Abstract
Dear Editor,
Individuals use different coping strategies to manage the consequences of disasters. New onset or increased substance use is one of the maladaptive coping mechanisms. If unaddressed, it may result in substance dependence or substance use disorder (SUD). 1 Understanding substance use patterns, such as prevalence, correlates, comorbidity, and predictors, among disaster-affected populations is important for planning preventive programs, identifying high-risk individuals, and assessing the need for mental health services. 2 Several studies worldwide that explored substance use in the aftermath of disasters observed a high prevalence of SUD or problem drinking, while a few observed no significant increase. 3 The pattern remains unclear in the context of large-scale disasters due to the uncertainty that may arise from differences between individual trauma and collective experiences in such events. According to the World Disaster Risk Report 2023, India ranks third in the most disaster-prone countries in the world. 4 Therefore, studying the nature of substance use, particularly alcohol, one of the most common substances used among men, is important to understand its impact on mental health and inform effective interventions.
Study Overview
This study is based on secondary data from the National Family Health Survey (NFHS), which is a nationwide survey of Indian states and union territories (UTs). Data from NFHS 4 (2015–2016) and Phase 1 of NFHS 5 (2019–2021) were compared to examine the impact of disasters on substance use, particularly alcohol, among men aged 15–49. Phase 2 of NFHS-5 was excluded as it was conducted after the onset of COVID-19, which may have influenced results. Additionally, the UTs of Jammu and Kashmir and Ladakh were excluded from the analysis due to administrative changes between the two surveys. Therefore, the alcohol use percentages of 20 states and UTs covered in Phase 1 of NFHS 5 were compared with NFHS 4 data. States and UTs were categorized as either disaster-affected or unaffected using the Emergency Events Database by the Center for Research on the Epidemiology of Disasters, which records events that cause at least 10 deaths or affect a minimum of 100 people as disasters. During the study period, states identified as disaster-affected experienced at least three such events, highlighting their recurrent hazard proneness.
The chi-square value for alcohol use for each region between NFHS 4 and NFHS 5 was calculated. Also, an independent sample t-test was used to compare the change in the percentage of men using alcohol between disaster-affected and unaffected regions (Table 1).
Alcohol Use Among Men Aged 19–45 in India.
Discussion
Although exposure to disasters may not directly cause substance use, it can increase vulnerability by lowering self-efficacy, inducing stress and trauma from loss, breaking social support systems, increasing the availability of substances, and causing difficulties in accessing other mental health services for SUD.5, 6 However, in the current study, no significant difference in the change in the percentage of men using alcohol between disaster-affected (mean = −8.21, SD = 5.76, 95% CI [−11.4, −5.02]) and unaffected regions (mean = −2.28, SD = 12.4, 95% CI [−17.7, 13.1]) was observed (p = .15). These findings align with previous literature indicating that disasters influence consumption patterns, with increases reflecting relapse, or continuation among existing users rather than initiation among non-users.2, 3
This pattern observed in the present study is consistent with broader national-level trends. NFHS data show a general decline in the proportion of men consuming alcohol between NFHS-3 and NFHS-5. 7 Yet, within this overall decline, the frequency of alcohol use among current users appears to have risen, suggesting a shift in drinking patterns rather than prevalence. Studies found that although the proportion of men reporting alcohol use in India decreased by 22.37% in NFHS 5 compared to NFHS 4, the frequency of alcohol consumption among users increased, such that the percentage of those drinking almost every day increased by 24.19%, those drinking about once a week rose by 7.14%, and those drinking less than once a week decreased by 12.76. 8 Taken together, these findings indicate that disasters can potentially increase consumption among existing users, which could account for the absence of an overall increase in prevalence.
Alcohol use patterns tend to evolve across different stages of disaster recovery, showing fluctuations in prevalence and intensity.9, 10 These variations suggest patterns may intensify, stabilize, or decline depending on the assessment period. Although this study relies on NFHS data representing a single time point, it provides a valuable snapshot within this dynamic process. It highlights the need for longitudinal research to capture shifts across the various stages of recovery.
Another important consideration is the role of state-level regulations and prohibition policies, such as Bihar’s ban in 2016 and Mizoram’s Liquor Prohibition Act of 2019, which might have contributed to the decline in alcohol use in these states. Such policies act as confounding factors, indicating that observed changes in consumption may not be solely attributed to disaster exposure.
Several limitations should be acknowledged when interpreting the findings of this study. Reliance on state-level NFHS data precluded district-level analysis and limited the ability to determine whether survey sites overlapped with disaster-affected areas. Policy variables, including alcohol taxation and prohibition, could not be assessed due to the unavailability of data. Similarly, indicators such as economic losses, percentage of population affected, accessibility, and availability of alcohol post-disasters were inconsistently reported across states and events, limiting their comparability and therefore inclusion in the analysis.
Conclusions
This study suggests that disasters in India may not lead to new alcohol use but can influence relapse or increased frequency among existing users, underscoring the importance of integrating substance use considerations into disaster policies. However, the findings remain exploratory, as the reliance on state-level NFHS data limited alignment with specific disaster sites, lacked initiation-specific measures, and therefore did not permit causal inference. Broader social changes and policy shifts, such as prohibition or rising awareness, appear to have a greater influence on shaping local alcohol trends. Future research should employ region-specific, longitudinal, and mixed-method designs, incorporating disaster severity indices, to clarify these dynamics and strengthen the evidence base for targeted interventions.
Supplemental Material
Supplemental material for this article is available online.
Footnotes
Data Sharing Statement
Not applicable.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Declaration Regarding the Use of Generative AI
None used.
Ethics Committee Details
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Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Prior Presentations
None.
Simultaneous Submission to Other Journals
None.
References
Supplementary Material
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