Dr. Luis Alfonso Berruecos Villalobos
In Mexico, alcohol is used both regularly and responsibly, as well as in excess. However, the disease known as alcoholism has already trapped many persons.
In our country, scientific research on alcohol use patterns, alcohol abuse and alcoholism is very recent, even though alcohol abuse and alcoholism undoubtedly constitute serious public health problems in almost all the countries in the world. This problem becomes even worse in nations where alcohol effects relate to serious economic and social disadvantages. This is the case of Mexico, where we have approximately 9 million alcoholics besides other damages caused by alcohol excessive consumption. These figures affect almost half of the total population if we consider that the current average family has 5 members (Berruecos, 1988).
In our country, alcoholism represents 11.3% of the total disease load (Belsasso, s/f). Thus, 49% of suicides and 38% of homicides in the country are committed under the effects of alcoholic beverages. Furthermore, 38% of injury cases occur as the result of alcohol abuse, particularly among young adults between 15 and 25 years of age, a period in life where accidents are the main cause of death (Galán, 2001: 37). It is worth noting that more than 13% of the population experiences the alcohol dependence syndrome, i.e. 12.5% male and 0.6% female between 18 and 65 years of age. Young adults between 15 and 19 years of age have car accidents associated with alcohol use that represent the main cause of death (15%), followed by homicides (14.6%) and suicides (6%) (Rosovsky, 2001: 49).
In Mexico City, at least 700 thousand minors have problems associated with drug abuse. This disease ranks fourth among the ten main causes for incapacity. On the other hand, 70% of accidents, 60% of trauma caused by accidents, 80% of divorces and 60% of suicides are somewhat related to alcoholism. It is estimated that approximately 2.6 million people between 12 and 45 years of age have no access to treatment for alcohol abuse o dependence, and that 64% of homicides are related to alcoholism. In Mexico, there are 12 thousand AA groups and close to 1,500 of the so-called annexes for detoxification through temporal reclusion.
According to studies carried out by the National Institute of Psychiatry, 9% of the women between 18 and 65 years of age living in urban zones have 5 or more drinks per consumption and 1% of them are alcohol dependent. It is estimated that 10% of the alcoholic beverages sold in Mexico is used by women, especially in large cities, and that 32 million Mexicans i.e., one third of the total national population are regular drinkers. In the case of women, those older than 60 constitute the most affected group and they are usually the ones who started drinking at young ages and continue to drink at present. These factors are associated to important changes in alcohol perception, role modifications, more availability of economic resources and access to employment. Social and cultural norms define differences in gender behaviors, especially because women are more sensitive to rejection. Women abandon alcoholic men less frequently, even though dependence is very similar in both genders in terms of symptoms. In summary, today women drink as much as men and are therefore in great disadvantage when it comes to health risks because they have more body fat that prevents alcohol from dissolving. Additionally, the fluctuation of hormone levels because of menstruation, pregnancy and menopause, as well as the fact of having less water in their body, make women more vulnerable to higher intoxication rates with less alcohol dosages (Medina Mora, 2001: 5B).
there are medical reports focused on alcohol effects on the human body that are as old as
the XIX century, psychosocial and cultural research on the subject is very recent (1970s)
and can be associated to the foundation of the National Institute of Psychiatry and its
Epidemiological and Social Research Division.
Unfortunately, the medical approach (sanitary, epidemiological and clinical) still prevails in the scientific arena, neglecting studies with a social, psychological and cultural focus. Likewise, there are many more studies carried out at urban environments than at rural settings, even though the rural population in Mexico is still significant in number. This mainly affects the knowledge we have about the situation of indigenous communities where poverty and discrimination accentuate alcohol use effects (Berruecos, 1989). It is worth mentioning that this indigenous population currently adds up to almost 16 million people who speak 64 different languages. This complex cultural mosaic demands urgent and creative actions that can no longer be postponed, especially if we are entering a new century. Therefore, today it is my intention to present the strengths and weaknesses of the psychosocial and cultural research related to drug use and alcoholism, as well as the lack of scientific interest on the things that are happening in the rural sphere. I will also try to analyze the reasons why alternatives are not included in public policies to face the challenges posed by this rural context in terms of alcohol abuse and alcoholism.
all know that alcoholism is the last phase of a process that starts with occasional or
experimental consumption of alcohol, then passes to moderate use of the substance (López,
2000) and finally ends with abuse. This phenomenon is almost as old as mankind and the
concern to understand it and control its effects has also come a long way.
However, it was not until the middle of the XIX century that an English researcher dared to consider alcoholism as a disease (Velasco, 1980 and 1997). Once his hypothesis was accepted, doctors immediately decided that, being a disease, alcoholism should become one of their objects of study. But it was not until the middle of the XX century, almost 100 years later, that in an international meeting of the World Health Organization, specialists agreed that this disease had to do with psychological problems that forced the individual to drink excessively, so research was finally opened to mind researchers (Barr, 1999). However, some years later it was also agreed that alcoholism was not only a psychological disease but also a social one, so by the end of the 60s the first social and cultural studies on alcohol use were carried out (Medina-Mora, 1988, Berruecos, 1988).
Mexico was not left aside the new objectives of the international organism for long because, at the beginning of the 70s, as mentioned before, the National Institute of Psychiatry was born and since then it dedicates part of its efforts to this important task.
Several national surveys on addictions have been carried out since 1988 (SSA, 1990), including those related to alcohol, which is the drug most used in Mexico. Unfortunately, most of these surveys have only an urban approach. There are also several studies in children, adolescent, school, university and elder populations (Berruecos, 2000) but, once again, they were mostly designed for large cities. Therefore, we do not know the exact dimension of the problem at rural or indigenous zones, where drug use devastating effects are even greater due to the discrimination and poverty these communities have been subjected to since colonial times (Berruecos, 1989).
In a study we carried out about the legislation for alcoholic beverages that existed since Porfirio Diazs administration to Miguel de la Madrids administration, we proved that there are many agreements, decrees, norms and guidelines that basically focus on alcohol offer i.e. on selling, distributing and using alcoholic beverages -, and very few regarding alcohol demand, prevention and education (Berruecos, 2001).
The only important official action in the last few years was the creation of the National Council Against Addictions that is currently working with low executive capabilities, limited budget and personnel, and that does not only takes care of alcohol addiction, but also of other diseases resulting from alcohol excessive consumption.
the appearance of AIDS, limited resources intended for health have been deviated to take
care of this disease, leaving other problems such as alcohol abuse on the side.
There are very few official education and prevention campaigns, even though there are some efforts from education and health authorities that have not yet translated in figures that show a reduction of the problem. That is why we dare to say that there are no public policies on the subject, especially among rural and indigenous communities, where there are no research or education / prevention programs whatsoever.
For all these reasons, it would not be wrong to say that there are no public policies in Mexico to face problems resulting from alcohol abuse and alcoholism in rural and indigenous populations and that those existing for urban communities are simple not enough. It is also worth noting that for many years alcohol has been the ideal instrument for workers and farmers indebtedness, whose work is partly paid with alcohol.
If alcohol plays an important role in the lifecycles that start at the moment the groom asks for his brides hand and continues to the birth of a child and the different processes and social stages in his / her life (Rivera Cruces, 2001 and García Salgado, 2001); if alcohol is part of the ancestral traditions and habits of our people (Vargas Guadarrama, 1999 and Medina-Mora, 1999); and if alcohol is also one of the most important businesses in Mexico and other countries, it is worth asking why there are no integral public policies in our country addressed to alcohol users and non-users affected by the problem.
new public policies on the subject were to be designed, several tasks would then
correspond to both the government and the society. These tasks can be classified in four
unpostponable actions to really taking care of the problem.
First, it would be extremely important to assign more resources for investigation purposes but not only clinical or biomedical in the field of alcohol use per population and more efforts should be done to know the rural and indigenous side of the problem (Medina-Mora, 1994 and Berruecos, 1994).
Second, it would also be very important to make efforts in the training field so more people could be suitable for the attention and research associated to the problem. Addictions constitute a very complex problem that requires not only a good research capacity but also broad knowledge of the problem, and this requires time. On the other hand, there are few serious specialists that really know what addictions are particularly alcoholism -, how they affect the body and how patients with symptoms should be taken care of. It would be very interesting to review the plans and programs developed by the medicine schools and other health and social institutions and organizations to prove that information provided to students is actually poor and deficient. To this we should also add the lack of research training among college students, which usually starts with a thesis elaboration to get a degree. In Mexico there are approximately 2 thousand psychiatrists and only 11 of them are members of the National Academy of Medicine and no more than 50 are trained to take care of addiction problems in a 100 million inhabitant country, with 9 million addicts and more than 30 million regular users. These data evidences the urgent need for training new professionals in the field (Belsasso, s/f).
Third, prevention, undoubtedly the least expensive and most effective tool, have not been fully implemented in our country, apart from isolated efforts of separate groups full of good intentions but probably without the appropriate knowledge in the field. Preventive campaigns have to be carried out at different levels, different moments and different scenarios. They must include various contents according to their target populations and, most of all, they should be complemented by evaluation and follow-up programs to measure their positive and negative results in a coordinated manner (CESAAL, 1999, Narro, 1994 and Tapia, 1994). Nowadays there are various preventive models (CIJs To Live Without Drugs; INEPARs Chimalli; SEPs PEPCA; and SSAs Build a Life Without Addictions) and since 1986, CONADIC coordinates efforts to prevent and fight health problems caused by addictions. For 12 years, the Mexican Institute for Youth has applied a program called PREVEA (National Youth Program for Addiction Prevention) (Conadic Informa, Special Bulletin, June 2001).
And fourth, there is the difficult area of rehabilitation and treatment for those already affected by the disease. This is certainly not an easy task, especially if we see the poor recuperation figures achieved in spite of the many treatments available today. Unfortunately, there are many people who believe they own the ideal, sometimes even magical, treatment, when most of the times such treatment does not even have a scientific foundation and is only based in tradition, fashion or pure marketing to take advantage from addicts relatives who are desperate and would do anything to heal their loved ones. It is amazing to see the numerous people that advertise their services as therapists or specialists, when in reality they are not trained for such a difficult situation. This might be the answer from society before the lack of treatment and rehabilitation official programs in the health sector, which implies that an alcoholic who does not have enough resources to seek professional help will probably end in the hands of those amateurs.
To fight this situation, there was an announcement last June about a program against alcoholism and alcoholic beverages abuse that includes the participation of experts and specialized institutions. IMSS and UNAMs Psychology School will install 50 care clinics for excessive drinkers throughout the country; ISSSTE will soon start a program to develop strategies to fight addictions, including alcoholism, which is currently one of the major concerns of different government agencies. CIJ, for example, takes care of patients with alcohol-related problems in its 75 operating units along the country. Furthermore, there will soon be a Mexican Official Norm for Addiction Prevention, Treatment and Control in order to improve service quality. Meanwhile, the National Council Against Addictions takes an average of 750 calls everyday through its telephone counseling services (Galán, 2001: 37).
In spite of current official norms (Meljem Moctezuma, 2000) such as the one issued on September 15, 2000 (Mexican Official Norm for Addiction Prevention, Treatment and Control) to establish the minimum quality standards to take care of these problems, there are still many treatment, rehabilitation and care centers that do not have trained or specialized personnel (Nava Hernández, 2000) and that are not supervised by any authority whatsoever. The same happens in the field of education, where there are also many programs, courses and college seminars so short and poor in quality that they cannot include the minimum information needed to approach the problem.
The truth is that the different administrations have neglected or ignored the problem, have not assigned enough resources for research purposes, have not been interested in supervising or evaluating existing services and programs, and have not made enough emphasis to enforce the law for example, in terms of sanitary control, alcoholic beverages advertising, sales points and schedules, and the continuous and undiscriminating offering that promotes excessive alcohol consumption.
If alcohol is here to stay, as it has been for thousands of years and will probably continue to be; if abstinence campaigns have failed and the problem continues to grow along with population and production; then it is time for the federal government and for society to become aware of the serious damage associated to alcohol abuse and alcoholism and take the necessary corrective actions.
In many countries it has been decided, for example, to increase the age at which a person can buy alcohol. In others, sales and advertising restrictions are more extensive and the sanctions for driving drunk are really high. There are places where there is simply no permission to produce more alcohol than the one meeting sales expectations, which means there are more strict controls to reduce the problem.
On the other hand, developed countries have established huge research interdisciplinary centers, scientific publications, and various academic international events to study the problem, and have promoted the work of legislators, experts and legal reforms to reduce its consequences. But mainly, they have assigned State resources to take care of those already affected by the disease. None of this is happening in Mexico, and the few efforts we see usually take place in isolation, without coordination and have little effective impact and results.
We should therefore ask ourselves if there is truly the political will to face this huge problem that affects society in general. Many plans and programs have been suggested for years, as well as advertising campaigns that have wasted precious resources. There are long speeches dedicated to tobacco or other drugs, congresses are organized everywhere, researchers publish the few results they can come up with under scarce resources, but family violence, work accidents, suicides, homicides, economic losses and many other situations that could be avoided or prevented if authorities were truly aware of the problem and willing to solve it, continue to impose their load on society.
Fortunately, there is a project of a program against alcoholism and alcohol abuse whose long-term goals have been planned for year 2006. This program is based on the experience gathered throughout the last 25 years of research and evaluation of policies and strategies since the launching of the 1984 General Law on Health, and pretends to reduce the negative effects of alcohol irresponsible consumption. This project also emphasizes that besides the economic damage alcoholism has on society, alcohol is also associated to four of the main causes of death accidents, hepatic cirrhosis, homicides and self-inflicted damage therefore underlining the need to coordinate personnel training, formation and actions addressed to prevention and research. The program also underlines the need to promote community participation and to review current legislation in the fields of alcohol production, distribution and sale, as well as the creation of treatment and rehabilitation centers, regulation of advertising campaigns, and permanent evaluation of programs and similar efforts (Velasco, 2001).
As long as no extra efforts, resources and attention are paid to alcohol abuse and alcoholism to know their magnitude and the best way to fight them, we will continue to face their devastating effects on society.
 Social Anthropologist and Historian. Full-time Professor at the Social Relations Department of the Xochimilco Unit of Universidad Autónoma Metropolitana and Professor for the Masters Program of Business Administration with Health Systems Formation, Postgraduate Studies Division of the Accounting and Administration School of Universidad Nacional Autónoma de México. Mexico City. E-mail: email@example.com or firstname.lastname@example.org
 Currently we have several studies that reflect the magnitude of the problem in Mexico, such as the National Surveys on Addictions carried out in 1988, 1993 and 1998 among the urban population between 12 and 65 years of age. Likewise, there are surveys among school populations carried out since 1976, a Drug Information Report System designed 15 years ago that registers drug trends, an Addiction Epidemiological Surveillance System that keeps drug use diagnosis up-dated since 1991, and various reports from the 72 CIJs centers throughout the country.
Dr. Luis Alfonso Berruecos Villalobos
He was born in Mexico City. His broad academic formation includes a bachelors degree in Ethnology, a masters degree in Social and Cultural Anthropology, a doctorate in Social and Cultural Anthropology, a doctorate in History of Mexico, and studies in Psychoanalytical Psychotherapy.
He has been a Collaborator, Professor, Researcher and Advisor for different institutions and universities such as: Michigan State University, Escuela Nacional de Antropología (National School of Anthropology), Centro Mexicano de Estudios en Farmacodependencia (Mexican Center for the Study of Drug Addictions), Asociación Nacional de Universidades e Institutos de Enseñanza Superior (National Association of Universities and Higher Education Institutes), Instituto Mexicano de la Audición y el Lenguaje (Mexican Institute of Audition and Language), Fundación de Investigaciones Sociales (Social Research Foundation), Secretaría de Educación Pública (Ministry of Education), Consejo Nacional contra las Adicciones (National Council Against Addictions) and the Museo Nacional de Antropología (National Museum of Anthropology).
He has participated in 457 conferences and lectures in Mexico, the United States, the Caribbean, Europe, Australia, New Zealand and the Middle East.
He is currently a Professor and Researcher at the Universidad Autónoma Metropolitana, Unidad Xochimilco; Advisor Professor and Mentor at the Administration and Accounting School of UNAM; Researcher at the Centro de Estudios sobre Alcohol y Alcoholismo (Center for the Study of Alcohol and Alcoholism); Member of the Evaluation Committee at the Consejo Nacional de Ciencia y Tecnología (National Council of Science and Technology); Associated Professional at the London University; and Professor and Academic Coordinator of the Foundation Ama la Vida (Love Life).