‘World No Alcohol Day’ is on October 2 Alcohol dependence and consequences in Sri Lanka
2 October 2024 12:00 am
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- Harmful effects of alcohol cause more than 200 diseases and injuries
- The government’s health expenditure on diseases related to alcohol consumption is Rs. 140 billion annually
On the 4th of January 2023, the World Health Organization proclaimed that “No level of alcohol consumption is safe for our health”. This is an important message as we commemorate the “World No Alcohol Day” which falls today (October 2) each year. However, despite this landmark proclamation of the WHO, alcohol continues to be the commonest toxin willingly consumed the world over.
Global Alcohol Dependence and some alarming facts:
Over 2 billion people use alcohol beverages
- Harmful effects of alcohol cause more than 200 diseases and injuries.
- Worldwide 3 million deaths occur every year from alcohol dependence.
- Alcoholism accounts for 5.1% of global burden of disease.
- Alcohol consumption causes death and disability relatively early in life - In people aged 20-39 years.
- 13.5% of total global deaths are attributed to alcohol dependence.
WHO statistics 2022 from Global burden of alcohol
In Sri Lanka, alcohol dependence is a major health and social problem. Most medical and social workers are aware of this. Unfortunately, only a few speak openly of this 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”. This is characterised by deterioration of physical and mental health, smooth economic function; inter personal relationships and decline of moral, spiritual and social standards.
Per Capita Consumption and Alcohol Rates In Sri Lanka
- 2005 - 2.6 liters per annum (https://www.statista.com )
- 2010 - 7.4 liters per annum (source : Excise Department – 2010)
- 2016 – 18.9 liters males over 15 and 6.7 liters females over 15, 14.9 liters for both sexes and
3.5 liters per annum (source : WHO Report)
- 2018 - 4.1 liters per annum (https://www.statista.com )
- 2020 - 2.7 liters per annum and 18.9 liters for males only
Source: World Health Organization (2018) Global Status Report on Alcohol and Health - Sri Lanka Fact Sheet.
- 2023 – 4.3 liters per annum – both sexes
18.9 liters male only
Source: ADIC Fact sheet November 2023
The above data clearly show that alcohol consumption has increased in Sri Lanka
Alcohol Dependence in Sri Lanka - Some alarming facts:
- 36.9 of males and 22.4 of females consume alcohol in Sri Lanka.
- Daily expenditure for consumption of beer and arrack is Rs.400mn and Rs.600mn respectively (NATA Fact Sheet 2023).
- Low income families spend 1/3rd of their total income on alcohol & tobacco.
- Around 18,000 men die annually from alcohol related deaths.
- Per capita consumption of alcohol in Sri Lanka is 3.5 litres - - This is the highest among SAARC countries.
- Per capita consumption among males alone is 18.9 litres.
- Government health expenditure on diseases related to alcohol consumption is Rs. 140 billion annually.
Source: Chairman’s report National Alcohol & Tobacco Authority 2017 and WHO Global Report 2020
Consequences of Alcohol Dependence in Sri Lanka - The disease burden:
- The disease burden – cirrhosis
(Sri Lanka has the second highest rate of cirrhosis in the world - 55 per 10,000 population).
- Gastrointestinal complications - pancreatitis, gastritis, gastric and duodenal, ulcers.
- Heart – cardiomyopathy, heart failure, high blood pressure.
- Carcinoma of liver, pancreas, stomach, oral cavity and breast.
- Neurological complications – dementia, myopathy, neuropathy and epilepsy.
- Psychiatric disorders – depression, suicide, convulsions and pathological jealousy.
- Morbidity and mortality from road traffic accidents (currently 8 deaths per day occur in the roads of Sri Lanka. Alcohol accounts for 70% of road accidents).
- Violence, homicide and crimes committed under the influence of alcohol.
- Sexual harassment and violence against women and children.
- Suicide – current rate of suicide in Sri Lanka is 15 per 100,000-
48% of suicides are related to alcoholism.
High Incidence of Alcoholism in Sri Lanka results from:
- The ready and easy availability and accessibility of alcohol via wine stores, restaurants, toddy taverns and supermarkets numbering more than 5,000 in the country.
- The demand for alcohol has recently reduced due to the high cost of alcohol beverages. However, the recent issue of 273 liquor licenses in 2023 and issue of more than 500 licenses for sale of soft liquor in 2024 have been counter-productive with increase in supply of alcohol. (Excise Commissioner’s statement September 2024).
- Un-estimated number of more than 200,000 distributing outlets of illicit alcohol makes illicit alcohol readily available.
Addiction to alcohol
Alcohol is a psychoactive substance that leads to physical and psychic dependence and the development of tolerance. The development of addiction of alcohol is influenced by genetic, environmental, social, mental and developmental factors. These interact with each other leading to alcohol addiction.
Increased risk of addiction to alcohol correlates strongly with male sex and strong family history of addiction. Psychiatric disorders such as depression, anxiety, schizophrenia and bipolar disorders also increase the risk of developing alcohol addiction. Working in environments of easy accessibility to alcohol, eg: waiters in restaurants and bartenders also increase the risk of addiction.
Treatment of alcohol addiction
Screening methods such as AUDIT and CAGE Questionnaire are methods to identify apparently asymptomatic people at risk of developing addiction to alcohol. Treatment of alcohol addiction is best undertaken in psychiatric units in government or private hospitals under the supervision of consultant psychiatrists.
Depending on the extent of addiction the following methods can be adopted.
- Simple advice regarding harmful health effects of alcohol and the financial consequences to the patient and family.
- Brief counseling with continued monitoring at regular intervals.
- For significant alcohol addicts - referral to consultant psychiatrists/addiction specialists for evaluation and medical treatment of alcohol dependence with available drugs. Eg: acamprosate, naltrexone, disulfiram or topiromate if required.
Acute and sudden complete withdrawal of alcohol in a heavily addicted alcoholic which leads to the development of an acute toxic confusional state referred to as “delirium tremens” is a medical emergency. This condition requires urgent admission to hospital followed by sedation, correction of dehydration, electrolyte imbalance, hypoglycemia and specialist treatment.
Reducing the burden of alcohol dependence in Sri Lanka :
Reduce the availability and accessibility to alcohol. This can be achieved by;
- Stopping the issue of new liquor licenses with immediate effect.
- Cancelling all liquor licenses issued to outlets situated within half mile radius of schools and places of worship.
- Increasing the minimum age for purchase of alcohol to 21 years.
- Restricting hours and days that alcohol is sold in outlets.
- Reducing the demand by increasing the price of alcohol.
The price of alcohol should be increased in accordance with the rise in cost of living in every annual budget.
- Enacting appropriate drink driving policies and appropriate fines.
- Application of correct taxation formula for alcohol.
This will ensure that all increases in taxation of alcohol will result in appropriate increase of income from taxation to the Treasury.
- Cancelling licenses of all distilleries that do not pay the correct taxes on time to the government.
- School based intervention to prevent alcohol, tobacco and dangerous drugs.
Children must be educated about the harmful effect of alcohol, smoking and dangerous drugs. The absolute necessity to say “No to alcohol, tobacco and dangerous drugs” must be impressed upon school children to save our future generations from the dangers of alcohol, tobacco and dangerous drugs.
(The writer is a consultant physician, Chairperson, Sri Lanka Medical Association Expert Committee on Alcohol, Tobacco and Dangerous Drugs and Vice President, Temperance Association of Sri Lanka )