Alcohol: A Neglected Threat

Factors affecting Alcohol Use in our society

• In modern contemperory society!
  “We finished the exam. Let’s have a party!” a friend exclaims,
  “No Alcohol!” another friend exclaims,
  “Is that a party?” other friend yells,
  “Hey, just taste it. You’ll love it, a peg of alcohol is good for your health; you’ll not suffer from heart attack.”
  Other friend gives rationale, “You’ll forget all your pain at least for a while, it relaxes your mind.” the friend encourages,
• In a traditional society!
  “It’s our culture, you need to drink it; It is sacred offering to our god and it's a Prasad from god.”
  “Your ancestor used to drink it, we drink and you can drink.”
  “Please, have some alcohol (the form could vary). You must be tired and hungry.”
  “When did you start drinking?”
  “I don’t remember at all, I used to drink since the day I know my existence”
  Those conversations clearly demonstrate the role of cultural practice, inadequate scientific knowledge, ignorance, peer pressure, adventure seeking habit in starting alcohol use.

Magnitude of Alcohol Use: Epidemic or Endemic?

The alcohol is one of the commonly used substances in our society but it is not tabooed or stigmatized like other substances such as heroin, opium at least in our society. Instead, alcohol has become an integral part of our culture. The alcohol use is pervasive in every society. Its use is highly contagious and endemic (not an infectious agent but the extent of its prevalence and incidence) especially among certain group of people in Nepal. "I recall my conversation with one of my students. He was a member of national level research on non-communicable diseases, he was astonished to see the people intoxicated with alcohol even during day time and they were even frightened to conduct interview itself in Dhankuta district, Nepal, where the majority belong to Matwali (Rai, Limbu, Magar, Yakkha) group (Population Monograph of Nepal, 2014)."
Belonging to an indigenous group that allow alcohol use and uses alcohol for sacred rituals, it is usual for me to see people, who used alcohol mildly, moderately to heavily. I saw many died with gastric bleeding, which was usually blamed for some witchcraft or god’s wrath sometimes. As the limited amount of alcohol has been further idolized as cardio-protective drink by modern science, this has been a most abused reasoning for the alcohol users lately.

Effect of Alcohol Use on Health

Physical Health: Many researches have accorded that alcohol can shrink the brain mass with regular and occasional heavy doses. It can cause alcohol related brain damage and dementia can occur as early as at the age of 40 to 50. Alcohol is metabolized in Liver so It also affects liver leading to Alcoholic liver diseases including Cirrhosis. Cirrhosis causes irreversible damage to liver cells and diminish the liver function. As it affects the liver, it can also lead to portal hypertension and further causing gastric bleeding. Many people die of untimely management of gastric bleeding. It also affects all other parts of the body. Heavy and regular drinkers also suffer from decrease in libido and other reproductive system dysfunction. Alcohol related cancers in esophagus, stomach, liver are also contributors of mortality and morbidity. Alcohol kills not only by deteriorating health of the people, it also causes mortality, disability and morbidity indirectly by road traffic accidents, homicides, injuries, violence.
Psychological Health: Just like other substances, alcohol causes physical and psychological dependency and its tolerance accelerates the amount of alcohol as the increased amount of alcohol is required to get the same level of effect. The alcohol becomes an eye opener for the alcohol-dependent people.
Social Impact: Alcohol overuse also impairs the family and social relationship. Even though occasional and scant drinking can be a mean of social interaction, the excessive use of alcohol brings strain in family as the uninhibited, incomprehensive, ineffective and offensive communication may prevail.
Economic Impact: Alcohol use directly impacts the economic status of the person by draining resources to purchase alcohol; those resources could have been used in other useful purposes such as nutrition, education, recreation of the family. Alcohol use can also affect the economic status of the family by reducing the working capacity and performance of the person.
Some beneficial effects of alcohol have been reported by researches especially congestive heart failure and diabetes mellitus but the negative effects offset the probable beneficial effects of it.

Control Measures

Formulation of laws and implementation: Strict implementation of National Alcohol Regulation and Control Policy - 2017 can successfully decrease the alcohol use. This policy reform increased the legal drinking age to 21 from 18, which is highly praiseworthy. Statutory and pictorial warning should be displayed in the alcohol containers. Just like control measures for smoking, the same graphic and text warnings encourage quitting of alcohol in alcohol users and discourage others to try alcohol. The policy has also bans the use of alcoholic beverages in public parties hosted by government institutions. This policy also bars of any form of advertisement about alcoholic beverages. Alcohols are restricted to sell in public places such as schools/colleges. The concept of dry days should also be added in the current policy as people are more likely to drink alcohol in certain occasions as in festivals.

Awareness Programs: Education is the key to success of any health programs. Education is aimed to impart the knowledge to modify the behavior and shape the perception about particular things. Substance abuse is manifestation of a behavior that can be modified by modification of existing knowledge. Awareness about negative impacts of alcohol will help in decrease in demand. Homemade alcohol is easy to find almost everywhere in the neighborhood of Nepalese community that can be overlooked by the existing laws making awareness programs more indispensable. Similarly, those neighborhoods whose economy depends on homemade alcohol should be provided with alternative vocational trainings and financing opportunities. Early education with integration in curriculum of schools can also be effective in shaping the attitudes of the future generation.
It is very essential to direct such awareness programs and other interventions to the most needy populations where the alcohol use is mostly concentrated such as aforementioned ethnic groups, rural area, community with low socio-economic status.

Some References

Paul CA, Au R, Fredman L, Massaro JM, Seshadri S, Decarli C, Wolf PA. Association of alcohol consumption with brain volume in the Framingham study. Arch Neurol. 2008 Oct;65(10):1363-7. doi: 10.1001/archneur.65.10.1363.
Walsh CR, Larson MG, Evans JC, Djousse L, Ellison RC, BASAN RS, Levy D. Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study. Ann Intern Med. 2002 Feb 5;136(3):181-91.
Jason Andrade, Alcohol and the heart. BCMJ. 2009 June. 51(5)
Editorials: Alcohol consumption and brain health. BMJ. 2017.
Rehm J, Mathers C, Popova S, et. al. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. The Lancet. 2009. Vol. 373. Issue 9682.

By Pramila Rai