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Vodka, the Elixir of Life ….. and Death

ALCOHOL AND ADDICTION MEDICINE

Alcohol and Community: The Russian Federation

May 8, 2007

Ellis L. Rolett, M.D. Dartmouth Medical School

Christian, 1990

Vodka, the Elixir of Life ….. and Death

“Without vodka the Russian people simply cannot live. It is their elixir of life, the living water, the universal cure.”

- Y. Georg, 1858

Vodka - a cultural context

“When the Russian is born, when he marries or dies, when he goes to court or is reconciled, when he makes a new acquaintance or parts from an old friend, when he negotiates a purchase or sale, realizes a profit or suffers a loss – every activity is copiously baptized with vodka….The Russian spends his entire life from cradle to grave, bathing and swimming in this drunken sea.”

– speaker at the All-Russian Congress on the Struggle against Alcoholism, 1914.

Transchel, 2006

Russia

Garrett, 2000; Malyutina, Addiction 96: 987, 2001

Alcohol - a cultural staple

Alcohol beverages were and are tightly interwoven into the fabric of Russian life.

Two Russian customs add to the problem of alcohol consumption:

a) a vodka bottle once opened, must be finishedb) a shot glass of vodka must be downed in one gulp

Binge drinking is rampant. In 1994/1995, 51% of men and 5% of women in Novosibirsk were binge drinkers.

ICAP Reports, 1997

Definition of Binge Drinking

≥ 84 g pure ethanol in a single session for men, 56 g for women

– 84 g ≈ 1/3 bottle of 40% vodka or six 12-oz bottles of beer

– 56 g ≈ 1/4 bottle of 40% vodka or four 12-oz bottles of beer

Feshbach, 2003

Alcoholism in Russia

Estimated numbers of alcoholics in 2002

– 8 million men– 2 million women– 0.5 million children under 15

Average per capita annual consumption of pure alcohol

– Russia: 14.6 L– WHO standard for dependency: 8 L

Alcohol and Pregnancy (1)

“Decision of the people’s court: loss of the right to motherhood”1979-2006

Kristjanson, Alcohol Clin Exp Res, 31: 299, 2007

Alcohol and Pregnancy (2)Survey conducted 1999-2000, St. Petersburg.88% of nonpregnant and 34% of pregnant women had had alcohol within the preceding 30 days.16% of nonpregnant and 2.5% of pregnant women had “binged” at least once in the preceding 30 days.60% reported drinking when they knew they were pregnant.75% of women who drank during pregnancy were aware that alcohol consumption during pregnancy could cause birth defects.Wine and beer were the preferred alcoholic beverages of both groups, but pregnant women consumed significantly less distilled spirits.

Health Consequencesof binge drinking & acute intoxication

PoisoningsAccidents and violence

– Automobile and industrial accidents– Domestic violence– Suicide– Homicide

Cardiovascular– Arrhythmias– Acute myocardial infarction

Male Death Rates by Age Group:change between 1989 and 1994

NBER Oct 2004

Causes of Excess Male Mortality between 1989 and 1994

41.8

21.3

10.4 10.1

32.7

7 6.3 4.7 4.5

10

3.3 2.6 1.9

Circ CAD CVA Other Exter Alc. Alc. Homi- Sui- Unkn- Pneu- Bron- TBdis. circ. nal pois. other cide cide own monia chitis

NBER Oct 2004

Male Life Expectancy

NBER Oct 2004

White, 1996; Carlson, 2000

Risk Factors for Alcohol Abuse

Disease of males. Male coping strategy Economic and social dislocation.

– Lower economic strata– Unemployment– Lack of job satisfaction– Weak family structure

Less well educatedGeographic isolation and far northern locationEscapism, blotting out the tedium of lifeLack of control over life; sense of powerlessness

Type of Alcohol Consumed, 2000

NBER Oct 2004

Beer Consumption Increasing

White, 1996

Pre-Twentieth Century History (1)988 CE - Grand Prince Vladimir embraces Christianity

rather than Islam, in part because Christianity allows consumption of alcoholic beverages.- “Drinking is the joy of Rus, we cannot do without it.”

15th C - Vodka is introduced into Russia- Production and consumption of alcohol becomes a government monopoly under Ivan the Terrible to generate revenue for the royal treasury. - Illicit trade in alcohol begins.

15th-18th C - Accounts by foreign visitors to Russia described it as a society of ‘drunkards.’

White, 1996; Herlihy, 2002

Pre-Twentieth Century History (2)19th C – Vodka becomes more affordable. Taxes on alcohol account for as much as 40% of state revenue, alcohol production and sales account for 20% of internal trade, grain and alcohol from Ukraine are Russia’s chief imports.

1886 - Law passed making it a criminal offense to give workers vodka in lieu of salary.

1894 - State Vodka Monopoly is created as an attempt to confine sale of alcohol to government stores. Marked increase in illicit vodka production results. Samogón is estimated to account for up to 1/2 of liquor consumption.

Herlihy, 2002; Transchel, 2006

Pre-Twentieth Century History (3)1896 – Alcoholism is defined as a disease at the 12th

International Congress of Physicians in Moscow.

1897 - Publication of An Alcoholic Paralysis by S. S. Korsakov represents the beginning of scientific inquiry into the causes and treatment of alcoholism in Russia


Early Twentieth Century History1900-1914 - 90% of alcohol consumed is vodka. Binge drinking is a common pattern

1905 - Russo-Japanese War “Who defeated the Russians? The Japanese did not conquer, but alcohol triumphed, alcohol, alcohol.” – German war correspondent.

1914 - Prohibition is instituted by the Czar to counter drunkenness in the military as Russia prepares for WW I. In part this contributes to the Bolshevik takeover in 1917: the loss of revenue from alcohol taxes makes it difficult for the government to feed Russian workers, and bread riots ensue.


Alcohol policies under Communism 1917-1989 (1)

1917 - Prohibition is extended under the Bolsheviks.

1919 - Party Program commits the new government to a struggle against ‘social diseases’ including alcoholism.

1923 - Prohibition is repealed because of rampant bootlegging and use of alcohol surrogates. Government monopoly on production and sale of alcohol is restored.

1924 – Temperance societies are formed and laws for compulsory treatment of alcoholics are passed.

Transchel, 2006


Alcoholism as a social disease

1926 – “The very nearest future will be a period of a heroic struggle with alcohol. If we do not stamp out alcoholism, beginning with cities, then we will drink up socialism and drink up the October Revolution.” - L. Trotsky

1928 – OBSA (Society for the Struggle with Alcoholism) is founded with the goals encouraging alternate cultural activities and expanding alcohol treatment facilities.



Alcoholism becomes an individual failing1930 - Stalin orders an increase in alcohol production.

1932 - All temperance societies are merged to form the “Healthy Living Society.”

- Alcoholism is no longer treated in the press, research on social and health issues related to alcoholism ceases.

1940 - More stores in Russia selling alcohol than selling food.

1962 - Statistics on production and sale of alcohol are no longer published by the government.

1966 - Decrees on hooliganism; fines levied for public drunkenness.

White, 1996


1967 - Rehabilitation centers run by psychiatrists (narcologists) are established for ‘compulsory treatment and labor re-education’ of alcoholics.

- Labor rehabilitation centers (LTPs) are the equivalent of detention camps:

• forced committal• compulsory labor• deduction of 1/3 of earnings for the state• ineffective medical therapy.

Herlihy, 2002Temperance society night shelter

Herlihy, 2002; Nemtsov, 2005

Treatment of Chronic Alcoholism

♦ Into the 1990s, treatment primarily consisted of withdrawal and aversion therapy.

♦ Apomorphine or antabuse and nicotinic acid were mixed with alcohol to induce vomiting.

♦ Hypnotic suggestion and ‘coding’ still being used.

White, 1996

Anti-alcohol Propaganda Campaign

1979 - A new campaign is launched.

State production of alcohol is reduced.

Anti-alcohol Propaganda Campaign

Anti-alcohol Propaganda Campaign Fails

General Secretary Brezhnev continues to drink heavily.

Life expectancy for men began to decline due to alcohol abuse, a fact so embarrassing to the government that it stopped issuing life expectancy figures.


A Change of Soviet Leadership!

1985 - General Secretary Chernenko dies of cirrhosis of the liver.

Mikhail Gorbachev takes his place.

Two months later Central Committee adopts resolution titled ‘On Measures to Overcome Drunkenness and Alcoholism’.

White, 1996

Official statistics on alcohol published after a lapse of 26 years

Younger onset of heavy drinking, average age 19.

Increase in heavy drinking among women and juveniles.

90 % of women drinking regularly in 1984 => rising incidence of FAS.

Eight-fold increase in per capita alcohol consumption between 1940 and 1984.

White, 1996

Official statistics (continued)

Staggering consequences to the economy

– decreased productivity, – decline in health of the population– decreased military preparedness

» at least half of the armed forces are heavy drinkers or alcoholics


The Gorbachev Anti-Alcohol Campaign (1)

Nationwide anti-alcohol campaign launched in 1985.Restrictions imposed on alcohol sales, many liquor stores are closed.Official drinking age raised from 18 to 21.Government alcohol production is cut in half, and prices are increased.Over 1 million private stills are destroyed.



Compulsory treatment of alcoholics

Removal of alcohol abusers from public office and employment.

Expulsion of alcohol abusers from the Communist Party.

White, 1996


“Waiting for opening time, 1988”

White, 1996; Nemtsov, 2005

The Gorbachev Anti-Alcohol Campaign: Outcomes (1)

Within 18 months…..– Alcohol consumption reduced by 25%– Absenteeism and crime down 30%

– 11% of heavy drinkers had become abstainers

White, 1996; Nemtsov, 2005


Health Consequences– USSR death rate began to fall– Overall mortality down 15% between

1984 and 1986– Accidental deaths down 1/3– Heart disease deaths down 13%– Alcohol poisoning deaths down over 50%– Life expectancy rose 3 years for men, 1

year for women

White, 1996


Health Consequences (cont)– Birth rate increased– Infant mortality decreased– Divorce rate decreased

White, 1996


Adverse Consequences– Drinkers find alternatives to alcohol:

colognes, industrial spirits, etc.– Sugar sales skyrocket as homebrewing

takes off.

Garrett, 2000; Herlihy, 2002

The Gorbachev Campaign Ends

In October, 1988, after three years, the Central Committee rescinds the reforms because of– increased home brewing– loss of government revenues

White, 1996

Alcohol Sales

Alcohol in the Post-communist Transitional Economy

1991 - Boris Yeltsin is elected president of Russia

1992 - State monopoly on alcoholproduction is ended.

White, 1996

Alcohol in the Post-communist Transitional Economy (cont.)

1992 – Massive importation of foreign liquor.

1993 - Russia overtakes France as the world’s heaviest drinking nation.

– Average male consumes a bottle of vodka every 2 days

– Major adverse health and societal consequences

1994 - 50% of alcohol sales are illicit.– 70% of alcohol sold by street traders is dangerous

Bootleg liquor sale on the street Ryan, 1995

Alcohol Tax Revenues circa 1995

Five-fold decrease in tax revenues since 1990 despite rising consumption.

Less than 40% of alcohol consumption is reported.

National Sport Fund, which is exempt from taxes, holds licenses for 90% of spirit imports.

Herlihy, 2002

65th Anniversary of Venedikt Erofeev’s Birth - 1998

Bronze monument erected at Kursky Station in Moscow

6 hours of radio and TV programming

1500 fans retrace the Moscow-to-Petushki odyssey

World War II Vodka Ration

On May 9, 2001 Moscow hosted celebrations marking the 56th anniversary of the Victory in the Great Patriotic War of 1941-1945. Veterans had a traditional meeting in the Gorky Central Park where the guests were treated with soldier's field-kitchen porridge and the indispensable "people's commissar's" 100 grams of vodka.

RIA Novosti. N.I01-1470

Last updated: 12/19/03 17:37 MSK

A press conference "Alcohol and narcotic terror in Russia" was held in MoscowParticipants of the press conference are sure that Russia is in for an alcoholic collapse because of the policy of making drunkards of people that is so obvious here now. These pessimistic forecasts are based upon data provided by the World Health Organization. The organization states that a nation absolutely dies away when alcohol production reaches 8 liters per head in a year. In 2000, the showing made up 18.5 liters per head in Russia. People speaking in support of sober mode of living say that if a program for strict control of alcohol consumption is not adopted in the country, the Russian nation will die down by the middle of the century and will become extinct in 50 years.

12/19/2003 16:50Alcohol Makes Russians an Extinct Nation

Recent Headlines (1)Russian Health Ministry Alarmed with GrowingAlcoholism IncidenceMoscow, 30 October 2002, RIA Novosti

“Over 2001, alcohol consumption in Russia went up5.3 to 8.3 litres per person.”

Russian Cabinet Uneasy as Drinking SkyrocketsMoscow, 18 February 2003, RIA Novosti

“Heavy drinking is getting worse as national vice, and causes grave concern of the Russian government. Official statistics put annual per capita alcohol consumption at 8.4 liters, and unofficially 14 liters against an average 3.5 in the Soviet years.”

Recent Headlines (2)Russia Threatened by a Humanitarian Crisis29 June 2005 Polit.ru

One-third of all deaths are alcohol-related (mainly vodka and samogon).

60% of fatal accidents are alcohol-related.

60% of working age Russians are inebriated when they die.

Birth rate

Death rate

Динамика рождаемости и смертности (на 1000 чел.) в России в 1978–2003 гг. («русский крест») (World Bank 2004)

(http://www.polit.ru/analytics/2005/06/29/demcrisis.html)

Recent Headlines (3)Alcohol Killing Russia's People, FutureSt. Petersburg, 18 May 2005, Knight Ridder Newspapers

“The average Russian man, in large part because of alcohol abuse, won’t make it to his 59th birthday.”

Russia Has 2.3 Million AlcoholicsMoscow, 03.19.2006, MosNews.com

“Russia has 2,369,000 people officially diagnosed with alcoholism, which is 14 percent more than the correspondent number in 2000, the country’s top epidemiologist Gennady Onishchenko told Interfax Saturday.”

Recent Headlines (4)

Counterfeit Vodka Kills Russians by the ScoreMoscow, 1 Nov 2006, Reuters

“Thousands of Russians have been poisoned by counterfeit vodka laced with toxic household agents, and hundreds have died from acute liver failure.”

When Vodka is Your Poison (“Yellow Death”)By John Sweeney, March 10, 2007, BBC News, Russia

“Thousands of Russians may have been poisoned by bootleg alcohol containing medical disinfectant causing drinkers' skin to turn yellow before they fall dangerously ill or die.”

Male Life Expectancy

NBER Oct 2004

D.A. Leon et al. (1997) The Lancet 350: 383

Health Consequences: Summary

Substantial changes in alcohol consumption accounted for most of the changes in life expectancy in the Soviet Union and Russia during the 1980s and 1990s.

Is there hope for the future? (1)

Since 1998 – Gradual increase in optimism about the future– Economic recovery, albeit uneven– On-time payment of pensions and wages – Putin presidency

More openness to Western ideas and customs– Adopting Western approach to management of

chronic alcoholism– Founding of AA groups

Is there hope for the future? (2)

Increasing availability of health information to the general public

Gradual change in attitude toward responsibility for one’s own health

Demographic consequences of alcoholism have set off alarms bells inside the Kremlin

Law No. 102 took effect January 1, 2006

Bibliography:“Vodka, the Elixir of Life…..and Death”

Brainerd, Elizabeth and David M. Cutler. Autopsy on an Empire: Understanding Mortality in Russia and the Former Soviet Union. National Bureau of Economic Research, 2004.

Carlson, Per. An Unhealthy Decade: A Sociological Study of the State of Public Health in Russia, 1990-1999. Stockholm: Almqvist & Wiksell International, 2000.

Christian, David. ‘Living Water’: Vodka and Russian Society on the Eve of Emancipation. Oxford; New York: Oxford University Press, 1990.

DaVanzo, Julie S., and Clifford Grammich. Dire Demographics: Population Trends in the Russian Federation RAND, 2001.

Garrett, Laurie. Betrayal of Trust: The Collapse of Global Public Health. New York: Hyperion, 2000.Herlihy, Patricia. The Alcoholic Empire: Vodka & Politics in Late Imperial Russia. Oxford; New

York: Oxford University Press, 2002.Leon, David A., et al. “Huge variations in Russian mortality rates 1984-94: artifact, alcohol, or

what?” Lancet (1997) 350: 383-8.National Research Council (U.S.). Committee on Population. Premature Death in the New

Independent States. Washington, D.C.: National Academy Press, 1997.Nemtsov, Alexander. “Russia: alcohol yesterday and today.” Addiction (2005) 100: 146-9.Ryan, Michael. “Alcoholism and rising mortality in the Russian Federation.” BMJ (1995) 310: 646-8.Transchel, Kate. Under the Influence. University of Pittsburgh Press, 2006White, Stephen. Russia Goes Dry: Alcohol, State, and Society. New York: Cambridge University

Press, 1996.

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