"During the past decade we have beeninvestigating reasons for the very high death rate among Russians,"said Martin McKee, professor of European public health at the LondonSchool of Hygiene and Tropical Medicine. "We have been looking indetail at men in Izhevsk, a city in central Russia. While we confirmedwhat we already knew, that a lot of vodka is drunk in Russia, we alsofound that … a surprisingly large number of people – seven percent –were drinking substances containing alcohol but not meant to be drunk.We then decided to find out what was in these substances."
"Historyhas shown us that alcohol plays an important role in life, health anddeath in Russia," added Vladimir M. Shkolnikov, laboratory chief at theMax Planck Institute for Demographic Research in Rostock, Germany. "Forexample, Mikhail Gorbachev's anti-alcohol campaign that was launched inMay 1985; it included heavy reductions in alcohol production and sales,an increase in alcohol prices, a strengthening of mandatory treatmentof alcoholism, and enforcement of measures against home production.Results were swift. From 1985 to 1987, life expectancy increased by 3.2years for men, and 1.4 years for women, after two decades of acontinuously slow decline."
In 1992, however, economic reformsled to a liberalization of alcohol prices and few, if any, restrictionson alcohol sales. "Hard liquor became available 24 hours a day," saidShkolnikov. "Consequently, from 1992 to 1994, life expectancy decreasedby 4.7 years for men and 3.4 years for women, largely due to accidentsand violence, alcohol-related causes, and cardiovascular deaths."
Forthe current study, researchers analyzed the surrogate products beingconsumed, dividing them into three broad groups: "samogon"(home-produced spirits, also known as "moonshine" in North America);medicinal compounds, essentially tinctures containing herbal remedies;and other spirits (mainly aftershave products and cleaning fluids).Commercially produced vodkas were used for content comparison.
Theresults indicate that a significant proportion of Russian men aredrinking products that have either very high concentrations of ethanol,or contaminants known to be toxic.
"We found that home-madealcohol had about the same amount of alcohol as vodka, but alsocontained a number of more toxic alcohols that could cause damage tothe heart and liver," said McKee. "The medicinal substances were aboutone and a half times as strong as vodka. The third group, includingproducts such as aftershaves, was more than twice as strong as vodka."
Both McKee and Shkolnikov believe the study results are highly applicable to other regions in Russia.
"Inthe early 1980s," said Shkolnikov, "it was estimated that samogonconstituted about one third of the total amount of alcohol consumed inRussia. Its production was largely concentrated in the countryside.Samogon consumption is, of course, in addition to other alcoholsurrogates such as eau de colognes, aftershaves, and medicinalcompounds."
"Our discussions with Russian colleagues suggest that[surrogate alcohols construe] a major issue," added McKee. "Samogon hasbeen part of Russian life for centuries. The so-called aftershaves aresold in brightly coloured quarter-litre bottles and it seems verydifficult to believe that those making them do not know that they arebeing drunk. The bottles seem to be produced in a few places anddistributed widely across Russia. So although we need to do more work,we believe they are being drunk widely. It also seems very likely thatthese substances are playing an important role in the high level ofalcohol-related deaths in Russia."
McKee said that he alsosuspects that the same types of substances are being consumed in manyother parts of the world. "These are products that are often consumedby people living on the margins of society, who are difficult toconduct research upon," he said. "This is consistent with historicallessons which show that substance abuse is often widespread duringperiods of rapid transition, such as the industrial revolution."
Shkolnikovconcurs. "When thinking about the Russian health crisis, one should notoverlook certain societal forces operating in the post-Soviet era," hesaid. "These include a totalitarian legacy of neglect of individualvalues and interests, substantial poverty and underdevelopment, growingunemployment and income inequality, long-lasting underfunding of thesocial sector, and an insufficient health-care system. Alcohol is usedas a means of escape from reality."
McKee is hopeful that theRussian government has become aware of the seriousness of the problem."Following a meeting that we had with President Putin's advisors," hesaid, "the president specifically mentioned the need to tacklesurrogate alcohols in his 2005 state-of-the-nation address."
Alcoholism:Clinical & Experimental Research (ACER) is the official journal ofthe Research Society on Alcoholism and the International Society forBiomedical Research on Alcoholism. Co-authors of the ACER paper, "TheComposition of Surrogate Alcohols Consumed in Russia," were: SándorSzûcs, Attila. Sárváry and Roza Ádany of the School of Public Health inDebrecen, Hungary; Nikolay Kiryanov of the Izhevsk Medical Academy,Russia; Ludmila Saburova of the Social Technologies Institute inIzhevsk, Russia; Susannah Tomkins and David A. Leon of the LondonSchool of Hygiene and Tropical Medicine; and Evgeny Andreev of theResearch Institute of Statistics in Goskomstat/Moscow, Russia. Thestudy was funded by the Wellcome Trust.
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