Response to our chronic addiction is a sick joke

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IT can seem comical to the outside observer that the alcoholic is so blind to their addiction. But this alcoholic myopia is essential to maintain the illusion of non-dependence, and therefore, normality.


Terence Cosgrave – 07 April 2013

The families of alcoholics know this. The alcoholic can deal with any problem as long they can have a drink. If the drink is costing too much and the family can’t afford it, the alcoholic thinks, “I have to get cheaper drink” – not what the non-alcoholic would think, which is the logical answer, “I have to give up alcohol”.

It would be similar to a situation, for example, where a government was faced with a difficult problem, and rather than tackle the core element of that problem, it issued a policy document of platitudes and palaver that did everything but face down the real issue.

Oh wait, that just happened with the launch of Healthy Ireland, a document that promises much, but in fact just lays out the paving stones of good intentions for a road to hell, rather than health.

Essentially, the document promises that the Cabinet will co-ordinate policy and various institutions will co-operate to make the health of the population a factor in all policy decisions.

But in the same way that “When?” is the first question to be asked when an alcoholic says they will quit, and all other facts are irrelevant in the face of that one – the first question to be asked of any government policy is: “How much resources are being put into it?”

The answer is none.

Certainly we get the cabinet committee on social policy to oversee the progress of the plan, we are promised that an implementation plan will be drawn up, and we get another quango with (presumably) the same obligatory political appointees.

But it fails to take serious action on the three big killers in Irish society and the three major obstacles to health – smoking, drinking and obesity. And these are serious and major problems. As Health Minister James Reilly has pointed out, very few products will kill half its users if used as per the manufacturer’s instructions, but tobacco will.

Irish culture is so saturated with alcohol that we don’t even notice that it costs us €3.7bn each year to deal with its misuse. And two out of every three Irish adults are either overweight or obese.

These three factors will eventually cause the health system to implode under the strain.

The growth in obesity is particularly daunting, as obesity is the leading cause of cancer in non-smokers.

It has other profound implications, now that Alzheimer’s disease is being re-classified by many medics as ‘Type 3’ diabetes, with growing evidence emerging that Alzheimer’s is primarily a metabolic disease.

There is already a strong link between diabetes and Alzheimer’s, with sufferers of Type 2 diabetes two to three times more likely to develop the disease. The link between obesity and dementia is less clear, but studies have linked mid-life obesity to dementia, and fitness and a better diet have been shown to decrease the incidence of dementia.

What does that mean for Irish health?

More obesity will mean more cancers, more dementia and other health problems, and at the rate these chronic diseases will grow, the health system will be overwhelmed.

Obviously, then, there is a huge need to tackle these problems at source – to reduce smoking, radically change drinking habits, improve diet and increase fitness levels among the general population, or the health system will collapse under the weight (literally) of an unhealthy population in the decades ahead.

And the way to do this is obvious – increase taxes on tobacco, initiate a sustained and vigorous campaign against smuggled tobacco, ban all alcohol advertising, increase the cost of alcohol substantially and take serious measures against obesity.

‘Serious’ measures would not include providing an apple for civil servants for their lunch, for example – that would be an example of avoiding the problem and putting it off for another day. That would be an example of pretending that you were doing something, when in fact you were doing nothing at all.

It might include higher private insurance fees for the seriously overweight, or a tax on heavily sugared drinks, or charging the full price to a patient for being in a bed because alcohol put them there.

But none of these measures are being considered. Like the alcoholic, we are giving up the drink, just not today, not tomorrow or the next day.

Maybe in the year 2020, when we can all joke that we would have done it in 2013 but we didn’t have 20-20 hindsight back then. Ha ha.

One has to sympathise with Reilly to a certain extent. As a doctor, he knows that if he is to do his job properly, he has to take into account the long-term health of the patient.

As a politician, he knows that, politically, all that matters are today’s figures.

His dilemma is a real one. When hospitals are crowded and patients are left on trolleys, no one says: “I blame the heavy drinkers who are taking up 2,000 of our 11,000 public beds tonight for this horrible situation.”

Two thousand beds. Think what that would do for the system if those beds could be used tomorrow?

And that happens every single night in our hospital system. If it were breast cancer causing it we would call it an epidemic, but alcohol … well, it’s part of what we are, isn’t it?

We just can’t imagine life without it, the Heineken Cup, the Guinness championship and the beds stuffed with people suffering from alcohol-related problems that keep others on trolleys. That’s just a normal cost, nothing unusual in that.

Like the genetic trait that allows the condition of being a TD to pass from parent to their offspring, we have become so conditioned to our own unhealthy normality, we consider it to be the norm.

The patient is very sick but the system is working perfectly and as it should.