The unintended effect of alcohol prohibition on adolescents’ mental health

Alcohol consumption is typically initiated during adolescence, with long-lasting implications on adult health, economic stability, and well-being. Analysing Bihar’s alcohol ban, this article finds adverse impacts on adolescents’ mental health – driven by increased access to illegal alcohol from neighbouring states and higher consumption of home-brewed and locally produced alcohol. Additionally, there was an increase in risky behaviours and deterioration in the adolescent social environment.

With 21% of the population belonging to the 10-19 age group as per the 2011 Census, India has the largest population of adolescents across the world. A large fraction of men under the legal drinking age in India consume alcohol (Luca et al. 2019). Alcohol consumption among the younger population is steadily increasing, with children as young as 13-15 years of age consuming alcohol (Gururaj et al. 2016). This is a public health concern, as alcohol consumption initiated during adolescence is associated with higher chances of alcohol disorders later in life (DeWit et al. 2000). Alcohol consumption in adolescence is also associated with traffic accidents, risky sexual behaviours, teenage pregnancies, violent crimes, mental health problems, lower academic performance, and poor employment opportunities (Ruhm 1996, Dee 1999, Felson and Staff 2010, Joshi et al. 2017). Young individuals have a higher ‘discount rate’ in comparison to adults (Lahav et al. 2010) – that is, they are more likely to choose the immediate reward from drinking and smoking over the delayed reward of academic (or labour market) success (Murphy and Dennhardt 2016).

However, it is difficult to estimate the causal relation between alcohol use and health outcomes due to unobserved factors (for example, individuals value health investments differently, which could lead to simultaneous effects on alcohol use: Some may value their present outcomes more than their future while others are more far sighted) and reverse causality (for example, poor mental health can lead to an alcohol problem). In our research (Aggarwal et al. 2025), we study the causal relation between alcohol consumption and mental health of adolescents in India.

While India’s average alcohol consumption is less than the developed world, there has been an increasing trend in alcohol consumption in recent years. (Prasad 2009). Almost 20% of men and 1% of women above the age of 15 years consume alcohol (National Family Health Survey, 2019). Several alcohol prohibition laws have been passed across India including bans implemented by the states of Gujarat, Mizoram, Nagaland, Andhra Pradesh, Haryana, Kerala, Manipur, and Tamil Nadu. Unlike previous regulations, the Bihar alcohol ban, announced overnight, makes for an interesting ‘natural experiment’ to estimate the causal impact of alcohol prohibition on alcohol consumption, mental health, and other related outcomes.

The Bihar Prohibition and Excise Act, 2016

The Bihar Prohibition and Excise Act, 2016 states that “no person shall manufacture, bottle, distribute, transport, collect, store, possess, purchase, sell or consume any intoxicant or liquor”. Initially, the ban was partial, targeting country-made liquor, but it was soon extended to cover all types of alcohol, including foreign-made liquor, across the state. While the ban has shown to be effective in decreasing domestic violence, increasing household savings, and reducing alcohol-related health issues (Chakrabarti et al. 2024), there has been a substantial loss in excise revenue, along with expenditure burden owing to resources deployed to implement the ban. The ban also led to increase in illicit production and smuggling of alcohol from outside the state including from neighbouring countries like Nepal, resulting in consumption of toxic or adulterated liquor. Newspaper reports and publicly available court orders suggest that juveniles and the poor were exploited to facilitate the transportation and sale of illegal alcohol. It is not surprising that the years following the ban show a rise in the excise revenue of neighbouring states like Uttar Pradesh and Jharkhand, indicating that illegal cross-border trade was indeed prevalent.

Figure 1. Excise revenue trends for Bihar and other states

We attempt to exploit the potential variation in alcohol access caused by the ban to study its impact on mental health of adolescents. We do so by comparing the outcome in Bihar (the state which was subject to the intervention) to other states where there was no alcohol ban. However, the illegal cross-border trade could lead to spillover effects of the ban on neighbouring states, which can potentially contaminate ‘control’ groups (not subjected to intervention). To combat the potential contamination problem, we use a control group of the closest states to Bihar which do not share any borders with Bihar. We argue that these states (namely Madhya Pradesh, Chhattisgarh, and Assam) are better control groups as the spillovers are less likely there.

Data and findings

The analysis is conducted using data from two sources. First, we study mental health outcomes among 10 to 20-year-olds using longitudinal data from Understanding the Lives of Adolescents and Young Adults (UDAYA), collected in two waves – first in 2015-2016 and then in 2018-2019 Next, we study alcohol consumption and its source for the age group 15 to 20 from two rounds of the Demographic and Health Survey, NFHS- 4 (2015-2016) and NFHS-5 (2019-2021).

After the complete, unannounced ban on the production, sale and consumption of alcohol, we find that the mental health outcomes of adolescents worsened (by 0.09 standard deviations¹ relative to the control group. The probability of extreme mental health conditions like thoughts of death and depressive symptoms see an increase of 2.6% and 4.2% after the ban. Those affected were 13.5% more likely to have trouble falling asleep, in addition to 5.2% higher likelihood of exhaustion and 3.2% of restlessness.

Figure 2. Adolescent mental health indicators and social environment

Further, alcohol consumption and smoking probabilities go up for adolescents in Bihar by 3 and 12 percentage points, respectively. Additionally, the ban led to an increase in risky behaviours, including bullying and fighting, and deterioration in adolescent social environment. Post-ban, adolescents were more likely to justify wife-beating, show greater violent tendencies, and reported more leisure time, as evidenced by increased time spent on the internet and watching TV/movies.

The ban also had a differential impact by household wealth of adolescents. The poorest income groups faced the brunt of the ban in terms of deterioration in mental health and were 3% more likely to consume alcohol. The increase in alcohol consumption for the poor can be attributed mostly to non-market sources, potentially more harmful than legal forms of alcohol. In contrast, the richest individuals had no significant change in alcohol consumption and no change in the source of alcohol, suggesting that the ban did not change alcohol-specific behaviour for this group.

Figure 3. Change in substance use among the poor and the rich

Policy implications

A total prohibition on alcohol disproportionately affects the poor. Not only does it lead to a loss in state revenue (which could have been used for welfare schemes), it also shifts the poor to turn to moonshining, while the wealthy source liquor from neighbouring states. This creates a situation where the vulnerable sections bear the brunt of the negative consequences like exposure to unregulated and unsafe alcohol, which can further exacerbate health and social inequities.

We also demonstrate that such policies have a significant, disproportionate impact on the young. Additionally, we highlight the often-overlooked cost of alcohol prohibition on the mental health of an impressionable population. These unintended consequences underscore the need for a more comprehensive understanding of the broader effects of such policies on vulnerable populations.

Note:

1. Standard deviation is a measure used to quantify the amount of variation or dispersion of a set of values from the mean (average) value of that set.