Alcohol and the Youth in Ethiopia

September 4, 2013

September is a National Alcohol and Drug Addiction Recovery Month in the US. In recognition of the significance of this event in a number of other countries, this year’s Recovery Month is anticipated to go international. The overall goal is to promote the benefits of prevention, treatment, and recovery for mental and substance abuse disorders, celebrate people in recovery, recognize the contributions of service providers, and uphold the idea that recovery is achievable. This year’s theme is “Join the Voices of Recovery: Together on Pathways to Wellness.” From the stated goals of the event, had it not been for the lack of appreciation and preparation, there are ample reasons for celebrating Recovery Month in Ethiopia as well. Among many other possible justifications, a more appropriated case in point can be the increasing trend of alcohol abuse by school-age youth of the country. There are some preliminary studies to back-up this contention.

In a study conducted in 1998 by a group of Ethiopian researchers, it was shown that out of a total of about 400 high school students, 33% were engage in the abuse of some kind of mind-altering substances. Among the reported substances, alcohol was considered to be major, with a prevalence rate of 58% in a private high school and 18% in urban as well as rural public high schools. The majority (68%) of the students in urban and rural public high schools started abusing alcohol between the ages of 6 and 19 years, while those in private school (73%) abused between the ages of 6 and 22 years. When a combination of multiple substances was used, with a few exceptions, alcohol was the first to be tried.

In another study carried out elsewhere, it was found that out of approximately 1700 high school students in a semi-urban setting, about 22% reported consuming alcohol. While the mean age of the consumers was 17 years, the consumption of the substance increased with the ages of the students. The majority of alcohol consumers in this study area were males.

A 2011 survey report demonstrated that among approximately 600 undergraduate medical students of Addis Abeba University, 22% reported drinking alcohol in the previous 12 months. The majority of the consumers were males and Orthodox Christians. The consumption of alcohol by these students increased with the years they attended university.

Researchers also showed that the consumption of alcohol by high school students in Adiss Abeba in 2000 was associated with increased engagement in sexual activity (by 38%). Since only 40% of the males reported condom use intentions, alcohol use was suspected to enhance the risk of exposure to sexually transmitted diseases (STD). Comparing the sexes, the influence of alcohol for inducing sexual activity was even greater in male students. In a similar study performed in a semi-urban town elsewhere, it was found that alcohol abuse by high school students was linked to increased engaging in premarital sexual practice (by 30%). In this practice, there was is a greater tendency for young people to have multiple sexual partners and running the risk of contracting STD, including HIV. Male students were generally reported to be engaged in such practice more often.

With regard to college students, there is a report that the abuse of alcohol was also associated with enhanced risky sexual behaviors, which were defined as patterns of personality that can expose to HIV infection.

There are a few research reports addressing the problem of alcohol abuse as a risk factor for violent behavior among high school and college students in Ethiopia as well. Based on a study conducted in semi-urban high schools in eastern Ethiopia, it was noted that the use of alcohol by female students (14-24 years old) was related to higher levels of sexual violence victimization, and this behavior was reported to increase when both women and men abused alcohol. Similarly, as assessed by self-expressed manifestation of anger and negative life events, the use of alcohol was also linked to increased manifestation of violent behavior (by 67%) among undergraduate college students in central Ethiopia. In addition, alcohol was also reported to contribute to increased risk of committing an act of violence by male students towards women. Female students who consumed alcohol also expressed encountering greater gender-based violence against them.

Different reasons have provided by students who participated in the above studies for initiating the use of alcohol, and these are summarized below.

• For relaxation and entertainment
• To relieve stress or tension caused due to various reasons
• For socialization
• Out of curiosity
• Influences of relatives (including parents), friends and peers
• Effects of use of other substances; for example, consumption of alcohol following khat chewing sessions to overcome the stimulant effect of the latter
• To alleviate the inhibition for performing certain activities normally thought to be risky or unacceptable
• Influence of advertisements (media, billboards, etc.)

From the reports summarized, it is obvious that the studies conducted so far concerning the abuse of alcohol by students in Ethiopia is very limited, implying that a lot remains to be done. However, based on what is generally known about alcohol from numerous scientific studies performed elsewhere, it is predictable that the abuse of alcohol has additional and even more serious consequences.

First, what does alcohol do to the body in order to be continuously (and excessively) consumed by an abuser? As with almost all substances of abuse acting on the brain, in most cases, alcohol initially produces euphoria, in association with the experience of pleasure and reinforcement. With repeated consumption, the user develops dependency on it, and this can be psychological and/or physical. Psychological dependence is known to be mediated by a set of neuronal pathways that leads to behavioral reinforcement of substance use. Depending upon several factors, with continued use, alcohol also results in physical dependency, which is alternatively known as neuroadaptation. This phenomenon is the result of adaptation of specific neurons or brain areas to the continued presence of alcohol. It is associated with the development of withdrawal syndrome if the substance is discontinued. Due to this effect, physical dependency contributes to the continued use of alcohol in order to avoid the unwanted symptoms of withdrawal. Further, the alterations in the normal functions of brain cells cause the abuser to be less sensitive to system activators leading to greater use of the substance to get the desired stimulation, a manifestation of tolerance.

With continuous and increased consumption, alcohol produces greater adverse effects of various types that can impact the overall health of the consumer. In Ethiopia, there are no legal restrictions to the production, distribution and use of alcohol and, for most people, its consumption is socially accepted. Alcohol is available in various formulations of industrial and traditional products such as beer, wine, and spirits, tella, tej, bordae and areki/katikala, the alcoholic (ethanol) contents of which could vary from each other.

When consumed in moderate quantities, alcohol does not produce major adverse consequences on health; in fact, it has been suggested to be beneficial particularly to the cardiovascular system. However, alcohol becomes problematic when it is consumed in excess and for a prolonged period.

The acute effect of alcoholic drinks on the brain usually results in sedation, in most cases, following a brief period of stimulation or euphoria. This is often accompanied by impairment of judgment. The effect of alcohol on the rest of the body include lowering of heart and respiration rates, slowing of reaction time, impairing of coordination (for example, difficulty in walking straight), and even loss of consciousness with very excessive drinking, among others.

Alcoholic beverage drinking for years (chronic effects) can affect most organs of the body including, of course, the brain. In the brain, it can cause damages of various intensities which may result in loss of memory, slurred speech and impairment in motor coordination. Chronic use can also lead to many additional adverse effects including elevated blood pressure, liver damage, nutritional deficiencies and immune impairment. In pregnant woman, besides causing problems to the woman, alcohol consumption can affect the fetus. This effect may result in the risk of delivering a low birth weight baby with a chance of developing learning difficulties later in life.

Most alcoholics with abuse problems manifest mild to moderate withdrawal symptoms, which include tremors, sweating, sleep disturbance, nausea and suppressed appetite, among many others. Occasionally, the withdrawal symptoms can be very severe and lead to a condition known as delirium tremens which is characterized by agitation, restlessness, tremor, disorientation, high fever, sweating, hallucinations, paranoia and loss of consciousness. To alleviate or escape from these unpleasant experiences, alcoholics seek to drink more alcohol.

In addition to producing the above adverse effects, alcohol is also recognized to cause multiple additional health effects on young people of school age. One major problem is the profound effect it can produce on the brains of young people. Since the brain of a young person is still growing, drinking can seriously affect its development. This can cause learning problems or lead to adult alcoholism later in life with all its consequences. In this regard, it has been found that people who drink by the age 15 years are five times more likely to abuse or become dependent on alcohol than those who begin drinking after the age 20 years. Young people who drink also are more likely to get poor grades in school and are at a higher risk for being a crime victim. In other words, at least partly due to its effects on the brain, alcohol consumption can prevent young people from reaching their full potentials.

Hormonal changes in young people also make them more likely to take risks and alcohol can further disrupt their judgments, leaving them more venerable to various adversities than older people. Since most children are smaller in size compared to adults, they are especially venerable to the effect of alcohol if they drink too much in a short time. The high blood level of alcohol can cause their brain to stop controlling the vital functions of their bodies, with serious consequences.

In conclusion, the limited research results reported from different schools in Ethiopia suggest that a significant number of students use alcohol for several reasons. In addition, the use of alcohol was markedly associated with violet behaviors towards women and heightened sexual activity without precautionary measures against STD and other negative consequences. From the nature of studies carried out (self-administered questionnaires), the number of students who used alcohol would be expected to be higher and this expectation is reasonable given what can be witnessed in most parts of the country concerning the rise in alcohol consumption of by the younger generation. Documented scientific evidence amply demonstrates that the abuse of alcohol is harmful to the human body, besides causing serious socioeconomic problems. Inherent to their mental and physical status, young people are venerable to additional adverse effects of alcohol, which can seriously hamper them from reaching their maximum positive potentials. Ethiopians at all levels of societal structures should be cognizant of this rising problem among the younger population of the country and take appropriate steps to come up with doable solutions. Among the actions that could be taken in this regard, the following are suggested for consideration.

• For evidence-based plan of action, more research is needed to be carried out in order collect additional information on the abuse of alcohol among a greater number of students covering a wider geographical area.
• Based on what is known so far, a number of other actions can also be taken for relatively quicker and more practical results. These actions can include the following: (1) educating students about the health and social problems associated with alcohol abuse; (2) as behaviors of students in relation to alcohol abuse can be influenced by others associated with them, community education on alcohol abuse (involving parents, relatives and teachers, among others) should also be organized and instituted. In this respect, mass media education can play an important role; (3) coping mechanisms should be more readily available to help victims of alcohol abuse; (4) factors that contribute to or promote the abuse of alcohol should be identified and appropriately dealt with to eliminate or minimize their negative effects; and (5) appropriate policies should be established at institutional and/or governmental levels to help curb the problems of alcohol abuse by the youth.

Readers are advised to be mindful of the information attempted to be emphasized in this article, while Recovery Month is being celebrated in many other parts of the world in the entire month of September.