While the western world is witnessing a declining trend towards alcohol, India is losing its culture of abstinence and witnessing the increased social acceptance for alcohol. India has seen a jump of more than 30% in seven years from 2010 to 2016 from 4.3L per capita to 5.7 L per capita of alcohol consumption, thanks to increasing availability and greater accessibility to alcohol.
Alcohol is unique risk for public health as it affects risk for 230 diseases and injuries. Alcohol is the leading risk factor for premature mortality and disability among those aged 15-49 years, accounting for 10% of all deaths in this age group. There are strong evidences for advocacy of complete prohibition of alcohol, lets visit few important ones
1. Alcohol and cardiovascular diseases
In India, single largest cause of death is attributed to cardiovascular diseases. Alcohol is associated with increased risk of hypertensive heart disease, cardiomyopathy, atrial fibrillation and flutter, coronary artery disease and haemorrhagic and other non-ischaemic strokes.
2. Alcohol and cancer
There is an established causal link between alcohol use and cancer development in the oropharynx, larynx, oesophagus, liver, colon, rectum and the female breast. Alcohol contribute to 3% of all cancer deaths.
3. Alcohol and liver diseases
Alcohol is one of the most frequent causes of liver disease; alcohol-involved subtypes of liver disease include alcoholic hepatitis, steatosis, steatohepatitis, fibrosis and cirrhosis. Acute alcoholic hepatitis and liver cirrhosis are associated with high mortality (which can reach 50% in acute alcohol hepatitis), and the median survival time of patients with advanced liver cirrhosis can be as low as 1–2 years.
4. Alcohol and mental health
11 mental health conditions have direct link to alcohol, ranging in their severity and duration from short-term acute alcohol intoxication to life-long disabling conditions such as dementia due to the use of alcohol. Alcohol consumption and AUDs are also associated with increased risk of suicides. People have approximately seven times increased risk for a suicide attempt soon after drinking alcohol, and this risk further increases to 37 times after heavy use of alcohol. The alcohol-attributable fraction for suicide was estimated to be as high as 18%. It is also known that the presence of AUDs at least doubles the risk of having depression. In India average of 369 suicides takes place every day.
5. Alcohol and Road Traffic accidents
According to many surveys, alcohol is direct cause of 30-50 percent of severe road traffic accidents leading to high toll on life of both users and non-users. Alcohol causes impairment in attention, cognition and dexterity, which are important for activities like driving a car.
6. Violence and aggressive behavior
Consumption of alcohol and other drugs are linked to almost 2/3rd of cases of violence according to several studies. Researches have established role of alcohol in not only street violence but also violence in the family and in intimate relations, including sexual violence. In India, 71% of women whose husbands often get drunk have experienced spousal physical or sexual violence, as against 22% of women whose husbands did not drink alcohol, according to the fourth National Family Health Survey, 2015-16
Drinking too much in a short period of time can affect breathing, heart rate, body temperature and gag reflex and may result in a coma and death. Alcohol is among the most lethal in terms of how close the amounts used for psychoactive effects are to the amount that is lethal. Ratio of effective dose of alcohol to that of lethal dose is 10. This ratio was in the same range as that for intravenous heroin, methamphetamine and cocaine.
8. Sexually transmitted Infections
Alcohol consumption has been shown to increase the risk of HIV/AIDS, viral hepatitis by increasing the risk of transmission, resulting from an increased risk of unprotected sex.
Alcohol consumption can suppress the immune system as seen in heavy alcohol exposure, which in turn increases the risk for active tuberculosis. There is a three-fold increase in the risk of tuberculosis associated with alcohol use disorder.
Alcohol consumption can influence the absorption and metabolism of tuberculosis drugs and increases the risk of chemically-driven liver damage (hepatotoxicity), which is already a common side effect of tuberculosis medications. People with alcohol use disorders are at greater risk for poor treatment adherence, treatment failure and drug-resistant tuberculosis infection.
10. Use in Pregnancy
Alcohol use during pregnancy is a risk factor for adverse pregnancy outcomes like stillbirth, spontaneous abortion, premature birth, intrauterine growth retardation and low birth weight, and can result in a range of lifelong conditions known as fetal alcohol spectrum disorders.
11. Alcohol use among Adolescents
Alcohol use in adolescents is associated with alterations in verbal learning, visual–spatial processing, memory and attention as well as with deficits in development and integrity of grey and white matter of the central nervous system. These neurocognitive alterations by adolescents’ alcohol use seem to be related to behavioural, emotional, social and academic problems in later life. Alcohol serve as ‘gateway substances’ and is highly consumed among street children, at rates as high as 40-80% in small-scale studies across metros. Many children work full days to support their drug habits, even dropping out of school for it. A Delhi Commission for Protection of Child Rights on Substance Abuse by Children study found that all children in conflict with the law were drug abusers. 95.5% of children in child care also consumed drugs, and so did 93% of street children.
12. Parental use of alcohol and effects in children
Parental alcohol use disorders (AUDs) are associated with a higher risk of their children developing depression in adulthood because of higher likelihood of frequent emotional symptoms, depression, low self-esteem and loneliness among both boys and girls in childhood. There is also decreased academic performance, increased conduct disorders and drug use.
13. Economic impact
A survey in 2015 in Gadchiroli district of Maharashtra by SEARCH revealed that the people of the district still spend Rs 79 crore on alcohol. This is abnormal amount for city with less than 11 lakh population and alcohol prohibition since 1993.The economic loss society is facing can be enormous if the study data is applied to whole country. According to “Pattern and consequences of alcohol misuse in India- An Epidemiological survey” conducted by NIMHANS, Bangalore – “Alcohol and its consequences impose a significant and additional economic burden in families with alcohol using members and disproportionately borne by spouses and children .Loans taken on higher interest rates further pushed the families into a debt trap. A large proportion of various welfare/ job- guarantee / compensation schemes payments are apparently spent on alcohol. Users reported a smaller proportion of their income spent on food and essential items and savings and greater loans and debts. Non-user families had a significantly larger asset-holding score than user families”
According to many studies, alcoholics cut off their nutritional expenditure to quench the thrust of addiction. In India malnutrition is already a public health concern with 33 % of adult men and 36% of adult women underweight (below 18.5 BMI). Alcohol makes the problem of malnutrition even worse by causing anemia and multiple vitamin deficiencies.
15. Work productivity
Alcohol users have decreased efficacy and productivity at work due to increased absenteeism, self-illness and illness / injuries to family. It also increases the accidents at work, the co-worker has to compensate for the alcoholic colleague during work.
16. Alcohol commercialization and increasing inequities and inequalities
Alcohol causes more harm to people of lower socioeconomic status than higher. When the poor become a consumer market, purchasing commercial brands of alcohol takes a larger toll on personal and family income than it does in other social classes. The poor are also more vulnerable to the public disruption, violence and health-related harms that come with increased alcohol consumption. Thus, playing its part in widening the gap in already disproportionate world.
17. Alcohol and other drugs
Often alcohol cases are seen with use of concomitant other drugs. Seldom there are cases of directly using more dangerous psychoactive substances, but beginning is mostly with gateway substances like alcohol and tobacco, which opens the door for more dangerous addictions.
Addiction of this loved poison is hitting hard the individuals, society and nation at large. It is high time government shows strong political will and take decision that Indians would be thankful for generations to come. From beginning with strong IEC and behavior change campaign to finally stringent policies like complete prohibition is need of hour if we still dream of making India global superpower.
About the author:
Dr. Glory Ghai is a development sector practitioner, doctor and research associate at CHD Group. Views expressed are the author’s own.