Alcohol dependence: Does the composition of the available beverages promote it?

doi:10.4236/ojpsych.2012.24042

Paper Menu >>

Journal Menu >>

Open Journal of Psychiatry, 2012, 2, 301-304 OJPsych

http://dx.doi.org/10.4236/ojpsych.2012.24042 Published Online October 2012 (http://www.SciRP.org/journal/ojpsych/)

Alcohol dependence: Does the composition of the available

beverages promote it?

Mary W. Kuria, Yvonne Olando

Department of Psychiatry, University of Nairobi, Nairobi, Kenya

Email: [email protected]

Received 8 September 2012; revised 7 October 2012; accepted 15 October 2012

ABSTRACT

Affordability and availability of alcohol are factors

that have been associated with alcohol dependence.

Ethanol content in the alcoholic beverages is an im-

portant determinant in alcohol dependence. Quality

control of alcoholic beverages available in the market

is important in safeguarding the health of alcohol

consumers. Few studies in Kenya have determined

the chemical composition of alcohol used by the study

participants. Objective: To determine the chemical

composition of alcoholic beverages used by a group of

alcohol dependent study participants. Design: The

study was a clinical trial with pre and post measure-

ments. Method: The CIDI and WHO-ASSIST were

administered to 188 alcohol-dependent persons at

intake and after six months. A researcher-designed

socio demographic questionnaire was also adminis-

tered at intake. Alcohol beverages were randomly

collected from the location of the study area and their

chemical composition analyzed using gas chromatog-

raphy. Results: The mean AUDIT score of the par-

ticipant was 28.6 for male and 26.6 for females. Three

of the alcohol samples collected was illicit brews col-

lected while 11 were licit. Four out of the eleven licit

brews had ethanol levels that did not complied with

the set government standards. Conclusion: Illicit

brews with high ethanol content are available in the

Kenyan market, while some of the manufacturers of

the licit brew do not comply with government set

content recommendations.

Keywords: Alcoholic Beverages; Ethanol; Composition;

Illicit; Licit

1. INTRODUCTION

The control of composition of alcohol standard is done

by the Kenya bureau of standards (KEBS). The Kenya

Bureau of Standards recommends spirits, gin whisky and

brandy to contain a minimum 37.5% of alcohol by vo-

lume, while beer should have 4% - 8%, fruit win 8% -

14% fortified wine 1 3% - 34 % alcohol by v olume.

There is an overwhelming proliferation of illicit alco-

holic brews both in the urban and rural parts of Kenya.

This prompted the law makers to enact the new Alcohol

Control Law. According to the newly passed law better

control of alcohol quality and enforcement of the laws

has been proposed. National Agency for the Campaign

Against Drug Abuse (the government body responsible

for dealing with substance abuse) acknowledges that

abuse and misuse of alcohol and other drugs in Kenya

has now reached magnitudes that may lead to a national

disaster if timely measures are not put in place [1].

The Kenya Alcoholic Drinks Control Act, (2010) de-

fines alcohol as “the product known as ethyl alcohol ob-

tained by fermentation and distillation of any fermented

alcoholic product”. “Alcoholic drink includes spirits,

wine, beer, traditional alcoholic drink and any one or

more such varieties containing one-half of one percent or

more of alcohol by volume” [2]. Worldwide three types

of alcoholic beverages namely, beer, wine and spirits.

Beer and wine have lower alcohol content as compared

to spirits.

Ideally the definition of alcohol should be at an etha-

nol content level low enough to include most of the al-

coholic beverages consumed in the country. Such defini-

tion takes into consideration the alcohol by volume con-

tent of the drink [3]. Amounts of alcohol consumed by a

person depend partly on the ethanol content. Estimates of

both mean volume of alcohol consumption and heavy

drinking amounts are influenced by variation in alcohol

concentration and quantity [4]. People from poor com-

munities prefer cheap and potent alcohol.

The use and abuse of alcohol in Africa involves both

local and industrialized typ es of alco hol [5 ] with as much

as half of the consumption being unrecorded alcohol [6].

Traditional drinks including homemade brews and dis-

tilled beverages accounts for 74% of the total alcohol

consumption in Kenya [7]. The use of the local tradi-

tional brews poses a danger to the society for a number

OPEN ACCESS

M. W. Kuria, Y. Olando / Open Journal of Psychiatry 2 (2012) 301-304

302

of reasons. Firstly, the manufacture of the traditional

brews is usually unhygienic and at times the brews have

been laced with methanol resulting to deaths blindness

and disabilities [8]. Secondly, most of the brews are

manufactured illegally without control on the ethanol

content. Thirdly, the cost of the brews is relatively lower

than that of the legal brews and therefore the majority of

the alcohol users can afford it. Kenya has currently

passed a law to legalize traditional and illicit brews so as

to regulate production, sale and consumption of alcoholic

drinks [1].

Kenyans have a hazardous drinking pattern of alcohol

which can cause social and medical harm [7,9] with an

increasingly use by underage and young persons [10].

These coupled with a repo rted increase in lifetime drink-

ing among young, black African; and use of drugs by

females as a way to cope with current or past life stress-

ors [11,12] demands that quality control of alcoholic

brews be instituted and enforced.

Anecdotal reports indicate that consuming killer sub-

stances bottled in filthy backyards and cleverly labeled

as fortified wine, gin, opaque beer, vodka, brandy or rum

are currently sold in the Kenyan market. According to

anecdotal reports the suspect drinks, said to control 80

per cent of the wines and spirits market, contravene all

the mandatory requirements for manufacture as well as

trade in alcoholic beverag es—tax obligation, quality cer-

tification, wholesomeness and packaging. Cheap alcohol

package in small quantities (250 milliliter) which have in

the past being available in the Kenyan market has cur-

rently being prohibited by the new Alcoholic Drinks

Control Act, 2010.

In Kenya, alcohol consumption is highest in poor

communities where potent home brewed alcoho l is cheap

and readily available. Quality control is weak; meaning

ethanol content can at times be dangerously high. Ex am-

ples of such home made brews include, “muratina”,

“mnazi”, “changaa”, “mbangari”, “busaa”, and “kumi-

kumi”. These are the illicit brews that the newly passed

law (Alcohol Drinks Control Act) intends to make licit

and industrialize the production in attempt to protect the

alcohol users from harmful effects of contaminated il-

licit brews (Kenya Gazette supplement, 2010). Since

cost and availability of alcohol are factors that influ-

ence alcohol use an increase in available licit types of

alcohol in market may result to more people drinking

alcohol.

Illicit drug use has spread from urban and advantaged

groups to rural and disadvantaged (poor) communities

where youth associate alcohol use with enjoyment, fun

and survival [13]. This is true for Kenya where use of

illicit alcohol has become common among rural and in-

formal settlement communities where dealing with the

alcohol dependence problem is further complicated by

the scarce resources in such communities.

In spite of the high health and social economic costs

associated with alcohol use disorders most African go-

vernments depend heavily on alcohol industries for reve-

nue received through taxation. These coupled with em-

ployment opportunities for people gives the alcohol in-

dustries a bargaining power when it comes to introduce-

tion, implementation and enforcement of alcohol po licies

in Africa.

2. METHOD

Ethical approval for the study was obtained from the

Kenyatta National Hospital/University of Nairobi ethi-

cal review board. Permission to collect the illicit alco-

hol brew samples was obtained from the Ministry of

Public Health and all ethical considerations were ad-

hered to. One hundred and eighty eight participants of a

community based detoxification and rehabilitation pro-

gramme were asked to indicate the types of alcohol

beverages they were using in order of prevalence irre-

spective of whether the brews were licit or illicit. Four-

teen most commonly used brews were randomly pur-

chased fro m the twelv e vi llage s lo cat ed wi thin the s tud y

area.

The purchased alcohol beverages were given a serial

number and taken to the Government Chemist for che-

mical, analysis principal investigator and a public health

officer.

The chemical composition of the alcohol samples was

determined through gas chromatography.

3. RESULTS

A total of 188 participants underwent community-based

detoxification but only 156 were followed up for the six

months. Majority (91.5%) was male and 8.5% were fe-

male. Majority (60.5%) of the participants had begun

drinking alcohol before the age of 18 years, with the

mean AUDIT score being 28.6 for males and 26.6 for

females. The mean age of the group was 31.9 years, with

majority (84%) of the participants aged below 40 years.

The majority (53.3%) of the participants earned an in-

come of less than 143 United States dollars per month.

The majority (51.1%) were married, while 38.9% were

single. The remaining participants were either separated

or divorced.

Fourteen samples of alcoholic b everage were collected

from the study area and labeled F517 - F527 for the licit

brews and F480 - F482 for the illicit brews. Two of the

illicit brews were within the beer range of alcoholic

brews while the third one was within the spirit range.

The results are shown in Table 1.

Four out of the eleven licit brews had not complied

with the recommended Kenya Bureau of Standards

M. W. Kuria, Y. Olando / Open Journal of Psychiatry 2 (2012) 301-304

303

OPEN ACCESS

Table 1. Ethanol content of illicit alcohol beverages.

Sample No. Sample description Ethanol content % (v/v)

F480/07-08 Chang’aa 33.54

F481/07-08 Muratina 4.84

F482/07-08 Busaa 6.03

ethanol levels. Samples in report F523 and F525 had

lower than recommended ethanol levels. Sample F518

was labelled as an herbal brew but was found to have a

high content of ethanol (8.9% v/v), qualifying it to be a

stronger than beer and in the range of fruit wines (8% -

14% v/v ethanol content). The manufacturer labeled sam-

ple F519 as a traditional brew but the ethanol content

(31.5% v/v) which qualified it to be a spirit. The results

are shown in Table 2.

4. DISCUSSION

Published data on chemical composition of alcoholic

beverages used by alcohol dependent persons is scarce in

Africa. There is a wide range of alcoholic brews sold in

Kenya and although the majo rity of these brews are licit,

a good number of them are illicit and are prepared, sold

in secret and is therefore unrecorded. There is no re-

commended ethano l content in the illicit alcoholic brews

since they are manufactured illegally. This poses danger

of dependence to the consumers since some of the alco-

hol brews may be potent. The manufacture of illicit

brews is common in informal settlements like th e current

study area. The law enforcers are unable to penetrate the

densely populated settlements. The current study did not

find any methanol or impurities in the alcoholic brews.

In the past deaths and blindness has been reported after

use of illicit brews laced with methanol and toxic sub-

stances [8]. In spite of the reported dangers people con-

tinue to drink the brews because they are cheaper and

sometimes more potent than the licit brews. Maintain-

ing the recommended alcohol standards is difficult in

informal settlements where law and order is mostly not

observed and law enforcers may not be able to penetrate

the area due to unplanned and congested residential and

business premises. Furthermore, adequate social or

health facilities are unavailable to assist the dependent

persons, majority of whom cannot afford the cost of treat-

men t.

There was a discrepancy between the actual and the

recommended ethanol content in the licit brews. Since

taxation of alcoholic brews depends on the ethanol con-

tent such discrepancies are likely to benefit the alcohol

manufacturers. According to [4] variation in alcohol con-

centration is one of the factors that determine volume

consumed. The finding that some brews marketed as

herbal drinks had a high ethanol content indicates that

non suspecting Kenyans are using alcohol unknowingly.

Herbal beverages are used by many people as health

drinks. Such users of “herbal” drinks that have high

ethanol content are likely to become alcohol dependent

due to the regular and heavy use, and eventually damage

their health.

Though industrialized types of alcohol are used in

Kenya, there is currently a heavy use of traditional be-

verages which are cheaper and more potent with a high

unrecorded consu mption of 5 litres per capita [3,14]. The

Table 2. Analytic report of illicit alcohol beverages.

Sample

identity

Number Sample description Ethyl alcohol

content % v/v KEBS recommended

levels of ethanol Methanol

levels (PPM)Total diss olved

solids (m/v)%Max. recomme nde d

dissolved solids

KEBS

Compliant/

Non-compliant

F517 Tiger brandy 39.16 37.5 (min) Nil 0.045 2.0 Yes

F518* Miti ni dawa 8.90 Nil Nil Nil Not indicted No

F519 Kienyenji African

brew 32.21 Nil Nil 0.0029 0.0284 No

F520* Stega traditional brew 3.97

<4 Nil Nil Not indicated Yes

F521 Kenya king gin 41.92 37.5 (min) Nil 0.0047 1.5 (max) Yes

F522 Hardyman gin extra 38.8 4 37.5 (min) Nil 0.0168 0.5 (max) Yes

F523 Free gin 32.21 37.5 (min) Nil 0.0 029 No

F524 Raaz brandy 38.07 37.5 (min) Nil 0.0352 2.0 (max) Yes

F525 Lakers extra golden

spirits 33.58 37.5 (min) Nil 0.0029 1.5 (max) No

F526 Kana extra golden

label 39.29 37.5 (min) N il 0.0252 Not indicated Yes

F527 Safari ice berg liquor 11. 4 5 Nil Nil Not indicated Yes

*Traditional alcohol brew; KEBS: Kenya Bureau of Standard; PPM : Parts Per Million; m /v: Mi lligram Per Volume ; v/v: Volume by Volume.

M. W. Kuria, Y. Olando / Open Journal of Psychiatry 2 (2012) 301-304

304

current study confirms that some of the traditional be-

verages are highly po tent with the ethano l contents in the

range of spirits. This coupled with a hazardous drinking

pattern of Kenyans endangers the health of the users.

A new alcohol law has been instituted to regulate the

sale of alcohol to reduce the complications associated

with their use. The challenge is law enforcement espe-

cially in the informal settlements. Maintaining standard

control of composition of alcoholic brews may help re-

duce the prevalence and severity of alcohol dependence.

5. CONCLUSIONS

The findings of the current study indicates not only dis-

crepancies in the expected and real ethanol content in the

Kenyan alcoholic brews but also high ethanol containing

illicit brews alcohol beverages.

Curbing of manufacture of illicit alcohol beverages

and enforcing quality control on alcohol available in the

market is important. Law enforcers should ensure that all

alcoholic drinks in the market are licit and co mplies with

set standards.

REFERENCES

[1] Kimani, J. (2006) NACADA, calling stakeholders to con-

tribute to develop an alcohol policy.

[email protected]

[2] Kenya Gazette (2010) The alcoholic drinks control act.

Kenya Gazette supplements No. 58 (Acts No. 4).

[3] World Health Organization (2004) Global status report on

alcohol. Department of Mental Health and Substance

Abuse, Geneva.

[4] Nayak, M.B., Kerr, W., Greenfield, T.K. and Pillai, A.

(2008) Alcohol not all drinks are created equal: Implica-

tions for alcohol assessment in India. Alcohol and Alco-

holism, 43, 713-718. doi:10.1093/alcalc/agn074

[5] Riley, L. and Marshal, M. (1999) Alcohol and public

health in 8 developing countries. World Health Organiza-

tion, Geneva.

[6] Rehm, J., Rehn, N., Room, R., Monteiro, M., Gmel, G.,

Jernigan, D. and Frick U. (2003) The global distribution

of average volume of alcohol consumption and patterns

of drinking. European Addiction Research, 9, 147-156.

doi:10.1159/000072221 PMid:12970583

[7] Obot, I.S. (2006) Alcohol use and related problems in

Sub-Saharan Africa. Africa Journal of drug and Alcohol

Studies, 5, 17-26.

[8] Nordwall, S.P. (2000) Homemade alcohol kills 121 in

Kenya. USA Today Airlington. In: Bahor, et al., Eds.,

Alcohol: No Ordinary Commodity, 3

[9] Shaffer, D.N., Njeri, R., Justice, A.C., Odero, W.W. and

Tierney, W.M. (2004) Alcohol abuse among patients with

and without HIV infection in public clinics in western

Kenya. East Africa medical Journal, 81, 594-598.

[10] Odejide, A.O., Ohaeri, J.U., Adelekan, M.F. and Ikuesan,

B.A. (1987) Drinking behavior and social change among

youths in Nigeria: A study of two cities. Drug and Alco-

hol Dependence, 20, 227-233.

doi:10.1016/0376-8716(87)90032-9

[11] Sawyer, K.M., Wechsberg, W.M. and Myers, B.J. (2006)

Cultural similarities and differences between a sample of

Black/African and colored women in South Africa: Con-

vergence of risk related to substance use, sexual behavior

and violence. Women Health, 43, 73-92.

doi:10.1300/J013v43n02_05

[12] Morojele, N.K., Kachieng’a, M.A., Mokoko, E., Nkoko,

M.A., Parry, C.D. and Nkowane, A.M. (2006) Alcohol

use and sexual behavior among risky drinkers and bar and

shebeen patrons in Gauteng province, South Africa. So-

cial Science and Medicine, 62, 217-227.

doi:10.1016/j.socscimed.2005.05.031

[13] Rocha-Silva, L. (2001) The nature and extent of drug use

and the prevalence of related problems in South Africa:

National surveillance. Human Sciences Research Council,

Pretoria.

[14] Rehm, J., Room, R. and Monteriro, M. (2004) Compara-

tive quantification of health risks. Global and regional

burden of disease attributable to selected major risk fac-

tors. World Health Organization, Geneva, 959-1108.