First published in the Daily Maverick 168 weekly newspaper.

The looting of liquor stores during the alcohol bans that are part of Covid-19 lockdown restrictions serves to highlight the toxic relationship South Africans have with alcohol.

The country’s high alcohol consumption has old and deep roots, which can be traced back to the introduction of the “dop” system in the 1800s, when labourers in the Cape received part of their wages in cheap wine.

A 2016 report by the World Health Organization (WHO) said that about 60% of South African drinkers aged 15 years and older were heavy drinkers. This was measured as the consumption of at least 60g or more of pure alcohol (or six standard alcoholic drinks) on one occasion or more in a month.

More than 70% of male drinkers over the age of 15 were heavy drinkers. For females in the same age group, the figure was 33.7%.

The WHO report noted a higher prevalence of alcohol use disorders (12.4%) and alcohol dependence (4.2%) in South African men compared with women, where the prevalence was 1.8% and 0.7%, respectively.

Although the majority of South Africans (53.5%) do not drink, South Africa ranks among the top five countries in the world that have the highest consumption of absolute alcohol per drinker per year.

Heavy drinking and alcoholism, however, are not the same thing. Alcoholism is a chronic, relapsing disease “characterised by compulsive and continued alcohol use despite harmful consequences”, says Guy du Plessis, an addiction counsellor and recovery coach in Cape Town.

Alcoholism is caused by multiple factors including genetic predisposition and alcohol use as a form of self-medication (for depression or anxiety, for example, trauma as well as adverse childhood experiences and poor early attachment to primary caregivers).

Alcoholism is progressive

One of the early warning signs of addiction is developing a tolerance for drinking, says Freddie van Rensburg, addiction counsellor and author of Life Anon: A 12-Step Guide for Non-Addicts.

“Another one is if you start picking up that people are not honest about their alcohol consumption.”

Isolating and neglecting family and work responsibilities are signs that the problem is progressing.

Van Rensburg believes the seed for alcoholism is planted before the age of seven as “it is in those years when our main belief system about ourselves is formed. Based on that belief system, the foundation for alcoholism is laid.”

He bases his conclusions on renowned addiction expert Gabor Maté’s philosophy that there’s no such thing as an “addictive gene” or an “addictive personality”. It is instead linked to childhood trauma.

“Functional alcoholism” is another concept he challenges.

“I think you’re dealing with a person who hides their alcoholism better than somebody else,” he says.

A high-functioning alcoholic is loosely defined as a person who maintains job stability and relationships while meeting the criteria for having an alcohol use disorder.

Functional alcoholics are less likely to seek help for their addiction since they are able to maintain the guise of normalcy to the outside world and themselves.

Crime and liquor are intertwined

The quarterly crime statistics for the period of April to June this year show high numbers of liquor-related offences, which include murder, attempted murder, rape and assault with intent to do grievous bodily harm.

Year-on-year crime statistics show a steady link between alcohol consumption and gender-based violence-related incidents. In the fourth quarter of 2020, more than 1,300 rape cases were linked to alcohol consumption.

The so-called “crime holiday” that occurred during the hard lockdown between April and June last year was largely attributed to the alcohol ban implemented at the time. During that period, so-called contact crimes dropped by 37.4%.

Van Rensburg says he was struck by how people “freaked out” over the prohibition of alcohol: “A lot of people need to assess their lives and see whether they use alcohol as a crutch. Once alcohol becomes a crutch, then one is starting to enter the phase from using to abusing alcohol.”

The decline in hospital trauma admissions also reflects the societal effects of alcohol abuse and alcoholism.

According to the South African Medical Research Council, alcohol use and, especially, heavy drinking, are causally related to trauma admissions.

A study comparing the effects of the lockdown and alcohol restrictions on emergency-room cases at Pholosong Regional Hospital’s emergency department in Gauteng found that cases declined by 33.14% in March 2020 and by 57.93% in April 2020 compared with two years prior.

Changes to regulations regarding alcohol are under consideration by way of the Liquor Amendment Bill, first mooted in 2016. The bill, which President Cyril Ramaphosa sent back to Parliament for reconsideration last year, proposed:

• Increasing the drinking age from 18 to 21 years old;
• Banning alcohol sales and advertising on social as well as small media;
• The introduction of a 100m-radius limitation of trade around educational and religious institutions; and
• The introduction of a new liability clause for alcohol sellers.

Since alcohol bans were instituted, political parties such as the DA have accused the government of using provisions afforded by the State of Disaster as a veiled attempt at introducing liquor policy changes. The party as well as groupings within the liquor industry have called on the government to expedite the introduction of the Liquor Amendment Bill. DM168

What is alcoholism?

“Alcoholism is a chronic, relapsing disorder characterised by compulsive and continued use despite harmful consequences.” – Guy du Plessis, addiction counsellor and recovery coach

“There’s a big difference between being a user of alcohol, being an abuser of alcohol and being an alcoholic. People call others who drink a lot alcoholics, but they’re not necessarily alcoholics. To look if someone falls into the category of addiction, we will look at two factors predominantly: do you need to drink more and more to get to the same level of drunkenness? Do you experience withdrawal when you don’t drink? We call it the tolerance and the withdrawal aspects. If both of those are present, then we may be looking at alcoholics.” – Freddie van Rensburg, addiction counsellor and author of Life Anon: A 12-Step Guide for Non-Addicts

The 12 steps of Alcoholics Anonymous

 AA’s 12 Steps approach follows a set of guidelines towards recovery, first published in 1939 by AA co-founders Bill Wilson and Bob Smith. The 12 Steps are:

1. We admitted we were powerless over alcohol – that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we
4. understood Him.
5. Made a searching and fearless moral inventory of ourselves.
6. Admitted to God, to ourselves and to another human being the exact nature of our wrongs.
7. Were entirely ready to have God remove all these defects of character.
8. Humbly asked Him to remove our shortcomings.
9. Made a list of all persons we had harmed, and became willing to make amends to them all. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practise these principles in all our affairs.

 A note on the ‘God aspect’ of the 12 Steps

 “A lot of people look at the steps and think they’re going to lure you under a ruse and then push God down your throat. If you want to see it that way then that might happen… A lot of people can gain hope if you raise awareness to the fact that AA is not a religious programme, it’s a spiritual programme. There is no God catch. The reason there’s ‘God of your understanding’ (step 3) is to invite people into the steps and to create or find their own God.” – Freddie van Rensburg

Alcohol consumption in South Africa

• SA is among the top five countries in the world that have the highest consumption of absolute alcohol per drinker per year.
• SA has the highest incidence of foetal alcohol syndrome, ranging from 29 to 290 per 1,000 live births.
• Alcohol contributes to a quarter of all trauma admissions, a third of all suicides, and more than half of all homicides and incidents of domestic violence in SA.
• People from lower income groups are less likely to be drinkers, but they carry a higher health burden if they do drink – in part because of inequality.
• Nearly 20% of children under 18 live with a parent (or responsible adult) who drinks heavily or has an alcohol problem.
• More than 50% of juvenile delinquents come from homes with alcoholism.
• Children of an alcoholic are two to four times more likely to become alcoholics.
• There is a ‘bidirectional relationship’ between depression and alcoholism: alcoholism can cause depression while depression can be worsened by alcohol.

Signs you or someone you love may be an alcoholic

• Getting “blackout drunk” frequently
• Rationalisation of drinking
• Isolating
• Neglecting family and work responsibilities
• A strong need or compulsion to drink (craving)
• Inability to stop drinking once started (loss of control)
• Forgetting the consequences of the drunken episode (memory loss)
• The occurrence of withdrawal symptoms, such as nausea, sweating, shakiness and anxiety when alcohol use is stopped. These symptoms are usually relieved by drinking alcohol or another sedative drug (physical dependence)
• The need for increasing amounts of alcohol to get “high” (tolerance)
• Possible violent behaviour

The AA’s website has a questionnaire that may help you to figure out whether you are struggling with alcohol addiction and need help.

See aasouthafrica.org.za.

Personal stories

Frank V – Abandoned and homeless

After starting to drink with a few glasses of wine at a young age, Frank V (as he asked to be called) eventually found himself at an Alcoholics Anonymous (AA) meeting at the age of 42 after three failed marriages, multiple job losses and suffering a deep depression.

“I came to AA as a low-bottom drunk,” he says.

A “low-bottom drunk”, the 75-year-old explains, is an alcoholic who has lost everything because of their addiction.

About two weeks before seeking help for his illness, Frank had been sleeping in a storeroom at the Old Hyde Park Hotel in Craighall, Johannesburg.

He has been sober for 32 years now and clearly remembers the moment when his life turned around. It was 18 May 1989, and his drinking had landed him in hospital.

“One nurse said to me in Afrikaans, ‘Jy moet bid’ – you must pray – and I got on my knees and prayed.”

After waking up from a coma, Frank said his desire to drink was miraculously gone. From there, he became an active AA member and runs recovery programmes at several rehabilitation centres in Johannesburg.

Frank spent two decades as an addict. In that time, he escaped from rehab, suffered from alcohol-related seizures, was arrested for drunken driving and was abandoned by family members.

“In the end there was no one who actually cared for me.”

He partly attributes his alcoholism to low self-esteem.

Frank is not ashamed of his past and urges anyone struggling with alcoholism or who suspects they may be an alcoholic to seek help before it’s too late.

“Alcoholism is a progressive illness. It’s very much like a ball running down a hill. The further down the hill it goes the faster it goes.”

Mr R – The functioning alcoholic

“Let’s just say my childhood was no bed of roses,” says Mr R (as he asked to be called).

Growing up in a household with mental illness, he became the caregiver and the “keeper of secrets”.

His first run-in with alcohol was when he was about 11 years old and he was asked by the adults in his home to dispose of a batch of liquor. He drank it instead.

“The effects were magical; the world spun. I remember thinking: ‘When I grow up, this is what I want!’ Of all the hopes and dreams I had as a child, that wish was granted – I became an alcoholic – and alcohol became my escape from reality.”

He binge-drank throughout his teenage years, a habit that gave him friends, self-confidence and a lack of inhibition.

When he was 25, he started his first company after a string of job successes. Despite this, his demons continued to linger.

“I have suffered from clinical depression since childhood. After my second alcohol-fuelled suicide attempt, I got over my ego sufficiently to find help for my depression.”

A counsellor picked up that he was struggling with alcoholism and suggested he join Alcoholic Anonymous’s 12-step programme, but Mr R was in denial. Soon after, he moved to Europe where his problems worsened – to the peril of his family and employees.

He reached his breaking point when he was alone in an apartment in the Netherlands.

“Like a zombie, I staggered to my laptop and googled AA. I dialled the number and a guy called Lukas gave me an Amsterdam address and said, ‘Come to a meeting’. I could manage one lousy AA meeting, I thought.”

That was two months shy of his 61st birthday.

After a lengthy recovery process that involved admitting his faults, mending broken relationships and embarking on a deep spiritual journey, he reached a point where he was able to start helping others.

“I have thrown myself into service with AA, partly because service keeps me more-or-less sane; partly out of gratitude; but mainly because I have found a purpose and meaning in life that I thought did not exist.

“As Albert Schweitzer puts it, the purpose of human life is to serve and to show compassion and the will to help others.”

Zelda – The life of the party

Zelda (not her real name) was always popular, funny and the life of the party, but by the age of 58 she had become a full-blown alcoholic who drank “24/7”.

“My ego thrived because of the attention, and it became a full-time job organising drinking (excuses) occasions,” she says.  

Drinking was a staple practice in her family and at age three she had her first glass of diluted wine.

Her drinking progressed through her teenage years, and by the time she was marched to an AA meeting by a fed-up family member in 2008, Zelda had left a path of destruction behind her.

“Blackouts, a four-hour stint in a police cell, being an absent mother, unsavoury and dangerous companions, a written-off motor vehicle, rape, lies, manipulation, to name but a few…”

Her partner at the time was a cocaine addict and a few years earlier she had become a “dry drunk” for three years to try to help him recover. A dry drunk is someone who quits drinking but still engages in destructive behaviours associated with alcoholism.

Her partner had been dragged along with her to AA, where for the first meeting, Zelda sat cooking up tactics to continue her drinking undetected.

“Use a stronger perfume, switch to vodka only, pretend to go to meetings and use the time to gamble and drink at the local pub.”

Two AA meetings later, Zelda decided she wanted the help. She’s been sober for 13 years.

“Alcoholism is a progressive disease, yet recovery has its very own progression. It gets better and better, day by day, 24 hours at a time.”

Kagiso – The cycle of addiction

For Kagiso, alcohol helped numb the pain of growing up in a dysfunctional home. Her mother suffered from depression and her father was an alcoholic.

The family’s businesses went under, and her father lost his job as a manager. Not long after, they became poor.

The burden of caring for her siblings fell on Kagiso’s shoulders. Eventually she dropped out of school – partly to earn money and partly because her family had become a laughingstock in her community of Katlehong.

To cope, she started drinking when she was about 17 years old.

“The first time I drank, I honestly did find comfort. I found joy when my mind was intoxicated,” she says.

Her drinking led to blackouts, headaches and hangovers. She realised early on that she had a problem but didn’t seek help until she was in her twenties. Her lifestyle had changed her physical appearance – she had what some called a “phuza face” – and she feared going out in public.

The mother of two was perpetuating the cycle of addiction in her family. Soon, her eldest child, whom she had before her recovery, fell into depression.

Kagiso eventually approached her pastor for help after seeing an AA advertisement and attended a meeting in Alberton as the programme was not running in Katlehong.

Rehabilitation programmes in the townships were scarce when Kagiso began her recovery journey more than five years ago.

“Maybe if my dad knew about AA back then he could have been saved.”

Her father was admitted to a psychiatric hospital after his drinking led to depression. He has since passed away.

“With us black people [alcohol] is our fun and entertainment, which is why people don’t see it as a disease.”

Now she is a staunch advocate for alcoholism recovery and is helping to spread awareness in and around Katlehong.

“I talk about my alcoholism anywhere and everywhere and I’m not afraid of being judged because that is who I am.

“If people know that I’m an alcoholic, I can help another alcoholic.” 

Anton – A second chance

Anton (not his real name) had spent 15 years in an alcohol recovery programme when complacency crept in and he began drinking again. A seemingly innocuous glass of wine during a dinner date with a new girlfriend threw him back into a cycle of addiction that lasted five years.

“I lost everything I had held dear – my wife, jobs, directorships, home, car and more. It is the most horrible place to be: to know the solution, to know the way out, but not being able to follow the path – almost as if someone was leaning over the cliff and reaching out but your fingers were just unable to reach the extended hand.”

Despite the fear of rejection and the guilt of having let people down, Anton returned to his recovery programme and instead of being judged and berated, he was surprised to be met with open arms.

“So began my second chance at recovery. The journey has not been easy and often I have found myself in difficult situations.”

Anton has been sober for nearly two decades.

“I have discovered deep and sincere friendships, been reunited with my sons and enjoy a wonderful rapport with my ex-wife, who has been a pillar and sterling support through the many hardships and challenges I have faced.” DM168

Update on 1 April, 2022:  At the 2022 Diageo SA Responsible Drinking Media Awards on 31 March, Sandisiwe Shoba received  top honour in the Best Newspaper Award (commercial)  category for this article .

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for R25 at Pick n Pay, Exclusive Books and airport bookstores. For your nearest stockist, please click here.