Alcoholic beverages have been used in human settlements for ages- their consumption was first documented in the Indus Valley civilisation between 3000-2000 BC.The two great Hindu epics Ramayan and Mahabharat also mention the use of alcohol.
Although, the recorded alcohol consumption per capita has fallen since 1980 in most developed nations, it has risen steadily inthe developing countries and alarmingly so in India. The pattern of drinking alcohol in India has changed from occasional and ritualistic use to being more frequently used in social gatherings. The useof alcohol is ubiquitous today.
According to a WHO report released in September 2018, the per capita alcohol consumption in India had increased two folds in a span of 11 years between 2005 and 2016.This raised concerns about the health and the social consequences of excessive drinking. India is the third largest alcohol consumer market in the world. A report published by Reserve Bank of India in September 2019 shows that excise and sales tax of liquor is the second or third largest sources of revenue of states and UTs within the country.The studies found consumption in northern India to be between 25-40% whereas in southern India, the prevalence of current use of alcohol varies between 33-50%, with a higher consumption among the lesser educated and the poor.
Alcohol abuse, also called alcohol misuse, is a serious problem. It is a pattern of drinking too much alcohol, too often. It interferes with your daily life. If a male consumes more than 14 drinks per week or more than four drinks per occasion; if women of any age and men older than 65 consume seven drinks per week or three drinks per occasion it is considered to be alcohol abuse. Binge drinking or heavy episodic drinking is a modern epithet for drinking alcohol with an intention of becoming intoxicated over a short period of time which brings a person’s blood alcohol concentration to 0.08 gm/dl or above. A study about prevalence of heavy episodic drinking among 15-19 years old in India in 2016 revealed that around 21.1% of males had drunk pure alcohol heavily on at least one occasion in the past 30 days.
Alcohol abuse mainly gives rise to behavioural problems.The people afflicted with alcohol abuse are paying a very heavy price in the form of deterioration of their physical, mental health, family relations, social relation and work related problems.Alcohol is also associated with criminal activities and many crimes are committed under the influence of alcohol. It is also a factor in cases of sexual abuse. On the social front alcoholics usually develop matrimonial discord and other family problems. An Indian scientific study published in 2016 revealed that prevalence of drinking in alcohol abusers varies from 27-37% during domestic violent episodes with married women.
At the work front, such persons usually lack very cordial relations with their co-workers and employer. Hence, many a time the need to undergo multiple change of jobs frequently especially in the private job sector. Employer and their co-workers perceive that heavy drinkers have lower performance, problems in personal relationships and lack of self-direction, though drinkers themselves do not necessarily perceive these effects on their performance. The authors have their own experience with an employee who regularly remained absent for two to three days after receiving salary and also used to steal money. In India 30% of the absentia from the duty is related with alcohol abuse. Because of their habit of daily spending on purchasing alcohol, most of them are under financial constraint.Hence, most of the time they are under debt, particularly, people from the lower socio economic strata.
Being orthopaedic surgeons, we see many road traffic accidents caused due to drinking and driving. Police must conduct regular checks on the roads to catch these miscreants. We have seen many complications of alcohol abuse in orthopaedic practice.
Avascular necrosis of the femoral head is the commonest orthopaedic complication for which the patient needs to undergo total hip replacement surgery which costs around Rs 2-3 lakh. The hundreds of patients of avascular necrosis (AVN) of femoral head who have been seen and interviewed by us, revealed that most of these patients got habituated to alcohol consumption at a young age. In general their hips are affected on an average of 10 years after the start of alcohol consumption of more than half a bottle or more.
Chronic alcoholism is the social evil which is the commonest cause of liver cirrhosis (liver scarring) and which had killed around 1.4 lakh people across India in 2016. Alcohol induced liver cirrhosis is the major indication of liver transplant in India which costs around Rs 20-30 lakh.
Drinking alcohol has become a social fashion particularly in urban and semi-urban areas particularly among the youth. Initially, the alcohol consumption was common in boys but now a day there is increasing trend of alcohol consumption among girls as well. During a drug de-addiction seminar last year, a senior police officer of Uttarakhand informed, that 16 % of students are affected with alcohol or drug abuse in Uttarakhand. The situation is grim in Dehradun especially in institutional areas where thousands of students are living. Most of these students are living in an unorganised way in small accommodations- hostels or as paying guest where their activities are overlooked.
We all make habits in our personal and professional life. It is an endless cycle running every moment when you are alive. We make habits which give pleasure and want to avoid the habit which gives us pain. Habit is something that you do often and almost without re-thinking. It is something that is hard to stop. If we analyse the cause of alcohol abuse then an important cause of abuse seems to be availability of alcohol, peer pressure and loneliness. Alcohol abuse is a habit which is formed usually in teenage. College going students particularly those who are living in the hostels away from their families are more prone to get into the trap of forming the habit of alcohol consumption and drug abuse. During teenage, there is a surge of hormones in the body which induces them in adventurous activities including tasting alcohol either due to peer pressure or trying out new things.
The increasing trend of lavish birthday parties in society in general and increasing trend of fresher's and farewell parties among college going students is a common trend which also is an important cause of giving an opportunity to taste alcohol for the first time in their life. Once the habit of alcohol abuse is formed, it is very difficult to get rid of it, as it is said, old habits die hard. The trend of welcome and farewell party should be conducted within the college campus not in hotels or any other commercial places and supervised by the college authorities, the parents or elder people especially if there is any provision of alcohol.
(The writers are orthopaedic surgeons based in Dehradun)