Not a drop to drink?

Published: May 15, 2011
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Despite the taboo, rehabilitation centres for alcoholics have cropped up in recent years, but can they really help?

Despite the taboo, rehabilitation centres for alcoholics have cropped up in recent years, but can they really help?

Despite the taboo, rehabilitation centres for alcoholics have cropped up in recent years, but can they really help? Despite the taboo, rehabilitation centres for alcoholics have cropped up in recent years, but can they really help?

“My life was ruined,” says Zarak*. A man in his mid-50s, he is currently undergoing therapy at the Willing Ways rehabilitation facility in Karachi. “I felt I was powerless. I went for treatment to the Aga Khan University Hospital four times but I could only hold off on the alcohol for 15 days — 30 at the most. I would be back to drinking after that.”

Zarak speaks haltingly as he recalls how he ended up in the sterile rooms of the rehabilitation facility. “I realised five years ago that the alcohol was controlling me, I was not in control. I would drink and argue with my family and in the morning I would promise never to do it again. Of course, I’d be back to drinking the next day. My relationship with my family suffered. So did my business — you can’t really work if you are out drinking till 4:00 am.”

He had to kick a habit built over a lifetime. Zarak started drinking 20 years ago with friends that he can now never see again. “This is part of the treatment at Willing Ways,” says Dr Murad. “You cannot meet ‘slippery friends’, bootleggers or go to places you used to drink at. We recommend total abstinence — even smoking cigarettes is considered a sign of relapse.”

Alcohol consumption by Muslims was banned in Pakistan in the 1970s but though forbidden by law, the practice is virtually impossible to uproot. There are 200,000 alcohol consumers in Karachi alone, according to an estimate by Dr Wakeel Murad, who heads Willing Ways’ Karachi chapter and “at least 10 per cent are alcoholics.”

Tahir Ahmed, who runs Therapy Works, one of the most well-known rehabilitation facilities in Karachi, contends that it is “statistically impossible” to estimate the number of alcoholics in the city. “People are drinking all kinds of liquor, from country (desi) liquor to the locally produced alcohol to foreign alcohol that they get from bootleggers, depending on their income bracket.”

But while the actual numbers are a subject of debate, there is little doubt that they are on the increase.

“Alcoholism is rising in alarming proportions in Karachi,” Ahmed says. “You have 14-year-old girls doing tequila shots. The stresses in the environment, within a family and outside, have increased. The cost of living, financial struggles and daily problems, as well as personal factors including the individual’s relationship with the family are contributing towards this. It makes people move from social to dependent and then to abusive drinking.”

According to Ahmed, “Abusive alcoholism usually begins after a sustained period of social drinking — at least 10 to 15 years. However, people also combine drinking with drugs in an attempt to get a greater ‘kick’. Younger clients use cannabis, between the ages 30 and 40 it is cocaine and for older people it is heroin. As their tolerance increases, they want something stronger to give them the same feelings of social disconnect.”

Dr Ishaque Sirhandi, the secretary general of the Pakistan Psychiatric Society, says alcoholism tends to be prevalent among the upper and upper-middle classes. “In the lower income classes, there is polydrug dependency — people are mixing different intoxicants.”

Rehabilitation facilities have cropped up in Pakistan in recent years. Therapy Works, which opened in 2002, has treated male and female patients of all ages.  At Willing Ways the majority of alcoholism patients are men aged between 40 and 60, though they have treated men as young as 25 as well as a number of women.

Dr Sirhandi believes many clinics are just “lavish bungalows with beds for patients, who are kept for 20 days or so and then ‘discharged’. Of course they are going to relapse. They don’t have any trained staff and often no psychiatrists. Now even if they do manage to get rid of someone’s drug or alcohol dependency, they are not equipped to deal with any psychiatric disorders that they may have.”

“The lack of psychiatrists and the government’s apathy are partially responsible for the current state of affairs,” he says. “There are 450 psychiatrists for a country of 180 million people. There need to be well-designed rehabilitation centres, qualified personnel and public-private sector partnerships. Otherwise in the next two decades we will have huge issues dealing with this.”

Despite the prevalence of alcohol and alcohol abuse, alcoholism is still considered a taboo. “Society does not accept alcoholism as a disease,” Dr Murad says. Gossip and innuendo about alcoholics often continues even after they have gone through rehab.

Dr Sirhandi says, “Look at the terms used for people with drug dependency issues — sharabi, mawali, charsi, jahaz. Our society needs to treat people with respect like they do abroad. Alcoholism is a disease. When a patient with any illness — diabetes for example — comes home from the hospital, the family flocks around him. Someone runs to get food while the other massages the patient and relatives bring fruits and flowers. But when an alcoholic comes home, the family views the person with suspicion, neighbours disassociate themselves from him/her and he/she can’t get a job because organisations won’t hire someone who had drug-dependency issues. Patients relapse because they feel they are being victimised for something they haven’t done or aren’t responsible for. Families and communities need to trust people after they have gone through rehabilitation.”

“The worst is the denial of it,” Tahir Ahmed laments. “Schools don’t want to talk about it and neither do families. They let the patient deny he is an alcoholic because of their own denial. We only treat minors when they come in with their parents, but if the schools have referred them here, the parents invariably try to play it down. They will make comments like ‘All the kids do it’ and ‘We don’t know how this happened’. Instead of investigating, they will deny and absolve the child. With older people, the reasons are different: ‘I’m drinking with my own money’ or ‘I’m functioning properly’.”

“There are also people who are benders. They stay sober five days a week, start drinking on Saturday and continue till Sunday evening. On Monday morning, they have a hangover and carry on until Saturday rolls around again,” Ahmed states. “The reason people drink is that they want to disconnect with themselves, that they find themselves so unacceptable that they do not want to feel a certain way. That is why we work a lot on self-acceptance and improving their self-esteem.”

Zarak says, “People know that I have undergone treatment. Sometimes I feel inferior when I am talking to others, but I know this is something I have to work on.”

Alcoholism, according to Ahmed, finds its roots in shame-based behaviour. “Even where it is socially acceptable to drink, it is still considered to be illegal and in the upper-middle class, it is believed to be immoral, because of what religion dictates.”

Dr. Murad cautions against looking at the problem simplistically, saying that alcohol is a mood elevator for many people, and that simply consuming alcohol does not mean that one is an alcoholic, “There are certain benefits to alcohol and drugs,” Dr Murad asserts. “That is why 90 per cent of people enjoy alcohol, and this disease only hits 10 per cent of people.”

Therapy Works stresses on maintaining complete confidentiality of clients.  They have clients who walk in for treatment or are brought in by spouses or siblings. Referrals come through the grapevine, as well as psychiatrists, hospitals and schools — which will refer students found drinking alcohol on campus. It also has a strong relapse prevention programme and therapy includes incorporating positive influences in your lifestyle, such as exercise and work.

Murad is quick to point out that alcoholism is a disease: “Research shows that drinking alcohol produces a toxin that makes people act a certain way. He cites research to show that alcoholism “could also be part of your genetic code and environment. Children of alcoholics are three times as likely to become one if they find an enabling environment. Of course even if it is part of one’s genetic code, if you do not find an environment, you won’t become an alcoholic.”

Ultimately, the problem lies in whether alcoholism is viewed as a disease or simply a vice, and it is this failure to perceive the true nature of the problem that prevents many from getting treatment. The sheer stigma of having an alcoholic in the family means that some would prefer to keep the problem under wraps rather than seek treatment.

Willing Ways also works with families on how to manage interventions and bring reluctant patients to the facility. Therapy Works’ Tahir Ahmed is strongly against coercive interventions, which he believes lead to anger and rage and a reaction which invariably leads the client to relapse. “We work on a technique called motivational intervention, which uses the ambivalence in a client — it speaks to the part of the client that says ‘I must stop’.”

Treating alcoholism can set one back many thousands of rupees. Therapy Works charges Rs300,000 per client. The amount covers 12 months of treatment, including a month of in-patient care. Treatment at Willing Ways costs Rs7,550 to Rs12,550 a day, depending on the type of residential room booked, and charges for outdoor counselling are between 10 and 12 per cent of that amount.

“My advice to my fellow alcoholics would be to seek treatment — find a good place and get admitted. It would be my best gift to them,” Zarak says.

*Name has been changed to protect the individual’s privacy

Published in The Express Tribune, Sunday Magazine, May 15th, 2011.

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Reader Comments (18)

  • Dr. Adnan
    May 15, 2011 - 3:49PM

    What about the prominent places serving alcohol in Lahore e.g. Royal Palms & Lahore Gymkhana, not to forget many foreign alcohol suppliers in Model Town, DHA and Township areas. Oh wait there is more “Got Weed?” has become the next thing to the infamous “Got Milk?”Recommend

  • Meerza R Khan
    May 15, 2011 - 4:06PM

    he he he
    In this God Foresaken Country at War with every one n being blasted by all, the only logical entertainment left is staying home and getting hi fi on Booze & Nostalgia.
    Aap k sub leaders & that includes some under an Alias name & ID, yeh hi krty hain,
    ha ha ha.
    Bahir ja kr marna hy keeya ???
    As far availibility is concerned Corrupt Customs & all the Embassies hain na, n its all syndicated.

    Karachi May Port Hy, (Vow Yummy Black label & Black Dog for 3000 Rs for the connected)
    Lahore May Border hy, (Oh I love Indian Mcdwells what a Scotch indeed for just 1500 rs or So)
    Quetta & Peshawar is pumped through Afghan Transit Trade.
    While at Gilgit & North some times while we cant get Nestle Water while Chineese Scotch is cheaply availble.
    At Islamabad i told you all the Beauracrats are actually part time Boot Leggers & Embessies Suppliers.
    ha ha ha ,
    Cheers to the Sunday.
    Meerza (Winks)Recommend

  • rashid nadeem
    May 15, 2011 - 4:31PM

    alcohol consumption should be legalizedRecommend

  • God
    May 15, 2011 - 5:09PM

    naise reportRecommend

  • Chris Cork
    May 15, 2011 - 5:50PM

    Good piece Saba. Yes, problem drinking is clearly on the rise and I hear about it increasingly. From many years of exposure to Pakistani people using alcohol I conclude that because there is no open culture of recreational drinking people tend to drink in volumes I would never consider, consumed at a speed I would never consider either. They drink big and fast and drink to get drunk – something I almost never do. My failure to get staggering-drunk has been remarked on several times. ‘Why are you not getting drunk…don’t you like this drink?’

    I also feel that the drinking culture here has little exposure to drinks with a lower alcohol content, like wines and beers. Most of the alcohol consumed here is spirits – whiskies or variants thereof – and very few people drink wine or beer. In part this is because they are so expensive to buy. A bottle of reasonably good imported wine is going to cost 1500 rupees in Islamabad, and you can get an awful lot of rough hooch for 1500rps!

    There is something of an irony in that we actually have a very good brewery – Murrees – that produces a range of alcohol products that are well made – their recent single malt whisky has got the seal of approval of the Scotch Whisky Association no less, and they are very wary of handing out the stars.

    I fear we are going to see this problem get a lot worse and quite quickly at that. It is notr just an urban thing either. I can tell you that there is a little still in just baout every village in south Punjab, producing sometimes lethal brews that get entire families drunk for a few rupees. I’ve seen it firsthand.Recommend

  • May 15, 2011 - 11:20PM

    Good story. Need more like these to raise awareness of such diseases. I knew the number of psychiatrists in Pakistan was very low but didn’t know it was as low as 450.Recommend

  • fahad iqbal
    May 15, 2011 - 11:23PM

    best ever material i ever read about this problem .so bold and beautiful Recommend

  • Sameer
    May 16, 2011 - 1:34AM

    Nobody mentions about people with vision who drink. I am sorry but if a country is called ‘ Islamic Republic’ all these things should be taken care of including strict punishments to rapists. While spending so much money here and there we should invest in Islamic research combined with studies. We should leave behind all these extremist Mullahs and discover a decent way of living.
    Drinking is considered pretty normal now and admit it or not it does leads to social issues no matter how rich or poor u r. I am sorry if people consider mind your own business regarding this issue they have no right to live in our society.
    I can write on and on abt this but I think its better to go out there and make a difference. Recommend

  • Maria
    May 16, 2011 - 8:21AM

    @Meerza R Khan: Not just Pakistan; look at every Muslim country out there. Alcohol and drugs can be had in any of them- even in strict Saudi Arabia where gambling, prostitution and alcohol can be obtained easily. The only ones who get caught and charged on disply are the poor foreigners but the wealthy do what they want. Ditto for the so called Islamic Republic of Iran where even members of the religious elite are said to have an appetite for expensive western booze. All Muslim nations publicly say one thing about alcohol but since they all feel that laws are for common people, they all ignore alcohol when they drink it.Recommend

  • usman
    May 16, 2011 - 9:45AM

    leagalize alchol consumption country needs money to run it will provide much needed income for the country if you cannot beat them join themRecommend

  • Fareed Ashraf Chaudhry
    May 16, 2011 - 2:29PM

    Those found guilty of drinking ought to be flogged in public. Maybe that will solve the problemRecommend

  • Pakistani Hindu
    May 16, 2011 - 10:17PM

    @Fareed Ashraf Chaudhry:
    You’re being sarcastic, aren’t you? :pRecommend

  • May 18, 2011 - 12:50AM

    we always want to ban on alcohol but ppl who want they purchase or get easily
    if we r living in the name of Islamic republic of Pakistan y ppl open such kind of bar
    and elite one bought illegally alcohol for sake of there mouth taste even Saudi Arabia we found such thing where women not alot to came out without there legal partner with etc but in case of alcohol is there any sanctions Recommend

  • pakistani christain
    May 18, 2011 - 2:02AM

    I have always heard of the famous drinking permit, never seen once in my life and never know a wine shop that asks for one … I think permits should be strictly managed, and if not then just legalize alcohol …Recommend

  • May 18, 2011 - 2:19PM

    Instead of spending 3 lac of your hard earned money get this fact in your head “You ll go to hell if you drink alcohol”. Recommend

  • waleed
    May 24, 2011 - 10:13AM

    well, in saudia arabia alcohol is banned in hotels and strictly prohibited. but one thing saudiy yong generation can get easily without any restriction. rules are very strict here and in pakistan there is no rul evey one is king. our govt involve our politican and Beauracrats and there children all crupt. so how is it possible to prevent. those who impose ruls they are all involve so………….. i think not possible to prevent.Recommend

  • Sohail Ahamd
    May 29, 2011 - 11:44AM

    My personal experience is that alcohol drinks are not good for health –Recommend

  • May 29, 2011 - 1:22PM

    well, in saudia arabia alcohol is
    banned in hotels and strictly
    prohibited. but one thing saudiy yong
    generation can get easily without any
    restriction. rules are very strict
    here and in pakistan there is no rul
    evey one is king. our govt involve our
    politican and Beauracrats and there
    children all crupt. so how is it
    possible to prevent. those who impose
    ruls they are all involve so………….. i
    think not possible to prevent.think not possible to prevent.

    Maybe you’re unaware of the underground parties and raves that occur in Saudi Arabia. They serve homemade Arabian booze. The “royalty” there is just as hypocritical as it is here. Here’s the link to the report:

    http://blog.foreignpolicy.com/posts/2010/12/08/insidesaudiarabiaspartysceneRecommend

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