Alcoholic Beverage Consumption in India, Mexico, and Nigeria

A Cross-Cultural Comparison

Linda A. Bennett, Ph.D.; Carlos Campillo, M.D.; C.R. Chandrashekar, M.D.; and Oye Gureje, M.B.B.S., Ph.D., FRANCZP

Drinking practices vary substantially among different countries. An understanding of such differences can help researchers, clinicians, and policymakers develop prevention, diagnostic, and treatment measures as well as overall alcohol policies that are appropriate for a given country. Accordingly, researchers have conducted cross-cultural analyses of drinking patterns and practices. Three countries included in such analyses are India, Mexico, and Nigeria. These countries differ substantially in their ethnic and cultural characteristics, including the role that alcohol plays in daily life. To gain a better insight into the attitudes toward alcohol in these countries, researchers have analyzed the alcoholic beverage preferences, gender and age differences in alcohol consumption patterns, drinking contexts and drinking patterns, alcohol-related problems, approaches to prevention and treatment, and drinking indicators in each nation. These analyses demonstrate that no single definition of “normal” drinking, problem drinking, or alcohol dependence can apply equally to all countries or cultures. KEY WORDS: AOD consumption; South Central Asia; western Africa; Mexico; cross cultural study; comparative study; ethnic differences; international differences; AOD preference; gender differences; age differences; context dynam- ics; AOD use pattern; problematic AOD use; epidemiology; public policy on AOD use; attitude toward AOD; AOD prevention; treatment; literature review

lcoholic beverage consumption acceptable. Television, movies, and of different ethnic backgrounds. Such patterns vary considerably among scholarly publications have depicted investigations initially focused on the A different countries and even and investigated differences in drinking differences among people of Irish, Italian, among different ethnic groups within traditions to such an extent that people and Jewish descent living in the United one country. These variations in drink- throughout the world are increasingly States. More recently, interest has focused ing patterns include, for example, the aware of drinking patterns in cultures on the drinking patterns among various types of beverages consumed preferen- other than their own. Native American, African-American, tially, occasions on which consumption Several decades ago, researchers in and Hispanic groups. Similar studies on typically occurs, drinking levels that are the United States began paying consid- the diversity of drinking traditions have considered normal, and population sub- erable attention to the role that alcohol been conducted in Europe, comparing, groups for whom drinking is considered consumption plays in the lives of people for example, drinking patterns between

Vol. 22, No. 4, 1998 243 Mediterranean and Scandinavian coun- uation were used to assist the develop- (see table 1). Moreover, the three countries. In addition, studies conducted in ment of public policies on drinking tries have distinct histories of traditional South and East Asia have demonstrated (Marshall 1982). alcohol consumption as well as widely that the roles of alcohol consumption in This article compares the drinking contrasting contemporary drinking daily life and on ritual occasions vary practices of people living in India, patterns and alcohol-related problems. considerably among different countries Mexico, and Nigeria. Each of these three All three countries participated in the or cultures and depend in part on the countries has a highly diverse and mul- Cross-Cultural Applicability Research religious practices of the groups studied. ticultural population, and major differ- (CAR) study, an investigation of the What is the relevance of studies on ences exist between their urban and diagnosis and assessment of AOD-related cross-cultural differences in alcoholic rural areas. Nevertheless, the three coun- disorders conducted jointly by the World beverage consumption? Cultural varia- tries studied differ sharply in drinking Health Organization (WHO) and the tions in drinking practices and beliefs practices. These differences allow for U.S. National Institute on Alcohol Abuse about alcohol have far-reaching impli- the exploration of potential implications and Alcoholism (NIAAA) in nine coun- cations for policymakers, clinicians, and of cultural variations in drinking patterns tries between 1991 and 1993. Respon- researchers in the field of alcohol and for the identification, prevention, and dents participating in that study included other drug (AOD) use and abuse. Based treatment of drinking-related problems heavy users of alcoholic beverages or on cross-cultural comparisons, combined currently encountered in India, Mexico, certain other drugs, family members of with information on historical changes and Nigeria. Following a brief description heavy users, health workers in the area and variations in drinking behavior within of the cultural and ethnic characteristics, of AOD problems, and other health each culture, researchers and policymakers this article reviews each country’s alco- or social service workers having regular can obtain a better understanding of the holic beverage preferences, epidemiologi- contact with people with AOD problems. relationships between drinking patterns, cal patterns in alcohol consumption, In addition, each of the three countries drinking-related consequences, and the typical drinking contexts and cultural was discussed in the International outcome of informal and formal alcohol drinking norms, alcohol-related problems, Handbook on Alcohol and Culture (Heath policies. Such analyses can assist in the and approaches to prevention or treatment. 1995) and in the Alcohol and Emerging development of appropriate alcohol- Markets volume (Grant 1998). Finally, related policies and in the identification several ethnographic, epidemiological, of effective clinical prevention and treat- Cultural and Ethnic and clinical studies have focused on ment strategies. For example, during Characteristics of the drinking and its consequences in India, the early 1980s the Institute of Applied Study Regions Mexico, and Nigeria. As a result, a Social and Economic Research (IASER) considerable amount of current infor- in Papua New Guinea conducted a cross- India, Mexico, and Nigeria were selected mation is available on the drinking cultural examination of traditional for cross-cultural comparisons in this practices, drinking-related problems, and drinking practices and the effects of article because they represent areas with strategies for handling those problems deprohibition. The results of that eval- distinctly different geographic locations in each of the countries studied (see and predominant languages and religions also table 2).

LINDA A. BENNETT, PH.D., is an associate dean at the College of Arts and Sciences and professor of anthropology, University Table 1 Cultural Characteristics of Regions in India, Mexico, and Nigeria That of Memphis, Memphis, Tennessee. Participated in the Cross-Cultural Applicability Research Study

CARLOS CAMPILLO, M.D., is project coor- City and Country Location Primary Language(s) Primary Religion(s) dinator in the Department of Epidemiology and Social Research in the Instituto Bangalore, India South Asia Kannada, Tamil, Hinduism, Islam, Mexicano de Psiquiatria (IMP), University Telugu, and Hindi Christianity, of Mexico, Mexico City, Mexico. Sikhism, Buddhism, and Jainism C.R. CHANDRASHEKAR, M.D., is additional professor of psychiatry at the Spanish Roman National Institute of Mental Health Mexico City, North Mexico America Catholicism and Neuro Sciences, Deemed University, Bangalore, India. Ibadan, Nigeria West Africa Yoruba Christianity, Islam

OYE GUREJE, M.B.B.S., PH.D., FRANCZP, is a professor in the Department of Psychiatry, SOURCE: Bennett et al. 1993. University of Ibadan, Ibadan, Nigeria.

244 Alcohol Health & Research World Alcohol Consumption in India, Mexico, and Nigeria

India, Mexico, and Nigeria are all the regions in which those practices religious tradition founded in the sixth highly diverse nations with rich cul- were observed. century B.C.). Additional information tural variability with respect to ethnic, In this article, the information pre- on Indian drinking practices in this arti- religious, and linguistic groups. The sented on Indian drinking practices is cle is based on two ethnographic studies drinking patterns observed in the coun- based on investigations conducted in of alcohol consumption conducted tries reflect that variability, and results Bangalore, a city in the southwestern among the Rajput, a military caste in obtained in specific regions of each state of Karnataka that served as a CAR northwestern India (Castairs 1979; country can be generalized only to study site. In addition to English, the Dorschner 1983). a limited extent. For example, one primary native language spoken in that The information on Mexican drink- cannot accurately characterize the region is Kannada. With respect to their ing practices presented in this article drinking patterns of all Indian ethnic religious affiliation, most people in the was obtained primarily in the capital and cultural groups based on findings Bangalore region are Hindu, although of Mexico City and its environs, for just one of those groups. Accord- there are also substantial numbers of which was also a CAR study site. The ingly, researchers describing drinking Muslims, Christians, Buddhists, Sikhs, predominant language spoken in practices in each country must specify and Jains (i.e., followers of an ascetic Mexico City is Spanish; the religion

Table 2 Differences in Drinking Practices Among Sites in India, Mexico, and Nigeria That Participated in the Cross-Cultural Applicability Research Study

Country

Drinking Practice India Mexico Nigeria

Most commonly consumed Arrack, palm wine, beer, Beer, tequila, rum, Palm wine and beer alcoholic beverages and imported liquors 96-percent proof alcohol, pulque, wine, and mezcal

Drinking predates Yes, but not particularly Yes, especially pulque Yes, drinking (especially of European contact central to social life consumption as part of palm wine and home-brewed traditional rituals and beer) was part of normal customs social and ceremonial life

Women’s drinking patterns Predominantly (about Majority (about 63%) Minority (about 30%) 95%) abstinent abstinent abstinent in two urban areas studied

Men’s drinking patterns Highly variable across Those who drink tend to Most drink on a regular basis regions drink rather frequently and often heavily

Context of drinking No regular context estab- Is an aspect of social A central feature of adult male occasions lished; thus far, not a part family life passages, life and in social, religious, of regular daily life or ritual fiestas and, for some and economic relationships occasions drinkers, part of daily life

Evidence of concerns about Increasing Definitely increasing Has been a concern for the young people’s drinking past two decades in some areas

Extent of major concerns Increasing problems seen Considerable concern Although there are increasing about alcohol-related in health, social, and about drinking among concerns, generally they are problems economic areas men; drinking is seen not viewed as sufficiently as having major serious to establish many consequences for health prevention and treatment and job performance programs

Vol. 22, No. 4, 1998 245 most commonly practiced is Roman at the same time seen as dangerous and only by “untouchables” and mem- Catholicism. Although the CAR study harmful” (p. 279). bers of other lower castes. focused mostly on Mexico City, it also addressed some urban-rural differences. •“English alcohol,” a distilled liquor— Additional information in this article is Comparison of Alcoholic usually whiskey or gin—associated based on research conducted in Chiapas, Beverage Preferences with British rule. At the time of a predominantly rural region (Eber the study, which coincided with a 1995). period of prohibition, English alcohol Much of the information on Nigerian India was extremely difficult to obtain. drinking practices was obtained in the city In Bangalore the following three types of Ibadan in the southwestern part of the The consumption of alcoholic of alcoholic beverages are consumed country, which also participated in the beverages in India predates British most often: CAR study. The predominant native colonization. However, in contrast language spoken in that region is Yoruba, to other countries—such as Nigeria • Arrack, a traditional drink produced along with English, and the most com- and, to some extent, Mexico— (both legally and illegally) by distill- mon religious affiliation is Christianity. alcohol consumption was not con- ing fermented molasses, raw brown Additional information on Nigerian sidered central to normal social life sugar, palm wine, rice, or palm sugar; drinking practices was drawn from a or daily meals in precolonial India. it has an alcohol content ranging study conducted among the Kofyar in Nevertheless, in certain tribal groups from 20 to 40 percent central Nigeria (Netting 1979) and from throughout the country alcoholic two studies of drinking patterns among beverages still are considered “a gift • Palm wine, another traditional bev- college students in various urban areas to humankind and, in turn, were erage produced from either the of Nigeria (Enekwechi 1996; Odejide reverently offered to the nature gods coconut tree or other palm trees, et al. 1987). and other sacred powers” (Mohan which has an alcohol content rang- For the purpose of establishing a and Sharma 1995, p. 134). ing from 20 to 40 percent general measure of the role that alcohol consumption plays in a culture or • Imported liquors, such as whiskey, Mexico country, researchers commonly use brandy, and rum. the terms “wet” and “dry.” Wet cultures In Mexico, a wide variety of alcoholic are those in which alcohol consumption beverages are consumed, including Beer is also consumed in the Banga- is a highly valued part of social life. some that predate colonial settlement. lore region, although less commonly Conversely, in dry cultures, alcohol Overall, however, Mexicans currently than the three types of beverages listed consumption typically is considered prefer beer and distilled alcoholic above. Of these alcoholic beverages, aberrant behavior (Bennett et al. 1993). beverages, such as tequila and rum. palm wine and beer are considered India, Mexico, and Nigeria differ in In fact, beer accounted for 89 “cool” or “soft” drinks, whereas hard their wet-dry classification (Room et percent of all alcoholic beverages liquors and arrack are considered “hot” al. 1996). For example, compared with consumed in Mexico in 1989 (Natera or “hard” drinks. societies that are traditionally thought Rey 1995). Pulque, wine, and Studies among the Rajputs of north- of as wet (e.g., Greece), India can be 96-percent proof alcohol are the western India identified three preferred considered a dry culture. Nigeria and next favorite beverages. Pulque, a types of alcoholic beverages1 (Dorschner Mexico, in contrast, can be classified traditional drink with an alcohol 1983): as intermediate (i.e., neither clearly content of 6 percent, is produced by wet nor clearly dry). In fact, Natera fermenting a sugary liquid from the • Daru, a drink distilled from the flow- Rey (1995) suggested that Mexico was heart of a certain species of agave ers of the mahwa tree and which best considered a “mixed” society in (i.e., the maguey plant). Like 96- ranges in alcohol content from 20 that neither the dry nor wet categories percent proof alcohol, pulque is con- to 40 percent. At the time of the study, neatly apply in terms of per capita sumed primarily in rural parts of daru was considered inexpensive consumption, characteristic patterns Mexico, whereas distilled beverages and was the most popular beverage of consumption, or social consequences and wine are more popular in urban in the Khaalapur community. of drinking. More recently, however, areas. Medina-Mora (1998) characterized Some differences exist in the alco- • Spirit produced from solvents, which Mexico as a “good example of a dry holic beverage preferences of various greatly varies in alcohol content and, culture where the rate of abstainers is population subgroups. For example, at the time of the study, was drunk high, the dominant pattern of heavy although both men and women drink drinking is rarely very heavy and binge pulque, women tend to prefer wine. drinking is common. Although it is 1These preferences may have changed during the Also, young people consume beer integrated in everyday life, alcohol is past 15 years. and wine more frequently than other

246 Alcohol Health & Research World Alcohol Consumption in India, Mexico, and Nigeria

alcoholic beverages (Medina-Mora et Comparison of groups. For example, among the Hindus al. 1988). Epidemiological Patterns (who make up more than 80 percent of Both drinking and intoxication and Gender and Age India’s population) alcoholic beverages occurred in Mexico before Spanish con- Differences in Alcohol are forbidden for Brahmins and other tact, but according to Natera Rey (1995): Consumption upper-caste groups who are strict vegetarians. Members of all other caste groups Legitimate drinking was mostly who are meat eaters (e.g., the warrior, ceremonial, confined to the upper India farmer, and scavenger-untouchable castes) classes, the old, and the wise. are permitted to drink. Muslims also are Commoners were allowed to drink Few general population studies of alcohol not supposed to drink, although some only in certain situations: women consumption patterns have been con- Muslim men consume alcohol. Finally, after giving birth, to ‘strengthen ducted in India, and those that do exist Buddhists and Jains, who are strict their blood’; men and youths after were conducted primarily in the late vegetarians, are forbidden to drink. In exhausting work, to ‘restore their 1970s, shortly after prohibition policies addition, political prohibition policies strength.’ Ceremonial drinking by the federal government and individual in certain states may contribute to occurred as offerings to honor or states were reversed. Furthermore, Indian drinking patterns. placate the gods, to bless gather- although various epidemiological stud- Another epidemiological study con- ings and collective tasks, to signal ies have been conducted in specific ducted in the rural areas of Rajasthan calendrical cycles, and promote regions of India, their generalizability demonstrated that although alcohol fertility in the fields (p. 179). to the entire country is questionable, at consumption had become accepted least in part because of methodological among men, it was still infrequent Today mezcal (an intoxicating drink problems (Isaac 1998). The most con- among women (Sundaram et al. 1984). with an alcohol content of 40 percent sistent finding in all of the studies was However, drinking by women was that is distilled from the agave plant) that men are the primary consumers of more accepted in certain castes, par- and tequila are considered national alcoholic beverages. However, the per- ticularly on festive occasions, such as alcoholic beverages in Mexico. However, centage of men who had consumed an weddings (Sundaram et al. 1984). In these beverages were not produced alcoholic beverage in the previous year general, by the early 1980s alcohol before the Spanish conquest and the varied widely among different regions, consumption apparently had become introduction of distillation techniques. ranging from 16.7 percent in Madras an accepted leisure activity for men For this reason, pulque is the alcoholic City in southern India to 49.6 percent who were married and living in small beverage most strongly associated with in a Punjab village in northwest India families (i.e., husband, wife, and no traditional Mexican rituals and customs. (Isaac 1998). Conversely, the alcohol more than three children) in this rural consumption rates among women were area (Sundaram et al. 1984). Further- Nigeria consistently low (i.e., less than 5 percent) more, alcohol consumption rates were (Isaac 1998). substantially higher among Hindus than In the Ibadan region of Nigeria the In a study of a clan of Rajput in the among either Muslims or Jains, who most commonly consumed alcoholic city of Khaalapur, Dorschner (1983) rarely consumed alcoholic beverages. beverages are palm wine, which is pro- identified three types of drinkers: abstain- duced from the sap of the palm tree ers, social drinkers, and alcoholics. Of Mexico and has an alcohol content of 3 to 6 the men included in the study, 44.5 percent, and beer. Another typical percent were abstainers, 16.4 percent Compared with other countries, Mexico alcoholic beverage consumed in that were social drinkers, and 39.1 percent has a relatively low per capita consump- region is burukutu, which is fermented were heavy drinkers or alcoholics. Thus, tion of alcoholic beverages. In 1984 from guinea-corn and also ranges in although slightly more than one-half people older than age 15 consumed alcohol content from 3 to 6 percent. of the men consumed daru, spirit, or an average of 5.4 liters of pure alcohol2 Throughout Nigeria, native gin distilled “English alcohol,” moderate social drink- (Medina-Mora et al. 1988). In another from palm wine is popular (Oshodin ing was not the norm among those epidemiological study, the consumption 1995), as is beer. In particular, the drinkers. In contrast, all the women in of pure alcohol among people ages 15 Kofyar in central Nigeria favor beer. the study were abstinent. These overall and older ranged from 4.3 to 4.9 liters According to Netting (1979), “[t]he drinking patterns are consistent with Kofyar make, drink, talk, and think national epidemiological studies con- 2For comparison, the per capita alcohol consump- about beer. It is the focus of cultural ducted in India but contrast sharply tion among people age 14 and older in the concern and activity” (p. 352). Alcohol with those of Asian countries and many United States in 1984 was approximately 10.0 consumption predates colonial rule in Western countries. liters (National Institute on Alcohol Abuse and Alcoholism 1997). Another study noted that the Nigeria; and, as in many African coun- One reason for the specific drinking per capita alcoholic beverage consumption in tries, alcoholic beverages are actually patterns in India may be the strong advo- Mexico is 2.9 times lower than that in Chile considered a type of food. cacy of abstinence by Indian religious (Edwards et al. 1994).

Vol. 22, No. 4, 1998 247 between 1972 and 1984 (Campillo et Differences in drinking patterns • Female students overall drank less al. 1987). These relatively low numbers between rural and urban areas also often than male students. Moreover, are somewhat misleading, however, have received considerable attention. when female students did drink, it because they are based solely on legally According to some studies, alcohol was typically at family festivities. produced alcoholic beverages and consumption is substantially higher in Conversely, male students drank do not include the large quantity of certain rural areas. For example, in more regularly and at daily and illegally produced alcohol consumed certain parts of Mexico a considerable weekend activities as well as on (Campillo et al. 1988). amount of drinking occurs in connec- special occasions. Another confounding factor in inter- tion with the celebration of numerous preting the relatively low per capita festivals. According to Natera Rey • In Ibadan, the majority of students alcohol consumption in Mexico is (1995), “ancestral custom mixed with had tasted alcoholic beverages— that a high proportion of Mexicans modern elements” characterize alcohol primarily palm wine—by age 11. do not drink. For example, according consumption patterns in both Indian to the National Survey of Addiction communities and rural areas of Mexico In another study conducted among conducted in 1988 among people (pp. 184–185). students at the University of Nigeria, ages 18 to 65 living in urban areas of Enekwechi (1996) noted significant Mexico, 46.5 percent of the people in Nigeria differences between men and women that age group abstained from alcohol with respect to influences on their consumption (i.e., drank an alcoholic Studies conducted in the 1970s on alco- drinking. For example, women reported beverage only once per year or less) hol use in Nigeria focused primarily a greater need to consume alcoholic (Natera Rey 1995). Abstinence rates on the drinking practices of middle-aged beverages at parties, whereas men differed substantially between men and young adult men. In recent years, reported that they were influenced by and women (26.6 percent versus 63.3 however, younger students (i.e., students their parents’ drinking and by the desire percent, respectively). However, those between approximately 12 and 14 years to be accepted by their friends. Further- people who did drink—primarily of age who are in the early grades of more, men believed more strongly than men—tended to drink frequently and, secondary school) have become more women that alcoholic beverages helped in many cases, heavily. In fact, only a involved in drinking. Specifically, since enhance their sexual performance and small proportion of the Mexican pop- 1977 both availability and consumption calm their nerves. Enekwechi (1996) ulation was responsible for most of of alcoholic beverages have increased concluded that “males are more likely the alcohol consumption: 75 percent substantially among young Nigerians, to drink for psychological and social of the available alcohol was consumed particularly secondary school students.3 reasons than females” (p. 5). by only 25 percent of the drinkers To evaluate the extent and effect of (Natera Rey 1995). these changes, Odejide and colleagues Several studies have investigated (1987) conducted a study of the drink- Comparison of Typical drinking patterns among Mexicans. ing practices among secondary school Drinking Contexts and In a 1989 survey of the adult population students approximately 16 years old in Preferred Drinking of Mexico City, only 17 percent of adults Ibadan and Abeokuta, two major cities Patterns reported drinking an alcoholic beverage located in western Nigeria. Of the two at least once per week (Medina-Mora cities, Ibadan is more industrialized. 1998). However, 31 percent of respon- The study yielded the following results: India dents reported being intoxicated at least once in the preceding year. These • Alcohol consumption among the Researchers often use generalized cate- findings may indicate that “the European students was significantly higher in gories to characterize drinking patterns pattern of frequent consumption of Ibadan than in Abeokuta. in different countries. Such categories low quantities of alcohol does not seem include abstinent cultures, such as those to characterize the culture” (Medina- • Palm wine was the preferred drink typically found in Muslim societies; Mora 1998, p. 273). The majority of in both cities. permissive drinking cultures that are regular drinkers are men, whereas characteristic of many Mediterranean women who consume alcohol are • In both cities, alcohol consumption countries; overly permissive cultures generally infrequent drinkers. Overall, occurred significantly more often (e.g., Japan and France); and ambiva- men drink more often and consume among students from middle- and lent cultures, such as those of many greater amounts of alcohol than do upper-class families than among Scandinavian and English-speaking women. Among both Mexican men students from lower-class families. cultures. India does not conform to and women, the prevalence of drinking any of these categories (Mohan and increases with increasing income but 3One potential reason for the increase in alcohol Sharma 1995). Instead, Indian atti- decreases with increasing age (Medina- availability may be the increase in the number of tudes about drinking include both Mora et al. 1988). breweries in Nigeria in the 1970s. permissive and abstinent features,

248 Alcohol Health & Research World Alcohol Consumption in India, Mexico, and Nigeria

especially when different population end of prohibition at both the federal Mexico groups are considered. and state levels by 1976. As a result, In contemporary Mexican society, in both This variability is not surprising beer production increased steadily urban and rural areas, alcohol consump- given the broad religious, ethnic, and throughout the 1980s (Mohan and tion is a facet of all aspects of social caste differences found in India (Mohan Sharma 1995). and family life. Alcohol consumption and Sharma 1995). For example, in One approach to assessing and is evident at all stages of the life cycle, his ethnographic study conducted in comparing attitudes about alcohol from birth and baptism to weddings Rajasthan, Castairs (1979) compared consumption in various countries is and funerals. Saints’ days, community caste differences in the use and signifi- to determine people’s definitions of celebrations, and other special occasions cance of the traditional beverage, daru. “normal” and “harmful” drinking as are marked by drinking (Natera Rey According to that study, men from the well as their perceptions of alcohol’s 1995). Nevertheless, a double standard Rajput caste—hereditary fighters and exists with respect to drinking (Medina- landowners—drank daru, whereas Mora 1998). Thus, drinking by women Brahmins—members of the highest- is considered inappropriate, whereas ranking caste who are religious leaders— The complex drunkenness among men is tolerated, were opposed to daru consumption. at least to a certain degree. In fact, men In fact, Castairs (1979) stated that and pervasive role are expected to drink, and the ability “[c]ertainly no Hindu who had tasted to drink large quantities is considered or even touched daru would enter one of alcohol consumption “macho” (Natera Rey 1995). of his temples (not even a goddess in religious and The complex and pervasive role of temple) without first having a purifi- alcohol consumption in religious and catory bath and change of clothes” (p. community rituals community rituals presents many 298). Thus, the Brahmins, who repre- obstacles to recovery from alcohol sented the spiritual aristocracy, and presents many problems. For example, an ethnographic the Rajputs, who represented the warrior obstacles to recovery study among people in the Chiapas and landowner aristocracy, each had province demonstrated that it was their own privileges. For example, the from alcohol problems. exceedingly difficult for both men Brahmins had the right to hold intel- and women to recover from their own lectual positions in government or the drinking problems or from the effects private sector. However, they were veg- of a family member’s drinking problems etarians and were forbidden to drink effects. In Bangalore, normal drinking (Eber 1995). The study also found alcohol. Conversely, the Rajputs’ priv- generally was described as the consump- that women used creative approaches ileges included the right to drink alcohol tion of small quantities of alcohol that to avoid developing drinking problems, and eat meat, and many Rajputs prided did not interfere with a person’s respon- such as participating in religious groups themselves on a regular, moderate drink- sibilities. Moreover, normal drinking and cooperatives. ing pattern. occurred only on special occasions and Although alcohol’s role in Mexican Even under British rule and with not more than once or twice per week. society differs substantially from its role the introduction of English drinking Conversely, harmful drinking was in Indian society, the expectations of customs, Indians generally did not defined as consuming arrack or hard alcohol’s effects are similar. People in incorporate alcohol consumption into liquor frequently and to such an extent Mexico City expected normal drinking their regular social activities. Further- that alcohol consumption led to per- to enhance feelings of well being and more, drinking did not become a sonal and/or work problems. happiness, provide relaxation (with- ritualized component of religion, as it People in the Bangalore region out, however, resulting in disinhibition), had in many other cultures (Mohan expected normal drinking to reduce and help achieve freedom without and Sharma 1995). Beginning in unpleasant feelings (e.g., pain, pres- anxiety. People who drank “quite a 1947, when India became politically sure, anxiety, fatigue, and boredom); lot,” however, were described as being independent, a strong movement improve their mood; and provide a drunk, losing control, and becoming against alcoholic beverage distribution “kick” that would lead to a sense of a “boozer” (Bennett et al. 1993). and consumption developed through- euphoria, increased activity, and a lack out the country. Indian states were of inhibitions. Conversely, people who given the prerogative to set their own had “quite a lot” to drink were described Nigeria temperance laws, and two states— as being mathu (i.e., drunk, with a Bombay and Madras—introduced negative connotation) or masthi (i.e., Alcohol consumption is a central abstinence laws by 1951. Other states drunk and experiencing negative con- feature of adult (i.e., age 18 and older) later passed similar laws. Beginning sequences), as losing control of their life in Nigeria and plays a major role around 1966, however, a shift in Indian behavior, and as experiencing a loss of in social, religious, political, and eco- alcohol policy occurred, leading to the consciousness (Bennett et al. 1993). nomic relationships. For example,

Vol. 22, No. 4, 1998 249 alcoholic beverages can be given as gifts people in that age group (5.6 percent 23 deaths among 100,000 people). to a bride’s relatives and as part of the of men and 0.5 percent of women) Furthermore, alcohol may be associated “bride price.” Alcoholic beverages are were considered alcohol dependent with most absences from work (Campillo consumed at virtually all ceremonies, (Sundaram et al. 1984). Alcohol-related et al. 1987). including festivals, weddings, and problems do not affect all population In 1982 the Mexican Ministry funerals. Moreover, drinking typically subgroups equally, however, because in of Health assumed control of and indicates hospitality. Although different the same study, Hindus were more likely responsibility for the nation’s health age groups and men and women are to drink than were Jains and Muslims. policies. This move has affected not explicitly separated during these Overall, a growing number of health, policies and programs addressing occasions, elders and men are expected social, and economic problems attribut- AOD-related problems throughout to drink more than either younger peo- able to rising alcohol consumption have the country. Beginning in 1983, the ple or women (Oshodin 1995). been documented throughout India National Council Against Addictions People in Ibadan defined normal (Isaac 1998). Treatment facilities for initiated measures to prevent alcohol- drinking as having a few drinks occa- these problems are organized by govern- related problems in Mexico. As a sionally at social events or drinking in mental or nongovernmental (both pri- result of those initiatives, by 1988, moderation to relax. Conversely, harm- vate and public) organizations. 16 of the 31 Mexican states had ful alcohol use was described as excessive Policies to control alcohol production signed measures such as forbidding drinking that results in intoxication and consumption in India were initiated the sale of alcoholic beverages to and in physical and social impairment. after the country’s independence in children younger than age 18 and to Nigerians generally considered it unde- 1947. For example, article 47 in the people who were intoxicated. Since sirable to drink too much (Oshodin Indian constitution states that “[t]he then, the council’s work has continued 1995). The anticipated effects of normal state shall endeavor to bring about and is currently under review, with an drinking in Ibadan included relief of prohibition of the consumption except understanding that “[m]ore emphasis stress and inhibition as well as feelings for medicinal purposes of intoxicating needs to be placed on local problems, of sociability, euphoria, and boldness. drinks and drugs which are injurious along with the development of specific Although normal drinking was described to health” (Isaac 1998, p. 148). Between subprograms” (Medina-Mora 1998, as reinvigorating, however, it was also the mid-1960s and 1976, however, the p. 281). Other measures introduced considered a cause of hyperactivity national government’s commitment in recent years include educational and sickness. Once a person had con- to total prohibition ceased. As a result, programs, warning labels, an increase sumed “quite a lot” to drink, however, the production and sale of alcoholic in the price of pure cane alcohol, he or she was described as being unin- beverages were greatly simplified during training in medical schools, and early hibited, sick, disoriented, irritable, the 1980s and 1990s, and shops, bars, identification and treatment programs voluble, clumsy, sleepy, or more alert and restaurants now can easily obtain (Campillo et al. 1988). A particular or as behaving irresponsibly4 (Bennett a license to sell alcoholic beverages. In emphasis has been placed on early et al. 1993). fact, national policies regarding alcoholic detection, especially among young beverages have “swung from total pro- and middle-aged men, the two popu- hibition to unrestricted sale with no lation subgroups at the greatest risk Comparison of Alcohol- controls” (Isaac 1998, p. 151). for alcohol-related problems Related Problems and Most Indian state governments also (Campillo et al. 1987). Approaches to Prevention are ambivalent about prohibition (Isaac Mexican women appear to be less and Treatment 1998). Although many states have estab- likely to receive professional treatment for lished temperance boards for educating alcohol-related problems. Thus, accord- India Indian people about the potentially harm- ing to the National Survey on Addictions, ful effects of drinking, these boards pri- a notable difference exists between the Although alcohol consumption is not marily sponsor newspaper advertisements. ratio of men to women attending Alco- an integral part of Indian social life, holics Anonymous (AA) programs (i.e., alcohol-related problems can occur. Mexico 10:1) and the ratio of men to women in For example, in one study conducted formal treatment programs (i.e., 16.7:1) in Rajasthan, 24.7 percent of all people Alcohol-related problems are reportedly (Medina-Mora 1994). This difference age 15 and older (36.1 percent of men common among Mexican men (Medina- indicates that women are substantially less and 13.4 percent of women) consumed Mora 1998) and may have a substan- likely to enter formal treatment than to alcohol. Furthermore, 3 percent of tial adverse effect on the overall health choose an informal treatment approach, and well being of the Mexican popu- such as AA. Furthermore, special inter- lation (Campillo et al. 1988). During ventions targeted at women are not 4As indicated by these descriptions, contradictory viewpoints exist among Nigerians about the effects the 1970s and 1980s, Mexico had one available in either formal treatment of having “quite a lot” to drink (e.g., expecting it of the highest mortality rates from liver programs or AA, even though women to make people either sleepy or more alert). cirrhosis in Latin America (i.e., 20 to are expected to control their own drink-

250 Alcohol Health & Research World Alcohol Consumption in India, Mexico, and Nigeria

ing as well as that of the men in their the CAR study, those indicators were social and economic pressure). In families (Medina-Mora 1994). relatively similar among the Indian, Bangalore, respondents considered the Mexican, and Nigerian study sites, alcoholic beverage primarily responsible Nigeria although some differences existed. At for intoxicated behavior and thought all three sites, becoming aggressive and that drinkers had relatively little control Alcoholic beverages are the most widely being uncoordinated were considered over their own behavior. Furthermore, abused psychoactive substances in signs of intoxication. With respect to heavy drinking was not expected to Nigeria, and the Nigerian government indicators of the need for medical atten- produce any positive effects. has recognized the need to establish tion, the following indicators were People in Mexico City had no clear- policies to control both alcohol pro- considered critical: cut opinion as to whether the alcoholic duction and consumption. In 1920 beverage or the drinker was responsible measures were established to control • In Bangalore: head injuries or for intoxicated behavior. In addition, the importation, sale, and local fer- unconsciousness Mexicans thought that both the drinker’s mentation and distillation of alcohol, self-control and social pressures influ- including the requirement for a special • In Mexico City: loss of conscious- enced a person’s drinking behavior. permit (Oshodin 1995). Because drink- ness, violence, and physical injuries People who were alcoholics, however, ing is an integral part of daily and were no longer considered able to control ceremonial life of those Nigerians who • In Ibadan: sustained injuries, persis- their drinking. Mexican respondents, are not Muslims, however, government tent vomiting, and unconsciousness. like those in Bangalore, saw no positive efforts to establish prevention and effects resulting from heavy drinking. treatment programs have had little Thus, at each site, medical attention Finally, respondents in Ibadan did effect. Compared with many other was not considered necessary unless a not consider drinkers to be responsible countries, the Nigerian government is serious disturbance of the central nervous for changes in their behavior when they not very strict in implementing policies system (i.e., loss of consciousness) and were intoxicated. Moreover, various fac- regulating alcohol production, distri- alcohol-related bodily injuries occurred tors, such as social situations, economic bution, and consumption. For example, (Room et al. 1996). factors, and other people, were perceived although existing laws regulate when In contrast to the similarities among to have a major influence on a person’s and where alcohol can be sold, they the three sites in the indicators of intox- drinking. As in Bangalore and Mexico are not strictly enforced. In addition, ication or need for medical attention, City, heavy drinking was not expected no age restrictions on the purchase or the thresholds for a diagnosis of alcohol to have any positive effects. consumption of alcoholic beverages dependence or addiction as defined by exist (Oshodin 1995). heavy drinkers, their family members, The position of Nigerian women and health care professionals differed Conclusions in regard to alcohol-related problems widely. For example, in Bangalore, where is particularly difficult (e.g., Ikuesan drinking occurs among a minority of The studies summarized in this article 1994). In most rural areas, women are men and is rare among women, respon- demonstrate that drinking practices strongly involved in the production of dents indicated extremely low thresholds and the definition of what constitutes alcoholic beverages, which may promote for a dependence diagnosis. Thus, one normal drinking vary sharply among drinking. Also, it generally is considered person stated that “drinking the equiv- different countries. Even within a acceptable for women to drink (except alent of three bottles of beer 1–3 days country, substantial differences in these among Muslim Nigerians). Drinking a month, and never drinking more; definitions and practices may exist problems among women, however, objections from friends, doctor, or clergy; among members of different ethnic or cause great disruption to their families trouble driving because of drinking; cultural groups. For example, although and result in stigmatization by the the same amount of alcohol having less India generally is considered a dry community (Ikuesan 1994). effect than before; and having had such country, drinking practices differ con- a strong desire to . . . drink that he could siderably between people living in the not resist it” were indicative of depen- southern or northern areas, and even Comparison of Drinking dence (Room et al. 1996, p. 217). among members of different castes Indicators Substantially higher levels of alcohol residing in the same region. As a result consumption were considered necessary of the cultural and ethnic variations To gain a better understanding of what for a diagnosis of alcohol dependence in in drinking practices, no single defini- is considered “normal” drinking or alco- both Mexico City and Ibadan. tion of problem drinking or alcohol hol dependence in various cultures, Another measure of people’s attitudes dependence exists that is uniformly researchers can assess and compare regarding alcohol is their perception of applicable in all countries or cultures. characteristics that are considered signs who or what is responsible for a person’s Similarly, researchers, clinicians, and of intoxication or an indication that a drinking (e.g., the drinker; the alcoholic public health officials attempting to drinker requires medical attention. In beverage; or external factors, such as develop effective prevention and

Vol. 22, No. 4, 1998 251 treatment approaches must consider and practices regarding alcoholic bev- IKUESAN, B.A. Drinking problems and the position the population’s attitudes and expec- erage consumption. Furthermore, the of women in Nigeria. Addiction 89:941–944, 1994. tations regarding alcohol consumption country is experiencing changes in the ISAAC, M. India. In: Grant, M., ed. Alcohol and (e.g., what constitutes heavy drinking) traditional family structure, a weakening Emerging Markets: Patterns, Problems, and Responses. and its effects (e.g., whether the drinker of informal cultural and religious controls Philadelphia: Brunner/Mazel, 1998. pp. 145–175. or the alcoholic beverage is responsi- on alcoholic beverage consumption, MARSHALL, M., ED. Through a Glass Darkly: Beer and Modernization in Papua New Guinea. ble for intoxicated behavior). and increasing contact with drinking Boroko, Papua New Guinea: Institute of Applied Cultures or countries such as the ones practices outside Indian society. As a Social and Economic Research, 1982. described in this article can undergo result, Indian policymakers must pay MEDINA-MORA, E. Drinking and the oppression broad social and related changes, which attention to these cultural variations of women: The Mexican experience. Addiction typically are accompanied by alterations in establishing appropriate prevention 89:958–960, 1994. in drinking patterns. An example of a and treatment programs for the diverse MEDINA-MORA, M.E. Mexico. In: Grant, M., ed. notable change in drinking patterns is segments of Indian society. Alcohol and Emerging Markets: Patterns, Problems, the experience of Mexican men who and Responses. Philadelphia: Brunner/Mazel, migrate to the United States. According 1998. pp. 263–284. to Medina-Mora and colleagues (1988, References MEDINA-MORA, M.E.; RASCON, M.L.; OTERO, p. 30), these migrants “modify their B.R.; AND GUTIERREZ, E. Patrones de consumo. BENNETT, L.A.; JANCA, A.; GRANT, B.F.; AND In: Gilbert, M.J., ed. Alcohol Consumption among consumption patterns by adopting SARTORIUS, N. Boundaries between normal and Mexicans and Mexican Americans: A Binational the more frequent drinking patterns pathological drinking: A cross-cultural compari- Perspective. Los Angeles: Spanish Speaking Mental preferred by Americans, maintaining, son. Alcohol Health & Research World 17(3): Health Research Center, University of California, 190–195, 1993. however, the high quantities per occa- Los Angeles, 1988. pp. 27–52. sion common in Mexico.” CAMPILLO, C.; MARTINEZ, R.D.; AND ROMERO, MOHAN, D., AND SHARMA, H.K. India. In: Heath, Changes in drinking practices often M. Early detection and management of alcohol- D.B., ed. International Handbook on Alcohol and related problems in Mexico. Australian Drug and Culture. Westport, CT: Greenwood Press, 1995. also influence the particular nature of Alcohol Review 6:309–313, 1987. pp. 128–141. alcohol-related problems and appro- CAMPILLO, C.; DIAZ, R.M.; AND ROMERO, M. La NATERA REY, G. Mexico. In: Heath, D.B., ed. priate approaches to prevention and prevencion en el abuso de alcohol en Mexico. In: International Handbook on Alcohol and Culture. treatment in a culture. For example, Gilbert, M.J., ed. Alcohol Consumption among Westport, CT: Greenwood Press, 1995. pp. Mexicans and Mexican Americans: A Binational 179–189. examination of the differences in drink- Perspective. Los Angeles: Spanish Speaking Mental ing practices in the three countries Health Research Center, University of California, National Institute on Alcohol Abuse and Alcoholism. discussed in this article suggests that a Los Angeles, 1988. pp. 233–252. Ninth Special Report to the U.S. Congress on focus on women’s drinking more likely Alcohol and Health. NIH Pub. No. 97–4017. CASTAIRS, G.M. Daru and bhang: Cultural fac- Bethesda, MD: the Institute, 1997. would be pertinent in Mexico and tors in the choice of intoxicant. In: Marshall, M., Nigeria than in India, where women ed. Beliefs, Behaviors, and Alcoholic Beverages. Ann NETTING, R.M. Beer as a locus of value among the Arbor, MI: University of Michigan Press, 1979. West African Kofyar. In: Marshall, M., ed. Beliefs, generally do not drink. Such a focus, pp. 297–312. Behaviors, and Alcoholic Beverages. Ann Arbor: in turn, could lead to the development University of Michigan Press, 1979. of prevention and treatment programs DORSCHNER, J. Rajput alcohol use in India. Journal of Studies on Alcohol 44(3):538–544, 1983. ODEJIDE, O.A.; OHAERI, J.U.; ADELEKAN, M.L.; AND tailored to the needs of women. 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