Romania is in 11th place on the global rankings for per capita alcohol consumption and in 2nd place on. the Eurostat statistics among EU member states for heavy episodic drinking, while Romanian men are the most frequent binge drinkers in the EU. Beyond the figures, there is a hazy and incomplete picture.
Nobody knows how much unregistered alcohol is produced and consumed in Romania, but probably most of the alcohol consumed in rural areas comes from in-house makeshift distilleries. There is no real estimate of the cost of alcoholism and alcohol-related illnesses on the state. Thousands die every year because of alcoholism and that’s usually after they’ve spent years in and out of hospital.
Alcoholism is more than a few random statistics which barely register. It is a story of how authorities have failed to systematically tackle the problem, a story about citizens not confronting our own cultural biases and predispositions, and most importantly, a story about the failure to offer the same care and empathy to alcoholism sufferers at the same level that any other patient would expect and deserve.
Symptom of a symptom
It’s morning and Marius Florea, a chef from the southern Romanian city of Craiova, pours himself a glass of juice after waking up from a night of heavy drinking with a friend.
“Daddy, but why are you drinking juice? Don’t you know that grown-ups drink vodka?”, his three-year-old son asks him.
“That question hit me like a sledgehammer” – says Marius – “I told myself, what on earth I am doing? Do I really want to offer him the same childhood that I have had?”.
As with many cases of alcoholism, Marius’ story did not start with the bottle. In many instances, unresolved issues from the past fuel alcoholism. Marius was born in a family with two alcoholic parents, which has had a lasting and damaging impact on him – “My father beat me countless times and when I was a child I felt responsible for his alcohol consumption; the shame was very unsettling.”
These issues dogged Marius throughout his adult life, and he used what he calls “the easier way” of frequent and substantial alcohol consumption in order to cope with anxieties and insecurities from his past.
The first sign that he was physically dependent on alcohol hit him when he was 35, when he began to feel sick if he stopped drinking. But it was his son that gave him the motivation to break the vicious cycle that started when he was a child.
He approached a clinic administered by ALIAT, an NGO focusing in the areas of prevention and treatment of addictions. But it wasn’t easy. “I was strolling back and forth in front of the gates for two hours before entering, it was an overwhelming pressure that was tearing me apart.”. It worked. Marius hasn’t touched alcohol in more than 11 years.
For the majority of alcoholics, this is the only solution. Even after a period of abstinence, a single glass can lead to a full-blown relapse. “Once you have crossed the border from a social drinker into addiction, you cannot ever go back to being a social drinker once again”, Marius says.
These words are echoed by Nancy Rice, a retired American teacher and former consultant for disadvantaged students, now living in Romania – “My uncle, whom I loved dearly, was a fighter in Allied campaign in Italy during the Second World War. The fighting there left a profound mark on him, and he tried to cure his post-traumatic stress with alcohol. Of course, he had never succeeded.”
She explains the dynamic of the addiction as a descending staircase with 100 steps: “Let’s say you went down 50 steps until the moment you manage to abstain. If you are to start drinking again however, you will not start again from the first step, but you will go right back to the 50th step and continue descending from there.”
An overdue intervention
Romania’s healthcare system only deals with very serious cases of alcoholism, often when the patient’s health is poor and they are in the grip of a full-scale addiction. Clinics and hospitals provide specific treatments for the over 200 illnesses caused by excessive alcohol consumption from liver failure to mental health issues, but they treat illnesses rather than provide integrated care and treating the addiction.
In 2020, some 7,726 patients were hospitalized for mental health issues stemming from alcohol consumption, fewer than previous years, due to the effects of the COVID-19 pandemic.
Many were admitted to the psychiatric hospital, “Alexandru Obregia” in Bucharest. As an emergency hospital, it only admits people in a serious condition: “Over half our patients reach our gates escorted by the police and many are agitated and violent”, says Dr. Ioan Mirea, a trainee doctor.
He says alcohol dependency is the most prevalent form of addiction in Romania. In severe cases, alcohol withdrawals can be lethal. Patients need a 2-3 week-long hospital stay to get sober and cope with the withdrawal symptoms.
However, the medical care that this hospital can offer is only limited to patients that experience severe withdrawal symptoms or acute intoxication.
“Let’s say that someone comes on our doorstep and says that they want to stop drinking, that they cannot go on like this, but they display no withdrawal symptoms or merely mild ones. Unfortunately, we would not be able to admit this person, as they do not meet the admittance criteria for an emergency hospital. We don’t have enough beds in hospitals for a city like Bucharest, to which we often add cases from neighboring counties.”. The only hospital that is specifically for addictions in Bucharest, a city of 2 million, is the “Sfântul Stelian” Hospital. However, it is almost always operating at full capacity, and has only 45 beds for all types of addictions.
Even though the Obregia Hospital has the resources and capacity to offer treatment, the 2-3 weeks detox cannot possibly solve the underlying issues that an alcoholic must manage. The psychological addiction lingers, because “there are a lot of unresolved psychological aspects that remain unaddressed”, as Dr. Mirea puts it.
In this case, the treatment in an “out-patient” manner could represent a solution, though generous psychological assistance and support groups. Considering that alcoholism has psychological roots, its treatment has to involve therapy to tackle the causes. However, such badly-needed long-term therapy programs are not covered by Romania’s public health insurer. At the same time, the public healthcare system does not have a single clinic specialised on alcohol addictions.
Such clinics are efficient in terms of recovery rates, as well as from an economic perspective. In the United Kingdom, another country wrestling with the prevalence of alcohol misuse and dependency, it is estimated that the opening in Manchester of a single unit exclusively dedicated to patients with alcoholism has saved over 1.3 million pounds from the NHS budget in the first two years since it has become operational.
These funds would have otherwise been wasted on the ineffective medical treatments of serious medical conditions caused by alcoholism.
It is easier to save lives in the classroom than in a hospital
With a lack of public services, NGOs and religious groups have stepped in.
ALIAT is probably the NGO that has had the largest experience in tackling alcohol addiction in Romania. In over 20 years of activity, it has completed numerous projects and has opened three out-patient clinics, in Bucharest and Suceava. These offer much-needed psychotherapy services, and have proven essential in facilitating the maintenance of abstinence.
However, the lack of alternatives is laid bare by the number of patients that seek these services: “At our out clinic we have a waiting list, there is a considerable workload pressure on our psychologists and psychiatrists”, says Viorel Roman, executive director of ALIAT. And this is only a fraction of those who would need such services:
“In Romania, psychotherapy is a bit of a luxury – it costs between 150 and 200 lei per session and few people can afford this”, he adds. The process to get such sessions covered from your medical insurance is complicated and makes available only a very limited number of discounts. If the situation looks tricky in the urban centers, for the 40% of Romania’s population that lives in rural areas, access to such services seems completely beyond reach.
Nonetheless, Viorel Roman is consistent in pointing out that this discussion only covers the late stages of “tertiary prevention”, during which the treatment is more difficult, and the patients have suffered from the consequences of an addiction. He believes the key is in prevention when people have not yet started to consume alcohol, or have not yet become addicted.
Secondary prevention is usually delivered through the “AUDIT” test, a questionnaire developed by the WHO and aimed at risk assessment by evaluating one’s patterns of alcohol consumption.
ALIAT distributes those tests around the country: “people are taking those tests right there, on the street, and we interpret the result on the spot, making a quick intervention which seems very effective – at a couple of hundreds of such tests, and discussion, you can save a life”, he explains.
. Through such evaluations, either in the community or GP practices, individuals can spot patterns of concern and prevent sliding into addiction.
Viorel Roman believes that primary prevention remains the most effective approach – this implying efforts to delay of the start of alcohol consumption amongst teenagers. ALIAT have been running for educational programs about the risks of excessive alcohol consumption for many years.
This happens rather sporadically, at the demand of a handful of more astute headteachers. The Ministry of Education does not offer a coherent curriculum on prevention which would bring together all the pre-university educational institutions, despite the fact that substantial evidence points towards a clear correlation between alcohol consumption at a young age and the possibility of developing alcohol addiction in adulthood.
In Romania, there is both a lack of public awareness and no request for thorough research from top decision-makers which contributes to the lack of a clear picture about alcoholism, some experts believe.
In 2019, the health ministry said at least 6,762 Romanians died as a result of alcohol consumption – liver cancer, alcoholic cardiomyopathy, “chronic liver ailments”, and what is generically named as “affections caused by alcohol”.
The real number the victims of alcoholism in Romania is likely much higher, if we take into account all the other types of cancer in which excessive alcohol consumption could have played a role.
There are also accidents caused by alcohol consumption and victims of alcohol-fuelled violence.
The costs of alcoholism are considerable. In comparison, the United Kingdom spent around 3.5 billion pounds for the treatment of different health issues caused by excessive alcohol consumption in 2019.
From an economic viewpoint, the main costs are loss of productivity and the health spending on on the treatment of alcohol-related illness which Romanian authorities have not estimated.
The Romanian taxpayer has no way of finding out how much is wasted due to ministerial indifference, and authorities have not financed studies that would shed light on the areas that demand well-planned investments.
The centre for non-existent policies
Alcoholism in Romania is a public health issue with many ramifications. In order for such a problem to be managed, there is a need for a coherent vision to cover aspects ranging from education to medical assistance, training of health and social care professionals and alcohol market regulation.
Such an approach is usually offered by a national strategy on alcohol harm and consumption, which would contain all relevant aspects and set the tone for all public policies that would need to be implemented. In 2012, the British Government has published such a document, and in 2021, the House of Lords was already demanding a new national strategy, in order to fill in the gaps in implementation and adopt the vision to the new realities on the ground, identified in a thorough analysis document drafted on the basis of a wide-reaching consultation.
In this process, over 92 institutions were consulted by the alcohol commission in the House of Lords, this including regional hospital, local councils, NGOs, think tanks, and academic institutions. This report even included 40 testimonies of people that have experienced alcohol harm, as “experts by experience”, put on equal footing with academics. The time spent by those individuals battling with addiction was valued by the decision-makers, under the statement that: “It is those whose lives are affected by alcohol every day who best understand its impact and yet their voices are often missing from policy discussions.”.
The obvious question is: “Why doesn’t Romania have an inter-ministerial council to manage the process of drafting such a national strategy?” It actually has one, but it is ineffective.
In March 2015, the “National Council for the Coordination of Policies and Actions on the Reduction of Excessive Alcohol Consumption in Romania” was set up with the aim of creating a national strategy on alcohol.
Since then, alcohol-related mortality in Romania has grown constantly every year, and reached almost 102 deaths per 100,000 people in 2019.
Despite the increase in deaths caused by excessive alcohol consumption, the council has not published anything. At a request from Universul.net, the Ministry of Health has answered that the accomplishments of the council to date included: the drafting of the council’s functioning rules,its ethical codel, and the drafting of the criteria for the selection of NGOs to be consulted, and the creation of a website section for the Council – a blank page with 3 hyperlinks which lead to the other three above-mentioned ‘accomplishments.’
Since 2015, the Council has selected two organizations for consultation purposes (ALIAT and the Association of Romanian Brewers). Neither has been contacted by the authorities.
Since 2019, the health ministry has not even named a state secretary who is responsible for the council’s activity. At the moment of publication, it remains a structure without any leadership and activity.
The people behind the statistics
It is easy to forget the ordinary people are the victims— caught between the medical jargon, statistics and an opaque state system.
Being an alcoholic is still a taboo in Romania, and the condition is widely misunderstood. People who are in need of help find it difficult to get help due to stigma and a lack of medical services.
Alcoholism can affect anyone, anywhere – “In therapy, I have had people who were managing 5,000 employees. I had people with millions of euros in their bank accounts. People that were working in state institutions, in pharmacies, anywhere you can think of, “ ALIAT’s executive director said.
Tragically, most alcoholics do not manage to achieve abstinence. Those who have had enough determination, enough help and enough luck to turn their lives around and give up alcohol have become a force for change and have chosen to help others that find themselves in the same situation.
For Marius Florea, the reason he offers to help as a volunteer is simple: “ I want to give back what has been offered to me.”.
One thing comes up time and time again in the testimonies of people with alcoholism that have recovered with the help of support groups like Alcoholics Anonymous, or with psychological assistance, is the notion of a climate of understanding, of dignity and hope.
Looking back on his own journey to recovery at that ALIAT clinic, Marius summed up his experience.
It gives you a sense of self-worth, that you are on the right track, that you are doing something right. You are the right person in the right place.”