How Covid-19 measures are affecting rehabilitation of alcohol and drug abuse patients

David Mwangi, a recovering alcoholic who is also a principal and counselor at Home Based Mentorship and Rehabilitation Center at Riamukurwe in Nyeri. [Mose Sammy/Standard]

It is 6am and Kevin Kamau* is pacing up and down inside his parents’ compound in Nyeri. He has had a restless night.

Having had a few shots of alcohol the previous night, Kamau is still feeling the urge to continue from where he left off. He is in a frenzy to quench his thirst.

But there is a problem. The only place he can get the daily supply of his tipple is closed and he is broke, the little money he managed to squeeze out of his friend has run out.

With the curfew measures in place limiting his drinking options and his parents and friends trying to cut him off alcohol, Kamau is crushing from within.

“It is not easy to stop drinking at once, so I asked around and heard there was a way to get a drink by leaving my water bottle at a local shoe shiner,” he confesses.

While Kamau has found a way to get liquor undetected, his friend Joseph Mathenge* has been using online videos on how to turn fruits into alcohol by fermenting them.

“I have made wine from bananas and pineapples just by mixing them with sugar and water, which I then leave to ferment for a few days,” says Mathenge.

The story of the two reflects the plight of recovering alcoholics thrust back to their old ways after rehabilitation centres taking care of them were shut in the wake of Covid-19. As the Government continues to fight the pandemic, one of the most vulnerable groups of people bearing the brunt of the measures put in place are recovering alcoholics and those battling drug addiction.

With most of the rehabilitation centres closed, the patients are back with their families, which are struggling to help them quit their addiction. The attempt to reform them has not been a walk in the park as most families lack the professional capacity for the task.

“We have a two pronged problem. We cannot manage to reform them, that is why we took them to rehabilitation centres, but we also don’t want them to remain in the centres for fear of contracting this Covid-19 disease,” says the mother of one of the recovering addicts.

In Kamau’s case, he would visit the shoe shiner to have a chat and then pretend to forget his water bottle. Later in the day he would show up and pick up the water bottle now filled up with his alcohol.

Nderitu Gikaara, a recovering alcoholic and trained counsellor, who has dedicated his life to helping alcohol addicts, says something needs to be done for the war to be won.

Alcoholism is a disease and has been classified in the Diagnostic and Statistical Manual of Mental Disorders, fifth Edition, as a relapsing brain disease, which should be treated like any other.

“The management and intervention to alcoholics in society is very difficult, because they are being affected by social, peer and economic factors,” Gikaara says.

Data bundles

He says recovering alcoholics without a strong support system are vulnerable to relapse. “As an addiction counsellor, I am privileged because I can reach out to some of my clients by video conferencing our Alcoholics Anonymous meetings as well as our one on one sessions due to social distancing rules,” he says.

However, this has its challenges as most of the patients may not have access to the Internet due to lack of data bundles or phones.

Gikaara got rehabilitated at Karia Health Centre in Nyeri County, which is one of the few county-based public facilities in the country offering drug and alcohol rehabilitation services. The facility is now closed due to the pandemic. The facility established in 2016 has seen 447 recovered patients through its 90-day in-house rehab programme.

Gikaara says those who are in recovery are facing several challenges, due to the measures to combat Covid-19, including accessing second generation liquors, which are now being sold at wines and spirits shops.

Another concern is the management of withdrawal symptoms for recovering alcoholics who, desperate to control the hand tremors, insomnia, nightmare and anxiety, may turn to drinking dangerous substances such as sanitiser.

“The stigma and lack of information surrounding alcohol addiction is also one of the problems facing recovering alcoholics who continue to be ridiculed and tormented by friends and relatives as they come to terms with the condition,” Gikaara says.

Counsellors and medical professionals are also facing challenges in offering rehabilitation services to clients with the strict anti-coronavirus measures.

Karia Health Centre Nurse-in-Charge Margaret Wathenge says the facility had to close its doors, despite a growing waiting list of patients hoping to be rehabilitated.

“We had our last patients discharged on May 5 after they completed their 90-day programme and then we closed down because we could not admit others due to the Covid-19 pandemic,” says Wathenge.

She says so far she has a waiting list of at least 60 people hoping to get into the programme.

“Our services are almost entirely free. Before 2018, we had no charges at all, but now we only ask the patient to cover the cost of food for the 90 days,” she says.

A spot check on some private rehabilitation facilities revealed that most charge between Sh60,000 and 150,000 for a three-month programme, which is out of reach for most families, especially during this pandemic.

National Authority for Campaign against Alcohol and Drug Abuse (NACADA) manager in charge of counselling and rehabilitation, Judith Twala, cited cost as one of the challenges to accessibility to rehabilitation services and facilities during this period.

“Most rehabilitations in Kenya are privately owned, hence for the owners to provide the quality care needed, they have to charge for the services, making access difficult,” says Twala.

She says most Kenyans are struggling with basic needs, hence the fee for rehabs is not a priority. Twala urges county governments to implement prevention, research and rehabilitation programmes to make the services accessible and affordable for the citizens.

“The fact that bars are closed has not stopped people from drinking because wines and spirits outlets are still operational. To make matters worse, people are currently purchasing alcoholic drinks online. Consequently, making alcohol available in our homes is a threat to our underage children and may lead to underage drinking,” she says.

Twala says most counsellors have now resorted to online meetings, which were not very effective.

“NACADA in collaboration with the Ministry of Health has developed guidelines for all rehabilitation centres on new admissions. The requirements are strict, hence most rehabs have resorted to closing down for the time being,” she says.

The anti-drugs authority has also lobbied, through the Ministry of Interior, to have rehabilitation programmes classified under essential services.

“This has helped rehab owners to acquire permits/passes, which makes client picking and dropping easy,” says Twala.

On the issue of stigma, she says most people perceive addiction as a moral issue instead of a public health issue.

“All stakeholders, including the families, workplaces and community at large, should know their role in supporting persons with substance use disorders,” says Twala.