Official concerns about alcohol consumption in the Soviet Union have been evident since at least 1914, when the Czarist regime implemented prohibition. In 1922, a campaign to crack down on illicit stills was initiated. Prohibitions were imposed by Stalin in the late 1920s, by Khrushchev in 1958, and by Brezhnev in 1972 and 1979 (The Economist 1989). From Khrushchev on, the antidrinking campaigns emphasized the role of the Ministry of Internal Affairs rather than the Ministry of Health, and focused on compulsory treatment and punitive measures. The campaigns were seen, even by the Soviet government, as fragmented and ineffective (Ivanets and Lukomskaya 1990), and, according to Vladimir Treml (1987), heavy drinking and alcohol-related problems continued to increase into the early 1980s.

When Mikhail Gorbachev became leader of the Soviet Union in 1985, the Presidium of the U.S.S.R. Supreme Soviet and the Soviet Republics issued edicts to initiate a new anti-alcohol campaign. Although evidence indicates that the objectives of that campaign, which are now being reexamined, have not been met, the program did result in a national focus on the problem that placed greater emphasis on health issues than had prior campaigns. In addition, the program established the All-Union Research Center on Medico-Biological Problems of Narcology (the Narcology Center), to coordinate research on the problems of alcohol and other drug dependence.

Also in 1985, the Soviets made the first inquiry regarding increased communication and cooperation with the United States in research on alcohol abuse and alcoholism. In 1988, after drafting a plan for scientific cooperation between the U.S.S.R. and the United States, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) began an active program of cooperation and scientific exchanges with the Narcology Center in Moscow. As a result of the initial linkage of the Narcology Center to the area of psychiatric and forensic sciences, and the allegations of human rights abuses in psychiatry (Judd 1989), nearly 3 years had passed before this cooperation could actually begin.

ALCOHOL CONSUMPTION, ALCOHOL-RELATED PROBLEMS, AND ALCOHOL CONTROL POLICY PRIOR TO 1985

Although the data are inconsistent on per capita alcohol consumption in the Soviet Union in the last 30 to 40 years (partly because of difficulty in obtaining data from the U.S.S.R. and partly because of lack of data regarding the production of home distillates), Treml (1987) has estimated that by 1985 annual consumption of absolute alcohol exceeded 16 liters per person over the age of 15. This rate is substantially greater than the 1976 Soviet estimate of 11.6 liters per capita, itself cited as a 500-percent increase over 1950 consumption (Segal 1976). Official data from the U.S.S.R. State Committee on Statistics indicate that, between 1960 and 1980, annual per capita consumption of alcoholic beverages more than doubled, from 3.9 liters of absolute alcohol in 1960 to 8.7 liters in 1980 (Ivanets and Lukomskaya 1990). These latter data, however, probably do not reflect consumption of "samogon," an alcohol distilled in the home. (It should be noted that alcohol consumption patterns in the former Soviet Union differed according to region and ethnicity. For example, people living in Russia, Ukraine, and Byelorussia primarily consume vodka and samogon and are the heaviest drinkers; those in the Baltics consume more alcohol, but are primarily beer drinkers; the Georgians, Moldavians, and Armenians are wine drinkers and drink less; and in the Muslim countries, consumption is generally low [The Economist 1989].)

Treml (1987) noted that "the U.S.S.R. was by the mid-1980s facing an alcohol problem of truly crisis proportions." The Economist (1989) reported that a decrease in life expectancy for Soviet males, from 66 years in 1965 to 62 years in 1984, was largely attributed to heavy alcohol consumption, and that studies from the West suggested that alcoholism was the third leading cause of death in the Soviet Union, after heart disease and cancer.

It has also been estimated that in the early 1980s one-fifth of all deaths in the Soviet Union were either directly or indirectly caused by alcohol (Treml 1987); two-thirds of murders and violent crimes were committed by intoxicated persons; and drunk drivers were responsible for 14,000 traffic deaths and 60,000 serious traffic injuries (Ivanets and Lukomskaya 1990).

PERESTROIKA AND THE ALCOHOL-RELATED REFORMS OF 1985

In April 1985, shortly after Mikhail Gorbachev became leader of the Soviet Union, the Soviet government, in the spirit of perestroika--which is based on reasoned argument, openness, and a flexible approach to problems--approved a major "new" antidrinking campaign.

The campaign included a multidisciplinary approach to alcohol-related problems. Ivanets and Lukomskaya (1990) describe in detail the two major components of the program--the regulation of the availability of alcoholic beverages, and the establishment of prevention programs focusing on decreasing the demand for alcohol.

Regulation initiatives included the following:

* reducing the production of vodka and cognac to 56 percent of 1984 levels. by 1987

* setting a minimum legal drinking age of 21 years

* prohibiting the sale of beverages in public places

* restricting hours of sales

* decreasing the number of sales outlets

* increasing prices substantially

* prohibiting advertising

* increasing prosecution of home distillers.

The prevention initiatives included the following:

* developing health education programs for distribution through the mass media

* suggesting alternatives for leisure time that did not involve drinking

* prohibiting public drunkenness and drunk driving.

* establishing a policy of intolerance for drinking in the workplace

* developing anti-alcohol propaganda to promote a social climate that cultivated temperance

* establishing the All-Union Temperance Promotion Society (TPS) to further these initiatives.

The TPS, which advocated a completely dry society, claimed to have 14 million members, who paid one ruble a year to belong. Members were expected to recruit new members, to help administer government anti-alcohol efforts, and generally to set an example of abstinence (Kirn 1987).

In 1985, the All-Union Research Center on Medico-Biological Problems of Narcology was established within the Ministry of Health, to study alcohol and other drug dependence. Location of the Center within the Ministry of Health was an important policy change, as, prior to 1985, major responsibility for alcohol-related issues had been with the Ministry of Interior, the criminal justice arm of the Soviet government. Initially, research at the new Center focused primarily on biological and clinical sciences. In early 1991, the Soviet Narcology Center changed its name to the All-Union Research Center on Medico-Biological Problems of Addiction (Addiction Center). Later in the year, the Center was reorganized to include research on social and legislative issues and prevention, as well as epidemiology; its name was changed accordingly to the All-Union Center of Addictions. In addition to biomedical research, the Center now stresses the importance of early identification, treatment, and social rehabilitation in the reduction of alcoholism and alcohol-related problems.

Evaluation of the outcome of the 1985 initiatives yields mixed reviews. Many officials of the former Soviet Union and Western observers now agree that the 1985 program was not successful and that a change in direction is needed. Partanen (1987) documents a confounding factor in the current reform movement in the former Soviet Union, a factor brought about by a philosophical struggle between two schools of thought--one that supports disciplinary and punitive measures and prohibition, and one that supports gradual moderation of drinking habits.

Official Soviet statistics, however, indicate many positive results of the campaign, including the following:

* decreases in alcohol-related mortality, absenteeism, and lost work time

* decreases in occupational and domestic violence

* decreases in alcohol-related traffic accidents and deaths

* decreases in alcohol-related crime (Ivanets and Lukomskaya 1990)

* decreases in public drunkenness and drinking in the workplace (Levin and Levin 1990).

Negative results include a major increase in the illicit production of samogon, resulting in a national sugar shortage, and a number of deaths from the consumption of methyl alcohol and antifreeze, used as substitutes for less available beverages (Ivanets and Lukomskaya 1990). Treml (1987) reports that stiffer penalties for drunkenness on the street and in the workplace, as well as reinforced police patrols, merely resulted in drinkers moving into the home, leading to more wife and child abuse and to destruction of property. Levin and Levin (1990) observe that previous alcohol-related problems, such as alcoholism among children, younger drinkers, and growing female alcoholism were still present, while a number of new problems, as noted above, had been created. They also note that the 1985 anti-alcohol campaign was old-fashioned and contradictory to the underlying basis of perestroika.

SOVIET-AMERICAN ALCOHOL RESEARCH COLLABORATION

In April 1987, a U.S.-U.S.S.R. Joint Health Committee Meeting took place in Washington, DC. Although no official alcohol or other drug representation was included in the Soviet delegation, draft proposals by the Soviet Narcology Center and informal suggestions by United States Public Health Service alcohol and drug representatives led the Committee to request that proposals be developed by appropriate institutions in both countries. In May 1988, representatives from NIAAA and from the National Institute on Drug Abuse traveled to Moscow, where they participated in a review of alcohol and other drug research in both countries, and in the preparation of a draft plan for scientific cooperation on the biomedical problems of alcohol and other drug abuse. Consequently, in November 1988, the areas of alcohol and drug research were formally added to the bilateral Health Agreement between the U.S. Department of Health and Human Services and the Soviet Ministry of Health.

Since 1988, NIAAA has participated in a number of activities with the Narcology Center (since renamed the Addictions Center). These activities have included participation in scientific meetings, a formal exchange scientist program, and a joint pilot study for developing instruments for assessing alcohol and other drug abuse and dependence.

In November 1988, staff from NIAAA and from the Office of the Administrator of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) participated in the first Soviet International Research Symposium on Alcohol Policies, in Baku, Azerbaijan, U.S.S.R. Selected papers from that symposium have been published (World Health Organization 1990). In March 1989, alcohol researchers from the United States and from NIAAA participated in a Soviet Scientific Symposium on Treatment of Alcoholism and Drug Dependence held in Gagra, Georgia, U.S.S.R. (Moskalenko et al. 1990).

In early 1991, after nearly a year of planning, an alcohol exchange scientist program in the biological sciences began. The first Soviet scientist arrived in the United States and was placed in an NIAAA-funded Research Center for 1 year. Four additional Soviet scientists were selected to work in NIAAA-funded centers during 1991. Plans for an American alcohol researcher to work at the Soviet Addiction Center in 1991 had to be modified to a short-term visit when economic conditions in Moscow began to deteriorate.

The major objective of the joint pilot study is to develop uniform data collection methods, including comparable alcohol abuse and dependence diagnostic criteria for use by American and Soviet (now Russian) researchers in alcoholism treatment studies. In January 1991, following the translation of research protocols. Soviet specialists on the project met with NIAAA and pilot project collaborators at the Philadelphia Veterans Administration Medical Center to establish procedures for administration of the project protocol and interview questionnaire. Preliminary interview data collected in Moscow have been sent to NIAAA for coding and analysis. An initial report of results of the joint project is expected in 1992.

Additional activities have included numerous short-term visits between American and Soviet researchers and government officials, including visits to many of the major laboratories and research centers in both countries. In June 1991, two Soviet epidemiologists participated in an NIAAA-sponsored Didactic Workshop on Alcohol Epidemiology. With the dissolution of the Soviet Union in December 1991, the All-Union Center of Additions was transferred to the Russian Ministry of Health. It is expected that NIAAA collaboration with the Addictions Center, including the selection of additional Russian exchange scientists to work in the United States in 1992, will continue and may even expand, depending upon the stability of the Russian government.

REFERENCES

The Economist. Russia's anti-drink campaign, Dec. 23, 1989, pp. 50-54.

IVANETS, N.N., AND LUKOMSKAYA, M.I. The U.S.S.R.'s new alcohol policy. World Health Forum 11:246-252, 1990.

JUDD, L.L. Foreword. Schizophrenia Bulletin Suppl. 15(4), 1989.

KIRN, T.F. Soviets attack alcohol problem anew, this time armed with 'perestroika.' Journal of the American Medical Association 258(17):2341-2348, 1987.

LEVIN, B.M., AND LEVIN, M.B. The anti-alcohol campaign in the U.S.S.R.--a dubious success. World Health Forum 11:253-256, 1990.

MOSKALENKO, V.D.: ALTSCHULER, V.B.; VALENTIK, Y.V.; BELYI, V.P.; AND ROSLYAKOVA, N.A. New approaches to the treatment of alcoholism and drug dependency: Review of reports presented at the International Symposium held in Gagra, Georgia, U.S.S.R., Mar. 28-30, 1989. Alcohol and Alcoholism 25(2/3):325-335, 1990.

PARTANEN, J. Serious drinking, serious alcohol policy: The case of the Soviet Union. Contemporary Drug Problems 14(4):507-538, 1987.

SEGAL, B.M. "Drinking and Alcoholism in the Soviet Union and the United States: A Comparison." Paper presented at the NCA-New York Affiliate Conference: Alcohol in the Soviet Union, Jan. 1976.

TREML, V. Gorbachev's antidrinking campaign: A noble experiment or a costly exercise in futility? Radio Free Europe/Radio Liberty. Radio Liberty Research Bulletin, Mar. 18, 1987.

World Health Organization. Alcohol Policies: Perspectives from the USSR and Some Other Countries. Report on a WHO/USSR Symposium, Baku, Azerbaijan, U.S.S.R., Oct. 31-Nov. 4, 1988. Appendix. Geneva: the Organization, 1990.