Enigma of Alcohol Lockdown Syndrome

Dr Gargi Sinha

May 11, 2020, 11:01:47   

A university student reported vigorously shaking because he missed his daily evening drinking habit with his friends since total lockdown started in India. He was sweating a lot, feeling incredibly anxious and spending sleepless nights. Another person, who works as a labourer, reported that he saw strange insects and animals in the space which were not seen by others. He was quite frightened that some unknown entity was going to kill him. His family members found him hiding behind the door because he was terrified of imminent death. Another middle- aged businessman was experiencing a series of convulsions. He was throwing up food and became quite dehydrated requiring intravenous fluids. He was so distressed that he tried to hang himself from a tree. All these cases have some resemblance. All of them were suffering from alcohol lockdown syndrome of various intensity, ranging from mild to a severe degree.

On 24 March 2020, Government of India declared total countrywide lockdown to curb community spread of coronavirus pandemic. The World Health Organisation highly appreciated India's initiative. Despite significant financial constraints, people of India embraced the lockdown decision with open arms. Unfortunately, the lockdown situation created an unprecedented health crisis for people dependent on alcohol. As a result, several phone calls to helpline numbers from the alcoholics and their family astronomically increased across the states.

Additionally, deaths and suicides due to alcohol withdrawal soared across the nation. Certain advocacy groups from Southern India raised concerns about the wellbeing of alcoholics due to closure of liquor shops and lack of awareness among community members about the treatment of alcohol withdrawal. Subsequently, when some states opened the liquor shops, they received incredible criticism from public and Media for prioritising revenue generation over citizen's health and safety due to spread of COVID19. People raised concerns about alcohol customers standing in the long queue disregarding social distancing norms. Such concerns are entirely legitimate. However, a critical piece of information, surprisingly missing in the Media reporting and the Government briefings. That was the plight of Indian citizens, who were severely suffering from alcohol withdrawal due to unavailability of substance during the lockdown, and some of them were sadly facing the fear of impending doom.

Alcohol is usually a socially sanctioned substance in most of the Indian communities. That means a proportion of Indian population drinks alcohol for social and recreational reasons. This group is generally not at-risk during the lockdown period because their body is not dependent
on alcohol. The landmark Indian National Substance Use Survey (2019) reported that 16 crores of Indian citizens were using alcohol during the period of the study. Tripura was found to be one of the highest alcohol prevalence states in the study. However, the situation is different in those people who are potentially dependent on alcohol. The same National Indian Survey also suggested that there were approximately six crores dependent drinkers in India. Dependent alcohol drinker when tries to give up their drinking, they experience a whole range of physical as well as psychological withdrawal symptoms. For instance, mild withdrawal symptoms are excessive sweating, shakes, lack of sleep, overwhelming anxiety, suicidal tendency, nausea, and vomiting, whereas severe withdrawal symptoms are convulsion, aggression, and delirium tremens. Severe alcohol withdrawal can be a life-threatening condition, and 1 in 5 people can die if untreated. While we are deeply concerned about 3-4% of mortality rate from COVID19; however, we appear to be completely oblivious of morbidity and mortality associated with alcohol withdrawal syndrome, which is 4-5 times higher than COVID19. It is difficult to ascertain whether our differential approach to alcohol withdrawal syndrome is due to a lack of our awareness about the severity of alcohol withdrawal or our moral stigma about alcoholism. Now, we have extensive evidence from research globally that alcohol dependence is a well- recognised medical condition, which requires specialised medical treatment.

Hence, to overcome the current health crisis, some strategies need to be put in place. Perhaps the opening of liquor shops may not be the right strategy to overcome the challenging situation. However, our community has a degree of responsibility to allay the suffering of those dependent drinkers. In an ideal case scenario, people should be made aware of the emergence of alcohol withdrawal syndrome and available support services such as detoxification centres and helpline numbers. Another way to communicate can be through the Government's daily briefing expressing concerns about alcohol withdrawal and its treatment during the lockdown. The Government perhaps needs to inform and guide people to seek help from local alcohol detoxification centres similar to urging people to attend COVID19 clinic for suspected Coronavirus infection.

Further, Media perhaps can take a crucial role here by regularly talking about this issue and inform people about helpline numbers and local alcohol detoxification centres. To disseminate this message to the community level, the Government can educate and involve the grass-root level workers such as ASHA workers to bring relevant people to the attention of health service for treatment. The Government can also offer treatment for alcohol withdrawal syndrome in the primary health centres, sub-divisional and district hospitals. Interestingly enough, alcohol
detoxification (treatment of alcohol withdrawal symptoms) does not require any state-of-art centres. Instead, a general physician doctor can carry out treatment for alcohol withdrawal even in the remotest region of the country with some online supervision from an addiction specialist. Unfortunately, alcohol lockdown syndrome is a highly distressing health crisis due to the sudden discontinuation of alcohol. Perhaps our community would be more humane if we could offer some help to this specific and preventable medical condition during the lockdown period to prevent unexpected deaths due to lack of intervention.

Dr Gargi Sinha
MBBS (Lady Hardinge Medical College, New Delhi), PGDACP(India), Grad Dip Public Health (Edith Cowan University, Western Australia) Member of Australian Health Promotion Association
Member of Australian Integrative Medicine
Visiting Consultant, Sinha Medical Acupuncture Research centre, New Delhi India Public Health Researcher (Drug and addictive behaviour)
School of Medical and Health Sciences Edith Cowan University, Western Australia Email:
Phone: +61 8 94458181
Author of health sociology blog
Author of educational resources on public health Co-founder, strategies of addiction for north east


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