Alcohol Dependency Assignment

Name- Ridhimaa Devlal

Roll no- 20528045

Aim-
The aim of the test is to assess the dependence level of people on alcohol.

Introduction-
Substance and Substance related disorders
Throughout history, people have used a variety of chemical substances to alter their mood,
level of consciousness, or behaviour. These substances can lead to addiction or acute
psychiatric symptoms. Their use is considered to be disordered when consumed in excessive
amounts leading to impairment and other negative consequences. Substance-related disorders
arise when psychoactive substances—substances that alter moods, thought processes, or other
psychological states—are used excessively. Addiction involves compulsive drug-seeking
behaviour and a loss of control over drug use. Withdrawal symptoms may also occur which
are negative psychological and physiological effects such as shaking, irritability, or emotional
distress—that occur when use is discontinued (Koob et al., 2014).
People with substance use disorder often show tolerance and/or withdrawal. Tolerance refers
to the need to ingest greater and greater quantities of a drug to achieve the same effect.
Someone who regularly drinks three beers a day will find over time that the same
physiological “high” from this amount no longer exists. The person must thus drink more
beer or switch to another, more powerful drug to achieve the same effect. Withdrawal refers
to maladaptive behavioural changes when a person stops using a drug.

Substance Dependence:
Drug dependence is usually described as addiction. Although we use the term addiction
routinely when we describe people who seem to be under the control of drugs, there is some
disagreement about how to defi ne addiction, or substance dependence (Strain, 2009). In one
definition, the person is physiologically dependent on the drug or drugs, requires
increasingly greater amounts of the drug to experience the same effect (tolerance), and will
respond physically in a negative way when the substance is no longer ingested (withdrawal)
(American Psychiatric Association, 2007).
Another view of substance dependence uses the “drug-seeking behaviors” themselves as a
measure of dependence. The repeated use of a drug, a desperate need to ingest more of the
substance (stealing money to buy drugs, standing outside in the cold to smoke), and the
likelihood that use will resume after a period of abstinence are behaviors that defi ne the
extent of drug dependence. Such behavioral reactions are different from the physiological
responses to drugs we described before and are sometimes referred to in terms of
psychological dependence. Definition of substance dependence combines the physiological
aspects of tolerance and withdrawal with their behavioral and psychological aspects
(American Psychiatric Association, 2000c). This definition of dependence must be seen as
a “work in progress” as many people can be considered dependent on such activities as sex,
work, or even eating chocolate. What most people consider serious addiction to drugs is
qualitatively different from dependence on shopping or television.

Alcohol abuse:
The terms alcoholic and alcoholism have been subject to some controversy and have been
used differently by various groups in the past. The World Health Organization (WHO) no
longer recommends the term alcoholism but refers instead to the harmful use of alcohol
—“drinking that causes detrimental health and social consequences for the drinker, the
people around the drinker and society at large, as well as the patterns of drinking that are
associated with increased risk of adverse health outcomes” The WHO, as well as researchers
in this area, also refer to heavy episodic drinking as the consumption of six or more
alcoholic drinks on at least one occasion at least once per month (WHO, 2014a).
The potentially detrimental effects of excessive alcohol use are enormous. Heavy drinking is
associated with vulnerability to injury (Cherpitel, 1997), marital discord (Hornish &
Leonard, 2007), and becoming involved in intimate partner violence (Eckhardt, 2007). The
life span of the average person with alcohol dependence is about 12 years shorter than that of
the average person without this disorder. Alcohol abuse is associated with over 40 percent of
the deaths suffered in automobile accidents each year (Chou et al., 2006) and with about 40
to 50 percent of all murders (Bennett & Lehman, 1996), 40 percent of all assaults, and over
50 percent of all rapes (Abbey et al., 2001).
Alcohol’s effects on brain:
Alcohol has complex effects on the brain. At lower levels, alcohol activates the brain’s
“pleasure areas,” which release endogenous opioids that are stored in the body (Braun,
1996). At higher levels, alcohol depresses brain functioning, inhibiting one of the brain’s
excitatory neurotransmitters, glutamate, which in turn slows down activity in parts of the
brain (Koob et al., 2002). Inhibition of glutamate in the brain impairs the ability to learn and
affects the higher brain centers, impairing judgment and other rational processes and
lowering self-control.

The physical effects of chronic alcohol use:

Alcohol that is taken in must be assimilated by the body, except for the approximately 5 to
10 percent that is eliminated through breath, urine, and perspiration. The work of alcohol
metabolism is done by the liver, but when large amounts of alcohol are ingested, the liver
may be seriously overworked and eventually suffer irreversible damage (Lucey et al., 2009).
In fact, from 15 to 30 percent of heavy drinkers develop cirrhosis of the liver, a disorder that
involves extensive stiffening of the blood vessels.
Psychosocial effects of alcohol abuse and dependence:
In addition to physical and medical problems, heavy drinkers often suffer from chronic
fatigue, oversensitivity, and depression. Initially, alcohol may seem to provide a useful
crutch for dealing with the stresses of life, especially during periods of acute stress, by
helping screen out intolerable realities and enhance the drinker’s feelings of adequacy and
worth. The excessive use of alcohol eventually becomes counterproductive, however, and
can result in impaired reasoning, poor judgment, and gradual personality deterioration.

The extensive problem of substance abuse and substance dependence in our society has
drawn both public and scientific attention. Although our present knowledge is far from
complete, investigating these problems as maladaptive patterns of adjustment to life’s
demands, with no social stigma involved, has led to clear progress in understanding and
treatment. Such an approach, of course, does not mean that an individual bears no
personal responsibility in the development of a problem. On the contrary, individual
lifestyles and personality features are thought by many to play important roles in the
development of substance-related disorders and are central themes in some types of
treatment.
Substance-related disorders can be seen all around us: in extremely high rates of alcohol
abuse and dependence, and in tragic exposés of cocaine abuse among star athletes and
entertainers. Addictive behaviour—behaviour based on the pathological need for a
substance—may involve the abuse of substances such as nicotine, alcohol, Ecstasy, or
cocaine. Addictive behaviour is one of the most prevalent and difficult-to-treat mental
health problems facing our society today.
The most used problem substances are those that affect mental functioning in the central
nervous system (CNS)— psychoactive substances: alcohol, nicotine, barbiturates,
tranquilizers, amphetamines, heroin, Ecstasy, and marijuana. Some of these substances,
such as alcohol and nicotine, can be purchased legally by adults; others, such as barbiturates
or pain medications like OxyContin (or marijuana in some states), can be used legally under
medical supervision; still others, such as heroin, Ecstasy, and methamphetamine, are illegal.
Alcohol related disorders-:
The terms alcoholic and alcoholism have been subject to some controversy and have been
used differently by various groups in the past. The World Health Organization no longer
recommends the term alcoholism but prefers the term alcohol dependence syndrome— “a
state, psychic and usually also physical, resulting from taking alcohol, characterized by
behavioural and other responses that always include a compulsion to take alcohol on a
continuous or periodic basis in order to experience its psychic effects, and sometimes to
avoid the discomfort of its absence; tolerance may or may not be present”
People of many ancient cultures, including the Egyptians, Greeks, Romans, and Israelites,
made extensive and often excessive use of alcohol. Beer was first made in Egypt around
3000 b.c. The oldest surviving wine-making formulas were recorded by Marcus Cato in Italy
almost a century and a half before the birth of Christ. About a.d. 800, the process of
distillation was developed by an Arabian alchemist, thus making possible an increase in both
the range and the potency of alcoholic beverages. Problems with excessive use of alcohol
were observed almost as early as its use began. Cambyses, King of Persia in the sixth century
b.c., has the dubious distinction of being one of the early alcohol abusers on record.
Gambling Disorder:
Although pathological gambling does not involve a chemically addictive substance, it is
considered by many to be an addictive disorder because of the personality factors that tend to
characterize compulsive gamblers (Petry & Madden, 2010). Like the substance abuse
disorders, pathological gambling involves behaviour maintained by short-term gains despite
long-term disruption of an individual’s life. There is a high comorbidity between
pathological gambling and alcohol abuse disorders (Blanco, Cohen et al., 2010) and with
personality disorders (Sacco et al., 2008). Pathological gambling, also known as
“compulsive gambling” or disordered gambling, is a progressive disorder characterized by
continuous or periodic loss of control over gambling, a preoccupation with gambling and
with obtaining money for gambling, and continuation of the gambling behaviour in spite of
adverse consequences.
Estimates place the number of pathological gamblers worldwide at between 1 and 2 percent
of the adult population (Petry, 2005). Both men and women appear to be vulnerable to
pathological gambling (Hing & Breen, 2001). However, rates differ by subpopulation; for
example, in some high-risk populations, such as alcoholics, the rates are higher. One study of
elderly African Americans from two senior citizen centres documented the extent of
gambling problems in this population; 17 percent were found to be people with gambling
disorders (Bazargan et al., 2001). Pietrzak and colleagues (2007) found that older, disordered
gamblers were significantly more likely than nongambling older adults to have alcohol-
abuse problems, nicotine addiction, and health problems.

Cultural factors also appear to be important in the development of gambling problems.

Pathological gambling is a particular problem among Southeast Asian refugees, especially
those from Laos. Surveys of mental health problems have reported almost epidemic
compulsive gambling among such groups (Aronoff, 1987; Ganju & Quan, 1987). Gambling
in our society takes many forms including casino gambling, betting on horse races or sports
(legally or otherwise), Internet gaming, numbers games, lotteries, dice, bingo, and cards.
Pathological gambling seems to be a learned pattern that is highly resistant to extinction.
Some research suggests that control over gambling is related to duration and frequency of
playing (Scannell et al., 2000). However, many people who become pathological gamblers
won a substantial sum of money the first time they gambled; chance alone would dictate that
a certain percentage of people would have such “beginner’s luck.” The reinforcement a
person receives during this introductory phase may be a significant factor in later
pathological gambling. Because everyone is likely to win from time to time, the principles
of intermittent reinforcement—the most potent reinforcement schedule for operant
conditioning—could explain an addict’s continued gambling despite excessive losses.
Epidemiology:

● Epidemiology of Alcohol 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.
● Epidemiology of alcohol related disorder in the United States according to DSM 5. In the
United States , It is estimated that 50 percent of adults who are 18 or older are current
regular drinkers and only 21 percent are lifetime abstainers (Pleis et al., 2009) In 2008,
23.3 percent of Americans aged 12 or older reported binge drinking, and 6.7 percent were
found to be heavy drinkers (Substance Abuse and Mental Health Services Administration
of alcohol 2010). An estimated 12.4 percent of persons 12 or older drove under the
influence of alcohol at least once over the past year. An estimated 22.2 million persons
(8.9 percent of the population injury was aged 12 or older) were classified with substance
dependence 12 month or abuse in the past year based on DSM diagnostic criteria. In this
dependent sample(3.1 million people were classified with dependence on of emergence
abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit
drugs but not alcohol, and 15.2 million were deaths s dependent on or abused alcohol but
not illicit drugs (Substance Abuse and Mental Health Services Administration, 2009.
The potentially detrimental effects of excessive alcohol use for an individual, his or her
loved ones, and society-are legion. Heavy drinking is associated with vulnerability to
injury (Cherpitel 1997), marital discord (Hornish & Leonard, 2007), becoming involved
in intimate partner violence (Eckhardt, abu 2007). The life span of the average person
with alcohol dependence is about 12 years shorter than that of the average person
without this disorder. Alcohol significantly lowers performance on cognitive tasks such
as problem solving and the more com plex the task, the more the impairment (Pickworth
et al., 1997). Organic impairment, including brain shrinkage, occurs in a high proportion
of people with alcohol dependence (Gazdzinski et al., 2005), especially among binge
drinkers-people who abuse alcohol following periods of sobriety (Hunt, 1993).
The alcohol usage depends on a large number of factors like peer pressure, liquor
policies in the states, in some states where there is leniency in usage of alcohol,
 consumption there is high. Also it depends on the socio cultural factors like in some
cultures it is taken normal to drink alcohol where as in some its not. At the national
level: In India, alcohol consumption is widespread across all the states and the union
territories (UT), and an estimated 160 million consume alcohol (13). According to
National Family Health Survey-4 (NFHS-4), 29.2 men and 1.2% women consume
alcohol (14). Alcohol use in India is estimated to cause an annual average loss of
1.45% of the gross domestic product (GDP) of the economy (15). India does not have
a solid national policy on alcohol consumption, and its use is regulated at the level of
individual states and UT, that’s why the consumption is so high.
Gender differences-
Alcoholic beverages have been a part of social life for millennia, yet societies
have always found it difficult to understand or restrain their use. A central theme
is that to better understand alcohol consumption and its consequences, we need to
better understand social and cultural influences on the differences between men
and women. That theme deserves careful and detailed attention for several
reasons.

First, compared with women throughout the world, men are more likely to drink,
consume more alcohol, and cause more problems by doing so. This gender gap is
one of the few universal gender differences in human social behavior. It is evident
in all areas of the world (Almeida-Filho et al., 2004; Degenhardt et al., 1997;
McKee et al., 2000; Perdrix et al., 1999; Rijken, Velema, & Dijkstra, 1998; Sieri
et al., 2002), in drinking versus abstinence (Mohan, Chopra, & Sethi, 2002;
Peltzer, 2002), in heavy drinking and intoxication (Gmel, Rehm, & Kuntsche,
2003; Higuchi et al., 1994; Siegfried et al., 2001), and in alcohol use disorders
(Jhingan et al., 2003; Kebede & Alem, 1999; Yamamoto et al., 1993). The gender
gap has varied but persisted for a long time, at least in European history (Martin,
2001; Plant, 1997; Sandmaier, 1980; Warner, 1997) and in the traditions of many
pre-industrial societies elsewhere (Child, Barry, & Bacon, 1965; Seale et al.,
2002; Suggs, 2001; Willis, 2001).

Research has suggested several possible reasons why universal gender differences
in drinking behavior might arise. For example, if women have lower rates of
gastric metabolism of alcohol than men (Baraona et al., 2001; Frezza et al.,
1990; Thomasson, 1995) or smaller volumes of body water in which alcohol is
distributed (Mirand & Welte, 1994; York & Welte, 1994), women may need to
consume less alcohol than men to derive the same effects. Or, women may be
more likely than men to experience unpleasant acute ef ects from alcohol (such as
hangover symptoms) (Slutske et al., 1995, 2003), or may not enjoy risky and
poorly controlled behavioral effects of alcohol as much as men (Hill & Chow,
2002).

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.

In the latest views it is assume that 3 million deaths occur due to the consumption
of alcohol every year in india. Approx 40 percent of road accidents occur in India
due to alcohol consumption. According to the recent studies the of family health
survey for 2019 and 21 suggested that 22% men consume alcohol the overall
consumption of the alcohol is higher in the rural areas and especially in the north
east and belt of the country. Women who drink alcohol in comparison to men is
less. The most of the states where women consume alcohol is Arunachal Pradesh
that is 18%, then comes Sikkim 15% , whereas for men the highest rate of alcohol
consumption is in Goa which is 59% then Arunachal Pradesh 57% Telangana
50% and lowest in Lakshadweep 1 %.

Alcohol consumption and related problems have risen substantially in many

Asian countries including India over the last several years. Alcohol related
disorders are increasingly being reported in India. Benegal (2005) in a review of
literature found a significant lowering of age at initiation of drinking in a sample
from Karnataka which also showed a drop from a mean age of 28 years to 20
years between the birth cohorts of 1920-30 and 1980-90. He asserted that alcohol
consumption had visibly increased in the non traditional segments of urban
women and young people, with a noticeable upward shift in rates of drinking
among urban middle and upper socio-economic sections.

According to the social learning perspective, an individual’s beliefs about the effects of
alcohol, referred to as alcohol expectancies, influence the likelihood that alcohol will be
consumed. Expectancies are defined as “the anticipation of a systematic relationship
between events or objects in a future situation”. Expectancies are involved in the onset
and maintenance of alcohol consumption during adolescence and are related to different
consumption patterns of drinking not only during this period but also in adulthood
(Goldman, Brown, & Christiansen, 1987). Goldman, Brown, Christiansen, and Smith
(1991) opined that the study of expectancies together with other variables such as gender,
age, and circumstances surrounding consumption could contribute to greater knowledge
of risk factors for alcohol use.
Gustafson (1993) found that men and high consumers had stronger expectancies and
rated these effects as more desirable than did women and low consumers. In a more
detailed study, Read, Wood, Lejuez, Palfai and Slack (2004) examined gender
differences in alcohol expectancies. They sought to delineate associations among
gender, alcohol quantity and alcohol expectancies in a sample of college drinkers,
using measures that assessed different expectancy dimensions, accessibility,
endorsement, and subjective evaluation
Findings of significant alcohol use among college students in a study by
NIMHANS, Bangalore are similar to the findings reported by Paul (1999). In her
study on alcohol use among college students, she found that 40% of 731 students in
Bangalore City colleges reported having used alcohol in the past. Sukhwal and
Suman (2008) also reported that alcohol use was fairly common among
undergraduate college students in Bangalore. In their study on alcohol related
beliefs on a sample of 236 students in the age range of 18 to 21 years, they found
that 48.30% boys and 33.30% girls had initiated alcohol use. Gender differences in
attitude towards alcohol found in the present study were also in line with earlier
studies (e.g. Sukhwal & Suman, 2008). The less favourable attitude towards alcohol
by girls in the present study might be due to dif erences in socialization of boys and
girls. Drinking alcohol by girls is generally unacceptable in Indian culture while
drinking by boys is more often tolerated.

While alcohol researchers in India, by and large, have ignored the subject of female
drinkers, the alcohol industry has not. A study on the emerging beverage alcohol market
in India, undertaken by the Rabobank group, clearly spells out that “the consumer base
for alcohol in India will gradually expand. The target segment (men between the ages of
20 and 59), estimated to be around 23% of the Indian population, is expected to grow by
3.4% annually, to 260 million by the year 2006. Taken together with the socio-economic
changes that are occurring, this makes India one of the most attractive markets for
overseas investors. There are also many potential consumers to be found in other
segments of the population. The introduction of new products such as flavoured and
mild alcoholic products aimed to recruit non drinkers and is targeted primarily at
women” (Naik, 2002).
Alcohol and violence:
Forty per cent of all males in the total sample and 22% of all women respondents
reported solving disagreements by physical fights or long lasting quarrels more than
several times a week. Fifty per cent of the male drinkers and 40% of the female drinkers
said that they became more aggressive towards other people after drinking. Twenty seven
per cent of female drinkers and only 9% of male drinkers reported that their
spouse/partner had been drinking more often than not, most of the time or all the time
that they had quarreled in the past year. Sixteen per cent of male drinkers and 3% of the
female drinkers reported getting into fights after drinking in the past year. Expectedly
enough, more male users (45.7%) reported quarreling more than several times a month
than male abstainers (35.6%). But among women, there appeared to be an inverse
relationship between drinking status and frequent quarreling (2.9% of female users,
compared to 5.9% of female abstainers).
Drinking is associated with pleasure, leisure and reward. Chronic stress has also been
shown to play a pivotal role in the continued alcohol abuse by addicts (Koob and Le
 Moal, 2001; Sinha, 2001). In human alcohol addiction, one of the essential factors
underlying addiction is a need for mood enhancement or relief from stress. As the stress-
and reward-systems in the brain are influenced by sex hormones, the development of
alcohol dependency, and approaches to recovery, may also be sex dependent and exhibit
sex disparity. Although men have a greater tendency toward alcoholism than women,
(Isralowitz et al., 2009; Tadic et al., 2009).
Evidence has demonstrated a greater incidence of alcohol-related damage, especially
neurological damage, in women. Though heavy drinking is less prevalent among women,
it can also be more damaging because drinking during pregnancy leads to increases in
prenatal ethanol exposure, which may cause severe permanent birth defects, including
neurotoxicity (Mancinelli et al., 2009). It is worth mentioning that the U-shaped
relationship can be found for both sexes with regards to the overall health prevalence. For
example, the relative risk for type 2 diabetes in men is protective when consuming 22
g/day alcohol and becomes deleterious at > 60 g/day compared with lifetime abstainers.
In women, consumption of 24 g/day alcohol is considered most protective and becomes
deleterious at > 50 g/day compared with lifetime abstainers (Baliunas et al., 2009).
Recent epidemiological study revealed a trend of alcohol use starting at early ages. One
recent study in adolescents reveals that certain biological and psychosocial factors impact
boys and girls in similar ways (Schulte et al., 2009). However, the two sexes quickly
diverge when it comes to both behavioral and physiological responses to alcohol. Boys
have a greater risk for disruptive drinking because of a low response to alcohol, later
maturation in brain structures and socialization toward heavier drinking. On the other
hand, courtesy of the stereotypical female characteristics, girls tend to have reduced
alcohol involvement. In adulthood, sex difference in response to alcohol is more
dramatic. According to data from “National Institute on Alcohol Abuse and Alcoholism”
female alcoholics have greater death rates than male alcoholics. Women alcoholics
experience an increased risk for liver diseases, circulatory disorders, breast cancer,
fertility impairment and early menopause.
Data in Indian context-
The tendency of substance usage behaviours to alter over time is well known. Both licit
and illicit drug usage have substantial negative effects on public health, and our nation
now has ample proof of this. Numerous substances of abuse have national level
prevalence estimates, although regional variances are quite noticeable. Rapid evaluation
surveys have made it easier to comprehend how usage patterns are evolving. Concerns
about substance usage among mothers and kids are growing. The goal of early
neurobiological research has been to identify those who are most susceptible to
alcoholism. Clinical studies in the field have mostly concentrated on comorbidity caused
by alcohol and other drugs. The amount of research on pharmaceutical and psychosocial
therapies is unfortunately small. Studies on the course and outcomes highlight the need
for improved follow-up in this group. A lot still needs to be done on the ground to prevent
and address the spectrum of problems brought on by substance use, despite the constant
criticism of the lack of a comprehensive policy and the many ideas given. It is projected
 that after the journal achieved "indexed" status, the number of papers on drug-related
research will rise in the Indian Journal of Psychiatry.

A study on Alcohol consumption during pregnancy among tribal women in India was
done by Pranab Mahapatra, Sanghamitra Pati, and Krushna Chandra Sahoo (Journal
of Indian Psychiatry) which aimed To explore the views and beliefs regarding
homemade alcoholic brew (Handia) by tribal women of Santal and Munda of
sundergarh district , odisha. The results of the study showed Majority women did not
perceive alcohol as
harmful even during pregnancy owing to its homemade nature. Further, the symbolic
offering of alcohol during rituals and family drinking has made it a normative behavior
with intergeneration transmission. Moreover, the emic and etic beliefs on alcohol's
benign nature and health benefits along with the explanatory models of its adoption
influence what is “perceived” and “entails” as “harmful” or “problem use” of alcohol.
Some pregnant women though were cognizant of the potential effects on the unborn
child; however, expressed their inability to quit.Thus, the inextricable weaving of
“alcohol drinking” into the tribal sociocultural fabric and deep embeddedness within
indigenous health belief ecosystem makes “problem alcohol use” a daunting behavioral
challenge to address in these populations.
Another study by By V. M. Anantha Eashwar, R. Umadevi, and S. Gopalakrishnan
(Journal of Family medicine and primary care) on alchohol consumption in india
revealed that 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.
Liquor policy in India-
Alcohol laws have always been a matter of debate from time to time. Drinking alcohol
comes under the legal ethics of various individuals. India is a country of huge diversity,
therefore perceptions of society also differ based on location, caste, gender, and moral
values. In India, the business of liquor remains one of the most regulated domains where
rules vary from state to state. In India, there is no uniformity with respect to liquor laws and
it varies from one State to another, be it the legal drinking age or the laws which regulate the
sale and consumption of alcohol. These variations in the prices and laws revolving around
alcohol are due to the inclusion of the subject of alcohol in the State list which comes under
the Seventh Schedule of the Constitution of India.
The drinking laws also list down the places where alcohol can be sold in the States. Where
in some States, liquor may be sold at groceries, departmental stores, banquet halls, and/or
farmhouses, some tourist areas having special laws that allow the sale of alcohol on beaches
and houseboats. Some states even ban the sale of liquor in its entirety.

Alcohol Laws in India:

• The legal drinking age in India and the laws which regulate the sale and
consumption of alcohol vary significantly from state to state.
• In India, consumption of alcohol is prohibited in the states of Bihar,
Gujarat, Nagaland and Mizoram.

• There is partial ban on alcohol in some districts of Manipur.

• All other Indian states permit alcohol consumption but fix a legal drinking age, which
ranges at different ages per region.

• In some states the legal drinking age can be different for different types of
alcoholic beverage.

Regulation:

• Alcohol is a subject in the State List under the Seventh Schedule of the
Constitution of India.

• Therefore, the laws governing alcohol vary from state to state.

• Liquor in India is generally sold at liquor stores, restaurants, hotels, bars, pubs,
clubs and discos but not online.

• Some states, like Kerala and Tamil Nadu, prohibit private parties from owning
liquor stores making the state government the sole retailer of alcohol in those states.

• In some states, liquor may be sold at groceries, departmental stores, banquet

halls and/or farm houses.
 • Some tourist areas have special laws allowing the sale of alcohol on beaches
and houseboats.

Drunken Driving Laws:

• The blood alcohol content (BAC) legal limit is 0.03% or 0.03 mg alcohol in 100 ml
blood.

• On 1 March 2012, the Union Cabinet approved proposed changes to the

Motor Vehicle Act.

• Higher penalties were introduced, including fines from ₹2,000 to ₹10,000

and imprisonment from 6 months to 4 years.

• Different penalties are assessed depending on the blood alcohol content at the time
of the offence.

Further, if the offence of drinking and driving is repeated by the offender within three years
of the commission of the previous similar offence, then the offender shall be punished with
imprisonment for a term which may extend to two years, or with a fine which may extend to
three thousand rupees, or with both. Moreover, negligent and rash driving (which includes
driving under the influence of alcohol) is a criminal offence and punishable under the Indian
Penal Code, 1860 (Section 279).

Consuming alcohol at public places will attract a fine of Rs 5,000 and if the offender
creates nuisance than the fine shall be up to Rs 10,000 with a jail term of three months.

Dry Days:

• Dry days are specific days when the sale of alcohol is not permitted.

• Most of the Indian states observe these days on major national

festivals/occasions such as Republic Day (26 January), Independence Day (15
August) and Gandhi Jayanti (2 October).
 • Dry days are also observed during elections in India.
The following is the list of the states which are known as the “DRY STATES”
where there is a prohibition -

GUJARAT- The sale and consumption of liquor have been banned in the State
since 1960. Only the non-residents of Gujarat can apply for limited Liquor Permits.

BIHAR- A total ban on alcohol was introduced in the State on April 4, 2016.
NAGALAND- The sale and consumption of alcohol have been banned since 1989.
MANIPUR – Partial prohibition of alcohol has been observed in the State since 2002.
LAKSHADWEEP- Consumption of liquor is only permitted in the island of
Bangaram.
Taxation on Alcohol:
• Most states levy either Value added Tax (VAT) or Excise duty or both.

• Excise duty is a tax levied to discourage the consumption of a product.

• It is calculated on a per-unit basis. Meaning, if you buy 1 litre of liquor, you pay a
fixed excise duty of Rs 15.

• Value-added Tax is charged in the proportion of the product. If a bottle costs Rs

100, and the state levies 10 percent VAT, the price rises to Rs 110.

• Alcohol which is not meant for consumption but utilized in industries

attracts an 18% GST tax.

Tax rates in states

• The 28 states/UTs in India approach liquor taxation differently.

• For instance, Gujarat has banned its citizens from consuming liquor since 1960.
But outsiders with special licenses can still buy.
 • Pondicherry, on the other hand, earns most of its revenue from alcohol trading.

• Bihar has prohibited alcohol consumption entirely, meaning the state’s revenue from
liquor consumption is nil. Its neighbor, Uttar Pradesh, earns the most excise duty on
liquor.

• The state does not levy VAT but a special duty on liquor, collecting funds
for particular purposes.

Andhra Pradesh, Telangana, Kerala, Karnataka, and Tamil Nadu consume as much as
45 percent of the liquor sold in the country.

Nationally, Maharashtra charges the highest rate but draws only a portion of its revenue
from its sales.

Legal age for Purchase and Drinking of Alcohol:

The Constitution of India under Article 47 has empowered each state to bring out the
prohibition of the consumption of intoxicating drinks and of drugs that are injurious to
health, except for medicinal purposes. Each state has enacted different laws for liquor
consumption and/or purchase, where some have completely banned it, others have enforced
prohibition up to a certain age limit.

The permitted age prescribed by the law for consumption and purchasing of alcohol is
different in each State. It is pertinent to note that there is also a difference in the legal age to
purchase and the legal age to consume alcohol within a State. In a lot of States, it is assumed
that both the permitted ages are the same; however, there exists a difference. In most states,
if you're an adult you are eligible to buy liquor, however, to be able to consume the same the
permitted age differs from 18 years to 25 years.

Change in Liquor Policy post Covid –19-

The Covid-19 pandemic has continued to impact India since its arrival in spring last year.
The government initially reacted by imposing a national lockdown from 23rd March to 4th
May in year 2020. The on-trade was completely closed, as were most liquor shops in every
state. Places of work shut down, so many young office workers left the urban centres. With
the on-trade stifled, retail purchases and consumption of beverage alcohol at home became
the norm in most mainstream categories. In India, however, women and younger consumers
still feel uncomfortable drinking in front of more conservative parents and family members at
home. Limitations on space and refrigeration favoured spirits over beer, RTDs and –
especially for young urban women – wine, all of which are usually consumed cold.

The implications of the pandemic response for India’s status as a federal republic soon
became clear. The importance of excise duty income from alcohol, tobacco and fuel was
brought into sharp relief as revenue streams dried up and the diminishing income from
national taxes, such as GST, were used to offset fiscal shortfalls at state level. Most states
responded by increasing excise duties – often suddenly and steeply – as well as charging
taxpayers one-off cess payments, commonly levied by central governments for a specific
purpose. Unusually, this cess (tax on tax), commonly levied by central government for a
specific and clearly defined purpose (and not shared with state governments), has been
applied in a number of instances at state level as a Corona-cess. Some states have been more
reluctant than others to review, reduce or cancel such supposedly temporary measures. For
instance, Andhra Pradesh – where the government had tried to enforce prohibition before the
pandemic – imposed a 75% excise duty increase for two days just as the national lockdown
ended last May; and on the same day, Delhi imposed a 70% cess on the maximum retail price
(MRP) of all liquor, which remained until 7th June.

The timing of the lockdown could not have been worse, especially for beer. The category
relies on young urban drinkers and after-work occasions and its peak season for consumption
was about to start. When lockdown ended, bars and restaurants re-opened in most states, but
were limited to 50% occupancy, and workers were slower to return to offices. Many are still
working from home or – during Q1 2021 – have returned to it.

Compared to some countries, where citizens often remained risk-averse and pessimistic after
the first lockdown, Indian consumer confidence seemed to bounce back quickly. Many
Indians
assumed – wrongly – that their everyday hygiene challenges afforded them a high degree of
natural immunity to the coronavirus.

The past year has confirmed that India is squarely a brown spirits market. Whisky absorbs
two-thirds of consumption in this market; brandy – with a strong presence in the south – takes
20%; and rum takes around half of that. In a total market that has shrunk by around one-fifth,
whisky declined only slightly less than brandy and rum, which fell around one-quarter. Beer
and RTDs suffered precipitous falls, deprived of many of the venues and occasions that had
driven consumption forward. All clear spirits witnessed steeper declines in consumption than
dark spirits: in each category, sales of domestically produced brands bottled in India (BII) fell
away faster. Even allowing for the experimentation evident in categories such as Irish
whiskey, consumers sought out brands that they knew, had earned equity and had consistent
quality. In short, they sought out certainties.

Change in supply and consumption:

A growing spurt in post-pandemic social gatherings and socialising is seeing an uptick in

food and beverages consumption, boosting alcohol sales in India. Consumers are also
switching from beer to brown liquor like whisky, rum, brandy and scotch on budgetary and
health concerns, industry experts say.

Indians have been getting out in droves to socialise in restaurants, clubs, pubs and bars –
making up for all the lost social interactions after the Covid-19 pandemics forced isolation.
Indian alcohol beverage market is the third largest market in the world after China and USA
by volume. This market is projected to grow at 11% per annum in value terms in 2021-
2025, while by volume it is projected to cross 1200 million cases by 2025.
The New Liquor Policy-

The Delhi Excise Policy 2021-22 was proposed by the Kejriwal-led AAP govt in November
2021.Under this policy, the government withdrew from the alcohol business and allowed
only private operators to run liquor shops. Delhi was divided into 32 zones inviting firms to
bid for a license. 849 retail vendors were issued licenses through an open bidding exercise by
the Excise department, which is headed by Sisodia. On paper, the policy seemed beneficial
for customers. These were the policy perks for customers:

1. Discounts for retail customers

2. Number of dry days was brought down to three

3. Drinking age was lowered from 25 to 21

4. Shops could stay open till 3 am

5. Provision was made for home delivery of liquor

Effect of liquor policies on severity of alcohol-

Research provides evidence on the effects of alcohol regulation on alcohol consumption

and associated public health outcomes using detailed individual level and aggregate data
from India, where state-level laws regulating the minimum legal drinking age generate
substantial variation in the availability of commercially produced alcohol across people
of different ages. We find that despite significant law evasion, men who are legally
allowed to drink are substantially more likely to consume alcohol. Further, men who are
legally allowed to drink are significantly more likely to commit violence against their
partners, suggesting a causal channel between alcohol consumption and domestic
violence. These results are robust to the exclusion of states with prohibition, implying
that they are driven by differences in MLDA. We also examine the effects of alcohol
regulation on other public health outcomes. Consistent with the existing literature, we
find evidence that smoking and drinking are complements. Finally, we provide
suggestive evidence that stricter alcohol control is associated with lower rates of motor
vehicle accidents and crimes against women, but not other forms of crime.

A number of states prohibit alcohol consumption altogether, and in others, the minimum
legal drinking age (MLDA) varies from 18 to 25 years old. In contrast, previous studies in
Western countries have relied on narrower bands of MLDAs: 21 in the USA, 18 or 19 in
Canada, 18 in Mexico, or 16 to 18 in Europe (Carpenter and Dobkin 2011). This wider
variation allows us to better isolate the impact of the alcohol regulation from the effect of
biological aging or other policy factors. Further, as in many recently developed and
developing countries, Indian alcohol policies are still in flux. For example, the state of
Mizoram removed prohibition in 2014, the state of Kerela started phasing in prohibition in
the same year, and the state of Bihar began enforcing prohibition in 2016. In addition, high-
profile cases of drunken driving, murders, and violence against women in India have
recently received worldwide attention, with the popular narrative focusing on alcohol
consumption and the need for policy interventions.

Data confirm that a large fraction of men under the legal drinking age consume alcohol. In
spite of non-trivial law evasion, however, by comparing the prevalence of alcohol
consumption among men above and below the drinking age in the same state, and men of the
same age across states with different age restrictions governing alcohol sales, we find that
regulations reducing access to alcohol are associated with substantive reductions in the
consumption of the good in question. Indeed, our results demonstrate while legal access does
not determine alcohol consumption absolutely, it does significantly affect the likelihood of
alcohol consumption—men who are of legal drinking age are almost 30% more likely to
drink alcohol, which is quite similar to results found in developed countries (e.g., Carpenter
and Dobkin 2010). Further, we show that being of legal drinking age is positively linked to
smoking, which is consistent with existing literature from developed country settings that
drinking and smoking are complements (Decker and Schwartz 2000; Dee 1999). It has been
demonstrated that husbands who are legally allowed to drink are both substantially more
likely to consume alcohol and commit domestic violence against their partners. The results
are robust to controlling for a rich set of individual-level characteristics and both observed
and unobserved state-level variation. According to a study conducted by the World Health
Organization, a third of violent husbands drink, and most of the violence takes place during
intoxication.

The update of the evidence on cost-effectiveness of policy options and interventions

undertaken in the context of the Global action plan for the prevention and control of
noncommunicable diseases 2013–2020 provides a new set of enabling and focused
recommended actions to reduce the harmful use of alcohol. The most cost-effective actions,
or so-called best buys, include increasing taxes on alcoholic beverages, enacting and
enforcing bans or comprehensive restrictions on exposure to alcohol advertising across
multiple types of media, and enacting and enforcing restrictions on the availability of retailed
alcohol.

Achieving a reduction in the harmful use of alcohol in line with the targets included in the
SDG 2030 agenda and the WHO Global Monitoring Framework for Noncommunicable
Diseases requires concerted action by countries, effective global governance and appropriate
engagement of all stakeholders. By working together effectively, the negative health and
social consequences of alcohol can be reduced.

Interpretation:
The aim of the test is to assess the dependence level of people on alcohol. Throughout
history, people have used a variety of chemical substances to alter their mood, level of
consciousness, or behaviour. These substances can lead to addiction or acute psychiatric
symptoms. Their use is considered to be disordered when consumed in excessive amounts
leading to impairment and other negative consequences. Substance-related disorders arise
when psychoactive substances—substances that alter moods, thought processes, or other
psychological states—are used excessively. Addiction involves compulsive drug-seeking
behaviour and a loss of control over drug use. Withdrawal symptoms may also occur which
are negative psychological and physiological effects such as shaking, irritability, or emotional
distress—that occur when use is discontinued (Koob et al., 2014). The terms alcoholic and
alcoholism have been subject to some controversy and have been used differently by various
groups in the past. The World Health Organization (WHO) no longer recommends the term
alcoholism but refers instead to the harmful use of alcohol—“drinking that causes detrimental
health and social consequences for the drinker ,the people around the drinker and society at
large, as well as the patterns of drinking that are associated with increased risk of adverse
health outcomes” The WHO, as well as researchers in this area, also refer to heavy episodic
drinking as the consumption of six or more alcoholic drinks on at least one occasion at least
once per month (WHO, 2014a). To assess the level of dependence on alcohol we used the
Severity of Alcohol Dependence Questionnaire. SADQ is a self-administered 20-item
questionnaire that evaluates severity of alcohol dependence. It is addressed to populations of
problem drinkers: inpatient, outpatient and community-based treatment agency attenders. It
was originally formulated in by Edwards et al. in 1970 then subsequently redefined by
Stockwell et al. in 1983. It takes up to 5 minutes to administer and it is easily scored. The
SADQ questionnaire may be used not only to screen alcohol dependence severity but also to
predict the likelihood of achieving control drinking goals or predict alcohol withdrawal
severity. A total of 243 participants were assessed which included working and non
working professionals both male and female.

Individual Data:

Working/ Non Gender Age Score on test Interpretation

working
professional
Yes Male 56 0 No dependence
Yes Female 49 0 No dependence
No Male 22 15 Mild physical
dependence
No Female 23 14 Mild physical
dependence

Alcohol Dependency Graph

16 15
14
14

12
Individual scores

10

2
0 0
0
Working professionals Non working professionals
Basis of categorization

Men women
The individual data shows that the working professionals do not consume alcohol but the non
working professionals have mild physical dependency. It could be due to the following
factors:
1. Age: Both the working professionals are ageing so to take care of health there is no
consumption of alcohol.
2. Nature of job: Both the working professionals are government servants and have
fixed job timings. It could be a huge factor in non-consumption of alcohol due to low
stress levels. Another factor could be having enough family time post working hours.
3. Peer pressure: Non- working professionals being younger generation could be
affected by their peers. Hence, there is intake of alcohol. Much of gender differences
can not be seen.

Group Data:

Working professionals Non-working professionals

Male Female Male Female

972 279 890 126

Total score- 1251 Total score- 1016

Alcohol dependency graph

1400

1200
279
1000
126
Sum of scores

800

600
972 890
400

200

0
Working professionals Non working professionals
Basis of categorization

Men Women
After analysing the pool of data, it was found that most working professionals were either
mildly dependent or moderately dependent. Very few were found to be non-dependent.
There were gender differences present in both working and non working professionals.
Males were found to be prominent consumers of alcohol.
The availability of alcohol and workplace culture including attitudes, behaviours and
expectations around drinking in work-related environments can influence individual alcohol
use and drinking patterns and the impact of alcohol-related harm on the safety and health and
overall productivity of the workplace. Workplace factors, including working conditions,
workplace customs, practices and environments can increase the risk of individual alcohol
use and influence individual drinking patterns including:

The differences in score of working and non-working could be due to the following reasons:
1. Some employees feel that they are in need to drink alcohol at the workplace heavily,
as they mistakenly think alcoholism is the best way to manage stress. Others think
that alcohol would improve their productivity.
2. Some jobs require constant business meetings with new partners which often happen
not only in offices but bars, clubs, and restaurants as well. Businesspeople usually
consume alcohol to create a friendly atmosphere during such negotiations, or in an
attempt to make their partner relax and accept their conditions easily. If such
unformalized meetings happen regularly for a long period, alcohol dependence may
develop, and a person becomes a heavy social drinker eventually.
3. Employees working in isolated areas who are separated from family and friends
may be more likely to consume alcohol as a result of boredom, loneliness or lack of
social activities, or social activities where the priority focus in drinking.

4. inadequate job design and training, which may lead to low job satisfaction and/or
work-related stress;

5. Organisational change e.g. restructure, job transfer or redundancy tend to create

stress leading to consumption of alcohol.

Reasons for gender differences:

1. If women have lower rates of gastric metabolism of alcohol than men (Baraona
et al., 2001; Frezza et al., 1990; Thomasson, 1995) or smaller volumes of body
water in which alcohol is distributed (Mirand & Welte, 1994; York & Welte,
1994)

2. Women may need to consume less alcohol than men to derive the same
effects. Or, women may be more likely than men to experience unpleasant acute
effects from alcohol (such as hangover symptoms) (Slutske et al., 1995, 2003), or
 may not enjoy risky and poorly controlled behavioral effects of alcohol as much
as men (Hill & Chow, 2002).

3. In fact, Landrine, Bardwell, and Dean (1988) found that attitudes and
expectations regarding the acceptability of drinking and drunkenness were
influenced by beliefs subsumed in traditional gender roles. It is hypothesized
that men in part drink more often than women in order to accede to an aspect of
masculinity. Conversely, girls and women endorsing stereotypical female
characteristics (virtue, nurturance, emotionality) are likely to report reduced
alcohol involvement (e.g., Ricciardelli, Connor, Williams, & Young,
2001; Wilsnack & Wilsnack, 1978).

4. There are gender differences in the extent to which parental variables influence
adolescent drinking. Parental monitoring tends to affect substance use in both
boys and girls over time (Schinke, Fang, & Cole, 2008; Webb et al. 2002), and
has been shown to influence boys’ alcohol use more strongly than girls (Barnes et
al, 2000).

5. Peer relationships have been identified as a key risk factor in the progression of
alcohol use among adolescents (Bates & Labouvie, 1995; Curran, Stice, &
Chassin, 1997). Social context influences drinking behaviours through both
proximal and distal perceptions of peer behaviour.

In conclusion, in group data there is mild to moderate dependency among working

professionals in comparison to non-working professionals. On the other hand there is no
dependency on alcohol among working professionals in comparison to non-working
population.

References:
Mahapatra P, Pati S, Sahoo KC. Alcohol consumption during pregnancy among
tribal women in India: Need for a concerted action. Indian J Psychiatry. 2021 May-
Jun;63(3):312-313.
Eashwar VMA, Umadevi R, Gopalakrishnan S. Alcohol consumption in India- An
epidemiological review. J Family Med Prim Care. 2020 Jan 28;9(1):49-55
Kirmani, M. N., & Suman, L. N. (2010). Gender differences in alcohol related
attitudes and expectancies among college students. Journal of the Indian Academy of
Applied Psychology, 36(1), 19-24.
Wilsnack, R. W., Wilsnack, S. C., & Obot, I. S. (2005). Why study gender, alcohol
and culture. Alcohol, gender and drinking problems: perspectives from low and middle
income countries. Geneva: World Health Organization, 2005, 1-25.