Multi-pronged strategies needed to reduce alcohol addiction in India

Alcohol has been produced and consumed in India since ancient times. Ancient Hindu scriptures mention sura, an alcohol-like drink made from fermenting rice flour and wheat, with other fruits like sugarcane and grapes, produced during the Indus Valley Civilization.

There is mention of sura consumption in the two Indian epics, Ramayana and Mahabharata. At the same time, the importance of abstinence from alcohol for spiritual growth, as well as the adverse effects of alcohol, has been known and espoused in our scriptures.

Abstinence from alcohol was nurtured as part of a high moral value in India by Mahavira, the founder of Jainism and Adi Shankaracharya, who popularised the advaita philosophy.

Also read: The dilemma of drink in India’s tribal areas

Fast forward to the 21st century, and India is grappling with myriad problems related to alcohol consumption. Excessive alcohol consumption is the major cause of liver cirrhosis, liver cancer and intoxication-induced road accidents.

Repeated alcohol use can cause gastric ulcers leading to hemorrhagic gastritis. Prolonged alcohol use is known to be the most common cause of liver failure. More than four drinks per day is associated with an increased incidence of cancer of the pharynx, oral cavity, oesophagus and larynx, according to a study by Bangardi et al in 2001.

Chronic alcohol use has also been known to cause various neurological and psychological disorders leading to long-term morbidity. 

Around 0.26 million Indians die every year due to overdose of alcohol consumption, according to a 2018 report by the World Health Organization. Of these, almost 0.1 million deaths occur in road accidents that can be attributed to alcohol abuse; 30,000 deaths occur in cancer patients due to chronic alcohol abuse; and 0.14 million people succumb to liver cirrhosis.

Sadly, in the case of alcohol-induced road accidents, the victims are often innocent people. The social consequences of excessive alcohol consumption are dire, which leads to domestic violence unleashed most often by men on hapless women and children of the family, especially in the poorer strata of society.

Another tragic consequence of excessive alcohol consumption, usually on the part of male members of the family, is millions of families across the country slipping into dire poverty due to the men-folk spending the limited financial resources of the family on alcohol. Sometimes it can also lead to loss of livelihood for the family’s sole breadwinner.

When it comes to the total amount of alcohol consumption by any country, India ranks among the top 10 worldwide, according to London-based research firm IWSR Drinks Market Analysis. India has also emerged as the second largest consumer of spirits, which includes whiskey, vodka, gin, rum, tequila and liqueurs, just after China.

Also read: Drinking and suicide: How alcohol use increases risks, and what can be done about it

Per capita alcohol consumption in India increased to 5.7 litres from 4.3 litres in 2010, according to WHO Global Status Report on Alcohol and Health 2018. This highlights the disturbing trend of increasing and excessive alcohol consumption in the country. On an average, only 1.3 per cent of the women in India consume alcohol; on the other hand, alcohol consumption in men is 18.8 per cent, according to the National Family Health Survey 2019-2021 (NFHS-5).

Alcohol consumption by both men and women is high in the northeastern and eastern states of India. Arunachal Pradesh, Telangana, Sikkim, Manipur, Goa and Jharkhand are the states with high alcohol consumption among men. 

Given the consequences of excessive alcohol consumption, the simplistic prescription that people may suggest is ‘just ban alcohol consumption’ across the country. However, this is not a simple decision. Alcohol is a huge revenue generator for the state governments as well as the central government.

India generated $47,500 million in revenue from the sale of alcohol, according to a 2022 study. It further pointed out that the market for alcohol is expected to grow by 8.86 per cent every year between 2022 and 2025. This brings to attention the significant role played by the alcohol industry in bankrolling the Indian economy.

At least, that is what our politicians and bureaucrats would like us to believe in any discussion related to banning alcohol! Besides, banning alcohol does not solve the problem since people addicted to alcohol will find ways to access it through illegal and unscrupulous providers of spurious substitutes, which can be even worse. 

The supporters of the argument that alcohol-related tax revenues are essential to help governments at the state and centre garner revenues do not factor in the colossal loss of contribution to the Gross Domestic Product (GDP) of the country.

The losses incurred due to death and disability and the lost productivity of otherwise capable people who function at lower levels of productivity once they are hooked on to alcohol are not accounted for. As is the case of loss of quality of life for themselves and their families and the losses due to alcohol-related social abuses.

The net impact calculated after accounting all these aspects indicates that alcohol consumption will be bad for the Indian economy eventually, according to a 2019 modelling study done by the Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh.

This study suggests that the estimated loss of 543 million life-years due to alcohol-led illnesses would add up to an economic loss of $71.6 billion between 2011 and 2050.

When we also consider all the healthcare-related costs and other economic losses in terms of health department finances, out-of-pocket expenditure of the general population and loss of daily productivity, the figure can go up to $ 27.7 trillion.This means that India loses 1.45 per cent of its GDP every year due to the impact of excessive consumption of alcohol. Ironically, this is more than what the government spends on its healthcare which is around 1.2 per cent of GDP!

The question now arises is, “How do we deal with this spiralling threat of unrestrained alcohol consumption and its repercussions on modern Indian society? The answer lies in empowering the communities to take the onus of their health by increasing awareness about alcohol and its ill effects and creating an enlightened society that would eventually reduce alcohol consumption voluntarily.

At the same time, rehabilitation and de-addiction facilities should be provided to those addicted to alcohol. Since the impact of alcohol addiction is at multiple levels in society, remedies would also have to be created at multiple levels. Enforcing a ban through government action and mobilising the community through local-level committees and research to gather evidence to substantiate the right policies would be comprehensive pathways to tackle the problem of widespread (and increasing) alcohol addiction.

A handful of non-profits have successfully dealt with alcohol de-addiction with such a multipronged approach in various parts of India. Society for Education, Action and Research in Community Health (SEARCH), based in Gadchiroli district in Maharashtra, is one such non-profit. 

“A thirty-year struggle against alcohol and tobacco — the ‘cholera and plague’ of our times — demonstrates the destruction that addiction creates and how this is no longer just a health issue, but a developmental issue. No single strategy can overcome this plague; it must be a multipronged approach if we want to be successful in controlling this addiction,” said Abhay Bang, founder of SEARCH.

Another organisation dealing with de-addiction through community engagement and creating awareness is the DHAN Foundation, based in Madurai. Anmol Jeevan Foundation working in Virar, Maharashtra, is another such non-profit that provides holistic rehabilitation to alcoholics and drug addicts through its 12-step recovery program.

Nada India Foundation, based in Delhi, also believes in creating awareness and bringing about social changes through people’s involvement. Their focus is to reduce the burden of alcohol and drug addiction among the marginalised and underprivileged sections of society.

The Centre has pledged to achieve the national target of a 10 per cent relative reduction in alcohol use by 2025, according to the National Action Plan and Monitoring Framework for Prevention and Control of Non-communicable Diseases.

The multi-dimensional strategy adopted by the various non-profits across India could pave the way for other organisations to emulate and collectively achieve this target in a more holistic way across the country. Indeed, this could be a trail-blazing initiative if implemented across India, which could very well be the rainbow on the horizon that the country needs in an otherwise dismal nationwide substance abuse epidemic. 

Views expressed are the authors’ own and don’t necessarily reflect those of Down To Earth

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