Need For Rational Alcohol Policy Instead Of
Failed Prohibitionist Approach
By Sukant Khurana & Brooks Robinson
24 April, 2011
The debate over the merits of alcohol consumption is hotly contested worldwide. There is no doubt that excessive drinking has caused pain and suffering for millions of people. On the other hand, human beings have been enjoying alcoholic beverages since prehistoric times and it is a tradition deeply rooted in many cultures, including Indian. Mild amounts of alcohol can have several health benefits while large doses can be poisonous. Can the two sides be reconciled? Can political action suspend or slow down the devastation caused by overindulgence? We are here to argue that yes, the two sides can be reconciled, but the current political action along the lines of prohibition is ineffective at best, and in most cases counterproductive. We argue for the implementation of an evidence-based smarter regulation policy that enhances the best qualities of alcohol, while minimizing its worst.
Before we analyze prohibition and its alternatives, let’s first discuss the effects of alcohol. Regulated alcoholic beverages contain ethanol, which is an edible type of alcohol. This is opposed to other alcohols such as methanol, also known as wood alcohol, which is highly toxic. Methanol can cause blindness and even death in sufficient quantity and is sometimes added into illicit alcoholic beverages to increase their potency. Ethanol, the edible alcohol, has very complex effects on humans. A single drinking episode can cause stimulation and sedation and have positive or negative health consequences depending on the amount consumed. Ethanol interacts with many proteins in the body, including ion-channels embedded in cell membranes, and therefore causes changes in how neurons function in the brain. In very low amounts it acts as a stimulant, while in higher amounts a sedative. In fact, if consumed in moderate quantities across many years, alcohol can have numerous positive health consequences. Moderate amounts of alcohol have been correlated with reducing dementia and Alzheimer’s disease, improving cardiac functioning, and reducing stroke incidences, type 2 diabetes, osteoporosis, gallbladder diseases, arthritis, renal cell carcinoma, thyroid cancer, and non-Hodgkin lymphoma among many other diseases. Ethanol in any form, as long as it is consumed in moderation, confers the above-mentioned health benefits and can save many health bills, particularly those relating to cardiac malfunction and strokes. Although there are many benefits of moderate alcohol consumption, it increases the craving for nicotine for smokers resulting in damage not due to the alcohol, but due to increased smoking. In addition, alcohol can be very dangerous for people with kidney and liver diseases and interacts with many prescription drugs. Apart from patients with such conditions, who should only drink after consulting a physician, alcohol has overall health benefits if consumed in moderation.
When alcohol is consumed in an uncontrolled and excessive manner however, the story is much different. Binge drinking, especially as a repeat pattern, is associated with many health problems including alcohol poisoning, liver sclerosis, cardiovascular diseases, sexual dysfunction, and fetal alcohol syndrome in unborn children of pregnant women. The World Health Organization (WHO) estimates that 2.5 million deaths per year worldwide are caused by alcohol related incidents, mostly due to heavy inebriation. The actual numbers are disputable, but the fact is that drinking causes many fatal accidents worldwide, and India is no exception. A strong correlation exists between heavy alcohol consumption and crime, though one can debate if alcohol actually causes crime or merely acts as a societal permission slip for perpetrators to commit preconceived crimes, as suggested by some placebo alcohol studies. Whether alcohol is societal permission slip or a causal agent, the evidence does point to a link between domestic violence and heavy alcohol consumption. Also, heavy drinking can result in blackouts that leave people vulnerable to crimes such as rape. Apart from health issues, the economic drain and the disruption of societal peace due to increased crime can be quite a big strain on society.
Another important aspect of alcohol to consider is the economic impact of its sale and employment generation. Alcohol is a significant source of revenue for India and can be a significant boost to the burgeoning tourism industry. On the other hand alcohol abuse can be serious drain on Indian economy.
Given that alcohol abuse is a serious drain on health, wealth, and the societal fabric of India, a solution is needed that limits alcohol abuse and the destruction it causes, while simultaneously encouraging healthy alcohol habits. Many grassroots movements, health organizations, NGOs, and governmental institutions have been clamoring around one approach: prohibition. The underlying assumption behind this approach is that all alcohol is bad. The problem with this attitude is twofold. First, even if one is willing to discount all evidence on the benefits of alcohol in small amounts and assume that alcohol is evil in any amount, prohibitionist experiments have time and again failed to significantly decrease, much less abolish alcohol consumption. Secondly, the overwhelming scientific evidence of the positive healthy role of alcohol in moderation, makes taking a prohibitionist approach simply ignorant. Despite the evidence pointing to the utter failure of prohibition, prohibitionist calls have come from various corners. Well-intentioned grass roots movements and a few sincere NGOs at one end and also self-benefiting NGOs (acting as fronts for converting black money to white through Hawala schemes) and the corrupt politicians looking out for various self-interests at another are all pushing hard for prohibition. We argue that such prohibitionist calls are not worth heeding. In the remainder of this article, we discuss the approaches to prohibition in India, the history of such approaches, and finally examine the best-studied prohibitionist experiment in world, that of US. We will then propose alternative, evidence-based approaches for evolving smart regulatory strategies that can go a long way in solving alcohol-related menace. Finally, we address problems that are unlikely to be solved by either approach, but can only be cured or contained by a well-informed citizenry and an overall socioeconomic improvement of the country.
At one extreme, prohibition can consist of a complete ban on alcohol sales and consumption. At the other end, it can simply be a regulation on alcohol promotion or a limit on the times alcohol can be sold. Prohibition in its extreme form is practiced in “dry territories” like Gujrat and Mizoram. Is alcohol consumption any lower in these states? No, the evidence suggests quite the contrary. In fact, Gujrat is one of the topmost states for alcohol addiction and abuse. Given the forbidden nature of alcohol in these dry states, people seem to look for excuses to drink in excess instead of limiting alcohol overindulgence to a few festivities per year. Bootlegging in these regions decreases alcohol quality and also increases the chances for methanol poisoning. In a single, devastating incident in 2009, 136 people died in one day in Gujrat due to the consumption of illicit alcohol, one of the worst of such accidents that has occurred worldwide. Andhra and Haryana have also gone dry in the past, a decision sorely regretted by the people of these states due to the increases in alcohol related health tragedies and crime, and losses of alcohol generated revenues. In dry states, the wealthy turn to imported smuggled alcohol that is not good for domestic industry, trade balance, and foreign reserves. The poor population on the other hand, turns to shoddy alcohol provided by bootleggers. Bootlegging in dry states encourages criminality, increasing the pressure on already strained and poorly performing law enforcement agencies. Purchasing alcohol on the black market allows bootleggers to vary prices and raise prices near the wedding season and other festivals like Holi and Diwali. This causes increased economic strain on alcohol consumers especially from the lowest economic strata of the society. In dry states, given the increased pressure to consume in hiding, people tend to binge especially on high alcohol content drinks, a far cry from healthy alcohol consumption. A ban on legal production also means loss of employment to decent law abiding citizens that can earn their living in regulated alcohol industry. Such bans also result in a loss of duty and tax to the state that can be a significant source of income. Sadly, many of these bans only apply to Indian citizens. Such a policy clearly implies that a foreigner can be trusted with alcohol, while an Indian cannot, a second-class treatment of one’s own citizens.
Another form of prohibition is setting dry days and limitations on the sale of alcohol. Like enforcing completely dry states, these ideas have been mostly ineffective due to people stocking up alcohol. In fact, increasing rather than decreasing the time for last call at bars has limited how many people rush to consume as much as possible and then drive drunk. Increasing the hours at which alcohol is served has been shown in many other places to actually reduce alcohol abuse related issues. Another prohibitionist strategy that has largely failed is to ration the amount of alcohol sold, though depending on the context it may have some merits. Unfortunately, well-conducted studies on the effects of rationing in different socio-economic and regional contexts of India are largely missing, although a recently revealed multibillion-dollar corruption using food ration schemes in Uttar Pradesh will give anyone jitters when contemplating the rationing of alcohol. Another prohibitionist strategy currently implemented in most states is to tax alcoholic beverages and charge heavy fees for the license to sell them. A plethora of evidence points to no decrease in alcohol consumption, but only to an increase in the sale of illegal and potentially dangerous alcohol. High fees required to procure licenses for selling alcohol mean that predominantly shady people (using bribes) or big monopolies with political connections end up having pubs and bars. This is obviously not good for ensuring a competitive economy as well as preserving law and order situation in the country. Another manifestation of alcohol prohibition is to prevent alcohol advertisements. Most studies on this topic show that alcohol advertisements do not actually increase alcohol consumption. Nonetheless, such studies have not been done in India and one can argue that results from Western studies may not be applicable in different cultural contexts. Even if one considers this argument to have some merit, the current “ban” does not make sense. It is pretentious to ban alcohol advertisements while allowing alcohol manufacturers to advertize low-selling, almost hypothetical products like music CDs and bottled water that have the same name as their alcoholic beverage.
Let us look at history of prohibition in US as a well studied case of alcohol regulation and what actually happens under prohibition. In the United States, soon after independence was won, a movement towards temperance and prohibition was started. It started small. Certain religious and activist groups frowned upon intemperance and pushed for education on the ills of drunkenness. Just prior to the civil war, a few states enacted laws effectively banning alcohol. These were clumsily written and some were even found to be against the constitution (e.g. the search and destroy law). Late in the 19th century, the movement for prohibition continued growing. There were stricter laws about who could sell alcohol and heavy tax payments were required when owning a saloon. To keep up with these taxes, saloon owners were forced to play dirty. They would receive kick-backs from prostitutes and pickpockets that were allowed to patronize the saloon.
Even though temperance was gaining steam during this time without enforced prohibition and many people were willfully choosing the route of abstinence, activists were pushing hard for laws. It is a shame that education about alcohol and free choice about drinking weren’t given more of a chance to succeed on their own. The progress was not obvious and rapid enough for prohibition activists and with the Progressive Era and World War I, the prohibitionists saw the perfect opportunity for complete prohibition and seized it. The Progressive Era in the United States was marked by efforts to reform and purify the government and other aspects of society including education, medicine, and insurance. Prohibition was a central issue and it was believed by many that legally eliminating saloons and drinking altogether, would go a long way in establishing an honest and productive United States. And with the start of the war, many more people were persuaded to join the prohibition cause with the argument that the resources required for alcohol production (grains, man power) would be better used in helping out the United State’s cause. By the time prohibition started however, the war had ended.
Many assumptions went into enacting a prohibition in the United States and they might sound reasonable at first glance, but experience has taught us a different lesson. In prohibiting alcohol, it was assumed that alcohol is harmful to the consumer and addiction to it is uncontrollable by individuals and thus must be addressed by the government. In addition, consumption of alcohol in any amount causes harm to society. This could be in the form of crime or lack of productivity of workers among other things. Above all, prohibition was thought to be the best solution to these problems.
During prohibition the demand for alcohol remained high however, with some studies suggesting multiple fold increase in alcohol abuse. It proved impossible to prevent all illicit alcohol production or even most of it. Alcohol can be produced almost anywhere and from a plethora of different ingredients eliminating “blueprint” in spotting its production. The real problem with the illegal making of alcohol was that it was logical for sellers and buyers alike that the alcohol be more potent. More “bang for your buck” so to say. So now alcohol users were drinking spirits with much higher alcohol content that was not regulated in any way and was much more likely to contain impurities and toxins that are more harmful to the human body that ethyl alcohol itself.
Another downfall of prohibition was that it created a brand new avenue of crime. The profit from bootlegging and alcohol smuggling was so much that major bootleggers and mafia funded pro-prohibition lawmakers. In addition, prohibition caused alcohol prices on the black market to be much higher than they would be during regulated sale of alcohol. Addicts were thus more likely to disregard the law in order to get their fix. These new crime concerns also caused havoc for the authorities and more governmental resources were required to control the alcohol black market and enforce prohibition. This extra cost of prohibition added with the absence of profit that occurs from taxing and regulating alcohol raised substantial financial concern. After 14 years of the “Noble Experiment” in America, prohibition was repealed and is now considered a huge blunder by many. As can be seen, there are many similarities between the failed prohibition in the United States and the prohibitions in India. Hopefully, this can be realized before history looks back on our time and the word “blunder” comes to mind.
So if prohibition is not the answer, then what is? An alternative to prohibition is a liberal attitude to the sale and consumption of healthy amounts and varieties of alcohol, while enforcing very strict punishments for unhealthy alcohol consumption patterns. Research has shown that having alcohol served in dedicated spaces spread across normal markets facilitates responsible alcohol consumption and actually reduced drunk driving. It was also seen that areas that have no bars or only expensive bars promote people binging on alcohol secretly, often in places like public parks. Making alcohol available at all times also will prevent genuine healthy consumers of alcohol from stocking up or binging before the onset of a dry time. Availability of information on healthy alcohol habits and the dangers of overindulgence is a great need in this time. In conjunction with liberal attitude towards healthy alcohol consumption and alcohol-related information, stricter punishments need to be legislated and implemented for drunk driving and other alcohol related crimes. Restaurants and pubs can be deterred from promoting unhealthy alcohol consumption by imposing strict punishments for serving a person who has consumed too much already. Instead of alcohol being permitted as an excuse for domestic violence, as has been used by many defense lawyers, handing out stricter punishments for alcohol-associated crimes can also be a good deterrent. It is important to recognize that, although heavy inebriation makes person loose certain inhibitions, most crimes considered alcohol-related crimes are conceived prior to alcohol consumption. In the Indian constitution the intent of the crime is one of the central issues in determining the extent of the punishment. Legislation recognizing that being drunk does not transform a preconceived crime into a crime of passion is vital to curtail such crimes. Another important factor in regulating alcohol abuse will be police reform. Currently, bribes from Rs 50 to 1000 are not unheard of and can often times get individuals off with just a warning about drunk driving. Unless the law enforcement and judiciary systems are replaced or reformed, no approach to alcohol regulation is going to work completely, though rational evidence based approach will fare better than prohibitionist strategies.
Perhaps of the most importance, as has been shown in several studies, is that responsible drinking by parents is the best way to form responsible habits in young adults. Just like it is useless to use a stork when explaining childbirth to a teenager, it is futile to use scare tactics when talking about alcohol. The more forbidden a fruit seems, the more interesting it is for a high school or college student. Talking about healthy alcohol habits makes more sense.
The alcohol issue also has another dimension in India, a problem that is less severe in many Western countries. There is a distinctive taboo concerning alcohol consumption in any amount, especially by women. The religious teachings of the Vaishnav sect of Sanatan Hinduism, Islam, Jainism, Sikhism, and Arya Samaj all tend to influence some ardent fundamentalist believers to look down upon alcohol consumption by others even if it is in healthy amounts, though the urban behavior of youths of all faiths is changing rapidly. History has taught us that making something a taboo does not solve the problem, but only makes it more tempting. Taboos encourage closeted and unsafe behavior like binge drinking in the case of alcohol or unsafe sex in the case of premarital relationships. What is sorely missing in India is information people can use to make an informed decision on both the healthy and unhealthy aspects of alcohol consumption. People need to understand that alcohol is a health problem in excess, but not in moderation for the average person. Another reason for binging by the economically downtrodden, especially in urban and semi-urban settings, is the lack of other escapes and distractions from what can amount to be a depressing life. For instance, the alcohol abuse in poor rural communities (with their social safety nets in the form of community bonds), especially in tribal societies, is much less severe than that of migrant workers in urban India. Even though rational evidence based approach to alcohol will work better than prohibitionist knee-jerk response, neither of the two can entirely solve this form of alcohol abuse. A general solution to alcohol associated domestic violence and economic drain is socioeconomic and cultural growth. By socioeconomic development we do not mean a sheer bloating of the middle class purchasing power or increased GDP, but a holistic growth, which in the recent witty wordplay of Yechuri (a CPM politician) was described as a reduction of the gap between the IPL (Indian Premier League) and the BPL (Below Poverty Line). Whether the nation continues to follow the dictates of current neoliberal Washington consensus, adopts a genuine free market model driven by national interests, takes a command economy-style road to capitalism as done by China, turns to a completely red path as wanted by Maoist insurgents, or reverts to the old Nehruvian populist salad bowl economy with chunks of socialism and capitalism, without genuine social and gender equity, some problems of excessive alcohol consumption are going to be with us forever.
We hope to stimulate informed discussion about alcohol policy in India and urge the adoption of an evidence-based rational approach to alcohol regulation so that the destruction caused by alcohol abuse can be contained and the benefits of healthy alcohol habits furthered. We realize that no policy will be perfect, but repeatedly trying a method in prohibition that has failed so many times is truly damaging to India and her citizens. We look forward to an era of smarter approaches to winning the war on addiction and by attacking it on many fronts including a rational alcohol policy and seismic shifts in socioeconomic structure, education, and cultural attitudes.
Sukant Khurana, Ph.D.
Section of Neurobiology,
University of Texas at Austin
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