Based on the available data that over half of its population over 15 years old drink more than the recommended amount of alcohol, Canada, earlier this week, released its first ever clinical guideline for treating high-risk drinking and alcohol use disorder (AUD). Prepared for healthcare providers, the guide has 15 recommendations for them to use when asking patients about alcohol, diagnosing AUD, managing alcohol withdrawal, and creating treatment plans, which include medication, counselling, harm reduction or combinations of these, based on individual needs. In tandem, it has debuted a new website available to the general public which points them to the resources and treatments accessible for high-risk drinkers.
High-risk, heavy, at-risk, and binge drinking – they all mean the same thing – is defined as a session in which individuals consume a large amount of alcohol (four or more drinks for women and five or more for men) within a short period. The effect of the alcohol on the system raises the risk of individuals losing control, misjudging situations and compromising or harming the health, safety and well-being of themselves and/or others.
In many countries, the line between alcohol abuse and what is generally termed as “having a good time” are extremely blurred. Indeed, there are villages, towns, and cities in which the entire citizenry, if polled, would confess to never having heard of high-risk drinking, and not knowing about an alcohol intake limit. Unfortunately, this description fits several areas in Guyana. One would find in these places, a devious, universal culture that lauds those who take ‘one too many’ and derides the ‘just-one’ individual or the teetotaler. It is also this same custom, mostly derived from patriarchy, that encourages men to offer or sometimes force alcohol on their sons as a depraved rite of passage, often at a young age.
The temporary euphoria which drinking induces through the increase of dopamine levels in the brain, as well as its relaxation, disinhibition and/or numbing effect, creates the urge in people to keep reaching for the bottle. The long-term result of this is AUD, which is the wide appellation covering alcohol abuse, dependence and addiction. To be clear, AUD is a medical condition which manifests both mentally and physically.
Myriad studies have shown that it worsens anxiety and depression and there is a definitive link between addiction and gender-based violence as well as child abuse. Meanwhile, it is well known to adversely affect the entire raft of chronic non-communicable diseases (CNCDs) that shorten lifespans and burden health systems both physically and financially. More recently, it has also been found that alcoholism causes some forms of dementia and worsens others.
Lest we forget, among the more egregious effects of alcohol use is driving under the influence, which very often leads to fatalities. The World Health Organisation estimated last year that globally some 1.3 million people die annually as a result of road crashes involving vehicles. Driving under the influence was listed as the second highest cause, topped only by speeding. However, it might be said that speeding is frequently a consequence of the impaired judgement arising from drunk driving.
In many countries, the seriousness of driving under the influence is reflected in the imposition of heavy fines, imprisonment, licence revocation and mandatory treatment. In cases where it results in the death of others, the crime is treated as a homicide and this is reflected in the charge and sentence. This is meant to serve as a deterrent, but in reality it is not hugely successful.
Here in Guyana, for example, the Motor Vehicle and Road Traffic Act was finally amended last November to provide for the charge of motor manslaughter to be laid in cases where fatalities occurred as a result of drunk driving. The fly in the ointment is the inadequate availability of properly calibrated and certified equipment for on-the-spot breath tests. While the law now also allows for blood tests, this is an unrealistic proposition given what is widely known of local public hospitals and laboratories.
Just like in Canada, studies conducted here, the most recent being the 2019/2020 Multiple Indicator Cluster Survey, determine that there is a serious issue with alcohol abuse. Even without that data, the evidence is damningly visible everywhere and also presents itself in the high incidence of uncontrollable CNCDs among the population. However, it would appear that the collection of statistics in our case is just a form of going through the motions as there is no indication of any real moves to treat with the problem.
