Like any issue, there is both merits and demerits but the point is which outweigh the other. From the medical aspect, lifting of prohibition has more harm than benefits. Chronic or long-term alcohol use has profound ill-effects on the individuals, his family, his career, social functioning, financially and society as a whole.

First of all let us know what alcohol does to our body and its long-term ill-effects on health both mentally and physically.

As alcohol is highly soluble in water and to some extent in fat, it is distributed to almost every system of the body and body membrances and brain neurons, leaving its harmful effects. After alcohol is consumed, the liver metabolizes or breakdown the compound. A single drink contains 127 grams of the active-ingredient of alcohol which the liver takes one hour to metabolize. So, when taken in large amount the liver is burdened and the alcohol remains concentrated in our body. With constant, regular long term use of alcohol the liver damage sets in. Out of the total amount of alcohol consumed only 2% to 10% gets excreted unchanged from the lungs or kidneys in urine or through sweat.

There are certain criteria to diagnose an individual as an alcoholic or having alcohol dependence syndrome or in layman's language an alcohol addict. They are, (1) tolerance - where larger doses are required to produce the desired effect or to achieve intoxication; (2) where certain symptoms of discomfort occurs when reducing the usual dose of intake or when the person attempt to stop taking it; (3) the person feels the need to take larger amounts and over a longer period than was intended. (4) Where the person feels a need to cut down or control its use with unsuccessful efforts; (5) more time is spent in activities necessary to obtain alcohol; (6) impairment in important social, occupational or recreational activities because of alcohol use and (7) alcohol use is continued despite knowing its ill-effects on physical or psychological problems. If any individual using alcohol fulfills the above criteria, he is said to have alcohol related problems/disorders and need medical attention and treatment. It can be noted that with regular use over long period, there is risk of developing alcohol dependence syndrome as he/she has lost control over its intake.

Acute effects of alcohol The acute effects of alcohol are manifested as alcohol intoxication after consumption of alcohol where the concentration in the blood peak in 30 to 60 minutes. Alcohol depress the functions of the brain-giving rise to various signs and symptoms such as slurred speech, incordination, unsteady-gait, abnormal movements of the eyes, impairment in attention and concentration, or memory and judgement. Alcohol impairs judgement by reducing conscious self control during the period of intoxication and along with lack of insight the individual tends to undertake risky activities and socially embarrassing behavior. The blood alcohol concentration of 80 mg/dl is defined as drunk driving and legally punishable. As the level of alcohol in blood rises various signs and symptoms with behavioral changes occur. When the level is at 100-200 mg/dl there is blurred vision, unsteady gait, aggressiveness, lack of judgement and person becomes quarrelsome. Forgetfulness and inability to recall at 200-300 mg/dl and coma occurs at 300-500 mg/dl and death may occur if the level ranges from 350-600 mg/dl. The effects of alcohol start at 15 mins after consumption and last for several hours. The above pictures are seen after consumption of alcohol and during the acute phase of intoxication and if the condition continues on long term basis various organ systems are affected.

Gastro-intestenial problems include severe inflammation of the oesophagus and stomach accompanied by vomiting and bleeding. There may be acute pancreatitis or irreversible chronic pancreatic destruction. Liver in particular are affected by long-term alcohol use leading to fatty liver, hepatitis and finally cirrhosis with liver failure. The daily consumption of upto 160 gm (200 ml of ethanol) of alcohol over a 15 years duration has the risk of developing cirrhosis. However, if there are other contaminants or toxic substance present in the alcoholic drinks, the duration of damage may be short. The short term mortality of alcoholic hepatitis may be as high as 20-60%.

Nutritional deficiencies results due to the direct appetite suppressant effects of the alcohol as it has high calorie content substituting for food. Alcohol also interferes with the absorption of nutrients required by the body which leads to weight loss, fatigue and lethargy. Chronic alcohol abuse cause multiple vitamin deficiency especially, thiamunic, phyridoxine, vitamine A neocin, folic acid and ascorbic acid. The result is weakness of the nervous and inflammation with muscle weakness, pain/ central nervous system symptoms of forgetfulness, mental confusion, intellectual decline etc.

On blood, the effect of alcohol is the depressant action on bone marrow which cause anaemia along with acute or chronic blood loss from gastro-intestinal tract bleeding. As there is deminished vitamin K production, bleeding problem may arise and so also decrease production of white blood cells and the immune system which can cause repeated infections.

On the heart, alcohol affects the muscles leading to cardiomyopathy muscles leading to cardiomyopathy and irregular heart beats. Moderate to heavy drinking is associated with increase in blood pressure and the risk of myocardial infraction and thrombosis is high among alcohol users.

Cancer - if the head, neck, oesophagus, stomach, liver, intestines and lungs are also associated with alcohol use.

Fetal alcohol effects: alcohol use in women, particularly pregnant women can have ill effects on the developing foetus- as alcohol easily cross the placental barrier leading to death and spontaneous abortion of the foetus. If the infant survive, it is associated with mental retardation, small head, facial abnormalities, congenital heart defects, deformities of limbs and diminished physical growth. The problem is irreversible.

Nervous system - alcohol has direct neurotoxic effects and with the coexisting thiamine deficiency seen in chronic alcoholics, there is significant alteration in the functioning of both the central and peripheral nervous system. Alcoholic neurophathy, myopathy and dementia also occurs.

Other problems - osteoporosis, particularly in women drinkers are common. Alcohol effects the immune system and lowers resistance to infection and hence tuberculosis is frequently seen amongst alcoholic.

Alcohol and Accidents Accidents among alcoholic is 3 times more common than in the general public. Road traffic accidents are seen mostly among drunk drivers or during the state of intoxication leading to fatal head injury, fractures and death. Alcoholics are also at risk for accidents at home due to fall and at work places while handling machines. It is reported that 20% of head injuries are associated with recent alcohol consumption which is true as seen in hospital attendance here too.

Sleep disturbance - Alcohol may perhaps induce sleep quickly but the normal sleep pattern or architecture is disturbed resulting in fragmented sleep which is non-restorative.

Psychiatric syndromes - Varieties of Psychiatric disorders are encountered during alcohol intoxication and withdrawal. It may also be a co-existing state. The common disorders include depression, anxiety, delusional disorder and psychosis. After abstinence too there may be panic disorder, anxiety neurosis, delusional disorders and frank psychosis.

The above information given are a brief picture of health hazards of long-term alcohol use and of individuals who are dependent on alcohol.

One must also note and agree that there are a large percentage of persons in our society who use alcohol in controlled manner without apparent health and social problems. Some use it as a recreational drink, and many are social drinkers. It will be worth while to go into what led to the use of alcohol to the level of disease process or alcohol related disorders. Research work have pointed to various factors that leads to alcoholism.

Childhood history - Children at high risk for developing an alcohol related disorders include having one or both parents affected with alcohol problem. Children having neurocognitive deficits, and those having a flaunted effect of alcohol as compared to individuals whose parents are not alcoholics. The above findings suggest a heritable biological brain function which may predispose a person to an alcohol related disorder. Other childhood risk factors include history of attention deficit hyper active disorder, conduct disorder or having both the conditions in early childhood. Antisocial personality disorder also predisposes a person to an alcohol related disorder.

Psychodynamic factors

The hypothesis of psychodynamic explanation is that people with harsh superego who are self-punitive turn to alcohol as a way of diminishing unconscious stress and those people who are fixated at the oral stage of development to reduce anxiety. The general personality as described by Psycho-analytic psychiatrist of persons with alcohol related disorder are shy, isolated, impatient, irritable, anxious/ hyperactive and sexually repressed. Alcohol may also be abused by some people to reduce tension, anxiety and psychic pain. And some may abuse it as alcohol lead to a sense of power and increased self worth.

Social and cultural factors

In certain social settings/ excessive and frequent drinking is often completely normal and socially accepted as in certain tribal festivals and ceremonies/ in college dormitories and military bases. Some cultural and ethnic groups are more restraint than others about alcohol consumption. Certain religions also endorse consumption of alcohol.

Behavioural and learning factors

Habits within a family, specifically parental drinking habits can bring about drinking habits in their offspring. From a behavioural viewpoint/ the positive re-enforcing aspects of alcohol can induce feelings of well-being and euphoria which reduce fear and anxiety/ which further encourage drinking.

Genetic and other biological factors

Many studies have shown that persons with first degree relatives affected with an alcohol related disorder are three to four time likely to have the problem than those who do not have first degree relatives with the problem. Patients with such family history are likely to have severe forms of the disorders and more alcohol related disorder.

Since recorded history alcohol has been associated with mankind and its use for pleasure is known from antiquity. The active ingredient of alcohol is ethanol which has its effect on the brain and the mind and the resulting behavioural manifestation. Time and again, the social, economic and psychological burden of this modern day pandemic of alcohol-related problems has been documented, explained by medical experts, counselled and the individuals themselves experienced and suffered, yet without response and success. Nothing is more than the fact that the prevalence of alcohol use and abuse is universal.

The problems were documented, the problem is now present and the future looks no different. If one thinks that prohibition is the solution to alcohol related problem/ we will be fighting a losing battle.

In the Manipur context prohibition will be more of a problem complicated and compounded/ rather than a way to solve any problem. An insight oriented view of the Manipur picture, when asked to opine will be a very honest—"Lifting of Prohibition will benefit" Interactions with intellectuals, academicians, professionals etc. have contributed their viewpoints seen purely from the state of affairs and context of the existing economic and health status of Manipur and its people.

Benefits of Lifting Prohibition from health aspect

The reality is that, as of now the state never attained the status of complete prohibition when prohibition was said to have imposed. Had there been no source of any alcoholic beverages the discussion would have been altogether different and quite straight forward.

* With prohibition, the demand does not decrease rather the illicit supply increases and so also illicit consumption.

* To meet the demand, product of local brew has to increase by using methods to enhance the process by using substances which may apparently be toxic to the body system.

* The use of contaminates or adulteration is also to enhance the intoxication effects which is highly toxic to the liver and brain.

* In the production of alcohol the taste of the alcohol is determined by the congeners which consists of methanol, butanol, aldehydes, phenol, tannins, lead, cobalt, iron and other substances which are toxic to our body.

* When the above chemicals are added in larger or disproportionate doses to increase the psychogenic effects the damage to the body system is severe and morbidity and mortality sets in faster.

* With the standard quality of alcohol as in unadulterated Indian made foreign liquor the duration required to lead to cirrhosis is as long as 15 years.

* With adulteration for reasons to meet the illicit demand the longevity of alcoholics may range from few years to 5 years.

* Lifting of prohibition may defer adulteration because of balance in demand and supply.

* Lifting of prohibition may to some extent, protect an alcoholic individual from severe damage to health.

* No law or threat can stop any individual who have opted to consuming alcohol at his free will, despite knowing the harm that alcohol can cause or has caused to him.

Economic benefits of lifting prohibition

* Manipur has no major resources to contribute to the financial improvement unlike other states or countries. With no known natural resources, industries, organizations or systems to tap any income for the state of Manipur, income arising out of lifting of prohibition will be quite substantial.

* With the lifting of Prohibition, black marketeering on alcohol will have no place which will definitely reflect on the financial improvement of any consumer individual which in turn has its positive effect on the financial condition of the family.

* Those who drink alcohol will continue to drink unless decided by oneself to give up. Lifting of prohibition will save time for the individual which otherwise would have spent time in acquiring the drink.

* Lifting of prohibition will provide some scope of employment area to some individuals.

* With time saved and decrease in expenditure, the regular users’ life-style may improve to some extent by having time with their family and participating in social activities.

* There are also controlled drinkers and social drinkers in our midst who does not harm themselves or their family and the social fabric.

Conclusion:

Conclusion is not the last. However summarizing the facts and realities on the basis of universal truism on alcoholism, evident from research works and more specifically in the context of Manipur only the collective wisdoms of intellectuals, academicians, professionals and importantly the women organizations can moderate and direct this issue on debate to its logical conclusion.

Facts and realities

* Alcohol has been there since recorded history.

* Use and abuse of alcohol is worldwide.

* Alcohol use was there, is using now and will continue to do so.

* No law, force or threat can deter any individual who drinks from drinking. It can only be determined by self.

* There is no known documentation of successful enforcement of prohibition or expected outcome.

* There are controlled drinkers and social drinkers and who gets use it as recreational drink.

* Certain ethnic groups, cultures and tradition endorse drinking.

* With prohibition, illicit production and supply is encouraged and adulteration occurs.

* With prohibition, black marketing flourishes.

* Alcohol intoxication has its hazards.

* Long-term alcohol use cause health damages both physically and mentally.

* Regular, excessive long-term alcohol use cause disturbance in career, academic, occupational, family relationships and social functionings.

* The fall-out of alcohol use and its burden include social, economic and psychological impact on the society.

* The causative factors of alcohol related disorders include childhood history, psychodynamic factors, social and cultural factors, behavioral and learning factors, genetic and other biological factors.

* Alcohol related problems has no direct association with availability of alcohol.