Education And Debate

Russian Report: Alcoholism and rising mortality in the Russian Federation

BMJ 1995; 310 doi: (Published 11 March 1995) Cite this as: BMJ 1995;310:648

Re: Russian Report: Alcoholism and rising mortality in the Russian Federation

Alcohol consumption in the former Soviet Union (SU) rapidly increased after the anti-alcohol campaign (1985-88) launched by Mikhail Gorbachev, while vodka enhanced its share [1]. The fact that the state, at different times, encouraged alcohol sales is known to the international community [2]. Indirect propaganda of alcohol consumption could be observed during the 1960-1980s before the start of the anti-alcohol campaign [3]. Retrospectively, it becomes clear that the campaign (1985-88) was just another tool used for the same purpose, with predictable failure and a recoil effect at the required moment. Alcohol abusers can have emotions of shame and guilt as well as low self-esteem [4], therefore being easier to manipulate. Drunkenness and theft at workplaces were often tolerated by the management. In a sense, it facilitated the economic reforms: workers did not oppose privatizations, performed not always in accordance with the law, because of drunkenness and involvement in illegal activities.

Anti-alcohol measures were taken by the government also before the campaign of 1985-88. In 1972 it was prohibited to sell vodka after 7 p.m. The 0.25 litre vodka bottles largely disappeared; and predominantly 0.5 litre bottles were sold. However, after 7 p.m. till the closing of shops, different sorts of cheap fortified wine were available. As a result, many workers, finishing their work around 5 p.m., could have consumed some vodka (often still at the workplace) but continued with fortified wine. Aged alcoholics said that, when they went home after work, it would be better for them to buy a 0.25 litre bottle of vodka: then they would safely come home and wake up in the morning fit for the next working day. Instead, they continued with wine surrogates, which caused a deeper intoxication and severe hangover next morning. Cheapest fortified wines acted stupefying: intoxicated individuals often lost self-control, fell asleep in public places, were arrested etc. Probably it was caused by poor quality alcohol added to the wine surrogates i.e. compounds other than ethanol [5].

Considering the above and previously published arguments [3,6,7], some governmental policies contributed to the mortality increase among workers and other social groups: by 1993 the average expectation of life at birth for Russian men was estimated to be 59 years [1]. In 2008, the difference in life expectancy between men in some West European countries and Russia was reported to be 20 years [8]. Some people in the former SU name it genocide of a part of the Russian nation; certainly, it is a question of terminology, how to define the policies predictably enhancing mortality. Correlation of morbidity (hepatic, pulmonary, cardiovascular diseases, dementia, etc.) and mortality with quality of consumed alcohol should become the topic of research in future. According to my experience after practice of pathology in Russia and abroad, pulmonary diseases (chronic exacerbating bronchitis, pneumonia etc.) were more frequent causes of death of alcoholics in Russia, which can be partly explained by the cold climate and lesser availability of pubs especially for working class and pauper drinkers. Immunosuppression could have played a role as well. The relatively high mortality rates from cardiovascular diseases in Russia during 1990s compared to other countries [8,9] were commented in [5]: since the Soviet time, autopsy has remained obligatory for the patients dying in hospitals, but the attitude has become more superficial: autopsies have often been performed incompletely, without much insight. If a cause of death is not entirely clear, it is usual to write into the death certificate "ischemic heart disease", "cardiac insufficiency" or a similar formulation. There is a tendency to overdiagnose cardiovascular diseases in unclear cases also among people dying at home and not undergoing autopsy. In my opinion, the causative role of alcohol in the relatively high mortality in Russia has been exaggerated e.g. in [10], possibly in order to obfuscate another important cause: limited availability of modern health care especially for middle-aged and elderly men [5]. The cause-effect relationship between alcohol and cardiovascular diseases is not discussed here; however, it should be mentioned that pathologists in the former SU know that deceased alcoholics often have below average atherosclerosis. In literature, complex relationship between alcoholism and atherosclerosis at autopsy was reported, e.g. that alcoholic men and old women had a significantly lower degree of atherosclerosis in the coronary arteries, while the opposite was found in young women [11]. Relationships between different patterns of alcohol consumption and cardiovascular diseases should be further studied under unbiased conditions.

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2. McKee M. Alcohol in Russia. Alcohol Alcohol 1999;34:824-9.

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4. Scherer M, Worthington EL, Hook JN, Campana KL. Forgiveness and the bottle: promoting self-forgiveness in individuals who abuse alcohol. J Addict Dis 2011;30:382-95.

5. Rohsenow DJ, Howland J. The role of beverage congeners in hangover and other residual effects of alcohol intoxication: a review. Curr Drug Abuse Rev 2010;3:76-9.

6. Jargin SV. Health care and life expectancy: A letter from Russia. Public Health 2012; doi: 10.1016/j.puhe.2012.11.003.

7. Jargin SV. Social aspects of alcohol consumption in Russia. S Afr Med J 2012; 102(9):719.

8. Zatonski WA, Bhala N. Changing trends of diseases in Eastern Europe: closing the gap. Public Health 2012;126:248-52.

9. Razvodovsky YE. Beverage-specific alcohol sale and cardiovascular mortality in Russia. J Environ Public Health 2010;253853.

10. Nemtsov AV. Alcohol-related human losses in Russia in the 1980s and 1990s. Addiction 2002;97:1413-25.

11. Thomsen JL. Atherosclerosis in alcoholics. Forensic Sci Int 1995;75:121-31.

Competing interests: No competing interests

03 January 2013
Sergei V. Jargin
Peoples' Friendship University of Russia
Clementovski per 6-82