Dr. Deyashini Lahiri Tikkaa,  Dr. Sai Krishna Tikka, Dr. Daya Ramb, Dr. Indu Dubey

Abstract: Societies in India irrespective of the religion primarily follow a ‘shame and honor’ culture, where persons committing sin, in this instance consumption of alcohol foresee potential danger of loneliness that subsequently leads to decline in self-esteem. In this study, we aimed at comparing alcohol dependent Hindus (‘H+’) and alcohol dependent non-hindus (‘H-‘) on loneliness and self-esteem and, correlating these two measures. Fifty patients (all males) diagnosed alcohol dependence syndrome according to ICD (DCR)-10 and having successfully completed detoxification were divided into age matched ‘H+’ and ‘H-‘groups, each consisting of 25 subjects. Severity of dependence, self-esteem and loneliness were assessed with Severity of Alcohol Dependence Questionnaire (SADQ), Rosenberg Self Esteem Scale and revised UCLA Loneliness Scale respectively. Appropriate statistical methods were employed. The two groups did not differ significantly on age of onset, duration of alcohol intake and duration of alcohol dependence. Self-esteem was significantly lower (t=-2.38, p=0.02) in ‘H+’ group than in ‘H-‘group. Pearson correlation showed significant negative correlation (r= -0.44, p=0.02) between loneliness and self-esteem in ‘H+’ group.

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According to a national survey [1], the prevalence of alcohol abuse is found to be 21.4% in India. And majority (i.e. 80.5%) of India follows Hinduism [2]. Hindu mythology describes alcohol under the terms soma and sura. Soma or somras, with its life augmenting effects, is meant primarily for the Gods and people of upper classes of society; whereas sura is used by lower classes of human society, especially the warriors mostly for relieving physical pain [3]. Alcohol also finds its mention in epics like Ramayana and Mahabharata, which dichotomize the society into ‘the good and the bad’ based on various factors among which alcohol use or non-use is an important one. Alcohol is conceived as that fluid or dravyam, which ruins the body and the mind, and hence is considered a sin or paapam [4].

Other major religions practiced in India, Islam and Christianity too conceives alcoholism as sin. Bible says that alcohol is a gift from god that makes life more joyous, but that overindulgence leading to drunkenness is a sin [5] whereas Qur’an’s second and longest chapter, Sura al-Baqarah says though there is some benefit for men; sin of alcohol is far greater than benefit.

These three religions primarily follow a ‘shame and honor’ culture, where one’s self esteem depends on the person’s social acceptance in interpersonal relationships. And person committing a sin foresees potential danger in social rejection that leads to decline in self-esteem [6]. This distress with social rejection can be equated to loneliness. According to its most accepted definition, loneliness is the distress that arises from the incongruity between perceived and desired social relationships [7]. From this, we infer that the cognitive discrepancy of loneliness is a factor responsible for lowering self-esteem in individuals committing a sin, consumption of alcohol in this context. We hypothesized that there will not be any significant differences in the comparison/correlation measures between the two groups on loneliness and self-esteem in context of alcohol dependence.

Loneliness and self-esteem have been independently seen to be related to alcohol. Loneliness is found to be positively associated with alcohol use [8] and self-esteem to have an inverse relation with alcohol use [9]. In this study, we compared alcohol dependent Hindus and alcohol dependent non-hindus on loneliness and self-esteem and then assessed the correlation between these two measures in the two groups to test our hypothesis.

Materials and methods

The study had the approval of the Institute Ethics Committee of Central Institute of Psychiatry (CIP), Ranchi, India. Written informed consent was obtained from all the subjects after explaining them fully about the procedures and then enrolled into the study.
Fifty patients (all males) were recruited into the study by purposive sampling from those who were admitted to the De- addiction Centre of CIP. The inclusion criteria were International Classification of Diseases- diagnosis and research criteria ICD (DCR)-10 [10] diagnosis of alcohol dependence syndrome having successfully completed the detoxification phase of treatment and age between 18 and 50 years. The exclusion criteria were any history of neurological illness or significant head injury and presence of co-morbid/induced psychosis or any other psychiatric disorder.

Severity of dependence on alcohol was assessed with Severity of Alcohol Dependence Questionnaire (SADQ) [11]. It has four sub-scales of physical symptoms, mood and state of mind, recent period of drinking and period of off drinking followed by heavy drinking. Self-esteem was measured on a 10 item, 4 point scale- The Rosenberg Self Esteem Scale [12]. And Revised UCLA Loneliness Scale [13], consisting of 20 statements to be scored on a 4 point was used to measure loneliness.

Among the 50 patients, 25 practiced Hinduism and 25 were non-Hindus. They were grouped as ‘H+’ and ‘H-’ respectively. To summarize the continuous and discrete data percentages, mean and standard deviations of two groups were computed. Means were compared between the two groups using independent t test for continuous variables and using Chi square test was used to analyze categorical variables to find out the group differences. Pearson’s correlation was computed to find correlation between age of onset of alcohol intake, duration of alcohol intake, duration of alcohol dependence severity of alcohol dependence, self-esteem and loneliness.


All subjects were males. The mean (SD) age of ‘H+’ was 37.79 (7.74) years and of ‘H-‘was 39.27 (8.01) years. The mean (SD) age of onset was 22.48 (7.21) and 22.18 (6.21) years in ‘H+’ and ‘H-‘respectively. The mean (SD) duration of alcohol intake was 15.00 (8.32) years and the mean (SD) duration of alcohol dependence was 5.97 (4.15) years in ‘H+’ group. In ‘H-‘group, mean (SD) duration of alcohol intake was 17.18 (5.23) years and the mean (SD) duration of alcohol dependence was 5.36 (2.84) years.  Comparison of two groups showed no significant difference on any of these measures. ‘H+’ group had the mean (SD) dependence severity (SAD-Q score), loneliness (Revised UCLA score) and self-esteem as 19.86 (12.25), 19.10 (4.65) and 37.38 (10.34) respectively; whereas mean (SD) dependence severity (SAD-Q score), loneliness (Revised UCLA score) and self-esteem in ‘H-‘group were 27.82 (9.05), 22.64 (2.54) and 42.55 (11.73) respectively. Self-esteem (t=-2.38, p=0.02) was significantly lower in the ‘H+’ group than in the ‘H-‘ group. There were no significant differences between the two groups on comparison of means of dependence severity (t=-1.95, p=0.60) and loneliness (t=0.44, p=0.67). Pearson correlation showed significant negative correlation (r= -0.44, p<0.05) between loneliness and self-esteem in ‘H+’ group (Figure 1 showing scatterplot).


Almost all Indians are affiliated to a religion, and barring a sparse set of people who belong to urban part of the nation, most of Indian population believes in god. Although studies find religious involvement is associated with lower degrees of depressive symptoms [14-15], Pargament (1997) [14] states that several patterns of religious belief like, considering ones misfortunes as god’s punishment, are associated with greater psychological distress. Most religions as introduced, consider alcohol consumption in excess as sin. Now, a ‘shame’ society in contrast to a ‘guilt’ society is a society where inculcation of shame and the complementary threat of banishment are used as primary ways of gaining control over children and maintaining control over adults. Threat of banishment from social relationships as introduced defines loneliness. Loneliness resulting from alcohol dependence, hence is believed as a misfortune, which is god’s punishment, for committing the sin of consuming alcohol. Considering the statement by Pargament (1997) [14], we can surmise that such beliefs inculcated by the ‘shame and honor’ culture are psychologically distressing. And lowered self-esteem is one result of such distress.

All religions are diverse. Various rituals and religious coping strategies differ from religion to religion. Here the question arises- do negative religious beliefs of all religions produce similar amounts of distress? Results of the present study showed that self-esteem of Hindu group was found to be significantly lower than in the non-hindu group. Through this finding, we propose that various beliefs a ‘shame and honor’ society instills, differ from religion to religion and in particular produce higher psychological distress in those practicing Hinduism.

The study’s finding that loneliness has significant negative correlation with self-esteem in the alcohol dependent Hindu group, is additional evidence to the postulation that higher loneliness results in lowered self-esteem. This finding again emphasizes that such an association is stronger in Hindus.


Inculcation of shame and, threat of banishment into belief system of Hindus is stronger than in other religions, which lead to significant decline in self-esteem on consumption of alcohol in dependence pattern. And also, association between self-esteem and loneliness is stronger in Hindus.

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