Harmful use of alcohol is detrimental to health, but daily consumption of 1-2 standard alcoholic drinks has been associated with some health benefits. This duality of health benefit and harm have often led to polarized debates on the consumption of alcohol. There is a need for better health promotion messages based on the dual strategies of abstinence and moderation to address the issue of alcohol and health.
Alcohol is a psychoactive substance, and harmful use of alcohol is associated with increased risk of cancer, cardiovascular disease, chronic liver injury, accidents and injuries and certain infectious diseases. Examples of harmful use of alcohol include heavy episodic drinking, alcohol use disorder, and increased likelihood of risky behaviour.
Heavy episodic drinking is defined as consumption of 6 or more standard alcoholic drinks (≥60gms of pure alcohol) in a single occasion at least weekly. The prevalence of heavy episodic drinking is 1% among Malaysians and 8.4% among Malaysians who currently consume alcohol (Malaysian National Health and Morbidity Survey, NHMS 2019). The national burden of heavy episodic drinking appears lower than the global estimates of 18.2% among the entire population and 39.5% among those who consume alcohol. However, the burden of harmful consumption of alcohol varies significantly by the different ethnic groups.
Alcohol being a psychoactive substance can produce dependence. Alcohol use disorder among drinkers can be categorized as low risk, risky, and probable dependence. The prevalence of risky drinkers and drinkers with probable alcohol dependence in Malaysia is 17.6% and 0.9%, respectively.
Alcohol use is also associated with changes in psychomotor and mental functions. Excessive use of alcohol may increase one’s likelihood of accidents, risky behavior, and social disruption. Harmful use of alcohol may also lead to unintentional injuries and social harm.
Current policies on alcohol prevention appear ad hoc and disjointed with differing motives. Examples of such policies include the tax increase for alcoholic drinks and the discussion to increase penalties for drunk driving. These policies appear good in theory (note: I am leaving the politics out of this discussion).
A tax increase in alcoholic drinks would increase the price of alcohol and should decrease its demand and accessibility. Besides, the higher price may discourage the younger population from initiating drinking habits. However, there needs to be stricter enforcement against the availability of counterfeit alcohol and illegal sale. Fake alcohol may pose even more significant harm than legal alcohol.
The taxes from alcohol consumption should not be viewed as a source of income. It should be re-invested into prevention programs. The prevention programs should address the spectrum of alcohol use: 1) For those who have not started drinking, health-promoting messages advocating abstinence; 2) For those who are drinking, appropriate health-promoting messages advocating responsible use of alcohol; 3) Alcohol cessation programs should be accessible for those who are dependent or whose life’s are affected by alcohol use
There is also the issue of how we approach drunk driving. There have been suggestions to increase the penalty of drunk driving to 20 years in jail and RM150,000 (Approximately US36,000). I agree that driving under the influence of alcohol or driving while intoxicated is harmful and should be addressed. However, I am not sure how this suggestion will help if there is no large-scale health promotion aimed at responsible use of alcohol and discouraging drunk driving. Some may view the sudden introduction of high penalties without any intense prevention programs as an effort to criminalize rather than to rehabilitate those who are affected.
A comprehensive and holistic health promotion plan is needed to address the issue of alcohol use and health. The primary aim of this plan should be aimed at prevention of harmful use of alcohol. An effective program will aim at reducing the initiation of alcohol use among those that do not consume alcohol and aim to reduce the harm among those that drink alcohol. Thus, alcohol prevention strategies should address demand, supply, and harm reduction. To reduce the harmful use of alcohol, we need to consider the following:
- Pricing policies.
- Revenue derived from the taxation of alcoholic drinks should be re-invested into prevention programs aimed at reducing the harmful use of alcohol.
- More vigorous enforcement against the availability of illicit and counterfeit alcohol
- Addressing availability of alcohol.
- Increase the legal age to 21 years for drinking alcohol
- Addressing marketing of alcoholic beverages.
- Consider advertisements ban of of alcoholic beverages in all media and sports
- Harm reduction
- Further expansion and increased awareness of alcohol cessation programs
- Increasing community action to decrease the harmful use of alcohol (via NGOs or community groups)
- Reducing the public health impact of illegally and informally produced alcohol
- Drink driving policies and countermeasures
Harmful use of alcohol is detrimental to health. A prevention program should be comprehensive and inclusive by addressing prevention across the spectrum of alcohol use.
Prof Dr Sanjay Rampal
Department of Social and Preventive Medicine
Faculty of Medicine
University of Malaya