94 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 19, NO. 2, 2006 © The National Medical Journal of India 2006 Amrita Institute of Medical Sciences, Elamakkara P.O., Kochi 682026, Kerala, India SUBIR K. DAS, D. M. VASUDEVAN Department of Biochemistry V. BALAKRISHNAN Department of Gastroenterology Correspondence to SUBIR K. DAS; subirkumardas@medical.amrita.edu Medicine and Society Alcohol: Its health and social impact in India SUBIR KUMAR DAS, V. BALAKRISHNAN, D. M. VASUDEVAN ABSTRACT Alcoholic beverages have been used in human societies since the beginning of recorded history. The patterns of alcohol intake around the world are constantly evolving, and alcohol is ubiquitous today. Research has contributed substantially to our understanding of the relation of drinking to specific disorders, and has shown that the relation between alcohol consumption and health outcomes is complex and multidimensional. Increases in the average volume of drinking are predicted for the most populous regions of the world in Southeast Asia including India. Cultural differences apparently influence the pattern of alcohol consumption. In addition, alcohol is linked to categories of disease whose relative impact on the global burden is predicted to increase. Therefore, it is appropriate to implement policies with targeted harm reduction strategies. The crucial need, from a public health perspective, is for regular means of coordination whereby prevention of alcohol-related problems is taken fully into account in policy decisions about alcohol control and regulation in the market for alcoholic beverages. Natl Med J India 2006;19:94 9 INTRODUCTION Alcohol and tobacco are important products of the global addic- tive demand and have experienced a rapid increase in per capita consumption. The fastest growth has been in developing countries in the Asian subcontinent where the per capita pure alcohol consumption has increased by over 50% between 1980 and 2000. 1 Alcoholic beverages, and the problems they engender, have been familiar in human societies since the beginning of recorded history. Accompanying the near ubiquity of alcoholic beverages in human history has been an appreciation of the social and health problems caused by drinking. Whether in Greece, Palestine or China, ancient texts speak eloquently of such problems. Scientific attention to problems of alcohol consumption has increased dur- ing the past 30 years. Every major world religion has at least some strands that counsel abstinence from alcoholic beverages. Alcohol is no longer viewed as a threat to all, but rather to a small subclass of ‘alcoholics’ or, in today’s technical terms, people who are ‘alcohol dependent’. Alcohol is causally related to more than 60 medical conditions. 2 Overall, 3.5% of the global burden of disease is attributable to alcohol, which accounts for as much death and disability as tobacco and hypertension. 3,4 ALCOHOL AND GLOBAL BURDEN Taking into account both recorded and unrecorded consumption (Tables I and II), the highest amount of alcohol consumed per adult resident is in Europe, especially in Russia and its surround- ing countries, and in the established market economies of western Europe and North America. The least amount of alcohol con- sumed per resident is in the mostly Islamic regions of the Eastern Mediterranean and in the lesser developed region of Southeast Asia, dominated by India. Between the subregion with the highest estimated consumption level (Europe C) and the subregion with the lowest (Eastern Mediterranean D) the difference in consump- tion is more than 20-fold. 4 Indian scenario Although the recorded alcohol consumption per capita has fallen since 1980 in most developed countries, it has risen steadily in developing countries, alarmingly so in India. The per capita consumption of alcohol by adults ≥15 years in India increased by 106.7% between 1970–72 and 1994–96! 5 The pattern of drinking in India has changed from occasional and ritualistic use to social use. Today, the common purpose of consuming alcohol is to get drunk. 6 These developments have raised concerns about the health and the social consequences of excessive drinking. 7 SOURCES OF DATA Measuring alcohol use and alcoholic liver disease in an individual or a country has several limitations. Most studies rely on inter- views with patients and their families to estimate the amount, frequency and duration of alcohol consumption. However, pa- tients may not accurately report the quantity of alcohol they consume 8 and the definition of a ‘standard drink’ varies from country to country. 9 Studies of the incidence and prevalence of alcoholic liver disease, rather than decompensated cirrhosis alone, in the general population are difficult to conduct because patients with compensated liver disease usually do not seek medical attention. Financial constraints among patients suffering from excessive alcohol use may hamper the ability to obtain routine healthcare and further delay the diagnosis of alcoholic liver disease. Because of this, alcohol-related problems are usually not detected until hepatic decompensation occurs. 10 The adult per capita data are available from the Global Status Report on Alcohol 11 and the WHO Global Alcohol Database created by the Marin Institute for the Prevention of Alcohol and Other Drug Problems, and presently maintained by the Swiss Institute for the Prevention of Alcohol Problems. There are three principal sources of data for per capita estimates: national govern-