There are many cultures in the world where alcohol is considered an important social bonding agent. In some places, however, the love affair with alcohol has turned sour, and problem drinking has become a national crisis. To look at alcoholism throughout the world is to look at humanity’s relationship with alcohol through a number of different lenses, each of which tells a unique story.
Drinking around the World
In 2015, the World Health Organization issued a “global status report” on levels of alcohol consumption around the world. Among the findings:
- Every year, there are 3.3 million deaths as a result of dangerous use of alcohol, amounting to 5.9 percent of all global fatalities
- Over 200 disease and injury conditions can be attributed to harmful use of alcohol
- Around 25 percent of the total number of deaths for people aged 20-39 can be traced back to irresponsible alcohol consumption
- Dangerous drinking and a number of mental health and behavioral disorders have a causal relationship with each other; additionally, “noncommunicable conditions” (i.e., injuries) are also taken into consideration
- Other “incidence of infectious diseases” that can be explained by harmful alcohol use are tuberculosis and HIV/AIDS
WHO’s 2015 report is an update of a report it issued in 2005, when it found that annual global consumption hit an average of 6.13 liters of pure alcohol (not alcoholic beverages) for every person over the age of 15. While that figure represents the entire world, only 50 percent of the people in the world consume alcohol, and most of them live in developed, wealthier countries. In many places across Asia and Africa, alcohol consumption levels are strikingly low; the production, sale, and consumption of alcoholic beverages range from strictly regulated to totally nonexistent due to religious and ethnic laws.
The Heaviest Drinkers in the World
The idea of Russians drinking more, in a country where people drink 18 liters of pure alcohol per person every year (which is over twice the internationally recommended limit), is a dangerous one. The life expectancy for Russian men is only 60 years (compared to 74 years in the United States and 75 years in China) – but makes sense in the context of how integral alcohol is to the Russian story and the Russian psyche. The New York Times references a historian who wrote of an 1859 peasant uprising against the state’s liquor taxes. The peasants signaled their discontent by going sober. In response, police “poured [liquor] into their mouths through funnels,” before arresting them and charging them with rebellion.
Rampant alcoholism in Russia, writes the Times, is nothing new. The country has a long and storied past with alcohol, going as far back as the year 988, when Vladimir the Great converted Russia to Orthodox Christianity, partly due to the denomination not prohibiting drinking. By the 1850s, vodka accounted for nearly half of Russia’s tax revenues.
As much as the Russian government profited financially from the sale of alcohol, it also enjoyed some other benefits. Citizens kept happy by the constant flow of vodka were less likely (and less capable) of expressing any political dissent. The New York Times hypothesized that this was even a method of intentional political suppression.
The party came to an end in 1992, when the Soviet Union collapsed, and the government’s monopoly over alcohol was repealed. With the alcohol industry now becoming privatized, there was a spike in the supply. In 1995, the World Health journal found that drinking levels hit 14.5 liters of pure alcohol per person. As the USSR fell and the Cold War came to an end, Russians were officially the heaviest drinkers in the world.
Treating Alcoholism in Russia
There are treatment options for alcohol abuse in Russia, but the Boston Globe warns that they look very different from those in the United States. While the standard form of rehabilitation for a drinking problem in America usually entails months (if not years) of therapy, the Russian version could be nothing more than a single visit to a doctor, a hypnosis session, and a prescription for pills. There is a prohibitively small element of mental health treatment to Russia’s programs.
The Globe attributes the stark difference to a mix of reasons: religious, cultural, historical, and even medical distrust between the United States and Russia. Millions of Americans have benefitted from a variety of approaches to treat their substance abuse, but generations of mutual suspicion have made for an indifferent (or even hostile) reception on Russian shores. Certain ideas do not translate well across certain borders, no matter how effective they may be at solving a common problem.
But a key reason why Russian treatment programs bear no resemblances to their American counterpart is that Russians and Americans have very contrasting definitions of what constitutes a drinking problem. A Russian medical anthropologist writes that Russians think of a drinking problem as the culmination of chronic alcohol use; the chronic alcohol use itself is thought of as “perfectly normal.” Problem drinking in Russia is only when a person is reduced to lying in a ditch. The idea of functional alcoholism doesn’t exist; someone who can turn up for work, while still drinking poisonous amounts of vodka, would be considered absolutely fine in mainstream Russian society.
The nature of aftercare support treatments like Alcoholics Anonymous is to get members talking to one another about their struggles and successes but even this may be difficult for a Russian person. For most of the 20th century, Russian citizens were intimidated by a dictatorship and police state into keeping their thoughts to themselves. The habit has become second nature; even with Russia becoming a democracy in 1991, modern-day Russians are loath to admit that there is something wrong. A woman who runs a free alcohol recovery center outside the city of Saint Petersburg explained to the Globe that no Russian would consider the act of drinking to be shameful; but drinking as a result of a mental health disorder would be thought of as “very” shameful.
However, there are signs that the Russian resistance to established treatment methods is changing. In the past, the Russian Orthodox Church was one of the biggest skeptics of the Alcoholics Anonymous method, believing it to be a “religious cult invading the country,” according to Current History. In 2010, however, the Church praised AA as an “effective instrument in rehabilitating drug and alcohol addicts,” but said it would create its own treatment. Raw Story described this as a “wary” change in the mainstream Russian mentality; in a country of 143 million, there are only 10,000 members of 400 AA groups. Most of those 143 million are unlikely to change their ways; Raw Story quoted an Orthodox Christian blogger who rejected AA’s position of “conquering alcoholism [by] themselves.” The blogger went back to the [Orthodox] Church, where alcoholism is conquered “with prayer and fasting.”
Perhaps summing up the opinion of 143 million of his countrymen when it comes to the Russian approach to alcohol treatment, the blogger asked, “Why reinvent the wheel?”
The Booze Battle
But the Irish propensity for heavy drinking is sowed very deeply into the cultural DNA of the island. The behavior has long been the subject of cultural tales and humor, and only recently has it been looked at as a serious health problem. The dichotomy is what The Irish Times calls “The Booze Battle”; the country recently topped a European survey for at-risk drinking, with 28 percent of Irish people binge drinking, and another 56 percent drinking to harmful levels. In 2007, Ireland’s per capita alcohol consumption was 11.3 liters for every adult; data released by the Organisation for Economic Co-Operation and Development (which includes Canada, the United States, and most of Western Europe) showed that the average among OECD countries was only 9.1 liters.
Other statistics come from a 2009 report by the Irish Health Board, which found that 54 percent of respondents (or 2.14 million adults out of the country’s population of 4.2 million) drink to the point of harming themselves or those around them; the European average of those who drink to that excess is only 28 percent.
More concern was noted by the World Health Organization, which reported in 2014 that Ireland possesses “the second highest rate of binge drinking in the world.” Adolescents as young as 15 years old were part of the 39 percent of Irish citizens who had engaged in episodes of heavy drinking, which far exceeds Britain’s 28 percent of binge drinkers. The only other country to drink as heavily and dangerously as Ireland was Austria, where 40.5 percent of residents drank too much, too quickly.
A Complex and Deep-Rooted Problem
The point is echoed by the Review of Economics of the Household journal, in which researchers wrote in 2013 that they found “relatively strong influences of […] English colonial settlement” on Irish drinking patterns. The researchers also noted that parental and sibling drinking affected both alcohol consumption itself and perceptions of what is acceptable drinking behavior among Irish families. Put everything together, and Ireland’s problem with drinking is “complex” and “deep-rooted,” says the journal.
Ireland’s maudlin history has long been romanticized, both by the Irish themselves and cultures influenced by the Irish diaspora. An Irish writer in Vice magazine observes that St. Patrick’s Day – which is celebrated in more countries than any other national festival, including in orbit on the International Space Station – is an excuse to wholeheartedly celebrate the stereotype of Irish as drinkers. As much as an occasion like St. Patrick’s Day commemorates Irish heritage and culture, the Vice writer feels that “a sense of guilt remains at the heart of the Irish psyche,” a guilt that is simultaneously buried and honored with alcohol.
Ever since the 18th century, when the discovery of gin led to a wave of heavy drinking, alcohol has remained a deep, inherent part of Irish culture. Even if the Irish wanted to change their ways, says Vice, the process would take decades. Any such desire is purely hypothetical; drinking, and being drunk, is Ireland’s currency. People all over the world identify Irish with alcohol and parties, and, for the most part, the Irish enjoy the designation; partly because of the association with good times, but also because it validates the Irish identity, making Irish people the envy of other cultures where alcohol use is repressed or relegated.
Treating Alcoholism in Ireland
But even in Ireland, every party comes to an end. In August 2016, The Irish Examiner wrote of a treatment center in Dublin that reported there were more people – most of them women, and most of them young, between the ages of 18 and 24 – who checked in to receive therapy for their alcohol problems than there were a decade ago. In 2006, 74 percent of the women enrolled in a treatment program were there because of reasons related to alcohol abuse; in 2015, the figure had increased to 93 percent.
Even as recently as three or four years ago, the chief executive of the center told the Examiner, nobody in their late teens or young adult years came in for treatment. In 2015, however, that age demographic accounted for 11 percent of clients, suggesting that the need for a cultural change is being felt at a very grassroots level.
The clinical operations manager at the center said that removing the stigma from addiction is key to recovery. This entails breaking down the idea that there is something wrong with people who don’t drink excessively, a point made by the now-sober people who spoke with The Fix to illustrate how difficult it can be to drink moderately in Ireland.
Across the Atlantic Ocean, America’s problems are similar. Americans over the age of 15 are far more likely to be involved in deadly accidents caused by alcohol overconsumption or to die from other reasons related to alcohol, even though people in that demographic drink only three-quarters of the alcohol that Europeans do. Reasons for this disparity are as diverse as the cultural differences. The legal drinking age in the United States is 21, which is higher than both Russia and Ireland, where the threshold is 18. Additionally, Europe tends to have better (and more widely used) mass transit infrastructures, leading to a lower incidence of vehicular accidents as a result of driving under the influence.
While the World Health Organization found that Austria and Ireland account for the highest rates of binge drinking in the world, other measures find that the United States is where the most excessive drinking takes place. Fifty percent of the alcohol consumed by adults, and as much as 90 percent of the alcohol consumed by people under the legal drinking age of 21, is done during a binge drinking session, according to the director for the Centers for Disease Control.
Binge drinking, writes Mic, is “intricately connected to American culture.” On many college campuses, it is a rite of passage for young people, some of whom are overwhelmed by the freedom and responsibility of life without parental supervision. During Spring Break, for example, college-aged men consume an average of 18 drinks in a single day, according to the American College of Health.
Such is the extent and severity of the drinking, that The New York Times wonders if the laws meant to stop young people from drinking too much are what influences them to drink all the more when the opportunity presents itself.