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).
Epidemiological
Overview
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.
Drinking
women
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).
Background
Although
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.
We
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).[2]
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.
Since
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.
Future
actions
If
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.
[1]
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: lberruecos@prodigy.net.mx
or lberruec@cueyatl.uam.mx
[2]
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).