The safe limit for alcohol consumption is zero ml. Yet, 23% of Indian men and 1% of women consume alcohol (NFHS-5). India also records one of the highest rates of heavy episodic drinking, with lakhs needing clinical and social support.
Alcohol consumption significantly raises the risk of injuries, mental illness, and non-communicable diseases, including cancer. Beyond health, alcohol use is associated with aggression, intimate partner violence, crime, suicides, and risky behaviour. It drives households into financial distress, often reinforcing generational poverty.
In 2021, alcohol-use contributed to approximately 2.6 million DALYs (Disability-Adjusted Life Years) in India, reflecting the combined toll of premature deaths and years lived with illness or disability. The estimated societal cost of alcohol-related health is ₹6.24 trillion. Meanwhile, per capita alcohol consumption increased by ~240% in the last two decades, an underestimate because nearly half of alcohol use in India is unrecorded.
Determinants of alcohol consumption
Alcohol use is shaped by a complex web of biopsychosocial, commercial and policy-leveldeterminants.
Biopsychosocial determinants: Biologically, some individuals are genetically predisposed to addiction. Alcohol activates the brain’s reward system – similar to nicotine or cocaine, praise, and money – making it habit-forming. Psychologically, people drink to relieve stress, anxiety, or experience euphoria. Socially, urban lifestyles, peer pressure, and glamourised portrayals in media have normalised alcohol use.
Commercial determinants: The industry has broadened its product portfolio with offerings such as fruit-flavoured spirits, pre-mixed cocktails, and other ready-to-drink options, making alcohol more appealing to new and younger users. Despite legal advertising restrictions, promotional tactics persist through surrogate advertising, brand sponsorships, and strategic product placements in Bollywood films and OTT content, where the depiction of alcohol has doubled over the past two decades. Pubs and bars offer incentives like ‘Happy Hours’ and free samples, while social media algorithms subtly amplify alcohol-related content (ARC).
The placement of liquor stores in residential and high-traffic areas, ensures easy access and everyday visibility. Packaging shapes consumer perception – sleek bottles, international labels, and premium branding enhance the aspirational value of alcohol.
Pricing ensures affordability. Indian Made Indian Liquor (IMIL) remains cheap and accessible to lower-income groups, especially in rural areas, while growing disposable incomes in cities have made alcohol increasingly affordable for the urban middle class.
Policy is the most influential determinant. The alcohol industry wields significant influence over regulation, often resisting stricter laws by emphasising its contribution to State revenues through excise taxes. Even bans on advertising are undermined through tactical marketing and alcohol persists in public life under different names.
Alcohol-policy landscape in India
Alcohol regulation in India falls under State jurisdiction, granting each State authority over legislation, excise taxes, supply chain, licensing and manufacturing, sale and consumption restrictions, prohibition, and pricing. This autonomy has led to regulatory variations across States.
For instance, Bihar, Gujarat, Mizoram, and Nagaland enforce prohibition, while Andhra Pradesh, Haryana, Kerala, Manipur, and Tamil Nadu had previously imposed similar bans. In contrast, some States are now actively promoting alcohol sales. Kerala’s new Akbari Policy markets toddy as a “natural, traditional beverage,” while Andhra Pradesh is introducing a policy offering alcohol for ₹99 to ensure “quality, quantity, and affordability.” Meanwhile, some States are exploring online alcohol delivery through platforms like Swiggy, Zomato, and Blinkit, contradicting efforts to restrict alcohol access.
Regulation of alcohol accessibility in India varies as equally as availability: the legal drinking age differs across States, ranging from 18 to 25 years. Alcohol pricing regulation exists in 19 of 33 States/UTs, with nine States setting only maximum prices while others setting both maximum and minimum prices. The GST Act excludes liquor from sales tax, leaving alcohol taxes to States, often vaguely defined in excise policies.
Compared to State policies, national-level policies are more specific addressing single aspects such as drunk driving or prevention of alcohol use and regulating supply-chain in an individual policy. However, India lacks a unified national policy on alcohol regulation.
Earlier, alcohol was excluded from the National Policy on Narcotic Drugs and Psychotropic Substances (NDPS) 2012 despite being a common psychoactive substance followed by cannabis and opioids. Later, alcohol regulation was included in the National Action Plan for Drug Demand Reduction (NAPDDR) 2021-22 under Nasha Mukta Bharat Abhiyan.
While the NAPDDR addresses alcohol regulation, its demand and supply reduction efforts are scattered across Central ministries and State governments. The Ministry of Social Justice leads demand reduction, while supply and harm reduction are handled by the Ministries of Home Affairs, Finance, and Health.
The National Mental Health Policy (NMHP) 2014 recognised the role of alcohol in mental illness and suicide prevention and suggested the need for a specific action plan. Similarly, the National Health Policy (NHP) 2017 mentioned curbing alcohol use through higher taxation.
More recently, the National Suicide Prevention Strategy (NSPS) 2022 identified alcohol as a major risk factor for suicides, advocating for a national alcohol control policy and measures to limit alcohol accessibility.
The National Action Plan and Monitoring Framework for Prevention and Control of Noncommunicable Diseases (NMAP) 2017-2022 also echoed the call for a national alcohol policy.
The way ahead: a systems approach to India’s alcohol crisis
Regulating alcohol is urgent but complex, given alcohol’s deep entanglement with State revenues, social norms, and political interests. India’s fractured, State-led approach and lack of a national implementation strategy have allowed industry influence to flourish, while public health suffers. It is time to move beyond short-term revenue thinking and adopt a systems approach – grounded in both evidence and equity. Based on the biopsychosocial and commercial determinants of alcohol consumption, we propose the following to regulate alcohol-use. These levers must act together to shift the ecosystem that enables harmful alcohol use.
Affordability: Alcohol pricing must deter excessive use without pushing the poor toward dangerous alternatives like illicit liquor. Higher excise taxes, paired with strong enforcement against illicit trade, can reduce harmful consumption.
Allocation: Health taxes on alcohol should not disappear into general revenues. Ear-marking these funds for public health, combined with transparent governance, can improve trust and accountability – and prevent corporate lobbying from redirecting them.
Accessibility: Alcohol access must be curbed beyond geographic distance. Online delivery, alcohol in malls, food courts, and other casual settings normalise its use. Urban policy must reduce availability in everyday spaces to signal a shift toward alcohol-free environments.
Advertisement: In the digital age, “alcohol influencers” in India promote consumption by framing alcohol positively. With the rise of social media influencers, user-generated ARC, and glamourised portrayals in movies and OTT platforms, the alcohol industry has found subtle ways to market. Regulating this “social surrogacy” – including algorithmic amplification – is key to reducing social appeal.
Attractiveness: From glossy packaging to surrogate advertising and premium displays, alcohol’s allure is manufactured. Plain packaging, visible warning labels, and controls on point-of-sale promotion are needed to disrupt the cycle of normalisation.
Awareness: Public understanding of alcohol’s health harms – especially its link to cancer, mental illness, and generational poverty – remains low. Large-scale public education campaigns, similar to tobacco control efforts, are overdue.
Artificial Intelligence:AItools can detect and suppress alcohol-related content on digital platforms and flag misinformation. When 180 million monthly users see health misinformation (e.g., WebMD praising alcohol), it is clear that digital regulation is a frontline public health priority.
Toward a national framework
India’s alcohol crisis cannot be solved through isolated actions or State-level measures. It is time for a National Alcohol Control Policy and Programme that prioritises people over profit, prevention over revenue, and long-term well-being over short-term gains.
(Dr. Vid Karmarkar, is a venture building partner at Fittr, and the founder of Canseva Foundation. vid.karmarkar@gmail.com; Jitendra Chouksey is the Founder and CEO of Fittr, a fitness company. jc@fittr.com)
Published – June 20, 2025 06:30 am IST
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