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ALCOHOL The Killer and Devastator

Cover Story

, by DR JAVED JAMIL

The Holy Qur’ān says:

They ask thee concerning wine and gambling. Say: “In them is great sin, and some profit, for men; but the sin is greater than the profit.” (2: 219)

O ye who believe! Intoxicants and gambling, (dedication of) stones, and (divination by) arrows, are an abomination, of Satan’s handwork: eschew such (abomination), that ye may prosper. Satan’s plan is (but) to excite enmity and hatred between you, with intoxicants and gambling, and hinder you from the remembrance of God, and from prayer. (5: 90-91)

Islam expressly prohibits alcoholic drinks and substances causing addiction. In fact the Qur’ān declares drinking and gambling as the Devil’s handiwork meaning that those who indulge in this act in any way are the rebels of God. Prohibition in Islam means prohibition on manufacturing, storing, selling, drinking or serving all alcoholic beverages anywhere on any occasion to anybody. Drinking has been labelled as Ummul Khhabais, that is the mother of all evils, in the Prophetic traditions, and the investigations have clearly established that drinking is Ummul Khhabais indeed. The Global Burden of Study has reported that “in 1990, alcohol was responsible for 3.5 per cent of the world’s total disability-adjusted life-years lost.” This exceeds the combined toll taken by smoking (2.6%) and illicit drugs (.6%). Alcohol is the leading cause of disability among men in industrialised nations.

Dependence on alcohol is counted as a disease in medical sciences, commonly referred to as Alcoholism. Alcoholism is divided into two groups: substance-use disorders and substance-induced disorders. The former include dependence and abuse; the latter include intoxication, withdrawal, delirium, dementia, amnesiac disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. Alcohol dependence and abuse are manifested by tolerance, withdrawal, inability to fulfil role obligations, recurrent substance related legal problems and social and interpersonal problems. 

Cirrhosis is another disease related to alcohol that more often than not proves fatal. It is among the leading killers in many countries where alcohol consumption is high. Other medical conditions related to alcohol include cancers (liver and laryngeal), heart diseases, maternal and child health problem (low birth weight and spontaneous abortion), injuries (falls, burns, or work-related), accidents (water and auto transport) and violence (suicide, assault and child abuse).

Alcohol is also related to traffic accidents, increased risks of all sex-transmitted diseases including AIDS and suicides. In women, it is related to several cancers like those of breast and liver. Maternal consumption during pregnancy increases the risk of birth defects in children. It is linked to the birth of children with Foetal Alcohol Syndrome. In several countries, FAS is considered to be the most important cause of mental retardation.

There have been several brazen attempts recently to popularise drinking on the basis of some dubious reports that impart a protective effect to alcohol for Ischaemic Heart Diseases. This has been strongly countered by independent experts. It will be worthwhile to quote here from a report:

“Over the past decade seemingly paradoxical evidence has emerged that alcohol consumption may have a protective effect on one aspect of human health: coronary heart disease. Studies have shown that individuals who consume small to moderate amounts of alcohol are less likely to have a myocardial infarction than those who do not drink. (For a review of the studies in the United States on the health benefits of alcohol, see NIAAA, 2000). These studies, however, have been challenged on two fronts: applicability of the findings to women; and methodology (see detailed discussion in World Bank Group, 2000).

“The majority of participants in the studies were men. In those where women did participate, the protective relationship was not so clear. Studies found that light consumption of alcohol (1.5 to 29.9 grams per day) protected older women (50 years of age and over) from CHD; light consumption also conferred protective benefits on women with one or more risk factors for CHD. These benefits did not hold true, however, for women with no CHD risk factors. Such women enjoyed no significant protective effects. Notably, women who drank more than 30 grams per day had significantly higher mortality, largely due to their higher risk of death from breast cancer.

“The research on beneficial effects of alcohol remains inconclusive for women. Furthermore, when discussing the beneficial effects of alcohol on the risk of CHD, it is important not to ignore the prevalence of CHD in a given developing country in relation to other health and social problems that are caused or exacerbated by alcohol. 5NIAAA (2000) has conducted an extensive review and analysis of FAS prevention research. Although research is largely US-based, the review offers a valuable framework for developing prevention programs.” 

It can be safely concluded that if some benefits – which even the Qur’ān accepts – may be accrued to the use of alcohol they will have to be weighed against harms and hazards related to alcohol, which are massive, qualitatively as well as quantitatively, which are enough for its being declared the “Devil’s handiwork”.

Furthermore, alcohol increases the risks of unhealthy sexual behaviour. Studies of AIDS in other countries, such as Thailand, indicate that alcohol consumption influences many dimensions of sexual behaviour. One such study, which included students, soldiers, and clerks revealed that “heavy drinking increased the odds of having had sexual intercourse; increased the odds of having visited prostitutes; and decreased the odds of consistent condom use in sexual encounters with sex workers (Van Landingham and others, 1993).” 

Another report says, “The relationship between drinking and HIV risk behaviours, such as visiting commercial sex workers or having sex without condoms, is not one of simple causality. It has been argued that drinking behaviour co-occurs with other dangerous factors; such a risk-taking includes beverages made from sugarcane alcohol and agaves, such as mescal and sotol. Aguardiente means "burning water" (Aledina-Mora, 1999).”

A list of the alcohol related problems is given below.

 

ALCOHOL RELATED PROBLEMS

Liver disease: elevated liver enzyme levels, fatty liver, alcoholic hepatitis, and cirrhosis.

Pancreatic disease: acute pancreatitis, chronic pancreatitis

Cardiovascular disease: Hypertension Cardiomyopathy, arrhythmia’s, stroke

Gastrointestinal problems: Gastritis, gastroesophageal reflux disease, diarrhoea

Peptic ulcer disease: Oesophageal varices: Mallory-Weiss tears

Neurologic disorders: Headaches, blackouts, peripheral neuropathy

Alcohol withdrawal syndrome: seizures, Wernicke’s encephalopathy, dementia, cerebral atrophy, peripheral neuropathy, cognitive deficits, impaired motor functioning

Reproductive system disorders: Foetal alcohol effects, foetal alcohol syndrome, Sexual dysfunction, amenorrhea, anovulation, early menopause, spontaneous abortion, Cancers Neoplasm of the liver, neoplasm of the head and neck, neoplasm of the pancreas, neoplasm of the oesophagus

Psychiatric comorbidities: Depression, anxiety Affective disorders, anxiety disorders, antisocial personality

Legal problems: Traffic violations, driving while intoxicated, public intoxication, motor vehicle accidents, violent offences, fires employment problems, Tardiness, sick days, inability to concentrate, decreased competence Accidents, injury, job loss, chronic unemployment

Family problems: Family conflict, erratic child discipline, neglect of responsibilities, social isolation, Divorce, spouse abuse, child abuse or neglect, loss of child custody

     Effects on children: Over responsibility, acting out, withdrawal, inability to concentrate, school problems, social isolation, Learning disorders, behaviour problems.

The alcohol consumption is directly associated with increased health risks related to alcohol, crimes, accidents, sex-related problems, suicides and domestic violence. Note the following facts:

·                     Worldwide, alcohol accounts for more than 2 million deaths; ·                     In developing nations, alcohol ranks as the fourth cause of disability among men; ·                     Deaths attributable to alcohol form 1.3 per cent for developed regions and 1.6 per cent for developing regions. ·                     ‘The Global Burden of Disease’ study estimated that, in 1990, alcohol was responsible for 3.5 per cent of the world’s total disability-adjusted life-years lost. This exceeds the tolls taken by tobacco (2.6 per cent) and illicit drugs (0.6 per cent) combined (Murray and Lopez, 1996). ·                     Among men, alcohol is the leading cause of disability in industrialised countries and ranks fourth in causing disabilities in developing countries (WHO, 1999). ·                     In developed nations, more than 136000 people die every year, in developing countries more than 636000 and in LAC countries more than 136000. ·                     In industrialised nations, 14.3 % and in developing nations, 4.4% of total disability adjusted life years are lost. ·                     There are countries with alcoholics in the range of 10-36 % of total population. (Remember that alcoholic means an alcohol-dependent person, not the persons who take alcohol irregularly.) ·                     Cirrhosis is one of the ten leading causes of death in Mexico. Among men between the ages of 35 and 45, it is the number one killer (Madrigal, 1998, Medina-Mora, 1999). In Mexico, Venezuela R.B., Argentina, and Trinidad and Tobago, cirrhosis deaths among men are as much as three times higher than the deaths among women.

 

Per cent of traffic fatalities attributed to alcohol

Chile                1970    46% (male traffic deaths)

Colombia        1990s   60%

Costa Rica       1990s   46%

Peru                 1990s   50%

Sources: Caetano, 1984; Madrigal, 1998

·       Alcohol was estimated to cause 41 per cent of suicide cases among men in Australia, compared to only 16 per cent among their female counterparts.

 

Selected Health Issues by Alcohol Attributable Fractions

Health issue         Australian         Canadian

                              Male Female         Male      Female

Liver cancer          0.18   0.12           0.29        0.16

Breast cancer         -        0.03            -               0.04

Unspecific

liver cirrhosis       0.54   0.43           0.54        0.54

Chronic

pancreatitis           0.84   0.84           0.84        0.84

Spontaneous

abortion                    -      0.04               -             0.20

Road injuries        0.37   0.18           0.43        0.43

Fall injuries           0.34   0.34           0.24        0.15

Fire injuries           0.44   0.44           0.38        0.38

Drowning              0.34   0.34           0.30        0.23

Suicide                    0.41   0.16           0.27        0.17

Assault                   0.47   0.47           0.27        0.27

Source: Edwards and others, 1995, Single and others, 1998

 

More than a quarter (26 per cent) of the women seeking counselling services in the urban areas of Mexico reported that their partners’ abusive behaviours were fuelled by intoxication (Ramirez and others, 1992). In the Solomon Islands, 32 per cent of family violence offences were related to problem of drinking (McDonald, 1995). Even higher rates were found in South Africa: 67.4 per cent of domestic violence cases in Cape Town and 76.4 per cent in rural areas involved alcohol use (Parry, 1995).

In both Canada and Australia, 16 per cent of child abuse cases could be attributed to alcohol. In Japan, 20 per cent of abused children had alcoholic parents, and in Hungary 8.6 per cent of child abuse cases in 1994 involved alcohol (Fekete, 1996). Alcohol has also been associated with a high proportion of child abuse cases in the UK (30 per cent) and Norway (50 per cent) (Moser, 1992).

Alcohol use disorders present serious problems for the interpersonal relationships, health, and productivity of employed men and women. Of the $117 billion estimated as the economic cost of alcoholism and alcohol abuse in the United States in 1983, nearly $71 billion (61 per cent) was attributed to lost employment and reduced productivity (U.S. Department of Health and Human Services 1990).

 

World-wide Deaths Attributable to Alcohol

                                                                Per cent Total

Cause of                      Total                       Alcohol  

Death                          Deaths                 Related    Deaths

 

Motor Vehicle            214,208               50            107,104

Oesophagus Cancer    805,980            75            604,485

Liver Cancer                488,060            15              73,209

Alcohol Dependence   279,930          100              79,930

Syndrome Cirrhosis    2,094,110          50         1,047,055

Total                                                                    2,111,783

 

ALCOHOL CONSUMPTION

Alcohol accounts for around 2 million deaths annually. Most of these deaths take place in industrialised, developing and Latin American countries. In Islamic countries, alcohol related deaths are virtually absent. All other problems related to alcohol are absent too. According to the data available, the economic cost of alcoholism and alcohol abuse in the US was 117 billion dollars in 1983. I could not find recent data. European countries lead the table of countries having maximum per capita consumption of alcohol. Canada, the US, South Africa and Australia follow Europe. South American, Asian and African countries come next. In Muslim countries, of course, the consumption is extremely low. Here is the list of top 20 countries in terms of alcohol consumption:

 

Top countries in terms of alcohol consumption

1. Luxemberg                      12 litres per inhabitant

2. Portugal                           10+

3. Ireland                              10+

4. Germany                         10+

5. France                               10+

6. Spain                                                10

7. Denmark                         9+

8. Austria                             9+

9. Great Britain                   8+

10. Belgium                         8+

11. Netherlands                 8+

12. Russia                            6+

13. Greece                            6+

14. Australia                       6+

15. Italy                 6+

16. Finland                          6+

17. USA                                6+

18. Canada                          6+

19. Japan                              6+

20. Sweden                          5+

21. Norway                         5+

All these are western countries. The high consumption rate, it may be argued, points to their high lifestyle and the ability to spend more. If the ability to spend more leads to spending on the purchase of slow poisons for themselves, it is better not to be rich. If westerners consume alcohol at such an alarming rate, it is because they have been made habitual or addicted to drinking by their cultural supervisors, the forces of globalisation. It is not surprising then that about 2 million deaths every year are attributable to alcohol-related problems. A substantial percentage of these deaths occur in the developed nations whose “advanced” health system is always busy in creating conditions that lead to the longevity of life. Still, they are not in a position to demand a ban on substances and practices that are the leading causes of mortality and morbidity.

Some of the findings of a research report entitled, “Alcohol-Attributable Mortality in a High Per Capita Consumption Country — Germany” by Ulrich John and Monika Hanke are startling. The report says:

·         Based on data from Europe, increases or decreases of 1 litre of pure alcohol in the per capita consumption were estimated to be associated with increases or decreases of 1.3% in all-cause mortality rates (Her and Rehm, 1998) ·         On this basis, for the USA, 4.5% of the total mortality was estimated to be alcohol-attributable (McGinnis and Foege,1999) ·         Restricted to middle adult age (36–64 years), in France, the rates are 19.1% of all male and 13.0% of all female death cases (Zureik and Ducimetière, 1996) ·         Alcohol-related disease, accounting for 25% of the total mortality in males and 13% in females, is a substantial part of the total mortality in the most productive part of adult life.

In males, the median age at death in all alcohol-attributable cases is 7 years and in AAM1 cases 15 years below that of the male general population. In females, the median age at death in all alcohol-attributable cases is 10 years and in AAM1 24 years below that of the female general population.

It is clear that the consumption of alcohol is least among Muslims and also therefore all the problems related to alcohol – alcohol related diseases, deaths, accidents, suicides, divorces, separations, unhealthy sexual behaviours, rapes, murders, etc. are very few.

 

ALCOHOL AND LIFE EXPECTANCY

Alcohol is one of the biggest trades in the world. There have therefore been concerted efforts by the market to promote beneficial aspects of alcohol with remarks such as “if taken in moderation, alcohol can improve life expectancy in the old age”. “If” and “can” in the remark suppress the facts that are very well known to the medical community. “Old age” is an attempt to attract older people. Safe drinking and safe sex are nothing but ploys to perpetuate dangerous trades. A paper by Benjamin J. Sadock and Virginia A. Sadock claims that Alcohol abuse reduces life expectancy by about 10 years, and alcohol leads all other substances in substance-related deaths. Another important paper entitled, “Alcohol-related mortality by age and sex and its impact on life expectancy” by Pia Makela examines the effects of alcohol on age in greater details. It says:

“The Finnish death register includes information on both the underlying and contributory causes of death and it yields an individual-level estimate of the contribution of alcohol in mortality.… According to the results, 6% of all deaths were alcohol related. These deaths were responsible for a 2 years loss in life expectancy at age 15 years among men and 0.4 years among women, which explains at least one-fifth of the difference in life expectancies between the sexes. In the age group of 15–49 years, over 40% of all deaths among men and 15% among women were alcohol related. In this age group, over 50% of the mortality difference between the sexes results from alcohol-related deaths. The use of data on contributory causes of death, the organisation of the Finnish death certification system and the relatively high proportion of alcohol-related deaths suggest that these data do not underestimate alcohol-related deaths to such an extent as has been the case in earlier studies using data from death certificates. This study shows that alcohol consumption is an important public health issue in Finland and a significant determinant of male premature mortality.”

Women are known to have higher life expectancy than men and alcohol is one of the major factors in this difference. “If one does not consider the many women who die while giving birth or in pregnancy, the female human life expectancy is considerably higher than those of men, who, on average, consume more tobacco, alcohol and drugs than females, in most countries many more men than women commit suicide, in general, men are more aggressive than women and thus are more likely to be murdered. In wars, many men die in combat as soldiers. Men tend to take more risks than females when they drive cars or motorcycles.”

A Miami university researcher reports:

“On average, each alcohol-related death was associated with 14.6 YPLL before age 65 and 25.9 YPLL before life expectancy. For both YPLL measures, deaths caused by intentional and unintentional injuries were associated with the greatest number of YPLL per death.

The conclusion of the report is an eye opener:

“Alcohol use is related to a huge health burden in the United States and most countries worldwide, even after discounting for its beneficial effects. In considering this burden, especially for chronic disease, one must keep in mind the limitations of epidemiological studies, which are mostly observational in nature (e.g., cohort studies and case control studies). However, most of the relationships between alcohol use and disease outcomes have also been corroborated by experimental physiological research…. much of the alcohol–related health burden could be avoided by initiating or strengthening policy measures proven to be effective in reducing alcohol use and related problems, such as taxing consumption, restricting access to alcohol, and random breath testing (Edwards et al. 1994).

“Some of these measures (e.g., taxation, restricting access) have been shown to reduce the social harm caused by alcohol consumption as well. Given the size of the burden of disease related to alcohol use and the availability of effective countermeasures, there seems to be no justification for continuing the status quo.... The Disability Adjusted Life Year (DALY) concept fulfils these requirements ideally. It is a measure that combines years of life lost because of early mortality (i.e., death before the life expectancy in the country with the highest life expectancy worldwide [currently Japan]) with years of life lost to imperfect health (Murray et al. 2000).

“The relationship between alcohol consumption and DALYs demonstrates that a substantial burden of disease is attributable to alcohol consumption. In 1990 this was estimated as globally higher than the burden of disease attributable to tobacco, even after subtracting the beneficial effects on CHD.” (Murray and Lopez 1996, 1997) (http://pubs.niaaa.nih.gov/publications/arh27-1/39-51.htm)

Some studies show that alcoholism actually decreases a woman’s life expectancy by 15 years.

It is high time a concerted worldwide campaign was initiated. Muslims must take a lead. Muslim countries must take the issue to the international forums. The campaign must also include all other intoxicant drugs and substances that are being increasingly used as intoxicants. These include many solvents and medicines.



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