A cop-out called prohibition

It is a poor policy option. Alcohol abuse is a public health, not moral, problem.

Written by Vikram Patel | Published:April 28, 2016 12:23 am
Police barricades outside TASMAC. (Photo: Twitter.com/@SriramMADRAS) Police barricades outside TASMAC. (Photo: Twitter.com/@SriramMADRAS)

Prohibition of alcohol is back on the political agenda with the recently elected Bihar government banning its sale and consumption to fulfil a key electoral promise. Other parties, such as the DMK and the AIADMK in Tamil Nadu and the Congress in Kerala, are also championing this cause. These states join a growing list, including Gujarat, a clutch of northeastern states and Lakshadweep, in imposing a policy which is currently not practised in any country outside the Islamic world. That prohibition can win elections is a vivid reminder of the tragic social consequences of alcohol consumption in the form of household impoverishment, domestic violence and premature mortality. That these policies are completely at odds with history and public health science testifies to the failure of our commonsense.

There is no evidence to show that prohibition has ever had its intended impact. Of course, just as banning beef has reduced beef consumption, banning alcohol will lead to reduced alcohol consumption. But, there appears to be little or no correlation between, say, domestic violence or household impoverishment and prohibition. Instead, there is an enormous cost to society, and here I refer not to the obvious massive losses to the exchequer but to the criminalisation of the majority of people who drink sensibly to address the problems caused by the minority who do not. It is, in effect, equivalent to banning motor cars because a few drive rashly.

Prohibition is a very poor policy option to address the adverse consequences of alcohol abuse when compared with a range of more effective public health approaches. The most notable international example of the failure of prohibition is that of the US where a constitutional amendment implemented this policy in the 1920s, only to be revoked 13 years later. The reason was simple: The policies led to the criminalisation of an entire section of the population, from those who manufactured the product to those who consumed it. It replaced a way of life which is as old as mankind with a corrupt nexus of smugglers, police, politicians and bootleggers.

The story is no different in India. As any reader of this paper who has been invited to a party in Ahmedabad can testify, the truly remarkable thing about prohibition in Gujarat is the range of alcoholic brands which are served in private homes. Of course, this is restricted to the rich who bypass regulations by virtue of being able to buy “permits” on medical grounds and escape police harassment. Lisa McGirr argues in her recent book, The War on Alcohol, that the enforcement of prohibition in the US was intrinsically biased against the poor, the working class, immigrant communities, and the marginalised. Prohibition, like so many other policies imposed from the moral high-ground, typically by those who do not drink, disproportionately affects the poor who resort to illegally brewed alcohol when they want a drink, not infrequently leading to their death, and are more likely to be harassed by the police.

Prohibition is rejected by most public health scientists who know this field; even the World Health Organisation does not recommend it. The complete lack of a public health approach to alcohol abuse in India is illustrated by the way in which the government has permitted the shameless surrogate advertising of alcohol by corporations, for example, through selling “bottled water” under the same brand names as their much better known alcoholic beverages. Amongst the many crimes Vijay Mallya seems to have gotten away with, that he could run an airline named after the most popular alcoholic beverage in the country has been perhaps the most damaging of all in terms of its impact on the burden of disease in India.

India remains one of the few nations which still focuses entirely on an archaic de-addiction model, administered by the ministry of social justice and empowerment, to address drinking problems, adhering to a centuries-old idea of these problems being a moral disorder rather than a health condition. There is a total absence of effective counselling interventions for those who wish to control their drinking. Instead, we live in such surreal times that “medicinal grounds” is the one situation in which drinking is permissible in states where prohibition is enforced. Essentially, this means that a person who wishes to drink can obtain a permit, after paying the required fee to a malleable physician, because he is a sharabi and his life would be threatened without a drink. This, of course, is the precise group who in any other country would have been offered psychological or medical interventions to control their drinking!

So, let us be prepared for more criminal activity, more deaths amongst the poor fuelled by illegally brewed poisonous alcohol, more hard liquor being drunk secretly in dingy corners, more corruption in the police force and more misery for those who wish to drink sensibly.

Prohibition of substances which give pleasure to people does not work. Addiction is a health problem, not a moral one, and there are many proven strategies which can reduce its burden. The desire to address the serious social problems caused by a minority of those who consume alcohol by prohibition is a travesty of the experience of history and public health science. When Mizoram repealed prohibition in July 2014, 17 years after it had been imposed, its excise minister explained that he had proposed this bill so that “those people who cannot do without drinks can find good quality liquor at cheaper prices”. He also claimed that he had “asked god to prevent me from introducing the bill in the assembly if that is what he really wanted”. Clearly, god had commonsense. Do our politicians?

 

The writer, a public health expert, works with the London School of Hygiene and Tropical Medicine, the Public Health Foundation of India and Sangath

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  1. J
    J.M.Dave
    Apr 28, 2016 at 3:06 pm
    Can the author please let us know what is the percentage of " people who drink sensibly to address the problems caused by minority who do not." To compare the prohibition of alcohol with banning motor cars because a few drive rashly is the strangest I have ever heard. J.M.Dave
    Reply
    1. A
      Arjun
      Apr 28, 2016 at 5:39 pm
      The author says there are "many proven strategies" to reduce the drinking problem. And yet, not a single one makes it into the article while "minority-majority juxtaposition" finds three mentions without any data. Worse yet, he says there has to be counselling opportunities for those who want to quit. That shows he is the one who is thinking about the rich only while writing. The poor whom the prohibition is targeted neither want to quit, nor do they know what counselling is and most of all, there isn't even regular health services available in rural Bihar while this guy advocates counselors to be provided. What a bunch of utter non-sense.
      Reply
      1. M
        Mathews
        Apr 28, 2016 at 3:59 am
        Ideny politics in India is the curse. Women vote-bank is e by prohibitionist politicians. Excessive drinking is a health and a moral issue, and should be addressed as such.
        Reply
        1. S
          Sri
          Apr 28, 2016 at 11:27 am
          "Alcohol abuse is a public health, not moral, problem" !!!! duh !!! Well, try telling this to women and children brutally beaten up, in fact really killed, by the alcoholic "patriarch", families destro by alcoholism, students' future destro by alcohol. I shake my head in wonder - is this what goes goes for "sociological research" in India ?
          Reply
          1. H
            Hemanth
            Apr 29, 2016 at 12:36 pm
            dude please know about the author before commenting. the author has published books on advocating and counselling services for the rural areas book name is " where there is no psychiatrist" and there other volumes of books he has published He has solutions for what you are asking? But be sensible in commenting
            Reply
            1. S
              Srinath Satyanarayana
              May 5, 2016 at 9:20 am
              Interesting and surprizing..! It appears that the Professor does not have an understanding of what was happening in Bihar..! He really thinks our Indian politicians and people are stupid and senseless..! He should have wandered on the streets of Patna.. He would have seen at every road there would have been people drunk and lying on the roads. People used to drink to get drunk…! There are no ways by which we can teach these people how to be moderate and be wise in their alcohol consumption once an alcohol bottle is in their hands..!lt;br/gt;lt;br/gt;I would have expected him to write about making use of this opportunity to see what happens and does not happen due to banning alcohol in the Bihar society from all perspectives. Instead he is equating Bihar with western potion..! Crimes that used to happen day in and day out in Bihar has come down by 27% [ ]. If this is indeed true, then looking at the effects from a public health point of view does not appear to be correct.lt;br/gt;lt;br/gt;Alcohol is not banned because of moral high-ground.. (that premise is wrong). It is banned to reduce its un-restricted access and easy availability. There are no sensible ways by which we can differentiate the majority and minority in our Indian context (when he says “majority of people who drink sensibly to address the problems caused by the minority who do not”) and whether there are any ways by which we can prevent the minority from drinking. lt;br/gt;lt;br/gt;Banning alcohol forever is definitely not required. But at times it may be required to bring in some course corrections. In Bihar, at this point in time, it appears that it was absolutely required. Anyhow, the Professor should have disclosed his conflict of interests a priori.
              Reply
              1. G
                Gautam
                Apr 28, 2016 at 5:34 am
                I have no doubt that if prohibition of alcohol remains a reality for the long term then in Bihar then it will give rise to Alcohol mafias and smugglers adhering to the Gunda Raj culture which Bihar has seen over the years . Kudos to the writer for an excellent article that totally makes sense and needs urgent attention
                Reply
                1. s
                  said_so
                  Apr 28, 2016 at 9:12 pm
                  prohibition achieved mostly in states that have a sizable muslim potion; their islamic ideas imposed on non-muslims; however, when it comes to beef consumption, it is the other way around, muslims complain and the ban is lifted. what a bunch of moronic policies.
                  Reply
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