Drug Of Choice

Originally published in the Informant√© newspaper on Thursday, 1 June, 2017. 

If you had to take a guess as to which drug causes the most harm in our country, what would it be? This drug has toxic effects on the user’s organs and tissues, impairs physical coordination and cognition and affects the user’s perception and behaviour. It’s widely available, and even sold in specialized stores. This drug is alcohol – humanity’s oldest drug. 

As a species, we’ve used alcohol since the late Stone Age, about 12 000 years ago, and spread across the globe. In China, evidence was found of fermented drinks appearing 9000 years ago. Wine was first produced in Iran about 7000 years ago. In ancient Egypt and Babylon, evidence dates alcoholic drinks back 5000 years ago, with evidence in Mexico stretching back 4000 years ago and in Sudan 3500 years ago. Since then, it has become part of our culture.

In ancient Greece, wine was often served at breakfast, and it became part of the diet of most Romans. By the Middle Ages, beer was an everyday drink for most people – even nuns had an allowance of 6 pints of ale a day! As our civilization progressed, however, attitudes started to change. While moderate consumption was still viewed positively, the negative effects of drunkenness was causing concern. It was not until we could start collating large amounts of health data that we could truly start seeing the effects of alcohol use on the population. 

And so it was that we could see the cost of alcohol. Globally, 3.3 million deaths a year occur due to harmful use of alcohol, accounting for 5.9% of deaths worldwide. Even though women are more vulnerable to alcohol-related harm from drinking, the harmful use of alcohol is the leading risk factor for death for adult males. That, however, only takes into account death – not the adverse health effects that occur due to its use.

First amongst these are neuropsychiatric conditions. While one may be aware of alcohol-use disorders, epilepsy is also affected by alcohol – and not only seizures induced by alcohol withdrawal. Depression and other anxiety disorders is also associated with alcohol abuse. Next, and as well known, is gastrointestinal diseases such as liver cirrhosis and pancreatitis. Fewer people know about alcohol’s carcinogenic properties, which increases the risk for cancer of the mouth, nasopharynx, other pharynx and oropharynx, laryngeal cancer, oesophageal cancer, colon and rectum cancer, liver cancer and female breast cancer.

By now, a few people will be thinking that ‘a glass or two of red wine is good for the heart.’ However, the beneficial effect of that disappears with heavy drinking, and in fact increases the risk for ischaemic heart disease and ischaemic stroke. Regardless of one’s drinking pattern, however, alcohol has damaging effects on hypertension, atrial fibrillation and haemorrhagic stroke. This is of particular concern for Namibia, as in discussion with Dr Simon Beshir of the Windhoek Heart Centre, he stated that in the majority of his heart patient referrals, alcohol consumption could be identified as a major cause.

Furthermore, alcohol use by expectant mothers can cause preterm birth complications, or Fetal Alcohol Syndrome. Then, of course, there’s the additional effect of a weakened immune system, enabling development of infections such as pneumonia and tuberculosis. And, naturally, the injuries sustained due to alcohol’s effect on psychomotor abilities and behaviour, resulting in unintentional injuries at best, and at worst, violence and suicide. 

How does this affect Namibia? A surface-level analysis based on per-capita consumption shows that adult Namibians, on average, consume 10.8 litres of pure alcohol per year – a bit above the African average of 6. However, that does not take into account Namibia’s abstainers. A total of 48.7% of adult Namibians are life-long abstainers, with an additional 12.3% former drinkers now abstaining, resulting in 61% of the adult population being abstainers. When that is taken into account, it means that the per capita consumption of alcohol for drinkers is 27.7 litres per year. It also reveals that 37.2% of our drinking population binge-drink at least once a month.

It should then be no surprise to learn that the prevalence of alcohol use disorders is 5.1% of the population, above the regional average of 3.3%, and 2.2% of the population is dependent on alcohol, above the regional average of 1.4%. Namibia’s death rate for liver cirrhosis is 14 people per 100 000 population per year, of which 68% can be attributed to alcohol abuse. Even more glaringly, while Namibia used to be worst in the world in income inequality, we’ve managed to improve on that front, only to take on a new title – worst in the world in traffic accident deaths. Our death rate for road traffic accidents is 35 people per 100 000 population per year – and 66.1% can be attributed to alcohol abuse. 

In total, we as a country lose 153 years of life per 100 000 population due to alcohol use, and 180 healthy years of per 100 000 population due to disease and disability due to alcohol. By now, some of you are undoubtedly thinking “something should be done,” and “there should be a law!” Unfortunately, the solution is not that easy. That experiment has already been done. For 13 years, during 1920 to 1933, the United States had the Prohibition. Yes, alcohol consumption dropped – but not by as much as you’d think. At first, it dropped to about 60% of what it was previously, but as the criminal underground started supplying demand, it crept back to 80% of what it was. This provided a major financial boost to organized crime, resulting in crimes increasing by 24% while the prohibition was in effect.

In Namibia, the Self-Regulating Alcohol Industry Forum has as its main objective promoting responsible drinking, but ultimately, the solution cannot come from without. Alcohol use and abuse is, after all, not done unwillingly at the start, even if it can become uncontrollable at the end. It is we, the people and the culture, that needs to address this cost. We need to start looking critically at ourselves, and decide if this is a cost we want to bear, both personally, in the case of drinkers, and socially, as a nation. When we decide that the cost is too high, that is when we’ll start solving the problem. Not before.

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