicide - result of a lack of satisfactory working philosophy of life
Negative injunction - Thou shalt, not kill
Positive injunction - Thou shalt carry thy cross
4.

Islaaic view on suicide

Source: Mir Iqbal Hussain

- Liberty with restraint
- Philosophy of life should be - Faith in self and faith in God
- No problems are insurmountable
- You are a trustee of this body anti soul and ycu cannot betray this trust
by destroying it.

.2

2

5.

Social strategies to prevent tnfcide

Source: Dr. Sreedharan

- Ko single cleai- cut strategy will help
- All the social injustices which are causative factors have to ba tackled
- Total approach should be Btrrssed
- Family Life Education is an important strategy

6. Suicide and the law
Source: Mr. Nizamuddin Dig
- Law: Sections 305, 306, 309 of Indian Penal Gode
- Police dept, would welcome any moves to make suicide a non-chargeable
offence
- Police will then only be made to take responsibility of handing over
case to a suitable social welfare agency dealing with such cases.
7. Suicide in India/Bangaloro - Statistics
Source: Dr. Satvavathi
- Every O.$4 min. one person commits suicide in the world
- Every 10.8 min. one Indian commits suicide
- San Francisco (suicide capital of USA) 1 euicide/36 hrs,
- Bangalore - 1 suicide/28 hours
~ Attempted suicides ~ 80$ of cases below 25 years of age
- Method of choice in 1958 - drowning most common
— Method of choice in reoent years - insecticidal poisoning
- Suicide represents a sickness of society
- Meed for a sound mind in a sound body in a round society
- "Ambivalence" characteristic of persons with suicidal tendencies. There
is a desire to live and a desire to die.
- Place of counselling and other strategies important at this stage of
ambivalence
- "Suicide prevention" centres and squads
- Newly developing science - Suicidology
1. Clinical.services
2. Training - esp of non professional counselling
3. Research

///////

f

T T RANGANATHAN CLINICAL RESEARCH FOUNDATION
"TTK HOSPITAL"
17,TVTH HAIN ROAD,INDIRA NAGAR,MADRAS- 600 020

REflONAL TRAINING PROGRAMME ON PREVENTION OF DRUG ABUSE AND
ALCOHOLISM SPONSORED BY NATIONAL INSTITUTE OF SOCIAL DEFENCE,

MINISTRY CT _lgl FARE, GOVERNMENT C ■? I DIA, NEW DELHI
DDICTIOH - ITS INFECT JF THE FAMILY

Addi-tion is a "family disease" in every c.isc of the term.
Treatment professionals should recognise that addiction cannot be
treated in isol'tion; improving patient's relationship with wife-

and other family members is an essential element in treatment.
Parents, wives and sometimes even children believe that it is

their duty'to try to control the chemical dependent, and stop
his__use of drugs. This results in those involved in close rela­
tionships-becoming as preoccupied with the individual,- as he is

with drugs. When those who have concern for the•p~tie nt "cover up"
for him, they unwittingly enable him to progress further into the
disease by becoming his care-takers. Addicted people r-?ke •
advantage of the vulnerability of their families or friend-s, and

manipulate them. Without that protective support system, they
would not be able to continue with their drug use fen? survive.
When the wife or parent covers up, pampers, pays bac.c the debts,
pretends nothing traumatic has happened, she does at because she

wants to protect the dignity of the family '-nd also because shs

does not want that person to be upset. She does not want to ro?l
the boat in case it provokes the use of more drugs. Unknowingly,

by doing this, she is allowing the dependent to continue behfevipg .
in an irresponsible way and endorsing whet his denial system

is already telling him - that’the "situation is not that Hd.
The family's reaction to the c--:-ic?l y-

■ dent

In coping with the tension ~r.n co-.’fvsiru“'ounds
disease, tie family members < - : -r ' n?c ft 11. - •
behaviour "att.r: c r tipi 1 ar >o -- -hemic'l

' oispley
-u-.-t's.
..5

1’

2

‘J’he family members sometimes let their preoccupation with the

chemical dependent cause pain to themselves and destroy their
lives.

Denia1
The family of the chemical 'nependent <- ny the existence of the

problem in order to avoid humiliation and embarrassment. What is (
obvious to others, is flatly denied by those who live on intiMate

terms with the dependent.

The family becomes ruite adept at

shielding the dependent, making excuses for his behaviour,helping

him out of tight spots,, covering up for -him with his employers

and others. To the. outside world, the wife or parent acts ag
though everything in life is normal. They fail to see their

own dependency - their dysfunctional behaviour. The minimising
and rationalising of the family member is often deeply ingrained
and believed in much the same way as the minimising and rationa­
lising of the addicted person. As a result, the family member

protects the person, denies that the relationship is troubled,
and denies the addiction of the person to whom she is attached.
They try to cope with the pain snd trauma by putting up a brave

front. But inside, they are torn apart with the agony of shamfe,
despair, fear and a feeling of worthlessness. Even to ^hem­
selves, they may minimise the extent of the problem. The chemiral dependent may be abusing his family while under the
influence of drugs; yet, the parent or w!.fe reassures hersfelf
that "things are not really that bad" or "1 don’t think he

has become addicted, yet."

3
Blaming
Unfortunately, the family members $tert blaming each other.Very
often, the chemical dependent, who is trying to take the focus off

himself, uses the situation to his advantage and sets one family
member off against another. For example, he may tell his mother
that he is using drugs because he is unhappy in his marriage.
He may say that his wife nags him continuously and he can’t
s^and it. To his wife, the same person complains bitterly about

hii domineering mother who never made any effort to understand
him as a child and sent him away to a boarding school. Thig
results in more pain and tension in the family because the two
women start blaming each other for his addiction. In so doing,
the family is kept from coming together and addressing the most

important issue of how to help the chemical dependent recover
from the disease.

Preoccupa tion
.The preoccupation of family members with the chemical dependent
is similar to his obsession for drugs. Their entire thinking

revolves around the dependent and they forget to take care o£

their needs. Their lives are modified to suit the needs of thji
chemical dependent. Acute stresses drive the wife or parent t$
,some behaviour or activity which she compulsively performs.

For example, she may be tracking down the movements of the
dependent all through the day, ever! though she might be aware th^t

by doin#. this, she could not control his drug use. Her compulsiza

preoccupation drives her to waste her energy in unproductive wayfc,
and the result is that she fails to perform her duties like

cooking, looking after the children etc. She finally ends up in a
self-destructive trap, controlled and manipulated. She trieg all

possible methods to make him give up drugs. But none of the

4
methods work. Worry takes over the family - worrying about over

dosing, about his physical health, about his being caught by the
police and about v.'hat to expect next. Family members become so

tense, afraid and angry that they begin to ' vestion their own
sanity.

Barga ining

4|

Bargaining also comes into play a.s the wife end parents try to

cope with this threat that has invaded their home.
"I will do whatever you want if only you quit’smoking ganja.
I will ring up your college and tell them that you are sick,
provided you stop using ganja from now onwards."

The goal of bargaining is to offer the chemical dependent some­
thing in return for his desired behaviour. But such bargaining

does not work at all. Instead, it leads to their frustration bpd

j

depression.

Depression
Eventually after so many promises, bargains and perhaps evbn

sober periods whieh have raised hopes and expectations, only V?
'have them dashed repeatedly in new rounds of drug taking, those
who are closest to the chemical dependent may plunge into dep­

ression, a feeling of complete and utter hopelessness -

"Is

no answer to the problem?" This is the stage that may be ejiterfei

any number of times during one's relationship with the chfemieal
dependent. The family may suddenly realise that loss or income
and consequent problems are imminent or they may be saddened by the

thought that his health is deteriorating and death is more or
less inevitable.
..5.

5
Suppressed anger

The wife/parent's efforts to control the chemical dependent

not pay off. And as attempts to control increase, the dependent

becomes less and less contrellahie -n'' she feels frustrated and
angry.

She suppresses her anger.

as

time passes, her mind becomes a ■

storehouse of pent up memories, hidden resentments, hurt feelings

end unresolved conflicts. Eventually, the chronic stress of un­

resolved emotional hurts become manifest in serious health
problems - ulcers, hypertension, heart disease, etc. Her energy

and vitality diminish.
Her repressed anger leads to a temper that explodes over trifles,
4,
frequent feelings of disappointment in others and a feeling of’

being let down. She avoids'relatives and friends. Suppressed a

does not protect, it does not make life run more smoothly. On
other hand, relationships become more difficult to handle. It des­

troys everything that the family hopes it will protect.

.

Isola tion

Living with a chemical dependent can be a very lonely existence.
The wife and parents, believe that no one else would ynderj^and

their problem and that no other family has been through suSh pain

and conflict. Repeatedly hurt and rejected, she has learnt to
keep sensitive feelings inside. She keeps herself cut off frol ail

sources of potential support. The result is that her loneZ’nejs

increases and gets intensified. With loneliness •"‘nd isolation,
come fear end anxiety. She feels totally powerless. Yet she

compulsively tries to handle all siti’a tions. 3”c< line the need
talce change, and at the same time feeling rx .1 ?■ ■

she lives

with a greet deal of =mbiguity, uncr r

- fear o£

ri r-

6

a^ndonment, loneliness, and rejection. As ■

result of these

feelinos of alienation, of low self-esteem, together with the
lack of communication and bitt-rness in the family, the family

members feel deeply alone.
Chan cje_of_Personality
The disease of addiction can bring ab'ut changes in the persona­

lities of members of the chemical dependent's family as well.
People who had been loving, tolerant and patient, suddenly find

themselves becoming aggressive and bitter as they struggle ^o

gh

cope w’ith addiction. Many parents and wives have coped with
difficult problems in life, yet the traumatic experience of;

living with the addicted

individual leaves them depressed, dis­

organised end disillusioned.

Co-dependency of family members
As a result of living in a problematic environment, the family

members unconsciously develop 1 co-dependency behaviour pat;terhs‘.

What is co-dependency?
"Qo-dependency is a specific condition that is characterised by

pyeoecupation and extreme emotional dependence on a person.
Eventually, this dependence on another person becomes a nathclb-hgical condition that affects the co-d-p^ndent in all othef

relationships" - Sharon Wegscheider-Cruse.

The family members of the chemical dependent become pre^ecvip^e^
with trying to sort out his life in a meaningful way. Xr, many

respects, their frantic efforts to change the chemica" depen^en^
become as compulsive as the behaviour of the dependent perso^,

"Co-dependency is a pattern of living, coping- and problem scflVing
created and maintained by a set of dysfunction" 1 rules withj.h
the family system. These rules interfere with healthy g^OwtA,

and make constructive chance very difficult, if not impoasi^e*
"

7
C-»-dependents suffer from a set of emotional problems. Their stra­
tegies of minimising, protecting, controlling, bargaining,sppea-

ling are classic coping react io's to the chemical dependent's
maladaptive behaviour. The co-drpor.d.. nt suffers from

- Difficulty in accurately identixyirg •

• expressing feelings.

" I decided not to get angry •■.•hen !>. ;:;tered home. But I could
not help shouting. What is wrong with .'e: Am I going crazy?"

- Difficulty in maintaining close relationships.
"I know I’ll feel lighter if I share my problems with my mother.

But I am unable to open up!"
- Unrealistic expectations for self and others.

"Somehow or the other my son should get into a professional
college. I don't know how he is going to do it! But he cantt
afford to let me down."

- An exaggerated need for others' approval in order to feel good.

"My friend said,

‘You must be a saint. I don't know how you put .

up with him. If I were you, I would not have telerab.d hip,'
I should live upto this image."
- Difficulty in making decisions.
"I need a change. I want to go to my parents' place for jujt

one evening. Should I go? Is it right? My God! I am unable to
dec ide."
- Anxiety about making changes.

"I have got a job. I need money. Should I accept it? Will 3 be
able to go? I'm scared."

- Feeling responsible for others,' bchrvignr.'
"He is going out. He may start drinking aqaiv. I.should seg.d
someone to watch him."

8
- Fear of abandonment.

"What can I do if he leaves me and goes out of the house?"
- Avoidance of conflict.

"He has not given ma any money this month. How am I going to

manage' Anyway I'll not ask him. ?.<: may g... t upset and start
using ganja again.
- A sense of shame and a lbw self-esteem.
"I cannot talk well. I'm inefficient. I don't want to meet

a nyone."

Co-dependenis appear to be self-sufficient,, strong and in control
of their lives. But beneath the public image of strength and

security, often lie the opposite feelings of insecurity, self­

doubt and confusion.

Thus, the people who are close to the chemical dependent dtf

suffer a lot due to his addiction. Although the chemical depen­

dent experiences emotional turmoil, his awareness is numbeg

fey

the drugs he has in his system. On the other hand, family members
have to bear the pain of reality. So they really need a lol; of
help, support and understanding.

■Help for the family
During recovery, the family members should fee made to feel th>

need to detach themselves from the problem which had all-’alonp
been the sole focus of their lives. If they want peace of min<5,

they have to be prepared to vzork through this process, They will

find it a great relief when they stop denying the problem and
pretending all is well. In course of time it will ?:..lp bgth

the dependent ?nd the family number if th;
problem, by d^ing the following.

.start f-cing the

9
- Stop trying to convince.- themselves that "if only he decides, he
can always give- up drugs." They have to accept- that it is a

serious problem which recuircs profession-® 1 help.

- Start talking calmly and factually to the ch.mice 1 dependent
about his drug use and subsequent h- :.?vicnjr when he is drug free.
The more open they are, the more uncomfortable they will make
him feel, about his use of drugs. He should be made 'to under­
stand th t he has a disease and that he can recover.

- Start communicating honestly and openly to the other merribers in
the family about their concerns.

- Start accepting that they are not alone; they have choices and

they need the support of Al-Anon and similar self-help (jrtJups
to cope with the problem. Self-help groups will help thetn £ind

ways of changing and building up their self-esteem.
- Start looking after their own needs and the needs of £hai£
children. They should realise that they have to start d.oin£ their

duties which they have neglected so far.

- Identify positive methods of diversion like going to tefti£>le f
pending time with children, pursuing hobbies --tc. Go<Jc, qxptr

rlences will give them the energy to face- problems.
- Plen one d’y ~t a time and start executing their plaiji.

Problems experienced during recqyery

Recovery of the chemical dependent brings a great deal (5f jcy to
everyone concerned. The family members’may hope that life is going
to take a turn for the better at once. They may feel that *-11

their tension will disappear. In a supportive environment, the
Counsellor should make them Understand that it would be very *

•

'*

?

unrealistic to expect that everything is going

.. wopoerfui
..10

10

immediately. They shouldzbe ntede aware of fhe. fact that there are
..certain problems which they may face during the patient's
recovery. An understanding will help them handle the problems

effectively.

* During recovery, iy is possible for the family numbers to expe­

rience gr..‘ t relief over his abstinence and yet miss the old,
familiar lifestyle. Although it was painful, there had always
been some predictability. They knew how he was going to behave,

what situations they would be required to handle, etc. But now
the recovering person is likely to be more independent and mo'e

demanding. This can leave family members resentful. All alonf,
the chemical dependent would not have been reacted td anythin
*

happening at home. Now he may expect his wife to make tasty
dishes, k. cp the house clean, help the children in their studies

etc. The family ney not be able to view bls -'onoc tat ions as

justified. •
*Friends and r_la fives would all -.long h"v. •’•dmiied the tolerance
of the fnmily. member end would have praised her for bearing the
brunt all alone. When the chemical dependent steps taking-drugs,

the positive comments are likely to be transferred fg him.

They may even pick on her. "Now that he has given up StASLs^ d?hy
don't you be more understanding? Why do you unnecessarily gg»
angry and shout"like this?" These remarks hurt them and jh if

Very common for the close family members to experience gxtrete

i

bitterness and’resentment, especially if they had cobed With
addiction by suppressing all their ttenuyo.

* Certain actions that would not stir a second though j£' displayed
by others, may Pe.t off alarms in the minds of loved ones, wheb

dted by the recovering ^r^on. It is virtually impossibly

:he family not to harbour d'ou>-. - wh--n, for example, they find

*.11*

11
some C’sh missing or when they find the- recovering person

moody, tired or notice him remaining extra long behind a
locked door or getting phone calls 't unusual hours.

-

The family members may treat the recovering person as a "brittle

doll". This is the result of a’ continuing f-_'r and a. prolonged
belief that anything they might say could c~use conflict and

make him go b’ck to drugs. To give in example, the recovering
person may come home in -on autorickshow. His mother may feel
that he need not extravagantly spend mon=y like that, when they
could ill afford even the basic necessities. But she will not

open her mouth for fear that it might upset her son, 'nd he
might get back to drugs. As a result, there- is no ccmmuni^.otion,
no clarity of roles and they work according to his expectations
because they are afraid of upsetting him. iKr- is «o chapce of

mutual trust developing in this kind of relationship because it
continues to be domin'-ted by f-T. Cn t.'u

only result in lot of stress f.->;

t: . ’

-

h? r/J, it Will

i 1 -■.

♦Family members may continue to b-v.. - r.-tr- nt towards #ie
p'tient for being o drug a’-'U'-c.r. Brothers may have s_ negative

attitude towards the patient and criticism 'is likely tq flow

freeely. Repeated remarks -about money wasted on drafts end fcq

treatment will be voiced by family members.
♦After many years of embarrassment and humiliation, lhe f&miiy
may have few outside interests or friends. All othe-h adjustrent
problems will be intensified by the family's lack of -social
APntacts end shared pleasures.

♦Family members will find it very difficult to listen fo th§
recovering- person. or relate to him in a meaningful waylEvep -

th'ovgh he may be making positive changes, th.iy may pot.

. .12

12
acknowledge? instead they may .xpect him to make changes

according to their expects tions.-For instance, they may make
plans for his future. Tb.y nr y ask him to go for work in the
mornings, attend classes in. the <v..nings, etc., without

discussing th_ issues.with him. They ar- likely to feel
that they have solutions to all his rro> ■ 1<. ns.
* The family members may have- conflicting Views if it comes to

the ouestion of giving him responsibilities. The recovering
person may be willing to take up certain responsibilities; but

the family may find it comfortable to assign him certain other
responsibilities. They may not be able- to trust him with the
responsibilities he wants to carry out. For instance, they will

find it comfortable to entrust him with insignificant jobs
like carrying vegetables, participating in physical wofk,‘ etc.,
whereas more important (and to the dependent, significant) jobs

like drawing money from, the bank, paying bills etc., will be

entrusted to other members.

The Counsellor must help the family realise that the family
support system surrounding the recovering person will require
some changing. Parents/wife need to alter their attitud-s fend
behaviour towards the recovering person. Even if one person if?

,the family network is willing to change, it will have very
positive results. The Counsellor should make the family melfoe;

understand that she need not continue suffering constant emo­
tional pein. She h-s to give up har preoccup’-tion anc obsessijn-,
with th- chemical dependent and, while still erriha, IcavQ hdSI

'

free to face reality and make sone choice” <
it may. not V.. easy for them an< ib< y

P ••

‘

-

help. Al-.' non “r.d simil’r
, ,
.
,,
■Chemical dtrt.-nsents wi_l prev-',-c^-

'

---

• * "

’

"

6n-.goj.nj

«« **

< ■ ■■ trvct.ive

13
advice and support. There they will meet people who have gone
through situations similar to their own. They -ill understand

and identify with the fear, the feelings of helplessness and

despair, the worry end guilt and the ..roblems in learning to

'let go' of the chemical dependent. The f-mily members really
need and deserve help to recover from this extremely painful,

family addiction. If they change, it is much more likely that the
chemical dependent will want to change too.

BIBLIOGRAPHY
'Choice
l.

Making' by Sharon Wegscheider - Cruse, Health

Communications Inc. Pompano Beach, Florida.
2.'Kick Heroin' by Liz Cutland - Sky books, London in association

with

Gateway Books, Bath.

3.'Lost in the Shuffle1' by Robert Subby, Health CommunlcetiPps Inc
Deerfield beach, Florida.

>
REGIONAL TRAINING PROGRAMME ON ALCOHOLISM AND DRUG ABUSE
SPONSORED BY

NATIONAL INSTITUTE OF SOCIAL DEFENCE
MINISTRY OF WELFARE
NEW DELHI
T.T.RANGANATHAN CLINICAL RESEARCH FOUNDATION
17,4th,Main Road,Indira Nagar,Madras 600 020

DENIAL
'DENIAL1 is a psychological process that takes place at the

unconscious level in the alcoholic. During this process, the

alcoholic's mind recreates an illusion so convincingly that

he believes it to be a 'reality'. He is not consciously
aware that this change in thinking is,taking, place.' People who

are closer to him, will definitely be able to identify the

methods of denial adopted by the alcoholic.
What exactly is 'Denial'?

The individual will not report accurately the quantity,fre ­
quency or the problems associated with his excessive alcohol

consumption. The adverse behavioural consequences and the

problems associated with his drinking will' either be minimised,

explained away, rationalised or denied completely. In short,
there will be a denial of reality.

For example, violent fights with the wife may be described'
as a minor argument, or rationalised as due to the arrogant

behaviour of the wife, or simply ignored.
The wife,friend,relative, or even a counsellor may perceive

this 'denial' of the alcoholic, as lying, - a method deli­
berately adopted by the alcoholic to escape taking respon­
sibility for his harmful actions. As a result of this,

p'eople close to him become hostile and develop an intense
hatred and dislike towards him for his dishonesty and

irresponsibility.

This chapter is intended to help in clarifying the factors

which produce and maintain the 'denial mechanism
*

of the

alcoholic,so that everybody including the counsellor may

respond helpfully bather than reject the alcoholic.
...2.

K
- 2 -

Why do alcoholics d'eny their problems?.
Drinking is an accepted behaviour in our society, and alcohol
is projected as an essential part of ‘good life1. For most
people, drinking is a harmless activity normally associated

with social occasions. Unfortunately, in the case of two out

of the ten people who drink, alcohol use slowly deviates from
a harmless to a harmful activity. Once the person starts
developing problems, he is branded a ‘drunkard
*

and a social

stigma immediately gets attached to him.

In other words, we reinforce drinking, but stigmatise the
victim of alcoholism. He is looked upon as an evil person

who deserves to be punished, rather than a sick person who
needs understanding, support, and above all, professional

help.
■Normally, nobody wants to be categorised and stigmatised as
an evil person, morally and mentally inferior to others, and
subject himself to punishment, disapproval, rejection and

social boycott. This is one of the factors which set the stage

for denial.

Two.diametrically opposite beliefs can never coexist for a very
long period in one indiwMllfll.

As a person/s drinking begins - to lead to problems, a conflict
is created. On the one hand,’alcohol has become a very impor­

tant component of hi.s lifer He likes to drink because it
produces a feeling of wellbeing and helps him to forget

problems. On the other hand, reality is trying to reinforce
awareness in him about the problems created by alcohol in

his family, occupation, social life etc.

At this point, he has only two options before him - reject
drinking or reject reality. He begins to reject reality

because he is unable to exercise the other option however
hard he tries.

As the disease of alcoholism progresses and becomes worse,
giving up drinking becomes increasingly difficult.Realities

...3.

- 3 -

of life appear more and more bitter and consequently the

mechanism of denial also becomes fully reinforced.
- The moral stigma associated with alcoholism provides

the ground for 'denial'.

- The tendency of family, co-workers and friends to cover
up the consequences of the alcoholic's adverse behaviour

provides the social environment which promotes and
encourages 'denial
.
*

- The individual's normal tendency to avoid internal conflict
encourages denial of unpleasant reality.

Early use of alcohol generally changes the individual's mood

in a positive way. Most people start using mood altering
chemicals in a social setting with friends, to help them

'loosen up'.
The alcoholic learns that the use of alcohol makes him feel
better. To him it is a compulsion, not an option. For a few

hours, it'makes him forget his problems, reduces his fears
and tension; removes his feelings of loneliness and gives him
an impression that he is able to solve all the problems.

Gradually, there appears a difference in the emotional effect

of using alcohol for the person who begins to become dependent
on it.
In the initial stage of alcoholism, the alcoholic drinks
much more than others; he doesn't1 sip drinks; he gulps fast;

and conceals the amount he drinks. He drinks more than others;

more often than others; and above all, |t means far more to
him than to others.

For him, drinking is no longer a matter of choice; it is
no more a display of his strength. This is the first sign

of his alcoholism. Repeated '..denial' by hiding the bottle
and drinking alone shows how necessary alcohol has become

fcr. him to lead his life. He starts with one drink and goes
on and oh; he is unable to stop.

...4.

4

Everyone end everything which were hitherto important in his
life become secondary and the alcoholic begins to reject every­

thing which he feels may threaten his continued use of

alcohol.
The reason why the alcoholic is unable to perceive what is
happening to him is understandable. As this condition' develops,

his self-image starts deteriorating. For many reasons, he is

unable to keep track of his own behaviour and he is-losing
contact with his emotional self. His defence systems continue
to grow; so that he can survive in the, face of his problems.

The greater the pain he suffers, the higher and more rigid
the defences become; and this whole process takes place without

his conscious knowledge. Finally, he becomes a victim of his
own defence mechanism.'
His rational activity turns into real mental mismanagement.
This serves to errect a secure wall around the increasingly
negative feelings he has about himself. The end result is that

he is separated from those feelings and becomes largely unaware

that such destructive emotions exist within him. Not only is
he unaware of hiS" highly developed defence system, he is also

unaware of the powerful feelings of self-hatred buried behind

it,sealed off from conscious knowledge, but explosively active.
Because of this, his. judgement is progressively impaired.

In short, instead of returning to 'feeling normal' after the
'high' wears off, the person experiences negative consequences

due to an excessive use of alcohol (e.g. embarrassment arising
out of actions done under intoxication such as aggression,
drunken driving,blackouts etc). The problem gets compounded
by the fact that these defences, by locking-in the negative

feelings,have now created a mass of free-floating anxiety,
guilt,shame, and remorse which become chronic in the course
of time.
The person is no longer able to start any given drinking
episode from the 'norma1 point', whereas before his illness
he could always do so, and then proceed, to 'foel good'.
Now he starts from a depressed or painful emotional state

...5.

5
and drinks to feel normal. In the.final stage of alcoholism he
has no option but to drink in an attempt to feel normal.
Because there is an absolute dependence on alcohol, it is
impossible for him to fully realise that there is a tie between

his negative, feelings or behaviour and alcohol.
'Denial' or an addictive thinking pattern begins to develop to

protect the alcoholic from the reality of his alcoholism. As

"Irendy stated, it is a defence mechanism used to protect

himself from the guilt, shame and blame which usually accompany

the consequences of his continued excessive use of alconol.
As he becomes more and more dependent on alcohol, the 'denial

mechanism' takes various shapes.

Let us discuss some of the most common forms of denial.

Simple denial
Initially, the alcoholic totally denies the existence of any
problem associated with his use of alcohol,: even though these
problems are quite obvious to

others.

For example, the alcoholic may admit that he takes alcohol,bu%
denies the.fact that his alcohol intake has produced any

adverse consequences.

"Drinking produces no problems whatsoever. As a
matter of fact,I feel 'good' and I am able to solve

my problems after drinking".
Minimising
He accepts that his drinking leads to some problems; but
keeps on repeating that these problems are not as much or as

many ns the.others make it out to be. He tries to convince
himself that it is much less serious than what actually’’.is.

- 6
"I drink, alright;

but it is. not all that bad ...

I drink only on weekends. I give enough money to my

wife to run the family. T am not spending excessively

on my drinks, as she complains. It certainly does not
cause any financial problem as it is "made to appear."

Blaming or projecting

The alcoholic blames others for his own shortcomings. In this

case, he denies responsibility for many of his alcohol-related
problems and shifts the responsibility to someone else.

It is only the cause of the behaviour which, is denied and

not the behaviour itself.

"My wife does not respect me.I slog only for her
and for my children.But she does not understand

of my problems. She is constantly on my back. She
does not bother about my feelings at all. I drink

only to forgc-t my misfortune".

Rationalising or giving excuses

The alcoholic gives innumerable excuses,justifications,and

alibis for his behaviour; but never admits that the real

cause for his adverse behaviour is his excessive use of
alcohol.

"My boss keeps on saying that I have not completed

my assignment on time. This is because he is totally

■ prejudiced against me and never cooperates whenever
I ask for help! I drink only to calm my nerves!"

The alcoholic never accepts that alcohol is the real reason
for his bad performance.

Intellectualisation or explaining away feelings
Here the person avoids facing alcohol-related problems by

dealing with them on a' superficially general, theoretical
or intellectual level.

7
"I am a doctor and I know what it tnean^ to be an

alcoholic. How can you ever come to the ^conclusion
that I drink excessively, thus damaging my liver or

brain? Do you really think that I am as stupid as all
that?
Anyway; I will not get angry with you, because it

does not do any good anyway."
Diverting
The alcoholic changes the' subject of conversation whenever

any reference to alcohol use or alcohol-related problems
crops up.
The alcoholic's friend says,
"You are developing severe problems due to excessive
drinking.lt is high time that you take care of your
health, see a doctor'-and go for treatment."

The alcoholic doos not allow his friend to even
finish the sentence. He immediately interrupts and ’

diverts saying,
"I heard you have not yet booked your ticket to
Bombay. Nowadays bookings are becoming difficult.

You have to book sufficiently in advance. The booking

clerk is my friend and I will certainly help you in
booking your ticket."
Hostility
Another form of denial which the alcoholic may use to his

■advantage is anger and irritability.
For instance, he may get extremely angry and aggressive
whenever the topic of addiction is broached because he has

learnt by his experience that his anger will make the other

person avoid that topic or leave that place.

...8.

-8 Silence

,

Here the addict maintains strict silence whatever be the pro­

vocation. He’uses this method to withdraw from reality.
The 'Denial Mechanism' in its various forms is always supported
by people around the alcoholic. Alcoholism rarely appears in
one person set apart from others.

It seldom continues in isolation from others. Therefore, to
understand alcoholism and 'denial', we must look not merely

at the alcoholic but also at others closely related to him.

For the alcoholic to maintain his 'denial', others contribute
unknowingly.

If excessive drinking continues for a long time, it inevitably
leads to a crisis, yzhere the alcoholic gets into trouble and
will end up in a mess, if only others are not there to support

him. This- can happen to each individual in a different way.

But the pattern always remains the same.'
Alcohol, which at first gave him a sense of success and inde­
pendence, has now exposed him and made him a helpless,totally

dependent child. Now,everything is taken care of by others.
He behaves as if he .is independent when all the while he is

totally dependent on others; and drinking makes it very
easy for him to convince himself that this is true. The
adverse consequences of his drinking always make him more

□nd more dependent oh others. When he gets into a crisis,

he waits for somebody to take up the responsibility and
cover up the consequences; thereafter he ignores the

crisis and walks away from it.
The people who protect are referred to as the Enablers,
the Victims, and the Compensators. Their behaviour is called

■’Enabling Behaviour".
...9.

9
"Enabling1' is a therapeutic term which denotes a destructive

form of helping. Any act that helps the alcoholic to continue
drinking without suffering the consequences of his inappropriate
use of alcohol is considered "Enabling Behaviour".

The Enabler
The Enabler is a person who may be impelled by his own .
anxiety and guilt to rescue the alcoholic from his problems.
He wants to save the alcoholic from the immediate crisis,

and relieve him of the tension created by the situation.. To
the enabler, it is like saving a drowning man. This rescue
mission conveys to the alcoholic what the person really
thinks, "You cannot face your problems without me."

In reality, the 'Enabler' is meeting a need of his own, rather
than that of the alcoholic, although he does not realise it
himself. The enabler actually reveals a lack of faith in

the alcoholic's ability to take care of himself, which is a

form of judgemental condemnation.
This role is normally played, by the 'doctors', or 'social
workers' who lack scientific information about alcohol or

alcoholism which is essential in helping alcoholics out of '
their problems.

The behaviour of these people conditions the alcoholic to
believe that there will always be a protector, who will' come
.

to his rescue, even though these enablers insist they will

|

never again rescue him. They have always rescued' him and

the alcoholic knows that they always will. Such -rescue
operations are as compulsive to them as drinking is to•the

alcoholic.
Victim .

The victim is usually the boss, the employer, the supervisor
or a co-worker. When the alcoholic fails to perform his job,

the 'victim' normally completes the work. If the alcoholic

is absent due- to his drinking or due to a hangover,the 'victim'
gets the work done for him.
...10.

10 -

Statistics in industries show that by the time drinking inter­
feres with a man's job, he may have been working for the same
company for quite a number of years, and his supervisor or

boss, by now would have become his real friend. Protection of
a friend is a perfectly normal response.

The victim always hopes that this will be the last time that
he will be rendering this sort of a help. But he continues
to protect the alcoholic again and again.

The alcoholic becomes completely dependent. on this repeated
protection and cover-up by the victim. Otherwise he will not
be able to continue drinking in this manner.

In short, it is this 'victim
*

who unknowingly helps the

alcoholic to continue with irresponsible drinking without
losing his job.
The compensator

The key person is normally the wife or parents of the alcoholic,

or the person with whom the alcoholic lives. This person has
played the role of 1 compensator * much longer than anybody
else.

The wife is hurt and terribly upset by his repeated drinking
episodes

She has to take up the responsibility to hold the

family together in spite of all the problem's created by

drinking. She becomes bitter,resentful, afraid, and deeply
hurt. She controls, sacrifices, adjusts, but never gives up.

The alcoholic blames her for everything that goes wrong in
the house, or outside.

In helping the alcoholic, she also consciously meets a need

of her own. She enjoys her inevitability arising out of the
alcoholic's total dependence on her.

She is also forced to play the role of a responsible and
accommodating housewife, who can function efficiently in spite

of the problems surrounding the entire family. She is afraid

...11.

11

that society will otherwise brand her as 'non-cooperative,
unaccomodating' and inefficient1.

She tries whatever is possible to make her marriage work and
to prove that she is able to manage her problems efficiently.

She plays all the roles - the role of a wife, the role of a

father, the role of an earning member and so on.
When-an alcoholic gets into.trouble, her typical response is
to try and minimise it.

"Let us hush this upi"
"Let me inform his office that he is taking leave

because there is a function at homel"

These are mcmefits'

when he is drunk. These are the ways the

compensator minimises the force and the pain of each crisis
as it develops. While they are trying to be helpful they are

actually aiding and abetting the development of the disease,.
Everytime they try to rescue an alcoholic, they are only

postponing the necessary treatment.
Living with a man with,the disease of alcoholism, she tries
to learn, and counsel him as well.

As a result of this, she hurts herself, adds more guilt,
bitterness or hostility to the -situation which in the course

of time becomes unbearable.
If the alcoholic is rescued from, every crisis either by the

Enabler,'the Victim or the Compensator, there is no chance

for. the alcoholic to recover at all. Long term recovery
is possible only if the major block, namely denial, is
broken.
In reality; the alcoholic is helpless; by himself he cannot

break the lock. He will recover only if the above mentioned
people learn to break his dependency on them by refusing to

help him get out of the crisis created by his alcoholism.

...12.

- 12 - •

The alcoholic will feel helpless and desperate because some
crisis or the other will inevitably occur due to his excessive

use of alcohol. He will find no one ready to take up respon­
sibility for his actions. He will find it impossible to deny

the problems .associated with his use of alcohol and it is the
crisis that will force him to come for help in despair.
The Enablers, the Victims and the Compensators, too, must seek
information, insight and understanding if they plan to change

their roles, so that the alcoholic's denialis broken and he
realises the need for help.
They should realise that;

- 'Denial' is the result of the social stigma attached to
alcoholism; the alcoholic's defense mechanism and the

'enabling behavior' of the people significant to him.
- A Crisis is an opportunity - it need not be terrifying.

- The problem is to get people knowledgeable enough to use it
creatively, i.e., out of crises, develop opportunities for

intervention.
- The resulting confrontation following a crisis can break
through denial and this will be the first step towards
recovery; - perhaps even the beginning of treatment.

- The task of treatment is to make the alcoholic well. But,it

is the task of intervention to bring him to treatment.

HH

REGIONAL TRAINING'PROGRAMME ON ALCOHOLISM AND DRUG ABUSE

SPONSORED BY

NATIONAL INSTITUTE OF SOCIAL DEFENCE
MINISTRY OF WELFARE
NEW DELHI
TITGRANGANATHAN: CLINICAL;RESEARCH- FOUNDATION
"TTK HOSPITAL"
17,IVth MAIN ROAD, INDIRA NAGAR,MADRAS 600' .020

MOTIVATION AND INTERVENTION

'

'Motivation' can be defined as the desire to change one's

own dysfunctional behaviour. Therefore it is one of the
key issues’ in the treatment of chemically dependent people,

and it forms the first phase of therapeutic treatment. In

this context, it may be said to include, the following;
- totally giving up drugs for life
- attempting to make changes in one's life-style

- realising that it is essential to take an active part

'

in the treatment programme
- be willing to make adjustments in order to recover.

The motivation of a client c,an be assessed based on the
following factors:

- Acceptance of his problem with chemicals
- Asking’ for help for the same

■

- Reporting for treatment without coercion

■ /•
• /

;

- Compliance with the terms laid down by the treatment cjnrtyre
- Past history of abstinence

/

- Internal locus of control (i.e) a desire to get better

one's own sake.

Chemical dependents generally come for treatment only wbhn
they are left to face some crisis all by themselves - idss

of job, marital dissolution or legal threat. At this point#

2

most chemical dependents are self motivated for help. Initially,

the client will focus attention on his immediate problems like
loss of-job, separation from wife, etc. At this juncture, it is

not at all advisable to try to make him understand that chemical
dependency is his real problem. The most important thing is
that, the therapist should show'supportive understanding and

give him reassurance that his problems will be looted into.

The client will now be experiencing severe stress, arising out

of acute fear - fear of withdrawal, fear about the kind of
treatment he is'.going to be given, fear about others coming to
know about his problem, etc.

"How am I going to face the physical problems associated with
withdrawal?"
"What kind of treatment are they.going to give me? - Operation?

- Electric-Shock?"
"How am I going to face my 'old friends' and neighbours?"
It is important that these inner barriers which prevent him

from admitting his need for help should be recognised and

discussed with .empathy.
If at all the professional wants to focus his attention on

chemical dependency, he should start talking to him about the
client's obvious physical problems like tremors, loss of

'■

appetite, and noticeable weakness. He should concentrate tjnly'
on the physical damages which are obviously seen.

The client may already have taken treatment in various centres,
and failed to recover. Therefore, his acceptance of treatment
will be minimal. He would already have tried (though unsucce­

ssfully) , to stay away from chemicals. He would have expe­
rienced problems associated with' withdrawal, Meeting other
recovering patients at the treatment centre and talking about

his internalised fear will also help him overcome his

anxiety. The recovering patients will talk about the

I

fear they had during admission and give him reassurance that
safe withdrawal'is possible.

Most of the chemically dependent people h-ve a motivable area,
which is a sensitive area that has to be identified by,the
.43,

.'

- 3 -

professions!. The client may have very warm feelings toward his
parents, employer or child. These sensitive areas have to be
identified bnd can be'done by'■at‘Eenti^e,i,'tibn-judgemental

listening' - listening to his, verbal. rnd non-vfefbnl-iCOEamunienfeiVe
tion.'

"I have come for treatment mainly because my mother is very
much upset and worried about my ill health!"
"I want to give .up drinking because I find that my drinking

upsets my daughter. I will go to any extent to keep her happy"..
These motivable areas can be located by encouraging the client

to talk ■’bout all his feelings - the relationships he respects

and wan^s to strengthen.
The therapist's most important task during the first interview
is to establish a positive relationship. His understanding,
non-condemning, non-judgemental attitude, his acceptance of the '

client, will in turn, help' the latter to accept himself. He wij.1
be able to overcome his guilt feelings, self-hate and self- ,
destructive tendencies. Once the client feels accepted, it wij.)
be relatively easy for him to discuss his problems freely,.tfte

mere mention of which would have irritated him earlier.

\

By now, the therapist should have gained the acceptance of the
client. His motivation has now got to be strengthened and

reinforced. The following methods have been tried and found to
be useful to enhance the patient's motivation.
Verbalisation and feed bock of the damages caused by chgmicSl

■dependency in the different areas of his life can now be
addressed. This can be done in individual counselling.sessions. '

Participation in group therapy and interaction with .other
chemically dependent clients will give him the reassurance

'that he is not 'alone'. He will come to realise that others
had the same or similar problems problems.and that they are.

able to-lead a better life without the chemical. He will get
reassured that abstinence is possible.

Videb presentations have been tried abroad and found to be

very effective. This involves video recording of the patient's

behaviour under intoxication and replaying it to him when he

is sober. This method is - little expensive, and therefore,not being tried in India.

- 4 -

The client should be. encouraged to read materials which give

comprehensive information about the disease of chemical
dependency. Open discussion of the successful recovery of
other patients may foster additional optimism in the client •

who has had a history of prior treatment failures, or who
is doubtful about the successful treatment outcome.

Another method which is used for motivating the: cli' nt1, is
involving individuals for whom the client has regard and '

respect. Their involvement in the treatment process will
increase the motivation of the individual. Friends or
employers who are genuinely interested in his well being

may prove to be strong sources of support.
Motivation can be increased by using concrete medical records

of the patient. Diagnostic tools like blood reports, CT scans,
and X-rays with proper explanation from the medical professional

will create an awareness in him about the physical damages
caused by his chemical dependency.
There may be chemically dependent people who do not respond

to any of the above stated motivational procedures. For them,
the emotional acceptance of the fact will take a very long time.

The therapist may be challenged by thorn again and again. The

strength of their 1 acceptance' will be tested ; on numerous
occassions.' Instead of rejecting the clients or confronting .
them with logic and argument, the professional should reassure

them that he is always there to hdlp and support them -and that
they are welcome any time for treatment.

However, acceptance of treatment by itself does not mean that
motivation is strong. .Constant follow-up and contact with the

professional is necessary to ensure sustenance of motivstidti,

which in turn will lead to a commitment to recover.
We have so far discussed techniques for enhancing the mofivatioji

of those clients who have■already come to the treatment d'eMtre,
On the other hand, there may be a group of clients who will be
unwilling to come to the treatment centre. In such cases, a
family member,usually thq wife, or any elder comes to tty
treatment centre asking for help. Their crucial fear will'be

"How do we bring him to the treatment centre?"
.3.

■

- 5 What is Intervention?
Intervention is suggested when the addicts refuse to take help
inspite of obvious symptoms. ?»ddiction is the only disease where

the victim does not fully realise the enormity of his problems.

Intervention is a process by which the progressively harmful

and destructive effects of chemical dependency are interrupted

and the person receives some kind of constructive he Ip ..Interven­

tion ensures that a person need not "hit the bottom" before such
help can be extended. Intervention is a method by which the
reality of his illness can be presented in an acceptable manner.
It means getting together and discussing in a caring way the

concerns of the family -about the person's harmful use of

chemicals.
Why Intervention is important ?
* It helps significant people understand how they have been a
party to keeping the illness alive -and how they can stop

enabling the progression of the illness

* It dispels the myth that a person has to "hit the bottom"
to have, a successful recovery

* It starts a meaningful dialogue? between the- family members
about the problems associated with alcohol/drug abuse and

creates a caring'attitude towards the addict

•

.

..it

* It brings anxiety, fear, pain, anger, isolation and hopeless­
ness into the open and unites people, builds courage and

teaches the power and strength of love
* It helps people learn about chemical dependency through a
series of meetings with a trained professional

* It leads to a meeting that, offers hope to the client
STEPS FOR INTERVENTION

.

STEP - 1
THE CALL FOR HELP;
It begins with one person who reaches out for help and through
that person, a group of meaningful people are gathered. The
first person to call for help is generally one of the persons
..6.

- 6

closest to the abuser, one who is more worried, afraid and
angry than the others. This person can help select other
concerned people. In this group it is important to include

the addict's children also. Host often they are the ones who

listen, witness the fights and anguish, and end up bearing
the family's pain. Friends, relatives, employers, clergymen,
doctors and others may also be included. The selection of
members has to be made by the family with the therapist’s

help. A group of. 5-9 members is a good number for intervention.

•

STEP - 2

EDUCATIONAL PROCESS

The people who are included in the intervention should know
about the disease concept of addiction, the enabling behaviour

of the family members and the defence- system of-the abuser.

This education process can be done with one family or a group
of several families. The advantage of the group is that the
isolation, fear, shame and worry are eased vhen they come to

know that they are not the only ones suffering on account of

this problem.

STEP - 3
DATA COLLECTION
A list of specific, non-judgemental facts relating to the abuse

of chemicals is presented in a caring manner during. the

intervention process.

Specific
(a)

Data

s First ha,nd knowledge of incidents and
behaviour as narrated by significant.
people should be reported.The-change
.‘in the person's character, behaviour ,4
personality
seen by the concerned
persons can be presented. On any
account avoid gossip or second-hand
information. Avoid generalis'ticn such
as "You always drink toe much" and
"You never come home sober". The persist
reporting the data should also be
encouraged to indicate h '-r it makes
her feel - such as emberr -.ssment, feax^
unhappiness, '-.to.

7 (b)Non-judgGmental
attitude

: Avoid looking down on the person or
making ^hjoral udgements. Stick to
factual reporting of behaviour and
incidents.

Care
(c)

and Concern

z The addict should be made to realise
that there are people who ..do- care
for him and are concerned about what \
is happening to him.

Pl-n
(d)

of action

; Decide beforehand as to what type of;
help you want the chemically dependent'
to get.If the -addict does not accept
this, have an alternative course of
action, include an 'if1 clause.

Consequences
(e)

; What alternatives does the persop'face
if he rejects all forms of help? Some
of the consequences could be high­
lighted - loss of job, wife, separating
from him, etc. Do not state conditions
that cannot or will not be carried out.

STEP - 4

.

TREATMENT PLAN

(a)The goal of intervention is total abstinence from alpohol/
drugs. The treatment plan is decided .by the counsellor and
the family members.
(b)
Abstinence
can be achieved through attendance at AA meetings
or taking treatment in a hospital or getting individual
counselling or a combination of all ti:a three.
(c)
All
issues related to taking treatment must be planned in
advance. For example, getting medical leave, from wqrfc, or
getting somebody to lock after .children at home, or making
some kind'of financial arrangements. All these must be
preplanned by the family with the help of the counsellor.
(d)
There
has to be an '.if' clause in case the person is not
prepared to take treatment or quit drinking.
-

The clauses could be;

- Wife will set up another establishment
- Boss will dismiss the addict from the job

- Friends will stop seeing him
The conditions should be realistic, practical and not those

which cannot or will not be carried out.

. .8.

8
STEP - 5
FAMILY TREATMENT PLAN

The family is encouraged to seek counselling for themselves so
that they can help the addict to seek help. Some of the

co-dependency symptoms which the family h~ve are:

1.Rescuing and making up excuses for the addict
2.Feeling responsible for the problem
3.Judging, blaming.and■nagging
4.Trying to be super responsible
5.Manipulating the dependent

6.Suffering from anxiety, fear and hurt.

STEP - 6
THE REHEARSAL
A rehearsal should be done with the therapist prior to the

actual confrontation of the client. The counsellor should guide
the meeting. It is helpful to have someone role-play the abusgjr -

perhaps a recovering alcoholic. During the rehearsal, data a^a

presented, treatment plans shared and consequences discussed."

STEP - 7
THE INTERVENTION

'

:

Intervention should be done when the addict is likely to be
sober. For example, early in the morning', on the workspot, in

the place of worship, etc.

SOME GUIDELINES FOR INTERVENTION PROCEDURE
1.Decide on the person who is going to open the session. This

person has to state the objectives of the meeting.

2.To break the family's "no talk" rule about addiction, the
counsellor should start the session by saying something like4

"Your family and friends are here because they are concerned
about what is happening -to you and to them, due to your drinking/drug abuse".

3,The therapist should also get a verbal assurance from the addict
that he will listen without interrupting until all the persons
are through with their points for 'talk1. "Everyone in the
.,0.

- 9 -

family is deeply hurt. Our goal is not to hurt or punish

anyone but to identify the kind of help your family needs".
4,

Make sure that e-ch fact presented is connected with the use
of drug.

5.

Avoid interrogations like, "Why do you drink?:: "Why did you
give your resignation?"

6.

Avoid using the word ’'alcoholic' or 'addict'. Use 'Problem

drinker'/'chemical dependent'. Never get into -n argument

about 'who an addict is'. While suggesting solutions, it is
preferable to use the word 'help'.
7.

During intervention, the members should be helped not to get

emotional, so that they do not threaten or blame the addict.
8.

If the-addict tries to change the subject or tries to focus
the group's attention on some other problem or person, bring
the discussion back to his problem.

9.

In case there are a few concerned persons who may not have
first hand data, allow them to speak towards the end.

10.Listen for "Surrender" statements such as "I didn't know if
was so bad". Or "I suppose there is something I should do
about this". Then focus on the agreed-upon alternatives.

11.Be empathetic with the addict while pointing out realises
and provide reassurance. When the person has accepted help, .
show him your support and care.

12.At the end of the intervention, the professional should be
in a position to provide a plan. For instance, fix up a bed
in a hospital or fix up an appointment with the doctor on

the same day.
13.If the patient is too difficult, don't give up immediately.

There is no complete failure to an intervention. The addict

may not hove accepted help at that point of time. Still the
programme would help in bringing out in the open many things
which would have been in their mind, and the family membefs
would be in a position to open the talk about the problem

.later on.

Thus, the task of motivation is to help the patient accept
treatment and -it is the task of intervention to bring him fo
treatment ♦

NEEDED - CHRISTIAN CARE FOR ALCOHOLICS

ALCOHOLISM— AN ILLNESS
. -

•'

.

COMMUNITY'HEALTH CELL
. 47/1, (First Floor) St. Marks Hoad
’
■ , BANGAtOaE - 560 001

The American Medical Association affirms it. '

Alcoholism is a highly complex'and .progressive illness .■ .
■: It is treacherous but treatable. . There' is. help for recovery.

What's this illness ,like?

Alcoholism is the

condition of a person which is characterized by his Ibss of
control over the use of ethyl alcohol. He finds that he
(or she) is consistently unable to refrain from drinking

or to stop drinking before getting intoxicated.

In brief,

alcoholism is uncontrolled drinking of’beverage alcohol.
■This uncontrolled drinking,.in,.turn, causes' problems in

■ one■or more areas-of the .alcoholic person's.life, such as
family life,,job, finances, arid health.
'
. . REASON^ -FOR CONCERN

.

It,.,is appropriate, for Christian people to be
concerned' aboutIperspnsZ with alcoholism arid .■■about their

’ families.’ .lHerC;are/some'reasons . for .concern: <■■..
■ - in the United States alcoholism causes intense■ suffering iri'the'lives of;some '9'-million:men: "and ■womeri.alcpholic-persons'and.-their
,
' million family ’-members, • arid we-,people of ’ " ’
i5 " Christ's:-felldwship‘ are-committed' to ‘‘the '■■'■■-J'-- ~ ■' ;rV
relief of human suffering.
(It is important
to note;here that;alcoholism ranks -as a
major health'problem'in the United, States,
along with-heart disease,■ mental'•••.illness- 2
• - ■■-' i and cancer. - .Fewer; than five per cent of
U.S. alcoholic persons are .skid row derelicts;
. the vast majority of-men and women ■■afflicted’-With
this illness live at.'home,.in respectable
, ., ■ . .
neighbourhood and are struggling to stay in
■ the mainstream of life.)
•’
- the alcoholism, illness involves- spiritual ",
factors "and’the’ specialised ministry ofthe Church is to supply spiritual resources
for the healing of such persons.

- alcohol involvement frequently alienates
people- of . God from.the life.,and. mission
of the Church and also keeps people froin ■
fellowship with Christ and His Church.

...2/-

\

■’< SI®?■
' ,".

"

’.-. •■<•;■.■■ o"J-' 'v'i-'
*

'

: .r '! 4

l/l-; " - ; .'. ',

(To assisi: IInotHri.srecbgnitirijn^rif^’yarip$^•
ism ’,'
a 'special;,•-insert.JfoIderj ’.'yirift'en’^htirejy •f'm.’.tae'-.medical- ; .
psychological
•j JS

this booklet; '-Tt-was' .^.e^are^lHy/IJOhn :^'.'rayn^i^^^x.eciiit"irveo .-. ■-■ ■
'

director; p'fl'the K}rdatriry£lt;'--LOuib''7C^

- 1 '’

''

■

i/ 7

-«{J

ORIGINS OF THS ILhNKSS

.

,y;c'ru'T

-■• ‘,.,7;Jp'''’siiil;'ey o^

......

is '.still an illne’’ss;-cf .-imcertaifi^briglns.-r'/But''it.'tooks-as ■-• -•
though it '"is 'probably paused- by various-eriomhinat-ions. ,df " •

"

factors.

•

-;. -•■••

What are' the. probable.' factors? ;.. Apparently "among

these' factors .are-the physiologicalthe, relational.4or.z:r-

psychological-Teligious'/Cthose 'which’.'-have ..to.'do.".with'. ;/,';', - .
relationships' with..God^ /self j -‘other'sy; and rli'fe ,‘ih rthesworld);.'

and the .social-cultural. '

‘ ■'■•

" ' ■; !'■.'.'', •

i>'

•■

■'■■':To say.it-pimply, pome persons'.-may 'be'.',or. become
alcoholics for purely‘.physical-or biochemical re a so ns

'

■ Others, evidently, beedme;;:aicoh611cs i;"bepaupe.'ih2ir,?l:i.fe. ';^:i/7

' • situation^ permi;t^'.^ri®heburage&tMW^dV'^oi')^fith^i^<y?5j?M?.,i.
. ' ’■ ■■ r--o!"‘’y■/••'.. '•'■•?■'■..
•■. relationship. ,'problems'lthrough-;;-t'hPl^pe'ssiye;.L.pse<-pf^alcohol
This use, in turn, becomes’.'uncontrol led because., of the"/.
development of- psychologicalfdepehherie'e;and 'puiteylikely ■ ■

also because of certain''changing body. functions7..

.

.It is important,'.-to ;recognise that-per's^ons 7do'-hot'7

have the alcoholism illness because they are morally-..weaker
than others, - more; sinful more'stubborn,'" or more"''lacking.' in..
will power than others-.t-Apparently what'happens .is 'this:..
the alcoholic ..person' s involvement -in’ human ’weakness and

the freedoms which -he..has in deciding hpw.he wants;to. live
combine, somehow, in his associations with ’people and places,
to permit, if not cause," him to use beverage alcohol to deal

with God, himself, others, and l.ife in the world.’. -Through
his increasing dependence bn ethyl .alcohol he comes .to
experience the. enslavement of" the alcoholism illness .

.

In no way, however , do- the; complex., arid somewhat

uncertain causes of alcoholism exempt ..the alcoholic person
from being responsible for -obtaining help.' '-'-The. alcoholic .

- 3- <

\

' '

‘person needs to become, and with help can become,' responsible
for obtaining treatment.- .
•
, ■
FOCUS ON RELIGIOUS FACTORS

.

‘

-

Let us emphasize a point here.- It seems
especially’apparent that', at the 'outset of and/or during

the course of the illness the alcoholic person;seeks' to .
deal. with'his'relational (religious and .spiritualneeds'

by means of the anesthetic effects .of -beverage -alcohol.
With alcohol seeming to provide some sort of. temporary relief'

from or even a solution'to his human needs, he' closes

himself off from the realistic. Christian, solution to his
.human-needs..

Alcoholism demonstrates how people inappropriately

seek in their own way to .solve human problems "for which'God

/'

offers an effective solution in Christ and the Christian
fellowship.
•

...

PROGRESSIVE-AND TREACHEROUS

■

'

•'

The alcoholism illness is especially .treacherous
■ for_two reasons that'have to. do with- its progression. . "

.

'

First, its progression increasingly damages the whole

'

person - body,'mind, and spirit - and this in all relationships.

Second, the nature of ., the illness-at ~i'ts".various . stages... .;

.

generally'precludes the'possibility of self-diagnosis-and
desire for recovery..

.

-.

The alcoholic person does not readily.recognize his
condition because he is te.porarily, and at least partially,
satisfied with his use of alcohol as a solution for life's
problems. When not wholly satisfied, the alcoholic person

likely views himself as a bad person or, at times, even
insane; and since he does -not want to admit to eitcher, he

avoids the necessity of seeing his alcohol dependence as a

problem.

.'
At any rate, the alcoholic person does not view

himself as having an alcohol problem.

Instead he usually

presents himself in grandiose, egocentric, and demonstrative

ways.

He makes special use of the defense mechanisms of

denial, rationalization, and projection .to defend himself

'■ .A/-

.

- 4 from the dread reality of his situation..

It is only when

his defenses are Weakened by the pain of his drinking that1
the alcoholic .person admits something of his real condition
and expresses a desire for change.' •
.
RECOVERY BY SURRENDER

,
'
'■ ' ■
■ .
'
• ■■ ' ■
■ •.
As previously stated, there is recovery for

■

alcoholism.

Recovery can take place at any stage of its

progression.

For-the vast majority of those who. work'in

•

•

the field of alcoholism, this recovery is only by way of
total abstinence from beverage alcohol.

However, the

alcoholic person can move toward recovery only when he

gives up completely his use of alcohol as a solution to

his human problems.

This means that he needs to look

upon his uncontrolled use of alcohol as the primary

problem in'his life and, with hope for recovery, turn to '
people around him for medical spiritual and psychologicalrelational help.

Something critical needs .to happen in the life
of the alcoholic person to'facilitate surrender.

The .

alcoholic person needs to experience the inevitable and

painful consequences of his alcoholic solution. - He needs to
have a real life Law experience about his decision to deal
with life counter to God's design. Of special importance,
he needs to know that his life-style is doing harm to a

part of God's creation - his own body - which St. Paul

aptly describes.as "the temple of God".

"

It is of greatest importance that the alcoholic

person be allowed by those who are close to him to have
this Law experience in an atmosphere of love and understanding

so that he can see for himself the appropriateness of

choosing destructive ways of meeting.his needs.

But lest

the despair, those who are close to him need also to
symbolize and communicate to him the hope and concern

of the Gospel.

They do this by speaking the Good News

of God's love in Christ and by being accepting, understanding
and genuine in their relationships.

,.5/-

-5RESOURCES OF CHRISTIAN CARE

'

•

Because 7alcoholism is.very much a problem of
inadequate and damaged relationships,, the Christian religion

offers significant help for alcoholic persons. Christianity
truly helps because its basic purpose is the healing of
man’s brpken and damaged relationships with God, ’ with self,
and with others.

It's like this: The Christian Good News and its

creative thrust into the lives of -people meets relationship
heeds in three ways:'
. - by. giving the alcoholic person the
assurance of God’s forgiving love
and acceptance in Jesus Christ:
. .

..

• ' - by .giving the alcoholic person the .
ability to.give and receive love;

■_

■ .

-by.giving the alcoholic person a place
. ■ •■in the Christian community where
there .is mutual acceptance, concern,
; J. and care.', ’; ’h"-, .
’*■

-'1 :

It becomes clear then that the -people of God are' •

■ uniquely and especially equipped to help alcoholic persons
by sharing:

•

- the acceptance of God in Jesus. Christ
with all of its power for restoring
relationships;
- the Christian fellowship with' all of
its power to sustain and foster
relationships.
Because of the alcoholic person’s difficulty

in relating well 'to anyone, including God, we can best
help him or her by forming a relationship with the
individual by which we make Gcd’s love concrete and real

as we relate to that person and as we speak the Gospel.
Such relationships provide a catalyst which enables the

alcoholic person to trust in Jesus Christ for renewal
and, at the same time, to begin to build solid
relationships with other people.

■ ..6/-

'care FOR THE FAMILY’

’

'

Caring relationships are important forrall
members, of the alcoholic person’s’.family, topi 'especially
for .the'husband or wife and children. '.Alcoholism 'is a
.family' illness. It harms the whole family‘and injures
the feelings, life style,’ and.interpersonal relationships

of all family members. . .
- .'
.. The ’ spouse and. other' family .members, often do "
not perceive the alcoholic person's excessive drinking

as -the primary family problem but simply.as.a symptom of
various problems for which they often feel they are to

Even if family members do look upon drinking as

blame.

■a major problem, they often blame themselves for the ",
alcoholic person's drinking and attendant behaviour.
.■Because .they look upon' compulsive drinking as being’, •

only socially and morally unacceptable, they consequently
fail to view the drinking as alcoholism and. as.an. illness.

... ’■

.

Family members .are inclined to' feel;both.guilty

and angry about the alcoholic person's drinking :and

.... '

. behaviour.' and seek to protect him and in some ways, even
;hostile .ways, t° force .him to stop-drinking'.‘.Such 1
individuals need help to lead fuller, happier lives
< and..to detach themselves from the.■ tangles .of the
alcoholic person's drinking ai id life-style. .

SUGGESTIONS FOR ACTION ‘
Here are seme specific things Christians can dor.

To help alcoholic persons and their families:
- we need to know about alcoholism and ’
be able to identify the illness as early
as .possible.
,,

- we must view alcoholism as an illness
to be treated along with'possible
underlying problems and causes.
- it is important for us to maintain
accepting, understanding, and genuine
relationships.

..7/-

.-'

■

- 7 - ' '

'

In our relationships with' the aleoholic person we need to:

- lovingly confront him with his' drinking
problem and give him information about
■alcoholism.

- help him to accept his uncontrolled
drinking as an.illness .for which he
needs help. . '
•
. . .

n

.

- assist him in obtaining medical treatment. '

- encourage him to become involved in'
. Alcoholics Anonymous and/or other group
therapy programmes.
- provide a Christian sharing group for
his growth and.benefit. .
In our relationships with the.alcoholic
person's family members help'them to:
,

- understand alcoholism as an illness.and .
identify and .accept it as such in the
' family.
'
•
■ .

■ - stop feeling responsible for'-his
. drinking and its consequences.

- quit .suffering when he .is drinking and .<-•
no longer protect him from the consequences
.’ of his drinking. ■
■' ’
- free him to experience the consequences .
of his drinking behaviour.
(

- shape' a more adequate personal life free
from drinking and cultivate an openness
to receive him back into a full relationship
when he is being helped toward recovery.
- become involved with Al-Anon and Alateen
(for the teen-age children of al alcoholic
person) or other effective therapeutic
programmes.
In the interest of Christian concern and
care for alcoholic persons and their families, Christian

congregations - or groups of congregations - should

consider the establishment of a Christian care center
or task force to provide supportive relationships and

practical assistance.
..8/-

\

- 8 For such concern .and care our Lord's
disciples have received the servant-mind .of Christ.

- He involved Himself with all sorts
and conditions of people in their. .
need in order to make them whole;•

' - He humbled Himself and subjected
' Himself to death on .a cross to restore
us and all meh to :our Heavenly Father
and to the. abundant and eternal life;'
- He has chosen us to have arid share with
others this life that is both abundant
and eternal.

A Memento, of
THE LUTHERAN HOUR
2185 Hampton Avenue
St. Louis,' Missouri 63139.

COMMUNITY HEALTH CELL
47/1, (First Floor)St. Marks noad
3ANGAU03E-660 001

THE

OP

ECONOMICS

ALCOHOLISM

AND

AND

POLITICS
DRUG

ADDICTION

DR.K.RAJARATNAM M.A., Pb.d (Lend)
DIRECTOR
Centre for Research on New International
Economic Order
EXECUTIVE SECRETARY
United Evangelical Lutheran Churches
in India

^.00 :

INTRODUCTION

1.01 :

'The drunk on the roadside gutter or the picture of
a drug addict in a hospital or jail are the images that
usually come to our minds when we try to view from
our middleclass perspective the problem related to
alcoholism and drug addiction. These stereotyped
images of addicts just about reflects a small fragment
of the various complex problems related to alcoholism
and drug addicts. While looking at the trauma of
human suffering we tend to overlook many powerful
forces and strong influences that operate in the
structure of the society which lay beyon^ the control

"

of individuals and at times even small communities.

Scuse of these are forces which keep the addicts in
the bondage of the drugs and in subtle ways propagate
addiction and drug dependency. My intention is in no
way to take away the responsibility of addiction
from the individual and place it solely on forces
beyond him, but to present a realistic picture of
these forces so that we may be able to view the
problem in a pragmatic manner and work towards
effective measures to combat the malady of addiction

2/

%

2/

and other problems related to alcohol and drugs.

1.02 i

We live in an age and time when Jx>litics and economics
are the most dominant forces prevailing over every
aspect of our lives. While appearing to be under our
control they evasively operate in a sphere quite
often beyond our reach and influence. We need to
understand their dynamics and magnitude in order
to effectively influence their course. In presenting
this paper it is my hope that I may be able to throw
seme light on a few of the salient economic and
political factorsthat influence the problems related
to drugs. As alcohol is the most commonly and widely
used drug we have to deal with it separately apart from
other drugs.

2.00 :

ECONOMIC FACTORS

2.01 :

First of all let us try to understand the magnitude
and trend of the problem. The starting point should
be the simple economics of production and consump­
tion of drugs including alcohol. There cannot be
an increase in production without a natural demand
or a well designed and promoted demand. The picture
presented by the expert is quite grimo Marcus Grant
of WHO comments, "Whilst alcohol consumption is
beginning to fall in some Western developed countries,
it is continuing to rise steadily on a global basis,
with particularly sharp increase in a number of
developing countries in Africa, Asia and Latin America.
Even though some of these countries were beginning
from a comparitively low basic figure, the present
trend would, if they continued, lead to very high
consumption rate before the end of the 1980‘s.
*
..3/

TABLE II
TABLE I

PERCENTAGE CHANGE IN PRODUCTION
OF BEER AND WINE IN SIX AREAS
OF THE WORLD BETWEEN 1960 AND 1980
COMPARED WITH THE POPULATION INCREASE
*

PERCENTAGE CHANGE IN PER CAPITA
CONSUMPTION OF ALCOHOLIC BEVERAGES
(AS 100% ETHANOL) BY TYPE OF BEVERAGE
IN SIX WHO REGIONS, 1970-77
Beverage

Africa

Americas

Wine
Beer
Spirits
All alcohol

•16.7
9.1
11.1
73

6.9

8.8
11.3

Eastern
Mediter­
ranean

Europe

0.0
8.3
71.4
12.5

• 4.2
15.6
4.3
3.0

Alik.1

,-jkuL

klk,

AS1 cl Cunx>«

South-East Western
Asia
Pacific

0.0
100.0
20.0
25.0

200.0
20.7
• 24.3
- 4.4

From Alcohol Policies in National Health Development Planning,
WHO Offset Publication No. 89. 1985.

11

Details of drugs seized duririgT9S5 are as lol-

s

lows-Hindu-July 27, 1986
Drug

Quantity
seized
(kgj

Heroin
Morphine
Opium
Ganja
Charas
(1986 up to June 30)
Opium
'
Ganja
Charas
Morphine.
Heroin

No. of
cases

599.7
115.2
1.187.02
53.559.04
7.494.17

63
45
"54
152
93

253.11
18.006.35
9.667.595
14.23
1,004.29

13
35
28
13
21

I

i *t

k

1 ■
111

£

□ Wine □Beer b Population
* Sources of data: (i) International statistics on al­
coholic beverages; production, trade and consump­
tion, 1950-1972, Helsinki, Finnish Foundation for Alco­
hol Studies, 1977 (Volume 27); (ii) Production year­
book, Rome, Food and Agriculture Organization of
the United Nations, 1981.
b Including north Africa.
c The production figures on which these percent­
age changes are based may be underestimates since
they cover only 40% and 73%, respectively, of the
world's population.

The drug syndicate In India Is active In Rajas­
than and Gujarat close to the borders of Kutch
and Ganganagar. Today heroin is one of the lar­
gest as well as fastest selling drugs in India. Its
street value ranges from Rs. 1 to 3 lakhs a kg.
followed by morphine at Rs. 40.000 a kg. opium
Rs. 1.000 to Rs. 2.000. cocaine Rs. 2 to 6 lakhs
and hash Rs. 2.000 to Rs 3.500.

From,Alcohol Policies in National Health Development Planning,
WHQUDffset Publication No. 89, 1985.

HI
Production of Alcoholic Beverages. India, 1970-1977 thousand litres
YEAR

1970

1971

1972

1973

1974

1975

1976

Beverage type
Indian-niade foreign
liquor

26 792

27 336

27 78S

22 183

26 SIX)

22 396

27 000

Country liquor
Beer

25 380
31 123

32 602
.36 416

34 148
50 886

42 579
57 728

42 579
58 611

25 778
57 350

43 000
70 000

(Mohan & Sharma,

1977

J. 95 000
1

80 000
1980")

4/
2.02 :

With relation to population growth and production
of wines and beer the picture does not seem to be too
bright. The Asian scene seems to be really dis­
proportionate causing concern.(Table II)

2.03

i

One can go on to quote more and more data to prove
the point that there is an alarming increase in the
production of alcohol over the last couple of decades
This is true of the national scene also, (Table III)

2.04 :

In a six year period the production of country liquor
and beer has doubled. In the foreign liquor front,
India has more than 350 brands to chose from. The
leading Me Dowells Company, registers an annual
growth of 10%. In the year 1976 the liquor manu­
facturers used up 169.4 million litres of pure
alcohol. In 1981 this went up to 207.9 million litres
and in 1985 it reaches 331 million litres which is
enough to produce 1134 million bottles of rum (India
Today, April 30, 1986). In simple monetary terms at
the rata of Rs.50/- for a bottle of rum, this would
amount to Rs.5670 crores.

2.05 :

We have a similar figure worked out by the seventh
finance commission; That the btates derive an average
of 500 crores of rupees, as excise revenue, on
alcoholic beverages. Simple arithmetic will show
that the cost to consumer, in terms of money will be
in the neighbourhood of 1500 crores (1981 price
index )

2.06 »

As we can see this relationship between production
and consumption in simple economic terms would mean
money - a lot of it and all that goes with it. In
seme cases, multinational and transnational companies
are also involved in the production promotion and
..5/

5/

sale of alcohol. It is estimated that US$
2 billion was the international advertising
budget for liquor promotion in 1981. Such is the
power and influence behind alcohol and problems
related to it.
2.07 :

In the national scene there has been increase
in production of both Western and country liquor
indicating that both the affluent and the poor
are drinking more and more. Studies published in
’Current research in drug abuse in India’ (°.Mohan)
indicate that prosperity in agriculture has contri­
buted more to the liquor consumption than to
family health. There are similar studies in
industrial areas also to show that the new found
affluence contribute towards more alcohol con­
sumption. In the rural areas the poor drink more
and more to escape from the harsh realities of socio
economic exploitation. It is ironical that the
'exploiter' and the 'exploited' are drinking more
and more for reasons of their own.

2.08 :

While not wanting to bog you down with statistical
details, it is still essential that some information
about other drugs are also given. While the prod­
uction and sale of alcohol is legal in most countries,
other hard drugs are taboo and illegal in most
parts of the world. This illegality adds to the mystery
surrounding the whole drug trade. We come into grips
with the situation not by what is consumed or even
produced, but by what is seized by law enforcement
agencies.

2.09 t

According to the UN Commission of Narcotic drugs,
Herion seizure till 1951, were less than 100 kg.
6/

€>/

In 1977 the haul came up to 2337 kb. 1980
estimated value of illicit drugs in the USA was
US$ 80 billion. Today heroin is one of the
largest as well as fast selling drug in India.
It’s street value range from Rs.l to 3 lakhs a kg.
followed by morphine at Rs.40,000/- a kg. Opium
Rs.1000/- to Ks.2000/-; cocaine at Rs.2/- to
6 Lakhs a kg; and harshish Rs.2000 to ^s.3500
(Hindus 7/7/86). ^he Table IV gives some insight
into what has been caught under the legal systems,
which is but only a small fraction of the real trade
and one can well estimate the enormous amounts of
money involved in this whole business.
2.10

:

Before going to the political dimensions of the
problem, let me touch on a few fallacys with relation
to the economics of Lcohol, As indicated earlier,
the States earn a large sum as excise due to the
sale of alcohol and use this argument to legitimise
Government involvement in alcohol production and
sale.The fact often forgotten is the amount the
Government Spends in terras of law enforcement,
medical care and loss of production which .are all
rasultant of alcohol related problems and these
drain away a large portion
of what the Government
claims to be the gain from liquor sale.

2.11

:

Alcohol is an anti development force which saps away
human energy and initiative. Though
no nationwide
survey has been conducted, the Indian Journal of
Social Work indicates that 2-4% of persons ia most
of the metropolitan factories are alcoholics
contributing towards absenteeism, poor performance,
low productivity, accidents and low morale among
others. It is paradoxical here that development

..7/

7/

pays more to the skilled workers, who misuse their
money on liquor which in turn adversely affects
the very development process. It is fair to cate­
gorically state that drug abuse is a deterent
to development.
2.11

:

For development we require capital/ and the for­
mation of this is done through small savings, especially
in rural areas. This saving never gets done mainly
due to alcohol and drug consumption among the
rural masses. Alcohol and drug drain away and arrest
the accumulation of funds needed for developmental
activities.

2.12

:

In the final analysis the production distribution
and sale of alcohol and drugs contribute to the
wealth of the affluent and powerful , while causing
problems to many in economic., social physical and
spiriiaal terms. In developing countries, like ours,
it creates the block market and parallel economy
and cripples the very development process.

3.00 :

POLITICAL FACTORS

3.01 :

Politics, both national and international play a big
role in creating and sometimes also effectively
eradicating the problems related to alcohol and drugs.
It was pointed out earlier that liquor consumption
in some of the developed countries are going down
while the global consumption is going up. This is
done by political decisions of seme of the developing
countries, by deliberately allowing large multinations
to promote and push the sale of alcohol in their
countries, at times even by creating a new cultural
8

8/
ethos so that what is not sold in the developed
country, will find an easy market locally.
3.02

As far as drugs are concerned political conflict
and military engagements have proved to create
the ideal climate for unscrupulous promotion of
drug trade. The Vietnam war has left behind an
ugly Asian drug legacy. And today, we have the
Afghanistan crisis and the related drug problems
which seems to ut a serious botheration to the
US and Pakistan (Hindu; 22/7/86 ). Our dailies
carry periodic stories of how our neighbours are
planning and plotting to promote drug consumption
in our cempuses and other remote communities near
the border. Drug has been reckoned as political
weapons to destablise the enemy and demoralising
the masses. Wars have been fought over
drugsj
the opium - war of bygone- years to be latest
military intervention in parts of Latin America
claims the reason, for the war to be either for or
against the drugs.

3.03:

But thanks to UN and Who today, a number of countries
recognising the danger of drug and alcohol are
cooperating in many ways to share information and
data and work together for the prevention of drug
related problems. There axe many international
agencies that are meaningfully involved in both
education and rehabilitation; and through UN help
mould the drug policies of the various member
countries.

3.04 :

Coming closer home to our national scene we find
India after Independence adopting a half hearted
..9/

9/
policy towards drugs and
alcohol. Prohibition
was left to the States as a directive principle
(Article 47 ). Today after three and a half decades
of independence all the States of India except
Gujarat, have lifted prohibition and liquor is
freely available in most parts of the country.
Sane States have introduced few measures to res­
trict sale,.but We are not quite sure how effective
these measures are.

3.05 :

In the legal framework we have come a long way in
appropriately dealing with problems related to al­
cohol and drugs. During the British Raj, cannabis
was a fact of life. The eight volumes 'Report of the
Hemp drugs commission • of 1894 concluded thus:
"The prohibition of ganja is an interference with
liberty - which the Government of India is not justi­
fied in taking " .Till recently we had the old
outmoded opium Act of 1857 and 1878 and the
Dangerous Drugs Act of 1930 - providing for 3 years
imprisonment with or without fine for drug trafficking
The laws were silent about people caught with ill­
egal narcotic drugs for personal use. In contrast
the 1985 Narcotic drugs and Psychotropic substance
Bill which has replaced the old ones enhances the
range of sentence for drug trafficking from 10 to 20
years imprisonment and fine of Rs.l to 2 Lakhs.The
punishment can go up to 30 years. It also prescribes
punishment for those found in illegal possession
of narcotics for personal consumption.

3.06 i

While the picture concerning the policy is encoura­
ging, the pattern designed for implementation is
quite complex and confusing. At the national level,

..10/

M>/

"

|

3.07 :

the responsibility for controlling and prevent­
ing the abuse of drugs is distributed between
various Ministries of Government of India, either explicitly
or implicitly. For instance, the Ministry of
Finance, is responsible for the control of export
and import of narcotic drugs (through the Narcotic
Commissioner), the Central Bureau of Investigation
is usually entrusts'? with the investigative aspects
of the problem in select cases having intar-state
or international ramifications. The Ministry of
Health is generally responsible for drugs other
than narcotics and for the treatment of drug
addicts. The department of Social Welfare is

responsible for social aspects of the problem,
research and rehabilitation of drug addicts. The
Ministry of Education is responsible for prevention
and control of the problem among the students and
in collaboration with the Ministry of Information
and Broadcasting, for creating an elightened public
opinion on the subject. Not all these responsibilities
are explicitly accepted and many of them are only
indifferently performed. Moreover, there is hardly any
co-ordination between these different agencies; and
to add still further to this fragmentation of a drug
policy, all matters relating to alcohol, the most
important and commonly abused drug, are left entirely
to the State Governments, which are also largely
responsible for the implementation of the central
laws for the control of drugs. No well-planned and
co-ordinated national drug control policy can emerge or
be implemented satisfactorily in such a fragmented
and unco-ordinated set up.

Till recently it has been quite popular for our
Government to declare India to be mainly a transit

..11/

11/
point for drug trafficking. Wedged between the
Golden Triangle formed by Burma, Thailand, and Laos
and the Golden crescent comprising Iran, Afghanistan
and Pakistan, India has in recent years emerged as
the major conduit for op.tum products. But let us ‘hot’
forget that India is also one of the world's largest
producers and exports of opium for legitimate use.
There has been questions an to whether all the opium
produced in India is used for legitimate supply alone.
At any rate f.b^re has been a systematic approach
of the Government attempting to reduce poppy culti­
vation in Madhya Pradesh, Uttar Pradesh and Rajastan.
Fran 54000 hectares in the last five years, the
cultivation has been brought down to 23500 hectares.
Attempts especially in motivating the farmers to look
for other alternative cash crops should be initiated
with interministerial cooperation to further cut down
the present poppy cultivation. New areas of cannabis
cultivation such as Kerala and.Tamil Nadu with their
large tracts under opium (IE 30/8/86 ) should be
kept under strict Government surveilance.

3.08 i

As prohibition ccmes uncisr the State, there has been
frequent policy changes concerning this to suit the
mood of the masses and at the same time to gain enough
in terms of .money . and power. Taaii Nadu is a good
example. During DMK rule in the 70
* s prohibition was
lifted and was quite popular. But without having
adequate social and cultural Institutions to accomodate
drinking in public, the average drinker found it hard
to feel at ease with his new found freedom, And before
people could get adjusted to the newness of open sale
of alcohol, there came prohibition due to pressure
from women voters. The average man became confused
and had to change his entire attitude toalcohol consum­
ption and his mode of consumption also underwent
devious changes.Before long, ance again prohibition
was lifted and just fifteen days back (6/10/86) the
.
. 12/

12/
AIDMK has announced that starting with 1987 there
will be prohibition once again. These erratic changes
of policy, concerning alcohol, many sociologists
and experts believe has substantially contributed
to growth of alcoholism in the State.

3.09 :

Almost all the major States in the Country, haave
had their share of liquor scandals, the latest being
the one for which Sir Ramakrishna Hedge resigned
in Karnataka. The liquor contracts, bottling and
all associated activities involve big money. The
governments are forced to £ive into the pressures
of these liquor Barons who fund the political parties
substantially and look for the spoils after the
elections. Though staying in the background the liquor
lobby in India is powerful and influential,

3,10 :

The Government and political parties are concerned
The Congress (I) Party has the All India anti­
Narcotics cell chaired by popular film star MP Sunil
Dutt. And in Tamil Nadu the Government is reconsider­
ing the introduction of prohibition. It is worthwhile
to note that these and other attempts through the
media handle the problems related to alcoholism and
drug addiction in the down to earth sociological
manner. They speak in terms of secular approach
rather than moral ones. The famous slogan in Tamil
Nadu is 'Kudi Kudiai Kedukkum ' meaning that drinking
will sjgoil the home. Similar ones are there in
Maharashdia “Beware drugs are deadly" - "Drugs the killing fiends. Do not join the living dead "
While we are not quite sure how effective these are,
they are still worthwhile noting for their secular
and sociological appeal.

4.00 I

CONCLUSION

4.01 :

This has been an attempt to show the power and influence
that is behind alcohol and drug trade and the resultant
13/

13/

problems. This should not in anyway discourage
our attempts in solving some of these' problems. we
have only to be cautious enough to realistically under­
stand the forces behind the problem and courage©^
enough to challenge them in pragmatic terms.

•smaaq oyqeuiSBad uy tnaqq o6ueTT®qo oq qbnoae
ettaabejnoo pue mayqaid aqq puyqeq seojog aqq ptreqs
-aaptra AyTeoyqsyyeea oq qfinoua snoyqneo eq oq Ayuo aAoq
eM •staayqoad asaqq go atnos buyAyos uy sqduwqqe ano
abeanoosyp AbmAub uy qou pynoqs syqj, «sBieTqoad

AT

MV’

T T RANGANATHAN CLINICAL RESEARCH FOUNDATION
"TTK HOSPITAL"
17,4th Main Road,Indira Nagar,Madras-600 020

REGIONAL COURSE ON THE PREVENTION OF DRUG ABUSE AND ALCOHOLISM
SPONSORED BY NATIONAL INSTITUTE OF SOCIAL DEFENCE,MINISTRY OF
WELFARE, GOVERNMENT OF I' DIA, NEW DEL.HI

DRUG TRAFFICKING - LEGAL ASPECTS

Addiction or abuse of narcotic substances is a worldwide problem.
Various countries adopt .different measures to curb substance
abuse. One commonly adopted measure is legally dealing with the

problem by reducing the available quantity and then dealing with

pushers stringently.
Geographically, India is sandwiched between the two chief sources

of opiates in the world - the golden triangle {Burma, Laos, •
Thailand) and the golden crescent (Afganistan, Pakistan, Iran).
Nepal is situated on the northern borders of the country which

has been and continues to be, a major source of Cannabis.

Thus, over the years, India has become highly vulnerable to the
transit of drrgs 'nd this, transit tra.ffr'c has reached alarming

proportions.

To meet this challenge, the Government of India took legal,
administrative and preventive steps. The first measure,

'The

Narcotic Drugs and Psychotropic Substances Act, 1985' was passed
by the Parliament and this came into effect from the 14th

November of the said year. This enactment also repealed the
erstwhile laws and gave sufficient teeth to law enforcement

agencies in the form of deterrent punishments to drug traffi«kers»
The Narcotics Control Bureau was set up as a Central Authority
to co-ordinate national and international drug enforcement

efforts. It is also responsible for the implementation of
the obligations in respeet of counter-measures against ill-icit
.A 2.

2

traffic and provides assistance to the concerned authorities in
foreign countries and concerned international organisations with

a view to facilitate co-ordination and universal action for pre­
vention and suppression of’ illicit trafficking of drugs. Powers of

investigation were vested in Central Agencies such as the Customs

and Central Excise Departments ,

the Directorate of Revenue

Intelligence, The Narcotic. Control Bureau, The Economic Intelli­
gence Bureau and also with the State Agencies like the State

Police Authorities, The State Excise Authorities and the State

Drug Control Administration. As a result of this, almost every
part of the country was covered with some investigative agencies
who have been active in the eradication of illicit cultivation-of
poppy and ganja.

In order to further strengthen the hands of enforcement agencies,
a Preventive Detention Ordinance titled 'The Prevention of

Illicit Traffic in Narcotic Drugs and Psychotropic Substances
Ordinance, 1985' was promulgated by the President on the 4th
of July 1988. This was subsequently made into a law by an

Act of Parliament.

NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES ACT - 1985
Prior to the enactment of Narcotic Drugs and Psychotropic

Substances Act, 1985, the statutory control over opium and othet
drugs (except cannabis) was exercised in India through three

Central enactments (i.e.) The Opium Act, 1857; The Opium Act,1878;
and the Dangerous Drugs Act, 1930. Control over the cannabis
group of drugs was exercised by laws enacted by. the state­

governments. The NDPS was enacted to remove the deficiencies and
inadequancfes in the old laws and to provide for deterrent punish­

ments for drug trafficking offences. It ccv <~ the entire range of

. .3.

narcotic drugs and psychotropic substances and prohibits their

non-medical and non-scientific uses, in compliance with the
International Treaties and conventions.
The scale of punishment foi

ffences prescribed by the

Act is shown below:

si .
No.

Description
of offences

_ Minimum
Imprisonment

Maximum

Fine

Impr isonment.

Fine

1,

Trafficking
(internal)

10-years
Rs.One
Rigorous
.. lakh
Imprisonment
(RI)

20 years
Rigorous
Impr isonment
(RI)

Rs.Two
lakhs

2.

Trafficking
(international)

10 years RI Rs’. One
lakh

20 years RI

Rs.Two
lakhs

3.

Trafficking
(internal) in
respect of
Ganja' and
Illegal
cultivation
etc.

05 yea r s RI

Rs.Five
thousand

-

-

4.

Trafficking
(internal)
in respect of
cannabis
other than
Ganja

10 years RI Rs .One
lakh

20 years fcl

Rs.Two
lakhs

5.

Unauthorised
dealing in
drugs outside
the country

10 years RI Rs.One
lakh

2 0 yee r s RI

Rs.Two
. lakhs

For repeat offences in respect of both narcotic drugs and psycho­

tropic substances (excepting item 3 of table) the minimum ■
punishment would be 15 years rigorous imprisonment and a fine of

1.5 lakhs and a maximum punishment of 30 years rigorous imprison­
ment and a fine of Rs.3 lakhs. There is also a prevision empo­
wering the courts to impose fines higher ' than the r....ximum
prescribed for reasons to be recorded ’ y them in their judgement.

- 4
While providing for deterrent punishments for trafficking offences

the Act envisages leniency towards drug addicts recognising that
these unfortunate people who have fallen a prey to drugs, have to
be approached with sympathy and should be given a chance to get

themselves treated. The persons'' found to have illegal possession
of drugs in small quantities (the variable measures for different

drugs which would be deemed small quantity for the.purpose of the

Act, have been laid down by the Government) are liable to a

punishment upto six months imprisonment or fine or both, which in
respect of hard drugs like heroin, would be upto one year 's.
imprisonment or fine or both. However, the court is empowered to
release the drug addict convict for undergoing medical treatment
for drug addiction on his executing the necessary bond prescribed

under the Act.
Attempts, abetment and conspiracy to commit an offence are also

■ liable to the same' level of punishments as for the offences them­
selves. All offences have been made cognisable and because of the
level of punishment,.most of the offences are non-baliable.

The A^t empowers the officers zof various central and state

government agencies for searches, seizures, investigations etc.

-NARCOTIC- DRUGS AND PSYCHOTROPIC SUBSTANCE'S (AATNDNENT) ACT 1988

On .the recommendations of the Cabinet Committee constituted for
combating drug trafficking and preventing drug abuse, the Narcotic
-Drugs-and Psychotropic Substances Act, 1985 was amended. The

salient features can be briefly stated as follows:
1.It expends the preamble, provides for forfeiture of property

used in illicit traffic in Narcotic Drugs and Psychotropic
Substances.

..5.

5
2,A nevz section 31A provides for death penalty on second convic­

tion in respect of specified offr.-.c^s involving specified
Quantities of certain drugs.
3

-. It provider .that no sentence awarded under this Act should be
s-uspend-ed, remitted or commuted.

4.A new section provides for pre-trial disposal of seized Narcotic

drugs and Psychotropic substances.
5.It provides immunity from prosecution to an addict volunteering

for treatment

for drag, addiction once in his life time.

time. The immunity may be withdrawn if the addict does not
undergo the complete treatment for the purpose.
Though these legislations have been devised to prevent illicit

trafficking, the problem of drug abuse is still growing. Whet is
evident is that drug trafficking and prevention of drug abuse

should be tackled on a war footing if this is to be eliminated.
It is only the political will of nations and the international
co-operation to combat the drug menace on a world-wide basis that

can deal effectively with this plague affecting our society.

BIBLIOGRAPHY
1,Kumar B V and Tiwari r r, The Narcotic Drugs and Psychotropic
Substances Laws of India, Konark Publishers Pvt.Ltd., Delhi,

India, 1989.
2.Sarin R L, Commentary on the Narcotic Drugs and Psychotropic
Substances Act, 1985, Vinod Publications, Delhi, India, 1986k

T T RANGANATHAN CLINICAL RESEARCH FOUNDATION
"TTK HOSPITAL"
17,4th Main Road,Indira Nagar,Madras-600 020

REGIONAL COURSE ON THE PREVENTION_OF DRUG ABUSE AND ATCOHOLISM

SPONSORED BY NATIONAL INSTITUTE OF SOCIAL DEFENCE, MINISTRY OF
WELFARE, GOVERNMENT CF INr>lA, NEL1 DELHI
BASIC COUNSELLING TECHNIQUES •

Counselling is a scientific process .••£ assistance extended by an

expert in an individual or group situation to a needy person (s).

The process aims at enabling the individual to learn and pursbe
more realistic end satisfying solutions to his difficulties.
The process primarily revolves around, the relationship between

the Counsellor and the Client. It is this relationship that leads
to growth and change.
DIFFERENCE BETWEEN COUNSELI.ING/GUIDANCE/ADVICE/PSYCHOTHERAPY

PSYCHOTHERAPY

ADVICE

is individual

involves an

is a compre­

■is a specialised
func f ion, problem

GUIDANCE

COUNSELLING

oriented and

experienced

hensive

focusses mainly

mature adult

process

oriented and

on early child­

talking to

which en-

helps the indi­

hood experiences

an inexperien­ ligtens

and trauma .

ced adult in

individuals

vidual to undet*? .
stand himself apd

a subjective

regarding a

to develop the

tone.

new place.

ability to tak$

subject or

decisions and mike

situation.

choices.

..2.

- 2

Spec ific Features of Counselling
Counselling is a series of activities performed in relation to

an individual/group and his/ their needs.

These activities are systematically planned a;--' are inter-related.
These activities are carried on over a -eriod of time, the length1

of which is dependent upon the need
*
- of tie client. Counselling
sessions are usually held every alternate cay initially and Onee

<

a week or less frequently in the later stages. Each session lasts

from 30 to 60 minutes.
In becoming a counsellor end functioning as a Counsellor there gre

two major aspects one needs to remember:

(i)

Quality of relationships and attitudes

(ii)

Methods, techniques and skill.

Obviously, quality of relationship is more basic of the two end

the development of this special relationship between the coun
*
sellor and client is crucial.
Three essential ingredients have been identified in the develop­

ment of positive treatment relationship.
(i)

A^jpurate understanding of .clients.

(ii)

Non possessive warmth.

(iii)

Genuineness or authenticity.

The Counsellor must be a willing and active intervenor,partici­
pant and interpreter of reality.
Basic principles in Counselling
Respect : The ability of a Counsellor lies in communicating to

the client the belief that every person possesses the inherent
strength end capacity to 'make it' in life and that each person

has the right to choose his own alternatives "-nd make his own
decisions.

. .3.

r

- 5Authenticity + The Counsellor should learn to be genuine, real and
honest and not have a 'holier than - thou' attitude, or communi­
cate an 'I am above you' attitude to the client.
-Avoid Assumptions?

Avoid making assumptions about the client.

This means letting the client be the •rir.= 1 judge of his own
feelings arid experiences.

Recognising trie clients go tential: It is important to recognise

the strengths and abilities of the client.
Conf identielity? To maintain confidents!ity and to develop trust

is most important in the counselling relationship.
The Process of Counselling

Stages in Counselling
The different stages in counselling are briefly stated be).owt
- Ma.king contact in a caring professional role leading to or tft

appointment for counselling.
- Building rapport.
- Finding out the purpose of the visit.

- Tentative assement of the nature of the problem and epproaeWs
in dealing with it.
— Leading to a contract which calls for commitment op the part
of the client.

- Process of. counselling.
- Feedback and/or follow-up with on’e or more sessions 4s per the

need of the. individual.
- Termination and / or referral.

Activities of a Counsellor

The major activities of a Counsellor in a one-to-one interaction
are the following:
1,Establish and maintain a climate for counselling.
2.Case history taking
-

3_Prepare necessary client reports.

4.Seek consultation from other professionals whenever necessary
5,Tailor individual treatment plans.
6.Handle crisis situations.

7.Explain the nature of problems.
8.Help client establish contacts with community services.
9.involve/coordinate other resource persons in treatment.

10.Prepare after care activities for the client.
11.Evaluate client's progress re-define goals if. necessary.
SKILLS/TECHN-! CUES OF COUNSELLING

The main vehicle through which the counselling takes place is

communication. Therefore communications skills are one of the '
m®st important skills for the counsellor.

The three element that comprise communic? tio~. between tW

individuals are:(i)

Listening

(ii)

Processing

(iii)

Feedback

Listening

is defined as receiving messages from

client by

focusing attention on what the client is expressing, both

verbally and non-verbally. Attending is a demonstration of
concern and genuine interest in the client.
Processing is the complex series of events that take place

within the counsellor between his listening and responding to
the client. It may include mentally cataloguing

da fa categor

zation, of beliefs, knowledge, attitude; feelings, any factor
that influences judgement and performance.

5
Feedback: is the verbal or non verbal response that the counsellor

makes as a result of processing the information received from

listening to the client.
Feedback skills can_be.-broken down into the following
Paraphra sing: A Counsellor's statement that mirrors the clients
statement in exact or similar wording.

Example: Client: My boss doesn't understand me at all.
He doesn't realize I'm always shaky
in the morning.

CounsellorsMornings are a tough time fbt you.

Reflection on feeling: The essence of the client's feelings either
stated or implied, as expressed by the Counsellor.
Example: Client: I didn't want to come here. There is

nothing wrong with me. I came to

see you only because my-wife insisted
Counsellor :You do not seem too happy abort . coming here

.or
I get the impression that you are ar-noyed.

Summarizing:
A brief review of the train points discussed in the session to

ensure continuity. in a 'focussed direction. This should be done at
the beginning and at the end of each session. In the beginning
the client is asked to summarize the previous session, and at the

end, counsellor summarizes the main points of the current
session

6

SKILLS INVOLVED IN IDENTIFIC- TICK ' ND

UNDERSTANDING’ CF CLIENTS PROBLEMS

PROBING

COUNSELLOR
SEIF DISCLOSURE

CONFRONTA­
TION

Probing; A Counsellor's response th-, t directs the client's atten­

tion inward to help.both parties examine the client s situation irt^
greater depth.
Example sClient; I've been doing this job for years now $nd

nobody ever complained before. Now’ they'pe saying
my job performance hasn't been as good.

Counsellor :In what ways specifically do they say yout

work hasn't been good?
Counsellor's Self Disclosure:

The counsellor's sharing 0^ hj.s

personal feelings, attitudes, opinions and experiences fOP the

benefit of the client.

Example: Client: You know I feel so ashamed. All my fxiehds ape
going to find out that I have a drinking problem

and I don't know how can I face them.
Counsellor:! understand how you feel, because

J San

remember how ashamed, I felt at first, when t

had to admit to my friends tbet my father
was an alcoho1ic.
Interpreting. Presenting the client with a 1 torr-a tive wtys of

looking at his situations. Used effectively,

interpreting

should assist the client to realize that there is more than ort$
way of viewing most situations thereby helping hjr. to apply.

- 7 -

this kind of unrestricted thinking to all aspects of his life

Confronta tion : A Counsellor's statement or guestion intended
to point out contradictions in the client's behaviour and state­

ments, Also used to induce the client to face an issue the coun­

sellor feels the client is avoiding.
Personal dualities of a Counsellor

•

The Counsellor, apart from having a thorough knowledge and
perfect proficiency in skills should also possess specific

qualities which would be discussed here.

(i)

A Good listener:

A Counsellor needs to-possess an inhetent

trait for being a good listener. A Counsellor should give up a

fondness or "love for one's ovzn voice";

(iij

Empathy:

Empathy means the ability ©rd willingness to

perceive life as the client perceives it, without oauting unduly
involved in it.

(iii)

Patience:

The r-uality of patience implir-s tie ability fp

maintain an equanimity during delays, to remain, undisturbed in

the midst of obstacles, and keep a non-comp la in inc calmr.er.s
during the development of failures.
(iv)

Intearity:

This implies

-moral soundness and uprightness

in the character of the individual.
(y^

Emotional Maturity:

The ability to maintain a balance and

not get unduly swayed.
(vi)

Genuineness:

The Counsellor's sincere interest Ln the care

and wellbeing of the patient, which in turn, results ur. his
expressions always truly reflecting his thoughts and feeling^,

/
..8.

- 8 -

Flexibility? Effective Counsellors should be able to adapt

bofch their role and pace according to'the client's needs and
capacities.

(viii) Self-disclosure;

Ability and wi?lingness to share with

the client any relevant personal experience.
Combined with compassion, motivation and technical know-hoW, tich
experience are'a.ssoc i~-ted- wi-th competent counselling.

I
ilr
it' I

T T RANGANATHAN1 CLINICAL RESEARCH FOUNDATION

"TTK HOSPITAL,r '

17,4th Main Road,Indira Nagar,Madras-600 020
REGIONAL COURSE ON THE PREVENTION OF DRUG. ABUSE & ALCOHOLISM

SPONSORED BY NATIONAL INSTITUTE OF SOCIAL- DEFENCE,MINISTRY OF ■
WELFARE, GOVERNMENT OF INDIA, NEW DELHI.
CAUSATIVE FACTORS
CAUSES OF ADDICTION

The search for a unitary cause of alcoholism/drug addiction has
shifted to inter-disciplinary exploration of factors that might,

individually or collectively, account for the development of

problem drinking/drug abuse in various types of individuals.
’ Although there is no generally agreed-upon model of how addictioh ,

starts, research into the physiological, psychological,and sdciologicai factors has resulted in a far greater understanding of
the conditions that may precede, underlie, and maintain problem
drinking. The state of knowledge is still quite crude. There have,'
however, been several promising leads which may ultimately

contribute to better prediction and protection of individuals
likely to develop addiction problems, and to improved treatment,.
techniques for those already ill.

■ Genetie theory
Some workers in the field theorise that addiction

may be inheri­

ted. Addiction appears to run in families; it is therefore,
suggested that an addiction prone individual may have inherited'
a susceptibility to be influenced adversely by taking drugs.

Research has provided some evidence to support this theory.

The possibility that humans may inherit a predisposition for
addiction or an immunity to it does not rule out other factors
also contributing to its occurrence in a positive or negative
manner.

Thus, the development of addiction may be the result

of a collection of factors rather than just one.

Learning theory
The learning and reinforcement theory explains addiction by

considering drug taking as a reflex response to some stimulus
and as a way to reduce an inner drive such as fear or anxiety.

This theory holds that persons' tend to be drawn to pleasant

. .2.

2
situations or -rej^^ed by unpleasant or tens ion-producing ones

In the latter case,. .addiction .is-: said to reduce the tension
or feelings of unpleasantness and to replace them with a
feeling of wellbeing or euphoria.
The obvious troubles experienced by' addicts might appear to
contradict the learning, theory in the explanation of addiction

The discomfort., pain and. .punishment trey experience should
presumably 'serve as . a deterrent to^rui9 taking
..fact that addicts
continue cto -take-: drug's;in the face­ of f imily,discord,’ loss of
employment, illness and other sequels of .repeated’bouts is

explained by the fact that drugs .have

the immediate - effect of

reducing tension while the unpleasant consequences’ of drug, taking
behaviour come only later.
The role of punishment is becoming increasingly important .in

formulating the cause of addiction based on-the principles’-of '

the learning theory.

While punishment may serve to suppress a

response, experiments have shown that under some circumstances

it can serve as a reward and reinforce, the behaviour-.. Thus if the

ctddidt
te'-Trrled
dtake drug-sunder conditions of both reward
and punishment, either type of condition may precipitate
renewed a£use of,drugs.
Ample experimental evidence supports the hypothesis that excessive

drug, taking can'be learnt.

However since conflicting studies .

exist, the learning theory requires further research.
Personality trait theory

Psychological research has also attempted to define the cause
.of addiction in terms of an 'addict personality1. Though it is
conceded that all addicts need not have th® same characteristics,it is populated that in the pre-addict stage, a personality
pattern or constellation of characteristics should be discernible

and should correlate with the predisposition towards addiction.
One -of the.main difficulties in this approach is that the
population ordinarily available for study is already in a trouble.

with addiction. The question is whether the persona 5'ity traits
observed in these people predate the onset- o' addiction, or are-a consequence of addiction

- 3 -

Using objective and projective tests, researchers, have attempted.
to identify an underlying personality disorder. As'yet, these

approaches have failed to identify a common personality structure
of the addict patient which would be predictive of addiction.
There is evidence that addict patients exhibit some personality

traits in common. Once the addiction has been established,these
patients show some common behavioural and trait manifestations
which appear to be more relevant to addiction than, to other

psychological disorders.

Cultural theory
The cultural theory Of addiction suggests that within a given
society, there are three ways in which the culture may influence
the rate of addiction.
The
a.

degree to which the culture operates to bring about inner

teneions or acute needs .for adjustment in its members. .
The
b.

attitudes towards drinking the culture produces suitable

substitute means of satisfaction.

The-degree
c.

to which the culture provides suitable substitute

means of satisfaction.

Societies may provide alternatives to or substitutes for addiction.

Some societies have less stringent sanctions against narcotit:
drugs and therefore have a lower addiction rate.

Others‘permit

emotiopal outlets through ceremonis and rituals and thereby ..
provide a culturally accepted means of anxiety reduction.

Deviant behaviour theory
Depending on the context, the use of addiction can be illegal or.
only illegitimate...acceptable or even sanctified...forbidden or
abdominated. Thus, the.concept of drugcabuse as deviant
behaviour is receiving increasing attention by researchers.
The deviant behaviour theory represents theaddict ■ • as someone

who, through a set of circumstances, becorres publicly labelled

a deviant and is forced by society's reaction into playing a
deviant role.

* .4.

____ ____

.....iijuji..

-xwayjfffM

- 4 Behaviorist theories

Behaviorist theories, applied to drug dependency, attempt to
characterize how users who learn to enjoy the effects of a

particular substance may continue to use that substance both
because if the learned positive effects, such as euphoria,'

and to avoid the learned.negative affects, or withdrawal.
Similarly, many drugs are thought to :;•:••• a an instrumental or

reinforcing effect which leads to cnntim. -ion of use and
dependency.
The reinforcement for use :? thought to be the
reduction in fear, stress, anxiety, or conflict which drugs may
provide, and thus the drug dependency may be a functional
adaptation for the individual in a personal sense despite adverse
consequences in Other areas.

This stimulus-response approach

to the causes of drug dependence leads to powerful explanations,
although some professionals view that as an over-simplification
of the dependency process.
Summary

All of the above theories overlap frequently in several ways,
with terminology being the major difference among them. Since no
single theory proposed thus far can account fcr the physical,

the psychological, and the sociocultural aspects of becoming
and being drug dependent, some professionals are now examining
the interaction of their theories as an explanation o?

dependence.

T T RANGANATHAN CLINICAL RESEARCH FOUNDATION

"TTK HOSPITAL"

17,4th Main Road,Indira Nagar,Madras-600 020

REGIONAL COURSE ON 'PREVENTION OF DRUG ABUSE AND ALCOHOLISM’
SPONSORED BY NATIONAL INSTITUTE OF SOCIAL DEFENCE,MINISTRY
OF WELFARE, GOVERNMENT OF INDIA, NEW DELHI
COUNSELLING FOR DRUG ADDICTION

1.What is Counselling?
Counselling is a deliberate effort to help a person in a rational

way to sort out his problems, to clarify the conflicts and issues

in his life and to discuss the feasibility of varipiis courses of
action.

This is done to enable the person assume the responsibi­

lity of making choices. It requires knowledge and skill to help

the person use available resources to improve bis situation.
Counselling is conducted with the.purpose of helping the indi­

vidual become more deeply aware of his situation and of himselt
in relation to his situation and where change is indicated, to
help him find methods to bring about the change.

Counselling process in addiction treatment

The Counsellor provides new information (•’rcblem classification
and setting objectives) which leads the

mt to

- change his old behaviour and
- adopt new attitudes and values

10 Principles to follow;
- Understand who an addict is, what addiction is, its symptoms
etc.

- Addiction is a family illness, hence the entire family needs
help and assistance..

- Never refer to addict as a drunkard or a dope.
- In working with an addict, confront him directly with the

problems caused by addiction.

Since addiction is an illness,

counsellor should feel comfortable to talk to the patient
about his abuse.

- The convictions and values of addicts will be different from

those of others. They may even be distorted. Accept it as patt

of the disease.
2

- 2 - Approach ant addict with compassion and " understanding”, not with
logic and argument. .

- Establish short fterm's goals for recovery.
- Relapses can occur during the process of recovery.. It is

important. that' the counsellor ■ stays', w'i th him through this

'.period. He..needs grea t-suppor t ; and, under standing at this
juncture.

- Maintain confidentiality..

- Ignore the past, use the present for the future--; Emphasis
should be on potential rather than performance.

£|

Motivation;

During the first contact with an eddict, it is e^dential to

find out to what extent he is open to help and what kind of help,
if any, he desires.

To discoverthe nature of <an addict's

motivation, the following questions should be in the mind o£
the counsellor as he listens and talks to the patient.

- What does the drug addict see^as his problem?
- From his point of view, is his’ drug taking’s problem or a

solution?

- Does he feel....t’hat he- needs- herip- from others? If so, what kind
of help does he want?

- Does he want some one to pacify his family, intervene with
his boss or does he need help to sort out his financial

problems?
Generally all addicts have inadequate.motivation-; More so, if

he sees drugs as a solution, dr if he wants help ■in changing

people around him, or if he wants to avoid the consequences of
his immature behaviour.

For some addicts, motivation may be

mixed.

They may be pulled in opposite directions by inner

forces.

A part of their mind wants to stop, another, part

drives them to continue taking drugs.

. .3.

3

At times, the pain of taking drugs and the fear of the

probable consequences of continuing the drug, outweigh' the
craving for the drug. When this happen, the addict 'hits bottom'
or-becomes open to help.

A hangover period following a binge may be present. "Hitting
the .bottom" leads to a state of .motional receptivity during
which the addict's defenois against recognising.his need for help
is temporarily cracked by the physical and emotional pain of the
exper ience.

In case of resistent addicts, two principles can be followed.
1. Avoid doing anything which would destroy the possibility of

developing a helpful relationship at a 1-ter time. Preachings,
sermons and pleadings should be avoided.

2.. Attempt to sow seeds of understanding of the person' and of

addiction, which may take root and eventually help the addict
. to open out and accept help.
"You can't help an addict until he is ready" - This: is a dan­

gerous half truth.

The danger is that the counsellor will use it

to avoid his responsibility which is to discover, stimulate and
mobilise the addict's latent motivation towards accepting help.
Initial contact
.When an addict meets a counsellor for the first time, he may

;not admit that he has a problem with drugs. It is not necessary
to discuss whether the person is an addict op only an occasional
user of drugs. The most important issue is whether- ho is satis-.
fied with' his life, the way it has been going for the past year ..

and whether drugs affected his life in any way.
Most of the addicts have a "motivable area" - a sensitive
area where they feel hurt or are aware'that they n-.ed help,

It would be something they are worried about. Uhen the hurt .

- 4 t
areas are discovered, the offer of help is likely to be accepted.
These hurt areas could be discovered, by encouraging the resistant

addict to talk about his drug use/abuse - what he.takes,' with
whom, how he feels, what happens after taking the drug etc.

Early in counselling, the addict-mil? b>; -"tfensive'. He maybe

much more concerned about his drug a' use, than what he admits to
the counsellor. But if the counsellor consciously avoids putting
too much pressure on him, he may gradually reveal more■of the

truth as the relationship grows stronger.
Here are some of the factors which cause the addict to avoid

facing his need for help - His fear of the pain of withdrawal,

his fear of not belonging to a drinking or drug taking group
which he enjoys; his feeling that the drug is all that *'work.s"

for him; the blow to his self-esteem on admitting loss of control,
his fear of what it might do to his education, family, or social

relations to be identified as an 'addict
.
*

It is important that

these inner barriers to admitting his need for help, be discussed

with understanding, and empathy by the counsellor.

■ Listening;
Listening is the most important technical tool needed by' the'
counsellor.. Listening requires suppressing one’s urge to interupt,
reassure, or ask a series of information'! ouestions. Listepin^

in depth means listening with the third car, of being sensitive

to the feelings behind the words and ike subtle messages communi­

cated in mood, posture and facial expression. Intensive listening

allows the counsellor to sense how the addict feels -?bout himself,
about others and about his problems. Gradually the counsellor
begins to grasp precious fragments of understanding of his innelf
world of hopes, fears, and pain.

He begins to see how life look®

through his eyes. Listening and responding with warm *
under?
standing serve to establish the first strands of the inter­

personal bridge called "rapport" over which t.ie counselling
process moves back and forth.

Denial; A major obstacle to long term recovery in the addict is
his defence mechanism.

It is a psychological mechanism which

operates at the unconscious level.

Facing the reality of addic­

tion can be very threatening to an addict and this is the main

cause for denial.

Many addicts keep

rationalising their

behaviour for so long that they gradually develop 'an almost
reflex action1 of defensiveness when challenged abouttheir
addiction. The label of immorality attached to addiction also

contributes to the denial of their problems.
Simple denial; Refusal to acknowledge that addiction• to drugs is
creating social, psychological and emotional problems.

Minimising!; Minimising either the extent of drinking/drug taking
-or the na’ture of problems caused by it.
Diversion;~ Diverting the conversation to another topic.
Blaming; Blaming the family or situation for their addiction.
Emotion-1 Blackmail; Utilising the emotions such as hostility

to avoid dealing with the problem of addiction.
Early confrontation with deniers is .most, ill advised.
- Initial goal in counselling deniers is to b-v- a contract
with clients to ret’.irn to the treatment institution.

- Discuss drug use during initial meetings- in a non-threatening
manner. (eg.) •

"Where there ever .times when • • you fe-..l it '■"& difficult to
handle drugs"?
"Have you ever thought of cutting down drugs"?

" How do you think your life might change if you quit using
drugs"?

"Let's examine why your patent is so upset about your drug
use".

- 6 - Confrontation should be done only after a comfortable

relationship is established with the patient, and it should

be done in a low-key. mann.er;
- A crisis related to-drug, abuse or even a hangover may serve

as a lead to confrontation.' Employing

supportive a<nd non

judgemental approach., the. counsellor might say, "I guess
we're going to have a closer 1.. ak ?t .your drug abuse,"

RelapseThe addict may avoid facing the counsellor after a slip
because of his guilt feelings. Under such circumstances, it may

be wise fcr the counsellor to take the initiative in re-establi­

shing contact.

This helps the addict to understand that the

counsellor is not judging him or getting angry with him because
he had a’ slip.

The Counsellor's response to resumed drug use should correspond
to the severity of the relapse - a brief relapse" should be tak&n

in a low-key, sympathetic manner, net an 'I told you so' attitude,

A major resumption of drug consumption should be tackled more

seriously.
- Counselling should be firm that patients must avoid situations
"which in the past have elicited use of drugs.
- Analyse feelings of stress .that have evoked drug.use in the

past.

- Signs like irritability, preoccupation etc. which lead to
slips, when noticed, should ba taken as warning signs of an

upcoining slip and necessary precautions should ;>■/ taken-.
- Missed -appointments or not -attending AA meetings from an
othc-rwise regular person are also warning signals. ■

Patient beinq drugged at the time of counselling?

- If the patient is" passive, send him hack v?th an appointment
fcr another day.

- Avoid references to his inappropriate b.l-nvicur as it is
likely that he may become unmanageable.- Show a sympathetic

attituda till he leaves.

7

Counselling Aggressive/Angry patients
Take him to a quiet area; preferably have a third person along.

Instead of direct questioning, make; supportive statements like
•I know how you must be feeling' . etc.
- Let the patient 'blow-off-stream' . Let the addict do the

maximum talking

- Resist temptation to disagree.
- Those posting physical threat should be seen in a place

whete there are people around.

- Avoid retaliatory, hostile remarks that might instigate
violence and state honestly that his behaviour is frigh-

tening/upsetting you,.
- ft the patient continues to be threatening, call the police

for help.
- Once he calms down, others -around can ask the person to ..
leave.
- If the person continues to come drugged, make it clear to hiir^
that in future, if he is drugged on the day of the appointment
he need not come nt; all.
Suicidol tendency:

Addicts have a high -rate of suicides/suicidal tendencies.
The following indications should always be considered
seriously:-

- History of previous suicidal behaviour; especially under

the influence of drugs.
- References to feelings of futility - "Life is not worth
■living".
- Pre-occnotticn with deathr

- Recent crisis/loss of a loved one i.e. death.divorce etc.

.,8.

8

- Continued expressions of hopelessness.■
- Dramatic mood swings.'

If 2 or more of the above indicators are present or if any
one appears on a .continuing basis, intense psychiatric consulta­

tion is adviseable.

Taking Responsibility for Recovery

The counsellor should not give the impression that die addict's
lack of sobriety is the counsellor's defeat, er that the addict's
success is a victory for the counsellor.
An addict's strong dependency needs, coupled with the role cf

the parent image of the counsellor, many lead to an unhealthy
dependency. It is essential to place the responsibility .for
recovering on the addict.
Provide Hope and Trust

Instilling a sense of hope in addicts is es‘vrti?l. This will
help the patient to learn to'trust himself err'1 others.

To relax the pafient by using such tools " s "c-- < ptance, under­
standing and ^Lstening..
To offer assistance to patients in arc.-s where he has serious

concerns and the patient steums block:.'.
To give reassurance to him that his condition is treatable and
changeable.
'

To set the tone and atmosphere
a positive note giving the
patient the opportunity to talk^reely.
To indicate to the patient the' success cf other patients who had

the same type of problems ;as the patient being interviewedf
•To accept the patient at the level he is in and not where the
therapist thinks he should be.

I

- 9 -

Discharge and follow-up
- Patients should be made to understand that recovery is
possible.

- They must be encouraged to set new -■nd realistic goals
which will help then in recovery.
- Importance of regular follcw^up and attendance to AA/NA
should be reiterated.

- Patients whe are dependent on their counsellors should be
encouraged to shift their dependency tc AA programme and

the weaning should be made smooth.
- Over confident patients should be encouraged to practice
the "one day at, a time" philosophy.
- Depressed patients should be encoufaged to meet the counsellor
and doctor regularly.

T T RANGANATHAN CLINICAL RESEARCH FOUNDATION
"TTK HOSPITAL"
17,1V TAIN ROAD, INDIRA NAGAR,MADRAS-600 020

REGIONAL COURSE ON 'PREVENTION OF DRUG ABUSE AND ALCOHOLISM1 j

SPONSORED BY NATIONAL INSTITUTE OF SOCIAL DEFENCE, MINISTRY OF
WELFARE, GOVERNMENT OF INDIA, NEW DELHI

PSYCHIATRIC PROBLEM! ASSOC IA .

' ITH ADDICTION

Alcohol intoxication is characterise^ by re 2 adaptive behaviour

like impaired judgement, belligerence etc. Signs of intoxication
include ataxia,,

nystagmus, slurred speech, flushing of the face,

irritability and impaired attention, disinhinition of sexual or
aggressive impulses and mood lability.

Alcohol Idiosyncratic Intoxication
This condition is also known as pathological intoxication and is
characterized by the sudden onset of marked behavioural changes

after the consumption of a small amount of alcobcl. The person is
confused, disoriented has visual hallucinations,

illusions and

transitory delusions. There is greatly increased psychomotor
activity, impulsive aggressive behaviour or depression with
suicidal ideation. This generally lasts for a few hours, terminate

in a prolonged period of sleep and the person is unable to recall

the episode.

Alcohol Hallucinosis
These are visual or auditory hallucinations usually beginning

within 48 hours of cessation of drinking. This may last for
several weeks or months without any other signs of alcohol
withdrawal or delirium.

It may be sometimes accompanied by

delusions but the sensorium will be clear.

2

Alcohol withdrawa1 Delir ium (DT)
It generally follows the cessation of prolonged heavy drinking.

Within hours of cessation the patient has tremors, hyper reflexia,

sweating., fever, tachycardia, hypertension, general malaise and
nausea cr' .vomiting. Major motor seizures may occur. Patients may
have transient hallucinations, illusion;? or vivid nightmares and

disturbed sleep. In addition to this there is a severe disturbance
in sensorium manifested by disorientation end clouding of con­

sciousness and fluctuating levels of psychomotor activity ranging
from hyper excitability to lethargy. Delusions and,agitated

behaviour are commonly present.
Alcoholic Encephalopathy (Wernicke's syndrome) and
Alcohol Amnestic Disorder (Korsokoff's Syndrome)

Alcoholic encephalopathy is a neurological disease manifested
by etaxia, ophthaImoplegia , nystagamusand confusion. This <pan

either spontaneously clear in a few days or weeks or can progress
into alcohol amnestic disorder in which the patient has an irre­
versible short term memory loss in the presence of s clear

sensorium. The early acute stage of Wernicke's syndrome responds
repidly to large doses of parentd 1'thiamine, as it is believed td

be caused by thiamine deficiency. Therefore malnutrition is a
pre-disposing factor and heavy alcohol consumption also produces

a malabsorption syndrome.
Dementia associated with aleohol abuse"

There is impairment in social or occupational functioning which
persists at least 3 weeks after cessation of-prolonged alcohol

use, ©ther complications of alcoholism-such as cerebellar signs,

peripheral neuropathy or cirrhosis may be present. It is not yet
know® whether dementia is a primary effect of alcohol or its

metabolites on the brain or an indirect-consequence of malnutri­
tion, freruent head injury and liver disease.

3

Excessive use of psycho active substances be it alcohol, ganja

or heroin is generally associated with psychiatric problems or

even underlying personality disorders. In most cases it is

difficult to ascertain whether the psychi=>trie condition
preceded or followed the substance abuse. However whether it is a

primary problem or secondary to addiction, it is very clear that

such problems have to be identified and treated with medications,
otherwise it will affect the recovery of the addict.

Given below are few of the problems that may co-exist with

addiction.

DepressionI)

Depression is the commonest psychiatric problems

associated with addiction. The patient seems dull and shows little
or no. interest in interacting with others, in eating and in

personal appearance. There- will also be fatigue, feeling of
worthlessness/ guilt, merbid thoughts,, poor concentration, pW
appetite, psychomotor retardation, insomnia or hypersomnia and

suicidal thoughts.

Sometimes there may be readtive depression in. which the symptoms

are., less severe. This is the result of a, conf licting environment
or situation. In such patients anxiety • ;.d depression co-exist.
The patient will have to take anti-depressant drugs for 3-6 monttyji

depending on the severity of . his problems. If suicidal thought^are present, it will be advisable to shift the patient to- a
hospital where 24 hours

Anxiety
II)

close supervision is possible.

Disorders - Anxiety is a diffuse, highly unpleasant

often vague feeling of apprehension, accompanied by one or more
bodily sensations - eg. an empty feeling in the pit of the stomach,

tightness in the chest, pounding heart, perspiration, headache,
restlessness etc.
.4.

4

Panic disorder is a spontaneous, episodic and intense periods of

anxiety usually lasting for less than an hour.

Both these disorders are more often associated with cannabis
use than with other drugs.

Mild anti depressant / anti-anxiety agents, use of relaxation

therapy and counselling on trigger r."ctors, r.. Ip.
Manic
III)

Degressive Psychosis - Only

of :11 addicts may

have bipolar disorders showing episodes .of mania and depression.
During the manic phase there is a euphoric mood, with excessive

spending, talking, gambling, grandiosity -nd decreased sleep.
During the depressive phase psychomotor ret'rd-tion, depression,

feeling of hopelessness, suicidal ideas will be seen.
Psychiatric Consultations and con'tinued use of medications are
extremely important.

Paranoid
IV)

Disorders - The dominant symptoms in delusional dis­

order is a delusion that docs not have an identifiable organic

basis. The patient's affect is appropriate to tie delusion and

his personality remains intact or deteriorates minimally over a
prolohged period of time. .Other signs and symptoms of thought

'disorder are minimal. The most common delusion is a paranoid
delusion in addicts.

Other
V)

Psychiatric Disorders - Sometimes addicts may also have

schizophrenic feature or schizo-affective disorders. These patient

may be primarily psychotic with secondary addiction.
Both the above categories requires prolonged medical help

and have to be on anti psychotics under the supervision of a
Psychietr ist.

T T RANGANATHAN CLINICAL RESEARCH FOUNDATION

"TTK HOSPITAL"
17,4th Main Road,Indira Nagar,Madras-600 020
REGIONAL COURSE ON 'PREVENTION OF DRUG ABUSE AND ALCOHOLISM1

SPONSORED BY NATIONAL INSTITUTE OF SOCIAL DEFENCE,
MINISTRY OF WELFARE, GOVERNMENT OF TNDI A, NEW DELHI .
VIOLENCE RELATED 10 APDICTIC N
Domestic Violence is a cri e that is. .’ommitted behind closed

doors in the privacy of the family. It is a problem that tends

to be denied, ignored or tolerated by our society which has
a1ways'viewed abuse in the family as a private matter and not
a social problem.

"Violence is defined as the last refuge of the incompetent.

It is the expression of the emotion, anger taken to a faculty

extreme". Domestic violence can also be defined as the
maltreatment of one family member by another. It is not only
dangerous but also counter productive and despicable.

Violence can be broadly divided into two categories called

(1) Primary,

(2) Secondary.

By Primary, we refer to individuals

who have violence as a basic problem, unrelated to contributing
factors like mental illness, alcoholism etc.

Therefore, it

could be due to a personality disorder.

Secondary violence is referred to as violence caused by or as a

consequence or outcome of.addiction’ to alcohol or j^rugs or due

to psychiatric disorders.
Domestic violence in the family structure can take different
forms such as;

2.

- 2 -

1)Violence between the couple - Due to incompatability, sex role

conflicts, personality clashes, family disputes, disparity in

educational or socio economic status etc.
) Child abuses A child can get abused in the family, by parents,
2.

for reasons like, undue expectations, Lack of parenting knowledge
differential treatment based on the sex, capabilities of the
child etc.

A handicapped child can get abused.

Illegitimate

child, a child being put in an orphanage, or correctional home,
free hostels, for financial reasons., child labour, step -parents

etc would come under child abuse.

3)Abuse of elders; Elders are abused by the children, as they are
looked upon as a burden on them. Desire to wrest control of
property rights from parents, or old age and economic dependence

on children, physical abuse under,intoxication, dumping destitute
parents to old age homes etc are someof the abuses on elders
*
4)Violence within the family due to; external factors likens

Dowry, property disputes between siblings, marriage against
family consent, addiction, 'mental illness, ate can also cause
•violence within family,
Salient Research Findings

Famiiy
l)

'
'

, 1

•

violence spans all.ages, races, nationalities,.

educational and socio economic groups.

Violence
2)

is never a one time occurence.

3)Violence is frequent during weekends, holidays and during
evenings and early morning hours.

. 3.

3 Women
4)

are subjected to physical violence and men to emotional

violence.

5)Violence. is said to be a learned behaviour.

Therc
6)

is generally a history of violence in the f-mily..

can be directed towards self, others .or, inanimate

Vidlence
7)

objects.
can cause severe physical injuries, resulting; in

Violence
8)

suicide or homicide.

9)

90% of the addicts who are violent are reported to be of
primary type.

10)

50% of the court cases, related to separation, divorce

are attributed to addiction and violence.
Equal apd unequal relationships

Violence is often a by product of unhealthy relationships within

the family structure. Healthy relationships in a 'family are
normally equal.

Signs of Equal
1.Family issues are discussed

Unequal relationships
One partner will have the final

say

mutually
2.Women accept a fair deal
of unequality

3.Female role expectations

Man expects a fair deal of

inequality.
Traditional stereo typed sex

nurturing
a)

roles which nurture feelings of

dependency
b)

1)Independence

«are
c)

2)Aggression

for family welfare

Control
3)
Support
d)

for the male in

4)Leadership in man

all his efforts.

4

Signs of equal
4.Both the partners have

equal rights

51Mutual respect for one
another's feelings,inte ­
rests and opinion

Unequa1 rela tionships
One partner has. more rights than
the other

One of the partner starts giving
up one.'s . likes, interests and

compromises unwillingly to avoid
conflicts

6.No secrets

. .

, '

The partners maintain lot of secrets

Studies show that for a violent relationship to continue the

battern and the battered have certain personality constellations
which is given below.

Characteristics of the batterer

Poor
l.

impulse control

2.Emotional dependency
3.Egoistic

4.Low self-esteem
5.Imma tur e

6.Self-Centered
7.Possessive

8.Paranoid
9.Weak stress management and Poor conflict resolution
skills

Characteristics of the battered mate
1.
Fear

2.Guilt

- 5 -

3.Shane
4.Social isolation
5.Low self-esteem

6.Enjoys & encourages spouse's dependency which makes her
feel competent.

7.Depression - Suicidal thoughts, attempts.
Characteristics of the abused children in violent relationships
l.Low tolerance

2.Poor impulse and control
3.
Depression

4.
Hypersensitive

5-.Low self-esteem
6.Lying, stealing, other behavioural problems

7.Rebellious

’*

8.
Pear
9.Apathy

10.Poor role model
11.Suicidal thoughts / attempts
Cycle of Violence

The dynamics of the violent-;relations by follows a specific
pattern which is termed as cycle of violence. The diagram

represents the cycle of violence

- 6 This cycle passes through following stages:
1.Starts' with courts ships/dating

2.Decides to marry/or stay together - very loyal and
committed to each other.

3.Tension builds - Blames the partner
The
4.

first’violent episode

5.Honeymoon phase

6.Repetition of the cycle
7.Denial of the violent episode

8.Self blaming by the wife
9.Seeking help

10.Ambivalence in and out of relationship.
Why do women stay in such violent relationship?

----------------------------- -----------------------------l)Lack of alternatives.
Economically dependent on the partner.
Fear
2)

and shame of the unknown may lead abused people to submit

to violence. They feel ashamed that the outside world know

about their violent’ relationship.

Lack
3)

of protection: Neighbours, relatives are not able to render

immediate and adequate protection.
4)Ignorance: Unaware of the facilities available to them,

5)Isolation: They have no where to go for support.

Cycle
6)

of violence: The belief that there are good time as well

as bad times. Good days give hope that it may improve with
time.

,7-

- 7 7)Traditional views of marriage and women - that if the wife had

been a better person, this would not have taken place.
8)Low self-concept : After acceoting insults, blarney and violence

over., years many feel worthless. Lack of education, job

experience and small children to take care of can make her
condition more dependent.
9)Love: The honey moon stage of violence cycle helps them to

keep love alive.
10)Threat: Many have been threatened with being killed if they
leave the relationship.

11)Secrecy: Since most violence occurs at nights, there is no

eyewitness to it and they are unable to voice their .
difficulties.
Having understood the dynamics of the violent' relationship, the
following to be worked out in counselling a battered women.

l)Safety for the women and her children - including emergency
shelter.

2)Under standing the cycle cf violence and processes that per­
petuate violent relationships as this mayvbe very helpful for

a woman who is trying to explore whether the relationship
can be saved and improved or must be ended.
3)Self-esteem: They must be helped to see through their inade­
quacies and helped to improve and strengthen their skills

.tc develop self-esteem.

..8.

8
4)Parenting issues: Children in such families often show emotional.

and behavioural disturbances.

It is important that women

recdive information on these processes to help their children in

adjusting.
5)Problem solving and decision making skills: They are often

afraid cf making any major decisions, it is essential coping

skills must be taught.
Dealing
6)

with the many conflicting and other difficult emotions

like anger, fear, guilt, depression and subidal tendencies,
7)Sex role stereotypes: Many women have poor images of- them­
selves and their roles.

They should be empowered to assert

themselves and be self sufficient.

8)Alcohol and Drug Abuse issues: Make them aware of the existence
of other problems ctjier than violence such as addiction or psy­

chiatric problems.
Job/Career
9)

needs’including training, vocational guidance,

placement facilities-^.
10)Support her to accept initial setbacks. She may go ahead

with some step and may draw back because cf fear. Reflect her

strengths and fears.
ll)Guide her to frame her future positively and realistically,.

SHANTI SEVA SADAN : PROJECT PEACE
(Regn No. 31/89- 90 )

DEADDICTION, REHABILITATION, PREVENTIVE EDUCATION CENTRE
FOR DRUG ADDICTS AND ALCOHOLICS
Regd Office :
Admn. Office :

33, Rest House Road, Bangalore 560 001.
100, Residency Road, C/o Chic Arts India,

Bangalore 560 025.

Tel: 579307
Tel: 567609, 568299

AN APPEAL
PROJECT PEACE
ALCOHOLICS.

needs your help—financial aid - help to treat and rehabilitate the DRUG ADDICTS and

SHANTI SEVA SADAN : PROJECT PEACE is a purely Charitable Society & voluntary organisation. It is registered
with the Registrar of Societies, Karnataka and with the Income Tax U/S 12A. U/S 80 G (dttteseon)

OUR OBJECTIVES AND AIMS are peace and freedom to the addicts and their families;
the drug addicts and alcoholics into society.

rehabilitation of

We shall organise medical relief and treatment camps ; in-house courses for deaddiction ; group therapies ;
Counselling of the addicts and their families etc. We shall organise preventive education through all media,

Rehabilitation into society and family and follow-up work will have an important place in our scheme.
We desire that you make our objectives your own.

OUR PROGRAMME will consist of deaddiction ( in a hospital ), and other renewal programmes that will
make our addict brothers new on psychic and spiritual levels. Freedom of conscience/religion of everyone
will be respected.
THE BENEFICIARIES

of our Peace Project will be all needy addicts ( and their families )

willing

to avail

themselves of our service, without any discrimination of caste, creed or status. The deserving poor
be also treated free or at a concessional rate when our funds permit or you find sponsor for them.

will

DO YOU KNOW THE OTHER BANGALORE ?
A city with 65,000 drug addicts? 150,000 - 200,000 alcoholics ?

-

A wet city with 2 out of 10 social drinkers tending to be alcoholics some day?
With addicts (to alcohol / drugs) causing industrial and road accidents ? and 80% absentism,
economy of the country ?Oh I Beautiful Bangalore I

paralyse

the

Let us keep Bangalore beautiful. Are YOU with us? Come, Let us promote PEACE. Support PROJECT PEACE.
HOW YOU CAN HELP US :

1.

Contribute by cash. Cheque or in kind. ( Cf list of our needs, )

2.

Introduce us (SSS:PP) to your friends : Speak to them about us.

3.

Introduce the addicts to us. And give them hope to live.

4.

Spare an hour or two at the Centre in voluntary service.

5.

Be a Peace Promoter : Encourage, give company to
They need acceptance; not condemnation.
Sponsor an addict at ' Project Peace '.

6.

renewed addicts.

We appreciate your positive response and help to light even one candle in the darkness of

Mr J.R. MATHIAS, B.Sc. (Text.)
Mrs B. VERGHESE
Secretaries

Mr A.B. FONTES, B.Com.
Treasurer

addicts'

lives.

Fr NOEL MENEZES, O.F.M. Cap.
Mr E. A PAIS
President

CAM
CO,»!TY health cell

STATEMENT ON THE NATIONAL CONSULTATION3’<F,’'st Hoods,.
-

~——■—

x. - 27

.

BANGA.O3E-

THEOLOGICAL RESPONSE TO ALCOHOLISM AND DRUG ADDICTION

Dimension of the problem

We are compelled to acknowledge that Alcoholism and Drug
Addiction are assuming an alarming proportion in our nation and
communities. Individuals’ who- are.afflicted by this disease while
causing damage- to themselves-also: place enormous burdens on the
members of the immediate family and on the community at large.
Substance addiction destroys the quality of life and ultimately
destroys one's relationship, with God.

We also acknowledge that the problems which cause substance
addiction are complex and attributable to physical, psycho-social

and spiritual realms.

The World Health Organisation and medical •

psychiatric experts have acknowledged it as a disease which

affects' people from all kinds of life.
must be multidimensional.

The process of healing

Therefbre, we feel that it is

imperative'that we -give a theological response to this human1
problem which has .both moral-and ethical implications.

The Human Predicament
This painful human condition is contrary to the will of God

and against the purpose of creation.

Men and women are created

by God in His own linage, and endowed with human freedom and
creativity.
We through our own self-centredness, self-indulgent ways, and

through self-righteousness have failed to responsibily relate

to God1s’creative design.

This has resulted in a state of

alienation which now exists between ourselves, 'nature, the

world around us and finally between ourselves and'God.
Taking alcohol and drugs'may begin with an individual

decision, but neither the individual alone nor the family are .
solely responsible for the malady of addiction.
There are larger
structural socio-political and psycho-pathological forces that
are at play here, which are seemingly beyond human control;

...2/-

-2God's Response

We believe that in God we find the purest expression of
love agape.

It is an expression of sublime and unconditional

love which is constantly searching and self-givingi We can
appropriate this love, agape, through faith (pistis).
Therefore

we 'the community of the Faith' who have experienced this
searching love of. God must attest’ that agape demands new
realities, among humankind and that agape itself is the basis of

motivation for love, bewteen people.

The'theological reality

of the presence of God's love in us must-issue a reciprocal
response.

The concrete historical expression of agape is in the

coming of Christ in order that we may fully understand and
experience that loving-relationship with God once again.

If

we say. that-we.have experienced this searching‘love of God
through Qhrist in our own ,1'ives then it is cyr responsibility
to seek and show that we too are agents of love and reconcilia­

tion.

..If we fail to empathise with our brothers or sister^

who are affected by substance.addiction then we have failed to
realise the agape' love'of God- through Christ.

Our Response
Our Theological Response therefore is 'fundamentally
a human response.

Alcoholism and drug abuse are realities in

our broken world.

A person who 'is an addict stands in need of

our love and understanding help.

Our Christian Response is

to stand beside the needy, be it in spiritual, economic, social

or psychological realms.

One of. the greatest yet largely untapped resource that
we possess is the very fact of Christian Community and fellow­

ship.

The word Koinonia

participation.

denotes communion, fellowship, or

An important function of Koinonia is to 'have

a share' in the suffering and affliction of others through

active assistance!.

Through living bonds of Koinonia, we the

members of church can actively share and assist each other in

the . affliction that beset us.

-3-

■Those of us who belong to the community of the Faith namely the church, must respond to this need both as individuals

and: as a whole community,. Our earnestness:must reach.beyond
words into deeds, and it is only then 'that the liberating force
of God's love through Christ, can become a reality,

God, through Christ, has revealed His love for all humanr
kind for the restoration of life to its fullness-.
This
universal love fof God transcends human made barriers of

casite, creed, colour and nation.
The model of Christ's ministry, in His dealing with
people with various illness shows us that -healing and restoratic

was dependent on Faith.

We believe that this faith .in God's

love demands the regognition of the inner strength in each
individual which has to be discovered so as to lead one to

God's love and human goodness are essential in

recovery.

our times both on the part of 'the individual victims and the

community, in the process of. restoration, healing and wholeh ?ss

Jesus has commissioned us to be His partners to- heal all
infirmities and-diseases, to proclaim releasb-from captivity

and to bind the broken.

In this situation of helplessness we

believe that there is an ultimate hope for everyone regardless
of the level of despair.

The Reality
What is called for is a caring Christian attitude and way

of life.

But we discover that there is in the church a lack

of awareness of all the facets of the problems related to
substance addiction.

This is buttressed by an inadequate

theological understanding which, has made the Church more
condemnatory than supportive of suffering addicts.
It is

in this context that we took stock of the Church's

role in preventing more and more of God's pwople from falling

into an abyss of despair and in the arrestingof the disease
and in therapeutic and rehabiiitatory care. In this context we
view

every congregation as a healing cd xuni'ty .

The local

congregation must be educated into recognising substance addic­

tion as a multidimensional disease which affects a person's
body, mind and soul.

.4The Pastor is'called to an important role in helping the

bOhgb&tat±8H to .understand the social, political, economic,
ethical.cand physical and spiritual aspects of the diseade of

addiction and in playing a sensitive and'supportive role in
identifying addicts and enabling them,in their recovery.

In this, context we recommend:
1,

2.

To the Senate of Serampore and to theological colleges:

a)

. That the curriculum be changed to include a
comprehensive course in the are of substance
’addiction, so that pastors who come into Ministry
on completion of their education will have sufficient
knowledge of the various aspects of the' problem and
will be equipped to provide a theological and
spiritual understanding of the problem to the
congregation, the community and to suffering addicts.

,b)

that theological students be'exposed to .the rural
and urban socio-political context that aggravates the
problem of addiction.- Students must also be exposed
through atleast year's practical experience, to the
various secular and other spiritual programmes already
existing in the fields of conscientisatipn, prevention
and treatment.

c)

That theological students who show interest in this
Ministry be encouraged to go in for greater
specialisation.

d)

that periodic seminars be organised for students and
staff on various aspects of substance addiction.
■ Experts and recovered addicts can be invited to
■ speak.
•
,

To national bodies (NCCI, CMAI, CBCI,)B6ard of Theological
Education, Serampore Senate etc.

a)

that attempts be made to bridge the existing gap
between theological institutions and the church, by
bringing together curriculum planners and bishops/heads
of churches to ensure that theological education will
be geared to the needs of the grass root level local
church and the community.

b)

that attempts be made for every Christian medical
hospital in India to have a unit for de-addiction
and psychotheraphy.

...5/-

-5- .

3.

c)

that national bodies and the churches will make
every effort to cqnscientise the people of the
negative consequences of substance addiction by
organising awareness camps, ■ seminars, training
programmes and workvshops.. and giving publicity
through Christian and secular journals etc.

d)

that 'media resources be identified and exploited
to deducate people of the effects of addiction and
to educate addicts to recognise their responsibility
for their actions so that they can make.a positive
contribution to society.

e)

that appeals be made to the government demanding
proper implementation of excise laws.

f)

that appeals be made to the concerned Chief Ministers
and the Prime Minister documenting the reality of noncompliance with excise laws.

g)

that a definite stand be taken against the production
and marketing of.addictive substances.

h)

tjiat every opportunity ’.'.'be taken to participate
in and express solidarity with all forces working
towards concientisation and prevention of abuse and
in the treatment of addicts.

i)

that one Spnday in a year be declared and celebrated
as ’drug awareness day1.

To the local church/pastors we recommend
a) that lay training programmes (eg. TECCA OF ITS-and
TAFTEE)
b)

that Pastors and elders themselves be temperate
and live exemplary lives.

c)

that the addicts be equipped to be. able to identify
addicts, counsel them and refer them to professional
care and to programme such AA.
' '

d)

that the church buildings be made available to
spiritually oriented groups such as AA for
their meetings

e)

that the programme of Sunday School (eg. AISSU/'
ISSU/VBS) youth groups, confirmation classes,
women's fellowship groups etc. include awareness
building and support work on substance addiction.

f)

that drug awareness programmes be organised for
school children, college students and the general
public.

g)

that pastors through sermons, pre-marriages counselling
bible study conventions, sensitise the Church to
problems related to addiction.

...6/-

-6h)

that recovered addicts to be invited to the regular
church, service to give their testimony so that the
congregation will be able, to respons to them positively
snd with empathy. Addicts need a sense of
belonging in order to reduce anomie and alienation.

i)

that healthy parenting ideas be fostered through
family life education so that parents.will
always be available to children helping to ease stresses'
with regard to modern day competitiveness and
creating an atmosphere of"loving and caring.

j)

that team ministries be initiated and small prayer
groups/theraphy sessions be encouraged for two or
three families who face the problem of addiction, Peer
group support plays a crucial role in the recovery
process and must be encouraged.

k)

that ecumenically organised 24 hour 'centres of
deaddiction day care centres and half way homes
and after care centres be set up in each area fully
equipped with mnot only medical but also psychiatric
care, counselling and spiritual programmes.
The Church
should should provide inexpensive, and subsidised
care wherever necessary.

1)

that the local congregation support every effort
to curb easy availability of addictive substances,
joining in protests wherever possible regarding
improper location of liquor shops and bars.

Drafting Committee
Rev. Dr. Gnana Robinson
Dr. Daniel Chetty

Rev. Dr. K.V. Mathew
Mrs. Aruna Gnanadason

Sr. Joan Chunkapura

Mr. Harry Charles
Mr. Jonathan Ganadason

T T RANGANATHAN CLINICAL RESEARCH FOUNDATION
"TTK HOSPITAL"
17;4th Main Road,Indira Nagar,Madras-600 020
REGIONAL COURSE ON THE PREVENTION OF DRUG ABUSE AND ALCOHOLISM
SPONSORED BY NATIONAL INSTITUTE OF SCCIAL DEFENCE, MINISTRY OF
WELFARE, GOVERNMENT OF INDIA, NEW DELHI
COMPREHENSIVE MULTI-DISC17 I ENARV '.PI-ROACH

A comprehensive treatment "nc-?-''

er.ented by a multi­

disciplinary team has been

'?ref. icial.

There are four broadly describee phenes in the"treatment of
addiction:

- Identification/intervention
- Detoxification
- Rehabilitation
- After-Care

Identifica tion/intervention
Identifying a chemically dependent person and motivating him to
take treatment are often carried out by a relative, a friend,

a fellow employee, a supervisor, a doctor or by school authori­
ties. When the chemically dependent's wife or parent brings the
person for treatment, it.is called family intervention. Similarly,
there may be medical intervention, where the physician intervenes,

discovers certain physical.damages in the individual indicative
of drug abuse and refers him for treatment. There can nlso be
occupational intervention, in which case, the employer identifies

the addict through an Employee Assistance Programme .or oy mere
observation and reports from the fellow workers. It can also

happen due to the intervention of school authorities •.ho Inform
the parents about the possible drug problems the str e-.t may be
going through.

- 2
Information, assessment and referral services

After identification, they are brought.to assessment centres.
These organisations are located in industries, welfare agencies,
and schools. In these centres relevant information including the

history of chemical use is collected from the patient and from
other .sources, Based on this information, chemical dependency
and other related problems are diagnosed and referrals suggested.
Detoxification

I

Detoxification is a process wherein the toxicity of the drug in
the body.is removed.
This calls for an inpatient setting, with close medical supervi­

sion.
Detoxification Centres
The primary function of these institutions is' to provide, treatment

services for. detoxification of patients who are experiencing

withdrawal.
Detoxification centres are located ip- hospistaIs, emergency care
services, etc.

The staff include physicians, nurses and counsellors.; Here the
patients undergo detoxification for a period of .3 to 10 days.

This period varies depending on the condition, of each patient.
These centres provide counselling which motivate the patients to
take further treatment. Referral to appropriate treatment
programme for continued care is also made.

- 3

Rehabilitation
This phase aims at helping the addict work towards abstinence,and
making him realise that he can also be useful to and respected by

his family, friends and community.. It also helps the patient to

make positive .changes in his life style..
During this phase, the family of the addict :is also given inten­

sive therapy. The programme helps the family- and friends under­
stand that addiction is ..a disease, become aware, of treatment and

post-treatment experiences and' the-need for making improvement- »
in their liwe-s-i This service ia provided ip-different iettinpsi
These include-:
- Residential treatm&nt -fae ility-

- Thera.peut.ic .community

-

., -

.. t

- Out-patient programme "

Residential treatment facility
These., treatment -centres provide an intensive s-tructbted programme

of. treatment and rehabilitation wherein patients are $iven

individual- attention. These are done in in-patient settings.

The goals of this treatment are:

- to help Jhe addict give up drugs totally for- life - to bring about positive changes in the patient's behaviour

and attitude,, and thereby enable him to lead a-, cualitative
life.
The treatment methods .adopted are individual counselling,, group

therapy, recreation therapy, therapeutic • community -meetings, anel
relaxation technicuas..

The philosophy of AA (i.e,,-powerlessneps

over alcohol and belief in a Higher Power), plays a significant

role in the treatment. programme.

4
The interaction between individuals and the group is utilised to
reinforce and strengthen continued abstinence. Balanced diet and

supplementary nutrition are provided as part of this therapy.
Patients are involved in the therapeutic activities like cleaning
the room, helping in the kitchen, watering the plants in the

treatment centres, etc. On completion of the programme the patient
will be presented with a medal in a small farewell party.
^Counsellors specialised in the treatment of addiction and reco­

vered chemical dependents play a major role in providing coun­

selling services.

These recovered.addicts help the patients to

get the maximum benefit by combining their personal experience
with specific training.

Therapeutic Community
This is a residential treatment programme based’ on therapeutic

community principle that has evolved from psychiatric setting
over the^last few decades. The objective here is the establish­
ment of a therapeutic social milieu. Programmes usually include

frequent community meetings and group" therapy sessions'. In these
groups, peer pressure is used to bring about change in patientc
and also tto confront individuals whenever necessary. Behaviour

modification techniques are also employed to modify undesirable
behaviour. There is usually little or no use of pharmacological

treatments, individual psychotherapy or.marital therapy.
This programme seeks to achieve a major behavioural and psycho­
logical reorientation of the individual..Much’ of their work. ■

involves resocialisation of the individual, as part of their.

rehabilitation.

.5.

- 5 In order to benefit from therapeutic communities, patients may be
required to stay for long periods.

Out-patient programme
This is designed for the ambulatory patient to receive medical/
rehabilitation care from a hospital or a clinic. The primary

function of the institution is to provide treatment in a nonresidential setting. These patients do not require in-patient

care, but need specialised treatment to come out of their
chemical dependency and to make adjustments to the problems they
are likely to face during abstinence. Counsellors prepare a social/

psychological assessment of each patient and. assign him to group
counselling sessions that meet regularly - evening or night

sessions for those who are employed end day sessions for those

unemployed. Individual counselling, is also included as part of the
out-patient therapy programme. If a. patient is found to . be

drinking or taking drugs while attending the programme, he is
transferred to the in-patient programme, or if' he is found to be
difficult (uncooperative, irregular, arriving intoxicated), he
is discharged.

After-Care
This includes the package of services provided to the patient

after, successful discharge from the programme. After-dare
activities can be viewed as the first line of defense against

return to drug use. The activities include attending self-help
programmes like NA/AA, regular follow-up at the treatment centra, ’
staying at the half-way home, etc.

..6

- 6

Self-help groups
Self-help groups are voluntary, small group structures formed for
mutual aid and for the accomplishment of a special purpose. They

are usually formed by peers who have come together for mutual
assistance in satisfying a common need - which may be. overcoming

a common handicap or a life-dis±upting problem or bringing about

a desired social and/or personal change - through emotional
suppor t.
The most well known self-help groups associated with chemical
dependency are:
1.Alcoholics Anonymous for alcohol dependent patients (AA) .

2,Narcotics Anonymous for drug dependent patients (NA')

3.Al-Anon for spouses or relatives of addicts
4,
Al-&teen for teenage children of addicts

Half-way homes
This is a programme that attempts to combine the advantages of ^he

residential treatment with those of the ambulatory treatment.

Patients live in a group, but ere per • litter to leave the premises.

during the day and on week-ends. Problems are solved through
group interactions and cojnmunity invc.! vc---nt. Members of this

programme would have already gone through a primary treatment.
The primary function of the institution is to provide, on a

residential basis, support and guidance to the patient to proceed

towards the goal of independent living. These patients recuire
limited medical supervision but are in need of continued help to

tafekle their alcohol/drug related problems. These centres provide
supportive help in the form of occupational, social and
recreational activities.

7

Patients who do not have a family or who are unmarried or divor­

ced, or those prone for relapse are recommended for this•
programme.

The treatment of chemical dependency involves considerable skilly
patience, understanding and experience. There is po known cure

for chemical dependency. The disease can only be arrested, and

the chemical dependents are given guidelines to lead a healthy

end productive life without chemicals'.

Pha se

Pha se I
Identification/lnter

vention

Goals

* Problem defi—
nition
* Patients ente­
ring tr ea tme nt

Methods
* Breaking of
denial through

empathetic,.
non-judgemental,

^Settings

Referral agency.
Employee Assis­
tance Programme,
School Welfare

Agency,Physi-

supportive,

cian's Office,

confronts -

Criminal justice

tion

■ System, Inpatient or out­
patient medical

and psychiatric

services.

Pha se IT
Detoxi-, >
fica/tion -

* Helping the

* Ingestion of

patient to
become drug
free

-medicines

* Motivation
counselling

towards treat­

ment and
rehabilita tion

* Nursing care

Out-pa tient .
emergency care

services, in­
patient hospi­
tal or detox ..
services.

Goals

Phase

Methods

Settings

Phase -III--. - For the patient
and his family
Rehabili-

* Individual

counselling '

• out-patient,

tation

* Re-educative '

Therapeutic
Community

'

* Change in selfconcept

* Change in per­

sonality traits
* Change in life

style

lectur es
* Group therapy

In-patient,

* Relaxation
therapy
* Spirtual Coun­

selling

* Restoration of
physical health
with proper

nutrition'
Phase IV
After-Care

* Prevention of

relapses
* Reinforcement
of new patterns
of sober
1 iv ing

* Same as Phase
III

Out-patient
clinics

* Self-help

Half-way hoqies

groups
* After-Care

Self-help

Sessions
* Vocational
rejwbilita-

gr oups.

T T RANGANATHAN CLINICAL. RESEARCH FOUNDATION
"TTK HOSPITAL'1
17,4th Main Road, Indira Nagar,Madras-6QQ 020
REGICNAI COURSE ON THE PREVENTION OF DRUG.ABUSE A'-U AICCHOLISM

SPONSORED BY NATIONAL INSTITUTE OF SOCIAL DEFENCE, 1\IN TO TOY, OF
WELFARE, GOVERNMENT OF INDIA,

HIV AND AIDS
Human Immunodeficiency Virus (HIV) was first discovered in 1983-

1984. It is the virus responsible for causing the disease known
as the Acquired Immunodeficiency Syndrome (AIDS).

The first AIDS case in India was Reported in May 1986. Since then
many have been reported and by 2000 it is estimated that nearly

five million people in India would be HIV positive and the number
of full blown AIDS cases would exceed one million. No one knows
exactly how many cases are infected today but for every one case
reported, 100 would be unreported in the general population.

Spre'-d of the Virus

The viruJ is spread by the following routes'
1 - Sexual intercourse - heterosexual

homosexua1
2.

- Needle sharing by intravenous drug abusers

3

- Pregnancy from mother to foetus

4

-Transfusion of blood and blood products

Pa thoqenesis

The HIV infects specific white blood cells and destroys the T4
lymphocytes. This is essential for the body's immune defence
system and when these sells are destroyed the infected person

becomes, susceptible to a range of opportunistic infectious

disease and fencers. AIDS is the term applied to a group of such

conditions, the presence of which indicates severe damage to the

.2.

2

immune system. HIV may also infect the nerve cells, causing neu­

rological disturbances. HIV infection is lifelong and the infected

person remains infectious for life.
Rafee of -regression to_AIDS
All those -’ho are infected with HIV •.■■11 develop AIDS within 5 -

12 years -nd these ?ho are diagnosed »s ’I-’die. within three
months to two years. The patient is the -c-t infectious during
the window period and just before

Person infected

3-6 months

the -■-■■ ?•>!orr.-.ont cf .AIDS.

Death

Asymptomatic
Appears normal
Patient is
HV •: ve
Infective '

AIDS

6 mtns to 5-12 yrs

5-12 'yrs

£
W

S months2 yrs

Window period
Pt shows HIV - ve
but is infectious

HIV -+te
Has jhfectionfe or
Car.cajf s

Manifests tions
Acute Prodrome 1 Manifestations

It generally precedes tin:

development of an antibody response

(seroconversion) or during the so called winno^ u^rioc. The topi­
cal signs are fever, lymphadenopathy, night sweats, skin rashei,
headache and cough.
.Stage - 1

The patient is either asymptomatic or presents with persistent
generalised lymphadenopathy - characterised by lymph node en­
largement to greater than 1cm in diameter involving two or more
extra inguinal sites and lasting for a tiesst for three months.

The duration of this phase may range tore a far; months to many
years.

- 3 -Stage

2 (Early disease)

This stage is characterised by the occurence of typical mucocuta­

neous lesions s'ch as oral hairy leukoplakia or infections such as

herpes zoster. Constitutional manifestations such as moderate
weight loss, fatigue-, enoraxia and night sweats are frequently

intermittent. Recurrent upper respiratory -ract infections may
also occur.
Stage - 3 (intermediate disease)

In this stage oral candidiasis, oral hairy leukoplakia .pulmonary

tuberculosis, labial or general herpes, viral vesicular dermatitis

and other bacterial infections causing pneumonia or gastro­

enteritis and a tumor called Kaposi's sarcoma can -occur. Conbtitutional symptoms include persistent fever, diarrhoea and weight

loss exceeding 10% of body weight.

Stage -■ 4 (Late disease)
There is profound immunosuppression so there are severe problems
caused by opportunistic infections (pneumonia, fungal infections,

etf.), severe forms of lymphoma and cachexia may also- oqcuf.
This is the last stage.

Neurological Manifestations■
The most frequent neurological disorder is subacute encephalo­

pathy characterised by progressive behaviour changes associated
with, dementia, it occurs in one third of the people with, late

stage HIV infection. Its onset is gradual with tremors,- slowness

of movement, memory loss and peripheral neuropathy and aphasia.
The course is usually progressive towards sever dementia. '

1 .

Mustism, incontinence, loss of vision and paraphlegia nay develop
in terminal stages.

Prevention stra tegies

1.Sexual transmission
Having
a)

single mutually faithful relationship

a person insists on having multiple sexual partners

If
b)

- using condoms from start to finish for all sexual
penetration - vaginal, anal and oral

Avoiding
c)

sex with people who have many partners (eg.prosti­

tutes)

2.Parenteral transmission

All
a)

bleed ’*
ndblood

products have to be checked for HIV before

using.

Needles,
b)

syringes and other skin piercing instruments have to

be cleaned with bleach and then sterilized.

3-Behaviour change for IVDU

Abstain
a)

from drugs

«-hange
b)

from IVDU to chasing or

smok-ing

f)Jf a person insists on IVDU at least use disposable syringes
and needles or sterilised ones and never share them.
4. Perinatal transmiss'ion

Females who are HIV positive should not-get pregnant as there ifi
a 40% chance that the child will be positive too.

..H£V testing

There are 2 viruses HIV

& HIV 2 and Elisa Kits pre available for

both. Elisa test is a simple inexpensive rrocedurs by which HIV
testing can be done. If., the person is tested nositive, either

repeat the test using another sample of blood or send for Western
Blot method. Western Blot method is more expensive and dona only

in a few cen.tres.

5

Pre-test counselling

I.Assessment of risk
a)Frequency and type of' high risk sexual behaviour - eg.

multiple sexual partners or unprotected sexual relationships

with'prostitutes.
b) Intravenous drug use - specially - s a croup activity with

sharing of syringes and needles.

, ,

received blood or blood products

Having
c)

Non-sterile
d)

invasive procedures like tattooing

Difference
e)

between HIV +ve & AIDS to be explained

Assessment
II,

of psychological factors and knowledge

a)Why is the test being requested?

b)What particular behaviour or symptoms are of concern to

the client?
What
c)

are the client's beliefs and knowledge about HIV

transmission?

How
d)

-

would the client react if he is positive or if he ij=

negative?

Who
e)

■

'

could provide emotional and social support to the p&tj'ieqt-

femily, friends or any others?

Talk
f)

about the window period

How
g)

can a change in behaviour redrx the likelihood of

transmission?
Post-test counselling

I, After a negative result
a)Possibility of a window period so need to re-chock after six

months
b)Further exposure to HIV infection can be prevented only by
avoiding high risk behaviour. The patient is not1 ijnmvne to
l ■ , HIV as .he may misguidedly think.

.' S, '

,

- 6 c’) It may be necessary to give information on control and

avoidsnce of HIV infection by development of positive

health behaviour and repeat explanations.
Il.Counse12ing -ft.r a positive result

The result should -< tol-' as e.rlyas possible clearly and

the patient should I?-: given fime to a’--sorb the news. Wait for
some. time. After ■? period -■ preli-ir'-r ’.adjustment, the

patient' should be c4ven ■: c.?_-r ihctv^j explanation of what
the news means. Do not .'-peculate ^hout prognosis' or estimate

time left to live. It is a time for offering support and
hope for achievable solutions to per son = 1-. and practical

problems that may result.
Psychological issues

1.Fear
2..Anxie ty

Grief
3,
Cuilt
4.

5.Depression

1

6.Denial
7.Anger

8.Suicidal -activity or thinking
9.Low Self-esteem
10,Hypochondrie and obsessive states
11.Spiritual concerns

Other Issues
1.Social issues - environmental and social pressures such as Joss
of income, discrimination, social stigma, relationship Chants
and--whanging requirements for sexual expression,

patient s

7

perception of the level end adequacy of social support is of

vital concern and may become a source of pressure and
frustra tion.

2. Medical management - Counselling may help t"patient to
gain access to appropriate medicr 1 care and day to d~y

manege-men t.

ooooooooooooooooooooooco
CREST
(Centre for Research Education Service & Training)
No. 14, High Street, Cooke Town, Bangalore-560 005

WE OFFER COUNSELLING & GUIDANCE TO :
YOUTH, STUDENTS, FAMILIES

—

IN ALL AREAS

and for Smoking, Alcohol and Drugs
at our Centre, Monday to Saturday between
9-30 a.m. and 4-30 p.m. (Ph. 577547)
at State Youth Centre III Floor, (Hobby Hall),
Nrupathunga Road, Bangalore-560 002
(Opposite St. Martha's Hospital)
From Monday to Saturday between 4 p.m. & 6 p.m.
WE UNDERTAKE TO CONDUCT :

Smoking, Alcohol, Drugs & Family Life Education
Programmes in Colleges, High Schools, Institutions,
Industries and Organisations on request.
APTITUDE TESTING : for students on Tuesdays
and Thursdays at State Youth Centre,
between 4 p.m. and 6 p.m.

PLEASE CONTACT US FOR FURTHER DETAILS

000000000000000000000000

HOW DO YOU KNOW

YOU are an alcoholic ?
Based on extensive researches, here’s a check-list of test questions used by
JOHNS HOPKINS UNIVERSITY HOSPITAL to determine whether a patient
is alcoholic or not. YOU are not answerable to anyone, but YOURSELF ; for,
the prize is your own SURVIVAL, SANITY, SOBER1TY and SELF­
FULFILMENT !

TEST QUESTIONS :
1.
2.

Do you require a drink the nextmorning ?
Do you prefer to drink alone ?

3.
Do you lose time from work due to drinking 1
4.
Is drinking harming your family in any way?
5 Do you crave a drink at a definite time daily ?
6,
Do you get the inner shakes unless you continue drinking?
7.
Has drinking made you irritable?
^ "pes drinking make you careless of your family’s welfare?
8.
^^Hlave you thoughtless of your busband or wife since drinking ?

10. Has drinking changed your personality ?
11. Does drinking cause you bodily complaints?
12 Does drinking make you restless?
13.
Does drinking cause you to have difficulty Jn sleeping ?
14.
Has drinking made you more impulsive?
15.
Have you less self-control since drinking ?
>6. Has your initiative decreased since drinking ?
17.
Has your ambition decreased since drinking?
18.
Do you lack perseverance in pursuing a goal since drinking ?
19.
Do you drink to obtain social ease? (In shy, timid, self-conscious persons.)
20.
Do you drink for self-encouragement ? (In persons with feelings of inferiority ).
21.
Do you drink to relieve marked feeling of inadequacy ?
22.
Has your sexual potency suffered since drinking ?
23.
Do you show marked dislikes and hatreds since drinking ?
24.
Has your jealousy, in general, increased since drinking?
25.
Do youshow marked moodiness as a result of drinking?
26.
Has your efficiency decreased since drinking ?
27.
Hasdrinking made you moresensitive ?
28.
Are yon harder to get along with since drinking ?
29^Do you turn to an inferior environment since drinking ?
30®! drinking endangering your health ?
31.
32.
33.
34.
35.

Is drinking affecting your peace of mind ?
Is drinking making your home life unhappy ?
Is drinking jeopardizing your business - your job ?
Is drinking clouding your reputation ?
Is drinking disturbing the harmony of your life ?

WE, IN ALCOHOLICS ANONYMOUS, would ask even more . ..
36.
37.
38.
39.
40.

Have you ever bad a complete loss of memory (black-out), while or after
drinking 7
Have you ever felt, when or after drinking, an inability to concentrate ?
Have you ever felt “remorse” after drinking ?
Has a physician ever treated you for drinking?
Have you ever been hospitalized for drinking ?,

SCORE RATING : if YOU have answered YES to any one of the test questions,

it is a warning that YOU may be an alcoholic , if YES to any
two, thecbances are YOU are an alcoholic; and if YOU
answer three or more, YOU are definitely an alcoholic.

-A BLUE PRINT FOR SOBERITY

IF YOU seek NEW LIFE for OLD...........
ASK YOURSELF...........
DO YOU WANT TO
1.

Become a real person?

2

Face realities ?

9. Believe that only if a man can
accept himself, is he fit for married
life or any other (form of construc­
tive life?

3.

Break the alibi-excuses habit?

4

Face responsibilities instead of
resorting to emotional fatalism ?

5.

Realize that you cannot eat your
cake and have it ?

6

Recognize that you, and not circum­
stances, is your major problem ?

7.

Acknowledge that your trouble lies
in being allergic to yourself rather
in than in the dirty deals life has
dealt ?

8.

Admit that you have had more
trouble with yourself than any other
man or woman you know ?

IF

Your

Answer

is

YES,

10. Eliminate fears, and turn into a
plus?
11. Tackle yourself, when depression
comes, and not blame circum­
stances ?

12.

Learn that to put yourself in
second place is the whole si^gificanceof life?

13.

Makefirst place your desire to help
and to rehabilitate unfortunate
alcoholics ?

14. Cultivate a spiritual faith even
though you go no further than
believing in an ultimate decency?

YOU

can

ACHIEVE.............

A :

You can bend any events (good or bad) to your own improvement.

B :

You will not cower to human opinion or fashion but look to higher
law dictated by your own self-respect.

C :

You will automatically use your freedom to resist the bondage of habit.

D

You will fraternize with congenial
genuine friends.

E :

You will learn to enjoy guarding your own intellectual rights.

F :

You will auto naticallyforget the past and listen for higher and finer notes
from your better self.
You will then be true to yourself, not false to any man.

G :

H :

company and acquire true-and

You will, then, possess true self respect, through honesty, which will
develop humility and a degr.-e of understanding of life’s technique.

WHEN ANYONE, ANYWHERE HAS A DRINKING PROBLEM,
ALCOHOLICS ANONYMOUS CAN HELP RECOVER

A A PALI EVENING GROUP
TPS III, ST. THERESA’S HIGH SCHOOL,
BANDRA. BOMBAY 400 050,

MEETINGS

:

SUNDAY - 7 p.m.

We Welcome Co-operation of:

Doctors, Social Workers, Family Counsellors & Labour & Personnel
Officers and Public - Spirited Citizens
Copyright: AAPEG-1975.

0ocP^'0

GiLCHOHOi. DEHUMANIZES ’

'-._____ ■•

ALCHOHOL RUINS H EH LT {H-

ALCHOHOL DESTROYS FAMILIES !
This is the plea of thousands of toiling women and men,
who have come together as a powerful force to campaign
against alchohol and bring about prohibition in Karnataka.

1995 saw women and men from all walks of life coming
together to protest against alchohol and their efforts were
duly recognised by the then Chief Minister and the present
Prime Minister Shri. H. D. Deve Gowda. Who promised to
enforce prohibition by June 1996.
But alas I the Government made mockery of its promises
gnd assurances and have postponed the prohibition to
July 1997,'.all in the name of losing revenues and lack of
personnel / infrastructure to manage the after effect of
prohibition.
This is a sham which no conscious citizens will ever
tolerate.

Loosing rev^hue at the cost of hundreds of lives of women,
Psychological complications of thousands of children in
families is not an excuse to be considered by the Gov­
ernment. It was the promise of prohibition that elected
the present government to rule, women voted for it with
the hope of better lives, we are Cheated III
Thus we call upon you to join us for the protest Dharna
and fasting on the 2nd October 1996 from 10-00 a.m.
to 4-00 p.m. after which the Memorandum will be pre­
sented to the Governor.
Meeting Venue - Mahathma Gandhi Statue, M.G. Road.

It is our United power which can save our families.
Come and be with us.
MAHILA PRAGATHI ■ WOMEN'S DESK
G
OTHER WOMEN'S ORGANISATIONS, BANGALORE.
■

-

... —

■

J

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‘goods - public health and the environment, for instance - the
behaviour of the tobacco industry came up again. Several
participants had expressed concern about the possible exclusion
of people from the developing world in the exercise because of
their lack of access to the Internet. Therefore, several
participants argued that efforts to set up such global public
policy networks must ensure 'inclusion' to the maximum extent
possible.
The lone voice demanding the right to exclude came from a
representative of WHO. The organisation is in the process of
developing an international treaty to regulate the promotion of
cigarette marketing. And it has consciously decided to exclude
the tobacco industry from its deliberations. The industry has no
moral right left to demand participation after its past
behaviour, contended the WHO official. A rare position for an
international bureaucrat to take in a world increasingly
dominated by private interests. "If you don't believe me, then
go and see the new movie. The Insider," he said. In fact, the
whistleblower, Jeffrey Wigand,-former scientist of Brown and
Williamson, one of USA's top cigarette, manufacturers, is today
an important participant in the WHO negotiations.
We, therefore, decided to go off and see the movie. The movie
had a powerful impact on us. After Wigand decided to tell the
world about the research he had been asked to undertake which
increased the addictive effect of nicotine, and thus contradict
k the public statement made by the company's CEO to the US
'Congress, the company did everything to keep him quiet. The
company fired him but with a confidentiality agreement that
threatened to destroy him financially. With a child suffering
from acute asthma, Wigand could not lose his medical insurance
cover. When the producer of 60 Minutes, an investigative
programme of CBS, discovered Wigand, he had to go through a
long, protracted process to get Wigand to agree. Wigand agreed
but CBS then faced the threat of violating the confidentiality
agreement and facing a major lawsuit.

The TV producer got Wigand to first give testimony inan antitobacco court case, a process that lies outside confidentiality
agreements. In the resulting tension exacerbated by prowlers
stalking Wigand's family, presumably sponsored by the company to
frighten him, Wigand's wife decided to leave him. But even after
all this, corporate lawyers at CBS stopped the telecast of the
programme. They feared that a lawsuit against damages would
reduce the stock value of CBS to a point that Brown and
Williamson could take it over.

The film reaches a frightening point when the power of money
literally seems to take over the power of the media - in fact,
) the very power of democracy - and leave Wigand and the TV
producer high and dry, without any friends and support. Finally,
the producer decides to risk his job and leaks the story of how
CBS has held up the 60 Minutes telecast to The New York Times.
With the cat out of the bag, CBS finally decided to air the
programme.
What amazed us is the parallel that the entire story had with
the Indian auto giant TELCO's effort to. frighten us in our
campaign,.against- diesel with a Rs 100 crore legal, notice._The
idea clearly was to tell us that by taking up such issues we
would run the risk of financial ruin. It appears that in the age
of the Internet and globalisation, Indian companies are learning
faster from their Western counterparts on how to fight the civil
society and the media than how to protect public health and the
environment.
- Anil Agarwal

3 of 4

12/16/99 9:34 AM

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12/16/99 9:34 A.\

KH-2-.

Globalization and Increasing Trend of Alcoholism *
I.

Introduction
Although alcohol consumption has existed in India for many centuries, the quantity
patterns of use, and resultant problems have undergone substantial changes over
the past two decades. Alcohol consumption produces individual health and social
problems. The global burden of disease from alcohol exceeds that of tobacco and is
on a par with the burden attributable to unsafe sex world wide (Global Status
Report on alcohol, WHO, 1999). Although recorded alcohol consumption per
capita has fallen since 1980 in most developed countries, it has risen steadily in
developing countries and alarmingly so in India. The per capita consumption of
alcohol by adults of 15 years and above in India increased by 106.67 percent
between 1970-72 and 1994-96!

2.

Alcohol industry
Based on beverage type the Indian alcohol industry has three prominent sectors:
The IMFL (Indian Made Foreign Liquor) and beer sector, the country liquor sector,
and the illicit liquor sector. The IMFL and beer sector is the most visible part of the
alcohol Industry, with a few large companies with multiple production units and
nation wide marketing networks. These companies control much of the market.
They have been present in India for several decades and have established several
brand names regionally or nationally. These companies aggressively advertise and
promote their brands and their corporate identities, and constantly monitor and
protect their products'and market shares. They arc also cash rich, since profit
margins are high in this industry.
Beginning in 1992 under liberalized industrial laws, some Indian alcohol
companies developed collaborative ties with international corporations. Joint
ventures have been established to use local production capacity to manufacture
international brands under a technology transfer and licensing system. These joint
ventures have served a dual purpose: they have brought international alcohol
brands to India, and they have utilized the existing production and marketing
strengths of Indian Industry. Hence they have been mutually supportive. Nearly all
of the major transnational alcohol companies now have a presence in India and
many internationally popular brands of whisky and beer have become available.
The upper middle and higher socioeconomic classes now purchase these ‘famous’
brands locally rather than having to cany these back from trips to other countries
or to buy them from illegal importers. The price of these products remains high,
but since they carry high social prestige value, there is good demand in this
premium range.

With liberalization and globalization, foreign liquor has become freely available.
The IMFL and beer industry spends much effort and money to promote and
advertise their brands. Since direct advertisement of liquor was
not permitted in the print and electronic media, the industry has found methods to
advertise indirectly (Saxena, 1994). Alcohol brands arc advertised in the form of
same or similarly named other products (e.g. mineral water, soda, and playing
cards) made by the same company. The advertisements
*Compileil by Mr. S D Rajentlran, Community Health Celt for the Asia Social Forum, 2'“' - 7"' January 2003,
Hyderabad. India.

display the alcohol product prominently. In addition, beverage ads have become
common on satellite cable television beamed to India from neighboring countries.
IMFL and beer producers also financially sponsor major sporting events (hat attract
sustained media attention, including live television coverage of the event. With its
new international linkages, the Indian alcohol industry has also got into the
entertainment and fashion world. It is now common for a liquor company to
sponsor a fashion show or musical event. Hence the Indian IMFL and beer industry
has initiated a high level of sustained marketing and promotional activities and
these have become especially aggressive in the 1990s.
The Indian alcohol industry produces a large amount of revenue for the
government. It has been estimated that direct collections of excise and sales tax (are
approximately USS 5 billion per year for the country as a whole. In Karnataka, it is
approximately Rs. 2400.00 crores per year. States derive as much as 25% of
money from alcohol sales for their annual budget. Besides the generation of legal
revenues for the government, the alcohol industry is thought to create an
approximately equal sum in “black money” that takes the form of bribes,
protection payments and profits from illicit alcohol. This gives the alcohol industry
enormous political power and clout, which may be used to help influence and
maintain government policies ‘beneficial’ to the industry but harmful to the people.
Studies indicate that the losses borne by household, states and the nation out weigh
■financial gains.

Table 1: Annual Distilled Spirits Production in India, by Year (April to March)
Year

AMOUNT
OF
ABSOLUTE
ALCOHOL
PRODUCED (IN THOUSANDS HECTOLIRES)

1982- 83
1983-84
1984—85
1985-86
1986-87
1987-88
1988-89
1989-90
"1990-91
1991-92
1992-93
1993-94
1994-95
1995-96

2862.55
3104.75
3310.64
____________________ 3407.49________________
3204.80
____________________ 3432.48_____________________
________________ 4190.45
No data available
No data available
4895.00
3467.00
3626.00
6056.00
7888.04
H

Source: Alcohol and Public Health in 8 developing countries, WHO, Geneva, 1999.

3.

Alcohol - Related Problems
It is probable, given equal amounts of drinking, that developing countries like
India experience more problems than developed countries (Saxena, 1997). Among
the reasons for this may be such things as a highly skewed distribution of drinkers
in the society, the prevalence of nutritional and infectious diseases, economic
deprivation, more hazardous and accident-prone physical environments, and lack
of any organised support system. Although conclusive scientific evidence for
alcohol related health and social problems is lacking for India, there are enough
2

indications in the available literature to infer that these are substantial. Women’s
sanghas participating in a women health empowerment training in several districts
in Karnataka have consistently said that the biggest problem they face relate to
alcohol abuse. Community health groups in different parts of the country also
recognize the importance of the problem. The rapid rise in alcohol consumption in
recent years has increased the likelihood of further growth of the following health
problems in the years to come.

3.1

3.2

Health problems include
o

Cirrhosis of the liver and premature death

•

Cardiomyopathy

®
•
o
o
•
•
•

Cancer of the upper gastrointestinal tract
Pancreatitis
Cognitive impairment or neuropsychiatric disorders
Road traffic accidents and injuries
Nutritional deficiencies and infections
HIV infections and STD
Hypertension

SOCIAL PROBLEMS
Excessive drinking produces a variety of closely inter related social problems in
India. For ease of description these have been divided into the following broad
categories.

3.2.1 Violence and Crime
Violence within and outside the home is frequent in India and a substantial
proportion of it is alcohol - related. Wife beating and child abuse under the
influence of alcohol are common, and street brawls and group violence happen
often after drinking

3.2.2

Workplace effects
Heavy drinking affects work performance in a number of negative ways. When
compared to their sober counterparts, drinkers are more frequently absent, are less
efficient, have more accidents at work, and also show maladjustment with other
workers which leads to over all decreased performance.

3.2.3

Economic Effects
While alcoholic beverages are less expensive in India, their purchase may still
require a substantial portion of a poor persons meager income. With one in three
people in India falling below the poverty line, the economic consequences of
expenditures on alcohol attain special significance. Besides money spent on
alcohol, a heavy drinker also suffers other adverse economic effects. These include
reduced wages (because of missed work and lowered efficiency on the job),
increased medical expanses for illness and accidents, legal cost of drink-related
offences, and decreased eligibility of loans. Most individuals with severe alcohol
dependence find it difficult to reduce their expenditure on drink, and hence their
families often must do without essential necessities. Although the overall economic

effect of alcohol use al the national level has not been estimated, it is likely that il
represents a substantial proportion of India’s national income.

3.2.4

Family Effects
Excessive drinking by one or more family member results in several negative
consequences for others in the family, especially for the wife and children of a
male drinker. These effects are particularly serious for poor families. As has been
mentioned above, much of the family income may be used to buy alcohol, wages
may decline, and the drinker may eventually lose his job. In such situation the wife
and children are forced into work, often in low paid, hazardous jobs. Children may
be unable to continue their schooling and may also suffer from nutritional
deficiencies because there is not enough to cat at home. Wife and child battering
are common, which lead to physical and mental trauma. Failure of the man to use
contraceptive methods often leads to unwanted pregnancies, further increasing
family size. These factors contribute towards greater poverty, often to the point of
destitution.
Strong family ties and social disapproval of divorce save many of these families
from a formal breakdown, but the prevalence of intermittent or prolonged marital
separation, as well as suicide, in heavy drinking families is high. Problems faced
by wives of alcoholic men have been studied scientifically by Ganihat et al. (1983),
but the many descriptive accounts by the lay press offer more vocal testimony of
these phenomena. Wives of alcoholic men show a high degree of depression
(Dcvar ct al., 1983) and of suicide (Ponnudurai & Jayakar, 1980)

4.

Govt, of India Response
Govt, of India should seriously think about the alarmingly increasing alcohol
related problems and work towards developing a clear-cut and comprehensive
Alcohol Policy.
The Indian Charter on Alcohol should be adopted with the following principles,
which would be agreed upon by all the health ministries of the Stales:
1.

All people have the right to a family, community and working life
protected from accidents, violence and other negative consequences of
alcohol consumption.

2.

All people have (he right to valid impartial information and education,
starting early in life, on the consequences of alcohol consumption on
health, the family and society.

3.

All the children and adolescents have the right to grow up in an
environment protected from the negative consequences of alcohol
consumption and, to the extent possible, from the promotion of alcoholic
beverages.

4.

All people with hazardous or harmful alcohol consumption and members
of their families have (he right to accessible treatment and care.

5.

All people who do not wish to consume alcohol, or who cannot do so for
health or other reasons, have the right to be safeguarded from pressures to
drink and be supported in their non - drinking behavior.

National Master Plan
The government of India formed an expert committee in 1986 to develop a
comprehensive strategy for reduction of both supply and demand of all substances
of abuse, including alcohol. The details of the master plan and its position on
alcohol - related issues are not yet available. Again Govt, of India should review
the National Master Plan and revise it for up to date condition. This plan should be
implemented through Primary Health Centres and through health workers. Il
should contain the following broad areas:

Training to PI 1C doctors and Health Workers
Raise awareness of the effects of alcohol in rural areas
Arrange community based de-addiclion treatment involving family members
and the community
4. Proper after care should be provided with the family and community support
5. Introduce Life Skills programme in high schools to increase the ability of
young people to meet the needs and challenges of every day life and avoid high
risk behaviors
6. Provide and / or expand meaningful alternatives to alcohol and drug use and
increase education, training and networking among community development
workers till organisations.
1.
2.
3.

In monitoring and implementing the above plan, the local NGOs and community
action groups should be encouraged to participate fully.

Conclusion
Globalisation is based on commercial interests, which want to increase the
consumption of alcohol. They promote the expansion of drinking into new social
context and situations. Their central perspective is that of the market, seeing
developing countries as 'emerging markets'. Drinking is shown as a symbol of
'cosmopolitan outlook’. European and North American life styles are presented
glamorously and attractively. We have to counter them. Globalisation has brought
in global methods of manufacture, distribution, advertisements and promotion of
alcohol consumption. We have to adopt or adopt global strategies to reduce alcohol
consumption and its ill effects on the health and social life of our people. While
interventions for primary prevention and community health based approaches arc
required along side medical dcaddiction approaches, it is imperative that social
movements also address the broader policy aspects and economic underpinnings of
the problem.

Since the BiM ’
•■’hjti'-u lheie has l$.u< - uecreasc in '.he
popularity of alcopops and a number of developments have occurred
including a commitment by Government to develop an alcohol
strategy as mentioned in the Government’s, Our Healthier Nation
strategy. A Ministerial Group on Alcopops was also set up in 1997.
This Group published a second progress report in November 1998
outlining action taken to reduce the incidence of under-age alcohol
misuse. These measures included two million pounds funding for
educational programmes and legislative changes involving
confiscation of alcohol from children drinking in public and the
closure of a loophole in the law which prevents employees of big retail
chains being prosecuted from selling alcohol to underage people.
They did not however recommend a change to the voluntary
arrangement which currently exists regarding the monitoring of the
drinks industry.
Education and enforcement

Control and prevention through legislation, however, are not the only
consideration as early exposure to and consumption of alcohol takes
place in the home environment8 and although some alcohol may be
purchased by the underage drinkers themselves, it can also be bought
for them. Availability of alcohol and peer influence has an impact on
consumption and the BMA supports interventions, especially
education programmes to help young people develop sensible
attitudes to drinking, and provide information on the short term risks
of acute alcohol intoxication and longer term effects of problem
drinking. All young women and intending parents should be made
aware of the dangers of alcohol consumption to the fetus particularly
in the early weeks of pregnancy. High levels of consumption in
pregnancy are associated with Fetal Alcohol Syndrome.
There is a statutory requirement under the National Curriculum
Science Order to cover certain aspects of drug education in schools.
At Key Stage 2 (7-11 years) pupils should be taught that “tobacco,
alcohol and other drugs can have harmful effects”; at Key Stage 3(1114 years) they should be taught that “the abuse of alcohol, solvents,
tobacco and other drugs affect health...." and at Key Stage 4 (14-16
years) they should be taught “the key effects of solvents, tobacco,
alcohol and other drugs on body functions”. Circular 4/95, Drug
Prevention and Schools, whilst promising to “focus on tobacco, alcohol
and volatile substances in addition to illegal drugs”, it fails to
adequately address the issue of alcohol and young people.9

Nh 2-.I

BRITISH MEDICAL ASSOCIATION
Board of Science and Education

BMA®

A publication from the BMA Science Department

Chairman, Board of Science
and Education:

Sir William Asscher

Head of Professional Resources
and Research Group:

Professor Vivienne Nathanson

Editor:

Dr David R Morgan

Written by:

Nicholas Harrison

Editorial Secretariat:

Hilary Glanville
Hayley Todd

Reproduction, transmission or storage of any part of this report by
any means is prohibited without the prior written consent of the
Secretary of the British Medical Association
First published in 1999 by:

British Medical Association
BMA House
Tavistock Square
London WC1H 9JP

British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
ISBN: 0 7279 1429 4

Acknowledgement for cover photograph: BMA News Review
Printed by the BMA Print and Design Unit
© British Medical Association 1999.

The report was prepared under the auspices of the Board of Science
and Education of the British Medical Association, whose membership
for 1998/9 was as follows:
Sir Dillwyn Williams
Professor B R Hopkinson
Dr I G Bogle
Dr W J Appleyard
Sir William Asscher

Dr P H Dangerfield

President, BMA
Chairman, Representative Body
Chairman, BMA Council
Treasurer, BMA
Chairman, Board of Science and
Education
Deputy Chairman, Board of
Science and Education

Dr H W K Fell
Miss C E Fozzard
Dr S Hajioff
Dr V Leach
Dr N D L Olsen
Dr S J Richards
Miss S Somjee
Dr P Steadman
Dr S Taylor
Dr D M B Ward

Approval for publication as a BMA policy report was recommended by
BMA Council on 3 March 1999.

Contents

Scope and background ........................................... ......................... 1

Designer drinks................................................................................ 2

Marketing.......................................................................................... 3
Monitoring of the drinks industry..................................................... 4

Current legislation............................................................................ 5
Education and enforcement ............................................................. 7
Conclusion........................................................................................ 8

Recommendations............................................................................ 9
References ...................................................................................... 11
Further reading.............................................................................. 11

Scope and background

The British Medical Association has developed comprehensive policy
addressing the issues surrounding alcohol use and the problems
which can arise from its misuse, in terms of the effect on the
individual and society in general. More recently the following
resolution was adopted as BMA policy at the 1996 BMA Annual
Representative Meeting (ARM):

That this Meeting is concerned that unacceptable levels ofalcohol are present in
some of the drinks which are aimed al the teenage market and believes that the
deliberate targeting ofthis group by purveyors ofalcohol should be made illegal.

Among the issues lying behind this resolution are:• Recent studies indicate a rise in the proportion of young people
(11-15 years) who drink regularly, and an increase in the amount
they are drinking on each occasion.1

® The appeal of ‘designer drinks’ is at its height between the ages of
13-16 years.2,3
® The BMA is concerned that unhealthy patterns of drinking by
teenagers may lead to an increased level of addiction and
dependence on alcohol in adulthood.'1
® Teenagers are more likely to have casual sex and are less likely to
use condoms when under the influence of drugs or alcohol? Such
risk taking may result in unwanted pregnancies and sexually
transmitted diseases.

Such trends are worrying as alcohol consumption, in particular both
regular heavy consumption and ‘binge drinking’, has been associated
with physical and mental health problems, antisocial behaviour,
domestic violence, accidents, and injuries. Drinking too much on a
regular basis will increase the risk of damaging ones health, ie liver
damage, mouth and throat cancer, raised blood pressure. ‘Binge
drinking' is a particular risk for young people as alcohol may have
more of an effect on them, compared to older drinkers.
There is a need for government action to address the problems of
underage and teenage drinking. This must involve changes to
legislation, responsible marketing, effective monitoring of the drinks
industry and health education. This paper raises a number of issues
for consideration by government and the drinks industry which are
specifically related to the 1996 ARM resolution, ie the problem of
designer drinks aimed at young people, principally those under 18
years old.

Designer drinks

During the nineties, new ranges of alcoholic drinks, often referred to
as designer drinks, were introduced into the market. These included
fruit flavoured wine and spirit based drinks, strong white ciders and
alcoholic ‘soft drinks’, ie alcoholic lemonades, sodas, and cola which
are often referred to as ‘alcopops’; the latter were introduced in 1995.
There has been significant debate on the potential appeal of these
drinks to young people and whether they have had any influence on
alcohol consumption. Evidence suggests that the consumption of
these drinks is associated with heavier drinking in less controlled
environments2 and therefore likely to pose a greater health risk.
Primarily because of their sweet taste and image, many teenagers find
that designer drinks taste less obviously of alcohol, compared to the
more traditional drinks of equivalent strength.6 The fact that the
alcohol flavour is masked by the sweetness of the drink may lead to an
underestimation of the strength, resulting in greater levels of
intoxication. Concern has also been expressed about the alcoholic
content of such drinks since some of them are stronger than the more
traditional drinks. (See Table 1)...
Designer drinks

Alcohol by volume
(ABV)

Alcoholic lemonades and colas (eg Two Dogs,
Hoopers Hooch)

3.5% - 5.5%

Strong fruit flavoured wine based drinks (eg
MD 20/20, Thunderbird)

13% - 13.5%

Cooler/mixer/blender type drinks (eg Bacardi
Breezer, Castaway)

4% - 6%

Super-strength ciders (eg Diamond White)

6.5% - 9%

Traditional drinks

Beer/lager/cider

3% - 6%

Super-strength lagers

8% - 9%

Wines

9% - 13.5%

Spirit based mixtures

14.5% - 25%

Spirits

37.5% - 43%

Table 1: Alcoholic content of drinks. Source: Young People and Alcohol Health Education Authority 1996.

ividt keting

There is concern that these drinks have been marketed to appeal to
young people, particularly those who are not legally permitted to
purchase them. In the Survey of attitudes and behaviour towards new types
ofalcoholic drinks in England 1996, undertaken by the Health
Education Authority, respondents were shown photographs of
different drinks and, contrasting alcopops with ordinary beer, lager
and cider, 11-18 year olds saw alcopops as more refreshing, better
tasting, less likely to taste of alcohol and ‘trendier’.6 There is then the
question of whether by appealing to young people, designer drinks
are to some extent legitimising underage drinking. Surveys have
shown that the level of consumption of designer drinks peaks around
the ages 13-16, suggesting that they are attractive to this age group.2,3
Designer drinks and alcopops are likely to have some appeal to young
people due to the marketing images, labelling style and names given
to the drinks. In addition to legislation designed to reduce availability
and the promotion of education programmes, marketing is an area
which warrants special consideration; price, strength and taste are also
factors taken into account in the choice of drink. Further evidence is
needed to determine whether the new designer drinks and alcopops
have encouraged more young people to start and continue drinking
as they get older, or have encouraged greater consumption and
whether these drinks act as ‘gateways’ to more traditional drinks. The
BMA would support the calls for further research to ensure their
impact is monitored.

Whilst some of the new drinks are stronger than traditional drinks
they are not necessarily the only drinks consumed by young people.
Lager and cider are often the most popular drinks (See Figure 1),
with alcopops preferred by the more occasional drinkers. The BMA
believes that problems associated with alcohol consumption and
misuse are not confined to the new drinks and alcopops alone. Very
few young people drink only alcopops.' Banning them would be
difficult and fail to address the wider problem. However, there are
measures which can be considered to address the concerns relating to
the marketing of designer drinks and alcopops in particular.

3

60

□

Frequent drinkers (more than once a week)

Figure 1: Type of alcoholic drink consumed most often by
respondents aged-13-16 years, according to frequency of consumption
(Base: all respondents who drink alcohol at least once or twice a
month, aged 13-16 (337 respondents) - results from a Health
Education Authority survey of a nationally representative sample of
1543, 11-18 year olds). Source.- Young People and Alcohol - Health
Education Authority 1996.
Monitoring of the drinks industry

Complaints can be submitted to the Portman Group under the
voluntary Code of Practice on “the naming, packaging and
merchandising of alcoholic drinks” which was launched in 1996 and
updated in 1997. Complaints can also be made about a retailer if it is
considered that not enough care is being taken to ensure alcoholic
drinks are sold to adults only. The Portman Group has no regulatory
powers over retailers or manufacturers. At present a complaint can be
made to an Independent Complaints Panel convened by the Portman
Group about any drink which exceeds 0.5% abv if it is considered that
the name, packaging or merchandising of the product:•

is more likely to appeal to under 18s than to adults;

• suggests any confusion as to the product’s alcoholic nature or
strength, or glamorises its alcoholic strength;

• links the product to illicit drugs or to dangerous or antisocial
behaviour, or encourages irresponsible consumption;

• suggests sexual success or prowess.

An independent proactive regulator with powers of enforcement
should be introduced to review complaints regarding
manufacturers of alcohol and marketing practices, replacing the
voluntary arrangement which currently exists with the Portman
Group Code of Practice.

The criteria for assessment of complaints about alcoholic drink
products (see Page 4) is supported, together with powers for an
independent regulator to vet alcoholic products before they are
launched and withdraw products which don’t comply with the
criteria.

The advertising code on alcohol should be subject to greater
enforcement by the Independent Television Commission and the
Advertising Standards Authority, particularly with regard to young
people and should include more rigorous controls on sports
sponsorship and cinema advertising.
The ruling in Scodand where it is an offence for anyone over 18
years of age to buy alcohol for a person under 18 years of age for
public, unsupervised consumption should be extended to the rest
of the UK and the existing licensing legislation be reviewed for
consistency.

A change in legislation to allow test purchases by under 18s
working with designated enforcement authorities in precise and
controlled circumstances is supported. It would enable more
effective enforcement and would have a major impact in reducing
this source of access to alcohol by children.
The BMA encourages the responsible sale of alcohol by all types
of retailers including off-licences, supermarkets and garages and
supports compulsory training programmes for licensees as a
condition of receiving a licence on the legislation relating to
young people and alcohol and in dealing with underage or
intoxicated customers.
The BMA supports voluntary initiatives to enable young people to
prove their age, subject to appropriate ethical considerations,
thereby curbing underage purchasing of alcohol and assisting
licensees.

The BMA believes that it is the responsibility of the drinks
industry, both producers and retailers, to ensure that their
customers are fully aware of the alcoholic content of the beverages
they purchase and the potential harmful consequences of excess
consumption. Retailers should be required to publicise
information about the strength of drinks and clarify the definition
of a ‘unit’ of alcohol at the point of sale.

9

There should be a legal requirement for all containers of alcohol
offered for sale and advertisements to carry; a prominent common
standard label which clearly outlines the alcohol content in terms
of units (clearly defining the meaning of a unit of alcohol, 8g of
alcohol per unit = approximately 1 small glass of wine, '/? pint
ordinary strength beer, lager or cider, single measure of spirits);
information on the maximum recommended daily level of alcohol
consumption and; a warning of the dangers of‘excessive’
drinking.

The BMA supports the calls from other organisations for
increased alcohol education to be introduced into schools starting
at primary level which should be formalised by means of specific
alcohol guidance from the Department for Education and
Employment (DfEE). Alcohol should therefore not be included
within drugs education as at present, but should be dealt with as a
separate topic.

Alcohol education should be available as a compulsory curriculum
module for training teachers, occupational health workers and
medical students.

10

The EMA supports the cr'f r
ug th . - complaints,
however, in order to be certain that drinks are not produced and
marketed to appeal to the underage drinker, the Association believes
that a number of changes need to be made, in particular with regard
to the independence of the monitoring body and legislative powers
required to undertake enforcement. At present the Independent
Complaints Panel considers complaints and reports submitted by
organisations such as Alcohol Concern and the Health Education
Authority. Fifty out of 87 complaints submitted up to January 1998
were upheld.' A proactive independent monitoring body with
regulatory powers and dedicated resources throughout the country
could undertake this role more effectively than a self regulated one,
operated at present by the Portman Group. Complaints at present are
only able to be made about products already in production and
available for sale and, consideration should be given to a regulatory
system at the pre- production and marketing stage.

Currently, complaints about advertisements for alcoholic drinks can
be submitted to the Advertising Standards Authority who monitor
advertising codes. The codes on alcohol should prevent the
suggestion that drinking enhances sporting prowess, although sports
sponsorship by drinks companies is commonplace. The BMA is
particularly concerned about advertising which is specifically targeted
towards the young and which links alcohol with illicit drug use, by use
of symbols of youth culture. The Portman Group recently ruled
against a producer for using marijuana leaves on a drinks label.
Cinema is another area which is under regulated with children often
exposed to alcohol advertising during screenings of films for under
18s.
Current legislation

The main regulations relating to young people and alcohol are set out
in the 1964 Licensing Act for England and Wales, The Licensing
(Scotland) Act 1976 and Licensing (Northern Ireland) Order 1996.
It is illegal for somebody under 18 to buy alcohol and it is illegal to
sell alcohol to somebody under 18 other than in the following
circumstances:- (See Table 2)

Under 5 years of
age

Illegal to give alcohol to a child, except with
permission from a doctor or in a medical
emergency.

Under 14 years of
age

Not allowed in to a bar during opening hours
unless the bar has a children's certificate. At the
discretion of the licensee, allowed in other parts of
the licensed premises but not allowed to buy or be
bought or consume alcohol. May consume alcohol
at home.

Aged 14 and 15
years

Allowed in a bar at the licensee's discretion but
not allowed to buy or consume alcohol. May
consume alcohol at home.

Aged 16 and 17
years

In England, Wales and Scotland, allowed to buy or
be bought certain drinks but only in separate
eating area and as an accompaniment to a meal.
Permitted drinks are beer and cider in England and
Wales. The law in Scotland also includes the
purchase of wine. May consume alcohol at home.

Table 2: Laws relating to the purchase and consumption of alcohol in
respect of persons under 18 years of age.

In England, Wales and Scotland, the police are allowed to confiscate
alcohol from persons under 18 years of age found drinking in public
places and are also allowed to confiscate alcohol if they have reason to
believe that the alcohol is to be consumed by individuals under 18
years of age. In Scodand it is an offence for anyone over 18 to buy
alcohol for a person under 18 to be consumed in public,
unsupervised, and the BMA believes that this should be extended to
the rest of the UK.

The use of test purchasing to detect underage sales practice in both
on and off-licences is supported. Current legislation allows for the
practice with regards to tobacco but not alcohol.
Current legislation has remained virtually unchanged for over 30
years and there are a number of anomalies (some of which relate to
different parts of the UK). For example, a 16 year old cannot
purchase alcohol or consume it in the street, but is allowed to have
certain drinks, eg beer and cider with a meal on licensed premises. At
16, young people are prohibited from buying alcohol but are old
enough to marry, join the armed forces, engage in sexual intercourse,
purchase tobacco and at 17, drive a car. This sends a confused
message to the young as do the current marketing strategies relating
to designer drinks. A Government review of existing licensing
legislation with a view to introducing consistent legislation is to be
welcomed.
6

Since the BmA ’
.?hjti'-., there has uccii - decrease in '.he
popularity of alcopops and a number of developments have occurred
including a commitment by Government to develop an alcohol
strategy as mentioned in the Government’s, Our Healthier Nation
strategy. A Ministerial Group on Alcopops was also set up in 1997.
This Group published a second progress report in November 1998
outlining action taken to reduce the incidence of under-age alcohol
misuse. These measures included two million pounds funding for
educational programmes and legislative changes involving
confiscation of alcohol from children drinking in public and the
closure of a loophole in the law which prevents employees of big retail
chains being prosecuted from selling alcohol to underage people.
They did not however recommend a change to the voluntary
arrangement which currently exists regarding the monitoring of the
drinks industry.
Education and enforcement

Control and prevention through legislation, however, are not the only
consideration as early exposure to and consumption of alcohol takes
place in the home environment8 and although some alcohol may be
purchased by the underage drinkers themselves, it can also be bought
for them. Availability of alcohol and peer influence has an impact on
consumption and the BMA supports interventions, especially
education programmes to help young people develop sensible
attitudes to drinking, and provide information on the short term risks
of acute alcohol intoxication and longer term effects of problem
drinking. All young women and intending parents should be made
aware of the dangers of alcohol consumption to the fetus particularly
in the early weeks of pregnancy. High levels of consumption in
pregnancy are associated with Fetal Alcohol Syndrome.
There is a statutory requirement under the National Curriculum
Science Order to cover certain aspects of drug education in schools.
At Key Stage 2 (7-11 years) pupils should be taught that “tobacco,
alcohol and other drugs can have harmful effects”; at Key Stage 3(1114 years) they should be taught that “the abuse of alcohol, solvents,
tobacco and other drugs affect health....” and at Key Stage 4 (14-16
years) they should be taught “the key effects of solvents, tobacco,
alcohol and other drugs on body functions”. Circular 4/95, Drug
Prevention and Schools, whilst promising to “focus on tobacco, alcohol
and volatile substances in addition to illegal drugs”, it fails to
adequately address the issue of alcohol and young people.9

Industry and government have a responsibility to promote and
enforce the legislation relating to alcohol purchase and consumption
and publicise the ‘sensible drinking message’ as widely as possible.
The BMA, as far back as the 1986 Annual Representative Meeting,
resolved to “support a policy ofsensible drinking of alcohol, recognised that a
total ban on alcohol advertising was impracticable, and urged government to
require a health warning against excessive alcohol consumption to be
incorporated into alcohol advertisements". Extending this view, the BMA
believes that a common labelling standard for alcohol units should be
developed and clearly displayed on products and also in
advertisements, together with the existing BMA sensible drinking
guidance, ie (2 units per day for women and 3 units per day for men).

Evidence suggests that off-licences are the most common place of
purchase of alcohol by 11-16 year olds.6 Many supermarkets and
garages, often now open 24 hours a day sell alcohol. Not all staff may
be aware of, or may pay less heed to the legislation, regarding the sale
of alcohol to young people. Retailers of alcohol have a key role to play
in the enforcement of legislation and in reducing the incidence of
underage drinking and also ‘binge’ drinking. Staff training
programmes and the wider use and promotion of voluntary ID cards
are positive measures to assist licensees and retailers. Consideration
should also be given to more punitive measures of test purchasing,
point of sale advertising restrictions, and legislation to make it illegal
for those over 18 to purchase alcohol for under 18s.
Conclusion

The problem of underage drinking and teenage alcohol consumption
should be viewed not just in terms of drinks aimed at the teenage
market but also in relation to issues concerning education, access to
alcohol and regulatory enforcement. Issues relating to the culture in
which young people are growing up and the example set by adults are
also important.
The BMA welcomes the research, education and other initiatives
undertaken in recent years by some key organisations working in this
field including the Health Education Authority, Alcohol Concern and
the Portman Group. The Ministerial Group on Alcopops has made
progress, however, with such a large group of vulnerable young
people involved, more effective action could have been proposed in
their 1998 review.

8

Chapter - IX
Youth Health, Drug Abuse,
Alcohol and AIDS

YOUTH HEALTH, DRUG ABUSE, ALCOHOL AND AIDS

Introduction:

In view of the increasing importance assigned to young people in terms of the
size of this segment of youth population (25-20% of the whole population of
the world), the role in shaping the present and future of humanity is in their
hands. Therefore it is very essential to take appropriate steps for their health
care and development. There is a growing concern all over the world to
develop plans for their betterment. It is all the more important for India to take
measures for this growing population which is 25% at present and will be
most 30% by the turn of the century. It has been estimated that in absolute
numbers, the youth and adolescent would be 370 million Adolescents,
particularly in India, are the selective survival group because of high infant
and child mortality rate. In one report, 50% of children do not survive to
celebrate their fifteenth birthday. Hence they become very precious for the
family, community, and nation at large. It is encouraging that in recent years
there is a declining trend in infant mortality and child mortality because of
improvement in health care programmes for children. So it is expected that in
the coming years the adolescent population would increase. On the other
hand for many reasons-this segment of population remains unattended_fpr
their growing biological and psychological needs because of poverty,
illiteracy, and ignorance. Hence the present adolescents and youth are
disgruntled and in conflict with the adults. Other factors like modernization,
urbanization, and industrialization are giving them a new direction- to leave
their traditional values without establishing new values and new skills to cope
with the changing scenario. Thus they are put into another kind of emotional
and social stress, dragging them to delinquency, crime, violence, and drug
abuse. There is a change in the moral codes and value systems, changing
their ethics, morals, and sexual conduct. Youth Health per se cannot be
discussed in isolation as a medical specialty along. The other influencing
factors, aspects and issues related to health at large should be given serious
consideration. Hence it is extremely important to involve experts in the fields
of medical and allied sciences, the media, administration and policy planning.

Health has been recognized as a basic human right in the UN. At the same time
infectious diseases have already cost millions of lives most of which are in the
vital age group, more specifically, the school going child and working age youth
who are the potential work forse of today and tomorrow. Despite public health
interventions, the mortality rates are on the rise in the country, providing fertile
grounds for spread of infections. Seventy percent.of young people between-25-to
40 years succumbed to adverse health conditions. Today, the young people are
Itietriselves becomfrigTaf'g'eTs_of a host of biological and psychosomatic ailments

and misdirected lifestyles. It is, therefore, necessary to develop and promote a
series of alternative economically low cost and viable life styles.
Incidences reproductive health risks and consequences such as unwanted and
teenage pregnancies, abortions, rape, STD etc. associated with youth behaviour
are on the rise. The maximum youth of 15 to 24 years of age group were prone
to_STD infection. Further, the changing family and disintegration of community
ties and social control system had led to delingernt behaviour among youth.
Social studies, here shown that there was a rapid increase in pre-marital sex and
rising trend ain teenage preganancies. 40 per cent of women reported for
abortions were unwed girls under the age of 20 and also an increasing sex
related high risk behaviour among college and university students. Citing a
survey made by Family Planning Association of India (FPAI) in 16 cities, he said
that 23 per cent of young within 15 to 29 years of age were educated and
unmarried and 20 per cent young men and 10 per cent young women did not
consider pre-marital sex to be shameful. 90 per cent of young women as against
77 per cent of men did not consider pre-martial sex as wrong. Another study of
students of Hyderabad showed that sex indulgence in rural areas was more than
urban areas as against the popular view that rural folk indulged less in sex than
their urban counterpart. It was important for the health planners to cover the
rural areas rather than limiting interventions in the urban sector. Every year '
about 3 million girls got married within age of 15 to 19 years and more than 1 |
thousand women died from child bearing. The Government had been
emphasising on child and infant mortality while youth mortality had been totally a
neglected sector.

Intervention programmes needed for consideration :

(I)
convergence of youth planning and health planning, (ii) appropriate
educational curriculum and information on STDs and reproductive health both in
formal and non-formal settings, (iii) youth programmes managers to understand
knowledge, beliefs, values and practices associated with diseases and its
prevention, (iv) proper training to STD patients to advocate health sexual
behaviour, (v) promoting healthy habits and personal sexual hygiene, (vi)
enhance individual behaviour relating to primary and secondary prevention of
behaviour , (vii) develop health action model on the basis of WHO
recommendations, (Viii) use of non-traditional methods in programme planning,
(ix)
Promoting mass and folk media along with appropriate health promotion
education, (x) holiness in youth friendly organisations, (xi) schools and colleges
as potential primary preventive agencies, (xii) imaginative outreach programmes,
and, (xiii) counseling and prevention centres through NGOs and youth
clubs/organisations.
For preparing and empowering the youth for the twenty-first Century, The
ministry of Human Resource Development, Govt.of India has identified the few
320

areas concerning strategies to deal with the problems and health needs of
adolescents and youth as follows:-

1.

2.
3.
4.
5.
6.

General Health
- Reproductive health and Sexual Health.
AIDS and Sexually Transmitted Diseases
Crime, Delinquency, Drug Abuse, Alcoholism, Use of Tobacco related
health
problems and Violence
Social and Medical support mechanisms for Adolescents and Youth in the
current Scenario.
To review the strengths and gaps in the current health programmes
Strategies for the future.

World Health Organisation defines adolescence as between the ages of 10 and
19 years (the second decade of life). Adolescents constitute about one-fifth of
the people in the world which means more than 1 billion persons. In India
adolescents constitute 22 5% of the population, or nearly 210 million in 1996.
While chronological definitions are necessary for statistics and comparison,
there is great variation in the onset of changes that herald adolescence and
culminate in adulthood.
Adolescence is a crucial and dynamic time in the lives of young people. It is a
time when young people develop their capacity for empathy with others, for
abstract thinking, and for looking ahead; a time when close and dependent
relationships with parents begin to give way to more intense relationship with
peers. The chief task of adolescence is to acquire a sense of identity.
The growing capabilities of young people re simply the raw materials of human
development. The increased capability of adolescence and youth do not
guarantee that healthy development would take place That depends upon other
factors at home and the community, and the mix of support and opportunity
provided by adults. The way they have been loved, valued and educated, and
the injustices and discrimination they had to face.
Who defines Youth as between 15 and 24 yrs In India Youth apparently lasts
longer. According to the Dept.of Youth Affairs, Ministry of HRD, youth lasts from
15 to 35~years. According to this definition, about 32% of India’s population (270
million in 1991 census) is constituted by Youth.

Youthhood constitute a period of transition, when the young people try hard to
make a place for themselves in the world. It is the period of new challenges, hew
opportunities, and new responsibilities. Appropriately, the National Youth Policy
(1988) lay strews on the mass education of youth, alongwith skill development
321

for self employment. Now we’ll take a brief look at the health needs and health
problems peculiar to adolescents and youth.

In addition to the general health problems of youth the following issues will get
serious consideration in a perspective plan upto 2020 AD.
Accidents and Injuries
Disablities
Changing emotional behaviour
Changing scenario of sexual behaviour
Impact of educational systems and media on their health.
Employment and career.

Some of the salient issues related to youth are outlined below:

1.

NUTRITION

Adolescents need food not only for their abundant activities, but also for
growth. The nutritional status of adolescents is usually measured in terms of
weight for height expressed as Body Mass Index (BMI), a better indicator of
health status of adolescents than weight-for-age because of wide variation in
rates of development. The data that is available indicate that the average BMI
among 11-18 year olds is considerably lower in the developing countries as
compared to industrialized countries (WHO, 1993).

Iron deficiency anemia is another common condition, especially in girls,
who need 10% more iron as a result of menstrual loss. Furthermore, the growth
related needs of adolescents continue into the early twenties and will overlap
with nutritional requirements generated by pregnancy. Iron needs in adolescent
girls may be further complicated by diseases such as malaria and hookworm.
Discriminatory practices against the girls also lead to lack of adequate intake
which may lead to protein energy malnutrition, anemia and other micronutrient
deficiencies in the young girls.
Eating disorders, essentially of psychogenic origin, such as anorexia
nervosa and anemia, are also a problem, especially with urban girls and youth
victims of violence in rural, urban and tribal areas that may threaten their
nutritional status. Mention may also be made of the increasing risk' of obesity
due to decreased physical activity and increasing use of junk food among
adolescents.

322

2.

SEXUALITY AND REPRODUCTIVE HEALTH

All young people experience puberty and go through physical and
psychological changes in relation to their awakening sexuality. While increasing
maturity can bring great pleasure and pride, it can also bring shame, sorrow and
suffering Reproductive health enables an individual to enjoy and control sexual
and reproductive behaviour, with freedom from guilt, fear and other
psychological, political and economic factors, and without suffering the control of
another person.
In most cultures the male is expected to play a more aggressive role and
the girl is expected to resist sexual advances and if she does not, blame, is more
likely to be placed on her whatever may be the judgement of the legal system. At
the same time, adolescents often lack sufficient knowledge and skills to delay
sexual relations till they are ready. They risk not only social disapproval, they
also risk unwanted pregnancy and sexually transmitted disease and tremendous
psychological damage.

3.

PREGNANCY AND CHILDBIRTH

Regardless of whether pregnancy takes place within, or outside of marriage,
there are serious biomedical hazards especially for adolescent girls below 17
living in poor conditions and where access to health services is inadequate. The
first birth of any woman carries greater risk than subsequent ones, especially for
the adolescent. Her risk may be compounded by her lack of experience,
knowledge and resources, and lack of social and familial support. Too early
pregnancy increases the risk of maternal and child morbidity and mortality. At
menarche girls have approximately 4% more to grow in height and 12-18% more
in pelvic growth. They are at a greater risk of complications such as obstructed
labour and of death.
The trend towards more unprotected sexual behaviour prior to marriage
has given rise to increased risk of induced abortion, sexually transmitted
diseases (STDs) including the new menace of AIDS. Problems of chronic
morbidity, infertility and even death face the young person who is not protected.

However, access to information and services to prevent unwanted and too
early pregnancy, and to protect oneself from STDs and AIDS, is often not
available to adolescents. It is often misleadingly believed that sex education and
provision of contraception with counselling will lead to promiscuity, whereas the
evidence suggests the opposite.

4.

ABORTION

323

Induced abortion (or pregnancy termination) offers a greater risk to the health
and if an adolescent than to an adult woman. The reasons for this are several.
An adolescent is more likely to hide pregnancy, unable or unwilling to seek
appropriate health care, wait longer in the gestation period to seek help, and is
more desperate not to have a baby. Self abortion or seeking abortion from an
unqualified practitioner are more likely. Infanticide is another option that may be
exercised. The psychological impact of such an act can be highly damaging.

5.

STDs AND HIV INFECTION

and 2 Youth are especially vulnerable because of high risk behaviour greater
biological susceptibility, limited access to STD treatment facilities, and the fact
that primary prevention (always difficult) is the only effective form of control for
HIV and other STDs.

Higher rates of STD are generally observed in the 20-24 year age group,
followed by 15-19 and 25-29 year olds. However, in nearly all parts of the world,
the peak age of infection is lower in girls then boys. In many countries, 60% of
all new HIV infections are occurring among 15-24 year olds, with a female to
male ratio of 2 to 1.
Young adolescent females are especially vulnerably because they tend to
marry, or have sexual intercourse with older men who have had more sexual
exposure. In addition, as a receptive partner, females run a greater biomedical
risk to begin with. The risk is magnified in teenage girls because their Immature
cervix and limited vaginal secretions provide a less efficient barrier. Nor do they
have the assertiveness or negotiating skills to induce their male partner to use a
condom. To compound matters, young girls are sometimes physically forced to
have first intercourse, leading to genital trauma with increased risk of infection.
As if this were not enough, STDs in women are more likely to have mild or
absent symptoms. Nor do the women find it easy to seek medical care for their
STDs. Lastly, one should not lose sight of the role of prostitution, including child
prostitution in the spread of STDs and AIDS.

6.

TOBACCO, ALCOHOL AND OTHER DRUGS

Aggressive advertising targeting the young to promote tobacco use has Shifted
from developed to developing countries. The use of risky substances, including
tobacco, alcohol and other drugs together than a significant effect on health in
later life, rasing the risk of cancers, cardiovascular diseases, respiratory
324

diseases, cirrhosis of liver etc. Alcohol and drugs moreover impair judgement,
and are likely to increase risk taking behaviour of young people such as the
hazards of unprotected sexual relations, of accidental injury and of violence.
Consumption of alcohol and tobacco by a pregnant mother can also harm the
fetus.

Tobacco is the most widely distributed in the world tody, and arguably the most
harmful smokers are also more likely to use alcohol and experiment with other
drugs.

Disinctions that once separated cultures, sexes and social classes are vanishing
as young people in developed and developing countries are increasingly using
alcohol (although males generally use alcohol more than females). Indeed
adolescents all over the world are getting increasingly influenced by the
electronic media and are becoming fellow members of the “adolescent global
village’, where peer pressure and the roles models hold sway.

7.

VIOLENCE

Violence against, and by, youth is finding frequent mention in the daily press.
One of the most pervasive issues in today's world is violence against women.
The adolescents are especially vulnerable. In 1993, the United Nations General
Assembly adopted a declaration against physical, sexual and psychological
voilence against women.

It is difficult to get reliable data on the problem, because of the ''shame” of the
victime, and the threat of further violence. Violence breeds many problems, and
mental health consequences including post-traumatic stress disorder,
depression, anxiety, sexial dysfunction, eating disorders, suicide and more
violence, even including homicide.

8.

MENTAL HEALTH

Adolescence is a period of change, and a period of stress. It is characterized by
uncertainities about their own identity, their possible position in their peer group
and in society at large, and their responsibility as adults. The need for parental
approval has to battle with the need for independence. No woner adolescents
show mood swings, and may even indulge in self-destructive behavious such as
use of alcohol, drugs, suicide and violence. They need to be treated with

openness, understanding and sympathy, and offered creative channels for their
energy.

9.

ADOLESCENT LABOUR AND HEALTH HAZARDS

Most of the child labour is constituted by the younger adolescents. They are
generally employed in cottage industries such as carpet making, bangle making,
and as held in mechanical repair shops, eatries, and as domestic held.
Adolescents labour deprives the young adolescent of opportunities for education
and healthy psycho-physical development.

The actual magnitude of the problem of child labour, particularly urban working
children (which includes street children), is not knwon due to the lack of accurate
survey and a comprehensive definition of child labour. Thus, it is very difficult to
estimate the actual number of child workers in urban areas and hence we are
compelled to rely on rough estimates made by different groups.
According to official reports, there were 17.36 million working chilren in India in
1985, 95 per cent of whom were foundTh rural India. As per the estimates mady
non-governmental organisations, the number of child laborers ranged between
44 and 100 million in 1985. whatever may be the truth, it is certain that the
number of child laborers in India is very high. During the period 1961-81, child
lahour was 5.66 per cent of the total child population and 6.22 per cent of the
total labour force.

In 1981. the total number of working children was 13.59 million. Of this, nearly
10.69 million child laborers were found in nine states. Andhra Prudish had the
highest number of child labour (1.95 million) followed by Madly Prudish (1.70
million), Maharashtra (1.56 million), Karnataka (1.3 million), Bihar (1.07 million),
Tamil Nadu (0.98 million), Rajasthan (0.81 million), Orissa (0.71 million) and
Gujarat (0.61 million). Of the totalchild labour of 13.59 million, the extent of
urban child labour numbered 1.05 million in 1981. However, this data excludes
children working illegally in unorganised units an those engaged in marginal
activities.
Of the total of 1.05 million urban working children, nearly 0.805‘million are
concentrated in nine states among which Tamil Nadu has the highest number of
urban child labour (0.151 million) followed by Andhra Pradesh (0.137 million),
Uttar Pradesh (0.125 million), Karnataka (0.124 million), West, Bengal (0.074
million), Madhya Pradesh (0.067 million), Bihar (0.044 million), Rajasthan (0.041
million), and Orissa (0.029 million). Moreover, in 1981, the sex-wise distribution

of urban child labour in India was 0.76 million and 0.29 million respectively for
boys and girls. Relatively Tamil Nadu had the largest number of working boys
(0.095 million) followed by Anhdra Pradesh (0.092 million), Karnataka (0.084
million), Maharashtra (0.075 million), West Bengal (0.047 million), Madhya
Pradesh (0.045 million), Bihar (0.036 million), Rajasthan (0.031 million) and
Jammu and Kashmir (0.012 million).

In the same year, Tamil Nadu had the highest number of girl child labour (0.056
million) followed by Adnhra Pradesh (0.045 million), Karnataka (0.039 million),
Maharashtra (0.034 million),, West Bengal (0.027 million), Madhya Pradesh
(0.022 million) and Rajasthan and Uttar Pradesh (0.01 million each). It is clear
that in 1981 child labour was mostly concentrated in nine states, of which six
states, namely, Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, West
Bengal and Madhya Pradesh had the maximum number of urban working
children, both boys and girls.
In 1981, the highest percentage increase in total child labour was in Jammu and
Kashmir (55.7 per cent) followed by Delhi (41.2 per cent), Meghalaya (30.0 per
cent), Maharashtra (27.8 per cent), Madhya Pradesh (23.4 per cent), Tamil Nadu
(22.2 per cent) and Karnataka (19 4 per cent). Compared to previous analysis,
this indicates a different trend of increase in the incidence of child labour in
differnt states, the growth rate of which was different in various states during the
period 1971-81.
In States having lower urban literacy rates, we find higher incidence of urban
child labour.UP has the lowest urban literacy rate (52.6 per cent), the rates for
some other states being Andhra Pradesh (58.9 per cent), Bihar (59.4 per cent),
Madhya Pradesh (61.7 per cent), Orissa (62.3 per cent), Gujarat (68.3 per cent),
West Bengal (68.7 per cent), Karnatak (69.3 per cent) and Tamil Nadu (70.9 per
cent).
Urban working children in India are mainly concentrated in nine states and in
some of the
metropolises, such as Delhi, Calcutta, Bombay, Madras,
Hyderabad, Bangalore,Kanpur etc. The incidence of urban working children is
greater in states where the incidence of urban poverty and unemployment is also
higher. Though the urban literacy rate and the incidence of urban child labour
are somehow related, we cannot infer anything definitely about relationship
between these phenomena.
As regards girl child labour, the sahre of male child labour in urban India is high,
as is the Census in 1981

This section of the working class is confronted with the highest level of
brutalisation, physcial and psychological damage resulting it to fractures
1 childhood systems. Long hours of work, inhuman treatement by the employees,
327

parental neglect, hazardous conditions of work have long-lasting negative
influence on their psyche and maining and mutation of their bodies.

SUICIDE

Among HIV and AIDS patients 60% of people committed suicides or had made
attempts once or twice earlier. It is therefore, imperative that such people be
identified who are vulnerable to suicides and preventive action be planned. In
the 21st century the youth may have to face tremendous emotional stress and
strain at work, in the family as well as society. Suicide levels in schools was
noticed due to failures in examinations or not getting high graes as per their
parents unrealistic expectations. During anti-mandal agitation, 150 young people
had committed sucides and suffered self-immolation. It was in this regard that
efforts may be made to organise crash courses for stress management and
identify potential suicidal youth. Pregaling suicidal behavious among youth is a
consequence of academic stress, inability to cope with lif challenges, socio­
cultural practices, religious bonds, community with high divorce rates, dowry,
fear of stigmatisation, lack of communicability with parents and family
breakdowns. Sone suggestions provided by him to address this problem include
(I) mental health care system with strong prevention and aftercare networks, (ii)
crash courses on youth stress management skills and techniques, (iii) identifying
protential suicide prone condidates and develop action plans through team
building for crisis management, (iv) special youth programmes for youth prone to
emotional stress, (v) role of rural youth organisations, and (vi) public awareness
drive on management of mental and physical trauma etc. (vii) Organisation of
mutual counselling sessions where ‘anxieties/feelings can be shared.
The National Perspective Plan for Youth (NPPY) when considering long term
planning has taken into account the existing and futuristic socio-economic and
cultural trends. In such a case one had to take the views to futurologists, as it
was observed that futuristic socio-economic and cultural trends. In such a case
one had to take the views of futurologists, as it was observed that futurology is a
growing science in the present context. In this context, youth health policy
should provide opportunities to instill confidence among youth, the new set of
idioms, rationale, images and orientation of health of their own as a part of the
complex socio-system. The preventive approaches should be more focussed on
behaviour rather than pathophysiology or curative aspects. Youth force should
act as conveyor belt in youth health planning in terms of community
participation, governmental efforts, inter-disciplinary approaches of medical,
social scientists, etc. and there should be a shift of focus from microcosm to
environment and from treatment to prevention. The doctors while managing
youth behaviours must be familiarized with its, on the other hand extensive
training Io youth and organisations on health related activities etc would have to
be provided. The youth should have a life span view in order to increase their
128

life expectancy. Long hours of TV watching and sedentary life should be
discouraged by providing more opportunities for fitness campaigns and attitudes
of having out-door activities.
Recent development on Gene Therapy to
manipulate features of children has also adverse effects.
In this regard,
guidelines would have to be developed for curtailing this fanay approach and
prevent research on genetic issues. Lastly, with the advent of social and
community medicines, a new medical discipline on Adolescent Medicine may
have to be developed.

There is a need to evolve policies and programmes which would facilitate young
people to know the ways and options of protecting themselves and to strengthen
self-esteem and negotiating skills Programme policy should have appropriate
IEC intervention to dispel the wide range of existing misconceptions and fears
among young people about the pandemic of HIV/AIDS.

10.

DISABILITY

Disabilities among adolescents and youth comprise of mainly four types.
a)
b)
c)
d)

Visual
Hearing
Orthopedic
Mental

These can seriously interfere with normal development and functioning. They
call for concerted efforts at rehabilitation, and bringing into the mainstream of
life; which require efforts at all levels - Government, community, and the family.

If we take 4% as the reasonable estimate of disability following International
Labour Organisation (ILO) guidelines, the number of disabled persons in India
was 34 million in 1991. The number of disabled persons in the working age of
18 to 45 years was 8 million.

Cognizance should also be taken of the socially handicapped adolescents and
youth, such as the patently deprived (orphans), beggars, street children and
others exploited by criminals and drug dealers etc.

11.

ACCIDENTS AND INJURIES
■529

The magnitude of the problem of accidents and injuries is certainly increasing
due to increase in traffic and industrialization. The changing level of risk
behaviour by the young people also contributes to the problem (unsafe driving,
use of alcohol and drugs, aggressive behaviour etc.

Suicides, violence, and homicides are the more serious aspects of the problem.
There is urgent need to collect more data on these problems.

12.

SEXUALITY AND BEHAVIOUR

Consumerist culture, about sexuality have made the most intimate human
relations i.e sexual activity, a highly comm^rialized and/or consumerist turn.
Innocent youth make experimentation on human bodies the way they try any
new consumer item-food, films, bidi-cigarette, alcohol & drug, induction of young
girls and boys into sex trade has taken an institutionalized form among all
sections of society - the poor, the middle class and the rich. Except for women’s
organisations no one has done any concrete work among the victims of misled
sexuality.
While the dimensions of time and space have shrunk, the dimensions of
individuals have enlarged due to worsening economic crisis and social tension.
The degeneration of the family system, society, and culture as a whole has
occurred. This is the cry of the senior generation which is above the present
youth and adolescents of today who certainly do not agree with this sentiment.
Today we witness an egocentric society based on contractual basis and
personal effort. The youth wish to create their own world in which they try to live
by themselves and for themselves.
In this situation, only development
organisations equipped with proper knowledge can make headway in dealing
with the problem of sexuality.
13.

DEVELOPMENT ORIENTED MEDIA AND THE YOUTH :

Media in any form is a powerful instrument to alter the behaviour of people,
especially of teenagers. May it be the print media, audio-visual electronic
media, or performing art media, or may be even writing on the wall. In the
modern world, media is not only effective, but also it is perniciously infective.
The electronic media’s speed is faster than the wind which travels across the
seas. Enormity of adolescent health problem makes it imperative fo create a
cause of professionals competent to deal with variety of health issues faced by
the youth in a manner which does not victimise the viction. With an
interdisciplinary approach, we need to handle individuals and the existing
system in such a way that humanizes the tarmentors and empowers the victims.
Training programmes of Development oriented media need to draw on the
310

collective visdom of medical professionals, mental health experts, social
scientists, scientists and technocrats. For effective social marketing of expert
knowledge and new methodologies of dealing with the problems decision­
makers of the government departments, criminal justice system, state
administration and the voluntary organisations need to work in partnership.

GENERAL HEALTH; REPRODUCTIVE HEALTH AND SEXUAL HEALTH
•
•
•
•
•
•
•
•
•
•

•
•

•

Nutritional Needs of the youth
Balanced diet
Energy expenditure of the working youth, school going youth, sports
persons.
Problems
Anemia, Strunted growth, Malnourishment
Mortality Pattern
Morbidity Pattern Food-Security - Pds
Anorexia nevvasa - psychological aspects
Evolution of Government Programmes - ICDS - Role of Anganwadi
workers, youth volunteers, teachers.
Voluntary efforts - Youth Clubs, NGOs, Panchayat, Mahila Swasthya
Sanghs, Mahila Mandals, NYKs
Training Programmes
Performance of Implementing agencies - leakages and way outs.
1. Health of Family Welfare Department
2. Women and Child Development
3. Deptt. of Education
4. Deptt. of Rural Development
5. Deptt. of Tribal Development
6. The UN System
Implementation of child-marriage on women's health
a) Necket in nuntmance.
b) Body not prepared for sexual.activity.
c) Stunted growth due to teenage-pregnancy.

REPRODUCTIVE HEALTH AND SEXUAL HEALTH

Knowledge about Reproductive Physiology

Reproductive physiology is an important aspect of sexuality and reproductive
health. Parents are normally reluctant to discuss about such matters with their

children They also object any such move from school or NGOs as they fear that
such information may encourage promiscuity. Thus, in the prevailing cultural
values in which talking with children about sex and related matters are still
considered as taboo, the adolescent boys and girls have hardly any access to
sources from which they could get reliable and authentic information on
reproductive physiology and sexuality. Because of such constraints, many
adolescents do not have information about sexual behaviour till their marriage
which in turn sometimes affect their .marital life quite adversely (Khan, et al,
1996)

Table 8 : Level of Knowledge among Students about Reproductive
Physiology
(Percentage)
Girls
All
Boys
Reported changes that occurs to a girl at
puberty *
76.3
83.8
69.6
Change in Size of breast
82.5
68.3
56.7
Starts menstruation
82.9
73.5
65.2
1 lair in private parts of the body
10.8
15.1
21.5
Dont' know

Reported Changes that occurs to a boy at
puberty *
Change in Voice
Hair in private part of the body
Others
Don't Know
Total No. of Students_____________________

76.7
84.8
11.1
9.3
270

74.2
65.0
7.5
26.3
240

75.5
75.5
9.4
17.3
510

* Percentage adds to more than 100 due to multiple responses.

A study among 510 students of 8 schools in Lucknow shows that they were not
fully aware of physiological changes that occur during puberty. However, girls
were more aware of such aspects for boys only (Table 8). This shows that
awareness of reproductive physiology that on these aspects, knowledge of the
students of private schools is much better than their counterparts in public
(government) schools.

An analysis of questions on attitude towards sexual practices shows that about
one-third of the students do not object to premarital sex, particularly if both the
partners agree for it. Boys, as expected appeared to have more liberal attitude
towards sex and is reflected by the fact that only 47 per cent boys against G3 per
cent girls considered pre-marital sex as sin. It is also interesting to note that, the

students of private schools appeared to be less liberal to premarital or extra
marital sex than students of public schools.

The study points out that country to the general belief, sex and family education
or awareness with family planning methods and sexuality will not promote
promiscuity. The results of the study supports this. The students of the private
' schools although demonstrated a much better awareness of reproductive
physiology, contraception and progressive attitude towards a healthy mixing with
I opposite sex, indulged less into sexual acts compared their counterparts in
/ public schools. It is possible with detailed information about sex and positive
' orientation towards sexuality, they have learnt to say 'No' to premature sex.

Age at First Birth
Any pregnancy before completing 18 years is considered as high risk
pregnancy.
Both national and international data show that chances of
developing pregnancy complications leading to serious maternal morbidity and
even mortality is significantly higher among those who become pregnant and
deliver child before completing 18 years than those who deliver their first child
between 18 and 34 years.

Table 9 : Age at First Birth by Age of Women and Residence
(Percentage)
<15
15-17
18-19
Rural
4.8
13.5
15-19
3.4
21.4
20-24
27.0
6.1
23.3
6.5
30.9
25-29
30-34
6.5
15-34
5.4
Urban

15-19
20-24
25-29
30-34
15-34

1.6
2.6
4.0
3.6
2.8

Total
15-19
2.9
20-24
5.1
5.8
25-29
5.7
30-34
4.7
15-34
Source : NFHS, 1992

5.9
13.5
18.3
*9
19
<537)'

2.9
17.5
19.2
20.7
/143>

11.4
23.2
27.3
27.4

4.3
20.3
22.2
23.5
/lip

333

NFHS data shows that one-fourth of the women aged 15-34 years had delivered
their first child before completing their 18th birthday (Table 9).
The
corresponding percentage for the rural and urban area are around 30 per cent in
30-34 age cohort to around 14 per cent in 15-19 age cohort. Even with this
declining trend, in absolute number the women in the age group 15-19 who start
child bearing before completing 18 years is very large (2.6 million).

For instance, early entry of women in reproductive process results in prolonged
reproductive span, and thereby, contribution to high fertility rate. Even if the
adolescent mothers have fewer number of children, but at shorter interval, they
contribute to high population momentum by narrowing the generation gap.
Similarly, early child bearing also increases the risk of infant deaths which is
known to be high among adolescent mothers
Finally, there are ample
evidences that early child bearing and short birth interval contribute to high
maternal morbidity and mortality as well. According to Registrar General; in
1987, 45 per cent of all maternal deaths in rural India took place among women
aged under 24. In a hospital based study covering 55 medical college hospitals,
ten district hospitals and 3 community blocks from 1992-94, 8.8 per cent of
maternal deaths were among teenagers, while 80.6 per cent were for women
aged 20-35 years (Bhatt, RV, 1996).

Contribution of Youth To Total Fertility

As can be seen from the Table 10, 17 per cent of the total fertility of the country
is contributed by adolescents, i.e women between 15-19 years. Another 34 per
cent is contributed by women in the age group 20-24. Thus, these two agegroups taken together contribute almost 50 per cent of the total fertility in India.
The table further shows that 91 per cent of the total fertility in the country is
contributed by the youth population falling in the age-group of 15 to 34 years.

Table 10 : Age Specific Fertility Rate and Contribution to TFR
(Percentage)____________________________________________________
Age specific fertility rate
Percentage contribution to
TFR
Age
17.1
15-19
0.116
34.1
20-24
0.231
25.1
25-29
0.170
14.3
30-34
0.097
90.6
0.614
15-34
Further analysis reveals that the women in India not only start child bearing at
very early age but also produce children in quick succession, thus, completing

their desired family size at an early age. According to NFHS data, for fifty per
cent of the women the interval between last two births was less than 31 months.
Such short intervals are associated with high risk factors, which lead to various
pregnancy complications.

Attitude Towards Family Planning
No significant attitudinal difference towards family planning is observed across
the three age cohorts, i.e, 15-19, 20-24 and 25-34. Further analysis, as
presented in Figure 1 shows that, a very small proportion adopts a contraception
right after marriage or after first child. Majority adopt acceptance of family
planning only after having second or third child. This conditional approval to
family planning both by males and females has significant bearing on early
acceptance of contraception for spacing purposes. Unless favourable attitude is
developed towards the acceptance of family planning at early child bearing
stage, acceptance of contraceptives for spacing purposes would not be easy.

Use of Contraceptives

One important determinant of fertility decline is use of contraception. The
following table gives the age-wise distribution of current use of contraception
among currently married young women in India.
Table 11. Percentage of Currently Married Women (15-34) by Contraceptive

Method Currently Used, India 1992-93
(Percentage)

Age
15-19
20-24
25-29
30-34

Any
Metho
d

Any
Modern
Method

Any
Modern
Temporar
y Method

9.8
26.7
51.2
64.2

7.7
23.0
44.9
57.3

6.6
13.2
17.4
15.2

6.6
19.3
39.1
52 4

3.4
15.6
35.1
48J3__

2.0
4.3
5.1
3.8

Tubectomy

Urban
1.1
9.5
26.5
40.0

Vasectom
y

Pill

IUD

Condom

0.1

1.7

1.7

3.2

0.3
2.2

2.2
3.1
2.2

4.6
6.2
5.3

6.4
8.1
7.5

0.4
1.3
3.1

0.6
1.4
1.4
0.9

0.4
1.4
1.9
1.4

0.9
1.5
1.7
1.5

0.1
0.4
1.2
2.8

0.8
1.6
1.9
1.3

0.6
2.1
3.1
2.6

1.2
2.7
3.5
3.2

1.0

Rural

1.3
10.8
28.8
41.3 ___
Total
4.0
2.7
1.3
15-19
7.1
17.3
6.4
10.5
20-24
21.0
8.4
25-29
42.4
37.8
28.2
30-34
50.9
40.9
55.9
7.2
Source : PRC & UPS, NFHS report, India, 1992-93

15-19
20-24
25-29
30-34

As our family planning programme is sterilization based the picture of heavy
female sterilization seems to be more popular among the youths. Quite naturally
use of this permanent method increases with age. The young women should be
motivated to use spacing methods. They can be motivated to use permanent
method after age 25 or 30 when they have achieved their desired family size.
Use of contraception is much higher in urban areas compared to rural areas.
But for the age group 30-34, the use of vasectomy is 2.2 per cent in urban areas
compared to 3.1 per cent in rural areas. Use of tubectomy is higher among rural
women. Use of condom is considerably higher among young urban women
(Table 11).
Need For Sex Education And Counselling

The adolescent in India is in a dilemma. Western culture is clashing with
eastern upbringing. Also increasing female education and industrial life has
changed aspiration of the people.
The sexual behaviour is changing in the
cities in India nd the changing environment promotes the young boys and girls to
experiment with unsafe sex. In the present world of STDs and HIV/AIDS these
experiments may have and are having fatal outcome. It can lead to a generation
of infected and debilitated people which will have serious socio-economic
consequences.

It is therefore, imperative that attention be focussed towards, the apathy
adolescents/youth which continues despite the recent interest created by AIDS
prevention programme. The FPAISECRT survey of 1993 showed the while over
70 per cent knew about AIDS only 1/3rd of them knew about common STDs like

gonorrhea. This indicates that efforts for family life education has to be made
more seriously and it has to be extended to both urban and rural sectors.

AIDS and Sexuality Transmitted Diseases
Youth planners for HIV/AIDS education must realise that the epidemic is
controllable in a way that outbreaks of typhoid, hepititis, malaria or the flue are
not. An individual can protect himself herself in way she/he cannot protect
against other diseases. For example, infected food and water jaundice mostly
beyond the control of consumers, cause typhoid and hos of other diseases,
nearness to a patient can cause flu, a sting from a mosquito can cause malaria
and even dengue. Fortunately, HIV doesn’t spread by such vectors at all if
young people could be educated to practise. Safer sex, India’s HIV epidemic
would taper off. Therefore, it is possible to see an India totally free from
HIV/AIDS by the year 2020 The high degree of popularity and success of the
University Talk AIDS programme is an encouraging indicator of how youth could
be mobilized for youth health and HIV prevention.

One area in which the youth themselves can play a vital role is prevention counselling. Traditionally young people are more willing to listen to their peers
on matters relating sex. Thus prevention counselling by youth for the youth can
be designed to assist young people in making choices about their life style and
practices. This may include support for all those who are interested in changing
their behaviour to avoid HIV infection.
Past experience has shown that it is possible to mobilize thousands of young
people under a purposeful scheme to work as Health Scouts. Such a scheme
should include all components of a health promotion and disease prevention
programme. Long and short term training needs of these Health-promotion
volunteers need to be assessed.

HIV/AIDS prevention and education programme cannot succeed without active
support and involvement of the formal Health Sector and NACO. Since youth
are going to be the affected by the pandemic. It is essential to establish a high
power Joint Committee of Health and Youth Sectors to provide policy direction
and resource support to the field agencies. A special youth health division in the
Health Ministry and another Youth Health Programme Division in central and
State Youth Ministries may be considered to provide sustainability to the issue
until it is brought under complete control.

Substance Abuse

337

A major health issue that has drawn maximum number of youth to its fold is
substance abuse. Habit forming exposure to tabaccoo, alcohol and drugs start
at a very early age with grave consequence for health in later life. A study
conducted in late eighties on the average age of drug users in India indicates
that 8.1 per cent of them were in the age-group of 11-26 years. And most of the
world’s drug users are between 18-35 years of age (UNDCP). The period of
youth is a critical transitional phase marked by a continuous saaroh fd? self­
identity and self-discovery. Curiosity and quest for new experiences motivate
them for experimentation. Young people in schools, colleges, factories, farms
and clubs sit, eat and work together.
New ideas and experiments keep
circulating in these groupings. It has now emerged as major preventable cause
of morbidity and mortality in most parts of the country. Broadly five categories of
youth are considered vulnerable to drugs. They are :

I. Youth with personality and emotional problems.

II.

Youth who are curious and involve in drug taking for kicks or experimentation.

III.

Youth who take to drugs for escaping social, academic or domestic tensions.

IV.

Youth who are under peer pressure to conform to a group norm ; and

V.

Youth who take to drugs for enjoyment.

Studies have shown that the reason for the young people taking to drugs for
the second or third time is not because the drug is highly enjoyable or they liked
it very much. The youth take to it for a variety of social and personal reasons
that have little to do with the effect or experience of drug as such. Connected
with it are a host of rituals, beliefs and symbolic meanings that make drug
use appear pleasant, special and glamorous.
These assumptions and practices need to be studied properly adopting
principles of social marketing. Such studies should include bahavioural
pattern and trends of interest among youth. Comparable results from
surveys of various youth groups should form the basis for the development of
a comprehensive preventive programme corresponding to the needs and
interests of the young people.
Moral and spiritual education is considered by many as a preventive
method. Setting up a network of information and activity centre to involve
youth in creative programmes and skill training of their choice would
definitely act as a barrier against the drug-addition. Combined with a
countrywide sports, youth exursion and recreational programme to
strengthen the intervention further. Training youth in counselling and
preparing NGOs to function as institutions for promoting family life
education and responsible parenthood would further contribute to the
efforts. Youtli on the threshold of matrimony need to be covered specially.

1 Families, being the primary enviornment for the children to imbibe values
and norms can exercise effective control. If parents themselves smoke, drink
and use drugs, the children won’t need to go outside to learn these
behaviours. Child neglect and wife beating is a typical problem in all drug
abusing families. Children who run away from such families are only exposed
to a more violent world. Deprived of concern and control they become victims
of fear and violence.

The focus should more and more be on preenting young people from
becoming drug addiots than trying to treat the addicts. This would require a
I strong parent-teacher-community initiative to constantly and jointly
I monitor vulnerable adolescents

A major gray area is the lack of personnel trained in adolescent
counselling. Special schemes may have to be launched to equip youth clubs
‘ with counselling skills and facilities. Youth Awareness Courses can be
| offered by NGOs having expertise in this field. Young people tend to respond
more actively to approaches that involve and allow them in programme
planning and implementation. Through such interventions young people
would feel more confident to cope in a society where drugs proliferate.

Integrating drug abuse education into curricula with focus on healthy life­
style can be one of the many alternatives to wean away the adolescents from
the destructive path of drugs.
■
Adults have the potential and power to provide young people with
i positive leadership and constructive role models. Mass media,
advertising agencies, opinion leaders are in a unique position to give
accurate- information about drug abuse to the general public in creative and
credible ways. Highlighting drug abuse, although well intentioned, has done
lot of damage to the issue. Films continue to project drug addicts as
protagonists who eventually get reformed by the power of romantic love. Tele
serials, radio plays and stories in print media discuss and dishout an
overdose of information making young people conclude ‘drug’ as the real
thing’, an exciting adventure with potential and promise of unknown pleasure.
So, efforts may be made to promote youth and community action groups
I who could influence individual attitudes and behavious through community
norms. Collaboration and networking between NGOs and Government
agencies need to be strengthened.

Health care and services also need to modify their approaches by moving
away from disease and treatment model to education and prevention with
user friendly services for the affected individuals.

(

Policy and administrative measures should include regulating drug prices
through taxation and enforcement, restricting and policing locations of drug
339

sale, regulating advertising which stimulate drug-use, controlling supply of
drugs and rehabilitating the drug-deaddicted. Social networking of
community based organisations and families could be developed as a
social monitoring mechanism against the drugs.
If the human societies hope to live in a drug free enviornment, if they
expect young members of the community to return home without drugs and
drinks, then we need to have thorough understanding of psycho-sexnet
problems among the adolescent boys and girls as well as sex-related medical
problems.
The survey results in these areas, have shown (I) increase in incidence of
STDs in the urban areas (ii) 10% of the total cases of STD reported at the
STD clinies are from the teenage groups (iii) 50% of the total cases contract
the disease while they are in their teem. This data-base given us realistic
understanding of dealing with this problem with the help of medical
intervention, state machinery, councelling by serial workers and sex­
education. Specially vulnerable groupes happen to be migrat youth, girlprostitutes/sex workers/call-girls, regular rape victims (both boys and girls) of
homosexnal and heterosexnel nature. Homeless youth in the urban areas
sleeping on the parametres, public gardens, railway platforms and near
urban slum are the most vulnerable sections in this regards as they don’t
speak about it because of sheer helplessness and team of retaliation.
Moreover they don't get facility of clean/safe public toilets and bathing
facilities. Thus along with HIV/AIDS/STDs they suffer reproductive tract/tract
infections

CRIME DELIQUENCY DRUG ABUSE AND VIOLENCE RELATED HEALTH PROBLEMS

Men has been using drugs since ages. Now because of Scientific understanding on its
devastating implications on family dite, economic development, social fabric and

moral standards, both state and the civil society have become alert, moreover,
drug and alchohal are not limited to cottege-industry or home based production.
Modernisation compled with combination and industrilisation have created a
situation wheree all addictive items are marketed extremely aggressively and
violently in the world market among the most valuable sections of society,
namely the youth global nature of drug traffking and alchohal and drug trade
being billion dollar industries, targetting on propoganda and rehabilitation
programme to the victims will not generate anything but frustration among
dedicated workers and health professionals. Burn out rate among Social workers
working with the criminals, deling and the victims of drug abuse has made it for
the NGOs work in close coleboration with the State apparatus 'and Criminal
justice system.

340

Increasing competition in employment, stress due to transitional society,
inbarisation degenerating nature system have left the youth of today to face a
myriad of problems which had a direct or indirect effect on their health The
National Prespective Plan for the Youth up to 2020 aims to create a congenial
atmosphere and allocation of human, financial and technical resources to
enable the youth to face this challenges by providing them with a good, effective
and strong support system and character training.

Agressive marketing of all addictive items, inablility of the economy to
absorb the youth (both educated and glorification) in a productive and satisfying
economic activitesin the civil society are inter-related factors resulting into
increasing rates and intensity of crimes, deliquency, drug abuse and
physical/sexual violence.
/so far most of the welfare and rehabilitate
programmes have addressed themselves to individual victims and their physical
and pscychological sufferings. There is a need for paradigin shift in this regard
because people and institutions working with the victims find that majority of
them happen to be boys and girls who suffer from self-esteem and diffidence
due to parental neglect, imensitivity of educational system, condidtion of
ahelterlessness and abuse of any creative outlet. Focus on individual boy/girl's
leads to unnecessary moralisation and victim-baiting, We must take cognisence
of the fact that youth workers traffiking durg/alchohal/sex-trade find it very
difficult to get out of the clutches of their employer who are protected by the
n existing system. Experiences of Institutions like Sneha Sadan (Bombay),
| Asirwad (Banglore), National Campaign against child-labour (Madras)and Nehru
li Yuva Kendra Sangathan in the North-East, U.P , Haryana here revealed that
I homeless youth, child-labourers living either in the slums or streets and youth
| form romedic tribes are the major victims of drug abuse, deliquency and
I HIV/Aids. Hence the issues concerning housing policy, public health and
sanitation, non-violent and non-addictive recreational facilities should be given
top priority . Morever the improvement of general health and medical services
and pleaded for the extension of the same to remote areas and extend
adequate physical education, yoga, recreation and sports activities for youth to
wean them away from the evils of drugs and alchohol. Adolescence was a period
where they were prone to drugs and other kind of such behaviour and indulge in
pre-martial sex leading to AIDS. International studies show that persons of 25 to
40 years of age suffer most from AIDS which is the most productive healthy
sections of society. WHO report assessed that by 2000 A.D. 45 percent of drug
abusers will be in the age group of 18 to 35 years. Abuse of drugs started at the
age of 10 reaching its peak by 18 years. Majority of drug abusers in NorthEastern States were within the 93% of addicts with 15 to 35 years of age. It was
here that youth as a major segement of the society had a pivotal role for curbing
the problem. In this regard, initiative may be taken to promote youth for youth
programmes. On the other hand, adequate counselling services may be
provided at homes, schools, colleges, etc. On ill-effects of drug abuse and also
141

sex education. Various Departments of Government of India had chalked out a
variety of programmes for coping with the meance including Department of
Youth Affairs & sports through NSS and NYKS in colieboration with NACO,
Ministry of Helath & Family Welfare and World Helath Organisation . Under the
NSS programme the Department of Youth Affairs & Sports had developed a
special programme known as UTA (University Talks on AIDS) which proved to
be a major success as an AIDS preventive strategy.

There is a need to develop a comprehensive blueprint for youth health
development which would reorient the existing programmes to serve the special
needs of youth and developing interventions to enhance accessibility and
provide benefits to reach the youth masses. This blue print would also serve the
special needs of youth and develop special intervention with a range of options
and a variety of strategies. The factors responsible for drug abuse and its
consequeces had to be realistically dealt with trough a holistic approach. The
problem of HIV/Aids was a new trend and was associated with drug abuse. It
was on the increase specially in the North-East which needed urgent attention.
Smoking was the major cause for drug abuse. He urged upon providing services
to various categories of youth including student and non-student, child labour,
adulthood, and the like, while developing intervention for youth. Programme of
Department of Youth Affairs & Sports NSS has a major infrastructure providing
services through 1 5 million volunteers and it was intended to expand it also at
the school level. One major innovative and successful programme under NSS
has been the University Talks on Aids(UTA), even before NACO could
materialise. One major organisation under this Department, the Nehru Yuva
Kendra, which covered every district of the country and had at least 2 lacs
registered youth clubs. Another strong youth movement is Scouts and Guides
besides the Youth Hostels Association of India having 60 hostels catering to 1
lac population all over the country. These efforts had increased outreach
programmes for youth. Keeping out reach of this network in mind, we need to
accept that Prospective Plan is not only for and bu the Government but requires
canvassing at different levels/faculties.
Shri K K Baksi, Secretary, Ministry of Wselfare, Govt of India, while
delivering his opening remarks (Annexure-V) reterated the purpose of the
symposium as one of the series of symposiums with which his Ministry had
collborated to organise in an effort to prepare a National Perspective Plan for
Youth. He pointed out that 74 percent of the total population of youth was in rural
areas. He emphasised upon any investment for youth development would go a
long way in making them self reliant and contribute to the socio-economic
development of the country. In this regard, and integrated andinterdisciplinary
approach would have to be pursued both by governmental and non­
governmental organisations. Scheme like NSS and NYK can be geared to
ameliorating the conditions of Youth from exploitation to facilitate participation in
developmental activities. Highlighting the existing mental and physical health of
N2

adolescence and youth as a consequece of improper education, nutrition, lack of
affection, physical atress and strains in modern day living. Adoption of
immediate interventions strategies with sufficient impetus to attend to the
problem of drug and alcohol abuse and HIV/Aids has to be at the top in the
agends. At present the Ministry is playing an effective role in awareness creation
and prevention education in this regard by actively involving the yoth groups . In
this endeavour for positive results and act as effective agents of change.
Adequate attention may have to be given to childhood and early adolescence
while developing interventions for prevention of HIV/Aids The Ministry of HRD
has made efforts to address this problem by adopting a scheme for assistance to
coluntry organisations for prohibition and drug abuse prevention through a
community based approach. Presently 270 non-gevernmental organisations
were being funded by the Ministry to run 230 Awareness, Assistance and
Counselling Centers and 129 Deaddiction cum Rehabilitation Centers. The
Perspective Plan will make and effort in the direction of effective networking and
linkages among NGO’s for youth development for forging inter-ministerial and
intra-ministrial linkages.
7 to 8 million people suffered from STD acquired during 19 to 35 years of
age. About 45 million get infection when young mostly due to their ignorence
about the nature of the problem and treatment facilities. It was found that there is
CO-relation between STDs and heart diseases He highlighted that a fifth of all
global adult HIV infections were in South and South-East Asia with a third of
them being young women. Infection was basically though injecting and non­
medical drug use. While 40 to 50 percent of prevalence was noticved among
males, 75 percent of India’s HIV carries were below 40 years. India’s HIV
infection was doubling every two years, and if the trend continues, it was
estimated that it would be 4 million by 1996 and 16 million by 2000 would be HIV
infected persons. Presently, 360 million men and women in 14 to 45 age group
were sexually active and one million were yound commercial sex workers.
Alarmingly, by 2005 A.D onwards the helath sector may have to invest Rs.
35,500 crores for HIV/AIDS only taking the present increading into
consideration. By the first decade of 21st century, 10,000 Indians would die out
of which 8,000 would be young people and 60 percent of hospital beds would be
having patient of HIV/AIDS, if the existing trend is not arrested. 70 percent of
AIDS patients lead to T.B.

SOCIAL AND MEDICAL SUPPORT MECHANISM FOR ADOLESCENTS AND
YOUTH IN CURRENT SENARIO

THE EPIDEMIOLOGICAL TRAID

In the balance of positive health, there is a delicate balance between the
three ever interacting entities that consitute the epidemiological traid, that is
between the host, agent and the environment. These three exists in a state od
dynamic equilibrium and determine the state of helath and disease.

The concept presumes that the host, the disease causing agent and the
environment that produce good helath (positive health)or disease are always
there. In case the host resistence to disease is good, the environment right and
conducive, and/or the disease causing agent weak then a state of good health of
the hosts exists. On the other hand, if the host resistance is weak and/or the
disease causing agent strong or present in greater number (e.g bacteria) or
more intense (e.g the qyantity of carbon monoxide in the air), or the environment
conducive to facilitate the disease agent in causing the disease, then good
health would cease and disease occur.

In thinking of any state of health, or disease the epidemiological traid
explains genetic disorders this applies, as here factors inside the jose also work
as the agent). In the case of drug abuse, the user is the host, the drug is the
agent and various social factors including the drug's availability the environment.
All of them co-exist at any given time, yet the disease called drug/alcohol addition
oocurs only when this balance is distributed by either the host becoming weak
abd prone due to physical, psychological or social reasons, or the drug being
more easily available abd in larger quantity or the social influences being, so
conductive.

Community worekrs working with the victims of HIV/AIDS and drug abuse
have to shoulder major burden of providing emotional, medical and material
support. Social stigma about these problems make parents and other family
members shy away from them. This creates tremendous burn-out among Social
workers who are left in lunch when they creak. This makes it mendentry for all
concerned citizens to accept Social responsibilities and deal with this problem at
a macro level. Social workers have to invest all their energies In Individual
victims. Criminal justice system can make effect intervention by esteblishing
support with drug-lords and cultivators of drug-related plants, instead of slely
concentrating on raids and brutashising the drug-peddlers. This can be achieved
only when Social workers, development oriented media, police abd military force
are able to establish support with pwoerful forces operating globally. Drug­
peddler longuiting in prison are totally disowned by their own family memebrs.
Only social workers have been able to touch hearts of this helpless victims. If
they are used as power in the powergome, they can be effective change agents.

For overall health needs of the Youth of poverty groups state needs to
provide need-based food-suply and helath-case facilities. Public health issues
can be taught to the educated youth so that they can provide first-aid services,
344

para-medical services, media-legal advise and monitoring of medical
malpractice. Voluntary Health Association of India, Media Friends Circle, Kerala
Shastra Sahitya parishad, Forum for Medical Ethies, Health and Human Rights
module envolved by CEHAT - Pene and Bombay, PPST Madras, preventive and
Social health department of Tata Institute of Social Sciences here served great
purpose in generating a cadre of well informed youth on health issues.

RECOMMENDATIONS :

Taking into account the population momentum and its consequences on
pollution growth and asociated socio-economic and health problems, the
following recommendation s have been worked out after the two days of
deliberations by participants in the workshop.

There is a need to change the present definition of youth from the present 10-35
years. The new definition suggested is the total population in the age group of
10-29 years as falling in the category of youth.
Providing employment and income generating activities for the youth is needed.
With the organized sector becoming less labour absorptive, unemployment
leading to poverty, mainutrition, ill health and unrest is inevitable. To prevent

such a situation it is imperative to provide alternative sources of satisfactory
income generation to the youths.
Registration of vital events like birth, marriage and death should be made
compulsory. Needless to say, this has many immediate and long term benefits.

No child marriage should take place before the legal age (18 years for girls and
21 years for boys) after the year 2005. It is to be noted that with enforcement of
the legal age of marriage the unmet need for sex among the youth will increase
and it is necessary to work out means to take care of this unmet need by
providing alternative activities! and occupations to this segment of the
population.

Establishment of peri-marital (before marriage, just married, after marriage)
counselling services at convenient locations. These centres should not confine
their activities solely to family planning, sex and marriage counselling and sex
therapy but also include family welfare, child guidance, general health,
nutritional advice and counselling for all the concerns of adolescent and youth,
particularly STD and HIV/AIDS.

year

Ensure that 'zero’ births take
2005 onwards.

place after the third order birth from the

All deliveries should be assisted by trained persons from 2005.

All abortions to be safely done in recognized institutions.

in

Family planning managers should involve the teen aged
their programme.

population also

Since three-fourth of the Indian population dwell in villages, it is essential
to integrate the rural and the urban youth, as also familiarize the urban youth
with the rural sector. For this, urural posting of all graduates in various
capacities should be made compulsory as the current practice exists only for
medical graduates.

Need to devise Indian alternatives while planning programmes for the
youth while taking into account traditional norms and values.
Planners and policy markers have to recogniiiiize the needs of the
adolescent, understand them and commit themselves to meeting these needs. A
wide group of people including parents, teachers, social workers, politicians and
policemen need training and orientation to help the youth achieve optimum
health.

It is imperative to form an apex body at the central and local levels to co­
ordinate the orchestrate of activities of the various departments like Health,
346

Education, Human Resource Development, Family planning and so on. The
government has also to ensure strict enforcement of the laws . In this context
the panchayat can play a key role.
Better and wider communication by involving the school community to
introduce the concept of gender equality. Change stereo types and provide role
models to the youngsters right from the school stage.

Provide family life education in schools and colleges.
Develop educative regional and local programmes to spread messages
which are revelent and culturally sensitive for the community as a whole.
Impart training on gender sensitization to various sections of the society,
particularly government officials, workers at the grassroot level and the
community at large.
Make effective use of all possible media, particularly the folk media, press
and radio for creating a conducive environment for social change. The existing
network of scounts, NSS and Yuvak Mandal volunteers can be utilized to canvas
and reach mesages to the youths at large at a personal level. This would be
more economical, personal and effective with greater chances of percolating into
their minds, as a sizable segment of population cannot be reached through
conventional mass media, the only alternative is through word of mouth
communication.

Devise strategies to effectively use the available infrastructure and netwok of
agencies at local levels like the Panchayat, Yuva Kendras and Mahila Mandals
rather than forming new committees and working groups. Involve NGOs and
Panchayat to promote sensitization in the community.

Create a data base by gender on income generation and all other aspects such
as utilization of health services, loan facilities, panchayat members and so on.
Make provisions for availability of information of women regarding legal,
economic and health matters. This again should be done involving Panchayats,,
Nehru Yuva Kendras and local NGOs so that the information is available in local
language and is culturally sensitive.

Provide leadership training to women. Ensure more involvement of women
Panchayat members in various programmes.
Sensitize and involve the males as partners. NGOs must step in “and play an
active role in devising programmes to involve males in reducing domestic and
sexual violence.
Also set up male clinics for their health services and
counselling.

Effectively use the services of the senior citizens in youth programmes. This
could be done by involving the older population expecially the retired ones to
VI7

take up the posts of technical support in youth organizations or be in-charge of
logistics and infrastructure. This could serve the dual role of providing social/job
security to the older generation while taking care of the younger one.
REFERENCES

Bhatt,R V (1996): Maternal Mortality in India
published

Project 1992-94; FOGSI (not yet

Centre for Operations Research and Training (CORT), Baroda (1997: Youth and
Population, Report of National Workshop pon Youth and Population held at
Baroda.

Khan I, Lakhanpal S.Khan W, Sinha R and Vishwakarma J (1996): Knowledge,
Attitute and Sexual Behaviour of School going Adolescents in Uttar Pradesh.
Paper presented at the national Workshop on Youth and Population held at
Baroda.
Kndu A (1996): Employment Growth and Casualization of Work in India. Paper
presented at the National Workshop on Youth and Population held at Baroda.
Pathak K B (1996): Youth in India: Demographic Characteristics and
Consequences. Paper prepsented at the National Workshop on Youth and
Population held at Baroda.
Patel B C, Rajagopal S and Khan M E (1996): Social and
Demographic
Profile of Youth in India. Paper presented at the National Workshop on Youth
and Population held at Baroda.
Watsa M C (1996): Adolescent Sexuality: Issues and interventions. Paper
presented at the National workshop on Youth and Population held at Baroda.

Dr. Sunil Mittal: Youth Health and India, including Aspects of Alcohol and Drug
Abuse and HIV/AIDS, Need for Action, Delhi, 1996.

348

MARCH 5, 2001 / VOL. 157 NO. 9

Speed
Limits

Jacky and Nong would give
almost anything to avoid a
moment like this one. Coming
down from a meth-induced
high to the shabby reality of
their Bangkok slum, their
hunger for speed exemplifies
the desperation that has made
file drug’s use a continent­
wide crisis Page 36
ASIA____________________________

SOCIETY__________________________________________

JAPAN: Bottom of the Heap.............................................................16

DRUGS: Asia's Speed Crisis............................................................ 36

Yoshiro Mori is on his way to becoming the least popular Prime
Minister in his countrys bistory. But while many Japanese are sure
they want him gone, no one seems to want to take his place

Methamphetamine has become Asia’s narcotic of choice. A
harrowingly personal account of the “mad medicine” that is holding
whole communities hostage to its promise of a life less ordinary

CHINA: Rubble Rousers.................................................................. 18

I.M. Pei’s historic home may give way to the citys building boom
THE PHILIPPINES: Monopoly Money............................................ 19

How a group of enterprising Mindanao scam artists known as
the Trillion Dollar Gang raked in millions by selling tall tales and
ridiculously fake U.S. Treasury bonds
INDIA: Seeking Solid Ground..........................................................20

A moving first-person account from the epicenter of Gujarat’s
devastating Jan. 26 earthquake, of the deep wounds, mental as
well as physical, it has inflicted on millions of survivors
UNITED STATES____________________________________
POLITICS: Oh No, Not Again.......................................................... 24

New allegations about Clinton’s brother-in-law’s role in the ex­
President’s Uth-hour pardons raise still more disturbing
questions about the scandal-plagued former First Couple

SPORT
FORMULA ONE: Growing Up Fast.................................................. 44

While their contemporaries are still learning to parallel park, teenage
race-car drivers are leaving the old guard in the dust

THE ARTS_________________________
BOOKS: The Tan Dynasty................................................................ 46

In her new novel The Bonesetter’s Daughter, author Amy Tan revisits
the meditations on identity and cultural memory that have made her
an eloquent, if unwilling, spokeswoman for Chinese Americans
LETTERS.............................................................................................. S

TRAVEL WATCH.................................................................................. 7
NOTEBOOK.......................................................................................... 9

WORLD WATCH

10

MILESTONES.................................................................................... 14

THE WORLD

YOUR TECHNOLOGY

ESPIONAGE: Ferreting Out the Mole............................................ 28

YOUR HEALTH.................................................................................. 54

Robert Hanssen’s life had all the makings of a perfect spy novel.
Until his arrest, after 15 years as a successful double agent, he played
a mild-mannered fbi agent by day and traded state secrets by night
Tools of the Trade: Hanssen’s bag of tricks.................................. 30
Spy Games: Espionage is alive and well. Here’s what’s at stake... 34
VIEWPOINT: Praise for Bush’s tough stance on Moscow........... 35

PEOPLE..............................................................................................56

53

COVER: Photograph for Time by Jonathan Taylor

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’ CPO Box 88 Tokyo. TIME Asia is published weekly except for two issues [three in Japan] combined periodically into one and occasional extra, expanded or premium Issues. Combined, expanded and premium issues count
asXo subscription issues. Principal office: Rockefeller Center. Nev/York, N.Y. 10020-1393, U.S. TIME Asia principal editorial and business office: 30/F, Oxford House, Taikoo Place, 979 King's Road, Quarry Bay. Hong Kong. Vol.
157 No 9 © 2001 Time Inc All nghts reserved. Reproduction in whole or in part without written permission is prohibited. TIME and the Red Border Design are protected through trademark registration in the United States and tn the
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TO

OUR

READERS

HILE WE TEND TO BE PROUD

A Philippine con job involving absurdly fake U.S.
bonds tapped into a local mania for bounty hunting

Says Greenfeld:
“Reporting this story was one of the great­
est personal challenges I’ve faced as a jour­
nalist. It was like visiting my own demons.”
This week’s other noteworthy article is
senior editor Aparisim “Bobby” Ghosh’s ac­
count of Gujaratis’ efforts to pick up the
pieces after the devastating earthquake that
struck Jan. 26. Soon after the temblor,
Ghosh asked for a two-week unpaid leave to
volunteer in the massive relief effort. Al­
though he didn’t go as a reporter, the tales
he brought back were so riveting that we
asked him to put them down on paper. The

TIME asia.com
ARTS

TRAVEL

ASIA

result is a gripping account of the walking S
wounded struggling to cope with the tragic J
45 seconds that shattered their fives. There ’
already have been many tales »
of the quake’s merciless de-”
struction, of miraculous rescues >
and of the initial efforts to J
rebuild the province. This is
a different kind of story, an
attempt to capture the fate of the By TIM MCGIRK CAGAYAN DE ORO
survivors, whose damaged souls
N THE MOUNTAINOUS JUNGLES OF MINmay never fully heal. For Ghosh,
danao, primitive tribesmen stumble
the effort was troubling: “Writing
upon the wreckage of an American B-17
about my experiences meant hav­
bomber from World War. II. In the
ing to relive them before my
; twisted fuselage they discover several
memory had a chance to soften their edges.
; strongboxes with U.S.' government markI kept seeing the faces of all those trauma­
ii^/fhe stacks of printed sheets inside are
tized people, hearing their voices.”
wWhless to the hunter-gatherer tribesThese articles represent the pinnacle of
' men but not to the city slicker who hap­
journalism, where detailed reporting and
pens to pass by a few days later—he ac­
elegant storytelling combine to offer memo­
quires there in exchange for a few trinkets.
rable insights on important issues. Thanks to : At this point in the tale, the narrator reachwriters like Greenfeld and Ghosh, this is
what Time does best.

Buried Treasuries

W

of all of the articles we
produce each week, I
urge readers to take a
particularly close look at a pair of
exceptional pieces in this week’s
magazine. The first, by deputy ed­
itor Karl Taro Greenfeld, is a stun­
ning inside look at Asia’s obsession
with methamphetamines, or speed.
Use of the drug first soared as work­
ing-class Asians struggled to keep
pace with the region’s breakneck eco­
nomic development; it subsequently
skyrocketed when boom turned to bust,
and layoffs transformed many urban
Asians overnight into have-nots who were
desperate to escape their squalid lives. To
report this story, Greenfeld spent five days
and nights with a tribe of speed freaks in a
Bangkok slum known as Do It Yourself
Happy Homes. (The Thais call the drug
ydba, or mad medicine.) His dramatic
piece, twinned with the powerful blackand-white photographs ofJonathan Taylor,
is magazine writing at its best: dramatical­
ly reported, wonderfully told. Moreover,
Greenfeld brings to the story unique in­
sight: as a young man in Tokyo years ago,

TECH

PHOTOESSAYS

Adi Ignatius, Editor, TIME Asia

With an extensive network of reporters and
editors, TIME is your comprehensive source
of news, information and analysis about Asia

FEATURES

DAILY WEB COLUMNS
Asia Buzz

• Monday Absolutely
Ridiculous, Anthony
Spaeth's tongue-in-cheek
take on Asian society
• Tuesday Subcontinental
Drift by Aparisim Ghosh and
Tech Talk with Internet guru
Eric Ellis
• Wednesday Made in Chi­
na by Hannah Beech and
Kaiser Kuo, and Seoul
Searching by Donald MacIn­
tyre in South Korea
• Thursday Robert Horn
pursues stories from South­
east Asia, and Tech India by
Saritha Rai in Bangalore
• Friday Letter from Japan
by Peter McKillop, and Alex
Perry goes Walkabout with
tales on tourism
• Saturday Short Takes,
Stephen Short’s guide to
Asia's popular arts

I

fake U.S. Federal Reserve notes in denomi­
nations from $100 million to $500 million.
The total: $2.15 trillion, more than the annu­
al American budget. The scam was blown by
ajoint U.S. Secret Service and Philippine po­
lice operation on Feb. 18, when they arrest­
ed one Mindanao ex-security guard; they are
hunting at least six other suspects, including
several foreign nationals.
Going by the number of zeros on their
notes, the Trillion Dollar Gang were cer­
tainly the iiiost ambitious
counterfeiters in history.
Their victims didn’t know that

ARCHIVES

Ghosh’s moving, firstperson account of peo­
ple’s efforts to rebuild
their lives

t

PHOTO ESSAY

WEB-ONLY EXCLUSIVES

Shaken and Stirred
Days after India’s most powerful
earthquake killed some 100,000
people, senior editor Aparisim
Ghosh traveled to shattered Gu­
jarat as a volunteer in the massive
relief effort. Amid the devastation
and stench of decaying bodies, he
spoke with the walking wounded
and heard their stories. Read

Waiting for Hope
Afghanistan’s three-year
drought is scorching the
earth and killing its chil­
dren. Now millions of
refugees are pouring
into camps that offer lit­
tle food, water or med­
ical aid. Check out
Alexandra
Boulat’s
‘u=AauuraD0Uiats
heart-wrenching photographs of
the humanitarian crisis
WHAT TURNS YOU ON’

Lgfsjalk About Sex
wants to know what goes..
inside Asia s bedrooms. Please take
out our short
S y' Re,s,ults-and much more ks P nfP??llshedinanupcomin,
issue of the magazine

L/
REALTHING:

U.S. Secret Service agent David Popp, above right, contrasts a genuine dollar
bill against the fakes. Archie Mingoc, inset, is the only person who has been arrested

es in to a rusty, banged-up box and pulls out
a sheaf of the papers, seemingly yellowed
by age: Treasury bonds, worth trillions of
dollars. Now the narrator makes his dra­
matic offeir: for a small downpayment, a big
piece of this windfall can be yours!.
Who would buy a yam like that?
According to the Philippine police, thou­
sands of gullible Filipinos and others did,
coughing up millions of real greenbacks to a
group of Mindanao fraudsters now dubbed
the Trillion Dollar Gang. The numbers could
be higher: police say many victims are prob­
ably too embarrassed to come forward. They
should be red-faced, having fallen for the
crudest of cons. Using computers and rudi­
mentary desktop.planters, die gang ran off

the U.S. government has never printed a
bond larger in value than $10 million; nor
did it matter that the fake dollar bills copied
onto the bonds were sloppy blurs in which
Benjamin Franklin looks like a blob from
Mars. They were taken in by the tantafizingly credible story. All tire fake bonds were
elated 1934 and marked to "mature” 30
years later. Each of the hustlers told his vic­
tims the bonds were being demonetarized
bythe U.S. government pulled from circu­
lation'in a matter of weeks, and that he
needed some cash to pax' his expenses to
Washington, where he would redeem the
Federal Reserve note before it expired. In
exchange, he offered to pay brick 1%—or $1
million to $5 million—ou every note cashe.'
TIME, MARCH 5.2001

in. “It is the scam du jour,” says U.S. Secret
Service agent David Popp, a former White
House bodyguard now stationed in Manila to
protect U.S. monetary instruments against
an onslaught of hustles, swindles and fakes
that have sprung up in the Philippines.
The counterfeiters’ tale struck a chord
with many treasure-mad Filipinos. News­
paper classifieds routinely advertise the
services of psychic fortune hunters, and
the four governments since Ferdinand
Marcos’ regime have embarked on search­
es for Japanese war loot—reportedly worth
billions of dollars in gold and Jewels—that
was allegedly buried somewhere in the
archipelago when General Yamashita Tomoyuki’s forces retreated before the Allied
invasion in 1945. The “primitive” tribes of
Mindanao are often the first to capitalize
on this gullibility. Says Gener- *
al Ruben Cabignati, regional military commander based in 8
the town of Cagayan de Oro 7
in Mindanao: “I know of so
many smart businessmen |
who have been tricked by >
these seemingly innocent na­
tives.” It helps that Min­
danao’s prolonged Muslim
separatist insurgency has cre­
ated a lawless haven for kid­
nappers, arms sellers, drug
traffickers and itinerant counterfeiters. ' .
The first clues to the Trillion Dollar
Gang were detected not in Mindanao but
in Los Angeles. In early 1998, customs of­
ficials found fake Treasury notes hidden in
the suitcase of a Filipino Jesuit priest.
Investigators eventually traced the fake
bonds to a shantytown on the edges of Ca­
gayan de Oro. There, in the home of a se­
curity guard named Archie Mingoc, police
found a box containing $1.38 trillion in
fake bonds and stacks of counterfeit
Japanese, Malaysian and Argentinian cur­
rency. A raid on the home of his brotherin-law, Renato Waban, yielded an addi­
tional $773 billion in bonds. Mingoc
swears Waban, who has since disap­
peared. asked him to stash die box. Police
believe Waban, who flew from Cagayan de

ASIA

h® E AWAY FROM HOME: Most earthquake survivors in Kutch now

SHOCK

In quake-shattered Gujarat, many
survivors will never fully recover
from the trauma of those horrible
45 seconds. A first-person account
20

riving into kutch, i’m unnerved by the DEVASTA­
TOR on both sides of the highway: the TV images and
newspaper
pictures didnregion,
’t prepare
methe
for this mutilat
Gujarat
’s western-most
where
fields­
oflandscape.
Saurashtra
giveepicenter
way to theofdusty
plainscotton
of the
ed
The
the earthquake
liesrann,
in
an 18,000-sq-km expanse that once was a marshland on the
shores of the Arabian Sea but is now practically desert. The
sparse vegetation is more brown than green. This inhospitable
terrain is home to the Kutchi people, former nomads renowned
for their hardiness. They, along with Gujaratis from the interior,
have fashioned a sturdy local economy from the only two gifts
nature has bestowed on this land: salt and sea ports. Over cen­
turies, that economy built cities like Bhuj, Bachchau, Anjar and
Rapar. It took the quake just 45 seconds to flatten them.
Having grown up on India’s stormy southeastern coast, I have
experienced some of Nature’s terrifying moods. But not even a full­
blown tropical cyclone can reduce a city of brick, stone and mortar
into a mountain of rubble. An earthquake is especially terrifying
because it shakes our most fundamental belief, that the ground be­
neath us is solid. Although I have volunteered to help in the relief

D

TIME, MARCH 5,2001

live in camps like this one, in Ratnal village. With entire cities
flattened, reconstruction will likely take months, maybe years

effort, I’m truly, deeply, frightened—and will remain so for the du­
ration as aftershocks, at least six a day, rumble underfoot. These are
mostly mild, 3.5 to 4.5 on the Richter scale, and last only five or six
seconds, but they are a constant reminder of the Big One.
Not that anybody in Kutch is likely to forget. Everyone I
meet has a horrible tale. The vice-principal of a school in
Gandhidham town saw a brick wall fall on her students. She
wonders if she can ever return to teaching. A construction
worker in Bhuj spent half a day shouting out encouragement
to a woman trapped in the debris as others tried, in vain, to
reach her; her last words to him were: “Be good to your fami­
ly.” Another man dragged two of his children out of their
home and had just returned for the third when the roof came
down; he and the child inside miraculously survived, but the
two outdoors were crushed by a collapsing wall.
After a week working for a nongovernmental organization
(ngo) in rural Saurashtra, I enlist as odd-job man in a kitchen tent
on the outskirts of Bhuj. Not an instinctive volunteer-type, I have no
idea why I’m here, just that those images on TV and in the papers
demanded more than the routine cash-and-clothes donation. But

there’s not much time for introspection at the kitchen, run by
Girishbhai, a small businessman. We serve two meals daily to quake
survivors from nearby camps, anywhere between 150 and 450 peo­
ple a day. After a couple of days, I realize Tm avoiding conversation
or eye contact with the people we’re feeding: I don’t want to hear
any more stories. But some horrors are impossible to escape. The
stench of decaying bodies still hangs over parts of Bhuj two weeks
after the quake. Elsewhere, there is the smell of burning flesh from
funeral pyres. Tm grateful to have been spared the sight of smashed
heads and twisted limbs.
And then there are the walking wounded: the thousands of
survivors whose minds cannot yet comprehend the full extent of
their tragedy. Dozens of people who come to our kitchen bear
the telltale signs of a nervous breakdown in progress, the stutter­
ing, the facial tics. Many others are in deep denial, like Varsha, a
Bhuj housewife in her late thirties. The apartment block that
housed her third-floor flat has collapsed. Although she and her
family were unhurt, the sight of all their worldly possessions go­
ing to dust has left her unbalanced. Every day, from dawn till
dusk, she stands guard over the pile of bricks and mortar, “to
make sure thieves don’t take our things.” There is no way any of
her “things” could have survived; the building is so thoroughly
destroyed I doubt a spoon is intact. But Varsha won’t-or can’tgive up hope. “We had a TV, a fridge... How will I know what’s
under there until they’ve removed the rubble?” she asks. She
wishes the clearing crews would come quickly, with their cranes
and bulldozers. But they are concentrating on wreckage where
there’s a chance of finding bodies. It will be several days, per­
haps weeks, before they get to Varsha’s home. “If only somebody
in this building had died here,” she laments. “Then the bulldoz­
ers would come and we’d get our things back.”
ngo veterans who have worked at other disaster sites say
most survivors will never fully recover from the trauma. Psychi­
atric help is hard to come by, and anyway, most people don’t rec­
ognize the need for counseling. To some, seeing a “crazy doctor”
is tantamount to admitting they are insane. The quake hasn’t
shaken people out of their ignorance, or false pride.
On the bright side, practically every other kind of aid has been
pouring into Gujarat—food, water, blankets, tents, volunteers.
More than any previous natural calamity, the earthquake has sent
Indians everywhere into a frenzy of giving. The trucks streaming
past Girishbhai’s kitchen bear the license plates of 20 different
states. (I counted.) Every religious group you can name has a
camp and kitchen in and around Bhuj. Even Tibetan refugees
have pitched in. Some folks have gone overboard in their generos­
ity. There is a surplus of used garments, sent by the truckload from
all over India. Just outside Bhuj, I see an enormous pile of clothes,
evidently offloaded from a passing truck. Back in Saurashtra, one
ngo is still wondering what to do with a truckload of shaving kits
sent by some well-meaning souls from Bombay.
Some surpluses are welcome: Kutch has received more wa­
ter in the past three weeks than in the previous two years. (There
has been a drought since 1998.) In Anjar. I spot a group of
urchins drinking bottled mineral water. Even the barren earth
has turned bountiful: geologists report that the quake has creat­
ed a new “river,” a 100-km channel ci fresi: v. ■; itom a subter­
ranean lake is snaking its way aerr.s
*
the . ■ ' Hindu priests im­
mediately pronounce this to be the S.Ui. the my thicai holy
river that disappeared ir.to the -,'r •mn: thousands . ( years ago.
Here and there, there a:.• r ,) >i•' ■'! new ponds bursting to the
surface, but just as quit -;l.
ppen. mg.
In the tent cities tl’.u h-Ae .>
ecl around Bhuj. Bachchau

TIME, MARCH 5.2001

ASIA

and Anjar, news of fabulous rivers and ponds is greeted with
healthy skepticism. For the moment, though, most survivors are
too busy grieving for their dead to be distracted by faux miracles.
Many families remain in a state of suspended mourning, uncer­
tain about the fate of missing relatives.
Sumati and Karsanbhai, encamped near Girishbhai’s kitchen,
are still waiting to hear from their 20-year-old son Vinod. He had
left their home in Bhuj a few minutes before the quake struck,
but there has been no sign of him since. Is he in another camp?
Did he flee to his sister’s home in Surat, to the south? Is his body
lying lifeless under some mound of bricks and stone—or was it
dumped, unrecognized, on a funeral pyre, like thousands of oth­
ers? The couple, small and frail in their mid-fifties, are trapped
somewhere between hope and despair. Every morning,
Karsanbhai heads out in search of Vinod, circulating among the
ngo camps, government emergency centers and military infor­
mation booths. He calls Surat to check if Vinod has arrived there.
Sumati, meanwhile, busies herself in the tent she now calls home,
emerging sometimes to help other women cook and clean. She
doesn’t speak to anybody, but is constantly muttering to herself.
Only when I draw within a meter of her do I realize that she is
chanting the name of a family deity: “Ma Sherawali... Ma Sher­
awali... Ma Sherawali...” She clings to a small idol of the TigerBome Goddess she found in the rubble near the camp.
Karsanbhai returns in the evening, grimy from sweat and worn
from walking all day without food or water. He can’t bear to look
Sumati in the eye. “Any news?” she asks, keeping her voice as mat­
ter-of-fact as a mother’s anxiety will allow. She knows the answer
before Karsanbhai can deliver it: “No. Maybe tomorrow.” At night,

22

Sumati breaks down and wails for her missing son. Karsanbhai ad­ PRIDE GOES WITH A FALL: In villages like Chaubari, self-sufficient
rural folk, left, are loath to take charity. But the quake has forced
monishes her: “Why are you grieving for somebody who isn’t
many to rely on the kindness of voluntary organizations, above
dead? You know we will find him, it’s only a matter of days.” An
hour later, it’s his turn to cry, and hers to scold: “I’m a mother, and for food while she seeks charity by the highway. The pickings are
slim. In 15 days, she has scored two olive-green blankets and a small
my heart tells me he’s alive. How foolish you will look when he
bag'of rice and lentils from a passing aid convoy. Her husband has
comes here tomorrow, and finds you mourning.” At dawn,
Karsanbhai heads out again, and Sumati calls to Sherawali.
fyj c9e UP with some onions. I offer to drive the family to a relief
The camps provide more than food and shelter. Huddled to­ camp near town, where they would get food and shelter. Balia re­
gether in the winter cold, survivors are forming informal support fuses, pointing to a small pile of stones that used to be her home.
What if the government surveyor came around while they were in
groups to cope with their collective sorrow. One morning, as
the camp? They would miss the chance to claim financial aid. I give
Karsanbhai prepares to leave for his daily search, two men step
up and offer to join him. If they go in different directions, three her what I have on me, but a handful of biscuits and a few rupees
can search more effectively than one. A fourth man brings them won’t last a day. So I urge her to move closer to the road, to improve
some bottles of water. Overwhelmed by this gesture, Karsanbhai her chances of receiving alms. She agrees, and accepts a gauze mask
for protection from the exhaust fumes. I’ve done a few unpleasant
hugs one of the men, sobbing uncontrollably.
Not all survivors are in the camps. Many have left Kutch, even things over the years, but nothing made me feel as low as having to
teach Balia to beg.
Gujarat, to live with relatives elsewhere. Some will never return.
Others are reluctant to leave the ruins of their homes. A young
BY THE TIME I LEAVE GUJARAT, THE CHAOTIC RELIEF EFFORT HAS
woman, barely out of her teens, squats by the side of the highway
not far from the sea bridge that connects Kutch to Saurashtra. She been replaced by some semblance of order. After some prodding
by New Delhi, the state administration has snapped out of its stu­
has a naked baby in one arm; the other is outstretched, seeking
alms. But she obviously has no experience in begging, because she’s por, launching a welter of rehabilitation and reconstruction
a good 10 m from the road, too far to be noticed by drivers whizzing schemes and working with the NCOS. Many volunteer groups are
past at 100 km/h. Passing that way a week later, I see her again, still pulling back, leaving the work to be done by organizations that
sitting a long way from the tarmac. This time I stop. She only speaks have the best resources on the ground. This allows for easier coor­
Kutchi, the local dialect, and understands very little of my Hindi, so dination, ensuring that aid is spread evenly. Corporate India has
our conversation is hit-and-miss. We get off to a bad start. I ask her responded magnificently to calls from the government, with many
companies adopting entire villages. Thousands of wealthy Guname. “Balia,” she replies. Her son’s name? “Balia.” And her hus­
band’s? “Balia.” He is apparently somewhere in the rann foraging , jaratis abroad—think of all those “Motel Patels” in the U.S.—are

TIME, MARCH 5,2001

sending money to impoverished relations or social service groups.
By tapping into its traditions of private enterprise and self-re­
liance, Gujarat will bounce back on its feet faster than many people
expect. There will be a New Bhuj, a New Bachchau, a New Anjar.
Today’s rubble will be turned into tomorrow’s construction materi­
al. Many of those who have been bereaved by the quake will also
be enriched by the massive reconstruction effort. My own guess is
that in 10 years the quake will have faded from public memory’.
Private memories are a different story. I get a final glimpse
into Gujarat’s wounded psyche on my last night at Girishbhai’s
camp. Most of the people—mainly slum dwellers—seem in good
spirits. Women gossip and giggle as they help the volunteers
cook up a fresh batch of khichdi, a nutritious mixture of rice and
lentils. The men are kept in splits by a barber’s risque jokes.
“Our homes were not worth much, so it will be easy to rebuild
them,” says 60-year-old Haji Aftab. “We feel sorry for the rich
and the middle-class folks, who lost expensive houses.” The resi­
dent chatterbox Malati, a maid in her early twenties, says she is
looking forward to the months ahead. “There will be so much
construction work here, my husband and brothers will all have
jobs," she says, grinning broadly. “When God takes with one
hand, he gives with the other." But as night falls, Malati grows
quiet, edgy. After dinner, she is the last pcmon to turn in. Then.
just short of midnight, we arc i'a;.1..
. pn. rcing scream
from the women’s tent. It is Malati, si >utingin her
me out! Get me out!” I learn th me lias been doing this every
night since the quake. fn j.t years there will be no physical evi­
dence of the great carl':qu.ke of 2001. But in the nightmares of
Malati and a million oih.rs. the earth will never stop shaking. S

TIME, MARCH 5,2001

■
UNITED

STATES
Charles Krauthammer

The Bush Doctrine
In American foreign policy, a new motto: Don t ask. Tell
or

F

Hillary says she knows nothing
about her brother's dealings
with her husband, but a new
investigation may change that
By MICHAEL DUFFY and KAREN TUMULTY
ill and hillary Clinton have always maintained

atied
hygienic
distance
between
their scandals,
like His
out
thehis
Travel
Office.
Whitewater
had separate
plot
lines:
lost memory,
her lost billing
records.
and Hers
towels.out
He hadLincoln
Monica;
she had she
cattle
fu­
He it
rented
Bedroom;
emp
And for atures.
month,
looked asthe
if the 177 clemencies
Clinton
granted in his final days were falling neatly into the His col­
umn. But last week it became clear that U.S. Attorney Mary Jo
White was investigating some that have signs of being com­
munity property—the commuted sentences of four members
of a Hasidic sect following a meeting, which Hillary attended,
between sect leaders and her husband.
There is not much you can do to an ex-President The re­
alists know ifs too late to impeach him and too hard to indict
him, since bribery is a difficult charge to prove. But with the
news of a broader investigation, the focus of the scandal ex­
pands to include not just the Clinton who is worried about his
legacy but also the one who is worried about her future. So
many of the people who were pardoned had connections to
New York that it was only a matter of time before the spotlight
expanded from the former President to the sitting Senator.
Not that it wasn’t breathtaking to watch a shiny new ex­
presidency disappear under a freak mud slide. The debris hur­
tled by so fast that the New York Times editorial page seemed to
run out of synonyms for disgust, revulsion and abuse. Jimmy
Carter, the perfect ex-President, broke the cardinal rule of the
brotherhood and called Clinton’s pardon of Marc Rich “dis­
graceful.” Even Terry McAuliffe, the former Presidents friend,
said that decision had been wrong. Perhaps worst of all, there
seemed to be no end to the bodies that might float down the
swollen river. Congressional investigators subpoenaed another
Clinton fund raiser, Beth Dozoretz, to tell all she knows about his
pardon of Rich, the billionaire fugitive living in Switzerland.
And shattering any doubt that Clinton’s pardons were
shaped like boomerangs was the news, broken by the newspaper of record in the Clinton era, the National Enquirer, that

B

24

|

!

I
j
8|
d
zI
|l
<1
si
si

eight years the clinton administration

preached the need for exquisite sensitivity to the Rus­
sians. They’d had a rough time. They needed nurturing
from their new American friends.
They got it. We fed them loans, knowing that much of the
money would disappear corruptly. We turned away from
atrocity in Chechnya lest we weaken the new Russian state.
But most important, we went weak in the knees on missile
a- defense. The prospect of American antiballistic missiles up( L/ set the Russians. And upsetting the Russians was something
we simply were not to do.
The Russians cannot keep up with American technology.
And they fear that an American missile shield will render
obsolete their last remnant of greatness: their monster,
nuclear-tipped missiles. So they insist that we adhere to a
1972 treaty signed with the defunct Soviet Union that pro­
hibited either side from de­
veloping missile defenses.
That the treaty is obsolete—it
long predates the world of
rogue states racing to acquire
missile-launched weapons of
mass destruction—does not
concern the Russians. With­
draw from the treaty, they
said, and you have destroyed
the “strategic stability” on
which the peace of the world
depends.
The Clinton Administra­
tion took that threat seriously—so seriously that for eight
years it equivocated on build­
ing an American abm system.
Finally, President Clinton
promised to decide by June 2000. Come June, he punted.
Eight years, and no defense. But the bear was content.
Bear contentment was never a high priority for Ronald
Reagan. He offered a different model for dealing with the
Russians. The ’80s model went by the name of peace through
strength. But it was more than that. It was judicious but un­
apologetic unilateralism. It was willingness—in the face of
threats and bluster from foreign adversaries and nervous ap­
prehension from domestic critics—to do what the U.S. need­
ed to do for its own security. Regardless.
It was Reagan who famously proposed a missile shield,
and even more famously refused to barter it away at the
Reykjavik summit, an event many historians consider the
turning point in the cold war. That marked the beginning of
the Soviets’ definitive realization that they were going to lose
the arms race to the U.S.—and that neither threats nor cajol­
ing could dissuade the U.S. from running it.
This decade starts with a return to the unabashed uni­

lateralism of the ’80s. It began last year with a speech by
George W. Bush proposing that the U.S. build weapons to
meet American needs—and not to accommodate the com­
plaints or gain the agreement of other countries. For 40 years
the U.S. would not cut its offensive nuclear missiles except
in conjunction with Soviet cuts. Bush’s refreshing question
was: Why? We don’t need Russians cutting our offensive
weapons through arms-control treaties. And we don’t need
Russians telling us whether ornot to build defensive weapons.
This was the genesis of the Bush Doctrine, now taking
shape as the Administration takes power. Its motto is, We
build to suit-ourselves. Accordingly, the President and the
Secretary of Defense have been unequivocal about their de­
termination to go ahead with a missile defense.
They staked their claim. And what happened? Did the
sky fall, as the Clinton Russia experts warned? On the conn trary. Convinced at last of
I American seriousness, the
► Russians immediately acqui? esced. After just one month
of Bush, Moscow has come
forward with its very own
missile-defense plan. The
fact that it is not well
sketched out and that it is in
part designed to split the U.S.
off from Europe is beside the
point. The Russians have re­
sponded, as did the Soviets
before them, to American
firmness. Faced with reality,
they accommodate to it.
Who defines reality:
there lies the difference be­
tween this Administration
and the last. Clinton let Russian opposition define reality.
Bush, like Reagan, understands that the U.S. can reshape, indeed remake, reality on its own.
In the liberal internationalist view of the world, the U.S.
is merely one among many—a stronger country, yes, but one
that has to adapt itself to the will and the needs of “the in­
ternational community.” That is why the Clinton Adminis­
tration was almost manic in pursuit of multilateral treaties—
on chemical weapons, biological weapons, nuclear testing,
proliferation. No matter that they could not be enforced. Our
very signing would show us to be a good international citizen.
This is folly. America is no mere international citizen. It
is the dominant power in the world, more dominant than any
since Rome. Accordingly, America is a position to reshape
norms, altei expectatio n w
..
alitie How?By
unapologetic and implacable d emonstrations of will.
Russia did not sec the dgru on missile defense. It saw the
future, as defined by th J.S , and decided to join it.
■

TIME, MARCH 5,2001

I

I
I
I

35

SOCIETY

Methamphetamine has become Asia’s drug of
choice. Our writer reports on the culture of
speed-and recounts his own addiction
By KARL TARO GREENFELD BANGKOK
ACKY TALKS ABOUT KILLING HIM, SLITTING

his how
throat
three
and hanging
for
his
freeloading,
fortill
hisnine
hanging
around,
for
hefrom
just stands
there,
spindly-legged
funeral
feast.down
He deserves
it, really,
sheout
says,
him upside
so the blood
drains
of
and narrow-chested
and pimple-faced
with his
big
way
ran from
the baby
they
yearninghim
eyes,the
and
justitbegs
forher
another
hit.pigs
used
to
slaughter
in
village
before a
She has run out of methamphetamine, what the
Thais call yaba (mad medicine), and she has become
agitated and irritable and potentially violent. Jacky’s
cheeks are sunken, her skin is pockmarked and her
hair is an unruly explosion of varying strands of red
and brown. She is tall and skinny and her arms and
legs extend out from her narrow torso with its slight­
ly protuberant belly almost like the appendages of a
spider who got shortchanged on legs.

J

UP IN SMOKE: Bingeing In a Bangkok hovel, Jacky and her friend
Nong share a tablet of meth, called yaba or mad medicine

36

Photographs for TIME by Jonathan Taylor

SOCIETY
a few of the housewives began smoking, and finally some of the
Sitting on the blue vinyl flooring of her Bangkok hut, Jacky
dads would take a hit or two when they were out of com whiskey.
leans her bare back against the plank wall, her dragon tattoos glis­
Now it has reached the point that on weekend nights, it’s hard to
tening with sweat as she trims her fingernails with a straight razor.
find anyone in the slum who isn’t smoking the mad medicine.
It has been two days—no, three—without sleep, sitting in this hut
When the yaba runs out after half the slum’s population has
and smoking the little pink speed tablets off sheets of tinfoil
been up for two days bingeing, most of the inhabitants feel a bit
stripped from Krong Tip cigarette packets. Now, as the flushes of
like Jacky, cooped up in her squalid little hut, her mouth turned
artificial energy recede and the realization surfaces that there’s no
up into a vicious little scowl and her eyes squinted and empty and
more money anywhere in this hut, Jacky is crashing hard and she
mean. She looks like she wants something. And if she thinks you
hates eveiyone and everything. Especially Bing. She hates that
have what she wants, then look out. She slices at her cuticles with
sponging little punk for all of the tablets he smoked a few hours
the straight razor. And curses Bing.
ago-tablets she could be smoking right now. Back then, she had
But then Bing comes around tire corner between two shanties
a dozen tablets packed into a plastic soda straw stuffed down her
and down the narrow dirt path to Jacky’s hut. He stands looking lost
black, wire-frame bra. The hut was alive with the chatter of a half
and confused, as usual. Jacky pretends he’s not there. She sighs,
dozen speed addicts, all pulling apart their Krong Tip packs and
looking at her nails, and stage whispers to me that she hates him.
sucking in meth smoke through metal pipes. Now that the pills are
Bing, his long black hair half­
gone, the fun is gone. And Bing, of
tied into a ponytail, stands next toa
course, he’s long gone.
cinder-block wall, rubbing his
This slum doesn’t have a name.
Over his head, a thick trail of red
The 5,000 residents call it Ban Chua
army ants runs between a crack in
Gan, which translates roughly as Do
the wall and a smushed piece of
It Yourself Happy Homes. The
pineapple. He reaches into his
expanse ofjerry-rigged wood-frame
pocket and pulls out a tissue in
huts with corrugated steel roofs
which he has wrapped four doa
sprawls in a murky bog in Bangkok’s
(bodies, the slang for speed tablets).
Sukhumvit district, in the shadow of
Jacky stops doing her nails, smiles
40-story office buildings and glassand invites Bing back into her hut,
plated corporate towers. The inhab­
asking sweetly: “Oh Bing, where
itants migrated here about a decade
have you been?”
ago from villages all around Thai­
This mad medicine is the same
land. Jacky came from Nakon
drug that’s called shabu in Japan
Nayok, a province near Bangkok’s
and Indonesia, batu in the Philip­
Don Muang airport, seeking finan­
pines and bingdu in China. Per­
cial redemption in the Asian eco­
haps it’s appropriate that speed is
nomic miracle. And for a while in
Asia’s drug of choice, with an esti­
the mid-’90s, conditions in this slum
actually improved. Some of the huts
mated 30 million users across the
had running water piped in. Even
region. Hard work remains this
the shabbiest shanties were wired
part of the world’s indomitable
for electricity. The main alleyways
virtue. Making money and gettmg
rich are viewed as glorious end®):
were paved. This was when Thai­
land’s development and construc­
themselves, no matter the means.
tion boom required the labor of
And methamphetamine use, at
every able-bodied person. There
first, dovetails nicely with those 16were shopping malls to be built,
hour days slaving on a construction
housing estates to be constructed,
site or hunched over a workstation.
highways to be paved. And someone
It is the perfect drug for those
had to service those office buildings
struggling to keep pace with an
SELLING HAPPINESS: A meth dealer in Bangkok's Bang
upwardly mobile continent.
and corporate towers.
Around the same time, mad Khet ghetto shows off his wares. Yaba sells for $ 1.20 a pill
While it has taken scientists
medicine began making its way into
years to figure out the clinical phar­
Do It Yourself Happy Homes. It had originally been the drug of
macology and neurological impact of ecstasy and other designer
choice for long-haul truck and bus drivers, but during the go-go
drugs like ketamine, methamphetamines are a blunt pharmaceu­
’90s, it evolved into the working man’s and woman’s preferred in­
tical instrument The drug encourages the brain to flood the
toxicant, gradually becoming more popular among Thailand’s un­
synapses with the neurotransmitter dopamine-the substance
derclass than heroin and eventually replacing that opiate as the
your body uses to reward itself when you, say, complete a difficult
leading drug produced in the notorious Golden Triangle. While
assignment at the office or finish a vigorous workout. And when
methamphetamines had previously been sold either in powdered
the brain is awash with dopamine, the whole cardiovascular sys­
or crystalline form, new labs in Burma and northern Thailand
tem goes into sympathetic overdrive, increasing your heart rate,
commoditized the methamphetamine business by pressing little
pulse and even your respi­
tablets of the substance that now retail for about 50 baht ($1.20)
ration. You become, after
each. At first, only bar girls like Jacky smoked the stuff. Then some
that first hit of speed, glori­
of the younger guys who hung out with the girls tried it. And then
ously, brilliantly, vigorously

awake. Your horizon of aspiration expands outward, just as in your
which means that meth labs are an ideal family business for
mind’s eye your capacity for taking effective action to achieve your
industrious Asians, who set them up in converted bathrooms,
new, optimistic goals has also grown exponentially. Then, eventu­
farmhouses or even the family hearth. Unlike ecstasy, which
ally, maybe in an hour, maybe in a day, maybe in a year, you run
requires sophisticated chemical and pharmaceutical knowledge
out of speed. And you crash.
to manufacture, or heroin, where the base product, the poppy
In country after country throughout Asia, meth use skyrock­
plant, is a vulnerable crop, there are no limits to how much meth
eted during the ’90s. And with the crash of the region’s high­
can be made or who can make it.
flying economies, the drug’s use has surged again as battered,
This gray-brick warehouse on the outskirts of Beijing is a typ­
tired populations try to work through their hangovers with even
ical, small-time meth lab. Here, the six members of the Li family
more mad medicine. If you used the drug to push yourself to work
oversee the process of creating crystalline methamphetamine.
harder when the region was on its way up, you then used it to
Their neighbors, says father Li, think they are making legal chem­
alleviate the boredom of unemployment when the region was on
icals, which is why crystals are drying out in the open between two
its way down. It has now become a continent-wide crisis, one that
warehouses. “No one knows that this isn’t an agricultural product,"
is creating millions of addicts and threatening to cripple societies
he smiles. “No one knows what methamphetamines look like.”
barely on the mend from an economic cataclysm and still
After Li’s speed is processed it is handed over to local crime
wrestling with huge
gangs, who ship it to
numbers of addicts
Japan, Taiwan, In­
Linked on more tra­
donesia and Australia
ditional drugs like
or take it overland
heroin. The numbers
into Burma to the Wa
reveal a region with
state, where the
an increasingly lethal
drugs are further re­
need for speed: in
fined into the tablets
Japan, between 1995
that are eventually
and
1999,
the
smuggled into Thai­
amount of metham­
land and sold, via
phetamine seized, a
numerous middle­
pretty good indicator
men, to Jacky and
of usage patterns, in­
her fellow addicts at
creased from 85 kg to
the Do It Yourself
nearly 2,000 kg—
Happy Homes. The
about 65 million hits.
pink pills that Jac­
The story is the same
ky smokes are all
in South Korea,
stamped WY, the
where there are now
symbol of the United
more than 7,000
Wa State Army.
meth-related arrests
annually, up from just HOUSE ARREST: Bing won’t leave his row of huts for fear of being picked up by the
THERE IS SOMETHING
412 in 1992. In police. He says he is so skinny that everyone will know he's a yaba addict
familiar about Jacky
iBmesia, 218 kg of
and her little hut and
shabu were seized in 1999, up from just 3 kg two years earlier. The
her desperate yearning for more speed and even for the exhilara­
amount of ice confiscated in China doubled in 1999 and then dou­
tion and intoxication she feels when she’s on the pipe. Familiar to
bled again last year to 20.9 tons. In Taiwan, speed now accounts
me because I’ve been there before. Not in this exact room nor with
for 85% of all drugs seized; in Cambodia, police seized 35,000
these people. But I’ve been on speed.
amphetamine tablets last year, up from 22,000 in 1999. And in
During the early ’90s, I went through a period when I was
Thailand, the government estimates that an astounding 800 mil­
smoking shabu. with a group of friends in Tokyo. I inhaled the
lion yaba tablets were imported and consumed last year-enough
smoke from smoothed-out tinfoil sheets folded in two, holding a
for every man, woman and child in the country to smoke a dozen
lighter beneath the foil so that the shards of shabu liquefied, turn­
each. A U.S. Drug Enforcement Administration agent who has
ing to a thick, pungent, milky vapor. The smoke tasted like a mix­
worked in Asia for many years warns: “The opium war may be
ture of turpentine and model glue; to this day I can’t smell paint
nothing compared to the Asian meth war.”
thinner without thinking of smoking speed.
The base of the drug-ephedrine-was actually first synthe­
The drug was euphorically powerful, convincing us that we
sized in Asia: a team of Japanese scientists derived it from the
were capable of anything. And in many ways we were We were
Chinese mao herb in 1892. Amphetamine and methamphetamine
all young, promising, on the verge of exciting careers in glamorous
fields. There was Trey, an American magazine writer, like myself,
are derived from this ephedrine base, or from pseudoephedra, an
in his 20s; Hiroko. a Japanese woman in her 30s who worked for
artificial alternative, in a hazardous process that involves heating
a Tokyo woman’s magazine; Delphine. an aspiring French model
and pressurizing solvents and other store-bought chemicals.
and Miki, an A. and R. man for a Japanese record label. When we
While the refining can be volatile, it is not terribly complex,

I can stoiing speed? but I can never stay stopped ”

38

TIME, MARCH 5.2001

TIME. MARCH 5.2001

39

SOCIETY
smoke. (Bing just shrugs when I ask if it’s true that he hasn’t left in ; Jacky applies a thick layer of foundation makeup to her face, and
much, I should listen to her.”
a year. “I’m too skinny to leave,” he explains, “everyone wifi know : -then
k™ dabs ™
------------..............................................
on retouching
cream and
then a coating of powder, she
“And he’s only 15 years old,” Yee adds.
I’m doing yaba”) Big has a job as a pump jockey at a Star gas sta­ talks about how tonight she has to find a customer; she needs to
Bing reminds her he’s 17.
tion. And he has a girlfriend, and he has his motorcycle, a Honda make a thousand baht. Shell work the dance floor at Angel’s and,
“I don’t know where the years go,” Yee says, taking another hit.
GSR 125, and this weekend, like most weekends, he’ll be racing his if she can’t pick up a foreigner, she’ll try Thermae, a sleazy afterbike with the other guys from the neighborhood, down at hours joint and the evening’s last resort for Bangkok’s bar girls. If
FOR THE COUNTRIES AT THE FRONT LINES OF THE METH WAR,
Bangkok’s superslum Klong Toey. That’s why tonight, a few days she can find a customer and save some money, she can visit her
trying to address the crisis with tougher enforcement has had
before the race, he is working on his bike, removing a few links of children out in Nakon Nayok. Her two daughters and nine-yearvirtually no effect on curtailing the numbers of users or addicts.
the engine chain to lower the gear ratio and give the bike a little old son live with her uncle. Jacky sees them once a month, and she
Asia has some of the toughest drug laws in the world. In Thailand,
more pop off the line. He kneels down with a lit candle next to him, talks about how she likes to bring them new clothes and cook for
China, Taiwan and Indonesia, even a low-level drug trafficking or
his hands greasy and black as he works to reattach the chain to the them. When she talks about her kids, her almond-shaped eyes
dealing conviction can mean a death sentence. Yet yaba is openly
gear sprockets. Around him a few teenage boys and girls are gath­ widen. “I used to dream of opening a small shop, like a gift shop
sold in Thailand’s slums and proffered in Jakarta’s nightclubs, and
ered, smoking cigarettes, some squatting on the balls of their feet, or a 7-Eleven. Then I could take care of my children and make
China’s meth production continues to boom. Even Japan,
their intent faces peering down at scattered engine parts. The money. I used to dream about it all the time, and I even believed
renowned for its strict anti-drug policies, has had virtually no
sound is the clatter of adolescent boys. Whether the vehicle in it was possible, that it was just barely out of reach.”
success in stemming speed use and abuse. “The drug situation is
question is a ’65 Mustang or a ’99
Back then, she was
so serious right now
I Honda GSR motorcycle, the postur­ a Jiotorbike messenthat the Prime Min­
ing of the too-cool motorhead trfyg gBBshuttling packages
ister himself is head­
to goose a few more horsepower out back
and
forth
ing the anti-drug
of his engine while at the same time throughout Bangkok’s
task force,” says
look bitchin’ in front of a crowd busy Chitlom district.
Yoshitaka Yamada,
I of slightly younger female specta­ She was laid off after
superintendent of
tors is identical, whether you are in the 1997 devaluation
the National Police
Bakersfield or Bangkok.
of the baht when
Agency's Drug En­
The slang for smoking speed in her company released
forcement Divison.
I Thai is keng rot, literally racing, the those messengers who
Even so, Japan has
same word used to describe the didn’t own their own
been fighting this
I motorcycle rallying the boys do motorbikes. “Now I
battle longer than
I every weekend. Their lives revolve don’t think about the
most Asian countries
I around these two forms of keng rot. gift shop anymore.
and has never been
They look forward all week to racing Smoking yaba pushes
able to eradicate or
I their bikes against other gangs from those kinds of thoughts,
even seriously dent
other neighborhoods. And while and the thoughts about
its methampheta­
they profess to have nothing but dis­ my children, to the
mine culture. “The
gust for the slum’s hard-core ad­ back of my mind. It’s
Japanese like stimu­
NOT EVERYONE IN JACKY’S NEIGHdicts, by 4 a.m. that night, in Big’s good for that. Smoking
lants because it suits
borhood is as badly off as Jacky and
room in his parent’s house, on a means you don’t have
their hard-working
I mattress laid on the floor next to his to think about the hard SPEED RACERS: Keng rot, literally racing, is Thai slang for smoking meth. The same word is
Bing. And even the slum has its
character,” explains
I beloved Honda, Big and his friajds tm^s.” Bing nods his used for the motorcycle rallies that screech through the streets of Bangkok’s worst slums
nicer alleys, where the huts are
Yamada. Certainly,
made of finished wood and there are
are smoking yaba and there ®- nlRl, agreeing. “When
today, amphetamines
flush toilets and the skittering rats
denly seems very little difference I smoke, it makes everything seem a little better. I mean, look at this
are more widely available in districts like Tokyo’s Shinjuku or
don’t root through piles of festering
Osaka’s Nishinari than ever before.
between his crowd and Jacky's. place, how can I stop?”
garbage. The teens and twenty­
Bing’s mother, Yee, slips off her sandals as she steps into the
In Taiwan, Dr. Lin Shih-ku, director of the Taipei City Psy­
“Smoking once in a while, on week­
somethings in these parts of the
chiatric Center’s department of addiction science, estimates
ends, that really won’t do any hut, clutching her 14-month-old baby. She sits down next to her
I harm,” Big explains, exhaling a son and while the baby scrambles to crawl from her lap, she be­
slum also like to smoke yaba, but
there are 200,000 addicts, or about 1% of the population; in
they look down upon Jacky and Bing
plume of white smoke. “It’s just like gins pulling the paper backing from a piece of tinfoil, readying the
Thailand there are an estimated 2 million speed addicts; in
and their flagrant, raging addic­
Indonesia the numbers could be even more appalling, though no
having a drink.” But it’s Thursday, I foil for a smoke. Her hands are a whir of finger-flashing activity­
tions. Sure, the cool guys in the HOLD ON: Big loves his bike and speeding on it. Weekends
accurate figures exist.
point out. Big shrugs, waving away assembling and disassembling a lighter, unclogging the pipe, un­
neighborhood, guys like Big, with a go up in meth and exhaust fumes racing in Klong Toey
Without any sort of outside help or intervention, quitting the
the illogic of his statement, the wrapping the tablets, straightening the foil, lighting the speed and
shaved head, gaunt face and sneer­
drug becomes arduously difficult. Especially since prolonged use
drug’s powerful reach pulling him then taking the hit. She exhales finally, blowing smoke just over
ing upper lip, drop into Jacky’s once in a while to score some
away from the need to make sense. He says whatever he wants her baby’s face. Bing asks his mother for a hit. She shakes her head.
can lead to severe psychosis. “Basically,” says Dr. Lin, “they go
drugs. Or they’ll buy a couple of tablets from Bing’s mother, who
now, and he resents being questioned. “What do you want from She doesn’t give discounts or freebies, not even to her own son.
crazy’.” In the meantime, for societies grappling with this crisis,
me? I’m just trying to have firn.”
deals. But they tell you they’re different from Bing and the hard­
many debilitating side effects result from hosting large addict pop­
At one point I ask Yee if she ever tells Bing he should stop
core users. “For one thing,” Big alibies, “Bing’s selfish. That’s how
The younger neighborhood kids who look up to Big are run­ smoking yaba. “I tell him he shouldn’t do so much, that it’s bad for
ulations, including spiking crime rates, la gern u ibr rs of absentee
people get when they smoke too much yaba. He loves himself
fathers, higher Hiv infection rates and increasing domestic abuse.
ning out every half hour to buy more speed. They’ll keep on racing him. But he doesn’t listen.”
because he’s high all the time.”
until dawn when the money is finally gone.
Undoing the damage could take the rest oi the decade, and if the
Perhaps she lacks credibility, since she smokes herself?
For another, Big points out, Bing hasn’t left the slum neigh­
In Jacky’s hut, Bing and a few bar girls are seated with their I
American experience of fightingapiolcny.’c battle against drugs is
“I don’t smoke that much,” she insists.
borhood in a year. He doesn’t work. He doesn’t do anything but
legs folded under them, taking hits from the sheets of tinfoil. As
any example, the war may never be totally won. More likely, these
“She’s right,” Bing agrees. “Since she doesn’t smoke that
countries and societies will have to write off
vast swaths of their populations as drug
casualties, like the American victims of the
’80s crack epidemic.

would sit down together in my Nishi Azabu apartment to smoke
the drug, our talk turned to grandiose plans and sure-fire schemes.
1 spoke of articles I would write. Delphine talked about landing a
job doing a Dior lingerie catalog. Miki raved about a promising
noise band he had just signed. Sometimes the dealer, a lanky fel­
low named Haru, would hang around and smoke with us and we
would be convinced that his future was surely just as bright as all
of ours. There was no limit to what we could do, especially if we
put our speed-driven minds to work.
It’s always that way in the beginning: all promise, potential,
fun. The drug is like a companion telling you that you’re good
enough, handsome enough and smart enough, banishing all the
little insecurities to your subconscious. And you bid them good
riddance, because in your giddiness you feel liberated from
those self-doubts—never mind that they are there for a reason, to
remind you that you are vulnera­
ble, that you are human. You feel 1
totally, completely alive.
i
I don’t know that it helped me to
write better stories; I don’t believe
meth really helps you in any way at
all. But in those months, it became
arguably the most important activi­
ty in my life. Certainly it was the
most fun. And I looked forward to
Haru coming over with another
20,000-yen baggie of shabu, the
drug resembling a little, oily lump of
glass. Then we would smoke, at first
only on weekends but soon we be­
gan to do it on weekdays, whenever
I had a free evening. At first only
with my friends. Then sometimes I
smoked alone. Then mostly alone.

“Smoking yaba means you don’t have bink about the hard times.”
TIME, MARCH 5,2001

TIME, MARCH 5,2001

SOCIETY
The sparkle and shine had been sucked out of life so completely that; living in Tokyo. And Haru, the dealer, I hear he’s dead.
Asia’s medical and psychiatric infrastructure is already being
eventually, in a fatal spill. But if you’re young and Thai and loaded
my world came across as some fluorescent-lit, decolorized, saltDespite all that I know about the drag, despite what I have
overwhelmed by the number of drug addicts, particularly meth
on mad medicine, you feel immortal and it doesn’t occur to you
petered version of the planet I had known before. And my own seen, I am still tempted by it. The pull of the drug is tangible and
abusers, who are crashing and seeking help. But in most of the
that this night of racing will ever, really, have to end. The hundreds
prospects?
Absolutely
dismal.
I
would
sit
in
that
one-bedroom
real, almost like a gravitational force compelling me to want to use
region, counseling facilities are scarce and recovery from drug
of bikers thronged on the street, the revving engines, the other kids
Nishi Azabu apartment and consider this sorry career I had em­ it again. To feel just once more the rash and excitement and the
addiction is still viewed as a matter of willpower and discipline
cheering as you make your runs, even the cops coming and setting
barked upon, these losers I associated with compounding the very sense, even if it’s ilf, Jfory, that life does add up, that there is mean­
rather than a tenuous and slow spiritual and psychological re­
off concussion grenades and then chasing you through the narrow
long
odds
that
I
would
ever
amount
to
anything.
It
really
seemed
ing and form to the passing of my days. Part of me still wants it.
building process. When it comes to methamphetamine addiction,
alleys of Klong Toey. It’s all so exciting, euphoric and fun you just
there was no hope, that I was destined to become this shabbily
where the brain goes through physiological changes that leave the
never think there’s any downside.
dressed, dull mediocrity, short on wit, lacking talent, unable to AT 2 A.M. ON A SATURDAY, BIG AND HIS FELLOW BIKERS FROM THE
abstinent addict clinically depressed because of depleted serotonin
There are still moments when even hard-core addicts like
muster the power or engines for sustained flight.
levels, recovery programs and rehab centers become a crucial way
Do It Yourself Happy Homes are preparing for a night of bike rac­
Jacky can recapture the shiny, bright exuberance of the first few
These feelings, about the world and my life, seemed absolutely ing by smoking more yaba and then, as if to get their 125-cc bikes
station between addiction and sobriety. But most of the region’s
times she tried speed. Even tonight, as she dances with a potential
real. I could not tell for a moment that this was a neurological in a parallel state of high-octane agitation, squirting STP perfor­
drug-treatment centers are run like a cross between military-style
Belgian client at Angel’s, and it looks like the customer is about
reaction brought on by the withdrawal of the methamphetamine. mance goo from little plastic packets into their gas tanks. The
boot camps and prisons. Even so, beds are scarce as addicts seek
to take her back to his hotel room, and she’s thinking that she’ll
My brain had stopped producing dopamine in normal amounts bikes are tuned up and the mufflers are loosened so that the en­
the meager resources available. In China, the nearly 750 state-run
soon have enough money to visit her children, it doesn’t seem so
because it had come to rely upon the speed kicking in and running gine revving at full throttle sounds like a chain saw cutting bone:
rehab centers are filled to capacity; in Thailand the few recovery
bad. It seems life is almost manageable. A few more customers
the
show.
Resear
­
centers suffer from a
splintering, ear-shatand who knows,
chers now report that
chronic shortage of
ng screeches that
maybe one will really
as much as 50%
staff and beds. While
brberate up and
fall for her and pay to
dopamine-producing
the most powerful
down the Sukhumvit
move her to a better
cells in the brain can streets. The bikers
tools for fighting ad­
neighborhood, to rent
be damaged after ride in a pack, cut­
diction in the West—
a place where even
prolonged exposure ting through back al­
12-step programs de­
her children could
to relatively low levels leys, running lights,
rived from Alcoho­
live. Maybe she
of methamphetamine. skirting lines of
lics Anonymous—are
could even open that
In other words, the stalled Bangkok traf­
available in Asia,
convenience store
their dissemination
depression is a purely fic, slipping past
after all.
and implementation
chemical state. Yet it each other as they
By the next after­
do not reach much of
feels for all the world cut through the thick
noon, however, all
the region. In Thai­
like the result of em­ city smog. This is
the promise of the
land, for example,
pirical, clinical obser­ their night, the night
previous evening has
Narcotics
Anony­
vation. And then, they look forward to
escaped from the
mous meetings are
very logically, you all week during bor­
neighborhood like so
far more common in
much exhaled smoke.
realize there is one, ing mornings at
English than in Thai.
school
or
dull
after
­
surefire solution, the
Jacky’s customer lost
But it is precisely
only way to feel noons pumping gas.
interest and found
these sorts of support
another girl. Even the
better: more speed. And as they ride
groups that can deter­
bike racing fell apart
I kept at that cycle massed together, you
mine whether an ad­ WORKING WOMAN: Jacky at a Bangkok nightclub, seeking a foreign client who will pay her
after the cops broke
for a few years and can almost feel the REST FOR THE WEARY: After three sleepless days high on yaba, Jacky's bar-girl friends crash
dict can stay away the 1,000 baht she needs. She says the money is for her kids; most of it goes to speed
up the first few rally­
started taking ngny suse of pride oozing in the hut. Coming down from speed induces a depression that leaves users craving more
more drugs tha^^t a9of them, intimi­
from speed. “On good
ing points. And now,
days, I am two people,” says Cai Zhoushen, a speed addict who has
on a hazy, rainy Sunday, Jacky and a few of the girls are back in her
methamphetamine, until I hit my own personal bottom. I spent dating other drivers to veer out of their way, even truckers
been sent to a Kunming rehab center three times. “One who wants
nearly six weeks in a drug treatment center, sitting through tedious hitting the brakes as the gang roars past.
hut. They’re smoking, almost desperately uploading as much
to quit speed and one who wants to just have it one more time.”
On Na Ranong avenue next to the Klong Toey slum, they meet
group therapy sessions, working out some plan for living that didn’t
speed as possible to ward off this drab day and this squalid place.
Or, as Bing puts it: “I can stop using speed anytime I want, but
Jacky pauses as she adjusts the flame on a lighter. “Why don’t
require copious amounts of methamphetamines or tranquilizers. I up with hundreds of other bikers from other slums like Makasan
I can never stay stopped.”
you smoke?” she asks me.
left rehab five years ago. I haven’t had another hit of shabu-or and Suan Phloo. They have been holding these rallies for a decade,
taken any drugs-since then. But I am lucky; I am an exception. some of the kids first coming on the backs of their older brother’s
She tells me it would make her more comfortable if I would
WHAT STARTED OUT AS A FUN DIVERSION FOR ME AND MY TOKYO
Of that crowd who used to gather in my Tokyo apartment, I am bikes. Ken rot is a ritual by now, as ingrained in Thai culture as the
join her. I’m standing in the doorway to Jacky’s hut. About me are
crowd degenerated in a few months into the kind of chronic drug
the only one who has emerged clean and sober. Trey, my fellow speed they smoke to get up for the night of racing. The street is
flea-infested dogs, puddles of stagnant water several inches deep
use that Jacky and her crowd have found familiar. I began to
with garbage, and all around is the stench of smoldering trash. The
magazine writer, never really tried to quit and now lives back at effectively closed off to non-motorcyclists and pedestrians. The
smoke alone, and I started smoking before going out on interviews
horror of this daily existence is tangible. I don’t like being in this
home with his aging parents. He is nearly 40 years old, still takes bikers idle along the side of the road and then take off in twos and
or to meet editors. I smoked, basically, to begin my days. In tire
speed-or ritalin or cocaine or whichever uppers he can get his threes, popping wheelies, standing on their seats; the tricks are re­
place, and I find depressing the idea of living in a world that has
evening, I’d take valiums or halcyons or cercines or any of a num­
hands on—and hasn’t had a job in years. Delphine gave up model­ ally third-rate motorcycle stunts, the kind you might see in a local
places like this in it. And I know a hit of the mad medicine is the
ber of sedatives to help me calm down. When I stopped smoking
ing after a few years and soon was accepting money to escort 4th of July parade in the U.S. What is impressive is the speed at
easiest way to make this all seem bearable. Taking a hit, I know, is
for a few days just to see if I could, a profound depression would
wealthy businessmen around Tokyo. She finally ended up working which the stunts are executed. Souped up and fitted with perfor­
a surefire way of feeling good. Right now. And 1 want it.
come over me. The drab grayness of the world would become
But 1 walkaway. And while I hope Jack}-and Bing and Big can
as a prostitute. Hiroko did stop taking drugs. But she has been in mance struts and tires, these bikes accelerate at a terrifying rate if
crushing and the boredom would seem ineluctable. Nothing
one day do the same, I doubt they evet ■ i. i hey have so little to
and out of psychiatric hospitals and currently believes drastic plas­ you’re on the back of one of them. And that blast off the line makes
seemed fun. Nothing seemed worthwhile. Every book was tortu­
walk toward.
-With reporting by Hannah Beechi'Bnijing,
tic surgery is the solution to her problems. Mild has been arrested I for an unstable and dangerous ride. It is the internal combustion
ously slow. Every song was criminally banal. Every movie crawled.
Macabe Keliher/Taipei and 3ad:.!<r 3: ...un-.: Tokyo
m Japan and the U.S. on drug charges and is now out on parole and' equivalent of yaba: fast, fun, treacherous. And certain to result,

#

"Smoking once in a while worrt do any h i, it's just like having a drink
42

TIME, MARCH 5,2001

TIME, MARCH 5.2001

Too fast to be denied,
a new band of motor
racing prodigies are
taking their places on
the grid, confounding
go-karts,
signedOne
a contract
withguard
Formula
Formula
’s old
One powerhouse McLaren to shape and

of many
boys,a Lewis
dreams
becoming
Formula
One
an A in French.
Typical
driver; he haspects
a collection
of Grand
Prix
videos and reads car racing magazines. In
Hertfordshire,
England,
ex­
Hamilton’s case,
however, these
are just
as much study guides as his algebra and
language textbooks. In 1998 Hamilton, a
this
15-year-old from
champion racer
ofyear
tiny, the
motorcycle-engined

By TIM BLAIR
develop
his racing career. He has been
alwaysworld
beenofhigh,
and
headed for thehave
340-km/h
Formula
CHOOLBOY
One since he was
just 13. LEWIS HAMILTON
a dutiful
Hisa
Hamilton is
is among
the student.
youngest of
grades inspeedsters
maths andwho
English
battalion of youthful
are
charging at Fl’s gates. Some have already
burst through: this Sunday in Melbourne,
Australia, 19-year-old Fernando Alonso will
compete in an Fl Grand Prix race for the
first time, alongside 21-year-olds Jenson
Button and Kimi Raikkonen, and Enrique
Bernoldi, 22. The sport has seen young
drivers before, but never in such numbers
or depth. “They’ve livened it up, haven’t
they?” says Jim Warren, whose junior form­
ula cars have been piloted in British races
by Raikkonen and Button. While Fl teams
queue to throw money at the best of the
new talent—BMW-Williams contracted
Button for $660,000 before he’d driven
the first race in his debut season last year—
some senior Fl figures fear the “baby racers”
may liven up the sport too much. “When
there is a major accident caused by the
presence of very inexperienced drivers in
Fl,” complained Max Mosley, president of
Fl’s ruling body, the Federation Interna­
tionale de 1’Automobile, Tm the one who
will have to explain it to the media.”
Mosley’s main worry leading up to the
Australian Grand Prix is Raikkonen, a former
kart champ with only 18 months’ experience
racing cars. Swiss Fl team Sauber signed

S

44

Young
Men

Hurry
Raikkonen for the 2001 season after noting
the Finn’s astonishing speed in junior racing,
but the FIA-citing rules that require dem­
onstrated expertise in lesser cars—balked at
awarding a permit (called a superlicense)
that would allow Raikkonen to compete. In
December, Raikkonen drove flat outfor hours
at Spain’s Jerez circuit while 25 members of
the FIA commission, made up of Fl teams,
sponsors, manufacturers, promoters and tire
makers, looked on. His superlicense was
granted by a vote of 24 to 1. The only “no”
vote came from Mosley, who told the London
Times the decision was “irresponsible and
potentially dangerous.”
The FIA president isn’t alone in his
concerns. Jaguar driver Eddie Irvine was
dismissive of Raikkonen’s test, and of sub­
sequent rapid times the Finn set during
practice in fine weather. “It’s all well testing
in sunshine,” he said. Button, after compet­
ing in only 17 Fl races himself, surprised
Fl observers by saying the Finn “may have
difficulties competing on a packed grid. It is
TIME, MARCH 3,2001

a big step up and he will have to be car^L”
Even schoolboy Hamilton is dubious. iSL
konen, he says, “is making a big mistake.”
Raikkonen’s learning curve looks more
like a sheer ascent. Last year he drove a
Formula Renault powered by a puny fourcylinder, 170-horsepower engine. This
year he’ll drive a Sauber propelled by a 10eylinder Ferrari engine that produces
more than 800 hp. and is slowed by crushingly effective carbon-fiber brakes; the
160-kg vehicle can catapult from zero to
160 km/h and back to zero in four frantic
seconds. The gigantic forces generated
during races chew through a complete set
of tires every 100 km and maul drivers.
Raikkonen may be talented, says former f
Fl driver Chris Amon, but his “pretty i
minimal” racing background simply can’t *
prepare him for the ordeal of controlling
an Fl car in close company.
In 1963, when Amon was one month
short of his 20th birthday, he became
the youngest man ever to race in Fl (there

M iv

miW
STATE LEVEE CONSULT/iTION ON SOLUTION^TO

ALCOHOL RELATED PROBLEMS
Although alcoffol consumption has existed in India for many centuries, the quantity,
pattern of use and resultant problems have undergone substantial changes over the past
20 years. These developments have raised concern about the public health and social
consequences of excessive drinking. In recent years it has been alarmingly increasing
and created high level effect on the socio-economic and health areas in the Indian
cominuni ly.

Chakravarthy (1990) reported alcohol use to be from 26% to 50% among rural southern
Indian males, and the prevalence was higher among those of lower socio economic status
and illiterate. Mohan etal (1979) found that 12.7% high school students were drinking
alcohol. Dube etal (1978) found the prevalence of ever having used alcohol among
university students was 31.6% medical students have shown a higher drinking prevalence
of from 40% to 60% (sethi and ivlanchanda). blow we could imagine the level of
jnrrpncg during the pup culture period of last one decide.
Obviously everybody knows the effects of alcohol consumption on :
HEALTH including accidents and psychiatric disorder's,
Family,
Workplace,
ViOleUvC alld Cl’llUe ai'iU

Economics

MMHANS found out that one of the main reason tor the highest suicide rate of
Bangaloreans would be alcoholism and of the farmers who committed suicide also
alcoholics.

Current Responses
Legislation and nolicv
India is one of the rare countries where prohibition has been incorporated into the
national constitution as one of the directive principles of sate policy. Article 47 of the
constitution of India reads that "the slate shall endeavor to bring about prohibition of the
consumption except for medicinal purpose of intoxicating drinks and of drugs which are
injurious io health". Alcoholic beverage production and sales is controlled by the states.
not the federal government, with a result that there arc different, often contractor.
■policies among all lhe 29 slates. Most of the states promoted the production and sale of
alcohol, fulfilling the constitutional requirement of prohibition by token sypolic
measures such as designating some days in the year as “dry days”.

The main reason for ignoring the constitutional prohibition is the large amount of
revenue that the state government derived from alcoholic beverages. The proportion of
revenue from alcohol is considerable, with some states obtaining as much as 10% of their
total revenues from their source, Alcohol producers and retailers also have lobbies to
maintain policies favorable to them, using their money and political clout to get their

-

Beyond uic rather crasuc step of prombition, governments have a number or other policy
options at their disposal to reduce alcohol consumption and alcohol related problems, but
these are not used in any meaningful way. Laws bun the sale of alcohol to minors ,bui
they are not strictly enforced. Retail licenses are granted increasingly by open auction.
thus fetching a high price. This in turn, forces retailers in to promotional activities so as
to increase inci! saies and pronis. Licenses 101 the production ol beverages alcohol.
especially beer, are now granted in large numbers. Public drinking is banned,, but action
governments have is the tax levied an alcohol beverages, which eventually affects retail

India has decreased in. real terms over the last twenty years. Government have resisted
tax increase an alcohol in order to maximize the’’* revenues from liiglter sales
A health warning printed on alcohol containers is mandatory and this legal nrovision is
iohoweo. But such wanting are no help to the large proportion oi illiterate consumers
who can not read them. No units or other measures of alcohol are mentioned on the

liquor companies have found ways to get around these rules, including surrogate
advertising, sponsorship of sports and other events, and satellite television. The net
result is a consistent level of high pressure promotion of premium and middie sector

Driving a vehicle with a blood alcohol level of more than 100 mg percent is a crime, but

In recent years the Indian government has relaxed rules concerning alcoholic beverage
imports, along with those for the local production of foreign brands under collaboration
agreements. This has provided an unprecedented opportunity for multinational alcohol
producers io establish themselves in India. Not only is this likely io increase alcohol
sales in India., but it also will give Western style drinking even more social legitimacy
ano a more positive image than before, lhese policy uecisions completely disregarded
public health considerations.
Prevention Effects
The ministry of Welfare is primarily responsible for preventing alcohol consumption.
Among its many other responsibilities, substance abuse has been relegated to a low
priority. Whatever efforts are made are targeted more toward illegal drugs and less
toward alcohol. In practical terms, alcohol prevention programmes amount io media
advertisements and the financing of some non governmental organization to operate
counseling and rehabilitation centers, ivlost ol tliese centers are xocaied m .Urban areas,
leaving large areas of rural India unserved bv my organized activity in this field.
TREATMENT FACILITIES
it has been estimated that there are fewer than 2000 beds for drug and alcohol related
problems with the support or ministry of health of Indian Government, which is
extremely small minuscule number for the several million individuals who need such
assistance in India.

Private medics! facilities have some what tilled this sao. but thev are so expensive that
only a few wealthy patients can use them. Those services arc also completely
concentrated in the larse cities.

The detection and treatment of alcohol related problems in health care facilities is
extremelv noor. Awareness of alcohol problems and skills in the recognition and

treatment oi tuem at a primary level is highly deficient. Some training programmes to
improve the skills of planning care personnel in this field have begun, but in the absence
it ot tOxxO’v\“Up support or monitoring they have not trad much impact on the services
rendered.
Community anti Non Governmental organization activities
Alcohol was not on the Community action agenda until about 1 Oyears ago. But in the
past number of movements have sprung up in opposition io excessive drinking. Perhaps
the best known of these is the anti alcohol action by rural women in Andhra Pradesh
(Saxena 1>94 a> Many women groups joined the movement and look action against the
alcohol sales and finally the Andhra Pradesh Government was persuaded to declare
prohibition txuougja out mo state, xnspired by this success, many otner groups mostly'
led by women - have resorted to direct action, but so far they have not had much success.
to the economic iosses from no alcohol sales.

Some non-governmental organisation have entered the alcohol Helu and have been
supported with government finances. They have provided counselling and rehabilitative
services. but their impact lias yet to be felt nationally. Lach state govcriimcni has
temperance board but these are onlv in name sake.
Alcohol has been used in India for a very long time, but the amounts consumed and
problems associated have increased in recent years. Distilled alcohol bergs are the ones
drunk most frequently, although beer has become more popular among the young.
Besides licensed beverages, illicit alcohol is widely available and may amount to half
against the Quantity oi legal alcoholic beverages. Hie ieceiii economic Liberalisation
policy has allowed multinational liquor brands entry to the Indian market, which may
Further increase me Quantities or alcohol consumed.

Although most of the population is abstinent, available evidence points to higher levels of
drinking with associated hearth and social problems among those who do drink. These
have already created serious public health problems and they also impede the
development of poorer regions oi the country especially urban slums and rural areas.
Policy responses to date from the federal and state governments have been inadequate
and inconsistent, resulting in the unopposed promotion of alcohol in most of the country.
Prevention programmes and treatment facilities are wholly insufficient to meet India’s
needs. It can be anticipated that alcohol use and related problems will grow in every
Indian state with rhe manner of unimaginable manner. Unless planned policy changes are
designed and vigorously implemented these problems are likely to produce an excessive
burden on every stale and country's resources.

Inviices for a consultation to prepare a concept paper to control alcohol related problems
mv
Lonsmiipiioii
14. |
■ i. • Dr.C.M.Francis
Justice Balakrishna (retired)
■
• ■ ' •___________ 1 15. Dr. Marie Mascharenas
16 I
I -• ; Ms Shanthi Ranganthan
i Dr.Anitha Reddy
11. : Ms.Mohini Giri - Women’s
■ 4 : Dr.ivlohan Issac
ig

: -■ i Di.Tiiciiiia Narayan

< -■ > Dr.JO2.ci JvaO
'■ ' Prof. Babu Mathew

'
9

'

_________ ■

| 20.

’ Dr.Sudharshan
' \is Donna. Fernandes (Vimochana)
' Mr.Vi1 .?.va kumar (World Vision)

I ta. i pf. prathima Murthy__
:
. Ms.PcmhManorama

19.

1 21.

C‘
1 23.

i uelegale liom Psychiatry Dept. ol
St.John’s
1 Ms.Jacida Kuinar — Saktlii
' Ms. Susheelamma_Samankali

' Ms. Vimala - Corporation Bank
■ Dr.Pruthvish

_____ \ -5- \ Dr. Alikwaja___

Ninilians Director
j 2. i Dr.Gangaiharan
’ 7 ! Dr.Mohan Isaac
j 4 ! Dr.Praiima Murthy

7

j

Dr. Vivek Senegal
Dr..Kuru Raj
Dr Sekar Sheshadri

Government:

; 1. ! 1 icaltn secretaiy and Commissioner
7
Finance secretary and Commissioner
j 3 i Lxcise oury Commissioner_________
: 4
Health and excise Ministers
1 5

' Nation Centre for Drug Abuse and

i 6

• Temberance

1 7

: Drug Abuse Division. WHO, New
! Delhi
! 8 i Siate Police - DGP

i
i Justice Saldhaiia and Legal Lxperts
i! Mr. .Toga Rao .T.aw School
11 , Mi . Dabu Mathc vv ~ Law School_____
12 Mr. Rajagopal. Chairman. State
i £ dice housing *^orp
13 ' Justice Balakrishnan

'
’ 10

14 ' Vice Chancellor of Medical
! University Dr.Chandrashekar
Dr. T.K.Srinivsan

i ■

16

Chief Justice of Karnataka High
! Court

■

i

MH-1-

How to Protect Your Children
from Child Abuse and Drug Abuse:
A Parent’s Guide

NOTE TO PARENTS:
Tear out this 28-page guide and
keep for future reference.

Boy Scouts

of America

Introduction
For over three quarters of a century, the Boy Scouts of America
has worked to develop the character, citizenship, and personal fitness
of America's youth. We realize that the future of our society is vested
in each successive generation and the values inherited.

*Jbday,
£
as we look toward the 21st century, society is challenged
by.-nose who would prey upon America's youth—either by altering
their minds with illegal substances or through physically or sexually
assaulting their bodies. These scourges—drug abuse and child
abuse—must be eliminated.

As a major youth-serving organization, the Boy Scouts of Amer­
ica has a unique opportunity to help protect the youth of our nation.
This booklet will help parents teach their children self-protection
strategies. In it are basic protection strategies and activities that par­
ents may do with their children. By doing these exer­
cises, parents will also be developing the kind of open communication
that will enable their children to feel comfortable discussing sensitive
problems or telling them about experiences involving inappropriate
adult behavior. Some of the exercises may count toward completion
of advancement requirements in Cub Scouting and Boy Scouting.

How to Protect Your Children from Child Abuse and Drug
Abuse: A Parent’s Guide is designed to provide parents and their
children with basic information that will increase awareness of the
magnitude of these problems and their manifestations. Through this
eLJt, the youth that are given knowledge and a sense of personal
power will be able to assist in their own self-protection. We as
adults owe children all the safety we can possibly provide.

Section 1
Youth Protection:
Child Abuse
The Boy Scouts of America is deeply concerned about the
g^jral welfare of our nation's children. There are many challenges
that confront today’s youth and child abuse is one of these. Child
abuse is a fact in our society and a matter of great concern for all
parents. Fortunately, child abuse is preventable, but parental action is
important to protect children. The first responsibility that parents
have is to be sure their children are safe from abuse in the home.
Unfortunately, studies show that more children are abused in the
home than anywhere else, often because of inappropriate or exces­
sive punishment.
Raising children in today’s complex society is a difficult, demand­
ing, stress-filled responsibility. The National Committee for the
Prevention of Child Abuse gives the following suggestions to avoid
unintentional physical or emotional abuse:
The next time everyday pressures build up to the point
where you feel like lashing out—STOP! And try any of these
simple alternatives. You'll feel better ... and so will your child.

• Take a deep breath. And another. Then remember you are
the adult.
Close your eyes and imagine you’re hearing what your child is
about to hear.

• Press your lips together and count to ten. Or better yet,
to twenty.

• Put your child in a time-out chair. (Remember the rule: One
time-out minute for each year of age.)
• Put your self in a time-out chair. Think about why you are
angry: Is it your child, or is your child simply a convenient
target for your anger.

• Phone a friend.
3

• If someone can watch the children, go outside and take

a walk.
• Splash cold water on your face.

don further attempts with that child. Only a very small percentage
of child molestation involves the use of physical force. Children need
to be trained to "run, scream, or make a scene” when inappropri­
ately approached by anyone-tfriend, relative, or stranger.

• Hug a pillow.
• Turn on some music. Maybe even sing along.
• Pick up a pencil and write down as many helpful words as
you can think of. Save the list.
Few parents intentionally abuse their children. When paints
take time out to get ahold of themselves before they get ah™'

of their children, everybody wins.
Parents also need to discuss the possibility of abuse outside the
home with their children and provide reassurance that any time a
child feels threatened, the parents will be there to discuss the prob­
lem and support the child.
One form of abuse that parents find especially difficult to discuss
with their children is sexual abuse. By overcoming the discomfort
that they experience when children bring up sensitive subjects such
as sexual abuse, parents may greatly reduce their children's chances
of being abused.

The Three R’s of Youth Protection
The three R's of youth protection are the key to an effective
youth protection strategy:

Recognize. The child needs to be able to recognize the situatic^fen
which he may be at risk of abuse. Traditionally, children have b5n

told of the risks associated with strangers. As we have come to
learn, in most cases, child abuse is committed by a person known to
the child, often one in a position of authority over him. Therefore, if
we only teach them to be wary of strangers, we are not protecting
our children as completely as we must. The exercises in this booklet
will help your child learn to identify situations requiring caution.
Resist. The child needs to be able to assert his rights to resist the
abuser. Interviews with child molesters document that when a child
resists advances made by a molester, the molester will usually aban­

4

Report. The child needs to be able to tell an adult when he has
encountered abuse, with the expectation that the adult will take
action to prevent further abuse. Children need to be taught to tell
their parents, teachers, or other adults whenever they encounter
q^fcjionable situations or attempted abuse. Since adults do not
alroys listen when children talk to them, the children need to be
told to keep on telling until someone listens.
Sometimes, a child may not be able to talk about what has hap­
pened, but will communicate in other ways. For example, he may go
out of his way to avoid being alone with a particular person. This is
a kind of communication to which parents need to be sensitive, as it
may be an indicator of abuse.

When a Child Discloses Abuse
If your child becomes a victim of abuse, your initial reaction can
be very, important in helping him through the ordeal. The following
guidelines may help you.

• DON’T panic or overreact to the information disclosed by
the child.
• DON’T criticize the child or claim that the child misunderstood
happened.

• DO respect the child's privacy and take the child to a place where
you and he can talk without outside interruption and distractions.
• DO reassure your child that he is not to blame for what hap­
pened. Tell him that you appreciate his telling you about it and
and that you will help make sure that it will not happen again.

• DO encourage your child to tell the proper authorities what hap­
pened, but try to avoid repeated interviews. This can be very
stressful for the child.
• DO consult your pediatrician or other child abuse authority on
the need for counseling to help your child.

5

In /T"/’ *fuabuse haPPens to your child, do not blamP
Individuals who victimize children are not readHv ? ! yourselfcome from all walks of life and all socioeconomic lev" J ot' ‘*
7
present a nice image-they go to church and are active in Ih" y
mumty. The molester is skilled at manipulating children f en hT
givmg excessive attention, gifts, and money. Most abuse occurs in
situations in which the child knows and trusts the adult
If you would like to learn more about child abuse and protect
mg your child, the Boy Scouts of America provides a ninety-minute
training program, Youth Protection Guidelines: Training for Voltf
*
teer Leaders and Parents. Contact your local council for scheduling
and availability.

Teaching Your Child to Be Assertive

Exercise 1: What if ...
In this exercise the parent sets up situations that the child should
recognize as potentially dangerous. Once the parent describes a situ­
ation, the child tells what he would do if ever confronted in such a
way. You can extend some situations by replacing the individual in
the scenario with someone that your child knows, such as a neigh­
bor, relative, or someone who has a position of authority. Your child
ds to understand that inappropriate behavior is wrong, irrespecof who does it. Suggested action is listed with each situation.
(Credit may be given for Wolf Achievement 12: Making Choices.)

«

Situations for Younger Children
1.

It is important that your child understands the right to react
assertively when faced with a situation he or she perceives as dan­
gerous. When teaching your child self-protection skills, make it clear
that although some basic strategies involved seem to contradict the
sort of behavior you might normally expect of your child, these
strategies applv to a situation that is not normal. When feeling
threatened, your child must feel free to exercise the right to:

A.

Tell the caller your parents are busy and cannot come to
the phone.

B.

Take a message and the phone number of the caller.

C.

D.

• trust his or her instincts and feelings

2.

• expect privacy
. say no to unwanted touching or affection
. say no to adult demands and requests
. withhold ihtormauon that could |e=P»«® *

. run. scream, and make a scene
. Physically fight off unwanted advances

Drotective strategies

following exemises 'ull hep
apply these strategies6

Do not tell the caller you are home alone.

An older boy is hanging around your school and tries to give
pills to younger students. What do you do?

A.

Tell your teacher.

C. Stay away from the boy with the pills.
You are home alone (or with your brother or sister) and a man
knocks on the door and says he wants to read the electric meter.
He is not wearing a uniform. What do you do? (A good alterna­
tive situation is to have the man wearing a uniform. Appropriate
responses would probably not be different.)
A.
B.

......

Ask if the message needs an immediate response, and tele­
phone your parent if it does.

™ B. Tell your parents even if you told the teacher.

3.

he ™le'"r unhelpM » »

. ask others for help

You are home alone and the telephone rings. A voice on the
other end asks if your parents are home. What do you do?

Always keep the doors locked.
Do not open the door to anyone without permission from
a parent.

C.

Tell the man to come back later when your parent can come
to the door. Do not let the person know your parents

8.

are away.
D.
Use the telephone to call a neighbor and ask for assistance.

4.

5.

Someone comes up to you and says that your parent is sick and
you are to go with him. What do you do?

A.

If at school, go to the principal or your teacher for assistance
and verification.

B.

If at home, or somewhere else, call the emergency numbe^'l
parent’s employer, neighbor, close relative—for assistance and
verification.

C.

Do not go anywhere without proof from someone in
authority who you have been told to trust.

Yell “STOP THAT” as loudly as you can.

B.

Run out of the room as quickly as possible.

C.
6.

Tell your parents, a police officer or security guard, or other
adult (such as your teacher) what happened.

You are walking to school in the rain. A car stops and its driver
asks if you want a ride. What do you do?

Avoid the man and tell him in a loud voice, “NO! I don’t
want my picture taken!”

B.

Never go in to anyone else’s house without your parent’s per­
mission.

you and he will be the doctor and you are the patient. He tells
you to take off your clothes so that he can examine you. What
do you do?

A.

Keep your clothes on.

B.

If he persists, yell at him and get away.

C.

Tell your parents.

Situations for Older Children
1.

You get on a bus by yourself and a person sits down next to you
and puts his hand on your thigh.

A.

Stay away from the car—you do not need to go close to the
car to answer.

A.

B.

Unless you have your parent’s permission to ride with the
person, say NO.
Tell your teacher when you get to school and tell your paP

B.

C.

You are playing on the playground and an adult comes up to you
and asks you to help find his lost puppy. What do you do?
A.

If you do not know the person stay away from him and go
directly home.

B.

Even if you know the person, do not help. Adults should ask
other adults for help. Before you help, you must get your par­
ent's permission.

C.

Tell your parents what happened.
8

State in a clear, firm voice loud enough to hear, “No. Take
your hand off.”
Move to the front of the bus near the driver.
Tell the driver and tell your parents when you get home.

2.

ents when you get home.

7.

A.

C.
Tell your parents about the man.
I^four friend's older brother tells you that he wants to play with

You are in a public restroom and someone tries to touch you.
What do you do?
A.

You are walking down the street and a man comes up to you
and wants to take your picture. He asks you to come to his
house. What do you do?

While collecting on your paper route, a woman customer offers
you a beer, puts her arm around you, and says what a fine body
you have.
A. Tell her, “I don’t like that, take your arm off me."
B.

3.

Tell your parents when you get home.

A friend of your cousin offers you a ride home, but instead of
taking you home, he drives down a dead-end street, parks, and
starts rubbing his hand on your leg.

A. Tell him NO in a firm loud voice.
9

B. Get out of the car and go to the nearest telephone—if too far
to walk home—and call your parents or the local police.
C.

4.

Tell your parents what happened.

You are baby-sitting for a family who got your name from the
bulletin board at the grocery store. They return late at night, and
apparently they have been drinking. As you are being driven
home, your employer makes suggestions that make you feel
uncomfortable.
A. It’s dangerous to advertise on the bulletin boards and nev^ppers. It is much safer to babysit for people you know.
B. Do not babysit for these people again.

C.

Tell your parents what happened.

Exercise 3: Child Abuse and
Being a Good Scout
When a boy joins the Scouting program, he assumes an obliga­
tion to be faithful to the principles of Scouting as embodied in the
Cub Scout Promise, Law of the Pack, Cub Scout motto, Scout Oath,
Scout Law, Scout motto, and Scout slogan.
The principles of Scouting do not require that a Scout place himin potentially perilous situations—quite the contrary, we want
Sluts to "be prepared” and “do their best” to avoid these situations.

We hope that you will discuss these with your Scout and be sure
that he understands the limitations to the requirements in considera­
tion of the rules of safety.

Cub Scouts

Exercise 2: My Safety Notebook
This exercise will help your child be prepared to avoid situations
that could lead to abuse or molestation. The safety notebook can be
a loose-leaf notebook or pages fastened with staples for which he
has made an original cover. (Credit may be given for Bear Elective
9: Art, and Webelos Artist activity badge.)
The safety notebook provides a place your child can list emer­
gency telephone numbers, including parents’ work numbers and a
neighbor or friend’s number to be contacted when parents are
unavailable. (Credit may be given for Wolf Achievement 4: Know
Your Home and Community.) In addition, your child can list the
safety rules that you have discussed with him. Encourage him to^

The Cub Scout Promise includes the phrase, “to help other
people.” This means that a Cub Scout should be willing to do things
for others that would please them, but only when his parents have
given permission, and know where he is and who he is with.
The Law of the Pack includes the statement, “The Cub Scout fol­
lows Akela.” Akela is a good leader and should never ask the Cub
Scout to do something that the Cub Scout feels bad about. If Akela,
who may be a teacher, coach, or other youth leader, ever asks the
Cub Scout to do something the Cub Scout thinks is bad, the Scout
has the right to say NO! and will tell his parents.

Scouts

decorate each page with pictures and drawings that illustrate some
of the rules.
He also may want to list other kinds of safety guidelines such as
rules for bicycle safety. (Credit may be given for Wolf Achievement
9: Be Safe at Home and on the Street, Bear Achievement 14: Ride
Right, and Webelos Readyman activity badge.)
"My Safety Notebook” is intended to be a fun activity for getting
across some serious concerns. It is a personalized reference source
that can reassure your child that he knows how to respond when
confronted by a potentially dangerous situation.

The Scout Oath includes the phrase, “to help other people at all
times.” The Scout Law says that a Scout is helpful, and the Scout
motto is “Do a Good Turn daily.” There are many people who need
help and a Boy Scout should be willing to lend a hand when
needed. Sometimes, people who really do not need it will ask for
help to create an opportunity for abuse. Boy Scouts should be very
familiar with the rules of safety so that they can recognize situations
to be wary of. For example:

10

11

• It is one thing to stand on the sidewalk away from the car to give
directions and something else to get in the car and go with the

person to show them where to go. A Scout should never get into
a car without his parent’s permission.

exercises could be done as part of a family meeting, as could the
development of safety rules for the safety notebook.

• It may be okay for a Scout to help carry groceries to a person’s
house, but he should never go into the house unless he has per­

Basic Rules of Safety for Children

mission from his parents.
The Scout Law also states that a Scout is obedient—but a Scout
does not have to mind an adult when that person tells him to do
something that the Scout feels is wrong or that makes the Scout feel
uncomfortable. In these situations, the Scout should talk with his^j.
parents about his concerns.

Exercise 4: Plays and Skits
Children might enjoy creating a script for a play or skit that will
dramatize their understanding of the safety rules. The skit may then
be presented to other children as a service project. (Credit may be
given for Wolf Elective 2: Be an Actor, Webelos Showman activity
badge, and service projects for Boy Scout Star and Life ranks.) As a
parent, you can guide the creation of the script so that the situations
are reality based and show successful avoidance of abuse. It is
important that children feel that they can protect themselves.

Exercise 5: Family Meeting

As we address the basic rules for child safety, it is important to
stress that traditional cautions about strangers are not sufficient to
^wtect our children. Because the child abuser is usually known to
w child, a more appropriate protection strategy is based upon
teaching children to recognize situations or actions to be wary of.
Children should be taught:

• If you are in a public place and get separated from your parent
(or authorized guardian) do not wander around looking for him or
her. Quickly go to a police officer, checkout counter, the security
office, or the lost and found department and tell them that you
have been separated from your parent and need help.
• You should not get into a car or go anywhere with any person
unless you have your parent's permission.
• If someone follows you on foot or in a car, stay away from him or
her. You do not need to go near the car to talk to the
people inside.

• Adults and older youths who are not in your family and who
need help (such as finding and address or locating a lost pet)
should not ask children for help; they should ask other adults.

The one most important step that parents can take to protect
their children from abuse is to establish an atmosphere of open <£’ munication in the home. Children must feel comfortable bringing ~
sensitive problems to their parents or relating experiences in which
someone approached them in an inappropriate manner or in a way
that made them feel uncomfortable. Studies have documented that
over half the abuse of children is never reported because the victims
are too afraid or too confused to report their experiences.
It is important that your children be allowed to talk freely about
their likes and dislikes, their friends, and their true feelings. One way
to create open communication is through family meetings at which
safety issues can be addressed by the entire family. (Credit may be
given for Webelos Family Member activity badge.) The “what if"

• You should use the “buddy system” and never go anywhere alone.

12

13

I ways ask your parent’s permission to go somewhere, especially
into someone else’s home.
• Never hitchhike.

• Never ride with anyone unless you have your parent’s permission.
• No one should ask you to keep a special secret. If this happens,
tell your parents or teacher.
• If someone wants to take your picture, tell your parents or
teacher.

• No one should touch you in the parts of your body that are cov­
ered when you wear a bathing suit (unless it is your doctor while

treating you or during a physical examination), nor should you
touch anyone else in those areas. Your body is special and
private.

• You have the right to say “NO!" to someone who tries to take
you somewhere, touches you, or makes you feel uncomfortable in
any way.
These are some simple safety rules that can be approached in
the same non-frightening manner in which you tell your child not to
play with fire. They emphasize situations common to many child
molestation cases.

Section 2
Youth Protection:
Drug Abuse
Our country is in the grip of a drug abuse crisis. We are seeing
only 9, 10, or 11 years old—playing a deadly game of Russian
lette with their hearts, their livers, and in particular, with that
most marvelous and delicate organ, their brains. Our brains are bet­
ter by far than any computer man can invent. Let’s say you have a
computer with 64K memory, and you blow out half the circuits. That
computer may still be able to perform some simple functions, but it’s
never going to be able to do the complex, sophisticated tasks it was
designed to do. That’s true of your brain, too.

What are Drugs?
A drug is a chemical substance that can be absorbed in the
body. All drugs, legal and illegal, can kill if improperly used.
Illegal drugs are sold unlawfully on the street. Legal drugs are
prescribed by a doctor.
Cigarettes are drugs! Beer is a drug! Cocaine and crack are
Ags! All drugs can be addictive. Once a person tries them, he or
sre builds an appetite for them. They can be dangerous and deadly,
and burn out the brain.
Drugs can produce a pleasurable effect on the mind and fool a
person into thinking he or she feels better, or acts better, or thinks
better, or plays games better. At first, that may seem to be true—but
each time the person takes a drug, he or she will fail to perform as
well as before.
No. 1 Killer: Tobacco. Tobacco is the number one killer drug and is
directly related to the death of almost four hundred thousand people
each year! Every day more than three thousand teenagers start
14

15

smoking. After age 20, every pack of cigarettes can shorten a per­
son’s life by 137 minutes. Nicotine in cigarettes clogs blood vessels,
shortens breath, and more. Chewing tobacco can give a person
mouth cancer.

No. 2 Killer: Alcohol. Alcohol is in wine, beer, cocktails, and wine
coolers. Beware! One can of beer contains as much alcohol as 1
ounce of liquor. One can of beer can affect a person’s reasoning,
judgment, breathing, and body coordination, and can cause dizziness
and a fuzzy head. After five beers a person is legally intoxicated^.:
and it takes as much as three and a half days to recover reflexe?
and normal brain function.
No. 3 Killer: The mixture of marijuana, beer, and drioing. As kids
get older, some are tempted to try marijuana and beer. Beer or
other alcohol and marijuana taken together can cause a drug over­
dose. Each doubles the effect of the other. For example: one mari­
juana cigarette (joint) plus one beer is like drinking three beers or
smoking three and a half joints.
Other Killer Drugs: Cocaine: Once a person becomes hooked on
cocaine, he or she can’t control the need for more. Cocaine reduces
performance. For some, cocaine seems to improve performance the
first time it’s used. But performance drops off and the user (abuser)
doesn’t know it or believe it because cocaine fools the brain into
thinking one is doing great. Wrong! Real performance gets worse
and worse every time it's used.

Steroids: It is a popular myth that using steroids will improve perfor­
mance. Steroids have many bad effects for young people. They
increase weight and strength, but can cause wide mood swings and
aggressive behavior, acne and pimples, bone damage, and a
decrease in sex drive.
Marijuana: This is most commonly used by teenagers who start
experimenting with drugs. It contains a mind altering substance that
stays in the brain one month after smoking one marijuana cigarette.
It often leads to other, more serious, drug usage.

Join the Crusade Against Drugs
Drug and alcohol abuse is the most serious threat to the well­
being of our children and to their future. Alcohol is America’s num­
ber one drug problem among youth. Using alcohol, a “gateway"
drug, usually precedes using other drugs. It kills approximately ten
thousand young people, 16 to 24, in alcohol-related accidents of all
kinds, including drowning, suicides, violent injuries, homicides, and
injuries from fire. Tens of thousands of teenagers are frequent
^hkers. Other thousands smoke, snort, and inject illegal drugs with

frightening regularity.
Now there is evidence that the drug menace is dipping even
lower on the age scale. Growing numbers of preteen children are
experimenting with alcohol and drugs.
The Boy Scouts of America has joined the national crusade to
combat drug and alcohol abuse.

How Bad Is the Problem?
Our teenagers use far more drugs than those of any other devel­
oped nation. High school drop-out rates are rising as much as 54
percent in some city schools. Much of this is drug related. Drug abuse
is slightly lower in rural areas, but not much; it is a national scourge.
We all know there’s a problem, but how big is the problem,
really? Do we have any statistics, any figures? According to recent
surveys by the National Institute on Drug Abuse (NIDA):
i^bout 61 percent of high school seniors have tried an illegal drug.
Wkbout 40 percent have tried an illegal substance other than
marijuana.

• By the senior year of high school, 17 percent of our nation’s
youth have tried cocaine. Six percent use cocaine at least once a
month.
• Twenty-six percent of seniors smoke marijuana.
• One in 20 seniors drinks alcohol, and 37 percent have had five or
more drinks in a row at least once in the prior two weeks.

Note: The first use of alcohol and illegal drugs can lead to serious
trouble, even death. Diet pills are drugs too, and very dangerous.

• Two out of five high-school senior boys admit having been drunk
in the past year.

16

17

• Thirty percent of seniors have smoked cigarettes, and 20 percent
are daily smokers.
• By the twelfth grade only about 10 percent of youth have never
used an illegal substance.
Although there is some good news indicating that older
teenagers—high school and college students—are now using fewer
drugs than they did in the early 1970s, there is also some really bad
news. Kids are experimenting with drugs and alcohol at earlier ages.
Today one in six 13-year-olds has tried marijuana. Many admit har,
ing used alcohol and pot before they were 12—too young to kno"
that they have joined a deadly game.
No question there’s a problem—a problem so vast we may feel
helpless. But there are things we can do, things that can affect those
closest to us—our families, our Scouting friends, our neighbors and
neighborhoods. Things that, as prevention, could make more differ­
ence than we would ever know.

Why Children Use Drugs

What Scouting Units Can Do
One of the primary goals of the Boy Scouts of America is physi­
cal, mental, and moral fitness. Many activities in Cub Scouting, Boy
Scouting, Varsity Scouting, and Exploring bear directly on that goal,
and so they offer innumerable opportunities for educating our mem­
bers about alcohol and drug abuse. Here are some examples.

•Cub Scouting
^)en leaders can use advancement requirements to lead into a dis­

cussion of the dangers of alcohol and drugs and how boys can
resist them. For example, boys working on Wolf rank are asked in
Achievement 12 (Making Choices) to tell what to do if they are
offered pills in the schoolyard. Boys working on Bear Achievement
7 (Law Enforcement Is a Big Job) may learn why it is so impor­
tant for the police to control drug trafficking. The den leader could
arrange a den visit to a police station to talk with an officer about
it. For Webelos Scouts, the Fitness activity badge requirements
encourage boys to resist peer pressure to try alcohol and drugs.

Wanting to fit in with other kids has always been the norm
among youth. Remember your childhood? Was it not the same?
Well, it is exactly the same with today’s children.
Most youth want to do things that are "in." If drugs and alcohol
are the "in" things to do, they will want to try them. A recent sur­
vey showed that:

• Den leaders and Cubmasters may use an occasional leader’s “min­
ute” to talk about the dangers of drug abuse. Avoid preachiness
but make the point that the best “highs” come from the fun
of Scouting, other youth groups, and sports—not from alcohol
and drugs.

• For all children who smoke marijuana, the most important reason
is "to fit in with others.”

In Boy Scouting and Varsity Scouting
•Adult leaders and older Scouts can use the requirements for the
^rersonal Fitness merit badge to lead Scouts to understand the dan­

• For fourth- and fifth-graders, the second most important reason is
“to feel older.”
• For those in grades six through twelve, it’s “to have a
good time.”
Fourth-graders are greatly influenced by television shows and
movies that glamorize alcohol and drugs—even though only the
bad guys use them. From fifth grade on, peer pressure is the pri­
mary influence on children who try alcohol and drugs.
These facts tell us that if we are going to stop the deadly game,
we should start with Cub Scout-age children.
18

gers of drug abuse. A high school coach or Personal Fitness merit
badge counselor might moderate a troop discussion about drugs
and alcohol:

• Candidates for Star, Life, and Eagle rank could be encouraged to
give service to parents’ groups and community centers that are
fighting drug abuse among youth.
• The Scoutmaster or Coach might focus on drug abuse for an occa­
sional Scoutmaster’s minute or Coach’s corner.

19

TRUE OR FALSE? Heroin is addictive, but cocaine

In Exploring
Explorer groups can go into school classrooms in the lower
grades to make presentations on drug abuse. They are particularly
effective for Cub Scout- and Boy Scout-age groups. The younger
boys look up to them.
If there is such an Explorer post in your area, it could be
invited to present the program for your pack, troop, team, or post.
Check with your local council service center.
Your unit may also get help from local parent and youth groups
that are fighting drug abuse.

is not.
FALSE! Cocaine is addictive to many of the people who try
it. When people are addicted to heroin, alcohol, or ampheta­
mines, they go a little crazy when they can’t get it. It’s the
same with cocaine addicts. They'll do just about anything to
get drugs—things they wouldn't dream of doing if they wer­
en't addicted—like lying and stealing.

TRUE OR FALSE? The effects of marijuana wear off in
a few hours.

What Parents Can Do
About Drug Abuse

FALSE! The feeling of being high may last for only a few
hours. But we now know that a person's ability to do compli­
cated tasks can be affected for as long as twenty-four hours.
Even if someone is smoking only after school, he or she
may eventually find it harder to concentrate during regular
school hours.

As a caring parent—the greatest influence on children—you also
can help your children resist the lure of alcohol and drugs by doing
the following:

1.

Squelch the notion that drug abuse “can only happen to other
people's kids.” The truth is that it can happen to anybody’s kids.

2.

Teach your children that using drugs is wrong, harmful to their
growing bodies, and illegal. You can set the example by not
using drugs yourself.

3.

Supervise their activities outside the home as much as possible.
Know who their friends are and what they’re doing.

4.

Talk with your children about their interests and problems. Listen
to them. If they can open up to you, they are much less likely to
turn to alcohol and drugs for relief from problems.

5.

Learn the signs of drug use and respond promptly if you observe
any in your children. The earlier a drug problem is spotted and
faced, the easier it is to overcome.

6.

Ask your local council service center (see Boy Scouts of America
in your telephone book) for a copy of the booklet Drugs: A
Deadly Game. It contains practical ideas for family- and Scoutingrelated projects and discussions. Sample these, for instance:
20

7.

Ask your local council service center if you may borrow the
video Drugs: A Deadly Game. Show this to your family and

then discuss it.

8.

Be alert for press, television, and radio features on drugs.
Watch, read, and listen together, then discuss what you learn.
Consider taping television and radio programs for further use.

9.

Discuss with your children how the use of drugs, including alco­
hol and tobacco, could seriously handicap their physical and
mental capacities. For example, in Scouting, attempts to pass
advancement requirements such as physical fitness, hiking,
swimming, Personal Fitness merit badge, etc., would be greatly
hindered.

10.

Is there a drug abuse hotline in your community? Ask a repre­
sentative to explain how the hotline deals with callers who

need help.

21

The Signs of Drug Abuse
A child under the influence of alcohol or other drugs may have
various symptoms, depending on the substance. But for all drugs,
you are likely to observe slurred or incoherent speech, memory
lapses, and indifference to hygiene and grooming.
Most people recognize alcohol abuse because of the pronounced
odor. For other common drugs, look for the following signs:

• Marijuana. Bloodshot eyes, dry mouth, increased appetite. Coig^
prehension and short-term memory may be impaired. Coordin"'
tion may be reduced.

• Cocaine and Crack. Dilated pupils and stuffed or runny nose.
Respiratory and heart rates speed up. Crack users may suffer
insomnia, loss of appetite, paranoia, and seizures.
• Inhalants (laughing gas, aerosol sprays, solvents, others). Inhaling
them causes nausea, sneezing, coughing, nosebleeds, and loss of
appetite and coordination. Some inhalants also cause headaches
and involuntary passing of urine and feces.
• LSD and PCP (phencyclidine). Dilated pupils, hallucinations,
higher heart rate and blood pressure, loss of appetite, sleepless­
ness. PCP users have incoherent speech, dulled senses, and poor
coordination.
• Heroin and Other Narcotics. Feeling of euphoria often followed
by drowsiness, nausea, and vomiting. Users may have constricted
pupils, watery eyes, and itching.

*

If You Suspect
Drug Abuse
If you have reason to believe your child is using drugs or alco­
hol, face the problem. Don’t ignore the signs. Your child needs help.
Experts recommend that a parent who observes signs of drug
abuse should:

• Impose disciplinary rules that remove the child from the circum­
stances where drug abuse might occur (perhaps a curfew, closer
supervision, or forbidding the child from seeing certain friends).
• Seek advice and assistance from a drug treatment professional
and from a parent group.

Family Discussions
9 ■t’s important to keep the lines of communication open within

the family. An environment that is supportive of adolescents is cru­
cial. Things that have nothing to do with drugs—like someone to
talk to—may be the real deterrent to drug abuse.
Discussing the different myths about drug use is a good way to
get children to open up. Listed below are several myths that parents
can discuss with their children:

Myth No. 1: You won’t become addicted to cocaine with casual use.
Fact: The two million cocaine addicts will tell you differently. The
up-and-down cycle of the cocaine user who always needs more to
get a kick is often started with casual use and often continued with­
out the user knowing he or she is becoming addicted.

Myth No. 2: One time can’t hurt you.
Fact: More potent, more available, and more lethal than ever,
cocaine, heroin, and a rapidly increasing list of synthetic drugs can
ita-eaten the life of even a first-time user. Cocaine, once thought to
less dangerous than other drugs, accounted for more than 350
deaths in 1986. Today's marijuana has three times the amount of
THC (the main mind-altering ingredient in marijuana) than marijuana
that was available in the 1960s and early 1970s.

Myth No. 3: The most dangerous drugs have been outlawed.

• Discuss the problem with the child in a calm, objective manner.
Do not confront the child while he or she is under the influence
of drugs.

Fact: New synthetic “designer” drugs are being marketed amazingly
fast so that, as one drug expert noted in U.S. News and World
Report (July 28, 1986), "These drugs haven’t been tested. No one is
even sure about the toxic effects. But people are still lining up to
buy them.... The public is taking the role of guinea pigs.'

22

23

Additional family discussions can focus on the following:
1. Discuss what someone would look like if he or she were using
cocaine, marijuana, or alcohol, or smoking cigarettes.

2. Discuss different ways of saying “no” diplomatically but firmly,
without feeling embarrassed.

3. Discuss peer pressure and how peers affect decision making. Ask
your children to think of some examples in which friends
influenced their decision about something.

e

Section 3
How to Communicate
with Kids
Communicating with kids—yours or someone else’s—isn’t all that
Ay, particularly when the subject is something like drugs or child
abuse. It’s not easy, but neither is it impossible, especially if you
keep these tips in mind:
• Establish rapport. Rapport comes from a record of friendly, honest,
face-to-face adult/kid relations. Welcome their suggestions. Laugh
at their jokes. Downplay the lectures. Stay flexible—but stay firm.

• Don’t wait till there’s a problem. Play and work and talk together
as part of the normal, day-to-day routine. Then, when a problem
hits, you can communicate.
• Whenever possible, join the group your kid joins—or at least work
closely with it. Sign up as a leader in your boy’s Cub Scout pack
or Boy Scout troop, for example. This not only gives you chances
to have fun together, but also puts you in a position to help
choose the other leaders, stress the values important to you, and
influence the program.

• Use peer pressure—the influence of kids on other kids—to help
get your message across. A street gang, school group, ball team,
Cub Scout pack, Boy Scout troop, or Explorer post can turn a
^^outh on—or off. Guide the majority—or the influential minority—
toward the right attitudes and actions. And they, perhaps without
conscious design, will begin working on the rest.

24

25

Section 4
Scouting’s Weapons for
Youth Protection

National Center on Child Abuse and Neglect
U.S. Department of Health and Human Services
P.O. Box 1182
Washington, DC 20013
703-821-2086

“It is time,” writes Chief Scout Executive Ben Love, “to take an
active role in the betterment of our world. We must wholehearte^
accept our responsibility to protect the weak, the needy, and the
destitute.”
Has Scouting a weapon for such an active role? Indeed, it has
two weapons, in fact.
The first is a weapon we call service. In Scouting it’s also known
as goodwill, the Good Turn, and helping others.
The second weapon packs a different kind of punch, but its
power can be impressive. We're talking about the power Scouting
seems to have to get inside the heads and hearts of the young and
produce certain miracles: for example, a discernible movement
toward responsibility, a tendency to care more about others and
more about themselves, too—the way they think, act, and talk.
In a word, we’re talking about growth. A growth, stimulated by
Scouting, that moves young people closer to becoming productive
adults. Perhaps someday we can live in a world that is free from the
scourge of child abuse and the devastation of drug abuse.

e

National Resources
Many communities have alcoholism counseling and drug treat­
ment programs for youth. To find those in your area, look in the yel­
low pages under “Alcoholism Information and Treatment Centers”
and “Drug Abuse and Addiction—Information and Treatment.”
For more information about drug, alcohol, or child abuse, con­
tact the following:

26

National Committee for the Prevention of Child Abuse
332 South Michigan Avenue, Suite 950
Chicago, IL 60604-4357
®-663-3520

National Center for Missing and Exploited Children
2101 Wilson Boulevard, Suite 550
Arlington, VA 22001
800-843-5678 (toll-free)
National Network of Runaway and Youth Services
1400 1 Street NW, Suite 330
Washington, DC 20005
202-682-4114

PRIDE (Parent’s Resource Institute for Drug Education). PRIDE refers
concerned parents to parent groups in their state or local area and
tells how to form such a group. It also provides telephone consulting
and referrals to emergency health centers. Call, toll-free,
1-800-241-9746.

f^ional Federation of Parents for Drug-Free Youth (NFP). This
is a national information and referral service that focuses primarily
on prevention of drug abuse by youths. It also assists anyone con­
cerned about a child already using alcohol or drugs by referring the
caller to a state or local group. Call, toll-free, 1-800-554-KIDS between
9 a.m. and 5 p.m. eastern time.

National Institute on Drug Abuse (NIDA). This national informa­
tion service provides technical assistance for anyone wishing to start
a drug prevention program. NIDA is focusing on the establishment of
“Just Say No to Drugs” clubs. Call 301-443-2403.
27

NIDA Hotline. This confidential information and referral line directs
callers to local cocaine abuse treatment centers. It also offers free
materials on drug abuse. Call, toll-free, 1-800-662-HELP.
Cocaine Helpline. Reformed cocaine addicts offer guidance and
refer drug abusers and parents to local treatment centers and family
learning centers. Call, toll-free, 1-800-COCAINE.

National Council on Alcoholism and Drug Dependence, Inc.
(NCADD). This national, nonprofit organization combats alcoholic?
other drug addictions, and related problems through its national T?
office, two hundred state and local affiliates, and thousands of volun­
teers in communities throughout America. Call 212-206-6770 (New
York) or 202-737-8122 (Washington, D.C.).
BSA Local Council Service Center. See Boy Scouts of America in
your telephone book.

BSA’s “Drugs:
A Deadly Game” Materials
• Drugs: A Deadly Game—eighteen-page, full-color booklet
• Drugs: A Deadly Game—videocassette (VHS)
• Drugs: A Deadly Game Teacher’s Guide

• Drugs: A Deadly Game—full-color poster (23" x 32")—features a
body chart that explains, in graphic form, the impact of drugs on
different parts of the body.
Note: These items may be ordered through your BSA local council
or by contacting the Drug Abuse Task Force, Boy Scouts of America,
1325 West Walnut Hill Lane, P.O. Box 152079, Irving, TX 75015-2079.
28

S/fW^IU
Programme on Adolescent Mental Health
SEA/MENT/129(B)
Distribution: Limited

Trainers' Guide for
Adolescent Mental Health Promotion:

Alcohol Use and Abuse

Health and Behaviour Unit . ~
Department of Sustainable Development and Healthy Environments
World Health Organization
Regional Office for South-East Asia
New Delhi
October 2002

I

CONTENTS

Page.
RAPPORT BUILDING WITH ADOLESCENTS.......................................................... 3

ACTIVITY 1 - DISCUSSION OF SITUATIONS OF ALCOHOL USE.......................... 5
ACTIVITY 2 - UNDERSTANDING ABOUT ALCOHOL AND ALCOHOL ABUSE....... 9

ACTIVITY 3 - EFFECTS OF ALCOHOL ON THE BODY........................................ 11
ACTIVITY 4:- MYTHS AND MISCONCEPTIONS ABOUT ALCOHOL..................... 13
ACTIVITY 5: IMPACT OF ADVERTISEMENTS....................................................... 17

ACTIVITY 6: ROLE PLAY: HOW TO SAY NO TO ALCOHOL................................ 19
CONCLUSION:.................................................................................................. 21

Annexes

WAYS TO SAY NO..............................................................................................22

STEPS IN REFUSING

..............................................................23

Page Hi

INTRODUCTION

Inform the adolescents that the group is going to have a session on understanding
and learning about the use and abuse of alcohol.
Note to the trainer: The fact sheet on alcohol use and abuse should be
distributed after the Session is over.
Before proceeding, please reassure the adolescents and establish the
guidelines for the session:

All responses will be kept completely confidential within the group.
Only issues and not individual persons will be discussed.
All are encouraged to participate and to share their personal experiences,
but they have the right not to respond.
> Under no circumstances should any adolescent be allowed to laugh at or
pass comments on the response of another adolescent
> Each adolescent should listen to others without interrupting.
> There are no right or wrong answers.

>
>
>

Explain to the adolescents the objectives of the session, which are:
>
>
>
>

Understand about the use and abuse of alcohol.
Learn about the effect of alcohol on people's behavior.
Examine the myths connected with alcohol.
Learning how to say NO to alcohol.

Session structure:

The session is divided into two, Phase I and II. Phase I deals with understanding
and sensitization of the issues on alcohol. It takes about one hour. In Phase II, the
adolescents will focus on experiential learning by practical demonstration on how
to stay away from-alcohol.

Page 1

Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

You will need 6"x3" index cards of at least three colours, two each per
adolescent, a board to paste the responses on, glue sticks, and markers. If index
cards are not available, the participants can write their responses on the
blackboard.

The session is based on questions and answers, discussions and role-play
activities. The role-play activities can be modified to make them relevant to the
local culture.
Annex 1 and 2 are to be given to adolescents for use during indicated
activities.

The text is divided into six activities. Each activity has learning objectives,
information to the trainer, the process to implement the activity, questions to the
adolescents and possible responses. Each activity is linked to and leads to the
next, so it is best to do them in order.

Page 2

Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

RAPPORT BUILDING WITH ADOLESCENTS

Learning outcomes:

The adolescents will feel reassured and comfortable, and will be able to mingle
with one another and share some of their ideas about alcohol use.

Information For Trainers:
Breaking the walls between the participants as well as between the participants
and the trainer is very important for the success of the session. Whatever the
adolescents perceive or understand, they need a platform to share. The warm-up
session facilitates the process of sharing.

Process:
Soon after adolescents enter the classroom, make them stand in a circle and ask
each person:

>

>
>
>

What is their first impression about a person who is drinking alcohol?
How is it different from a person having a soft drink?
If they were to interact with a person consuming alcohol, what kind of
conversation will they have with that person, will it affect the nature of
conversation?
Ask them to narrate one behaviour of that person when he is drunk.
How do they identify a person who is drunk?

Possible responses:
(1)

First Impression:

>
>
>
>
>

When I see a person drinking alcohol, I feel he /she must be very modern
or fashionable.
I think it is a sign of changing times, people drink alcohol instead of juice.
I feel very sad for the person's family.
I feel frightened that the person may become violent and attack me.
I think the person is a failure in society.
Page 3

Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

>
>
(2)

Interaction/conversation:

>
>
>
>
(3)

Conversation may be very restricted.
Conversation may not make sense.
There may be physical advances especially to the opposite sex.
Cannot take what they say seriously.

Behaviour of a drunk person:

>
>
>
>
(4)

A person drinking a soft drink is simple and docile.
Soft drinks are out of fashion and only for girls.

Using abusive language.
Shouting.
Criticizing.
Incoherent speech.

A drunk person:

>
>
>
>
>
>

Lying on the road unconscious.
Red eyes and foul breath.
Cannot walk straight and keeps falling down.
Incoherent speech.
Vomiting.
No self control.

Assessment of activity:

Assess if the students are comfortable with each other and with a sensitive topic
such as alcohol use. If yes, proceed to the next activity. If no, try to determine
what they are still uncomfortable with and spend some more time discussing
these issues.

Page 4

Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

ACTIVITY 1 - DISCUSSION OF SITUATIONS OF ALCOHOL USE

Learning outcomes:
Adolescents will understand and have a mental picture of a person who abuses
alcohol.

Information for trainers:

Please refer to the fact sheet and be familiar with the Section on what is harmful
use of alcohol, alcohol abuse, rural alcohol consumption, impact of alcohol on
women, consequences of alcohol use and what can be done about alcoholrelated problems.
Process:

(A) Ask 4 adolescents to volunteer to read out one of the following case
studies each:

(1) Phoolchand was the owner of a small teashop. He lived with his wife and
two children. His wife, Kamala, was a housemaid. One day a group of 4 to
5 people came to his shop. They started coming regularly, and as the days
passed, they became good friends of Phoolchand. He started closing his
shop early, and to spend more time with them in the evening. They would
sit till late at night drinking alcohol and it soon became a regular affair. As
a result, he soon lost interest in work and family duties. He became an
abusive husband and started hitting Kamala and his children. He no longer
had control over his temper and actions. He started spending all his
earnings on alcohol.
(2) There was a couple named Tony and Tanya. They were both blessed with
good looks and belonged to very good families. Both were well mannered
and talked very politely to everyone. Tony was a defense officer and Tanya
was a housewife though she was a highly qualified women. They both
regularly had social evenings and attended parties but never drank alcohol.
Tanya became close friends with a senior officer's wife, who was also well
educated. Tanya started confiding in her. One afternoon Tanya came
running to her friend's house and began to cry and narrated the complete
story of her married life, which was very different and shocking from what

Pages

Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

(4)

it seemed to everyone. She said Tony was an alcoholic. He tortured her
everyday with cigarette butts, after consuming 8 to 9 pegs of alcohol at a
stretch. He was highly suspicious of her and would hit and threaten her.
She was helpless and needed a solution.
Mona, a good-looking, highly qualified professional woman believed that
drinking alcohol reduced her stress. The stress she faced was in her
professional life. She would spend a couple of hours in the bar everyday
and after two or three drinks would head back home. While driving, she
would sometimes get caught by the police for driving very rashly. She had
several accidents. Can any solution be found?
Anchal is a student of tourism and hospitality management living in a
hostel. She was the only daughter of her divorced parents. She would
often get calls from her mother and father, who would say bad things
about the other parent. She was totally fed up with everything. She loved
them both and wanted them to be together. This was a dream, which
seemed far from reality. As days passed by, she began to spend more time
with friends to divert her mind from tensions. She soon began to drink a
glass or two of beer, which soon led to consumption of stronger alcoholic
drinks. She then felt the need for it everyday and began having it in her
room in the hostel. One of her friends wanted to help her but did not
know what to do.

(B)

Ask the adolescents the following questions on each case study:

(3)

Case study-1

>
>
>
>

Do you know people like Phoolchand? If yes, share what you know.
How did he get drawn into the habit of drinking alcohol when he was a
happy and economically sound person?
Should one blame Phoolchand or his friends for Phoolchand's drinking
habit?
What can be done to make Phoolchand look after his family?

Case study-2

>

Page 6

Tony and Tanya's behaviour in public is so deceptive. Is this the right
thing for them to do?

Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

>
>

Does Tony hate his wife, or is alcohol perverting him to torture his wife?
Can we blame alcohol for his behaviour?
What should Tanya do?

Case study-3

>
>
>

is Mona's recourse to alcohol to release stress appropriate? Will alcohol
help her?
Can you think of other ways to release stress?
Who would be the best person to help Mona: she herself, her friends or
family?

Case study-4
>
>
>
(C)

How does Anchal feel about her parents criticizing each other? Is it
common in many houses?
Can Anchal concentrate on her studies?
How can Anchal's friend help her to get out of the habit of consuming
alcohol?

Ask them:

Do you feel Phoolchand, Tanya, Mona and Anchal would be able to function
effectively and efficiently if they were to give up alcohol?
(D)

Possible responses:

Case study 1

>
>

>
>
>

Yes, we know of many people like him, my maid's husband is like that.
People initially start drinking during a ceremony or festival. Sometimes,
they join a group of friends. However, some people begin to drink
alcohol regularly.
May be, his friends pressurized him.
One should blame both, Phoolchand and his friends for Phoolchand's
drinking habit.
Counselling can be done, Phoolchand can go to a de-addiction centre,
sometimes religious centres can help.

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Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

Case study 2

>

>

>

Tony is trying to keep his bosses happy and not know his bad habits.
Tanya should not tolerate this behaviour, she should try to get help for
her husband.
A person is not responsible for his behaviour when drunk. TRAINER:
Discuss: Drunk or not drunk, a person, is responsible for his behaviour.
Tanya should become stronger and needs support to be assertive and not
take any nonsense.

Case study 3

>
>
>
>
>

Mona is stressed because of her work. This is what international
competition has done.
She wants to compete and be professionally good.
Alcohol will ruin her, not relax her.
She can go for a walk, or workout or read or do social work.
Mona, herself, her friends and family can all help in their own way.

Case study 4
>
>
>

After a bitter divorce, people often criticize the other spouse.
It will be very difficult for her to continue her studies, but somehow she
must think of herself.
Anchal's friends and other relations may be able to help her.

Assessment of activity:

Ask the adolescents if they have a mental picture of a person who uses too
much alcohol and some of the harmful effects from alcohol abuse. If they have no
further questions, proceed to the next activity.

Page 8

Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

ACTIVITY 2 - UNDERSTANDING ABOUT ALCOHOL AND ALCOHOL
ABUSE
Learning outcomes:

The adolescents will understand about alcohol and alcohol abuse.
Information for trainers:

Please refer to the Fact Sheet and be familiar with the Section on what is alcohol,
what is harmful use of alcohol, alcohol abuse, impact of alcohol on women,
different types of alcohol and their equivalent strengths, harmful effects of alcohol.
For this activity, you may wish to give the participants the information in the
fact sheets by writing it on the board. It is unlikely that adolescents will already
know the specific details about alcohol, its use and abuse.

A scientific discussion on this topic is the best way to inform children about
alcohol and its harmful effects.

Some common signs and symptoms of alcohol abuse
> Absence from school or work.
> Depression or unhappiness.
> Drinking in order to cope with personal problems.
> Drinking to overcome shyness.
> Loss of interest in family and friends.
> Loss of interest in activities which were once of interest.
> Difficulty in sleeping.
> Poor judgment.
> Drinking outside of a social setting.
> Showing up intoxicated in inappropriate settings.
> Drinking to build self-confidence.
> Mood fluctuations.

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Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

. >
>
>
>
>

Developing health problems.
Experiencing memory blackouts during or after drinking.
Usually drinking to the point of intoxication.
Feeling guilty about drinking.
Not fulfilling promises or obligations.

Can a person determine if they themselves are drinking too much alcohol?
A person can benefit greatly from simple introspection on whether increased
alcohol consumption could be affecting his/her life. Four simple questions which
comprise the CAGE test can help a person decide whether he/she may have an
alcohol-related problem. If the answer to two or more questions is 'yes', there is a
strong likelihood that the person needs help for the alcohol-related problem and
must seek help.

The CAGE test:
Cut down

1

Have you ever felt that you ought to cut down
on your drinking

Annoyed

2

Have people annoyed you by criticizing your
drinking?

Guilty

3

Have you ever felt bad or guilty about your
drinking?

Eye Opener

4

Have you ever had a drink first thing in the
morning to steady your nerves or get rid of a
hangover?

Another simple question which can help a person decide if they may have
an alcohol-related problem is to ask themselves, "Do I need a drink?" This
question may seem too simple, but if the honest answer is "yes", it suggests that
alcohol is affecting a person's daily life to the point that they cannot optimally
function without it. This is a good indication to seek help for their alcohol-related
problem.

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Process:
Please address the following questions:

>
>
>
>
>
>
>
>
>
>
>
>

>

What is alcohol, what are the different types of alcohol?
What is alcohol abuse?
What is alcohol dependence?
Can beer be as harmful as whisky?
Do you think alcohol is a problem for young people?
Is alcohol a problem for poor people?
Are women more vulnerable to adverse effects of alcohol?
What does alcohol do to your body?
Is it safe to drink and drive?
Describe some common signs and symptoms of alcohol abuse.
Is it possible for a person to determine if they themselves are drinking too
much alcohol?
Ask the adolescents to list how many medical complications of alcohol
they are aware of.
Ask the adolescents to list financial, occupational, familial, social and legal
complications of alcohol use.

Assessment of activity:

Ask the adolescents if they understand the harmful effects of alcohol use and the
term alcohol abuse. Please make sure that all their questions are adequately
addressed. If there are no further questions, proceed to the next activity.

ACTIVITY 3 - EFFECTS OF ALCOHOL ON THE BODY
Learning outcomes:

The adolescents will get sensitised to how alcohol affects the body and the effect
of various amounts of alcohol on bodily function. Information on harm that can
occur after consumption of different amounts of alcohol should be emphasized.

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Information for trainers:
Please refer to the Fact Sheet section on acute intoxication due to use of alcohol.
It is very informative for adolescents to know the meaning of "blood alcohol
concentration" (BAC).
Process:

Please describe to them some real life examples of what can happen at each level
of intoxication.
Effects on the body at different blood alcohol
concentrations (BAC)
Blood alcohol .
Effect on the body
concentration

20-30 mg/dl

Slight euphoria, extrovert behaviour, slight decrease in
analytic capability, slight impairment in skilled function,
increased risk-taking behaviour.

30-80 mg/dl

Moderate impairment of balance, speech, reaction time and
vision, judgement and self control reduced, reasoning ability
diminished.

80-200 mg/dl

Definite impairment of motor function and judgement.
Fluctuations in mood and increased risk-taking behaviour,
dangerous driving.

200-300 mg/dl

Marked slurring of speech, inability to carry out even simple
tasks, needs assistance in walking, severe mental confusion.

> 300 mg/dl

Loss of consciousness, convulsions and possible death

Assessment of activity:
Ask the adolescents if they understand about the effects of alcohol on the body. If
you are satisfied that they have understood, proceed to the next activity.

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Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

ACTIVITY 4 - MYTHS AND MISCONCEPTIONS ABOUT ALCOHOL
Learning outcomes:
Adolescents will learn about myths and misconceptions and the facts about
alcohol.

Information for trainers:
Most of us have some preconceived notions about alcohol. Some of these notions
are not true. These myths cloud our thinking and prevent us from accepting the
dangers of alcohol when it affects us, our friends or family. By dispelling these
myths, one becomes aware of the reality and can be motivated into action.
To distinguish between a myth and a fact, accurate information is necessary.
There are many myths and beliefs surrounding the use of alcohol and these need
to be corrected.
A myth is a widely held belief that is assumed to be true but which has
either not been tested or which has been tested and found to be false. A fact is an
idea, an event, or an experience, which has been tested and found to be true The
evidence for the truth of a fact can come from many sources - scientific research,
historical evidence, common experience, physical evidence, etc.

Do not tell the adolescents that the statements being read are myths. Make
sure they read the statements and understand what is being said.
MYTHS
V

He's too nice to be an
alcoholic.

>

Women can't be alcoholics.

>

He only drinks beer.

>

She's too young to be an alcoholic.

He only drinks after work.

>

1 never see him drink.

He's not always drunk.

>

She's too intelligent to be an
alcoholic.

>

He seldom misses work.

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Process:

>
>
>
>

>

Make the adolescents stand in a circle.
Give each of them a card with a myth printed on it.
Tell them that they should read it one by one.
Facilitate a discussion on each myth, after it has been read. Some probing
questions to facilitate discussion can include:

What do you think about what was said?
Do you believe what was said is correct?

>

>

>
>

Why do you feel the way you do?

Who says such things?
Each adolescent who desires to agree or disagree with a statement should
be given an opportunity. Special attention should be given to the source
of the idea expressed by the adolescent. From the discussion it will
appear that some adolescents agree with the statement and some do not
Exploring why adolescents believe what they do believe is important in
dispelling the myths. Scientific discussion and facts should be used in
trying to correct what they believe incorrectly.
After some discussion, record a vote of what the adolescents believe
about the statements concerning alcohol. Do not give the correct
answers, but keep the record until the end of the discussion.
Finally, show the true statements taken from the table below.
Discuss the myth and fact together.

Myths and Facts about alcohol:

Myth:

Alcohol stimulates a person to become more lively.

Fact:
Alcohol is actually a depressant of the brain and its function. There is a
common belief that it removes (depresses) inhibitions. Careful observation has
shown that "removing inhibitions" happens before alcohol levels in the blood
reach a noticeable threshold. Thus, the real reason for "removing inhibition"
appears to be anticipatory learned behaviour.
Myth: People who become aggressive and violent after alcohol use cannot control
their behaviour because it is caused by alcohol's action on the brain.

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Fact: Many people learn to associate certain moods and behaviours with the
alcohol effect and behave in a manner in which they wish to behave. The
behaviour then becomes 'conditioned'. People can learn to change the
conditioning. .
Myth: Alcohol enhances sexual performance and desire.

Fact: Shakespeare's quote that alcohol 'provokes the desire but inhibits the
performance' is well-known. Alcohol interferes with achieving erections. In
research studies, alcohol has been shown even to reduce sexual desire.
Myth: Alcohol promotes good sleep.
Fact: People dependent on alcohol cannot sleep well without alcohol. Those
who do not use alcohol regularly may have disturbed sleep after alcohol
consumption.

Myth: Alcohol helps people to forget their problems.
Fact: This has become a 'truth' because regular and heavy alcohol users often
say this is the reason why they drink alcohol. Very often the opposite is found to
be true - people bring up forgotten problems only when they are intoxicated.

Myth: Alcohol is a good way to cope with cold weather.
Fact: Alcohol dilates blood vessels and makes the skin feel warm. But in a cold
environment, the body tries to save heat by cutting down the blood supply to the
skin. Thus alcohol is not a good way to "warm up" in the cold. If a person is
exposed to the cold after consuming alcohol, there can be significant heat loss
from the body.
Myth: Beer is not "hard liquor", so it can be consumed safely.
Fact: Beer is an alcoholic beverage, although it contains a lesser amount of
alcohol than "hard liquor" like whisky or rum. Beer contains 4 to 8 per cent
alcohol. One 12-ounce bottle of beer is equal to one peg of whisky. Thus, if
somebody drinks six bottles of beer in an evening, he/she has consumed the
equivalent of six pegs of whisky.

Myth: Alcohol has been shown to be "good for the heart", so one should drink
alcohol every day.
Fact: There is some research which has shown the potential protective effect of
alcohol on the heart. This research has been based on consumption of small
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amounts of alcohol, mostly wine on a daily basis. Consumption of alcohol on a
daily basis is a matter of concern, as some people cannot control the quantity of
alcohol consumed. Consumption can gradually increase to dangerous levels.
Heavy alcohol consumption is certainly bad for the’ heart and the body.

Myth: He is really a good man, it's the alcohol which makes him abuse me.
Fact: When a woman is beaten by a husband while he is sober, she may consider
this as unacceptable. However, if he behaves in exactly the same manner after
drinking, she may forgive him and blame alcohol. Society's view of intoxicated
people makes it less risky to behave deviantly while intoxicated. However,
projects on prevention of harm from alcohol have shown that if society will not
tolerate unacceptable behaviour with or without alcohol, such behaviour ceases.
An unacceptable behaviour is unacceptable, with or without alcohol.
Myth: In our society, alcohol 'loosens up' people, so they enjoy themselves.
Fact: Most societies have set the norms for un-inhibited behaviour while
intoxicated. People appear to adhere strictly to these norms and rules. The
'uncontrolled' impulses appear to be controlled by society's instructions about the
effects of alcohol upon behaviour. Thus, people learn about drunkenness from
what their society "knows" about drunkenness.

Myth: If your friends are drinking, you have to drink to have a good time with
them.
Fact: Behavioural research has documented that in a group drinking alcohol, even
those who are not drinking can have an equally good time and behave in the
same uninhibited manner. Adolescents call this "getting high on other people's
alcohol".
Assessment of activity:
Ask the adolescents if there are any other beliefs about alcohol which they
would like to discuss. If not, proceed to the next activity.

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Trainers' Guide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

ACTIVITY 5 - IMPACT OF ADVERTISEMENTS

Learning outcomes:
Adolescents will be able to understand the impact of advertisements on the
community's consumption of alcohol and its effects.

Information for trainers :

Alcohol advertising is a big business for the alcohol industry. The objective is to
glamourize alcohol and link it to "modern lifestyle" or "having a good time".
Alcohol companies sponsor many popular events such as sports events. Many
countries have banned the advertisement of hard liquor on television. Some have
banned advertisements in the print media and bill boards as well. A few countries
have a complete ban on advertisement of hard liquor. However, policies on
advertising beer and wine are much more liberal. A new phenomena is surrogate
advertising, in which mineral water or even juice is shown in bottles resembling
liquor bottles. This leads to brand identification and indirect promotion of hard
liquor.
Advertising to young people is a crucial activity for the alcohol industry. This
age group is the "prize" they all hope to capture as future consumer. The World
Health Organization recognizes that advertising alcohol to young people is a
serious problem.

The discussion should help adolescents understand that advertisers are
tempting them to buy their products.
Process
>
>
>

Ask the adolescents where they find advertisements for alcoholic
beverages?
Ask them to bring the cuttings of advertisements and pin them up for a
discussion.
Discuss the message that runs through all the advertising events.

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Trainers' Cuide on Adolescent Mental Health Promotion: Alcohol Use and Abuse

>
>

What do the advertisements fail to tell us?
How do their brothers and sisters react when they watch advertisements?

Possible responses:
Shops, newspapers, magazines, television and on shops.

The messages in the advertisements are as follows:

>
>
>
>

Alcohol enhances social status.
Alcohol is equal to success.
Alcohol is necessary in social settings.
One should drink alcoholic beverages.

What do the advertisements fail to tell us?

>
>
>
>
>
>
>
>
>

The dangers of alcohol use.
The hazards of driving after drinking.
Drunkenness.
Becoming ill.
Being a social nuisance.
Fighting.
Arguments.
Long-term physical effects.
Long-term social effects (social breakdowns, loss of job etc.).

Influence of advertisements:

Adolescents try to copy what they see.
Assessment of activity:

Ask the adolescents if they understand the impact of advertising on alcohol use in
the community, particularly how advertising impacts consumption of alcohol by
adolescents. If there are no other issues to discuss, proceed to the next activity.

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Trainers' Cuide on Adolescent. Mental Health Promotion: Alcohol Use and Abuse

ACTIVITY 6 - ROLE PLAY: HOW TO SAY NO TO ALCOHOL

Learning outcomes:

Adolescents will learn to assert themselves and say "NO" to alcohol.

Information for trainers:
Role-play is an important component of experiential learning. It will help
adolescents to actually learn about alcohol. Before they can say "NO" to alcohol,
it is important for adolescents to understand why people drink alcohol. So before,
they can learn to exert themselves, make them understand the pressure on them
to drink.

Process:

Divide the class into four groups. Give each group one issue related to "who
decides whether I should drink alcohol". Make each group read out the question
and discuss the possible responses.
Now give each group one situation and allow them to develop a role-play
from the given situation. They should be as creative as possible. After the role play
facilitate a discussion on how it helped them to understand the situation and also
tell them that they should be able to find ways of asserting themselves and saying
"NO" to alcohol.

Possible responses:

Who decides whether people should drink alcohol?

>
>
>

They themselves.
Their friends.
The community acceptance (it is OK for boys of a certain age to drink
alcohol).

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Why do people drink alcohol?

>
>

They are consuming alcohol because they want to and like it.
Someone else has taken the decision for them to drink, even though they
prefer not to.

What is the image of alcohol and alcohol users?

>
>
>
>
>
>

A person who has grown up.
Adventurous.
Defiant/like to break rules.
Graduated from soft drinks.
Member of a fraternity.
High social status.

How do advertisements influence us?

>
>
>
>

They create a glamourous image.
Tell us there is nothing wrong with it.
Makes us identify with actors and sports stars.
Encourages us to consume alcohol.

Situation: 1

Jeevan is a 16-year-old boy and the only child of a poor family. He is very close
to his mother who suffers from a dreaded disease. His mother has not told him
about her problem. One day she sends him to get a very important medicine
but Jeevan spends the money on alcohol due to peer pressure. When he returns
home, he realizes that his mother is desperately in need of that medicine
without which she is unable to breathe. He finds himself full of guilt and
remorse.
Situation: 2

Meera a 15-year-old girl who lives with her alcoholic father who abuses her
mother physically and mentally. The situation worsens to such an extent that
one day she persuades and convinces her mother to leave home with her. She
obtains help from some nearby social service groups.

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Situation: 3

Raja and Rani were in love with each other and were seen by others as made for
each other couple. Raja who used to occasionally drink soon became a
compulsive alcoholic. Due to continuous stress in his work place and his
reduction of the ability to regain self-control as a result of alcohol, he lost his job
and also started abusing Rani physically. Rani did not know how to assert herself
and stop his drinking habit.
Situation: 4

Deepak and Mohan, senior school students tried to bully a couple of junior
adolescents to consume alcohol and also threatened them in different ways, if
they disobeyed. At the same time, Ram and Shyam of the same class came
forward and rescued the juniors and won the heart of others in school. How
could they do that? They also managed to help Deepak and Mohan by sending
them to a counsellor.

Possible responses on how to evade the pressure - please see
Annexes 1 and 2.
Assessment of activity:
Discuss with the adolescents if they would be able to evade the pressure to
consume alcohol, particularly when it is against their wish.

CONCLUSION:
Discuss any issue about alcohol use and abuse which the adolescents may want
to discuss, so that, at the end of the session, they clearly understand the hazards
of alcohol use and abuse.

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Annex 1
WAYS TO SAY NO
Method

Persuader

Decider

Polite refusal

"Can I get you a drink?"

Give reason

"How about a beer?"

"I don't like beer"

Be firm

"Here, smoke this joint with
me"

"No, thanks"

"Come on!"

'No, thanks".

"No, thanks".

"Just try it, chicken

"No, thanks".

Walk away

"Hey, do you want to buy
some brown sugar"?

Say 'no' and walk away
after you say it

Cold shoulder

"Do you want some brown
sugar"?

Keep going as if you did
not hear the person. (Not
the best to use with
friends).

Give an alternative

"Let's go upstairs to my room"

"I'd rather stay here and
watch T.V".

Reverse the pressure

"Come on, just upstairs with
me"

"What did I just tell you?
Were you listening?"

Avoid the situation

If you know of people or
situation where people will
pressurize you to do things
you don't want to do, stay
away from these situations.

Strength in numbers

Hang around with
people who support
your decision not to
drink, use drugs, etc.
"I am not comfortable
doing this".
"It makes me unhappy".

Own your feelings

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Annex 2

STEPS IN REFUSING

Situations:
> An invitation to drink.
> An invitation to smoke.
> An invitation to skip the class.
> An invitation to go out at night.
> An invitation to spend a night at a friend's house.
Steps in refusing:
> Tell your friend what you feel and the reason why you feel so. Most
friends would listen to your reasons.
> Refuse clearly.
> Ask your friend's opinion on his invitation to show that you have not
rejected it outright. Thank your friend if he accepts your refusal.
> In case they insist and are insulting, you should try not to pay attention to
their words. Instead, try to concentrate and think how to avoid going with
him as follows:

-

Repeat your refusal, say good bye, and start walking away.

-

Negotiate with him, and invite him to do some other activities.

-

Postpone your answer in order to change your friend's
intention.

Page 23

o

An "alcoholic" is a person who, as a result of the abuse of
alcohol, is experiencing serious and recurring personal and
social problems or health damage, and who, because of these
problems, would benefit from treatment. However, there is a
wide range of personal styles and consumption — including
occasional light drinking and constant heavy drinking — and
the shadings between different levels of consumption are
imperceptible. Thus there is no clear line of separation
between “hazardous drinking” and “alcoholism.”

Although the terms “alcohol dependence” and “alcohol
dependent person” are more accurate, “alcoholism" and
“alcoholic” are widely recognized words in popular and even
clinical use, and’are therefore used throughout this pamphlet.

<1978 Alcoholism and Drug Addiction Research Foundation, Toronto.
Printed in Canada

o

ALCOHOLISM AND THE FAMILY
by Donald E. Meeks, DSW

An alcoholic’s family is often seen as both the cause and
victim of the drinking problem. While it may be true that
family pressures had a hand in the early development of the
alcoholic, it is also true that the family shares in suffering the
consequences. Clearly, problem drinking affects and is affected
by family behaviors and relationships which can help the
alcoholic regain and maintain sobriety or, alternately, make
recovery even more difficult to attain.

Often, families undergo drastic internal reorganization in
attempting to cope with a problem drinker in their midst. The
usual responsibilities undertaken by the drinker are
reassigned to others, a situation resented by the alcoholic, who
feels, and perhaps is, excluded from the healthy relationships
that would normally exist in the family. The problem drinker
also may experience guilt from letting the family down.
Whatever the surface appearances, anger, tension, and
resentment are usually part of the family picture.
Children as well as adults become increasingly torn by
anxiety and conflict and may be forced to take sides. They
may be required to play adult roles such as caring for younger
brothers and sisters, and they are sometimes expected at early
Dr. Meeks is director of the Addiction Research Foundation’s School
for Addiction Studies.

1

ages to contribute to the family income. At times they may
fear for a parent’s safety or for their own, and they are often
unwilling or ashamed to bring friends home.

A child in the family of an alcoholic may develop troubles
seemingly unrelated to the drinking but which arise directly
from the anger, resentment, and confusion at home.
Underachievement at school, aggressiveness, or sullen and
withdrawn behavior are not unusual.
As commonly painted, the marital partner and children of a
problem drinker are victims of the problem. While this may
be true, it may also mislead the family in its efforts to resolve
its problems. In order to interrupt the destructive cycle, the
behavior of every family member, including the drinker’s,
should be examined. Despite popular beliefs, children as well
as adults may be drawn into and become part of the
destructive pattern. In short, to restore healthy functioning, it
may be necessary for the family as a whole to change.

Since all family members are affected by problem drinking, all
must carefully examine how what they do is affected by the
drinking and how their actions in turn affect the drinker and
the drinking. The family may require help from a source
outside itself in order to assist in this process. The necessary
steps to take involve confronting the problem, seeking help,
trusting the counselor, engaging in the helping process,
dealing with setbacks, and finally, adjusting to recovery.
CONFRONTING THE PROBLEM

It is sometimes difficult to distinguish problem drinking from
heavy social drinking, a confusion that may serve as a shield
for the alcoholic. If heavy drinking is frequent, or if there are
medical, financial, employment, legal, or other problems

2

occurring as a result of the drinking, then the situation
constitutes a problem. Acceptance of such a drinking problem
is fraught with anxiety. The common questions are: Will the
problem not go away if we ignore it? Is this an indication of
mental illness? Will the drinker have to be hospitalized?
What will the boss say and do? What will family, friends, and
neighbors think?

The answers to these questions are not necessarily simple.
Seldom does a drinking problem disappear when it is simply
ignored. While excessive drinking is not in itself a mental
illness, emotional conflicts may cause or be caused by it.
Indeed the problem may be treated as an illness when the
emotional conflicts are triggered by drinking that is out of
control, i.e. when the drinker can no longer limit how often
the drinking is done, where it is done, or how much is drunk.

If medical problems are present or if the person cannot stop
drinking in his or her natural surroundings, hospitalization
may be necessary. However, this is true for only a small
percentage of alcoholics.
An alcohol problem does test the depth of friendships, and
friends who remain loyal can provide a great deal of needed
support. But, inevitably, some acquaintances may be lost as a
result of the problem. Fear of what others may think or do
can stand in the way of seeking help. This is often the case
with people who hold a job. It is unlikely that a severe
drinking problem can exist without some problems occurring
on the job. Decreased efficiency, lateness, and absences
accompanied by any excuse except the true one are very
common. It is encouraging, however, that a growing number
of employers accepts the fact that salvaging a good employee
is better than starting with someone new. Many programs
have attempted with some success to involve employers and
the trade unions in the helping process.

3

It would be unrealistic to suggest that no risks will be
involved in the open acknowledgement of a drinking problem.
However, the risks must be weighed against the consequences
of not confronting the problem head on. Often a drinking
problem is hidden or denied in a misguided effort to protect
the drinker and the rest of the family. Hiding or not facing
the problem allows it to get worse, whereas early efforts to
seek help may protect the drinker and the family from further
damage.

$
SEEKING HELP

When the family members accept the problem for what it is,
they must then decide what action to take.

Each community has within it, or nearby, programs
established specifically to help alcoholics. Some programs are
staffed by professionals; others, such as Alcoholics
Anonymous, are operated by persons who have experienced
alcohol problems themselves. Again, the sooner one seeks and
obtains help, the better the prospects for reducing damage
caused by the problem.
Often the alcoholic is the last member of the family to accept
the existence of a serious drinking problem and the need for
help. In this case the wife, or husband, and other relatives
should seek help for themselves. Since the alcoholic is not the
only one confused and troubled by the drinking, help can be
used to advantage by other members of the family, and it
should include advice about ways to involve the alcoholic in
the helping process.

4

TRUSTING THE COUNSELOR

In the beginning it is sometimes difficult to share intimate
thoughts and feelings with a stranger, but it is important to
give information freely and openly to the counselor. Conflicts,
fears, and anxieties must be clearly understood in order for
them to be dealt with effectively.

Helping agencies attempt to select people with the qualities
needed to encourage trust and confidence. Counselors are
aware of the intimate, confidential nature of the information
they are given, and they are bound by their own ethics and by
law to keep the information confidential. They are also aware

that their job is not to judge but to understand and to offer the
best help possible. All of this should reassure the client that
counselors can be trusted. If the counseling process is to be
sincere, open, and productive, trust is a necessary ingredient.

ENGAGING IN TREATMENT

Involving everyone in treatment not only helps the alcoholic
but assists other family members in dealing with their own
conflicts, anxieties, fears, and confusion. Often individual
treatment is required to help the alcoholic stop drinking and
start on the road to recovery. While this is going on, other
members of the family may be counseled separately to help
them understand and deal with their problems.

Marital counseling or family therapy may begin when the
alcoholic is sufficiently recovered and able to participate.
Marital counseling usually involves the couple with a
counselor and attention is given not only to the drinking but
to other problems in the relationship — at home, at work, and
in the community.
Family therapy involves the total family who shares a
common household, including children old enough to
participate. Parents may be reticent about discussing the
problem in front of children but in family therapy they may
discover for the first time how much the children already
know and how deeply they are concerned. These therapy
sessions provide a safe, reassuring atmosphere in which the
children can talk about their feelings and contribute to the
solution of family problems.

Family therapy helps families discover ways in which the
total family can establish a healthier, more satisfying life,
including ways in which the family can support the
alcoholic’s efforts to stay sober.

DEALING WITH SETBACKS

)

A drinking problem that has taken years to develop will not
be resolved overnight, even with treatment. The drinker arid
the family should be prepared for a long and difficult process.
Some drinkers, once sober, never drink again. They are able,
over a long period of time, to reassemble their lives and
resume family and work functions. In other cases, the
alcoholic may begin to drink again with accompanying
deterioration in work, social life, and family relationships.

All involved — family, counselors, friends — must exercise
patience. Moreover, they must accept the drinking relapse as
part of a difficult process. Rather than reacting with despair or
defeat, the family and others involved can help the drinker
return to sobriety. Often one or several drinking relapses may
be experienced before a firm recovery is accomplished.

ADJUSTING TO RECOVERY

A common belief is that once the drinking stops all family
problems disappear. On the contrary, attaining sobriety is but
one step in that direction. During the subsequent recovery,
family members must adjust to each other on a new basis and
new problems may emerge. Roles and functions undertaken
by the spouse and children during the drinkihg period, while

7

they may have been burdensome, also probably provided
some satisfaction. For example, older children may have been
coerced into the abnormal role of pseudo-parent to younger
brothers or sisters, or the wife or husband may have had to
assume the other’s duties — financial, household, etc. — as well
as their own.
New ways must be established to give and receive emotional
support both to the recovering alcoholic and to adjusting
family members. The adjustment may be complicated if the
family members distrust the recovered alcoholic’s ability to
remain sober. They may fear giving up their acquired
responsibilities with their relative security for the perhaps
faint hope that this time the drinker will stay sober. Restoring
trust is not easy. But it is necessary.

Problems which had been considered as part of the drinking
problem may surface during the recovery period. Lack of
communication, an unsatisfactory sexual relationship,
mismanagement of finances, or difficulty in disciplining the
children can no longer be blamed on the drinking. Each
problem must be faced and dealt with on other terms. Far
from being a time when help is no longer required, recovery
can be a stage where adjustment is difficult and help is
essential.

8

SUMMARY

Families of alcoholics are affected by and affect a drinking
problem. In order to help the alcoholic recover and stay sober
it is sometimes necessary to assist the family in changing
some of its ways of doing things. Help for families is aimed
not only at assisting the alcoholic member but also at enabling
other family members to deal with their problems.

Family adjustment to a drinking problem is usually
accompanied by anger, tension, and resentment. Problems in
the home may have been triggered by the drinking. Children
as well as adults experience confusion, anxiety, and conflict.
As the pattern of destructive behaviors develops, all members
of the family may contribute to family problems. In order to
help, it is necessary to examine all family behaviors.
Usually, the family of an alcoholic requires help from a source
outside itself. Aid may be sought from a clergyman, a family
physician, a self-help group such as Alcoholics Anonymous,
or from a professional helping agency. Seeking help requires
squarely accepting and confronting the problem and making a
decision to act. Refusing to face the problems makes them
worse. In order to achieve full benefit from outside help it is
important to openly and honestly share information, feelings,
and concerns. The quality of counseling is only as good as the
sincerity and openness of the people involved.

Therapy and counseling may take different forms. Initally, the
alcoholic may require a period of individual therapy. This
may be followed, if appropriate, by marital counseling with
the couple or by family therapy. Family therapy includes
children old enough to participate. Children are more aware of
and more deeply affected by alcohol problems than is usually
suspected. The aim of such therapies is to help family

10

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members understand and deal with their problems in order to
improve family life for all of its members.

An alcohol problem takes a long time to develop. It will not be
resolved overnight. Time and patience are required to work
through a variety of related problems. In the process, setbacks
such as a brief or extended return to drinking may occur.
Such setbacks should not be considered as a total failure. All
involved must help the alcoholic again return to sobriety.

With recovery, all problems cannot be expected to magically
disappear. The family must adjust to having the recovered
alcoholic back as a full member in the family circle. It must
deal with some problems in the relationship that were
previously blamed on the drinking. Adjustment to recovery
may be difficult and help at this stage may be essential.

Some sources of help and information for families with
problems that involve misuse of alcohol are listed below. This
list is not intended to be comprehensive, but it does provide
basic contacts available in most communities.

Alcoholics Anonymous, Al-Anon, Alateen
Children’s Aid Society

Clergyman
Doctor

Family Service Association
Hospital
Medical Office of Health

Government — Community and Social Services
Salvation Army

Social Planning Council

Victorian Order of Nurses
Welfare Office
Media
RF_MH_2_SUDHA.pdf

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