The fatal attraction of alcohol
By Sambit Dash
In part II of this 3-part essay, we saw how India’s experiments with prohibition have seriously gone wrong and that it is not a practical policy. In the backdrop of increasing alcohol consumption in the country, there needs to be more pragmatic policies to tackle the harmful effects of this substance.
There is no denying that alcohol brings with it a host of problems. In a study conducted by AIIMS in 2019, it was stated that about 57 million Indians are addicted to alcohol. According to a WHO report of 2018, about 2.6 lakh deaths in India were attributed to excessive consumption of alcohol.
In a study in Kerala, it was found that risk of mortality and of cardiovascular disorders is significantly high in the age group of 20-44 alcohol-consuming males when compared with non-drinkers. One-fifth of hospitalisations, 20 per cent of brain injuries and 60 per cent of injuries have been attributed to alcohol.
Then there is the problem of binge drinking. Indians, perhaps owing to the taboo that cultural norms have placed around alcohol, tend to drink for the purpose of getting drunk. Drunk driving and road accident deaths attributed to it is another major concern. Road accidents kill a humongous number of Indians each year and about 3-4 per cent of these deaths are attributed to drunk driving as per National Crime Record Bureau (NCRB) reports.
In the weeks leading to ban on alcohol during the lockdown, the National Commission of Women reported that it received more complaints as compared to the same time period prior to the lockdown. Earlier studies have attributed one-third of domestic violence to alcoholism. The number of people seeking treatment for alcohol addiction at India’s premier mental health institute NIMHANS has risen during this period.
The Road Ahead
Addressing many of the ills associated with alcohol in fact does not lie with alcohol but with State capacity. The WHO classifies alcohol consumption pattern into five broad drinking categories – social, binge, harmful, hazardous and alcohol dependence. The target should be to nudge binge and harmful drinkers to move to social drinking; for hazardous drinkers not to fall into the dependence category and for alcohol dependent patient, as well as other categories, to access counselling and rehabilitation facilities.
India’s number in this regard is abysmal to say the least. In a study by Rajasthan Police and Abdul Jameel Poverty Action Lab (J-PAL), a research unit at the Massachusetts Institute of Technology in Boston, US (with which Nobel laureate Abhijit Banerjee is associated) in 2017, it was shown that rotating checkpoints for breath analysis and incentivising police personnel on these duties considerably reduced drunk driving-related accidents. Such behavioural nudges and institutional changes can bring desired change.
Building capacity to address domestic violence in terms of ease of reporting to police, swift action, speedy justice and supporting women will go a long way in not only addressing domestic violence associated with alcohol abuse, but the other two-thirds of such cases too. Drunken brawl and hooliganism after drinking are issues that a general law and order maintenance can take care of.
The question is should the State aim at increasing its police to citizen ratio and in maintaining law and order or ban alcohol. The answer is obvious. Many countries have strict rules regarding sale of alcohol. Alcohol is not sold to people who appear drunk to the shopkeeper and minimum legal drinking age (ranging from 18-25 in various States in India) is strictly followed. These are flouted with impunity in India.
About 4 per cent of all alcoholics in India are high risk individuals. An effective approach to curb alcoholism is to sell low proof alcohol, again a call that governments can take, after generating and analysing evidence in its favour. Again, given the fact that rural India consumes more alcohol than urban India (11 litre vs 5 litre per capita as per NSSO report of 2011-12), strategies need to evolve which are more population-specific than blanket ones.
Alcohol is a contentious and complex issue. The worst thing that can happen to debate around it is to embed it in issues of morality. Prohibition as a policy is ineffective wholly. If Bollywood is to provide a testimonial, then the villain and/or melancholic hero drinking has given way to social and casual drinking by the protagonist, male and female.
This is indicative of the societal changes happening around alcohol. Individual liberty in a democracy cannot be compromised vis-à-vis alcohol. The dangers that alcohol bring with it to the table cannot be ignored. Public health stands at risk from alcohol abuse. Many other ills can however be addressed with better State capacity and other interventions, which serve a greater good.
One can only hope that the debate on alcohol in the midst of Covid-19 pandemic gives way to more informed policy-making.
__ The author is Senior Grade Lecturer, Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus). He comments on public policy, healthcare and issues of social interest. He tweets at @sambit_dash