Determinación del problema diagnóstico

The 2010 GNH survey, carried out by the Centre for Bhutan Studies (CSB), included five questions related to alcohol consumption.

These questions do not seem to have been designed to capture the problems related to alcohol abuse, but the

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data is sufficient to draw some preliminary conclusions on drinking pattern for the present purpose.

It was the population based survey covering about 7143 respondents across 20 districts. The main questions regarding alcohol consumption were: (1) In your entire life, have you ever consumed any kind of alcohol? (2) How old were you when you first started drinking? (3) Have you consumed any type of alcohol during the past 12 months? (4) How often did you consume alcohol during the past 12 months? (5) During the last 12 months, how often did you drink enough to feel intoxicated or drunk, that is, when your speech was slurred, you felt unsteady on your feet, or you had blurred vision?

Question (4) is used here to measure frequency of drinks. However, the number of drinks, volume and alcohol type were not captured in the survey.

While the survey was not exactly designed to measure frequency of drinks, an attempt is made to use this data to apply Frequency Measure (FM) method among others like Quantity Frequency Measure (QFM), Graduated Frequency Measure (GFM), Short-term Recall Method (STRM), Diary Method (DM) and Timeline Follow Back (TLFB).

The FM method queries the respondents on their typical drinking frequency in a given timeframe. Question 4 asks if a respondent drinks every day, occasionally or not at all. Because the FM method does not assess the amount of alcohol consumed on each drinking occasion, it does not allow estimation of a person’s average or total volume of alcohol consumed.

The FM method is not the best method to determine the volume of alcohol consumed, but nothing can be done at the moment unless alcohol-related questions are rephrased and revised in the next survey or in other similar surveys.

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There is another methodological limitation. The information used here is self-reported consumption, which is subject to both intentional and unintentional errors of recall by respondents. Denial is often the characteristic of the substance abuse survey. The alcohol dependent often denies the correct answer, and so they underreport the frequency and their drinking habits. Other than estimating how often a person drink, this data does not permit applying standard drink concept.

In the WHO’s Comparative Risk Assessment (CRA) for calculating the Global Burden Disease (GBD, 2004), a composite index called as Patterns of Drinking Score (PDS) is used. PDS measure the risky and less risky pattern of drinking. It reflects how people drink instead of how much they drink.

PDS has different array of drinking attributes such as quantity of alcohol consumed per occasion, festive drinking, proportion of drinking events when drinkers get drunk, the amount drank by the individuals who drink daily or nearly daily, drinking with meals and drinking in public places (Global Status Report on Alcohol and Health, 2011, pp. 15). Exact PDS cannot be applied here, but one of its parameters can be used.

Question 5 asks respondent about the proportion of drinking events that leads to severe intoxication or make person drunk. Higher frequency of drinking events that renders a person drunk reflects higher risky drinking pattern.

The WHO (GSR, pp. 16, 2011) defines Heavy Episodic Drinkers (HED) as those who drink at least 60 grams or more of pure alcohol on at least an occasion in the past week. The present data cannot be used to exactly fit this definition, but those who drink to get drunk occasionally still show a pattern of binge drinking, and some may fall in the HED category.

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Of the respondents aged 15–98 years in 2010, 33.5% of male and 36.2% of female abstained from drinking in the last 12 months. The abstainers here are taken as those individuals who drank in their lifetime, but never drank 12 months prior to the survey. The highest proportion of former drinker was observed in the age range of 36-55 in the case of males, and 26-55 in the case of females. Among the current drinkers, the majority of them were in the age group 26-35 for both male and female. However, females were more likely to be non-drinkers than males (females who did not drink at all in the lifetime was 36.5% and for males was 22.8 %).

Among the current drinkers, 24.5% of males drank daily and female drinking daily was 15.1%. However, more females tended to drink occasionally than male (Table 10). The higher proportion of occasional drinkers was observed in the age groups of 26-55 for both males and females. The individuals drinking daily and getting drunk was insubstantial. However, 18.1% of males and 11.7% of females got drunk occasionally to the extent that one’s

speech became slurred, felt unsteady on feet, or had blurred vision. Intoxication level drinking is an important determinant to understand drinking patterns, but it should not be considered as heavy or chronic drinking pattern.

The mean drinking onset age for males was 19.77 and for females it was 20.11. The worrisome trend was that 22% of drinkers had begun drinking at the age of 18 years or before. At this age, young people are not permitted to drink by legal provisio

ns.

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Table 10: Prevalence of alcohol consumption and some drinking indices by age and gender

Male (%) Female (%)

Age category Age category

Drinking pattern 15-25 26-35 36 45 46-55 56-65 66+ Total

15 to 25 26 to 35 36 to 45 46 to 55 56 to 65 66+ Total

Percentage of respondents who get drunk / who do not drink to drunkenness:

Daily 0.0 0.0 0.1 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.2 0.1 0.0 0.3 Occasionally 0.7 3.2 3.7 3.1 4.1 3.3 18.1 0.5 1.9 2.3 3.6 2.1 1.3 11.7 Never 3.7 14.0 17.0 18.5 16.4 12 81.7 7.6 20.9 20 18 13.1 8.4 87.9 Total 4.4 17.2 20.8 21.7 20.4 15.4 100 8.2 22.8 22 22. 15.4 9.6 100

Percentage of respondents who never drank in their lifetime:

Non-drinker 1.8 3.8 4.6 4.6 3.8 4.1 22.8 7.3 11 9.2 6.8 5.3 4 43.2

Percentage of respondents who drank in their lifetime but did not drink in the last 12 months:

Abstention (12 months) 2.7 6.5 7.3 7.4 5.8 3.8 33.5 5.1 9.8 7.8 7.3 4.2 1.9 36.2

Percentage of respondents who drank in their lifetime and continue to drink:

80 Source: GNH survey, 2010, CBS

Male (%) Female (%)

Age category Age category

Drinking pattern 15 to 25 26 to 35 36 to 45 46 to 55 56 to 65 66+ Total 15 to 25 26 to 35 36 to 45 46 to 55 56 to 65 66+ Total

Percentage of respondents who are current drinkers; and drinks daily and occasionally:

Daily 0.8 3.4 4.9 5.0 3.4 0.9 24.5 0.6 3 3.5 3.9 0.9 0.0 15.1 Occasional

8.0 21.6 18 13.8 9.0 5.4 75.5 14.0 28 18 14 6.8 4.4 84.9

Drinking onset (mean age) 19.97 (SD=8.84) 20.11 (SD=7.75)

Drinking onset (age groups) 18 years below Male 17.9 15.7 2.2 12.2 Female Total 14.2 29.3 1.6 29.9 24.8 3.8 11.4 37.0 19-30 years 31-50 year)

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As 18% of males and 12% of females got drunk occasionally, these kinds of drinking patterns can be taken as ‘binge drinking’. How often a person gets drunk depends on how he or she drinks (with or without meals), the type of drinks, body tolerance and volume. Binge drinking here refers to excessive occasional consumption that can lead to feelings of intoxication and temporary physical dysfunction, whether intentional or unintentional. Only this qualitative definition can be used at present, as there is no standard amount of alcohol that is officially quantified to be considered as binge drinking.

Normally, all kinds of social problems such as traffic accidents, fights and violence occur when a person drinks to an extent that his speech becomes slurred or body become unstable. The probability of an alcohol-related injury tend to be greater among those who get occasionally drunk compared to daily moderate drinkers and heavy alcohol dependents (Gruenewald et al., 1996; Treno et al., 1997 cited in Assanangkornchai et al, 2010, pp. 2010). This occasional heavy drinking pattern occurs mostly in the young age groups (25-45). This should be considered as an issue of concern.