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Rethinking alcohol addiction: Not a lack of willpower, but a mental disorder

Scare tactics may deter people from picking up addictive substances. But this tough stance doesn't work when rehabilitating someone with full-blown addiction, say recovering addicts and experts.

SINGAPORE: If you’re seeking tough love, you won’t find it with Mr Ranjit Singh.  

The 59-year-old counsellor at the National Addictions Management Service (NAMS) under the Institute of Mental Health (IMH) won’t implore a recovering person to stop using drugs or alcohol because he understands their position – and his empathy isn’t lip service. 

He would simply speak the words he wishes he’d heard while trying to kick his own addictions when he was younger. 

“When I work with someone, I sit down and I say yes, I can completely understand where you are. I've been there, done that. I know your current challenges, and I know why you need to use (drugs). I'm not here to stop you. At this point you need it … but let’s talk about this,” he told CNA.  

“This is the language I use instead of saying, you need to stop drugs, or you take drugs then you go to prison. That doesn't work at all.” 

This “zero-tolerance policy” doesn’t help with the rehabilitation part of recovery from addiction because it reinforces stigma, he said. “People aren’t coming forward (for help) for fear of getting arrested or going to prison.” 

As a recovering person himself, Mr Singh knows “the addict himself wants to stop”, but might not know how to verbalise that desire. 

“He may express it in a very disrespectful manner, very cocky, very self-entitled. It can be very challenging to deal with someone like us at that stage. Because we’re lost, we’re confused, frustrated and angry. Deep within, we have childlike behaviours,” he said. 

Having battled similar demons since he took his first sip of alcohol at 14, Mr Singh knows how different his life may have turned out if he'd received the right help. 

A "FULL BLOWN" ADDICTION  

Alcohol first transformed Mr Singh from an awkward teenage boy, who couldn’t relate to the people around him, into someone who was bold, cool and relaxed, oozing with charm towards girls. 

“This was a miracle drug for me. This was what I wanted,” he told CNA.

59-year-old Ranjit Singh is a recovering person with alcohol addiction. He is also a counsellor at the National Addictions Management Service located at the Institute of Mental Health. (Photo: Ranjit Singh)

With the money he earned from his part-time job, he developed a daily drinking habit. He then started using marijuana with a group of friends, eventually moving onto benzos (benzodiazepine) and heroin.

By the time he was 22, he was a “full-blown addict” with substance use disorder. 

At 27, he was arrested and sentenced to the Drug Rehabilitation Centre (DRC) for 10 months. There, he made a plan to turn his life around, beginning with marrying his wife (then girlfriend) once he was released. 

But that plan was put to rest, as he picked up the bottle again upon his release. 

“When I came out, instead of using heroin, I drank alcohol. I told myself, alcohol is okay because it’s legal everywhere. In my mind, I wanted the highest amount of alcohol. That was dry gin, which had about 49 per cent alcohol,” he said. 

Within six months of his release, he was using heroin again. Not even the prospect of getting married could stop him. 

MISGUIDED INTERVENTION 

Mr Singh initially tried to address his relapse by praying to be stronger.  After all, people told him they were able to stop drinking alcohol or smoking cigarettes, so he could “just stop” too. 

“People used to say, ‘I used to drink alcohol, smoke cigarettes, and now I’ve stopped. If I can do it, you can too.’ So if they can’t, why can’t I? … I even went for counselling,” he said. 

“All this advice was very excellent, but I couldn’t stop. The desire to stop was there, but I wasn’t able to translate it into action … I tried and it became worse, and I started beating myself up.” 

While he understood people meant well, their solutions treated addiction as a matter of willpower. After working at NAMS, he’s realised that addiction isn’t just a “behavioural or social problem” as many people see it, but a biological problem.

“Addiction is a chronic mental disorder and does not occur because of a lack of willpower,” Dr Mohamed Zakir Karuvetil, a consultant at NAMS, told CNA. 

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), alcohol use disorder is classified under mental disorders. 

“Once an addiction develops, it gives rise to significant psychological, social and occupational consequences in life and runs a chronic course with multiple relapses during recovery, which is very similar to other mental disorders,” explained Dr Karuvetil. 

“All addictive behaviours are fundamentally based on altering (i.e. stimulating) the brain reward pathway. Cross addiction with other drugs or behaviours is possible as our brain reward system shares the similar mechanism with many available drugs and behaviours.”

8 signs of alcohol addiction

  • Craving: A strong and continuing compulsion or need to drink.
  • Tolerance: The need to drink increasing amounts of alcohol in order to "feel the buzz" or to "get high".
  • Physical dependence: Withdrawal symptoms when a person stops drinking after a period of excessive drinking. Symptoms include anxiety, sweating, nausea and "the shakes".
  • Loss of control: Alcohol is often taken in larger amounts or over a longer period than was intended.
  • Unsuccessful efforts to manage behaviour: Unable to cut down or control alcohol use, despite a persistent desire to do so.
  • Time-consuming alcohol-related activities: A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.
  • Giving up other important activities: Important social, occupational or recreational activities are given up or reduced because of alcohol use.
  • Ignoring physical and/or psychological problems: Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the alcohol. For example, continued drinking despite recognition that an ulcer was made worse by alcohol consumption.

Source: Dr Mohamed Zakir Karuvetil, consultant at the National Addictions Management Service under the Institute of Mental Health

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Mr Singh couldn’t completely kick his addictions, because the intervention presented to him during his recovery didn’t address these “root issues about why (he was) using and what’s happening”. One of these intervention tactics involved using the law to “instill fear”. 

“In Singapore, I think having this stringent law is effective to steer people away from drugs. Even as a recovering person, I stopped because I was fearful of getting arrested. I stopped because if I don’t, my wife will leave me. I stopped because I wanted to be accepted by society,” he shared. 

“But so many of these are extrinsic factors. Eventually, it needs to be intrinsic motivation. That’s where the recovery programme, proper understanding of addiction and recovery will develop (the intrinsic motivation).” 

When a person develops substance use disorder, these methods don’t work anymore, he said. Instead, you need to place yourself in the individual’s shoes.

“Empathise with the individual. Be there. Love the person unconditionally. And that’s where the connection comes in. That comes when you have the right understanding of what is addiction, what is substance use disorder, what is recovery,” he added. 

RECOVERY TAKES A VILLAGE

A common belief in the literature on addiction states: “The opposite of addiction is connection.” 

Feeling isolated would thus be a potential trigger for those in recovery. Within the first week of the “circuit breaker” period in 2020, We Care Community Services attended to six crisis calls – up from their usual two per week, the centre’s managing director Tham Yuen Han told CNA last year.

Sharon Ong manning a pop-up booth for SPCA (Society for the Prevention of Cruelty to Animals). (Photo: Sharon Ong)

In fact, isolation compelled Sharon Ong, 53, another recovering addict who spoke to CNA, to start drinking. When she was a caregiver for aged family members, it was an “immensely isolating” experience.

She remembers “literally gulping” at the start of drinking sessions because she was in a hurry to get “a buzz” – but this wasn’t a buzz from being high or happy. 

“It’s not that the taste of alcohol is so wonderful. After the first sip, it actually feels very miserable if you’re drinking as a compulsion. A lot of the time, I suspect people are drinking because they don’t want to feel,” she explained. 

“I feel sympathy for myself in those days because I’d be literally gulping so I could get to the stage where I wasn’t feeling or caring.” 

As a result, for recovering people to successfully battle addiction, they need to connect with others, explained Mr Singh, who found his turning point and “ecosystem of recovery” in a church. 

When a fellow recovering addict shared about kicking his cocaine habit, it gave Mr Singh renewed hope that recovery was possible, despite having been told otherwise by naysayers. 

“The guy shared his experiences, his strengths and his hopes, and all of that was so clear. All the things that he shared, I knew. But here he was living it out. That was the X factor for me,” he said. 

A churchgoer befriended Mr Singh when he noticed him crying, and eventually helped him find a halfway house with a 10-month recovery programme. The churchgoer was also his first friend who “wasn’t an addict”. 

Having a network of support, including family and friends, is “pivotal” to help the recovering person, because “addiction doesn’t affect just an individual”, said Senior Minister of State for Health Janil Puthucheary at the 5th National Addictions Awareness Day on Aug 20.

Among community partners that Dr Puthucheary listed, the Singapore Anti-Narcotics Association, Central Narcotics Bureau, We Care Community Services and the National Council on Problem Gambling partnered with NAMS “to empower persons with addictions and their families with the skills and knowledge to manage their challenges and addictions”. 

These partners have also been involved in setting up helplines and web chat services to support those in the community and to reach out to those who need help, he said.

How to help a loved one with alcohol addiction

  • Have an understanding as to why your loved one is consuming alcohol daily. (Many times people self-medicate for an underlying problem such as emotional or mood dysregulations, poor sleep, as a confidence booster, to address loneliness or combat boredom. These factors need to be addressed first if present.)
  • Do not keep alcohol at home.
  • Anticipate and take precautions with high-risk situations.
  • Help your loved one to avoid a regular fixed time of drinking.
  • Improve the self-confidence of your loved one by engaging in voluntary work.

Alternatively, contact NAMS via www.nams.sg or call the All Addictions Helpline at 6-RECOVER (6-7326837).

Source: Dr Mohamed Zakir Karuvetil, consultant at the National Addictions Management Service under the Institute of Mental Health 

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As for Ms Ong, her medical social worker and IMH provided support when she decided to do "total sobriety", she said. This meant there could be no concessions made for social drinking or any situations that might cause her to relapse, as she felt she had an “addictive personality”.

“I suppose some people may choose to go into a lifelong juggling act: How much is social drinking? Can I have one more drink without considering myself relapsed? Is it a problem if I have a very ‘happy’ night?” she said. 

“I can spend a lot of energy taking the enormous risk of trying to be a social drinker. But I told my medical social worker that I wanted to stop drinking entirely. Total sobriety.” 

Today, Ms Ong is 10 years sober. 

Ultimately, however, kicking addiction isn’t just about stopping drugs or alcohol use, but about a better quality of life in the long run, noted experts. 

“If the person deviates from the recovery plan, it is important to be supportive to encourage the person to return to the original goals. The goal of support is not just to help the person overcome the addiction, but also to help them move towards a healthy lifestyle,” said Dr Karuvetil. 

Getting clean for Mr Singh meant prioritising the "quality of my life, my emotional health and my mental health". 

For the last six years at NAMS, he has done this by paying it forward, becoming the person his younger self needed.

Source: CNA/gy(cy)

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