A Public Health Approach To Alcohol Use and Its Related Harms in Iran
Abstract
In this research commentary Shokoohi and colleagues discuss the Iranian alcohol policy which prohibits Muslim Iranians (99% of the population) to consume alcohol and the alcohol harms which exist in the country despite of the policy. They also discuss the need for implementing the alcohol support services which are planned and the need for public health campaigns.
Despite alcohol being prohibited for consumption in Iran, a nation-wide household mental health survey suggested that 5·7% of the adult population had consumed alcohol in the previous year. Moreover, alcohol poisoning outbreaks due to the consumption of substandard alcoholic drinks are frequent and contribute to alcohol poisoning deaths and hospitalizations across the country.
While the prevalence, amount, and health consequences of alcohol consumption in Iran are lower than in non-Muslim majority settings—because of Islam’s promotion of alcohol abstinence and Iran’s prohibition policies—the burden of alcohol related harms is substantial and should no longer be overlooked. Indeed, the Iranian Ministry of Health has acknowledged this issue by establishing a joint multisectoral initiative to develop a national program that aims to reduce alcohol consumption by 10% between 2015 and 2025 through three main action steps:
- Integration of alcohol screening, brief intervention, and referral to treatment in primary health care, aimed at detecting problematic drinking practices early and providing appropriate treatment and care;
- Primary prevention, aimed at providing nondrug-specific primary prevention program for substance use disorders (eg, parental interventions) in community health centres; and
- Treatment programs, aimed at improving access to alcohol treatment services.
Although the development of such policies is an important step towards tackling alcohol-related problems in Iran, they have not been fully and successfully implemented into the primary health care system, which is already understaffed and overburdened.
Iran’s current alcohol use policies have, therefore, failed to consider comprehensive primary prevention strategies such as provision of educational programs to the public, age-specific school based prevention programs, and targeted prevention programs for individuals at risk.
While Iran’s religious-driven zero-tolerance alcohol policy might help keep alcohol consumption at a low level, it is insufficient and fails to reduce alcohol related harms, particularly among those who either are at risk or already have alcohol problems.
The authors conclude that it is time for Iran to identify and develop culturally acceptable best-practice models to improve how it addresses alcohol consumption and its related harms among its population. Establishing a consistent and effective dialogue between religious or political authorities and the scientific and public health communities is an essential first step.
