Saturday, October 30, 2010

When is teen alcohol drinking problem drinking?

The legal age for obtaining an alcohol permit (yes, that's a prerequisite for alcohol consumption in Maharashtra) is 25 years. However, a recent survey of teenagers in major Indian cities including Pune would have us believe that 45% of Class XII students consume alcohol five to six times a month.
Adolescence is characterised by experimentation
The maturing adolescent brain with its new tool of abstract reasoning seeks to explore the environment and reach its own conclusions regarding the world. Experimenting with socially acceptable intoxicants is just another facet of this behaviour. So, whether legal or otherwise, some of Pune's teens will continue to consume alcohol.

When does alcohol drinking become problem drinking? Is it to do with the frequency? If 5-6 times a month is excessive would 2-3 times be alright? Is it OK to drink alcohol in groups but not OK to drink when alone? When would it be time to seek help?
How would a teenager know the experiment has gone out of control?
The CRAFFT was designed to answer this question. It is a brief screening test for adolescent alcohol and other drug use. CRAFFT is an acronym of key words in six questions. Our staff nurse gets teenagers to answer it in the waiting room. 
(Knight JR; Sherritt L; Shrier LA//Harris SK//Chang G. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatrics & Adolescent 156(6) 607-614, 2002.)

The CRAFFT questions
  • C - Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?
  • R - Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
  • A - Do you ever use alcohol/drugs while you are by yourself, ALONE?
  • F - Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
  • F - Do you ever FORGET things you did while using alcohol or drugs?
  • T - Have you gotten into TROUBLE while you were using alcohol or drugs?
2 or more YES answers suggests a 94% chance of significant alcohol related problems

Wednesday, October 13, 2010

Why would a mother burn her daughter?

A family tragedy was played out through a small article in the Pune news. In a fit of rage a mentally ill woman set her daughter alight while she was asleep. The narrative was short and the item tucked into one of the inner pages under a largish headline.
 This was the reason - the why - mental illness
World Health Report 2001
 A glib explanation for a horrific event lays the entire burden of its causation at the doors of a mental health disorder. The World Health Organisation  (WHO) has estimated that one in four persons will have a mental health disorder at some stage of life .

Violence is rarely a manifestation of mental illness
In this rare cause of burning (mental illness), the burning of her daughter is an indicator of the severity of the mother's mental illness. Yet society, of which this news item is a barometer, has unquestioningly accepted mental illness as a sufficient cause. In a nation with about 0.48 mental health workers of any kind  for every 100,000 people, a woman who had previously managed to access mental health care slips through the organisational net and goes on to seriously injure her own daughter. A family that had against overwhelming odds obtained mental health care for a loved one could not mobilise the resources to access it again when her illness escalated. Ease of access to mental health care is crucial. Why?
Common mental illnesses are effectively treated with medication
Most people with mental illness achieve control over their behaviour and impulses. The cost of treatment with standard and effective medication is less than Rs5-10/day. The social costs of mental illness is the major barrier, keeping those needing care from seeking it. The other barrier is institutional, keeping those seeking care from getting it. This mother could not cut through the social and institutional barriers to obtain that care. That is why a mother burnt her daughter.