Alcohol Self-Help Groups in Saint Vincent and the Grenadines: A Cultural Approach

INTRODUCTION: In 2004, there were 4.1 deaths from alcohol use disorders per 100,000 people in Saint Vincent and the Grenadines (SVG)- one of the highest rates in the world. There are no medical resources currently for patients with alcoholism in this country. Thus, work was done to pilot self-help groups modeled on Alcoholic Anonymous (AA), in SVG in summer 2012. A follow-up team returned to SVG in summer 2013 to assess the success of those groups and to pilot more groups in various regions. The team worked to tailor a unique self-help program specific to the cultural foundation of the local community. This study looks at what specific factors were associated with the groups that attained success, explores local perceptions regarding alcoholism, and delved into what techniques may aid in preventing alcoholism in this country from the ground up. METHODS: The goal of the second phase of the project was multi-faceted and was accomplished via three medical students traveling to the country for approximately 9 weeks. The first goal involved ascertaining the reason as to what qualities made the Barrouallie group, the only remaining self-help group from the first phase, sustainable and what qualities caused the other groups to cease meeting. Secondly, due to the needs for programming in other communities, a large goal was to expand the program using the knowledge obtained in qualitative analysis to start other groups. Lastly, the group aimed to analyze the local adult populations general attitude and understanding of alcoholism as a disease process. Due to the limitations of the project in 2012, this second phase foremost sought to deeply understand the community needs and cultural factors that influence alcoholism and the use of AA in this country. By working towards an understanding rather than immediate progress in terms of number of self-help groups, the team aimed to create sustainable self-help groups. Ultimately, five new self-help groups were piloted by the end of the 2013 summer. These groups were located in Bequia (two meetings over summer 2013), Kingstown (two meetings), SVG Mental Health Center in Glen (four meetings), and Troumaca (one meeting) and consisted of 2-10 members. The team, after surveying the area to assess alcohol-related education in local schools, also piloted education sessions for local children and adolescents in Troumaca, Kingstown, and Arnos Vale. RESULTS: The only remaining self-help group after the 2012 pilot program was Barrouallie. This group had 9 participants attending since August 2013. Eight of them have stopped drinking completely, and the 9th member has been sober since July 2013. Eight members agreed that the group was "very helpful," and five of them joined the group through word of mouth. One participant noticed the "seriousness" of the group he saw at the park, so he decided to join. This openness was not apparent in the failed groups from 2012. When asked what could make their group more successful, approximately 66% of the subjects stated "encouraging more people to join the group." Of the former participants, 100% of them answered "yes" to whether the group helped them overcome their drinking problem. The former subjects stopped coming due to pregnancy or schedule conflicts. The current participants felt that forgoing anonymity would help to disseminate the group elsewhere in SVG. The group was then aired on local television to spread their message, and they also expressed interest in being aired on the radio and recruiting locals they knew in other villages to start groups in their own communities. The Barrouallie group chose to display shirts conveying their dedication to abstaining from alcohol and place their meetings in open areas where anyone could be welcome. Other pertinent suggestions from former participants to recruit new participants included finding the alcoholics at the rum shops themselves. Lastly, in the convenience sample from Kingstown, 75% of subjects claimed alcoholism is "not a disease," and the majority weren't aware of its specific organ effects and were not educated in school regarding alcohol and drug abuse and their repercussions. RECOMMENDATIONS: Unlike the AA model, which is based on the premise of privacy and unrevealed identities outside of those at the meetings, the only group that was sustained in SVG from the summer 2012 phase of the project explicitly and voluntarily shed its anonymity. This philosophy of community engagement and self- identification was used for establishing five new self-help groups whose viability is currently being assessed. The open culture of SVG allowed a unique group design to attain success. In a country so close-knit and small, obtaining the western ideal of privacy and confidentiality is not only extremely difficult, but simply may not lead SVG towards a decrease in alcoholism. For this culture, openness may be the form of therapy that can make this feat possible. The lack of alcohol education was apparent when the majority of locals surveyed didn't realize that it is a disease or how it affects the organs. The team initiated an educational campaign at camps and churches to promote prevention of alcoholism at an early age. The team recommends that in the future, a two-tiered approach must be utilized to decrease the incidence of alcoholism in SVG: one aimed at prevention in schools via education, and the second aimed at non-anonymous self-help groups led by local community leaders such as nurses or community-known peace corps members rather than necessarily an alcoholic as the AA would advocate. Cultural competency must be taken into consideration when implementing programs to address alcohol use disorders, as alcoholism is an overlooked global issue.