As per World Health Organization “Alcohol is a toxic and psychoactive substance with dependence producing properties“. As per WHO estimates, 2.6 million deaths every year are attributable to Alcohol consumption. In India it is estimated that about 160 million individuals consume alcohol, and of these 14 million have a serious alcohol related problem, which we call Alcoholism.
On the other hand Alcohol is about a 1.8 trillion dollar Industry in the world, and is expected to grow. In India, which is a low-consumption country, alcohol sales contribute an equivalent of 50 billion US dollars to the government as excise revenue, which is around 2.5% of our GDP. So, Alcohol brings in a lot of revenue, and for many countries, it is an important export.
Alcohol is an oldest recreational drink
Producing and consuming alcohol predates documented history. The process of fermenting foods, and consuming its output was discovered across unconnected civilizations. This independent discovery of brewing and fermenting even predates agriculture. The beverage so produced, became an asset. This was used in traditional societies on a variety of occasions such as births, initiations, marriages, feasts, conclaves, crowning, magic rites, as a medicine, for worship, hospitality, war making, peace making, and even in a funeral. Along with water, milk and honey, wines also found their place in religious rituals.
It is likely that in the ancient world consumption of alcohol was under some kind of social control. Ancient Greek and Roman literature, does condemn excessive drinking (or drunkenness), but it was more of a social aberration, rather than a medical condition. Further, most alcohols were ferments, and further diluted with water. The estimated proportion is likely between 4 and 7% in these beverages. Many societies had their drinking rules, some of them are quite ritualistic.
From Wines to spirits
Distillation and purification of alcohol followed in the late ancient and early medieval period. This process concentrates alcohol, and produces spirits. Over the centuries, spirits became more popular. It is said about distilled alcohol that “the sixteenth century created it; the seventeenth century consolidated it; the eighteenth popularized it. Drinks such as Champaign, Whiskey, Gin and Rum are all products of 15th to 18th centuries. With industrialization, the production as well as amount of consumption of alcohols soared. The beverages were also more concentrated than ever before. They became part and parcel of all ship voyages, and spread through the maritime use to the colonized nations.
Industrial revolution, that led to urbanization, disintegration of families, and over-production of spirits, also had another unintended consequence. Most industries worked in shifts, and workers were expected to be sober laborers to operate heavy machinery. On the other hand, many saloons (or pubs, or bars) had opened up in urban centers. These were also perceived as sites for gambling, prostitution and other ills. Thus, in 1820s began first such temperance movements, largely due to social concerns rather than due to medical reasons.
Temperance movements and prohibition
Advent of Islam introduced the concept of prohibition in the middle-east. In fact any amount of consumption of alcohol, and gambling were considered as a sin. It was still a question of morals, rather than a law. Initial temperance movements in the 19th century also invoked morality, and social change rather than a law to prohibit manufacture, sale, storage and consumption of alcohol.
In 1914, a legal prohibition was tried in Russia, but it soon failed. Between 1920 and 1933, USA enforced prohibition. It instead led to more crime, illicit alcohol production, and falling revenues for the government. Many countries have attempted prohibition in the past, but later reverted these decisions. Only a handful of countries in the middle-east continue prohibition.
In India, prohibition is currently in place in Gujarat, Bihar, and Nagaland. Various other states had imposed prohibition at different times (Tamil Nadu, Harayana, Andhra Pradesh, Kerala, Manipur, Mizoram etc) but it later withdrew largely due to concerns about falling revenues and illicit liqour.
Alcoholism enters medical lingo
For many centuries, a person who was habitually under influence of alcohol was in a state of inebriety or drunkenness. From the 1840s, we had a term dipsomania as “a morbid and insatiable craving for alcohol, often of a paroxysmal character.” It was Swedish physician named Magnus Huss who coined the term alcoholism in 1852, to denote both the action of alcohol on the human system, and the diseased condition produced by alcohol.
Alcoholism is defined as a severe form of alcohol abuse and involves the inability to manage drinking habits. Since 2013, alcoholism, alcohol abuse or alcohol dependence are more politely referred to as an alcohol use disorder. While the term depends on quantity of use, some tell tale signs indicate that this may be a problem. While, most alcohol use is recreational, it becomes alcoholism, when recreation becomes a compulsion.
In addition to social issues such as loss of income, family discord, social isolation, and loss of productivity, alcoholism has many medical consequences. Many of these have also become more apparent in the last century. Drinking alcohol is associated with a risk of developing diseases of cirrhosis of liver, and irreversibly injures pancreas. It also causes diseases of brain, cerebellum and weakens muscles of the heart. It has a known effect on reducing immunity, and is known to cause cancers of esophagus and stomach. Excessive alcohol use also leads to behavioral conditions such as depression, and anxiety.
Alcohol and Road traffic accidents
20th century has seen an explosion of automobiles. Mobility and speed requires attention, control and prompt response to external stimuli. As alcohol blunts these responses, a significant part of alcohol-attributable disease burden arises from injuries such as road traffic accidents. In 2019, about 300,000 individuals died due to alcohol related accidents. More than half of these were due to someone else’s drinking. All countries in the world prohibit driving under influence of alcohol.
According to World Health Organization, there is no form and amount of alcohol consumption that is totally risk-free. However, unlike campaign against narcotic drugs or tobacco, campaign against alcohol is rather tardy. With a legacy of failed prohibition in the past, few nations will be willing to do it again. This leaves it to social norms and individual understanding, to tackle and beat alcoholism.