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--> 7 Soviet and Russian Statistics on Alcohol Consumption and Abuse Vladimir G. Treml Introduction The purpose of this chapter is to summarize and offer analytical comments on the availability and reliability of official government statistics on alcohol and related issues in the former Soviet Union and contemporary Russia. The collection, collation, dissemination, and analysis of statistics on alcohol consumption, alcohol abuse, and alcohol-related mortality and morbidity were long neglected in the Soviet Union. Responsibility for collecting and analyzing alcohol statistics was divided among several state agencies that used different definitions and classifications and, as a rule, did not share the data among themselves. Open publication of virtually all statistical data related to alcohol consumption, alcohol abuse, and alcoholism ceased in the early 1930s, not to be resumed for almost 60 years. From time to time, some quantitative statements were made in specialized medical sources, but these were based on small samples and were of little, if any, utility. Recent inquiries in Moscow and elsewhere suggested that some alcohol statistics continued to be collected in classified documents, but many important data series that are routinely available in most countries in the world were simply discontinued in the early 1930s. Publication of some selected statistics finally resumed1 during the later stages of Gorbachev's perestroyka, but generally speaking, the availability, reliability, and usability of Soviet and post-Soviet Russian alcohol statistics remain poor. For more than 60 years, excise taxes on alcoholic beverages and state profits derived from the alcohol and wine industry and imports accounted for between 12 and 14 percent of all state revenues. Therefore, Soviet policies with respect to
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--> alcohol and its impact on society were to a large degree driven by short-term considerations of fiscal expediency, i.e., the need to provide the state treasury with steady alcohol-related revenues.2 Supporting these policies were several vague and simplistic notions shared by central Soviet authorities and the Communist Party. First, it was firmly believed that heavy drinking and alcohol abuse were historical products of bourgeois-capitalist institutions and as such should ultimately disappear in a ''classless" and "conflict-free" socialist society. The alcohol issue was thus never very high on the government agenda. What alcohol abuse remained in the new Soviet society was viewed as stemming from character flaws of the individual, absence of personal willpower, peer pressures, alien (foreign) influences, and the like, but was not believed to be related to systemic features of the society. Contrary to all evidence (and disregarding cause-and-effect considerations), it was also assumed that alcohol abuse and heavy drinking were associated with low educational, "cultural," and income levels. Thus, projected progress in education at all levels and planned increases in real income were optimistically expected to reduce drinking and to eradicate alcohol abuse. It was believed further that deviant behavior, social disruptions, economic and violent crime, and other consequences of heavy drinking and alcohol abuse could be effectively contained by restrictive and penal measures, controlled by law enforcement agencies, and corrected by appropriate educational and popular propaganda programs. The responsibility of medical institutions was confined to treatment of the worst clinical cases of alcoholism, alcohol-related cirrhosis of the liver, and alcohol psychoses. The need for involvement of medical, public health, educational, legal, and social organizations in prevention, counseling, and rehabilitation of heavy drinkers and alcoholics was never seriously considered by state and Communist Party authorities. The socialist centrally planned state had a complete monopoly on the production, pricing, foreign trade, and distribution of alcohol. Setting higher-than-average excise tax rates3 on alcoholic beverages and thereby making them expensive relative to other consumer goods and to average wages was considered an optimal state policy because it would discourage drinking, while also providing the state treasury with much-needed and easily collectible revenues. The high level of ruble retail trade sales of alcoholic beverages (which accounted for between 15 and 20 percent of total retail turnover) was also viewed as an important factor in helping central planners, industry, and consumer trade authorities balance the inadequate supply of consumer goods with people's income. It was conceded that high prices of state-produced alcoholic beverages would encourage illegal distillation of samogon 4 and home production of wine, but it was believed, contrary to all evidence, that law enforcement agencies would be able either to eliminate or to minimize home production. The almost complete absence of information on the consumption of alcohol and on the health, social, and economic consequences of heavy drinking and
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--> alcohol abuse in the Soviet Union led to complacency on the part of the authorities and the public. From time to time, the government would release brief and undocumented references to the fact that annual per capita consumption of alcohol in the Soviet Union was between 2.3 and 3 liters of pure alcohol-one of the lowest rates in the world. Such statements, of course, reinforced this complacency. The next two sections focus, respectively, on statistics on alcohol consumption and alcohol abuse. The fourth and fifth sections address two issues related to alcohol abuse: the impact of Gorbachev's anti-alcohol campaign and deaths from alcohol poisoning. These issues, which remain controversial, illustrate the problems involved in working with available Russian statistics. Statistics on Per Capita Consumption of Alcohol in Russia Table 7-1 shows a standard Russian tabulation of consumption of alcohol and alcoholic beverages per capita. Data of this type are available for some 75 regions of the country.5 The official statistical agency of the Soviet Union, Goskomstat SSSR, collected all alcohol consumption data in value terms (current and constant rubles) and in liters for different types of beverages (e.g., vodka, wine, beer, cognac, and champagne) from periodic reports of the retail trade network of republics, regions, and cities. The central statistical agency of newly independent Russia, Goskomstat of Russia, continued the traditional Soviet method of data collection and publication of alcohol statistics.6 The appearance of legal private and cooperative retail trade outlets and restaurants and of unorganized "street trade" during the period of transition to a market economy in Russia made such data collection more difficult and the resulting statistics probably even less reliable than the earlier series based on a single state source. The available statistics on legal per capita alcohol consumption show that the highest level of drinking in Russia was reached in the early 1980s, that is, just before the start of Gorbachev's anti-alcohol campaign. As the result of drastic cuts in state production and in sales of alcoholic beverages, along with hefty price increases, per capita consumption in the Soviet Union dropped to its lowest point, 3.9 liters of pure alcohol, in 1987. The momentum of the reform, however, could not be sustained for long because of losses of tax revenue and the unpopularity of the restrictive measures and reduced sales. Starting in 1988, the state alcohol industry began to increase production. The most striking feature of these data is that while Russia was and is known as a country with severe alcohol abuse problems, in the early 1990s it ranked 33rd among 50 countries in terms of per capita consumption.7 We will return to this issue later. Because of the methods and sources employed in data collection, the statis-
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--> TABLE 7-1 Per Capita Consumption of State-Produced Alcoholic Beverages in Russia Year Alcohol Totala Vodkab Wineb Beerb 1970 8.30 12.10 12.30 18.00 1975 9.90 13.90 12.90 23.00 1980 10.50 14.90 13.90 24.10 1984 10.45 13.90 16.62 24.94 1985 8.80 11.75 13.78 24.81 1986 5.17 6.54 6.71 18.30 1987 3.90 5.33 6.14 17.90 1988 4.40 6.04 7.68 19.90 1989 5.16 7.80 7.87 21.50 1990 5.56 9.00 6.09 20.72 1991 5.57 9.59 4.74 18.73 1992 5.01 7.04 3.23 10.43 1993 5.92 11.96 2.60 19.82 1994 6.76 13.72 3.47 18.14 a In liters of 100 percent ethanol. b In liters by volume. NOTES: Per capita alcohol consumption data were derived from sales of all state-produced alcoholic beverages, i.e., vodka, fruit wine, grape wine, cognac, champagne, and beer, converted to 100% alcohol. Home-distilled samogon and home-made wine are excluded. Per capita consumption of fruit wine, cognac, and champagne is not shown separately. SOURCES: Goskomstat Rossii (1993c: 254-265); Goskomstat Rossii (1992:145-152); Goskomstat Rossii (1995:201); TsSU RSFSR (1987:48-53). tics on per capita consumption of alcohol in Russia have several serious shortcomings, described below. Consumption of all homemade alcoholic beverages, both legal and illegal, is excluded. In recent years, Soviet statisticians made some estimates of samogon production, but these estimates are rather rough and are restricted to sugar-based samogon only. The estimates exclude samogon produced from other inputs, such as potatoes, grain, and fruits, as well as home-made wines and beers. Table 7-2 summarizes estimated statistics on samogon consumption in Russia. It must be stressed that the estimates shown in Table 7-2, as well as other estimates available in the Russian literature, should be viewed as first approximations only. Penalties for illegal home production and purchase of samogon have always been severe, and samogon producers have over time developed various techniques for escaping police attention. Thus detection and quantification of
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--> TABLE 7-2 Per Capita Consumption of State and Illegal Homemade Alcohol in Russia (liters of 100 percent alcohol) State Year Alcohol Samogon Total 1960 4.60 5.2 9.80 1970 8.30 3.7 12.00 1975 9.90 3.2 13.10 1980 10.50 3.5 14.00 1984 10.45 3.8 14.25 1985 8.80 4.5 13.30 1986 5.17 5.4 10.57 1987 3.90 6.8 10.70 1988 4.40 6.8 11.20 1989 5.16 6.5 11.66 1990 5.56 6.2 11.76 1991 5.57 6.7 12.27 1992 5.01 8.8 13.81 1993 5.92 8.5 14.43 SOURCES: Treml (1982a: 47-66) and Treml (no date: samogon files); see also Shkolnikov and Nemtsov (in this volume). samogon consumption are rather difficult. The samogon estimates given here should be regarded as having about ± 10 percent error. Historically, samogon was primarily a rural phenomenon: agricultural populations always had easier access to the produce needed for samogon production, while lower monetary incomes reduced their demand for state-produced alcoholic beverages. Large-scale rural-to-urban migration explains the decline in per capita samogon consumption during 1960-1975. Gradually, however, home distillation of samogon spread to urban areas. As can be seen from the estimates, the share of samogon in total alcohol consumption varied from less than 30 to over 60 percent of total consumption. It should be emphasized that in addition to state-produced alcoholic beverages, samogon, and home-made wine, consumption of alcohol in the Soviet Union and Russia has included stolen ethanol, a variety of technical alcohols, and alcohol surrogates (alcohol-based liquids such as aftershave lotions and colognes).8 The quantities of these substitutes for legal alcoholic beverages are impossible to estimate, but since they are significant, the per capita data tabulated above are understated. The long neglect of home distillation in studies of alcohol in the Soviet Union and the scant attention given the phenomenon in contemporary Russia are therefore regrettable. Among other developments, we should note that Gorbachev's government paid a high price for the lack of understanding
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--> of the country's penchant for and skills in illegal home production. Drastic cuts in production and sales, combined with two major increases in prices of alcoholic beverages in the 1985-1987 phase of the anti-alcohol campaign, resulted in the rapid growth of samogon and uncontrolled drinking and an alarming diversion of sugar and other produce from human consumption to home distillation.9 These developments contributed to the virtual abandonment of the anti-alcohol campaign in the late 1980s. However, as can be seen in Table 7-2, the reversal of the policy of reducing the production and consumption of state-produced alcoholic beverages in 1988 was not reflected in a comparable decrease in the consumption of samogon. State alcohol prices, which remained high relative to prices of other goods and incomes, continued to make samogon production very profitable. The ethnic identity of drinkers cannot be established on the basis of available state statistics. To the best of the author's knowledge, neither state statisticians nor academic analysts have ever looked at ethnic differentials in per capita consumption of alcohol. These differentials are, however, significant and cannot be disregarded in any serious analysis of the alcohol situation in the country. According to the author's rough estimates, people of the Muslim culture consume on a per capita basis slightly less than half of the alcohol consumed by Slavs and other ethnic groups in Russia.10 As a result, regions of Russia in which Muslims constitute a significant portion of the population show a lower incidence of alcohol-related mortality and morbidity and socially disruptive alcohol abuse. Gender differences in drinking cannot be derived from the available alcohol consumption sales data. To the best of the author's knowledge, Soviet and Russian statisticians and medical authorities did not and do not have reliable estimates or time series on this subject. It is generally believed that drinking among women began to increase rapidly in the 1960s, but there are no supporting statistics for this belief. Several studies undertaken by the author, as well as infrequent vague and undocumented references found in the Soviet and Russian literature, suggest that in the last 10 years or so, men have been drinking between 3.8 and 4 times the amount of alcohol consumed by women.11 Alcohol-related morbidity, mortality, and abuse statistics show correspondingly lower rates for women. There are a number of miscellaneous shortcomings in available alcohol consumption data. Among other unresearched topics and gaps in alcohol consumption statistics, we should note the absence of any reliable age-distribution data for drinkers, as well as of series for frequency over time and quantity of drinking. Age and gender breakdowns for most alcohol-related morbidity and mortality statistics are also absent. Per capita alcohol consumption data for Russia presented here (even when adjusted for Samoan consumption) do not fully explain the alarmingly high cost of heavy drinking and alcohol abuse reflected in high rates of mortality and morbidity, low life expectancy, and social and economic disruption. The high-risk groups are mainly adult male Slavs (Russians, Ukrainians, and Belorussians).
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--> TABLE 7-3 Vodka as Percent of Total Alcohol Consumed in Russia, Selected Years Year Percentage 1960 75 1970 58 1975 56 1980 57 1984 53 1985 53 1989 60 1990 65 1991 69 1992 74 1993 81 1994 81 NOTE: The data shown do not take into account consumption of samogon. SOURCE: Tremolo (no date: vodka and alcohol files). The explanation for the alcohol abuse includes not only the relatively high level of overall consumption of alcohol, but also the high share of alcohol consumed in the form of vodka and Samoan, as can be seen in Table 7-3. Drinking vodka results in faster intoxication, more frequent violence, and more serious somatic effects, particularly accidents of different types and fatal alcohol poisonings (as discussed below), than does drinking wine or beer. A second, equally important factor is the mode of drinking prevalent among Slavs, which characteristically consists of "drinking binges"—the intermittent consumption of large quantities of alcohol in a relatively short period of time and often without accompanying meals. It should be noted that a small group of Russian alcohol specialists have long suggested that total alcohol prohibition is fruitless and that the most promising policy would be to educate the public in "civilized" drinking. This position was never popular in the Soviet Union, and its proponents were all but silenced during Gorbachev's anti-alcohol campaign. It will be noted that the 1960 high share of vodka of 75 percent of total alcohol consumed had been reduced by government policy to the lowest point of 53 percent just before the start of Gorbachev's anti-alcohol campaign. An unexpected and alarming result of the campaign was that the share of vodka increased rapidly.12 In summary, we can say that even in recent years, the availability, usability, and reliability of state statistics on alcohol consumption and related matters in Russia leave much to be desired. Clearly, no coherent and effective public policy
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--> with respect to the production,13 consumption, and pricing of alcoholic beverages, to law enforcement, or to medical treatment can be formulated on the basis of these sketchy and unreliable statistics. Statistics on the Overall Impact of Drinking and Alcohol Abuse in Russia This section supplements the discussion in the previous section by presenting selected official statistics on alcohol mortality, registration of alcoholics, and alcohol-related accidents; see Tables 7-4a and b, 7-5, and 7-6, respectively. Space limitations and the scope of this paper prevent detailed comments on these statistics. A few observations are, however, in order. Russian medical authorities are well aware of the fact that heavy drinking and alcohol abuse are significant contributors to a number of health problems, including cardiovascular and gastric ailments, tuberculosis, and a wide variety of accidents. Soviet and Russian medical and statistical sources recognize only four causes of death directly linked to alcohol, as summarized in Tables 7-4a and b. One notable feature of these tables is that the overall rate is dominated by deaths TABLE 7-4a Mortality From All Causes Related to Alcohol, Soviet Union (in thousands) Cause of Death 1980 1984 1985 1986 1988 1989 Alcoholic psychosis 1.1 0.9 0.6 0.2 n.a. n.a. Chronic alcoholism 4.6 5.7 5.0 2.6 n.a. n.a. Cirrhosis of liver 2.4 2.2 2.1 1.1 0.72 0.85 Alcohol poisoning 42.4 38.5 32.2 19.4 17.10 19.50 Total 50.5 47.3 39.9 23.3 n.a. n.a. Rate per 100,000 Population Alcoholic psychosis 0.4 0.3 0.2 0.1 n.a. n.a. Chronic alcoholism 1.8 2.1 1.8 0.9 n.a. n.a. Cirrhosis of liver 0.9 0.8 0.7 0.4 0.24 0.29 Alcohol poisoning 15.9 14.0 11.6 6.9 6.0 6.70 Total 19.0 17.2 14.3 8.3 n.a. n.a. NOTE: Gorbachev's anti-alcohol campaign was announced in April 1985 and began with cuts in the production and sale of alcoholic beverages; per capita consumption of alcohol, including samogon, was artificially boosted by 1 to 2 percent. n.a. = not available SOURCES: Goskomstat SSSR, Press Release January 25, 1988; Goskomstat SSSR (1989:496-501); Goskomstat SSSR (1990:442-444).
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--> TABLE 7-4b Mortality From Causes Related to Alcohol Abuse, Russia (death rates per 100,000 population) Alcohol Psychosis Chronic Alcoholism Alcoholic Cirrhosis of Liver Accidental Alcohol Poisoning Total Year 1984 0.3 2.4 0.7 19.6 23.0 1985 0.2 2.1 0.6 16.4 19.3 1986 0.0 1.0 0.3 9.3 10.6 1987 0.1 0.8 0.2 8.0 9.1 1988 0.1 0.7 0.2 7.8 8.8 1989 0.1 0.8 0.2 8.8 9.9 1990 0.1 1.1 0.3 10.81 2.3 1991 0.1 1.0 0.3 11.2 12.6 1992 0.1 1.5 0.3 17.6 19.5 1993 0.4 3.9 0.7 30.9 35.9 1994 0.5 7.0 1.7 37.4 46.6 SOURCES: See Table 7-5. from accidental alcohol poisoning. This phenomenon is discussed separately in the following section. There are difficulties in accurate diagnosis of alcoholism and alcohol psychoses and registration of alcoholics with medical authorities in all countries, and as with other alcohol-related statistics, the available data should be viewed as subject to significant error. The Soviet and Russian statistics are particularly unreliable. The main reasons for this are a shortage of medical alcohol specialists and psychiatrists and insufficient numbers of and spaces in both general and specialized medical facilities. In fact, some facilities have been closed in recent years, reflecting the general crisis in Russian public health (Oganov et al., 1994:39; Goskomstat Rossii, 1994a:70). Accordingly, the reduced numbers shown in the tabulated data do not reflect health improvements, but rather the deterioration of medical services. It should also be noted that the number of reported alcohol-related accidents and crimes depends on the availability and deployment of police forces in the country and priorities accorded to control of alcohol disturbances by the public. The rapid growth of violent crime in Russia and the widely reported corruption of all law enforcement agencies suggest that the antisocial behavior of alcoholics and heavy drinkers is not very high on the government agenda, and available statistics should reflect this. Impact of Gorbachev's Anti-Alcohol Campaign Gorbachev's 1985 anti-alcohol campaign began with cuts in the production
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--> TABLE 7-5 Alcoholics and Those Suffering from Alcohol Psychosis, Russia Year Number Population Rate per 100,000 Number of Alcoholics Registered With Public Health Authorities 1985 2,770,300 1,933 1987 2,901,100 2,008 1989 2,764,400 1,872 1990 2,653,100 1,791 1991 2,562,300 1,728 1992 2,465,700 1,663 1993 2,452,000 1,657 Number of Persons First Diagnosed as Alcoholics 1985 356,785 249 1989 269,709 183 1990 224,878 152 1991 170,963 115 1992 153,173 103 1993 215,000 145 Number of Persons First Diagnosed as Suffering From Delirium Tremens (Alcohol Psychosis) 1985 23,891 18 1989 11,037 8 1990 14,318 10 Number of Alcoholics Directed by Courts to Undergo Compulsory Treatmenta 1989 42,861 1990 45,110 a Denotes people confined to so-called Medical-Labor Centers (Lechebnotrudovye profilaktorii) for terms varying from 6 months to 2 years. SOURCES: Goskomstat SSSR (1990a:49-51); Goskomstat RSFSR (1991:108-117); Goskomstat Rossii (1993a:56-59); Goskomstat Rossii (1994a:70-71); Goskomstat Rossii (1994b:160-161): Oganov et al. (1994:37-40); Statkomitet SNG (1994:483-484). and sale of alcoholic beverages, combined with hefty price increases and a number of administrative penalties for alcohol abuse. In 3 years, per capita consumption of state-produced alcoholic beverages was cut by a remarkably high 67 percent. By 1988, for all practical purposes, losses of budgetary tax revenues and the increasing unpopularity of the campaign forced the authorities to reverse these measures and start to increase the production and sale of alcohol. Many
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--> TABLE 7-6 Selected Data on Alcohol-Related Accidents and Law Enforcement Intervention, Russia, in Thousands Intervention 1985 1986 1987 1988 1989 1990 Persons sentenced for driving while under the influence 13.5 27.3 35.9 42.3 41.4 44.1 Road accidents caused by intoxicated drivers 30.1 26.5 27.1 32.0 39.1 38.0 Road deaths caused by intoxicated drivers 6.6 5.2 5.2 6.3 8.0 8.1 Road injuries caused by intoxicated drivers 32.9 28.3 30.8 36.8 45.0 43.8 Persons arrested/fined for public drinking and disorderly conduct n.a. n.a. 5.9 5.6 5.4 5.4 Persons fined for buying samogon n.a n.a. 64.5 70.0 48.7 55.6 Reported cases samogon production 48.9 122.2 74.8 7.1 3.4 2.9 Crimes committed while intoxicated n.a. n.a. n.a. 266.4 310.5 335.3 Persons denied parental rights 16.8 11.1 8.0 6.5 5.7 6.0 Persons denied civil rights 18.5 19.5 15.8 14.0 10. 8.4 n.a. = not available SOURCES: Vestnik Statistiki (1989:56-57); Vestnik Statistiki (1991:64-65); Goskomstat. RSFSR (1991:93-107); Statkomitet SNG (1994:486). statistical series on mortality, morbidity, and alcohol-related social disturbances showed significant and rapid improvement during the campaign. Many Western and Russian specialists, not unreasonably, link the restrictive measures of the campaign and drastic cuts in per capita consumption of alcohol to reduced mortality, decreased incidence of crime, and other beneficial social and health effects. Thus, according to the standard Soviet statistical handbook for 1987, "The average number of deaths in 1986 and 1987 compared to 1984 had
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--> declined by about 200,000; the struggle against alcoholism of the last few years contributed to the decline of mortality'' (Goskomstat SSSR, 1988b). Similar conclusions are reached by Shkolnikov and Nemtsov (in this volume), the author describing the campaign (White, 1996:135-160), and others. This author believes that the beneficial demographic, health, and social effects of Gorbachev's anti-alcohol campaign have been misinterpreted and significantly overstated (see Shkolnikov and Nemtsov in this volume for a further discussion of the anti-alcohol campaign). We can start by noting that some statistical data were "doctored" or manipulated to present a more favorable picture of the campaign's results. It is now a well-established fact that Gorbachev directed Goskomstat SSSR to change the formula used in national income accounting to produce artificially high rates of growth in the 1985-1987 period. 14 An earlier paper by the author questions the official position that reduced drinking resulting from the campaign contributed to the reduction of more than 100,000 deaths from cardiovascular problems during the period by noting that this number breaks down to 54 percent fewer female deaths and 46 percent fewer male deaths. Since heavy drinking, alcohol abuse, and adverse health effects are much more prevalent among men than women, a reduction in drinking should have been reflected in a proportionately higher reduction in male deaths.15 Perhaps the most striking statement about the effects of the campaign was recently made by the eminent Russian specialist in alcoholism Dr. Alexander Nemtsov (1995:46), who said that "the anti-drinking campaign saved 700,000 lives in Russia in 1985-1987." This estimate is based on a rather simplistic manipulation of statistics and cannot be accepted as valid.16 There are other reasons to question the excessively favorable interpretations of the effects of the anti-alcohol campaign offered by some authors. Deceptions and distortions in official statistics were practiced for many years in the Soviet Union, both at the very top of the government and at lower levels. Thus the local police units may have classified traffic accidents caused by drunken drivers as not related to drinking in order to impress their superiors; for the same reason, local medical authorities may have been tampering with reports by lowering the number of fatal alcohol poisonings. Another possible source of falsification is the drinkers themselves. For example, regulations introduced in the course of the reform prohibited awards of sick leave to drinkers who suffered trauma while intoxicated. To avoid this, an intoxicated man who, say, fell down and hurt himself might wait for several hours to lower his blood alcohol level before seeing a doctor. This, of course, would lower the number of traumas recorded as resulting from intoxication, but not the total number. Alcoholic psychoses, chronic alcoholism, and cirrhosis of the liver take several years to develop in an average drinker. Would the effects of the reduction in drinking on these diseases be reflected in alcohol mortality as is rapidly as is recorded in official statistics? There is no question that the administrative measures of 1985-1987 and the
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--> consequent reduction in per capita consumption must have had some beneficial results, but certainly not to the extent commonly cited. The discussion in both this and the next section illustrates the need for more comprehensive, detailed, and high-quality statistics and quantitative analysis of the alcohol problem in Russia before acceptable conclusions can be reached. Fatal Alcohol Poisoning: A Neglected Problem One of the most alarming phenomena related to alcohol abuse in the former Soviet Union and Russia has been and is mortality from so-called fatal alcohol poisoning (Russian opoy). Death occurs from ingesting a critical measure of vodka or a similar strong beverage in a relatively short time.17 Even from the limited available data, it is clear that the most extraordinary aspect of fatal alcohol poisoning in the former Soviet Union and Russia is its extremely high level, as shown in Table 7-7. For comparison purposes, the rate of death from alcohol poisoning in the United States in the late 1970s was 0.18 per 100,000 population (U.S. Department of Health, Education, and Welfare, 1979:1-163) and varied at around 0.5 for a large number of countries. The Soviet and post-Soviet rates varying from 10 to 37 are thus so high that they do not fit into the range of international experience. Several aspects of fatal alcohol poisoning must be noted here. First, alcohol poisoning is particularly high in Slavic areas, as can be seen from the data in Table 7-8, and rates of death for men are five to eight times higher than the rates for women in both Slavic and Baltic republics, which account for most deaths. The ranking of geographic areas within Russia by mortality due to alcohol poisoning has been remarkably stable from year to year, even though national averages for consumption of vodka have changed considerably.18 This author believes that frequent references in the Russian literature to samogon and toxic alcohol surrogates as the main cause of fatal alcohol poisoning are misleading (see also Shkolnikov and Nemtsov, in this volume). Certainly, the presence of toxins in the beverage would increase the likelihood of death from alcohol poisoning, but in all probability the majority of deaths are caused by drinking standard state-produced vodka. It is important to note that high rates of fatal alcohol poisoning reflect on the poor state of public health in the former Soviet Union and contemporary Russia. Death from alcohol poisoning is not instantaneous: the victim slips into a comatose state after ingesting a critical amount of alcohol, and death occurs several hours later; the drinker could be saved during this time by simple medical procedures (Banshchikov and Korolenko, 1973:61). Prompt and proper medical attention could therefore reduce the tragically high level of alcohol-related deaths. However, the absence of needed statistical data19 and of serious research will continue to frustrate medical specialists in setting public policy in this regard.
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--> TABLE 7-7 Deaths From Poisoning: All Poisons and Alcohol (rates of death per 100,000 population) U.S.S.R. Russia Year All Poisons Alcohol All Poisons Alcohol 1968 13.1 7.6 n.a. n.a. 1969 14.1 8.7 n.a. n.a. 1970 16.3 9.7 n.a. 10.4 1971 16.4 10.6 n.a. 11.2 1972 17.7 10.4 n.a. n.a. 1973 19.0 11.9 n.a. n.a. 1974 20.8 12.9 n.a. n.a. 1975 23.1 13.9 n.a. n.a. 1976 25.7 15.9 n.a. n.a. 1977 27.3 16.6 n.a. n.a. 1978 30.7 18.1 n.a. n.a. 1980 n.a. 15.9 n.a. n.a. 1984 n.a. 14.0 n.a. 19.6 1985 n.a. 11.6 n.a. 16.4 1986 n.a. 6.9 n.a. 9.3 1987 n.a. n.a. n.a. 8.0 1988 12.46 6.03 n.a. 7.8 1989 13.27 6.79 15.57 8.8 1990 n.a. 8.25 n.a. 10.8 1991 n.a. n.a. n.a. 11.2 1992 n.a. n.a. n.a. 17.6 1993 n.a. n.a. n.a. 30.9 1994 n.a. n.a. n.a. 37.4 NOTES: The data cover a longer span of time to show the trends and variability of the phenomenon. Furthermore, 1968-1978 estimates are the author's and were never reported in the Soviet Union or Russia. Rates of death from all poisons cover both accidental poisonings and suicides by poison. In this respect, the series are not quite comparable with rates of death from all poisons in the Soviet Union in 1989 and 1990 and in Russia in 1989, which exclude suicides by poison and are thus understated. n.a. = not available SOURCES: 1968-1978, USSR and Russia estimates by Treml (1982b, 1982c, 1983). All other rates from Goskomstat SSSR (1990a: 444-447); Goskomstat SSSR (1988:501); Vestnik Statistiki (1989:62); Sotsiologicheskiye Issledovaniya (1988:119); Goskomstat Rossii (1994b:71); Vestnik Statistiki (1991:66).
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--> TABLE 7-8 Characteristics of Fatal Alcohol Poisoning by Republics, 1989 (death rates per 100,000 population) Death Rates Republic Male Female Slavic Republics High consumption of alcohol, mix dominated by vodka 15.02 2.55 Baltic Republics High consumption of alcohol, mix dominated by vodka and beer 8.61 1.82 Moldova High consumption of alcohol, mix dominated by wine 4.70 2.50 Central Asia Republics (Muslim) Low consumption of alcohol, consumption of vodka much lower than in Slavic republic 1.82 0.95 Transcaucasian Republics Medium to low consumption of alcohol, mix dominated by wine 0.24 0.00 NOTE: It must be stressed that the groupings used in this table follow administrative regions of the Soviet Union with varying ethnic composition. In some republics, such as Kazakstan, Slavs constitute the majority of the population; the number of Slavs is also high in the Baltics. SOURCE: Goskomstat SSSR (1990:445-490); Treml (no date: alcohol poisonings files). References Banshchikov, V.M., and Ts.P. Korolenko, eds. 1973 Voprosy Alkogolizma. Moscow: Meditsina. Cronin, Anne 1995 The tipplers and the temperate: Drinking around the world. New York Times, January 1. Goskomstat RSFSR 1990 Chislennost', Sostav I Dvizheniye Naseleniya V RSFSR. Moscow. 1991 Statistika Sotsial' Nykh Anamaliy, Statisticheskiy Sbornik. Moscow. Goskomstat Rossii 1992 Pokazateli Sotsial'nogo Razvitiya Respublik, Krayev, I Oblastey Rossiyskoy Federatsii. Moscow. 1993a Demograficheskiy Ezhegodnik. Moscow. (available only on floppy disk). 1993b Meditisinskoye Obsluzhivaniye Naseleniya Rossiyskoy Federatsii V 1992. Moscow.
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--> 1993c Pokazateli Sotsialinogo Razvitiya Rosskiyskoy Federatsii I Ee Regionov. Moscow. 1993d Rossiyskaya Federatsiya V 1992, Statisticheskiy Sbornik. Moscow. 1994a Sotsialino-Ekonomicheskoye Polozheniye Rossii V Yanvare-Avguste. Moscow. 1994b Sotsial'no-Ekonomicheskoye Polozheniye Rossii V. Moscow. 1995 Rossiyskiy Statisticheskiy Ezhegodnik. Moscow. Goskomstat SSSR 1988a Naseleniye SSSR 1987. Moscow. 1988b Narodnoye Khozyaystvo SSSR V. 1987. Moscow. 1989 Naseleniye SSSR 1988. Moscow. 1990a Demograficheskiy Ezhegodnik SSSR. Statisticheskiy Sbornik. Moscow. 1990b Byudzhety Rabochikh, Sluzhashchikh I Kolkhoznikov V 1975-1988. Moscow. 1990c Okhrana Zdoroviya V SSSR. Moscow. Izvestiya 1989 O nekotorykh negativnykh yavleniyakh v bor'be s p'yanstvom i alkogolizmom. Izvestiya TsKaKPSS 1:48-51. Mayer, V.F., and E.B. Ershov, eds. 1971 Differentsirovannyi Balans Dokhodov I Potrebleniya, Gosplan SSSR. Moscow. Nemtsov, A.V. 1995 Alkogol'naya Situatsiya VRossii. Moscow. Fond: Zdorov'ye I Okruzhayushchaya Sreda. Oganov, R.G., R.A. Khalitov, and G.S. Zhukovskiy, eds. 1994 K Zdorovoy Rossii: Politika Ukrepleniya I Profilaktika Zabolevaniy. Moscow. Gosudarstvennyi nauchnoissledovatel'skiy tsentr profilakticheskoy meditsiny Ministerstva zdravoohkraneniya i meditsinskoy promyshlennosti Rossiyskoy Federatsii. Popkin, Barry M., and N. Zohoori, eds. 1995 Monitoring Health Conditions in the Russian Federation: Russian Longitudinal Monitoring Survey. School Of Public Health, University Of North Carolina, March. Chapel Hill. NC. Sotsiologicheskie Issledovaniya 1988 1:119. Statkomitet SNG 1994 Strany-Chleny SNG V 1993: Statisticheskiy Ezhegodnik. Moscow. Treml, V.G. 1982a Alcohol in the USSR: A Statistical Study. Durham, N.C.: Duke University Press. 1982b Death from Alcohol Poisoning in the USSR. Soviet Studies 34(4):487-505. 1982c Fatal Poisonings in the USSR. Research Bulletin, Radio Liberty/Radio Free Europe. 50(3203): 11-12. 1983 Gli avvelenamenti mortali nell'Unione Sovietia. Revista Di Politika Economica 73(3):886-896. 1989 Was 1989 a Year of Demographic Disasters? Report on the USSR 1(22):1-3. no date Soviet/Post-Soviet Alcohol Database, Duke University. TsSU RSFSR. O Khode Vypolneniya V Rossii Resheniy Partii I 1987 Pravitelistva Po Voprosam Preodoleniya Piyanstva I Alkogolizma. Moscow. U.S. Department of Health, Education and Welfare, Public Health Service 1979 Vital Statistics of the United States. Hyattsville, Md. Vestnik Statistiki 1989 6:64-82. 1991 9:62-66. White, S. 1996 Russia Goes Dry: Alcohol, State and Society. New York: Cambridge University Press.
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--> Notes 1. Data published since the late 1980s offer fairly detailed albeit still insufficient coverage of 1985 and later years, but little information is available for the preceding decades. Most basic statistics on alcohol consumption and abuse in the Soviet Union for the period from the early 1930s to the early 1960s are not available in public documents. Some of these data could probably be roughly reconstructed from primary historical alcohol production and sales records and police and public health archives, but such agendas seem to have rather low priority for the Russian government at this time. 2. Thus, budgetary alcohol revenues exceeded by a significant margin revenues generated by individual income taxes and social security collections. It is not, therefore, surprising that the influential Ministry of Finance of the Soviet Union was traditionally opposed to any cuts in sales of alcoholic beverages. In fact, Gorbachev's anti-alcohol campaign was rolled back after 2 years, mainly because of losses of budgetary revenues. 3. In the 1980s, the so-called "turnover tax" accounted for close to 90 percent of the retail price of vodka. 4. Samogon is the Russian equivalent of the American "moonshine." It is an alcoholic beverage produced by untaxed illegal home distillation of fermented foodstuffs such as grain, sugar beets, potatoes, and other vegetables and fruit. The alcohol content of samogon is usually about 40 percent. Production is very simple and requires few skills and equipment. The quality of the samogon produced depends on the inputs used and the method of distillation and filtration; the results can vary from a toxic and malodorous brownish brew to a clear vodka-type beverage. 5. Since per capita consumption is derived from the standard resident population, ignoring drinking by out-of-town visitors, the resulting statistics overstate consumption in larger cities and resort areas; furthermore, regional data exclude sales of alcohol on military bases. 6. Statistics on expenditures on alcoholic beverages are also available from periodic detailed surveys of 90,000 household incomes and expenditures (broken down by regions and household categories) regularly conducted by Goskomstat. These surveys have long been criticized in the West and in the Soviet Union for producing distorted and unrepresentative results and are probably worthless. For example, in 1980 and 1985 consumption of alcoholic beverages in rubles based on household budget surveys was reported, respectively, at 52 and 59 rubles per capita (Goskomstat SSSR, 1990a: 16 and 50). Per capita consumption estimated on the basis of total retail sales of alcoholic beverages was calculated as 204 and 210 rubles, respectively (Goskomstat Rossii, 1993c: 197-206). The understatement of quantities of alcohol consumed based on surveys of drinkers is well known to alcohol specialists in many countries. Soviet and post-Soviet household surveys are, however, particularly biased, and at the same time are too often used uncritically for analytical and policy purposes. 7. See Cronin (1995). Other comparisons collected in the author's database show similar results. 8. According to a report to the Central Committee of the Communist Party on the progress of Gorbachev's anti-alcohol campaign, sales of certain types of alcohol-based glue increased from 760 tons in 1985 to 1,000 tons in 1987; sales of glass cleaners increased from 6,500 to 7,400 tons in the same period; and sales of perfume products, which averaged 3.2 billion rubles in the 1983-1984 period, rose to 4.5 billion rubles in 1987 (Izvestiya, 1989:50). 9. Understandably, large-scale factory production of alcohol is far more efficient in the use of inputs than is home distillation. Thus any shift of production of alcohol from state facilities to homes entails significant net losses of produce. 10. These estimates were derived by regression analysis for three separate years for 73 regions in Russia, broken down into ethnic populations. The estimates of the ratio of per capita consumption of alcohol by Slavs and others over that by Muslims are as follows:
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--> 1970 1.95 1979 1.89 1989 1.77 The downward trend in the ratios may suggest a slow reduction in the differences in drinking patterns among ethnic groups. There are, however, other factors affecting per capita alcohol consumption by ethnic groups, such as differences in age and gender structure, which cannot be statistically controlled for, and therefore the trend is somewhat uncertain (Treml, no date: ethnic patterns files). 11. Treml (no date: gender differences files). An early reference gives the adult male/female ratio for the Soviet Union as 3.9 (Mayer and Ershov, 1971:112); a mean male/female ratio based on four recent sample surveys conducted by Western specialists in Russia was reported as 3.8 (Popkin and Zohoori, 1995:1). 12. The dismantling of wineries and breweries ordered by the authorities proceeded more rapidly than the dismantling of ethanol and vodka plants, and once the campaign was reversed in 1988, the rebuilding of vodka plants was also more rapid; furthermore, large-scale destruction of slow-growing grapevines and hops plants slowed the growth of wine and beer production in later years. 13. Space limitations prevent the author from covering the data on alcohol production and foreign trade statistics. In this respect, the statistical database available in the Soviet Union and Russia is far better. Detailed time series on industrial production of ethanol, vodka, wine, beer, cognac, champagne, and beer, in liters, have been collected regularly, as have data on exports and imports, in value terms and in physical units. These statistics are, of course, important for economic and budgetary analysis, but add little to our understanding of drinking and alcohol abuse. 14. Based on the author's interviews with Moscow Goskomstat officials in 1991 and 1992. Details concerning national income accounting are as follows. Production, imports, and sales of alcoholic beverages were drastically cut by authorities in the period 1985-1987. For example, retail trade sales measured in current prices dropped by 22 percent in 1986 compared with 1995. Since sales of alcoholic beverages accounted for some 10 to 12 percent of the consumption component of national income (net material product) in the early 1980s, such drastic cuts normally would have resulted in lower rates of growth of national income. The ruse secretly employed by the state statistical agency was to subtract sales of alcohol from national income during the early years of the campaign, thus removing the negative impact of reduced sales. Rates of growth of national income were thus artificially boosted by 1 to 2 percent. 15. The statement was first made by the Politbureau member responsible for the campaign, Egor Ligachev (Pravda, July 10, 1986:2) and then repeated by Goskomstat Deputy Chairman Alexey Nevzorov (Kul'tura I Trezvost', No. 9, 1986:4). For the author's earlier criticism see Treml (1989:2-3.) 16. Nemtsov derived his estimate of 700,000 Russian lives saved in the following manner. The data below show percent increases in the absolute number of deaths over the previous year in Russia between 1980 and 1987: 1980 +2.4 1981 0 1982 1.3 1983 +4.0 1984 +5.6 1985 -1.6 1986 -7.8 1987 +2.2 Nemtsov takes the 2 years of unusually high increases in deaths, 1983 and 1984, and assumes that deaths would have continued at the same high rate were it not for the start of Gorbachev's anti-alcohol campaign. The difference between the sum of hypothetical deaths in 1985-1987 (based on +4.0 and +5.6 percent) and the actual number is about 700,000. It is true that 1985 and 1986 are years of declining deaths, but the projection of the high rates of 1983 and 1984 for these years is, of course, not acceptable. 17. It is impossible to be precise about the critical level of alcohol that would cause death, as this depends on personal characteristics of the victim and the toxicity of the alcoholic beverage. The rule
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--> of thumb often cited in Russian medical sources is that 0.5 liter of 40 percent vodka consumed by a healthy adult male of average weight without food in less than an hour would be fatal. On the other hand, an infant might die from drinking as little as an ounce of vodka. Generally speaking, wine and beer are much less dangerous because of their lower alcohol content. Wine and beer impurities and toxins present in some alcoholic beverages, particularly in poorly filtered distilled beverages, increase the dangers. 18. Ranking 72 regions of Russia by rates of death from alcohol poisoning for four years for which the data are available (1985, 1986, 1989, and 1990) and comparing rankings for pairs of years produces Spearman rank coefficients varying from +0.7 to +0.9. 19. The alarmingly high levels of fatal alcohol poisoning were completely ignored in the former Soviet Union or, when mentioned at all, were attributed to samogon.
Representative terms from entire chapter: