Go easy on the booze this holiday season

Peer pressure drove Sudip to start drinking at a young age. Soon, he was an addict and lost his job at a travel agency. His personal relationships soured and health deteriorated. He dabbled in various trades, but was often inebriated from early morning. 

He did sober up. When the earthquake struck in 2015, he was travelling with his infant son. The shock drove him to drink again. 

Sudip has been in and out of rehab, but nothing worked until he was tasked with organising Alcoholics Anonymous (AA) meetings in Kathmandu. The challenge finally made it possible to overcome his own addiction.

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“I used to find solution in drinking. Now, I know that not drinking is the solution,” says Sudip, now in his mid 40s and 15-months sober. 

We caught up with Sudip during one of his meeting with AA in Patan this week where 23 men from their 20s to 60s were seated in rows. While the oldest member spoke about how he had not had a drink for 10 years, a newly-sober member talked about how difficult it had been for him. Each was met with applause. 

Alcohol kills more than three million people every year around the world, mostly men. A recent paper in the journal Lancet reported that no level of alcohol improves health, challenging the notion that moderate drinking is good for the heart. 

Some 21% of men in Nepal are regular drinkers, but only 1.5% of women. The annual per capita alcohol consumption among Nepalis is 2.2 litres, but increases to 28.8 litres among drinkers (36.2 litres in men). Nearly 1% of Nepalis suffer from alcohol dependence, according to WHO, but this seems to be an underestimate as it does not count homemade alcohol. 

“There has been an increase in alcohol consumption in Nepal and it is a bigger risk factor than smoking, air pollution or adulterated food. Plus it leads to an increase in crime rate,” says psychiatrist Rabi Shakya at Patan Hospital. 

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The challenge is that cultural drinking is accepted, people use it as self-medication, and social drinking has become the norm. Sale of alcohol shoots up during festivals like Dasain and Tihar.

“Alcohol-related problems are a common cause of hospital admissions, and it is rising with liver cirrhosis and mouth cancer and infectious diseases,” says Buddha Basnyat, a physician at the Patan Academy of Health Sciences. 

Binge drinking during festivals like Dasain are worrisome because that is when cured alcoholics are most susceptible to suffer relapse. 

“Dasain is a trigger, a temptation for all the recovering alcoholics like us,” admits Samir Timilisina, Chair of Alcoholics Anonymous in Kathmandu. AA began in Nepal in 1970s and holds meetings six days a week at Patan Hospital, Teaching Hospital and Lazimpat. There are currently 60 regular members. 

Timilsina himself struggled with addiction for 25 years and has been sober for the past 14 months. “AA meetings are for those who have realised their problem, want to quit but are unable to do so. We share each other’s stories and draw inspiration from that,” he explains. 

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Senior cardiologist Prakash Regmi at Bir Hospital is busiest this time of the year. Patients with Holiday Heart Syndrome, a condition with abnormal and high heartbeat due to excessive drinking, crowd his clinic. They need immediate treatment, or may die due to heart failure or stroke.

“Our mentality that festivals cannot be celebrated without booze needs to be wiped out,” says Regmi.

Mark Zimmerman has been practicing medicine in Nepal for 32 years, and has found alcoholism to be common, but difficult to treat. 

“It is a disease, but excessive drinking is considered a habit, a coping mechanism to deal with stress, and therein lies the biggest problem,” explains Zimmerman, who has noticed a rise in female alcoholics among his patients. 

“At any given time, up to 10% of patients here are alcohol related, and most have damaged 3-4 organs due to excessive drinking. But this is just a tip of the iceberg because those are only who come to hospital,” he adds.

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Alcoholism is especially prevalent in impoverished western Nepal, where rice sent by the government to tide over food insecurity is often distilled into bootleg alcohol. Until six years ago, Accham was a dry district, but that led to the sale of spurious liquor, leading to a huge disease burden.

“Alcohol is a major source of revenue generation. But we have not thought about the much higher price we are paying for treatment,” says Bikash Gauchan of Bayalpata Hospital in Achham.

The government adopted a stricter policy for alcohol sales last year, making it mandatory for manufacturers to put pictorial warnings covering at least 75% of the bottle like in cigarette packs, and to ban liquor advertising. People under 21 are not allowed to buy alcoholic products, and retailers cannot sell alcohol from 5AM to 7PM. While some rules have come into effect, the alcohol industry has fought back. 

Increasing the tax on alcohol has worked in most countries, but here it could force users to turn to unsafe moonshine. A complete ban in Bihar has actually resulted in massive smuggling of Nepal-made beer and spirits across the border. 

Says psychiatrist Raju Shakya: “Alcoholism should be the number one public health agenda. If we can reduce alcohol consumption, it will remove many health issues.”

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