The story was corrected on April 13, 2020 to reflect that a prisoner in question was an undertrial, not on parole. It was first published on April 3.
Kerala recorded its first death from the novel coronavirus disease (COVID-19) on March 28, 2020. Five people reportedly suffering from alcoholism, however, committed suicide until March 28. The state government had decided to shut wine shops and bars on March 25, when the nationwide lockdown was imposed.
Seven died from alcoholism as of April 2, with several other suicide attempts and many more admitted in de-addiction centres with serious psychological issues.
The nationwide lockdown — to tackle the spread of the COVID-19 — has left the medical fraternity in the state divided over how to deal with alcoholism.
The state’s healthcare system and government were praised for taking measures to curb the spread of the disease.
Kerala had successfully treated the first three cases of the virus infection in India and its health department was also in the limelight recently after it helped an old couple recover from COVID-19.
The government and the healthcare system, however, seem to be helpless when it comes to tackling the issue of alcoholism.
Alcoholics were left to grapple with the sudden unavailability of liquor after the lockdown, with reserves running out for many, increasing withdrawal symptoms.
This was in addition to coping with revenue losses that the stoppage in sale of alcohol would bring to Kerala.
The state had recorded Rs 14,508 crore in liquor sales in 2018-19, with state excise revenue to the state government at Rs 2,521 crore in the same period.
“Closure of wine shops is leading to a big social problem,” said Kerala Chief Minister Pinarayi Vijayan, at a press conference on March 27.
“As withdrawal symptoms increase, alcohol addicts will face bodily and psychological issues. They need treatment and counselling,” Vijayan said.
Three people had taken their lives till the day leading to the press conference, including an undertrial who police suspects drank sanitiser, thinking the alcohol content in it would satisfy him.
Two more people had taken their lives afterwards, taking the toll to five suicides with two more suicide attempts.
The unfolding issue prompted Vijayan to say that the government was considering giving alcohol to those addicts with serious medical conditions during withdrawal stages, with a prescription from a doctor.
Some medical experts warned that alcohol should be made available to patients who were completely dependent on it, while others argued that doing so would result in crowding and violate social distancing norms.
The government’s move was criticised by the state government doctors’ association.
“It is unscientific and immoral to treat alcoholism with alcohol without any expert supervision,” said Joseph Chacko, the secretary of the Kerala Government Medical Officers Association (KGMOA).
“Alcoholism should be scientifically treated at de-addiction centres,” he added.
Even though government hospitals were overwhelmed with tackling the COVID-19 outbreak, they could still accommodate alcoholics who faced severe withdrawal symptoms in such centres, Chacko said.
Severe cases accounted for only 5 per cent of drinkers in the state, according to him.
He said that if the government was adamant in making liquor supply possible, the task should be entrusted to the state’s excise department, keeping social distancing in mind.
The government eventually went ahead with the plan, stating that those with serious withdrawal symptoms could receive prescriptions from doctors to get special passes from the excise department and obtain alcohol.
Government doctors, protesting the decision, observed April 1 as a black day and reported to work wearing black badges.
The Indian Medical Association, KGMOA and Congress leader TN Prathapan approached the Kerala High Court and sought a stay on the government order. They argued that the government’s plan was against the basic tenets of medicine.
The high court then stayed the government order, adding that it was a “recipe for disaster”.
Unavailability of alcohol for those who drank daily, was nothing but a medical emergency, according to M Harish Tharayil, Professor of Psychiatry, Government Medical College, Kozhikode (Calicut) in Kerala.
“Their regular body mechanism is tuned to alcohol’s chemical presence in it,” he said.
Mild withdrawal reactions such as hand shivering could, in extreme cases, lead to seizures and a state of delirium, upsetting the person’s mental stability.
Alcoholism in 80 per cent of such cases could, however, be cured through self-motivation and counselling, he added.
Many cases of suicide from alcoholism arose due to delirium, said Tharayil, citing a recent case in the state where an alcoholic was seen digging a pit at midnight at his home, believing his child had died.
Alcoholics were in a state of captivity because of the lockdown, further complicating the issue, he added, stressing on the need for a dedicated ambulance service and publicised telephone number that people in distress could reach out to.
The state’s excise department — that has counselling centres — addressed 469 phone calls since March 25, according to Muhammad Rasheed, joint excise commissioner (Awareness Programme Co-ordination).
The department usually refers serious cases to de-addiction centres functioning at the government hospitals in all 14 districts, he said.
‘’Considering the present circumstances, we have proposed the government to increase bed count in all de-addiction centres,’’ he said.
The situation was being exploited, with alcohol reserves being sold at exorbitant prices, said a 46-year-old man from the state’s Ernakulam district, who works as a driver.
“A brandy bottle costing Rs 350 is sold for Rs 2,000 and above,” he said. “I am not desperate for it now. I think this is a good opportunity to get rid of the habit,” he added.
Johns K Mangalam, president of the Punarjani trust — that runs an alternative alcoholic de-addiction centre for 16 years — sides with the Chief Minister’s plan to provide alcohol in limited quantity.
Alcoholics can use the lockdown as an opportunity to bring down their consumption gradually with the supervision of their family members, he said.
More than 10,000 patients were treated at the Punarjani trust’s de-addiction centre applying this method, according to Mangalam.
Many existing de-addiction centres were, however, a nightmare for alcoholics as they often suffered extreme measures like isolation and confinement, often in violation of human rights, he said.
“Once a person comes out of such a centre, he is often seen as mentally ill by the society,” he added.
Anyone could identify a severe alcoholic from his behaviour, according to him, adding that doctors should to the government’s plan.
The closure of liquor shops led to seizure of thousands of litres of illicit liquor by the police and excise teams across the state, according to a report.
The sale of jaggery — a primary ingredient used to brew country liquor — had also spiked, said local media reports.
Kerala has the highest per capita consumption of alcohol in the country, with alcohol sales often sky-rocketing during festive seasons in the cash-crunched state.
Activists who support de-addiction and religious leaders, however, regularly ask for prohibition.
This dry spell is expected to last till April 15, if not longer.
The state government and civil society would need to spend considerable energy in making sure that alcoholics do not take extreme steps, while family members need to offer emotional support to them.