Culturally prevalent unrecorded alcohol consumption in Sikkim, North East India: cross-sectional situation assessment

Introduction: India is a major producer and consumer of unrecorded alcohol, an under recognized public health problem. This situation assessment was conducted in Sikkim, a state in north east India with a strong culture of unrecorded alcohol, to describe patterns of consumption and possible alcohol problems. Methods: This cross-sectional study combined primary and secondary information. About 395 participants with current unrecorded alcohol consumption completed a baseline assessment. Key informant survey enrolled 28 participants, who responded to a 23-item questionnaire on public health and social impact of unrecorded alcohol. Results: Mean age of participants was 37.5 +/- 11.4 years. This assessment did not detect underage regular drinking. Most unrecorded alcohol are home brewed chang (rice beer) and raksi (distilled from cereals). Early hour first drink and "no effect of alcohol today" signified alcohol problems. Key informants confirmed cultural use, household production, cheap price and alcohol problems; but did not approve commercial production and sale. Conclusion: This study shows widespread unrecorded alcohol consumption in Sikkim. There was no evidence of underage drinking, but indications of alcohol problems were present. Stakeholders agreed that unrecorded alcohol is cultural, but accepted harmful effects and need for intervention and legal provisions. Community based outreach and screening for alcohol problems; licensing and quality control; and alternative livelihood are possible policy implications.