alcoholism in india essay

Last updated 27/06/24: Online ordering is currently unavailable due to technical issues. We apologise for any delays responding to customers while we resolve this. For further updates please visit our website: https://www.cambridge.org/news-and-insights/technical-incident

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings .

Login Alert

• > Journals
• > Cambridge Prisms: Global Mental Health
• > Global Mental Health
• > Volume 9
• > Alcohol use among adolescents in India: a systematic...

Article contents

Introduction, financial support, conflict of interest, ethical standards, alcohol use among adolescents in india: a systematic review.

Published online by Cambridge University Press:  07 January 2022

• Supplementary materials

Alcohol use is typically established during adolescence and initiation of use at a young age poses risks for short- and long-term health and social outcomes. However, there is limited understanding of the onset, progression and impact of alcohol use among adolescents in India. The aim of this review is to synthesise the evidence about prevalence, patterns and correlates of alcohol use and alcohol use disorders in adolescents from India.

Systematic review was conducted using relevant online databases, grey literature and unpublished data/outcomes from subject experts. Inclusion and exclusion criteria were developed and applied to screening rounds. Titles and abstracts were screened by two independent reviewers for eligibility, and then full texts were assessed for inclusion. Narrative synthesis of the eligible studies was conducted.

Fifty-five peer-reviewed papers and one report were eligible for inclusion in this review. Prevalence of ever or lifetime alcohol consumption ranged from 3.9% to 69.8%; and prevalence of alcohol consumption at least once in the past year ranged from 10.6% to 32.9%. The mean age for initiation of drinking ranged from 14.4 to 18.3 years. Some correlates associated with alcohol consumption included being male, older age, academic difficulties, parental use of alcohol or tobacco, non-contact sexual abuse and perpetuation of violence.

The evidence base for alcohol use among adolescents in India needs a deeper exploration. Despite gaps in the evidence base, this synthesis provides a reasonable understanding of alcohol use among adolescents in India and can provide direction to policymakers.

According to the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, among adolescents and young adults (aged 10–24 years), alcohol-attributable burden is second highest among all risk factors contributing to disability-adjusted life years in this age group (GBD 2019 Risk Factors Collaborators, 2020 ). The exposure of the adolescent brain to alcohol is shown to result in various cognitive and functional deficits related to verbal learning, attention, and visuospatial and memory tasks, and behavioural inefficiencies such as disinhibition and elevated risk-taking (Spear, Reference Spear 2018 ). Alcohol consumption in adolescents results in a range of adverse outcomes across several domains and includes road traffic accidents and other non-intentional injuries, violence, mental health problems, intentional self-harm and suicide, HIV and other infectious diseases, poor school performance and drop-out, and poor employment opportunities (Hall et al ., Reference Hall, Patton, Stockings, Weier, Lynskey, Morley and Degenhardt 2016 ).

Adolescence is a critical period in which exposure to adversities such as poverty, family conflict and negative life experiences (e.g. violence) can have long-term emotional and socio-economic consequences for adolescents, their families and communities (Knapp et al ., Reference Knapp, Scott and Davies 1999 ; Knapp et al ., Reference Knapp, McCRONE, Fombonne, Beecham and Wostear 2002 ). Substance use, including alcohol, is typically established during adolescence and this period is peak risk for onset and intensification of substance use behaviours that pose risks for short- and long-term health (Anthony and Petronis, Reference Anthony and Petronis 1995 ; DeWit et al ., Reference DeWit, Adlaf, Offord and Ogborne 2000 ; Hallfors et al ., Reference Hallfors, Waller, Bauer, Ford and Halpern 2005 ; Schmid et al ., Reference Schmid, Hohm, Blomeyer, Zimmermann, Schmidt, Esser and Laucht 2007 ; Hadland and Harris, Reference Hadland and Harris 2014 ). As such, early initiation of alcohol use among adolescents can provide a useful indication of the potential future burden among adults including increased risk for academic failure, mental health problems, antisocial behaviour, physical illness, risky sexual behaviours, sexually transmitted diseases, early-onset dementia and the development of alcohol use disorders (AUDs) (Hingson et al ., Reference Hingson, Heeren and Winter 2006 ; King and Chassin, Reference King and Chassin 2007 ; Dawson et al ., Reference Dawson, Goldstein, Patricia Chou, June Ruan and Grant 2008 ; Nordström et al ., Reference Nordström, Nordström, Eriksson, Wahlund and Gustafson 2013 ).

India continues to develop rapidly, and accounts for most of the increase in alcohol consumption per capita for WHO's South-East Asia region (World Health Organization, 2018 ). Although India has a relatively high abstinence rate, many people who do drink are either risky drinkers or have AUDs (Benegal, Reference Benegal 2005 ; Rehm et al ., Reference Rehm, Mathers, Popova, Thavorncharoensap, Teerawattananon and Patra 2009 ). Finally, the existing policies in India have failed to reduce the harm from alcohol because the implementation of alcohol control efforts is fragmented, lacks consensus, is influenced by political considerations, and is driven by narrow economic and not health concerns (Gururaj et al ., Reference Gururaj, Gautham and Arvind 2021 ).

India has the largest population of adolescents globally (253 million people aged 10–19 years), constituting 21% of the population (Government of India, 2011 ; Boumphrey, Reference Boumphrey 2012 ). Additionally, adolescents as young as 13–15 years of age have started consuming alcohol in India (Gururaj et al ., Reference Gururaj, Varghese, Benegal, Rao, Pathak, Singh and Singh 2016 ). Despite this growing public health problem, the official policy response in India remains primarily focused on AUDs, particularly alcohol dependence in adults, with an absolute disregard for the potential of prevention programmes. One potential reason for this is the limited understanding of the onset and progression of alcohol use and AUDs amongst adolescents in India. The aim of this paper is to bridge that knowledge gap by synthesising the evidence about the prevalence and correlates of alcohol use and AUDs in adolescents from India.

The specific objectives are to examine the following in adolescents from India: (a) prevalence of current and lifetime use of alcohol, (b) prevalence of current AUDs, (c) patterns (e.g. frequency, quantity) of alcohol use, (d) sociodemographic, social and clinical correlates of alcohol use and AUDs, and (e) explanatory models of and attitudes towards alcohol use and AUDs, e.g. perceptions of the problem and its causes. This paper synthesises the evidence about alcohol and AUDs using data from a comprehensive review that we conducted of any substance use and substance use disorders amongst adolescents in India.

Systematic review . The review protocol was registered prospectively on Prospero (registration ID CRD 42017080344).

Inclusion and exclusion criteria

There were no limits placed on the year of publication of the paper, gender of the participants and study settings in India. We only included English language publications as academic literature from India is predominantly published in such publications. Adolescents were defined as anyone between 10 and 24 years of age (Sawyer et al ., Reference Sawyer, Azzopardi, Wickremarathne and Patton 2018 ). Studies reporting alcohol use and/or AUDs in a wider age range (including 10–24 years) were included only if data were separately presented for the 10–24-year age group. We included observational studies (surveys, case-control studies, cohort studies), qualitative studies and intervention studies (only if baseline prevalence data were presented). We included studies which examined alcohol use and AUDs defined as per the International Classification of Diseases (ICD)/Diagnostic and Statistical Manual of Mental Disorders (DSM)/clinical criteria or using a standardised screening or diagnostic tool.

We searched the following databases: PsycARTICLES, PsycInfo, Embase, Global Health, CINAHL, Medline and Indmed. The search strategy was organised under the following concepts: substance (e.g. alcohol, drug), misuse/use disorder (e.g. addiction, intoxication), young people (e.g. adolescent, child) and India (e.g. India, names of individual Indian states). The detailed search strategy is listed in Appendix A .

Two reviewers (DG and KW) independently inspected the titles and abstracts of studies identified through the database search. Any conflicts about eligibility between the two reviewers were resolved by AN. If the title and abstract did not offer enough information, the full paper was retrieved to ascertain whether it was eligible for inclusion. Screening of full texts was done by AN, AG and DG; and any conflicts about eligibility were resolved by UB. Screening of the results of the search was done using Covidence ( https://www.covidence.org/ ), an online screening and data extraction tool.

AN searched the following resources to identify relevant grey literature: Open Grey, OAlster, Google, ProQuest, official English language websites of the World Health Organization and World Bank, English language websites of ministries of each state and union territory within India responsible for substance misuse as well as the official websites of the Indian Narcotics Control Bureau and Ministry of Social Justice and Empowerment.

Any grey literature with relevant data published by a recognised non-governmental organisation, state, national or international organisation was included. Studies were included based on the robustness of study design and quality of data. If there were multiple editions of any published piece of grey literature, only the latest published edition of that report was included. Once retrieved, their titles, content pages and summaries were read by AN and if deemed eligible they were added to a list of potentially eligible reports. If the grey literature's summary, content and title did not include enough information, then the full text was examined by AN to determine eligibility for inclusion.

Finally, experts in the field of substance use disorders in India were contacted to explore if they could identify any further useful sources of information and were invited to submit unpublished data and unreported outcomes for possible inclusion into the review. Reference lists of selected studies, grey literature and relevant reviews were inspected for additional potential studies.

A formal data extraction worksheet was designed to extract data relevant to the study aims. The following data were extracted: centre (e.g. name of city), sampling technique, sample (e.g. general population), sample size, age(s), tool used to measure alcohol use and/or AUD, definitions of alcohol use and AUD, prevalence of alcohol use and/or AUD, age of initiation, type of alcohol, quantity and frequency of alcohol use, attitudes towards alcohol use, effect of alcohol on health, social, educational and other domains, and risk factors/correlates of alcohol use and or AUD. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al ., Reference Moher, Shamseer, Clarke, Ghersi, Liberati and Petticrew 2015 ), a record was made of the number of papers retrieved, the number of papers excluded and the reasons for their exclusion. AT independently performed data extraction, AG checked the data extraction, and AN arbitrated any unresolved issues. The quality of reporting of included studies was examined using the STROBE Statement – checklist of items that should be included in reports of observational studies (Von Elm et al ., Reference Von Elm, Altman, Egger, Pocock, Gøtzsche and Vandenbroucke 2007 ).

A descriptive analysis of the data was conducted, and the results are mainly reported in a narrative format focusing on each of the objectives described above (Popay et al ., Reference Popay, Roberts, Sowden, Petticrew, Arai, Rodgers and Duffy 2006 ).

In total, 6464 references were identified through the search strategies described above. Overall, 251 records were eligible for the wider review, of which 55 were about alcohol use and have been reported in this paper ( Fig. 1 ). Additionally, one report of magnitude of substance use in India which was recommended by an expert was also included (Ambekar et al ., Reference Ambekar, Agrawal, Rao, Mishra, Khandelwal and Chadda 2019 ).

Fig. 1. PRISMA flow diagram.

Study descriptions

One study was conducted online (Gupta et al ., Reference Gupta, Lam, Pettigrew and Tait 2018 ) and one in a national treatment centre in North India (Mandal et al ., Reference Mandal, Parmar, Ambekar and Dhawan 2019 ), both of which potentially had access to participants from across the country ( Table 1 ). All the rest were conducted at a single or multiple settings in a city, town, district, village or state. The sample size of the studies ranged from 23 (Bhad et al ., Reference Bhad, Jain, Dhawan and Mehta 2017 ) to 7350 (Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ). In studies that reported mean age of the samples, it ranged from 13.10 years (Pillai et al ., Reference Pillai, Patel, Cardozo, Goodman, Weiss and Andrew 2008 ) to 20.56 years (Garg et al ., Reference Garg, Chavan, Singh and Bansal 2009 ).

Table 1 Description of studies included in the review

Prevalence of alcohol use and AUD

The prevalence of ever use or lifetime use, broadly defined as consumption of alcohol at least once in their lifetime, ranged from 3.9% in school students aged 12–18 years (Rani and Sathiyaskaran, Reference Rani and Sathiyaskaran 2013 ) to 69.8% in 22–23-year-old medical students (Kundapur and Kodyalamoole, Reference Kundapur and Kodyalamoole 2016 ) ( Table 2 ). Ever use in females ranged from 6.5% in students from class 8 to class 12 (age 12–19 years) (Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ) to 52% in an online survey of adolescents aged 13–17 years (Gupta et al ., Reference Gupta, Lam, Pettigrew and Tait 2018 ), and in males it ranged from 9.79% in students from classes 9 and 11 (age up to 17 years) (Kotwal et al ., Reference Kotwal, Thakur and Seth 2005 ) to 47% in an online survey of adolescents aged 13–17 years (Gupta et al ., Reference Gupta, Lam, Pettigrew and Tait 2018 ). The prevalence of ever use in rural areas ranged from 7.37% in high school students (Tsering et al ., Reference Tsering, Pal and Dasgupta 2010 ) to 20% in students aged 15–19 years (Kumar et al ., Reference Kumar, Kumar, Shora, Dewan, Mengi and Razaq 2016 ), and in urban areas it ranged from 5.23% in high school students (Tsering et al ., Reference Tsering, Pal and Dasgupta 2010 ) to 23.08% in students aged 15–19 years (Kumar et al ., Reference Kumar, Kumar, Shora, Dewan, Mengi and Razaq 2016 ).

Table 2 Prevalence of alcohol use and alcohol use disorders

Current use

The definition of current use of alcohol varied across studies. The more commonly used definitions were alcohol consumption at least once in the past year for which the prevalence ranged from 10.6% in senior high school students aged 12–18 years (Mohan et al ., Reference Mohan, Rustagi, Sundaram and Prabhu 1981 ) to 32.9% in 15–19-year-old individuals from rural settings (Mohan et al ., Reference Mohan, Sharma, Darshan, Sundaram and Neki 1978b ); and at least once in the past 30 days (month) for which the prevalence ranged from 2.1% (Sharma et al ., Reference Sharma, Singh, Lal and Goel 2015 ) in 15–19-year olds from disadvantaged urban settings and 35.6% in injectable drug users attending needle and syringe programme centres (Armstrong et al ., Reference Armstrong, Nuken, Samson, Singh, Jorm and Kermode 2013 ). Some studies did not define current use and others used non-standard definition of current use such as ‘who had not used drugs either daily or weekly in the past month’ (27.6%) (Gupta et al ., Reference Gupta, Narang, Verma, Panda, Garg, Munjal and Singh 1987 ), and ‘habit of using alcohol, 3 days or more a week’ (0.8%) (Jayakrishnan et al ., Reference Jayakrishnan, Geetha, Mohanan Nair, Thomas and Sebastian 2016 ). The biggest countrywide survey of substance use in India reported a prevalence of current alcohol use to be 1.3% amongst those aged 10–17 years (Ambekar et al ., Reference Ambekar, Agrawal, Rao, Mishra, Khandelwal and Chadda 2019 ).

Some studies reported the prevalence of AUDs and defined them using standardised tools (Alcohol Use Disorder Identification Test [AUDIT], CAGE questionnaire, Alcohol, Smoking and Substance Involvement Screening Test [ASSIST]), ICD 10 criteria or bespoke definitions. Among medical students (18–23 years) who were drinkers, the prevalence of hazardous drinking was 19.29% (Anandi et al ., Reference Anandi, Halgar, Reddy and Indupalli 2018 ), alcohol dependence was 3.7–10% (Kundapur and Kodyalamoole, Reference Kundapur and Kodyalamoole 2016 ; Haorongbam et al ., Reference Haorongbam, Sathyanarayana and Dhanashree 2018 ), binge drinking 14–30% (Kundapur and Kodyalamoole, Reference Kundapur and Kodyalamoole 2016 ; Anandi et al ., Reference Anandi, Halgar, Reddy and Indupalli 2018 ) and ‘problem drinking’ (not defined) was 41.46% (Garg et al ., Reference Garg, Chavan, Singh and Bansal 2009 ). Among students of classes 8, 10 and 12 (12–19 years), 1.6% (2% males, 0% females) of lifetime users had alcohol dependence (Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ). In adolescent street children (11–19 years), 37% had AUD defined as recurrent substance use resulting in one or more of the following occurring in 12 months: failure to fulfil major role obligations at work or home leads to a physically hazardous situation, or causes legal problems (Gaidhane et al ., Reference Gaidhane, Syed Zahiruddin, Waghmare, Shanbhag, Zodpey and Joharapurkar 2008 ).

Patterns of drinking

Among drinkers, 0.6–10.4% consumed every day (Armstrong et al ., Reference Armstrong, Nuken, Samson, Singh, Jorm and Kermode 2013 ; Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ; Kundapur and Kodyalamoole, Reference Kundapur and Kodyalamoole 2016 ), 19.1–40% consumed at least once a week (Armstrong et al ., Reference Armstrong, Nuken, Samson, Singh, Jorm and Kermode 2013 ; Kundapur and Kodyalamoole, Reference Kundapur and Kodyalamoole 2016 ), 3.8% consumed weekly (Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ), 9.5% consumed less than once a week (Armstrong et al ., Reference Armstrong, Nuken, Samson, Singh, Jorm and Kermode 2013 ) and 10.6% consumed monthly (Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ) ( Table 3 ). Usual median number of drinks consumed among those between 13 and 17 years was 3.5 for both males and females (Gupta et al ., Reference Gupta, Lam, Pettigrew and Tait 2018 ). Among 10–19-year-old males from an urban slum over the past month, 54.2% consumed up to 50 ‘pegs’ of alcohol (Kokiwar and Jogdand, Reference Kokiwar and Jogdand 2011 ). Among males from a low-income community, in those between 18 and 20 years, 88.2% were ‘low drinking’ (low amount/low frequency, low amount/moderate frequency or substantial amount/low frequency), 9.3% were moderate drinking (low amount/high frequency or substantial amount/moderate frequency) and 2.5% were high drinking (substantial amount/high frequency); and in those between 20 and 24 years, 82.6% were low drinking, 13.5% were moderate drinking and 3.8% were high drinking (Singh et al ., Reference Singh, Schensul, Gupta, Maharana, Kremelberg and Berg 2010 ).

Table 3 Initiation of, attitudes towards, patterns of and correlates of drinking

Initiation age

The mean age for initiation of drinking ranged from 14.4 to 18.3 years ( Table 3 ). The mean age of initiation was significantly lower in rural areas compared to urban areas [10.66 ( s.d. 4.02) v . 12.5 ( s.d. 3.57); p  < 0.0001] (Nagendra and Koppad, Reference Nagendra and Koppad 2017 ); and locally brewed alcohol [mean ( s.d. ) 11.09 (2.775)] was initiated at a younger age compared to commercially available alcohol in an industrial town [mean ( s.d. ) 13.90 (2.194)] (Mahanta et al ., Reference Mahanta, Mohapatra, Phukan and Mahanta 2016 ).

Among male substance use disorder patients at drug deaddiction centres, 41.3% had initiated alcohol use between 10 and 19 years (Bashir et al ., Reference Bashir, Sheikh, Bilques and Firdosi 2015 ). Among 22–23-year-old medical students, 25.6% had started consuming alcohol between 15 and 17 years, and 10.4% had started consuming alcohol before they were 15 years (Kundapur and Kodyalamoole, Reference Kundapur and Kodyalamoole 2016 ).

In students between 18 and 22 years, 18.0% had initiated drinking between 10 and 14 years, 55.1% had initiated between 15 and 19 years, and 26.9% after 19 years (Mohanty et al ., Reference Mohanty, Tripathy, Palo and Jena 2013 ). Among medical and dental students, 4.26% initiated before 12 years, 19.15% initiated between 12 and 18 years, and 76.60% initiated after 18 years (Rathore et al ., Reference Rathore, Pankaj, Mangal and Saini 2015 ). Comparing males and females, 5.88% males ( v . 0% females) initiated before 12 years, 16.18% ( v . 26.92%) initiated between 12 and 18 years, and 77.94% ( v . 73.08%) initiated after 18 years (Rathore et al ., Reference Rathore, Pankaj, Mangal and Saini 2015 ). Finally, comparing urban and rural drinkers, 6.50% urban drinkers ( v . 6.10% rural) initiated before 8 years, 8.94% ( v . 10.98%) initiated between 9 and 10 years, 27.65% ( v . 39.02%) initiated between 11 and 12 years, 26.83% ( v . 30.49%) initiated between 12 and 14 years, 24.39% ( v . 10.98%) initiated between 15 and 16 years, and 5.69% ( v . 2.44%) initiated after 17 years (Kumar et al ., Reference Kumar, Kumar, Shora, Dewan, Mengi and Razaq 2016 ).

Knowledge and attitudes

Overall, 55.3% of college-going students (17–21 years) believed that there was no risk of harmful effects of alcohol; with more females than males who believed that there was no risk (69.4% v . 43.4%); and a higher proportion from villages (64.4%) thought there was no risk as compared to those from towns (60.7%) or cities (50.0%) (Kalpana and Kavya, Reference Kalpana and Kavya 2012 ) ( Table 3 ). Among medical students (22–23 years), 44% considered it safe to consume alcohol, and 88% believe drinking patterns are mood-dependent (Kundapur and Kodyalamoole, Reference Kundapur and Kodyalamoole 2016 ).

In medical students (17–23 years), reasons for initiation of drinking included curiosity (19.6%), attending a party (17.5%), friends' influence (15.2%) and social gatherings (9.8%); and reasons for continued use included enjoyment (31.5%), as a coping mechanism for depressive symptoms (17.8%), socialisation (14.8%) and to take mind off other issues (9.6%) (Haorongbam et al ., Reference Haorongbam, Sathyanarayana and Dhanashree 2018 ). Among college-going students (mean age 16.7 years; s.d. 0.5) there was a stronger endorsement of negative reinforcements (e.g. cognitive impairment, risk taking) than of possible positive reinforcements (e.g. sociability, tension reduction); and compared to males, significantly more females felt alcohol consumption could not reduce tension and endorsed increased sociability and cognitive impairment (Sandhya et al ., Reference Sandhya, Carol, Kotian and Ganaraja 2013 ). Knowledge of harm of alcohol among substance users was greater in adolescents from urban than rural areas (61.5% v . 30.8%) (Tsering et al ., Reference Tsering, Pal and Dasgupta 2010 ).

Risk factors/correlates

The cross-sectional nature of the studies only allowed the examination of correlates of alcohol use ( Table 3 ). Alcohol consumption was associated with being male (Medhi et al ., Reference Medhi, Hazarika and Mahanta 2006 ; Mohanan et al ., Reference Mohanan, Swain, Sanah, Sharma and Ghosh 2014 ; Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ; Kundapur and Kodyalamoole, Reference Kundapur and Kodyalamoole 2016 ; Anandi et al ., Reference Anandi, Halgar, Reddy and Indupalli 2018 ; Mandal et al ., Reference Mandal, Parmar, Ambekar and Dhawan 2019 ), older age (Medhi et al ., Reference Medhi, Hazarika and Mahanta 2006 ; Rathore et al ., Reference Rathore, Pankaj, Mangal and Saini 2015 ; Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ; Gupta et al ., Reference Gupta, Lam, Pettigrew and Tait 2018 ; Mandal et al ., Reference Mandal, Parmar, Ambekar and Dhawan 2019 ) and going to private rather than public schools (Jain et al ., Reference Jain, Dhanawat, Kotian and Angeline 2012 ; Rani and Sathiyaskaran, Reference Rani and Sathiyaskaran 2013 ). Specifically for locally brewed alcohol, it was associated with younger age and rural residence (Mandal et al ., Reference Mandal, Parmar, Ambekar and Dhawan 2019 ). Alcohol consumption was associated with having a part-time job, and failing a subject or a year in school (Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ).

Alcohol use in adolescents was associated with parental/guardian's use of alcohol or tobacco, lack of parental supervision, and not having ‘understanding’ parents (Rani and Sathiyaskaran, Reference Rani and Sathiyaskaran 2013 ; Mohanan et al ., Reference Mohanan, Swain, Sanah, Sharma and Ghosh 2014 ; Jayakrishnan et al ., Reference Jayakrishnan, Geetha, Mohanan Nair, Thomas and Sebastian 2016 ; Mandal et al ., Reference Mandal, Parmar, Ambekar and Dhawan 2019 ). Alcohol use decreased with a decrease in the frequency of friends sharing alcohol-related information on Facebook and YouTube; and increased frequency of sharing personal alcohol-related content on Twitter was associated with an increase in alcohol use (Gupta et al ., Reference Gupta, Lam, Pettigrew and Tait 2018 ). Alcohol consumption was also associated with close friends using substances (any type) or peer pressure to drink alcohol (Mandal et al ., Reference Mandal, Parmar, Ambekar and Dhawan 2019 ).

Alcohol consumption was associated with tobacco use, illicit drug use, attention deficit hyperactivity disorder (ADHD) symptoms, suicidal thinking, planning and attempts, and non-contact sexual abuse and perpetuation of violence (Nadkarni et al ., Reference Nadkarni, Dean, Weiss and Patel 2015 ; Jaisoorya et al ., Reference Jaisoorya, Beena, Beena, Ellangovan, Jose, Thennarasu and Benegal 2016 ). Finally, higher acceptance of alcohol is associated with lower spirituality, less religiosity, less ‘God Consciousness’ and less formal religious practices (Sukhwal and Suman, Reference Sukhwal and Suman 2013 ).

Quality of reporting studies

In 42 of the 57 studies, there was appropriate reporting of more than 70% of the 22 STROBE criteria ( Appendix B ). Only one study reported on all the 22 criteria (Nadkarni et al ., Reference Nadkarni, Dean, Weiss and Patel 2015 ). For 15 of the 22 criteria, there was appropriate reporting in more than 70% of the studies. The poorest reporting was about study biases, generalisability of the findings, and role of the funder.

The existing evidence base has several limitations which preclude a robust synthesis and any conclusions we draw are, at best, exploratory in nature. Although the information about AUDs is relatively limited, the prevalence among drinkers appears to be high, and the patterns of drinking in a reasonably high proportion were suggestive of risky drinking (heavy drinking that puts the drinker at risk of developing problems), especially considering that this is a young population with a relatively short drinking history.

This is consistent with the steady rise in recorded alcohol consumption in most developing countries, albeit from relatively low base prevalence rates. It also parallels the increases in adult per capita consumption of alcohol and heavy episodic drinking that have been observed in India and other developing economies in east Asia, south Asia and southeast Asia (Shield et al ., Reference Shield, Manthey, Rylett, Probst, Wettlaufer, Parry and Rehm 2020 ). Amongst adolescents, the prevalence of current alcohol use in Sri Lanka was 3.4% (95% CI 2.6–4.3) (Senanayake et al ., Reference Senanayake, Gunawardena, Kumbukage, Wickramasnghe, Gunawardena, Lokubalasooriya and Peiris 2018 ), lifetime alcohol use in males was 45% (26% risky drinking) in Pakistan (Shahzad et al ., Reference Shahzad, Kliewer, Ali and Begum 2020 ), alcohol use was reported by 19% from traditional non-alcohol using ethnic groups and 40% from traditional alcohol using ethnic groups in Nepal (Parajuli et al ., Reference Parajuli, Macdonald and Jimba 2015 ), and 13% in Bhutan (Norbu and Perngparn, Reference Norbu and Perngparn 2014 ).

The data about patterns of drinking observed among adolescents in India are inconclusive but there appears to be some tendency towards heavy drinking. Among adolescents across several countries, there are consistent reports of binge drinking as a social norm among peer groups (Russell-Bennett et al ., Reference Russell-Bennett, Hogan and Perks 2010 ). The prevalence of binge drinking increases from age 15–19 years to the age of 20–24 years, and among drinkers, binge drinking is higher among the 15–19 years age group compared with the total population of drinkers (World Health Organization, 2018 ). This means that 15–24-year-old current drinkers often drink in heavy drinking sessions, and hence, except for the Eastern Mediterranean Region, the prevalence of such drinking among drinkers is high in adolescents (around 45–55%) (World Health Organization, 2018 ).

In India, the age of initiation commonly was mid- to late-teens; and male gender, rural residence and locally brewed alcohol were associated with earlier initiation of drinking. Across most of the world, initiation of alcohol use among adolescents takes place at an early age, usually before the age of 15 years. Among 15-year-olds, there is a high prevalence of alcohol use (50–70%) during the past 30 days in many countries of the Americas, Europe and Western Pacific; and the prevalence is relatively lower in African countries (10–30%) (World Health Organization, 2018 ). However, across the world, there is a huge variation in alcohol use among boys and girls of 15 years of age and vary from 1.2% to 74.0% in boys and 0% to 73.0% in girls (World Health Organization, 2018 ). Finally, with the strategic targeting of adolescents as alcohol consumers by the industry, increasing overall population prevalence and normalisation of drinking alcohol, and the increasing normalisation by virtue of learning more about how adolescents in other countries drink, one could speculate that the age of initiation would reduce and prevalence of alcohol consumption in adolescents in India would rise, in the coming years.

In India, knowledge about alcohol and its potential harms was limited in rural areas. The reasons for starting and continuing drinking were a mix of expected enhancement of positive experiences and dampening of negative affect. This is consistent with findings in Indian adults where alcohol consumption was seen to be mainly associated with expectations about reduction in psychosocial stress and providing pleasure (Nadkarni et al ., Reference Nadkarni, Dabholkar, McCambridge, Bhat, Kumar, Mohanraj and Patel 2013 ). Across the world, adolescents primarily report drinking for social motives or enjoyment – enjoyment (Argentina) (Jerez and Coviello, Reference Jerez and Coviello 1998 ), to make nights out more pleasurable (UK) (Plant et al ., Reference Plant, Bagnall and Foster 1990 ) and being social (Canada) (Kairouz et al ., Reference Kairouz, Gliksman, Demers and Adlaf 2002 ). Coping motives, on the other hand, are less common, but are associated with AUDs later in adulthood (Carpenter and Hasin, Reference Carpenter and Hasin 1999 ). The difference in drinking motives between adolescents from India (a mix of pleasure and coping) and other countries (primarily pleasure), and the similarity between reasons given by Indian adolescents and Indian adults, possibly reflect contextual/cultural differences and will have implications on transferability of interventions from other contexts and wider age-applicability of interventions developed for adults in India.

We can broadly organise our findings about correlates for drinking into socio-demographic characteristics (e.g. age, gender), immediate environment (e.g. parents, friends, digital space) and clinical correlates (e.g. other substance use, suicidal thoughts). Risk and protective factors influencing the use of alcohol in adolescents are both proximal and distal factors and include individual cognitions and peer-influence risk factors (e.g. attitudes favourable to alcohol use and peer drinking), family environment (e.g. parental discipline and family bonding) and school context (e.g. academic commitment and achievement) (Bryant et al ., Reference Bryant, Schulenberg, O'Malley, Bachman and Johnston 2003 ; Fisher et al ., Reference Fisher, Miles, Austin, Camargo and Colditz 2007 ; Patock-Peckham and Morgan-Lopez, Reference Patock-Peckham and Morgan-Lopez 2010 ). Most commonly adolescent males drink more often than adolescent females, but there has been some blurring of the distinction between the genders in developed countries (Currie et al ., Reference Currie, Roberts, Settertobulte, Morgan, Smith and Samdal 2004 ; Hibell et al ., Reference Hibell, Guttormsson, Ahlström, Balakireva, Bjarnason, Kokkevi and Kraus 2009 ). This convergence of drinking patterns is particularly seen in the Nordic countries, Ireland, the UK and the USA, and manifests as almost equal prevalence rates for consumption of spirits and similar frequency of intoxication for both genders (Hibell et al ., Reference Hibell, Guttormsson, Ahlström, Balakireva, Bjarnason, Kokkevi and Kraus 2009 ). Evidence from South Asian countries indicates that male gender, age greater than 14 years, depression, religious beliefs, parental/family members' drinking, reduced parental supervision, peer-drinking/pressure/approval and urban neighbourhood are associated with adolescent drinking (Athauda et al ., Reference Athauda, Peiris-John, Ameratunga, McCool and Wickremasinghe 2020 ).

The most important study finding is that despite several studies over the years, the evidence base has several gaps, notably the limited geographical span, small sample sizes and heterogeneous definitions of alcohol use and AUDs. Of particular importance are the various sample selection strategies, especially for the smaller studies, which limit the generalisability of findings. Another gap is the lack of consistency in the measurement of alcohol use, which is especially critical in a context where ‘standard drink’ does not translate semantically or literally into the vernacular, and there is an immense variability in the types of alcoholic beverages (commercial, licit non-commercial, illicit home-brewed, adulterated alcoholic beverages) and in the type and size of vessels from which alcohol is poured or consumed in. Additionally, there were several gaps in the reporting of many studies which raise questions about their internal validity. In the absence of critical information such as data sources, measurement and statistical methods, it is difficult to draw an inference about the robustness of the studies which had inadequate reporting ( Appendix B ). Finally, although the cross-sectional design of the studies allows us to examine the prevalence of alcohol use and AUDs, it limits the conclusions that we can draw about causal relationships between the various potential risk factors and alcohol use/AUDs.

Although the included studies are not without limitations that are important to consider before drawing conclusions, this synthesis allows us to get a reasonable understanding of alcohol use among adolescents in India and derive preliminary conclusions that the prevalence is high and rising, which brings with it the attendant burden of the associated adverse impacts. Furthermore, despite the gaps in the available data, it carries several implications for policy makers. Because alcohol is an important cause of motor vehicle accidents and suicide, which are the leading causes of death among adolescents in India (Joshi et al ., Reference Joshi, Alim, Maulik and Norton 2017 ), interventions that seek to help adolescents avoid or better manage alcohol consumption are a priority. Examples of such evidence-based interventions include public health engagement campaigns to increase awareness of alcohol-related harms, advocacy through community engagement/mobilisation to promote better enforcement of laws related to drinking, engagement with alcohol outlets to promote responsible beverage service, and engaging adolescents and families including through peer-led classroom curriculum to enhance the resilience of adolescents, improve family socialisation and increase awareness of alcohol-related harms (McLeroy et al ., Reference McLeroy, Norton, Kegler, Burdine and Sumaya 2003 ; Hawkins et al ., Reference Hawkins, Brown, Oesterle, Arthur, Abbott and Catalano 2008 ; Wakefield, Loken, and Hornik, Reference Wakefield, Loken and Hornik 2010 ; Hallgren and Andréasson, Reference Hallgren and Andréasson 2013 ). The most important implication of our review, however, is the need to develop the very nascent literature base through robust studies, especially longitudinal research that can support evidence-based prevention interventions and policy change. Future studies should focus on increasing their geographical span and sample sizes, ensure the use of standard definitions of alcohol use and AUDs which are consistent with global literature, and acknowledge and examine contextual variations in types of alcoholic beverages and type and size of vessels from which alcohol is poured or consumed in. Introducing such measures will enhance the robustness, validity and generalisability of the findings; and allow for better comparisons over time and geography. This would require greater support from the Government through ensuring availability of in-country research funding, prioritisation of the issue and utilisation of the evidence generated to inform its policy on alcohol.

Our review is limited by our inclusion criterion related to language. However, this might not be a major limitation considering that peer-reviewed journals in India are only in English as far as we are aware, and researchers generally disseminate their outputs in English language journals. Our review's major strength lies in its originality (the first such review to comprehensively map the landscape of substance use among adolescents in India), use of robust processes (e.g. double screening) and examination of grey literature to identify any relevant evidence.

To conclude, the evidence base for alcohol use amongst adolescents in India needs further and deeper exploration, but in the meanwhile, the available evidence allows us to get a preliminary understanding of the issue and to make a case for policy action to tackle alcohol consumption in this age group.

Supplementary material

The supplementary material for this article can be found at https://doi.org/10.1017/gmh.2021.48

Acknowledgements

We would like to acknowledge Professor Pratima Murthy, Professor Vivek Benegal and Professor Atul Ambekar for helping us identify relevant grey literature.

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

There are no real or perceived conflicts of interest in undertaking or publishing this research.

As this is a systematic review, it did not involve any direct data collection from human subjects.

Appendix A: Search strategy

1. abuse.tw

3. misuse.tw

7. disorders.tw

8. disorders/

9. withdraw*.tw

10. withdraw*/

11. withdrawal syndrome.tw

12. withdrawal syndrome/

13. screening.tw

14. screening/

15. overdose.tw

16. overdose/

17. megadose.tw

18. megadose/

19. dependen*.tw

20. dependen*/

21. intoxication.tw

22. intoxication/

23. harm*.tw

25. hazard*.tw

26. hazard*/

27. behavior.tw

28. behavior/

29. Addict*.tw

30. Addict*/

31. alcoholi*.tw

32. alcoholi*/

33. delirium.tw

34. delirium/

35. binge drink*.tw

36. binge drink*/

37. consumption.tw

38. consumption/

39. drink*.tw

40. drink*/

41. sniff*.tw

42. sniff*/

43. snort*.tw

44. snort*/

45. cessation.tw

46. cessation/

47. smok*.tw

49. inject*.tw

50. inject*/

51. OR (1–50)

52. Drug.tw

54. Substance.tw

55. Substance/

56. Alcohol.tw

57. Alcohol/

58. ‘purple drank’.tw

59. ‘purple drank’/

60. 1plsd.tw

62. unclassified drug.tw

63. unclassified drug/

66. chlorobenzoic acid derivative.tw

67. chlorobenzoic acid derivative/

70. Ecstasy.tw

71. Ecstasy/

72. methadone.tw

73. methadone/

74. morphine.tw

75. morphine/

76. buprenorphine.tw

77. buprenorphine/

78. diamorphine.tw

79. diamorphine/

80. amphetamine.tw

81. amphetamine/

82. amphetamine derivative.tw

83. amphetamine derivative/

86. bidi.tw

88. tobacco.tw

89. tobacco/

90. cigarette.tw

91. cigarette/

92. electronic cigarette.tw

93. electronic cigarette/

94. e-cig.tw

96. beedi.tw

98. benzodiazepine derivative.tw

99. benzodiazepine derivative/

100. benzodiazepine.tw

101. benzodiazepine/

102. bhang.tw

103. bhang/

104. Hashish.tw

105. Hashish/

106. cannabi*.tw

107. cannabi*/

108. ‘brown sugar’.tw

109. ‘brown sugar’/

110. medical cannabi*.tw

111. medical cannabi*/

112. tetrahydrocannabinol.tw

113. tetrahydrocannabinol/

114. hash.tw

116. charas.tw

117. charas/

118. cocaine.tw

119. cocaine/

120. cocaine derivative.tw

121. cocaine derivative/

122. smack.tw

123. smack/

124. crack.tw

125. crack/

126. syrup.tw

127. syrup/

128. chlorpheniramine.tw

129. chlorpheniramine/

130. ‘cough syrup’.tw

131. ‘cough syrup’/

132. codeine.tw

133. codeine/

134. dexamphetamine.tw

135. dexamphetamine/

136. dextromethorphan.tw

137. dextromethorphan/

138. 3,4 methylenedioxyamphetamine.tw

139. 3,4 methylenedioxyamphetamine/

140. psychedelic agent.tw

141. psychedelic agent/

142. ganja.tw

143. ganja/

144. 4 aminobutyric acid.tw

145. 4 aminobutyric acid/

146. 4 hydroxybutyric acid.tw

147. 4 hydroxybutyric acid/

148. GHB.tw

150. Ketamine.tw

151. Ketamine/

152. glue.tw

154. heroin.tw

155. heroin/

156. nicotine.tw

157. nicotine/

158. diamorphine.tw

159. diamorphine/

160. inhalant.tw

161. inhalant/

162. kava extract.tw

163. kava extract/

164. kava.tw

166. smokeless tobacco.tw

167. smokeless tobacco/

168. khaini.tw

169. khaini/

170. laughing gas.tw

171. laughing gas/

172. nitrous oxide.tw

173. nitrous oxide/

174. LSD.tw

176. Lysergic acid diethylamide.tw

177. Lysergic acid diethylamide/

178. Acid.tw

180. Lucy.tw

182. magic mushroom.tw

183. magic mushroom/

184. hallucinogenic fungus.tw

185. hallucinogenic fungus/

186. mari#uana.tw

187. marj#uana/

188. MDMA.tw

190. Midomafetamine.tw

191. Midomafetamine/

192. amphetamine.tw

193. amphetamine/

194. methamphetamine.tw

195. Methamphetamine/

196. Crystal meth.tw

197. Crystal meth/

198. Amobarbital.tw

199. Amobarbital/

200. Methylphenidate.tw

201. Methylphenidate/

202. Modafinil.tw

203. Modafinil/

204. Morphine.tw

205. Morphine/

206. Opiod*.tw

207. Opiod*/

208. Opiate*.tw

209. Opiate*/

210. Opium.tw

211. Opium/

212. ‘paint thinner’.tw

213. ‘paint thinner’/

214. promethazine.tw

215. promethazine/

216. psilocybin#.tw

217. psilocybin#/

218. Quaalude.tw

219. Quaalude/

220. Methaqualone.tw

221. Methaqualone/

222. Salvia divinorum.tw

223. Salvia divinorum/

224. Psychotropic agent.tw

225. Psychotropic agent/

226. Snuff.tw

227. Snuff/

228. Chewing tobacco.tw

229. Chewing tobacco/

230. Tramadol.tw

231. Tramadol/

232. Viagra.tw

233. Viagra/

234. Sildenafil.tw

235. Sildenafil/

236. Z-class.tw

237. Z-class/

238. Zdrug.tw

239. Zdrug/

240. Eszopiclone.tw

241. Eszopiclone/

242. Zaleplon.tw

243. Zaleplon/

244. Zoipidem.tw

245. Zoipidem/

246. Zopiclone.tw

247. Zopiclone/

248. Hypnotic agent.tw

249. Hypnotic agent/

250. Prescription durg.tw

251. Prescription drug/

252. Prescription medicine.tw

253. Prescription medicine/

254. Prescription medication.tw

255. Prescription medication/

256. OR (52-255)

257. adolescen*.tw

258. adolescen*/

259. child*.tw

260. child*/

261. youth*.tw

262. youth*/

263. student*.tw

264. student*/

265. girl*.tw

266. girl*/

267. teen*.tw

268. teen*/

269. boy*.tw

271. young adult*.tw

272. young adult*/

273. young*.tw

274. young*/

275. OR (257-274)

276. india.tw

277. India/

278. ‘Indian union’.tw

279. ‘Indian union’/

280. Andaman and Nicobar Island*.tw

281. Andaman and Nicobar Island/

282. Andhra Pradesh.tw

283. Andhra Pradesh/

284. Arunachal Pradesh.tw

285. Arunachal Pradesh/

286. Assam.tw

287. Assam/

288. Bihar.tw

289. Bihar/

290. Dadra and Nagar Haveli.tw

291. Dadra and Nagar Haveli/

292. Chhattisgarh.tw

293. Chhattisgarh/

294. Daman and Diu.tw

295. Daman and Diu/

296. National Capital Territory of New Delhi.tw

297. National Capital Territory of New Delhi/

298. Delhi.tw

299. Delhi/

300. Goa.tw

302. Gujarat.tw

303. Gujarat/

304. Haryana.tw

305. Haryana/

306. Himachal Pradesh.tw

307. Himachal Pradesh/

308. Jammu and Kashmir.tw

309. Janmu and Kashmir/

310. Janmu.tw

311. Janmu/

312. Kashmir.tw

313. Kashmir/

314. Jharkhand.tw

315. Jharkhand/

316. Karnataka.tw

317. Karnataka/

318. Mysore.tw

319. Mysore/

320. Kerala.tw

321. Kerala/

322. Travancore-Cochin.tw

323. Travancore-Cochin/

324. Madhya Pradesh.tw

325. Madhya Pradesh/

326. Madhya Bharat.tw

327. Madhya Bharat/

328. Maharashtra.tw

329. Maharashtra/

330. Manipur.tw

331. Manipur/

332. Meghalaya.tw

333. Meghalaya/

334. Mizoram.tw

335. Mizoram/

336. Nagaland.tw

337. Nagaland/

338. Odisha.tw

339. Odisha/

340. Orissa.tw

341. Orissa/

342. Punjab.tw

343. Punjab/

344. Chandigarh.tw

345. Chandigarh/

346. Rajasthan.tw

347. Rajasthan/

348. Sikkim.tw

349. Sikkim/

350. Tamil Nadu.tw

351. Tamil Nadu/

352. Madras State.tw

353. Madras State/

354. Telangana.tw

355. Telangana/

356. Tripura.tw

357. Tripura/

358. Uttarakhand.tw

359. Uttarakhand/

360. Uttaranchal.tw

361. Uttaranchal/

362. Uttar Pradesh.tw

363. Uttar Pradesh/

364. United Provinces.tw

365. United Provinces/

366. West Bengal.tw

367. West Bengal/

368. Mizoram.tw

369. Mizoram/

370. Nagaland.tw

371. Nagaland/

372. Lakshadweep.tw

373. Lakshadweep/

374. P#d#cherry.tw

375. P#d#cherry/

376. OR (276–375)

377. 51 AND 256 AND

Appendix B: Quality of reporting of peer-reviewed studies included in the review (excluding the report)

Nadkarni et al. supplementary material

This article has been cited by the following publications. This list is generated based on data provided by Crossref .

• Google Scholar

View all Google Scholar citations for this article.

Save article to Kindle

To save this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle .

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

• Abhijit Nadkarni (a1) (a2) , Allison Tu (a2) (a3) , Ankur Garg (a2) , Devika Gupta (a1) (a2) , Sonal Gupta (a2) , Urvita Bhatia (a2) (a4) , Niharika Tiwari (a2) , Anna Heath (a2) (a5) , Karen Wen (a2) (a6) , Godwin Fernandes (a2) and Richard Velleman (a2) (a7)
• DOI: https://doi.org/10.1017/gmh.2021.48

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox .

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive .

Reply to: Submit a response

- No HTML tags allowed - Web page URLs will display as text only - Lines and paragraphs break automatically - Attachments, images or tables are not permitted

Your details

Your email address will be used in order to notify you when your comment has been reviewed by the moderator and in case the author(s) of the article or the moderator need to contact you directly.

You have entered the maximum number of contributors

Conflicting interests.

Please list any fees and grants from, employment by, consultancy for, shared ownership in or any close relationship with, at any time over the preceding 36 months, any organisation whose interests may be affected by the publication of the response. Please also list any non-financial associations or interests (personal, professional, political, institutional, religious or other) that a reasonable reader would want to know about in relation to the submitted work. This pertains to all the authors of the piece, their spouses or partners.

Essay on Alcoholism in India: Tracing the Historical Roots and Grappling with Modern Implications

How it works

India is rich in history, diverse cultures, and significant traditions, but over recent years, a growing trend has emerged: increased alcohol use. Its rise has brought many issues, impacting society and health. We will explore the history of alcohol in India, its social effects, and the health problems it causes. From ancient times, when sacred texts mentioned alcohol, to today’s modern challenges, India’s relationship with liquors has been complex. This exploration sheds light on the current state of alcoholism and offers insights into its broader implications for Indian society.

By understanding the context, we can address and reverse some of the problems such an escalating issue presents.

• 1 Historical Context
• 2 Social Impact
• 3 Health Concerns
• 4 Conclusion

Historical Context

India’s ties with alcohol date back to ancient times. Old scriptures like the Rigveda speak of drinks like ‘Soma’ and ‘Madhu’. These were part of rituals and celebrations. As time passed, different regions developed unique drinking habits. Local customs and beliefs shaped these. The British era brought a change. Their drinking customs and the business of spirits and liquors influenced their practices. After India gained freedom, some states banned alcohol. But in others, because of harsher everyday challenges, drinking grew. History gives us a backdrop to understand today’s difficulties with alcohol in India.

Social Impact

Alcohol’s grip on society is tight. One primary concern is domestic violence. Many families face turmoil when alcohol fuels anger. Moreover, a lot of money spent on spirits pushes families toward poverty. It’s heartbreaking to see homes break due to this.

In some circles, alcohol has become a status symbol. It’s seen as a sign of being modern or elite. This mindset can make young people drink more, sometimes because of peer pressure. They think it’s a way to fit in.

Liquor also plays a role in accidents and crime. Roads become unsafe. Quiet nights turn loud with disturbances. Safety itself is at risk. The societal effects of alcohol in India are vast. They range from broken homes to unsafe streets. To truly understand the depth of the issue, one must see the bigger picture.

Health Concerns

• Alcohol brings many health risks. A common one is liver failure. People face severe health problems, but liver problems aren’t the only ones. Drinking a lot for a long time increases the risk of cancer and heart disease. It also affects the mind, leading to issues like depression.
• Another big concern is fake or illegal alcohol. Moonshine can be very harmful. In some cases, it has caused mass poisonings and many deaths.
• India’s healthcare system is under pressure. This makes it harder to treat other health issues, too.
• Alcohol poses a significant health challenge. It affects the body and mind. It even puts extra strain on medical resources. Understanding and addressing these health problems is crucial to protect India’s future.

Alcoholism in India is a pressing issue. Its roots run deep in history and today’s society. The impacts are felt in the social context and in healthcare. We need action from policymakers, communities, and individuals to make a change. Awareness and action could pave the way for a healthier India.

Cite this page

Essay on Alcoholism in India: Tracing the Historical Roots and Grappling with Modern Implications. (2023, Sep 18). Retrieved from https://papersowl.com/examples/essay-on-alcoholism-in-india-tracing-the-historical-roots-and-grappling-with-modern-implications/

"Essay on Alcoholism in India: Tracing the Historical Roots and Grappling with Modern Implications." PapersOwl.com , 18 Sep 2023, https://papersowl.com/examples/essay-on-alcoholism-in-india-tracing-the-historical-roots-and-grappling-with-modern-implications/

PapersOwl.com. (2023). Essay on Alcoholism in India: Tracing the Historical Roots and Grappling with Modern Implications . [Online]. Available at: https://papersowl.com/examples/essay-on-alcoholism-in-india-tracing-the-historical-roots-and-grappling-with-modern-implications/ [Accessed: 29 Jun. 2024]

"Essay on Alcoholism in India: Tracing the Historical Roots and Grappling with Modern Implications." PapersOwl.com, Sep 18, 2023. Accessed June 29, 2024. https://papersowl.com/examples/essay-on-alcoholism-in-india-tracing-the-historical-roots-and-grappling-with-modern-implications/

"Essay on Alcoholism in India: Tracing the Historical Roots and Grappling with Modern Implications," PapersOwl.com , 18-Sep-2023. [Online]. Available: https://papersowl.com/examples/essay-on-alcoholism-in-india-tracing-the-historical-roots-and-grappling-with-modern-implications/. [Accessed: 29-Jun-2024]

PapersOwl.com. (2023). Essay on Alcoholism in India: Tracing the Historical Roots and Grappling with Modern Implications . [Online]. Available at: https://papersowl.com/examples/essay-on-alcoholism-in-india-tracing-the-historical-roots-and-grappling-with-modern-implications/ [Accessed: 29-Jun-2024]

Don't let plagiarism ruin your grade

Hire a writer to get a unique paper crafted to your needs.

Our writers will help you fix any mistakes and get an A+!

Please check your inbox.

You can order an original essay written according to your instructions.

Trusted by over 1 million students worldwide

1. Tell Us Your Requirements

2. Pick your perfect writer

3. Get Your Paper and Pay

Hi! I'm Amy, your personal assistant!

Don't know where to start? Give me your paper requirements and I connect you to an academic expert.

short deadlines

100% Plagiarism-Free

Certified writers

Shopping Cart

No products in the cart.

Alcoholism in India- Concerns, Challenges and Way Forward

From Current Affairs Notes for UPSC » Editorials & In-depths » This topic

In March, India, like several countries shut down liquor shops. During this period, the mental health of many alcoholics deteriorated with several even attempting suicides. When the shops were reopened in May, long queues and chaotic crowds with blatant disregard for social distancing norms were observed across the country. States have started online sale of liquor. This calls for a look into the issue of alcoholism in India.

This topic of “Alcoholism in India- Concerns, Challenges and Way Forward” is important from the perspective of the UPSC IAS Examination , which falls under General Studies Portion.

Why is alcoholism a cause of concern?

• Alcohol, by its nature, is toxic and has ‘dependence inducing properties’ .
• It causes about 3 million deaths across the world every year, according to Global Status Report on Alcohol and Health, 2018 , released by WHO .
• Globally, it is responsible for 1% of disease burden . Alcohol is responsible for disease burden more among males (7.1%) than females (2.2%) . This alcohol-attributable disease burden is especially high in low income and lower middle income countries .
• It is a leading risk factor for premature deaths and disabilities in the 15-49 years age group. 10% of all deaths in this age group can be attributed to alcohol consumption.
• Most of the alcohol related deaths among males were due to injuries , digestive diseases and alcohol use disorders (AUD) . In case of females, it was mainly due to cardiovascular diseases , digestive diseases and injuries .
• Alcohol related hospitalization and deaths is higher among the vulnerable and disadvantaged
• The harmful use of alcohol has a direct impact on the countries’ progress towards Sustainable Development Goals – especially with regards to the health related targets like child and maternal health , infectious diseases like TB and AIDS , non-communicable diseases, mental health , poisoning, etc. Annual per capita consumption of alcohol is an indicator for target 3.5 of SDG i.e. “Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol”.
• Alcoholism cements the inequalities between countries with the poorer countries facing higher ‘harm per litre’.

In times of COVID-19

• There has been a world-wide increase in domestic abuse cases with people staying indoors with their families for longer periods. WHO opines that alcohol can be a contributing factor.
• In the initial periods of the COVID-19 outbreak, rumours about alcohol killing off the virus led to deleterious effects. In fact, ethanol consumption is known to weaken the immune system .
• 700 people were killed in April in Iran when they consumed methanol believing that it might cure the disease . This is despite Iran being a prohibition country.
• During the initial stages of lockdown, suicides were one of the leading causes of death. Alcohol withdrawal was identified to be one of the reasons.
• People have been drinking more alcohol to overcome the boredom due to the lockdown .

Express Learning Programme (ELP)

• Optional Notes
• Study Hacks
• Prelims Sureshots (Repeated Topic Compilations)
• Current Affairs (Newsbits, Editorials & In-depths)
• Ancient Indian History
• Medieval Indian History
• Modern Indian History
• Post-Independence Indian History
• World History
• Art & Culture
• Geography (World & Indian)
• Indian Society & Social Justice
• Indian Polity
• International Relations
• Indian Economy
• Environment 
• Agriculture
• Internal Security
• Disasters & its Management
• General Science – Biology
• General Studies (GS) 4 – Ethics
• Syllabus-wise learning
• Political Science
• Anthropology
• Public Administration

SIGN UP NOW

How prevalent is alcoholism in India?

• India is one of the largest consumers of alcohol in the world. Of all alcohols, India is the 9 th largest consumer by volume .
• After China , it is the largest consumer of spirits – especially of whisky . Almost one in every two bottles of whisky brought in the world is sold in India. During the 2018 global dip in alcohol consumption, India was instrumental in driving a 7% uptick in the global whisky sales.
• There has been an 11% increase in consumption since 2017 – i.e. consuming over 663 million litres .
• The per capita consumption of alcohol is also increasing.
• Highest prevalence is in Chhattisgarh, Tripura, Punjab, Arunachal Pradesh and Goa .
• Over 45% of all the liquor sold in India is in just 5 southern states : Andhra Pradesh, Telangana, Tamil Nadu, Karnataka and Kerala . Notably, over 10% of these states’ revenues is from taxes on liquor sales.
• The next largest consumers in India are Punjab, Rajasthan, Uttar Pradesh, Madhya Pradesh, West Bengal and Maharashtra .
• According to the 2019 Magnitude of Substance Use in India report from the social justice ministry, alcohol is the most common psychoactive substance used by Indians.
• Over 14% of the 10-75 years age group consume alcohol. This means that 16 crore people consume alcohol.
• Predominantly consumed alcoholic beverages in India are ‘desi sharab’ (country liquor) and spirits (Indian made Foreign Liquor) – each accounting for 30% .
• AUD is prevalent in the states of Tripura, Andhra Pradesh, Punjab, Chhattisgarh and Arunachal Pradesh . An additional 5% of the population consume alcohol in a harmful way .
• The report highlighted that 1 in 5 alcohol users are affected by alcohol dependence and hence require urgent treatment .
• 11% of Indians are binge drinkers according to WHO. This is against a global average of 16% .
• A major cause of concern is that more than half of alcohol consumed in the country is ‘unrecorded alcohol’ according to WHO. 1/3 rd of consumers drink cheap local brews – often adulterated and resulting in tragedies .
• A 2014 survey by International Alliance of Responsible Drinking found a preference for such local or homemade brews among a large number of drinkers.

Prelims Sureshots – Most Probable Topics for UPSC Prelims

A Compilation of the Most Probable Topics for UPSC Prelims, including Schemes, Freedom Fighters, Judgments, Acts, National Parks, Government Agencies, Space Missions, and more. Get a guaranteed 120+ marks!

Why does India have high levels of alcohol consumption?

• One of the reasons for the increase in alcohol consumption in India is that more people are earning sufficient income to purchase it. This has outpaced the efforts to reduce consumption.
• Alcohol is becoming increasingly affordable . This trend is also observed in low and middle income countries worldwide- more than in high income countries.
• Increased urbanisation and an expanding middle class are also contributors.
• Social pressures are a major contributor to the high prevalence of alcohol consumption in India. Many social activities are centred on alcohol and the drink being perceived as a ‘social lubricant’ .
• A 2019 survey noted the increased consumption of alcohol among women – referred to as ‘the pinking’ of the alcohol market- as a contributor too.
• Political dependence on the revenue generated by the industry- especially among the states. This was evidenced by how states decided to reopen liquor shops despite a fast growing pandemic to improve their revenues.
• Sustained messaging about the ‘attractions of alcohol consumption’ via movies and other TV programs .
• Aggressive marketing by the alcohol industry.
• Lax regulation of the industry.
• Low awareness about the negative impacts of alcohol on health.

What are the measures taken by government to reduce alcoholism in India?

• The Constitution itself has provisions for bringing in alcohol prohibition in India. Article 47 of the Directive Principles of State Policy states that “the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health”
• Several states have imposed prohibition on alcohol. These states, dubbed ‘the dry states’ , include Gujarat, Bihar, Manipur and Nagaland . Complete alcohol ban is also in force in the UT of Lakshadweep .
• States have imposed a legal drinking age in their jurisdiction. In some states it is 18 years , while in others it is 21 years and in yet others it is 25 years .
• Under the Motor Vehicles Act , any person found driving with a blood alcohol content of over 0.03% ( drunken driving ) is penalized. Punishment may even entail a prison term of up to 4 years .
• Advertisement of alcoholic beverages on television is banned in India.
• The Social Justice and Empowerment Ministry has been implementing the Scheme of Prevention of Alcoholism and Substance (Drug) Abuse since the 1980s . This scheme makes use of voluntary organizations (and others) to provide a range of services like identification, counselling, treatment, rehabilitation, creating awareness, etc. It targets a wide range of people with special focus on children, youth, women, prison inmates and other high risk groups like sex workers, drivers, etc.
• A toll-free helpline was set by the centre in 2015 to assist people with regards to substance dependence.
• In 2016 , the Supreme Court banned the sale of liquor within 500 m of any national or state highway . In 2004 , the National Road Safety Council too had agreed that liquor shops should not be licensed to open shop along national highways.
• The government has set a National Target to achieve a 10% reduction in prevalence of alcohol use by 2025 .
• Several state governments have permitted the online sale of alcohol to reduce aggregation of crowds at the liquor shops.
• Recently, on International Day Against Drug Abuse and Illicit Trafficking, the centre launched the ‘Nasha Mukt Bharat’ campaign to curb alcoholism and drug abuse in India. 272 districts identified as ‘vulnerable’ are to get treatment and de-addiction facilities .
• India has an international obligation to curb alcoholism as it is signatory to the UN Conventions- Convention on Psychotropic Substances, 1971 and Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988 .

What are the challenges?

• Imposition of prohibition is known to have several adverse unintended consequences as seen from the American Prohibition experiment from 1920 to 1933 . Its unintended consequences include the emergence of an entire black market for alcohol composed of speakeasies, bootleggers, organized crime syndicates , etc. which operated in every segment from production to distribution and sale. There was a significant increase in the number of deaths due to poisoning by methanol and other adulterants present in these illegally manufactured beverages.
• Strict regulations often have the unintended consequence of fuelling black market operations and consequently more dangerous versions of the banned product coming into the market.
• Several experiments with making alcohol more expensive only produced ‘small and modest’ reduction in its consumption.
• A huge part of state revenues is from sale of alcohol.
• There is a prevalence of nexus between the liquor barons and the political class .
• A day before the Supreme Court order regarding the ban of alcohol sales near highways, the rules were diluted to allow for several exemptions, after allegations of ‘judicial policymaking’ and several concerns raised about the livelihood of the alcohol industry’s stakeholders.
• The closing down of liquor shops in the initial periods of lockdown failed to reduce domestic abuse cases. Experts opined that alcohol is simply an excuse used by abusers to act violently against family members. Now, they use the lack of alcohol as an excuse to abuse.
• There was an increase in alcohol smuggling across the state borders and emergence of black markets .
• The reopening of liquor shops led to gross disregard for social distancing norms among the alcohol consumers.
• The lockdown increased consumption of alcohol. This is perceived as a result of people trying to overcome boredom apart from lack of work , isolation and stress arising from general uncertainty.
• In the current times, revenue shortages are faced by the states with the lockdown restricting normal economic activities. At the same time, governments have to provide for the basic food and social security of the people. Hence, there is very low incentive for the government to bring in any serious schemes to curb alcoholism.
• The online sale and home delivery of alcohol, if it becomes the new norms, will increase the availability of alcohol . This would be detrimental to the efforts to restrict its availability over the years.

What is the way forward?

• Reducing alcoholism cannot be achieved using a one-off method or a sudden blanket ban across the country. It needs to be brought in by phases .
• Political will is a key component in reducing the harmful use of alcohol.
• The policies designed for the purpose must be tailor made for local circumstances . It should be comprehensive and inclusive with clarity in division of responsibilities.
• A dedicated agency can be established for following up on the implementation of these policies and the consequent action plans and implementation mechanisms.
• The primary care physicians are the first point of contact for those suffering from AUD. This presents a valuable route of action in AUD control. These physicians can be equipped with tests like the WHO prescribed AUDIT (AUD Identification Test) to identify at-risk people and those with milder levels of AUD.
• They can be trained to manage problems using 3 core steps:
• One-on-one counselling to create awareness about ill effects of alcohol.
• Prescription of medications (eg: disulfiram ) in necessary cases.
• Referring patients to higher levels of care for treatment and rehabilitation.
• The health and social service providers for tackling AUDs must be made culturally sensitive . There is a need to de-stigmatize the issue to encourage more people to seek help and reduce relapses.
• The penalty for drunken driving must be appropriate enough to have a deterrent effect . Provision of alternate means of transport after the drinking hours can reduce alcohol-related accidents.
• The benefit of ‘behaviour change communication’ was seen with India’s Swachh Bharat Abhiyan . This could also be used for curbing problematic alcohol use.
• The WHO identified 10 key areas where the countries could focus on, with regards to interventions and policy options:
• Leadership, awareness and commitment
• Health services’ response
• Community action
• Drink-driving policies and countermeasures
• Availability of alcohol
• Marketing of alcoholic beverages
• Pricing policies
• Reducing the negative consequences of drinking and alcohol intoxication
• Reducing the public health impact of illicit alcohol and informally produced alcohol
• Monitoring and surveillance

As recent as in February, 2020, the WHO Executive Board unanimously identified global alcohol burden as a ‘public health priority’ . It called for ‘accelerated action’ to curb alcohol harm. Article 21 of the Constitution puts an obligation on the government to preserve the life of the people. Continued free availability of alcohol will have an especially adverse effect in the present times. Sustained and systematic efforts to largely eliminate harmful alcohol use in the society will have a major bearing on public health and the general quality of life.

Practice question for mains

Several state governments have opted for online sale of alcohol in the midst of a pandemic. Compare the pros and cons of this decision. (250 words)

https://www.who.int/health-topics/alcohol#tab=tab_1

https://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1

https://www.newindianexpress.com/world/2020/apr/29/700-killed-in-iran-after-drinking-toxic-methanol-to-cure-coronavirus-2136857.html

https://www.bbc.com/news/world-asia-india-52640266

http://socialjustice.nic.in/writereaddata/UploadFile/Magnitude_Substance_Use_India_REPORT.pdf

https://timesofindia.indiatimes.com/india/womens-increased-alcohol-consumption-contributing-to-indias-growing-love-for-alcohol-survey/articleshow/70960088.cms

https://www.hindustantimes.com/india-news/pour-me-another-india-s-alcohol-intake-up-38/story-z8iVSto80HzG5A1RLl6HwN.html

https://vikaspedia.in/social-welfare/social-awareness/schemes/scheme-of-prevention-of-alcoholism-and-substance-drug-abuse-2015

https://thewire.in/government/liquor-sale-alcohol-coronavirus

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014857/

https://timesofindia.indiatimes.com/india/centre-to-build-treatment-de-addiction-facilities-in-272-districts/articleshow/76648876.cms

https://www.business-standard.com/article/news-ians/toll-free-helpline-launched-for-alcohol-and-drug-addicts-115010700943_1.html

https://scroll.in/article/833499/supreme-court-explains-why-its-highway-liquor-shop-verdict-is-not-judicial-overreach

https://www.pbs.org/kenburns/prohibition/unintended-consequences/

GET MONTHLY COMPILATIONS

Related Posts

Oxytocin Ban – Issues and Impacts

Clinical Trials in India – Conflict between Public Health Vs Safety...

Significance of Cervavac

There was a problem reporting this post.

Block Member?

Please confirm you want to block this member.

You will no longer be able to:

• See blocked member's posts
• Mention this member in posts

Please allow a few minutes for this process to complete.

People have wished team india

Thank you! You have wished India.We are giving away an iPhone.

We will announce winners soon.

Use WISHINDIA200 for Rs.200 off HT Premium Subscription Redeem Now

• Latest News

• Entertainment
• Real Estate
• Wish Team India Luck
• T20 World Cup 2024
• Crickit Predictor
• World Cup Schedule 2024
• World Cup Most Wickets
• World Cup Points Table
• Budget 2024
• The Interview
• Web Stories
• Virat Kohli
• Mumbai News
• Bengaluru News
• Daily Digest
• Election Schedule 2024

The link between alcohol consumption and violence: The road to de-addiction

A consequence of alcohol consumption is gendered domestic violence at home. to counter this, the government must set up interventions towards rehabilitation. .

It was heartening to see the Delhi government put an end to the buy one, get one free (BOGO) offer by new liquor shops opened under the business-friendly excise policy. Heartening because of a significant problem that alcohol consumption brings with it in India and the world over — domestic violence. Ending the BOGO offer will, at the very least, not make the lives of many women worse off, dealing with husbands who may drink twice as much.

Women, living in vulnerable situations, both economically and otherwise, have had to contend for long with the alcoholic male member of the family who would abuse, beat and drain his earnings down a bottle of hooch.

In 2019, the ministry of social justice and empowerment (MoSJE), released the findings of a national survey, commissioned to study the extent and pattern of substance abuse in India. The survey showed that about 14.6% of the population uses alcohol, 2.8% uses cannabis products, 2.1% uses opioids, 1.08% uses sedatives, and 0.7% uses inhalants, with a small proportion of the country’s population using cocaine, amphetamine-type stimulants, or hallucinogens.

The survey also said that more than 57 million Indians are affected by harmful or dependent alcohol use and need help for alcohol addiction-related problems. In extreme cases, the adverse outcomes of substance abuse are suicide and death. But in many cases, the aftermath of a booze-fuelled evening is physical violence — the burden of which, most often, is borne by family members, especially wives.

The Covid-19 pandemic worsened the lives of female family members. During the many lockdowns in the past two years, incidents of violence against women in the household went up exponentially. The National Commission for Women’s data shows that India recorded a 2.5 times increase in domestic violence between February and May 2020. United Nations (UN) Women said that in the first four phases of the lockdown, women organisations across the country reported more cases of domestic violence than they had seen in the last 10 years, for a similar period.

India, like most other South Asian countries, has a highly gender stratified culture that sanctions complete authority to the men. Consequently, the incidence of various forms of violence against women, including from within the family, is a common phenomenon irrespective of the woman’s socio-cultural group.

There has been some improvement, but there is still a long way to go. As per the recent National Family Health Survey (NFHS), 29.3% of ever-married women aged 18-49 years have experienced spousal violence in the form of physical and/or sexual violence. The patriarchal mindset and the acceptance of violence are also justified by female members of the house.

Of the women surveyed under the NFHS, those from 18 states across the country felt that hitting or beating the wife was justifiable. Much of this violence occurs under the influence of alcohol or other substances.

We need to reorient our de-addiction strategy. Substance use reduction for a person with active addiction requires psycho-social intervention and cannot be forced. There is a need for a more empathetic programme/intervention to continue support to those who are on de-addiction treatment. At the same time, the intervention needs to address vulnerability reduction among female spouses.

An intervention that is focused on improving a couple's relationship (such as a couple-empowerment programme) is needed to address this issue. This is even more important in times like these. There is enormous pressure on the families not only in terms of the fear of Covid-19, but also in sustaining their livelihood, a well-functioning relationship between a man and his wife can win over the multidimensional battle families are confronting.

Currently, India’s government-run drug de-addiction programme is heavily focused on the de-addiction of users and harm reduction — primarily prevention of HIV among persons who inject drugs and treatment of people —implemented by its nodal agency National AIDS Control Organization; and demand reduction of the illicit drugs under the Scheme for Prevention of Alcoholism and Substance Abuse.

The programmes, however, pay very little attention to the much needed social or familial aspects of substance use. An ideal intervention designed for couples with husbands having a substance-use disorder should aim to reduce the substance dependence of the male spouse; improve the autonomy and mental health of the female spouse; and enhance positive gender norms and communications between the couple.

In a few states such as Gujarat and Bihar alcohol sale/consumption is banned, but it is common knowledge that people with active addiction in such places resort to country hooch or black-marketed liquor.

Forced abstinence in any case is counterproductive. The first Covid-19 induced lockdown in 2020 is a case in point of how horribly wrong bans can go, with cases of people suffering from addiction dying by suicide being reported. Instead, what we need is to be empathetic to such individuals and become partners in their journey towards rehabilitation. At the same time, we need to empower their spouses to handle the situation by providing sustained counselling support.

Alcohol is a major revenue stream for governments. While banning it is not the solution, we can look at using a small percentage of such revenue receipts into building a robust de-addiction infrastructure and increasing the network of counselling and medical facilities that are dedicated to fighting this menace. And yes, while at it, ending the BOGO marketing strategy is a way forward in this effort.

Dr Rajiv Tandon is director – health, Lopamudra Ray Saraswati is manager – health, and Prince Bhandari is associate – health, Research Triangle Institute (RTI) International, India

The views expressed are personal

Get World Cup ready with Crick-it! From live scores to match stats, catch all the action here. Explore now!

Get Current Updates on India News , Elections 2024 , Lok sabha election 2024 voting live , Karnataka election 2024 live in Bengaluru , Election 2024 Date along with Latest News and Top Headlines from India and around the world.

Join Hindustan Times

Create free account and unlock exciting features like.

• Terms of use
• Privacy policy
• Weather Today
• HT Newsletters
• Subscription
• Print Ad Rates
• Code of Ethics

• Live Cricket Score
• India Squad
• T20 World Cup Schedule
• Cricket Teams
• Cricket Players
• ICC Rankings
• Cricket Schedule
• Points Table
• T20 World Cup Australia Squad
• Pakistan Squad
• T20 World Cup England Squad
• India T20 World Cup Squad Live
• T20 World Cup Most Wickets
• T20 World Cup New Zealand Squad
• Other Cities
• Income Tax Calculator
• Petrol Prices
• Diesel Prices
• Silver Rate
• Relationships
• Art and Culture
• Taylor Swift: A Primer
• Telugu Cinema
• Tamil Cinema
• Board Exams
• Exam Results
• Competitive Exams
• BBA Colleges
• Engineering Colleges
• Medical Colleges
• BCA Colleges
• Medical Exams
• Engineering Exams
• Horoscope 2024
• Festive Calendar 2024
• Compatibility Calculator
• The Economist Articles
• Lok Sabha States
• Lok Sabha Parties
• Lok Sabha Candidates
• Explainer Video
• On The Record
• Vikram Chandra Daily Wrap
• EPL 2023-24
• ISL 2023-24
• Asian Games 2023
• Public Health
• Economic Policy
• International Affairs
• Climate Change
• Gender Equality
• future tech
• Daily Sudoku
• Daily Crossword
• Daily Word Jumble
• HT Friday Finance
• Explore Hindustan Times
• Privacy Policy
• Terms of Use
• Subscription - Terms of Use

Psychology Discussion

Essay on alcoholism.

ADVERTISEMENTS:

After reading this essay you will learn about Alcoholism:- 1. Meaning of Alcoholism 2. Classification of Alcoholism 3. Consequence 4. Causes 5. Current Methods to Treatment Alcoholism 6. Psychosocial Measures.

• Psychosocial Measures of Alcoholism

Essay # 1. Meaning of Alcoholism:

The problem of alcoholism has posed a serious threat to modern civilization for the very fact that around the world and particularly in the west very swiftly teenagers are turning alcoholics. It is stated that out of every 20 persons in the U.S.A., at least one is an alcoholic.

In India, a study sponsored by the Dep’t of Social Welfare, Govt., of India, in 6 states, Bombay, Delhi, Hyderabad, Madras, Varanasi and Jaipur on a sample of 35,000 showed that the most commonly abused drugs were alcohol, tobacco and pain killers.

In the revised edition of DSM III-R there is no specific diagnostic category called “Alcoholism”. Alcoholism is classified under the general term of “Psychoactive substance use disorder” and the specific syndrome that relate to alcoholism.

Alcohol is the major Psychotic drug used worldwide. Only in the U.S. there are estimated more than 13 million people who are diagnosed as alcoholics. DSM III-R reports that according to the community study approximately 13 per cent of the adults had alcohol abuse or dependence at some point of their life.

Following heart disease and cancer alcoholism is the third largest health problem in the U.S. today. As estimated by DSM III-R about 35 per cent of the American adults abstain, 55 per cent drink less than three alcoholic drinks a week and only 11 per cent drink an average of one ounce or more alcohol a day.

Drinking pattern also vary with age and sex. It is thus obvious that a small percentage of the population consume 20% of the total and 30% of the drinkers consume 80 per cent and 10 per cent of the drinkers consume 50 per cent.

Alcoholism is linked with many social evils including automobile and train accidents, murder, rape, physical assault, molestation, industrial accidents and also homicide and suicide. It disrupts social and familial life.

Cancer and heart diseases occur due to heavy drinking. It is also responsible for lowered efficiency and absenteeism among industrial workers. It is considered as the third major cause of death in U.S.A. The average life span of an alcoholic is 12 years less than of a normal person.

The W.H.O. (1969) has defined alcoholics as excessive drinkers whose dependence on alcohol has attained such a degree that they show noticeable mental disturbance or an interference with their mental and bodily health, their interpersonal relations and their smooth social and economic functioning, or who show the prodromal (beginning) signs of such developments.

Alcohol is a depressant drug which affects the central nervous system immediately. It no doubt produces some stimulation and reduces tension and brings relaxation. But when larger amounts are consumed, sensory motor coordination, balance, vision, speech, thought processes and perceptions are affected.  

Essay # 2. Classification of Alcoholism:

I. the alpha alcoholics:.

It is the beginning stage. The alpha alcoholic depends upon alcohol to reduce or relieve emotional tension or physical pain. It does not lose control after the use of the drug. But when he finds that use of alcohol is more important than communicating with others, his interpersonal relationship deteriorates.

ii. The Beta Alcoholics:

In addition to interpersonal difficulties physical problems arise by the excessive use of alcohol like cirrhosis of liver and ulcers, heart troubles. But in this type there is no physical or psychological dependence.

iii. The Gamma Alcoholics:

The gamma drinkers lose control of their drinking and exhibit significant signs of physical, psychological and social deterioration. The physiological dependence in the gamma drinkers is such that when they stop drinking physiological withdrawal symptoms are found.

iv. The Delta Alcoholics:

The delta alcoholic is the most severe type among the four. The drinkers drink right from the morning continuously without any break and cannot abstain from drinking for any period of time. He neglects his food and becomes weak. He is never found to be sober. When the drinking is cleared, it leads to severe physiological withdrawal symptoms.

Essay # 3. Consequences of Alcoholism:

A Japanese proverb says “First the man takes the drink, then the drink takes the man.” The physiological, social, psychological familial and occupational disturbances arise due to the adverse consequences of alcoholism.

Physiological damages include damage of the liver, endocrine glands, heart failure and hypertension etc. The physical effects are so adverse that according to Talbolt (1974) withdrawal from alcohol may lead to death in certain cases. It is also psychologically unpleasant. Hallucinations occur.

There is physical pain. Vision and speech are affected. The nervous system may not automatically continue functioning, breathing may stop and convulsions may occur. When this stage is somehow passed, the person gets back his normal life to some extent and many of the symptoms may disappear. But alcoholic toxicity is still present and needs medical care.

Delirium tremens are the most important psychological symptoms associated with withdrawal of alcohol. These tremens occur in people who are over 30 years age and drinking consistently at-least for 4 years. It is caused by a suaden drop in the intake of alcohol. The symptoms of delirium tremens are restlessness, sleeplessness, night mares, hallucinations, and delusions of terrifying nature.

After the delirium Korsakeff’s psychoses may also occur; with the symptoms of amnesia, disorientation in time and place, distortion of memory or pseudo memory. Due to pseudo memory, the person talks about things that never happened to him and this occurs in women alcoholics more frequently.

Alcohol being a central nervous system depressant like the other anaesthetics, when 0.05 per cent alcohol is found in the blood, thought, judgment and restraints are loosened and sometimes disrupted. Voluntary motor actions by and large become visibly clumsy at a concentration of 0.10 per cent.

When the level of alcohol in blood reaches 0.20 per cent, the function of the entire motor area of the brain is significantly depressed and the parts of the brain controlling emotional behaviour is likely to be affected. At 30 per cent a person is usually confused and may become stuporaous.

At 40 to 50 per cent the alcoholic is in coma and at more higher levels, centres of the brain controlling breaching and rate of heart beat are affected leading to possibility of death. Alcohol also decreases REM sleep and causes insomnia.

Alcoholic paramecia also may occur in some who are predisposed to faulty adjustment and suspicion. Abuse of alcohol may also lead to all sorts of maladaptive characters like jealousy, hatred, fault finding and the adjustive capacity of the person becomes weak day by day.

Essay # 4. Causes of Alcoholism:

It is said that alcohol tends to induce a pleasant feeling tone, brings relaxation, reduces tension and provides physical and mental stimulation to work. Pointing out the physiological effects of wine, a Roman poet wrote, “It discloses secrets, ratifies and confirms our hopes, thrusts the coward forth the battle, ceases the anxious mind from its burden and instructs in arts.”

However, the alcoholic has strong craving for alcohol and this makes him unfit for any job in the sense that his attention is centred around alcohol only.

Why a person becomes alcoholic while others not?

It has several causes.

i. Biological Factors :

Some believe that alcoholism or the tendency for alcohol may be inherited. Findings of the studies by Erickson (1968), Rodgers (1966) and Schlesinger (1966) show certain evidences of the presence of certain genetic components in the occurrence of alcoholism.

Winokur (1970) found that alcoholism does tend to run in families. In a study of 259 hospitalized alcoholics he found that more than 40 per cent had a parent who was an alcoholic. Goodwin (1973, 1974) on the basis of their findings viewed that “it was being born to an alcoholic biologic parent rather than being raised by one that increases the risk of the son becoming an alcoholic.”

It is said that children of alcoholics become alcoholics about 4 times more often than children of non-alcoholics even when they are not brought up by their own parents. In a 30 year longitudinal Swedish study of adopted male children who subsequently become alcoholics, it was found that about 25 per cent had biological fathers who were also alcoholics.

Another Swedish study revealed that monozygotic twins had about twice the coincidence rate of alcoholism as dizygotic twins of the same sex. Studies also indicate a higher craving for alcoholism among dizygotic twins than among non-twin siblings.

Irwin (1968) reported that more than 50 per cent of the alcoholics had an alcoholic parent. On the other hand, Roe, Burks and Mittleman’s (1945)’s findings doubt the genetic hypotheses. Studies of Rose, Burks have supported the above study.

There are majority of cases where children of alcoholic parents do not become alcoholics. Thus Coleman (1981) says, “whether the familial incidence results from shared genes or a shared alcoholic environment is a matter of some controversy.”

The exact role of genetic factors in the causation of alcoholism is therefore not known. It is viewed that constitutional predisposition to alcoholism can be acquired as well as inherited. However, the genetic factors may play their role in predisposing causes.

ii. Psychological and Personality Factors :

Besides the physiological dependence alcohol also produces a strong psychological dependency as well because of the following factors:

(a) Psychological vulnerability:

It refers to a type of personality which makes one vulnerable or predisposed to alcohol under conditions of stress. Instead of using some other defence to adjust with or overcome the stress, these people turn to alcohol.

Personality studies of alcoholics show that they are emotionally immature, they need a lot of praise, appreciation and attention from others and they are very much hurt and disturbed by failures and frustrations.

They feel very in-secured and inferior and have low frustration tolerance. Winokur (1970), Pralt (1972) and Mcclelland (1972) have stated that many young men take to heavy drinking to prove their masculinity and to achieve feelings of adequacy and competency.

According to the findings of James (1968, 1971), Wood uff (1973), antisocial personality and depression may also have some links with heavy drinking.

In-spite of these findings it is not yet established which specific characters are responsible in the development of alcoholism. Nobody can deny that there are also many persons with identical personality characteristics and yet they have not become alcoholics.

However, the role of personality maladjustment in the causation of alcoholism cannot be denied. Since excessive drinking impairs the total life adjustment of an individual, the question arises as to what needs alcohol fulfils that the individual so much depends upon it?

According to the psychological theories alcohol takes the person away from the burdens, responsibilities, heart aches, sorrows and distresses, worries and anxieties of modern life. Alcohol is a vehicle to escape from conflicts, business worries and inferiority complexes.

It gives courage to the coward, confidence to the timid, pleasure to the unhappy and success to failure that is what those who take alcoholics say. In brief, alcohol permits a flight from the disappointments and frustrations of reality. These explanations nevertheless speak only a part of the story.

(b) Stress, tension reduction and reinforcement:

Innumerable observa­tions of the personal lives of alcoholics and quite a number of investigations point out that an alcoholic is dissatisfied with life and has very less frustration and stress tolerance capacity. They probably take it to be away from reality, a reality without hope and meaning for them.

This view has been particularly put forth by the American Medical Association Committee on Alcoholism and Drug Dependency (1969). According to Schafer, alcoholism is a conditioned response to anxiety. When the person finds that each time he takes alcohol it reduces his anxiety, stress and gives him relaxation, he is further reinforced to take it more and more until he becomes alcoholic.

Other experts on the subject reject this view and opine that alcoholism is only a learned maladaptive response which is reinforced and maintained by tension reduction.

Bandura (1969) stated that delayed consequences are very harmful and destructive for the person; yet people are more influenced and controlled by the immediate effect. The immediate reinforcement encourages them to take to drinking more and more.

(c) Marital crisis and other familial problems:

Marital problems pose many crisis for the individual. It not only hurts him, but brings in self devaluation. Divorce, separation, untimely death of children or spouse add to the extra marital relationship of one of the partners, constant quarrel and conflict between husband and wife, poverty and disease may lead to habitual drinking.

Alcohol problems are also correlated with a history of school difficulty, High School dropouts and persons with records of antisocial activity and delinquency appear to be at particularly high risk for alcoholism. Cirhosis data suggest that persons in certain occupation are more likely to develop alcoholism.

Alcoholism is estimated to be associated with at-least 50 per cent of traffic accidents, 50 per cent homicides, 25 per cent of suicides and large number of deaths in a year from alcoholic related diseases.

Persons with a harsh superego turn to alcohol as a means of reducing their unconscious stress. Some alcoholics are fixated at the oral stage of development and relieve frustration by taking substances in mouth. The alcoholic personality is described as shy, isolated, impatient, irritable, anxious, hypersensitive and sexually repressed.

iii. Sociocultural Factors:

The role of sociocultural factors in alcoholism and alcohol abuse has been emphasised by many investigators, particularly in certain societies and cultures, drinking has been considered as a social act. This sociocultural trend encourages many to drink in clubs, parties and in many other social get together.

According to Pliner and Capped (1974) liquor has come to play an almost ritualistic role in prompting gaiety and pleasant social interaction. Different cultures pose different degree of stress for the person. Horton (1943) noted that greater the insecurity level and stress in a culture, greater is the need for taking alcohol to the level of becoming an alcoholic.

Bales (1946) in a quite useful study pointed out 3 cultural factors that play a part in determining the incidence of alcoholism in a given society:

(a) The degree of stress and inner tension produced by that culture.

(b) The attitude towards drinking fostered by that culture.

(c) The degree to which the culture provides the substitute means of satisfaction and other ways of copying with tension and anxiety. To add to this, the effects of rapid social change and social disintegration in a particular culture, with which people are not able to cope, lead to further stress and anxiety.

Eskimos for instance, in many places of rural Alaska, (Time, 1974) are taking to heavy drinking mainly due to the rapid social change in their traditional values and way of life.

In comparison to other countries of the world, alcoholism is said to be a major problem in the United States and Soviet Union. An overall analysis of the various explanations of alcoholism reveals that it is not caused by a single factor. It is an outcome of multiple variables influencing simultaneously. Many more factors of alcoholism are still unknown and future research can only highlight these factors.

Alcoholism is a highly complex disorder involving multifarious causes. Thus, the appropriate approach to the treatment of alcoholism seems to be multidisciplinary. Alcoholism requires flexibility and individualisation of treatment procedures. Hospitalisation and institutionalisation of alcoholics are being treated in community clinics.

When the impairment because of alcoholism becomes severe the patient needs constant care. The risk is 35 per cent of alcoholic pregnant woman having a defective child. Excessive consumption of alcohol also causes her more imbalances leading to the risk of abnormalities.

Treatment can be most successful in patients who voluntarily come to a psychiatrist for treatment because they feel that they need help to give up alcoholism. This conscious feeling that alcohol is undesirable for them is to be aroused by someone since this realisation has a tremendous impact.

Physical punishment is an old type of treatment which does not work. In many plants, however, alcoholic employees are threatened by employers with immediate discharge from job which leads to permanent cure in some cases. Vigilance during the first week of the month may also reduce alcoholism to some extent.

Essay # 5. Current Methods to Treatment Alcoholism:

I. biological measure:.

Medical measures in detoxification include, elimination of the harmful alcoholic substances from the individuals body, treatment of withdrawal symptoms. A drug called chlordiazepoxide has helped a lot in the treatment of withdrawal symptoms like motor excitement, nausea, vomiting, delirium, tremors and convulsions.

It also alleviates tension and anxiety. After detoxification psychological measures like family counselling, employment facilities including other social readjustments are provided.

ii. Aversion Therapy :

The patient is given to drink at regular intervals mixed with emetic drugs; which have extremely uncomfortable effects. Antabuse may also be administered to prevent the return of drinking immediately. It is presumed that since each such drink makes him ill, he will become sufficiently conditioned to stop taking to alcohol.

By means of electric shock aversive conditioning, technique can be applied with success. But unless his emotional problems are solved he may again take to drinking in-spite of the uncomfortable feeling it provides and he will again continue to drink.

Davidson (1974) has viewed on the basis of extensive comparison of available studies that despite a number of positive results there was insufficient data to assess the long range effectiveness of aversion therapy on alcoholism.

iii. Brain Surgery :

Fritz, Roder and his associates (1974) from Gottingen University in Germany have opined “our research have revealed that dependence on drugs or alcohol assumes that proportions of a natural urge after a certain period and the sexual drive or urge to eat, is controlled by a certain brain centre. Neutralizing this centre which is more than 50 cubic millimetre in volume, will cure the patient for all time.”

However, to use brain surgery for the treatment of alcoholism is a controversial matter in view of its dangerous procedure.

Essay # 6. Psychosocial Measures of Alcoholism:

It involves:

(a) Group therapy,

(b) Socio-therapy,

(c) Alcoholics Anonymous.

i. Group Therapy :

The alcoholic must realise that he has a problem which needs his cooperation for its solution. This very recognition of the problem and its undesirable devastating consequences will have the way to therapy. After this through group discussion in the midst of family members and through family therapy treatment may proceed. Here each family member is given a responsibility for cooperating in treatment.

Behaviour therapy:

Through behaviour therapy the alcoholic is taught other ways and methods to reduce anxiety. By the help of relaxation training, assertiveness training, self controlled skills and new strategies to master the environment, efforts are made to reduce anxiety and tension of the alcoholic.

A number of operant conditioning techniques are also used which condition alcoholics to modify their drinking behaviour or abstain from drinking completely. The reinforces in these techniques used are monitory reward, an opportunity to live in an enriched, in-patient environment and access to pleasurable social interaction.

ii. Socio Therapy:

The therapist helps the patient to work out a solution that will give him the satisfaction he is lacking. His aversive life situations are to be alleviated. The therapist must help the patient to reopen the happy chapter of his family life once more having a congenial and cordial relationship with family members, relations and friends.

He should be helped to develop effective methods of adjustment. He should not be allowed in any way to live in high risk environments.

Thus, the aim of socio-therapy is to deal adequately with the hostility, negative attitude of the family, friends and society towards the alcoholic. Keeping this in mind currently community reinforcement approach has developed the main aim of which is to help the problem drinkers to achieve more satisfactory adjustment in personal, professional and social life.

iii. Alcoholics Anonymous:

It is a practical approach to the treatment of alcoholism which has been quite effective. It is mostly a psychotherapeutic programme in which person to person and group relationships are encouraged, spiritual development is the central point of its approach to treatment.

Discussions on the problem are made. It provides for its members an atmosphere of mutual understanding, acceptance and sympathetic fellow feeling. The alcoholics are encouraged to solve their problems without the feelings of isolation and shame.

The alcoholics anonymous technique lifts the burden of personal responsibility from the alcoholic by helping him to realise that “alcoholism like many other problems is bigger than he.

” Regarding the effectiveness of Alcoholic Anonymous Coleman (1981) states “By mutual help and reassurance through participation in a group composed of others, who have shared similar experiences, many an alcoholic acquires insight into his problems, new sense of purpose, greater ego strength and more effective coping techniques.”

Among patients who really want to be cured and whose drinking has been of recent origin, this approach to alcoholism has met with considerable success. Not only treatment, prevention of alcoholism is particularly important in India, keeping in view the widespread misery, wastage, illness and loss of life it causes.

Social consciousness through propaganda campaigns, posters, audio visual aids and education is aroused among people regarding the adverse effects of alcohol. The rural illiterate masses and the weaker sections of the society who have particularly become victims to alcohol should be given special attention.

Related Articles:

• Essay on Unipolar Depression: Factors and Treatment
• Essay on Stress: It’s Meaning, Effects and Coping with Stress
• Organic Mental Disorders: Definition and Classification | Essay | Psychology
• Theories of Marital Therapy | Essay | Therapies | Psychology

• Get new issue alerts Get alerts
• Submit a Manuscript

Secondary Logo

Journal logo.

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

Alcohol consumption in India– An epidemiological review

Eashwar, V. M. Anantha 1, ; Umadevi, R. 2 ; Gopalakrishnan, S. 2

1 Department of Community Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamil Nadu, India

2 Department of Community Medicine, Sree Balaji Medical College and Hospital, Chrompet, Chennai, Tamil Nadu, India

Address for correspondence: Dr. V. M. Anantha Eashwar, Department of Community Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, Tamil Nadu, India. E-mail: [email protected]

Received October 10, 2019

Received in revised form November 23, 2019

Accepted December 04, 2019

One of the most important products of global addiction demand is an alcoholic beverage. In developing countries like India, alcohol consumption tends to be a major problem because of the various socio-cultural practices across the nation, different alcohol policies and practices across the various states, lack of awareness of alcohol-related problems among the community, false mass media propaganda about alcohol use, various alcohol drinking patterns among the alcohol consumers and the emergence of social drinking as a habit because of the widespread urbanisation across the country. Stringent alcohol policies are needed across the various states to reduce alcohol consumption, and alcohol consumers have to be educated about the various harmful effects of alcohol consumption and the effects it can have on their mind, body and soul. This review article focuses on the burden of alcohol consumption in context with its various harmful effects on the mind and body with a note on the alcohol policies in the country.

Introduction

The term alcohol refers to 'ethyl alcohol'. It is consumed as an alcoholic beverage in diluted concentrations of absolute (i.e., 100%) ethyl alcohol. There are various types of alcoholic beverages that are consumed around the world. One standard alcoholic beverage corresponds to 10 g of absolute alcohol. The quantity differs among the types of alcoholic beverages. The most commonly used alcoholic beverages are beer, wine, whiskey, rum, vodka, gin and brandy and locally brewed beverages like arrack and toddy. Alcohol consumption becomes a problem when the individual engages in problematic drinking pattern that puts him at the risk of developing adverse health events.[ 1 ] The various drinking patterns of alcohol consumption[ 2 3 4 5 ] are given in Table 1 .

Global prevalence of alcohol consumption

According to recent data published by the World Health Organization (WHO), the total per capita consumption of alcohol by individuals above 15 years of age is 6.2 L of pure alcohol per year, which equals 13.5 g of pure alcohol per day. However, there is a wide variation between the WHO regions and member states. Nearly 5.1% of the global burden of disease is attributable to alcohol consumption, and it causes nearly 3.3 million deaths every year.[ 1 ]

Alcohol consumption and its associated factors in various parts of India

Alcohol consumption practices vary across different parts of India because of various socio-cultural diversity and difference in laws governing individual States within India. Table 2 shows the prevalence of alcohol consumption in various parts of India and the associated factors governing alcohol use.[ 6 7 8 9 10 11 12 13 14 15 16 17 18 ]

Disease burden because of alcohol consumption

• At the global level :
• Alcohol use disorder (AUD) (which includes a level that's is sometimes called alcoholism) is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect or having withdrawal symptoms when you rapidly decrease or stop drinking. The prevalence of AUDs is highest in Europe (7.5%) and the lowest among eastern Mediterranean regions, which includes Afghanistan, Bahrain and Egypt. Globally, 50% of the deaths caused by liver cirrhosis, 30% of the deaths because of oral and pharyngeal cancers, 22% of the deaths caused by inter-personal violence, 22% of the deaths because of self-harm, 15% of the deaths caused by traffic injuries, 12% of the deaths because of tuberculosis (TB) and 12% of the deaths caused by liver cancer were attributed to alcohol consumption.[ 1 ]
• At the national level :
• The 12-month prevalence of AUDs in India in the year 2010 was 2.6% and that of alcohol dependence was 2.1%. In 2012, 33.1% of all the road traffic accident deaths were attributable to drunk and driving. The National Mental Health Survey of India 2015–16 found the prevalence of AUDs to be 9% in adult men. In India, the alcohol-attributable fraction (AAF) of all cause deaths was found to be 5.4%. Around 62.9% of all the deaths due to liver cirrhosis were attributable to alcohol use.[ 19 ]

Medical consequences of alcohol use

When alcoholic beverages are consumed, alcohol gets absorbed from the stomach and small intestine. It is distributed through blood circulation to every organ in the body. The alcohol gets absorbed by the liver at a rapid pace and excreted through the kidneys, which accounts for 95% to 98% of the alcohol consumed.[ 5 ] In a study done by Gururaj et al ., it was concluded that, because of the increase in the alcohol consumption occurring all over the country, the hospital admission rates because of alcohol consumption were also increasing with 20% to 30% of admissions because of direct or indirect problems caused because of alcohol consumption.[ 20 ]

The various medical complications because of alcohol consumption are:

• Gastrointestinal (GI) complications: The direct effect of alcohol on the lining of the stomach can lead to acute gastritis and present as vomiting, usually associated with heavy drinking. Repeated damage can lead to hyperacidity leading to peptic ulcer disease. Alcohol is one of the most important reasons for haemorrhagic gastritis. The most common complication of long-term alcohol is alcoholic liver disease (ALD)[ 5 ]
• Cancer : Drinking as few as 1.5 drinks per day increases a woman's risk of breast cancer 1.4-fold. For both the genders, four drinks per day increase the risk for oral and oesophageal cancers by approximately three-fold and rectal cancers by 1.5 fold.[ 5 ] In a study done by Bangardi et al ., it was found that alcohol most strongly increased the risk of cancers of the pharynx, oral cavity, oesophagus and larynx[ 21 ]
• Changes in the genitourinary system : Acutely, modest doses of ethanol can not only increase sexual drive but can also lead to decrease in the erectile capacity in men. Even in the absence of liver impairment, significant minority of chronic alcoholic men show irreversible testicular atrophy with shrinkage of seminiferous tubules, resulting in decrease in ejaculate volume and a low sperm count.[ 22 ] In a study done by Chandra et al ., it was found that there was disproportionately high association of alcohol abuse with high-risk sexual behaviour and HIV infection[ 23 ]
• Muscular changes : Between one-half and two-thirds of alcoholics can have skeletal muscle weakness caused by the acute alcoholic myopathy, which may improve with abstinence, but it is not fully cured. Effects of alcohol consumption on the skeletal system can include lower bone density.[ 22 ] In a study done by Venkat et al ., it was found that those who suffer from chronic alcoholism suffered from avascular necrosis of the femoral head and reduced bone density[ 24 ]
• Neurological complications : The short-term effects of alcohol consumption that can get relieved after stopping alcohol consumption include blackouts, blurred vision, impaired memory and slower reaction times.[ 25 ] In a study done by Peng et al ., it was found that chronic alcohol use can lead to the development of alcoholic tremors, myopathy, Wernicke's encephalopathy and cerebellar degeneration[ 26 ]
• Psychiatric complications : Consuming alcoholic beverages to overcome depression and anxiety has been a common practice. Though alcohol can relieve those conditions to some extent initially, it starts to deplete the neurotransmitter serotonin in the brain, causing depression and anxiety and the need to consume more alcohol to medicate depression arises. This chronic use can lead to increased risk for suicide, personality disorders and risk-taking behaviours.[ 26 ] Problems related to alcohol consumption made up to 17.6% of psychiatric emergencies in an Indian general hospital.[ 27 ]

Social consequences of alcohol use

Alcohol consumption not only affects the individuals but also his family members get affected in one way or the other. The person in an intoxicated state may indulge in domestic violence with his family members; may exhaust the savings of the family, which can negatively affect the education of his children, and the children of alcoholic fathers will have strained relationship with their family members, which can affect their psychological wellbeing. In a study done by Gururaj et al ., in Bangalore, it was found that emotionally abusing the spouse was found to be 2.5 times more common among persons who consume alcohol, 23.3% of the users physically abused their spouse and 7.8% of them physically abused their spouse resulting in injuries.[ 29 ] In a study done by Markowitz et al ., domestic violence was reported by 20% of women and husband's practice of alcohol consumption was reported by them as the most significant cause for domestic violence.[ 30 ]

Impact of alcohol use on economic and family finances

The economic impact of alcohol consumption plays a major role in families belonging to lower socio-economic strata. In a study done by Bonu et al ., it was found that there was an empirical association found between the use of alcohol and tobacco and impoverishment through borrowing and selling off assets in distress because of hospitalisation.[ 30 ]

In a study done by Benegal et al ., it was found that alcohol-dependent persons spent more money than they earned, they were forced to take loans to spend for their expenses related to alcohol consumption, on an average, 12.2 working days were lost to the habit and around 60% of the families were financially supported by the income from other family members.[ 31 ] In a study done by Ramanan et al ., half of the persons who consume alcoholic beverages had strained relations with their family members especially their spouse and children.[ 12 ]

Road traffic accidents

One of the major problem of alcohol consumption are road traffic accidents which occur due to driving vehicles under the influence of alcoholic beverages. Both developing and developed countries report high rates of road traffic accidents because of alcohol consumption.[ 5 ]

In a study conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) in 12 major hospitals of Bangalore city, it was found that nearly 28% of injuries because of road traffic accidents were directly attributable to alcohol. The roadside survey revealed that nearly up to 40% of the drivers were under the influence of alcohol.[ 31 32 ] In a study done by Aditya et al ., it was found that 20% of the fatal road traffic accidents were because of alcohol use. The blood alcohol concentration (BAC) of 38% of those alcohol users were above the permissible limits.[ 27 ] In a study done by Gururaj it was found that alcohol abuse was reported in over 20% of the traumatic brain injuries.[ 33 ] According to the latest data released by the National Crime Records Bureau (2015), Tamil Nadu recorded the highest number of drunk and driving accidents in the country.[ 34 ] In a study done by Korlakunta et al ., high-risk behaviour was more common among alcohol-dependent individuals with road traffic accidents being the most frequently observed.[ 35 ]

Legal problems because of alcohol consumption

Another important area where complications arise because of alcohol abuse is legal problems. Crimes that are committed following alcohol intoxication include sexual/physical assault, rape, exploitation of women in commercial sex work and homicide. According to the National Crime Records Bureau of India, the different crimes that are related to alcohol consumption fall under four major acts namely, the Prohibition Act, Gambling Act, Psychotropic Substance Act and Excise Act. However, the major reason because of which the public nuisance created because of alcohol abuse goes unnoticed is that those crimes are classified under petty crime and they largely go unrecognised or they may get overlooked.[ 29 ]

Benefits of alcohol consumption

There are many studies that have pointed out that drinking alcohol in moderate amounts is good for the heart as they help in preventing coronary artery diseases (CADs). However, individual susceptibility plays a major role in the protective benefits of alcohol consumption. The American Heart Association (AHA) states that 'it is not possible to predict in which people alcoholism will become a problem' and advice not to consume alcohol for the benefits it may carry.[ 36 ]

In a multi-centre study done in India, it was found that even light or occasional consumption of alcohol might increase the risk of CAD. So, the benefits of alcohol consumption may not be true for Indians at least.[ 37 ]

Alcohol policy in India

Although the prohibition of alcohol use is encouraged in the constitution of India, alcohol policy is a state subject. States are having full control of alcohol-related legislation, excise rates and the production, distribution and sale of alcohol. Newly independent India, which was born post-independence, retained alcohol prohibition until mid-1960s, and by 1970, only the state of Gujarat had a complete alcohol prohibition policy.[ 29 ] In Bihar, there is complete prohibition of alcohol use since 4 April 2016. However, following a year after the ban, trade of illicit liquor flourished along the borders, as the neighbouring states have no prohibition on alcohol. In addition, there seems to be illicit trade of narcotic drugs as people have begun to look for other substances for addiction.[ 38 ]

Another controversial 'Dry State' is Manipur, where the prohibition of alcohol consumption is in force since 1991, but scheduled castes (SCs) and scheduled tribes (STs) were allowed to brew their traditional liquor. In 2002, the government lifted the ban of alcohol in some districts in Manipur. Manipur is now popularly called 'Wettest Dry State'. Government is now looking to remove the prohibition act, as illicit liquor use, deaths because of methanol poisoning and substance abuse are on the rise.[ 39 ] The major reason states experience fluctuation on the alcohol prohibition at the policy level is that it generates nearly 15% to 20% of their revenue from alcohol taxation, contributing a significant amount to the state treasury.[ 40 ] In states like Gujarat, where complete prohibition is in force, the rich have continued access to alcoholic beverages and the lower class and poor people resort to illegal brewing of alcohol with increase in deaths because of methanol poisoning.[ 39 ] In countries like United States of America (USA) increased taxation on alcoholic beverages has been used to reduce alcohol consumption. In India, those measures will not work, as the alcohol consumers have easy access to illicit liquor and substances. Other laws related to the regulation of alcohol-use like hours of sale, drunken driving and sale to minors are regularly breached.[ 41 ] Legal drinking age is the minimum age after which a person is allowed to buy alcohol. The legal age in different states in India is given in Table 3 .[ 42 ]

Drunken driving (Motor Vehicle Act)

When a person consumes an alcoholic beverage, there is a rise in BAC because of which there is gradual and progressive loss of driving ability because of increase in the reaction time, overconfidence, degraded muscle coordination, impaired concentration and decreased auditory and visual acuity. This is known as drunken driving. There are laws to govern drunken driving in India. The BAC limits are fixed at 0.03%. As per the Motor Vehicle Act, any person whose BAC values are found to be more than this limit are booked under the first offence and may be fined about INR 2,000 to 10,000 and/or he or she may face a maximum of 6 months to 4 years imprisonment.[ 43 ]

Alcohol advertisements

As per the Cable Television Network (Regulation) Amendment Bill, advertising of alcoholic beverages was banned in India. Still, private channels are often permitting alcohol companies to advertise using surrogate means like using brand names for soda or water or music. However, as the target audience is moving from watching television to mobile phones, liquor companies have now begun to invest in online video marketing.[ 43 44 ]

Alcohol prohibition in Tamil Nadu

Before independence, the Madras Abkari Act, imposed in the year 1886, enacted strict rules and regulations that prohibited the local manufacturing of alcoholic beverages and confined it to the central distilleries, where excise duty was paid to the government before being sold in the market. This favoured foreign liquors resulted in anti-alcohol agitation by Indian freedom movements like Swadeshi and Non-Cooperation Movement. In 1937, alcohol prohibition was imposed in Salem district, which was later extended throughout the presidency.[ 45 ] After independence, Tamil Nadu continued liquor ban until 1971. After 1971, the then chief minister (CM) lifted the prohibition of alcoholic beverages. Again, in 1981, the CM during that period closed down all arrack and toddy shops but left the Indian-made foreign liquor untouched. That was the time when it was noticed that, whenever alcohol prohibition was imposed, illegal sales of toddy and arrack and consumption of methanol would rise, resulting in loss of many lives; thus, the ban would be lifted.[ 6 ] In 2002, the retail sale of alcohol was brought under government control. A panel of five IAS officers governs it. It has nearly 6,800 retail alcohol outlets across the state.[ 46 ] As of now, no steps are being taken by the government on the sale and consumption of alcoholic beverages in the state.

Primary care intervention for alcohol-related problems

In developing countries like India, primary care physicians are the first contact of patients with the healthcare system. It is a major platform for screening to identify at-risk individuals and diagnose AUDs. As recommended by the WHO, the AUDs Identification Test (AUDIT), for use in a primary care setting, is a validated screening tool. It can be used to identify alcohol consumers who are harmful/hazardous drinkers and alcohol-dependent individuals.[ 2 47 48 ] Systematic reviews and randomised controlled trials (RCTs) have demonstrated that brief intervention in primary care setting by one-to-one counselling can help at-risk drinkers and those with mild alcohol-related problems.[ 49 ] Based on evidence, primary care management of alcohol-related problems include three core steps, namely, counselling the patient on the ill-effects of alcohol and, if necessary, prescribing medications like disulfiram and connecting with the patients by organizing treatment programs and forming support groups. If necessary, they have to refer the patient to higher centres for further care and management.[ 50 51 52 53 ]

Alcohol consumption is emerging as a major public health problem in India. Multi-centric scientific community-based research studies have to be conducted in various individual states to understand the problem better. Various policymakers, media, professionals and society have to be educated about the consequences of chronic alcohol through sensitisation programmes and health education campaigns. There is a dire need for rational alcohol control policy with specific objectives like alcohol taxation, production and promotion policy.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

• Cited Here |
• Google Scholar

Alcoholic; dependence; hazardous drinking; liver cirrhosis

• + Favorites
• View in Gallery

Readers Of this Article Also Read

Simultaneous infection of hepatitis a and hepatitis e viruses amongst acute..., has tax reforms in india been effective in tobacco control: evidences on..., association between mid-upper arm circumference and body mass index in pregnant ..., communicable or noncommunicable diseases building strong primary health care..., gestational diabetes mellitus 2018 guidelines: an update.

The Absolutely True Diary of a Part-Time Indian

Sherman alexie, ask litcharts ai: the answer to your questions.

“I’m fourteen years old and I’ve been to forty-two funerals,” says Junior after losing three loved ones in alcohol-related accidents. “That’s really the biggest difference between Indians and white people.” For Junior, to be Indian and to live on the reservation means dealing not only with overt racism—going to a dentist who believes Indians only need half as much novocaine as white people do, or facing racist insults from his white classmates in Reardan—but also with the inherited disadvantages and forms of structural oppression that have held his community back for generations. There’s the vicious cycle of poverty, in which “you start believing that you’re poor because you’re stupid and ugly. And then you start believing that you’re stupid and ugly because you’re Indian. And because you’re Indian you start believing you’re destined to be poor.” There’s the reservation school system, originally designed to “kill Indian culture” and now so poorly funded that students must use their parents’ used and outdated textbooks. And there’s “the fricking booze”: the reason, according to Junior, that all Indian families are unhappy, with too many people dying young. Most of the adults in Junior’s life, including his father and his father’s friend Eugene , turn to alcohol as a way of dealing with the sense of despair and defeat brought on by poverty and a racist system that doesn’t “pay attention to their dreams”—and become even further embedded in that system as a result. Alcohol has also been incorporated into Indian traditions such as powwows and wakes, so that ironically, even celebrating the lives of people who have died as a result of alcohol abuse can lead to further heartbreak.

All of these elements contribute to what Junior portrays, and his teacher Mr. P. describes, as a culture of depression, defeat, and hopelessness on the reservation, and they are what Junior tries to escape when he leaves for Reardan. Importantly, while these obstacles shape Junior’s life and circumstances, they aren’t treated as opportunities for character-building—after all, “poverty doesn’t give you strength or teach you about perseverance. No, poverty only teaches you how to be poor.” Rather, they are presented as the simple and brutal realities of Junior’s life, and the lives of all the Indians around him.

Racism, Poverty, and Alcoholism ThemeTracker

Racism, Poverty, and Alcoholism Quotes in The Absolutely True Diary of a Part-Time Indian

I think the world is a series of broken dams and floods, and my cartoons are tiny little lifeboats.

My parents came from poor people who came from poor people who came from poor people, all the way back to the very first poor people. Adam and Eve covered their privates with fig leaves; the first Indians covered their privates with their tiny hands .

It sucks to be poor, and it sucks to feel that you somehow deserve to be poor. You start believing that you’re poor because you’re stupid and ugly. And then you start believing that you’re stupid and ugly because you’re Indian. And because you’re Indian you start believing you’re destined to be poor. It’s an ugly circle and there’s nothing you can do about it.

Poverty doesn’t give you strength or teach you lessons about perseverance. No, poverty only teaches you how to be poor.

After high school, my sister just froze. Didn’t go to college, didn’t get a job. Didn’t do anything. Kind of sad, I guess. But she is also beautiful and strong and funny. She is the prettiest and strongest and funniest person who ever spent twenty-three hours a day alone in a basement.

And let me tell you, that old, old, old, decrepit geometry book hit my heart with the force of a nuclear bomb. My hopes and dreams floated up in a mushroom cloud. What do you do when the world has declared nuclear war on you?

“You’ve been fighting since you were born,” he said. “You fought off that brain surgery. You fought off those seizures. You fought off all the drunks and drug addicts. You kept your hope. And now, you have to take your hope and go somewhere where other people have hope.”

“You always thought you were better than me,” he yelled. “No, no, I don’t think I’m better than anybody. I think I’m worse than everybody else.” “Why are you leaving?” “I have to go. I’m going to die if I don’t leave.”

There are all kinds of addicts, I guess. We all have pain. And we all look for ways to make the pain go away.

I mean, the thing is, plenty of Indians have died because they were drunk. And plenty of drunken Indians have killed other drunken Indians. But my grandmother had never drunk alcohol in her life. Not one drop. That’s the rarest kind of Indian in the world.

Two thousand Indians laughed at the same time. … It was the most glorious noise I’d ever heard. And I realized that, sure, Indians were drunk and sad and displaced and crazy and mean, but dang, we knew how to laugh. When it comes to death, we know that laughter and tears are pretty much the same thing.

We had defeated the enemy! We had defeated the champions! We were David who’d thrown a stone into the brain of Goliath! And then I realized something. I realized that my team, the Reardan Indians, was Goliath.

Gordy gave me this book by a Russian dude named Tolstoy, who wrote: “Happy families are all alike; every unhappy family is unhappy in its own way.” Well, I hate to argue with a Russian genius, but Tolstoy didn’t know Indians. And he didn’t know that all Indian families are unhappy for the same exact reason: the fricking booze.

India's toxic alcohol problem

Bootleggers add lethal methanol to illegal liquor to cheaply increase potency, leading to widespread casualties

• Newsletter sign up Newsletter

At least 54 people have died in India's southern state of Tamil Nadu after drinking illegal alcohol laced with toxic methanol. 

Nearly 200 people have been treated since last Wednesday and "dozens are still hospitalised" with symptoms including vomiting and diarrhoea, said Al Jazeera . 

Selling and consuming alcohol is banned in several parts of India, which leaves space for a black market of bootlegged liquor, but "few can afford branded spirits". 

Subscribe to The Week

Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.

Sign up for The Week's Free Newsletters

From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.

More than a dozen people died last year in a similar incident in a nearby district. Other Indian states, including Assam, Punjab and Bihar, have also reported "hundreds of deaths from bootleg alcohol", said Chennai-based journalist Anupama Chandrasekaran for NPR . 

'The worst in years'

"Hundreds of people die in India every year from cheap alcohol, which is made in illicit backstreet distilleries," said Metro . Vendors often add the toxic chemical to bootlegged liquor to increase its potency, but even a small amount can lead to blindness, liver damage and even death.

Despite "public demands for a crackdown on illegal vendors" the deaths continue. But this "unthinkable tragedy" in the village of Karunapuram, in the Kallakurichi district, is "the worst in years".

The tainted liquor was locally brewed and laced with methanol and then wrongly put on sale last Tuesday, according to Tamil Nadu state chief minister M.K. Stalin. "Within hours" of drinking the alcohol, 37 people were dead. Some "collapsed in the street and died almost immediately".

Authorities have seized 200 litres of the illegal alcohol, and at least seven people have been arrested so far. Several police officers have also been suspended, according to local media reports. 

"It is a complicated socio-economic problem," said Kallakurichi's new top official M.S. Prasanth. "There is a demand due to poverty and some of these people are choosing lower-priced drinks. We have to cut down the supply and do some long-term interventions in the area."

Prasanth has brought in specialist doctors from neighbouring districts and the antidote for methanol poisoning. "Despite these efforts," said Chandrasekaran, "a quarter of the hospitalised patients didn't survive."

'The men work just to drink'

Poor labourers in the district regularly buy black-market liquor in plastic bags for 60 rupees (57p) and drink it before work, a local councillor told The Indian Express . "Men staggering home drunk is not an unusual sight in the village of Karunapuram". 

"The men work just to drink, and the women run the family," said rickshaw driver Shankar, who lives on a street where 23 people died.

On Wednesday, Ponnusamy Rajendran, a 55-year-old labourer, bought "three 50-cent plastic pouches of bootleg alcohol to feed his addiction", said NPR. Rajendran died in a government hospital on Thursday. "He had a limited budget with his wages and after sharing half his earnings with his family, he calculated and found it profitable to buy fake alcohol," said his son-in-law Kaliappan Gnanavel. 

But despite evidence of a "mass poisoning", a district official (who has since been transferred) initially denied that the deaths were due to illegal alcohol. It was "shocking", a local councillor told The Indian Express. "I seemed there was pressure to downplay the incident."

Rajendran's daughter said the family "have battled with the bootleggers to halt the sale of this substance", only to be told: "Why do you allow him to come and purchase from us?" 

"This is a major crisis and it must never occur again," she said.

Sign up for Today's Best Articles in your inbox

A free daily email with the biggest news stories of the day – and the best features from TheWeek.com

Harriet Marsden is a writer for The Week, mostly covering UK and global news and politics. Before joining the site, she was a freelance journalist for seven years, specialising in social affairs, gender equality and culture. She worked for The Guardian, The Times and The Independent, and regularly contributed articles to The Sunday Times, The Telegraph, The New Statesman, Tortoise Media and Metro, as well as appearing on BBC Radio London, Times Radio and “Woman’s Hour”. She has a master’s in international journalism from City University, London, and was awarded the "journalist-at-large" fellowship by the Local Trust charity in 2021. 

The Week Recommends Faith Omole's debut play explores complex relationships with 'flair'

By Irenie Forshaw, The Week UK Published 27 June 24

Under the radar Grr, the bears are back!

By Devika Rao, The Week US Published 27 June 24

The Explainer A conflict is flowing down the river

Speed Read U.S. Surgeon General Vivek Murthy issued a first-of-its-kind advisory

By Peter Weber, The Week US Published 26 June 24

Speed Read Babies born in states with more abortion restrictions may be likelier to die within a year

By Peter Weber, The Week US Published 25 June 24

Talking Points New York Governor Kathy Hochul proposed a mask ban. Here's why she wants one — and why it may not make sense.

By Anya Jaremko-Greenwold, The Week US Published 24 June 24

Under the radar Prevention organizations are struggling to keep the numbers from escalating

By Theara Coleman, The Week US Published 24 June 24

Speed Read A rare genetic trait called Christchurch could delay the onset of disease

By Peter Weber, The Week US Published 20 June 24

Under the Radar Quartz comes at a cost

By Devika Rao, The Week US Published 17 June 24

Under the Radar Lack of awareness of symptoms and shortage of specialists means sufferers are vulnerable to accusations and attacks

By Harriet Marsden, The Week UK Published 11 June 24

In Depth Getting older, younger

By Devika Rao, The Week US Published 10 June 24

• Contact Future's experts
• Terms and Conditions
• Privacy Policy
• Cookie Policy
• Advertise With Us

The Week is part of Future plc, an international media group and leading digital publisher. Visit our corporate site . © Future US, Inc. Full 7th Floor, 130 West 42nd Street, New York, NY 10036.

• Fact sheets
• Facts in pictures
• Publications
• Questions and answers
• Tools and toolkits
• HIV and AIDS
• Hypertension
• Mental disorders
• Top 10 causes of death
• All countries
• Eastern Mediterranean
• South-East Asia
• Western Pacific
• Data by country
• Country presence 
• Country strengthening 
• Country cooperation strategies 
• News releases
• Feature stories
• Press conferences
• Commentaries
• Photo library
• Afghanistan
• Cholera 
• Coronavirus disease (COVID-19)
• Greater Horn of Africa
• Israel and occupied Palestinian territory
• Disease Outbreak News
• Situation reports
• Weekly Epidemiological Record
• Surveillance
• Health emergency appeal
• International Health Regulations
• Independent Oversight and Advisory Committee
• Classifications
• Data collections
• Global Health Estimates
• Mortality Database
• Sustainable Development Goals
• Health Inequality Monitor
• Global Progress
• Data collection tools
• Global Health Observatory
• Insights and visualizations
• COVID excess deaths
• World Health Statistics
• Partnerships
• Committees and advisory groups
• Collaborating centres
• Technical teams
• Organizational structure
• Initiatives
• General Programme of Work
• WHO Academy
• Investment in WHO
• WHO Foundation
• External audit
• Financial statements
• Internal audit and investigations 
• Programme Budget
• Results reports
• Governing bodies
• World Health Assembly
• Executive Board
• Member States Portal
• Publications /

Global status report on alcohol and health and treatment of substance use disorders

• Share full article

Advertisement

Supported by

Toxic Moonshine Leaves at Least 53 Dead in India’s South

Consumption of tainted bootleg alcohol has caused several instances of mass deaths in recent years as drinkers seek out illicit liquor to save money or evade the law.

By Mujib Mashal and Hari Kumar

Reporting from New Delhi

The death toll from tainted liquor in the southern Indian state of Tamil Nadu has reached 53, officials say, and is likely to rise, with many others in critical condition. The victims were sickened by drinking a bootleg alcohol with a high content of methanol.

Rajat Chaturvedi, the police superintendent in the Kallakurichi District, where the past week’s deaths have occurred, said that 98 people had been hospitalized. “The dead and hospitalized people are mostly daily wage laborers,” he said.

The first death, from drinking local alcohol sold in small pouches for about 50 cents, Mr. Chaturvedi said, was reported on Wednesday. The village of Karunapuram was the worst hit, with more than a dozen victims receiving last rites in a mass cremation on Thursday.

Consumption of tainted alcohol has caused several mass-casualty events across India in recent years. In some states that prohibit alcohol, people turn to smuggled or unregulated liquor. Elsewhere, villagers choose the bootleg product because of its lower price.

In 2019, at least 150 people died in two districts of the northeastern state of Assam from drinking bootleg alcohol. Weeks earlier, 100 people had died in the states of Uttar Pradesh and Uttarakhand.

In August 2020, at least 120 people died in Punjab from drinking toxic local alcohol, with 92 of the deaths in just one district.

In December 2022, at least 70 people died from drinking tainted alcohol in the eastern state of Bihar. Bihar has banned the sale and consumption of alcohol since 2016, but people consume illegal smuggled alcohol or cross the border into Nepal for cheap local alcohol.

Last year, at least 22 people died from consuming similar toxic local alcohol in two other districts of Tamil Nadu, where liquor sales are legal but the number of outlets is restricted. The latest mass casualty has put the state’s government under pressure from opposition leaders as well as from the state’s high court. Opposition lawmakers, who arrived at the assembly dressed in black, called for the resignation of Tamil Nadu’s chief minister, M.K. Stalin.

Mr. Stalin announced an investigation headed by a retired judge and ordered the police across the state to crack down on the homemade liquor trade.

The man accused of making this week’s batch of poisonous alcohol has been arrested, along with his wife and at least one other person, according to police officials. The Kallakurichi District’s top civilian official has been transferred, while several police officers have been suspended.

Local residents have said that the police were complicit, taking a cut from the bootlegger’s peddlers who brought the alcohol to the villages, according to the Indian news outlet The News Minute .

“We cannot say direct involvement of local police, but due to their lack of action, police people were suspended, right from constable to deputy superintendent of police,” said Mr. Chaturvedi, who took charge of the district’s police force after the tragedy.

Mujib Mashal is the South Asia bureau chief for The Times, helping to lead coverage of India and the diverse region around it, including Bangladesh, Sri Lanka, Nepal and Bhutan. More about Mujib Mashal

Hari Kumar covers India, based out of New Delhi. He has been a journalist for more than two decades. More about Hari Kumar

Tainted alcohol leaves dozens dead and 100 in hospital in southern India

At least 36 people have died after drinking illegally brewed alcohol tainted with methanol in southern India. 

The incident occurred in the state of Tamil Nadu in the Kallakurichi district. 

The state's top official said more than 100 people were being treated in various hospitals, while the number of deaths could rise further. 

Those affected were suffering from vomiting, stomach aches and diarrhoea. 

Ambulances, doctors and specialists from nearby areas have been deployed to assist. 

Methanol is a toxic alcohol often found in household cleaners and fuels. 

Police have arrested four people over the sale of illicit alcohol and seized 200 litres of the methanol-mixed alcoholic drink.

The state government also said it had taken disciplinary action against at least 10 officials, including the district's chief administrator and its police chief.

"Such crimes that ruin society will be suppressed with an iron fist," the state's chief minister MK Stalin wrote on social media.

Deaths from illegally brewed alcohol are common in India in areas where people cannot afford licensed brands. 

The illicit alcohol, which is often spiked with chemicals to increase its potency, has also become a hugely profitable industry as bootleggers pay no taxes. 

In 2022, more than 30 people died in eastern India after allegedly drinking tainted alcohol, while in 2020, 120 people died after a similar incident in India's northern Punjab state.

• X (formerly Twitter)

Related Stories

At least 13 people dead, several feared trapped in passenger and goods train collision in india.

Cyclone Remal leaves 16 dead and millions without power in Bangladesh and India

Essay on Alcoholism

Students are often asked to write an essay on Alcoholism in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Alcoholism

Understanding alcoholism.

Alcoholism is a serious issue. It is a disease where a person cannot control their desire to drink alcohol. They keep drinking even when it causes harm.

Alcoholism can be caused by genetics, environment, and mental health. Some people are more prone to it because of their family history. Others might start drinking due to stress or depression.

The Effects

Alcoholism can lead to health problems like liver disease. It can also cause problems at work, school, or with relationships. It’s important to seek help if you or someone you know is struggling.

250 Words Essay on Alcoholism

Introduction.

Alcoholism, also known as alcohol use disorder (AUD), is a chronic disease characterized by an inability to control or abstain from alcohol use despite its negative consequences. It is a pervasive global issue with significant health, social, and economic implications.

Causes and Risk Factors

Impacts and consequences.

The impacts of alcoholism are far-reaching. Physiologically, it can lead to liver disease, cardiovascular problems, and neurological damage. Psychologically, it can result in depression, anxiety, and increased risk of suicide. Socially, it can disrupt relationships, lead to job loss, and contribute to social isolation.

Treatment and Prevention

Treatment for alcoholism typically involves a combination of medication, therapy, and support groups. Prevention strategies include education about the risks of excessive alcohol consumption, early intervention for at-risk individuals, and policies to limit alcohol availability.

Alcoholism is a complex disease with a multitude of contributing factors and consequences. Understanding its causes, impacts, and treatment options is key to addressing this pervasive issue. As future leaders, we must advocate for effective prevention strategies and accessible treatment services to combat alcoholism.

500 Words Essay on Alcoholism

Alcoholism, also known as Alcohol Use Disorder (AUD), is a chronic disease characterized by an inability to control or abstain from alcohol use despite its negative repercussions. It is a multifaceted disease, with complex interactions between genetic, environmental, and psychological factors.

Genetic Underpinnings of Alcoholism

Scientific research has established a strong genetic component to alcoholism. Certain genes can make individuals more susceptible to alcohol addiction, demonstrating that alcoholism is not merely a result of personal weakness or lack of willpower. It is estimated that genetics accounts for about 50% of the risk for AUD. However, having a genetic predisposition does not guarantee the development of alcoholism, indicating the significant role of environmental factors.

Environmental Factors and Alcoholism

The psychological impact of alcoholism.

Alcoholism inflicts significant psychological damage. It can lead to a range of mental health disorders, including depression, anxiety, and increased risk of suicide. Furthermore, alcoholism can negatively impact cognitive functions, impair judgment, and lead to behavioral changes. It is also closely linked to social problems, such as domestic violence, child abuse, and other forms of crime.

Treatment and Recovery

Alcoholism is a treatable disease, with various therapeutic strategies available. These include behavioral treatments, medications, and mutual-support groups. Behavioral treatments aim to change drinking behavior through counseling, while medications can help to manage withdrawal symptoms and prevent relapse. Mutual-support groups like Alcoholics Anonymous provide a supportive community for individuals recovering from alcoholism.

Prevention is Better than Cure

Alcoholism is a complex, multifaceted disease that requires a comprehensive approach for its prevention and treatment. Understanding its genetic, environmental, and psychological dimensions can inform effective strategies to combat this pervasive public health issue. While alcoholism is a serious disease, recovery is possible with the right support and treatment. Therefore, it is essential to foster a supportive environment for those struggling with this disorder, free from stigma and judgment.

That’s it! I hope the essay helped you.

Happy studying!

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

India: Tainted alcohol death toll rises to 54 in Tamil Nadu

Vendors sell the cheap alcohol for huge profits to customers who cannot afford branded drinks.

At least 54 people have died and dozens are still hospitalised after drinking alcohol laced with methanol in the southern Indian state of Tamil Nadu.

Nearly 200 people have been treated since Wednesday in the district of Kallakurichi, and more than 100 people are still being cared for across multiple hospitals.

Keep reading

At least 34 people die in india after drinking bootleg liquor, millions of students at risk: india’s elite exams hit by corruption ‘scam’, landslides kill at least 15, displace millions, in bangladesh and india.

Forty-eight men and six women succumbed to the tainted liquor as of Saturday with others being treated for symptoms including vomiting, stomach aches and diarrhoea.

People regularly buy illegal alcohol as few can afford branded spirits sometimes leading to large casualty incidents since some vendors add methanol to increase the potency of their drink.

But methanol, a highly toxic chemical substance used for industrial purposes, can lead to blindness, liver damage or death even in small quantities.

According to MS Prasanth, a senior district official, at least seven people have been arrested by the authorities, who earlier said they also seized 200 litres (6,763 fluid ounces) of the illegally produced alcoholic drink.

The government of Tamil Nadu said on Thursday it had taken disciplinary action against 10 officials in charge of managing illegal alcohol and failed to prevent the incident.

Tamil Nadu Chief Minister MK Stalin announced the families of the victims and those hospitalised will receive financial compensation from the government. He also ordered a former High Court judge to investigate the incident.

State ministers and opposition leaders – who have criticised the government for failing to prevent mass poisonings – travelled to the district to meet victims and their families.

A mass cremation of the deceased has already been carried out with families carrying out last rites next to each other.

More than a dozen people died last year in a similar incident in a nearby district of Tamil Nadu. More than 120 people died in the northern state of Punjab in 2020.

In 2022, more than 30 people died in eastern India’s  Bihar  state and at least 28 died in  Gujarat  state in the west after drinking tainted liquor sold without authorisation.

Watch CBS News

Tainted liquor kills more than 30 people in India in the country's latest bootleg alcohol tragedy

By Arshad R. Zargar

June 20, 2024 / 9:18 AM EDT / CBS News

New Delhi — At least 34 people have died in India after consuming illegally brewed liquor in the southern state of Tamil Nadu. More than 100 others were still being treated in hospitals Thursday for stomachache, vomiting and diarrhea after consuming the methanol tainted liquor, according to state officials.

Tamil Nadu's top official, Chief Minister M. K. Stalin, said he was "shocked and saddened" by the deaths and promised to take action against anyone involved in the illicit liquor business.

At least one person was arrested and about 44 gallons of the methanol-mixed alcoholic beverage were seized, the government said.

"Those involved in the crime have been arrested… action has also been taken against the officials who failed to prevent it," Stalin said in a social media post on Thursday, adding that he had ordered an investigation. "Such crimes that ruin the society will be suppressed with an iron fist," he said.

Stalin's administration suspended the superintendent of police in the Kallakurichi district, where the alcohol deaths occurred, along with the district's top tax official.

The state government deployed a team of specialist doctors to Kallakurichi to help hospitals deal with the high number of cases. M. S. Prasanth, another senior state official, said the number of patients in critical condition was changing, indicating that the number of deaths could increase.

Deaths from illegally brewed alcohol are common in India. The liquor is often produced by spiking off-the-shelf alcohol with cheap chemicals such as methanol and even pesticides to increase its potency. It's an unorganized, illegal, but hugely profitable trade.  

Bootleggers sell vast quantities at cut rates to the poor, without paying taxes to the government.

In December 2022,  more than 30 people died  in the eastern Indian state of Bihar after consuming tainted alcohol. In July 2002,  28 people died  and 60 became ill after drinking bootleg liquor in the western state of Gujarat, where the sale of alcohol is banned.

More from CBS News

U.S. soldier charged with sexually assaulting a teenage girl in Japan

Kenyan leader nixes tax hikes after more than 20 killed in protests

Seine River maintains unsafe bacteria levels a month from Olympics

Second U.S. service member in months charged with rape in Japan's Okinawa

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.13(4); Oct-Dec 2020

Prevalence of Alcohol and Tobacco Use in India and Implications for COVID-19 - Niyantrita Madhumeha Bharata Study Projections

Madhava sai sivapuram.

1. Department of General Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinna-Avutapalli, Andhra Pradesh, India

Raghuram Nagarathna

2. Department of Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India

Akshay Anand

3. Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Suchitra Patil

Hongasandra ramarao nagendra.

Abuse of legal substances in India includes alcohol and tobacco, which are the major risk factors for various non-communicable diseases and deaths. The current pandemic has identified tobacco consumption as a risk factor for COVID-19, highlighting the need to control substance abuse. The objective of this study was to estimate the prevalence of substance abuse in India and discuss the cost-effective public health strategies (such as yoga) to alleviate COVID-related anxiety in order to prevent substance abuse and its associated co-morbidities such as type 2 diabetes mellitus. This study reports the data on tobacco and alcohol abuse from a nationwide randomized two-arm diabetes control trial (Niyantrita Madhumeha Bharata, 2017) conducted by the Indian Yoga Association (IYA) through Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru. Data of 30,354 participants who abuse tobacco and 30,159 participants who abuse alcohol were collected all over India. The prevalence is estimated at around 8.7% for alcohol abuse and 7.9% for tobacco abuse, Arunachal Pradesh state ranking the highest regarding both alcohol and tobacco abuse, while the Tripura state ranked the lowest. School and college-based mandatory yoga programs need to be implemented to prevent the increase of substance abuse in India to alleviate the psychosocial stress of adolescents and college-going students, besides the installation of the mindfulness-based diabetes yoga protocol (DYP) in the wellness centers of Ayushman Bharat.

Introduction

Alcohol and tobacco are legal substances that are often abused in India and constitute major risk factors for various diseases, also increasing the burden of non-communicable diseases, especially when these substances are used by the general public [ 1 , 2 ].

Globally, 1.3 billion people are using tobacco products, and the annual death rate is around six million [ 3 ]. According to the 2018 World Health Organization (WHO) factsheet, tobacco abuse and addiction kill more than one million people in India, which is one-sixth of the world deaths due to tobacco usage and accounts for 9.5% of all deaths in India [ 4 ]. These facts inform us of the dangers of tobacco consumption on one’s general health. Furthermore, the WHO reports indicate that tobacco-related deaths will rise to a million, accounting for 10% of global deaths by 2030, if appropriate measures are not taken [ 5 ]. Tobacco is a plant that is grown, and the leaves of the tobacco plant are dried and further fermented. The fermented tobacco leaves are converted to tobacco products, which can be either smoked as tobacco products or used as smokeless tobacco products. The smoked tobacco products include cigarettes, cigars, bidis, rolled cigarettes, cheroots, hookah pipes, tobacco rolled in maize leaf and newspaper, chillum [ 6 , 7 ], while the smokeless tobacco products available include khaini, betel quid with tobacco, gutka, tobacco lime mixture, pan masala, oral tobacco, snuff and others [ 7 ].

Currently, electronic cigarettes known as e-cigarettes and flavored tobacco products are on the rise in India and across the world [ 8 ]. The chief ingredient of tobacco causing addiction is nicotine, which is a carcinogenic agent responsible for various diseases and has high mortality [ 9 ]. Tobacco consumption leads to multiple diseases such as ischemic heart disease, hypertension, neoplasia, especially lung cancer, throat cancer, tracheal cancer, oral cancer, oesophageal cancers, chronic obstructive pulmonary disease (COPD), lower respiratory tract infections, male infertility, and other diseases [ 10 ]. Considering the current COVID-19 pandemic across the world due to the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), it has been reported that angiotensin-converting enzyme-2 (ACE-2) receptors are the target receptors for the SARS COV-2 virus [ 11 , 12 ] and the nicotine, being the major component in tobacco, it directly impacts the putative receptor of the ACE-2 enzyme making the individual vulnerable and at higher risk for the COVID 19 attack [ 13 ].

According to the WHO, there are three million deaths yearly anually due to alcohol consumption, which constitutes around 5.3% of total deaths globally and 5.1% of the global burden of disability-adjusted life years (DALYs) due to alcohol consumption [ 14 ]. In India, a study conducted by Girish et al. estimates that 13% of the Indian population consumes alcohol, with a higher percentage of males consuming alcohol compared to females [ 15 ]. The consumption of alcohol leads to various digestive or cardiovascular diseases, including cancer. Around 900,000 deaths are due to alcohol-related injury across the world [ 14 ]. It is estimated that about 336 persons die every day due to alcohol consumption, and 40% of road traffic accidents are related to alcohol intake [ 16 , 17 ]. Multiple systematic reviews and meta-analyses have shown that with an increase in alcohol consumption, the risk for type 2 diabetes mellitus increases in heavy drinkers [ 18 - 20 ]. Since India is the diabetic capital, there is an urgent need to prevent not only alcohol-associated comorbidities but also alcohol addiction.

The main objective of the current study was to estimate the prevalence of the consumption of legal substances such as alcohol and tobacco in India and discuss various non-pharmacological cost-effective ways (such as yoga) that can restrict the consumption of alcohol and tobacco, thereby preventing people from becoming addicts. There is growing evidence about the positive effects of yoga on the control of type 2 diabetes mellitus [ 21 , 22 ], stress (one of the precursors/motivation for the use of tobacco and alcohol) [ 23 , 24 ], and addiction [ 25 ]. This helps to control the increasing addiction to legal substance abuse in India.

Material and Methods

The present study was a part of a larger project - Niyantrita Madhumeha Bharata (NMB), 2017 (Diabetes control in India). This study was a nationally representative door-to-door cross-sectional survey in India. Out of 29 states and 7 union territories in India, 26 states and four union territories were included.

This study was funded by the Ministry of Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) and the Ministry of Health and Family Welfare, Government of India. The study was approved by the Institutional Ethics Committee of the Indian Yoga Association (IYA), Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA), Bengaluru (vide Res/IEC-IYA/001 dt 16.12.16). Informed consent was obtained from all the participants during the door-to-door survey. Data were collected from adults above 18 years of age.

The entire methodology of the project has been published in two papers [ 26 , 27 ]. The whole country was divided into six zones in India, represented in Figure 1 . In states with 10 to 30 districts, 2 districts were selected, and from a state with 10 or fewer districts, one district was selected for sampling. The door-to-door survey, which included the basic demographic information of the participants and information about legal substance use (alcohol and tobacco) in India, was used. At the time of carrying out this study, the implications of the COVID pandemic were not foreseeable.

Different zones of India.

The data were simultaneously collected from all the regions ( Figure 1 ). Since a large amount of data was obtained, the information was uploaded in the NMB apps and was cross-verified randomly. The hard copies of the data and data centralization were carried out at S-VYASA. The data that was collected for this manuscript is shown in Figure 2 . We have excluded the Punjab state from our analysis as the non-response to the questions regarding alcohol and tobacco use were very high and causing statistical errors. The statistical analysis was done using the Statistical Package for Social Sciences (IBM Statistics for windows, SPSS v21.0), and the significance of associations (p-value) were calculated using the chi-square analysis at S-VYSVA, Bengaluru, India.

The number of participants from the door-to-door survey.

The data collected from the door-to-door survey of the NMB 2017 under IYA and S-VYASA University represented in Figure 2 were analyzed. Table 1 shows the prevalence and gender-wise distribution of legal substance abuse (both alcohol and tobacco) in India. We noticed that the prevalence of alcohol abuse (8.7%) was higher than the tobacco abuse (7.9%). When compared among the genders, both alcohol and tobacco consumption was higher among males (15.8% alcohol and 13.1% tobacco) when compared to females (3.2% tobacco and 2.4% alcohol).

Gender-wise distribution regarding tobacco and alcohol abuse in India.

For further analysis, we have divided the tobacco abuse among various states and union territories in India, as shown in Table 2 . The highest rate of tobacco abuse was found in Arunachal Pradesh, belonging to the north eastern part of India, and the lowest tobacco abuse was seen in Tripura state.

Prevalence of tobacco abuse among various states and union territories in India.

Prevalence of alcohol abuse among various states and union territories in India.

As with tobacco abuse, we have divided the prevalence of alcohol abuse among various states and union territories in India, as shown in Table 3 . The highest percentage of alcohol abuse was found in Arunachal Pradesh, and the least alcohol abuse was seen in the Tripura state. The prevalence pattern of alcohol abuse is similar to the tobacco abuse pattern. The weighted percentages of the individual states and union territories were included in Table 4 .

The weighted percentages of the individual states for subjects that abuse tobacco and alcohol included in the study.

Summary of the AYUSH Diabetes Yoga Protocol [ 25 ].

From the data of 30,354 participants that abuse tobacco and 30,159 participants that abuse alcohol, it was seen that 7.9% and 8.7% of people abuse tobacco and alcohol, respectively. This is the nationally representative population. In a study conducted by Prakash et al. , it was noted that among 35,102 men aged above 45 years, the prevalence of tobacco use was around 15%, which is close to our study where a similar percentage of 13.1% of tobacco abuse was seen in men. The slight difference might be due to the inclusion of people aged 18 years or above in our sample [ 28 ]. It is also noted that more than 50% of people who consume alcohol are also tobacco abusers, which was concluded in the same study [ 28 ]. Due to the lack of awareness among the people in rural areas, a higher prevalence of tobacco and alcohol consumption of more than 30% is seen especially in the older adults across various places in India [ 29 , 30 ]. It was also noticed in various studies that tobacco and alcohol constitute a major risk for non-communicable diseases such as cardiovascular diseases, cancer, and others [ 31 , 32 ]. Also, there is no comprehensive study on the usage of substances by adolescents. In a large sample study done by Jaisoorya et al. , the prevalence of psychological distress was reported to be around 34.8% among college-going students and adolescents. This fact seems to have negative outcomes, especially in the case of substances that lead to addictions gradually [ 33 ]. Therefore, the importance of preventing the usage of substance abuse in adolescents is highlighted.

It is generally perceived that there is a lack of strict regulation about tobacco and alcohol abuse because of the apparent link with Government revenue generated for the country by the tobacco and alcohol industry annually. For example, the tax revenue in 2019 generated from smoking cigarettes alone is 348.34 billion Indian rupees, which is 15% higher than the 2018 fiscal year, pointing to the increase in the consumption of tobacco annually [ 34 ]. Similar estimates of excise revenues from the alcohol industry are approaching 10.4 trillion Indian rupees in 2019-20. By 2023, it is estimated the sales will increase [ 35 ]. In contrast, the health care GDP of India has remained at one percent of the last ten years since 2009, although the GDP per-capita of Indians has doubled between 2009-10 and 2017-18. However, the GDP of developed countries such as the United States of America is around 18% [ 36 ]. Considering the statistics, the need of cost-effective solutions towards substance abuse is required at various levels of age groups to increase the health of the country, especially in times of the COVID19 pandemic.

One of the cost-effective solutions that should be considered for implementation in order to reduce legal substance abuse and its associated comorbidities is yoga, especially the Diabetic Yoga Protocol (DYP) developed by the Ministry of AYUSH by a 16-member committee across the country (Figure 5) [ 37 , 38 ]. The DYP protocol is a 60-minute session with a regular follow-up that can facilitate both the release of stress caused by the closure of liquor and wine shops in the country during the current lockdown and also prevent the conversion of prediabetes to diabetes [ 21 , 23 , 25 ]. This is highly required, especially in the northern states of India, such as Arunachal Pradesh, due to the high usage of legal substances.

School and college-based mandatory yoga programs to control psychosocial stress

The adolescent and college-going students display psychosocial and academic stress [ 39 ], which is higher than most countries partly due to the population of the country [ 40 ]. The increasing propensity towards substance abuse such as alcohol and tobacco [ 35 , 39 ] also renders tobacco consumers and other addicts that are more vulnerable to diabetes and COVID-19 infection [ 41 ]. To reduce such stress among adolescents and college-going adults, a mandatory three-day yoga programme per week needs to be implemented [ 37 ]. This yoga protocol has been shown to reduce stress and control diabetes in the nation-wide study that took place in India [ 42 , 43 ]. The early implementation of such protocols among teenagers that go to school coupled with awareness about the harmful effects of smoking and alcohol abuse can result in substantial reduction and prevention of addiction in the near future [ 44 ].

Mindfulness-based DYP into the wellness centers of Ayushmann Bharat

In February 2018, the Indian government had launched a universal health coverage program known as Ayushmann Bharat to control non-communicable diseases. As a part of the program, 150,000 public peripheral health centers focused on health and wellness agenda are being operationalized for delivering comprehensive primary health care by the end of 2022 [ 45 , 46 ]. As a part of these centers, mindfulness-based DYP must be introduced into these wellness centers to reach out to the public, which will be a cost-effective non-pharmacologic way to reduce substance abuse in India. Several randomized controlled trials on the effect of yoga [ 47 , 48 ] and mindfulness [ 25 ] on substance abuse have shown positive results towards the cessation of substance abuse over time. The introduction of the mindfulness-based DYP into the wellness centers will prevent substance abuse at the initial stages and decrease the global disease burden.

The sample used in this study was collected across the country; however, the sample is not representative of each individual state, and a convenient sample size was taken from each state. In some states, the non-response rate for the questions about tobacco and alcohol abuse was high, and states such as Punjab were excluded from the data collection process to prevent statistical errors. There might have been reporting bias in the statements of individuals who have abused tobacco and alcohol only once. This paper did not help us give the right percentages of tobacco and alcohol abuse in the transgender population as this population sample is insufficient.

From this current study, it is estimated that around 8.7% of alcohol and 7.9% of tobacco users exist in India, with the highest rate of tobacco abuse in Arunachal Pradesh and the lowest in Tripura (for both types of substance abuse). To prevent the disease burden from legal substances abuse, a cost-effective non-pharmacological approach (considering the GDP of India for health) is required. Such approaches include a school/college-based mandatory yoga program to control psychosocial stress in adolescents, including the installation of DYP into the wellness centers of Ayushmann Bharat for the general population to prevent legal substance abuse and decrease the disease burden on the country.

Acknowledgments

This study was funded by Ministry of Health and Family Welfare, Ministry of AYUSH, Government of India routed through the Central Council for Research in Yoga and Naturopathy (CCRYN) and implemented by the Indian Yoga Association (F. No. 16-63/2016-17/CCRYN/RES/Y&amp;D/MCT/Dated: 15.12.2016).

Conflict of Interest

The authors declare that there is no conflict of interest.

I Thought Coming Out Would Fix My Life — Then Came My Alcoholism

There's a popular gay movie trope about the douchebag who relentlessly drinks himself into oblivion because he can't accept his sexuality. Oh, how badly I wanted that to be the case for me.

In 2014, when I was 20 years old, I sat with my arms crossed and back slouched against a plastic chair in a dimly lit room in Perry Street Workshop in New York's Greenwich Village. Rows of people faced a podium where a frail, elderly Asian man with tiny, circular glasses recounted a life of self-destruction that began with a sip of beer as a teenager. As the man spoke about the disease that swallowed him whole, I tried on alcoholism like a shoe.

"Nothing mattered to me besides not being sober," he said, and I couldn't relate to him less.

My problem was my secret destroying me from the inside.

Even if I was at the stereotypical rock bottom for someone my age — a Gates Millennium Scholar turned college dropout with only the next party to my name — I refused to cement in stone an identity as an "alcoholic," which to me seemed synonymous with desperation and failure. I had a lovely upbringing and so much ambition, even if it was presently riddled with regret.

The people at AA spoke about drinking as an insurmountable temptation that occupied their existence, but I didn't need alcohol to function. I only drank when I went out, which I could reduce from every night to the weekends. Although I probably experienced more blackouts than folks twice my age, it stemmed from my unhappiness.

My problem was my secret destroying me from the inside: I was gay, but hadn't yet come out. Although I struggled to assimilate into heteronormativity my whole life, I managed to be in denial of my sexuality until the grown-up streets of New York made it impossible to ignore my urges. I had decided on college in Manhattan to escape the cage of fraternity culture, but while doing so, I learned my type was muscly men in their 30s.

Admitting my truth publicly felt impossible, as if one existence would cancel out the other. Growing up in the suburbs of Miami, I had never experienced LGBTQ+ visibility or access to perspectives beyond fear and stereotypes. Queerness seemed destined for exile from the world I knew. I had coped with my closeted life by binge drinking.

Instead of going back for another meeting, I decided to come out. It felt like I was losing everything I knew at that moment, so I figured I might as well start fresh.

Luckily, once I accepted my gayness, all my loved ones supported me unconditionally. Yet, my mid-twenties rolled around with a waiter from Galaxy Diner showing up at my home off-the-clock with my phone and wallet. After going to town on a burger and an omelet, I had left them tucked between the check. I had spent the entire morning ransacking my apartment without recollection of how the night had ended.

In an instant, I went from internally vowing to quit drinking — for real this time — to proudly sharing this anecdote with friends over cocktails the next evening.

"Well, was the delivery guy hot?!" one of them asked, and the rest laughed, showing no concern that I didn't know if I walked, crawled, or was escorted to bed. I had a knack for spending entire nights on autopilot and had mastered the Irish goodbye when it was time to go home and pass out.

The consensus was that getting too drunk could happen to anyone , so why did it keep happening to me?

Addiction runs rampant in America (about 10 percent of American adults suffer from Alcohol Use Disorder), exacerbated by a mental health crisis and a doom-filled news cycle. I was one of an incomprehensible number of fish struggling to swim in a sea of countless justifiable reasons to hit the bars. A toxic relationship with booze was the least unique thing about me, yet I felt determined to be the exception.

Alcoholism had a way of sweeping everything under the rug and stomping it flat.

So much of my life was spent worrying that the exposure of my gayness would impede my will to live; I couldn't grapple with the fact uttering "I'm gay" wasn't the spell that stopped blackouts. I wasted my youth struggling to conceal my identity that I arrived at adulthood as a stranger to myself and oblivious to the issues beyond.

As I struggled to get my drinking under control, I tried to be the opposite of the people I had seen at that one AA meeting. I dressed as fabulous as possible during the worst of my hangovers, as if being messy one night could be disguised with style the morning after. I became a people-pleaser, going out of my way to do favors and help friends in any way I could to atone for a drunken mishap that hadn't happened yet. I feigned memory when I had no clue what my friends were talking about. I swore off shots. I refused to chug cocktails. I never pregamed or drank at home or during the day, unless it was happy hour or brunch.

Approaching 30, I begrudgingly learned over and over again that there was a spectrum for alcoholism I couldn't escape. The minute I forgot to prioritize moderation with every sip and allowed myself to drink like an average person, all hell broke loose for belligerence.

"You're not an alcoholic," a media friend told me, whom I typically only drank with at industry events limited to a few hours. "Trust me, I'd know. My old roommate used to drink vodka from a tumbler cup on her way to work."

I shrugged and admitted that seemed like a more serious problem, too embarrassed to relive the worst of my mistakes. Alcoholism had a way of sweeping everything under the rug and stomping it flat — I could walk a straight line and prevent myself from stumbling if I knew it was under me.

I conflated control with mastering the appearance of my life, but I knew all too well I could put all the effort in the world into being something, and it wouldn't make it any easier or more permanent tomorrow. I always reasoned I didn't need alcohol to exist, so why was I doing everything in my power to avoid living without it?

Although I once kept a medley of secrets from my family, including pretending to attend college for an entire semester (my coming out was a double whammy), they were certain they would have noticed if I were an alcoholic. Shy of my 29th birthday, during a gathering with my mom and brothers, I came out again: "I'm an alcoholic."

"Don't say that," one of my brothers advised. "Don't manifest those words."

Mom acted as if I called myself a slur. She didn't drink and hated the concept of alcohol and drugs, but she didn't understand why I couldn't just stay sober without branding myself with such a "negative" term.

I remembered how my guts would quiver in high school when I heard someone say "faggot," as if saying the word aloud made it true. People seemed to have this idea of alcoholism as a sickness that required me to fit their mold of self-destructive behavior to qualify. The fact I could take a sip of wine without exploding into a bender meant I was fine.

A few months later, my self-identifying alcoholic friend Eric invited me to tag along to a Northside AA meeting in Brooklyn. Nearly a decade later, I was once again faced with people presumably like me, which my LGBTQ+ community helped me learn meant we were kindred in the struggle rather than the nuances of the journey.

"I've run out of mistakes to regret," a woman in her 40s said during the round circle, and it hit hard.

I didn't want to wait to collect moments of "rock bottom" like magnets on the fridge of my drunkenness. After all, rock bottom was a particular feeling rather than any situation. Opening my heart to their words, I saw the regret and shame that connected us as a community. The illness manifested differently in every story, but was rooted in a lack of control, a stream of excuses, and sobriety as the only solution.

Just as I once believed my gayness existed before my problematic drinking, there was neither the chicken nor the egg — the gay or the drinker. Just me. Coming out didn't change my life. Vocalizing it only granted me the permission to live and love freely, which brought me fulfillment. And I'd learn the same was true for my alcoholism.

When it comes to identity, words only have the power we give them and come alive how we honor them. Initially, I struggled to decide whether to tell my closest friends or wait until I overcame the dominos of brief relapses that followed my decision to quit. A few cocktails might've been harmless in theory, but it felt like a destructive buzzkill once I identified as an alcoholic.

My friends and family stepped up as allies when confronted with my gayness. What felt like a lifetime later, they became a mirror reflecting all the greatness I had to offer when I took off the armor and put down the drink.

Jamie Valentino is a Colombian-born freelance journalist and romance columnist published in the Chicago Tribune, the Houston Chronicle, Men's Journal, Reader's Digest UK, Vice, and more. Jamie has worked as a travel correspondent, covering the 2022 World Cup from Argentina, siesta culture in Barcelona, and the underground nightlife scene in Milan.

• Personal Essay