The link between alcohol consumption and violence: The road to de-addiction
A consequence of alcohol consumption is gendered domestic violence at home. To counter this, the government must set up interventions towards rehabilitation.
It was heartening to see the Delhi government put an end to the buy one, get one free (BOGO) offer by new liquor shops opened under the business-friendly excise policy. Heartening because of a significant problem that alcohol consumption brings with it in India and the world over — domestic violence. Ending the BOGO offer will, at the very least, not make the lives of many women worse off, dealing with husbands who may drink twice as much.
Women, living in vulnerable situations, both economically and otherwise, have had to contend for long with the alcoholic male member of the family who would abuse, beat and drain his earnings down a bottle of hooch.
In 2019, the ministry of social justice and empowerment (MoSJE), released the findings of a national survey, commissioned to study the extent and pattern of substance abuse in India. The survey showed that about 14.6% of the population uses alcohol, 2.8% uses cannabis products, 2.1% uses opioids, 1.08% uses sedatives, and 0.7% uses inhalants, with a small proportion of the country’s population using cocaine, amphetamine-type stimulants, or hallucinogens.
The survey also said that more than 57 million Indians are affected by harmful or dependent alcohol use and need help for alcohol addiction-related problems. In extreme cases, the adverse outcomes of substance abuse are suicide and death. But in many cases, the aftermath of a booze-fuelled evening is physical violence — the burden of which, most often, is borne by family members, especially wives.
The Covid-19 pandemic worsened the lives of female family members. During the many lockdowns in the past two years, incidents of violence against women in the household went up exponentially. The National Commission for Women’s data shows that India recorded a 2.5 times increase in domestic violence between February and May 2020. United Nations (UN) Women said that in the first four phases of the lockdown, women organisations across the country reported more cases of domestic violence than they had seen in the last 10 years, for a similar period.
India, like most other South Asian countries, has a highly gender stratified culture that sanctions complete authority to the men. Consequently, the incidence of various forms of violence against women, including from within the family, is a common phenomenon irrespective of the woman’s socio-cultural group.
There has been some improvement, but there is still a long way to go. As per the recent National Family Health Survey (NFHS), 29.3% of ever-married women aged 18-49 years have experienced spousal violence in the form of physical and/or sexual violence. The patriarchal mindset and the acceptance of violence are also justified by female members of the house.
Of the women surveyed under the NFHS, those from 18 states across the country felt that hitting or beating the wife was justifiable. Much of this violence occurs under the influence of alcohol or other substances.
We need to reorient our de-addiction strategy. Substance use reduction for a person with active addiction requires psycho-social intervention and cannot be forced. There is a need for a more empathetic programme/intervention to continue support to those who are on de-addiction treatment. At the same time, the intervention needs to address vulnerability reduction among female spouses.
An intervention that is focused on improving a couple's relationship (such as a couple-empowerment programme) is needed to address this issue. This is even more important in times like these. There is enormous pressure on the families not only in terms of the fear of Covid-19, but also in sustaining their livelihood, a well-functioning relationship between a man and his wife can win over the multidimensional battle families are confronting.
Currently, India’s government-run drug de-addiction programme is heavily focused on the de-addiction of users and harm reduction — primarily prevention of HIV among persons who inject drugs and treatment of people —implemented by its nodal agency National AIDS Control Organization; and demand reduction of the illicit drugs under the Scheme for Prevention of Alcoholism and Substance Abuse.
The programmes, however, pay very little attention to the much needed social or familial aspects of substance use. An ideal intervention designed for couples with husbands having a substance-use disorder should aim to reduce the substance dependence of the male spouse; improve the autonomy and mental health of the female spouse; and enhance positive gender norms and communications between the couple.
In a few states such as Gujarat and Bihar alcohol sale/consumption is banned, but it is common knowledge that people with active addiction in such places resort to country hooch or black-marketed liquor.
Forced abstinence in any case is counterproductive. The first Covid-19 induced lockdown in 2020 is a case in point of how horribly wrong bans can go, with cases of people suffering from addiction dying by suicide being reported. Instead, what we need is to be empathetic to such individuals and become partners in their journey towards rehabilitation. At the same time, we need to empower their spouses to handle the situation by providing sustained counselling support.
Alcohol is a major revenue stream for governments. While banning it is not the solution, we can look at using a small percentage of such revenue receipts into building a robust de-addiction infrastructure and increasing the network of counselling and medical facilities that are dedicated to fighting this menace. And yes, while at it, ending the BOGO marketing strategy is a way forward in this effort.
Dr Rajiv Tandon is director – health, Lopamudra Ray Saraswati is manager – health, and Prince Bhandari is associate – health, Research Triangle Institute (RTI) International, India
The views expressed are personal