Current Patterns and Trends of Alcohal

7/31/2019 Current Patterns and Trends of Alcohal

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CURRENT PATTERNS

& TRENDS OF ALCOHOL USE

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GLOBAL

Region Consumption Range Median Countries Percentage of(litres) surveyed/ population

Total No. covered

Africa 03.9 0.02 - 07.72 0.95 28/46 76.7

America 16.2 1.66 - 14.03 5.74 32/35 99.9

Eastern 00.4 0.05 - 10.00 0.53 12/21 90.4Mediterranean

European 10.5 0.85 - 15.12 8.26 49/52 99.9

South-East Asian 01.7 0.04 - 08.64 0.99 07/11 98.4

West Pacific 04.8 0.34 - 18.39 1.95 20/27 99.9

Table 2.1 : Annual per capita consumption of alcohol per adult 15 years of age and over

Annual per capita alcohol consumptionper adult can be derived by:

Alcohol production + Alcohol imports - Alcohol exports

population 15 years of age and over

Per Capita Consumption

According to (WHO) estimates, there are about 2 billion

people worldwide who consume alcoholic beverages and 76.3million with diagnosable alcohol-use disorders. Table 2.1shows per capita consumption of alcohol in various regionsof the world.

Source : Global Status Report on Alcohol, WHO-June 2001and 2004.

CURRENT PATTERNS & TRENDS OF ALCOHOL USE

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Spectrum of Alcohol Consumption

The International Classification of Diseases(ICD-10) published by the World HealthOrganization (WHO) uses the term harmfuluse to indicate a pattern of alcohol usesimilar to alcohol abuse.

The extent of alcohol use is related toproblems that have a significant impact onpublic health. The proportions of populationin different groups of the drinking spectrumvary considerably in different societies. Ageneral rule, derived from European andAmerican experience, is that 10% of thealcohol drinking population consumes half

the total amount of alcohol in that society.

Harmful Use

A Pattern of alcohol use that is causingdamage to health. The damage may bephysical (as in case of hepatitis fromprolonged use of alcohol) or mental(e.g. episode of depressive disorder

secondary to heavy consumption ofalcohol).

Source: Adapted from WHO (2003b)

Source: Get High on Life Without Alcohol. Report by WHO SEARO , 2003

Figure 2.1 : Spectrum of alcohol use

Abusers(Problem users)Harmful users)

Non-users

Social user

Regular users

Dependent users

Hazardous Use

Hazardous use is a pattern of alcoholconsumption carrying with it riskconsequences to the drinker. Thedamage may be to health-physical ormental, or they may include social

consequences to the drinker or others.In assessing the extent of risk, thepattern of use, as well as other factorssuch as family history, should be takeninto account.

Source: Adapted from Babor and Higginas Bibble(2001)

Dependence Syndrome

A cluster of behavioural, cognitive, andphysiological phenomena that developafter repeated alcohol use and thattypically include a strong desire,difficulties in controlling its use,

persisting in its use despite harmfulconsequences, a higher priority given toalcohol use than to other activities andobligations, increased tolerance, andsometimes a physical withdrawal state.

Source: Adapted from Benegal et al (2001)

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Figure 2.2: Levels of alcohol consumption by population

LOWConsumption

Dependent drinkers

Heavy drinkers

Social drinkers

HIGHConsumption

Source: Get High on Life Without Alcohol. Report by WHO SEARO, 2003

Population base Population base

Levels of Alcohol Consumption


In 1956, the French demographer, Ledermann, proposed a hypothesis that a rise in the total consumption of alcohol in society willincrease disproportionately the number of heavy and dependent drinkers and that a reduction in the total consumption will havethe greatest impact on the number of heavy drinkers.

In populations where consumption is low, e.g. South-East Asian countries, the pyramid will be narrow and the proportion of

dependent drinkers will be less. In populations where consumption is high, e.g. Western countries, the pyramid will be broad andcorrespondingly the number of dependent drinkers will be larger.

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Market Trends & Emerging Patterns

Many regions of the world have reached a stable and saturated consumption status while a few traditional markets, e.g. Europe, areshowing declining trends of alcohol consumption. As a result, new potential markets such as Asia have become the focus forindustry, which are increasingly targeting these markets.

Operating through different media channels, the wide variety of promotional strategies is expected to result in a rise in theproduction, distribution and consumption of alcohol in the South-East Asia Region.

Global consumption by economic standards also indicates that consumption has rapidly risen in the developing regions of theworld since 1970, as opposed to decreasing consumption in the developed regions and transitional economies of eastern andcentral Europe as Figure 2.3 and Figure 2.4 indicates.

Figure 2.3: Per capita consumption (age 15+)by WHO Region 1970-96 (in litres of pure alcohol)

Source: Global Status Report on Alcohol, WHO, 1999(based on data from FAO & UNDP)

x

AFRO AMRO EMRO EURO SEARO

0

2

4

6

8

10

12

14

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

Figure 2.4: Per capita consumption (age 15+)by Economy Region 1970-96 (in litres of pure alcohol)

0

2

4

6

8

10

12

14

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1994

1992

1996

Total Developed Developing In transition

Source: Global Status Report on Alcohol, WHO, 1999(based on data from FAO & UNDP)

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number of ads on network, local and

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Source: Gaining Less or Losing More?WHO Alcohol Control Series 2, 2006

Recent changes in alcohol consumption patterns

Emergence of wine and beer drinking

Increase in drinking among women

Early experimentation and decreasing age of initiation

Shift from urban to rural areas and transitional towns

More binge drinking

Greater acceptability of drinking as an accepted social norm Alcohol use combined with high-risk sexual behaviour

Source: WHO, 2003

World Trade Organization

and alcohol

Amongst the key elements ininternational agreements of the World

Trade Organization, important aspectsrelevant to alcohol control policyinclude:

Equal treatment to foreign anddomestic liquor

Removal of state monopoly on themanufacture, distribution andretailing of alcohol

Reduction or elimination of quotason the quantity of liquor which canbe imported

These requirements are likely toincrease alcohol consumption intraditionally low-use countries.

The average drinking pattern isa summary measure of theextent of alcohol use in acountry or community,estimated users, the averageper capita consumption and

pattern of drinking fromsurvey findings. The estimateaverage drinking pattern is inthe range of 1 to 4 (4 being the mostdetrimental pattern based on thenumber of heavy drinkingoccasions, drinking outside meals,high levels of fiesta drinking in

public place and 1 being leastdetrimental pattern, least heavydrinking occasions, drinking withmeal, low levels of fiesta drinkingand least drinking in public places.)

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India is showing a phenomenal increase in alcohol consumption, with the initiation age on an alarming decrease. Therecorded market and consumption levels are still very low vis--vis the global standard. The illicit market (spurious,seconds and thirds) consumption is far more than legal sales. Table 2.2 and 2.3 provide details of the types of alcoholbeverages available commonly.

Beverages Source Alcohol contents(percentage)

Brandy Fruit juices 40 - 50

Whisky Cereal grains 40 - 55

Rum Molasses/sugarcane 40 - 55

Wine (Port, Sherry, Grapes (also other fruits) 10 - 22Champagne, etc)

Beer Cereals 4 - 8

Source: Get high on life without alcohol-Report by WHO SEARO Region, 2003

Country Local brews

Bangladesh Bangla Mad, Cholai, Tari

Bhutan Ara

India Arrack, Desi Sharab, Tari, Tharra, Toddy, Fenny

Indonesia Palm w ine

Nepal Raksi, Tadi, Chayang, Tomb

Sri Lanka Toddy, Arrack

Thailand Oou, Krachae, Namtanmao, Sartha, Waark

Table 2.3: Types of local brews in the countriesof the South-East Asia Region

Source:Vivek BenegalNIMHANS

INDIAN


Table 2.2:Types of alcoholic beverages

Figure 2.5: Rise in sales in Karnataka in bulk litres

1988 1989 1990-91 1991-92 1992-93 1993-94 1994-95 1995-96 1996-97 1997-98 1998-99 1999

ARRACK

BEER

IMLLight Beer

Strong Beer

SALE IMLSALE ARRACKSALE BEERLIGHT BEERSTRONG BEER

0

100

200

300

400

500

600

700

800

900

1000

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Production of Alcohol in India

India is generally regarded as a traditional dry or abstaining culture (Bennet et al, 1993). Yet, it has one of the largest alcoholbeverage industries in the world. The UB Group, for example is the third largest spirits producer in the world after Diageo andPernod Ricard (ICAP, 2006c). India is the dominant producer of alcohol in the South-East Asia region (65 percent) and contributesto about 7% of the total alcohol beverage imports into the region. More than two thirds of the total beverage alcohol consumptionwithin the region is in India (Table 2.4).

There has been a steady increase in the production of alcohol in the country, with the production doubling from 887.2 million litresin 1992-93 to 1,654 million litres in 1999-2000 and was expected to almost treble to 2300 million litres (estimated) by 2006-07(Figure 2.5). (The Planning Commission of India, 2003).

Source: www.faostat.fao.org

Table 2.4: Alcohol production and import (metric tonnes)

India is one of the largestproducers of alcohol in the world

and contributes to 65 percentof production and nearly

7 percent of imports into theSouth Asian region.

The amount of alcohol producedin India during 2006 - 07 was

approximately 4 millionmetric tonnes.

Alcoholic Beverages Production Import

World 231035679 17876448

Asia 55981448 (24%) 1445338 (8.1%)South-East Asia 6411451 (11%) 105116 (7%)

Bangladesh 3004 (3%)

Myanmar 22062 (0.3%) 10350 (10%)

India 4186853 (65% ) 6876 (7%)

Indonesia 252756 (4%) 3594 (3%)

Korea, DPR 332400 (5%) 7300 (7%)

Maldives 2487 (2%)

Nepal 18600 (0.3%) 820 (1%)

Sri Lanka 21600 (0.4%) 1029 (10%)

Timor-Leste 0 3810 (4%)

Thailand 1577180 (25%) 56579 (53%)

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Though consumption is still low, patterns of alcoholconsumption vary widely through the country. Punjab, AndhraPradesh, Goa and the north-eastern states have a much higherproportion of male alcohol consumers than the rest of the

country. Women tend to drink more in the states of ArunachalPradesh, Assam and Sikkim in north-east; Madhya Pradesh,Chhattisgarh, Orissa and Andhra Pradesh in central and eastIndia; and Goa in the west, compared to other states.

Prevalence of Alcohol Use

The prevalence of alcohol use is still low in India as per somestudies done around the country (Table 2.5). The per capitaconsumption is 2 litres per adult per year (calculated fromofficial 2003 sales and population figures). After adjusting forundocumented consumption, which accounts for 45 to 50percent of total consumption, this is likely to be around 4 litres.

Table 2.5: Prevalence of alcohol use

Source: H. K. Sharma, National Drug Dependence Treatment Centre AIIMS,New Delhi

Never use Alcohol 25 - 74%

Prevalence (12 months) 19 - 34%

Prevalence (30 days) 12 - 20%

Regular users in last 30 days 6 - 10%

Problematic / Alcoholics 5%

Women (mostly abstainers) > 90%

International Institute for Population Sciences (IIPS) and MacroInternational. 2007. National Family Health Survey (NFHS-3), 2005-06:India: Volume I. IIPS. Mumbai

Prevalence of alcohol use among women - NFHS 3

International Institute for Population Sciences (IIPS) and MacroInternational. 2007. National Family Health Survey (NFHS-3), 2005-06:India: Volume I. IIPS. Mumbai

Prevalence of alcohol use among men - NFHS 3


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A recent National Household Survey of DrugUse recorded alcohol use in the past year inonly 21 perecent of adult males. Expectedly,this figure cannot mirror accurately the widevariation that obtains in a large and complexcountry such as India. The prevalence ofcurrent use of alcohol ranged from a low of 7perecent in the western state of Gujarat

(officially under Prohibition) to 75 perecentin the North-eastern state of ArunachalPradesh. There is also an extreme genderdifference. Prevalence among women hasconsistently been estimated at less than 5perecent but is much higher in the north-eastern states. Significantly higher use hasbeen recorded among tribal, rural and lower

socio-economic urban sections.

s cs fOfficial stati ti o

t a econsump ion r

coin mpleteas

u men d ndocu te

n m nt

co su ptio accoun s

f r p rceno almost50 e

tof

n um ntotalco s ptio .

m tes f p rEsti a o e capita

ti n e consump on edto

n sfactori thi

d e uun ocument dvol me.

National Survey Drug Abuse, 2004

Chandigarh

Delhi

Gwalior

Lucknow

Patna

RanchiKolkata

Dibrugarh

Guwahati

Imphal

Jaipur

Ahmedabad

Nagpur

Bangalore

Thrissur

Chennai

Siliguri

Figure 2.6: Prevalence of alcohol use in adult men in India

34.4 to 56.7 (3)

16.7 to 34.4 (5)

12.4 to 16.7 (5)

6.5 to 12.4 (5)

(Ray et al, 2004)

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Unrecorded Consumption and High

Expenditure

The unrecorded consumption and expenditure onalcohol still remains high in India, as in other South-East Asian countries such as Sri Lanka and Myanmar.(Table 2.6).

A substantial percentage of family income is spent on

alcohol, more so in rural households , which also tend tobe poor and marginalized, (32 percent Urban and 24percent Rural). (Figure 2.7).

Trends in Rural and Marginalized

Communities

Marginalized communities (geographically isolated,

minorities, tribes, economically or socially deprivedcommunities) are often victims of the harmful effects ofalcohol. In these areas, alcohol is sometimes introducedfor quick profits, exploiting the ignorance of thecommunity regarding harm from alcohol use.

It is projected as an escape from the deprivation towhich they are exposed. Sometimes employers paywages in alcohol rather than in cash (WHO, 2004).

Some marginalized communities, especially tribalcommunities brew alcohol at home leading todiversion of food grains to alcohol production, furtheraggravating hunger and poverty.

Figure 2.7: Family income spent on alcohol

Source: Dr. Vivek Benegal, NIMHANS, Bangalore, 2004

Perc

entageoffamilyincomesp

ent

Rural

24%

35

30

25

20

15

10

5

0

Urban

32%

Population

Source: Adapted from WHO, 2004

Table 2.6: Estimated volume of unrecorded consumptionof alcohol per capita for 15+ population in the SEAR

(in litres of pure alcohol)

Country Unrecorded Unrecordedconsumption consumption as

percentage of totalconsumption

Thailand 2.0 19

India 1.7 50

Myanmar 0.4 52

Sri Lanka 0.5 73


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Due to low levels of literacy and awareness, marginalized communities are veryseverely affected by harm from alcohol consumption, including illicit andspurious liquor.

Table 2.7 shows the tragedies reported due to use of illicit alcohol.

Place, Year Deaths or cases Remarks

Villupuram, Tamil Nadu, 2005 5 deaths ----------------

Nelamangala, Bangalore, 2005 21 deaths Fake government emblems on the sachets

Hoskote, Bangalore, 2005 10 deaths ----------------

Rewari, Haryana, 2005 8 deaths ----------------

Bikaner, Rajasthan, 2005 5 deaths Nearly 36 suspected to have died

Kolayat, Rajasthan 2005 21 deaths ----------------

Menambedu, Tamil Nadu, 2005 13 deaths Intoxicants worth Rs.170,000 and15,175 liters illicit liquor seized

Lucknow, Uttar Pradesh, 2005 7 deaths, ----------------

Cuddalore (near Chennai), Tamil Nadu 46 deaths 120 treated, 29 lost

2004 their vision 33 deaths in the previous month

Diwosas, Bareilly, Uttar Pradesh, 2004 14 deaths ----------------

Thrissur, Kerala, 2004 3 deaths ----------------

Unnao, Uttar Pradesh, 2004 9 deaths ----------------

Mumbai, Maharashtra, 2004 99 deaths,100 hospitalized 1110 litres illicit liquor seized

Tangra, West Bengal, 2004 35 deaths ----------------

Koopana, Kerala, 2004 7 deaths, 30 ill ----------------

Hissar, Haryana, 2003 6 deaths, 12 ill ----------------

Dharwad, Karnataka, 2003 6 deaths ----------------

Tiruvallur, Tamil Nadu, 2003 13 deaths, 92 male ill ----------------

Table 2.7: Media reported illicit alcohol tragedies in India, 2003-05

Source: Compiled from media reports in daily newspapers

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Patterns of Drinking

Though the overall prevalence of drinking is low and thefact that there are strong gender differences in the habit ofdrinking, amongst men and women, frequent and heavyconsumption is the dominant pattern. Surprisingly thereappears to be little difference between men and women inthe amount of alcohol consumed on typical drinkingoccasions. At an average five standard drinks are

consumed per typical drinking occasion.The frequency of use varies between men and women,with men drinking more frequently than women. It isinstructive to note that while almost 70 percent of themale drinkers drink daily or almost daily, 55 percent ofwomen drinkers also drink at the same frequency Thiscan hardly be termed infrequent drinking.

Dry cultures are known to predispose to deviant,

unacceptable and asocial behaviors consequent to alcoholuse as well as chronic disabling alcoholism Repeatedobservations have documented that more than 50 percentof all drinkers in India, satisfy the criteria for hazardousdrinking. The signature pattern is one of heavy solitarydrinking, predominantly spirits, typically more than fivestandard drinks per occasion. The dominant drinkingexpectancies favour drinking to intoxication and alcoholuse is strongly associated with expectations of

disinhibition and violence, especially among men, which'legitimizes' male drunkenness and violence Patterns ofalcohol consumption are probably more important thanper capita levels of alcohol use in predicting whetherpeople will experience problems with their drinking,making them better indices of the likelihood of harm inthe population.

5.11 million consumers in Karnatakastate annually consume 100.87 million

litres absolute alcohol equivalent

(56.53 million litres excise paid and 44.345million litres of beverage undocumented)

Documented Undocumented

Benegal et al, 2003

Per capita consumption of 2.98 litres absolute alcohol per year(1.67 litres excise paid beverage and 1.3 liters undocumentedbeverage per person per year.)

Keeping in mind the large numbers of abstainers, a moreappropriate measure of actual consumption would be 19.7 litresabsolute alcohol equivalent per consumer per year.

44%

56%

Source: WHO Collaborative project on unrecorded consumption of Alcohol(2003). Project report from the India site.

Figure 2.8:Per capita consumption of alcohol in Karnataka


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Source: Dr. Vivek Benegal, NIMHANS, Bangalore 2003.

Birth Chart Initiation of regular use

28

27

26

25

24

23

22

21

20

19

18

A

geofonset

Figure 2.9: Progressive lowering of the age atwhich consumers start regular drinking

1920to 30

1980to 90

1970to 80

1960to 70

1950to 60

1940to 50

1930to 40

27.67

24.31

23.3523.3622.87

21.13

19.45

Trends Among Women

The little information that exists about patterns of consumption inIndia indicate that women consumers can have an equally

explosive pattern of alcohol consumption as men. Traditionally,their numbers have been lower but persuasive marketing andadvancing urban lifestyles can make a significant change in thisand they make another popular target group. A recent study inKarnataka reported no major difference between the amounts ofalcohol drunk by men or women on any typical drinking occasion.

Table 2.9: Alcohol consumption (average age of initiation)

Year 1986 1990 1994 1998 2002 2006

Age 19 17 15 14.5 14 13.5

Source: Johnson J. Edayaranmula, ADIC-INDIA, 2007Drinking Patterns in Kerala,

Table 2.8: Drinking population (percentage)

Age 1990 1994 1998 2002 2006Below 21 2 6 9 12 14

21-30 29 31 33 34 35

31-40 38 36 36 34 34

41-50 24 22 18 16 14

Above 51 7 5 4 4 3

Source: Johnson J. Edayaranmula,ADIC-INDIA, 2007

Drinking Patterns in Kerala,

The age of initiation to alcohol is going down, as studies donein Kerala by Alcohol and Drugs Information Centre (ADIC)-India (Figure 2.9) and Karnataka show (Figure 2.7 and 2.8)

Different states have different legal minimum age limits foralcohol consumption, with the lowest being 18 years inKarnataka and Kerala and the highest at 25 years in Delhi;Maharashtra has permissible age for beer and wine as 21years

and 25 years for spirits. There is increasing lobbying by thealcohol industry for reduction in the permissible age.

Young people, especially teenagers, are more sensitive to

alcohol use because their bodies and brains are stilldeveloping. Studies and findings around the world areconclusively underscoring the dangers of early alcohol useresulting in a much higher risk of dependence and abuse, butthe legal age in India for serving alcohol is seldom checked.

Increasingly in India, the young are being lured towards

alcohol use. They are impressionable, want to be seen as fun,hip, cool & belonging to their peer groups and friend circles.

Alcohol also provides an excuse to behave in an uncontrolled

manner, which make controlled societies, like in many Asiancountries, including India, even more at risk, where alcoholconsumption tends to be done without the knowledge ofparents and family.

Drinking Age and Trends Among Youth

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Current Patterns and Trends of Alcohal

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