On an average day, anywhere between 5 to 15 persons visit the Drug Treatment Center (DTC) at Hyderabad’s Institute of Mental Health (IMH). The Center, which works in coordination with AIIMS-Delhi, offers free consultation and treatment for alcoholism and substance-abuse cases. Amid the novel coronavirus crisis and unprecedented nation-wide lockdown, the mental healthcare professionals in Telangana are staring at an exigency worse than what they have experienced a decade and a half ago.
With the threat of COVID becoming more real, Telangana Chief Minister K Chandrasekhar Rao, while speaking at a press conference on the evening of March 22, categorically announced that all liquor outlets, like other non-essential establishments, will remain closed till March 31. Prior to this, in an order dated March 14, Chief Secretary Somesh Kumar had issued directions to close down clubs, bars including tourism-run bars and permit rooms of liquor outlets till March 21. A day after the CM’s announcement, Prime Minister Narendra Modi announced a 21-day lockdown extending till April 14.
The last time Telangana witnessed a non-availability of alcohol was in 1995 when the then chief minister of united Andhra Pradesh, N T Rama Rao, announced a prohibition on sale and consumption of alcohol as part of fulfilling his election promise. The decision was revoked by N Chandrababu Naidu who took over the reins in 1997. Psychologists and psychiatrists in the state are now worried about a situation where addressing the mental health issues arising out of withdrawal from alcoholism can be an added burden on the ongoing fight against Covid-19.
Telangana has 2,400 licensed liquor outlets and around 700 bars which are currently shut. Except for stray incidents of wineshop owners selling out of their stock at homes at an increased price, alcohol is nearly out of bounds for the common man. Dr D. Keshava Rao, senior psychiatrist and a former president of Telangana Psychiatric Society, wonders if at all government has given thought into alcohol withdrawal issues arising out of its sudden non-availability. Recalling his tenure at the Institute of Mental Health in Hyderabad during the 1995 prohibition, Rao said, a team of doctors was deployed to educate the public on how to cope with the non-availability of alcohol.
“It took 18 months to fully impose the prohibition across the state. Even during a full prohibition, people had their stocks through illegal supplies or travelled to neighbouring Karnataka,” he said. “Now, with a nation-wide lockdown, arranging for treatment to cases of chronic alcoholism could not just be an additional burden but also very difficult to do,” he added. Incidents of consumption of spurious liquor or disinfectants that smell like alcohol cannot be ruled out.
Regarding the alcohol withdrawal symptoms, Rao says a sudden cessation or lowering the quantity of alcohol consumption in those habituated to alcohol every day may lead to mild withdrawal symptoms like tremors, shaking, restlessness, irritability, etc in 8-12 hours. In 48-72 hours, one may develop severe side effects like withdrawal seizures (rum fits) and can develop delirium, a disturbed state of mind, characterised by restlessness, illusions, and incoherence, occurring in intoxication, fever, and other disorders.
Speaking to indianexpress.com, Dr. M Umashankar, superintendent at 600-bedded Institute of Mental Health (IMH), the lone mental hospital in the state, admitted that cases of alcohol withdrawal issues are likely to rise with each passing day. Apart from deaddiction centres in major government hospitals, he said, government psychiatrists are available in 27 of 33 districts across the state. “Recently, under a national mental health program, medical officers at primary health centres were given training on mental health treatment. So we have a three-tier system in place where one could first visit a medical officer at PHC first, then government psychiatrist at the district and then be admitted into hospital if necessary,” he said. According to him, looking at the physical condition of a patient, doctors would initiate rehydration and stabilise him/her with detoxification drugs first, and then anti-toxification drugs depending on the severity of the matter. All of this may take between seven and 15 days.
Not all who consume alcohol may be dependent and a majority may sail through without any withdrawal symptoms, opines Krishna, a member of Alcoholics Anonymous (AA) in Hyderabad. Non-availability of alcohol, he says, is not a common man’s problem and that a person who wants alcohol at any cost will make arrangements for the same depending on his affordability. Citing his experience with chronic alcoholics, Krishna says non-alcoholics would get used to the situation, adjust to it and forget about it.
“Withdrawals are self-limiting. Forget emotional withdrawal and self-pity, three days to six days is sufficient to take care of physical withdrawals. Those who need hospitalisation are severe alcoholics and that is a very small percent of the population,” he said.
The AA-community conducts around 35-40 meetings a week with a participation of 5 to 25 people who want to stay sober. Due to the lockdown and social distancing requirements in place, the AA community has now started their regular meetings on video conferencing and content in different languages are made available on social media platforms.
The alcohol market in Telangana was worth Rs 18,000 crore and was expected to grow to Rs 22,000 crore. D Venkateshwara Rao, president, Telangana Wine Dealers’ Association, maintains that they are a crucial part of ‘break the chain’ initiative and refutes any demand for relaxation in terms of keeping liquor outlets open for a couple of hours a day. “All liquor shop owners have agreed to close down shops to prevent the spread of coronavirus. Like all other sectors, we are also keenly watching what is going on,” he said.
Meanwhile, in districts, police personnel are overburdened keeping a watch on tribal tandas (hamlets) that are known for brewing arrack and tapping toddy. A senior police official in one of the districts admitted that alcohol withdrawal symptoms are being seen in the society, but it’s too early for law enforcers to act as round-the-clock enforcement of lockdown has put them under a lot of stress. As of now the larger issues before them include facilitation of essential services in the day-time and check on hoarding and black-marketing as well as enforcement of lockdown throughout the night.
The officials of the Department of Prohibition and Excise have been ensuring stoppage of the flow of Gudumba, or the illicitly distilled (ID) liquor, in the state and several districts have been declared Gudumba-free, while those in the profession were given financial assistance for rehabilitation. Stating that there is no scope for brewing illicit liquor during the current lockdown, C Vivekananda Reddy, Deputy Commissioner of Prohibition & Excise, Hyderabad, said while in theorya surge in the making of spurious liquor was possible, but not in practice. He asked where would one procure the raw material, spirit or means for transport, etc during the current lockdown. However, he admitted that a few cases of illegal sale of duty-free liquor have come to fore in Hyderabad. Though arrests were recorded and materials seized, the offenders were issued a notice and sent away as the courts, too, are shut. At Dhoolpet in Hyderabad, which was once notorious for Gudumba sale, the state government had rehabilitated as many as 650 families, who were earlier in the illegal profession, with a package of Rs 2 lakh each. In the state, as many as 6,323 families were given financial assistance as part of their rehabilitation package until last year.
PS: Those having alcohol withdrawal symptoms can contact IMH at 040-23813252 or reach out to Alcoholics Anonymous at http://www.aagsoindia.org or call AA India Helpline at +91 9022771011.
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