About 60% of South African drinkers are classified as heavy drinkers. With Alcoholics Anonymous celebrating 75 years of service, we spoke to recovering alcoholics about their struggles with addiction.
First published in the Daily Maverick 168 weekly newspaper.
The looting of liquor stores during the alcohol bans that are part of Covid-19 lockdown restrictions serves to highlight the toxic relationship South Africans have with alcohol.
The country’s high alcohol consumption has old and deep roots, which can be traced back to the introduction of the “dop” system in the 1800s, when labourers in the Cape received part of their wages in cheap wine.
A 2016 report by the World Health Organization (WHO) said that about 60% of South African drinkers aged 15 years and older were heavy drinkers. This was measured as the consumption of at least 60g or more of pure alcohol (or six standard alcoholic drinks) on one occasion or more in a month.
More than 70% of male drinkers over the age of 15 were heavy drinkers. For females in the same age group, the figure was 33.7%.
The WHO report noted a higher prevalence of alcohol use disorders (12.4%) and alcohol dependence (4.2%) in South African men compared with women, where the prevalence was 1.8% and 0.7%, respectively.
Although the majority of South Africans (53.5%) do not drink, South Africa ranks among the top five countries in the world that have the highest consumption of absolute alcohol per drinker per year.
Heavy drinking and alcoholism, however, are not the same thing. Alcoholism is a chronic, relapsing disease “characterised by compulsive and continued alcohol use despite harmful consequences”, says Guy du Plessis, an addiction counsellor and recovery coach in Cape Town.
Alcoholism is caused by multiple factors including genetic predisposition and alcohol use as a form of self-medication (for depression or anxiety, for example, trauma as well as adverse childhood experiences and poor early attachment to primary caregivers).
Alcoholism is progressive
One of the early warning signs of addiction is developing a tolerance for drinking, says Freddie van Rensburg, addiction counsellor and author of Life Anon: A 12-Step Guide for Non-Addicts.
“Another one is if you start picking up that people are not honest about their alcohol consumption.”
Isolating and neglecting family and work responsibilities are signs that the problem is progressing.
Van Rensburg believes the seed for alcoholism is planted before the age of seven as “it is in those years when our main belief system about ourselves is formed. Based on that belief system, the foundation for alcoholism is laid.”
He bases his conclusions on renowned addiction expert Gabor Maté’s philosophy that there’s no such thing as an “addictive gene” or an “addictive personality”. It is instead linked to childhood trauma.
“Functional alcoholism” is another concept he challenges.
“I think you’re dealing with a person who hides their alcoholism better than somebody else,” he says.
A high-functioning alcoholic is loosely defined as a person who maintains job stability and relationships while meeting the criteria for having an alcohol use disorder.
Functional alcoholics are less likely to seek help for their addiction since they are able to maintain the guise of normalcy to the outside world and themselves.
Crime and liquor are intertwined
The quarterly crime statistics for the period of April to June this year show high numbers of liquor-related offences, which include murder, attempted murder, rape and assault with intent to do grievous bodily harm.
Year-on-year crime statistics show a steady link between alcohol consumption and gender-based violence-related incidents. In the fourth quarter of 2020, more than 1,300 rape cases were linked to alcohol consumption.
The so-called “crime holiday” that occurred during the hard lockdown between April and June last year was largely attributed to the alcohol ban implemented at the time. During that period, so-called contact crimes dropped by 37.4%.
Van Rensburg says he was struck by how people “freaked out” over the prohibition of alcohol: “A lot of people need to assess their lives and see whether they use alcohol as a crutch. Once alcohol becomes a crutch, then one is starting to enter the phase from using to abusing alcohol.”
The decline in hospital trauma admissions also reflects the societal effects of alcohol abuse and alcoholism.
According to the South African Medical Research Council, alcohol use and, especially, heavy drinking, are causally related to trauma admissions.
A study comparing the effects of the lockdown and alcohol restrictions on emergency-room cases at Pholosong Regional Hospital’s emergency department in Gauteng found that cases declined by 33.14% in March 2020 and by 57.93% in April 2020 compared with two years prior.
Changes to regulations regarding alcohol are under consideration by way of the Liquor Amendment Bill, first mooted in 2016. The bill, which President Cyril Ramaphosa sent back to Parliament for reconsideration last year, proposed:
- Increasing the drinking age from 18 to 21 years old;
- Banning alcohol sales and advertising on social as well as small media;
- The introduction of a 100m-radius limitation of trade around educational and religious institutions; and
- The introduction of a new liability clause for alcohol sellers.
Since alcohol bans were instituted, political parties such as the DA have accused the government of using provisions afforded by the State of Disaster as a veiled attempt at introducing liquor policy changes. The party as well as groupings within the liquor industry have called on the government to expedite the introduction of the Liquor Amendment Bill. DM168
“Alcoholism is a chronic, relapsing disorder characterised by compulsive and continued use despite harmful consequences.” – Guy du Plessis, addiction counsellor and recovery coach
“There’s a big difference between being a user of alcohol, being an abuser of alcohol and being an alcoholic. People call others who drink a lot alcoholics, but they’re not necessarily alcoholics. To look if someone falls into the category of addiction, we will look at two factors predominantly: do you need to drink more and more to get to the same level of drunkenness? Do you experience withdrawal when you don’t drink? We call it the tolerance and the withdrawal aspects. If both of those are present, then we may be looking at alcoholics.” – Freddie van Rensburg, addiction counsellor and author of Life Anon: A 12-Step Guide for Non-Addicts
AA’s 12 Steps approach follows a set of guidelines towards recovery, first published in 1939 by AA co-founders Bill Wilson and Bob Smith. The 12 Steps are:
- We admitted we were powerless over alcohol – that our lives had become unmanageable.
- Came to believe that a Power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we
- understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all. Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory and when we were wrong promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practise these principles in all our affairs.
A note on the ‘God aspect’ of the 12…