Prevalence and statistics of alcoholism in different countries of the world

The study of ethnocultural features of alcoholism (alcohol dependence, according to ICD-10) involves comparative studies of the socio-psychological prerequisites for the development of this disease, its prevalence, clinical manifestations and course in various ethnic groups and cultures. As a result of such studies, ethnoculturally differentiated approaches to the therapy and prevention of alcohol dependence, the formation of a cultural-normative attitude towards alcohol have been developed.

It should be especially noted that among all forms of mental pathology, alcohol dependence and the disorders caused by it are studied most widely from an ethnocultural standpoint. This is due to the direct connection between alcohol consumption and historical, cultural and social factors. Today, not only in psychiatric, but also in general medical, psychological, sociological, philosophical, ethnographic and other literature, there are many works examining various aspects of human consumption of alcohol and its derivatives. Ethno-narcological studies are rarer, and the information they provide about the historical features of attitudes towards alcohol in specific ethnic groups, differences in levels of alcohol consumption and prevalence of alcohol dependence, ethnic specificity of clinical manifestations of alcohol-related diseases is largely contradictory.

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An excursion into the history and current state of ethnocultural studies of alcoholism

According to statistics from the World Health Report: Mental Health: New Understanding, New Hope (WHO, 2001), today about 400 million people on Earth abuse alcohol, and 140 million suffer from alcohol dependence. It is noted that the prevalence of alcohol-related mental disorders varies greatly in different regions of the world, being lowest in the Middle East and highest in North America and Eastern Europe. According to DHJemigan et al. (2000), alcohol consumption is growing faster in the rapidly developing regions of the world, which gives rise to justified concerns about the future increase in alcohol-related problems.

Ethnocultural factors that play an important role in the formation of alcoholism include existing alcoholic customs in each nation - historically formed and passed down from generation to generation forms of drinking alcoholic beverages with corresponding spiritual equivalents of everyday consciousness and worldview. Alcohol customs perform two social functions: they are a means of stabilizing the relationships and forms of drinking established in a given environment, and they also reproduce these relationships in the lives of new generations. The use of alcoholic beverages and their abuse correlate with specific historical conditions of society and indirectly act as a form of society's attitude to alcoholic customs and intoxication.

The influence of culturally determined stress on alcoholism was studied in the works of J. Schaefer (1976) on the material of a random stratified sample of 47 tribal societies. Extremely severe forms of drunkenness, moreover, associated with aggression, were verified in those societies where there was a fear of supernatural forces, a weakly fixed family structure, hunting and gathering technology, a simple political system, the absence of social-class differences and a simple organization of society. According to the author, people in such conditions feel anxious and helpless, and alcohol helps them feel more confident. Where "mild" (moderate) drunkenness prevails, loyalty to the authorities, obedience, preservation of traditions, close family ties, an agrarian type of technology, fixed settlement across the territory, a complex division of labor, the presence of social-class differences are characteristic.

The interpretation of the presented data was carried out by F. Hsu in 1981 on the basis of his concept of kinship systems. According to the author, the primary source of an individual's behavior in any culture lies in the nature of his relations with other members of society. At the same time, each person has three basic aspirations: sociability, security and status. The place of an individual among others is not static and changes according to circumstances that depend on the content of kinship systems that determine the general pattern of thoughts and actions of society.

F. Hsu identifies 4 types of societies by the nature of the interdependencies that dominate them. The first type emphasizes the "father-son" axis (most Eastern peoples), the second - the "husband-wife" axis (Western peoples), the third - the "mother-son" axis (the peoples of Hindustan), and the fourth - the "brother-brother" axis (some peoples of South Africa). Sobriety correlates with the "mother-son" axis, and "soft" drunkenness - with the "father-son" axis.

The greatest number of studies concerning the ethnocultural characteristics of alcohol consumption and the prevalence of alcoholism have been conducted in the United States. They usually compare white Americans, African Americans, and Hispanics living in the country. Thus, N. Moraarc et al. (1990), having examined 2105 patients in San Diego (California), revealed statistically different levels of alcohol consumption among white Americans, African Americans, and Hispanics, with the lowest levels being among elderly white Americans. The connection with the socioeconomic conditions of life in these ethnic groups was not considered. H. Caelano (1988), having studied Mexicans, Puerto Ricans, and Cubans living in the United States, revealed the greatest number of alcohol-related problems among Mexicans. S. Marsh (1995) studied the degree of anticipation of alcohol consumption and the desire to drink among representatives of different ethnic groups in San José (California) and San Antonio (Texas). Among Hispanics, these indicators were significantly higher than among native white Americans. In contrast, I. Kerk (1996) described a greater tendency to drink alcohol among white Americans compared to Hispanics living in the United States, and also identified more psychosocial risk factors for the development of alcoholism among white Americans than among Asians. Thus, even these few data indicate the absence of a unified point of view regarding the ethnocultural predisposition of ethnic groups living in the United States to alcohol abuse and the development of alcoholism.

Studies that describe alcohol abuse patterns in different ethnic groups and provide information on alcohol dependence itself are also fragmented and unsystematic. The absence of a unified scientific methodology even within a single country or region is noteworthy. Thus, when examining the state of this problem in the United States, one can point to the works of R. Cbou (1994), who provides the results of the National Epidemiological Study of Alcoholism for 1988 and 1992. In 1992, 2% of men could be classified as alcohol dependent, 44% drank at least once a month, and only 34% considered themselves teetotalers. These figures were significantly higher for Latin Americans and African Americans living in the United States. However, J. P. Seale et al. (1992), using the Brief Michigan Test for Latent Alcoholism in individuals attending family clinics in Texas, with its predominantly Hispanic population, found no difference in the figures obtained (24.4% among men and 4.2% among women) from the figures in other ethnic groups.

V.M. Booth et al. (1992), having analyzed 6282 observations in national medical centers of the USA, where patients were treated inpatients or underwent courses of detoxification and short-term maintenance therapy, came to the conclusion that white Americans significantly more often remain in treatment until its complete completion, while Hispanics and African Americans more often visit these centers only for detoxification. Patients of Caucasian origin are distinguished by their older age compared to representatives of other national minorities. R. Castaneda et al. (1988) found that alcoholism is more severe in Puerto Ricans compared to white Americans and African Americans. In addition, cognitive impairment is less common in white Americans. M.E. Hiltou (1988) found that among African Americans and Hispanics, alcoholism is more often found in divorced and single men, unlike white Americans. KL Cervantes et al. (1991), having examined 132 patients with alcoholism of Chinese nationality using the CAS method, identified in them different social contexts of chronic alcohol use, and, consequently, different needs for medical and social care. These same researchers confirmed the existing data in the literature on the greater severity of alcoholism and its higher prevalence among Latinos compared to native white Americans. In addition, in a group of 452 patients from Los Angeles, they found a somewhat lower prevalence of alcohol dependence among US-born Latinos compared to immigrants. RJ Jones-Webb et al. (1996), having assessed the relationships between socioeconomic status and the severity of the consequences of alcohol dependence in African Americans and white Americans, found that for African Americans it was inversely proportional to their income. S. Higuchi et al. (1994), comparing the Japanese, Japanese Americans, and Caucasians, concluded that for men of all these subgroups, the most dangerous age is young age, although the percentage of middle-aged alcoholics is also high among the Japanese. Japanese Americans (by origin) consumed less alcohol than Caucasians.

Ethnocultural studies of alcoholism have also been conducted in other countries. Thus, according to JW Powles et al. (1991), Greeks who moved from their country to Melbourne (Australia) have 3-8 times lower levels of alcohol consumption compared to those who remained in their homeland. Comparing 618 Bulgarians (Christians and Muslims), V. Ahabaliev et al. (1995) with the help of a specially designed questionnaire revealed an earlier age of first alcohol consumption and the beginning of its regular use among Bulgarian Christians. The authors linked this fact to the peculiarities of the religious worldview of Bulgarian Muslims.

In England, N.M. Mather et al. (1989), having examined all patients observed in 1980-1987 for alcoholism, calculated the age-specific incidence of alcohol dependence among men and women of European and Asian nationalities. Among Asian men, this indicator was the highest - 105.8 per 10,000 population. Among European men, it was 2 times lower - 54.3. Among women, on the contrary, the incidence was higher among representatives of European nationalities - 18.6 per 10,000 (among Asian women - 4.1). R. Cochrane et al. (1989), comparing data on patients with alcoholism admitted to English hospitals in 1971 and 1981, established the highest prevalence of this disease among the Irish and Scots, and the lowest - among immigrants from Africa and the Caribbean region; assessing the prevalence of alcoholism in 200 people born in India but living in England, found ethnic heterogeneity in this group. Alcohol abuse and alcoholism were most common among Sikhs and Hindus. At the same time, Sikhs and Hindus born in India more often had alcohol problems and consumed larger doses of alcohol than Hindus born in England. According to L. Harrison et al. (1996), mortality associated with alcohol dependence is highest among immigrants from Ireland, India and the Caribbean region. According to the results of 12-year observation, mortality is growing faster among Caribbeans and Irish than among the British.

S. Wickramasinghe et al. (1995), studying the relationship between ethnic differences and biological consequences of alcoholism in Asian and European men in the Asian region, noted more frequent and severe liver damage in Asians. K. Namkoong et al. (1991) in a cross-cultural study of the prevalence of alcohol dependence among residents of Kangwha (Korea) and Yanbian (China) found a greater number of patients with a long period of alcohol abuse among the population of the Korean city (16.48 and 6.95%). B. Cheng (1996), using a semi-structured interview, revealed high rates of prevalence of alcohol dependence (according to ICD-10 criteria) in the four main ethnic groups of Taiwan - from 42.2 to 55.5%. These rates have become much higher than 40 years ago, when they were equal to 0.11-0.16%. T. Izuno et al. (1991) described a variety of social problems associated with alcohol abuse and dependence among Japanese living in California and Hawaii. N. Kawakami et al. (1992) surveyed 2,581 Japanese employees using the Kaspersky Alcoholism Screening Technique (KAST) and found that 15% of men and 6% of women could be classified as suffering from this disease.

Moving on to a review of ethno-narcological studies in Russia, it should be noted that as early as the beginning of the 20th century, the role of ethno-cultural factors in alcohol consumption and the development of alcoholism was pointed out by the outstanding Russian scientist V. M. Bekhterev. In the Soviet years, due to well-known political and ideological reasons, ethno-cultural studies of alcoholism were not actually conducted, and up until 1988, the publication of works on the prevalence of alcoholism in the USSR in the open press was prohibited. Based on this, the most informative ethno-cultural study of that time was the work of the American scientist B. M. Segal (1976), in which an attempt was made to compare the patterns of alcoholization and alcoholism in Soviet and American societies.

According to the author, during the post-revolutionary formation of the "urbanized amorphous mass" of the population, the main factor contributing to the spread of drunkenness in the USSR was chronic social stress caused by the lack of civil and political freedoms, helplessness and impotence, an ambivalent attitude toward power, constant financial difficulties, and the suppression of spontaneous personal activity. At the same time, in terms of the role of anxiety in the phenomenon of alcoholism, the Soviet Union could only be compared with archaic communities. In addition, drunkenness became one of the leading types of informal connections between an individual and his or her social group in the country.

Since the 1980s of the last century, a number of interesting studies have been conducted in the country, most of which concerned the comparison of the prevalence of drug addiction disorders in various national entities of the USSR, and later in Russia.

According to I.G. Urakov (1985-1988), there were regions in the country with consistently low (Transcaucasian republics) and high (Russia, Ukraine, Belarus, Latvia, Estonia) rates of alcoholism. The difference was 3-4 times. The author linked this to genetic, cultural, religious and other factors unknown at that time. Tomsk researcher V.B. Minevich (1990) asked himself in his work why the prevalence of alcoholism (per 100,000 population) in viticultural Armenia was 1.5 times lower than in neighboring and equally viticultural Georgia. In multidimensional studies of alcoholism conducted by A.K. Kachaev and I.G. Urakov (1981), when comparing the sale of alcohol and recorded alcoholism in Estonia and Tajikistan, it was noted that even with practically identical alcohol consumption, the rates of alcoholism in Estonia are 2.5 times higher.

In recent years, ethno-narcological studies have been conducted quite intensively in the regions of Siberia and the Far East. These areas are of interest, on the one hand, due to the presence of indigenous peoples in their population structure, and on the other hand, due to the high proportion of migrants in the general population. Many authors have noted that the small peoples of the North of Siberia and the Far East have a high level of alcohol consumption and the rapid development of malignant alcoholism. According to a number of researchers, this is due to both established alcohol traditions and the characteristics of ethanol-oxidizing and other alcohol biotransformation systems that determine low tolerance to alcohol and the development of altered forms of intoxication. In particular, according to Ts.P. Korolenko et al. (1994), only 8% of the aborigines have traditional intoxication manifestations. V.G. Alekseev (1986) described areas in Yakutia where indigenous people live and consume less alcohol than areas with a mixed population (newcomers and indigenous people), but the prevalence of alcoholism in the former is significantly higher.

V.B. Minevich (1995), studying the indigenous (Nganasans) and alien (Russian) population of the Taimyr Peninsula, found that Nganasans, regardless of age, have a greater alcohol dependence and are more susceptible to stress than alien Russians. A positive correlation between stress and alcohol dependence in young Nganasans has been reliably established.

L.E. Panin et al. (1993), having conducted research among the indigenous peoples of the North, noted that the incidence of alcoholism among the Yakuts is higher than among the Russians, and among the small peoples of the North it is higher than among the Yakuts. Along with this, it was found that the more alcoholic beverages the population consumes, the more alcoholics there are in the population. According to the authors, this situation is due to the fact that very intensive industrial development of the territory is being carried out in the North, further and further displacing the small peoples of the North from their inhabited pasture territories, which is the main psychotraumatic factor leading to mass alcoholization and the growth of alcoholism.

In conclusion, it should be noted that, despite a fairly significant number of studies devoted to the ethnocultural characteristics of alcoholism, many aspects of this complex problem remain controversial, insufficiently clear and require further study. Only one thing is certain: without knowledge of the ethnic and cultural specifics of alcoholic diseases, it is unlikely that significant success will be achieved in reducing their prevalence.

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