Alcohol policy needed for lockdowns: No need to detest booze, say mental health experts

NEW DELHI: India needs to handle its relationship with alcohol better, said top mental health experts at the All India Institute of Medical Sciences (AIIMS) and the National Institute of Mental Health & Neurosciences (Nimhans). Concerned about crowds outside liquor shops violating social distancing norms, one of them underscored “the need to acknowledge the country’s drinking behaviour and not be condescending towards alcohol consumption”.

Long queues formed outside liquor shops in New Delhi, Mumbai, Bengaluru, Lucknow and other cities after they reopened on Monday. But Delhi had to close some shops because of the overcrowding even as the state imposed an additional levy on liquor. Maharashtra police had to use force to disperse people in several areas and the state had to shut liquor shops in Mumbai. To be sure, there’s also no escaping the link between drinking and domestic violence, experts said.

A policy on alcohol supplies, especially during a lockdown, is needed, said Atul Ambekar, professor of psychiatry at the National Drug Dependence Treatment Centre of AIIMS.

“In India, we have always had this ‘vice versus virtue’ dichotomy whenever we talk about alcohol,” he said. “It is well known that alcohol can be a public hazard, but not making alcohol available hasn’t ever worked. A substantial part of India is middle class that does not have a bar or a stock at home. What we need is a sensible regulation and a sensible market. The crowds are not surprising as the product was not available for 40 days. We saw crowds for food, transport too.”

‘Calibrate Demand, Supply’

Policymakers need to calibrate demand and supply, to maintain social distancing, and seriously consider options such as home delivery of alcohol, said Rajesh Nagpal of the Delhi Psychiatric Society.

“It is a biological need,” he said. “One cannot wish it away by a policy tweak, or temporary unavailability. Policymakers should leave their moral glasses far away when they frame rules in this regard.”

It might have been better to have kept the vends working throughout. “Looking at the crowds, in hindsight, one can say that the sale of liquor sale in retail outlets could have remained open. That could have prevented rebound crowding,” Nimhans director BN Gangadhar told ET. “The breaking of social distancing norms for liquor in many states is disturbing because it can affect the gain we have had from the lockdown… Like coffee powder or milk, or oil, alcohol is an essential for many people. This is a lesson to remember — to not shut the supply of alcohol completely.”

Store Pickups

Allowing store pickups of alcohol, as with takeaway food, could have been one option.

“People would have come in batches, waited and gone back with what they want, just like they did with food packets,” he said. “The crowding was due to eight weeks of ban and then fear that what if the clampdown happens again.”

Instead of bans, the country needs support systems to deal with dependence, he said.

“While fewer people drink alcohol in India when compared to the international average, one third of them are likely to suffer from alcohol-induced disorder here,” Ambekar said.

Withdrawal Symptoms

Doctors across the country reported a surge in patients with severe alcohol withdrawal symptoms in the initial weeks of the lockdown, prompting the health ministry to release a video on ‘How to Safely Stop Drinking due to Lockdown’.

“The pricing structure and alcohol market in India is also responsible in many ways for this, because the low alcohol concentrated beverages are much more expensive in India, compared to high-level ones such as whisky,” Ambekar said. “Hence, by volume, it is more affordable for a person to get drunk on whisky than beer, as the latter tends to get more expensive.”

The pricing structure should be inverted, he said. State governments typically derive about 15-30% of their total revenue from excise levied on alcohol.

According to a report by the National Drug Dependence Treatment Centre of AIIMS last year, about 160 million people consume alcohol in India.

“Even in developed countries, this issue of how much should bars be allowed at a time like this has been raised,” Ambekar said. “It is very difficult to label alcohol as an essential product anywhere in the world, but at the same time, a complete ban on availability of alcohol is also problematic to a society where a substantial amount of people consume alcohol… Online registration, home delivery and other models have to be explored.”

Alcohol & domestic abuse

As for alcohol and domestic abuse, in the past month, the National Commission for Women has seen a significant increase in the number of cases across the country.

“When a person is dependent on alcohol, it induces an instability and he may indulge in violent behaviour. All forms of violence get aggravated when the person is under the influence of alcohol, be it domestic violence, intimate partner violence, street violence,” Ambekar said. “What is also true is that the risk of violence grows when people are suffering from withdrawal.”

People are also apt to want a drink because of the current uncertainty. “Besides the fear of infection, there are serious social and economic reasons that are pushing people to worry — it could be a job loss or a delayed surgery or an exam or postponed marriage,” Gangadhar said. “Disruption of routine is a huge trigger for stress. It can lead people to drink more, smoke more, eat more, depend more on mobile screens.”

ET VIEW: Liquor Home Delivery, ASAP

When medical experts say liquor sales should be intelligently regulated, so that demand can be met and crowding avoided, governments should listen. Home delivery from shops and online purchases must be allowed immediately. It’s baffling why most states are dithering on this, since they need the revenue. And as the experts said, regulated liquor sales could have continued through the lockdown, and we wouldn’t have been seeing crowds, lathicharge and panicky open-then-shut orders.

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