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Ind. J. of Applied & Clinical Sociology 10 (4), 2015, 70-77 ISSN: 2230-9772 (Print); 2347-5927 (Online) ©: Human Development & Welfare Institute Some Sociological Aspects of Alcoholism & Substance Use Amit Thakur Tolerance – more alcohol required to meet cravings and to get drunk Abstract: This article describes the sociological perspectives, history, and consequences of alcoholism considered as a major problem and also some times as a social vices in India. Alcoholism has been also sometimes referred as drinking however drinking and alcoholism differs. Drinking has been part of several ancient cultures and civilization but alcoholism does not. AIMS AND SCOPE Sociologists, Anthropologists, Medical Scientists, Historians, and Psychologists have studied alcoholism. Sociologists generally study alcoholism in terms of causes, consequences, control, and reconstruction. However broadly alcoholism studied in terms of cultural and psychological aspects, which has consequences on the society and individual that could be harming. Key words: Alcoholism, Definition; Aims and scope of study, Theories of alcoholism and substance use; Causes of drinking; Forms of drinking; Types of liquors-substances; History of drinking; Effects of drinking; Control and policies. According to Selden Bacon (1943) "The sociologist is interested in the customs of drinking, the relationship between these customs and other customs, the way in which drinking habits are learned, the social controls of this sort of behavior, and those institutions of society through which such control issues”. Definition: Alcoholism is a major Social Vices in India. There have been differences between drug or alcohol use, abuse, or addiction. Anderson (1998) pronounced a sociological definition in cultural identity theory. According to him, alcoholism or substance use could involve with- Therefore, the sociologist aims to know the social categories in which much or little or no drinking occurs, he seeks correlations of amount and type of drinking with occupational, marital, nationality, religious, and other statuses more importantly. (1) A pattern of regular and heavy use over a significant period, (2) A set of drug related problems (at work, or with interpersonal relationships, one’s own health, and formal social control agencies), In addition, studying the societal functions served by the drinking, social rubs concerned with drinking, social pressures for and against this practice, and finally behavior pattern ridiculing with other institutions and folkways. (3) Previous and failed attempts to terminate drug consumption, THEORIES OF ALCOHOLISM SUBSTANCE USE (4) Self-awareness as having a drug and/or alcohol problem. AND General Sociological Theories:- In medical science, the term alcoholic refers to a person who suffers from chronic, severe illness characterized by four key symptoms:- 1. Structural-Functionalism: The structuralfunctional paradigm- credited largely to August Comte, Emile Durkheim, and Talcott-Parsons– adopts a macro view of society as a complex system whose parts work together to promote solidarity and stability. Craving – strong need to have alcohol Loss of control – an inability to cease drinking, no control of the situation Physical dependence – withdrawal symptoms when alcohol is not drunk which includes nausea and vomiting 2. Symbolic Interactionism. Unlike the structural-functionalist and social-conflict models, the symbolic interactionist perspective takes a more micro-level orientation to deviance and drugs, or a more close-up focus 70 on social interaction in specific situations. It sees society as a product of the everyday interactions of individuals. Like structuralfunctionalism, symbolic interactionism embraces the idea of consensus. However, symbolic interactionism also acknowledges variation and conflict. development theory. In addition to elaborating on weak bonds between children, families, and institutions, it also combines insights from social learning and differential association theory to explain adolescent substance use. Social development theory focuses on the bonds youth develop with those around them,indicating strong ties to social control theory. It is a process-based theory, noting the importance of understanding socialization influences over time. In short, bonds develop between youth and socializing agents (families, school officials etc) around them during adolescent development. 3. The Social-Conflict Model: Unlike the two prior models that embrace the idea of consensus, social-conflict theories view society as an arena of inequality and conflict. For conflict theorists, those with the greatest economic, social, and cultural assets control society’s structure. For conflict theorists, deviance is theorized as a response to the alienating conditions of material and immaterial inequality and group (e.g., ethnic and racial minorities) marginalization. 5. Social Learning Theories Social learning theories have focused on explaining actual drug use, i.e., frequency and level of drug use. Most of the scholarly work investigating this theory has utilized a quantitative survey approach, featuring questions to individuals about the types of drugs they use, how frequently they use them, and how much of each they use. All those three theories could be applied in larger contexts. 4. Social Process Theories Social process or socialization theories focus on how people or groups become involved with drugs and alcohol, how their involvement changes over time, and what might initiate that change. Social process theories like labeling theory are really theories of deviant behavior and identification. A. Differential Association. In the period surrounding the Great Depression (1930s1940s), Donald Sutherland articulated a theory of deviance called “differential association” that attempted to explain new forms of deviance by “unusual” suspects, i.e. people who were otherwise law-abiding prior to the Great Depression. His theory integrates ideas from both structural-functionalism and symbolic interactionism by proposing that criminal behavior is learned through a process of associating with others who define law breaking as desirable. A. Labeling Theory and Deviant Roles, Careers, and Identities: Symbolic interactionist, like Hughes, Becker, Lemert, Goffman, Matza, Brown, Denzin etc., have traditionally maintained that deviance, such as drug and alcohol use and abuse, could best be understood as a type of “career,” or a set of behaviors, roles, and identities that comprise a lifestyle, running counter to conventional society in some ways and consistent in others. B. Elliott’s Integrated Model of Delinquency: Elliott is yet another scholar to extend Sutherland’s differential association theory to illicit drug use, especially among teens. Unlike Aker’s focus on reinforcement, Elliott combines elements of social control and strain theory to extend social learning theory’s ability to explain substance use. His main contribution is that strong bonding with deviant peers is the primary cause of drug use. B. Social and Self Control Theories: A second popular social process theory is Hirschi’s social control theory: Its focus has been almost exclusively on deviant behaviors, such as delinquent acts (theft, vandalism, etc.) and drug use, rather than deviant roles and identities. It does not address the transition from drug use to abuse directly, but unlike interactionist theories, it does explain original or primary deviance. 6. Social Structural Theories A third category of sociological theories that has addressed substance use and related deviance can be called “social structural” theories. They differ from those discussed above by focusing on phenomena that exist C. Hawkins and Catalano’s Social Development theory: An important extension of social control theory in the area of substance use and abuse is Hawkin and Catalano’s social 71 outside of individuals and small groups, but which are theorized to have an impact on them, i.e., macro-level factors. Macro-level factors organize a society, community, or neighborhood. They range widely and can include dimensions of stratification (e.g, disparities in status and power by race, class and gender), environmental characteristics (e.g., poverty, job availability, and ethnic heterogeneity), and institutions (schools and community and government agencies) -- their resources, practices and policies. 1. Casual 2. Habitual 3. Binge drinking 4. Trouble drinking FIVE TYPES OF ALCOHOLIC 1. The young adult subtype – largest group and yet the least likely to seek help for their problems with alcohol 2. The young antisocial subtype – tend to be in their mid-twenties and can be categorized by early onset of drinking and alcohol related problems, often have depression or other mental health issues. 3. Functional subtype – Usually middle aged, educated, and employed 4. Intermediate familial subtype – Typically middle aged and come from families with multi-generational alcoholism 5. Chronic severe subtype – Smallest subtype and can be defined as those who have multigenerational alcoholism in their family, have high rates of personality disorders and other mental health issues plus significant substance abuse issues 7. Social Disorganization Theory: One of the earliest and perhaps most influential of the social structural theories is social disorganization theory. It first appeared in the deviance literature via Clifford Shaw and Henry McKay’s work on delinquent boys in Chicago, circa 1930. Shaw and McKay observed that crime and delinquency (e.g., vandalism, minor theft, curfew violations, and drug use), did not exist similarly across Chicago neighborhoods. Some areas had much higher rates of crime and delinquency than others did. EFFECTS OF ALCOHOLISM 1. Health effects: Alcoholic ketoacidosis, cirrhosis of the liver, pancreatitis, epilepsy, polyneuropathy, alcoholic dementia, heart disease, nutritional deficiencies, peptic ulcers and sexual dysfunction, and can eventually be fatal. Other physical effects include an increased risk of developing cardiovascular disease, malabsorption, alcoholic liver disease, and cancer. Damage to the central nervous system and peripheral nervous system can occur from sustained alcohol consumption. Women could have increased risk of breast cancer, reproductive dysfunction such as anovulation, decreased ovarian mass, problems, or irregularity of the menstrual cycle, and early menopause. A. Merton’s strain theory: Like Sutherland’s differential association theory, Merton’s strain theory was proposed in the midst of macrolevel societal change. B. Social Reproduction and Social Capital Theories: C. Cultural Identity Theory: Anderson (1998) developed this theory. Cultural identity theory attempts to explain substance abuse as an identity change process. At a very basic level, the cultural identity theory envisions drug abuse as a deviant identity matter featuring motivation and opportunity. Individuals are motivated toward altering their identities via drugs because of personal and social alienation experienced in childhood and early adolescence. CAUSES OF DRINKING 2. Psychological effects: Severe cognitive problems, dementia, anxiety, and depression disorders, Psychosis, confusion, schizophrenia, Panic disorder 1. Misery drinking 2. Occupational factor 3. Lack of recreational activities 4. Ignorance 5. Inherent Nervous defects 6. God’s curse or gift 7. For companionship and fun 8. Fashion 9. For business reasons 10. Sudden success in business 11. Urbanization 12. Social inadequacy 13 Thrill and pleasure seeking attitudes 3. Social effects: Alcohol abuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary, and assault. Road accidents, crime, marital conflict, divorce, and individual-family- social, community, national disorganizations. Increased expenditure on Health, judicial and social welfare systems, FORMS OF ALCOHOLISM 72 Material damage. High Premature death, Excess morbidity and unemployment sacred drink and frequently used by the community during Yagnas. However, Soma was considered highly useful to keep body and mind fit, fine, and healthy.in medieval period since advent of Islam several new drinks introduce in India. Use of substances also increased. However, Bhang also used since long and that was intake after crushing the leaves and using the paste directly or mixing that with milk and other edible materials. Likewise, ganja and tobacco has a long history of their use. Europeans believed introduced range of distilled and fermented beverages. 4. Cost of alcoholism: The social costs of alcohol consumption amount to between 1% and 3% of gross domestic product. Thus, for the European Union in 1998, the social costs of alcohol consumption can be estimated at between US $65 million and US $195 million (at constant 1990 prices and exchange rates). About 20% of the total costs are direct costs, representing the amount actually spent on medical, social, and judicial services. About 10% of the total costs are spent on material damage. About 70% of the total costs represent lost earnings of individuals who die prematurely or are unable to perform their productive tasks in the way they would have if they had not been consuming alcohol. CONTROL ON DRINKING AND POLICY 1. Individual or Self Control 2. Social control: - A. Informal, B. Formal A. Informal control Cultural recipes- Appropriate Occasions for Use, Manner of Use, How much is enough? When others use, To facilitate another activity, Speed of Use, Availability and Expedience Purposes of use, learning to Use within Multiple Environments, Differential Use along the Life Cycle., Expedience, Disapproved vs. Approved Substances. TYPES OF LIQUORS/ SUBSTANCES Parental and Family Influence- The family socializes children to conventionally approved food habits. Esteemed Role Model Influences Alcoholic drinks could classify into two categories such as Fermented Beverages and Distilled Beverages. Beers, Barley Wine, Fruit bears; Palm tree juice with a variety of other beverages could term as Fermented beverages. Likewise Spirits, Brandy, Whisky, Vodka, Rum could term as Distilled beverages. Several countries of world have their own list of liquors. Peer Group Influence- Media Influences, Informal measures: a. Condemnation, Campus monitoring, c. Parental Control, Family structure, e. Parental monitoring, Parental nurturance, g. School functioning, Religious variables Khaini (Smokeless tobacco), Gānjā (A highly potent form of cannabis, usually used for smoking), Afeem (Opium), Brown sugar (Smack- an adulterated form of heroin), Heroin, Pān Parāg, Jardā (chewing tobacco), and Fennel. b. d. f. h. Formal control measures: a. regulating the marketing of alcoholic beverages, (in particular to younger people); b.regulating and restricting availability of alcohol; c. enacting appropriate drink-driving policies; d. reducing demand through taxation and pricing mechanisms; e. raising awareness and support for policies; f. providing accessible and affordable treatment for people with alcohol-use disorders; and g. Implementing screening programs and brief interventions for hazardous and harmful use of alcohol. HISTORY OF DRINKING IN INDIA Drinking has been part of every known civilization and culture including Indian since ancient past, historic, and pre historic. Vedic texts refer about a drink called Somaras that was prepared from Soma plant after crushing that by stone and extracting juice of the plant however, that juice used after mixing an amount of milk. Somaras considered most EFFORTS IN INDIA Governmental: In 1790, British enacted excise laws and rules in India. The Indian Excise 73 Committee was appointed in 1905. In 1920, Indian National Congress led by Gandhi adopted resolution for prohibition on liquor and drug shops. Montfort reforms in 1921. In 1937, several Legislative Councils in several provinces passed resolution for prohibition as ultimate goal. Prohibition enquiry committee constituted in 1954. It recommended emerging as a major public-health concern in India. Sales of alcohol have seen a growth rate of 8 percent in the past 3 years. Officially, Indians are still among the world's lowest consumers of alcohol—government statistics show only 21percent of adult men and around 2percent of women drink. Nevertheless, up to a fifth of this group—about 14 million people—are dependent drinkers requiring “help”. a. Specific benefits accrued- reduction in consumption, economic benefits, and social gains, The concern, say experts, is that there has been a rapid change in patterns and trends of alcohol use in India. Chief among them is people are beginning to drink at ever-younger ages. The percentage of the drinking population aged less than 21 years has increased from 2percent to more than 14percent in the past 15 years, according to studies in the southern state of Kerala by Alcohol and Drugs Information Centre India, a non-governmental organization (NGO). Alarmingly, the study found that the “average age of initiation” had dropped from 19 years to 13 years in the past two decades. b. difficulties encountered- administrative, legal, social, economic, c. Conclusionsd. recommendations- stop drinking in hotels, stop advertisements, reduce number of shops, close shops, reduce quantity of supply, reduce production, no shops in specified areas, villages, and towns. Prohibition involves two measures legal and administration. Study team on prohibition 1964. Central excise, state excise departments, Central Narcotics Intelligence made functional. The centre points out that a “powerful international and domestic alcohol lobby” is purposely targeting young Indians. The local industry has introduced flavored alcohol drinks to attract previously non-drinking women and young men. Multinational companies have identified India with its vast unexploited markets as one of the worlds most sought after places for investment. STUDIES ON ALCOHOLISM With more than half of all alcohol drinkers in India, falling into the criteria for hazardous drinking, alcohol abuse is emerging as a major public-health problem in the country. India's reputation as a country with a culture of abstinence especially in matters regarding alcohol is underserved, say experts. The country, which has seen a rapid proliferation of city bars and nightclubs in recent years, is fast shedding its inhibitions about alcohol as a lifestyle choice. Many alcohol adverts now feature spirited groups of young people having a good time. Although alcohol advertising is banned in the electronic and print media, surrogate advertising is rife, argues Monika Arora, director of the NGO, Health Related Information Dissemination Amongst Youth Student Health Action Network. “Drinking water and apple juice is packaged by alcohol companies. It's all about getting young people to start early and be life-long consumers. Bollywood films now glorify alcohol where the good guys drink.” This situation has led to fears of an undocumented rise in alcohol abuse not only among poorer classes but also in sections of society that were previously considered dry. The health minister has recognized the scale of the problem—and has called for a policy that will regulate sales and the pricing of drink. The shifting composition of Indian drinkers has seen a rise in the number of Indian women drinking regularly and heavily. One recent study in the southern state of Karnataka found young women consumed similar amounts of alcohol to young men on any typical drinking occasion. Many experts say that although this move is welcome it may not be enough to curb the harmful effects of the rise in alcohol consumption in society. The increasing production, distribution, and promotion of alcohol has already seen drink-related problems 74 What is of particular concern—and an important indicator of health risks—is that the signature pattern of alcohol consumption in India is frequent and heavy drinking. More than half of all drinkers fall into the criteria for hazardous drinking, which is characterized by bingeing and solitary consumption to the point of intoxication. Moreover, spirits account for 95percent of the beverages drunk in India. of a powerful alcohol lobby with industry figures influencing the political process, both in the form of party donations and as representatives. However, experts argue that Indian society is losing considerably more than it is gains. Because of the political expediency surrounding prohibition, what is not being looked at is demand reduction strategies. Using their findings in the Bangalore study, researchers from NIMHANS have calculated that the direct and indirect costs attributable to alcohol addiction is more than triple the profits of alcohol taxation and several times more than the annual health budget of Karnataka. Extrapolating their findings to the whole of India they estimate the total alcohol revenue for 2003—04 of 216 billion rupees falls 28 billion rupees short of the total cost of managing the effects of alcohol addiction. These included the tangible costs of health care, occupational, financial, social, and legal factors. Another problem for policy makers is the fact that two thirds of the alcohol drunk in India is unrecorded because it is either illicit local home brew or has been smuggled into the country. Employers in poor, marginalized communities sometimes pay wages in alcohol rather than cash, according to WHO. The hazards of spurious liquor can be fatal, with frequent reports of death, disability, and hospitalization resulting from its consumption across the country. One barrier to developing a national alcohol policy for India, experts say, is the woeful lack of data and research on its national health, social, and economic effect. What is known is that alcohol-related problems account for more than a fifth of hospital admissions; 18percent of psychiatric emergencies; more than 20percent of all brain injuries and 60percent of all injuries reporting to India's emergency rooms. The role of alcohol in domestic violence is substantial: a third of violent husbands drink, according to a WHO study in 2004. Most of the violence took place during intoxication. The official response to India's problem remains focused on that in acute need rather than on prevention. This situation means that official policy concentrates on just the 4percent of the alcohol-dependent adult male population—and ignores the 20percent of the population who are “at risk” of serious alcohol abuse. Experts argue that government thinking on how best to mitigate the risks for alcohol is 20 years behind that of tobacco. Under its National Drug De-addiction Program, the Government of India has funded 483 detoxification and 90 counseling centers. Almost half of attendees are being treated for alcohol dependency. There is evidence even to suggest that the poor are beginning to drink more than they earn—a deadly spiral of alcohol and debt. One recent study by the National Institute of Mental Health and Neuro Sciences (NIMHANS) in households of rural, urban, town, and slum populations of 28 500 people in and around the city of Bangalore, Karnataka, found that the average monthly expenditure on alcohol of patients with alcohol addiction is more than the average monthly salary. Nevertheless, the success of the programs is low and states fail to adequately fund them, health professionals say. Doctors working with addicts in government hospitals report a “complete lack” of non-pharmacological care and training. “Once we've treated them there's no social worker or clinical psychologist to refer them to so we just send them to AA (Alcoholics Anonymous. Although the Indian constitution includes the prohibition of alcohol among its directive principles, alcohol policy is devolved to individual states—as is the levying of taxes on it. Since most states derive around a fifth of their revenue from alcohol taxation—the second largest source after sales tax—they are generally ambivalent towards stemming its flow. Moreover, there is a long history in India The problem is that the treatment of alcoholism is a low priority in Indian's health sector. Just 600 doctors have been trained to treat alcohol abuse in the past decade. It's seen as deviant behavior among most doctors: a hopeless situation that is unrewarding to treat and so there's no motivation or financial incentive on doctors to work in this fields. 75 To address this, the Indian Government has set a target to train, via AIIMS, 1000 doctors, as many paramedics, and 500 nurses to specialize in alcohol-abuse treatment in the next 4 years. Once trained, the plan is to deploy them across India's 560 district hospitals to increase access to treatment. There is, however, a growing lobby urging the health ministry to act. Indian Alcohol Policy The key is to break the stranglehold of state revenue departments who see increasing consumption of alcohol as a boon to treasury coffers. to use and spread of narcotic substances. Progressive increase of substance abuse in the developing countries not only adds to increasing morbidity pattern but also has been forming a nexus for several dreaded infections of recent times. It has been found in studies from different countries that geographical distribution of drug abuse co-related well with the availability of drugs. The geographical location of India between the Golden Triangle (Burma, Laos & Thailand) and Golden Crescent (Iran, Afghanistan and Pakistan) makes it a transit point for the trade of various substances. A key factor affecting illicit drug demand is that the age of initiation is falling almost every year, especially with regard to people seeking treatment for opiate abuse. According to reports of United Nations International Drug Control Programme during 1995, more young people in the age group of 15-19 years entered treatment plan than during the entire three years period from 1992 to 1994. It required pressing the ministry of health, headed by a minister who has advocated prohibition in certain states, to take a lead in passing a law that privileges public health over tax receipts. The lack of a national alcohol policy creates “a very difficult situation” for health professionals working to tackle alcoholism. A sample survey was conducted among 289 subjects during the January 2013. All the respondents were aged 18 and above. They were interviewed by surveyors on a schedulebased questionnaire to collect information about prevalence and model of alcohol and substance abuse in the urban Patna district. The study indicated that occurrence rate could be measured at 17.23 percent. The study further reveals that approximately 41 percent were non matric and almost 44 percent were in the age groups of 24-35 years. Among daily wages earners and laborers the prevalence rate was measured as high as almost 45 percent. 82 percent reported that he had tasted the first drink between the age group 15-25 years of age. Most common type of alcohol consumed was country liquor by almost 62 percent. Almost 58 percent said that they consumed alcohol in company of one or more friends. 52 percent admitted suffering from Binge drinking. 65 percent admitted that he had family and social problems due to drinking habits. They admitted conflict with family members and other neighbors. 64 percent admitted that use drinks at least twice and thrice in a weak. 42 percent admitted that they consumed drinks on daily basis. About timing almost 67 percent said that they consumed alcohol in the evening and nights. 56 percent admitted consuming other substances such as cigarette, beedi, pan parag and gutkha. In terms of age of onset, the study revealed a significant fact that 94 83percent respondents had their first drink between the ages of 15-25 years. Most commonly consumed type of alcohol was country liquor (by 69 07percent) followed by English and country liquor (both by 10 99percent) When alcohol users were asked about their frequency of intake, 36.43 percent responded that they took less than once a month. 16 38percent took it 2-3 times a month while 15 40percent once a week (Table2) Analysis of amount of alcohol taken in a single sitting revealed that 46.01percent had one-two pegs at a time while 29 74percent had three-four pegs Another 12 72percent had five-six pegs and the rest (11.53percent) had seven-eight pegs at a single sitting When users were asked to analyze their amount of drinking. 56 14 percent labeile^ it iess than or equal to average Regarding me place of drinking, majority consumed it at home or friends place usually with some company only in evening and night Only those who were chronically addicted drink the whole day 50.03percent had arguments with family or friends after taking alcohol, 4.95 percent had physical fights while 8.94percent had shortage of money in the family due to alcohol abuse. In 3.34percent cases husband wife relationships were strained. Global trade and liberalization of sociocultural interaction of the society had made easy access When medical implications of alcohol were analyzed, 25.75 percent alcohol abusers replied 76 that they had remained intoxicated for more than 48 hours. 32.21percent became unsteady after taking alcohol while 31.89percent had slurring of speech after drinking. 39.43percent had increased argumentativeness due to drinks while 12.93percent took alcohol to steady their nerves. 0.54percent was convicted at the time of interview due to their anti-social behavior after taking alcohol. were smokers also. 6.89percent had the habit of taking Pan Masala/Zarda. 2.04percent of alcohol users were taking khaini also along with alcohol. Frequency of opium and cannabis abuse came out to be 1.51percent and 1.18percent respectively. 42.11 percent of khaini abusers were taking it less than once weekly, 31.57percent once weekly or more while 26.32percent were abusing khaini almost daily. Among opium abusers 35.71percent were consuming it less than once weekly, 42.86percent consumed opium once weekly or more while 21.43percent were abusing daily. In family history of alcohol, user's father was abusing alcohol in 23.16percent cases while in 7.5percent cases abuse in family was present in uncle/ grandfather. 26.61percent alcohol users cited to be sociable as reason for their drinking, 22.95percent drink to overlook worries/frustrations, 13.68percent replied that they drunk to cheer up while 14.26percent drank to think and work better. Analysis of cannabis abusers revealed that 63.64percent were abusing less than once a week while 27.27percent were abusing it once a week or more. 57.69percent alcoholic smokers replied that they took 1-4 cigarettes/day (only while drinking), 35.89percent took 5-8 cigarettes/day while 6.42percent took 9-15 cigarettes/day. On analysis of alcohol users for other substance abuse it was found that 16.81percent users ***** 77