Alcoholism, says sociologist Ricardo Zarco, is the most common form of addiction among Filipinos.

by AVIGAIL M. OLARTE

	EXPERTS are saying that alcoholism is a disease that is hard to diagnose because alcoholics usually deny that they have a problem to begin with.

WHEN HE answers the phone, he sounds impatient and slurry. It is just six in the evening, but 59-year-old Mon is already drunk — again.

Just two days ago, he had sworn never to take another sip of his favorite brandy. The pledge was made on the 11th anniversary of an accident that nearly cost him one of his feet; he had fallen off a jeepney on his way home after a drinking spree, and the doctors had wanted to amputate his badly injured right foot. But he chose to keep it against his doctors' advice. Now it has turned purple with gangrene and has him in pain every day, pain that no pill can cure, but which he says is dulled by the strong liquor he drinks by the bottle daily.

We decided not to use Mon's real name in this story because he was drunk when he said we could publish it; his eyes were glazed, his speech slurred, his handshake loose and sloppy. He was also drunk when he pledged to stop drinking. He seemed full of guilt and remorse all the same, knowing full well the grief his drinking has caused his family. Yet while he may have been sincere in making that promise, there was no way he could fulfill it — at least not without a doctor's help, which he steadfastly refuses to seek, and certainly not after 41 years of almost non-stop drinking.

Like many Filipinos, Mon began drinking in his teens, as a way to pass time with friends. When he got older, it became part of his daily routine. As years passed, the habit turned into an addiction, although Mon would probably not be ready to admit that. In fact, in the Metro Manila slum community where he is the executive officer in charge of peace and order, few of the men openly drinking the day and most the night away in the dank street corners would probably acknowledge that they have grown dependent on alcohol.

According to toxicologist and psychiatrist Joselito Pascual of the Philippine General Hospital (PGH), alcoholism is a disease that is hard to diagnose because alcoholics usually deny that they have a problem to begin with.

"Alcohol addiction is one of the toughest problems (to solve)," agrees sociologist Ricardo Zarco. He also notes, "It is the most common form of addiction you would find among Filipinos. You'll find Muslims and Christians, the rich and the poor, addicted to alcohol."

For sure, a society that celebrates an individual's capacity to imbibe huge amounts of alcohol — the tagay (toast) culture, as some experts put it — has something to do with that addiction. And while there are practically no official statistics to come by that would show just how prevalent alcoholism is in this country, there are enough indications that the situation may be more serious than most people assume.

Dr. Lynn Panganiban, for instance, says that alcohol was the top poison recorded among patients of the National Poison Management and Control Center (NPMCC) at PGH last year. This has been the trend for most of the past 15 years. Panganiban, who is chief of the NPMCC, also says that alcohol has traded places with methamphetamine hydrochloride (better known as shabu), the next leading poison, only a few times or so.

She says that since 2002, the NPMCC has been accepting on average 89 cases of intoxication and other alcohol-related problems a year. This may seem low, but then no less than the World Health Organization (WHO) has observed, "Alcoholism is not considered a medical problem by most Filipinos." It says as well that majority of alcoholics do not submit to medical treatment even if their condition is chronic — and even if they are aware that it could lead to more serious illnesses.

PGH's Pascual says the top most common diseases related to alcohol in the Philippines — at least based on his hospital's yearly admissions — are liver cirrhosis and liver cancer, cardiac-related, stroke, and trauma (hemorrhage due to an accident). In 2004, cirrhosis of the liver was among the 15 leading causes of death among Filipinos.

Prolonged use of alcohol could likewise result in memory loss, lung infections, bleeding of intestines, ulcer, and even damage to an unborn child. It could also lead to impotence, shrinking of testicles, and affect one's ability to perform sexually.

IN 2001, the College of Public Health of the University of the Philippines and the Department of Health did a joint study that yielded what appear to be the only figures on drinking in this country so far. It said 38.9 percent of the sample population of 10,240 Filipinos (13 years old and above) were alcohol drinkers. Of this number, more than half were "light drinkers," meaning they took in less than four drinks a day. Only about five percent of the sample population were considered "heavy drinkers," or those who quaffed more than 12 drinks a day. (One drink is equivalent to one glass of wine or cocktail, or a shot of liquor.)

By comparison, about five percent of the U.S. population — or some 15 million Americans — are considered alcoholic. Anecdotal evidence, however, indicates that denial among alcoholics is stronger in this country than in the United States.

Panganiban says that among the substance-abuse illnesses, alcoholism "is the most difficult to cure." She points out that alcohol not only causes multiple organ damage, the withdrawal period for alcoholics also takes longer than that of, say, shabu addicts.

"They cannot suddenly stop it," says Panganiban. She explains that in just eight to 10 hours without alcohol, a patient starts to feel uneasy and irritable, experience tremors, sweating, and nausea, something that could lead to convulsions without medical supervision.

Zarco, meanwhile, confesses that of the dozen or so alcoholic patients he has worked with so far, all but one died. He says they were all "rich, successful, and powerful." Palpably sad and frustrated, he says he failed to make them quit; they simply had too much power and authority that nobody, not even their families, could make them stop.

Panganiban, who handles mostly poor patients, also agrees that quitting alcohol is really a personal decision. The alcoholic must squarely face that he has a problem and that it is a problem he cannot possibly handle on his own.

According to Panganiban, a PGH support group for alcoholics has been attracting mostly males — waste collectors, construction workers, jeepney drivers, even those who are jobless — and most are surprisingly in their 20s and 30s. "They're getting younger," Panganiban observes, and increasingly, women have been seeking treatments, too.

Yet the fact that they are seeking help is a positive development, she says. "I think more people are understanding that alcoholism is a disease and that it has affected their family life, and so they try to seek help on how they could make changes," says Panganiban.