Vodka, the Elixir of Life
….. and Death
Cultural, economic and health
aspects of alcohol use in Russia
April 27, 2010
Ellis L. Rolett, M.D.
Dartmouth Medical School
Vodka, the Elixir of Life
….. and Death
Churches, ikons, crosses, bells,
Painted whores and garlic smells,
Vice and vodka every place –
This is Moscow’s daily face
- Olearius, Travels, 1647
Smith & Christian, 1984
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
Christian, 1990
Vodka - a cultural context (1)
“Russia's hard drinking is not a purely
physiological phenomenon - it is, rather,
psychological and social. Drinking to the
Russians is something like Buddhism to the
Indians or Confucianism to the Chinese. It
is a kind of a national religion.”
- Aleksandr Zinovyev
Moscow News, №33 8/23/2007
Vodka - a cultural context (2)
“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
Negotiating a sale
Ukraine, 2008
Russia
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 finished
b) a shot glass of vodka must be downed in one gulp
Binge drinking is rampant. 40% of male drinkers and 11% of
female drinkers consume ≥ 7 drinks on a typical drinking day.
Garrett, 2000; R. Room, Int J Epidemiol 2005
Back in Time: Cultural History
 Communal
intoxication was a key social
custom among ancient Slavic tribes.
who conquered Kievan Rus in 9th C
introduced a more violent drinking style.
 Norsemen
 Vodka
became central to social interaction and
the economy, especially among peasants.
and cheap vodka in late 19th C eroded
communal control over individual drinking.
 Taverns
 Drinking
to get drunk became the norm.
Segal, 1990; Transchel, 2006
Liquor taxes (1)
Smith and Christian, 1984
Liquor taxes (2)
Smith and Christian, 1984
Early Twentieth Century History
1900-1914 - 90% of alcohol consumed is vodka. Binge
drinking is a common pattern
1905 - Battle of Tsushima, 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.
White, 1996; Herlihy, 2002
Communist Takeover
 Engels
argued that alcoholism resulted from economic
exploitation of workers.
“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.”
 Trotsky:
“Vodka and other narcotics will draw us back to
capitalism, rather than forward to Communism.”
 Lenin:
 Stalin
equated alcoholism with capitalism. With
overthrow of capitalism, alcoholism was no longer
regarded as a societal problem, rather as individual
criminal behavior.
Segal, 1990; Transchel, 2006
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; Herlihy, 2002
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
White, 1996
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.
White, 1996; Herlihy, 2002
The Gorbachev Anti-Alcohol
Campaign (2)
“Waiting for opening time, 1988”
White, 1996
The Gorbachev Anti-Alcohol
Campaign (3)
 Compulsory
treatment of alcoholics
 Removal
of alcohol abusers from
public office and employment.
 Expulsion
of alcohol abusers from the
Communist Party.
White, 1996; Herlihy, 2002
The Gorbachev Anti-Alcohol
Campaign: Positive Outcomes
♦ Life expectancy rose 3 years for men, 1 year for
women.
♦ Overall mortality down 15% between 1984 and
1986.
♦ Accidental deaths down one-third.
♦ Heart disease deaths down 13%.
♦ Alcohol poisoning deaths down over 50%.
♦ Birth rate increased.
♦ Divorce rate decreased.
♦ Absenteeism and crime down 30%.
White, 1996; Nemtsov, 2005
The Gorbachev Campaign:
Adverse Consequences
♦ Drinkers find alternatives to alcohol: colognes,
industrial spirits, etc.
♦ Sugar sales skyrocket as homebrewing takes off.
White, 1996
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
Garrett, 2000; Herlihy, 2002
Alcohol in the Post-communist
Transitional Economy
1991 - Boris Yeltsin is elected
president of Russia
1992 - State monopoly on alcohol
production is ended.
Alcohol in the Post-communist
Transitional Economy (cont.)
 1992
– Massive importation of foreign liquor.
- Russia overtakes France as the world’s
heaviest drinking nation.
 1993
– 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
White, 1996
Bootleg liquor sale on the street
Ryan, 1995
Magnitude of the Problem
 Estimated
numbers of alcoholics in 2007
– 7 million men (official statistics), but may well be twice as
high
– mainly men
 Average
per capita annual consumption of pure
alcohol
– Russia:
» 18 L (10 L legal, 8 L illegal) across entire population
» Equivalent to 60 bottles of spirits for every man, woman, and
child
– WHO standard for dependency: 8 L
 Estimates
of alcohol related deaths and alcohol
poisonings vary widely
Pravda, 11/9/2006; The Times, 4/13/2007
Risk Factors for Alcohol Abuse
 Disease
of males.
– Male coping strategy
– Normative pattern of male socializing
 Economic
–
–
–
–
and social dislocation.
Lower economic strata
Unemployment
Lack of job satisfaction
Weak family structure
 Less
well educated
 Low self-esteem
 Geographic isolation and far northern location
White, 1996; Carlson, 2000; Leon, 2007; Denisova, 2010
Health Consequences
of binge drinking & acute intoxication
 Poisonings
– Illicit alcohol
– Alcohol substitutes
 Accidents and violence
– Automobile and industrial accidents
– Domestic violence
– Suicide
– Homicide
 Cardiovascular
– Arrhythmias
– Acute myocardial infarction
Alcohol and Pregnancy






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.
Kristjanson, Alcohol Clin Exp Res, 31: 299, 2007
Global Distribution of Alcohol
Consumption and Drinking Patterns
WHO Region
Beverage Type
Americas A
(Canada, Cuba,
USA)
Europe A
(Germany,
France, UK)
Europe C
(Russia,
Ukraine)
1Liters
2Range
Alcohol
Consumption1
Heavy Drinkers
%
Average
Drinking
Pattern2
> 50% beer,
25% spirits
9.3
11.2
2.0
Wine & beer
12.9
15.7
1.3
Spirits
13.9
18.6
3.6
of pure alcohol per resident age 15 and above, annually
1-4, with 4 being most detrimental
Rehm, Eur Addiction Research 2003
Type of Alcohol Consumed: 2000
NBER Oct 2004
Moscow Scene 2008
Alcohol Surrogates
Counterfeit Vodka Kills Russians by the Score
Moscow, 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 a medical disinfectant
(Extrasept) causing drinkers' skin to turn yellow
because of acute toxic hepatitis.”
Alcohol Surrogates
http://www.guardian.co.uk/world/2007/jun/15/russia.science
United Nations Report 2008

Life expectancy among Russian males is 59 years,
on a par with underdeveloped African countries.

Projected population decline is from current 142 M
to 100 M by 2050.

Compared to countries with similar economic
development, among working-age population
mortality is 3-5 times higher for men and twice as
high for women.
UN in Russia: Demographic Policy in Russia, 2008
United Nations Report 2008 (cont.)

Causes include alcoholism, smoking, industrial and
automobile accidents, suicide, poor nutrition, and lack
of health care.

Annual death estimates:
- Alcohol 425,000
- Smoking 330,000
- Industrial accidents 180,000
- Traffic accidents 40,000

Alcohol-related deaths in Russia are 6 times higher for
men and 5 times higher for women than in Europe.
UN in Russia: Demographic Policy in Russia, 2008
Demographics
Drunken Nation: Russia’s Depopulation Bomb
Nicholas Eberstadt, World Affairs, Spring 2009
In 2007, Russia ranked 164 of 226 nations in life expectancy.
Major causes of premature mortality were cardiovascular
disease (CVD) and accidental deaths.
♦ CVD mortality was almost 4 times higher than in
Western Europe.
♦ Injuries and poisonings were over 5 times higher than in
Western Europe.
♦ Alcohol abuse was a major contributor to both of the
above, especially among younger males.
Dissolution of USSR
Eberstadt 2005
Eberstadt 2005
Male Life Expectancy
NBER Oct 2004
Eberstadt, 2005
Eberstadt, 2005
Eberstadt, 2005
Eberstadt, 2005
Mortality men ages 35-39 (1980-2005)
Russia
Latvia
Hungary
Poland
Estonia
Czech Republic
http://demoscope.ru/weekly/2009/0363/img/l_graf03.gif
Eberstadt, 2005
Life Expectancy: 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.
D.A. Leon et al. (1997) The Lancet 350: 383
Summary (1)
 Alcohol
plays a highly symbolic role in
Russian culture.
 It
functions as a means of social
interaction, commemoration of
significant events, and escape from
unfulfilling existence.
 Binge
drinking is deeply ingrained in
Russian society, especially among
workers and those living in rural areas.
Summary (2)
 Hazardous
drinking patterns (binging,
surrogates, illicit alcohol) are
pervasive.
 Russia
is facing a demographic crisis.
 It
has the lowest male life expectancy
in the developed world.
 Alcohol
abuse is a major contributor
to both of the above.
New Anti-Alcohol Campaign
New Anti-Alcohol Campaign
 Main
features under consideration:
– Specialized life-improvement centers for
alcoholics, smokers and obese persons
– Nationwide PR campaign
– Restriction of alcohol sales to youth
– Increase in price of vodka
– Crackdown on producers of illegal alcohol
 Stay
tuned!
End
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.
Cockerham, W.C. et al. “Psychological distress, gender, and health lifestyles in Belarus, Kazakhstan, Russia, and
Ukraine.” Social Science & Medicine (2006) 63: 2381-2394.
DaVanzo, Julie S., and Clifford Grammich. Dire Demographics: Population Trends in the Russian Federation
RAND, 2001.
Denisova, Irina. “Adult mortality in Russia.” Economics of Transition (2010) 18: 333-363.
Eberstadt, Nicholas. “Drunken Nation: Russia’s Depopulation Bomb.” World Affairs (2009), Spring: 51-62.
Eberstadt, Nicholas. Presentation to CSIS Global Aging Initiative, Washington, 2005.
Herlihy, Patricia. The Alcoholic Empire: Vodka & Politics in Late Imperial Russia. Oxford; New York: Oxford
University Press, 2002.
Jargin, Sergei. “On the causes of alcoholism in the Former Soviet Union.” Alcohol & Alcoholism (2010) 45: 104-5.
Leon, David A., et al. “Huge variations in Russian mortality rates 1984-94: artifact, alcohol, or what?” Lancet (1997)
350: 383-8.
Leon, David A., et al. “Hazardous alcohol drinking and premature mortality in Russia: a population based casecontrol study.” Lancet (2007) 369: 2001-9.
National Research Council (U.S.). Committee on Population. Premature Death in the New Independent States.
Washington, D.C.: National Academy Press, 1997.
Bibliography (cont.)
“Vodka, the Elixir of Life…..and Death”
Nemtsov, Alexander. “Russia: alcohol yesterday and today.” Addiction (2005) 100: 146-9.
Philips, Laura L. Bolsheviks and the Bottle: Drink and Worker Culture in St. Petersburg, 1900-1929. DeKalb:
Northern Illinois University Press, 2000.
Ryan, Michael. “Alcoholism and rising ;mortality in the Russian Federation.” BMJ (1995) 310: 646-8.
Segal, B. M. The Drunken Society: Alcohol Abuse and Alcoholism in the Soviet Union. New York: Hippocrene
Books, 1990.
Smith, R.E.F. and David Christian. Bread and salt. Cambridge: Cambridge University Press, 1984.
Transchel, Kate. Under the Influence. Pittsburgh: University of Pittsburgh Press, 2006.
White, Stephen. Russia Goes Dry: Alcohol, State, and Society. New York: Cambridge University Press, 1996.
WHO Global Status Report on Alcohol 2004. The Russian Federation.
http://www.who.int/substance_abuse/publications/en/russian_federation.pdf (last viewed 23 Apr 2010)