This document discusses alcohol and smoking as social problems. It notes that alcohol abuse is associated with negative health, social, and economic consequences. Alcohol abuse is influenced by easy accessibility, perceptions of social norms, and cultural factors. Binge drinking and chronic drinking are defined. Smoking rates are also provided for Nepal. Smoking is linked to increased health risks and addiction. Both alcohol abuse and smoking are influenced by familial and social connections. They also result in significant societal and economic costs. Prevention strategies discussed include increased taxation, advertising regulation, brief interventions, and education.

1. ALCOHOL : A SOCIAL PROBLEM
Dr.Rajan Bikram Rayamajhi
School of Public Health & Community Medicine
B. P. Koirala Institute of Health Sciences
Dharan, Nepal
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2. Background
A state of complete physical, mental & social
wellbeing & not merely an absence of disease or
infirmity that enables an individual to lead socially &
economically productive life.
Family is the primary unit of all the societies. It is a
group of biologically related individuals living together
and eating from the same kitchen.
The family share the common physical and social
environment.
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3. o Family, being a part of cultural unit. It reflects the
culture of the wider society of which it forms a part
and determines the behavior and attitudes of the
members.
o Alcohol abuse is a pattern of drinking that results in
harm to one’s health, interpersonal relationships, or
ability to work.
o Current guidelines set by America Health Society
states that alcohol consumption per week, for adults
noted to be nine drinks for a male and seven for a
female. 3

4. Alcohol abuse is a psychiatric diagnosis describing
the recurring use of alcoholic beverages despite
negative consequences.
Alcohol abuse is sometimes referred to by the less
specific term alcoholism.
Alcoholics – 2 Types: Those who have social and
pleasure-seeking tendencies & Those who are
anxiety-ridden people who are able to go without
drinking for long periods of time but are unable to
control themselves once they start 4

5. o Easy accessibility of alcohol is one of the main
reason behind alcohol abuse.
o Another influencing factor among adolescents and
college students are the perceptions of social norms
for drinking.
o People often drink more to keep up with their peers
because they believe that their peers drink more than
they actually do or that they expect to drink more
given the context. (sporting event, fraternity party).
o Alcohol abuse is also associated with acculturation
because social and cultural factors such as an ethnic
group’s norms and attitudes can influence alcohol
abuse. 5

6. Binge drinking: Four or more drinks for
a female and five or more drinks for a
male at one sitting.
Chronic drinking: Daily or almost
daily alcohol consumption
(60 drinks per month)
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7. 7

8. Drinking is a personal choice but
affects the person and environment
surrounding you.
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9. o 58.5% of them were male whereas rest of them were
female.
o 56.6% of them belonged to groups which traditionally
use alcohol.
o 64.8% of them were from rural areas whereas others
were from urban areas.
o About 0.8% of them had drink for 20+ days in a month.
o The median age of drinking was 13 years.
o Traditional and cultural occasions were the most
important occasion for initiating drinking. (60%)
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10. o Individual who responds to alcohol in a
certain way. [Positive reward]
o Personality characteristics that encourage
use. [Impulsiveness]
o Member of social group:
o Pressure to drink. [College Fraternity]
o Confusion over drinking ground rules.
o Drink with meals or drink to get drunk.

11. Social Factors
Alcoholism is high:
Americans, Swiss, Irish, Poles.
Low in others:
Chinese, Greeks, Orthodox, Jews

12. Culture with Lower Alcoholism
o Children learn alcohol is a
beverage.
o Served in dilute forms.
o Abstinence is acceptable.
o Parents model moderate
drinking
o Getting drunk not seen as
comical.
o Everyone knows ground rules .

13. Culture with Higher Alcoholism
o N o g r o u n d r u l e s .
o M i x e d m e s s a g e s f r o m d i f f e r e n t
i n d i v i d u a l s a n d g r o u p s .
o G e t t i n g d r u n k i s a c c e p t a b l e .
o H e a v y d r i n k i n g i s e n c o u r a g e d .
o D r i n k i n g a s i g n o f m a s c u l i n i t y o r
a d u l t h o o d .

14. Media Images of Alcohol
o I r e l a n d h a s h i g h e s t
h e a v y d r i n k i n g r a t e s
i n E u r o p e .
o Yo u t h b o m b a r d e d
w i t h a l c o h o l a d s .
o H a v e b e g u n t o
r e s t r i c t a d v e r t i s i n g .
o C h a n g e t h e c u l t u r e .

16. Driving Limits
In United States,
Most states set the legal level of intoxication at 0.08 to 0.10
BAL ( Blood Alcohol Level)
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17. Drinking is a Personal Choice
But Still
Others are affected !!!!
 Friends and family
 Strangers
 Unborn babies: Fetal alcohol syndrome
When mother drinks, baby drinks.
Alcohol disrupts brain development 17

18. Fetal Alcohol Spectrum Disorders
 The most serious risk during pregnancy is fetal alcohol spectrum
disorders (FASD).
 It describes permanent birth defects caused by maternal consumption
of alcohol during pregnancy.
 Establishing the prevalence of FASD is very difficult, but it is
estimated that at least 1 percent of children in the U.S suffers from
FAS or other alcohol-related birth defects.
 Approximately 1 percent of children are affected by fetal alcohol
spectrum disorder

19. 19

20. Smoking
o Women aged 15 and over who smoked any form
of tobacco, including cig., cigars and pipes
excluding smokeless tobacco: 28.57% [2009].
o Similarly, in males it was found to be 35.95%
[2009].
o Study done in Dharan by S. R Niraula found that
majority of the smokers were in the age group 15-
24 years.
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21. TRADITIONAL
o Smoked in a pipe for
ceremonial purposes
o Used as an offering to a
healer, elder or other
person as a sign of
respect or thanks
o Medicinal tobacco was
often used as a
painkiller
COMMERCIAL
o Deliberate targeting of
specific consumer
groups
o Premeditated and
conscious addition of
chemicals that lead to
addiction
o Scarcely contains
actual tobacco
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22. o 85% of teenagers who smoke two or more cigarettes
completely, and overcome the initial discomforts of
smoking, will become regular smokers.
o In a study of high school seniors, only 5% of those
who smoked believed they would still be smoking
two years after graduation. In fact, 75% were still
smoking eight years later.
o One-third to one-half of young people who try
cigarettes go on to be daily smokers.
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23. o Nicotine is a vessel constrictor, reducing
the body’s blood flow. Smoking increases
cholesterol levels and hardens arteries.
o Diabetes increases cholesterol levels and
the levels of some other fats in your
blood.
o The combined cardiovascular risks of
smoking and diabetes is as high as 14
times those of either smoking or diabetes
alone.
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24. Familial & Social Connection with Smoking
o People who encounter smoking on a regular basis will be
desensitized to cigarettes and won’t see the health risks
readily.
o Parents are the greatest influence on their children’s
behavior.
o Children whose parents smoke are twice as likely to become
smokers themselves.
o Perceived parental opinion is also a major contributing
factor in youth smoking. If children believe their parents
disapprove of smoking they will be less likely to become
smokers.
o Siblings also serve as contributors to youth smoking. 24

25. Societal or Economic Cost
o Alcohol abuse is associated with many accidents, fights, driving
offenses and unprotected sex.
o Alcohol is responsible in the world for 1.8 million deaths and
results in disability in approximately 58.3 million people.
o Approximately 40 percent of the 58.3 million people disabled
through alcohol abuse are disabled due to alcohol related
neuropsychiatric disorders.
o In South Africa, where HIV infection is epidemic, alcohol
abusers exposed themselves to double the risk of this infection.
o Additionally, alcohol abuse increases the risk of individuals
either being the victim of sexual violence or perpetrating sexual
violence.
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26. o Alcohol misuse costs the National Health
Service (UK) three billion pounds sterling per
year and the cost to employers is 6.4 billion
pounds sterling per year.
o It doesn’t include the crime and social problems
associated with alcohol misuse.
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27. Prevention
o Increased taxation of alcohol and smoking.
o Stricter regulation of alcohol and smoking advertising.
o Brief Interventions for alcohol abuse reduce the
incidence of accidents, sexual violence, unplanned
pregnancy.
o Information and education on social norms and the
harms associated with alcohol abuse delivered either via
the internet or face to face has been found to result in a
decrease in harmful drinking behaviors in young
people.
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28. THANK YOU
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