This chapter evaluates the Soviet approach to the treatment of alcoholism during the last two Soviet decades. It will be shown how the particularities of Russian and Soviet drinking habits were tackled by propagandists, psychiatrists and the police, especially in the newly established field of narcology. ‘Narcology’, a term coined in the Soviet Union in the 1960s, refers to a branch of psychiatry that specialises in the study and treatment of drug and alcohol abuse. Comprehensive in approach, narcological treatments incorporated numerous societal actors, such as healthcare professionals, security personnel, employers, and families and friends of alcoholics. The punitive potential of such treatments was underlined by the deprecation of alcoholism, and the subsequent stigmatisation of alcoholics, in the Soviet context. Soviet treatments for alcoholism held the power to permanently exclude individuals from Soviet society, while simultaneously ensuring the exploitation of their cheap labour in the so-called ‘labour treatment centres’ or ‘labour treatment prophilactoria’ (LTPs).¹

On both sides of the Iron Curtain much has been written by academics and in popular media on Soviet and Russian drinking.² It is therefore generally known that the late Soviet years witnessed a well-documented surge in alcohol consumption. ‘Between 1960 and 1979 alone, alcohol sales nearly quadrupled [with] disposable household income spent on alcohol reaching 15–20%.’³ In 1982 the USSR ranked among the top four alcohol-consuming countries in the world.⁴ In the Soviet case eight of the total of fourteen litres of alcohol consumed per person annually were ‘distilled spirits 80-proof and higher’.⁵ However, alcohol consumption patterns varied, depending on local cultural traditions, and some regions, especially the Muslim republics (such as Tadzhikistan, Turkmenistan and Uzbekistan), were notably less open to drinking. The Baltic republics and the Slavic Soviet states, like Russia, Ukraine and Belarus, on the other hand, consumed twice as much alcohol per capita.⁶ This chapter focuses on the Slavic republics, where problems related to alcohol consumption proved to be the most common and severe.

As Sandra Anderson has shown, the sale of alcohol substantially subsidised the Soviet economy: ‘By 1985, the taxes on alcohol amounted to about 40 percent of all direct and indirect taxes paid by Soviet citizens and about 13 percent of the state’s entire budget receipts.’⁷ This illustrates the traditional importance of alcohol for the national economy and the heavy dependence of the Soviet system upon its people’s continued alcohol consumption, a tradition that is documented as far back as the late fifteenth century.⁸ The consequences of this tradition for heavy drinkers, their families and for society itself proved to be grave.

Daniel Tarschys has calculated the total annual death toll due to alcohol abuse during the late 1970s as ranging from 370,000 to 400,000.⁹ It was not only people dying from alcohol-related conditions that aroused official concern; because of heavy drinking, fewer children were being born, and infant mortality had increased significantly, with rising numbers of female alcoholics in the two final Soviet decades.¹⁰ These concerns were reflected in the continuously rising average amount of liquor, beer and wine consumed by the Soviet population.¹¹ What is more, everyday life was severely affected by excessive alcohol consumption. The Ministry of Internal Affairs complained from the 1970s onwards that absenteeism, poor work performance, accidents, violent crimes and vandalism were often caused by workplace intoxication.¹² In total, harm related to alcohol abuse cost the state an estimated 10 per cent of the national income.¹³ It was not only economists and government officials who were alarmed. The general public were well aware of the dangers of heavy drinking, and media reports openly addressed the issue. In 1972 the future Nobel Peace Prize laureate Andreĭ Sakharov (1921–1989) wrote a concerned letter to Leonid Brezhnev (1906–1982): ‘Drunkenness has assumed the dimensions of a national calamity. It is one of the symptoms of the moral degradation of a society that is sinking ever deeper into a state of chronic alcohol poisoning.’¹⁴ The alarm of commentators is even more striking given their unawareness of official statistical data for certain medical and forensic trends such as suicide rates in the Soviet Union, which were considered ‘sensitive’ and hence strictly kept under lock and key.¹⁵

Although the negative impact of heavy drinking was commonly known, it seems that the general public were not overly concerned. One explanation for this indifference towards the effects of alcohol abuse is rooted in the drinking tradition that was prevalent in some regions, which has been described as a ‘disturbed permissive culture’.¹⁶ In such a setting, excessive alcohol consumption was socially acceptable, thus shielding heavy drinkers from criticism or peer intervention.¹⁷ Biss argues that in the second half of the twentieth century, large parts of the population tolerated public drinking rituals, bingeing and alcohol-induced violence.¹⁸ Standard vodka bottles were not even resealable, encouraging consumers to finish the bottle once it was opened.¹⁹ Even violent episodes, continuous drinking sprees, abusive behaviour and other forms of damage were tolerated, as long as they did not prompt state interference.²⁰ The famous actor and singer Vladimir Vysot͡skiĭ (1938–1980) struggled for years with his own substance abuse, which eventually led to his untimely death in 1980. His song ‘Nikakoĭ oshibki’ (Flawless) addresses the fear of an official psychiatric diagnosis and of institutional treatment, which often involved punishment. A physician’s diagnosis marked the watershed between generally accepted social drinking and alcohol substance abuse:

As long as a person’s drinking did not result in official attention in the workplace or by the police, it was hardly ever addressed.

In private settings, heavy drinking was even considered an asset. This was especially true for men, who were encouraged to drink by their peers, thus making drinking ‘a male activity’.²² Masculinity was often expressed by excessive drinking, and alcohol consumption helped to establish hierarchies, for example at work.²³ Various different rites of initiation involved drinking large quantities of alcohol and were commonly expected by colleagues and society. A failure to perform according to these unspoken rules aroused suspicion and resulted in being marked as ‘feminine’.²⁴ Drinking was part of the role performed by Soviet men, and even the official newspaper Komsomol’skai͡a pravda (The Komsomol Truth) once warned of the ‘emasculation’ of official festivities if the availability of alcohol was to be reduced.²⁵

These positions undermined the already weak political efforts to curb public alcohol consumption, although the negative effects of excessive drinking were pronounced, especially among men. Male life expectancy rates were steadily decreasing.²⁶ Dutton suggests that this was due to a number of reasons, such as ‘circulatory system diseases as causes of death; the probably increasing death rates from accidents, suicides, and poisonings’.²⁷ He also suspects that the recorded increase in alcohol consumption per capita between 1959 and 1977 highlights the connection between drinking and disease.

Research on the relationship between gender and alcohol abuse in the Soviet Russian case has shown that both consumption of vodka and displays of violent behaviour increased from the 1960s onwards and that this increase was closely linked to post-Stalinist ideas of masculinity.²⁸ Drinking was widely regarded as a regular pursuit in Soviet society, and it also provided a safety valve for dissent and discontent. It became the antagonist of the arranged normalcy.²⁹ Among the wider population no critical conscience about the negative effects of prolonged alcohol abuse developed, and heavy drinking at work or during state holidays was sometimes actively encouraged by senior professionals or communist activists.³⁰ These kinds of behaviour were considered normal – until an individual was stigmatised and shunned by the diagnostic verdict of ‘alcoholic’.³¹ Although alcoholism evolved into an ever-growing burden for Soviet society, it was not dealt with in a consistent manner, as the following analysis of alcohol treatment in the Soviet Union shows.

Ideology and official campaigns

The medical treatment of alcoholism in the Soviet context proved to be challenging, since the medical profession was subjected to political pressure. As in most societies, in the Soviet Union alcoholics were stigmatised as morally weak individuals. They were considered ‘deviants’ and treated like a political problem, because they presented a challenge to the Soviet narrative of societal progress and scientific rationality.³² Complex and ambiguous social phenomena muddied the clear waters of state-projected societal development towards Communism. In this line of thinking, alcoholism was considered a ‘legacy of the past’ and progressive members of society were to abstain from drinking (see Figure 12.1).³³

Similar responses can be identified in Western European countries when abstinence movements, medical scientists and political thinkers have linked alcoholism to irrational and moral degradation, as Jasmin Brötz has shown in relation to late nineteenth-century and early twentieth-century Germany in her contribution to this volume (see Chapter 6). Soviet treatment programmes featured a combination of repressive and educational measures in order to eradicate alcoholism from Soviet society. Because excessive drinking was often observed in combination with criminal behaviour, party officials frequently called for compulsive treatment of alcoholics.³⁴ Since alcoholism challenged state narratives, its treatment was to follow standardised procedures whenever state representatives voiced concerns. This prevented the establishment of low-level interventions, such as local or private initiatives to help alcoholics, and was in stark contrast to treatments in other Eastern European countries, such as Czechoslovakia and Yugoslavia.³⁵

The Soviet Union preferred a behavioural explanation for alcoholism over the concept of alcoholism as a disease. Therefore alcohol therapy focused on the de-conditioning of reflexes.³⁶ As in most fields of Soviet research, the principle of seniority led to a conservative research environment, where proponents of established truths, such as the Pavlovians, held powerful roles.³⁷ This restrictive mindset dominated the scientific discourse on alcoholism and its treatment, as well as the administration of the health sector more generally.³⁸ Even so, some researchers were open to new ideas. For example, the Leningrad-based researcher Igor Sytinsky and Z.P. Gurevitch explained in a Western publication on the Soviet treatment of alcoholism in 1976: ‘Alcoholism is a very complex socio-psychological and medical problem … a chronic and often recurring illness that has multiple causations including genetic, biological, psychological and sociological factors.’³⁹ But these conclusions were not sufficient to challenge the predominant ideological assumptions back in the Soviet Union.

Figure 12.1 The well-known Soviet anti-alcohol poster from 1954 displays a cultured young man confidently rejecting a glass of vodka during a meal, with the simple command ‘No!’

The Communist Party and the Ministry of Health were officially in support of moderate drinking because, by itself, alcohol as a substance was not seen as the root of alcoholism. Although the decision of the Council of Ministers of the USSR in ‘O dopolnitel’nikh merakh po usilenii͡u bor’by s p’i͡anstvom i alkogolizmom’ (On additional measures for reinforcement of the struggle against drunkenness and alcoholism) of 1978 officially ‘intensified both the anti-alcoholic propaganda efficiency and the treatment of alcoholic patients’, it failed to reach its ambitious goal, ‘to eradicate alcoholism’.⁴⁰ As Sytinsky had pointed out only a few years earlier,

The new official declarations were inapt when it came to alleviating the yoke of alcoholism; in this sense they were typical of late Soviet policies. As Anderson has pointed out, anti-alcohol campaigns were primarily ‘done by low-level Communist Party activists who have no medical knowledge’.⁴² Their efficacy was therefore minimal.

However, there were political attempts to limit drinking in public and to reduce the negative effects of high alcohol consumption. During Brezhnev’s time as leader of the Soviet Union, prices of alcoholic beverages were raised in 1979 and 1981, and new political campaigns against heavy drinking were initiated on different political levels.⁴³ During the 1980 Summer Olympic Games in Moscow, the USSR even replicated the US policy of relocating alcoholics from urban centres to rural areas, thus removing them from the sight of international visitors.⁴⁴ Alcoholism therefore became a problem for officials in rural areas, and it was exacerbated by the fact that higher alcohol prices had revitalised the moonshining tradition of the Russian peasantry, namely the illicit private production and consumption of strong spirits.⁴⁵ Brezhnev’s successor, Yurĭ Andropov (1914–1984), intensified measures against alcohol abuse and even lowered alcohol prices in order to counter the negative consequences of private distilling and the abuse of low-grade alcohols. The less expensive legal brands of vodka introduced under Andropov, colloquially called ‘Andropovka’, also helped to alleviate fiscal losses.⁴⁶ This development did not indicate a turn in political intention, but appears to have been introduced as a matter of sheer necessity.

What was the main reason for the overall failure of repeated official attempts to tackle alcoholism? Since the general public lacked awareness of the dangers of alcohol abuse, official government campaigns were widely considered to be untrustworthy – a hallmark of late Soviet propaganda.⁴⁷ The government was well aware of its limited ability to re-educate a population that largely supported the common practice of excessive drinking.⁴⁸ The general population was accustomed to a discrepancy between official politics and the facts of everyday life, especially when it came to accepting shortages.⁴⁹ Consequently, alcohol, especially strong spirits, remained readily available. Consistent measures against drunkenness were not enforced, because the government was well aware of the great importance of alcohol as a means of substance-based escape from everyday life. The state depended upon fiscal revenues from alcohol sales and was not willing to jeopardise societal peace by taking away the soothing pastime of drinking. As long as the population was functional, namely worked hard and paid taxes on spirits, state control was assured.

Narcology: medical and political goals entwined

The greatest change in the Soviet treatment of alcoholics was the emergence of narcology in the 1960s.⁵⁰ This new psychiatric field was established for pragmatic reasons: most alcoholics had previously been treated in regular psychiatric hospitals, which could no longer keep up with the increasing number of patients with alcoholism. The overall number of alcoholic inpatients in Soviet psychiatric hospitals had tripled between 1965 and 1978,⁵¹ and other psychiatric conditions increasingly could not be treated appropriately in the then woefully overcrowded institutions.⁵²

By the mid-1980s, the profession of the psychiatrist-narcologist was established as an additional medical field in schools, university departments and research facilities.⁵³ But narcology was far from being an entirely new discipline. Most of its key elements had already become established decades earlier and merely merged ‘into a coordinated and interlocking system’ of coercion and medical treatment.⁵⁴ Unlike the Czechoslovak example, where local initiatives or interested professionals became trailblazers of successful alcoholism therapy, addiction treatment in the Soviet Union remained within the realm of psychiatric clinics and was policed by security institutions.⁵⁵ The fabric of the Soviet clinical regime was steeped in this repressive approach, as illustrated by the oath taken by Soviet doctors. Besides being duty-bound to preserve the ‘noble traditions of national medicine’, the Soviet physician was obliged to ‘always obey and promote principles of Communist morality’ and be ever-mindful of the honourable title of a ‘Soviet physician … always acting responsibly for the people and the Soviet state’.⁵⁶ Thus, aside from their role as physicians, medical personnel also fulfilled policing obligations.

One important innovation in the field of narcology was not related to alcoholism itself, but was connected to its administrative set-up. The Ministry of Health and the Ministry of Internal Affairs were jointly in charge of alcohol treatment, thus reflecting the Soviet view of alcoholism as both criminal offence and medical condition.⁵⁷ Official state publications openly called for ‘psycho-hygienic and prophylactic work both inside’ and outside institutions, alongside preventive measures and medical interventions.⁵⁸ Narcology was established in order to ensure continuous surveillance of patients by the Ministry of Internal Affairs and the Ministry of Health, with the former having the last say in the case of any potential difference of opinion.⁵⁹

The field of narcology was not only focused on alcohol – involving research, medical examinations and treatment – but was also based on coercion. Narcology seeped into the structures of everyday Soviet life as broad networks of narcological dispensaries in the work sphere were established alongside the organisation of independent workshops and departments at industrial factories, where alcoholics continued to work while receiving medical treatment.⁶⁰ One narcologist praised the ‘possibilities in social-labour re-adaptation of alcoholic patients by helping them to stop hard drinking and return them to the normal social-productive life’.⁶¹ Despite the comprehensive authority of narcology, a distinction (with regard to their respective functions) between LTPs and ‘drunk-tanks’, on the one hand, and research facilities, on the other, was officially upheld. According to this separation, the former were under the jurisdiction of the Ministry of Internal Affairs, while the latter remained under the control of the Ministry of Health.⁶² As both ministries cooperated closely, narcologists were in fact provided with powers commonly reserved for the police. Narcologists thus held the authority to interfere in the private and work sphere alike in order to enforce ideas of normalcy. This panoptical approach relied on co-workers and relatives to discipline and report on the drinking behaviour of potential alcoholics.⁶³ Even healthcare professionals monitored each other’s alcohol consumption.⁶⁴ Fear of coercion caused potential alcoholics to stop drinking in order to avoid forced contact with health institutions, counselling and doctors.⁶⁵ This development was encouraged by diagnostic categories that lacked clarity, as related in the popular Vysot͡skiĭ song mentioned above. Narcology fostered a precedence of the penal code. Difficulty in abstaining after a couple of drinks was considered a ‘pathological drive towards alcohol’ and therefore constituted an official reason for treatment, even against the patient’s will.⁶⁶ Enforced treatment was usually the unavoidable endpoint of a heavy drinker’s struggle with drinking, although narcology always provided alternative voluntary medical treatment options earlier on.

Medical treatment, stigma, labour and social control

Alcoholism was the most commonly diagnosed condition in regular psychiatric institutions. By the end of the Soviet era alcoholics made up roughly one half of the total number of patients in psychiatric hospitals, as well as in clinics attached to factories and dispensaries, where medicine and other treatment were administered.⁶⁷ The majority of patients with alcoholism in dedicated treatment centres were admitted involuntarily, though some did go voluntarily to sober up, obtaining free care and receiving sick pay at the same time.⁶⁸

Narcology addressed those deemed to be substance abusers in a plethora of situations and at different stages. Potential alcoholics were initially confronted with psychiatrist-narcologists and police officers, not with social workers, since this profession did not exist in the Soviet Union.⁶⁹ The patient’s fate was then determined not only by medical necessity, but also by the availability of particular treatments and on the basis of ideological preconditions. Some forms of treatment, like altitude chambers or specific medication, were not readily available on the medical map of the late Soviet Union and were therefore limited to patients in large urban institutions.⁷⁰

The anthropologist Eugene Raikhel outlined three different avenues in the admittedly fairly heterogeneous treatment of Soviet alcoholics.⁷¹ Those in one group, usually first-time patients, were treated locally as outpatients, in local clinics or in psychiatric hospitals. More serious cases were admitted to narcological clinics, where they participated in work therapy, providing a cheap work force, with 40 per cent of the earnings being kept by the institution.⁷² The last group of patients, so-called chronic alcoholics ‘who [were] considered dangerous to society’, were sent to special colonies or LTPs.⁷³ The purpose of these institutions was to isolate patients from society in order to provide ‘compulsory treatment and labour re-education’, which could last from six months to up to two years. Alcoholics were sent to the LTPs by district courts without a chance to appeal the verdict.⁷⁴

The first time many heavy drinkers came into contact with narcology was in one of the many drunk tanks in the Soviet Union at that time. These holding cells were maintained to supervise intoxicated people until they sobered up. Depending on the size of the facility, up to thirty beds might be available for patients who were picked up in a severely intoxicated state, usually during night-time. In the morning, patients were required to pay a fee to the nurse on site, and failing this they were transferred to hospitals for further treatment.⁷⁵ The public were aware of drunk tanks, not least because they entered popular consciousness in 1971 through Vladimir Vysot͡skiĭ’s song ‘Militseĭskiĭ protokol’ (Police protocol), in which he describes two friends picked up by the designated police squad and brought to a drunk tank. The song goes on to recount how, as the morning dawns and they awaken, the narrator suggests to his friend that they continue drinking.⁷⁶ Each year, drunk tanks were frequented by up to 15 per cent of the adult population of the USSR.⁷⁷ These institutions were criticised for not providing sufficient medical care and for neglecting drunken inmates, frequently with fatal consequences. As Treml suggests, the high number of alcohol-related fatalities was therefore caused not solely by excessive drinking, but also by the ‘deterioration of the quality and availability of health and medical services in the USSR’.⁷⁸ Treml, writing in 1982, suspected these institutions of ‘benign neglect’, for alcoholics were officially stigmatised and their lives were not held in high esteem.⁷⁹ Since the cells were overseen by local police, they also served punitive purposes. An involuntary overnight stay at a holding station usually also resulted in notification of the individual’s employer.⁸⁰ This measure aggravated social pressure at work and triggered financial concerns, since employers were able to withhold as much as one third of monthly pay or to cancel or reduce vacation entitlements in a case of poor performance, especially if this was due to alcohol abuse.⁸¹

Outpatient detoxification at hospitals lasted from eight to ten days, during which time vitamins, tranquillisers and antidepressants were administered.⁸² Some factories even had their own dispensaries, where on-site alcohol therapy was provided, including detoxification, medical and psychological evaluations and, eventually, prophylactic work therapy. These measures could be prolonged indefinitely, and, even after treatment was considered completed, patients remained on the passive register of the respective dispensary for a minimum of two years.⁸³ These registers primarily served purposes of social control, and policing not only helped state healthcare institutions to evaluate dispensaries’ overall performance, but also allowed close supervision of former and active patients. They therefore contributed to the overall climate of control in the health sector. Once on the list, the patient was not allowed to hold occupations of responsibility or obtain a driving licence or a gun permit.⁸⁴ In 1984 2.7 million people were registered as alcoholics, amounting to about 2 per cent of the Soviet population.⁸⁵

Not every alcoholic was treated on an outpatient basis, and personnel were aware of institutions’ limitations, especially when it came to ‘degraded alcoholics’.⁸⁶ Some of the more severe cases with little hope of recovery remained outpatients. This enabled them to live in their familiar surroundings, with family or work ties more or less functional. While this was sometimes justified as a means of upholding the patients’ social setting, it also allowed the state to avoid costly periods of treatment.⁸⁷ Outpatient treatment, to some degree, mirrored Soviet ideas of collectivism and socially useful work, and was aimed at convincing patients of their irrational state, thus healing them as individuals and as social beings; Michel Foucault’s analysis of psychiatric institutions during the European Enlightenment was based on a critique of a similar kind of thinking.⁸⁸ Although alcoholism was considered incurable, one case of complete convalescence is documented. The psychiatric Serbsky Institute in the centre of Moscow ‘cured’ the alcoholic Yurĭ Brezhnev (1933–2013) after three weeks of treatment for alcoholism.⁸⁹ He was the son of the leader of the Soviet Union in 1964–82, Leonid Brezhnev. Prominent patients, it seems, could be freed of the branding ‘alcoholic’.

Like other fields of psychiatry, narcology emphasised the curative function of work when it came to re-integrating people exhibiting deviant behaviour into society. In the Soviet Union the role of labour was of fundamental importance and was repeatedly mentioned in the Brezhnev Constitution of 1977.⁹⁰ Failure to work was considered parasitic and therefore pathological.⁹¹ Not only did the vocabulary used by Soviet psychiatrists bear resemblance to National Socialist phraseology, but, as E. Follath and R. Oltmanns have pointed out, the psychiatrists also made use of German research that had originally supported the Nazi euthanasia programme during World War II.⁹² Soviet psychiatry and narcology depicted useful work as a prime indicator of successful medical treatment.⁹³ Ideas of rehabilitation were thus closely connected to the patient’s work performance, ultimately determining their social standing and political allegiance.⁹⁴ Accordingly, poor work performance due to alcohol consumption was a fast track to involuntary therapy. As Anderson noted, ‘A 1967 decree permit[ted] compulsory treatment for alcoholics who “violate[d] labour discipline, public order, and the rules of the socialist community”.’⁹⁵ Work therapy did not only serve medical and financial interests; it also combined curative and penal measures – a repeatedly surfacing theme throughout the history of work therapy in clinical settings.⁹⁶ The importance of the role of punishment is particularly apparent in the case of LTPs, where patients were mandated to work at factories without receiving any particular medical treatment.⁹⁷ It is important to consider that the concept of involuntary patient labour was not limited solely to the context of the psychiatric system, since in the Soviet Union ‘work, society and psychiatry [were] intrinsically bound up’, as recent comprehensive research has pointed out.⁹⁸

Labour therapy was highly compatible with the Soviet understanding of psychiatry; psychoanalysis and other individual psychotherapeutic approaches, however, were readily dismissed.⁹⁹ Although the conflict between Pavlovians and psychoanalysts had ebbed away by the 1960s, psychoanalysis continued to be under attack by Soviet officials because it supposedly supported bourgeois and non-scientific positions. Group counselling, thanks to its collective approach, constituted an acceptable form of talking therapy. Likewise, charismatic psychiatrists, selected staff and recovering alcoholics were encouraged to influence patients by questioning their precarious lifestyle.¹⁰⁰ Whenever Soviet publications or professionals mentioned psychotherapy, they usually referred to lengthy, strictly hierarchical conversations between psychiatrist and patients. Such sessions were peppered with political recommendations and often accompanied by hypnosis. Therapeutic group sessions and work therapy complemented the programme, as social performance and work productivity held substantial ideological value.¹⁰¹ Treatment also included clinically administered drugs. A combination of methods was used in aversion therapy, also known as conditioned reflex therapy, and in Disulfiram therapy.¹⁰²

Aversion or conditioned reflex therapy attempted to create a link between alcohol and negative connotations, the aim being that the sight, smell and taste of alcohol would induce reactions like nausea and vomiting. This goal was achieved by injecting patients with the emetic apomorphine, after which they consumed an alcoholic drink, which they were not able to keep down. Narcologists also called this procedure active anti-alcohol therapy.¹⁰³ Because of the efficacy and immediate results witnessed by patients and physicians, the procedure was highly appraised and was even performed against a patient’s will.¹⁰⁴ It is also an example of Pavlovian medical practice, which was highly compatible with the Soviet understanding of alcoholism.

Disulfiram therapy was the second most prominent form of medication-based therapy in narcology. Disulfiram, available in the Soviet Union under the brand name Antabuse, is a medication that inhibits the breakdown of acetaldehyde in the liver, causing discomfort and the symptoms of an immediate hangover when taken with alcohol. Depending on the amount of alcohol ingested, a life-threatening condition may arise. The medication was given orally, in a subcutaneous injection or as a suppository. Patients treated with Antabuse were informed of the potentially lethal consequences and were required to accept personal liability before treatment; after they were released, their spouses or employers were entrusted with monitoring their continuous sobriety.¹⁰⁵ Because this treatment was given only to selected patients, results were fairly positive. However, once people who were determined to drink removed their implants or were convinced they had received only a placebo, the deterrent effect of Antabuse vanished.¹⁰⁶

The combination of detoxification, rational conversations with the narcologist, conditioned reflex therapy and disulfiram therapy was the ideal model for treatment proposed by Soviet narcology. Other factors that were deemed important for recovery involved steady work, a stable social surrounding and the development of new interests, free of alcohol.¹⁰⁷ The success of this ideal approach strongly depended on the patient’s cooperation. For unwilling or hesitant alcoholics, the Soviet Union created additional measures that did not require the patient’s approval.

Legal and penal measures against alcoholics

Narcology consolidated the links between the medical and penal field, while affirming the moral condemnation of alcoholism. During the mid-1980s, clinically identified alcoholics had to comply with treatment; otherwise they were committing a punishable crime.¹⁰⁸ It is revealing that a substantial number of alcoholics, about 5–6 per cent of the registered alcoholics in the 1980s, underwent compulsory treatment, usually work therapy, in corrective labour colonies under supervision of the Ministry of Internal Affairs.¹⁰⁹ These developments were partly prompted by economic necessity.¹¹⁰ The institutional association between treatment centre and prison also reflected the continuing Soviet conception of alcoholism as a moral shortcoming.¹¹¹

Compulsory hospitalisation represents one of the most infamous chapters of Soviet psychiatry and received considerable attention in the Western world.¹¹² Human rights groups like Amnesty International called this practice ‘spiritual murder’ and a ‘variation of gas chambers’, while the dissident Andreĭ Amal’rik spoke of ‘Stalinism without [open] violence’.¹¹³ The legal provision for coerced treatment appears intentionally vague and vested the medical committees with excessive powers. In 1962 the Ministry of Health issued instruction no. 04–14/32, which listed the criteria required for involuntary hospitalisation. The criteria included aggressive tendencies against people or institutions, ‘anomalous’ behaviour and a variety of mental disorders – including dissimulation, where patients lack pathological symptoms altogether. In 1969 the instruction was extended by the Ministries of Health and Internal Affairs’ joint order no. 345–209, extending the grounds for coerced treatment to ‘potentially improper behaviour and socially dangerous tendencies’.¹¹⁴ Instruction no. 06-14/43 of 26 August 1971, issued by the Ministry of Health, confirmed the practice of pre-emptive treatment whenever a psychiatrist was convinced of the necessity.¹¹⁵ This development was followed by corresponding regulations for alcoholics and addicts. A Soviet textbook on the treatment of alcoholism demanded: ‘When the behaviour of a person suffering from alcoholism or drug addiction is considered socially dangerous, this constitutes an absolute indication for immediate hospitalization.’¹¹⁶ Because of the broad catalogue of pathological criteria, forensic psychiatrists essentially held universal powers to treat virtually everybody. The orders highlight the close connection between the Ministry of Health and the Ministry of Internal Affairs, even before the establishment of narcology in the mid-1970s. The human rights abuses associated with treating patients against their will have been the target of severe criticism in Western societies, as the anti-psychiatric movement in the late twentieth century has shown.¹¹⁷

Soviet authorities sometimes accused political dissidents of being alcoholics in order to incarcerate them in treatment centres. The underground publication A Chronicle of Current Events quoted Ida Nudel (born 1931), a Soviet Jewish woman who had repeatedly demanded permission to emigrate to Israel:

The legislation did not only provide opportunities for abuse and punishment. Some Soviet psychiatrists took advantage of the chance to remove alcoholics from their surroundings in order to protect those most affected by the consequences of excessive drinking. According to Soviet legal understanding, compulsory treatment of alcoholics was acceptable because it was determined by a people’s court and therefore legitimised by Soviet society.¹¹⁹ And despite the Helsinki Conference on Security and Co-operation in Europe in 1975, collective rights still dominated over individual rights in Soviet legal tradition.¹²⁰ Narcology was confronted with complaints by

Any such complaint was considered a lack of insight into one’s illness and was hence countered by re-education measures, which could last up to two years.¹²²

Inpatients were subjected to the same treatment as outpatients. After detoxification, they underwent aversion or conditioned reflex therapy, and some were treated with disulfiram before being released. Labour therapy played a major role, as did re-education measures. After inpatient treatment, treatment on an outpatient basis was provided for three to four years, with the ultimate goal of ‘helping the patients to cease hard drinking and bring them back to the full value of social-industrial activity’.¹²³ Strikingly, only ‘hard drinking’ was considered to be the root of all evils, not drinking in general.

Igor Sytinsky praised the important and positive role of the alcoholic’s family and community in successful treatment.¹²⁴ However, this viewpoint disregards the fact that institutions also heavily relied on information obtained from relatives and co-workers in order to control the alcoholic probationer. Proceedings, eventually leading to repeated forced confinement, were frequently initiated by informers among colleagues, peers and family members, and once suspicious behaviour was reported, the medical process took over again. During the legal proceedings, the alcoholic’s procedural rights were revoked. The recidivist was then left in the hands of a medical committee, a procedure which, as reported by Raikhel, was sometimes abused by relatives and even malicious neighbours, who denounced the alcoholic for selfish reasons.¹²⁵ This was true not only for substance abusers, but also in the case of potential candidates for a psychiatric institution. Presumption of sanity was not legally enshrined during the process of admission to a medical institution. Rather, the alleged alcoholic, schizophrenic or depressive was required to prove her or his sanity, without the support of legal procedures.¹²⁶

Compulsory treatment for alcoholism provided the same loopholes that prevailed in regard to the potential for abuse in psychiatry, focusing on punitive measures rather than clear diagnostics. Criminals, alcoholics and the mentally ill could all be diagnosed and treated on the basis of similar assumptions and procedures. Significantly, labour therapy centres were overseen by the Ministry of Internal Affairs, which was in charge of the Soviet prison and labour colonies.¹²⁷ This moral and administrative proximity between the punitive and the curative was apparent in many elements of the regimes of medical institutions. Even psychiatrists wore uniforms, institutions were surrounded by barbed-wire fences, and escape attempts were treated as criminal offences.¹²⁸

Involuntarily hospitalisation kept alcoholics under a prison-like regime. They could be medicated against their will and were required to perform forced labour. These procedures were officially sanctioned in the name of medical necessity, but in reality remained highly compatible with and hardly separable from the actual penal system. What is more, a steady exchange of prisoners and patients between medical institutions, penal colonies, the Gulag and regular prisons took place, encouraged by vague symptom classifications and ambiguous medical diagnoses. Michel Foucault considered this interchangeability a result of moral condemnation of medical conditions. In this sense, he characterised addiction and psychiatric illness in the Soviet context as ‘crime’s strange twin’.¹²⁹

Despite the widespread acceptance of liquor in Soviet everyday life, the legal system relentlessly pursued criminal offences committed under the influence of alcohol. Article 39 no. 10 of the Penal Code of the RSFSR of 27 October 1960 called for harsher sentences for inebriated perpetrators.¹³⁰ The intention was to deter potential criminals from drinking. Arguably, legislators feared that an exculpating court ruling would increase the numbers of alcohol-related crimes, such as vandalism and assault. The criminalisation of heavy drinking was also consistent with the official government view on alcohol abuse and counted in the courts as an aggravating factor; for example, it could lead to an individual being tried for murder instead of manslaughter. According to Soviet legal scholars, excessive drinking was responsible for the creation of unsafe environments, and it was considered a constitutive precondition for certain crimes.

The penal code also provided the legal foundation for the compulsory medical treatment of alcoholic perpetrators. Potentially, not only did alcoholic criminals face harsher sentences for crimes committed in a state of inebriety, but Article 62 of the above-mentioned legislative text also allowed for additional sentences and coerced treatment for alcohol abuse. During the 1960s, the Supreme Court of the RSFSR proposed to the Supreme Soviet the expansion of legal jurisdiction to non-criminal alcoholics, in order to curb increasing rates of vandalism and street violence.¹³¹ Although the proposal was not successful, the establishment of narcology in the following decade opened the path for the involuntary treatment of alcoholics, which was consistent with the proposal’s main intention. Stricter measures against ‘hooligans, parasites, and alcoholics’ were eventually introduced under Andropov, and were intensified under his successor Konstantin Chernenko (1911–1985). Both of these officials believed alcoholism to be a severe threat to the Soviet people.¹³²

Alcoholics kept under lock and key were not treated like non-alcoholic perpetrators. Even the official amnesty when the sixtieth anniversary of the USSR was celebrated in late 1982 excluded detainees who were incarcerated for alcohol-related crimes.¹³³ This decision was consistent with previous amnesties, like the pardon of 27 June 1980, which was extended to numerous groups of incarcerated patients ‘serving sentences of up to five years’.¹³⁴ Among the exceptions to this act of grace were ‘those serving a sentence, who have not yet completed their course of treatment for alcoholism, drug addiction or venereal disease’.¹³⁵ The actual end of a criminal sentence therefore depended upon the completion of treatment, which was to be determined by the institution.

Civil court claims and litigation against alcoholics could lead to their being deprived of their parental rights and being evicted from their homes; they were stripped of their legal capacity. If workers sustained injuries in a drunken state, they could be demoted; scientists could lose their university degrees if deemed to be inebriated, and families could be denied compensation if a relative died as a result of alcohol abuse.¹³⁶ In the Soviet Union, anti-alcohol legislation can be more accurately described as anti-alcoholism legislation, since alcohol remained a highly esteemed source of national income and social stability. Mikhail Gorbachëv (born 1931) was the only general secretary who tried to tackle the problem on a more comprehensive level.

The political campaign for sobriety under Mikhail Gorbachëv

Although Mikhail Gorbachëv is most commonly associated with the battle against Soviet alcohol abuse, his aspirations for a sober society were not new and merely intensified a political aim that had existed ever since the establishment of the USSR. All four of the general secretaries covered in this chapter attempted to eradicate the grave societal consequences of alcohol abuse, especially its impact on individuals’ health and the negative consequences of alcohol abuse for workplace safety and production.¹³⁷ Gorbachëv’s far-reaching approach began with the resolution ‘O merakh po preodolenii͡u p’i͡anstva i alkogolizma’ (On measures to overcome drunkenness and alcoholism), which was adopted by the Soviet Communist Party on 7 May 1985.¹³⁸ The implementation of these measures was fast, as Gorbachëv’s polity benefited from the more stringent administrational network that had been re-established during the Andropov era. But Gorbachëv’s strategy also differed from that of his predecessors in one important aspect. He identified alcohol as the prime target in the battle against alcoholism and attempted to change societal views on the substance itself.¹³⁹ The motivation for this course of action was consistent with his comparatively liberal political position, soon to surface in his ground-breaking (and eventually Union-shattering) reforms. Gorbachëv encouraged people to openly address problems – including the extensive alcoholism prevalent in Soviet society. At the same time, his anti-alcohol campaign was the last project of attempted large-scale ‘social engineering directed by the party state’.¹⁴⁰

A broad catalogue of measures was imposed, including raising the drinking age, an increase in the price of alcohol, a ban on alcohol advertisements, restrictions on the production and availability of alcohol and intensification of anti-alcohol propaganda.¹⁴¹ The field of narcology was expanded and strengthened by means of extra funding. New sanctions on public and workplace intoxication were imposed, coerced treatment was made even easier, and new categories of alcohol-related offences were introduced.¹⁴² In combination with the politics of glasnost (openness, transparency), the crackdown on alcohol triggered a sharp increase in alcohol-related trials and admissions to treatment centres. According to Biss, under Gorbachëv’s administration the former secrecy that had surrounded the topic of alcohol abuse was gradually lifted.¹⁴³ In this sense, as in regard to the poor state of the Soviet economy, light was shed upon alcoholism, revealing it to be one of the most (de)pressing societal issues at that time.

The immediate results of these concerted actions were impressive, for heavy drinking in public and in the workplace came to be increasingly condemned among men, and subsequently decreased. While the average life expectancy for men had been only sixty-two years in 1984, it rose to sixty-five in 1987, when the campaign ended. (Life expectancy returned to its initial low level in 1991–92.)¹⁴⁴ Between 1984 and 1988, alcohol-related fatal accidents plummeted and the number of new inpatients for alcoholism treatment decreased by 25 per cent.¹⁴⁵ People who found it difficult to stop or restrict their alcohol consumption continued to drink in illegal bars, in dormitories and in private apartments. In these areas domestic alcohol-related criminal offences increased.¹⁴⁶

During the Gorbachëv years alcoholics found themselves in an invidious situation, because alcohol ceased to be a readily available commodity. Vodka was substituted with ‘shoe polish, cologne, glue, varnish, disinfectants, anti-freeze, insecticides and other toxic spirits’, and the black market prospered.¹⁴⁷ This new custom led to a surge in poisonings: in the year 1987, 40,000 people became seriously unwell, and more than a quarter of that number died, as a result of drinking these toxic liquids.¹⁴⁸ Despite the positive impact of Gorbachëv’s anti-alcohol measures overall, especially in the medical field, they were disobeyed by a staggering 85 per cent of the overall population.¹⁴⁹ As enthusiasm for Gorbachëv’s reforms died away and other political and societal challenges, such as the national independence movements, surfaced, the anti-alcohol campaign soon lost its momentum. When it ended after just three years, alcohol-related death rates soared immediately, especially among Slavic men. The number of male fatalities in the age range from thirty-five to forty-four years rose by 75 per cent.¹⁵⁰ This development was made worse by social and political insecurity, unscrupulous producers of low-grade alcohol and the increasing availability of narcotics.¹⁵¹ Gorbachëv’s campaign therefore could be considered a success – but only while it lasted. After the imposed dry spell, alcoholism raged on.

Narcology ended with the Soviet system, as market economy principles entered the clinical field in post-Soviet Russia. Private and state-sponsored treatment initiatives began to work with patients, and the former exclusive official view on and the moral condemnation of alcoholics was complemented by ‘imported methods and movements, ranging from Alcoholics Anonymous to Scientology’.¹⁵² However, the problem of high alcohol consumption was unaltered and, as more recent evidence has shown, Russian alcohol consumption remains extremely high.¹⁵³

Conclusion

This chapter has examined some of the particularities of Russian and Soviet alcohol abuse and the government responses to it. Because the state relied on fiscal revenues from the taxation of alcohol, widespread drinking was tolerated to a certain extent. Private and public alcohol consumption was part of particular regions’ culture, and excessively heavy-handed interference by the authorities risked resistance or at least the proliferation of moonshining. At the same time, the pathologisation of heavy drinking, the criminalisation of drunkards and the conflation of punitive and medical treatments within forensic settings and penal work regimes became characteristic of the period preceding Gorbachëv.

It has been shown that Soviet state measures were inapt at changing the firmly entrenched heavy drinking culture. This was especially true for the Slavic and Baltic Soviet republics, where drinking traditions weighed more heavily than in the Muslim republics. The creation of narcology as a field of psychiatry by the Soviet state had established a firm link between health and security politics and provided narcologists with great powers. However, medical concerns were not the only motivation behind this development. It also offered a means of social control and a punitive approach founded on the civil and penal legal opportunities for compulsory medical treatment. Coherent political measures as introduced by Gorbachëv in 1985 alleviated the problems, but the political system collapsed before a change in popular attitudes to alcohol consumption could take hold. As the transition to the Commonwealth of Independent States took shape, political challenges outweighed ambitions to tackle post-Soviet alcoholism in the young republics. Private institutions and self-help groups like Alcoholics Anonymous soon replaced concerted state policies, which for the most part lacked the ambition and public support to successfully address the individual and societal harm of alcoholism.