Liquor Consumption in India : Regulation and Prohibition
Liquor Laws: Regulation and prohibition regarding liquor or alcohol consumption in India
AUTHOR : AKSHU RANA
Abstract
One of the most important products of global addiction demand is an alcoholic beverage. In developing countries like India, liquor consumption tends to be a major problem because of the various socio-cultural practices across the nation, different alcohol policies and practices across the various states, lack of awareness of alcohol-related problems among the community, false mass media propaganda about alcohol use, various alcohol drinking patterns among the alcohol consumers and the emergence of social drinking as a habit because of the widespread urbanization across the country. Stringent alcohol policies are needed across the various states to reduce alcohol consumption, and alcohol consumers have to be educated about the various harmful effects of alcohol consumption and the effects it can have on their mind, body and soul. This review article focuses on the burden of liquor consumption in context with its various harmful effects on the mind and body with a note on the alcohol policies in the country.
Keywords: Alcoholic, dependence, hazardous drinking, liver cirrhosis
Introduction
The term alcohol refers to ‘ethyl alcohol’. It is consumed as an alcoholic beverage in diluted concentrations of absolute (i.e., 100%) ethyl alcohol. There are various types of alcoholic beverages that are consumed around the world. One standard alcoholic beverage corresponds to 10 g of absolute alcohol. The quantity differs among the types of alcoholic beverages. The most commonly used alcoholic beverages are beer, wine, whiskey, rum, vodka, gin and brandy and locally brewed beverages like arrack and toddy. Alcohol consumption becomes a problem when the individual engages in problematic drinking pattern that puts him at the risk of developing adverse health events
Global prevalence of alcohol consumption
According to recent data published by the World Health Organization (WHO), the total per capita consumption of alcohol by individuals above 15 years of age is 6.2 L of pure alcohol per year, which equals 13.5 g of pure alcohol per day. However, there is a wide variation between the WHO regions and member states. Nearly 5.1% of the global burden of disease is attributable to alcohol consumption, and it causes nearly 3.3 million deaths every year.[
Alcohol consumption and its associated factors in various parts of India
Alcohol consumption practices vary across different parts of India because of various socio-cultural diversity and differences in laws governing individual States within India. the prevalence of alcohol consumption in various parts of India and the associated factors governing alcohol use.
Disease burden because of alcohol consumption
At the global level:
Alcohol use disorder (AUD) (which includes a level that’s is sometimes called alcoholism) is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect or having withdrawal symptoms when you rapidly decrease or stop drinking. The prevalence of AUDs is highest in Europe (7.5%) and the lowest among eastern Mediterranean regions, which includes Afghanistan, Bahrain and Egypt. Globally, 50% of the deaths caused by liver cirrhosis, 30% of the deaths because of oral and pharyngeal cancers, 22% of the deaths caused by interpersonal violence, 22% of the deaths because of self-harm, 15% of the deaths caused by traffic injuries, 12% of the deaths because of tuberculosis (TB) and 12% of the deaths caused by liver cancer were attributed to alcohol consumption.
At the national level:
The 12-month prevalence of AUDs in India in the year 2010 was 2.6% and that of alcohol dependence was 2.1%. In 2012, 33.1% of all the road traffic accident deaths were attributable to drunk and driving. The National Mental Health Survey of India 2015–16 found the prevalence of AUDs to be 9% in adult men. In India, the alcohol-attributable fraction (AAF) of all cause deaths was found to be 5.4%. Around 62.9% of all the deaths due to liver cirrhosis were attributable to alcohol use.[
Medical consequences of alcohol use
When alcoholic beverages are consumed, alcohol gets absorbed from the stomach and small intestine. It is distributed through blood circulation to every organ in the body. The alcohol gets absorbed by the liver at a rapid pace and excreted through the kidneys, which accounts for 95% to 98% of the alcohol consumed. In a study done by Gururaj et al., it was concluded that, because of the increase in the liquor consumption occurring all over the country, the hospital admission rates because of alcohol consumption were also increasing with 20% to 30% of admissions because of direct or indirect problems caused because of alcohol consumption.
The various medical complications because of alcohol consumption are:
- Gastrointestinal (GI) complications: The direct effect of alcohol on the lining of the stomach can lead to acute gastritis and present as vomiting, usually associated with heavy drinking. Repeated damage can lead to hyperacidity leading to peptic ulcer disease. Alcohol is one of the most important reasons for hemorrhagic gastritis. The most common complication of long-term alcohol is alcoholic liver disease (ALD).
- Cancer: Drinking as few as 1.5 drinks per day increases a woman’s risk of breast cancer 1.4-fold. For both the genders, four drinks per day increase the risk for oral and esophageal cancers by approximately three-fold and rectal cancers by 1.5 fold. In a study done by Bangardi et al., it was found that alcohol most strongly increased the risk of cancers of the pharynx, oral cavity, esophagus and larynx.
- Changes in the genitourinary system: Acutely, modest doses of ethanol can not only increase sexual drive but can also lead to decrease in the erectile capacity in men. Even in the absence of liver impairment, a significant minority of chronic alcoholic men show irreversible testicular atrophy with shrinkage of seminiferous tubules, resulting in decrease in ejaculate volume and a low sperm count. In a study done by Chandra et al., it was found that there was disproportionately high association of alcohol abuse with high-risk sexual behavior and HIV infection
- Muscular changes: Between one-half and two-thirds of alcoholics can have skeletal muscle weakness caused by the acute alcoholic myopathy, which may improve with abstinence, but it is not fully cured. Effects of alcohol consumption on the skeletal system can include lower bone density. In a study done by Venkat et al., it was found that those who suffer from chronic alcoholism suffered from avascular necrosis of the femoral head and reduced bone density.
- Neurological complications: The short-term effects of alcohol consumption that can get relieved after stopping alcohol consumption include blackouts, blurred vision, impaired memory and slower reaction times. In a study done by Peng et al., it was found that chronic alcohol use can lead to the development of alcoholic tremors, myopathy, Wernicke’s encephalopathy and cerebellar degeneration.
- Psychiatric complications: Consuming alcoholic beverages to overcome depression and anxiety has been a common practice. Though alcohol can relieve those conditions to some extent initially, it starts to deplete the neurotransmitter serotonin in the brain, causing depression and anxiety and the need to consume more alcohol to medicate depression arises. This chronic use can lead to increased risk for suicide, personality disorders and risk-taking behaviors. Problems related to liquor consumption made up to 17.6% of psychiatric emergencies in an Indian general hospital.
In a case-control study of completed suicides in Bangalore done by Gururaj, it was found that alcohol consumption was a major risk factor for suicide with nearly a 25 times increase among the alcohol users. Suicide rates among women increased by nearly six times who were a spouse of alcohol abusers. A study done by Vijay Kumar et al., in Chennai, found that suicide rates were higher among alcohol users as compared with non-users.
Social consequences of liquor use
Alcohol consumption not only affects the individuals but also his family members get affected in one way or the other. The person in an intoxicated state may indulge in domestic violence with his family members; may exhaust the savings of the family, which can negatively affect the education of his children, and the children of alcoholic fathers will have strained relationships with their family members, which can affect their psychological well being. In a study done by Gururaj et al., in Bangalore, it was found that emotionally abusing the spouse was found to be 2.5 times more common among persons who consume alcohol, 23.3% of the users physically abused their spouse and 7.8% of them physically abused their spouse resulting in injuries. In a study done by Markowitz et al., domestic violence was reported by 20% of women and husband’s practice of alcohol consumption was reported by them as the most significant cause for domestic violence.
Conclusion
Liquor consumption is emerging as a major public health problem in India. Multi-centric scientific community-based research studies have to be conducted in various individual states to understand the problem better. Various policymakers, media, professionals and society have to be educated about the consequences of chronic alcohol through sensitization programs and health education campaigns. There is a dire need for rational alcohol control policy with specific objectives like alcohol taxation, production and promotion policy.
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