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Our Favourite Drink
E H Kua

Alcoholism is not perceived as a major problem in Singapore or the Asean countries, but with the growing affluence there is a trend towards a steady increase in alcohol consumption. It is difficult to ascertain the prevalence of alcoholism in a given population but it is well recognised that a rise in the national per capita alcohol consumption is often followed by a proportional rise in the rate of alcoholism.
There are very few studies on alcoholism in Chinese people although drinking is not uncommon within the culture, especially during auspicious events such as weddings, festivals and birthdays. The extent of alcohol consumption in Singapore was surveyed in a Ministry of Health study in 1990(1). The random sample included 1,547 subjects aged 18 to 65 years, stratified in terms of sex, ethnic group and socio-economic status according to thc population census. The results indicated that only 17% of Chinese drank alcoholic beverages, 8% drank 4-20 days a month and 2% more than 20 days a month. 
Studies have demonstrated the significance of cultural factors in determining the occurrence of alcoholism. In a comparative study of alcoholism in Chinese and Indian patients admitted to a hospital in Singapore, there was a preponderence of men in both ethnic gtoups. It was also found that Indian patients started drinking at an earlier age and more had a family history of alcohol problems(2). 
Although alcoholism is predominantly a male problem, in a study of alcohol-related hospitalisation in Singapore, about 30% of a sample of 62 cases were Chinese women, who were admitted mainly for depression or attempted suicide. Most of the women were young (mean age 27 years) and did not have any serious physical health problems but had relationship or work conflicts(3).
Studies in the West have shown that the prognosis of alcoholism is generally not optimistic. A follow-up study in Singapore of 70 patients referred for treatment of drinking problems found that after one year, 60% remained in abstinence, 8.5% social drinking, 28.5% relapsed or defaulted and 3% died(4). A poor outcome was observed in younger patients (20-39 years) compared to older patients (40-59 years). Compared with studies in the West, the outcome was better and this was partly because the Singapore patients were generally less severely dependent and had good family support.
One of the most cost-effective policies to reduce alcohol-related problems is the early identification of heavy and high risk drinkers. The article by Allen et al is a timely reminder that early detection is crucial and the family doctor has a pivotal role(5).