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Association Between Distilled Spirits Consumption and
Violent Mortality Rate
YU E. RAZVODOVSKY*
Grodno State Medical University, Department of Psychiatry, Belarus
ABSTRACT The association between alcohol and violent mortality is well documented.Considerably less is known about the beverage-specific effect of alcohol on mortality rate.The role of drinking patterns in the alcohol–violent mortality association is a veryimportant issue today. Aim: To estimate the beverage-specific effect of alcohol on violentmortality rate. Measurement: Trends in different types of violent mortality rate(mortality due to accidents and injuries, mortality due to suicide and homicide, mortalitydue to motor-traffic accidents) from 1970–1999 in Belarus were analyzed in relation totrends in the level of different types of alcoholic beverage consumption per capita applyingtime series, factor and cluster analyses. Results: The results of this study demonstrateda positive and statistically significant effect of changes in strong spirits per capitaconsumption on violent mortality rate. At the same time, the relationship between thetotal level of alcohol consumption and different types of violent mortality rates is far belowstatistical significance. The analysis suggest that a 10% increase in spirits consumptionper capita would result in a 7.5% increase in accidents and injuries mortality rate, in a 5%increase in suicide rate, in an 11.4% increase in homicide rate, in a 1% increase in fataltraffic accidents rate. Conclusion: The results of this study support the idea that violentmortality rate tends to be more responsive to changes in distilled spirits consumption percapita than in total level of alcohol consumption. The main evidence for this conclusion isthat a positive and statistically significant relationship between violent mortality rate andthe level of vodka consumption per capita was revealed. The level of strong spiritsconsumption per capita is most strongly associated with such indexes as mortality dueto homicides, suicides, accidents and injuries, and to a lesser degree with mortality due toroad accidents. This study supports the idea that violent mortality and alcohol are moreclosely connected in culture with prevailing intoxication-oriented drinking patterns andadds to the growing body of evidence that a substantial proportion of violent mortality inBelarus is due to the acute effect of binge drinking.
Introduction
It is widely recognized that alcohol is implicated in many types of health andsocial problems. Alcohol use and abuse are associated with an increased risk ofaccidents, industrial and transport injuries, suicide and homicide (Romelsjo,
Drugs: education, prevention and policy ISSN 0968–7637 print/ISSN 1465–3370 online # 2003 Taylor & Francis Ltdhttp://www.tandf.co.uk/journals
DOI: 10.1080/0968763031000082124
Drugs: education, prevention and policy,Vol. 10, No. 3, 235–250, August, 2003
* Correspondence to: Yu Razvodovsky, Grodno State Medical University, Department of Psychiatry,Belarus. Tel: +(0)152 33 33 18. Fax: +(0)152 33 53 41. E-mail: [email protected]
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1995). For all this harm there is a dose–response relationship (Harkin et al., 1995).It is difficult to determine an accurate impact of alcohol on violent mortality rate.The meta-analysis, synthesized US medical examiner studies of non-traffic fatal-ities for the purpose of estimating alcohol involvement by injury mechanismdemonstrates that alcohol is an important factor in many fatal injuries and that itsimportance varies by cause of injury (Smith et al., 1999). The aggregate percentagedetermined to be intoxicated (BAC� 100 mg/dL) was highest among homicidecases (31.5%), followed by unintentional injury deaths (31.0%) and suicide cases(22.7%). In Brazil almost half of fatally injured victims (48.3%) presented a positiveblood-alcohol content (Carlini-Cotrim, & da-Matta-Chasin, 2000). However, theexact proportion varied according to the cause of death with 64.1% of victims ofdrowning testing positive for alcohol, 52.3% of homicide, 32.2% of suicide and50.6% of motor vehicle accidents.
In recent years, the relationship between the total level of alcohol consumptionand violent mortality rate has been thoroughly studied and described in thescientific literature. Aggregate level studies usually report a significant andpositive association between alcohol consumption and violent mortality. Apositive association between the level of alcohol consumption per capita andthe number of road accidents in the USA was discovered by means of auto-reggression and integrated moving average (time series analyses) ARIMA analysisof monthly data (Wagenaar, 1984). An association between the level of alcoholconsumption per capita and violent crime rates in such countries as France,Norway, Sweden and Finland was shown by means of time series analysis(Lenke, 1993). Time series studies in thirteen nations for the period 1950–1972indicated that suicide and homicide rates were usually positively associated withper capita consumption of alcohol (Lester, 1995). More recent time series analysesbased on the statistical data for the time period 1950–1995 covering fourteenEuropean Union (EU) countries revealed a positive and statistically significantrelationship between alcohol and changes in aggregate alcohol consumption andoverall accident mortality in all countries. The countries were sorted into threegroups—traditional spirits countries of northern Europe, traditional beer coun-tries of central Europe and wine countries of southern Europe. The estimatedeffect parameter was larger in northern Europe than in central Europe, andsmallest in southern Europe (Skog, 2001). The results of this study are compatiblewith the hypothesis that accident mortality rates are influenced by per capitaalcohol consumption in southern, central and northern Europe. However, alcoholappears to play a larger role in northern Europe than in southern Europe. Timeseries analysis suggests a significant positive association between alcohol andsuicide. This association was revealed most often in northern European countriesand was found least often in southern Europe (Ramstedt, 2001). The findingssupport the hypothesis that suicide and alcohol are more closely connected in drycultures, with prevailing intoxication-oriented drinking patterns.
So, according to a wide range of studies total level of alcohol consumptionseems to be positively associated with violent mortality rate. Considerably less isknown, however, concerning the beverage-specific effect of alcohol on mortalityrate. It seems difficult to make a generalization regarding beverage-specific effectsof alcohol on violent mortality rate at the population level. The study based on USdata between 1970 and 1989 has shown an association between strong spirits salesand suicide (Gruenewald et al., 1995). The authors found that a 10% increase inspirits sales would result in a 1.4% increase in suicide rate. In finding that
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increased spirits sales and suicide are linked, the study advocated a policy withthe plausible claim that reducing spirits sales would help diminish suicide rate.Time series analysis of annual aggregate level data on alcohol sales and homiciderates for the period 1950–1995 were performed for fourteen EU countries(Rossow, 2001). Total alcohol sales were positively and statistically significantlyassociated with homicide rate in five countries. Beer sales were positively andstatistically significantly associated with homicide rate in four countries, winesales in another two countries, and spirits sales in yet another two countries.When estimates were pooled across countries, the strongest association betweentotal sales and homicides was found in the northern European countries and theweakest, but still statistically significant, in the southern European countries.These findings support the hypothesis that homicide rates are influenced byalcohol sales in the countries where the drinking culture is characterized by heavydrinking episodes.
There have been many debates concerning the role of drinking pattern in thealcohol–mortality association. It is known that occasional heavy drinking in-creases the risk of violent mortality in a linear fashion (Edwards, 1994). Recentevidence from eastern Europe suggests a positive association between alcoholand mortality (McKee & Shkolnikov, 2001). Moreover, alcohol has often been putforward as a major factor in explaining the Russian mortality crisis. An analysis bycause of death strongly supports the argument that alcohol plays a major part inthe decline in life expectancy in Russia and shows that mortality due to accidentsand injuries has been important in explaining the mortality crisis (Walberg et al.,1998). All causes of injury are more common in the former Soviet Union republicsthan in western Europe. By 1997 mortality from all external causes in men underthe age of 65 was five-times higher in the countries of the former Soviet Unionthat in western Europe (McKee & Shkolnikov, 2001). For road-traffic accidents,however, the difference between the two regions (50% higher in the SovietUnion) is small compared with the three- to four-fold difference for suicide andnineteen-fold difference for homicide (World Health Organization, 2001). Othercommon causes of mortality in the former Soviet Union include drowning anddeaths in fires. There is speculation that a key contributing factor to the recenttrends in mortality is related to binge drinking (Cockerhman, 2000). In Russia, thenumber of deaths from external causes closely reflects the number of deaths fromalcohol poisoning, both geographically and over time. Analysis of daily variationin deaths based on data from Moscow City death certificates revealed that therewas a significant increase in deaths from alcohol poisoning, accidents, violenceand cardiovascular diseases (especially sudden deaths) on Saturdays, Sundaysand Mondays (Chenet et al., 2001).
Drinking alcoholic beverages, predominantly strong ones, in big amounts(binge drinking) is associated with various socially accepted occasions and ischaracteristic of the traditional alcohol-consumption pattern in Belarus (Razvo-dovsky, 2000). The combination of the high level of alcohol consumption percapita and the intoxication-oriented drinking pattern has lead to the great effectof alcohol on the violent mortality rate in this country.
This paper deals with the time series analysis of the trends in the level ofdifferent types of alcoholic beverage consumption per capita, and different typesof violent mortality rates (mortality due to accidents and injuries, mortality due tomotor-traffic accidents, rates of suicide and homicide) in Belarus between 1970and 1999.
Spirits Consumption and Violent Mortality Rate 237
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Methods
All data provided in the article are taken from the Ministry of Statistics of Belarusannual reports from 1970 to 1999 (Ministry of Statistics, 2000). The levels ofmortality are presented at the rate of 1 to 100,000 of the population. Consumptionof alcohol per capita (in liters of pure alcohol) is estimated on the basis of the totalalcohol consumption as determined by sales statistics, divided by the totalpopulation. During the study period two different International Classificationof Diseases (ICD) versions were used: ICD-8 and ICD-9. Time series, factor andcluster analyses were applied to this research. Time series analysis has been usedin the assessment of the population-level association between alcohol and totalmortality in this paper. Multiple linear regression (SPSS) was also used for thepresent analysis with the level of spirit consumption as independent variable andthe level of mortality as dependent. A diagnostic test for residual correlation isgiven by the Box-Ljung Q-test, which indicates whether the model has beenadequately fitted. A large part of alcohol-related mortality has an exponential riskfunction and therefore a semi-logarithmic model has also been used in presentstudy.
Results
History of Alcohol Policy in the USSR
In the former USSR, alcohol-related problems are acknowledged to have achievednotable growth by the early 1970s. The state, led at that time by Brezhnev, couldnot help but take notice of the situation. In 1972 the resolution ‘About theMeasures Restricting Alcohol Consumption’ was passed. According to the docu-ment, the production of alcohol and the number of shops selling it were to be cut.But the measures proclaimed turned out to be merely a theoretical declarationthat led to no practical result. The beginning of the 1980s was marked by a newattempt to fight alcohol-related problems. The new Soviet leaders, Andropov firstand then Chernenko, took a number of measures aimed at alcohol-availabilityrestriction. It was done within the framework of the labor discipline strengthen-ing campaign. Thus, for instance, the availability of alcohol from shops waslimited to certain times of the day only. The measures taken resulted in a declineof both alcohol consumption per capita and alcohol-related mortality level.Nevertheless, the level of alcohol-related problems in society remained extremelyhigh. A new epoch in the soviet anti-alcohol policy dates back to 1985, when anew state leader, Gorbachev, came to power. The decree on anti-alcohol measureswas adopted on May 7, 1985. A large-scale campaign, aimed at achieving anotable decrease in alcohol production and sales was presupposed in thedocument. A rapid 50% reduction of the alcohol consumption level was accom-panied by a 10% decrease in the total mortality rate. Mortality due to accidents,injuries and poisoning was decreased by 30%; mortality due to alcoholism,alcoholic psychosis and poisoning by alcohol was decreased two and a halftimes (Schkolnikov & Nemtsov, 1997). It should be pointed out that the sharpdecline in alcohol consumption was achieved mainly by a reduction of winedrinking. Decreasing the production levels of wine, both during the campaignand afterwards, added to its unavailability. This, in its turn, led to an alteration inthe alcohol-consumption structure, i.e. to a prevalence of strong beverages in it.In general, the results of the campaign can be interpreted controversially. It must
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have been a success within the framework of failure (Tarchys, 1993). Thus,alongside the positive results mentioned, the campaign had some negativeones as well. Among them were the growth in the consumption of home-madealcoholic beverages and an increase in poisoning by various toxic substances. Theoutcomes of the anti-alcohol campaign show that severe, restrictive alcoholpolicies aimed at lowering the total level of alcohol consumption cannot beconsidered optimal. The interpretation is still more complicated if we take intoaccount the fact that the total level of alcohol consumption varied greatly fromone region of the country to another. Until 1991 Belarus (Byelorussia) was one ofthe republics of the Soviet Union, and was among those republics with thehighest levels of alcohol consumption per capita. In this respect, the results of theanti-alcohol campaign in this particular republic are of interest. The period oftime, which lasted from 1989 to 1999, was characterized by the decline of therestrictive policy. The liberalization of society was accompanied by the liberal-ization of the state attitude towards alcohol. Lack of state control over alcoholproduction and sales meant, in fact, the absence of an anti-alcohol policy. As aresult, the 1990s were associated with a growth of alcohol consumption per capitaand with a rapid growth of different types of mortality.
Mortality Rate
The trends in various types of violent mortality compared with the trends inspirits consumption per capita can be seen in Figures 1–5.
As we can see, there is a general upward trend in violent mortality rate. In theperiod from 1970 to 1999 the level of all causes of violent mortality increased 2.4-fold (from 72.4 to 170.4 per 100,000 of population). The rate of mortality due toaccidents and injuries increased 3.2-fold (from 26.3 to 83.2 per 100,000 of popula-tion). The rate of fatal traffic accidents grew by 63% (from 12.9 to 21.0 per 100,000
Spirits Consumption and Violent Mortality Rate 239
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Figure 1. Trends in the violent mortality rate (V) and the level of strong spiritsconsumption per capita (S).
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of population). The rate of suicide doubled (from 17.6 to 34 per 100,000 ofpopulation), and the rate of homicide increased 4.2-fold (from 2.7 to 11.2 per100,000 of population). A sharp decline in the rate of the different types of violentmortality was observed in the period from 1984 to 1986. Thus, the rate of all-causeviolent mortality decreased by 29.9% (from 107.0 to 75.0 per 100,000 of popula-tion), the rate of suicide dropped by 40% (from 29.5 to 17.7 per 100,000 of
240 Y. E. Razvodovsky
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Figure 2. Trends in the accidents and injuries mortality rate (A) and the level ofstrong spirits consumption per capita (S).
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Figure 3. Trends in the homicide rate (H) and the level of strong spiritsconsumption per capita (S).
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population), the rate of homicide decreased by 31% (from 5.8 to 4.0 per 100,000 ofpopulation) and rate of motor-traffic accidents decreased by 17% (from 17.1 to14.2 per 100,000 of population). The rate of mortality due to accidents and injuriesin the period from 1981 to 1983 decreased by 10.6% (from 36.7 to 32.8 per 100,000of population) and in the period from 1984 to 1990 dropped 2-fold (from 37.4 to18.6 of population).
Spirits Consumption and Violent Mortality Rate 241
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Figure 4. Trends in the fatal traffic accidents rate (Tr) and the level of strongspirits consumption per capita (S).
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Figure 5. Trends in the suicide rate (Su) and the level of strong spiritsconsumption per capita (S).
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Alcohol Consumption
During the years 1970 to 1999, four periods in the dynamics of the alcoholconsumption per capita level can be distinguished: (1) 1970 to 1979; (2) 1981 to1983; (3) 1984 to 1987; and (4) 1987 to 1999 (Figure 6).
During the first period the consumption level grew from 6.4 liters to 10.1 liters,which means the increase was 58%. From 1981 to 1983 this rate declined from10.2 to 9.6 liters. During the years 1985 to 1987 the level of alcohol consumptionwas decreasing. In 1987 the rate was at its lowest for the whole period underconsideration. It made 4.4 liters; compared with 1987 the level had decreased by55%. From 1988 to 1999 the alcohol-consumption level increased by 2.1-fold (from4.6 to 9.7 liters). A sharp rise in the level of alcohol consumption occurred in 1993,when compared with 1992 the rate grew by 1.8 liters, which was a 30% increase.This rise was mainly due to vodka consumption. The growth of the total alcohol-consumption level in the 1970s was accounted for by the prevailing role of wine,the consumption of which increased 1.9 times (from 3.1 to 5.9 liters) during theperiod from 1970 to 1981. During the period from 1982 to 1994 consumption ofwine decreased from 5.7 to 1 liter per capita. During the period from 1970 to 1999,the level of vodka consumption per capita doubled (from 2.7 to 5.4 liters percapita). During the period from 1980 to 1982 this index decreased by 12.5% (from3.2 to 2.8 liters per capita). From 1984 to 1987 this index decreased by 34% (from3.2 to 2.1 liters per capita). During the years 1988 to 1999 the level of vodkaconsumption grew 2.6 times (from 2.1 to 5.4 liters). The level of beer consumed inthe same period was practically stable. Oppositely directed dynamics of con-sumption—vodka on the one hand and wine on the other, led to an alteration inthe structure of alcohol consumption, with a new prevalence of strong spirit in it.As far as the level of alcohol consumption is concerned, the results of the research
242 Y. E. Razvodovsky
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Figure 6. Trends in different types of alcoholic beverages consumption percapita: T, total level of alcohol consumption; B, level of beer consumption;
W, level of wine consumption; S, level of spirits consumption.
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show that it varied from one period to another. These variations were determinedto a great extent by the policy of the state regarding alcohol. The restrictivemeasures during the periods of the anti-alcohol campaigns, 1981–1983 and 1985–1988, led to a decline in alcohol consumption levels while, vice versa, theliberalization of alcohol policy in 1990s was accompanied by growth in thevodka (strong spirits) consumption level. From the point of view of public health,the anti-alcohol campaigns had a great positive effect, which was proved by thedecrease in the rates of alcohol-related mortality. In general terms, the results ofthe research correspond with the commonly accepted point of view that statepolicy can regulate the level of alcohol consumption and, correspondingly, therate of violent mortality.
Analysis
The graphs (Figures 1–5) show that the consumption of spirits has a strongassociation with the level of mortality due to accident and injuries, homicide,suicide, and motor-traffic accidents. Pearson’s correlation suggests a higherdegree of covariation between variables consumption of spirits and mortalitydue to accidents and injuries (r ¼ 0:91, p < 0:000), suicide (r ¼ 0:76, p < 0:000),homicide (r ¼ 0:90, p < 0:000), and fatal traffic accidents (r ¼ 0:52, p < 0:013).At the same time, the relation between the total level of alcohol consumptionand different types of violent mortality rates is far below statistical significance(Table 1).
The results of the factor analysis show that such factors as mortality due toaccidents and injuries, homicides and suicides as well as the level of vodkaconsumption per capita make one group of factors (Table 2). The rate of fataltraffic accidents, the level of wine and beer consumption per capita along with thetotal level of alcohol consumption makes another group of factors.
The results of the cluster analysis vividly demonstrate the correlation betweenthe level of vodka consumption per capita and different types of violent mortality(Figure 7).
The minimum range in the analysis equalled 1—the person correlation coeffi-cient. Such variables as mortality due to accidents and injuries, suicide andhomicide as well as the level of vodka consumption per capita appeared in onecluster, whereas such variables as the level of wine and beer consumption percapita appeared in an absolutely autonomous cluster. As the correlation coeffi-cient between such variables as the mortality due to accidents and injuries,
Spirits Consumption and Violent Mortality Rate 243
Table 1. Results of the correlation analysis.
Index Spirits Wine Beer Total
Accidents and injuriesr 0.913 �0.355 �0.494 0.107p <0.000 <0.082 <0.012 <0.611
Suicider 0.755 �0.048 �0.286 0.367p <0.000 <0.820 <0.165 <0.071
Homicider 0.904 �0.571 �0.665 �0.139p <0.000 <0.003 <0.000 <0.508
Traffic accidentsr 0.524 �0.566 �0.591 �0.372p <0.013 <0.003 <0.002 <0.067
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homicide and suicide and the level of vodka consumption per capita is close to 1,a linear regression model was applied in further analysis. The equation of linearregression describes 78.9% of the total dispersion of the accidents and injuriesmortality index and is characterized by high validity. The error of estimate is11.7% (F ¼ 90:6; p < 0:00001). The regression coefficient is also characterized byhigh validity (for B0 p < 0:002; for B1 p < 0:000001). The analysis of residualsproves the adequacy of the model. The residuals are evenly distributed aroundthe area of the normal dates presupposed and do not exceed j� 1:3�þ 1:5�j.Thus, the relationship between the indexes under analysis can be described bythe equation of linear regression y ¼ B0 þ B1 � x, where y is mortality due toaccidents and injuries, x is level of spirits consumption per capita, B0 ¼ 32:05, andB1 = 21.81. It is natural to suppose that at a certain stage the growth of the vodkaconsumption level will stop due to satiety. To prove this hypothesis we made a
244 Y. E. Razvodovsky
0.0
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B W Tr S H A Su
Figure 7. Results of cluster analysis: B, level of beer consumption per capita; W,level of wine consumption per capita; Tr, rate of fatal traffic accidents; S, level ofvodka consumption per capita; Su, rate of suicide; H, rate of homicide; A, rate
of accidents and injuries.
Table 2. Results of factor analysis.
Index Factor 1 Factor 2 Factor 3
Accidents and injuries 0.945 0.195 �0.218Suicide 0.981 �0.037 0.038Homicide 0.856 0.436 �0.225Traffic accidents 0.175 0.332 �0.924Spirits 0.837 0.339 �0.263Wine �0.104 �0.922 0.262Beer �0.307 �0.846 0.267Total 0.289 0.932 0.032
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logarithmic model in which the mortality index (ln y) is described by means ofthe satiety function: ln y = B0 +B1 ln x. We can see that all the characteristics ofthe logarithmic model are better in this case than in the linear one. Theequation of regression describes 83.3% of the total dispersion of the accidents andinjuries mortality index. Fischer’s coefficient was higher: F ¼ 120:9; p < 0:000001.The error of estimate makes only 2.1%, B0 ¼ 3:80 (p < 0:000001), B1 ¼ 0:71(p < 0:000001). Thus, the logarithmic model more adequately describes theassociation between the level of mortality due accidents and injuries and thelevel of vodka consumption. This case can be described by the flexibilitycoefficient ( �). To make the logarithmic model of the flexibility coefficient weapplied the following formula: �¼ y0xðx=yÞ ¼ 0:71. It can be seen from the formulathat an increase in vodka consumption of 10% results in a 7.1% increase in themortality level. The association between the suicide rate and the level of spiritsconsumption is more adequately described by a logarithmic model. The equationof regression describes 58.1% of the total dispersion of the suicide index. Theerror of estimate makes 4.1%, B0 ¼ 2:60 (p < 0:000001), B1 ¼ 0:50 (p < 0:00001),F ¼ 34:29; p < 0:000001, �¼ 0:50. It means that a 10% increase in vodka con-sumption results in a 5% increase in the suicide rate. The association betweenhomicides rate and the level of vodka consumption per capita is more adequatelydescribed by a linear regression model. The equation of linear regressiondescribes 79.6% of the total dispersion of the dependent variables. The errorof estimate makes 18.4%, B0 ¼ 1:02 (p > 0:05), B1 ¼ 2:23 (p < 0:00001), F ¼ 94:55;p < 0:000001. To make the linear model of the flexibility coefficient we applied thefollowing formula: �¼ y0xðx=yÞ ¼ 1:14. So, an increase in vodka consumption by10% results in an 11.4% increase in the homicide rate. The association betweenfatal traffic accidents and the level of spirits consumption per capita can bedescribed by a logarithmic model. However, this association is rather weak andthe equation of regression describes only 28.2% of the total dispersion of thedependent variables. The error of estimate makes 5.1%, B0 ¼ 2:56 (p < 0:000001),B1 ¼ 0:10 (p < 0:005), F ¼ 10:43; p < 0:005, �¼ 0:10. It means that a 10% increasein vodka consumption results in a 1% increase in the fatal-traffic-accidents rate.Thus, the level of vodka consumption per capita is most strongly associated withsuch indexes as mortality due to homicides, suicides, accidents and injuries, andto a lesser degree with mortality due to road accidents. Mortality due to accidentsand injuries, and due to suicides are described by a logarithmic model. In all casesB1 is greater than 0 but less than 1 and, therefore, an increasing level of vodkaconsumption per capita will be associated with a decreasing tendency regardingthe tempo of increase of the mortality types stated. Mortality due to homicides isdescribed by a linear model. The flexibility coefficient of homicide rate exceeds 1.This fact reveals no tendency to ‘satiation’ of the homicide mortality index, i.e.linear growth of this mortality type, directly associated with the increase of vodkaconsumption per capita, can be predicted.
Discussion
The association between accidents and alcohol is well established in manycountries. Use and abuse of alcohol influence the likelihood of all types ofaccidents (Giesbrecht, 1989). In Belarus accidents and injuries associated withmechanical devices, falling, drowning, and fire are frequent cause of prematuredeath. Alcohol is responsible for approximately 50% of cases of violent mortality
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(50% of fatal accidents and suicides and 60% of homicides are alcohol related). It isimportant to note that in the context of the high levels of alcohol consumptionseen in Belarus, there is evidence that a substantial proportion of violent deathsare due to the acute effects of binge drinking. The analyses performed in theframework of this study also strongly support the argument that alterations to thestructure of alcohol consumption have played a major part in the increase ofviolent mortality rate in Belarus.
It has been recognized that alcohol impairs perceptual and motor functionsessential to the task of driving. Perhaps no other behavior has been more closelyassociated with impaired driving than alcohol consumption. Obviously, the morefrequently that someone drinks and the more units that they consume on any oneoccasion, the more opportunities they have to drive while impaired. In themajority of studies that have examined both frequency and quantity of con-sumption, quantity per occasion appears to be the more important factor. A studythat has focused on the drinking pattern of convicted drink-impaired driverssuggests that impaired drivers consume more alcoholic beverages per occasionthat do general drivers (Wilson & Mann, 1990). There is also an apparentassociation between impaired driving frequency and the incidence of otheralcohol-related problems (Miller & Windle, 1990). Wilson and Jonah (1989)reported that convicted impaired drivers were more likely to have been chargedwith a non-vehicle-related offense, such as assault, than a group of controldrivers. This study suggested a positive association between impaired drivingand involvement in other criminal activity. There is strong evidence for arelationship between impaired driving and aggression, impulsivity and depres-sion, as well as a general state of emotional maladjustment. In a review of thecharacteristics of the convicted impaired driver Moskowitz et al. (1979) concludedthat, ‘There are indications of psychosocial disturbances in his life and hisdrinking behavior appears to reflect stress and difficulties’. This means thatstressful life events may precipitate heavy alcohol consumption as a copingmechanism and thus contribute to increases in the frequency of drinking anddriving. Motor-vehicle crashes are the most common non-natural cause of deathin Belarus and approximately 55% of all traffic fatalities are alcohol related. Thisstudy revealed an interesting trend: beginning in the 1991, the rate of fatal trafficaccidents began to decline, despite the increased number of cars per capita. Thisapparent turnabout in the drinking–driving problem may be explained by the factthat legislation has imposed rather strict sanctions on drunk drivers (removal ofdriving license and heavy fines).
Alcohol abuse has long been considered an important, and probably causal,factor in suicidal behavior (Lester, 1995). The mechanism of the association,however, is unclear. Two aspects account for this relationship: (1) the high suiciderate among alcoholics; and (2) decreased self-control during alcohol intoxicationmay facilitate the decision to commit suicide. There are a number of theories forthe association between alcohol use and abuse and suicidal behavior. Accordingto one of them, depression may be the primary etiological factor leading to bothalcohol abuse and suicide. Another theory suggests that alcohol abuse result indepressive disturbances, which may increase the risk of suicide. Still anothertheory admits that alcoholism can create marked psychosocial disruption, soalcoholics in their middle-age are especially vulnerable. Hufford (2001) present aconceptual framework of distal and proximal risk factors relating alcohol tosuicidal behavior. According to this concept distal risk factors create a statistical
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potential for suicide. Alcohol dependence, as well as associated comorbid psy-chopathology and negative life events, act as distal risk factors for suicidalbehavior. Proximal risk factors determine the timing of suicidal behavior bytranslating the statistical potential of distal risk factors into action. The acuteeffects of alcohol intoxication act as important proximal risk factors for suicidalbehavior among the alcoholic and non-alcoholic alike. These mechanisms areresponsible for alcohol’s ability to: (1) increase psychological distress; (2) increaseaggressiveness; (3) propel suicidal ideation into action through suicide-specificalcohol expectancies; and (4) constrict cognition which impairs the generationand implementation of alternative coping strategies. As far back as the nineteenthcentury, Durkheim, in his classic work on suicide, placed emphasis on thenegative consequences of rapid social and economic changes (Durkheim, 1992).The association between the suicide rate and level of anomie is also proved bycontemporary research. Thus, positive correlation is established between thesuicide rate on the one hand and the rate of divorces and unemployment onthe other (Leenars et al., 1993). One of the most interesting aspects of world healthin the late twentieth century has been the large decline in the mortality rates inthe former Soviet Republics between 1984 and 1987, followed by an equallydramatic increase in 1990s (Makinen, 2000). The trends in suicide mortality havebeen more or less correlated with the great societal transformation. Someresearchers try to explain changes in suicide mortality by psychological causeslike the ‘Post-Soviet syndrome’ (Mokhovicov, 1998). Other explanations includethe deterioration of general socioeconomic circumstances, changes in norms andvalues and other symptoms of anomie and social stress (Wasserman & Varnic,1994). The most frequently proposed cause of the changes in suicide rates hasbeen the level of alcohol consumption (Wasserman & Varnic, 1998). The mainevidence for this hypothesis is the fact that a positive correlation between level ofalcohol consumption and suicide rate has been found. It seems obvious that thesudden decline in suicide rate appeared to be entirely due to the anti-alcoholcampaign of 1985–1987, which significantly reduced alcohol consumption bylimiting its manufacture and availability. However, despite the fact that all thenewly independent states of the former Soviet Union have been going throughsimilar transformations, it is not possible to identify any general trend of suicidemortality in this country. Such Eastern European republics as Belarus, Estonia,Latvia, Lithuania, Russia, and Ukraine belong to the ‘high-suicide, unequal sexdistribution’ group. This group experienced a substantial drop in suicide ratesbetween 1985 and 1989, especially for middle-aged males, followed by a largeincrease between 1989 and 1993. It should be noted that Belarus has the highestlevel of alcohol consumption of all the countries of the former USSR. Azerbaijan,Georgia, Tajikistan, Turkmenistan, and Uzbekistan, which all belong to the ‘lowsuicide, equal sex distribution’ group, demonstrate a different pattern of suicide.These republics exhibited falling rates of suicide rate for the entire period from1985 to 1993. It was shown that changes in the level of alcohol consumption andhomicide were significantly correlated with those for suicide in the first group ofcountries only (Makinen, 2000). This evidence conflicts with the theory of ‘socialcorrelates of suicide’, and confirms the mediating role of culture in relation tosuicide. The transitional period in Belarus is associated with a decreasing incomelevel for the majority of population and, correspondingly, with lower livingstandards, increasing unemployment, growing mortality and, finally, a risinglevel of alcohol-related problems. It is known that dramatic social transforma-
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tions, which cause rapid changes in social reality, result in alterations to behaviorstereotypes. In such situations alcohol can be considered a universal means ofrelaxation and escape from the surrounding world. The increasing level of alcoholconsumption, in its turn, leads to a rise in the suicide rate. The fact that a strongpositive association between the rate of suicide and such indicators of alcohol-related problems as the level of mortality due to liver cirrhosis, alcohol poisoning,alcoholism and alcoholic psychosis has been found confirms this hypothesis(Razvodovsky, 2001). Moreover, a gender difference in suicide rate was apparentin the period 1990–1999. Male suicide mortality rates rose in this period by 77%(from 34.5 to 61.1 per 100,000 of population) while female mortality rates onlyincreased by 25% (from 8.0 to 10.0 per 100,000 of population). In this context, itshould be noted that, in general, the level of alcohol consumption among men ismuch higher than among women (Razvodovsky, 2000). This empirical evidencesupports the concept of male depressive syndrome. This syndrome comprises lowstress-tolerance, acting-out behavior, low impulse-control, substance abuse and ahereditary loading of depressive illness, alcoholism and suicide (Walinder &Rutzt, 2001). The fact that dramatic socioeconomic changes can have adverseeffects on male suicide rate is not a new idea. Durkheim in his seminal workemphasized that, ‘Whenever serious readjustments take place in the social order,whether or not due to a sudden growth or to an unexpected catastrophe, men aremore inclined to self-destruction’ (Durkheim, 1992).
It is a well-known fact that auto-aggressive behavior is closely connected withaggressive behavior. Recent research suggest that violent behavior in the last yearof life was a significant predictor of suicide (Conner et al., 2001). Researchevidence tends to support the alcohol–aggression link, indicating that alcoholconsumption is strongly linked to verbal aggression, aggressive threats, familyviolence, marital aggression, violence-related emergency-room visits, and homi-cide (Kreutzer, et al., 1984). A well-designed study of alcohol involvement inviolence found that in 50% of violent incidents, either the victims, the assailant, orboth had been drinking (Pernanen, 1991). Alcoholics and problem drinkers aremore likely to engage in criminal behavior than people in the general population(Combs-Orme et al., 1983). It seems natural that alcohol use and abuse weaken theindividual’s inhibitions against impulsive violence and significantly increase theprobability of aggressive behavior. Theories explaining the effect of alcohol onaggression in term of frustration suggest that intoxication subjects clearly increasetheir aggression when frustration is high (Gustafson, 1985). There is an increasingbody of scientific evidence showing that the relationship between alcohol con-sumption and aggressive or violent behavior is not a direct causal link, but rathera complex interaction of biochemical, psychological, situational and culturalfactors (Heath, 1995). From the research evidence available, we can concludethat aggressive behavior is determined by social and cultural factors rather thanthe chemical actions of ethanol.
Conclusion
The results of present study support the idea that violent mortality rates tend tobe more responsive to changes in distilled spirits consumption per capita than tothe total level of alcohol consumption. The main evidence for this conclusion isthat a positive and statistically significant relationship between violent mortalityrates and the level of vodka consumption per capita was revealed. This study also
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supports the idea that violent mortality and alcohol are culturally closelyconnected to prevailing intoxication-oriented drinking pattern, and the growingbody of evidence that a substantial proportion of violent mortality in Belarus isdue to the acute effects of binge drinking. A way of conceptualizing the variablesused in this study is to view violent mortality rate as an expression of psycho-logical distress. The results of this study indicate that levels of strong spiritsconsumption per capita are positively associated with four symptoms of distress.The outcome of this study also suggests that violence-related mortality preven-tion programs should put more focus on addressing alcohol problems.
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