Alcoholic Beverage Consumption in India, Mexico, and Nigeria

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 dynamics; AOD use pattern; problematic AOD use; epidemiology; public policy on AOD use; attitude toward AOD; AOD prevention; treatment; literature review

A Cross-Cultural Comparison

lcoholic beverage consumption acceptable. Television, movies, andof different ethnic backgrounds. Such scholarly publications have depicted investigations initially focused on the patterns vary considerably among different countries and even and investigated differences in drinking differences among people of Irish, traditions to such an extent that people Italian, among different ethnic groups within one country. These variations in drinkthroughout the world are increasingly Jewish descent living in the United and aware of drinking patterns in cultures States. More recently, interest has ing patterns include, for example, the types of beverages consumed preferen- than their own. other focused Several decades ago, researcherson the drinking patterns among various in tially, occasions on which consumption typically occurs, drinking levels that are the United States began paying considNative American, African-American, erable and considered normal, and population sub- attention to the role that alcohol Hispanic groups. Similar studies on groups for whom drinking is considered consumption plays in the lives of people the diversity of drinking traditions have been conducted in Europe, comparing, for example, drinking patterns between
Vol. 22, No. 4, 1998 243

Mediterranean and Scandinavian counuation were used to assist the develop-table 1). Moreover, the three coun(see tries. In addition, studies conductedment of public policies on drinkingtries have distinct histories of traditional in 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 theseAll three countries participated in the three or cultures and depend in part on the countries has a highly diverse and Cross-Cultural Applicability Research mulreligious practices of the groups ticultural population, and major differ- study, an investigation of the (CAR) studied. ences exist between their urban and diagnosis and assessment of AODWhat is the relevance of studies on rural areas. Nevertheless, the three related cross-cultural differences in alcoholic coundisorders conducted jointly by the World beverage consumption? Cultural varia- studied differ sharply in drinking tries Health Organization (WHO) and the tions in drinking practices and beliefs practices. These differences allow U.S. National Institute on Alcohol Abuse for about alcohol have far-reaching impli- exploration of potential implications the and Alcoholism (NIAAA) in nine councations for policymakers, clinicians,of cultural variations in drinking tries between 1991 and 1993. Responand researchers in the field of alcohol and patterns dents participating in that study other drug (AOD) use and abuse. Based for the identification, prevention, and included on cross-cultural comparisons, treatment of drinking-related problems users of alcoholic beverages or heavy combined currently encountered in India, Mexico, other drugs, family members of certain with information on historical changes Nigeria. Following a brief and heavy users, health workers in the area and variations in drinking behavior description of AOD problems, and other health within of the cultural and ethnic or social service workers having regular each culture, researchers and characteristics, contact with people with AOD problems. policymakers this article reviews each countrys In addition, each of the three countries alcocan obtain a better understanding of the beverage preferences, holic was discussed in the International relationships between drinking patterns, epidemiologiHandbook on Alcohol and Culture drinking-related consequences, andcal patterns in alcohol consumption, the (Heath Cultural and Ethnic and cultural outcome of informal and formal alcohol typical drinking contexts 1995) and in the Alcohol and Emerging Characteristics of the policies. Such analyses can assist in the drinking norms, alcohol-related Markets volume (Grant 1998). Finally, development of appropriate alcoholproblems, several ethnographic, epidemiological, Study Regions related policies and in the identification approaches to prevention or and clinical studies have focused on and of effective clinical prevention and India, Mexico, and Nigeria were selected and its consequences in India, treatment. drinking for cross-cultural comparisons in this treatMexico, and Nigeria. As a result, a article because they represent areas ment strategies. For example, during considerable amount of current inforwith the early 1980s the Institute of Applied mation is available on the drinking distinctly different geographic locations Social and Economic Research (IASER) practices, drinking-related problems, in Papua New Guinea conducted a and predominant languages and and LINDA A. BENNETT, PH.D., is an religions crossstrategies for handling those problems associate cultural examination of traditional in each of the countries studied (see Nigeria dean at the College of Artseffects of Table 1 Cultural Characteristics of Regions in India, Mexico, and 2). That drinking practices and the and also table Participated in the Cross-Cultural Applicability Research Study Sciences deprohibition. The results of that evaland professor of anthropology, CARLOS CAMPILLO, M.D., is project City and Country University Location Primary Language(s) Primary Religion(s) coorof Memphis, Memphis, Tennessee. Bangalore, India Hinduism, Islam, dinator in the Department of Kannada, Tamil, South Asia Christianity, Telugu, and Hindi Epidemiology Sikhism, and Social Research in the Instituto Buddhism, and Jainism Mexicano de Psiquiatria (IMP), C.R. CHANDRASHEKAR, M.D., is addiUniversity tional professor of psychiatry at of Mexico, Mexico City, Mexico. the Roman Spanish North Mexico City, National Institute of Mental Health Catholicism America Mexico and Neuro Sciences, Deemed University, West Africa Ibadan, Nigeria Christianity, Islam Yoruba Bangalore, India. OYE GUREJE, M.B.B.S., PH.D., FRANCZP, is a professor in the Department of SOURCE: Bennett et al. 1993. Psychiatry, 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- Indian drinking practices in this artion religious, and linguistic groups. Thesented on Indian drinking practices cle is based on two ethnographic is drinking patterns observed in the coun- on investigations conducted in based studies tries reflect that variability, and results Bangalore, a city in the southwestern alcohol consumption conducted of obtained in specific regions of each state of Karnataka that served as a among the Rajput, a military caste in CAR country can be generalized only to study site. In addition to English, the northwestern India (Castairs 1979; a limited extent. For example, one primary native language spoken in that Dorschner 1983). cannot accurately characterize the region is Kannada. With respect to their information on Mexican drinkThe drinking patterns of all Indian ethnic religious affiliation, most people in the practices presented in this article ing and cultural groups based on findings Bangalore region are Hindu, although obtained primarily in the capital was for just one of those groups. Accordthere are also substantial numbers of Mexico City and its environs, ingly, researchers describing drinking Muslims, Christians, Buddhists, Sikhs, which was also a CAR study site. The practices in each country must specify Jains (i.e., followers of an ascetic and predominant language spoken in 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 Arrack, palm wine, beer, and imported liquors Mexico Beer, tequila, rum, 96-percent proof alcohol, pulque, wine, and mezcal Nigeria Palm wine and beer

Most commonly consumed alcoholic beverages

Drinking predates European contact

Yes, but not particularly central to social life

Yes, especially pulque consumption as part of traditional rituals and customs

Yes, drinking (especially of palm wine and home-brewed beer) was part of normal social and ceremonial life

Womens drinking patterns

Predominantly (about 95%) abstinent

Majority (about 63%) abstinent

Minority (about 30%) abstinent in two urban areas studied Most drink on a regular basis

Mens drinking patterns

Highly variable across regions

Those who drink tend to drink rather frequently and often heavily

Context of drinking occasions

No regular context established; thus far, not a part of regular daily life or ritual occasions Increasing

Is an aspect of social family life passages, fiestas and, for some drinkers, part of daily life

A central feature of adult male life and in social, religious, and economic relationships

Evidence of concerns about young peoples drinking

Definitely increasing

Has been a concern for the past two decades in some areas Although there are increasing concerns, generally they are not viewed as sufficiently serious to establish many prevention and treatment programs

Extent of major concerns about alcohol-related problems

Increasing problems seen in health, social, and economic areas

Considerable concern about drinking among men; drinking is seen as having major consequences for health and job performance

Vol. 22, No. 4, 1998

245

most commonly practiced is Roman Catholicism. Although the CAR study the same time seen as dangerous only by untouchables and memat focused mostly on Mexico City, it also and bers of other lower castes. addressed some urban-rural differences. harmful (p. 279). English alcohol, a distilled liquor Additional information in this article is usually whiskey or ginassociated based on research conducted in Comparison of Alcoholic with British rule. At the time of Chiapas, Beverage Preferences the study, which coincided with a a predominantly rural region (Eber period of prohibition, English alcohol 1995). India was extremely difficult to obtain. Much of the information on Nigerian In drinking practices was obtained in theBangalore the following three types The consumption of alcoholic of alcoholic beverages are consumed city beverages in India predates British most often: of Ibadan in the southwestern part of colonization. However, in contrast the to other countriessuch as Nigeria country, which also participated in the Arrack, a traditional drink produced and, CAR study. The predominant native (both legally and illegally) by distill- to some extent, Mexico alcohol consumption was not conlanguage spoken in that region is ing fermented molasses, raw brown sidered central to normal social life Yoruba, sugar, palm wine, rice, or palm sugar; along with English, and the most com- has an alcohol content ranging or daily meals in precolonial India. it Nevertheless, in certain tribal groups mon religious affiliation is Christianity. from 20 to 40 percent throughout the country alcoholic Additional information on Nigerian beverages still are considered a gift drinking practices was drawn from a Palm wine, another traditional bev study conducted among the Kofyar in erage produced from either the to humankind and, in turn, were central Nigeria (Netting 1979) and from coconut tree or other palm trees,reverently offered to the nature gods and two studies of drinking patterns among which has an alcohol content rang- other sacred powers (Mohan and Sharma 1995, p. 134). college students in various urban areas from 20 to 40 percent ing of Nigeria (Enekwechi 1996; Odejide et al. 1987). Imported liquors, such as whiskey, Mexico For the purpose of establishing a brandy, and rum. In Mexico, a wide variety of alcoholic general measure of the role that alcobeverages are consumed, including hol consumption plays in a culture or Beer is also consumed in the Banga- that predate colonial settlement. some country, researchers commonly uselore region, although less commonly Overall, however, Mexicans currently the terms wet and dry. Wet cultures the three types of beverages prefer beer and distilled alcoholic than listed are those in which alcohol consumption above. Of these alcoholic beverages, beverages, such as tequila and rum. is a highly valued part of social life. palm wine and beer are considered fact, beer accounted for 89 In Conversely, in dry cultures, alcohol cool or soft drinks, whereas hard percent of all alcoholic beverages consumption typically is consideredliquors and arrack are considered hot consumed in Mexico in 1989 (Natera aberrant behavior (Bennett et al. 1993). or hard drinks. Rey 1995). Pulque, wine, and India, Mexico, and Nigeria differ in Studies among the Rajputs of north96-percent proof alcohol are the their wet-dry classification (Room et western India identified three preferredfavorite beverages. Pulque, a next al. 1996). For example, compared with of alcoholic beverages1 types traditional drink with an alcohol societies that are traditionally thought (Dorschner content of 6 percent, is produced by of as wet (e.g., Greece), India can be 1983): fermenting a sugary liquid from the considered a dry culture. Nigeria and Daru, a drink distilled from the flow- of a certain species of agave heart Mexico, in contrast, can be classifieders of the mahwa tree and which (i.e., the maguey plant). Like 96as intermediate (i.e., neither clearly ranges in alcohol content from 20 percent proof alcohol, pulque is conwet nor clearly dry). In fact, Natera to 40 percent. At the time of the study, primarily in rural parts of sumed Rey (1995) suggested that Mexico was daru was considered inexpensiveMexico, whereas distilled beverages best considered a mixed society inand was the most popular beverage wine are more popular in urban and that neither the dry nor wet categories the Khaalapur community. in areas. neatly apply in terms of per capita Some differences exist in the alcoconsumption, characteristic patterns Spirit produced from solvents, which beverage preferences of various holic of consumption, or social consequences greatly varies in alcohol content and, population subgroups. For example, of drinking. More recently, however, at the time of the study, was drunk although both men and women drink Medina-Mora (1998) characterized pulque, women tend to prefer wine. Mexico as a good example of a dry1 Also, young people consume beer the culture where the rate of abstainersThese preferences may have changed duringand wine more frequently than other is past 15 years. high, the dominant pattern of heavy drinking is rarely very heavy and binge 246 Alcohol Health & Research World drinking is common. Although it is integrated in everyday life, alcohol is

Alcohol Consumption in India, Mexico, and Nigeria

alcoholic beverages (Medina-Mora et groups. For example, among the Hindus Comparison of al. 1988). (who make up more than 80 percent of Epidemiological Patterns Both drinking and intoxication and Gender and Age Indias population) alcoholic beverages occurred in Mexico before Spanish conare forbidden for Brahmins and other Differences in Alcohol tact, but according to Natera Rey upper-caste groups who are strict vegeConsumption (1995): tarians. Members of all other caste Legitimate drinking was mostly Few general population studies of groups ceremonial, confined to the upper alcohol who are meat eaters (e.g., the warrior, India classes, the old, and the wise. consumption patterns have been confarmer, and scavenger-untouchable Commoners were allowed to drink ducted in India, and those that do exist castes) only in certain situations: womenwere conducted primarily in the late are permitted to drink. Muslims also are after giving birth, to strengthen 1970s, shortly after prohibition policies supposed to drink, although some not their blood; men and youths after the federal government and by Muslim men consume alcohol. Finally, exhausting work, to restore their individual Buddhists and Jains, who are strict strength. Ceremonial drinking states were reversed. Furthermore, vegetarians, are forbidden to drink. In occurred as offerings to honor or although various epidemiological studaddition, political prohibition policies placate the gods, to bless gather- have been conducted in specificin certain states may contribute to ies ings and collective tasks, to signal regions of India, their generalizability Indian drinking patterns. calendrical cycles, and promote to the entire country is questionable, at Another epidemiological study confertility in the fields (p. 179). least in part because of methodological ducted in the rural areas of Rajasthan problems (Isaac 1998). The most condemonstrated that although alcohol Today mezcal (an intoxicating drink sistent finding in all of the studies was consumption had become accepted with an alcohol content of 40 percent men are the primary consumers of that among men, it was still infrequent that is distilled from the agave plant) alcoholic beverages. However, the peramong women (Sundaram et al. 1984). and tequila are considered national centage of men who had consumedHowever, drinking by women was an alcoholic beverages in Mexico. However, alcoholic beverage in the previous year accepted in certain castes, parmore these beverages were not produced varied widely among different regions, ticularly on festive occasions, such as before the Spanish conquest and the ranging from 16.7 percent in Madras weddings (Sundaram et al. 1984). In introduction of distillation techniques. in southern India to 49.6 percent City general, by the early 1980s alcohol For this reason, pulque is the alcoholic Punjab village in northwest India in a consumption apparently had become beverage most strongly associated (Isaac 1998). Conversely, the alcohol accepted leisure activity for men with an traditional Mexican rituals and customs. consumption rates among women were were married and living in small who consistently low (i.e., less than 5 families (i.e., husband, wife, and no percent) more than three children) in this rural Nigeria (Isaac 1998). area (Sundaram et al. 1984). FurtherIn the Ibadan region of Nigeria the In a study of a clan of Rajput in the more, alcohol consumption rates were most commonly consumed alcoholic city of Khaalapur, Dorschner (1983)substantially higher among Hindus than beverages are palm wine, which is proidentified three types of drinkers: among either Muslims or Jains, who duced from the sap of the palm tree abstainrarely consumed alcoholic beverages. Mexico and has an alcohol content of 3 to 6 ers, social drinkers, and alcoholics. Of percent, and beer. Another typical the men included in the study, 44.5Compared with other countries, Mexico has alcoholic beverage consumed in that percent were abstainers, 16.4 percent a relatively low per capita consumption region is burukutu, which is fermented social drinkers, and 39.1 percent of alcoholic beverages. In 1984 were people from guinea-corn and also ranges in were heavy drinkers or alcoholics. Thus, older than age 15 consumed an alcohol content from 3 to 6 percent. although slightly more than one-half average of 5.4 liters of pure alcohol2 (Medina-Mora et al. 1988). In another Throughout Nigeria, native gin distilled of the men consumed daru, spirit, or from palm wine is popular (OshodinEnglish alcohol, moderate social epidemiological study, the consumption of pure alcohol among people ages 15 1995), as is beer. In particular, the drinkKofyar in central Nigeria favor beer.ing was not the norm among those and older ranged from 4.3 to 4.9 liters According to Netting (1979), [t]he drinkers. In contrast, all the women in 2 Kofyar make, drink, talk, and think the study were abstinent. These overall For comparison, the per capita alcohol consumption among people age 14 and older in the about beer. It is the focus of cultural drinking patterns are consistent with United States in 1984 was approximately 10.0 concern and activity (p. 352). Alcohol national epidemiological studies con- (National Institute on Alcohol Abuse and liters consumption predates colonial rule ducted in India but contrast sharplyAlcoholism 1997). Another study noted that the in per capita alcoholic beverage consumption in Nigeria; and, as in many African coun- those of Asian countries and many with Mexico is 2.9 times lower than that in Chile tries, alcoholic beverages are actually Western countries. (Edwards et al. 1994). considered a type of food. One reason for the specific drinking patterns in India may be the strong Vol. 22, No. 4, 1998 247 advocacy of abstinence by Indian religious

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 Conversely, male students drank in 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 connecspecial occasions. Another confounding factor in inter- with the celebration of numerous tion preting the relatively low per capitafestivals. According to Natera Rey In Ibadan, the majority of students had alcohol consumption in Mexico is (1995), ancestral custom mixed with tasted alcoholic beverages primarily palm wineby age 11. that a high proportion of Mexicans modern elements characterize alcohol do not drink. For example, according consumption patterns in both Indian In to the National Survey of Addiction communities and rural areas of Mexicoanother study conducted among students at the University of Nigeria, conducted in 1988 among people (pp. 184185). Enekwechi (1996) noted significant ages 18 to 65 living in urban areas of differences between men and women Mexico, 46.5 percent of the people in Nigeria with respect to influences on their that age group abstained from alcohol Studies conducted in the 1970s ondrinking. For example, women reported alcoconsumption (i.e., drank an alcoholic hol a beverage only once per year or less) use in Nigeria focused primarily greater need to consume alcoholic on beverages at parties, whereas men (Natera Rey 1995). Abstinence rates the drinking practices of middle-aged reported that they were influenced by differed substantially between men and young adult men. In recent years, however, younger students (i.e., their parents drinking and by the desire and women (26.6 percent versus 63.3 students to be accepted by their friends. Furtherpercent, respectively). However, those between approximately 12 and 14more, men believed more strongly than years people who did drinkprimarily of age who are in the early gradeswomen that alcoholic beverages helped of mentended to drink frequently and, enhance their sexual performance and in many cases, heavily. In fact, onlysecondary school) have become more a involved in drinking. Specifically, since their nerves. Enekwechi (1996) calm small proportion of the Mexican popconcluded that males are more likely ulation was responsible for most of 1977 both availability and consumption of to drink for psychological and social the alcohol consumption: 75 percent alcoholic beverages have increased substantially among young Nigerians, reasons than females (p. 5). of the available alcohol was consumed by only 25 percent of the drinkers particularly secondary school students.3 To evaluate the extent and effect of (Natera Rey 1995). Comparison of Typical these changes, Odejide and colleagues Several studies have investigated (1987) conducted a study of the drinkDrinking Contexts and drinking patterns among Mexicans. ing practices among secondary school In a 1989 survey of the adult population Preferred Drinking students approximately 16 years old in of Mexico City, only 17 percent of adults Patterns Ibadan reported drinking an alcoholic beverage and Abeokuta, two major cities located in western Nigeria. Of the two at least once per week (Medina-Mora cities, Ibadan is more industrialized. 1998). However, 31 percent of responIndia dents reported being intoxicated at The study yielded the following results: Researchers often use generalized cate Alcohol consumption among the least once in the preceding year. These gories to characterize drinking patterns students was significantly higher in findings may indicate that the in different countries. Such categories Ibadan than in Abeokuta. European include abstinent cultures, such as pattern of frequent consumption of those Palm wine was the preferred drink low quantities of alcohol does not seem typically found in Muslim societies; to characterize the culture (Medina-in both cities. permissive drinking cultures that are Mora 1998, p. 273). The majority of characteristic of many Mediterranean In both cities, alcohol consumption regular drinkers are men, whereas occurred significantly more often countries; overly permissive cultures women who consume alcohol are (e.g., Japan and France); and ambivaamong students from middle- and generally infrequent drinkers. Overall, upper-class families than among lent cultures, such as those of many men drink more often and consume Scandinavian and English-speaking students from lower-class families. greater amounts of alcohol than do cultures. India does not conform to women. Among both Mexican men any of these categories (Mohan and 3 One and women, the prevalence of drinking potential reason for the increase in alcohol Sharma 1995). Instead, Indian attiavailability may be the increase in the number of increases with increasing income but tudes about drinking include both breweries in Nigeria in the 1970s. decreases with increasing age (Medinapermissive and abstinent features, Mora et al. 1988).
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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, contemporary Mexican society, in In This variability is not surprising beer production increased steadily both given the broad religious, ethnic, and throughout the 1980s (Mohan and urban and rural areas, alcohol consumpcaste differences found in India (Mohan Sharma 1995). tion is a facet of all aspects of social and Sharma 1995). For example, in One approach to assessing and and family life. Alcohol consumption his ethnographic study conducted in comparing attitudes about alcohol is evident at all stages of the life cycle, Rajasthan, Castairs (1979) compared consumption in various countries is from birth and baptism to weddings caste differences in the use and signifito determine peoples definitions ofand funerals. Saints days, community cance of the traditional beverage, daru. normal and harmful drinking ascelebrations, and other special According to that study, men from the as their perceptions of alcohols well occasions Rajput castehereditary fighters and are marked by drinking (Natera Rey landownersdrank daru, whereas 1995). Nevertheless, a double standard Brahminsmembers of the highestexists with respect to drinking (Medinaranking caste who are religious leaders Mora 1998). Thus, drinking by women The complex inappropriate, whereas and pervasive role is considered among men is tolerated, were opposed to daru consumption. drunkenness In fact, Castairs (1979) stated that at of alcohol consumption least to a certain degree. In fact, men [c]ertainly no Hindu who had tasted are expected to drink, and the ability in religious and or even touched daru would enter one to drink large quantities is considered of his temples (not even a goddess community rituals macho (Natera Rey 1995). temple) without first having a purifiThe complex and pervasive role of presents many catory bath and change of clothes (p. alcohol consumption in religious and 298). Thus, the Brahmins, who repre- obstacles to recovery community rituals presents many sented the spiritual aristocracy, and obstacles to recovery from alcohol from alcohol problems. the Rajputs, who represented the problems. For example, an warrior ethnographic and landowner aristocracy, each had study among people in the Chiapas their own privileges. For example, the province demonstrated that it was Brahmins had the right to hold intelexceedingly difficult for both men effects. In Bangalore, normal drinking women to recover from their own lectual positions in government or the and private sector. However, they were generally was described as the vegdrinking problems or from the effects consumpetarians and were forbidden to drink of a family members drinking problems tion alcohol. Conversely, the Rajputs priv- of small quantities of alcohol that (Eber 1995). The study also found did not ileges included the right to drink alcohol interfere with a persons respon-women used creative approaches that sibilities. Moreover, normal drinkingto avoid developing drinking problems, and eat meat, and many Rajputs prided themselves on a regular, moderate occurred only on special occasions and as participating in religious groups such not more than once or twice per week. cooperatives. drinkand Conversely, harmful drinking was ing pattern. Although alcohols role in Mexican Even under British rule and with defined as consuming arrack or hard society differs substantially from its role the introduction of English drinking liquor frequently and to such an extent in Indian society, the expectations of customs, Indians generally did not that alcohol consumption led to peralcohols effects are similar. People in sonal and/or work problems. incorporate alcohol consumption into Mexico City expected normal drinking their regular social activities. Further- People in the Bangalore region to enhance feelings of well being and more, drinking did not become a expected normal drinking to reducehappiness, provide relaxation (withritualized component of religion, as unpleasant feelings (e.g., pain, presit out, however, resulting in disinhibition), had in many other cultures (Mohan sure, anxiety, fatigue, and boredom); help achieve freedom without and improve their mood; and provide a anxiety. People who drank quite a and Sharma 1995). Beginning in kick that would lead to a sense oflot, however, were described as being 1947, when India became politically independent, a strong movement euphoria, increased activity, and a lack drunk, losing control, and becoming of inhibitions. Conversely, people who against alcoholic beverage distribution a boozer (Bennett et al. 1993). Nigeria had and consumption developed through- quite a lot to drink were Alcohol consumption is a central out the country. Indian states were described feature of adult (i.e., age 18 and older) as given the prerogative to set their own being mathu (i.e., drunk, with a life in Nigeria and plays a major role temperance laws, and two states negative connotation) or masthi (i.e., social, religious, political, and ecoin Bombay and Madrasintroduced drunk and experiencing negative connomic relationships. For example, sequences), as losing control of their abstinence laws by 1951. Other states later passed similar laws. Beginningbehavior, and as experiencing a loss of Vol. 22, No. 4, 1998 consciousness (Bennett et al. 1993). 249 around 1966, however, a shift in Indian alcohol policy occurred, leading to the

23 alcoholic beverages can be given as people in that age group (5.6 percentdeaths among 100,000 people). gifts of men and 0.5 percent of women)Furthermore, alcohol may be associated with most absences from work (Campillo to a brides relatives and as part of were considered alcohol dependent the et al. bride price. Alcoholic beverages are (Sundaram et al. 1984). Alcohol-related 1987). consumed at virtually all ceremonies, problems do not affect all populationIn 1982 the Mexican Ministry of Health assumed control of and including festivals, weddings, and subgroups equally, however, because in responsibility for the nations health funerals. Moreover, drinking typically same study, Hindus were more the policies. This move has affected indicates hospitality. Although different likely policies and programs addressing age groups and men and women are drink than were Jains and Muslims. to AOD-related problems throughout not explicitly separated during these Overall, a growing number of health, the country. Beginning in 1983, the occasions, elders and men are expected and economic problems attributsocial, to drink more than either younger peo- to rising alcohol consumptionNational Council Against Addictions able have initiated measures to prevent alcoholple or women (Oshodin 1995). been documented throughout India related problems in Mexico. As a People in Ibadan defined normal (Isaac 1998). Treatment facilities for drinking as having a few drinks occathese problems are organized by result of those initiatives, by 1988, 16 of the 31 Mexican states had sionally at social events or drinking governin moderation to relax. Conversely, harmmental or nongovernmental (both signed measures such as forbidding prithe sale of alcoholic beverages to ful alcohol use was described as vate and public) organizations. children younger than age 18 and to excessive Policies to control alcohol production people drinking that results in intoxication and consumption in India were initiated who were intoxicated. Since then, the councils work has continued and in physical and social impairment. the countrys independence in after and Nigerians generally considered it unde- For example, article 47 in the is currently under review, with an 1947. understanding that [m]ore emphasis sirable to drink too much (Oshodin Indian constitution states that [t]he needs to be placed on local problems, 1995). The anticipated effects of normal shall endeavor to bring about state along drinking in Ibadan included relief of prohibition of the consumption except with the development of specific subprograms (Medina-Mora 1998, stress and inhibition as well as feelingsmedicinal purposes of intoxicating for p. of sociability, euphoria, and boldness. drinks and drugs which are injurious 281). Other measures introduced in recent years include educational Although normal drinking was described to health (Isaac 1998, p. 148). Between programs, warning labels, an increase as reinvigorating, however, it was also mid-1960s and 1976, however, the the in considered a cause of hyperactivitynational governments commitment the price of pure cane alcohol, training in medical schools, and early and sickness. Once a person had con- total prohibition ceased. As a result, to identification and treatment programs sumed quite a lot to drink, however, production and sale of alcoholic the he or she was described as being uninbeverages were greatly simplified (Campillo et al. 1988). A particular emphasis has been placed on early hibited, sick, disoriented, irritable, during detection, especially among young voluble, clumsy, sleepy, or more alert 1980s and 1990s, and shops, bars, the and or as behaving irresponsibly4 (Bennett restaurants now can easily obtain middle-aged men, the two popuand lation et al. 1993). a license to sell alcoholic beverages. In subgroups at the greatest risk Comparison of Alcoholfact, national policies regarding for alcohol-related problems Related Problems and (Campillo et al. 1987). alcoholic Mexican women appear to be less beverages have swung from total proApproaches to Prevention likely to receive professional treatment hibition to unrestricted sale with no and Treatment for controls (Isaac 1998, p. 151). alcohol-related problems. Thus, accordMost Indian state governments also India ing to are ambivalent about prohibition (Isaac the National Survey on Although alcohol consumption is not 1998). Although many states haveAddictions, an integral part of Indian social life, estaba notable difference exists between the alcohol-related problems can occur.lished temperance boards for educating men to women attending Alcoratio of Mexico For example, in one study conducted holics Indian people about the potentially Alcohol-related problems are reportedly Anonymous (AA) programs (i.e., in Rajasthan, 24.7 percent of all people 10:1) harmcommon among Mexican men (Medina- and the ratio of men to women in age 15 and older (36.1 percent of meneffects of drinking, these boards pri- treatment programs (i.e., 16.7:1) formal ful Mora 1998) and may have a substanand 13.4 percent of women) consumed (Medina-Mora 1994). This difference marily sponsor newspaper tial adverse effect on the overall health alcohol. Furthermore, 3 percent of advertisements. indicates that women are substantially and well being of the Mexican populess lation (Campillo et al. 1988). During 4 As indicated by these descriptions, contradictory the 1970s and 1980s, Mexico had likely to enter formal treatment than to one viewpoints exist among Nigerians about the effects of the highest mortality rates fromchoose an informal treatment approach, liver of having quite a lot to drink (e.g., expecting it such as AA. Furthermore, special intercirrhosis in Latin America (i.e., 20 to to make people either sleepy or more alert). ventions targeted at women are not available in either formal treatment 250 Alcohol Health & Research World programs or AA, even though women are expected to control their own drink-

Alcohol Consumption in India, Mexico, and Nigeria

ing as well as that of the men in their CAR study, those indicators were the 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 although some differences existed. for intoxicated behavior and thought At Nigeria all three sites, becoming aggressive anddrinkers had relatively little control that Alcoholic beverages are the most widely being uncoordinated were considered their own behavior. Furthermore, over 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 attenproduce any positive effects. has recognized the need to establish tion, the following indicators were People in Mexico City had no clearpolicies to control both alcohol proconsidered critical: cut opinion as to whether the alcoholic duction and consumption. In 1920 beverage or the drinker was responsible measures were established to controlIn Bangalore: head injuries or for intoxicated behavior. In addition, the importation, sale, and local fer- unconsciousness Mexicans thought that both the mentation and distillation of alcohol, drinkers including the requirement for a special Mexico City: loss of conscious In self-control and social pressures influpermit (Oshodin 1995). Because drinkness, violence, site, physical injuries Thus, at each and medical attention enced a persons drinking behavior. ing is an integral part of daily and was not considered necessary unless a People who were alcoholics, however, ceremonial life of those Nigerians who Ibadan: sustained injuries, persis In serious disturbance of the central were no longer considered able to are not Muslims, however, government vomiting, and unconsciousness. tent nervous control efforts to establish prevention and system (i.e., loss of consciousness) their drinking. Mexican respondents, and treatment programs have had little alcohol-related bodily injuries occurred those in Bangalore, saw no positive like effect. Compared with many other (Room et al. 1996). effects resulting from heavy drinking. countries, the Nigerian government is In contrast to the similarities among Finally, respondents in Ibadan did not very strict in implementing policies the three sites in the indicators of intoxnot consider drinkers to be responsible regulating alcohol production, distriication or need for medical attention, changes in their behavior when they for bution, and consumption. For example, the thresholds for a diagnosis of alcohol intoxicated. Moreover, various facwere although existing laws regulate when dependence or addiction as definedtors, such as social situations, economic by and where alcohol can be sold, they heavy drinkers, their family members, factors, and other people, were are not strictly enforced. In addition, and health care professionals differed perceived no age restrictions on the purchase or widely. For example, in Bangalore, to have a major influence on a persons consumption of alcoholic beverages where drinking. As in Bangalore and Mexico exist (Oshodin 1995). drinking occurs among a minority of City, heavy drinking was not expected The position of Nigerian women Conclusions men and is rare among women, responto have any positive effects. in regard to alcohol-related problems dents indicated extremely low is particularly difficult (e.g., Ikuesan The studies summarized in this article thresholds 1994). In most rural areas, women are demonstrate that drinking practices for a dependence diagnosis. Thus, one strongly involved in the production of and person stated that drinking the equiv- the definition of what constitutes alcoholic beverages, which may normal drinking vary sharply among alent of three bottles of beer 13 days promote a month, and never drinking more; different countries. Even within a drinking. Also, it generally is considered objections from friends, doctor, or country, substantial differences in these acceptable for women to drink (except definitions and practices may exist clergy; among Muslim Nigerians). Drinking trouble driving because of drinking;among members of different ethnic or problems among women, however, the same amount of alcohol having cultural groups. For example, although less cause great disruption to their families India effect than before; and having had such generally is considered a dry and result in stigmatization by the a strong desire to . . . drink that he country, drinking practices differ concommunity (Ikuesan 1994). siderably between people living in the could southern or northern areas, and even not resist it were indicative of depenComparison of Drinking dence (Room et al. 1996, p. 217). among members of different castes residing in the same region. As a result Indicators Substantially higher levels of alcohol of the cultural and ethnic variations consumption were considered To gain a better understanding of what in drinking practices, no single defininecessary is considered normal drinking or alcotion for a diagnosis of alcohol dependence inof problem drinking or alcohol hol dependence in various cultures, dependence exists that is uniformly both Mexico City and Ibadan. researchers can assess and compare applicable in all countries or cultures. Another measure of peoples characteristics that are considered signs Similarly, researchers, clinicians, and attitudes of intoxication or an indication that a public health officials attempting to regarding alcohol is their perception of drinker requires medical attention. In develop effective prevention and who or what is responsible for a
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persons drinking (e.g., the drinker; the alcoholic beverage; or external factors, such as

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IKUESAN, B.A. Drinking problems and the position treatment approaches must consider practices regarding alcoholic bevand of women in Nigeria. Addiction 89:941944, 1994. the populations attitudes and expecerage consumption. Furthermore, the tations regarding alcohol consumption country is experiencing changes inISAAC, M. India. In: Grant, M., ed. Alcohol and the Emerging Markets: Patterns, Problems, and (e.g., what constitutes heavy drinking) traditional family structure, a Responses. and its effects (e.g., whether the drinker weakening Philadelphia: Brunner/Mazel, 1998. pp. 145175. or the alcoholic beverage is responsi- informal cultural and religious MARSHALL, M., ED. Through a Glass Darkly: of Beer and Modernization in Papua New Guinea. ble for intoxicated behavior). controls Boroko, Papua New Guinea: Institute of Applied Cultures or countries such as the on alcoholic beverage consumption, Social and Economic Research, 1982. ones and increasing contact with drinking MEDINA-MORA, E. Drinking and the oppression described in this article can undergo practices outside Indian society. As of women: The Mexican experience. Addiction a 89:958960, 1994. broad social and related changes, which Indian policymakers must pay result, typically are accompanied by alterations attention to these cultural variations MEDINA-MORA, M.E. Mexico. In: Grant, M., ed. Alcohol in drinking patterns. An example of in establishing appropriate prevention and Emerging Markets: Patterns, Problems, a and Responses. Philadelphia: Brunner/Mazel, notable change in drinking patternsand treatment programs for the diverse is 1998. pp. 263284. the experience of Mexican men who segments of Indian society. v MEDINA-MORA, M.E.; RASCON, M.L.; OTERO, References migrate to the United States. According B.R.; AND GUTIERREZ, E. Patrones de consumo. to Medina-Mora and colleagues (1988, BENNETT, L.A.; JANCA, A.; GRANT, B.F.; AND In: Gilbert, M.J., ed. Alcohol Consumption among p. 30), these migrants modify theirSARTORIUS, N. Boundaries between normal and Mexicans and Mexican Americans: A Binational Perspective. Los Angeles: Spanish Speaking Mental consumption patterns by adopting pathological drinking: A cross-cultural comparison. the more frequent drinking patterns Alcohol Health & Research World 17(3): Health Research Center, University of California, 190195, 1993. Los Angeles, 1988. pp. 2752. preferred by Americans, maintaining, CAMPILLO, C.; MARTINEZ, R.D.; AND ROMERO, MOHAN, D., AND SHARMA, H.K. India. In: Heath, however, the high quantities per occaM. Early detection and management of alcoholD.B., ed. International Handbook on Alcohol and sion common in Mexico. related problems in Mexico. Australian Drug and Culture. Westport, CT: Greenwood Press, 1995. Alcohol Review 6:309313, 1987. Changes in drinking practices often pp. 128141. also influence the particular nature CAMPILLO, C.; DIAZ, R.M.; AND ROMERO, M. La of NATERA REY, G. Mexico. In: Heath, D.B., ed. alcohol-related problems and approprevencion en el abuso de alcohol en Mexico. In: International Handbook on Alcohol and Culture. Gilbert, M.J., ed. Alcohol Consumption among Westport, CT: Greenwood Press, 1995. pp. priate approaches to prevention and Mexicans and Mexican Americans: A Binational 179189. treatment in a culture. For example, Perspective. Los Angeles: Spanish Speaking Mental examination of the differences in drink- Research Center, University of California, Health National Institute on Alcohol Abuse and Alcoholism. Ninth Special Report to the U.S. Congress on ing practices in the three countries Los Angeles, 1988. pp. 233252. Alcohol and Health. NIH Pub. No. 974017. discussed in this article suggests that a CASTAIRS, G.M. Daru and bhang: Cultural fac-Bethesda, MD: the Institute, 1997. tors focus on womens drinking more likely in the choice of intoxicant. In: Marshall, M., NETTING, would be pertinent in Mexico and ed. Beliefs, Behaviors, and Alcoholic Beverages. Ann 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, Nigeria than in India, where womenpp. 297312. Behaviors, and Alcoholic Beverages. Ann Arbor: University of Michigan Press, 1979. generally do not drink. Such a focus, DORSCHNER, J. Rajput alcohol use in India. Journal in turn, could lead to the development of Studies on Alcohol 44(3):538544, 1983. ODEJIDE, O.A.; OHAERI, J.U.; ADELEKAN, M.L.; AND of prevention and treatment programs IKUESAN, B.A. Drinking behaviour and social change EBER, C. Women and Alcohol in a Highland Maya among youths in NigeriaA study of two cities. tailored to the needs of women. Town: Water of Hope, Water of Sorrow. Austin,Drug and Alcohol Dependence 20:227233, 1987. Although this article has focused TX: University of Texas Press, 1995. OSHODIN, O.G. Nigeria. In: Heath, D.B., ed. primarily on cross-cultural variations EDWARDS, G.; ANDERSON, P.; BABOR, T.F.; ET among the three countries discussed,Alcohol Policy and the Public Good. Oxford, International Handbook on Alcohol and Culture. AL. Westport, CT: Greenwood Press, 1995. pp. UK: Oxford University Press, 1994. it is important to recognize the cultural 213223. variation within each of these nations. ENEKWECHI, E.E. Gender differences in motivaR.; JANCA, A.; tion For example, although Indias prohibi- for alcohol use among Nigerian university ROOM,SARTORIUS, N.BENNETT, L.A.; SCHMIDT, L.; AND WHO cross-cultural students. Journal of Alcohol and Drug Education tion policies of the past have failed applicability research on diagnosis and assessment 41(2):110, 1996. of substance use and disorders: An overview of misGRANT, M., ED. Alcohol and Emerging Markets: methods and selected results. Addiction 91(2): erably (Isaac 1998, p. 170), that 199220, 1996. Patterns, Problems, and Responses. Philadelphia: country Brunner/Mazel, 1998. SUNDARAM, K.R.; MOHAN, D.; ADVANI, G.B.; is in the midst of developing a master HEATH, D.B., ED. International Handbook on SHARMA, H.K.; AND BAJAJ, J.S. Alcohol abuse in a plan for reducing the demand for and rural community in India. Part I: Epidemiological Alcohol and Culture. Westport, CT: Greenwood supply of all psychoactive substances, 1995. Study. Drug and Alcohol Dependence 14:2736, Press, 1984. including alcoholic beverages. However, India is characterized by tremendous cultural variability with respect to beliefs

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