Personal views: The politics of alcoholism in India
Authors: Vikram Patel
Journal: BMJ (1998)

At a recent meeting in Goa organised by the National Commission for Women, its chairwoman, the vibrant and outspoken Ms Mohini Giri, exhorted the women of Goa to join hands with millions of women in other Indian states to demand that prohibition be implemented to reduce the appalling damage resulting from alcohol misuse by men. 

The use of prohibition in India has a long history. Gujarat, the home state of Mahatma Gandhi, declared prohibition soon after the British left and has stuck to this policy ever since. More recently, however, prohibition became a major vote winner in the states of Andhra Pradesh and Haryana. Alcohol misuse has become such an enormous problem that it is now the main issue on which elections are being fought and won. 

Alcohol misuse is one of the main killers of young men in India today. But its real impact is on the social and family dynamics that underlie our communities. Domestic violence and an exacerbation of poverty have made alcohol misuse the single most important problem for women in India. A recent study in Goa showed that women attending primary care clinics were more likely to cite a drinking relative as a key problem in their homes. They were also more likely to cite problems with making ends meet and to suffer from a depressive or anxiety disorder. 

What has changed over the past 20 years is that these women are now an increasingly potent electoral force. Women’s organisations have successfully mobilised millions of women and struck a sensitive chord in identifying alcoholism in their families as being a potentially preventable cause of poverty and abuse. Rather deviously, women have been identified by opportunistic politicians as a vote bank; political parties have thrown all the benefit of hindsight to the wind and made prohibition their prime election promise. The result was that the Telegu Desam party won a famous electoral victory, winning 224 out of 294 seats in Andhra Pradesh. Subsequently, the party which put prohibition at the top of its agenda won the elections in Haryana with a large majority. 


But has prohibition made any difference to the real problem—that is, drinking by men? If Gujarat is anything to go by prohibition is a complete failure. Not only is alcohol readily available to the rich, but the poor have to resort to illegal brews, with a consequent rise in criminal activity and deaths from methanol poisoning. Prohibition has introduced massive problems for the government treasuries and caused further hardships for the poor by increasing unemployment. In Andhra Pradesh alcohol breweries were shut with the loss of hundreds of legitimate jobs; the state was virtually bankrupted. The government attempted to counter the budgetary deficit by raising taxes and the cost of subsidised rice, the staple food of millions of Indians. Despite this, the deficit continued to spiral out of control reaching a third of the annual budget outlay. Finally, the Reserve Bank of India threatened to withdraw the overdraft facility to the state. The government then relented and introduced the AP Prohibition Act 1997, which effectively removed prohibition in favour of a more regulated alcohol retailing system. 


“There has been no mention of any public health initiatives”



An amazing feature of all this grassroots democracy is that there has been no mention of any public health initiatives to tackle alcohol misuse. Primary preventive strategies would enable the reduction of problem drinking in an entire population. Such strategies could include the strict enforcement of laws on licensing and on drinking and driving, and the provision of peer education on drinking behaviour in colleges and schools. Secondary prevention would enable the reduction of the effects of problem drinking once it had been detected in an individual. How often does a woman who has been battered by her alcoholic husband receive counselling or a health worker visit her home to counsel the husband? How often does a man who has been in hospital for a bleeding gastric ulcer or after a drinking and driving accident receive information on the nearest Alcoholics Anonymous meeting place? Counsellors could work with other organisations, such as Alcoholics Anonymous and the Indian Psychiatric Association, in a united campaign to help families affected by problem drinking. 

The policy of prohibition is at odds with an essential ingredient of any community health programme—namely, its participatory approach. By identifying drinking in men as the problem, the current approach alienates and excludes them from participating in finding a solution. Bar owners and alcohol manufacturers, usually men, see their livelihood destroyed and, instead of empathising with women on this sensitive issue, they feel threatened. 

The current drive by the National Commission for Women is an admirable example of women uniting in an effort to make their lives better by forcing the government to act. But in their vociferous support for prohibition women’s groups should remember that it will always be the poor who will suffer the most from prohibition. A community based, participatory public health model to tackle alcohol misuse is the only way to reduce the negative impact of problem drinking while safeguarding the economic benefits of alcohol, avoiding punishing the majority who drink sensibly, and preventing deaths and crime which result from the illegal bootlegging industry.