Refrain From Risky Drinking

Alcohol has played a central role in almost all human cultures since ancient times. All societies and communities make use of intoxicating substances, alcohol being by far the most common.

The harmful use of alcohol has been associated with more than 200 diseases and injury conditions. The degree to which individuals consume alcohol varies greatly among people, cultures, and society, as does its impact on health and the risk of associated behavioural and medical problems.

In 2010, alcohol consumption per capita among male and female drinkers worldwide differs considerably with an average of 19.4 litres for males and 7.0 litres of pure alcohol for females (WHO, 2018). Although the per capita consumption of alcohol in Nepal is low in comparison to many other countries in the world, it still is posing considerable risks to health and alcohol-related injuries. The projected estimates show that the per capita consumption of Nepali people aged 15 years and older is 2 litres of pure alcohol (World Bank, 2016).  

Death

Worldwide, harmful use of alcohol is associated with 3 million deaths every year which is 5.3 per cent of all deaths. Similarly, 5.1 per cent of the global burden of disease and injury is attributable to alcohol, and alcohol consumption causes death and disability rather early in an individual’s life. It has been estimated that for people aged 20–39 years, about 13.5 per cent of total deaths are attributable to alcohol use (WHO, 2022).

Risky drinking or harmful alcohol use includes binge drinking, heavy drinking, and any use by pregnant women or by people under the age of 21. Drinking five or more drinks on a single occasion for men or four or more drinks on a single occasion for women is considered as binge drinking. Heavy drinking is drinking 15 or more drinks per week for men or eight or more drinks per week for women. According to a STEPS survey by NHRC in 2019, 6.8 per cent of adults (12.4 per cent of men, and 1.7 per cent of women) engaged in binge drinking in Nepal.

Alcohol gets into the bloodstream quickly. The amount and type of food in our stomach can change how quickly this occurs. For example, high-carbohydrate and high-fat foods can make the body absorb alcohol more slowly than on an empty stomach. How fast alcohol gets absorbed in our bodies depends on type and alcohol content. Certain types of alcoholic drinks get into the bloodstream faster and stronger drinks get absorbed faster.

Alcohol slows down respiratory rate, heart rate, and brain functions. The effects of alcohol may start within 10 minutes and peak at around 40 to 60 minutes. Alcohol stays in our bloodstream until it is metabolised by the liver. The amount of alcohol in our blood is measured as blood alcohol level. The alcohol level rises if we drink alcohol faster than the liver can break it down.

The governments in different countries have set a legal limit for blood alcohol. However, Nepal has zero blood alcohol levels while driving. As low as 0.05 causes reduced inhibitions, 0.10 causes slurred speech to 0.20: euphoria and motor impairment, 0.30: confusion, 0.40: stupor, 0.50 causes coma, and 0.60 and beyond results breathing stops and death. 

Statistically, physical, psychological, and social problems associated with alcohol affect only a small minority of consumers, even among risky drinkers. The prevalence of alcohol-related problems is not directly related to average per capita consumption as countries with low average consumption often reported relatively high rates of alcohol-related social and psychiatric problems, while countries with much higher levels of consumption score low on most indices of problem drinking.

Alcohol consumption increases the risk of alcoholism, falls, drowning, and other accidents, head, neck, stomach, colon, breast, and other cancers. Heart attack and stroke, motor vehicle accidents, risky sexual behaviours, unplanned or unwanted pregnancy, sexually transmitted infections (STIs), suicide, and homicide are other problems commonly seen among risky drinkers. Drinking during pregnancy can harm the developing baby as severe birth defects or fetal alcohol syndrome has been seen.

Policy

The Government of Nepal has promulgated a national policy on regulation and control of alcohol in 2017.  The policy has many provisions that are expected to have an impact on the alcohol consumption patterns of Nepali people.

The ban on advertisement, promotion, and sponsorship; health warning on alcohol containers; ban on selling alcohol near schools, colleges, and heritage sites; sale of alcohol only to an adult age 21 years or more; fixing selling alcohol between 4 PM to 9 PM and more regulations on the provision of limited numbers of liquor stores in stipulated areas will definitely have profound effects on consumption patterns although some of the provisions may have effects on hospitality industries and total revenues from alcohol sales. 

There has been a significant decrease in the number of fatal road traffic accidents following a ban on drunk driving in Nepal. However, there are challenges to implementing policy rigorously. There are effective treatments available for people who are willing to give up drinking. There exist rehabilitation centres for alcohol and other substance use disorders in the government as well as in the private sector. Moreover, there is lacking policy directives for such rehabilitation centres including the provision of trained counsellors, psychologists, and psychiatrists.

Despite numerous strategies to prevent risky drinking, people throughout the world are exposed to risky drinking and many become addicted to its use. Therefore, the success of every treatment strategy heavily depends on the individual’s will, and support from family members and the community. Hence, it is important not to deny the problem and seek treatment as soon as possible.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Centre. lohanis@gmail.com)