2

CURRENT PATTERNS & TRENDS OF ALCOHOL USE

CURRENT PATTERNS & TRENDS OF ALCOHOL USE

GLOBAL
Per Capita Consumption
According to (WHO) estimates, there are about 2 billion people worldwide who consume alcoholic beverages and 76.3 million with diagnosable alcohol-use disorders. Table 2.1 shows per capita consumption of alcohol in various regions of the world.
Annual per capita alcohol consumption per adult can be derived by:
Alcohol production + Alcohol imports - Alcohol exports population 15 years of age and over

Table 2.1 : Annual per capita consumption of alcohol per adult 15 years of age and over
Region Consumption (litres) 03.9 16.2 00.4 10.5 01.7 04.8 Range Median Countries surveyed/ Total No. 28/46 32/35 12/21 49/52 07/11 20/27 Percentage of population covered 76.7 99.9 90.4 99.9 98.4 99.9

Africa America Eastern Mediterranean European South-East Asian West Pacific

0.02 - 07.72 1.66 - 14.03 0.05 - 10.00 0.85 - 15.12 0.04 - 08.64 0.34 - 18.39

0.95 5.74 0.53 8.26 0.99 1.95

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

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Spectrum of Alcohol Consumption

The International Classification of Diseases (ICD-10) published by the World Health Organization (WHO) uses the term harmful use to indicate a pattern of alcohol use similar to alcohol abuse. The extent of alcohol use is related to problems that have a significant impact on public health. The proportions of population in different groups of the drinking spectrum vary considerably in different societies. A general rule, derived from European and American experience, is that 10% of the alcohol drinking population consumes half the total amount of alcohol in that society.
Non-users

Figure 2.1 : Spectrum of alcohol use

Regular users

Social user

Dependent users

Abusers (Problem users) Harmful users)

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

Harmful Use
A Pattern of alcohol use that is causing damage to health. The damage may be physical (as in case of hepatitis from prolonged use of alcohol) or mental (e.g. episode of depressive disorder secondary to heavy consumption of alcohol).
Source: Adapted from WHO (2003b)

Hazardous Use
Hazardous use is a pattern of alcohol consumption carrying with it risk consequences to the drinker. The damage may be to health-physical or mental, or they may include social consequences to the drinker or others. In assessing the extent of risk, the pattern of use, as well as other factors such as family history, should be taken into account.
Source: Adapted from Babor and Higginas Bibble (2001)

Dependence Syndrome
A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated alcohol use and that typically include a strong desire, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to alcohol use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.
Source: Adapted from Benegal et al (2001)

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CURRENT PATTERNS & TRENDS OF ALCOHOL USE

Levels of Alcohol Consumption

In 1956, the French demographer, Ledermann, proposed a hypothesis that a rise in the total consumption of alcohol in society will increase disproportionately the number of heavy and dependent drinkers and that a reduction in the total consumption will have the 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 and correspondingly the number of dependent drinkers will be larger.

Figure 2.2: Levels of alcohol consumption by population

LOW Consumption
Dependent drinkers Heavy drinkers

HIGH Consumption

Social drinkers

Population base

Population base

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

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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, are showing declining trends of alcohol consumption. As a result, new potential markets such as Asia have become the focus for industry, 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 the production, 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 the world since 1970, as opposed to decreasing consumption in the developed regions and transitional economies of eastern and central 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)
AFRO 14 12 10 8 6 4 2 AMRO EMRO EURO

Figure 2.4: Per capita consumption (age 15+) by Economy Region 1970-96 (in litres of pure alcohol)
14 12 10 8 6 4 2 Total Developed Developing In transition

x SEARO

1972

1982

1970

1976

1978

1980

1986

1988

1974

1984

1990

1992

1972

1982

1970

1976

1978

1980

1986

1988

1990

1992

1974

1984

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

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

1994

1996
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CURRENT PATTERNS & TRENDS OF ALCOHOL USE

number of ads on network, local and

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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

The average drinking pattern is a summary measure of the extent of alcohol use in a country or community, estimated users, the average per capita consumption and pattern of drinking from survey findings. The estimate average drinking pattern is in the range of 1 to 4 (4 being the most detrimental pattern based on the number of heavy drinking occasions, drinking outside meals, high levels of fiesta drinking in public place and 1 being least detrimental pattern, least heavy drinking occasions, drinking with meal, low levels of fiesta drinking and least drinking in public places.)
Source: Gaining Less or Losing More? WHO Alcohol Control Series 2, 2006

World Trade Organization and alcohol Amongst the key elements in international agreements of the World Trade Organization, important aspects relevant to alcohol control policy include: Equal treatment to foreign and domestic liquor Removal of state monopoly on the manufacture, distribution and retailing of alcohol Reduction or elimination of quotas on the quantity of liquor which can be imported These requirements are likely to increase alcohol consumption in traditionally low-use countries.
Source: WHO, 2003

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CURRENT PATTERNS & TRENDS OF ALCOHOL USE

INDIAN
India is showing a phenomenal increase in alcohol consumption, with the initiation age on an alarming decrease. The recorded 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 alcohol beverages available commonly.
Table 2.2: Types of alcoholic beverages
Beverages Brandy Whisky Rum Wine (Port, Sherry, Champagne, etc) Beer Source Fruit juices Cereal grains Molasses/sugarcane Grapes (also other fruits) Cereals Alcohol contents (percentage) 40 - 50 40 - 55 40 - 55 10 - 22 4-8

Table 2.3: Types of local brews in the countries of the South-East Asia Region
Country Bangladesh Bhutan India Indonesia Nepal Sri Lanka Thailand Local brews Bangla Mad, Cholai, Tari Ara Arrack, Desi Sharab, Tari, Tharra, Toddy, Fenny Palm wine Raksi, Tadi, Chayang, Tomb Toddy, Arrack Oou, Krachae, Namtanmao, Sartha, Waark

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

Figure 2.5: Rise in sales in Karnataka in bulk litres

1000 900 800 700 600 500 SALE IML SALE ARRACK SALE BEER LIGHT BEER STRONG BEER

ARRACK

BEER
400 300 200 100 0 Light Beer

IML

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

Source: Vivek Benegal NIMHANS

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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 alcohol beverage industries in the world. The UB Group, for example is the third largest spirits producer in the world after Diageo and Pernod Ricard (ICAP, 2006c). India is the dominant producer of alcohol in the South-East Asia region (65 percent) and contributes to about 7% of the total alcohol beverage imports into the region. More than two thirds of the total beverage alcohol consumption within 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 litres in 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). Table 2.4: Alcohol production and import (metric tonnes)
Alcoholic Beverages World Asia South-East Asia Bangladesh Myanmar India Indonesia Korea, DPR Maldives Nepal Sri Lanka Timor-Leste Thailand
Source: www.faostat.fao.org
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Production 231035679 55981448 6411451 22062 4186853 252756 332400 18600 21600 1577180 (24%) (11%) (0.3%) (65% ) (4%) (5%) (0.3%) (0.4%) 0 (25%)

Import 17876448 1445338 105116 3004 10350 6876 3594 7300 2487 820 1029 3810 56579 (8.1%) (7%) (3%) (10%) (7%) (3%) (7%) (2%) (1%) (10%) (4%) (53%)

India is one of the largest producers of alcohol in the world and contributes to 65 percent of production and nearly 7 percent of imports into the South Asian region. The amount of alcohol produced in India during 2006 - 07 was approximately 4 million metric tonnes.

CURRENT PATTERNS & TRENDS OF ALCOHOL USE

Prevalence of Alcohol Use
The prevalence of alcohol use is still low in India as per some studies done around the country (Table 2.5). The per capita consumption is 2 litres per adult per year (calculated from official 2003 sales and population figures). After adjusting for undocumented consumption, which accounts for 45 to 50 percent of total consumption, this is likely to be around 4 litres. Table 2.5: Prevalence of alcohol use
Never use Alcohol Prevalence (12 months) Prevalence (30 days) Regular users in last 30 days Problematic / Alcoholics Women (mostly abstainers) 25 - 74% 19 - 34% 12 - 20% 6 - 10% 5% > 90%
International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005-06: India: Volume I. IIPS. Mumbai

Prevalence of alcohol use among women - NFHS 3

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

Prevalence of alcohol use among men - NFHS 3

Though consumption is still low, patterns of alcohol consumption vary widely through the country. Punjab, Andhra Pradesh, Goa and the north-eastern states have a much higher proportion of male alcohol consumers than the rest of the country. Women tend to drink more in the states of Arunachal Pradesh, Assam and Sikkim in north-east; Madhya Pradesh, Chhattisgarh, Orissa and Andhra Pradesh in central and east India; and Goa in the west, compared to other states.
International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005-06: India: Volume I. IIPS. Mumbai

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A recent National Household Survey of Drug Use recorded alcohol use in the past year in only 21 perecent of adult males. Expectedly, this figure cannot mirror accurately the wide variation that obtains in a large and complex country such as India. The prevalence of current use of alcohol ranged from a low of 7 perecent in the western state of Gujarat (officially under Prohibition) to 75 perecent in the North-eastern state of Arunachal Pradesh. There is also an extreme gender difference. Prevalence among women has consistently been estimated at less than 5 perecent but is much higher in the northeastern states. Significantly higher use has been recorded among tribal, rural and lower socio-economic urban sections.
f Official statistics o e consumption ar incomplete as undocumented unts consumption acco ent of for almost 50 perc . total consumption pita Estimates of per ca d to consumption nee factor in this lume. undocumented vo

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)

Chandigarh

6.5 to 12.4 (5)

Dibrugarh

Delhi Jaipur

Lucknow Gwalior Patna

Siliguri

Guwahati Imphal

Ahmedabad Kolkata

Nagpur

Ranchi

Bangalore Chennai

Thrissur

(Ray et al, 2004)

National Survey Drug Abuse, 2004

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CURRENT PATTERNS & TRENDS OF ALCOHOL USE

Unrecorded Consumption and High Expenditure
The unrecorded consumption and expenditure on alcohol still remains high in India, as in other SouthEast 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 to be poor and marginalized, (32 percent Urban and 24 percent Rural). (Figure 2.7). Table 2.6: Estimated volume of unrecorded consumption of alcohol per capita for 15+ population in the SEAR
Country Unrecorded consumption
(in litres of pure alcohol)

Unrecorded consumption as percentage of total consumption 19 50 52 73

Thailand India Myanmar Sri Lanka

Source: Adapted from WHO, 2004

2.0 1.7 0.4 0.5

Trends in Rural and Marginalized Communities

Marginalized communities (geographically isolated, minorities, tribes, economically or socially deprived communities) are often victims of the harmful effects of alcohol. In these areas, alcohol is sometimes introduced for quick profits, exploiting the ignorance of the community regarding harm from alcohol use. It is projected as an escape from the deprivation to which they are exposed. Sometimes employers pay wages in alcohol rather than in cash (WHO, 2004). Some marginalized communities, especially tribal communities brew alcohol at home leading to diversion of food grains to alcohol production, further aggravating hunger and poverty.
Percentage of family income spent
35 30 25 20 15 10 5 0

Figure 2.7: Family income spent on alcohol

24%

32%

Rural

Urban

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

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Due to low levels of literacy and awareness, marginalized communities are very severely affected by harm from alcohol consumption, including illicit and spurious liquor. Table 2.7 shows the tragedies reported due to use of illicit alcohol. Table 2.7: Media reported illicit alcohol tragedies in India, 2003-05
Place, Year Villupuram, Tamil Nadu, 2005 Nelamangala, Bangalore, 2005 Hoskote, Bangalore, 2005 Rewari, Haryana, 2005 Bikaner, Rajasthan, 2005 Kolayat, Rajasthan 2005 Menambedu, Tamil Nadu, 2005 Lucknow, Uttar Pradesh, 2005 Cuddalore (near Chennai), Tamil Nadu 2004 Diwosas, Bareilly, Uttar Pradesh, 2004 Thrissur, Kerala, 2004 Unnao, Uttar Pradesh, 2004 Mumbai, Maharashtra, 2004 Tangra, West Bengal, 2004 Koopana, Kerala, 2004 Hissar, Haryana, 2003 Dharwad, Karnataka, 2003 Tiruvallur, Tamil Nadu, 2003
Source: Compiled from media reports in daily newspapers
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Deaths or cases 5 deaths 21 deaths 10 deaths 8 deaths 5 deaths 21 deaths 13 deaths 7 deaths, 46 deaths 14 deaths 3 deaths 9 deaths 99 deaths,100 hospitalized 35 deaths 7 deaths, 30 ill 6 deaths, 12 ill 6 deaths 13 deaths, 92 male ill

Remarks ---------------Fake government emblems on the sachets ------------------------------Nearly 36 suspected to have died ---------------Intoxicants worth Rs.170,000 and 15,175 liters illicit liquor seized ---------------120 treated, 29 lost their vision 33 deaths in the previous month ---------------------------------------------1110 litres illicit liquor seized ----------------------------------------------------------------------------

CURRENT PATTERNS & TRENDS OF ALCOHOL USE

Patterns of Drinking
Though the overall prevalence of drinking is low and the fact that there are strong gender differences in the habit of drinking, amongst men and women, frequent and heavy consumption is the dominant pattern. Surprisingly there appears to be little difference between men and women in the amount of alcohol consumed on typical drinking occasions. 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 is instructive to note that while almost 70 percent of the male drinkers drink daily or almost daily, 55 percent of women drinkers also drink at the same frequency This can hardly be termed infrequent drinking. Dry cultures are known to predispose to deviant, unacceptable and asocial behaviors consequent to alcohol use as well as chronic disabling alcoholism Repeated observations have documented that more than 50 percent of all drinkers in India, satisfy the criteria for hazardous drinking. The signature pattern is one of heavy solitary drinking, predominantly spirits, typically more than five standard drinks per occasion. The dominant drinking expectancies favour drinking to intoxication and alcohol use is strongly associated with expectations of disinhibition and violence, especially among men, which 'legitimizes' male drunkenness and violence Patterns of alcohol consumption are probably more important than per capita levels of alcohol use in predicting whether people will experience problems with their drinking, making them better indices of the likelihood of harm in the population. Figure 2.8: Per capita consumption of alcohol in Karnataka

Documented

Undocumented

5.11 million consumers in Karnataka state annually consume 100.87 million litres absolute alcohol equivalent (56.53 million litres excise paid and 44.345 million litres of beverage undocumented)

44% 56%

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 undocumented beverage per person per year.) Keeping in mind the large numbers of abstainers, a more appropriate measure of actual consumption would be 19.7 litres absolute alcohol equivalent per consumer per year.
Source: WHO Collaborative project on unrecorded consumption of Alcohol (2003). Project report from the India site.

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Drinking Age and Trends Among Youth

The age of initiation to alcohol is going down, as studies done in 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 for alcohol consumption, with the lowest being 18 years in Karnataka 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 the alcohol industry for reduction in the permissible age. Young people, especially teenagers, are more sensitive to alcohol use because their bodies and brains are still developing. Studies and findings around the world are conclusively underscoring the dangers of early alcohol use resulting in a much higher risk of dependence and abuse, but the 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 Asian countries, including India, even more at risk, where alcohol consumption tends to be done without the knowledge of parents and family.
Table 2.8: Drinking population (percentage) Age Below 21 21-30 31-40 41-50 Above 51 1990 2 29 38 24 7 1994 6 31 36 22 5 1998 9 33 36 18 4 2002 12 34 34 16 4 2006 14 35 34 14 3

Table 2.9: Alcohol consumption (average age of initiation) Year Age 1986 19 1990 17 1994 15 1998 14.5 2002 14 2006 13.5

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

Trends Among Women

The little information that exists about patterns of consumption in India indicate that women consumers can have an equally explosive pattern of alcohol consumption as men. Traditionally, their numbers have been lower but persuasive marketing and advancing urban lifestyles can make a significant change in this and they make another popular target group. A recent study in Karnataka reported no major difference between the amounts of alcohol drunk by men or women on any typical drinking occasion. Figure 2.9: Progressive lowering of the age at which consumers start regular drinking
28 27 26 27.67

Age of onset

25 24 23 22 21 20 19 18

24.31 23.36 23.35 22.87 21.13 19.45

Birth Chart Initiation of regular use

1920 to 30 1930 to 40 1940 to 50 1950 to 60 1960 to 70 1970 to 80 1980 to 90

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

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

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