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การบริโภคเครื่องดื่มแอลกอฮอล์ในประเทศไทย

โดย นพ.บัณฑิต ศรไพศาล/วารสารคลินิก ปีที่ 22 ฉบับที่1มกราคม 2549





จากข้อมูลจากรมสรรพสามิตพบว่า อัตราการบริโภคเครื่องดื่มผสมแอลกอฮอล์เฉลี่ย 58.0 ลิตรต่อคนต่อปีใน พ.ศ. 2546 เพิ่มจากปี พ.ศ. 2532 ที่อัตราการดื่มเฉลี่ย 20.2 ลิตรต่อคนต่อปีเกือบ 3 เท่าตัว เฉพาะอัตราการบริโภคเฉลี่ยต่อคนต่อปีเพิ่มขึ้นในปี พ.ศ. 2546 เทียบกับปี พ.ศ. 2532 มากกว่า 8 เท่าตัว จากอัตราเฉลี่ย 4.4 ลิตรต่อคนในปี พ.ศ. 2532 เพิ่มเป็น 39.4 ลิตรต่อคนในปี พ.ศ. 2546 โดยในปี พ.ศ. 2546 กรมสรรพสามิตและกรมศุลกากรเก็บภาษีเครื่องดื่มแอลกอฮอล์สูงถึง 6.27 หมื่นล้านบาทจากการใช้เงินประมาณ 2 แสนล้านบาทของคนไทยในการซื้อมาบริโภค

ข้อมูลที่ได้จากการสำรวจการดื่มเครื่องดื่มแอลกอฮอล์ของประชากรไทยอายุ 11 ปีขึ้นไป ในโครงการสำรวจสถิติสังคม การสำรวจเกี่ยวกับอนามัยและสวัสดิการ ซึ่งทำการสำรวจทุก 5 ปี ของสำนักงานสถิติแห่งชาติ พบว่าปี พงศ. 2546 คนไทยดื่มสุรา 18.6 ล้านคน คิดเป็นร้อยละ 35.46 ของประชากรอายุ 11 ปี ขึ้นไป แยกเป็นชาย 15.5 ล้านคน หรือร้อยละ 60.8 ของเพศชายอายุ 11 ปีขึ้นไป เป็นหญิง 3.95 ล้านคนหรือร้อยละ 14.5 ของเพศหญิงอายุ 11 ปีขึ้นไป สำหรับการสำรวจของสำนักงานสถิติแห่งชาติปี พ.ศ. 2534, 2539, 2544 และ 2546 พบว่า การดื่มเครื่องดื่มแอลกอฮอล์ตั้งแต่ 1-2 ครั้งขึ้นไปต่อสัปดาห์ ซึ่งถือได้ว่าเป็นกลุ่มที่ดื่มประจำ มีแนวโน้มที่จะเพิ่มขึ้นในประชากรชายจากร้อยละ 34.9 ในปี พ.ศ. 2534 เป็นร้อยละ 39.1, 39.3 และ 43.9 ในปี พ.ศ. 2539, 2544 และ 2546 ตามลำดับ ส่วนเพศหญิงมีอัตราร้อยละ 18.1 ในปี พ.ศ. 2534 และมีแนวโน้มที่ลดลงเป็นร้อยละ 20.4, 19.5 และ 16.7 ในปี พ.ศ. 2539, 2544 และ 2546 ตามลำดับ

การสำรวจจำนวนผู้บริโภคเครื่องดื่มแอลกอฮอล์จากครัวเรือนตัวแทนทั่วประเทศที่มีอายุระหว่าง 12-65 ปี ซึ่งทำการสำรวจโดยคณะกรรมการบริหารเครือข่ายวิชาการสารเสพติด พบว่า ในปี พ.ศ. 2546 ประชากรร้อยละ 58.5 หรือประมาณ 26,566,000 คน เคยดื่มเครื่องดื่มแอลกอฮอล์ในชีวิต ร้อยละ 46.4 หรือประมาณ 21,083,200 คน ดื่มในช่วง 1 ปีที่ผ่านมา และร้อยละ 34.8 หรือประมาณ 15,786,500 คน ดื่มในช่วง 30 วัน ก่อนการสำรวจ เมื่อเทียบกับการสำรวจเช่นเดียวกันนี้ในปี พ.ศ. 2544 พบว่าอัตราการดื่มในปี พ.ศ. 2546 ลดลง แต่หากดูเฉพาะผู้ที่ดื่มมากกว่า 20 วัน ในระยะเวลา 30 วัน ก่อนสอบถาม ซึ่งถือเป็นกลุ่มที่ดื่มประจำหรือผู้ที่มีโอกาสติดสุราสูง พบว่ามีแนวโน้มสูงขึ้น คือจากร้อยละ 3.5 ในปี พ.ศ. 2544 เป็นร้อยละ 4.1 ในปี พ.ศ. 2546




จำนวนเยาวชนที่ดื่มมากขึ้นและอายุที่เริ่มดื่มน้อยลง

ข้อมูลจากสำนักงานสถิติแห่งชาติ พบว่าเด็กรุ่นใหม่มีแนวโน้มการดื่มแอลกอฮอล์เพิ่มมากขึ้น และเริ่มดื่มที่อายุน้อยลง ในช่วงเวลาเพียง 7 ปี (พ.ศ. 2539-2546) กลุ่มผู้หญิงวัย 15-19 ปี เป็นกลุ่มที่น่าจับตามากที่สุด เนื่องจากมีการเพิ่มจำนวนขึ้นเกือบ 6 เท่า คือ จากร้อยละ 1.0 เป็นร้อยละ 5.6 และในกลุ่มหญิงที่ดื่มวัย 15-19 ปีนี้ร้อยละ 14.1 เป็นกลุ่มที่ดื่มประจำ (ดื่ม 1-2 ครั้งต่อสัปดาห์ถึงดื่มทุกวัน) วัยรุ่นเพศชายวัย 11-19 ปี ที่ดื่มมีจำนวนประมาณ 1.1 ล้านคน คิดเป็นร้อยละ 21.2 ของประชากรในกลุ่มอายุนี้ สำนักงานสถิติแห่งชาติสำรวจซ้ำในปี พ.ศ. 2547 พบว่าประชากรชายเริ่มดื่มสุราครั้งแรกเมื่ออายุเฉลี่ย 19.4 ปี โดยร้อยละ 52.8 ของประชากรชายเริ่มดื่มครั้งแรกในช่วงอายุ 15-19 ปี ขณะที่หญิงเริ่มดื่มครั้งแรกในช่วงอายุ 20-24 ปี

ขณะที่ผลสำรวจจากนักเรียนมัธยมศึกษาในจังหวัดลพบุรี พบว่า นักเรียนชายและหญิงที่ดื่มสุราซึ่งมีอายุ 14-16 ปีในปัจจุบัน ระบุว่าเริ่มดื่มตั้งแต่อายุระหว่าง 13-14 ปี ด้วยอัตราส่วนสูงที่สุดประมาณร้อยละ 44 และ 46 ตามลำดับ ส่วนนักเรียนชายและหญิงที่อายุปัจจุบัน 17-20 ปี ระบุว่าเริ่มดื่มเมื่ออายุ 15-16 ปี สูงสุดด้วยอัตราใกล้เคียงกันคือประมาณร้อยละ 43 และ 40 ตามลำดับ จึงมีแนวโน้มว่านักเรียนเริ่มหัดดื่มเครื่องดื่มแอลกอฮอล์เมื่ออายุน้อยลงเรื่อยๆ

แบบแผนการดื่มและรสนิยมในการดื่ม

ประชากรไทยดื่มสุราเป็นประจำเกือบ 1 ใน 6
ในปี พ.ศ. 2547 สำนักงานสถิติแห่งชาติได้สำรวจพบว่าประชากรอายุ 15 ปีขึ้นไปร้อยละ 17.8 ดื่มสุราหรือเครื่องดื่มมึนเมาเป็นประจำ และร้อยละ 14.9 ดื่มนานๆ ครั้ง ส่วนประเภทของเครื่องดื่มแอลกอฮอล์ที่ประชากรนิยมดื่มมากที่สุด ได้แก่ เบียร์และสุราขาว คิดเป็นร้อยละ 33.0 และ 32.3 ตามลำดับ

ผู้ที่ดื่มประจำส่วนใหญ่เลือกสุราขาวเป็นเครื่องดื่มประจำ สุราไทยเป็นเครื่องดื่มที่นิยมดื่มรวมเป็นกลุ่ม สุราจีนและยาดองเป็นเครื่องดื่มสำหรับการดื่มคนเดียว ส่วนเบียร์ผู้ชายจะดื่มเป็นกลุ่ม แต่ผู้หญิงจะดื่มเบียร์คนเดียว สุราขาวสำหรับผู้ชายนั้นจะดื่มทั้งเป็นกลุ่มและดื่มคนเดียว แต่ผู้หญิงจะดื่มสุราขาวเป็นกลุ่มมากกว่า

โครงการการศึกษาปัญหาที่เกี่ยวข้องกับการบริโภคเครื่องดื่มแอลกอฮอล์ เพื่อหามาตรการทางเลือกป้องกันและแก้ไข ซึ่งดำเนินการระหว่างปี พ.ศ. 2539-2541 ที่จังหวัดลพบุรี พบว่า เครื่องดื่มที่ได้รับความนิยมของครัวเรือนในจังหวัดลพบุรี ได้แก่ สุราไทยหรือที่ชาวบ้านเรียกว่าสุราแดง มี 3 ยี่ห้อ คือ แม่โขง หงษ์ทอง และแสงทิพย์ สุราขาวที่ชาวบ้านเรียกเหล้าขาวหรือ 35 ดีกรี สุราจีนหรือที่ชาวบ้านเรียกสุราเชี่ยงชุน เบียร์คือ สิงห์และช้าง และยาดอง มีการแบ่งกลุ่มผู้ดื่มเป็น 2 กลุ่ม คือกลุ่มที่ดื่มเป็นประจำซึ่งดื่มทุกวันหรือเกือบทุกวันโดยดื่มเครื่องดื่มแอลกอฮอล์ชนิดใดชนิดหนึ่งหรือ 2 ชนิดอย่างสม่ำเสมอ อีกกลุ่มคือกลุ่มผู้ดื่มเป็นครั้งคราวเป็นผู้ที่ดื่มแต่เฉพาะเมื่อมีงานรื่นเริง งานเทศกาลหรือโอกาสสังสรรค์ กลุ่มที่ดื่มประจำส่วนมากร้อยละ 60.1 เลือกสุราขาวเป็นเครื่องดื่มประจำ ผู้ที่ดื่มเป็นประจำประมาณครึ่งหนึ่งเป็นพวกดื่มคนเดียว อีกครึ่งหนึ่งเป็นพวกที่ต้องดื่มเป็นกลุ่ม เช่น ดื่มกับเพื่อนบ้านหรือที่ทำงาน สุราไทยเป็นที่นิยมของผู้ดื่มเป็นกลุ่มมากกว่าผู้ดื่มคนเดียวตรงข้ามกับสุราจีนและยาดอง ซึ่งเป็นที่นิยมของผู้ดื่มสุราคนเดียวมากกว่าดื่มเป็นกลุ่ม สำหรับเบียร์มีลักษณะต่างกันระหว่างผู้ดื่มหญิงกับผู้ดื่มชาย คือ เบียร์นั้นเป็นที่นิยมของผู้ชายที่ดื่มเป็นกลุ่มมากกว่าผู้ชายที่ดื่มคนเดียว แต่ตรงข้ามกับผู้หญิงซึ่งนิยมดื่มเบียร์คนเดียวมากกว่าดื่มเป็นกลุ่ม นั่นหมายความว่าสุราไทยเป็นเครื่องดื่มที่นิยมดื่มรวมเป็นกลุ่มสุราจีนและยาดองเป็นเครื่องดื่มสำหรับดื่มคนเดียว ส่วนเบียร์ผู้ชายจะดื่มเป็นกลุ่ม แต่ผู้หญิงจะดื่มเบียร์คนเดียว สุราขาวสำหรับผู้ชายนั้นจะดื่มทั้งเป็นกลุ่มและดื่มคนเดียว แต่ผู้หญิงจะดื่มสุราขาวเป็นกลุ่มมากกว่า เครื่องดื่มที่ผู้หญิงนิยมดื่มมากกว่าผู้ชาย ได้แก่ น้ำผลไม้ผสมแอลกอฮอล์ไวน์พื้นบ้าน/สปาย/ไวน์ชาวบ้านทำเอง

ผู้ที่ดื่มเป็นครั้งคราวส่วนใหญ่จะดื่มเป็นกลุ่ม เบียร์และสุราไทยใช้เป็นเครื่องดื่มกับกลุ่มเพื่อนที่ทำงาน (เพื่อนในวิถีชีวิตแบบใหม่) ส่วนสุราขาวใช้เป็นเครื่องดื่มกับกลุ่มเพื่อนบ้าน(เพื่อนในวิถีชีวิตดั้งเดิม)

สำหรับกลุ่มผู้ดื่มเป็นครั้งคราว เป็นกลุ่มที่มีพฤติกรรมรวมกลุ่มทางสังคมอย่างชัดเจน ผู้ดื่มเป็นครั้งคราวกว่าร้อยละ 80 มักดื่มเป็นกลุ่มกับเพื่อนบ้าน ญาติ เพื่อนที่ทำงาน และกับลูกน้อง พฤติกรรมการดื่มมีความแตกต่างระหว่างชนิดเครื่องดื่มกับกลุ่มที่ดื่มด้วย กล่าวคือผู้ชายที่ดื่มสุราไทยและผู้ชายที่ดื่มเบียร์มักจะดื่มกับเพื่อนที่ทำงานเป็นส่วนมาก คือ ร้อยละ 45.3 และร้อยละ 39.4 แต่ผู้ชายที่ดื่มสุราขาว จะดื่มกับญาติกับคู่รักมักจะดื่มเบียร์หรือสุราขาว ร้อยละ 24.5 และ 23.7 ตามลำดับ ส่วนผู้หญิงไม่ว่าจะดื่มสุราไทย เบียร์ หรือสุราขาว ก็มักจะดื่มกับเพื่อนบ้านเป็นส่วนมาก ร้อยละ 62.2, 58.3 และ 67.4

แรงงานสูงอายุนิยมดื่มสุราขาว แรงงานวัยกลางคนนิยมดื่มสุราไทย และแรงงานวัยรุ่นและผู้ใหญ่ตอนต้นนิยมดื่มเบียร์

ส่วนการสำรวจแรงงานในจังหวัดลพบุรี พบว่าเบียร์เป็นเครื่องดื่มซึ่งเป็นที่นิยมในกลุ่มแรงงานที่อายุต่ำกว่า 19 ปี กลุ่มอายุ 20-29 ปี และ 30-39 ปี ส่วนแรงงานอายุ 40-49 ปี จะนิยมดื่มสุราไทยมากที่สุดและผู้ที่อายุ 50 ปีขึ้นไป นิยมดื่มสุราขาว ส่วนใหญ่ผู้ใช้แรงงานจะดื่มสุราเป็นครั้งคราว ผู้ใช้แรงงานชายเกือบครึ่งรายงานว่าดื่มเฉลี่ยแต่ละครั้ง 1 ขวดแบน (350-375 มล.) ขณะที่อีก 1 ใน 5 ของแรงงานชายดื่มแต่ละครั้งเฉลี่ย 1 ขวดกลม (750 มล.)

เด็กวัยรุ่นนิยมดื่มสุราสมัยใหม่ ได้แก่สุราไทยและเบียร์

วิชัย โปษยะจินดา และคณะวิจัยศึกษาเครื่องดื่มแอลกอฮอล์ที่นักเรียนในจังหวัดลพบุรีดื่มบ่อยที่สุด พบว่านักเรียนที่ดื่มเครื่องดื่มแอลกอฮอล์ประมาณครึ่งหนึ่งดื่มสุราไทย นักเรียนที่ดื่มจำนวน 1 ใน 4 เลือกดื่มเบียร์ ขณะที่จำนวนนักเรียนที่ดื่มสุราต่างประเทศและไวน์คูลเลอร์เท่ากันคือประมาณ 1 ใน 10 ส่วนที่เหลือดื่มสุราขาวบ้าง สุราเถื่อนบ้าง ยาดองบ้าง สำหรับเหตุผลในการเลือกดื่มสุราไทยของนักเรียนทั้งชายและหญิงตรงกันคือ สุราไทยหาซื้อได้ง่าย ดื่มแล้วสนุกสนาน ส่วนเหตุผลในการเลือกดื่มเบียร์ทั้ง 2 กลุ่มเห็นตรงกันคือดื่มแล้วไม่เมาและมีแอลกอฮอล์น้อย

ผลกระทบจากการดื่มเครื่องดื่มแอลกอฮอล์

ผลกระทบจากการดื่มเครื่องดื่มแอลกอฮอล์มีหลายประการและมากขึ้นตามปริมาณที่ดื่มด้วย

ผลการศึกษาผลกระทบของการดื่มเครื่องดื่มแอลกอฮอล์ที่จังหวัดลพบุรี พบว่า กลุ่มที่ดื่มประจำเพศชายรายงานว่าเกิดปัญหาทะเลาะวิวาทเป็นอันดับหนึ่ง คือ ร้อยละ 45.6 ตามมาด้วยปัญหาสุขภาพ และปัญหาอุบัติเหตุร้อยละ 32.9 และ 30.1 ตามลำดับ ส่วนเพศหญิงที่ดื่มประจำรายงานว่าเกิดปัญหาทะเลาะวิวาทปัญหาสุขภาพ และปัญหาอุบัติเหตุร้อยละ 33.2, 19.7 และ 4.8 ตามลำดับ และยังพบว่าการดื่มเครื่องดื่มฯ ทำให้เกิดอันตรายหรือปัญหากับผู้ดื่มมากขึ้นตามปริมาณการดื่มที่มากขึ้นด้วย โดยพบว่าอัตราส่วนของปัญหาที่เกิดขึ้นกับผู้ดื่มทั้งด้านการทะเลาะวิวาทสุขภาพ และอุบัติเหตุมีมากที่สุดในกลุ่มที่ดื่มเครื่องดื่มฯ “ประจำ” ลดน้อยลงในกลุ่มที่ดื่ม “ครั้งคราว” และน้อยที่สุดในกลุ่มที่ “หยุดดื่ม” ปรากฏการณ์เช่นนี้เกิดทั้งผู้ดื่มผู้หญิงและผู้ชาย ดังนี้ ปัญหาการทะเลาะวิวาทเกิดกับชายดื่มประจำมากกว่าชายหยุดดื่มเกือบ 6 เท่า เกิดกับหญิงดื่มประจำมากกว่าหญิงหยุดดื่มเกือบ 14 เท่า ปัญหาสุขภาพของชายดื่มประจำเกิดขึ้นมากกว่าชาย หยุดดื่มถึง 3 เท่ากว่า และในกลุ่มหญิงดื่มประจำสูงถึง 9 เท่า เมื่อเทียบกับหญิงที่หยุดดื่ม และปัญหาอุบัติเหตุ ซึ่งเกิดกับผู้ชายมากกว่าผู้หญิงนั้น เกิดกับชายดื่มประจำมากกว่าชายหยุดดื่มถึง 7 เท่า เกิดกับหญิงดื่มประจำสูงเกือบ 14 เท่า เมื่อเทียบกับผู้หญิงหยุดดื่ม

ผลการศึกษาผลกระทบทางสุขภาพจากการบริโภคเครื่องดื่มแอลกอฮอล์โดยกนิษฐา บุญธรรมเจริญและคณะ ทำงานศึกษาภาระโรคจากพฤติกรรมและปัจจัยเสี่ยงทางสุขภาพ สำนักนโยบายและยุทธศาสตร์ กระทรวงสาธารณสุข ในปี พ.ศ. 2542 พบว่าภาระโรคที่มีสาเหตุจากการดื่มเครื่องดื่มแอลกอฮอล์เป็นอันดับ 2 ของการสูญเสียทางสุขภาพ โดยทำให้เกิดภาระโรค คิดเป็นร้อยละ 5.8 ของการสูญเสียทั้งหมด โดยเป็นรองจากการมีเพศสัมพันธ์ที่ไม่ปลอดภัย และสร้างภาระโรคมากกว่าการสูบบุหรี่ ความดันเลือด การไม่สวมหมวกนิรภัย เป็นต้น โดยเพศชายมีการสูญเสียที่มากถึงร้อยละ 9.2 ส่วนเพศหญิงน้อยกว่า คือ สูญเสียเพียงร้อยละ 1.

ผลกระทบด้านปัญหาความรุนแรงและการทะเลาะวิวาท

ครอบครัวเป็นกลุ่มแรกที่ได้รับผลกระทบจากการดื่มฯ ของคนในครอบครัว
การดื่มสุราส่งผลให้เกิดผลกระทบตามมามากมาย ไม่เฉพาะต่อผู้ที่ดื่มเท่านั้น แต่เกิดกับคนรอบข้างด้วย ครอบครัวที่มีสมาชิกดื่มเครื่องดื่มฯ แม้เพียง 1 คน ผลกระทบที่เกิดขึ้นอาจมากหรือน้อยตามความรุนแรงของปัญหา แต่หน่วยที่ต้องแบกรับภาระความเสียหายคือ ครอบครัว จากการวิจัยพบว่า ปัญหาที่เกิดในครอบครัวจากสามีที่ดื่มเครื่องดื่มฯ “ประจำ"”แล้วทำร้ายร่างกายภรรยาเกิดขึ้นร้อยละ 5.7 และภรรยาที่ดื่ม “ประจำ” แล้วทำร้ายร่างกายสามีเกิดขึ้นร้อยละ 6.2 ของผู้ที่ดื่มประจำ ดังข้อมูลจากการวิจัยเชิงคุณภาพของมูลนิธิเพื่อนหญิง พบว่าผลพวงของการดื่มสุราทำให้เกิดความรุนแรงในครอบครัว จนกระทั่งป้าบังอร (นามสมมติ) ต้องตัดสินใจเลิกกับสามีอย่างเด็ดขาด ป้าบอกว่า “วันนั้นเขาเมามาก แล้วมาพาลป้า ป้าก็บอกเขาดีๆ ว่าเมาแล้วก็ไปนอน แต่เขาไม่ฟังตรงเข้ามาเตะป้าที่หน้า โดนฟันป้าหัก ฟันที่หักปักหลังเท้าเขาไป 2 ซี่ ปากของป้าเต็มไปด้วยเลือด จนต้องไปโรงพยาบาลเย็บปากและเหงือกที่แตก ป้าต้องรักษาตัวเป็นเดือนๆ ทรมานที่สุด เจ็บระบมปากไปหมด กินได้เฉพาะน้ำข้าว ใช้หลอดดูด กินแบบนี้เป็นเดือนๆ จึงตัดสินใจเลิก ลูกๆ ก็โตกันหมดแล้ว ช่วยตนเองได้แล้ว ไม่อยากอยู่กับเขาอีกแล้ว

รณชัย คงสกลธ์ ศึกษาเปรียบเทียบครอบครัวที่มีความรุนแรง 100 ครอบครัว กับครอบครัวที่ไม่ใช้ความรุนแรง 100 ครอบครัว จาก 7 ชุมชนรอบโรงพยาบาลรามาธิบดี พบว่า ครอบครัวที่ใช้สุรามีโอกาสเกิดความรุนแรงในครอบครัวเป็น 3.84 เท่า เมื่อเทียบกับครอบครัวที่ไม่ใช้สุรา

การดื่มสุรานอกจากจะทำให้เกิดอันตรายแก่ครอบครัวผู้ดื่มแล้ว ยังทำให้ผู้อื่นเดือดร้อนด้วย

ผลของการวิเคราะห์ข้อมูลคดีอาญาศาลจังหวัดลพบุรี ซึ่งมีสาเหตุมีการดื่มสุราเกี่ยวข้องเมื่อเทียบเป็นความชุกจำเพาะตามประเภทฐานความผิด พบดังนี้
1. ความผิดทำให้เสียทรัพย์ มีการดื่มสุราเกี่ยวข้องร้อยละ 59.1
2. ความผิดเกี่ยวกับเพศ มีการดื่มสุราเกี่ยวข้องร้อยละ 34.8
3. ความผิดต่อร่างกาย มีการดื่มสุราเกี่ยวข้องร้อยละ 20.8
4. ความผิดฐานบุกรุก มีการดื่มสุราเกี่ยวข้องร้อยละ 16.1
5. ความผิดฐานข่มขืนกระทำชำเรา มีการดื่มสุราเกี่ยวข้องร้อยละ 10.5

ผลกระทบด้านปัญหาสุขภาพ

สุราก่อให้เกิดโรคมากมายและสร้างภาวะโรคเป็นอันดับต้นๆ ของปัจจัยเสี่ยงทั้งหลาย

สำหรับปัญหากายภาพเรื้อรังนั้น องค์การอนามัยโลกคาดประมาณว่า ร้อยละ 30 ของการตายจากมะเร็งหลอดอาหาร โรคตับ โรคชัก อุบัติเหตุจราจร ฆาตกรรม และการบาดเจ็บโดยเจตนา มีสาเหตุจากการบริโภคเครื่องดื่มแอลกอฮอล์ และในกลุ่มประเทศยุโรปที่มีอัตราการบริโภคพอๆ กับคนไทยนั้น 1 ใน 4 ของการตายในผู้ชายอายุระหว่าง 15-29 ปี นั้นมีสาเหตุมาจากการบริโภคเครื่องดื่มแอลกอฮอล์ โดยอาจสรุปเป็นความเสี่ยงระหว่างผู้ไม่ดื่มและผู้ที่ดื่มประจำทุกวัน (category II) ในปริมาณ 20.0-39.9 กรัมของแอลกอฮอล์บริสุทธิ์ หรือเทียบได้กับเบียร์ 1-2 ขวดใหญ่ โดยประมาณดังนี้ แท้ง (spontaneous abortion) เสี่ยง 1.8 เท่า มารดาคลอดทารกน้ำหนักต่ำ (low birth weight) เสี่ยง 1.4 เท่า มะเร็งปากและช่องปาก (mouth and oropharynx cancers) เสี่ยง 1.8 เท่า มะเร็งหลอดอาหาร (esophagus cancer) เสี่ยง 2.4 เท่า มะเร็งอื่นๆ เสี่ยง 1.3 เท่า ความดันเลือดสูง เสี่ยง 2.0 เท่า ตับแข็ง (liver cirrhosis) เสี่ยง 9.5 เท่า หัวใจเต้นผิดปกติ (cardiac arrhythmias) เสี่ยง 2.2 เท่า

ข้อมูลปัญหาสัมพันธภาพและสุขภาพจิตจากการบริโภคเครื่องดื่มแอลกอฮอล์ ซึ่งเป็นปัญหาสังคมที่มีขนาดปัญหาค่อนข้างใหญ่ซึมลึกแต่ไม่ค่อยมีการพูดถึง ได้แก่ อัตราการติดสุรามีความสัมพัน์กับภาวะความเครียดและอาการซึมเศร้าสูงมาก โดยมีผลการวิจัยพบดังนี้ ผู้ที่ติดสุราร้อยละ 51.2 มีความเครียดอยู่ในระดับสูงหรือรุนแรง ร้อยละ 48.6 มีอาการซึมเศร้าอยู่ในระดับที่ถือว่าควรจะไปพบแพทย์ ร้อยละ 11.9 มีความคิดอยากฆ่าตัวตาย ร้อยละ 11.3 มีความคิดอยากฆ่าผู้อื่น เด็กวัยรุ่นที่มีบิดาเป็นโรคพิษสุราเรื้อรัง มีความเสี่ยงต่ออาการเกิดปัญหาสุขภาพจิตมากกว่าเด็กวัยรุ่นที่บิดาไม่เป็นโรคพิษสุราเรื้อรัง 11.5 เท่า มารดาวัยรุ่นที่บิดาเป็นโรคพิษสุราเรื้อรังมีความเสี่ยงต่อการเกิดปัญหาสุขภาพจิตมากกว่ามารดาวัยรุ่นที่บิดาไม่เป็นโรคพิษสุราเรื้อรัง 13.5 เท่า และผู้ติดสุราส่วนใหญ่ร้อยละ 64.3 มีบิดามารดาหรือญาติที่ดื่มสุรา ปัญหาการหย่าร้างและเปลี่ยนงานในผู้ติดสุรามีแนวโน้มสูงเกินครึ่งหนึ่งของผู้ติดสุรา

จากรายงานประจำปีขององค์การอนามัยโลกปี ค.ศ. 2002 (พ.ศ. 2545) ที่มุ่งชี้ให้เห็นภาระโรค (disease burden) จากมุมมองความเสี่ยงและพฤติกรรมเสี่ยงพบว่า การบริโภคแอลกอฮอล์เป็นความเสี่ยงที่มีภาระโรคสูงเป็นอันดับ 5 รองจากภาวะขาดอาหาร เพศสัมพันธ์ที่ไม่ปลอดภัย (unsafe sex) ภาวะความดันเลือดสูง การบริโภคยาสูบ โดยการบริโภคแอลกอฮอล์นำมาซึ่งการตายก่อนวัยอันควรจากอุบัติเหตุ ความรุนแรง และโรคภัยไข้เจ็บมากมายซึ่งการบริโภคแอลกอฮอล์เป็นสาเหตุสำคัญ

ผลกระทบด้านปัญหาอุบัติเหตุและการบาดเจ็บ

สุราเป็นสาเหตุสำคัญของอุบัติเหตุและการบาดเจ็บ

จากข้อมูลของโรงพยาบาลขนาดใหญ่ในเครือข่ายเฝ้าระวังการบาดเจ็บระดับจังหวัด สำนักระบาดวิทยา กระทรวงสาธารณสุข จำนวน 14 โรง ใน ปี พ.ศ. 2541 พบว่า จำนวนผู้บาดเจ็บที่ถูกทำร้ายทั้งหมด 15,714 ราย มีการเสพสุราเป็นปัจจัยร่วมถึงร้อยละ 45

จากสถิติคดีจราจรทางบกในพื้นที่ทั่วราชอาณาจักรของสำนักงานตำรวจแห่งชาติ พบว่าจำนวนคดีอุบัติเหตุที่มีสาเหตุจากการดื่มสุราเพิ่มขึ้นอย่างมากตั้งแต่ปี พ.ศ. 2543 จนถึงปี พ.ศ. 2547 โดยเพิ่มขึ้นคิดเป็น 5 เท่า ในเวลา 4 ปี จากจำนวน 1,811 คดี ในปี พ.ศ. 2543 เป็น 9,279 คดีในปี พ.ศ. 2547 ดังแผนภูมิที่ 1

ตัวอย่างที่ชัดเจนอาจเห็นได้จากรายงานการเฝ้าระวังการบาดเจ็บรุนแรงจากอุบัติเหตุขนส่งในช่วงวันหยุดปีใหม่ พ.ศ. 2547 ของสำนักระบาดวิทยา กรมควบคุมโรค พบว่าร้อยละ 72.7 ของผู้บาดเจ็บรุนแรงจำนวน 1,405 คน จากพาหนะทุกประเภทดื่มเครื่องดื่มแอลกอฮอล์ก่อนเกิดเหตุ และที่น่าเศร้าคือ ร้อยละ 44.2 ของผู้บาดเจ็บรุนแรงที่มีอายุต่ำกว่า 18 ปี ซึ่งสูงกว่าปี พ.ศ. 2546 ซึ่งมีร้อยละ 19.2


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ที่มาของข้อมูล: จาก คลินิก ปีที่ 22 ฉบับที่ 1 มกราคม 2549 หน้า 7-13


ผู้แต่ง: โดย นพ.บัณฑิต ศรไพศาล/วารสารคลินิก ปีที่ 22 ฉบับที่1มกราคม 2549 - dmhstaff@dmhthai.com - 9/1/2006

   ความคิดเห็นจากคุณ Nuttawut

สวัดดีครับ คุณหมอ
ผมเป็นนักวิชาการสาธารณสุขประจำโรงพยาบาลชุมชนในจังหวัดเชียงใหม่ จากข้อมูลการศึกษาของคุณหมอ น่าสนใจมาก ผมกำลังจะศึกษาเรื่องนี้ในเขตอำเภอที่ผมทำงานอยู่ เพราะที่นี่ประชาชนดื่มสุรากันเก่งมาก อยากได้ข้อมูลเพิ่มเติมที่คุณหมอศึกษาอยู่ในฉบับเต็ม Full paper ถ้ายังไงก็ขอเป็นวิทยาทานนะครับคุณหมอ รบกวนส่งตาม Email. ข้างต้นนะครับ

ณัฐวุฒิ

  : nut_hos@hotmail.com ::  11/4/08 04:08

   ความคิดเห็นจากคุณ ดร.วราภรณ์ กุประดิษฐ์

สนับสนุนค่ะจากงานวิจัยที่พบในอุดรธานีเรื่อง
การศึกษาความสัมพันธ์ของสัดส่วนการบริโภคเครื่องดื่มแอลกอฮอล์ที่ส่งผลต่อพฤติกรรมความรุนแรงของวัยรุ่นในจังหวัดอุดรธานี
สรุปผลจากการวิเคราะห์ข้อมูลเชิงปริมาณ(Quantitative Data)
1) ตัวแปรที่มี Potential Association กับการมีพฤติกรรมรุนแรงชัดเจน ( ) (p-value 0.250) มี 6 ตัวได้แก่ เพศ อายุในปัจจุบัน ระดับการศึกษาสูงกว่ามัธยมศึกษา ขนาดของสัดส่วนการบริโภคเครื่องดื่มแอลกอฮอล์ บริบทการบริโภคเครื่องดื่มแอลกอฮอล์ และประเภทของการบริโภคเครื่องดื่มแอลกอฮอล์
2) ตัวแปรที่มีความสัมพันธ์กับพฤติกรรมความรุนแรงของวัยรุ่นในจังหวัดอุดรธานี( ) มี 3 ตัวคือ ระดับการศึกษาสูงกว่ามัธยมศึกษา ขนาดของสัดส่วนการบริโภคเครื่องดื่มแอลกอฮอล์ และอายุที่สูงขึ้น โดยสามารถอธิบายความสัมพันธ์ของพฤติกรรมความรุนแรงของวัยรุ่นในจังหวัดอุดรธานีได้ดังนี้
2.1) วัยรุ่นที่มีระดับการศึกษาที่สูงกว่ามัธยมศึกษาจะมีโอกาสมีพฤติกรรมรุนแรง ชัดเจนเป็น 31.18 เท่า(95% CI: 4.60, 211.41) ของวัยรุ่นที่มีระดับการศึกษามัธยมศึกษา หรือ ต่ำกว่า เมื่อควบคุมอิทธิพลของอายุ และคะแนนขนาดของสัดส่วนการบริโภคเครื่องดื่มแอลกอฮอล์
2.2) ทุกๆ หนึ่งปีของอายุที่สูงขึ้นของวัยรุ่น จะทำให้โอกาสมีพฤติกรรมรุนแรงชัดเจน เพิ่มขึ้น 63%(95% CI: 21%, 119%)เมื่อควบคุมอิทธิพลของระดับการศึกษา และคะแนนขนาดของสัดส่วนการบริโภคเครื่องดื่มแอลกอฮอล์
2.3) ทุก ๆ หนึ่งคะแนนของขนาดของสัดส่วนการบริโภคเครื่องดื่มแอลกอฮอล์ที่สูงขึ้น จะทำให้โอกาสมีพฤติกรรมรุนแรงชัดเจนลดลง 14% (95% CI: 6%, 22%) เมื่อควบคุมอิทธิพลของระดับการศึกษา และอายุ
3) ขนาดของสัดส่วนการบริโภคเครื่องดื่มแอลกอฮอล์ของวัยรุ่นในจังหวัดอุดรธานี ที่ดื่มมากที่สุด 3 ลำดับแรกคือ สุราพื้นบ้านต่างๆ เบียร์ต่างๆ และสุราขาว ตามลำดับ และพบว่า ขนาดของสัดส่วนการบริโภคเครื่องดื่มแอลกอฮอล์ของวัยรุ่นในจังหวัดอุดรธานีที่น้อยสุดคือ สาโทหรือสาเก
4) บริบทการบริโภคเครื่องดื่มแอลกอฮอล์ของวัยรุ่นในจังหวัดอุดรธานีที่ดื่มมากที่สุด 3 ลำดับแรกคือ งานวันสงกรานต์ ในผับและวันเลี้ยงสังสรรค์ระหว่างเพื่อน ตามลำดับ ส่วนบริบทการบริโภคเครื่องดื่มแอลกอฮอล์ของวัยรุ่นในจังหวัดอุดรธานีที่น้อยสุดคือ แก้บนเจ้าที่
5) ประเภทของการบริโภคเครื่องดื่มแอลกอฮอล์ของวัยรุ่นในจังหวัดอุดรธานีที่ดื่มมากที่สุด 3 ลำดับแรกคือ เบียร์ต่างๆ สุราผสม เช่น แสงโสม แม่โขง และสุราขาว ตามลำดับ และประเภทของการบริโภคเครื่องดื่มแอลกอฮอล์ของวัยรุ่นในจังหวัดอุดรธานีที่น้อยสุดคือ สุราพิเศษประเภท เกาเหลียง เซี่ยงชุนหรือสุราแบบจีนอย่างอื่น
6) ผลกระทบและพฤติกรรมหลังบริโภคเครื่องดื่มแอลกอฮอล์ของวัยรุ่นในจังหวัดอุดรธานีมากที่สุด 3 ลำดับแรกคือ มีอาการมือสั่น โมโหง่าย และทะเลาวิวาท ตามลำดับ และผลกระทบและพฤติกรรมหลังบริโภคเครื่องดื่มแอลกอฮอล์ของวัยรุ่นในจังหวัดอุดรธานีที่น้อยสุดคือ การไม่อยากเรียนหนังสือ


  : wrissa1234@yahoo.com ::  20/4/10 21:14

   ความคิดเห็นจากคุณ พรทิพย์

ตอนนี้หนูอยากทำวิจัยเกี่ยวกับการดื่มเครื่องดื่มที่มีแอลกอฮอล์ อยากได้งานวิจัยฉบับเต็มของคุณหมอมาเป็นวิทยาทานค่ะ ขอขอบพระคุรไว้ล่วงหน้านะคะ

  : real_care@hotmail.com ::  25/6/10 01:05

   ความคิดเห็นจากคุณ พรทิพย์

ตอนนี้หนูอยากทำวิจัยเกี่ยวกับการดื่มเครื่องดื่มที่มีแอลกอฮอล์ อยากได้งานวิจัยฉบับเต็มของคุณหมอมาเป็นวิทยาทานค่ะ ขอขอบพระคุรไว้ล่วงหน้านะคะ

  : real_care@hotmail.com ::  25/6/10 01:05

   ความคิดเห็นจากคุณ อรนลิน

ตอนนี้กำลังทำวิจัยเรื่องการดื่มสุราในเด็กวัยรุ่นคะ ของานวิจัยของคุณหมอมาเป็นงานวิจัยที่เกี่ยวข้องได้ไหมคะ ขอฉบับเต็มได้ไหมคะ ขอขอบคุณคะ

  : i_love_jeab@hotmail.com ::  12/7/10 08:50

   ความคิดเห็นจากคุณ ชญานิศ

สวัสดีค่ะ คุณหมอดิฉันสนใจการทำวิจัยเรื่องการดื่มแอลกอฮอล์คะ รบกวนส่งข้อมูล Full text ให้ทางเมล์ด้านบนด้วยนะคะ ขอบคุณค่ะ

  : chaya_@HOTMAIL.CO.TH ::  18/9/10 04:39

   ความคิดเห็นจากคุณ น้อง

คุณหมอดิฉันสนใจการทำวิจัยเรื่องการดื่มแอลกอฮอล์คะ รบกวนส่งข้อมูล Full text ให้ทางเมล์ด้านบนด้วยนะคะ ขอบคุณค่ะ


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   ความคิดเห็นจากคุณ กสิวัฒน์

สวัสดีครับคุณหมอ ตอนนี้ผมกำลังศึกษาอยู่มหาวิทยาลัยเทคโนโลยีราชมงคลพระนคร คณะวิศวกรรมศาสตร์ คือผมสนใจที่จะทำงานวิจัยเรื่องนี้มากครับ ผมอยากจะรบกวนขอ Full text มาเพื่อเป็นวิทยาทาน ช่วยส่งมาทางเมล์ด้วยน่ะครับขอบคุณครับ

  : webksc@htomail.com ::  17/11/10 06:26

   ความคิดเห็นจากคุณ kitti

กำลังจะทำวิจัยอยู่เลย รบกวนส่ง full text ให้ด้วยได้ไหมครับผมอยู่ม. บูรพาครับ

  : kitklung@gmail.com ::  9/1/11 01:07

   ความคิดเห็นจากคุณ thip

กำลังทำวิจัยเรื่องนี้อยู่ค่ะ อยากได้ข้อมูลมากๆ ขอข้อมูลไว้ศึกษาเปนแนวทางได้มั้ยคะ รบกวนส่ง full text มาทางเมลล์ให้ได้ไหมคะ

  : thipwan_tt@hotmail.com ::  18/1/11 08:38

   ความคิดเห็นจากคุณ เตย

เรียนคุณหมอที่เคารพ

คือว่าหนูกำลังศึกษาและสนใจที่จะทำวิจัยเรื่องนี้พอดีค่ะ รบกวนขอข้อมูลจากคุณหมอไว้เพื่อเป็นแนวทางได้ไหมคะ รบกวนส่ง Full text ทาง email จะได้ไหมคะ ขอกราบขอบพระคุณล่วงหน้าค่ะ

เจ้าพนักงานสาธารณสุข

  : apin-t@msn.com ::  29/1/11 10:33

   ความคิดเห็นจากคุณ เตย

เรียนคุณหมอที่เคารพ

คือว่าหนูกำลังศึกษาและสนใจที่จะทำวิจัยเรื่องนี้พอดีค่ะ รบกวนขอข้อมูลจากคุณหมอไว้เพื่อเป็นแนวทางได้ไหมคะ รบกวนส่ง Full text ทาง email จะได้ไหมคะ ขอกราบขอบพระคุณล่วงหน้าค่ะ

เจ้าพนักงานสาธารณสุข

  : apin-t@msn.com ::  29/1/11 10:35

   ความคิดเห็นจากคุณ นักศึกษา

เรียนคุณหมอ
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  : digitsoul99@hotmail.com ::  23/5/11 00:30

   ความคิดเห็นจากคุณ ประดิษฐ์ มากเทพวงษ์

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ผมเป็นนักวชาการของสำนักงานสาธารณสุขอำเภอ
กำลังทำวิจัยเรื่องพฤติกรรมการบริโภคเครื่องดื่มที่ทีแอลกอฮอล์ จึงใคร่รบกวนขอข้อมูลจากท่านอาจารย์
เพื่อประกอบการศึกษาครับ ขอบคุณครับ

  : pradit_41@hotmail.com ::  26/5/11 01:25

   ความคิดเห็นจากคุณ ประดิษฐ์ มากเทพวงษ์

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ผมเป็นนักวชาการของสำนักงานสาธารณสุขอำเภอ
กำลังทำวิจัยเรื่องพฤติกรรมการบริโภคเครื่องดื่มที่ทีแอลกอฮอล์ จึงใคร่รบกวนขอข้อมูลจากท่านอาจารย์
เพื่อประกอบการศึกษาครับ ขอบคุณครับ

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