Journal of Addictive Behaviors,Therapy & RehabilitationISSN: 2324-9005

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Letter to Editor, J Addict Behav Ther Rehabil Vol: 4 Issue: 1

Alcohol Abuse in Russia: History and Perspectives

Sergei V Jargin*
People’s Friendship University of Russia, Clementovski per 6-82, 115184 Moscow, Russia.
Corresponding author : Sergei V Jargin
People’s Friendship University of Russia, Clementovski per 6-82, 115184 Moscow, Russia
E-mail: [email protected]
Received: June 01, 2014 Accepted: March 11, 2015 Published: March 13, 2015
Citation: Jargin SV (2015) Alcohol Abuse in Russia: History and Perspectives. J Addict Behav Ther Rehabil 4:1. doi:10.4172/2324-9005.1000135

 

Abstract

Alcohol Abuse in Russia: History and Perspectives

There is abundant literature about alcohol consumption and alcoholism in Russia, which is undoubtedly immense. Nevertheless, there is also a tendency for the issue to be exaggerated, which may veil shortcomings of the health care system, and shifts responsibility for the relatively low life expectancy onto the patients as self-inflicted diseases caused by excessive alcohol consumption. Acknowledging the role of individual choice, the purpose of this review is to draw attention to the alcohol-abuse issues and related problems, such as the inconsistent quality of alcoholic beverages, which have sometimes caused poisonings even after consumption in moderate doses. Furthermore, apart from excessive alcohol consumption, the following causes of the relatively low life expectancy in Russia, not clearly perceptible from the literature, are pointed out: insufficient quality and availability of the health care, particularly for middle-aged and elderly men, including those prone to the alcohol consumption; low quality and toxicity of some alcoholic beverages, acknowledging that there have been improvements over approximately the last decade.

 

Keywords: Alcoholism, Alcohol-related dementia, Russia

Keywords

Alcoholism; Alcohol-related dementia; Russia; Health care

The Late Soviet Period

Alcohol consumption in Russia has been a topic of extensive research and publication. According to the World Health Organization (WHO), the recorded adult per capita consumption in the Russian Federative Republic within the former Soviet Union (SU), having increased during the 1960s, was relatively stable during the 1970s (around 7.5-8 liters of pure alcohol annually) and reached a maximum of about 8.5 liter/year before the start of the anti-alcohol campaign in 1985 [1]. It is known to the scientific community that the State sometimes encouraged alcohol sales, and there was some veiled propaganda of alcohol consumption during the 1960-1980s (before the start of the anti-alcohol campaign) [2]. Some editions such as the very popular “Book about delicious and healthy food” [3], praised medicinal and other qualities of alcoholic beverages, which was accompanied by illustrations with bottles standing on a richly covered table, seen and admired by many children. A particularly efficient tool of the alcohol propaganda was creation by certain mass media and films of an attractive image of a cheerful and manly drunkard. The carrier of this notion was, for example, the extremely popular magazine ‘Crocodile’. Some articles and caricatures were formally directed against alcohol but, in fact, romanticized alcohol consumption and the reckless drunken atmosphere. The ‘Crocodile’ and other mass media created and poetized alcoholic stereotypes: (водка-и-селедка: consumption of vodka with salty herring; бутылка- на-троих: a bottle for three persons) etc. Association of certain pastimes such as fishing or domino play with alcohol consumption was promoted by numerous pictures and cartoons, as well as the most popular Soviet-time films starring the famous actor Yuri Nikulin, who embodied the image of a charismatic drunkard. Alcohol consumption was not only tolerated but sometimes visibly encouraged among workers, students and intelligentsia. Some Soviet festivals were associated with drinking, especially the New Year, when consumption commenced well before midnight, often continuing until next morning. Other festivals associated with alcohol were the International Women’s Day and professional holidays such as Builder’s Day on the second Sunday of August. Birthdays and other personal events were regularly celebrated in many workplaces, while parties were often initiated or indirectly supported by management. At such events in medical, educational and scientific institutions, the consumption of technical or medicinal alcohol was tolerated by management, who regularly stole alcohol themselves. Certain individuals encouraged others to drink in excess, with non-drinkers were often stigmatized.
During Soviet times, even when there were no anti-alcohol campaigns, alcoholic beverages were not as easily available as in many other countries. The number of bottle stores was limited, with queues usual. After standing a queue, larger amounts of alcohol were usually bought and consumed. Analogously, people rarely came to a beerhouse just for one drink: after standing a queue, companies or couples usually stayed there for hours. In the author’s opinion, the limited availability of alcohol, and the difficulties obtaining it, is a factor contributing to deeper alcohol intoxications.

Treatment of Alcoholism

Treatment and prevention of alcoholism during the Soviet time was generally ineffective. Placebos and persuasion were the usual methods [4], with aversion (emetic) therapy and multiple teturam-alcohol reactions applied [5]. Correctional centers, the so-called work-andtreatment preventoriums, were a form of detention for 1-2 years, but it was still relatively easy for patients to obtain alcohol "under the table". The preventoriums were criticized as being contradictory to the human rights [4]. Implantation of teturam preparations, possessing only a placebo effect [6,7], was offered in private, while the patients or their relatives were persuaded efficacy and paid for the implantation. "Ultra-rapid psychotherapy", known in Russia as "coding" commenced during the anti-alcohol campaign of the 1980s, but was criticized as contradictory to medical ethics [8] due to utilization of intimidating suggestions, painful and unpleasant manipulations: spraying the pharyngeal mucosa with ethyl chloride, massage of the trigeminal nerve branches, abrupt backwards movements of the patient’s head by the therapist [8-10], and the use of general anesthesia in some instances [11]. The method continues to be used in some former Soviet Republics [12].

Anti-Alcohol Campaigns

The anti-alcohol campaign (1985-88) was initially successful, leading to a temporary decrease in the alcohol-related mortality [2]. According to the WHO, the recorded adult per capita alcohol consumption in Russia reached a minimum just below 5 liter/year in 1987 [1]. At the same time, the campaign resulted in numerous fatal cases because of the increased consumption of alcohol-containing surrogates and technical fluids. The quality of alcoholic beverages deteriorated during that period [13]. After the campaign, the alcohol consumption rapidly increased again, with vodka forming a larger share in the total [14], having partly replaced wine [1].
As mentioned above, veiled propaganda of alcohol consumption was recognizable before 1985 [15,16]. Retrospectively, the anti-alcohol campaign (1985-88) served a similar purpose, while its failure and the "recoil effect" were predictable. In the author’s opinion, massive alcohol consumption after the anti-alcohol campaign facilitated the economical reforms of early 1990s. It is known that alcohol abusers can experience emotions of shame and guilt and have a low self-esteem [17], therefore being probably easier to manipulate and to command.
The impact of anti-alcohol measures sometimes contrasted with the declared goals. In 1972, sales of vodka and other spirits on Sundays, and between 7 p.m. and 11 a.m. on all other days, were prohibited, but after 7 p.m. till the closing of shops at 8-10 p.m., and on Sundays, fortified wines (alcohol concentration 17-19%) were being sold. Some cheaper fortified wines were poor quality, inducing more severe intoxication and hangovers than vodka. In practice, workers who finished work at around 5 p.m., considering that there were usually queues at the shops, often started drinking vodka in the workplace, then continued with fortified wines, or only consumed the latter. It was general knowledge amongst these drinkers that it was not advisable to drink fortified wine after vodka as it often led to severe intoxications, resulting in vomiting, sleeping in public places etc. At this time, 0.25 liter bottles of vodka disappeared almost completely, replaced by 0.5 liter bottles. For older drinkers especially, it had been preferable to buy a 0.25 liter bottle of vodka after work and to go home: then he or she would wake up next morning in a better condition for the next workday. Instead, they drank poor-quality fortified wines, which caused deeper intoxications and higher health and social risks.
and social risks. As discussed earlier, some measures aimed at reducing of mass alcohol abuse, have in fact contributed to deeper intoxications and increased mortality due to the widespread consumption of toxic alcohol-containing fluids. After the anti-alcohol campaign (1985-88), average life expectancy at birth for Soviet citizens decreased sharply, particularly for men - by 1993 it had decreased to about 59 years [14]. The current Russian male life expectancy is estimated to be 64 years [18]. According to widespread opinion, many Russian alcohol abusers do not live long enough to die of liver cirrhosis or its complications. Among the most frequent causes of death of alcoholics in Russia are bronchopulmonary diseases including chronic bronchitis, bronchopneumonia, pleural empyema, and tuberculosis [19-22]. This must be partly caused by the cold climate coupled with the limited availability of warm public houses for drinkers with few economic resources, so that they often drink and loiter outdoors and can fall asleep in a cold place. Smoking is also likely to be a contributing factor.
Another contributor to high mortality has been the poor quality of alcoholic beverages, in particular, consumption of counterfeit products and surrogates sold also in legally operating shops [23, 24]. During the anti-alcohol campaign, many poisonings were caused by alcoholcontaining technical fluids. In 1988, the author observed in some Siberian villages many people in condition of up to severe intoxication after consumption of a window cleaner. The quality of legally sold alcoholic beverages deteriorated during that period; and after the campaign, poor-quality alcoholic beverages were produced and sold massively [24]. Numerous cases of death after the ingestion of moderate amounts [25], with a relatively low blood alcohol level [24] were reported, obviously caused by the substances other than ethanol contained in the consumed products.

Alcohol Consumption: 1990s to Present

According to the World health Organization, recorded adult (15 years and older) annual average alcohol consumption in Russia during the years 2003-2005 was 11.03 liters of pure alcohol per capita. Total (recorded plus unrecorded) adult per capita consumption in 2005 amounted to 15.76 liters/year [26]. In 2008-2010, the average total consumption in Russia was 15.1 liters/year (male 23.9, female 7.8). Heavy episodic drinking is more typical for men than women (29.8 vs. 10.3 % of the whole population) [1]. There are also gender differences of alcohol consumption in Russia: men have preference for vodka, and they drink it in larger amounts in comparison with women. Women are more likely to drink milder types of alcoholic beverages [27,28]. These data generally agree with our observations, although many women do participate in heavy binge drinking of vodka (Figure 1) or fortified wines, while those with alcohol use disorders may consume almost as much alcohol as men and may be at greater risk for negative social and medical consequences [29]. During the Soviet time, gatherings with female participation often preferred wine – fortified, sparkling or dry, which was inexpensive and often of acceptable quality. Since then, inexpensive natural wine, especially fortified, has largely disappeared [13]; and more beer is consumed instead [1].
Figure 1: Ms. K. living to the north from Karelia.
A discussion of the changing pattern of alcohol consumption in Russia would be incomplete without an overview of social transformations during the last two decades, including the dissolution of the social strata containing the majority of alcohol consumers in urban areas - working class and intelligentsia. Their carefree lifestyle, often accompanied by alcohol consumption, was largely lost after the economic reforms of the 1990s: many factories and scientific institutions were closed or restructured; and personnel faced unemployment in conditions of an underdeveloped social security system with by far insufficient unemployment benefits. Many people, in order to preserve a current or to find a new job, had to discontinue or reduce their alcohol consumption. In addition, the ongoing replacement of ethnic Russian workers by immigrants from less drinking regions (Middle Asia, the Caucasus) has further contributed to the decrease in alcohol consumption by workers.
According to the author’s observations, the pattern of alcohol consumption in Russia has been changing since approximately the year 2000, with the average amounts of consumed alcohol tending to decrease. The decrease was mentioned in some publications [30,31]; but for an inside observer this tendency seems to be more pronounced. During the Soviet period and shortly afterwards, many inebriated individuals could be seen in public places: drinking, sleeping, making noise, etc. In contrast with the past, there are almost no heavily drunk people in the streets today, and even marginalized populations are rarely seen drunk in public.
According to our observations [13] and a widespread opinion, after the anti-alcohol campaign of 1985-88, the quality of alcoholic beverages deteriorated (Figures 2 and 3), but alcohol became more easily available. Current measures in Russia to limit the availability of alcohol, such as the prohibition of small (0.33 liter) beer cans, may contribute to higher levels of alcohol consumption. The prohibition (from 1 January 2013) on selling beer between 11 p.m. and 8 a.m. may cause some people to purchase larger amounts in advance with a corresponding consumption.
Figure 2: Poor quality imitations of Port.
Figure 3: On the label it is written: dry wine produced from grape Cabernet; no ingredients are listed. Inside is obviously a stained and flavored alcohol solution.
During the last decade, alcohol consumption patterns have been changing. There has been a decrease in heavy binge drinking of vodka, partly replaced by an increase in the moderate consumption of beer [1]. This is especially noticeable among younger people and in metropolitan areas, but similar tendencies can also be seen in smaller towns and rural areas. The ongoing immigration from the regions with less widespread alcohol consumption and the fact that local alcoholics have “died out” with fewer successors, are contributing factors. Other reasons for these changes are greater emphasis on individual responsibility under the conditions of the market economy, as well as intimidation and crime against alcoholics and people with alcoholrelated dementia, primarily aimed at the appropriation of their apartments, houses and other property [32-34].

Alcohol Consumption and Health Issues

“Numerous epidemiological studies led to the consensus that vodka binge drinking is a key reason” for premature mortality in Russia [35]. It is difficult to generalize without reliable statistics, but heavy binge drinking is visibly in decline in today’s Russia, especially in large cities such as Moscow [13]. The role of alcohol as a cause of premature death cannot be denied, but this role was obviously more significant during the 1990s, when alcohol consumption increased as a recoil effect after the anti-alcohol campaign. The causative role of alcohol in the relatively high mortality rates was obviously exaggerated in some publications, e.g. [36], where “the enormous scale of alcohol-related mortality” was reiterated without mentioning health care quality and availability as a contributing factor to premature death. There is a tendency in the Russian literature to exaggerate the topic alcohol abuse and its causative relationship with mortality, especially from cardiovascular diseases [19,20,24,36,37]. Statements such as ‘Alcohol accounts for most of the large fluctuations in Russian mortality, and alcohol and tobacco account for the large difference in adult mortality between Russia and Western Europe’ [38] tend to conceal the role of health care access and quality issues.
The current problems of the health-care system in Russia were described in the recent review [39]. Russia is an upper middle income country, but with low budget health care spending [40]. Unlike most developed countries, economic growth in Russia has not been matched with an improvement in life expectancy. On the contrary, life expectancy among men has fallen from 64 years in 1965 to 63 years in 2011, whereas that of women has increased from 72 years to 75 years [39]. All Russian citizens have a right to free medical insurance, which covers a set of diagnostic and therapeutic procedures. However, the patients are often recommended by physicians to undergo additional procedures, for which patients cover the costs. There is also a genderrelated aspect, visible for an inside observer: the predominance of middle-aged and elderly women over men among the governmental policlinic visitors. In particular, patients recognizable as alcohol abusers are sometimes treated not in accordance with medical ethics [41,42]. For these and other reasons, many middle-aged men including alcohol abusers often stay at home even if they have symptoms, thus receiving no adequate treatment especially for chronic conditions. In general, Russia provides an example of a disparity between the need for alcohol care and the limited options available to most individuals, especially those marginalized by poverty and stigma [43].
Experiences of an inside observer largely agree with the explanations by Dr. Sonya S. Shin and co-workers [43] that alcohol use disorders are undertreated in Russia, while shortage of evidence-based interventions is largely a norm. As the alcohol use disorders are treated by narcologists, general practitioners are not sufficiently attentive and responsible in their attitude to the patients recognizable as alcohol abusers. Moreover, the patients have many discouragements for seeking care for alcohol-related health problems, including out-ofpocket payment for services and stigmatization associated with registration within the Narcology Services (so-called narcological dispensaries), which can result in difficulties seeking employment, having a driving license etc. [43]. Even today, some employers ask for a certificate from the narcological dispensary. Current treatment measures for alcohol use disorders are considered ineffective now as before. Another barrier to effective treatment is the limited drug availability and high cost of medications, which must be purchased by the patients themselves [44]. For example, the relationship between alcohol consumption and hypertension mortality was analyzed without taking into account a significant factor contributing to a higher incidence of hypertension-related mortality: insufficient availability and quality of the therapy of hypertension and some other predisposing conditions such as diabetes mellitus [45]. The up-to-date therapy of hypertension is relatively expensive, while there are no discounts for the majority of the patients. The procedure of obtaining discounts is associated with red tape, waiting in queues, etc. War veterans are figuring in the first place among the categories of citizens entitled to free or discounted medicines, while there are reasons to suspect that the veteran status has sometimes been bestowed gratuitously. Furthermore, many physicians, employed by the government, practice also in private. Privately handled cases are usually given more attention, negatively influencing quality of services in the public sector. Different kinds of psychological pressure and manipulation, including waiting in queues, offensive and humiliating treatment, are applied to redirect patients to the private sector. As a result, a regular therapy of hypertension, especially that using modern medication, is hardly affordable on a regular basis for people with low incomes, especially the unemployed, many pensioners and alcoholics.
Furthermore, a relatively high mortality rate from cardiovascular diseases in Russia has been reported [35,46]. A cause of the high registered cardiovascular mortality in the former SU is evident for anatomic pathologists. If a cause of death is not entirely clear, it is usual to write on a death certificate: ‘Ischemic heart disease with cardiac insufficiency’ or a similar formulation. A tendency to overdiagnose cardiovascular diseases also exists for people dying at home and not undergoing autopsy. This is likely to be one of the causes of the considerable increase in registered cardiovascular mortality [47,48]. Besides, there is a tendency to overdiagnose alcoholic cardiomyopathy post mortem. In a large autopsy study, all 654 deceased "hard drinkers" were diagnosed post mortem with cardiomyopathy; while in the majority of the patients classified as chronic alcoholics (172 cases) the cardiomyopathy was graded as pronounced [20]. Cardiomyopathy has been used to explain for sudden death among alcohol consumers [20], while the real cause of death could have been undiagnosed diseases, poisonings with lowquality alcoholic products or others [23]. The tendency to exaggerate the cause-effect relationship between alcohol consumption and the cardiovascular morbidity is relatively new in the Russian literature. An earlier epidemiological study reported that rates of cardiovascular diseases including hypertension were not significantly higher among excessively drinking men compared to the general male population [21]; a lesser prevalence of atherosclerosis in alcoholics older than 40 years compared to the controls was reported in [22].
Finally, evaluating the results of surveys and questionnaires [49,50] it should be taken into account that these research tools have been largely discredited in Russia by means of obtrusive solicitations to partake in different surveys, often asking for private information: in the streets, on telephone, and previously also by agents coming to private homes. Answers to the questionnaires can be biased, especially with regard to such a delicate matter as alcohol consumption and abuse.

Conclusion

The conclusion of this review is cautiously optimistic: Russia has taken a step out of her alcoholic past. The growing Russian economy permits today further development and modernization of the health care and social security systems. Admittedly, there must be a societal and political will for that. In conclusion, societies should care of their weaker members including those suffering of alcoholism and alcoholrelated dementia.

Acknowledgments

The author is sincerely grateful to all colleagues who participated in discussion and improvement of this paper, and to Dr. Bronwyn Ellis for proofreading the final version of the text.

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