Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.) Chapter 28: Alcohol and Other Drugs (introduction...) Use and misuse of alcohol and drugs Why do people begin to use alcohol or drugs? When does use become misuse? Why people misuse drugs and alcohol Problems from alcohol and other drugs Common health problems Drugs and alcohol can be worse for women Overcoming problems with alcohol and drugs (introduction...) Quitting Learning to stay free of drugs and alcohol Problems from tobacco Health problems from smoking Smoking is worse for women Living with someone who has a drinking or drug problem Preventing drug and alcohol misuse

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 28: Alcohol and Other Drugs

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¨ Many people do not realize that alcohol and tobacco are harmful drugs.

Many kinds of drugs are used in everyday life. In some places, drugs or brewed drinks have a sacred role in traditions. In other places, alcoholic drinks like wine or beer are commonly served with meals. Drugs and alcohol are often part of festive or social events. And some drugs are used as medicines.

Some drugs that are often used in harmful ways are:

· alcohol: drinks such as brew, beer, spirits, liquor, wine.

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· cocaine, heroin, opium.

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· betel, khat, tobacco leaf.

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· marijuana and hashish

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· glue, fuels, and solvents.

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· pills that help a person lose weight or stay awake.

· medicines, especially those for severe pain, or that help a person sleep or relax.

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In this chapter we talk about the health problems these drugs can cause, their effects upon women, and ways to stop using drugs, especially alcohol and tobacco, the most commonly misused drugs in many communities.

Use and misuse of alcohol and drugs

Why do people begin to use alcohol or drugs?

People often begin to use alcohol or drugs because of social pressure. Boys and men may face pressure to drink or use other common drugs to prove their manhood. A man may believe that the more he drinks, or the more drugs he uses, the more manly he is.

Many girls and women are also beginning to face social pressure to start drinking or using drugs. They may feel that they will appear more grown-up or more modern. Or they may think they will be accepted more easily by others.

Companies that make and sell alcohol and drugs use social pressure, too. Advertisements that make using drugs and alcohol look glamorous, especially to young people, encourage people to buy them. And when companies that make alcohol, or places that sell alcohol, make it seem easy and even fun to buy, people want to buy more. This kind of pressure is especially harmful, because often people are not aware it is affecting them.

Some advertisements, music, and movies encourage young people to drink and use drugs.

When does use become misuse?

Whatever the reason for starting, alcohol and drugs can easily become misused. A person is misusing drugs or alcohol if she loses control over when she uses alcohol or drugs, over the amount she uses, or over the way she acts when using alcohol or drugs.

Here are some common signs that people are misusing drugs or alcohol. They:

· feel they need a drink or a drug to get through the day or night. They may use it at unusual times or places, such as in the morning, or when they are alone.

· lie about how much they or others use, or hide it.

· have money problems because of how much they spend on buying drugs or alcohol. Some people commit crimes to get money for drugs or alcohol.

· ruin celebrations because of how much they drink alcohol or use drugs.

· are ashamed of their behavior while using drugs or alcohol.

· are not working as well as before or are not going to work as often because of using alcohol or drugs.

· have problems with violent behavior. A man may become more violent towards his wife, children, or friends.

¨ If using a drug is changing your life, it is time to stop or to use less. It is better to stop before the drug harms you, your family, or your friendships.

Why people misuse drugs and alcohol

Many people end up misusing drugs and alcohol in order to escape from problems in their lives.

All types of people do this. But people whose parents misused alcohol or drugs are much more likely to try and solve their problems in the same way. This is because a 'weakness' to misuse drugs or alcohol may be passed from parents to children. And as children watch their parents use alcohol or drugs to escape problems, they learn this same behavior.

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Alcohol and drug misuse is also common among people who do not feel any hope about changing the miserable conditions of their lives. People who are displaced from their homes or facing desperate problems - like losing their jobs or way of earning a living, losing family members, or being abandoned by a partner - are also more at risk for misusing drugs and alcohol.

Women often begin to misuse drugs or alcohol because they do not feel that they have any control over - or power to change - their lives. They may feel dependent upon, or at the mercy of, their partner or male family members. And if women have low status in the community, it may be hard for them to value themselves.

Unfortunately, drugs and alcohol usually make all these problems worse, and people feel even less able to improve their lives. Instead of looking for ways to improve their situations, most people who misuse drugs or alcohol spend their time, money, and health on trying to avoid and forget their problems.

Dependence and addiction When a person misuses drugs or alcohol, both the mind and the body can begin to feel an overpowering need for the drug. When the mind feels this need, it is called dependence. When a person's body feels such a strong need for the drug that she gets sick without it, it is called physical addiction. Alcohol and some drugs can cause addiction. Once a person becomes addicted, she will need more and more alcohol or drugs to feel their effects. (For information about overcoming the physical addiction caused by alcohol)

Problems from alcohol and other drugs

Common health problems

People who use alcohol and drugs a lot get sick more often and more severely than others. They are more likely to have:

· poor nutrition, which causes more sickness.

· cancer, and problems of the heart, liver, stomach, skin, lungs and urine system - including ones that cause permanent damage.

· brain damage or fits (seizures).

· memory loss - waking up not knowing what happened.

· mental health problems, such as seeing strange things or hearing voices (hallucinations), being suspicious of others, having flashbacks, or feeling severe depression or anxiety.

· death from using too much at one time (overdose).

Using drugs and alcohol can permanently damage your health.

In addition, injuries or death from accidents happen more often to these people (and often to their families). This is because they make bad decisions or take unnecessary risks, or because they can lose control of their bodies while using alcohol or drugs. If they have unprotected sex, share needles used to inject drugs, or trade sex for drugs, they are at risk for hepatitis and sexually transmitted diseases.

¨ People who chew tobacco are at risk for most of the same health problems as those who smoke tobacco.

Drugs that are chewed. Chewing tobacco and betel nut often ruin a person's teeth and gums, and cause sores in the mouth, cancer of the mouth and throat, and other harm throughout the body. Khat can cause stomach problems and constipation. Many chewed drugs can cause dependence.

Sniffing glues and solvents. Many poor people, and particularly children who live on the streets, sniff glue and solvents to forget their hunger. This is very addictive and causes serious health problems, such as problems with seeing, trouble thinking and remembering, violent behavior, loss of judgement and body control, severe weight loss, and even heart failure and sudden death.

Any use of drugs and alcohol is dangerous if a person: · is driving, using a machine, or dangerous tool. · is pregnant or breastfeeding. · is caring for small children. · is taking medicine, especially medicines for pain, sleep, fits (seizures), or mental health problems. · has liver or kidney disease. It can be dangerous to use drugs or medicines together with alcohol.

Drugs and alcohol can be worse for women

In addition to the problems that anyone who misuses drugs or alcohol may suffer, women face some special health problems:

· Women who drink large amounts of alcohol or use a lot of drugs are more likely to get liver disease than men.

· Many women and girls are pushed into sex they do not want when they drink alcohol or use drugs. This may result in unwanted pregnancy, STDs, and even HIV/AIDS.

· If used during pregnancy, drugs and alcohol can cause children to be born with birth defects and mental disabilities, such as:

- problems of the heart, bones, genitals, and head and face.
- low birth weight.
- slow growth.
- learning difficulties.

When a pregnant woman drinks alcohol, smokes, or uses drugs, the baby does too.

A baby can also be born dependent on drugs and suffer the same signs of withdrawal as an adult.

Women feel more shame

In most communities, women's behavior in public is more strictly controlled than men's behavior. Often it is considered normal for men to use alcohol or drugs, but not for women to do so. If a woman loses control of her behavior because of using too much alcohol or drugs, she is thought to be a 'loose woman', even if she is not having sex with others.

To avoid the shame that comes from making her drug or alcohol misuse public, a woman is more likely to drink steadily over a long period of time, rather than drinking a lot at one time. This kind of drinking makes it easier for her to control her behavior. She is also more likely to keep her misuse a secret and to put off getting treatment. All these behaviors increase the harm that comes from alcohol or drug misuse.

Misuse and violence in the home Misusing alcohol and drugs makes violent situations worse, especially in the home. Women who have partners who misuse drugs and alcohol often suffer injuries and even death. For more information, see the chapter on "Violence."

Overcoming problems with alcohol and drugs

Although it may seem difficult to overcome a dependence or addiction to alcohol and drugs, it can be done. There are 2 stages: quitting and then learning ways to stay free of drugs and alcohol.

Quitting

If you think you have a drinking or drug problem and want to quit:

1. Admit you have a problem.

2. Decide to do something TODAY.

¨ Stopping is often easier with the help and support of others.

3. Stop. Or use less and then stop. Many people can stop drinking or using drugs all at once. All it takes for them is the will to stop and the belief they can do it. Others need help from a group or treatment program like Alcoholics Anonymous (AA) that helps people with drinking or drug problems. There are AA groups in many countries. There may also be other groups or treatment programs in your area. Most women feel more comfortable in a group with women only. If there are no groups in your area, try starting your own group with someone who has been successful in helping people to stop drinking or using drugs.

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4. If you start drinking or using drugs again, do not blame yourself. But try to stop again right away.

Alcoholics Anonymous (AA) To become a member of AA, a person needs only one thing: a desire to stop drinking. As a member; you will regularly meet with others who have quit drinking, in order to share your experience, strength, and hope. You will also have a sponsor - a person who has stopped drinking for a period of time, and who can give you individual support and guidance. AA does not charge any money. It does not support or oppose any causes, or have connections to any religious or political groups. Instead, AA tries to stay free of conflict with other groups in order to fulfill its main purpose: to carry its message to the drinking person who still suffers.

Physical addiction and withdrawal

When a person is physically addicted to alcohol or a drug and quits using it, she will go through a period of withdrawal. During this time her body must get used to being without the drug.

¨ Some herbal teas can help the liver cleanse the body of poisonous effects of alcohol or drugs. A traditional healer may be able to suggest good local herbs.

Alcohol addiction and withdrawal. After quitting drinking, it can take about 3 days for most signs of withdrawal to stop. Many people get through these days without problems. But since some people have very serious signs, it is important to have someone watch over the person and give help when needed.

Early signs of withdrawal:

· slight shaking
· nervous and irritable feelings
· sweating
· trouble eating and sleeping
· aches all over the body
· nausea, vomiting, stomach pain

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These signs may go away on their own, or they may get stronger. If they do, the woman should go to a health worker immediately. If help is far away, give her 10 to 20 mg of diazepam by mouth to prevent seizures. Give another 10 mg an hour later if the signs are not getting better. If you are still traveling, you can repeat the dose every 4 to 5 hours.

The following signs are an emergency. Any person with these signs must get medical help immediately:

· mental confusion
· seeing strange things or hearing voices
· very fast heartbeat
· seizures

¨ When someone is addicted to alcohol, lack of alcohol in the body can cause seizures.

After you have quit drinking As soon as possible, start eating foods (or drinks) with a lot of protein, vitamins, and minerals. These foods help the body heal itself: liver, yeast, breads made from whole wheat, other whole grains, beans, and dark green vegetables. If you cannot eat, vitamins may be helpful. Take a multi-vitamin or B-complex vitamin that contains folic acid.

Learning to stay free of drugs and alcohol

Once a person has overcome physical addiction, it is important to learn how to stay free of drugs and alcohol to prevent the problem from developing again. The best way to do this is to learn better skills for coping with life. This is not easy to do and will take time.

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A woman who has misused alcohol or drugs often feels powerless and full of shame. She needs to learn that she is able to make changes to improve her life. One way to begin is to make small changes that help prove to herself and to others that she can cope with problems.

¨ If you are trying to stay free of drink or drugs, avoid places where you will feel pressure to use them. Work with others to organize social events where drugs and alcohol are not used.

Here are some ideas that have helped women build coping skills:

· Develop a network of support among those close to you and ask for help when you need it. It is much easier to think about problems and begin to solve them when you can talk and work with others.

· Try to solve one problem at a time. That way problems will not seem so large that you cannot cope with them.

· Try to tell a friend or someone you trust about things that worry or upset you, or that make you sad or angry. You may begin to understand why you feel the way you do and what you can do to feel better.

· Work with other people on a project to improve your community. This proves to you and to others that you know how to work for change. You may also find that doing this helps you make personal changes, too.

· Meet together regularly with other people who are working to stay free of alcohol or drugs.

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Problems from tobacco

Health problems from smoking

Persons who smoke become addicted to a drug in tobacco called nicotine. Without a cigarette, they may feel sick or nervous. It is very hard to stop smoking, because nicotine is a very addictive drug.

Since more men than women smoke, smoking has mainly been seen as a men's health problem. But smoking is a growing cause of poor health among women. It is also a growing cause of health problems in poor countries. One reason for this is that tobacco companies are trying harder to sell cigarettes in these countries, as more people in rich countries stop smoking.

In both men and women, smoking can cause:

· serious diseases of the lungs, including chronic bronchitis and emphysema.

· severe colds and coughs.

· cancer of the lung, mouth, throat and neck, and bladder.

· heart attack, stroke, and high blood pressure.

Some of these problems can cause death. In fact, 1 out of 4 people who smoke will die from a health problem connected to smoking.

¨ Smoking can cause disease in those around you who do not smoke.

Children whose parents smoke have more lung infections and other lung and breathing health problems than children whose parents do not smoke.

Smoking is worse for women

In addition to the problems above, women who smoke have a greater risk of:

· difficulty getting pregnant (infertility).
· miscarriage, and babies born too small or too soon.
· problems when using birth control pills.
· monthly bleeding that ends earlier in life (menopause,).
· weaker bones that break more easily during mid-life and old age (osteoporosis).
· cancer of the cervix and womb.

A woman who is pregnant should try to avoid other people who are smoking, so that the smoke will not harm her baby.

Living with someone who has a drinking or drug problem

Often women must care for someone, like a partner or a male relative, who has a drinking or drug problem. Living with someone with these problems is very difficult, especially if the person does not want to change. You can help yourself and your family if you:

· do not blame yourself. It is not always possible to help another person control his or her drug or alcohol use.

· try not to rely on the person's opinion of you to feel good about yourself.

· try to find a support group for you and your family. Sometimes this is the only way a family can cope with the problem.

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¨ Al Anon is an organization like AA, that provides support and help for family members of alcoholics.

Bonnie, from the USA, talks of her struggle with her husband's drinking. She now works with Al Anon.

How to help someone with a drinking or drug problem:

· Help him admit he has a problem. This may be all that is needed for him to use less or stop, unless he is addicted.

· Talk to him about stopping when he is not drunk or on drugs.

· Try not to blame him.

· Help him to avoid situations where he may feel pressured to drink or take drugs. This means not being with people with the same problem, even if they are friends.

· Help him to find other ways to cope with life's problems and to have better mental health.

· Help him make a plan for stopping and follow that plan.

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Preventing drug and alcohol misuse

To prevent drug and alcohol misuse successfully, you must consider the social forces that contribute to drug use.

Try meeting with others to discuss why alcohol or drugs have become important in community life. How did the problem start? What makes people use more? Are there new pressures on men or women that make it harder for them to control their use of alcohol and drugs? How can the drugs or alcohol be made less important in your community?

Once you understand the reasons for the problem, your group might want to work on ways to reduce social pressures to drink or use drugs.

A group of men and women in Chiapas, Mexico organized against alcoholism as part of their movement for democracy and social justice. They realized that people who drink heavily sometimes impose their will on others, in the same way as the police had used force to control the community. The group gave warnings to individuals whose misuse of alcohol was hurting other people, and intervened in cases where drunk men abused their wives. Alcohol played both negative and positive roles in the community. Shamans often drink rum, a sacred symbol, as part of their healing rituals/The group found ways to combat alcoholism and keep the spirit of their tradition by substituting non-alcoholic drinks in these rituals.

Helping young people resist alcohol and drugs

Many people who have drug and alcohol problems as adults began using them when they were young. Drugs or alcohol can seem like an easy way to have fun or escape from problems, especially if others are using them. Young people often feel confused and powerless about the many changes they must cope with - their growing bodies and new responsibilities. Young people are also influenced by many pressures, especially their friends, older people they admire, and advertising.

Find popular role models who speak out against drugs. Your children may find the message more powerful if it comes from a person they admire.

One way to reduce drug and alcohol misuse is to help young people learn to resist harmful pressures. Here are some ideas that have worked in many communities:

· Encourage the schools in your community to teach young people about the problems of using drugs and alcohol.

· Make it harder for people to sell drugs to young people.

· Organize to remove advertisements that make cigarettes and alcohol look glamorous and modern.

· Become a good role model. If you drink a lot or use drugs, chances are your children will too.

· Teach your own children about the problems drug and alcohol use can cause. They can then influence their friends.

· Help young people have fun without drugs and alcohol.

· Help your children develop skills and self-esteem to resist the social pressure to use drugs and alcohol.