1. BP Koirala Institute of Health Sciences (BPKIHS): bikrambandhare0@gmail.com

*             Correspondence: bikrambandhare0@gmail.com

Keywords: Alcohol, Nepal, Nepalese population, addiction, impacts

1. INTRODUCTION

Alcohol misuse has always existed in human history, and in the modern world, alcohol usage is a widespread occurrence. Around the world, alcohol is consumed in a variety of ways. According to the United States, alcohol is one of the two licit substances, with tobacco ranking highest [1]. After childhood underweight and unsafe sex, alcohol is the third biggest risk factor for disease burden globally. In 2009, alcohol caused approximately 4.5% of Disability- Adjusted Life Years (DALY), which is significantly higher than that of tobacco and illegal drugs combined [2–3]. Its use and problems are present in almost every community, and Nepal is no different. Instead, it has been noted that a fairly high frequency of alcohol problems exists in some areas, such as eastern Nepal [4]. Nepal is a landlocked nation surrounded on three sides by India and China to the north. Its very small total area of 147,181 sq. kilometers is home to a rich biodiversity and cultural legacy [5].  Nepal is renowned for its diverse geographic landscape as well as its multiethnic, multicultural, multilingual, and multireligious surroundings. In terms of resources, both economic and otherwise, the Eastern Region of Nepal makes up a significant portion of the nation. It makes up almost 25% of the nation’s land area and 1/4 of its people. The population is multilingual and multiethnic, with around half belonging to the “Matawali” group. The “Matawali” tradition not only accepts but also encourages the usage of alcohol. In Nepal today, the customary barrier to alcohol use among the traditionally abstaining community, known as “Tagadhari,” is weakening [6]. The country has few systematic community-based studies to assess alcohol usage and related problems. Although few in number, the findings that are currently available, from both clinical settings and community-based investigations, demonstrate the prevalence of alcohol addiction and related issues in Nepal. Due to its prevalence and size, alcohol is the most problematic drug in the nation [7, 8].

2. LITERATURE REVIEW

Using the AUDIT and SCID for alcohol abuse and dependence, Pradhan B et al. (2011) discovered that 8% of hospital-based samples had alcohol abuse and 32.3% had alcohol dependence [9–11]. Within clinical environments, substance use problems were diagnosed in 8% of referral outpatient psychiatry cases, [12], 17% of psychiatry in-patients, [13], 24% of psychiatric consultation liaison cases, [14], and 29.5% of cases seen in psychiatric emergencies. The majority of these instances involved alcohol use disorders. In a study conducted by Shakya et al. (2011) [16], it was discovered that the most common diagnosis made by patients seen in psychiatric emergencies and consultation liaison psychiatry at BPKIHS was substance-related disorder. Specifically, 32% of individuals living with HIV/AIDS who sought assistance from the HIV clinic at BPKIHS had an alcohol-related problem state (alcohol use disorders) with a CAGE score of e” 2. A significantly greater percentage of elderly OPD psychiatric patients (14%) also had alcohol issues, according to another study by Shakya [18]. About 40% of mentally ill female spouses of Nepalese abroad workers seeking assistance from the Psychiatric department of BPKIHS admitted to currently drinking alcohol, and 4% had alcohol use disorder as their primary diagnosis [19]. Maskey R et al. discovered that alcoholic cirrhosis accounted for the vast majority of cirrhosis cases (86%) in BPKIHS [20].A thorough investigation into the prevalence of alcohol consumption across the various sects in eastern Nepal has to be conducted. Nonetheless, a report on a community-based study that examined alcohol use disorder among 2344 randomly selected home samples in Dharan is available. The survey used the CAGE questionnaire. Jhingan HP et al. (1999) found that 25.8% of people had a current alcohol use problem, and that 19.5% of people (28.4% of men and 11.67% of women) reported heavy drinking (e” 2 CAGE). Higher rates of prevalence were observed in the “Matawali” group, widowers, divorcees, older adults, and those with less education. According to Niraula SR et al. (2002), 17% of 2340 cluster samples of Dharan women over the age of 15 had alcohol intake on their records. Women from hilly ethnic groups, divorcees, and smokers had higher prevalence rates of alcohol consumption. 9% of expectant mothers, a startling percentage, admitted to drinking alcohol [20]. According to Shakya, 5% of participants in this region’s health camps struggle with alcohol or drug use disorders. According to Shyangwa PM et al., 63.5% of BPKIHS’s young doctors and medical students acknowledged “ever using” drugs, 56.5% reported using them “last year,” and 42.5% reported using them “last month.” At 90.9%, alcohol was the most favored substance. Also, almost one-third of females reported having “ever used” drugs [21]. Similar results were observed in another extensive study conducted by Shakya DR et al. among BPKIHS medical students [22]. According to Shakya DR, the majority of problem drinkers initially use alcohol under the guise of the societal norm in eastern Nepal that considers alcohol to be food, peer pressure, stressful situations, and ease of availability. Males begin drinking earlier than females (average age 15.96 vs. 18.68), whereas among females, the first drink was more closely linked to stressors (1% vs. 13%). In contrast to men (40%) who claimed that different stresses contributed to, exacerbated, or prolonged the condition, more women reported these factors [23]. In a thesis, Sharma R et al. (2011) [24] and Shyangwa PM et al. in a different study identified pre-morbid personality problems, mental comorbidity, and a family history of alcohol dependent syndrome (ADS) as significant risk factors for ADS recurrence [25]. Thapa KB et al. discovered that a number of variables, including physical co-morbidity, greater blood AST and bilirubin, and higher daily alcohol intake, were substantially linked to the development of delirium tremens during the alcohol withdrawal condition [26]. Research found that the use of alcohol significantly affects blood sugar management and treatment adherence in individuals with type 2 diabetes [27–30]. Alcohol use has been linked to suicidal behavior and phenomena, according to Shakya DR. About 30% of people who attempted deliberate self-harm (DSH) had a history of alcohol use. Of the total, 5.5% had never used alcohol before the attempt, 9% had used it harmfully, and the remaining 5.5% had ADS [31].

3. CONCLUSION

Alcohol misuse is a widespread issue globally, with alcohol ranking as one of the two licit substances, after tobacco. It is the third biggest risk factor for disease burden after childhood underweight and unsafe sex. In 2009, alcohol caused 4.5% of Disability-Adjusted Life Years (DALY), higher than tobacco and illegal drugs combined. Nepal, a landlocked nation surrounded by India and China, has a diverse population, with the Eastern Region making up 25% of the nation’s land area and a quarter of its population. Despite the weakening customary barrier, alcohol addiction remains prevalent in Nepal.

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