Alcoholism is a disease. It is chronic, or lifelong, and it can get worse over time and be life-threatening. Alcoholism is based in the brain.

These are some of the typical characteristics of alcoholism:

• Craving: a strong need to drink
• Loss of control: the inability to stop drinking
• Physical dependence: withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, when alcohol use is stopped after a period of heavy drinking.
• Tolerance: the need for increasing amounts of alcohol to get "high"

Know the risks

Research suggests that a person is more likely to drink too much if she/he has any of the following:

• Parents and siblings (or other blood relatives) with alcohol problems
• A partner who drinks too much
• The ability to "hold her liquor" more than others
• A history of depression
• A history of childhood physical or sexual abuse

The presence of any of these factors is a good reason to be especially careful with drinking.

How do you know if you have a problem?

Answering the following four questions can help you find out if you or someone close to you has a drinking problem.

• Have you ever felt you should cut down on your drinking?
• Have people annoyed you by criticizing your drinking?
• Have you ever felt bad or guilty about your drinking?
• Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

One "yes" answer suggests a possible alcohol problem. If you responded "yes" to more than one question, it is very likely that you have a problem with alcohol. In either case, it is important that you see your health care provider right away to discuss your responses to these questions.

Even if you answered "no" to all of the above questions, if you are having drinking-related problems with your job, relationships, health, or with the law, you should still seek help.

Treatment for alcohol problems

Treatment for an alcohol problem depends on its severity. Routine doctor visits are an ideal time to discuss alcohol use and its potential problems. Health care professionals can help a woman take a good hard look at what effect alcohol is having on her life and can give advice on ways to stop drinking or to cut down.

Addictive behavior

Why do some people become addicted, while others do not?

Nothing can predict whether or not a person will become addicted to drugs. But there are some risk factors for drug addiction, including:

• Biology.

Genes, gender, ethnicity, and the presence of other mental disorders may increase risk for drug abuse and addiction.

• Environment.

Peer pressure, physical and sexual abuse, stress, and family relationships can influence the course of drug abuse and addiction in a person's life.

• Development.

Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it is to progress to more serious abuse.

More information on Alcoholism, substance abuse, and addictive behavior

• Alcoholics Anonymous
• American Council on Alcoholism
• Center for Substance Abuse Prevention, SAMHSA
• Center for Substance Abuse Treatment (CSAT), SAMHSA, OPHS, HHS
• Narcotics Anonymous World Services, Inc.
• National Inhalant Prevention Coalition
• National Institute on Alcohol Abuse and Alcoholism, NIH, HHS
• National Institute on Drug Abuse, NIH, HHS
• Nicotine Anonymous World Services
• Substance Abuse and Mental Health Services Administration
• Substance Abuse Resources & Disability Issues (SARDI) Program

by Sean Callahan

by Rev. Fr. Dr. Binoy Alexander
Vicar, St. Ephrem Knanaya Syrian Orthodox Church, Detroit, MI
St. Basil's Syriac Orthodox Church, Cleveland, Ohio
Faculty, South University
Member of Malankara World Advisory Board

Family is the first and vital cell of the society. One of the greatest plans of God for Christian family is to become the role model in society. True Christian family builds good relationship within and outside the family. We can generally say that whatever we plan and execute for the benefit of our family members to become healthy families, rooted in Christian values, will only make good families in the future. The family is the miniature society in which growing children learn how to relate with others.

Alcoholic addiction affects the whole set up of the family. Alcohol use of a member of family affects other family members through their interpersonal relationship. According to Murray Bowen's family system theory, family members are not completely autonomous in their behaviors, emotions, and thinking. Bowen says "the thoughts, feelings, and behavior of each family member…. Contribute to and reflect what is happening in the family as a whole." (1) The misbehavior of an alcoholic can increase the level of anxiety and stress in the entire family. As anxiety and stress grow, family members lose their capacity to care for themselves and to lead healthy lives. Like the alcoholic needs help for recovery, other family member also need pastoral care.

(i) Alcoholism

The National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine defines alcoholism as "a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences and distortions in thinking, most notably denial." (2)

Alcoholism is a learned habit which harmfully affects the physical, psychological, social and spiritual health of the alcoholic. Since it is a learned habit it can be treated successfully with the cooperation of the alcoholics and their family members. In 1956, the American Medical Association recognized alcoholism as a disease, which means an excessive craving for alcoholic beverages despite its dangerous consequences on the whole life of the addicted person. Alcoholics have no control over their drinking. Even if they stop drinking for a while, they go back to obsessive drinking due to the strong urge of the body for alcohol or withdrawal symptoms. As a disease, it can be treated successfully. Through pastoral care and counseling the alcoholic should be convinced of his/her condition.

(ii) Effects of Alcoholism

Alcoholism affects the whole human body and ends in death, but there is hope to free oneself from the deadly cycle of alcoholic effects. Alcoholic effects can be short term and some can be long term. Alcoholic effects manifest themselves in the alcoholics' life in many different forms. It is a disease. It is deadly but curable. In addition, like any other disease there are many different effects. Unfortunately, for alcoholics these effects are not always physical. They can take many forms such as physical, psychological, emotional, intellectual, social, financial, and spiritual levels.

(1) Physical

Alcohol affects the entire system of the body. Through a gradual process it affects different organs of the addicted person.

a. The liver:

The liver is a most fascinating organ. It breaks down wastes and toxic substances. It manufactures essential blood component including clotting factors. Liver disease occurs because the presence of alcohol disturbs the metabolic machinery of the liver. Three major forms of liver disease are associated with alcohol abuse,

(a) Acute fat liver
(b) Alcoholic hepatitis
(c) Alcoholic cirrhosis.

They are the result of several years of excessive alcohol consumption.

b. The Heart:

Long term heavy alcohol use is directly responsible for a specific heart muscle disease, and it is called alcoholic heart muscle disease (AHMD). (3)

c. The Brain:

Chronic alcohol use can lead to various degrees of dementia and organic brain disease. Alcohol use makes changes in the brain. Alcohol interacts with the brain's chemical neurotransmitters, which carry nerve impulses from one nerve cell to another. The release of certain neurotransmitters makes the addicted feel good. Psychoactive substance affects the brain's neurochemistry by increasing the release of these neurotransmitters, and its absence in the brain stops the feeling. Through the repeated use, the substance will become a necessary component of the brain. Gradually it leads to the stage in which the substance will become an unavoidable part of the brain to maintain the normal feeling (tolerance). In the absence of the addicted substance the brain will react with painful symptoms throughout the body (withdrawal) and also stimulus the body for more substance (craving). (4) In accordance with the blood-alcohol level, the alcoholic person experience changes in feeling and mental functions. As blood alcohol level increase, the degree of mental inefficiency increases and the alcoholic person experiences an increased feelings of relaxation and sedation. When the blood-alcohol level reaches 0.40 or o.50 percent, the alcoholic person becomes an unconscious stage and in o.60 percent level alcoholic's brain becomes so depressed and may lead to death. (5)

d. Blood:

The blood carries oxygen to the tissues. It takes up waste products of cell metabolism and carries them off to the lungs and kidneys for removal. It carries nutrients, minerals and hormones to the cells. Alcohol or some of its metabolic products, like acetyl dehyde are thought to interfere with the bone marrow's ability to use iron in making hemoglobin, which is the oxygen carrying part of the blood. The body normally destroys and recycles old red blood cells, through a process called hemolytic. Abnormal hemolytic may occur in alcoholics. (6)

(e) Central Nervous System:

The Central Nervous System is the major organ system, which is most widely and profoundly affected by the effects of both acute and chronic alcohol use. Chronic alcohol use can lead not only to psychological dependence but to physical dependence too. The heavy consumption of alcohol reduces the sensitivity of the central nervous system. As a result, more doses of alcohol are needed to produce the same effect, which will lead gradually the individual to alcoholic addiction. (7)

(2) Psychological Effect

Psychologically one person uses alcohol to reduce his /her anxiety, relieve feelings of inadequacy and to escape from difficult life situations. The alcoholic persons cannot stand up to the stresses and crisis of daily life. What they do is that they depend on alcohol to obtain some relief but this only aggravates the situation. Anxiety and tensions are the regular companions of alcoholics. Alcohol increases their low self esteem and creates a kind of fear. They have the fear to face people and authorities. They are under the clutches of guilt feelings. They live in the world of loneliness. They feel that they are driven out from the family relationship with other family members.

(3) Intellectual Life

As we see above alcoholism affects brain. Therefore, short term memory problems are very common among the alcoholics. One may hear something and understand it but within a few minutes that person forgets it. Sometimes during stressful period, it is very difficult to remember significant events from the past. These memories are not gone but the person may be able to remember them easily at other times. Alcohol makes some changes in the brain which may lead to depression, impaired judgment, memory loss, anxiety, mood swings, and suicidal ideation. (8)

(4) Emotional

Alcoholics face many problems with their emotions. They may feel anxious or excited and have more stresses than they can handle, then there is an emotional shutdown. If this happen to them then they become emotionally numb, It may lead them to become emotionally unable to feel anything. They may swing from one mood to another without knowing why they also become impatient and irritable. Alcoholic may have fear especially fear of death. They may have suicidal tendency. (9)

(5) Spiritual Life

Spiritual life is really a problem for the alcoholics. Alcoholics slowly drift away from God when they are more addicted to alcohol. They turn away their faces from worshiping places and prayer centers. It is a hobby for them to criticize the religious authorities. They not only pray with the family members but also they may also do not allow them to pray. Moral life of the alcoholics is not up to the mark.

(6) Social Life

Social life is a problem for most alcoholics. They lose their social status because of the displeasing behavior patterns with others. They always associate with other alcoholics. They do not recognize and respect the dignity of others. The alcoholics neither can nor keep up steady and stable relationship with people in their society. Alcoholism increases crimes and other social evils. It affects the economy of the society, morality and the value system of the society.

(iii) Alcoholism and its impact on Family

Alcoholic family refers to a family in which the alcohol is the organizing principle. Family members develop the same behavioral disorder as the alcoholic. The addiction of one member of a family will inevitably have an impact on the lives of other family members. In an alcoholic family alcohol badly affects the smooth going of father-mother or husband and wife relationship which may interrupts other relationships like social, moral, and financial in the family. Alcoholism may lead the non-abusing spouse to become over involved with the children and to get some of their emotional needs met through the children and the children also may become overly dependent on them. (10)

Alcoholism is an illness that has tremendous emotional impact upon the immediate family members like spouse, parent, sisters, brothers and children. Whatever changes take place in the attitude and behavioral pattern of the alcoholics, they severely affect the life cycle of the family, its members, the relationship, their well being etc. The alcoholic persons cannot carry out the responsibilities of the family in a proper manner. They cannot keep up a good relationship with the family members. They cannot commit themselves to the well being of the family. In a family, if one is an addict, it may ruin their marital relationship. The partners may remain married but they lead relatively separate lives. The addict may work and spend much time with drinking or drug-using friends rather than at home. The non-dependent spouse is automatically forced to carry the full responsibility of the family. Children may feel rejected and unloved and they may develop emotional problems and sometimes they may develop bad habits like alcohol or drug use in order to overcome their problems. (11)

(1) Alcoholism is a Family Disease.

Alcoholism can be called as a family disease, because each member of the family is affected by it socially, physically, emotionally, financially, psychologically and spiritually. It is unbelievable that if we hear the misfortunate experiences of the wife of an alcoholic who gets burden every day and beaten every night and humiliated before the kids, and because of this the kids are neglected and isolated. Alcoholism not only kills the alcoholic, it kills the family. The alcoholic family becomes frustrated when the relatives and friends can no longer tolerate the consequences of alcoholism and avoid the alcoholic and his/her family. The family members are also directly affected by the alcoholic's misbehaviors, and in their attempt to counter act or over come this situation they may get caught up in the consequences of the illness and become emotionally ill themselves. (12)

(2) Family Relationship

In the family relationship (Marital Relationship), if one partner is alcoholic it may surely lead to some or other kind of unsatisfactory sexual relations. Gradually addiction can cause loss of interest in sex. As we know sexual functioning is not merely a physical activity but has strong psychological components. Alcohol affects both physical and psychological character of an individual. Sometimes alcohol may provoke sexual desires, but heavy doses actually impair sexual performance. Shakespeare narrates it like this "alcohol provokes the desire but takes away the performance" (Macbeth, act 2, scene 3). Alcoholic addiction can cause loss of interest in sex for both partners by interfering with physical arousal which leads to impotence and retarded ejaculation in males and orgasm problem in females. (13)

(3) Parents-children Relationship

Parents have the responsibility of letting their children know that they are loved, wanted and accepted. They need to help children become independent responsible persons. The child as well as its parents can individually and together develop into mature persons in a family. Children who are growing up in alcoholic family deserve special attention. In an atmosphere of conflict, tension and uncertainty,
their needs may not be met satisfactorily. In an alcoholic family children lack good models to form their own identities. (14)

(4) Family Spirituality

The alcoholic family may lose their interest in family prayer. The family that prays together stays together. The families of alcoholics neither pray together nor stay together. There may be disturbances and quarrels in the family due to on alcoholism. This does not create an appropriate atmosphere for prayer. For Christians, God is all powerful and provides everything in their life. But for alcoholics, alcohol replaces God in their life and they started to worship alcohol instead of God. The alcoholics believe that alcohol can give them whatever pleasure they need in their life. However, in the long run, alcoholism makes their lives more frustrated and horrible.

(iv) Wives of Alcoholics

She is a lonely person, depressed one. She feels sometimes totally helpless. She has complaints against everybody. She is angry and frustrated. She will take out her anger on her own children. She has low self esteem and a lot of guilt feeling. She will segregate herself from others. She is sometimes tortured physically and mentally. Wives of alcoholics easily become sick due to insufficient nutrition and mental anguishes. They dislike eating food either out of frustration or poverty or the violent situation. They forget the needs of the family and their children. They may daily undergo to physical torture. They are forced to look after the duties of the family. They are forced to borrow money, take loans and ask for financial assistance from their family members and relatives. Sometimes they may also face sexual harassment.

Alcoholic husband makes a tremendous emotional impact on his wife. The nature and degree of that impact varies from one woman to another .Certain painful psychological outcomes are common to all such as guilt feeling, anger, depression, fear, anxiety and shame. Wives of alcoholics more often hold themselves accountable for their husband's excessive drinking. Some wives feel responsible for having contributed to the drinking problem, while others blame themselves for failing to put an end to it. (15)

In our malayalee culture, sometimes most of the wives of alcoholics go after black magic and other superstitious beliefs. They are ready to spend any amount of money for these in order to rescue their husbands from alcoholism. In the beginning stages of their lives the wives of alcoholics spend a lot of time in prayer, fasting and other spiritual activities. Later on they slowly avoid spiritual practices and think that even God has abandoned them.

The wives of alcoholics do not have active participation in the social life. They want to keep aloof from others. They keep themselves away from most of the social events. They are afraid and ashamed of being enquired about their husband's and their well being. They do not wish that friends or relatives come to visit them. Sometimes they themselves think that she is the cause of everything. Relatives, friends and others may accuse them for their husbands' drinking habit.

(v) What parish priest can do?

Pastoral care givers can do a great deal to help the alcoholics, their family members, and other loved ones to recover their health and well-being. If the priest is trained in family therapy that can help him to give a better care to the family. Even without formal training, they can listen the members of the family very patiently, and without any prior judgment.

(1) House Visiting

House visiting is the main part of our parish ministry and priests are very well welcomed and permitted to visit every house at any time without any prior appointment. Family is the basic unit of the Church and Society. Jesus Christ visited many houses in His public ministry, and wherever Jesus visited He established peace, salvation, and healing there. Main pastoral duty is to give living Christ to others. When a priest visits families he can give Christ's peace and healing to them through God's words and acts. Today family life consists of many problems like unemployment, poverty and other evils like alcoholic and drug addictions. Through pastoral house visits they can understand the family situations i.e. their family background, the economic conditions, prayer life, and unity among members, relationship with other families. In the alcoholic family the situation will be pathetic. There will be many deficiencies then they can assist and support them in many ways such as make the alcoholic and his family members aware that alcoholism is a family disease and find out its causes and effects, how it can be overcome through
counseling and treatment. By sharing they can understand them more and reduce their helpless situation. .

(2) Pastoral Care and Counseling

As we know pastoral counseling is an art of listening. In counseling we can talk with each member of the family. By this we can understand the history of family, the condition of alcoholic and how it affects the family life especially the education of children, the spiritual life of the family, and marital problems. Through counseling we bring them to the awareness of the duty of each one in the family and convince them that alcoholism is a disease which can be treated. If the pastor is not trained in counseling, he/she can make use of other experts in counseling, and recommend near by available treatment centers. Pastors can recommend family members for counseling at a substance abuse center. Moreover we should maintain personal contact and provide continuous support. We should motivate the alcoholics to go for treatment by telling them that they need not feel ashamed about going for treatment. (16)

(3) Awareness Program

In alcoholic treatment, the awareness program is the most important one. In the church we should conduct awareness program twice in every year. Through this program we can make the alcoholics aware about the need of treatment, teach the family members that how to handle an addict in the family and also introduce them different available resources.

(4) AA Meeting and Al-Anon Family Groups

Pastoral care givers should encourage alcoholics to attend AA meeting and make arrangement for that, and also encourage the family members to attend Al-Anon or a similar self-help program The Al-Anon family groups are a fellowship of relatives and friends of alcoholics and help each other to solve their common problems. They make use of the 12 steps for the recovery of the alcoholics. (17)

Twelve step Program: It is based on the experiences of the earliest AA members and summarizes the process by which they achieved sober lives. The first step requires a person to admit his or her powerlessness before alcohol. Here the addicted person accepts his/her weakness and wants help from someone who is powerful than himself /herself. Accepting one's need for a higher power is the purpose of second step. In the third step the addicted surrenders himself/herself to the higher power-God, as that person understand God. In the 4th step, the person takes an exhaustive moral inventory of himself/herself. Then he /she shares his or her wrongs and asks God to forgive and remove these shortcomings in the following three steps. The 8th and 9th steps encourage the addict to make a list of all persons whom he/she had harmed and then makes direct amends. The last 3 steps seek the expansion of recovery by continuing the personal inventory, admitting wrongs on an ongoing basis, and deepening a conscious connection with God. (18)

Priest or care giver of the community can do a great job to make the family members aware of the importance of the treatment, of different possibilities for recovery, and also encourage them to go for counseling. If nobody takes initiative for treatment, it is the duty of the pastor to arrange a plan for bringing the family members together and encourage them to take the alcoholic for better treatment. The pastor could point out the near by available treatment centers and provide other helpful resources. Pastors should be aware that addiction is a disease; as it progresses addicts' ability to control themselves diminishes. Here they need outside interventions, and without the intervention and cooperation of care givers and family members recovery is not possible. Due to shame and guilt the family members are not interested to reveal the addiction problem within their family and they keep it secret in order to preserve their prestige before others. Moreover, most of the family members are unaware of their responsibilities in handling addicts. They also don't know how to handle an addict or what to do in a particular situation. Sometimes the family members may say that it is not our responsibility to get the addicted out of its bondage. But one thing is clear that addiction being a progressive disease, it requires mutual cooperation of all those who are related to the addicted person. As alcoholism progresses, the relatives, friends and family members automatically become involved. Their mistakes like blaming, isolating, mocking, etc will lead recovery more difficult for the alcoholic. Prior to thinking about the treatment for an addict, the family members should try to fully educate themselves about the situation and learn how to handle the addicts by consulting the experts and also seek treatment for themselves, so that they will not make dangerous mistakes. Here education is more important through which they can understand the neurophysiologic nature of the disease.

References:

1. Denis Meacham, The Addiction Ministry Handbook: A Guide for Faith Communities,96

2. Katherine Ketcham and William Asbury, Beyond the Influence: Understanding and Defeating Alcoholism (Bantam Books, 2000), 45

3. Charles R. Carroll, Alcohol: Use, Nonuse, and Abuse , (Indiana, WM. C. Brown Company), 47

4. Denis Meacham, The Addiction Ministry Handbook: A Guide for Faith Communities (Boston: Skinner House Books,2004 ), 2.

5. Charles R. Carroll, Alcohol: Use, Nonuse, and Abuse , 42

6. Charles R. Carroll, Alcohol: Use, Nonuse, and Abuse,45

7. Charles R. Carroll, Alcohol: Use, Nonuse, and Abuse,47

8. George B. Cutten, The Psychology of Alcoholism (New York: Arno Press,1981) , 89

9. Charles R. Carroll, Alcohol: Use, Nonuse, and Abuse , 48

10. Denis Meacham, The Addiction Ministry Handbook: A Guide for Faith Communities, 221

11. Dennis Thombs, Introduction to Addictive Behaviors, 3rd edition, (New York: The Guilford Press, 2006), 195.

12. Debra Jay, No More Letting Go: The Spirituality of Taking Action Against Alcoholism and Drug Addiction, (New York: Bantam Books,2006), 100

13. Bucky Dann, Addiction: Pastoral Responses, ( Nashville, Abingdon Press,2002), 59

14. Denis Meacham, The Addiction Ministry Handbook: A Guide for Faith Communities,223

15. Debra Jay, No More Letting Go, 95

16. Bucky Dann, Addiction: Pastoral Responses, 91

17. Bucky Dann, Addiction: Pastoral Responses, 91

by Dr. Vinu Thomas, Dubai

HG Philipose Mar Chrysostom, Senior-most Metropolitan of Mar Thoma Church, lamented in a press meeting in Abu Dhabi that Liquor addiction is destroying the social and moral framework in Kerala and has thus resulted in various growing vices in the state.

HG pointed that all the religions exhort the faithful to abhor the use of liquor and said campaign against addiction of liquor should be done with all vigor and strength unitedly by all religions in Kerala. HG suggested that Licenses should not be given for Liquor Shops in Kerala for the next three years and all illegal Liquor shops should be strictly ordered to shut down.

HG said stealing occurs because those who do have wealth do not share it and humorously added that when one don't willingly give what is deserved to the needy in 'the day.' In frustration and dire need, they come and steal in 'the night.' Housing, Education and Health should be made available to all by those in power.

HG said those poor ones who bought rice for 25 Rupees per Kg before, now after Oommen Chandy Government's distribution of Rice at Rs.1/- per kg began, are now buying Liquor for Rs. 24 and Rice for Rs. 1. HG said Agriculture should be wholeheartedly encouraged in Kerala using biologically acceptable manures to produce healthy crops and vegetables.