The social context of Russian alcohol consumption

Any account of recent Russian drinking is impossible without considering the social context of the USSR and its subsequent collapse in 1991. Russian men born between 1950–70 (the cohorts in this study) would have grown up in relative stability and had their schooling, employment, healthcare, and housing provided, although frequent supply shortages led to reliance on social exchange networks known as blat [18]. However during the collapse of the USSR in 1991 and the unstable post-Soviet period of the 1990s, Russians experienced a series of deep social, political and economic changes characterised by increasing income inequality, increasing criminality [19,20], and for most people, a chaotic struggle to survive [21]. In the 1990s Russia suffered a severe economic crisis where levels of poverty and unemployment soared [22], many suffered wage delays, and many lost their savings. Rapid changes in the nature of employment, industry and the meaning of networks meant that older generations had difficulty adjusting, and ended up feeling displaced and ‘unneeded’ [21]. Since the 2000s the economy has prospered due to oil and gas exports; correspondingly employment rates and the standard of living have improved making life more stable for Russian citizens [23].

Patterns of alcohol consumption in Russia

For centuries Russia has been noted for its heavy drinking [24] and by the start of the 1900s, drinking was commonly regarded as ‘part of the national character of the Russian people’ [25]. The Soviet government did little to curb rising consumption, in part because alcohol excise duty contributed significantly to the government budget [26]. From the mid-1980s to today rates of harmful alcohol consumption have fluctuated dramatically. Gorbachev’s anti-alcohol campaign from 1985–87 [27] successfully reduced consumption but immediately afterwards in the early 1990s there was a dramatic increase in alcohol-related mortality, fuelled by the sudden availability of cheap alcohol that followed market deregulation. A further spike occurred in 1998 related to the social effects of the Rouble crisis [28]. Since 2005 alcohol-related mortality has declined partly due to progressive restrictions on alcohol production and its availability [29]. However, in Russia and the former Soviet Union alcohol use still accounts for 10–14% of total mortality [30], one in every five male deaths, and a quarter of total disease burden, more than any other world region [31].

Per capita annual consumption in Russia is high, estimated at 15.7 litres of ethanol in 2011 [32], and the drinking pattern is characterised by a high proportion of alcohol drunk as spirits [33], a norm of drinking to intoxication and binge drinking [8,24], and the relatively common use of non-beverage alcohols (also known as surrogates) like eau de cologne and medicinal tinctures [14,34]. Men drinking more frequently, more as spirits and are several times more likely to binge drink than women [13,16,35,36]. In a cross-sectional survey from Izhevsk in the 2000s approximately 10% of men reported going on ‘zapoi’ (defined as period of two or more days of continuous drunkenness where a person is withdrawn from social life) and 7% drinking non-beverage alcohols in the last year [14]. Treatment for alcohol problems relies heavily on suggestion-based methods such as ‘coding’ (kodirovanie) usually provided privately by narcologists (Russian addictions specialists) [37].

Masculinity and drinking in Russia

Several studies have explored gender ideology and heavy drinking in Russia [35,38–40]. Men’s heavy drinking is commonly perceived as ‘natural’, something that ‘real men’ do, in keeping with their breadwinner role, and there is a strong element of machismo to Russian male binge drinking [8,9]. Some argue that Russian male heavy drinking reinforces aspects of ‘hegemonic masculinity’ particularly in working class work environments [38]. Typically Russian women (particularly wives) have a duty to monitor and control men’s drinking, a form of gendered caring which constructs femininity in opposition to masculinity [41,42].

In Russia, alcohol is perceived to be the primary male stress reliever [15,39,43]; by contrast women have an ability to cope without resorting to drink [44]. This might explain why disruptions in a man’s work life were seen as understandable cause of heavy drinking [8], and partly why rates of hazardous drinking are highest amongst those suffering social stress such as unemployment and divorce [45]. Male hazardous drinking increased in the early 1990s, coinciding with high rates of unemployment, wage delays and changes to working patterns [45].

In Russia alcohol also plays an important role in work, business and exchange [8,46,47]. Research from the 1990s shows that the workplace was a more important drinking context in Russia than in other countries [48], with 20% of Russians reporting drinking at work, compared to only 2% of Finns [48]. Ethnographic studies showed how vodka drinking in all-male work brigades (known in the Soviet period as ‘kollektivs’) strengthened bonds among workers [11,49]. A study from the 2000s found that zapois often started with work colleagues, and that particular used alcohol instead of payment [8]. Despite changes to employment in the post-Soviet period, studies suggest that workplace drinking and the perception that it promotes social solidarity continue in many industrial sectors [10,11]. Focussing on the blue-collar workplace is particularly important given the concentration of hazardous drinking in those with lower socio-economic position [14].

Theoretical framework for Russian male drinking

Previous studies theorising Russian men’s heavy drinking have employed the concepts of ‘hegemonic masculinity’[38] and ‘health lifestyle theory’ [50]. The former argued that historically ritualised heavy drinking allowed working class men to access dominant masculine ideals [38]. Cockerham and colleagues have applied ‘health lifestyle theory’[50] which argues that Russian mens’ health behaviours (including their drinking) are primarily determined by the ‘habitus’[51], allowing little individual agency [50]. Bourdieu defined habitus as “systems of durable, transposable dispositions”, which both structure social life and interaction, and are constantly being reproduced by social activities. This passive portrayal of Russian men echoes the notion of ‘homo soveticus’- a person whose mentality was a legacy of the Soviet ideals of state paternalism and is devoid of individuality. Although both theories are supported empirically [39,43], both emphasise cultural reproduction and do not include convincing accounts of how change occurs, which is important for this study. To overcome this limitation one approach is to focus on aspects of identity that vary over the life course such as age. In a recent study in Scotland respondents described their drinking as passing through developmental stages [52] each with expectations of age-appropriate behaviour. In Russia the concept of ‘doing age’ has been used to theorise grandmothers’ care-giving [53] and this has been extended to ‘doing gendered age’ in a recent Russian study on patterns of gendered reciprocity [54]. These contributions emphasise the intersection of gender and age norms, such that the gendered expectations to which men and women are expected to conform modify as they age. The performance of age- and gender-appropriate behaviour could feasibly be applied to Russian men’s drinking, allowing us to reconcile theories of masculinity and habitus with change over the life course.

Sample selection

The sampling frame consisted of 1,447 men who were interviewed twice before and had agreed to participate in future research. Purposive sampling was used to try to ensure we interviewed men with a range of drinking patterns and included increases, decreases and stability in alcohol consumption. To do this we used a question from the 2008–09 interview which asked “Have there been any changes in your drinking behaviour since the last interview?, with possible answers “I used to be an abstainer, but now I drink alcohol/I used to drink alcohol, now I’m an abstainer/I used to drink alcohol, now I drink surrogates as well/I used to drink surrogates, now I drink alcoholic drinks but no surrogates/no change/other (free text response)”. Initially, 37 respondents were randomly selected from across the categories above. 19 were successfully contacted by telephone or face-to-face and agreed to participate (the other 12 did not answer the telephone, or refused due to health problems or not having the time) and were interviewed between October 2009 and October 2010. After initial data coding, we identified the need to have more accounts of increases in drinking, and further randomly selected another six respondents from categories indicating such changes, all of whom agreed to participate. In total there are 25 interviews conducted between October 2009 and February 2012. We did not discuss the transcripts and research findings with the participants after the interview itself.

Interview methods

The study was approved by the ethical committees of the London School of Hygiene and Tropical Medicine and the Izhevsk Medical Academy. Verbal consent was obtained before each interview commenced and participants were assured that their data would be treated confidentially. This was consistent with the exclusive use of verbal consent in the Izhevsk studies [8] and was approved by the ethical committees on the basis that in Russia there remains a substantial reluctance to sign any official document for fear of the individual being held to account by the authorities for what they had said.

The interviews were conducted by five interviewers (2 male, 3 female) experienced in sociological interviewing. Four of the interviewers held qualifications in sociology (One had a PhD, the others had MSc or equivalent), and were employed by Izhevsk State University as researchers. All had received training and had experience at qualitative interviewing. The other interviewer was a psychiatrist (holding a medical degree) with expertise in qualitative interviewing and addiction treatment. All interviews were audio recorded and most took place one-one-one in the respondent’s home. Prior to interview the interviewers were given details of the interviewee’s name and address; all other information was elicited during interview. Our interviewing methodology was consistent with the biographical-narrative approach [58] which assumes that psychological and social phenomena are best understood as situated within a broader context of life history and they are partly constructed through narration. Therefore in order to understand alcohol use and life events we would need to enquire about the respondent’s entire life, and their perceptions of events and actions. The interviewers initially asked the respondents to describe events in their lives over the previous 8–10 years particularly calling attention to the period between the IFS first and second interviews. The interviewers also asked about the man’s health, which led onto asking about any significant changes in drinking over the men’s entire life course, meaning the narratives extended further back to include the Soviet period. The interviewers used a short pre-agreed topic guide to probe the respondent on changes in alcohol consumption that might be related to their family circumstances, their employment and workplace, and their health (Table 1). The interviews lasted anywhere between 15 minutes to one hour. Afterwards the audio recordings were transcribed verbatim.

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Table 1. Topic guide used by interviewers in the study.

https://doi.org/10.1371/journal.pone.0142993.t001

Coding and analysis

The coding was done independently by three different researchers (KK, LS and NB) using the original Russian transcripts in NVivo version 8 [59]. After each stage of coding the interpretations were discussed and any differences negotiated. Initially, the transcripts were categorised according to whether they gave accounts of increases, decreases, or stability in alcohol use. They were then open coded to identify cross-cutting reasons for changes which were arose from the data, such as health problems, peer pressure or family responsibilities. After that a deeper level of coding identified themes and motivations, and common conceptualisations of the role of alcohol in the life course. Any excerpts used for illustration were professionally translated into English (and checked for meaning with the original interviewer), and the interviewee number shown after each quotation. Where possible we also compared the narrated accounts of drinking and life events with those reported in the IFS-1 and IFS-2 study interviews.

Sample characteristics

Table 2 shows the respondents’ age and socio-demographic factors taken from the self-reported questionnaire data collected at IFS-2 (2007–09) and the qualitative interview. At the time of qualitative interview, the men were aged between 32 to 60 years (median 56 years). All of the men were ethnic Russians. Three quarters of the men (19) had achieved secondary or ‘specialised’ secondary/professional education (as their highest level), and a minority had some higher education (6). At the qualitative interview 20 men (80%) were in regular paid work, and the rest unemployed, in irregular work or retired. Over half of the interviewees (14 men) were employed in industry, most as semi-skilled manual workers (machine operators, mechanics etc), but three were team supervisors. Of the remaining men, three were directors or business owners, and a further eight had unskilled professions such as drivers or security guards. The majority of the men (22) were living with their spouse or partner and only one of the men was childless. Self-reports of drinking at IFS-2 (for the previous year) showed that two of the men had abstained, four had drunk non-beverage alcohols in the previous year, and the remaining 19 men were non-hazardous beverage drinkers.

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Table 2. Socio-demographic characteristics and drinking patterns of the 25 men interviewed in the study.

https://doi.org/10.1371/journal.pone.0142993.t002

Of the 25 interviews, 18 described decreases, two described recent increases and five described fluctuations between abstinence and drinking. We compared the qualitative descriptions of recent alcohol use with the reports of change, and the cross-sectional reports of alcohol use from the previous two interviews in 2004–05 and 2007–09, and found the patterns to be generally consistent. Any differences were among men who reported fluctuations in the qualitative interview, and it was possible that sudden changes were not well captured by the questionnaire.

Decreases over time

The explanations for decreases in consumption could be grouped into three interrelated themes: work, family, and the process of ageing or maturing. Within these, there were external influences that were felt to be both controlling and empowering, through changing norms or social control, and internal motivations where the man felt he had made a conscious, personal decision. The dominant trajectory was heavy drinking in young adulthood or middle age, often associated with particular workplaces, or sets of work colleagues. With age this was replaced by increased emphasis on home and family which coincided with reductions and greater control over drinking.

Increases, fluctuations and abstinence

Men who had these patterns tended to have more unstable employment and family histories than other interviewees, and stressful personal situations had triggered periods of heavy drinking:

“I can tell you I started drinking in 1975. … That is the year my son was born disabled.”

(#7)

“My wife is constantly ill… She has invalidity and doesn’t work. They removed her bladder, for a long time she lived without going to the toilet. I began to drink more vodka.”

(#8)

Dramatic fluctuations were sometimes associated with undergoing the alcohol treatment popularly known as coding (kodirovaniye), which usually refers to a suggestion-based method where the narcologist persuades the patient that they have altered their brain so that alcohol consumption is physically dangerous [37]. Coding was a temporary fix and believed to last typically for a few years. Some men were pressured to undergo treatment by family (“my wife was nagging me about it” (#24)) and others had feelings of personal failure inducing them to seek help. Some broke their coding and returned to heavy drinking as a way of coping with personal tragedy, accidents and stress. Those who successfully completed the period of abstinence under coding also returned to drinking afterwards.

Similar to the decreases described above, the ability to abstain without coding was often a source of masculine pride and self-esteem, a public display of willpower and self-control in the face of social pressure and addiction. For some abstinence was a personal challenge and a chance to earn the respect of relatives:

“my wife’s girlfriend and her husband came over and they dared us that we couldn’t possibly quit drinking, and then we stood up the challenge, and for 2 years I didn’t touch alcohol…

(#17)