Bored, happy, sad? A glass of cold beer always does the trick. Beer is simply more sociable than other drinks. Heading to the bar, buying rounds and toasting each other are just some of the ways beer helps dissolve social barriers. So when you are having a bad day, there is no harm in having a cold one to cheer yourself up, right? Wrong.
From your bar stool, your next destination could be a shrink’s couch, telling BOSASNet councillors in a psycho-therapy that “ I am not supposed to be here” the most common line they hear from addicts who believed one cold beer cannot do any harm.
Isaac Tokonyane, a counsellor at Botswana Substance Abuse Support Network (BOSASNet), says we should be conscious of the role we play in the life of friends or relatives who abuses substances. “Don’t encourage your friends to drink so they can be more fun to be around; don’t laugh when they ‘blackout.”
These are not just the rumblings of a smart Alec trying to make all the right noises. In Botswana, substance abuse, alcohol particularly, has been linked to the high rate of road carnage due to drunk driving and also to other high risk social behaviours such as unprotected sex. With a population of 2.3 million and a 17.6 percent HIV/AIDS prevalence rate as per statistics from the local National AIDS Coordinating Agency (NACA) unprotected sex often leads to infection with sexually transmitted diseases such as HIV. Back in 2002 the World Health Organisation (WHO) World Health Report stated that, “The hazardous and harmful use of alcohol has now become one of the most important risks to health: it is the leading risk factor in developing countries with low mortality rates and ranks third in developed countries.”
In 2005 the World Health Assembly called on the WHO to, “intensify international collaboration in reducing public health problems caused by the harmful use of alcohol.” Another observation recorded by the WHO explains that, “While alcohol use is deeply embedded in many societies, recent years have seen changes in drinking patterns across the globe: rates of consumption, drinking to excess among the general population and heavy episodic drinking among young people are on the rise in many countries.”
Alcohol is a depressant meaning when used it slows down the body’s central nervous system, also affecting the brain, and therefore the user’s reasoning and perceptions are comprised. In the case of the drunk driver, the individual is driving while the body system is slowing down, which results in the motor coordination being affected and the driver taking longer to coordinate the stepping of the brakes if brakes are needed. BOSASNet acting Executive Director, Lebogang Mothibatsela explains: “We can’t definitely speak of alcohol intoxication being the sole cause of road accidents; that would be a fallacy. But a driver who is not under the influence of alcohol is at a lower risk of causing a road accident.” Botswana Police records from the Traffic Division complement the link of alcohol abuse to the high numbers of lives lost on the roads by revealing that for the past three months of 2013, beginning of January to end of March, there have been 200 reported road accidents caused by drunk driving.
BOSASNet , an NGO offering specialised professional support for individuals suffering and affected by abuse and dependency of substances offers a peep show into how rife the problem is in Botswana. The NGO admits clients aged 13 years and above, although Mothibatsela explains that there are children as young as primary school going ages that are using and abusing substances. The reference to substances includes legal and illegal substances such as alcohol, tobacco; prescribed medications such as pain killers and cough syrups; and hard street drugs like marijuana, cocaine and ecstasy. All in all, the range is quite varying. “The word ‘drug or drugs’ often has negative connotations in society. We, therefore, prefer to use the word ‘substances’ which encompasses everything,” clears Mothibatsela.
Mothibatsela explains that this public health NGO was founded by like-minded community members who had been either directly affected by substance abuse or understood the need for specialist services for people suffering from or affected by substance abuse. She singles out Mitho Gilika, one of the organisations founders who went through a personal issue of a family member who was abusing substances and realised there was no support for people like her family member available locally. She was joined by Peter Hunda, who is still a board member, who was interested in establishing such a centre and worked at putting together the constitution and formally registering the NGO in late 2008. One of the services that BOSASNet now provides is ‘outpatient substance abuse and dependency rehabilitation’ for people suffering from or affected by substance abuse and dependency.
Isaac Tokonyane one of BOSASNet Counsellors emphasizes that there is a difference between ‘abuse’ and ‘dependency’ and that these are two different stages. Substance abuse is when a person uses substances for reasons other than their intended use; for example, if a doctor prescribes painkillers for pain and the person using them likes how it feels and as a result takes more than the recommended dose. “Dependency, however, means addiction. Both abuse and dependency are considered maladaptive behaviours. The maladaptive use of substances,” clarifies Tokonyane. Dependency specifically means when the individual finds it difficult to stop using the substance, in this case the painkiller the doctor prescribed, to the degree that it is not easy to reduce or stop the use of the substance without the person experiencing withdrawal symptoms, sometimes severe like heart seizures. “If you are addicted you can die from withdrawal from certain substances if not properly treated, monitored and supported; you need the substance in the body on a daily basis. Dependency is not a choice or a habit. The World Health Organisation (WHO) recognises dependency as a disease that is treatable and manageable but not necessarily curable,” adds Tokonyane.
According to Mothibatsela there is no such thing as a safe level of use when it comes to some substances such as tobacco, “We cannot speak of a normal use of tobacco,” she cautions. The advice for consumption is zero use for illegal substances, “For legal substances it is within the legal limits and as per the recommended or prescribed doses,” she shares. Substances affect us differently and differently under different circumstances hence the reason why we are advised not to consume or take alcohol if pregnant, intolerant, sick or on certain medication. Tokonyane adds that it is difficult to pinpoint specific reasons people abuse substances that anything can trigger people to abuse substances. “People can start drinking after a death, loss of a parent or after discovering they have a terminal illness. Being dumped can also trigger someone to start abusing substances,” he adds. Some people abuse substances depending on their mood; tired, happy, celebrating or wanting to settle their nerves before a major event.
During the confidential psycho-therapy sessions the counsellor often gets clients saying to him ‘I am not supposed to be here’, the ones who believe they do not have a problem. Some individuals take long to admit to having a problem requiring professional help; for others falling and breaking a table could be the sign they need to seek help. Not everyone is fortunate enough to avoid the repercussions of substance abuse and at times drastic, irreparable and traumatic consequences occur. “For others it is after killing someone in a car accident that they realise they need help. For some it could be losing everything; wife, children, job, income but someone else it could be much less. Don’t wait for the tragedy to strike before you stop or seek help,” advices Mothibatsela.
The acting Executive Director explains that the weekly column they have in The Voice serves as a platform to make community members aware of the signs of substance abuse and also to impart informative educational knowledge on substance abuse. “Recovering from substance abuse is not only about the individual abusing them; it is also about having a supportive environment or circle around you of family, friends and colleagues, people who will understand the problem and support you as you receive professional help,” says Mothibatsela shedding more light on the objective of the newspaper column.
People should be conscious of the role they play in the life of an individual who abuses substances. Tokonyane explains how certain behaviours may perpetuate substance abuse. “Be sensitive to the issue and take it seriously. Don’t encourage your friends to drink so they can be more fun to be around; don’t laugh when they ‘black out’. There are couples who are together because they use cocaine, when one of them stops using they might realise that there was no relationship in the first place; and that their common bond was using cocaine.” In this regard recovery is not just about putting the glass down; it involves making a whole lot of social lifestyle changes.
Mothibatsela observes that substance abuse is an area that society would prefer to keep in denial about. “Nationally we don’t want to talk about it. It’s one of those ‘us and them’ issues.” The centre has thus far admitted over 300 clients and it has had to refer numerous other clients who did not fit the admission criteria of the centre to other service providers. In November 2012 due to lack of sufficient funding the centre shut down its clinical services. “In December 2012 we received a second no cost extension from our original Alcohol Levy Fund grant of 2009 of P3.1 million. This no cost extension will help us operate until the end of this April 2013,” says the acting Executive Director. “For now another donor has stepped in beginning 1st May 2013 with funding which will support us until the end of March 2014. We have continued to fund raise to support what donors have given so we can continue operations beyond March 2014,” she adds.
Prior to the existence of BOSASNet, people suffering substance abuse in Botswana were only referred to government health departments or to the Sbrana Psychiatric Hospital for psychiatric treatment and substance detoxification, as there was no specialized place for their condition. “Sbrana and BOSASNet are now service providers that work hand-in-hand. While Sbrana is able to provide detoxification to substance abuse and dependency treatment, the hospital refers patients to us for after care service,” adds Tokonyane. With groundwork being attained over the past few years, Mothibatsela looks forward to a more robust development in this field which she feels has been neglected. “We hope to see policies and developments that facilitate the infrastructure of substance abuse; education, prevention, rehabilitation and support interventions. We hope to see a national accessible specialized in-patient rehabilitation centre that provides comprehensive treatment. We hope to see our clients making progress, achieving their goals, and knowing they have support. Ultimately we want to reduce the stigma and discrimination that surrounds substance abuse and dependency so that the community understands the issues and support those who are in recovery, says Mothibatsela closing the discussion. If you or someone you know has a substance abuse problem call BOSASNet on 7265 9891 or 7210 7298 to speak to a counsellor in confidentiality.
