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Mevludin Hasanović1,2,3* and Izet Pajević1,2,3
Received: June 08, 2017; Published: June 15, 2017
Corresponding author: Mevludin Hasanović, Department of Psychiatry, University Clinical Center Tuzla Rate Dugonjića bb, 75000 Tuzla, Bosnia and Herzegovina
Although the harmful effects of alcohol have long been observed, organized social measures for the prevention of excessive consumption of alcoholic beverages were taken relatively late. In the beginning they were purely repressive measures through both religious and secular laws of through moral lessons and educational recommendations. There are not many experts who have publicly advertised against this scourge of the family, society and every individual who became a victim of alcoholism. Teetotaler societies in Bosnia-Herzegovina began with the establishment and work at the late 19th and early twentieth century. The authors provide a historical overview of societal and professional institutions that fight against alcoholism in the area of northeast Bosnia following the definition of the World Health Organization, that alcoholism is illness and alcoholic is a patient. Through the period before World War II, between the two world wars, the national liberation struggle period from 1941 to 1945, and the post-war socialist enthusiasm to the last war from 1992 to 1995.
During this period, the upward development of the organized struggle against alcoholism is documented in the former Yugoslavia and its part of the Republic of Bosnia and Herzegovina – the region of northeast Bosnia. The last war has devastated all the assumptions of the socio-political organization and interpersonal relations and thus the basis of funds organization and human resources for the protection of public health. In this way the structures of social support to alcoholics and their families were closed, except medical facilities that have treated the issue of alcohol consumption beside all other medical issues of the population. During the war, due to high trauma of veteran and civilian population, a number of posttraumatic effects appeared which lead to people seeking release in self-medication by alcohol abuse, worsening the issues of alcoholism and its aftermaths. After this tragic war many of the socio-political relations and the issue of functional organization of health is redefined, which resulted in search for new formulas of successful dealing with very serious drinking problem in the postwar situation in the region of Tuzla Canton.
Keywords: Social; Cultural; Historical; Teetotal
The Qur’an does not mention a lot of alcohol, but pedagogically it explains its gradual ban in a convenient way by pointing out that alcohol is not used in a “good” benefit. Say, “My Lord has only forbidden immoralities - what is apparent of them and what is concealed - and sin, and oppression without right, and that you associate with Allah that for which He has not sent down authority, and that you say about Allah that which you do not know (Chapter: Al-A’raf, verse: 33). The item (verses) of the Qur’an makes only one step in the prohibition of alcohol, but the verses are not listed nor are the examples of the alcohol prohibition. In fact, the Qur’an wants to make people give up alcohol, but the great difficulty is the fact that they have been united with him and what he’s become a habit and tradition. They ask you about wine and gambling. Say, “In them is great sin and [yet, some] benefit for people. But their sin is greater than their benefit.” And they ask you what they should spend. Say, “The excess [beyond needs].” Thus Allah makes clear to you the verses [of revelation] that you might give thought”(Chapter: Al-Baqara, verse 219). Here it is quite clear that the “bad” benefit is actually alcohol and gambling.
When the human psyche is gradually prepared, and then comes the verse about the alcohol ban. O you who have believed, indeed, intoxicants, gambling, [sacrificing on] stone alters [to other than Allah], and divining arrows are but defilement from the work of Satan, so avoid it that you may be successful. Satan only wants to cause between you animosity and hatred through intoxicants and gambling and to avert you from the remembrance of Allah and from prayer. So will you not desist?” (Chapter: Al-Maida, verses: 90-91). With this gradual method, Qur’an puts man at a crossroad: unity or division, alcohol or prayer (al-salah), God or Satan (the devil), reason or desire (passion)?
In the end, he concludes: O you, who have believed, do not approach prayer while you are intoxicated until you know what you are saying or in a state of janabah (impure), except those passing through [a place of prayer], until you have washed [your whole body]. Indeed, Allah is ever pardoning and forgiving (Chapter: An- Nisa, verse: 43). There are many paths that lead man to a rational and educational way of thinking. Love is the motivation for man to do good deeds. One’s actions are the result of his morality (ethics). As long as a man doesn’t believe in the beauty of something, he won’t love it. A person’s traits are the product of his world view that is reflected in a number of the following items:
c. love it and
d. Strive for that.
God, who knows man as His creation, approaches him from the inside and from that point of view, clears the way for knowledge and enlightenment. Success can be achieved if we seriously respect and consistently implement the recommendations published, persistently and patiently.
“Alcohol is the mother of all evils” (Muhammad, The Prophet peace be upon him).
Josip Broz Tito, the president of former Yugoslavia declared: “A nation that is able to convert the pub to reading rooms, and a wonderful gift of nature and of man - fruit and grapes into useful food instead of alcohol, it will become the most powerful and the most fortunate among everyone”. Although the harmful effects of alcohol have been noticed a long time ago, relatively late organized social measures have begun to combat excessive alcohol consumption and abuse. At first they were exclusively repressive measures through religious and secular moral rules or through educational lessons and recommendations.
In his doctoral thesis on “medical, philosophical and chemical essay about drunkenness” In 1788., Thomas Trotter was the first to step on the notion that alcoholism is a disease, however, he was left standing alone for a long time until others started to share the same point of view. At the beginning of the twentieth century the publication of educational articles and brochures dedicated to the fight against alcoholism began. There are more processed problems created by alcohol abuse, especially in the internal organs and the brain. Therefore, alcoholics with impaired health either physical or mental are beginning to be treated at the hospital, usually in the mental hospitals .
One of several doctors in Bosnia during the Ottoman authorities in mid-nineteenth century, Dr. Gal, popularly known as Veli-Bey had described the health situation in Bosnia in the list of “Sarajevski cvijetnik”: “Despite all the reforms, the country is stunted, and the people are increasingly poorer. What’s worse it was terribly physically degenerated. Syphilis produces horrible devastation in the nation, as does brandy” Some writers in former Yugoslavia lived the bohemian life of drinking and given a bad example to the youth. Andric in “Stories about serf Sinan” said: “Who cures grief with brandy, which does not heal from grief, but dies of brandy.” Teetotal societies in our country started to form in the late nineteenth and early twentieth century by taking a moralistic attitude toward alcoholism with a basic program with the intention to ban alcohol completely.
According to Dr Omer Mijatov (1980) the teetotal movement established and started to working on in Foča, 1893, and later it successfully evolved in other parts of Bosnia-Herzegovina, primarily thanks to efforts of Dr Risto Jeremić, who established the teetotal society “Brotherhood” as a young medic in Foča. Later, as a respected doctor and community worker, working in Tuzla from 1904-1914 as a surgeon, municipal and regional physician doctor, actively participated in the anti-alcoholism and health education movement. Under his influence and reputation on his work the organization “Brotherhood” was founded in other parts of Bosnia and Herzegovina, especially in region of Bosanska Krajina. Before the World War One the “Brotherhood” had 46 companies with thousands of members, but was forbidden by the outbreak of war because of close political ties with the “Young Bosnia” and “National Defence” [2,3].
Within the idea of lifting the public health through broad and intensive health education and preventive action, the teetotal movement was developed between the First and the Second World War. Dr Andrija Štampar was a supporter of the idea and the largest holder of sobriety, thereby putting himself at the head of the constellation of prominent health workers throughout Yugoslavia. Alcoholism was then seen in a broader context as a socio-medical problem, which contributed to the formation of a new approach to alcoholics as patients before the onset of accompanying heavy organic and mental complications or before the alcoholic gets in the state of social misery.
First Association of Alcoholics Anonymous was founded in 1935 in America. Its successful operation and expansion indicated that the successful treatment of alcoholics can be achieved only through the active involvement in the process of treating the alcoholic. Over time it became clear that the involvement of alcoholics and their families and the working environment, greatly contribute to better treatment effects and reduce relapses.
In former Yugoslavia, The Second World War interrupted preventive and sober activities. The phenomenon of alcoholism was not well understood in the national liberation war. Combatants of National Liberation, highly motivated to achieve the ultimate goal of people’s freedom, showed a high virtue and moral force in determining the attitude towards everything that could in any way interfere with the achievement of this goal or stain the character of a fighter in the way of achieving these goals. But after the release, the new state was faced with an urgent task to restore and build the material and spiritual goods as a precondition for the realization of the ideals of humane socialism. Four-year war trauma was not recognized, and then the suffering, highly traumatized citizens of the “new Socialistic Yugoslavia” were offered a socialist ideology that is itself contained alcoholism as “someone else’s leftover of capitalist social relations.” Changing ideology has not changed the need of people to seek tranquilizers and entertainment in the new social vortex horizontal and vertical migration. Instead of reducing, alcoholism became a more prominent medical and social problem. The increase in alcoholism seriously threatened to jeopardize the progress of the whole society, and the social forces learned what kind of problem they have and began to get organized and take action in the fight against this evil.
Thanks to Jellinek for defining to the World Health Organization, that alcoholism is a disease and an alcoholic a patient, the Red Cross of Yugoslavia began to form a commission to fight against alcoholism in the year 1954. At the same time an alliance against the Yugoslav League of alcoholism and railroaders to combat alcoholism was being established .
At the initiative of the Municipal Committee of the Red Cross, in Tuzla in 1959 Counseling was for alcoholics. Since 1964 this counseling was included in the regular work day working of the Dispensary of Nervous and Mental Disease Health Center in Tuzla. At the same time the Municipal Board of Association against Alcoholism was founded in the year 1971 resulting in two clubs of treated alcoholics in Tuzla. AA clubs were formed in other municipalities of the Tuzla region, i.e. the region of the Northeast. In Tuzla, the opening of Neuropsychiatric Division in 1954 the formation of the Counseling Centre for Alcoholics in 1959, the foundation of Dispensary of Neural and Mental Illness in 1964, the formation Treated Alcoholics clubs in 1971 secure favorable conditions for a modern approach to alcoholism as a social problem and medical help faster and broader organization of professionals and community organizations in the prevention and treatment of alcoholism in the region of the Northeast. The Medical Faculty in Tuzla in the year 1976 get conditions for the formation of the Department of Neuropsychiatry contributing to the development of a scientific approach in dealing with mental disorders and therefore alcoholism .
In Brčko a Neuropsychiatry Department opens in 1983. Thus hospital treatment disperses to another hospital center in the region of the Northeast. In the intensive ambulance operation the biggest problem were alcoholics who had until then been treated in Jagomir at Sokolac in Tuzla with frequent recurrences after returning home. With the opening of this Department within the Medical Center in Brčko, becoming sub-regional center and by the beginning of war in 1992, Brčko had five neuropsychiatrists. The hospitalization treatment in the Tuzla region spread to another hospital center of sub regional capacity, covering areas: Orasje, a part of Bosanski Šamac, a part of Srebrenik, a part of Lopare, Čelić, Gradačac and villages along the Sava river in Županja municipality that had gravitated toward Brčko.
At the outbreak of war in 1992 in Bosnia and Herzegovina and in the northeast region of Bosnia, completely new socio-economic and medical psychological relations appeared [5,6]. The sociopolitical, military, material and financial structure of the country collapsed, the war brought huge devastations and assumptions for the treatment and prevention of alcoholism. The war itself has brought many reasons that a lot of people became severe alcoholics . The Department of Psychiatry in Tuzla had is separated from the Neuropsychiatry Department and under very difficult conditions provided all services to the local populations under control of the Army of BiH . There were sporadic cases of alcoholism, because the scarcities of all supplies therefore lack of alcohol meant they rarely drunk during the war, although many of the fighters started their alcoholic experience because of the fear which they could not differently overcome.
After the war the period of transition started to the present, when we go into two reforms in Healthcare. Establishing of the family medicine services in primary care , and the concept of community mental healthcare which includes establishing of the Centers for Mental Health, which are supposed to assume the role of prevention and work in the environment from which the patient comes to reduce the number of inpatient treatments .
Faced with numerous possible problems in the organization of healthcare of related population, the specific concerns of alcoholics are unduly neglected, so those are virtually in the background over the past 26 years.
This has contributed, that the problem has been developed to a significant extent and that the response of the community and professional services are not measured by the standardized and modern scientific and technical knowledge, standards and achievements. In November 2008 at the Department of Psychiatry in Tuzla, has started a Sample Club of Treated Alcoholics which successfully operates and develops on, thus creating conditions for the establishing and revitalization of Treated Alcoholics Clubs in Tuzla Canton.
The first symposium about alcoholism in Bosnia and Herzegovina with international participation realized in Tuzla, April 2010 is a logical consequence of the above data and a very strong confirmation of our commitment to be stronger and more organized in catching the alcoholism problem in this area and beyond.