The Scourge of Alcohol Dependence in Sri Lanka



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by Dr. Anula Wijesundere -


Consultant Physician

Vice President, Temperance Association of Sri Lanka


Alcohol is undoubtedly the commonest toxin consumed willingly the world over. In Sri Lanka, alcohol dependence is a major health and social problem. Most medical and social workers are aware of this problem. Unfortunately, few speak openly of this grave malady which is destroying our countrymen in the prime of their lives. Consumption of increasing amounts of alcohol over a period of time leads to the development of the "Alcohol Dependence Syndrome" characterized by deterioration of physical and mental health, inter personal relationships, moral and social standards, and the deterioration of economic status.


Buddhist perception of alcohol


2560 years ago, the Gauthama Buddha realized the evil of alcohol and advised his disciples to refrain from alcohol. In the Kumbha sutra, that he preached Kings Sarvamithra and Kosala, he indicated 48 evils of alcohol consumption. Refraining from alcohol and other intoxicants is the fifth precept of Buddhism. Unfortunately, most Buddhist males ignore this basic precept.


History of alcohol dependence in Sri Lanka


All evidence indicates that Sri Lankans did not consume alcohol for many centuries. In 1505, following the Portuguese invasion of Sri Lanka, they promoted greatly the drinking habit among the countrymen. In 1658, following the Dutch invasion, there was further promotion of alcohol consumption. In 1796, the British liberally issued liquor licenses to open up taverns all over the country. They increased state coffers by tax collections and promoted the drinking habit widely via the "Toddy act "of 1912.


Alcohol consumption rates in Sri Lanka. 


Sri Lanka has a high consumption rate for alcohol. According to the WHO "Global alcohol trends" in 2014, the per capita consumption of alcohol was 3.7 litres for both sexes and 7.3 litres for males only. These figures account for use of licit or recorded alcohol only.  However, it is well known that  over 55% of alcohol consumed by males in Sri Lanka is unrecorded or illicit alcohol or Kassippu  ( 8.9 liters ) The total per capita consumption of alcohol among males in Sri Lanka would  therefore amount to 16 .2 liters. This is the highest among the SAARC countries. 


A survey done by the Health Ministry in Sri Lanka in 2015 showed that 34.8 % of Sri Lankan males consume alcohol. However, the NATA (National Alcohol and Tobacco Authority) statement in 2016 indicates that 40 % of Sri Lankan males consume alcohol. Fortunately, the prevalence among Sri Lankan females is only 0.5%, and mostly involves the upcountry tea estate workers..


Alcohol, economics and health.


According to the chairman of NATA, the government spends as much as Rs. 140 billion (editorial – The Island 6 Aug 2016) annually on the treatment of patients suffering from non-communicable diseases mainly due to alcohol and victims of road traffic accidents from drunk driving. He debunks the theory of the alcohol industry that they increase the government coffers, as the revenue from taxes on alcohol amounts only toRs. 106 billion.


According to President Sirisena, the government allocates Rs. 16 billion to uplift the living standards of the rural community annually. However he states that the expenditure on alcohol is more than twice that amount!  This is not surprising as each gramasevaka division in the country annually spends Rs. 10 million and Rs.7.5 million on alcohol and cigarettes respectively. This confirms the horrendous revelation that the tax payers’ money is completely wasted in the name of poverty alleviation programs such as "Samurdhi and Divineguma" programmes etc. 


It is estimated that about 65 people die in Sri Lanka daily due to alcohol related deaths. This amounts to over 23,000 deaths annually. The leading cause of death among Sri Lankans for all ages is heart disease. However, the leading cause of death among Sri Lankan males between the ages of 25 to 45 is alcohol related disease.


Drinking culture in Sri Lanka.


Today, drinking alcohol has become a national pastime. This terrible culture of drinking has unfortunately penetrated into and intricately infiltrated to every strata of our society in our country. The rich consume whisky while the poor take to Kassippu. In our culture, every event is made into an occasion to drink. In rural areas alcohol is consumed at paddy thrashing or harvesting events and when young girls reach menarche. At funeral houses, alcohol is provided to card players guarding the corpse throughout the night and even grave diggers.  This awful culture must be stopped! When will Sri Lankans ever learn?


Why do Sri Lankans drink?


A survey done at the Sri Jayewardenepura General Hospital in the author's former unit titled "Alcohol consumption - causes, quantity and consequences" in 2012, revveled that alcohol was a panacea for everything!  Alcohol was consumed with friends for recreation, for insomnia, for energy or laziness, for tiredness, for joy or sorrow, for heat or cold for courage or fear or sometimes no reason at all! 


It was also found that the majority (75%) had high consumption rates of more than 250ml of hard liquor per day, far ahead of permitted levels. Arrack was the major binge (85%), followed by beer (50%), and illicit brew (46%).  The majority consumed mix of hard liquor and beverages.


Toxic effects of alcohol,


Consumption of alcohol over a period of time leads to physical and psychological dependence and the development of tolerance. It is also addictive and psycho active like heroin. However, unlike heroin which is taboo in society, alcohol is widely and socially accepted.


This is possible due to the powerful alcohol industry which is difficult to control. In most countries the alcohol industry is financially strong, is politically powerful and is able to lobby media, politicians and governments.


In this context, we must congratulate our President, Maithripala Sirisena for the personal interest taken in setting up the "Presidential Task Force" islandwide for the control of alcohol, tobacco and dangerous drugs.


Consequences of Alcohol Consumption in Sri Lanka


Alcohol consumption is a major health and social problem in Sri Lanka. The magnitude of the problem is reflected in,


(1) Rising incidence of hospital admissions due to alcohol related diseases


(2) Rising incidence of road traffic accidents, violence and homicide


(3) Rising incidence of sexual abuse and violence against women and children


(4) Deterioration of moral and spiritual values and standard


Alcohol related diseases.


Alcohol and cirrhosis: Consumption of alcohol over a period of time results in fatty changes of the liver which later transforms to cirrhosis with liver cell degeneration, and accumulation of fluid in the abdomen followed by degeneration of the brain.


Sri Lanka has the second highest incidence of cirrhosis in the world – 55/100,000 population. We are second only to Maltova, a nation of Vodka drinkers.


Alcohol and carcinomas:


Alcohol consumption is directly associated with carcinoma of the stomach, oesophagus, and carcinoma of the liver – hepatoma


Alcohol and the heart:


Alcohol consumption causes degeneration of the heart muscle, and heart failure causing alcoholic cardiomyopathy. High blood pressure and increased cholesterol are also consequences of high consumptions


Alcohol and the gastro-intestinal tract:


Acute and chronic gastritis and formation of gastri ulcers, and acute and chronic pancreatitis with endless abdominal pain and immense suffering are consequences of regular boozing.


Alcohol and the nervous


system:


There is progressive degeneration of the brain leading to deterioration of intellectual functions social behaviour resulting in dementia.


Degeneration of the peripheral nervous results in unsteady gate and increasing tendency to fall and sustain head injuries.


Alcohol and psychiatric problems:


Alcohol abuse may cause many psychiatric disorders such as depression, pathological jealousy increased tendency to epileptic fits and suicide.


Alcohol and suicide:


Approximately 10 Sri Lankans die daily by committing suicide while another 11 unsuccessful attempts are carried out daily. Annually about 4000 Sri Lankans deaths result from suicide.


In 1996 and 2003, Sri Lanka recorded the highest suicide rates in the world. Currently (2015) our suicide rate is 28.8 per 100,000 population. We rank number 4in global suicide rates below Guyana (South America) and North &South Korea who rank 1st 2nd and 3rd respectively. Among Sri Lankan suicides, 48 percent are related to alcohol consumption, unlike in the West, where majority of suicides are related to depression.


Alcohol and sexual problems


Excessive consumption of alcohol leads to degeneration of the testicles and impotence, thereby resulting in reduced fertility. Impotence often leeds to alcoholics being jealous of their wives suspecting them of engaging in extra marital affairs. This often leads to marital disharmony.


Fetal alcohol syndrome


No level of alcohol can be considered safe in pregnancy. Consumption of alcohol between the 4th and 10thweeks of pregnancy can produce an abnormal baby with a small head,small nose and small eyes with low birth weight and mental retardation. Babies born with this condition have been reported from the North Central Province (from Chilaw) and the upcountry estate sector where women are known to consume alcohol.


Alcohol and road traffic


accidents


Around 7 people die daily on the roads in Sri Lanka. In 2015, as many as 2801 Sri Lankans died of road traffic accidents.The majority of these sad deaths have been attributed to excessive speed, over confidence, wrong judgments, fatigue and drowsiness under the influence of alcohol.


Traumatic injuries, violence & homicide:


Consumption of alcohol, specially binge drinking is associated with the development of "Dutch courage". This leads many alcoholics to engage in violent behaviour and commit crimes that they would never had attempted in a sober state.


Alcohol and violence against women and children:


Consequences of the head of the house hold  being addicted to alcohol is indeed  disastrous for the entire household. The  end results are eternal quarrels between the parents, disharmony in the home,  abject poverty, and a  very sad home environment  for children. Children from such environments often show poor social adaptability in adult life.


 


We often hear and read tragic stories from rural areas where husbands come home drunk,find little or no food prepared at home due to dire poverty, axing their wives to death, in drunken frenzies. Furthermore, in many Sri Lankan families,women obtained employment in Middle East to improve the economic state  and build their own homes. In many instances, the mother's absence leaves the doors wide open for drunken husbands and their boozing friends to sexually abuse young children during their drinking binges.


Deterioration of moral and spiritual standards:


To indulge in intoxicating drinks it to deteriorate through all stages of morality, concentration and wisdom. As Ven Bhikku Bodhi quotes in "Discipline of Sobriety" in the Island newspaper of  August 17,2016, the use of alcohol blunts the shame and moral dread and thus leads almost inevitably to a breach of the other precepts .One addicted to liquor will have little hesitation to lie or steal, will lose all sense of sexual decency and may easily be provoked even to  murder. Alcoholism is indeed a costly burden on our entire society.


Reducing the burden of alcohol dependence,


1. Reducing the availability and accessibility of alcohol .This has been shown to reduce the consumption and consequences of alcohol. The direct association between "demand and supply" is well known.


a. Reducing the number of alcohol selling outlets by closing down all liquor outlets situated within 500 meters from schools and places of worship.


b. Cancelling all licenses issued to supermarkets.


c. Prohibit sale of alcohol at all liquor outlets after 9.00pm.


d. Prohibit consumption of alcohol at hotels, restaurants& bars after 11.00pm.


e. Stop issuing licenses for the establishment of new liquor sale outlets.


f. Establish short prohibitive periods for sale of alcohol during periods of increased alcohol consumption.


e.g. Easter, Christmas and New Year.


2. Strictly enforce all policies and recommendations of NATA and the Presidential Task Force for Control of Alcohol, Tobacco and Drugs.


For these programmes to be successful, the work should be time targeted, implemented to the letter and evaluated at regular intervals.


3. Strictly enforce all existing laws related to alcohol consumption and while driving, consumption at public and government offices.


4. Education and persuasion – this is possibly the most popular approach practiced at present to prevent alcohol intake. For this to be successful, target groups should be selected from schools, universities, low income groups, urban slums.


For any programme designed to control alcoholism in Sri Lanka to be sustainable and effective, it is essential to mobilize all stakeholders to work as a team. This team should include NATA and Presidential Task Force teams as well as customs, Excise department, police, religious dignitaries, voluntary societies, NGOs, medical and social support groups and the concerned public. If the above can be achieved in a given time frame, we could rid Sri Lanka and save our countrymen from the scourge of alcohol dependence.


 
 
 
 
 
 
 
 
 
 
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