New Delhi: Rajesh Singh, 43, woke up at 2 am. Sweating profusely, he had an elevated pulse rate and “a killing headache”. He was having severe alcohol withdrawal symptoms.
As all liquor stores were closed until this week, he had run out his stock in the first week of April, ten days into the lockdown. Last Tuesday, his wife had to call a local de-addiction centre for tele-counselling.
This past Monday, Singh woke up at 7am and reached the liquor store in Noida Sector 18 half an hour before the shop was set to open. “I now have enough to survive another month of lockdown,” he said.
Millions like him have been flocking to their nearby liquor stores with little regard for social distancing since Monday as the Centre allowed standalone shops to open to help states collect revenue from the sales.
For many, it is not so much a mere tool for amusement but a way to get over withdrawal that may result in restlessness, higher blood pressure, insomnia, headache, nausea, vomiting, palpitation, tremors and decreased appetite.
Last year, a report by National Drug Dependence Treatment Centre under All India Institute of Medical Sciences (AIIMS) had revealed that 5.7 crore people in the country are estimated to be dependent on alcohol.
The study further concluded that 16 crore people in India between the age of 10 and 75 consume liquor. Simply put, every third consumer in India needs help for alcohol-related problems.
The concern was further amplified during the lockdown. Calls to tele-counselling and de-addiction helpline numbers witnessed a 200 per cent spike ever since liquor stores were shut.
Calls on toll-free number 1800110031 shot up to an average 266 calls per day from March-end to April 5. Officials in the Ministry of Social Justice and Empowerment informed that average number of calls earlier used to be approximately 90.
Data further revealed that the helpline received 236 calls per day between April 5 and 12. For the next ten days, calls averaged at 159 per day. Most number of calls were received from Uttar Pradesh.
According to data compiled by a group of researchers, comprising public interest technologist Thejesh GN, activist Kanika Sharma and assistant professor of legal practice at Jindal Global School of Law, as many as 338 people died because of state or nationwide lockdowns from March 19 to May 2.
Out of this, 45 deaths are associated with withdrawal symptoms and seven died after consuming hand sanitzers and aftershave liquids in attempts to satiate their alcohol craving.
"Among psychologists, we have been discussing that people would be facing serious difficulties without alcohol. I have been receiving calls almost on a daily basis with regard to withdrawal. I have been advising them to visit hospitals," said Dr Prem Lata, a psychotherapist based out of New Delhi.
Last week, Ministry of Social Justice and Empowerment issued an advisory to immediately admit and give treatment to people with “severe” alcohol withdrawal symptoms during lockdown.
It is a significant challenge for some people with alcohol dependence who are at risk of experiencing “severe alcohol withdrawal” and its consequences, it said.
In the ‘severe’ category, the affected people might get seizures (convulsions), delirium tremens that leads to confusion, disturbed level of consciousness, impaired awareness of surroundings, hallucinations and abnormal behaviour, and wernicke-korsakoff syndrome - a variety of neurological and cognitive symptoms, especially common in malnourished patients. Such severe patients require emergency medical care and hospitalisation, the advisory stated.
Studies reveal that the mortality rate for people with severe withdrawals is over 15 per cent. A 2018 report by WHO noted that about 2.6 lakh deaths in India each year can be directly or indirectly traced to excessive alcohol consumption.
Quarantine-induced lifestyle changes
Karishma Sen, 24, has never been a heavy drinker. A fitness enthusiast, she usually hits the gym five days a week, and she knows alcohol can negatively affect her stamina and immune system. "I quit drinking after college and witnessed major improvements to my mental and physical health. Then the lockdown happened,” she said.
Karishma found herself waiting in a kilometre-long queue for booze on Monday morning in Bangalore.
“The lockdown has completely ruined my entire routine. I used to go out every day. It used to keep me calm,” she said. The quarantine handicapped social lives of many. Being at home for more than a month, Karishma finished her stock of alcohol within 15 days and since then was looking for ways to find more. She even looked for online options but found none.
Google searches for “alcohol delivery India” and “alcohol delivery” had increased many fold in the last month.
For a lot of people alcohol also serves as a differentiator. "Earlier, there were two parts to my day. One, when I was at work. Second, when I came back home and could relax. Now there is nothing of that sort. I am always at home. I just need to put my laptop down to stop work. There is no change. So now every evening I pour myself some wine to relax and make myself feel that work is over,” said Ranjan Sinha, 44, a corporate lawyer in Mumbai.
The extent to which people can go to buy booze may be ascertained from a video that surfaced on Tuesday from the national capital as customers lined up for a kilometre outside a shop.
"We have been waiting since 6 am. There are some who are here since 4 am. We are ready to wait in the queues and have no problem in paying the extra cess. The money will go to help coronavirus patients in the country. This is our contribution," said a man waiting outside the liquor store.
Clinical psychologist Amar Verma said, "This is a time that poses a lot of strain and challenges for many people. Sources of entertainment and distraction have stopped. A lot of people prefer turning to addictive substances that they think help them cope."
However, the World Health Organisation urges people to abstain from drinking alcohol while on lockdown, describing it as an “unhelpful coping strategy”.
Are you drinking more than you should?
Prioritising drinking sessions over more immediate and important work is probably the first sign that one is headed straight in the direction of addiction.
Signs of alcoholism can be behavioural or physical. Drinking alone, hiding or lying about drinking, blacking out, sleep disorders and tremors are only a sample of the many signs of an alcohol use disorder.
Because alcoholism rewires the brain and affects a person’s mood, thinking and behaviour, it’s classified as a mental illness. Thus, many of the hallmark signs of alcoholism involve changes in behaviour, including regularly drinking more than planned or for longer than intended, allowing drinking to interfere with work or family obligations, drinking at odd times of the day, feeling the need of a drink to get through the day, worrying about having enough alcohol for an evening or weekend and feeling annoyed at being criticized for drinking among others.
When alcoholism is severe, an individual may develop a physical dependence.
Symptoms of dependence include becoming tolerant to some of alcohol’s effects and experiencing withdrawal symptoms when alcohol is not consumed. A person who is physically dependent on alcohol may also experience cravings — an intense need or desire to drink.
Needing a drink first thing in the morning to shake off nausea is also a sign of dependence.
Heavy Cess and State Coffers
Liquor shops across the country have been doing roaring business since Monday.
Liquor sales on Tuesday saw an all-time record high for a single day in Karnataka. According to excise officials, liquor worth Rs 197 crore was sold across the state, compared to Rs 45 crore the previous day. The previous all-time record was Rs 170 crore on December 28, 2019.
The Karnataka government has now imposed extra 11 per cent excise duty on on alcoholic beverages across all categories after similar steps by Delhi and Andhra Pradesh.
With these measures, the Karnataka government is looking to offset Rs 2,600 crore losses from excise revenue it suffered during the lockdown.
In West Bengal, a whopping Rs 40-crore liquor sale was recorded on the first day of reopening of the standalone shops on Monday, according to estimates provided by a trade association. In Uttar Pradesh sales spiked by close to 50 per cent to sales worth around Rs 100 crore.
In Delhi, despite the ''special corona fee'' of 70 per cent levied on sale of alcohol, long queues were seen across all districts.
A video from Nainital showed torrential rain and an unexpected shower of hail could not dampen the spirits of liquor buyers. Hundreds of them stood in queues with umbrellas, braving the downpour. Liquor stores in Nainital had opened on Tuesday.
what a patience by nainital people for liquor after open liquor shop pic.twitter.com/xpCfQSMHHM— Bhupendra Singh (@Bhupend94977693) May 5, 2020
Liquor stores in Haryana reopened on Wednesday after the state government imposed a 'Covid cess' on alcohol. A day earlier, deputy chief minister Dushyant Chautala had informed that the cess will be Rs 5 per quarter in case of country liquor, Rs 20 per quarter in case of Indian-made foreign liquor, Rs 5 in case of strong beer and Rs 2 in case of other beer.
The Andhra Pradesh government on Tuesday announced another hike in liquor prices by 50 per cent, just a day after imposing a 25 per cent increase as shops were reopened in view of relaxation given amid the Covid-19 lockdown. The government said that the decision has been taken as a step towards "discouraging alcohol consumption".