Here is an alcohol use primer for Myanmar people. It would be nice to see the gender aspects discussed.

Jamie

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Don’t let the drink take you
Dr Thel Khin Hla
Myanmar Times
18 October 2019

"First you take a drink, then the drink takes a drink, then the drink takes you,” wrote F. Scott Fitzgerald in his novel, The Great Gatsby. This eloquently summarises our relationship with alcohol for many of us. As a quintessential social lubricant, imbibing alcohol has become synonymous with celebrations and good times in many cultures across the world. As traditional and international festive seasons roll around in Myanmar, it is time to give our drinking habits a good hard look and ensure that we, and not the alcohol, remain firmly in the driving seat this festive season.

Since time immemorial

Nearly three million deaths each year (5 percent of all deaths worldwide) have been attributed to alcohol use. Sustained alcohol use is a well-known risk factor for the development of conditions like stroke, heart disease, liver cirrhosis and various forms of cancers. It worsens anxiety and depressive disorders, as well as acts as a ‘gateway drug’ to the use of other psychoactive substances which may unmask further complications. It compounds socioeconomic woes by exacerbating violence, aggression and crime. It claims countless lives on the roads where it is estimated that alcohol contributes to up to two-thirds of road traffic accidents in low-income countries, according to the World Health Organisation (WHO).

But alcohol is a drug we have used since time immemorial. In fact, it predates our humanity, with evidence suggesting that primates ingested fermented fruits containing alcohol. Alcohol was also one of the first things humans produced after learning to cultivate fruits. As we grow wiser about its negative side effects, many attempts have been made throughout history (legislatively and economically) to restrict alcohol availability as a means of curbing its use, but with varying levels of success. Many of us simply do not want to live without it.

A ‘standard drink’?

How much can we safely drink? Most international guidelines would recommend drinking no more than two “standard drinks” per day, with the proviso that in the case of pregnant women and other vulnerable adults (such as those with pre-existing brain injuries or psychiatric illness worsened by alcohol) the advice is that none is best. It should be noted here that one alcoholic beverage does not equate to one standard drink. The definitions of what is considered a “standard drink” vary between countries but roughly, it contains the equivalent of 10 grams of ethanol, which is the amount of alcohol the average human body can process in an hour.

Different drinks come in different strengths and sizes, and can therefore contain more than one standard drink. For example, the same 375mL of beer would count as 0.8 standard drink if it’s a light beer (2.7 percent alcohol) whereas at regular strength (4.8 percent alcohol), it would constitute 1.4 standard drinks. You might think a glass of wine counts as one drink, but at 13 percent alcohol by volume, a typical serving of wine which measures at 150mL would be equivalent to 1.6 standard drinks. Have 2 of those, and you are already over the daily recommended limit. When it comes to spirits such as whiskey, where most contain 40 percent alcohol by volume, a standard drink is a mere 30mL (or the equivalent of two tablespoons)!

Hazardous alcohol use

When we think of ‘hazardous alcohol use’, most of us probably think of someone in the depths of alcohol dependence through years of heavy alcohol use - someone who has consumed alcohol to the detriment of their health, relationships and career and those of their loved ones. While dependence is the most serious and harmful form of alcohol use disorders, experts warn that physical and psychological harm can arise even without the presence of dependence.

Binge drinking, for example, where people engage in occasional or irregular bouts of heavy drinking or drink deliberately to get drunk, is a form of hazardous alcohol use that is much more common than alcohol dependence and contributes significantly to the overall morbidity and mortality. But what counts as ‘binge drinking’ may surprise you – defined as drinking more than four standard drinks in one occasion, which is an amount easily exceeded by many who drink alcohol regularly. Binge drinking causes harm in a variety of ways including memory loss, injury to yourself or others, loss of coordination, lack of judgment (especially dangerous behind the wheel of a vehicle) and even alcohol poisoning – which can be fatal if your blood alcohol concentration exceeds a certain threshold, usually around 0.30 percent.

‘Harm per litre’

Myanmar, like many other developing countries, is in the grips of rising alcohol consumptions, likely as a by-product of economic growth. In contrast, alcohol consumption is stable in most developed countries. Therefore, manufacturers are increasingly targeting new and unregulated markets in developing countries. According to the WHO, Myanmar had average per capita consumption of 2.9 litres of pure alcohol in 2010, which increased by over 60 percent to 4.8 litres in 2016. But when we consider that over 70 percent of the population are abstainers (who have not consumed any alcohol in the preceding 12 months), those who do drink consume a whopping 17.6 litres of pure alcohol per year. Among the drinkers, up to one-third engages in binge drinking, many of whom are teenagers aged 15 – 19 years.

On the other hand, in many developed countries, despite a per capita consumption of pure alcohol that is higher than Myanmar, there may be fewer rates of morbidity and disability from alcohol use disorders. Italy, for instance, has a very low age standardised alcohol attributable death rates and low prevalence of alcohol use disorders, despite a per capita pure alcohol consumption of 7.5 litres in 2016. It has been shown that ‘harm per litre’ done by alcohol is greatest among low and middle income countries where economic development from a poorer society to a richer one has brought about large increases in availability of alcohol and its related harm as a result, with few restrictions in place to regulateservice of alcohol.

Safe drinking habits

So, if you are heading out this festive season, here are a few things to bear in mind to ensure everyone has a safe night with alcohol:

Do not drink and drive.

There is no excuse for driving any vehicle when you’re not sober, even if you think you’ve only had ‘a few’. Your momentary lapse in judgement could kill or maim you and many others. Get the bus, call a taxi or a rideshare service like Grab, or designate a friend who doesn’t drink to be the driver for the night. Do whatever it takes so that you don’t become another tragic statistic.

Friends don’t let friends drink and drive.

Notice your friend who has had a few drinks reach for their car keys to drive home? Take their keys, call them a taxi, or drive them home if you are sober. They may seem normal after a few drinks, but their judgement, reflexes and reaction times are all impaired by this point, which places them at an increased risk of fatal road traffic accidents. You might be unpopular for the night, but that’s a small price to pay for looking out for your friends.

Set yourself limits and stick to them

If you are only going to have a couple of beers for the night, stick to your limit. Don’t be pressured into drinking more than you intend to. You can alternate between alcoholic and non-alcoholic beverages or dilute your alcoholic drinks with water or ice so they last longer. Drink slowly – remember your body can process roughly only one standard drink per hour, so experts recommend pacing your alcoholic drinks to one per hour too.

Have a substantial meal before you drink alcohol.

Alcohol mixed with food takes longer to absorb than alcohol consumed on an empty stomach, slowing the rate at which alcohol enters the bloodstream. Also, eating before drinking might result in a full stomach that you will be less inclined to fill with alcohol.

Have alcohol free days.

Alcohol is a toxin that your body has to detoxify and eliminate. For that reason, experts recommend at least two alcohol free days per week so your body can rest and recover.

Dr Thel Khin Hla is a doctor with the Myanmar Oxford Clinical Research Unit in Yangon.

https://www.mmtimes.com/news/dont-let-drink-take-you.html