Gregorio Rodríguez, 62, is a 30-year veteran of Alcoholics Anonymous (AA) in Costa Rica. He says that before he joined AA, alcohol dependence nearly destroyed his life. "I lost many years to alcohol," he recalls with regret.
Rodríguez started drinking heavily at age 18 and by his early thirties had gone into debt to support a three- or four-bottle-a-day habit. What pains him most, however, is the impact his drinking had on those he loves.
"The consequences of alcohol are a traumatized family," he says. "They don't know when you'll be home, or if you're coming home. My wife was hospitalized three times because of emotional trauma."
Rodríguez remembers the night his wife, Gloria, packed his things in a paper bag and told him to leave. Not long after, he found himself in the center of town, unsure of his name or where he lived. Eventually, with the help of AA, he "accepted once and for all" that he was an alcoholic and got on the road to sobriety.
"Alcoholics Anonymous saved my life," Rodríguez declares.
While public health efforts focus on reducing consumption of alcohol in the population at large, alcoholism—or alcohol dependence—remains a critical problem for individuals and their families. The syndrome usually involves a preoccupation with alcohol, a compulsion to drink it, mental and physical impairment, and an inability to control or stop drinking at will. Proponents of AA call it a disease, probably with genetic roots. The World Health Organization (WHO) considers it a mental health disorder with biological, psychological and social roots.
Heredity may well play a role in alcoholism, but treatments focus on motivational changes, learning new lifestyles and coping mechanisms, and physical dependence and related neuroadaptation by the body.
Maristela Monteiro, an alcohol expert at the Pan American Health Organization (PAHO), says treatment programs should be an integral part of a country's health system, and should be community-based and broad—covering the whole range of problems related to heavy drinking. Those who offer treatment include social service agencies, alcohol specialists, psychologists, psychiatrists, inpatient hospital programs, workplace programs and, of course, AA.
AA keeps many alcohol-dependent people sober and offers support to their families. Rodríguez went to AA after his wife discovered Al Anon, the support group for family and friends of alcoholics, and learned how to persuade her husband to get help.
The couple swears by AA, and Rodríguez—after 30 years of sobriety—is a veritable AA poster boy. But AA doesn't solve every problem. Rodríguez's children still refuse to speak to him.
"Alcoholism doesn't just affect the alcoholic," says Marco Segura, mayor of Escazú, a San José suburb. From experience, he says, he knows what it is to have an alcoholic father.
Ideally, AA and policymakers would work together to reduce alcohol problems. But often, the two bring conflicting approaches to alcohol. Many, like Segura, divide the world between alcoholics and nonalcoholics, those with "the disease" and those who are well. In this view, levels of consumption are not seen as key.
"Alcohol is a problem for both individuals and society," Monteiro. "I would never say that treatment for alcohol dependence is not important. But if the goal is to have a significant impact on public health, we need to reduce consumption in the population at large."