Alcoholism in Nepal is overshadowed by other addictions like injecting drug use and smoking. But because of its cultural acceptability, experts say, alcoholism has become the single biggest medical and social problem in Nepali society today.

Most families are in denial about members who are alcoholic, or they hide it because of the shame and stigma. Yet, recent research proves that alcoholism is rife, it strikes all economic, social and ethnic groups and it has repercussions on family and society that go beyond just the medical problems of the addict.

Alcoholism today is understood as a chronic disease with genetic, psychosocial, and environmental factors influencing its spread. In Nepal, our present attitudes reflect prejudices that existed in western countries more than four decades ago. Alcoholism here is still thought to be a self-indulgent problem of the emotionally weak-willed and immoral. Alcoholics are stereotyped as binge drinkers, or have physical and financial problems because of their expensive addiction. Insensitive pop songs and music videos that glorify drinking as a form of escapism enforce the stereotype, while advertisements that present it as socially respectable make it aceptable.
The commonly held Nepali perceptions of alcoholism prevent many people from identifying their problem. If the family is aware, it is swept under the rug. Instead of seeking professional help the alcoholic family member is shamed and isolated, forcing them to drink more.

A recovering alcoholic in his early 20s confessed to us: "When my drinking became a problem, my family forcibly sent me to the Gulf for employment by concealing the fact that I had a drinking problem." Now back from three long dry years in Saudi Arabia, he is undergoing rehabilitation in Kathmandu.

"Nepalis should learn to accept alcoholism like diabetes-a disease genetically carried and triggered by an environment a person is born to," says Mike Krajniak, of the Recovery from Alcohol Abuse Program (RAAP) in Kathmandu.

Studies have shown that Asians are genetically weak in tolerating intoxication, and the children of alcoholic parents are more likely to become alcoholic if there are environmental triggers. Treatment is impossible without the help and support of family and friends, something that is in short supply for alcoholics.

The fact that alcohol is readily available even to minors accentuates the dangers of abuse. Many social organisations and support groups are working on an alcoholism agenda, but there aren't enough. Only about 200 persons a year receive professional counselling and treatment for alcoholism in Kathmandu. None of the existing organisations deal with women. Counsellors say most people don't know that alcoholism is a disease, and recovery is possible.

Another problem is the cost of the treatment. A standard three-month recovery program costs between Rs 3,000- 5,000 a month. Those who can afford to, go abroad for confidentiality.

There has never been a study in Nepal about the social and economic cost of alcohol abuse. Neither is there any reliable statistics regarding alcohol consumption. Jagadish Lohani of Youth Vision, a drug rehabilitation centre, told us: "Nepali society is firmly in the grip of an alcohol epidemic, and this is the first step towards other substance abuse." He is worried that most of us are unaware of the social and economic burden caused by alcoholism when we persist in ignoring the social implications of the disease.

In the last fiscal year, the National Trading Company imported alcohol and cigarettes worth Rs 50 million. Unofficial sources say the consumption of home brewed alcohol is five times that of branded liquor. A source at the Nepal Brewery and Cigarette Association estimated more than 40 million litres of liquor are produced and consumed by individuals at home.

After the government officially recognised the liquor industry as a potential major revenue generator, the consumption of alcohol has increased greatly. Restrictions on mass production and sale of liquor were loosened more than 30 years ago. That decision encouraged both the import and the manufacture of cheap alcohol in the country, which suddenly increased availability and access.

Within a decade of licensing, liquor industries became one of the highest investment sectors and also the strongest lobby group. The huge investment, an average of Rs 70 million, and the huge revenues it contributes to the exchequer have gained the liquor industry a strong standing. In the last fiscal year, these distilleries produced more than 5.9 million litres of liquor, approximately 3.8 million litres were exported.

Alcohol commercials have been banned on radio and television, but liquor manufactures are sponsoring socially valued activities like popular sports and public gardens. They have also started putting up street hoardings highlighting the health hazards of drinking.

A drug addict who claims his substance abuse started with alcohol says, "The government is happy with the revenue from liquor. I think it should stop and rethink its policies. It should realise that the nation's youth and families are paying a high social and emotional price to generate those revenues." So far, the only group that seems to be listening are the Maoists who have declared parts of rural Nepal dry, and have threatened liquor manufacturers.

Alcoholism goes far beyond hangovers and liver damage, and therefore does not just have medical consequences for the drinker. It is a progressive disease, and a social one that claims primary and secondary victims. The family, especially the women and children, bear the burnt of it.

A startling 15-30 percent of inpatients at hospitals in Nepal come with problems directly or indirectly related to alcohol abuse. The ratio of males to females average 60:40 and most of them are between 20- 40 years. "Drug addiction has a high profile appeal for social organisations, but in the Nepali context alcohol abuse is almost 15 times a bigger problem," says Dr Mark Zimmerman, medical director at Patan Hospital which is Nepal's first to start an alcoholic support group. But even here, the problem is so vast that doctors are stretched too thin to provide adequate counselling.

Over the last decade, the Nepali chapter of Alcoholics Anonymous (AA) has tried to reach more Nepali alcoholics but without much success. Says Krajniak: "There is only so much the support groups and rehabilitation centres can do. We must take the social stigma out of alcoholism and recognise it as a disease that can be treated."

Alcoholics Anonymous Nepal: 411605
Patan Hospital: 522266/ 78
Mike Krajniak, Recovery from Alcohol Abuse Program (RAAP): 442512
Youth Vision: 429192