Where the problem starts

Looking at alcohol use, and trying to discern the fine line between a social habit and a deadly addiction

Looking at alcohol use, and trying to discern the fine line between a social habit and a deadly addiction as Japanese officer Kobori in the hit 1988 film version of Khu Kam. But it was alcoholism that turned his life into a downward spiral. He sometimes reportedly spent 10,000 baht a day on women and booze. "Alcohol was the cause of everything. I was sick because I drank too much alcohol," said Warut in an interview with a TV station earlier this year.

Warut died of alcoholism-related complications last month at the age of 49 after being admitted to an intensive-care unit at a Chiang Mai hospital following his collapse at home. Doctors said Warut suffered from renal failure complicated by a kidney and blood infection. His body is now being kept for 100 days at a temple in Chiang Mai's Mae Rim district awaiting cremation. His close friend and actor Maethanee "Nino" Buranasiri said in an interview that Warut saw alcohol as a way out of problems. "He [Warut] was a stressful person but he usually came up with his own solution without discussing it with anyone ... and his answer was drinking to forget," said Maethanee. Warut, who had a history of drink-related health problems, had reportedly told friends he did not expect to live beyond 50.

While fans mourned the passing of the late rising star, his death actually puts a spotlight on the issue of alcoholism and its consequences -- a huge public-health conundrum on a national scale. According to figures reported by the Centre for Alcohol Studies under Prince of Songkla University, almost 3 million Thais were found to be alcoholic. Thailand also saw over 50,000 alcohol-related deaths per year.

Is there a fine line between a moderate drinker and an alcoholic, given that drinking is considered part of the country's socialising culture? How much alcohol is too much?

Psychiatrist Dr Piyawat Dendumrongkul said that alcoholism has nothing to do with the amount people drink.

"Some people who drink just a little can be an addict. Others drink the whole bottle but are not addicted," said Dr Piyawat.

Alcohol dependence or alcohol addiction is, according to the specialist, a psychiatric disorder where patients have to be dependent on alcohol. Also known as alcohol abuse, it is a condition whereby one needs to drink more alcohol to achieve the same effects.

"It's when the brain starts to learn that it's not enough to drink just this amount and that it needs more. Otherwise, physical reactions like shaking, body discomfort and irritation will develop."

According to Dr Piyawat, there are two major criteria for an alcoholism diagnosis: tolerance and withdrawal. Tolerance means a person keeps requiring an increased amount of alcohol, and withdrawal symptoms are not just physical but psychological, and occur when the use of alcohol ceases. Physical withdrawal conditions include headache, dizziness, breathing difficulty, nausea, vomiting, sweating and fast heart rate, while the psychological ones include anxiety, restlessness, irritation, fatigue, insomnia, poor memory and poor concentration, to name a few.

While scientists worldwide continue debating what's a safe amount of alcohol, a large global study did claim recently that there is no safe level for alcohol consumption. Published in August in the world's leading independent medical journal, The Lancet, the major study on drinking carried out in 195 nations found that even an occasional glass of wine or beer increases the risk of health problems and death, and that alcohol use is more likely to harm than to help.

Alcohol itself usually does not kill, but hard drinkers or those addicted to booze in most cases die of alcohol-related illnesses.

The latest statistics by the World Health Organization (WHO), released last month, report that more than 3 million people died in 2016 from drinking too much alcohol, meaning one in 20 deaths worldwide was linked to harmful drinking. The WHO estimated that around 237 million men and 46 million women globally are problem drinkers or alcohol abusers. And despite evidence of the health risks it carries, global consumption of alcohol is predicted to rise in the next decade.

"Alcohol makes the body more vulnerable to diseases and less tolerable to complications," Dr Piyawat explained. "Like normally when you have a cold it's fine. But once you drink a lot, a cold may turn into lung inflammation. Alcoholics are more likely to get killed by complications rather than directly by alcohol, because it is not a narcotic that can [often] lead to fatality."

Apart from withdrawal conditions, physical reactions consequential of alcohol abuse, said Dr Piyawat, are premature brain deterioration characterised by poor memory following an abnormal sleep/wake schedule. If left unattended, this could lead to an illness called alcoholic dementia.

Alcohol abuse can also bring about so-called night blindness (impaired vision at night), abnormalities in the endocrinology system, alcoholic hepatitis, fatty-liver disease, deteriorating kidney and immunity function as well as complications in the gastrointestinal tract including increased gastric acid, gastric ulcers, vomiting blood and, worst of all, a perforated ulcer whereby gastric acid burns through the wall of the stomach and leaks into the abdominal cavity, damaging other organs. Psychologically, alcohol dependence can result in compromised functioning at work, poor memory, hallucinations, unconsciousness, aggression and lost control, as well as relationship problems, divorce and debt.

"I find a lot of patients are in great debt," said the psychiatrist.

Therapies for alcohol abuse can be carried out both on an outpatient and inpatient basis, depending on the severity. But mostly it begins with cutting alcohol followed by treatments for alcohol-related complications and dealing with withdrawal symptoms. All this, added Dr Piyawat, could involve a therapeutic procedure called a motivation interview, whereby a specialist tries to find patient's soft spot -- family, for example -- and use it to motivate them to adjust their behaviour.

When it comes to alcohol dependence in Thailand, Dr Piyawat is of the opinion that despite campaigns and movements against heavy drinking, many people still consider drinking a means to socialise, an acceptable habit.

"Compared to the past, when we overlooked the importance of studies regarding alcohol abuse, now Thais are more aware of the issue.

Alcohol dependence is better-monitored, which makes it look like Thailand has more addiction cases. This is not necessarily true because we have people who are addicted to it but at the same time there are also those who drink for pure entertainment or as part of their jobs or professional culture."

But for the alcohol addict to quit drinking completely, the most important thing is their determination to change.

"The most difficult part is for people to accept that they are an addict," said Dr Piyawat. "Like other psychological illnesses, some people do not realise or accept that they are sick. Others do not want to seek medical help. Treatments for alcohol abuse can actually start at home by reducing the amount people drink. If that fails, it could probably mean they are heavily addicted, and in that case they need to visit a doctor because there could be withdrawal symptoms and other complications that require professional help."

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