The chapter by Shkolnikov and Nemtsov reveals that alcohol consumption is temporally related to mortality trends and to fluctuations in rates of injury and cardiovascular disease in Russia. Alcohol abuse results as well in large productivity losses to society (Cook, 1990). Research to produce evidence on these linkages is still being conducted even as precise measurement of alcohol consumption and abuse remains a problem. Adverse consequences of alcohol abuse include directly related mortality (through, for example, alcohol poisoning, cirrhosis, and stroke) and indirectly related mortality through injury, some intestinal cancers, and hypertension. Mortality directly related to alcohol does not contribute significantly to potential years of life lost as discussed above. However, the chapter by Treml points out that mortality rates due to alcohol poisoning in Russia are extremely high relative to those of other developed countries.
Shkolnikov and Nemtsov also observe that alcohol consumption has generally been higher in Russia and the Baltic states than in the other NIS countries. Official estimates of per capita consumption of alcohol for Russia are unrealistically low, since they ignore the significant role of home production of samogon ("moonshine") and wine in consumption patterns in both urban and rural areas. Samogon consumption in Russia is estimated at roughly 30 to 60 percent of the consumption level of state-produced alcohol. Based on various estimates of real levels of consumption, alcohol consumption in Russia climbed steadily over the 1970s and 1980s, reaching a maximum in 1984, dropping to a low point in 1986 or 1987 as a result of Gorbachev's anti-alcohol campaign, and increasing thereafter until 1992-1993 following the cessation of the campaign. Corrected estimates for the 1990s suggest that Russians drink 14 liters of pure alcohol per capita, with a high concentration among adult males. Drinking among males is roughly estimated to be at levels four times greater than among females, although female drinking began increasing in the 1960s with increased production of wine and beer. Yet recent increases in alcohol-related mortality among females during 1991-1993 suggest increasing levels of alcohol consumption among females (Komarov et al., 1994). This is a cause for concern given the greater susceptibility of women to the negative effects of alcohol (Gavaler and Arria, 1994).
The Russian alcohol consumption level of 14 liters per capita is among the highest levels in the world, but not unique; France has a similar level. What is unique is the high level of consumption combined with binge drinking among Russians. Adverse consequences of alcohol consumption are strongly related to patterns of drinking (Camargo, 1989). Customary drinking patterns in Russia involve binge drinking of large quantities of vodka or samogon with little or no accompanying food, which, as Treml points out, is hypothesized to result in faster intoxication, more frequent violence, serious accidents, stroke, cardiac arrhythmias, and fatal alcohol poisoning. In the European countries of the NIS, the modest benefits of moderate alcohol drinking through a reduction in ischemic