Is prohibition the way to address the post-COVID-19 alcohol hangover?

Many people have looked forward to a post-lockdown drink in pubs, bars and clubs that have been closed for much of the last three months in many countries around the world.

But alcohol is a key driver of health harms, and some researchers are arguing that our experiences during lockdown give policymakers a unique opportunity to address alcohol-related harm and crime.

The shutdown of non-essential activities in response to Covid-19 meant the closure of licensed premises in many countries, limiting the availability of alcohol. Sales data suggest the purchase of alcohol rose sharply just before the premises closed.

Reduced alcohol consumption during lockdown had some positive effects on local community life

It has also prompted speculation and commentary: Were people stocking up to avoid shopping as often or out of fear of shortages? Or were they actually drinking more, to cope with the lockdown? And if so, what would be the knock-on effects?

But some governments went a step further, prohibiting alcohol completely in an effort to reduce alcohol-related harm.

In the south-west Indian state of Karnataka, the findings of a survey by two NGOs suggests that reduced alcohol consumption during lockdown had some positive effects on local community life, “reducing quarrels in families and increasing peace and harmony”.

The survey was conducted among 9,400 people by Sri Kshetra Dharmasthala Rural Development Project (SKDRDP) and Jana Jagrutihi Vedike – organisations that support women in rural areas of the state, acting as microfinance guarantor for bank loans, but also running alcohol awareness and addiction treatment projects, including 10-day, intensive “addiction camps”. Some 41% of respondents reported “an increase in happiness in the community” because of the absence of alcohol.

“The lockdown has shown that alcohol is not an essential commodity. We should continue the prohibition beyond the lockdown,” said SKDRDP executive director L.H. Manjunath.

Alcohol bans bring to mind the prohibition era 100 years ago when ordinary Americans resorted to criminality in order to drink alcohol that Al Capone's gangsters were happy to supply.

But alcohol prohibition has been in force for many years in some Indian states, including Bihar, Nagal and Gujarat, the birthplace of Mahatma Gandhi who viewed alcohol as a corrupting influence imported by foreign rulers.

The one-month national ban on alcohol sales formed an important component of the pandemic lockdown by the government of teetotaller Narendra Modi. But the ban also deprived state governments of vital tax revenue at a time when they needed to increase spending on health and social services. In some states, a tax levied on beer, wine and spirits can contribute between 15 to 30% of total revenues.

But Dr Manjunath believes the benefits of prohibition would outweigh the losses in his state.

“Poor people in my state who earn 500 rupees a day (£5) are spending about (£1.60) 150 rupees on alcohol. It’s expensive, kills people, destroys families and wastes whatever development work we do,” he said. “We have written to the government saying they should consider letting the alcohol ban be permanent and help us improve the lives of the poor people in our state.”

There are advocates for prohibition elsewhere. In South Africa, where half of all murders take place on a Friday or Saturday night, researchers at the Institute for Security Studies thinktank say murders have reduced by 63% during the lockdown when alcohol sales were banned for nine weeks.

South Africa's police minister Bheki Cele said the ban on alcohol sales had helped lower overall crime rates. Two weeks after South Africa ended its temporary prohibition, President Cyril Ramaphosa linked a surge in rapes and killings of women to the end of the country's strict coronavirus lockdown, calling it a "dark and shameful week".

Ramaphosa has admitted that South Africa is facing a crisis of violence against women – more than 2,700 women were killed last year. But the relationship between alcohol consumption and related harms is complex. Campaigners stressed that the South African police force's gender-based violence hotline received 2,300 calls in the first five days of lockdown — nearly three times the rate prior to lockdown — suggesting that violence against women had gone up not down, despite prohibition.

There is little data yet on the impact of Covid-19 on, for example, alcohol-related domestic abuse. And while alcohol use is common among a high proportion of domestic abuse cases, research shows that alcohol (and other drugs) do not cause domestic abuse. However, studies do show that alcohol can increase the risk of perpetrating domestic abuse, increase the risk of being a victim of domestic abuse and increase the severity of domestic abuse.

In Britain, research conducted by Opinium for campaign group Alcohol Change UK found that people’s drinking habits did change during coronavirus lockdown there – and it changed in two directions.

One in three of the 1,555 drinkers surveyed said they had either stopped drinking or reduced how often they drink during lockdown. However, around one in five drinkers (21%) said they drank more frequently during the lockdown. One in 14 (7%) reported that alcohol had made the tension in their household worse during lockdown. One in seven people with children under 18 living in their household reported that alcohol had increased tensions.

Director of research and policy Lucy Holmes says Alcohol Change UK is not campaigning for prohibition but believes limiting the availability of alcohol is a key policy lever for reducing related harm.

"Alcohol is not an essential commodity. We should continue the prohibition beyond the lockdown"

“During lockdown, availability has been limited in terms of when and where you can buy alcohol,” she said. “But conversely, it’s been available 24/7 because people have been in their homes most of the time.

“Alcohol-related harm costs our NHS about £3.5bn a year. Alcohol-related crime and disorder cost our country around £11 billion. This is a massive problem and challenge and although patterns of consumption are changing, alcohol harm continues to increase. However, we’ve got a great opportunity now, because of this significant, weird experience we've all been through to put public health at the heart of public policy.”

For policy ideas, she points to Scotland which has introduced minimum unit pricing and is beginning a consultation on alcohol marketing; the alcohol abstinence orders and sobriety tags being introduced in England and Wales, and voluntary agreements being struck between some London boroughs and retailers who agree not to stock the over-strength beers and ciders often linked to street-drinking.

“One policy won’t be enough,” said Holmes. “There are very direct short-term harms from alcohol, and there are some very long-term harms. Our policies need to address both.” – Ian Wylie

(Photo credit: Roberto Carlos Roman/Unsplash)