Alcohol abuse:

Licence to premature death

by Lionel WIJESIRI

In a Symposium held in Bali, Indonesia few months ago, organized by the World Health Organization, Professor R Ray, Chief of the National Drug Dependence Treatment Centre, India noted the magnitude of alcohol use and dependence in India, Sri Lanka, Myanmar, Nepal and Thailand.

Talking about Sri Lanka he said that surveys indicated 53.1% of males above 15 years old are current alcohol users and 80% of them are frequently confronted with alcohol abuse related problems. From 1975 to 2002 the increase in deaths from liver diseases increased from 3.8 to 15.2 per 100,000. And, it is also estimated that alcohol is the leading risk factor for males, causing 10% of years lost to death and disability.

Other independent surveys reveal that among the urban poor in Sri Lanka 30% of families use alcohol and spend more than 30% of their income on it. Amongst them, over 10 percent of male respondents reported spending as much as or more than their regular income on alcohol.

However, researchers have discovered that calculations of the expenditures on alcohol grossly under-represent reality. The drinkers deliberately or unwittingly underestimate the amount of money they spend on alcohol. Also, amounts spent during special occasions, such as weddings and other celebrations, can entail large expenditures on alcohol, and while these tend not to be included in calculations of 'average' alcohol expenditures, people did report becoming indebted because of them.

These data clearly lead us to a larger and bigger picture. It's about an impending catastrophe we cannot ignore anymore! Are we becoming a nation of alcoholics? To put things in real perspective, one might say that Sri Lanka has already become a nation of hard drinkers and quote figures. According to the figures from Excise Department, every year we gulp over 75 million litres of legal hard alcohol and 55 million litres of beer and toddy (soft alcohol). Research has shown that the consumption of illicit alcohol well exceeds that of hard alcohol. Grim news, indeed! Our record is second only to France as far as the rate of per capita alcohol consumption is concerned.

Awareness

More and more studies indicate that health, social and economic harm from alcohol abuse is widespread in our country. As the average use of alcohol has been on the increase, it is imposing numerous challenges on our policymakers, professionals, civil society and public health.

The wide range of social and health problems include depression, injuries, cancer, cirrhosis, family disruption and loss of work productivity amongst others.The medical analysts say that health and social problems from alcohol consumption often affect others besides the drinker. While men do the bulk of the drinking, women disproportionately suffer the consequences, including alcohol-related domestic violence and reduced family budgets. The saddest part is that heavy alcohol use takes a particular toll on our young, and has been linked to high rates of youthful criminal behaviour and impaired ability to achieve educational qualifications. Many deaths and much disease and suffering within families and neighbourhoods could be prevented by reducing alcohol use.

One more related matter is the volume of traffic accidents in Sri Lanka. Over 6000 people are killed (or grievously hurt) every year. At least 40 per cent of these accidents are alcohol-related, mainly with intoxication on the part of the driver.

Liquor Policy

What we urgently need today is a more dynamic liquor policy. The legislation flowing from such a policy should be guided by the need to decrease per capita consumption of alcohol. In particular, the policy should involve an integrated approach which cuts across departments and sectors as different tiers of Government. In my opinion, this could easily be done through the National Authority on Tobacco and Alcohol, which can bring together representatives of Government departments, community organizations, religious bodies, trade unions and the liquor industry at national level.

Similar interaction will be required at provincial government, local authority and community levels. Local authorities and representative community organizations and forums should work together in ensuring that the way in which liquor is distributed and sold limits the negative externalities as well as in addressing the negative effects which have already occurred.

Above all, religious formations can also play a key role in addressing the devastation caused by alcohol in their communities and must be encouraged to be integrally involved in these initiatives.

Externalities

Addressing the externalities involves handling issues common to all sectors , but particular interventions are needed to education, rehabilitation, women and youth.

Education: There is a need for more extensive education at a range of levels. Firstly, there is a need for general education about the potentially harmful effects of alcohol by means of the media, schools, public health facilities, community organizations and other vehicles.

Central to any education initiative is the goal of community empowerment to enable people to take control over their lives.

There is also a need for the expansion of a comprehensive education programme for people within the liquor industry, in particular those who serve alcohol to the public. The programme will need to cater to the educational needs of both those in the formal industry as well as the informal sector.

Rehabilitation: Extensive welfare programmes are required to meet the needs of both alcohol abusers and the victims of alcohol related domestic violence, rape assault and other crimes.

Youth: The alcohol related effects on our youth require urgent attention. There is a significant increase in the consumption of alcohol amongst youth. This sets in place high consumption patterns and related problems into adulthood. The reasons for increased consumption include high levels of unemployment as well as a lack of recreational facilities to cater to social needs. Two key interventions in this regard are job creation initiatives and the provision of recreational facilities in communities across the country

Alcohol abuse and crime: There is a strong relationship between alcohol and a wide range of criminal activity. In parts of the country, in excess of 80% of all assaults and murders are alcohol related in that either the assaulter or victim or both were under the influence of alcohol. We have to look for mediating factors in the relationship between the two. These factors can be complex, however, and lie in cultural and social interactions that determine alcohol use patterns which result in criminal behaviour.

Women: Women are often victims of alcohol related violence. They bear the brunt of "managing" an alcoholic in the family. Broken homes and picking up the economic slack of an abusing breadwinner squandering precious earnings are all classical scenarios that women have had to cope with. Although saddled with more and more responsibilities, women who try to rationalize the behaviour of such abuser often end up psychologically depleted and physically exhausted. These disconcerting realities underline the urgency of our focusing on the effects of alcohol abuse on women.

Sacrifice

The above are some of the issues which need to be urgently addressed.

Other issues include an integrated approach to alcohol related accidents on public roads and an approach to ensure that advertising highlights the potentially harmful effects of alcohol.

However, the availability of adequate funding to address these issues is central to the successful implementation of the programme. Not only funding, but public participation is also essential to monitor the process and feed back with input into ways in which problems could be more effectively addressed than in the past.

One final point! Any effort that seeks to limit liquor consumption without imposing a total prohibition will be objected to by a certain section of people on the ground of violating individual freedom. Let them be mindful of one fact. There are times when personal pleasures and liberties of some have to be sacrificed when efforts are made to ensure protection of the total society against evil influences and practices.