Journal of Alcoholism & Drug Dependence
Open Access

The Role of Rehabilitation Centers in Treating Alcoholic Patients in Kerala

A. Sangamithra^* and K.S.Dhanya ^*Correspondence: A. Sangamithra, Department of Economics Bharathiar University, Coimbatore, Tamil Nadu, India, Email:

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Introduction

Alcohol is a substance that is produced by fermentation of yeast, sugars, and starches. It is most commonly consumed in the form of ethanol, which is the active ingredient in alcoholic beverages such as beer, wine, and liquor [1]. The harmful use of alcohol can result in harm to other people, such as family members, friends, co-workers and strangers. Moreover, the harmful use of alcohol results in a significant health, social and economic burden on society at large. Alcohol consumption is a causal factor in more than 200 disease and injury conditions. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioral disorders, including alcohol dependence, major non communicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases, as well as injuries resulting from violence and road clashes and collisions. (Alcohol-World Health Organization 2022). Alcohol addiction or alcoholism is a pattern of alcohol use that involves problems controlling the drinking of alcohol, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when one rapidly decrease or stop drinking of alcohol [2].

One of the most important products of global addiction demand is an alcoholic beverage. Around 5.7 crore of people in India go through the devastating effects of alcohol addiction. Abuse of alcohol is one of the most extensive mental health disorders that affect our society. It affects the individual and the society in general. For the individual, alcohol addiction has compound threats; it affects their physical health, and mental health. Continual use of alcohol in risky amounts can lead to death as well.

Usually, an addicted person doesn’t know he is an addict and considers himself a casual user or drinker. However, the family members, significant others, and friends detect the warning signs way early than the addict himself. But acknowledging the problem is difficult, in fact, for some, they hit the rock bottom until they realize the problem [3]. Although, early detection and treatment of addiction enhance the recovery and remission chances, however, deeply rooted addictions can also be treated.

Literature Review

Alarming rise of alcohol addiction

Alcohol is the most widely used psychoactive substance in India, according to the ‘National Survey on Extent and Pattern of Substance Use in India’. Dependence or consuming it in a harmful way, followed by Andhra Pradesh and Tamil Nadu released recently by the Ministry of Social Justice and Empowerment. Around 14.6 percent of all Indians in the 10-75 age groups consume alcohol and over 5 percent are in need of medical help to address alcohol-dependence. Of those who are alcohol-dependent, just 2.6 percent received treatment and 0.5 percent was hospitalized for treatment. Uttar Pradesh has the highest number of people (1.6 crore) suffering from alcohol-with 47 lakh and 37 lakh people who are problem drinkers. With 20 lakh alcohol- dependent people, Karnataka figures 10^th in the country. The highest prevalence of alcohol- dependence is in Tripura with 13.7 percent of the population, followed by Arunachal Pradesh (7.2 percent) and Chhattisgarh, Punjab and Andhra (around 6 percent). The use of heroin is high, while the use of opioids in the country is three times the global average 2.06 percent in India compared to 0.70 percent globally. The study found that 0.7 percent of Indians used inhalants, with around 4.6 lakh children and 18 lakh adults needing help for its problematic use. (National Survey on Extent and Pattern of Substance Use in India conducted by National Drug Dependence Treatment Centre (NDDTC) [4].

Not only alcohol abuse assumed serious proportions in the country, but there is also a huge gap between those who need medical treatment and its availability. For one, Indians tend to look upon alcohol and drug addiction as moral issues. Consequently, alcohol addicts are unwilling to seek treatment. We need to wake up to the fact that depression, anxiety, mood disorders and mental illnesses underlie addiction and thus these are problems that need to be medically treated. For addicts, the problem does not simply go away, and they may need hospitalization. While alcohol consumption is 17 times more prevalent among men than among women, the latter is harder to tackle. Social stigma attached to women drinking or doing drugs pushes the problem deeper underground among women than among men and is thus more difficult to detect and treat. Peer pressure plays a huge role in children taking to alcohol and narcotics. Many teenagers see alcohol and drugs as ‘cool’ stuff to engage in. Others see their use as symbols of modernity and liberation. So long as liquor and drugs are seen as trendy, it will be difficult to curb its use among youth. (National Institute on Drug Abuse (NIDA).

Brutal and unscientific approach followed in rehabilitation centers

India has hundreds of illegal rehabilitation centers where alcoholics are beaten up and drug-users chained. Theirs is a brutal and unscientific approach that often worsens the problem. These need to be shut down. What we need are more psychiatrists, trained counselors and rehabilitation clinics. To regulate the functioning and licensing of alcohol de-addiction and rehabilitation centers under Sections 71 and 78 of the NDPS Act, and give more power to the department, in Punjab the state government decided to amend the rules and notified amended rules as ‘The Punjab Substance Use Disorder Treatment and Counselling and Rehabilitation Centres Rules 2020’ on July 28 last year. However, the Health Department did not implement the amended rules for 16 months. In all these months, it kept issuing licenses as per the rules of 2011, which had ceased to exist with the notification of the new rules. By doing so, health officials not only indulged in an illegal act but also issued licenses in haste. Between 2011 and 2020, in nine years, the Health Department had issued 132 licenses for the opening of such centres [5]. However, the department issued as many as 43 licenses by following “non-existent rules” for the opening of new centres in over one year-between September 2020 and October 2021. The number is much higher than the annual average of nine years before the notification of the new rules.

New strict rules

• No centre shall keep patients in basement

• Name of psychiatrist, his registration number and fee structure to be on display in local language

• Must have a qualified psychiatrist and his name must be included in the license

• Cannot dispense any medicine without testing by FDA lab

• Every centre will submit its annual performance to government

• Government can regulate and monitor treatment charges and price of the medicine dispensed

Kerala, is a high literacy State; many persons, young and old, are addicts of various intoxicating substances like drugs, alcohol and other narcotics whose consumption makes one a slave to them. Many families are destroyed with one or two members severely addicted to such substances. With increasing incidents of such cases, often resulting in violent crimes, rehabilitation of such persons has assumed vital importance in the State in recent years. Though a number of rehabilitation centers in Kerala function as part of the steps taken by the State Government, there is a need for more such Centers in different Districts. Kerala has many rehabilitation centers for treating addicted persons of alcohol. Many of them are very highly rated and are well known for their success in treating those with Drug and Alcohol addictions.

However, it is well known that there are only very few local selfgovernments equipped with treatment facilities in their areas. It is to be noticed that though the revenue generates from the sale of alcohol drinks is very high, a well-equipped treatment facilities in the state for the problems due to alcohol consumption is very less.

Treatment process

Having alcoholic beverage will not always be treated as alcohol addiction. Sometime alcohol addiction can be difficult to find out as alcohol is widely available and accepted in many cultures. Even in few cold climatic regions it is necessary to survive there [6]. There are some reasons that allow a person to shift from having an occasional drink to full alcohol addiction. There are so many major and minor factors. Few of them are:

Stressful environment: If a person have a stressful work, he may be likely to drink more alcohol to get relief from the stress. Stress may not be always from work or job; it may grow from family problem, health problem or relation problem etc.

Drinking just to have the taste: Few teenagers and adults just drink alcoholic beverage just to know the taste for the first time. Sometime this kind of curiosity makes the habit and after that addiction.

Drinking at an early age: Research says that those who drink at an early age are more likely to have alcohol addiction because of not only the past habit but also the tolerance power of body increases.

Mental health issues: Any kind of mental problem like depression, anxiety, bipolar disorder etc. will increase the tendency of alcoholism. Drinking alcohol is the instant and temporary solution of getting rid of mental issue so; most of the people try this instant method.

Taking alcohol with medication: Many people take drugs with alcohol. It’s a very common practice. Some medicine can increase the toxicity of alcohol. Even sometime it can be very dangerous.

Genetic issue: Family history plays a major role to decide that one person will be alcohol addicted or not. This is a simple biological process as we all know that the characteristics can be transmitted from parental generation to the next generation through DNA.

Lack of family supervision: A lack of support from family or parents can lead a child to be alcohol addicted. Financial condition of the family also can effect on it.

Alcohol rehabilitation is the process of combining medical and psychotherapeutic treatments to address dependency on alcohol. The goal of alcohol rehabilitation (inpatient or outpatient) is for the patient to remain permanently abstinent and gain the psychological tools for long-term sobriety. Anyone whose life, health, work or relationships are affected by chronic alcohol use can attend rehab treatment. The intent of rehabilitation is to enable a patient to be successful in life and avoid the drastic consequences that alcohol abuse can cause.

The first and most important step of treating alcohol addiction is to identify the issue and seeking help. Early diagnosis of alcohol addiction is the key to ensuring better outcomes during recovery from addiction. Thus, it becomes important to identify the early signs of addiction. The early signs can include:

Being unable to stop or limit the amount of alcohol consumption, spending a lot of time to drink alcohol, Putting alcohol above other personal responsibilities such as, Feeling urge to drink more alcohol, Avoiding the contact of close people, Being aggressive without drinking, increased lethargy, depression, or other emotional issues.

After identifying the early signs of addiction, the next most important step is to seek help. Seeking help could be through a clinical psychologist, psychiatrist, or any other mental health professional. This is where most individuals and families falter; they delay the step of seeking help. The earlier you seek professional help for addiction, the faster recovery will be.

After consulting a professional, they will evaluate the patient in detail and then recommend treatment options. Based on the availability, finances, and more there are multiple treatment options available. These include:

• Out-Patient Services

• In-patient Services

• Rehabilitation Services

Amongst these, rehabilitation at a de-addiction center is seen to be the most effective option to ensure sustainable and long-term recovery from alcohol addiction. Recovery and rehab are often used interchangeably, however, both concepts held slightly different notions. Recovery is the lived experience of a person and it is a process of change that helps the individual to improve health, have a purpose in life, have a supportive, loving, and helpful social circle, and strive to reach full potential. On the other hand, rehab means the treatment services offered to the person during the process of recovery. Thus, rehab is part of the recovery [7]. Rehab can be inpatient or outpatient where extensive medical and psychological services are provided to help through the process of recovery. The recovery and rehabilitation process is different for every person.

Discussion

De-addiction treatment centers

The word ‘rehab’ is often used interchangeably with “treatment,” “addiction treatment,” and “addiction recovery center.” Rehab is used to describe a supervised program designed to help treat individuals who are struggling with drug or alcohol addiction. These days, it is a broad term, as there are a multitude of different approaches, treatment modalities, and amenities that rehabs offer. A de-addiction center plays an important role in the recovery process from alcohol addiction. It is a space where the individuals can focus only on recovery as the rest of their daily needs are cared for. There are various ways in which a de-addiction center aids recovery.

Psychoeducation: To begin the process of rehabilitation, deaddiction facilities must first debunk several common myths regarding alcohol addiction. Many families and people feel that alcohol addiction is a choice, which drives them to hold individuals responsible for their behaviour.

While using alcohol is initially a choice, the nature of alcohol means that the situation soon spirals out of the individual's control, resulting in physical, mental, and emotional dependency on the substance. Psychoeducation is thus a vital initial step in the de-addiction process. Individuals and families will have a greater understanding of the nature of addiction as a result of this and will be on the same page when the recovery process begins. Psychoeducation also aids families in making the required changes to help.

Detoxification: Addiction has two key aspects for an individual. There's the physical side and then there's the psychological aspect. Individuals must first be entirely free of the physical troubles that come with alcohol addiction in order to heal from the psychological and emotional repercussions of addiction. Detoxification has a role here. Detoxification is the process of completely removing all traces of alcohol from a person's body. Detoxification is facilitated at the de-addiction facility under continual observation to ensure that all traces of the alcohol are flushed from the individual's system. Because detoxification carries the possibility of withdrawal symptoms, constant supervision is required. Withdrawal symptoms can be quite harmful if they are not treated and monitored properly. Professionals at a de-addiction facility can prescribe medicine and therapy to assist the client cope with withdrawal symptoms.

Intensive psychotherapy: The next and most crucial phase in the recovery process is psychotherapy. There are many different types of therapeutic techniques. Psychotherapy is a broad word that encompasses a variety of techniques. Cognitive Behavioral therapy, counseling, group therapy, family therapy, and other therapeutic techniques are used to treat drug addiction. All of these treatments work together to aid the individual's rehabilitation. Psychotherapeutic techniques assist the individual in comprehending the mental processes that underpin their addictive behaviour and learning how to manage it. There are a variety of supportive therapy options available to help you get back on your feet faster. Reel therapy, horticultural therapy, art therapy, music therapy, dance therapy, and other modalities are among them.

Family therapy: Addiction to alcohol is a serious illness that causes a great deal of suffering. It has a tremendous impact on both you and your family. According to studies, those who are battling addiction have strained connections with their family, particularly with their spouse, parents, or children. This eventually leads to a complete disintegration of family bonds. Family counseling is an important aspect of this. A trained psychiatric social worker works with the family and the person to help them reclaim the trust they previously shared.

Furthermore, many families may come to blame their problems for their addiction problems. Family therapy helps families and from all of this. As evidenced by the above, effective recovery from alcohol addiction is possible. A deaddiction center aids this recovery.

Rehabilitation advantages

There are many benefits to attending a rehabilitation program for drug or alcohol addiction. These days, rehab programs are more accessible and widely available than ever before, and with so many different specialties, locations, and program styles, no matter what type of rehab an individual is seeking, they will likely be able to find a good fit. Rehab programs are available as inpatient, outpatient, partial-hospitalization programs, extended care, and more.

Overall, one of the greatest benefits of attending rehab which, in this case, speaks to inpatient rehab is the opportunity to step away from the stressors and triggers of everyday life and focus fully on one’s recovery while receiving treatment. This can be incredibly beneficial as it takes away the option to easily relapse while in treatment, because clients remain in a secure environment free from drugs and alcohol. Particularly for individuals receiving treatment for the first time, setting a solid foundation of recovery in an environment free of the possibility and temptation to use can make all the difference in those early and sometimes difficult initial weeks of sobriety. Other pros of rehabilitation include:

Built-in recovery community and peer support: An individual will have the opportunity to be surrounded by people who can relate to their experience.

A range of individual and group therapies: Most rehabs include a number of psychotherapy sessions and group sessions in their programming. Specific therapeutic treatments will vary.

Structure and supervision: Rehab programs provide daily and weekly schedules that encourage consistency and structure, which is beneficial to recovery [8]. Inpatient rehab also often provide 24/7 supervision, so clients have access to round-theclock care and support.

Goal-setting and developing new, healthy habits: With the guidance and motivation of a support team as well as peer support, a person can begin to discover and work toward new, achievable goals. Goal-setting is often a topic of discussion in aftercare planning and relapse prevention, as well. The provided structure of rehab gives opportunity to develop new routines and habits to support these goals.

Ongoing support: Many rehab programs provide alumni or aftercare support in the form of a regularly scheduled, continuous support group or similar offering.

Rehabilitation disadvantages

The most challenging aspect for individuals considering rehabilitation, aside from resistance to quitting using their substance of choice, is likely the financial burden of rehab programs. In a national survey conducted by the Alcohol Abuse and Mental Health Services Administration in 2013, a staggering 93percent of individuals who felt they needed alcohol abuse treatment did not ultimately receive treatment.

A significant percentage of those individuals reported not receiving treatment because they did not know where to begin, did not have health insurance, or their health insurance did not cover substance abuse treatment. For people who cannot attend rehab, there are 12 step programs, such as Alcoholics Anonymous, and other similar programs in most cities and countries, with an enormous network of experience and support, all free of charge.

Depending on the level of care a person needs, rehab can be quite expensive, particularly inpatient programs. Luckily, there are other options for treatment that are less expensive, such as Intensive Outpatient (IOP) [9]. Many rehabs also offer scholarships and payment plans to make their programs more accessible, and they have staff that can work with an individual’s circumstances to help them find the best route for them.

Alcohol rehabilitation goals: The following alcohol rehabilitation goals involed

End alcohol abuse (Goal 1): The most important goal of alcohol rehabilitation is to stop drinking. This goal serves as a starting point for all the other goals in during alcohol treatment.

Establish a positive support system (Goal 2): This is an important rehabilitation goal because it allows for success after the program is complete.

Improve general health (Goal 3): Improved general health allows for a healthier lifestyle and is also important for long-term sobriety. This goal is often achievable during inpatient alcohol rehabilitation and can be met in the first weeks of alcohol sobriety. Some cases of extreme alcohol abuse may require longer period of time to see improved health.

Improve personal circumstances (Goal 4): This alcohol rehabilitation goal aims to give the patient a successful future outside of the program.

Meet employment and educational needs (Goal 5): This goal also aims to set the patient up for future success outside of an inpatient or outpatient alcohol rehabilitation program.

Reduce criminal behavior and resolve legal problems (Goal 6): Rehab centers aim to remove any negative aspects of the patient’s life in order to facilitate future success.

Treat psychiatric disorders and psychological problems (Goal 7): Alcohol rehabilitation aims to provide treatment or refer treatment facilities for specific psychological problems.

Conclusion

Some people with drinking problems work hard to resolve them. With the support of family members or friends, these individuals are often able to recover on their own. However, those with alcohol dependence usually cannot stop drinking through willpower alone. Many of them need outside help. They may need medically supervised detoxification to avoid potentially life threatening withdrawal symptoms, such as seizures. Once people are stabilized, they need help to resolve psychological issues associated with the problem of drinking. There are several approaches available for treating alcohol problems as no single approach is best for all individuals. Rehabilitation is, without doubt, a crucial aspect of health that is aimed at enhancing function and independence. As a field of health, it has evolved through different stages before arriving at its present model that incorporates different components of biological, societal and contextual factors that have effects on the health and function of individuals experiencing various health challenges. Regardless of rehabilitation and is instrumental to a patient's wellbeing, regardless of the underlying health condition. Who the beneficiary is, who delivers it or the context in which rehabilitation is delivered, optimizing function is the ultimate goal of by restoring, preventing or slowing deterioration in functioning (sensorial, physical, intellectual, mental, cognitive, or social), rehabilitation places the person at the centre and contributes to people reaching their full potential and participating in society. Its impact is therefore not only on the individuals, but also on their families, communities, and economies.

References

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