Alcohol misuse, impact on health and society

Prof (Dr) Nimai Chand Luwang *

Alcohol use is quite common in India both in rural and urban areas, varying from 23% to 74% among males and 24% to 48% among females. In the west, alcohol is consumed everywhere: festivals, sporting events, weddings, backyard barbecues, concerts, brunch… it is hard to think of any social event that does not at least offer it.

Alcohol is commonly used as a social lubricant but it does not mean that a person who consumes alcohol feel comfortable in a social situation is likely to become alcoholic. People drink alcohol initially to enjoy and relieve anxiety. They may also consume it to gain relief from existing psychiatric or emotional problems.

Consequently, they begin to drink habitually, thereby leading to chronic alcoholism. Alcohol is an addictive substance which can lead to physical dependence, inability to stop at will and occasional drinking can be a slippery slope that may lead to addiction. Alcohol consumption becomes a problem when the individual engages in problematic drinking that puts him at the risk of developing adverse health events.

Alcohol consumption varies across different parts of India because of various socio-cultural diversity and difference in laws governing individual States. It is also bound by varying customary laws and cultures.

A few decades ago, consumption of alcohol was considered an unhealthy practice in Manipur by most communities. However, it has been observed that it has become widely prevalent in the Meetei society and is now regarded a fashion both among males and females.

Alcohol Use Disorder (AUD), alcoholism is a pattern of alcohol use that involves problems controlling drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problem, having to drink more to get the same effect having withdrawal symptoms.

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 by traffic injuries, 12% of the deaths because of tuberculosis (TB) and 12% of the deaths caused by liver cancer are attributable to alcohol consumption.

Alcohol consumption is one of the main contributing reasons for the modern epidemics of obesity, diabetes and consequential health problems like kidney failure, heart attacks, blindness etc.

In India, in the year 2010, prevalence of AUDs was 2.65 pc and that of alcohol dependence was 2.1%. In 2012, 33.1% of all the road traffic deaths were attributable to drinking and driving. Prevalence of AUD in adult men was found as 9%. Around 62.9% of all deaths due to liver cirrhosis were attributable to alcohol use.

Medical and Health consequences of alcohol use

When alcoholic beverages are consumed, it 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 rapidly and excreted through the kidneys amounting to about 95% to 98% of the consumed alcohol.

Hospital admission rates because of alcohol consumption and related conditions were also increasing with 20% to 30% admissions.

Short- term risks of alcohol misuse include:
accidents and injuries requiring hospital treatments, such as head injuries and trauma;
violent behaviour and being victim of violence;
unprotected sex that could potentially lead to unplanned pregnancy or sexually transmitted infections (HIV/AIDS);
loss of personal possessions, such as wallets, keys, or mobile phones;
alcohol poisoning which may lead to vomiting, fits, and falling unconscious.

People who binge drink means those who drink heavily over a short period of time are more likely to behave recklessly and are at greater risk of experiencing an accident.

Long term risks include:
persistent alcohol misuse increases risk of serious health conditions, including;
heart disease, stroke, liver diseases (mainly cirrhosis of liver),
liver cancer, mouth cancer, bowel cancer,
breast cancer, pancreatitis, obesity, diabetes and so on.

Acutely, modest doses of ethanol (alcohol) can not only increase sexual drive
but can also lead to decrease in erectile capacity,
testicular atrophy resulting in decrease of ejaculate volume and low sperm count in men;
Muscular changes leading to skeletal muscle weakness and decreasing bone density;
Neurological complications including blackouts, blurred vision, impaired memory,
alcohol tremors, myopathy, encephalopathy and cerebral degenerations etc..;

Psychiatric complications: Chronic alcohol consumption leads to depression and anxiety leading to mental disorders and misbehaviours and may lead to suicide. Ultimately, chronic drinking may lead to cirrhosis of liver resulting in death. Drinking and driving is the main cause of road traffic accidents. Drunken driving is responsible for 28% of deaths due to road traffic accidents.

Dependant drinkers usually experience physical and psychological withdrawal symptoms if they suddenly cut down or stop drinking, this include: hand tremors, sweating, hallucination, depression, anxiety, insomnia (difficulty in sleeping). This often results in “relief drinking” to avoid withdrawal symptoms.

Social consequences of alcohol use

Alcohol consumption not only affects the individuals but also his family members and society in one way or the other.

Persons in intoxicated state may indulge in domestic violence which is a common feature with his family members; may exhaust the family savings which can negatively affect the education of his children, psychological wellbeing of the family, emotionally and physically abusing the spouse. Husband’s practice of alcohol consumption is the most common cause of domestic violence.

Impact of alcohol use on family economy

Alcohol consumption denudes family resources and reserves and leaves women and children as its most vulnerable victims. A social stigma is still attached to the families with member(s) having chronic alcoholism. People who misuse alcohol may blow through family budget, cause fights, ignore children, and otherwise impair the health and happiness of people they love.

In time, family members may even develop symptoms of codependency, inadvertently keeping the addiction alive, even though it harms them. When alcohol is consumed, a person is more likely to impulsively buy things without thinking through the consequences of those purchases in the moment.

It can lead to increase in debt, chronic drinkers may have to leave jobs due to health problems. Alcohol dependent persons spend more money than they earn, and are forced to take loans to spend for expenditures related to alcohol consumption and for treatment of related medical conditions.

Alcohol consumption can affect work performance by way of absence from work, work accidents, reduction in productivity, leading to unemployment.

Apart from money spent on drinks, heavy drinkers may suffer other economic problems such as lower wages and loss of employment opportunities, increased medical and legal expenses, and decreased eligibility of loans etc. This results in strained relations with their family members, especially their spouse and children.

Legal problems of alcohol consumption

Crimes following alcohol intoxication is a very common feature which may include sexual/physical assault, rape, exploitation of women in commercial sex work and homicide. Alcohol consumption is associated with numerous legal problems.

Drinking increases a person’s likelihood of getting into quarrels and fights, displaying disorderly conduct in public, driving under the influence, and becoming involved in domestic disputes and violence.

The legal issues and crimes that are related to alcohol consumption fall under four major laws/acts namely, the Prohibition Act, Gambling Act, Psychotropic Substance Act and Excise Act. However, public nuisance created because of alcohol abuse goes mostly unrecognized and unnoticed.

Benefits of alcohol consumption

A wide range of studies in medical science suggest that drinking alcohol in moderate amounts may be good for the heart as it prevents coronary artery disease (CAD). However, individual susceptibility plays a major role in protective benefits of alcohol consumption.

The American Heart Association (AHA) states that “it is not possible to predict in which people alcoholism will become a problem” and advises against consuming alcohol for the benefits it may carry.

In a multicentre study done in India, it was found that even light or occasional consumption of alcohol might increase the risk of coronary artery disease (CAD). So, the benefits of alcohol consumption may not stand true for Indians.

Achieving Sobriety

Socially, alcohol is a huge problem, even for those who have established a lifestyle surrounding drinking can experience harm regardless of having a dependence on alcohol. Once addicted, as it is hard to turn away from alcohol and finally put the bottle down. The idea of legalising alcohol and lifting prohibition law should be rejected.