Thursday, January 24, 2013

Irresponsible Drinking & Regulation

irresponsible drinking
Irresponsible drinking requires regulation to modulate its potential for harm. There are specific neurotoxic effects of alcohol drinking. The responsible individual needs to learn personal skills to refuse alcohol drinking when required to do so. The potential harm to society with irresponsible drinking and driving necessitates regulation at a societal level.

Regulating irresponsible drinking

Alcohol drinking and driving in Pune over New  Year's eve was markedly reduced as compared to last year. This year 145 drunk driving arrests were made as against 252 last year. This reduction was despite an increase in the total number of  arrests made in Pune for irresponsible drinking and driving in 2012 as compared to the previous year. The heightened deployment of police personnel manning 30 prominent points of the Pune roads on New Year's eve was apparently deterrent enough.

Alcohol drinking and liquor sales were down by 20-30% in September 2012 following a police raid on an unlicensed rural Pune nightspot. The uproar by its patrons and subsequent police action on liquor retailers and other restaurants resulted in the Pune District Wine Traders Association lamenting the impact of plunging alcohol sales at premium outlets and lounge bars.

Is regulation effective?

The effects of regulating alcohol drinking have been specifically studied.
  • In Kentucky — the birthplace of bourbon whiskey and the home of many distilleries — dry districts had less alcohol-related auto accidents and drunk driving arrests. This should cheer the citizens of Chandrapur which will be the third district in Maharashtra state to go dry in a bid to curb irresponsible drinking.
  • In Alaska, isolated villages that prohibited alcohol had lower rates of serious injury resulting from assault, and motor vehicle collisions. A local police presence in these dry villages further reduced the incidence of assault
Regulation of alcohol drinking is effective and necessary. It provides a deterrence to irresponsible drinking and illegal distribution of alcohol. Alcoholism treatment financially benefits the family. Regulating alcohol drinking works to benefit society.

References
  1. Darryl S. Wood, Paul J. Gruenewal. Local alcohol prohibition, police presence and serious injury in isolated Alaska Native villages. Article first published online: 27 FEB 2006 DOI: 10.1111/j.1360-0443.2006.01347.x
  2. Wilson RW, Niva G, Nicholson T. Prohibition revisited: county alcohol control consequences. J Ky Med Assoc. 1993 Jan;91(1):9-12.

Thursday, September 22, 2011

Stress in the festival season

festival time
Festivals as a source of stress? Festivals are meant to be a time of happiness, enjoyment and family togetherness. However for some it can be time of great stress and can adversely affect mental health. The extended festival season starts around Independence Day (15th Aug) and extends right up to New Year including Ganesh Chathurti, Dusshera, and Diwali. Vacations have a positive effect on well-being. However, these effects fade soon after resumption of work (de Bloom 2009). These four months of celebration are associated with psychological distress and mental health problems for many individuals and their families.

Festival distress

(Harion 2009)
Expectations take their toll on the family. Festivals are a prime time for couples to come in for counselling with relationship problems, problems with in-laws, siblings and their children. 'Don't we get to celebrate at least once in our own home?". They end up celebrating each in their own parental homes at Pune and Ahmedabad.

For those in the workforce it means negotiating and competing with everyone else for leave or being the only one left in the office. No one at home understands why you cannot get leave. No one understands why work-pressures and deadlines increase in the time leading up to the holiday. Financial stress also comes into the picture; cool electronics, gifts, partying and vacation trips cost.

For people with mental health problems festivals are another source of stress. Well intentioned, though ill informed relatives prevail on them to stop their medications 'they are addicting', 'why do you need to take them if you're allright?' Many are coaxed into stopping medications entirely.They relapse some time after they return to work, when the social supports are at a minimum and the beneficial effects of the vacation begin to wear off. That is also the time when they have to start paying out the EMIs. This time lag to relapse after stopping psychotropic medication is a prominent factor in non-adherence. 'But he was allright at home. It's the job that is causing stress; we are thinking of relocating'.

Fasting and sleep deprivation are associated in the run up to the festivities. In vulnerable people, especially those with mental health problems, these can play havoc with the body rhythm and with medication regimens leading to a relapse. Every religion excuses ill followers the rigours of these rituals, yet the very people who should be supporting moderation often goad their vulnerable members to comply. 'I thought he was just being lazy'.

Alcoholism is another problem that is likely to recur. It starts insidiously at the beginning of the festival season. By the time the season ends its time for another stint of 'deaddiction'. Binge drinking at parties is just another problem that requires to be addressed recurrently.

Violence and injuries in the home occur through the combination of excitement, stress, tiredness and alcohol. Pressures lead to conflict and then violence. Domestic abuse is about one-third more likely on the day of the festival than the daily average. Homicide rates are generally higher on all major holidays.

Loneliness and isolation are particular issues at festivals. The holiday season is the time of the year when our desire for social contact is most likely to outstrip what our circumstances will allow; it is into this gap that loneliness creeps (Lancet 2010). As festivals are associated with friends and family, it can be difficult for those on their own to avoid feeling lonely at this time. This is especially so for older people living alone who may have no one to spend the festive season with. The loneliness felt on the festival day is often the worst. Festivals can be a sad and nostalgic time, when the loss of a family member may become especially painful. It is often a difficult time for bereaved people. The rates of suicide are known to increase especially on New Years Day (Bridges 2004).

What to do?

Prior to the festival
  1. Communicate. Make your festival plans keeping your spouse in mind. If there were problems  last year don't expect them to disappear. ' I thought we agreed on that last year'. Putting off the discussion could ruin your festivities.
  2. Collaborate. Work together to find a solution that satisfies the needs of all parties. You may not get everything you want, but you get enough of what you want to feel satisfied. Colaboration requires respect for the needs of the other party, communication skills, patience, and creativity. Parties usually do better when they collaborate than when they compete.
  3. Watch the finances. Budget for the expenses and keep a track.
During the festival
  1. Limit your alcohol. Don't drink if you don't want to.
  2. Keep to your normal sleep-wake schedule as far as practicable. When it is disrupted return to your normal schedule at the earliest. Take some time out for exercise.
  3. Take some time off for just yourself and your family. A walk, movie or meal away from the others will contribute to a few more days of harmony.
  4. Your medication is sacrosanct. Don't negotiate on this.
Strategies for loneliness
(Masi 2010)
  1. Improve social skills: After relying on a partner to share experiences and thoughts a separation, breakup or bereavement requires relearning of skills needed to build new relationships and participate in community functions.
  2. Enhance social support: Find a listening ear – people who are lonely can find it helpful to speak to a counsellor or someone removed from their situation.
  3. Increase opportunities for social contact: Be a volunteer – many charities and organisations need help at festivals and you could spend a few hours working as a volunteer. The absence of close family need not be the end of companionship. 
  4. Address maladaptive social cognition: Loneliness can also be tackled by helping people to feel happier in their own company.
    • 'Everyone else is having a good time'. Keep busy – try to stop the festival taking over your life. Make time for enjoyable activities, such as reading, walks, joining a social club or going for a movie.
    • 'What's the point, I'm just not up to it'. Take some physical exercise – this reduces stress and enhances mood. Just getting off the sofa and getting outside should improve mood.
  5. Visit an older neighbour who lives alone if you have a little spare time on your hands over the holidays; it might be just what they need to make their holiday a happy one. 
References
  1. Bridges SF. Rates of homicide and suicide on major national holidays. Psychological Reports, 2004,94,723-724.
  2. de Bloom J, Kompier M, Geurts S, de Weerth C, Taris T, Sonnentag S. Do we recover from vacation? Meta-analysis of vacation effects on health and well-being. J Occup Health. 2009;51(1):13-25. Epub 2008 Dec 19.
  3. Hairon N. How christmas festivities and pressures can damage health and well-being. Nurs Times. 2008 Dec 16-2009 Jan 12;104(50-51):33-4.
  4. Masi CM, Chen HY, Hawkley LC, Cacioppo JT. A meta-analysis of interventions to reduce loneliness. Pers Soc Psychol Rev. 2011 Aug;15(3):219-66. Epub 2010 Aug 17.
  5. No authors listed. Tackling loneliness in the holidays.Lancet. 2010 Dec 18;376(9758):2042.

Sunday, January 9, 2011

How to refuse alcohol - keepin' it REAL

How to refuse an alcohol containing drink? The lead up to the festive season comes with a slew of articles on how to consume alcohol without experiencing a hangover. Then come the lessons on managing a hangover. Finally by New Year, come the statistics on drunken driving and police action on youngsters partying in rural Pune hideouts. Nothing about how to refuse alcohol while partying.

Alcohol refusal strategies

MN Gosin(2003) has classified drug resistance strategies into four types summarised by the acronym REAL
R - Refuse: say no.
E - Explain: decline with an explanation
A - Avoid: stay away from situations where alcohol is offered
L - Leave: exit situations where alcohol is offered

refuse alcohol;
Don't reach for it

10 tactics to resist alcohol at a party

These tried and tested ways to politely resist alcohol are classified along REAL lines. Remember you have the right to choose not to consume alcohol at any time. If that’s not respected you are probably in the wrong company. Once you take your stand don’t hold back. Participate, then you are less likely to be singled out to have a drink forced on you.
  1. Firmly decline alcohol. Ask for a soft drink. Don’t apologise. When your friends recognise you mean it this time they will not press you. (R)
  2. Go for a soft drink ‘to start with’. ‘Stick with this’ if your friends remember to ask later. Grab a soft drink and don’t let go. Once you have a soft drink in your hand it is easier to just wave the alcohol offer away. (R)
  3. In the initial stages keep a glass constantly in your hand. Make sure its at least a third full at all times. (R)
  4. Don’t reach for any glass of alcohol, even if it’s paid for by one of your friends. There are enough people around who will drink it gladly. (R)
  5. Volunteer to be the ‘designated driver’. If there are more than one of you claiming this position your task is easier. See point 8. (E)
  6. Insist that you’re on medication that reacts with alcohol (eg Tiniba for a stomach problem). If you are known to have diabetes or hypertension say your doctor advised you not to drink alcohol (He did, didn’t he?). (E)
  7. Say you have to work on a presentation/ pick up your mother after the party. Any plausible reason for the need to remain sharp will do.(E)
  8. Stick with a known tee-totaller in the group. Its easier to resist exhortations to drink alcohol when you have a partner.(A)
  9. When invited inform that you won’t be drinking alcohol. They’ll say its for the pleasure of your company. Hold them to it at the party (A)
  10. Leave when you suspect your soft drink may be spiked. (L)

Do these strategies work?

(Kulis et al, 2008)
  • Refusal - significantly reduces binge drinking.
  • Explanation - may not be so effective, at least in teenagers.
  • Avoidance - significantly reduces alcohol use
  • Leaving - significantly reduces binge drinking

What worked for you?

  1. Gosin M, Marsiglia FF, Hecht ML. Keepin' it R.E.A.L.: a drug resistance curriculum tailored to the strengths and needs of pre-adolescents of the southwest. J Drug Educ. 2003;33(2):119-42.PubMed
  2. Kulis S, Marsiglia FF, Castillo J, Becerra D, Nieri T. Drug resistance strategies and substance use among adolescents in Monterrey, Mexico. J Prim Prev. 2008 Mar;29(2):167-92.PubMed

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