The intractable economic downturn in the country led to the presentation of alcoholic beverages in pocket-friendly sachets and polyethylene terephthalate (PET) bottles by distilleries. But while the distillers are smiling to the banks over the successful business model, the country’s productivity and frail healthcare system are heavily impacted. Several aspects of private and national lives are seriously affected by alcoholism. ENO-ABASI SUNDAY writes that phasing out alcohol in sachets and putting in place a national alcohol policy among others could be game-changing.

For minutes, Adeniyi Okanlawon, 26, appeared to be in a trance, as he stared pensively into space. Gutted from within, streams of tears, which reflected the inner turmoil that he was experiencing, freely cascaded down his sunburnt cheeks.

Within the premises – a derelict structure in the Akala area of Mushin Local Council – hordes of other young men within the age bracket of 25 to 40, huddled in tiny groups, spotting all shades of rumpled black attires.

Dishevelled and with a face that is akin to a shrub’s field, Okanlawon kept muttering things that only he could discern. After being on this for a while, he finally let out a loud shrill and concluded with the words, “Ah! Ipaye, ore mi ti ku.”

The 26-year-old had just returned from Atan Cemetery, where the remains of a contemporary, Ipaye Omolaye, 24, were committed to Mother Earth after he suddenly died of multiple organ failure arising from Alcohol Use Disorder (AUD) better known as alcohol addiction, or Alcohol Dependence Syndrome (ADS).

Until his sudden demise, Omolaye was a motor boy better known in Lagos as a “conductor.” He dropped out in Junior Secondary School Two (JSS2). With a petty trader mother and siblings that were in dire need of the necessities of life, he took to the roads to fend for his kith and kin as the heir apparent. His father passed on when he became a teenager.

Like many of his peers in the neighbourhood where he grew up, Omolaye abused substances and was rarely without sachets of all sorts of liquor in his breast pocket or the ones in his pants. After several attempts to wean him off alcohol, his loved ones simply surrendered. They left him to run his race.

Interestingly, despite knowing that Omolaye died as a result of alcohol addiction, his peers/contemporaries and most others consoled themselves by sipping dozens of both licensed and unlicensed alcoholic beverages.

Shakiru Akinyele, a commercial tricycle driver, and Alaba, a carpenter, were neighbourhood chums in the Sadiku/Dada area of Papa Ajao, Mushin Local Council of Lagos State. But both died months apart as a result of complications arising from alcoholism. They left behind five children and two wives.

On Friday, October 13, 2023, 43-year-old Olawaseyi Oduwaiye, was buried according to Islamic rites having suffered from organ failure occasioned by alcoholism.

For years, Oduwaiye’s family members and employer fought a lengthy battle to divorce him from an addiction that eventually claimed his life. He died without a wife or a child but left behind an aged mother and siblings.

Using Mushin Local Council as a microcosm of the country, it is obvious that millions of young Nigerians could be dealt life-changing consequences if they are not weaned off alcohol abuse, which is attaining epidemic proportions.

Youths are not alone in this risky voyage, whose consequences on family, community, state, and country are dire. People of all age brackets are neck deep in the malady.

Iremide Akinyemi is a commercial transporter, who operates along the Lagos-Ibadan route. He never sets out on a trip without “clearing his eyes” with a few sachets of his beloved alcoholic beverage.

While drivers like Akinyemi peddle the erroneous assumption that the consumption of alcoholic beverages among other things energises drivers, professionals think otherwise. Among other things, they say it induces microsleep.

Microsleep is when you fall asleep for a period of several seconds. This occurs so quickly that people who have an episode might not even realise that they have fallen asleep. It occurs at any time of day, not just at night.

“Since the big bottle of hot drink now costs thousands of naira that many of us cannot afford, we now buy the ones in a sachet, which is even more convenient to carry about,” Akinyemi rationalised.

At a building site in the Eight Miles area of Calabar, Cross River State, Effanga Usua, the foreman told The Guardian that he feared for the safety of some of the artisans that he has worked with considering the volume of alcoholic beverages that they consume daily.

“They will tell you that it boosts their energy level, but I know enough to conclude that they are killing themselves slowly. Some of them are so young, but what they drink has a telling effect on them. Sadly, some of them have become addicted to it, and this is what may complicate their health condition, or eventually lead to their death,” Usua submitted.

When youths gather in most rural and urban locations for non-religious activities in most parts of the country, seldom are some of them without sachets of alcoholic beverages loaded in their pockets or pigeon holes in their vehicles.

Where they are without such, dealers in sachet alcoholic beverages, who are spread across most parts of the country are always on hand to make the supply chain seamless.

The vicinities and precincts of sensitive institutions including schools, hospitals, and government offices, as well as motor parks and garages where millions of youths make a living, are dotted with outlets selling and distributing all forms of alcoholic beverages.

Even though not all who consume more than the recommended amount of alcohol daily have alcohol use disorder (since alcohol impacts each individual differently), experts describe moderate alcohol intake as one drink a day for women, and two for men. In this context, a “drink” constitutes 12 ounces of beer, five ounces of wine, or 1.5 ounces of liquor.

In the Nigerian milieu, Asoko Insight market data maintain that beer is the most preferred alcoholic beverage consumed. This is reflected in the 55 per cent market share, which it controls. Right behind it is spirits, which holds a 30 per cent consumption rating, and wine settled for 15 per cent.

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Despite coming second with a healthy 30 per cent consumption rating, spirits are not lying low as reflected in the activities of beverage giants that are developing new business models to attract attention to the segment, and also making the products accessible to the young and the poor.

Conversely, worldwide, 45 per cent of the total recorded consumed alcohol is spirits, with beer coming second in terms of pure alcohol consumed (34 per cent) followed by wine (12 per cent).

Burgeoning clan of alcoholics

Loosely defined, alcoholism is the drinking of alcohol to the point that causes problems, and continuing to drink even after problems arise.

The absence of a National Alcohol Policy, lack of standard drink measurements, or low-risk drinking guidelines (LRDG) in the country, stakeholders insist has impacted the country negatively despite the proliferation of industry-sponsored Responsible Drinking Message (RDM).

Further manifestation of the negative consequences of the above, can also be gleaned from the 2023 World Health Statistics key messages on alcohol, which paints a concerning picture for the country as far as alcohol abuse is concerned.

Some of the dire health challenges brought about by alcohol abuse include liver cirrhosis, high blood pressure, mental health problems, violence and injuries, and poor productivity among others.

Matters are made worse by the fact that research by experts indicates that more than half (53 per cent) of Nigerians aged 15 years and above are alcohol consumers; 47 per cent are abstainers, a category that includes people who have never had any alcoholic drink and those who used to drink but stopped for religious, health or cultural reasons.

More females (62 per cent) than males (33 per cent) fall under the category of abstainers. This distribution is similar to what is obtained in most low-income countries, but different from the situation in Western countries where higher proportions of adults are alcohol drinkers.

“What is striking about the Nigerian situation and a source of concern in public health circles is the way the people drink, or the pattern of drinking in the country, i.e., the typical quantity and frequency of alcohol consumed by a drinker. The total alcohol per capita consumption in the general population globally is about 6.4 litres of pure alcohol (ethanol) and about 6.2 litres in the African region. In Nigeria it is more than double that number (13.4 litres). The calculated total alcohol per capita for drinkers only is 15 litres globally, and 18.4 litres for Africa. In Nigeria the figure is 25.5 litres,” said the Executive Director Centre for Research and Information on Substance Abuse (CRISA), Prof. Isidore Obot.

He continued: “More distressing is the extent of heavy episodic or ‘binge’ drinking, a pattern of consumption that involves taking 60 grams or more of pure alcohol (up to six drinks) on at least one occasion in the past month. A drink is that quantity of beverage (a glass of beer or wine, a shot of liquor) that contains about 10 grams of ethanol).

“Fifty-five (55) per cent of drinkers in Nigeria, especially male and young drinkers, engage in binge drinking. This pattern of drinking to intoxication is harmful consumption; it is strongly associated with intentional/unintentional injuries and interpersonal violence.”

Many young people are daily taking to alcohol either as a result of peer pressure, ignorance, curiosity, or a combination of all. This unpleasant development has been confirmed by research that shows a high level of alcohol penetration in secondary schools and university students.

One such research, was spearheaded by D. Samson Femi Agberotimi and surveyed how prevalent alcohol use was among students and how this differed by gender, age, and geographical location, etc.

Part of the summary of the research said: “We conducted our survey in six Nigerian federal universities, spread across the six regions. We collected data from a sample of 1,173 students using a structured questionnaire. We found that about one-third (31.4 per cent) of the respondents had used alcohol in the past 30 days. About 16.8 per cent of the students in our survey consumed alcohol at a non-risk level, while about 14.6 per cent were drinking in ways that put their health and well-being at risk, for example being drunk on many occasions, or engaging in risky behaviours under the influence of alcohol. Our findings raised a concern about the high rate of alcohol use among Nigerian university students.”

‘We must rid society of alcohol in sachets’

Alcohor use across the world leads to the death of 320 every hour, with younger persons being the worst hit. The attendant pathetic health and social challenges notwithstanding, alcohol remains the most used and abused psychoactive substance among young adults.

Thus far, the presentation of alcoholic beverages in sachets and Polyethylene terephthalate, also called PET bottles has been a commercial success for distilleries and sundry manufacturers. On the flip side, its debilitating impact on the society, ranging from the young to the old, as well as the poor has been a source of worry.

To stem the tide, the National Agency for Food and Drug Administration and Control (NAFDAC) stopped the registration of alcohol in sachets and small-volume PET and glass bottles above 30 per cent alcohol by volume (ABV).

The move by the agency is part of measures to curb the abuse of alcohol across the country, even as the ban was approved following the recommendation of a high-powered Committee of the Federal Ministry of Health and NAFDAC on one hand, Federal Competition and Consumer Protection Commission (FCCPC) and Industry represented by the Association of Food, Beverages and Tobacco Employers (AFBTE), Distillers and Blenders Association of Nigeria (DIBAN) in December 2018.

Ahead of the ban, NAFDAC said producers of alcohol in sachets and small volumes had agreed to reduce production by 50 per cent with effect from January 31, 2020, while ensuring that the products are completely phased out in the country by January 31, 2024. With barely 80 days to the expiration of this deadline, manufacturers are still emptying tonnes of sachet alcoholic drinks into the market.

Considering how deep the alcohol challenge has percolated the society, Obot, who is a member of the World Health Organisation (WHO) Advisory Committee on Alcohol, Drugs, and Addictive Behaviours, Geneva, agrees with NAFDAC that sachet-packed alcoholic beverages should be outlawed.

“The sale of alcohol in sachets is a clear affront to the public health concerns about drinking and health. They are available to young people and accessible to all, cheap, and heavily marketed in rural and urban areas across the country. They obviously should be banned as part of a broad policy on alcohol.”

He added that even though it will take an economist to address how much alcoholism is costing the country, “what seems clear is that the economic loss due to alcohol is much higher than the loss due to illicit drugs. The loss is due to early death from a host of medical conditions, accidents, violence, money wasted, etc.”

A mental health expert and senior lecturer at the University of Calabar, Dr Achi Bekomson, while acknowledging efforts so far put in place by the government to stem alcoholism, added that “there are still challenges in effectively enforcing these measures, especially in remote or underserved areas. The widespread availability of cheap alcohol in sachets and the lax enforcement of existing regulations contribute to alcoholism.

“Additionally, the issue of alcohol consumption among security personnel, political office holders, lawmakers, and celebrities sets a concerning example for young people. This behaviour can normalise excessive drinking and perpetuate a culture where alcohol is associated with power or prestige.

“More targeted and comprehensive education and prevention programmes are needed to effectively reach young people and raise awareness about the consequences of alcohol dependency. These programmes should not only focus on health effects but also highlight the social and economic consequences of alcohol abuse.

“Furthermore, there should be stricter enforcement of existing regulations, along with efforts to tackle the production and distribution of alcohol in sachets. It is important for the government to work in collaboration with communities, healthcare professionals, and NGOs to develop and implement effective strategies to combat alcohol abuse among young people in Nigeria,” the university teacher stated.

The researcher admitted that there are “valid concerns about the slow progress in ending the sale of alcohol in sachets in Nigeria. Administrative bottlenecks and corruption can indeed be significant barriers to the enforcement of laws and regulations, including those related to alcohol sales. This is a widespread issue in Nigeria and can manifest in various ways…”

Alcoholism as hurdle for national development, mental wellness

Only recently, psychiatrists at the Federal Neuro-Psychiatric Hospital, Kware, Sokoto State, lamented that between 2021 and last month (October), the number of psychiatrists in the country has reduced to 200 from around 300.

Such exodus has serious implications for the mental well-being of the country.

This perhaps explains why Prof. Obot, who is the Vice-President, the Global Alcohol Policy Alliance (GAPA), said the government must urgently provide the needed support that will aid care provision to people who use drugs in civil society.

Said Obot: “Substance abuse is obviously a present and growing problem in Nigeria. If there was any doubt about this, the national survey of 2017 dispelled such doubt. Out of about 14 million past-year drug users, one in five is suffering from drug use disorders, which include abuse and dependence. Law enforcement has been strengthened, but not the health response.

Part of the problem is the prevailing view that drugs are a criminal justice system and not a public health issue. The situation is however shifting slowly but there is a clear and urgent need for the government to provide support that will aid providers of care to people who use drugs in the civil society community and the private sector.

“When we talk about drug abuse in Nigeria, we often forget that alcohol is a drug, and that alcohol abuse constitutes a greater menace to the health and welfare of individuals and the society at large than illicit substances. About 50 per cent of Nigerians are consumers of alcohol, but not all drinkers are problematic drinkers. Dependent drinkers, people who need treatment for their alcohol addiction are probably 10 per cent of the population of drinkers.”

Lending his voice to the thinning number of psychiatrists, Obot said that the dwindling number of experts highlights the challenge. It is not just psychiatrists in tertiary care, but other healthcare workers in primary care centres who play important roles in prevention and early intervention. These are psychologists, nurses, counselors, etc. We are experiencing similar shortages of these experts. The personnel challenge in the health care sector in Nigeria is a national emergency affecting everybody.

Also of the view that alcoholism has consequences on national development and also weighs heavily on the country’s fragile healthcare is Dr Bekomson.

“Alcohol abuse surely has consequences on national development because it puts a strain on the healthcare system, as it leads to a range of health issues, including liver disease, cardiovascular problems, mental health disorders, and injuries from accidents or violence. These conditions burden the healthcare system, potentially diverting resources from other areas of healthcare.

“Furthermore, alcohol abuse can have broader societal impacts, including decreased productivity, increased crime rates, and disrupted family dynamics. These factors can contribute to economic and social challenges that may hinder the overall development of a country.

Nigeria urgently needs a national alcohol policy

The continuous absence of a national alcohol policy, Prof Obot said will only worsen the country’s alcohol challenge. He, therefore stressed the urgent need for one.

Said he: Nigeria does not have a national alcohol policy, a coordinated system of control of the availability and consumption of beverages containing ethanol. It is clear from the experiences of other countries that alcohol problems can be minimised with appropriate policy options like control of availability and access, prices, and marketing. Nigeria urgently needs a national policy on alcohol to put in place the strategies that are evidence-based and promoted by the World Health Organisation.

But for Bekomson, a psychologist and counsellor: “In the immediate, alcoholics need understanding, support, and access to appropriate treatment and resources.

Relatives and society should show empathy and understanding towards individuals struggling with alcoholism; recognise that it is a complex issue, and avoid stigmatising or shaming them.

“They should be encouraged to seek professional help, such as therapy, counseling, or rehabilitation programmes…However, relatives and the general society should encourage activities that promote physical and mental well-being, such as exercise, hobbies, and social interactions, and avoid behaviours that enable addiction, such as providing money for alcohol or covering up the consequences of their actions.

“Most importantly, there should be increased awareness about alcoholism and its effects and education about available resources and treatment options.

For Elisha Onuegbu, an investment banker, if alcoholism becomes endemic, it can negatively impact foreign investment in the country, as companies may be hesitant to invest in a country with high levels of alcohol-related problems, as it may lead to a less productive and reliable workforce.

“Alcoholism puts a burden on the social welfare system as affected individuals may depend on government assistance programs for support due to unemployment or health-related issues. These costs divert resources from other essential social services, such as education and infrastructure development.

“Excessive alcohol consumption can tarnish Nigeria’s image as a tourist destination. High levels of alcohol-related problems, including violence and disorderliness, can deter tourists from visiting the country, impacting the revenue generated from the tourism sector.

So, to mitigate these impacts, “the government could implement a range of measures such as increasing alcohol control policies, providing support and treatment options for individuals struggling with alcohol addiction, and promoting public awareness campaigns regarding the dangers of alcohol abuse.” (The Guardian)

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