“Safe” per capita alcohol consumption: 8 liters (2 gallons) a year (World Health Org.)

Russia:
- 14-15 liters per year.
- Alcoholic population of 20 million (Russia pop. Is 145 million)
- Annual deaths due to alcohol poisoning 25,000-40,000
- Reduced life expectancy (males av. lifespan is 57 yrs)

1980s Gorbachev’s “anti-alcohol campaign”:
- mix of suasion and partial prohibition
- achieved limited results
- growth in illegal production of bootleg “liquor” (some is deadly poison)

Causes of excessive drinking:
- deterioration in state health care
- economic insecurity
- low morale
- sense of disillusionment
- Yeltsin bad example, considered himself an alcoholic

Putin:
- criticized excessive drinking
- tightened state control over manufacture of alcoholic beverages
- raised retail taxes
- still no coherent program to combat alcoholism

Russian National Alcohol Association, August 2000:
15,823 Russians died of alcohol poisoning in first 5 months of the year. Increase of 45% over same period on 1999. Cause: drinkers turning to illegal and unregulated (=dangerous) alcoholic beverages to escape higher taxes.

Soviet society off-limits to AA until late Gorbachev era.

Soviet collapse (1991) - AA groups could be found in 12 cities throughout Soviet Union.

1999 – AA groups in 90 cities and towns.

Early post-Soviet period – contacts with Western (esp. American) addiction specialists.
 Western-style treatments introduced. 12 step approach.

Until 1989 – state-controlled treatment of alcoholism relied on tough approach – often included punishment for excessive drinking. Gov’t officials saw alcoholism as lapse in discipline and “deviant behavior”.

Democratic Russia – compulsory treatment abolished.

Medication and “psychological” techniques provided by city narcological dispensaries.

“PROPHYLAXIS” (programs to keep alcoholics from resuming drinking) relies on alcohol aversion drugs – antabuse – as standard forms of medication, administered orally/intravenously.

Psychological methods of prophylaxis exhibit peculiarly Russian features.
 Use from of emotional stress therapy/hypnotherapy – “coding” – induces a subconscious aversion to alcohol.

Bother approved methods:
- BRAIN “SURGERY” w/use of needle – sometimes performed by unqualified persons
- “BOILING” patients – raising body temperature to 50 C (122 degrees Fahrenheit) after general anesthesia – should alleviate acute withdrawal symptoms.

Russian journalist – “In the US it is not so shameful to be an alcoholic, but here it is a very big secret”.

Self-help psychotherapeutic approach – neither punitive nor dehumanizing. Relies on voluntary association w/community of alcoholic peers, to fight common disease. Spiritual element – “higher power”.

Russian psychiatrist “AA works better in Russian because as people we are more spiritual than you Americans”

1999 - author observed AA groups in Moscow, St. Petersburg, Nizhni Novgorod, and Kazan.

Recovering alcoholics said alcohol turned them into “BOMZhl” (homeless bums).

Every person the author met credited AA for their salvation.

Patients who are “socially adaptable” respond best.

AS LONG AS SOCIAL LIFE AND MORALE ARE DEPRESSED BY LOW LIVING STANDARDS AND OTHER HARDSHIPS, THOSE W/DRINKING PROBLEMS WILL HAVE DIMINISHED MOTIVATION TO GO INTO RECOVERY.

AA still meets resistance in Russia, esp. from medical profession, gov’t officials, and Russian Orthodox Church clergy.

Medical professional:
- training leaves them skeptical of effectiveness
- see it as encroaching on their territory
- difficult to get them to change perspective (have no incentive to do so)
- success of AA could undercut physicians’ income (AA requires no fees)
- AA threatens esp. physicians who privately collect large fees for “curing” alcoholic binges, leaving their patients w/idea that they can resume drinking w/impunity
- Medicine and gov’t still tightly interwoven – major medical facilities owned and operated by gov’t (though medical personnel are branching off to set themselves up in private business)
- Head of a Moscow state hospital introduced a 12-step program (only one in a state hospital)

Russian Orth Church:
- See it as religious cult invading the country
- Public blessing of AA by Patriarch Alexei II (1993) helped overcome misgivings, though they still exist among rank-and-file clergy

Moscow – only 2 programs using 12-step principles (1 public, 1 private)

St. Petersburg – only 2 (1 private, 1 partially funded by gov’t)

“House of Hope on the Hill” – outskirts of St. Petersburg – only free, private alcohol treatment center in Russia
- Uses AA’s 12-steps
- supported by wealthy American
- existed for only 3 yrs
- helped more than 500 patients
- annual budget $60,000
- in 2000 added a women’s wing
- 45% of patients reported to have stayed sober for at least a year. 7% for Russian centers that rely on drugs\ therapy and intimidation
- patients that relapse are eligible to come back – and many do

Necessary: AA documentation in Russian, at least the one-page texts of the “12 steps and 12 traditions”

AA groups not dependent on major funding.
Outside support can be helpful (e.g. in purchase of AA literature)
Subsidies from:
- American NGO (Connecticut businessman LOUIS F. BANTLE)
- International Institute for Alcoholism Training and Education
made it possible for professionals and recovering alcoholics to visit US treatment facilities, receive training, and return to put into practice what they learned.
 

AA implications in Russian society:
groups are true collectives/no higher authority, based on ties of mutual trust among participants.

AA seen by patients as mini-course in values of free, open society.

Remedies to alcohol abuse cannot be imposed from above.
Road to recovery must be found within alcoholic’s own universe.
Indispensable: alcoholic’s own will to help himself and his ability to band together voluntarily w/other alcoholics.