Prevalence and statistics of alcoholism in different countries of the world

The study of the ethnocultural features of alcoholism (alcohol dependence, according to ICD-10) involves conducting comparative studies of the socio-psychological prerequisites for the formation of this disease, its prevalence, clinical manifestations and course in various ethnic groups and cultures. As a result of such studies, ethno-cultural-differentiated approaches to the therapy and prevention of alcohol dependence, the formation of a culture-normative relationship to 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 from the ethno-cultural positions most widely. This is due to the direct connection of alcohol consumption with historical, cultural and social factors. To date, not only in the psychiatric, but also in the general medical, psychological, sociological, philosophical, ethnographic and other literature, there are many works examining various aspects of the use by mankind of alcohol and its derivatives. Rare are ethno-narcological studies, and the information about the historical features of the relationship to alcohol in specific ethnic groups, differences in levels of alcohol consumption and prevalence of alcohol dependence, ethnic originality of clinical manifestations of alcoholic diseases are contradictory in many respects.

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

According to the statistics given in the World Health Report. Mental health: a new understanding, a new hope "(WHO, 2001), to date, about 400 million people in the world abuse alcohol, and 140 million - suffer from alcohol dependence. It is noted that the prevalence of alcohol-related mental disorders is very different in different parts of the world, being the lowest in the countries of the Middle East, and the 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 provokes well-founded fears about the future increase in alcohol-related problems.

Among the ethnocultural factors that play an important role in the formation of alcoholism, there are the existing in every nation alcoholic customs - historically formed and passed from generation to generation forms of drinking alcohol with the appropriate spiritual equivalents of everyday consciousness and worldview. Alcoholic customs fulfill two social functions: they are a means of stabilizing relationships established in the given environment and forms of alcohol consumption, and they also carry out the reproduction of these relations in the life of new generations. The use of alcoholic beverages and their abuse correlate with the specific historical conditions of society and indirectly act in the form of a society's attitude to alcoholic practices and intoxication.

The influence of culture-deterministic stress on alcoholization was studied in J.Schaefer (1976) on the basis of a random stratified sample of 47 tribal societies. Extremely heavy forms of drunkenness, connected with aggression, were verified in those societies where there was a fear of supernatural forces, a weakly fixed family structure, hunting and gathering technology, an uncomplicated political system, a lack of social class differences and a simple organization of society. According to the author, people feel anxiety and impotence in such conditions, and alcohol helps them feel more confident. Where "soft" (moderate) drunkenness prevails, loyalty to power, obedience, preservation of traditions, close family ties, the 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 data presented 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 the individual's behavior in any culture lies in the nature of his relationship with other members of society. In this case, each person has three basic aspirations: sociability, security and status. The place of the individual among others is not static and varies according to circumstances that depend on the content of the kinship systems that determine the general pattern of the thoughts and actions of society.

F.Hsu identifies four types of societies by the nature of the interdependence that dominates them. The first type assumes an emphasis on the "father-son" axis (most eastern peoples), the second on the "husband-wife" axis (western peoples), the third on the mother-son axis (the peoples of Hindustan) and the fourth on the " brother brother "(some of the peoples of South Africa). Sobriety correlates with the "mother-son" axis, and "soft" drunkenness - with the "father-son" axis.

The largest number of studies on the ethno-cultural characteristics of alcohol consumption and prevalence of alcoholism, carried out in the United States. Typically, they compare living in the country of white Americans, African Americans and Hispanics. So, N. Moraa and others (1990), having examined 2,105 patients in San Diego, California, found statistically different levels of alcohol consumption among white Americans, African Americans and Hispanics, the lowest among older white Americans. The connection with the socio-economic conditions of life in these ethnic groups was not considered. H. Saelano (1988), studying Mexicans living in the United States, Puerto Ricans and Cubans, found the greatest number of problems associated with alcohol in Mexicans. C.Margin (1995) in San Jose (California) and San Antonio (Texas) studied the degree of anticipation of drinking and the desire to drink from representatives of various ethnic groups. In Latin Americans, these indicators were significantly higher than that of native white Americans. In contrast, I.Kerk (1996) described a greater propensity to drink alcohol among white Americans than Hispanics living in the United States, and also found that white Americans had more psychosocial risk factors for alcoholism than among Asian immigrants. Thus, even these few data point to the lack of a single point of view regarding the ethno-cultural predisposition of ethnic groups residing in the United States to abuse alcohol and the occurrence of alcoholism.

Studies in which, along with a description of the characteristics of alcohol abuse in different ethnic groups are given information about the actual alcohol dependence, also have a disparate and unsystematized nature. Attention is drawn to the lack of a single scientific methodology, even within the framework of one country or region. So, considering the state of this problem in the US, one can point to the work of R. Cobu (1994), which brings the results of the National Epidemiological Study of Alcoholism for 1988 and 1992. In 1992, 2% of men could be attributed to alcohol-dependent, 44% - drank at least once a month and only 34% referred to teetotalers. With respect to the Latin American and African American living in the United States, these figures were significantly higher. However, JPSeale et al. (1992), using a brief Michigan test for latent alcoholism in individuals attending family clinics in Texas with its predominant Latin American population, found no difference in the numbers (24.4% for men and 4 , 2% - among women) from indicators in other ethnic groups.

V.M. Booth et al. (1992), analyzing 6,282 observations at US national medical centers, where patients were treated permanently or undergoing detoxification courses and short-term maintenance therapy, concluded that white Americans are much more likely to be treated until it is complete, while As Latino and African Americans often visit these centers only for detoxification. Patients from the Caucasus are older than those of other national minorities. R. Castaneda et al. (1988) found that alcoholism is more severe in Puerto Ricans than in white Americans and African Americans. In addition, white Americans are less likely to experience cognitive impairment. M.E. Hiltou (1988) found that in African Americans and Hispanics, alcoholism more often occurs in divorced and single men than in white Americans. KL Cervantes et al. (1991), who examined 132 Chinese alcoholics using the CAS method, identified other social contexts of chronic alcohol use, and, consequently, other needs for medical and social assistance. These same researchers confirmed the available literature data on the greater severity of alcoholism and its higher prevalence in Latin Americans compared with native white Americans. In addition, in a group of 452 patients from Los Angeles, they found a slightly lower prevalence of alcohol dependence among the American-born Hispanics compared with immigrants. RJ Jones-Webb et al. (1996), evaluating the links between the socioeconomic status and the severity of the consequences of alcohol dependence in African Americans and white Americans, found that for African Americans it is inversely proportional to their incomes. S. Higuchi et al. (1994), comparing Japanese, Japanese-Americans and Caucasians, concluded that the youngest age is the most dangerous for men of all these subgroups, although the percentage of middle-aged alcoholics among Japanese is also high. Japanese (by origin) Americans consumed less alcohol than people from the Caucasus.

Ethnocultural studies of alcoholism were 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 drinking compared to those who stayed in their homeland. Comparing 618 Bulgarians (Christians and Muslims), V. Ahabaliev et al. (1995) with the help of a specially developed questionnaire revealed the earlier age of the first consumption of alcohol and the beginning of its regular use among Bulgarian Christians. The authors linked this fact to the peculiarities of the religious outlook of the Bulgarian Muslims.

In England, N.M. Mather et al. (1989), examining all patients observed in 1980-1987. About alcoholism, calculated age-specific incidence of alcohol dependence among men and women of European and Asian nationalities. Among male Asians, this indicator was the highest - 105.8 per 10 LLC population. At European men, he was 2 times lower - 54.3. In women, on the contrary, the incidence was higher among representatives of European nationalities - 18.6 per 10 LLC (in Asian - 4.1). R. Cochrane et al. (1989), comparing the data on patients with alcoholism admitted to English hospitals in 1971 and 1981, found the highest prevalence rates among Irish and Scots, and the lowest among those from Africa and the Caribbean ; Estimating the prevalence of alcoholism among 200 people born in India, but living in England, found the ethnic heterogeneity of this group. The most common abuse of alcohol and alcoholism was found in Sikhs and Hindus. At the same time, Sikhs and Indians born in India often had alcohol problems and consumed large doses of alcohol than Indians born in England. According to L. Harrison et al. (1996), the mortality associated with alcohol dependence is highest among emigrants from Ireland, India and the Caribbean. Following a 12-year follow-up, mortality rates are growing faster among Caribbean and Irish people than among Britons.

S. Wickramasinghe et al. (1995), studying in the Asian region the relationship between ethnic differences and the biological consequences of alcoholism in Asian and European men, noted more frequent and severe liver damage in Asians. K. Namkoong et al. (1991) found that in a cross-cultural study of prevalence of alcohol dependence among residents of Kangwha (Korea) and Yanbian (China), a larger 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, found high prevalence rates of alcohol dependence (according to ICD-10 criteria) in the four main ethnic groups of Taiwan - from 42.2 to 55.5%. These indicators were much higher than 40 years ago, when they were equal to 0.11-0.16%. T.Izuno et al. (1991) described many social problems associated with alcohol and alcohol abuse abuse among Japanese people living in California and Hawaii. N.Kawakami et al. (1992), using the method of revealing concealed alcoholism (KAST) conducted a survey of 2,581 Japanese employees and found that 15% of men and 6% of women can be attributed to those suffering from this disease.

Turning to the review of ethnological research in Russia, it should be noted that as early as the beginning of the 20th century, for the role of ethno-cultural factors in alcohol consumption and the formation of alcoholism, the prominent domestic scientist VM Bekhterev pointed out. In the Soviet years, due to well-known political and ideological reasons, ethno-cultural studies of alcoholism were not actually carried out, and up to 1988 the publication of works on the prevalence of alcoholism in the USSR was banned in the open press. Proceeding from this, the most informative for that time ethnocultural research was the work of the American scientist BMSegal (1976), in which an attempt was made to compare the patterns of alcoholism and alcoholism in Soviet and American societies.

According to the author, in the period of the post-revolutionary formation of the "urbanized amorphous mass" of the population, the chronic social stress caused by the lack of civil and political freedoms, helplessness and powerlessness, an ambivalent attitude to power, constant material difficulties, suppression of spontaneous personal activity. However, the role of anxiety in the phenomenon of alcoholization, the Soviet Union could only be compared with archaic communities. In addition, drunkenness has become one of the leading forms of informal communication between an individual and his social group in the country.

Since the 1980s, a number of interesting studies have been carried out in the country, most of which concerned the comparison of the prevalence of narcological disorders in various national entities of the USSR, and subsequently in Russia.

According to I.G. Urakov (1985-1988), in the country regions with steadily low (Transcaucasian republics) and high (Russia, Ukraine, Belarus, Latvia, Estonia) indicators of prevalence of alcoholism were allocated. The difference was 3-4 times. The author attributed this to genetic, cultural, religious and other factors unknown at that time. Tomsk researcher VB Minevich (1990) in his work asked why in the vine-growing Armenia the prevalence of alcoholism (per 100 LLC of the population) is 1.5 times lower than in the neighboring and equally vinicultural Georgia. In multidimensional studies of alcoholism, conducted by AK Kachaev and IG Urakov (1981), when comparing the implementation of alcohol and registered alcoholism in Estonia and Tajikistan, it was noted that even with almost the same alcohol consumption, alcoholism rates in Estonia were 2.5 times higher.

In recent years, ethno-narcological studies are quite intensively conducted 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 structure, on the other hand, due to the high proportion of migrants in the general population. Many authors noted that the small peoples of the North of Siberia and the Far East have a high level of alcohol consumption and the rapid formation of malignant alcoholism. According to a number of researchers, this is due both to established alcoholic traditions, and to the peculiarities of ethanol-oxidizing and other alcohol biotransformation systems that determine a low tolerance to alcohol and the formation of altered forms of intoxication. In particular, according to TS.P. Korolenko et al. (1994), only 8% of aborigines have intoxication traditional manifestations. V.G. Alekseev (1986) described the areas in Yakutia where indigenous people who consumed less alcohol than those with mixed populations (arrived and indigenous people), but the prevalence of alcoholism in the first of them is much higher.

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

L.E. Panin et al. (1993), having conducted research among the indigenous peoples of the North, noted that the morbidity of alcoholism among the Yakuts is higher than that of Russians, and among the small peoples of the North, higher than the Yakuts. Along with this, it was revealed that the more people consume alcoholic beverages, the more alcoholic patients in the population. According to the authors, this situation is due to the fact that in the North there is a very intensive industrial development of the territory, further pushing out the small peoples of the North from the rangeland, which is the main psychotraumatic factor leading to mass alcoholism and alcoholism.

To summarize, it should be noted that, despite a rather large number of studies devoted to the ethno-cultural characteristics of alcoholism, many aspects of this complex problem remain controversial, insufficiently clear and need further study. Unconditionally, only one thing: without knowledge of the ethnic and cultural specifics of alcoholic diseases, it is unlikely to achieve significant success in reducing their prevalence.

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