Treatment of alcoholism in Trinidad and Tobago, 1956-65

ABSTRACT

An alcoholism treatment programme has been in operation at the St. Ann's Hospital, Port of Spain, Trinidad since March, 1956, combining emetine aversion treatment in groups with milieu therapy and group psychotherapy. In January, 1961, the treatment programme was moved to a separate unit with 20 beds, and the group therapy was handed over to an occupational therapist. An Alcoholism Rehabilitation Officer was appointed who was himself an alcoholic, and A.A. meetings were held on the ward. Patients were followed up at weekly out-patient clinics. The closest collaboration has been maintained throughout with Alcoholics Anonymous, the first group of which begun in March, 1956. A significant role has been played in Community Education by the Alcoholism Sub-committee of the Mental Health Association. This collaboration produced a remarkable growth in the number of A.A. groups, which by 1966 numbered 31 in a population of 950,000. The growth of A.A. groups, especially in small rural villages, created a change in the social environment which gave the recovered alcoholic a sense of personal worth. Calypso singers treated at the unit wrote calypsoes about their experience and played a part in promoting community acceptance of the disease concept of alcoholism. A follow-up study was carried out in 1963 and 1964 on 370 patients, 57 of whom had been treated in 1956 and 313 in 1961. The differences in the characteristics of these two groups indicated an improvement in the community attitude to alcoholism and a greater willingness to seek treatment. The overall outcome was defined in terms of a seven-point scale of abstinence and social functioning with total abstinence of two years or better at one end, and death at the other. The overall success rates were calculated as percentages of the whole, counting those lost to follow-up as failures. Group I (seven-year follow-up of 57 patients) showed 52.6 per cent. success with 36.8 per cent. totally abstinent for more than two years, 3.5 per cent.(2 patients) having returned to social drinking, and 10.5 per cent. dead, half of them by suicide. These results compared favourably with the follow-up studies by Davies, Shepard and Myers and by Wing at the Maudsley Hospital over four years. A further comparison was made with the follow-up study of untreated alcoholics by Kendall and Staton over a period of similar to that of Group I of the Trinidad study. Group II (two-year follow-up of 313 patients) showed 42.49 percent. success with a total abstinence of 35.14 per cent. These rates are only apparently lower than those of Group I because of the large group (40.8 per cent.) lost to follow-up. The group lost to trace, was, however not significantly different from the sample as a whole, and there were reasons to believe that in fact Group II had done rather better than Group I. The ratio of success to known failures improved from 21 to 2.51. An attempt was made to break down the number treated in terms of type of treatment. As this was not a planned study no claims were made for the significance of the figures, but the group who elected to have emetine and who went to A.A. on discharge emerged with strikingly better results. The importance to therapy of obtaning cultural acceptance of the disease concept of alcoholism is stressed. Reasons are sought for the large proportion of East Indians among those coming for treatment. Negroes and East Indians in Trinidad form subcultures of comparable size, yet highest rates of alcoholism seem to come from the Indians with stable family units and male role models, while the matrifocal Negro group seems less vulnerable. This finding is at variance with the expectations of psychoanalytic theory, and sociocultural deprivation seems the likely explanation. (AU)