The Need To Tackle The Good, Bad And Ugly Of Alcohol Consumption
By Sukant Khurana:
Enjoying a couple of drinks is not synonymous with the risky behaviour of binge drinking. Nonetheless, binge drinking is a rising trend on college campuses, hostels, and among the neo-rich as well as the illiterate sections of India. Given that healthy alcohol consumption and alcohol abuse are both rapidly increasing, especially with a burgeoning middle class, we need to tackle the good, the bad and the ugly of alcohol, head on before it gets out of control.
In the last few years, there has been a dramatic rise in rehabilitation clinics and NGOs mostly professing prohibition. Many NGOs are asking for prohibition, increased taxation, retaining bans on alcohol products, and limiting sale outlets. Whether genuinely good intentions are behind the requests, or these NGOs are merely fronts for amassing wealth can only be assessed on a case-by-case basis. Regardless of the intentions, it is obvious that their efforts have been at best ineffective and in most cases actually counterproductive. Do not get us wrong, I am not dismissing all prohibitionist movements as the special interests of a small section. In many instances, genuine grass root movements of concerned citizens, especially the mothers and wives of addicts, have resulted in gaining sufficient momentum for a ban on alcohol to become a state and central election issue. Prohibition by the late populist chief minister N. T. Rama Rao in Andhra Pradesh was a result of such a grass root movement founded in the socio-economic costs of alcohol abuse in the agricultural sector. The prohibition in Andhra was rather short-lived and an utter failure, much like the current bans in Gujarat and Mizoram. Banning the regulated sale of safe alcohol has resulted in people consuming hazardous alcohol of shoddy quality, binging in secrecy, and driving to and from far away destinations to consume alcohol, which results in increased alcohol related traffic incidences. The bans have also meant the loss of much needed revenues for a growing India, that regulated alcohol sales generate. This counterproductive nature of prohibition is a global trend and the American prohibition era and Pakistan’s prohibition from the Zia era onwards are good case studies for anyone wanting to evaluate the merits and demerits of going dry.
Unfortunately, due to a lack of data acquisition, reporting, and monitoring by federal and state agencies, there is very little large scale data available on drinking patterns in India. This deficiency of empirical evidence is debilitating for effective policy changes, but it is not the only bottleneck preventing a mature national debate on alcohol consumption. The immature political agenda that amounts to an unproductive and pretentious debate on alcohol policy remains the biggest bottleneck while simultaneously quieting people with genuine grievances and grave personal tragedies caused by alcohol abuse. In short, apathy, ignorance, and incompetence by those in power are killing people. Unfortunately, the topic for the limited national debate has been alcohol vs. no alcohol, as if alcohol is only bad and not a part of our long rich culture, heritage, and a potential source of health and economic benefits.
Even if one believes that the state and central governments genuinely believe that all alcohol is bad, then their double standards make no sense. One of the most laughable and pretentious acts is the ongoing ban on alcohol advertisements, while allowing alcohol manufacturers to advertise low-selling, almost hypothetical products like music CDs and bottled water that have the same name as their alcoholic beverage. The hundreds of deaths in Orissa and Gujarat due to illicit liquor should have been a wakeup call for the need to change the infantile alcohol debate currently focusing around prohibition. It is not however just the government that is to blame despite the glaring failure of prohibition. Many anti-alcohol organizations, including ones decorating their homepages with ministerial inaugurations, have been sticking to their guns on demands for prohibitory rules rather than encouraging healthy alcohol policies and education. Just like forcing abstinence is no way to solve the problem of sexually transmitted diseases, prohibition of alcohol is no way to cure the evils of alcohol addiction and binging. It is unlikely to expect that recently unveiled increases in the health budget, superficial increases of focus on alcohol addiction, and more donations to prohibitionist NGOs are going to fix the problem of alcohol abuse. Sales of alcohol, whether legal or illegal, will continue as they have in the past. What can make a difference though, is the spread of information on alcohol abuse. In a democracy, the buck really stops with the private citizen; hence this piece is intended as food for thought for drinkers and potential drinkers so that they can make their own informed choices.
It is claimed by some federal reports that the epidemic of binge drinking can account up to 45% of total consumption in the US. Activists organizations against regulations put the numbers much lower, but still at shocking levels. The data for India is limited, but the trend is towards steep increases in binge drinking, as is the case in other economies where alcohol is a forbidden fruit – a societal taboo. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), the alcohol section of the US federal health agency the National Institute of Health (NIH), defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration above 0.08% (v/v). This usually takes around 5 drinks for males and 4 for females in a span of approximately 2 hours.
Binge drinking, especially as a repeat pattern, is associated with many health problems including alcohol poisoning, liver sclerosis, cardiovascular diseases, sexual dysfunction, and fetal alcohol syndrome in unborn children of pregnant women. In addition, according to the Center for Disease Control and Prevention (CDC), of the USA, binge drinkers are over 10 times more likely to report driving under the influence of alcohol compared to non-binge drinkers. The World Health Organization (WHO) estimates that 2.5 million deaths per year worldwide are caused by alcohol related incidents. The actual numbers are disputable, but the fact is that drinking and driving do not happily coexist and drunk driving is a serious strain on the global economy including urban India. A strong correlation exists between alcohol and crime, though one can debate if alcohol actually causes crime or merely acts as a societal permission slip for perpetrators to commit preconceived crimes, as suggested by some placebo alcohol studies. Without doubt, blackouts due to binging leave people vulnerable to crimes of predation such as rape. Given the infestation of many cities with rapists, especially the National capital territory, accepting any drink from a stranger or binging in the presence of strangers should be a big no no.
I might sound like I am using hypocritical scare tactics while criticizing prohibition, but hold on; I am not done talking about the benefits of responsible drinking. Being a neuroscientist interested in addiction, I cannot deny coming across a plethora of literature on the many health benefits of moderate drinking. Moderate drinking is no more than 2 drinks for women and no more than 3 to 4 drinks for men in a day, preferably well-spaced with snacks or meals to slow ethanol absorption. Moderate amounts of alcohol have been correlated with reducing dementia and Alzheimer’s disease, improving cardiac functioning, and reducing stroke incidences, type 2 diabetes, osteoporosis, gallbladder diseases, arthritis, renal cell carcinoma, thyroid cancer, and non-Hodgkin lymphoma. These advantages of moderate alcohol consumption are not limited to red wine that, in part, derives benefits from other ingredients. Ethanol in any form, as long as it is consumed in moderation, confers the above mentioned health benefits. I would like to point out that there is a weak, though contested link between increased risk of breast cancer and cataracts due to consumption of the upper end of what constitutes moderate drinking. So if you have a reason to suspect predisposition to either of the two ailments, then erring on the safe side until further evidence establishing or refuting the causality may be a wise choice. The benefits of drinking however can be outweighed by the risks when moderate drinking turns to binging and these dangers should offer sufficient warning to anyone binging to take the happy middle path of moderation or quit altogether. If one chooses to drink alcohol, then he or she should think about making it a social thing, to be enjoyed slowly and responsibly, maybe while thinking of the Nazms of Shayre Aazam Mirza Ghalib or of Madhushala by Hariwansh Rai Bachchan or humming the latest release of Shakira in some newly opened pub in Connaught Place (sorry, Rajiv Chowk makes no sense). Make it a social lubricant and not a societal burden.
While abstinence taught by ‘Vaishnav’ traditions of Hinduism (especially after influence of Bhakti movement), Islam, Sikhism, and Jainism, has its place; so do the Vedic hymns, ‘Shaivism’, Buddhism, ‘Tantra’, streams of Catholicism, and many indigenous animist and tribal traditions that celebrate alcohol in moderation. Though it is poorly recognized in the West, a place where distillation only started in Middle Ages, India is a land that has enjoyed all kinds of alcoholic beverages, including distilled spirits, as made obvious from definitive records of distillation in the works of Sushruta in the early Chritian era (Hindu right likes to predate him but I choose to go by conservative critical estimates). Based on indirect evidence some historian claim that even ‘Charaka’ and ‘Agnivesh’ knew of distillation but critics point to linguistic style of controversial sutras that appear to have been later interpolated.
It is safe to say that generations of Indians have enjoyed alcohol from times immemorial and even distilled alcohol, a recent luxury in the West, for around 2000 years. Whether looking back at our knowledge of ancient India or at a recent admixture of Portuguese and Indian traditions in the form of the cashew drink of Fenny (a must when visiting Goa), alcohol is food in moderation and poison in excess. When we think of the absolute abstinence of Mahatma, let us also think of the enjoyment of Mahua – the liquor made from flowers, which has played a central role in the lives of indigenous people from ancient times. If you are of religious bent and enjoy alcohol, then maybe the “madhyam marga” taught by Buddhism and Bhagvata Gita will guide your alcohol choice. If you worship at the altars of science and look at religion from cultural perspective, like us, then I hope that the overwhelming data on the dangers of excess will sway you to the mature path of moderation.
I hope that peer pressure is not what drives a collegiate adult or a newly well-heeled who has made the quick buck by selling land around a metropolis, to drinking in excess. Alcohol should not be thought of as a forbidden fruit, as cultural taboos in contemporary India have made it out to be. It should not be a vehicle for teenage rebellion or an exit route from the rural life of a broken village and its traditions into a vacuum of the temporary and complete apparent freedom and glitters that urban India has to offer, but only welcomes the instant-rich for their money. Multiple studies on college drinking in the USA, Australia, and UK have shown that people overestimate how much their peers are drinking and hence binge due to peer pressure. Across multiple studies, the strategy of publishing college drinking habits, instead of seeing, hearing, and speaking no evil, actually has been repeatedly shown to encourage more responsible drinking habits. Alcohol is not really that special on its own. It is only as special as the person enjoying it and the company that makes pleasant moments, lifelong memories and friendships.
I hope this time around, those who do not know when to stop, celebrate festivities with non-alcoholic beverages and those who want to sip a little drink do it with their family and friends with a gentle ‘suroor’ and not drunken revelry.