In 1971 a remarkable album was released by Jugoton, Yugoslavia’s premier record label. Normally associated with rock stars, pop acts and folk singers, the record represented Jugoton’s foray into an entirely new domain. Formally known by its catalogue number LPY 50908, Alkoholizam u riječi i pjesmi (Alcoholism in Word and Song) was jointly credited to Vladimir Hudolin and Ruža Vešligaj.¹ Vešligaj, who handled the music and lyrics, had herself entered into treatment for alcoholism in 1965, later transitioning to provide counselling and musicotherapy to fellow alcoholics. Hudolin’s main contribution to the LP, meanwhile, consisted of recorded lectures about the causes, nature and treatment of alcoholism. A psychiatrist and the country’s leading alcohologist (the term Yugoslavs sometimes used to describe specialists in alcoholism treatment), he was undoubtedly well positioned to provide such an education, having already been regularly offering courses on alcoholism to families and patients within his clinic in Zagreb. Perhaps most significantly, vocals on the album’s eight musical tracks were performed by the Vocal Octet of the Zagreb Club of Treated Alcoholics, a group of patients who, like Vešligaj, had graduated through Hudolin’s innovative treatment programme housed on the rather ironically titled Vinogradska Cesta (Vineyard Road). The LP, which found its way into homes and treatment centres across Yugoslavia, was emblematic of Hudolin’s signature approach to alcoholism, combining public education about the illness with social opportunities for his patients. This chapter details what came to be internationally known as the ‘Hudolin method’, highlighting the essential components of Yugoslavia’s most significant form of alcoholism treatment and charting its evolution and expansion from the Vinogradska clinic to dozens of countries across the world. It demonstrates that the Yugoslav approach to managing alcoholism both was shaped by and contributed to the global social psychiatry movement. As such, it offers historians a less-researched example of how treatment methods for alcoholism proliferated globally throughout the twentieth century.

By the early 1960s, it had already become apparent that the modernisation programme launched after World War II by the new Communist authorities could not necessarily solve all of the problems facing Yugoslav citizens. Gains had been made in several key economic and social indicators, especially after Yugoslavia’s 1948 break from the Soviet sphere of influence, but the large-scale changes brought about by Yugoslavia’s unique self-managing socialism model shed light on several emerging social problems.² One of the most significant issues facing the new Yugoslavia, in terms of both health and social costs, was alcoholism. Throughout the 1950s and 1960s, psychiatric researchers raised alarms about the increasing rates of alcohol abuse, noting that consumption was rising among traditional drinkers (agricultural and industrial workers) as well as among segments of the population that had historically eschewed drinking, including women and the country’s sizeable Muslim population.³ Researchers’ concerns soon transformed into panic, with Hudolin and others warning that hundreds of thousands of alcoholics remained hidden, beyond the reach of the country’s small number of psychiatric practitioners.⁴ With these numbers in mind, physicians warned that alcoholism represented ‘one of the most difficult problems of contemporary social medicine’ and the single most significant national problem facing Yugoslavia.⁵

In their efforts to explain the explosion of alcoholism, researchers were generally split between those who assumed a change in the real rates of alcoholism and those who believed that increased prevalence rates were primarily related to changing conceptions of problem drinking and better education of both the public and practitioners. Those who favoured the latter perspective largely blamed the country’s high alcoholism rates on holdovers from the past, such as peasant drinking traditions and alcohol’s traditional pre-eminence in rural medical treatment.⁶ Those who favoured the idea that rates of problem drinking were really increasing, on the other hand, instead pointed to modernisation itself as the crux of the issue. In the first decades of Communist rule, urbanisation and industrialisation proceeded at a comparatively rapid pace. Researchers highlighted the way in which rural workers became disconnected from family structures through migration to the cities, finding solace in pubs and bars.⁷ Others focused on the fact that industrialisation not only increased the opportunities for drinking (through mechanised production and subsequently lower prices), but also involved working conditions that themselves prompted drinking, either for self-medication or because of the workplace’s professional culture.⁸ However one framed things, it was apparent to practitioners across Yugoslavia that the problem with alcoholism not only was widespread, but was also threatening the country’s future. If the climate of optimism and sense of progress that marked Yugoslavia in the late 1950s and the 1960s were to be maintained, finding a way to tackle the problem of alcoholism was paramount.

Yugoslav responses to alcoholism

Against a backdrop of professional (and to a lesser extent popular) panic over alcoholism, the country’s mental healthcare providers were inspired to theorise and test novel forms of treatment, eager to come up with something that could stem the rising tide of problem drinking. Many of Yugoslavia’s clinicians read and travelled widely, which provided them with opportunities to test the varied forms of treatment being discussed within European psychiatry. For example, like their colleagues elsewhere, many Yugoslav practitioners experimented with psycho-pharmaceuticals, albeit with limited results. The only medication to gain traction was disulfiram (Antabuse), which researchers noted had the ability to help to prepare patients for more meaningful psychotherapeutic treatment.⁹ In Slovenia, meanwhile, the Ljubljana-based practitioner Janez Rugelj (notorious for his authoritarian temperament) crafted an unorthodox therapeutic intervention that aimed to raise the level of culture and masculinity of his patients. Deeming his treatment programme ‘the most difficult in the world’, he demanded that his patients participate in regular eight-kilometre running sessions and alpine mountain climbs. He compiled mandatory reading lists that drew from both the fictional and non-fictional worlds and insisted that patients raise their intellectual and cultural awareness if they were to remain in the programme, which he insisted had a success rate of 95 per cent.¹⁰ Others, such as Marko Trbović of Sarajevo, continued to apply more traditional forms of individually focused treatment, with psychodynamic psychotherapy in particular enjoying some success.¹¹

On the whole, however, the most significant new form of treatment drew heavily on the principles of social psychiatry, an emerging approach that was finding traction across the psychiatric world in the 1960s. Whether in Belgrade (at the Institute for Mental Health) or at Zagreb’s Stojanović University Hospital, the most significant forms of alcoholism treatment would look beyond the individual to their wider social milieu. These practitioners acknowledged the alcoholic as a problematic individual, but stressed that wider social networks – families, social groups and workplaces – were themselves integral in prompting and supporting alcoholism, described by one expert as a ‘social-infectious disease’.¹² Moreover, they looked to society more broadly, locating the roots of alcoholism in the economic demands of the drinks industry, the peasant tradition of home distillation and even Yugoslavia’s abundant population of plum trees (from which the favoured local spirit šljivovica was made).¹³ Put simply, for leading Yugoslav theorists, alcoholism was fundamentally better understood as a social illness than as a disease of the individual.

The person most responsible for applying social psychiatry to the problem of alcoholism was Vladimir Hudolin, who dedicated his career to developing a treatment modality capable of reducing the enormous social, economic and health burden of alcoholism that he saw as a threat to both Yugoslavia and the wider world. As early as 1960, he articulated the notion that responding to the country’s mass alcoholism problem would necessarily involve an entirely new approach, one that required novel forms of intervention both inside and outside the clinic.¹⁴ By the 1980s, he had become so convinced by his experiments with alcoholism treatment that he began calling for a full-on social psychiatric revolution within the profession as a whole, seeing the lessons he had learned in treating alcoholics as applicable to wider groups of the mentally ill.¹⁵

Although what would eventually become internationally known as the ‘Hudolin method’ was a product of Yugoslavia, its roots can be traced to the UK. In 1959, as he was assuming the position of chief psychiatrist at the Stojanović University Hospital in Zagreb (otherwise known as the Vinogradska clinic), Hudolin was one of several Yugoslav clinicians to visit the UK for advanced training.¹⁶ Although he met a number of practitioners during his sojourn, he came to be particularly influenced by the work of Maxwell Jones and Joshua Bierer, controversial figures whose work challenged the tenets of mainstream psychiatry. At the Belmont Hospital, Jones had spent the 1950s testing a form of ‘social therapy’, which would eventually blossom into the concept of the ‘therapeutic community’.¹⁷ Although therapeutic communities would spread widely and diversify over the years, Jones’s initial desire was rooted in the notion that more democratic, egalitarian and group-minded forms of treatment would be ultimately beneficial to patients. Hudolin and others would follow Jones’s unusual career as he travelled the globe seeking to inject social-mindedness into the psychiatric profession. Bierer, a progenitor of the social psychiatry movement, echoed Jones’s desire for new forms of treatment that defied the traditional top-down, closed-door facility of the psychiatric hospital. Initiating one of the UK’s first open-door facilities, the Marlborough Day Hospital, Bierer was also famous for the creation of social clubs whose membership included current and former patients, as well as staff.¹⁸ Bierer adopted something of an evangelical zeal, dedicating a substantial portion of his life to bringing together like-minded practitioners in the International Association for Social Psychiatry. Although it is difficult to know exactly how much time Hudolin spent studying under these practitioners, they clearly left an impact; his work would continually reference Jones’s research, and Hudolin was even responsible for having Bierer’s autobiography published.

Shortly after his return to Yugoslavia, Hudolin laid out his vision for how the country ought to tackle the burgeoning alcoholism problem, devising a strategy to guide his fellow practitioners.¹⁹ Firstly, he argued, it was necessary to take the struggle against alcoholism to society itself, engaging in widespread public education campaigns that would be led not only by physicians but also by treated alcoholics themselves. Given that central role that social structures played in supporting alcoholism, he encouraged the participation of other social actors (such as the Red Cross and temperance organisations) as well. Secondly, he strongly encouraged outpatient therapy when possible, anchoring treatment in various forms of psychotherapy. Although he believed that some individuals would require a short stay in hospital, it was important that they be returned to the community as quickly as possible. Thirdly, he insisted that family and the wider social environment of the patient be involved in the therapeutic process, seeing individually focused treatment as insufficient. Guided by the ideas of social psychiatry, he described alcoholism as an illness implicating the entire social network of the alcoholic; concentrating solely on the individual would be unlikely to result in significant improvement. His fourth and fifth pillars of alcoholism treatment – the therapeutic community as the organising principle for inpatient treatment and the formation of post-treatment social clubs of former alcoholics – clearly reflected the learning he had done in the UK. While these notions would evolve and be taken up somewhat differently by alcohologists across the country, this skeletal framework would guide thinking on alcoholism for decades.

For those patients who required hospital stays, whether in long-term open-door facilities or in day hospitals, socially oriented care would be the order of the day. It was important, Hudolin cautioned, that the principles of the therapeutic community guide all forms of inpatient care.²⁰ The community itself was consisted of patients, nurses, psychiatrists and social workers, all of whom were, theoretically at least, members of equal standing, able to cooperatively craft regulations for the community’s management. Group-focused tasks made up the bulk of activity within the hospital, either through various types of therapy or in educative endeavours. Regular group psychotherapy, in which patients discussed their issues with their peers and staff, was a fixture of Hudolin’s method, and individually focused treatment was comparatively frowned upon.²¹ Group therapy was seen as important because, on the one hand, practitioners believed that problems in social relationships were often fundamental causes of alcoholism; learning to work out one’s problems in the context of a social environment could only have positive consequences for patients with anti-social tendencies.²² Given Yugoslavia’s expertise in group psychotherapy, itself something partially forged through connections with London-based practitioners like Wilfred Bion and S.H. Foulkes, Hudolin’s insistence that group psychotherapy form the backbone of treatment aligned with the capabilities of Yugoslav practitioners.²³ Clinicians hoped that the group orientation of the programme would provide patients with a forum in which they would learn to re-establish non-alcohol-dependent relationships.²⁴

On the other hand, group treatment also offered the possibility of patients engaging in mutual assistance and care, something practitioners hoped would inculcate a sense of agency and capability among those being treated. The therapeutic community approach required patients to become more self-reliant than was expected in classical, top-down psychiatric approaches, and tasks such as cooking and recreational planning fell under the auspices of patients rather than staff. If successful, patients would regain belief in their own abilities and faculties. To further this goal, the therapeutic community also employed occupational therapy.²⁵ In Hudolin’s clinic, the patients set up a carpentry shop to construct their own recreational area and remodel portions of the clinic itself. Others, meanwhile, operated a printing operation that published educational materials about alcoholism, as well as Hudolin’s own alcoholism journal.²⁶ To further entrench a notion of sociality and self-confidence, decisions related to life within the community were to be democratically taken in large daily group meetings.²⁷ Such an approach aimed to stymie the development of a paternalistic relationship between staff and patient, using the principles of cooperative self-management to guide decision-making.²⁸ In this formulation, it was thus the responsibility of patients to overcome their drinking problem; physicians merely provided them with a social environment to bolster their likelihood of success.

To this end, clinicians were expected to encourage patients to take an active role in organising social life within the community. In a Belgrade-based therapeutic community, following Bierer’s lead, patients organised parties on a regular basis, with each patient taking responsibility for specific tasks relating to the event.²⁹ Psychiatrists hoped to demonstrate that fun could be had without alcohol, and that this lesson would carry on beyond the patients’ discharge from the clinic. Beyond parties, patients took charge of organising sports, games and various arts and crafts. Given Hudolin’s sense that music was the best way to activate the emotional powers of the patient, regular hours were also set aside for singing and instrument playing, culminating in the release of Alcoholism in Word and Song, which Hudolin described as chronicling ‘the greatest moments from the lives of alcoholics in musical composition and interpretation by alcoholics’.³⁰ In his view, the fact that patients wrote and recorded the material themselves was of crucial therapeutic importance, and musicotherapy enjoyed a prominent position within the world of alcoholism treatment.

Yet the LP, which was disseminated across Yugoslavia, formed only one portion of the educative component of the Hudolin approach. In reality, education about alcoholism took up much of the time in a patient’s day, with therapists underscoring that patients could better deal with their illness if they understood the key psychiatric precepts behind it. Patients read widely on the illness and were expected to pass exams on the subject at various intervals in their treatment. Yet they were not the only individuals who needed to be educated; families, and in some cases even a patient’s work colleagues, were also brought into the clinic to undergo education. Several practitioners held the conviction that wives (patients were overwhelmingly men) played a near-decisive factor in determining the success of treatment, so he saw their alcohology education as paramount for successful treatment.³¹ In Belgrade, Branko Gačić was a pivotal figure in conducting family education on alcoholism, establishing a special programme for families at the Institute for Mental Health in 1973. Beyond the family, Gačić also felt it important to expand education about alcoholism into the patient’s wider social circle, including friends and colleagues, who were also expected to take examinations on the topic of alcoholism.³² In Zagreb, Hudolin offered lectures to family members on topics such as ‘How to handle an alcoholic’ and ‘Family behaviour and alcoholism’.³³ Family members, especially wives, could then act as emissaries to transmit knowledge about alcoholism to the patient’s wider social network.³⁴ In this way, Hudolin’s groups were somewhat similar to the Danshukai self-help groups discussed by Akira Hashimoto in this volume (see Chapter 9). In both instances, there was a clear understanding of alcoholism as an illness that struck the whole family, and thus the family as a whole could be brought into treatment. Abstinence, the stated goal of almost all Yugoslav alcoholism treatment, seemingly depended upon raising the level of knowledge and awareness within the patient’s social circle and beyond into the wider community.

Yet families and friends were not only understood as potential facilitators of abstinence; they were sometimes described as incubators of alcoholism itself. For that reason, practitioners aimed not only to educate family members, but to actively treat them as well. At Belgrade’s Institute for Mental Health, researchers emphasised that poor marriages were themselves important aetiological factors for alcoholism, with the passive-submissive personalities of some wives being singled out as problematic and thus in need of treatment.³⁵ Borislav Djukanović, based in Belgrade, argued in a monograph entitled Alcoholism and the Family that practitioners should consider the marriage itself alcoholic in nature, rather than simply the individual.³⁶ The roots of problem drinking were found in the way spouses related to each other, rather than simply within the drinker. Other practitioners, such as Belgrade’s Slavka-Moric Petrović, looked into the past, highlighting deficiencies and flaws in the alcoholic’s upbringing as integral to the development of problem drinking.³⁷ Unsurprisingly, parental abandonment, conflict and the father’s own problems with drinking were all cited as evidence that families could act as ‘alcoholic nurseries’.³⁸ For young alcoholics, parents could function as ‘counter-alcoholics’, in need of treatment themselves, if their child’s alcoholism was to be truly addressed.³⁹ As Gačić summarised, ‘The goal of our systemic treatment of alcoholism is not only the individual’s abstinence … [o]ur major treatment goal is a process of change for the whole family which consists of a new life philosophy and a new and better lifestyle … .’⁴⁰ Beyond the family, experts described the drinking cultures and working conditions of certain workplaces as pathogenic in terms of alcoholism. In particular, those employed in manual labour (miners, steelworkers, railway workers and so on) were particularly threatened in this regard.⁴¹ For this reason, practitioners extended treatment to include a whole host of ‘co-alcoholics’ in a problem drinker’s life, including their ‘friends, neighbours, colleagues, [and] bosses’.⁴² To truly treat alcoholism in the Yugoslav fashion meant not only rehabilitating patients to deal with the outside world; it was also necessary to change the outside world by bringing a small part of it into treatment itself.

When a group of American psychiatrists visited Vinogradska in the early 1970s to learn about Hudolin’s experimental methods, the importance of group therapy, the therapeutic community and the educative component of treatment could be seen in the clinic’s daily schedule:

Varied iterations of this schedule were probably common across much of Yugoslavia, and other accounts of the functioning of day hospitals and therapeutic-community-based approaches to alcoholism allude to the same sorts of activities.⁴⁴ Whether in day hospitals (which involved the patient attending treatment throughout the workday before returning to his family later) or in fully inpatient treatment, these interventions saw medical institutions as places to bring together alcoholics in the hope of resocialising them, offering opportunities to relearn how to form social relationships, lend one another mutual support and rediscover a sense of agency and capability. In this regard, institutions like Hudolin’s Vinogradska clinic were putting Maxwell Jones’s aims into action, hoping to fundamentally reshape the social landscape of the alcoholic.

Hudolin Clubs

To further this goal, Hudolin and others expended significant efforts elucidating a plan for people after their inpatient treatment had concluded. A fundamental flaw in most inpatient forms of alcoholism treatment, they argued, was that the individual must at some point leave the confines of hospital to re-engage with the ‘real world’. Even those who had been through the confidence-building process of the therapeutic community would struggle upon returning to a society that, from Hudolin’s perspective, was designed in such a way as to promote alcoholism. As a consequence, figuring out how to prevent relapse in the context of an alcohol-loving society was a primary concern.

In order to address these problems, Hudolin leaned upon Bierer’s experiments with patient social clubs. Perhaps the therapeutic community, or at least its social atmosphere, could be ‘extended’ somehow beyond the end of official treatment. Known alternatively as Clubs of Treated Alcoholics, Sociotherapeutic Clubs or Alcohol Aftercare Clubs, the first of these groups began to appear in Yugoslavia during the late 1950s and early 1960s. In Belgrade, Dusan Petrović, who, like Hudolin, had spent part of 1959 in London studying the work of Maxwell Jones and Joshua Bierer, led efforts to set up ‘Saturday Club at Six’ (named to avoid stigmatising its members).⁴⁵ In Zagreb, meanwhile, Hudolin launched a group called ‘Prepored’ (Renaissance). The aim of these groups was to bring together former alcoholics, family members and at least one member of the medical community in a weekly meeting to offer mutual support against temptation and provide an alternative social environment so that the alcoholic could avoid ‘drinking society’.⁴⁶ As with inpatient treatment, families, friends and colleagues of the alcoholic were central to the functioning of the club, reflecting the way in which Hudolin and colleagues positioned alcoholism as an illness of the patient’s social ecology.

These clubs were not mere meeting places, and they often came to occupy a significant space in a person’s life. Groups often published monthly newsletters, operated bars (selling only soft drinks), helped members find employment and engaged in wider community activities. In this regard, they were designed to magnify and prolong the confidence-building and socialising nature of the therapeutic community, providing a supportive arena and reminding members that they had agency in their lives. Another crucial function of the clubs was the continuation of patient education on the topic of alcoholism. For instance, after celebrating one year of club membership, former patients could undergo ‘postgraduate’ training in alcoholism which consisted of a one-week seminar course, after which time they would be included among the volunteer teachers and leaders of the club.⁴⁷

As the popularity of these clubs spread (eventually reaching nearly 1,000 total clubs in Yugoslavia by the time of the country’s dissolution in 1991) republic-level and federal-level meetings of club delegations were held to promote the public struggle against alcoholism (and frequently alcohol itself). One such federal meeting in Bosnia opened with the ‘Anthem of Treated Alcoholics’ (track 1 on the Alcoholism in Word and Song LP) and then continued with resolutions in favour of opening new chapters in rural areas, fighting ‘disinformation’ and ‘malicious rumours’ about the clubs’ activities, pressuring the Yugoslav Lottery to donate funds to the club and finally proclaiming support for the decision to declare Comrade Tito a national hero (for the second time).⁴⁸ More generally, these large congregations allowed club members from across the region to share experiences, plot future possibilities for cooperation and hand out awards for long-term abstinence. Although published figures of membership numbers are not available, it is clear that tens of thousands of Yugoslavs participated in these clubs, with some of these organisations continuing to operate into the twenty-first century, well after the country’s collapse.⁴⁹

The spread of the Hudolin approach

On the surface, the Hudolin Clubs shared some characteristics with other alcoholism-oriented programmes built around mutual support, namely Alcoholics Anonymous (AA), and it might be tempting to conflate the two organisations. However, despite their shared interest in mutual self-help and creating new social possibilities for members, Yugoslavia’s clubs of treated alcoholics differed in several important ways. Firstly, these groups were atheistic in tone, shunning the ‘Twelve Steps’ approach and its emphasis on giving oneself over to a higher power.⁵⁰ Secondly, as with Danshukai in Japan, the ‘anonymous’ aspect of AA was nowhere to be found in Yugoslavia, where any form of secret society was forbidden (in fact, Hudolin and the republican government of Croatia even kept an official register of treated alcoholics).⁵¹ Far from claiming anonymity, members of these clubs often outed themselves by participating in public information activities and campaigns against alcoholism – an important facet of the Hudolin approach. Thirdly, the clubs typically required the participation of a healthcare professional (psychiatrist, nurse, social worker or similar), something that stands in sharp contrast to AA’s lay-oriented approach. Finally, as a consequence of the ecological approach favoured by Yugoslavia’s most important alcohology theorists, families and friends participated in Hudolin Clubs with great regularity, further separating the Hudolin approach from AA.

These differences may help to explain the remarkable fact that Hudolin Clubs did not remain confined to Yugoslavia, offering historians a comparatively rare example of East European medical expertise being exported globally. By the mid-1960s, Hudolin’s personal connections to key members of the wider world of alcohology, ranging from Max Glatt and Archer Tongue in the UK to staff at the Rome Clinic in Italy, meant that the principles of his approach were being disseminated beyond Yugoslav borders.⁵² Moreover, following in the footsteps of Bierer, Hudolin was very active in the emerging social psychiatry movement, which resisted the tendencies of both biological and Freudian schools of thought by underscoring that mental health problems were consequences of social environments (rather than simply individual deficiencies). Alongside figures such as Jules Masserman (USA), George Vassiliou (Greece), A. Guilherme Ferreira (Portugal), Jose Angel Bustamante (Cuba), Henri Collomb (Senegal) and others, Hudolin was an important early member of the International Association for Social Psychiatry (later renamed the World Association of Social Psychiatry), hosting the organisation’s international congresses in Zagreb on several occasions and being elected as the third president of the association in 1974. Moreover, he was a regular contributor to the journal founded by Bierer in 1955, the International Journal of Social Psychiatry, and served on the World Health Organization’s expert committee on alcoholism from 1965 to 1992. In short, far from being isolated behind the Iron Curtain, as historians of science and medicine have sometimes been too quick to assume about those operating in Eastern Europe, Hudolin and Yugoslavia’s other alcohologists were well connected to global networks of psychiatric knowledge.

These relationships, both personal and professional, acted as the seeds for the global spread of Hudolin Clubs towards the final decades of the twentieth century. Although Hudolin travelled widely, his efforts to spread this social psychiatric approach to alcoholism treatment were initially concentrated in Italy. In 1979, on the heels of the hospital closure reforms initiated by Franco Basaglia (with whom Hudolin maintained a long-term friendship), he helped to launch the first Italian club of treated alcoholics in Trieste, helping to cement the viability of outpatient treatment.⁵³ Over subsequent decades, Italy would play host to several thousand Hudolin Clubs, offering a significant alternative to AA, and the Hudolin name would be revered in Italy for many years to come.⁵⁴ Beyond Italy’s borders, Hudolin-inspired clubs of treated alcoholics proliferated globally from the 1980s onwards, with groups operating in more than thirty countries across the world on four continents, ranging from Ecuador and Venezuela to Scandinavia, sub-Saharan Africa (Cameroon, Kenya) and South Asia (India, Sri Lanka). Although the proliferation of clubs involved some evolution of the original concepts, they still largely follow the fundamental principles laid out by Hudolin.

Conclusion

In the late 1980s, just a few years before the country’s collapse, one researcher published a series of articles which succinctly depicted the contours of the decades-long struggle against alcoholism that Hudolin and others had waged. Publishing in the journal Socijalna psihijatrija (Social Psychiatry), one of the country’s most prestigious medical journals (a sign of how deeply entrenched the ideas of social psychiatry had become), Dragoslav Nikolić highlighted what must have been a frustrating conundrum for the country’s expanding community of alcohologists. On the one hand, practitioners like Hudolin and Gačić had been successful in convincing their fellow physicians that alcoholism was an issue worthy of psychiatric attention, and treatment capacity for alcoholism had increased substantially in the period between the 1960s and 1980s. At the same time, however, despite the substantial proliferation of both alcohologists and treatment possibilities, the country’s alcoholism problem remained significant. By the mid-1980s, alcoholism was the seventh most commonly treated medical problem (it had been the seventeenth most common in in 1969), and every seventh patient in Yugoslav psychiatric hospitals was diagnosed with alcoholism.⁵⁵ Although some of the increase may be attributable to the fact that physicians and the public were much more educated and accepting of alcoholism in the 1980s than they had been in the 1960s, it is also quite possible that rates of problem drinking were truly accelerating despite the best efforts of the alcohologists.⁵⁶ Undoubtedly, practitioners hoped that continued public education and the spread of the social psychiatric approach would eventually allow them to bring down the country’s soaring alcoholism rates, despite the social forces that propelled drinking.

Ultimately, the story of Yugoslavia’s experimental approach to tackling alcoholism suffered from two deaths. The first was that of the country itself. In June 1991 Croatia and Slovenia declared their intention to leave the federation, with Bosnia and Macedonia following shortly thereafter. Several years of warfare marked by near-unimaginable brutality, itself often facilitated by drunken rages, consumed the Balkans throughout the 1990s and brought about a definitive end to Yugoslavia. Throughout the conflict, Hudolin-style clubs suffered greatly for a host of reasons – lack of funds, population movements and the deaths of members – and comparatively few continued to function after the war. The second death was that of Hudolin himself, who passed away in Zagreb in 1996, less than a year after the cessation of hostilities in Croatia. And although Hudolin’s legacy endures into the twenty-first century, it is most significant in areas outside the former Yugoslavia, with the World Association of Clubs of Alcoholics in Treatment (WACAT) continuing to spread the Hudolin model around the globe.