112th CONGRESS Printed for the use of the 

1st Session Commission on Security and Cooperation in Europe 

RUSSIAN–U.S. COOPERATION IN THE 

FIGHT AGAINST ALCOHOLISM: 

A GLASS HALF FULL? 

AUGUST 2, 2011 

Briefing of the 

Commission on Security and Cooperation in Europe 

Washington: 2014 
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Commission on Security and Cooperation in Europe 

234 Ford House Office Building 

Washington, DC 20515 

202–225–1901 

csce@mail.house.gov 

http://www.csce.gov 

Legislative Branch Commissioners 

HOUSE SENATE 

CHRISTOPHER H. SMITH, NEW JERSEY, 

Chairman 

JOSEPH R. PITTS, PENNSYLVANIA

ROBERT B. ADERHOLT, ALABAMA

PHIL GINGREY, GEORGIA

MICHAEL C. BURGESS, TEXAS

ALCEE L. HASTINGS, FLORIDA

LOUISE MCINTOSH SLAUGHTER, 

NEW YORK

MIKE MCINTYRE, NORTH CAROLINA

STEVE COHEN, TENNESSEE

BENJAMIN L. CARDIN, MARYLAND, 

Co-Chairman 

SHELDON WHITEHOUSE, RHODE ISLAND

TOM UDALL, NEW MEXICO

JEANNE SHAHEEN, NEW HAMPSHIRE

RICHARD BLUMENTHAL, CONNECTICUT

ROBERT F. WICKER, MISSISSIPPI

SAXBY CHAMBLISS, GEORGIA

MARCO RUBIO, FLORIDA

KELLY AYOTTE, NEW HAMPSHIRE

Executive Branch Commissioners 

MICHAEL H. POSNER, DEPARTMENT OF STATE

MICHAEL C. CAMUN ̃ EZ, DEPARTMENT OF COMMERCE

ALEXANDER VERSHBOW, DEPARTMENT OF DEFENSE

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ABOUT THE ORGANIZATION FOR SECURITY AND COOPERATION IN EUROPE 

The Helsinki process, formally titled the Conference on Security and Cooperation in 

Europe, traces its origin to the signing of the Helsinki Final Act in Finland on August 

1, 1975, by the leaders of 33 European countries, the United States and Canada. As of 

January 1, 1995, the Helsinki process was renamed the Organization for Security and 

Cooperation in Europe (OSCE). The membership of the OSCE has expanded to 56 participating States, reflecting the breakup of the Soviet Union, Czechoslovakia, and Yugoslavia. 

The OSCE Secretariat is in Vienna, Austria, where weekly meetings of the participating States’ permanent representatives are held. In addition, specialized seminars and 

meetings are convened in various locations. Periodic consultations are held among Senior 

Officials, Ministers and Heads of State or Government. 

Although the OSCE continues to engage in standard setting in the fields of military 

security, economic and environmental cooperation, and human rights and humanitarian 

concerns, the Organization is primarily focused on initiatives designed to prevent, manage 

and resolve conflict within and among the participating States. The Organization deploys 

numerous missions and field activities located in Southeastern and Eastern Europe, the 

Caucasus, and Central Asia. The website of the OSCE is: <www.osce.org>. 

ABOUT THE COMMISSION ON SECURITY AND COOPERATION IN EUROPE 

The Commission on Security and Cooperation in Europe, also known as the Helsinki 

Commission, is a U.S. Government agency created in 1976 to monitor and encourage 

compliance by the participating States with their OSCE commitments, with a particular 

emphasis on human rights. 

The Commission consists of nine members from the United States Senate, nine members from the House of Representatives, and one member each from the Departments of 

State, Defense and Commerce. The positions of Chair and Co-Chair rotate between the 

Senate and House every two years, when a new Congress convenes. A professional staff 

assists the Commissioners in their work. 

In fulfilling its mandate, the Commission gathers and disseminates relevant information to the U.S. Congress and the public by convening hearings, issuing reports that 

reflect the views of Members of the Commission and/or its staff, and providing details 

about the activities of the Helsinki process and developments in OSCE participating 

States. 

The Commission also contributes to the formulation and execution of U.S. policy 

regarding the OSCE, including through Member and staff participation on U.S. Delegations to OSCE meetings. Members of the Commission have regular contact with 

parliamentarians, government officials, representatives of non-governmental organizations, and private individuals from participating States. The website of the Commission 

is: <www.csce.gov>. 

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RUSSIAN–U.S. COOPERATION IN THE FIGHT AGAINST 

ALCOHOLISM: A GLASS HALF FULL? 

AUGUST 2, 2011 

PARTICIPANTS 

Page 

Mark Milosch, Chief of Staff, Commission on Security and Cooperation in Europe ................. 1 

Kyle Parker, Policy Advisor, Commission on Security and Cooperation in Europe .................. 2 

Heidi Brown, Senior Analyst, Kroll Associates, New York, NY .................................................. 3 

Dr. Eugene Zubkov, Co-Founder, House of Hope on a Hill, Leningrad Oblast, Russia ............ 5 

Dr. Margaret M. Murray, Director, International Research Program, National Institute on 

Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD ...................... 20 

APPENDICES 

Reportage article by Heidi Brown entitled, ‘‘Drinking Games, Can Russia Admit it has a 

Problem?’’, Summer 2011 ........................................................................................................... 29 

Power Point presentation on Alcoholism Treatment in the United States by Dr. Margaret 

M. Murray .................................................................................................................................... 40 

Alcohol and Alcoholism Advance Access published May 30, 2007, article by Marya 

Levintova entitled, ‘‘Russian Alcohol Policy in the Making,’’ .................................................. 57 

Congressional Research Service Memorandum dated January 10, 2010 ................................... 63 

Congressional Research Service Memorandum dated December 27, 2010 ................................ 67 

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RUSSIAN–U.S. COOPERATION IN THE FIGHT AGAINST 

ALCOHOLISM: A GLASS HALF FULL? 

AUGUST 2, 2011 

Commission on Security and Cooperation in Europe

Washington, DC

The briefing was held at 2 p.m. in room 2360, Rayburn House Office Building, Washington, DC, Mark Milosch, Chief of Staff, Commission on Security and Cooperation in 

Europe, moderating. 

Panelists present: Mark Milosch, Chief of Staff, Commission on Security and Cooperation in Europe; Kyle Parker, Policy Advisor, Commission on Security and Cooperation in 

Europe; Ms. Heidi Brown, Senior Analyst, Kroll Associates, New York, NY; Dr. Eugene 

Zubkov, Co-Founder, House of Hope on a Hill, Leningrad Oblast, Russia; and Dr. Margaret Murray, Director, International Research Program, National Institute on Alcohol 

Abuse and Alcoholism, National Institutes of Health, Bethesda, MD. 

Mr. MILOSCH. I’m here for Chairman Chris Smith. I’d like to welcome everyone to 

today’s briefing on U.S. and Russian approaches to treating the disease of alcoholism. My 

name is Mr. Milosch, and I’m Congressman Smith’s Chief of Staff at the Helsinki 

Commission. 

As many of you know, the Commission is mandated to focus on the human dimension 

of the Helsinki process, but not so well known is that our own country is also included 

in monitoring and review, and will be today. 

The problem of alcoholism, and indeed addiction in general, knows no international 

border and remains a major problem in Russia and in the United States. Recently the 

Helsinki Commission held a hearing examining demographic trends in the OSCE region. 

Alcoholism is a major factor in the high mortality rate of Russian men. And Russia 

is geographically the largest OSCE state. Alcoholism also seriously affects the United 

States, the most populous OSCE state. 

Chairman Smith Chairs also the Global Health Subcommittee of the House Foreign 

Affairs Committee, and has spent a long career in Congress advocating for the human 

rights and dignity of those who have little or no voice in politics. Certainly the suffering 

alcoholic, misunderstood and often blamed for failing to sober up, deserves our attention. 

The U.S.-Russian relationship is vast, complex and often troubled, but an impasse on 

a key strategic question need not mean progress cannot be made in other parts of the 

relationship. The Bilateral Presidential Commission plays an important role in addressing 
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the panoply of interests and concerns, and includes a health working group where questions of alcoholism and addiction are discussed. 

It is our hope that today’s conversation can make a valuable contribution to these 

worthy efforts, and particularly to stimulate the sharing of best practices such as Alcoholics Anonymous. We have an expert panel to address many of these points, and I will 

let my colleague, Kyle Parker, introduce our witnesses. 

Before doing that, I would just like to note that there were folks from HHS and 

USAID who are directly involved in our bilateral dialogue on alcoholism who we had 

hoped could participate but were unable due to the August vacation season. 

As a courtesy, we also sought the participation of the Russian Embassy, and I believe 

we have some representatives here in the audience, and I hope they will pose some questions to the panel. 

Finally, we have some submissions from Russia for the record, which I will let Kyle 

explain in more detail. 

Kyle? 

Mr. PARKER. Thank you, Mark. 

The two submissions we have for the record are sitting out on the table. Actually, 

no, we have three. Two of them unfortunately we just got and they’re in Russian, so I 

put them out there understanding that I think some of you probably do read Russian. For 

those who don’t, we’ll have those translated and they’ll be on our site and become part 

of the formal record of today’s event. 

One of them comes from Andrei Sitov, who is the Bureau Chief of ITAR–TASS, I 

think, for the past 12, 13 years in Washington, has written extensively on this story. As 

well, we have a submission from Leonid Nikitinsky at Novaya Gazeta in Moscow, who has 

also covered this story based in Russia. 

We also have a submission for the record from Dr. Marya Levintova, with the 

National Institutes of Health, on alcohol policy. And, again, hopefully we’ll have our third 

panelist, also from NIH, to speak. 

A couple of quick words. 

You know, this story, it seems, every week now for many months there’s two or three 

major stories in the English language press and the Russian press about alcoholism in 

Russia. A lot has focused recently on some of the legal reforms, policy changes such as 

the reclassification of beer, the way it’s advertised, things that may have some effect. 

Today’s briefing, however, is going to assume that despite our best efforts, both Russian and U.S. efforts to head the problem off at the pass and address these risk factors, 

you will still have people who will nonetheless get sick and be sick with alcoholism, and 

so what can be done for them? 

What does the alcoholic who has a problem in, say, Peoria—what’s available to him? 

How is that alcoholic treated? How is he viewed in society? What about in a place like 

Irkutsk or Voronezh? What’s available? What are the treatment paradigms? What’s 

working? 

We will hear quite a bit today about the House of Hope which is in the Leningrad 

Oblast, which I believe might be the only institution in Russia, or certainly one of the 

major ones, that’s treating alcoholism based on the approach of the 12 steps of Alcoholics 

Anonymous. 
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With that, I’d like to jump right in and hear from our witnesses. We’ll start off with 

Heidi Brown. And Heidi spent more than a dozen years covering Russia for Forbes Magazine, in the Far East as in Moscow, and became interested in Russia’s alcoholism problem 

while studying in St. Petersburg, and has written extensively on the House of Hope and 

alcoholism in Russia. 

And we’re very glad to have you here today, Heidi, coming from New York City to 

join us. She is currently a senior analyst at Kroll. Heidi? 

Ms. BROWN. Thank you so much. I also want to thank the Helsinki Commission for 

getting this panel together to talk about this important issue, and specifically Kyle Parker 

for working with me on my research the last year or so while I’ve been putting an article 

together that came out in June. 

Can you hear me OK? OK. I get a little nervous sometimes when I speak publicly. 

Just a little bit of background about how I got involved in this as a journalist. 

In 1992, when I was studying in a language program at St. Petersburg State University, it was a very chaotic time. And we were all very young. We were living in a dormitory with Russian students and kind of not really understanding how difficult things 

were for them, and sort of the historic context that everything was taking place. 

And, you know, they took away the subsidized bread. You know, a lot of things 

changed for people. They were very angry and anxious. But when I look back I realize 

that the main way people were dealing with this lack of clarity and the anger that they 

had for all the changes in the country was through alcohol. And we really saw it in the 

dormitory, living with the students. 

I had two male dorm mates who were basically drunk all the time. And of course 

we’ll all acknowledge that that’s sort of applicable here, too, to college students in the 

United States, but it was to a very extreme degree. 

One of my dorm mates would get so drunk that you couldn’t even tell whether he 

was conscious or unconscious. He would just sort of stand there and sway back and forth. 

And, again, I’ll say also, the Dartmouth kids were known for being able to keep up with 

the Russians. 

But, you know, once I moved on and I got a professional journalism job in Vladivostok, again it was very clear how much alcohol played a role in helping people cope with 

their problems. 

And then when I was at Forbes I had lunch 1 day with a consular official from New 

York, and he was complaining—which is very common when you talk to Russians—that 

the Western media only wants to cover negative things about Russia. We have this 

agenda; we always want to make things look bad. 

And I said, well, you know, tell me something positive. I want to hear something positive. I have spent a long time studying the country and its people and I actually have 

a lot of faith in the country’s ability to pull out of its problems. 

And he said, well, there’s this clinic outside of St. Petersburg that’s doing really 

amazing things. And it was begun by an American businessman named Lou Bantle. And 

it’s struggling financially but I really think you should go take a look. It’s doing really 

special things. And it’s the only clinic in Russia that’s using the Alcoholics Anonymous 

method, that’s completely free, and it’s treating families and patients all the time. 

And so I went back to my editors, and they really liked the angle because there was 

an American involved, there was a businessman doing interesting things. And I think no 
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one would argue with the fact that alcoholism is a theme that touches everybody and it’s 

universal. 

So I met Eugene Zubkov after that, and we talked a lot, and he gave me some background and context, more than just the stereotypes that I had seen of what alcoholism 

truly means to Russians and how difficult it is for them to really fight this disease, and 

how few options they have for treatment. 

So I went over and I visited the house, and I had very mixed reactions to it because, 

you know, I pictured it as an American, going to a beautiful place on a river where everyone is sort of strolling around and holding hands and it’s very beautiful. And this place 

wasn’t like that. It’s a very kind of basic place. 

It’s on this sort of treeless hill, and you walk up and you see a lot of people who 

are really in pain. And as Eugene Zubkov explained it to me, these are people who kind 

of are on their last stop in life. They’ve tried everything else. And I’ll talk a little bit about 

the things that they tried. 

But you see, when you go into the home and you meet with people, how grateful they 

are to have an opportunity to do something completely different, which is to really look 

at themselves and think about the way alcoholism has affected them and their families, 

which most Russians don’t get the chance to do. 

So I did the article, and then later, which is actually very recently, I did an article 

for the World Policy Journal, which asked me to look at the issue a little bit more deeply, 

more about the disease and not just the House of Hope. 

And so I wanted to step back and, as a sort of introduction to the other people who 

will be following me, just give you a couple of statistics and a brief history of what’s happening with the disease in Russia and how it got to the point where it is today. 

In 1991 there were 150 million people in the country of Russia. Today the population 

stands at 140 million, which is a huge drop. A boy who was born today probably will not 

live past the age of 60. It’s been determined by scientists that half of Russian male deaths 

are due to alcohol-related diseases and accidents. Half a million deaths a year are alcoholrelated. 

And then, just as an aside, part of the problem with the consumption of vodka in 

Russia is because of counterfeit vodka. And out of 2.3 billion liters of vodka that are sold 

a year, about 700 million of them are counterfeit and very dangerous. 

So, just briefly a little history. We all think about Russians and drinking and vodka 

as sort of this, you know, fun—you can’t picture Russia without vodka. And the question 

kind of is, well, how did that happen? You know, are Russians just intrinsically vodka 

lovers? Like how did it all get started? 

Well, when Vladimir the Great, back in 982, decided to establish Russia as the 

country that we know today, he wanted to convert his population to a monotheistic religion. And he actually chose Christianity over the others because it calls for and accepts 

the consumption of alcohol. 

And from there, in the 1500s people started producing their own vodka. The czars 

implemented monopolies in Russia to make sure that they could profit from people’s 

consumption of vodka. And as we went through into the 19th century, landowners were 

actually paying their serfs partly in vodka for their labors. 

Later leaders tried to impose prohibitions to keep people from actually drinking the 

vodka, but they turned to making their own. They made their own moonshine and they 
5 

often got poisoned. So, actually even Lenin tried to impose a prohibition on consumption 

of alcohol but even he had to lift it. 

So when Stalin came in, he imposed the monopoly again and the country was able 

to profit from sales of vodka again. Brezhnev tried to stop it, imposing lots of draconian 

rules. Gorbachev was the last leader to try to encourage people to stop drinking, but his 

measures were so unpopular that he actually had to withdraw them. 

So today, where are we? As Mark mentioned, the government is taking steps to try 

to keep people from drinking again, and what it’s doing is raising taxes on liquor. So, for 

example, a bottle of vodka which used to cost $3 is now going to cost $3.50. And it’s actually going to make Russia having the most expensive vodka in the world, if you can 

believe it, when you look at income levels in Russia. But, unfortunately, this just encourages people to go and try to get alcohol in other ways. 

You know, other ways they’re trying to regulate—advertising. There’s a narcologist 

who has been designated by Vladimir Putin as the head of sort of the addiction problem 

in Russia, and he’s taking steps by sort of educating people to drink better and to drink 

less. 

So there’s not really an emphasis on treatment. You know, there’s a lot more of an 

emphasis on deterring people from drinking. And that’s why, you know, we’re looking at 

the House of Hope today, and other treatment methods, to try to keep a focus on how 

to help people once they get sobriety. How do they live with their sobriety? 

Thank you. 

Mr. PARKER. Thank you, Heidi. 

We’ll now move to Dr. Zubkov. Dr. Zubkov, glad to have you. And thank you for 

making the trip down from the city today. 

Dr. Zubkov was trained as a Soviet narcologist, I believe in the late 1970s; is a practicing psychologist in New York; has been extensively involved in the treatment of alcoholism in Russia as well as here, based now more than, I think, two decades in the United 

States; he is one of the co-founders of the House of Hope in the Leningrad Oblast. 

He went to medical school at the First Pavlov Medical University in St. Petersburg, 

so is a Russian M.D., and works in the New York Counseling Center in Manhattan. 

Dr. Zubkov, we recognize you for any remarks you wish to make. 

Dr. ZUBKOV. Thank you. I would like to thank the Commission for inviting me, and 

Kyle Parker, who helped me to, you know, understand what I need to talk about, and 

actually who provided me with the possibility to talk about, you know, House of Hope and 

the problem of alcoholism in Russia. 

I actually would like to briefly describe the remarkable example of how one man’s 

personal initiative could have a very dramatic international impact. You know, Russia has 

a historically well-documented thousand years of relationships with alcohol. And, you 

know, Russians continue to drink and the need for help is critical. 

In 1999, American philanthropist and corporate executive Louis Bantle made his first 

trip to Soviet Union. Visiting numerous treatment centers, he was shocked at how alcoholism was treated. He started a small not-for-profit group which was called International 

Institute for Alcoholism Education and Treatment, which has saved thousands of lives in 

Russia and trained 300 Russian professionals, including members of the clergy, doctors, 

high-profile personalities—painters, singers, you know, rock personalities. 
6 

Lou wanted to help Russian society to leave the stigma associated with the disease 

and to expose Russian treatment professionals to Western treatment modalities. In 1996, 

the House of Hope on a Hill, which utilizes, loosely, Minnesota model and is based on 

12 steps’ way, was founded, then built. And since then, 4,500 patients have gone through 

a 28-day rehabilitation process in our 30-bed center near St. Petersburg in the small village of Petercula—most of all, the key personnel at House of Hope were trained in best 

American rehabs. And there are now 370 AA meetings, AA groups in Russia, and 40 percent of those meetings were initiated by the graduates of the house. In 1996 there were 

seven AA meetings in St. Petersburg. Today there are 39. And also, most of those 

meetings were initiated by the graduates of the house. 

One thing I wanted to add, the rehabilitation at the house is absolutely free. And 

I’d like to correct: There are quite a few rehabs which you utilize in 12-step model in Minnesota, but ours, the House of Hope, is the only free rehab. It is completely free. 

And I would like to add that we’ve had patients come over from 90 cities in Russia, 

along from far east from Vladivostok, from Khabarovsk, Chechnya, you name it. You 

know, we have a map with pins where, you know, people come. 

And, as well, we have patients come from Brighton Beach area, from New York, and 

they were accepted and they received treatment because Russian was their first language, 

and from Greece, from Germany. 

And I’m not talking about Ukraine and Belarussia and Estonia, but we have a very 

diverse group of, you know, patients. And then when those patients return back to their 

communities, most of them, they start their own meetings. 

For example, if somebody goes to, you know, to the village, a small city which hadn’t 

been exposed to it, they start a meeting there. And that’s what happened. I think out— 

yeah, 40 percent out of this 370 registered AA meetings in Russia were started by the 

graduates of the house. 

And through his death in 2010, the house was funded by Mr. Bantle. Several Russian 

and American companies and individuals have supported House of Hope almost since it’s 

inception as well, but there was a small trickle of money, not a lot of input. 

The city of St. Petersburg also twice made financial contribution to our efforts. Usually it was connected somehow to the election campaign. But, you know, that support was 

more a result of a personal context rather than the result of the traditional fundraising 

efforts. 

I would like to take a moment to acknowledge Robert Bantle, who is in the audience 

today. This year marked the 15th anniversary of the founding of House of Hope by Lou 

Bantle. Bob is now carrying on his father’s legacy, begun in 1996, and is continuing to 

fulfill his father’s commitment to help suffering alcoholics in Russia. 

And alcoholism is a very serious problem in Russia today in terms of both adult mortality and lost productivity. As in the United States, alcoholism is a profound drain on 

health care resources. 

Russian narcology, which is sort of similar to our American addictionology, is a different field, though probably Dr. Murray could better comment on the research aspects 

and cooperation in the field. But Russian treatment methods are largely very biologically 

oriented and sometimes strange. 

For example, you know, one of the most popular modalities of treatment is 

intramuscular or intracutaneous Antabuse implant. So Antabuse is being implanted under 
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muscular—and, you know, people pay a lot of money on this, and this is still considered 

a reliable method. 

And after this, the patient is basically—he is on his own. He doesn’t get any therapeutic support. He doesn’t go to any meetings. And when he has a personal crisis, the 

easiest way for him to resolve it is try to drink, and very often this could end in fatalities. 

You know, people die or they become disabled. 

And, you know, they have a lot of consequences. And, actually, the list of famous 

people who died as a result of these Antabuse implants is long, is numerous. A lot of Russians, you know, famous and high-profile personalities in the 1970s and 1980s died as a 

result of this Antabuse implant. 

Also there is—according—but if there—you know, there will be questions, I’d be 

happy to answer in more detail what these methods are. And, you know, 12-step methods 

and, you know, Minnesota models, are frowned upon. 

Doctors are mostly interested to establish direct contact with the patient and sometimes, you know, exercise some kind of a control over the patient rather than to let 

patient loose and do their recovery by himself, though certainly there are some exceptions 

like Dr. Zykov, for example, who is very cooperative. 

But, you know, the people who are really supportive of 12-step programs in the medical community, they are very few. And generally, though, the method is not endorsed and 

does not support it, and it’s not prohibited, but it’s not still popular with the physicians 

and the church. 

The United States and Russia share the program of treatment and defining not only 

for alcoholism but substance as a whole, including tobacco, licit and illicit drugs. Both 

countries have criminalized the disease of addiction for both countries. Substance abuse 

is an 800-pound gorilla in the family room. Denial runs rampant in both countries, and 

thoughtful discussion of practical solutions, sad to say, is largely absent in the media. 

Substance abuse is the largest preventable killer of both citizens of Russia and the 

United States. There are 75,000 alcohol-related deaths in Russia each year recently, and 

23,000 from acute alcohol poisoning. 

Russia has—according to the data of 2009, Russia has 2.7 million alcoholics on the 

official register. It means probably three times that many patients that are not registered. 

They’re over the register, in the official number. You know, the supposed number of alcoholics could be five times higher. 

Both countries tax tobacco directly and they tax drug use indirectly. Just as Prohibition in the United States bombed, the criminalization of the production and distribution 

of alcohol, high taxes on alcohol in Russia have had a similar effect. 

In Russia, at least one-third of 27 billion liters of water produced annually is sold 

and taxed fraudulently, and one-third is sold in adulterated toxic reformulation. In other 

words, one third of all alcohol in Russia is pure illegal. Two-thirds is poison. 

In the United States, public awareness of the deleterious effects of substance abuse 

was pioneered by individuals and groups like Surgeon General Everett Koop, Betty Ford, 

Mothers Against Drunk Drivers, to mention a few, but the impact of the effort has taken 

decades to impact American society. 

Dr. Koop’s anti-smoking campaign took 20 years to take hold, and he was resisted 

tooth and nail by the vested interests of the tobacco and alcohol industries, as well as 
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by both the print and broadcast media because of the massive revenues generated by ads 

for these products. 

Like the Brezhnev-era incarcerations of alcoholics, you know, sobering tanks and, you 

know, prison for alcoholics, from 1964 to 1980, now the USA today jails many of its alcoholics and addicts. And of those jailed for substance abuse-related crime, only a tiny percent receive treatment, who are jailed for their substance abuse: alcohol, tobacco, drugs. 

Substance abuse-related incarceration is a growth industry dramatically more expensive 

than outpatient treatment. 

And—3 minutes more. And I wanted to say a few more words of House of Hope. You 

know, the beauty of the House of Hope model, that it can be easily reproduced across the 

former Soviet Union. Our method doesn’t require special treatment or medication. 

In recent years we have been approached by people from many regions of Russia, 

Ukraine, Estonia and Belarus to help us train their staff or to start new treatment centers. Often the only thing that stands in the way of the beginning of a new clinic in 

another location is resistance from the ignorant local official or local officials. 

At the House of Hope, we face more than the obstacle of national addiction. Our problems are larger than the low percentage of alcoholics who receive treatment. We are struggling with the primitive state of philanthropy in Russia. That means we get very few 

donations from the Russians. 

The Bantle family has been essential to our existence, but we need to expand our 

base of support in order to survive. For example, you know, all charitable donations in 

Russia are taxed. Therefore people don’t want to donate. If they donate, you know, a large 

amount of money, they basically say, I have extra money. And, you know, this is not good 

for somebody who lives in Russia. 

For years we have tried to raise funds from the Russians using our network of political and business connections within the country, but we have been forced to accept the 

fact that our community is not an attractive target for donors. In Russia, corporations and 

philanthropists prefer to support high-profile, socially acceptable organizations such as 

performing and visual arts, for example. 

You know, when we approached one of the major businessmen, oligarchs, he said, 

why should I support you? I would give 3 or 4 million to Mariinsky Theater and my name 

will be in the program. With you, same thing: We don’t want ourselves to be associated 

with—you know, with a rehab. Though the recent exception, for example, the brewery 

Baltika is continuously supporting us for many years. 

We also tried to approach many U.S. businesses operating in St. Petersburg and in 

Leningrad Oblast. Leningrad region there are about 150 U.S. corporations. They operate 

businesses in—you know, in the region. And we’ve had two American interns who did— 

you know, they did a great job. They’ve done all the letter-writing, you know, very nice 

letters, solicitation letters. 

We received the list from the American Chamber of Commerce in St. Petersburg. We 

hand-delivered the letter twice, 150 letters which were signed by our board of directors 

committee, you know, which had all—you know, Yuri Shevchuk, Mitsky and a lot of, you 

know, high-profile Russians. And we didn’t get even a single response in writing, though, 

you know, we delivered to the switchboard. The secretary signed that they received our 

mail, and it went directly to the bucket. 
9 

So, in conclusion, I just wanted to say that both United States and Russia socially 

isolate and neglect or incarcerate their addicts and drunks. As an addiction expert from 

Russia living in the United States and having the opportunity to observe the problems 

that are common in both countries, I can see that there’s much opportunity to cooperate. 

And in my opinion, the key here is to take an inspiration from people like Lou Bantle 

and make the commitment. Thank you. 

Mr. MILOSCH. Thank you very much. 

If you don’t mind, I’ll ask a couple of questions and then we’ll go to Kyle with a 

couple of questions, and then we’ll go out to the audience. I guess I’ll bundle mine 

together. 

I’d be very curious to hear any thoughts that either of you might have on a kind of 

question of national feeling. I mean, I confess here to an American prejudice without 

knowing much about Russian methods of dealing with alcoholism. I tend to think that 

the solution is Alcoholics Anonymous. Right or wrong, this is how I approach the problem. 

I’d like to hear your thoughts on how the fact that AA comes out of the United States 

might be an obstacle to its progress in Russia because it may seem like, well, this comes 

from a country that’s historically been our rival, or how orthodoxy deals with the fact that 

of course AA comes out of a kind of American secularized Protestant milieu and, you 

know, how do they deal with that? 

Do they recognize that there’s nothing really in the AA program that’s hostile to 

orthodoxy and try to make it their own, or does it always remain something else? That’s 

the first thing I’ll throw out, orthodoxy and the Russian national feeling. 

I’d also like to hear about the implications of this problem, because it seems that the 

implications of alcoholism in Russia are huge. We’ve already mentioned demographics. 

Russia is in a demographic crisis, but it will even go way beyond that. You know, the 

problem is as serious as it is. 

As I’ve read in the essays of Ms. Brown and Mr. Zubkov, it’s going to affect relations 

between men and women deeply. What can one expect when one gets married? The 

expectations are going to become low. How do the sexes relate to each other? How do the 

generations relate to each other when you have so many children raised in alcoholic 

households? 

It just seems like a wound on marriage, childhood, social development, something 

that is going to in fact go beyond the problem of the person splayed out on the concrete, 

but it’s going to affect the mood and social relations of everybody in the country because 

it affects their expectations. So that’s just kind of a big thing I throw out, if you have 

any comments on that. 

Third, it occurs to me that we’re also dealing with social attitudes here that are very 

hard to change, in that the attitude that hard drinking, drinking a bottle of vodka, you 

know, out-drinking your neighbor, the people who are with you at the table, becomes a 

kind of test of Russianness, and that’s very dangerous when a test of your patriotism 

becomes how much can you drink, or a test of manliness. 

And the social attitudes often react negatively to pressure. The more campaigns you 

have to change them, then the more certain milieus will dig in, and then it becomes an 

act of a rebellious spirit, of independence. It’s very hard to attack these kinds of loaded 

attitudes without provoking a reaction that doesn’t undo anything that you—any progress 

you make. 
10 

So I’m just throwing a lot out there. I would like to hear what either of you have 

to say. 

Ms. Brown? 

Ms. BROWN. Sure. I think as Medvedev and Putin do a tandem answering of the 

questions, you can jump in whenever you want. 

So, I guess I’ll take the third one, the question about social attitudes, first. 

I do think that their—and, again, you know, I will start my answer by saying I am 

an outsider. I am not Russian. So this is—what I say has to do with my observations over 

the years. 

But in terms of social attitudes toward drinking, you know, when I observed my own 

responses over there, I realized how much I had internalized stereotypes about drinking 

in Russia, because after visiting the House of Hope, I went with some friends out to 

dinner, and some of the people were—actually, most of the people at the dinner were 

recovering alcoholics. 

So here we were in a group at a restaurant on Nevsky Prospect in St. Petersburg, 

and we’re all sitting down to dinner and we’re all talking. And I’m sitting there thinking, 

what’s missing? Here we are, we’re all meeting, we’re celebrating. Oh, yeah, we’re not 

toasting. 

Like, how is this possible? We’re sitting in Russia celebrating something and we’re 

not toasting. Is this really Russian? Like, can you be Russian, can you have a Russian 

cultural celebration, a funeral, a meeting, an acquaintance, spend time together without 

drinking? Hmm, you know? 

And I do think that right now that’s something that Russians are asking themselves. 

You know, and you might disagree with me, but I think that as the country starts to try 

to come to grips with why it can’t get out of its own way in terms of improving the situation, really starting to tackle alcoholism and move on, I think people are starting to say, 

you know, can we have Russian culture without having vodka involved? 

And, you know, again, I alluded to this narcologist who Vladimir Putin has supported. His name is Yevgeny Bryun, and he’s—I interviewed him. He’s a lovely man. But 

he supports the older method that Dr. Zubkov alluded to of using medications to treat 

alcohol instead of therapy. 

And I feel that his approaches, which are—you know, when you’re sitting at the table 

drinking with your family and your friends and you’re getting drunk, take a walk around 

the table and open the windows so you don’t get too drunk. Or, you know, he said that 

he’s trying to improve policy by encouraging people to drink other kinds of alcohol, like 

beer and wine and not just vodka. 

So this is an educated, trained professional. And he wants to help people. I mean, 

he admits fully—he doesn’t try to put under the rug the fact that people have an alcoholism problem in Russia. 

So I don’t know if that answers the question about social attitudes. I mean, I just 

feel partly that, you know, it’s a kind of a two-part problem. There’s the way Russians 

see drinking and there’s also the way we foreigners see drinking in Russia, and it kind 

of goes together. 

I will let Dr. Zubkov answer the question about families and alcoholism. 
11 

In terms of AA in Russia, I think you’ve really hit it on the head. I think there is 

a lot of mistrust of Alcoholics Anonymous there because it is seen as Western. And as 

much progress has been made in Russia, and as cosmopolitan people have become and 

the traveling that’s been done, there are a lot of people who still have sort of a nationalism or a resentment about methods that have come from abroad. 

Alcoholics Anonymous didn’t really come to Russia, I believe, until the 1990s. Is that 

right, the early 1990s, late 1980s? 

Dr. ZUBKOV. Eighty-nine. 

Ms. BROWN. Yeah, and you can imagine in a country where there is no religion except 

for the state, and Alcoholics Anonymous requires the belief in a higher power, the government certainly doesn’t want you to believe in a higher power other than the state. And 

it was very much discouraged and actually seen as a threat. 

I have a friend who told me stories about trying to smuggle in the AA book in the 

1980s and having customs officials rifle through her suitcase. You know, it was medical 

supplies and AA books. She could have brought the medical supplies in to sell at a high 

profit, but they left those in the suitcase and they took out the AA books. 

And, you know, in terms of the church, again, a really good point. What you see today 

is the church probably has—and this is according to one priest that I interviewed in 

Moscow—probably about a quarter of the priests in the Orthodox Church are alcoholic. 

And it’s a very insidious disease in the church because you have to use wine in your ceremonies. 

So on the one hand, people can hide and they can continue their disease. On the 

other hand, if a priest wants to overcome his alcoholism, it’s almost impossible because 

he has to use wine in the ceremonies. 

And the church, like many other large, established religious institutions in other 

countries, keeps its secrets and encourages priests not to talk about things publicly. Patriarch Kirill, who is very close, reportedly, with Vladimir Putin and has his backing, has 

sort of nominally made comments that Alcoholics and Anonymous and other therapy 

methods could be considered effective. 

But at the end of the day, he—I mean, just one example of the way that he’s not 

really working with AA and other positive methods is that the priest told me that he actually reversed an earlier rule. He had told priests that they didn’t have to use wine in their 

ceremonies if they were battling alcoholism. They could just use juice. And he has taken 

away that rule so that you have to use it. 

And, you know, again, in this country, in Russia, which is sort of starting to find its 

religious identity again, you know, to have the head of the church not be fully behind 

every method that could possibly help people, you know, that’s definitely questionable. 

Dr. ZUBKOV. I wanted to add a couple of words on orthodoxy and, you know, relation 

of the orthodox hierarchs. Two or three hierarchs made comments on 12 steps way, and 

basically they were, at the best, neutral. And they didn’t say they endorse it; they say, 

well, you can use it if it’s under supervision of a priest. And basically that was it. 

But the bigger problem is that, you know, first, a lot of priests don’t follow what their 

patriarchs say. There is a lot of—very often, you know, priests don’t abide by—they’re 

ignorant of, you know, the opinions of their senior hierarchs. 

And, second, it is—AA is still viewed, actually, as a Protestant invasion, and this is 

the major problem. And, for example, you know, the infamous Serbsky Institute, they 
12 

have a physician who writes about AA. He wrote, I don’t know, about a dozen very 

enflamed articles about, you know, how it is negative for the Russian society, how it is 

absolutely unacceptable for the Russian psyche. And one of his most recent topics links 

Satanism to AA. 

So, it is completely out of—and, you know, the doctor who wrote this article was 

inspired by one of the senior priests in Moscow. So on one end there’s a patriarch who 

said this is OK. On the other end, you know, they read—you know, the huge number of 

priests which do say, we don’t want to deal with it because it’s questionable, it’s Protestant, you know, and those people do things by themselves, they do it without our control. 

And so far relations are difficult, though there are priests who have—who even 

started 12-step programs, but I would say then probably there are five or six people 

altogether. There are not many. 

Mr. MILOSCH. That’s interesting because I think in the United States. I’m not aware 

of any associations between AA and being Protestant. I don’t think people in the United 

States would make that connection. 

Ms. BROWN. But I think it’s the idea of Protestantism being Western. 

Mr. MILOSCH. Being American, yeah. 

Dr. ZUBKOV. Yes, but, you know, the Oxford Group, which actually gave birth to AA, 

they were a Protestant group, a Protestant gathering of people. But still, it was a business 

association, so what about—you know, Protestants have a lot of excellent rehabs. You 

know, they charge money for it. I mean, sometimes it’s business. 

Ms. BROWN. In Russia? 

Dr. ZUBKOV. In Russia, but they fund a lot of excellent rehabs. 

And, you know, church views it as probably a subversive activity. They’re always 

trying to link whatever Protestants do to the sects. 

Mr. MILOSCH. Do either of you have any thoughts on the far-reaching implications 

of alcoholism for marriage, child raising, the social atmosphere in the cities? 

Ms. BROWN. I mean, the only thing I’ll say is just based on a couple of interviews 

I did with people who are recovering at the House of Hope. 

One man, I think he was in his 60s, and he’s actually very typical of the kind of— 

I mean, unless you would argue with me—typical of the kind of person who has sort of 

reached the end of the road and, you know, come to the House of Hope to give it one last 

shot. 

You know, he’d taken the Antabuse dosage that Dr. Zubkov has described several 

times. He’s been in and out of jail. And his pattern fits one of the patterns of alcohol 

consumption in Russia, which is to go on what’s called zapoy, which are extended binges 

that last for a week, 2 weeks. 

And it makes it very insidious in the family of an alcoholic because they can convince 

themselves that the person is not an alcoholic because they can go for weeks or months 

with being sober. And, again, Antabuse can exacerbate that because you go for a long 

period of time being sober. 

But the people who practice these binges, their families fit into the pattern and they 

begin to expect when these zapoy are going to happen, and they know how long they’re 

going to last. And so, this man told me about his pattern and how his wife started to ask 
13 

him, OK, well, when’s the next time you’re going to start your binge, because you seem 

really unhappy. 

And that was one of the reasons why he actually stopped his Antabuse treatments, 

because he would go, you know, for 3 to 6 months without drinking. And the Antabuse— 

unless maybe we haven’t made it clear enough, but it doesn’t do anything about addiction. 

It just makes you not—it makes it very uncomfortable to drink. 

So there is nothing that’s actually happening in your family or in your own ability 

to cope with sobriety when you’re on a medication like that. The wife noticed: You know, 

you’re not drinking. You seem really unhappy. Let’s go back to the pattern. Stop taking 

the Antabuse. Start your binges again. 

Mr. MILOSCH. Thanks very much. 

Kyle? 

Mr. PARKER. Yes, thank you. And just a quick note. We will be joined shortly by our 

witness from NIH. She’ll be happy to give us the expert American perspective, our model, 

with some authority. 

Also, from the bios—I just grabbed a couple of things from your bio, Dr. Zubkov. It’s 

a long and impressive re ́sume ́. And so, again, those are out there on the table. I see people 

have availed themselves. There’s some other helpful information. 

The CRS memos I’d draw particular attention to because they’re not public. They 

were created for the Commission some months ago. There’s an interesting one that examines the effectiveness of AA. 

I think the general conclusion is that it’s at least as effective as other treatment 

models. Again, Dr. Murray will be able to share a little bit more about American best 

practice. 

I have a couple of quick questions, in no particular order. 

First, where do Russian AA meetings happen? Over here in the United States they’re 

all over the place. They’ve become almost like Chinese restaurants and burger joints— 

I mean, you can’t go to a small town that doesn’t have one across the United States. In 

fact, they happen here on the Capitol campus, indeed even in the Capitol building itself. 

I know they happen in bars in some places, and they happen around the clock in 

places like New York City. I’m wondering, you know, it seems to be here in the United 

States as sort of the church basement, it’s the community center, and in a sense, when 

you look at the numbers in Russia where AA is, it’s there but it’s not really there in terms 

of the numbers. They’re so small. 

What stands in the way? Is it difficult to get the local community center, the local, 

I don’t know, Obkom or Gorispolkom or whoever has a room that you can use to allow 

some drunks to drink some coffee, smoke a few cigarettes and tell some jokes once a 

week? So that would be one question. 

The other question is, does the Soviet memory or legacy of informants, kompromat, 

eavesdropping, do you see that affecting in any way the willingness of folks to come 

together anonymously? At the same time, if you’re in a town, people do recognize people, 

especially a small town. 

I can imagine that here in the United States it’s probably not the most natural thing 

to do to bare your soul to one another in, again, not really a public setting but certainly 

not a walk-talk, right? You’re meeting somewhere. How does that play out in Russia? 
14 

And, last, prisons—prisons, prereleases. What’s going on inside the Russian prison 

system? I know there’s been a lot of work this past year on the Bilateral Presidential 

Commission, and this work was recently institutionalized just a couple months ago in the 

creation of a new rule of law working group. 

A lot of great work has been done out at Post by people like Tom Firestone in 

Moscow; here in Washington, Catherine Newcombe, who’ve worked with FSIN, the Russian prison system, in looking at these types of rehab, rehabilitation, job training, but how 

would treating alcoholism addiction fit into that at FSIN? 

Dr. ZUBKOV. Well, first about AA. AA is perfect for us. It works. The only problem, 

that people are not often referred to the meetings. You know, two major groups of professionals here who are confronted with a problem, you know, who see a drunk, you know, 

they’re the priests and they’re the doctor, the physicians. 

So, very often what they do, they try to reassure the patients. They either try to 

make the patient their client and therefore continue professional relations at the charge 

level. 

And also the church, the church is trying, you know, to set up a network of its own 

rehabs. And they get, definitely, preferential treatment from the state. For example, GOS 

narcocontrol, you know, it’s the structure which is analogous to—— 

Ms. BROWN. The DEA? 

Dr. ZUBKOV. Yeah, DEA. They recently signed an agreement with the Moscow patriarchate, you know, for the rehab organization, where the Russian Orthodox Church claims 

it has 30 rehabs. Thirty rehabs is the number which definitely doesn’t reflect the total 

number of the rehabs, you know. 

And, you know, House of Hope and a couple older rehabs which are for 20 years in 

existence, they have never been mentioned, even in this document. So there is a preferential treatment. 

And I think it’s the lack of the referral and, you know, the information. When people 

get to the meetings you know, a certain percentage always stays, a lot like here. It is 

about 30 percent, you know, who stay. And then some people relapse and they come back, 

you know. 

But there was an upsurge in the 1990s when the number of the meetings rapidly 

increased, but then in the—you know, after the year 2000 there was sort of a plateau, 

probably with 5 percent, 10 percent annual growth. 

And, you know, this informants thing, this is usually people who don’t want to go 

to the meetings. I mean, they usually—this is like, you know, the usual thing they say: 

We don’t want to be here because we’re afraid that there might be an informant. But usually it’s just an excuse not to go to the meetings. You know, the same people have to go 

in through the treatment at the house, for example—you know, through the rehabilitation 

they pick up and they do actually pretty well. 

And as for the prisons, I could say, you know, they’re just starting to do it. It’s pretty 

new. And, for example, the first prison program in the penitentiary was also down by the 

International Institute by Lobentyl in 1997, if you are familiar with the special type hospital in St. Petersburg. 

You know, the one, Fyngergergrienka, you know, all of the dissidents were there. It’s 

a huge hospital, 1,000 beds. The first program was started by the institute there, and it’s 

still in existence, still doing good. It’s not really spreading. It’s still, you know, their inside 
15 

problem. And director of the hospital, Dr. Tashkin, he was the first to let somebody who 

was a patient in the hospital in. So he did let the inmate in after he was let out. 

Ms. BROWN. And do you know where there meetings happen? I’m curious too. 

Dr. ZUBKOV. Well, you know, I see no problem with the meeting space. I mean, very 

few meetings are going in the churches, where the priest sympathizes, but usually when 

they want to start meetings, you know, they have a space—you know, they have space 

immediately. They don’t 

Mr. PARKER. Government buildings, universities? 

Dr. ZUBKOV. No. Usually they rent—it’s in an apartment or a studio. You know, it’s 

some public space which they pay a small rent to upkeep. But meeting space definitely 

is not a problem. 

Mr. PARKER. What about employee assistance programs? 

Dr. ZUBKOV. I’m not familiar there’s a single one. You know, we offered to develop 

it because Mr. Bantle had a use—— 

Mr. PARKER. Have you spoken with people like Andy Somers at AmCham to see if 

that could get it started with American companies? 

Dr. ZUBKOV. No. 

Mr. PARKER. Would that be worthwhile? We could followup with him. 

Dr. ZUBKOV. But I’m not sure that there is even one employee assistance—— 

[Cross talk.] 

Ms. BROWN. Did you want to say something? 

Mr. PARKER. Should we move to public questions? 

Mr. MILOSCH. Yeah, sure. 

Mr. PARKER. Please. 

QUESTIONER. I just have a response that relates to your question. [Off mic.] 

Mr. PARKER. Thank you, Doctor. 

QUESTIONER. [Off mic continuing]. Employee assistance programs are actually—— 

Mr. PARKER. There’s a microphone, just so the transcriber will catch your remarks. 

[Cross talk.] 

Mr. PARKER. That one over there. 

QUESTIONER. So, yeah, basically—— 

Mr. PARKER. Say your name and your affiliation. 

QUESTIONER. Sure. Sure. Marya Levintova, Fogarty International Center, National 

Institutes of Health. 

So the employee assistance programs are of interest to a lot of companies in Russia. 

Many multinational companies have affiliations in Russia, you know, Pepsi, Philip Morris, 

and you name it. And all of them are experiencing various issues that they would like 

to resolve, and these programs are definitely on their radar. 

They have not, at this point—from what I know, they have not moved it to the point 

of where they can actually say that these programs exist. 

Mr. PARKER. At this point we can, again, move to public questions. Please, if you have 

a question, the microphones are on. 

QUESTIONER. Thank you very much. Ron McNamara with the Helsinki Commission. 
16 

I wonder if you could address the question, as it affects children with perhaps a mom 

who is alcoholic, and trying to address that question. 

I also, I guess, in listening to you, was wondering about young people and trying to 

have interventions that try to affect, you know, the question of drinking early in life. At 

the hearing that Mr. Milosch referred to, one of the startling points that I took away from 

that is that the life expectancy of a male in the Russian Federation is slightly lower than 

it was in 1961. So that sort of really confronted this aspect that contributes to those 

statistics. 

And then finally, certainly with regard to the question of corruption in the Russian 

Federation, I’m sort of intrigued in terms of—and not—don’t get me wrong. I’m not trying 

to, if you will, pick on the Russian Orthodox Church, but I wonder if there’s sort of a little 

bit of a conflict. 

I don’t know—I know, for example, that the church is quite involved in terms of the 

tobacco and cigarette industry or sales. And I wondered, to the extent that the Russian 

Orthodox church itself might be involved actually in one way or another in terms of 

alcohol as a commodity or product. So if—I wonder if you could—might address some of 

those concerns or issues that came to my mind. Thank you. 

Mr. PARKER. Thanks, Ron. Any others in this round? 

Ms. BROWN. I’ll take the last point, because I did some reporting on it. As I mentioned in my intro, the counterfeit vodka trade is enormous. It definitely helps to account 

for some of the health problems that are developing and have developed in the health of 

the population. I can admit that I was a victim of counterfeit vodka consumption when 

I was in Vladivostok. It’s a very strange feeling. Luckily, none of us died, but my—the 

effect that it had on me was fainting and hitting my head. And the bottle looked completely normal. It looked like a regular bottle of vodka. 

The production often happens in the south of Russia. They produce the vodka using 

very cheap materials, and then they either—the bottle of vodka in Russia, in an attempt 

to regulate it, every bottle that’s sold in stores has to have a stamp that the producer 

pays a dollar for, or sometimes the retailer. 

So a lot of times, of course it’s an organized-crime group or something unofficial, 

where they produce the vodka in a plant that looks normal and very modern. But they 

steal a stamp off the back of a truck, or they pay corrupt officials less money for the 

stamp, and it just gets slapped on the bottle. Again, you know, very nice-looking sticker. 

And what an expert on the vodka trade told me is that it just—in order for the counterfeit-vodka trade to be as widespread as it is—in other words, going from production to 

distribution to sale at a retailer like a store or a kiosk means that probably people very 

high up in the power structure are involved as well. 

So, you know, I can’t name any names. I don’t have examples of specific government 

agencies who are involved. But any time you have, you know, an industry like the 

counterfeit alcohol industry, which accounts, again, for two-thirds of alcohol or vodka sold 

in the country, you can assume that you’ve got local police, city officials, regulators, perhaps tax police, others, also either turning a blind eye or profiting from it. It has to be. 

And again, organized crime groups are involved. 

And to be fair, also to point out that the tradition of making your own bathtub gin, 

which is called Samagan, continues to this day very proudly. Some people think that it 

tastes better. And they continue to give it out as gifts or—as I mentioned, when the tax 
17 

increases or when vodka sales are curtailed, as they just recently were last year, people 

are happy to go back and get it from other outlets and make it themselves or have friends 

make it for them. 

Mr. PARKER. Do we have other questions? 

Dr. ZUBKOV. I can also comment on the—— 

Mr. PARKER. Sure. 

Dr. ZUBKOV. And I think I forgot to address one question about the importance and 

impact of alcoholism. I’ve met with many politicians because, you know, all of our fundraising is done, you know, on the very personal level. You have to meet with people. You 

have to convince them to do it. And, you know, out of 25 meetings, one usually works. 

And I’ve met with some pretty high-level politicians, and everybody admits that it’s a 

national disaster and this is a national threat which could destroy the country. 

And at the same point—you know, at the same time, you know, one of the very rich 

people whom I met, he said, so what? I mean, I would donate $100,000. But I won’t 

donate to your cause. I mean, I’m not interested. And that’s—but everybody, you know, 

in church, in ministry of health, they say it is a problem, No. 1. 

And there is a program which is called Health of the Nation which allocated a pretty 

significant amount of money and—but so far I don’t know what came out of it. I don’t 

know if anything. And as for the church, you know, I think all tobacco scandals expired 

in the 1990s. the most recent tobacco scandal was in 1996/1997. But the attitude in general, I think it’s about control, it’s about merging with the state and, you know, establishing control and, you know, the concept of ‘‘Russki mir,’’ Russian world. 

But even the rehabs—I mean, some of them, they have a modified 12-step program, 

which they modify and they call it orthodox steps of sober. But basically these are transformed and changed, you know, 12 steps, away, even to the point—but they don’t want 

to endorse something which is completely independent and unaffiliated with them. 

Ms. BROWN. I was just going to really quickly add to the question about corruption. 

You know, it’s—in a country like Russia, I’m sure you know, where there’s very little 

transparency and a lot of incentive to not uncover difficult truths by both journalists and 

other advocates, there’s been discussion in the public sphere about how much of a role 

corruption plays in the ongoing production of counterfeit vodka, but also this kind of— 

what we’ve been discussing—inability to really get your—the government’s hands around 

the problem and turn to steps like AA. And corruption often comes up as one of the issues. 

So I want to put it out there. Unfortunately, you know, no one has been able to actually identify, you know, what government official is responsible or what ministry. But 

when you look at the problem and the way that it’s not advancing, you have to—it’s just 

the elephant in the room. Like, whose vested interests are there that are preventing, for 

example, the counterfeit vodka industry from being dismantled? 

Mr. PARKER. Yeah, please. 

QUESTIONER. My name is Lawrence Avasian. I am the Director of the U.S.-Russia 

Civil Society Partnership Program. And it’s the analog to the Bilateral Presidential 

Commission. There are working groups under this new program, including public health. 

And we’re going to be very interested in talking to you about how this might fit in under 

the public-health aegis. 

My question is—are my glasses on—twofold. One is, to what extent is this a problem 

among women in Russia as well as—of course, we know it’s probably dominated by men. 
18 

But to what extent is this a problem among women? And on the other hand, since we 

know alcoholism is a family disease and often an alcoholic may not hit a bottom until the 

family confronts him or her, how widespread is the growth of Al-Anon and the recovery 

of the family of the alcoholic? 

Mr. PARKER. Thank you. Please, have at it. 

Dr. ZUBKOV. OK. There are, in—I know in big cities there are several Al-Anon 

groups, though I cannot give you the numbers. I don’t know how many. But I know in 

St. Petersburg, there are five, probably, Al-Anon meetings, probably. I just cannot give 

you the numbers offhand. I can look them up and, you know, give it to you later. But 

I don’t have the numbers at once. 

And, you know, the family—of course it affects the families. And, for example, we 

have a family program which is 10 years old at the House of Hope and which is very good, 

which is very efficient, almost, you know, 100 percent of the families of the patients who 

are at the House of Hope, they subscribe to the family program. And most of the rehabs, 

they do have family programs. 

As for conception of women, when I started to work—that was 1979—I do remember 

that the statistics we were provided, that ratio between male-female of alcoholism in the 

Soviet Union was 1 to 10. I think by 1993 this ratio changed by nine to eight. Current, 

nine to eight—I—one to eight, one to eight. One to eight, yes. Unfortunately, I don’t know 

current numbers. I don’t know today’s numbers. I just know numbers on the register, 

which Minister Bolik (sp) provided on the register. But that numbers I do have. 

Ms. BROWN. I’ll just—if you don’t mind, I’ll just add. In the story that I did for the 

World Policy Journal, there’s a statistic on fetal alcohol syndrome, which obviously concerns consumption of alcohol amongst women. And in the city of Murmansk, some American academics did a study of the children in the orphanage and studied, you know, the 

percentage of those children who were born with fetal alcohol syndrome. And they found 

that more than half were. So obviously the people who end up having to turn to orphanages for help are in a specific situation. 

But another study that I looked at was from St. Petersburg. A group—I think it was 

from Tufts—they surveyed women on the street, and I believe maybe in a gynecology 

clinic, and asked them about what they knew about the effect of alcohol on pregnancy. 

And basically 80 to 90 percent of them answered questions about how alcohol affects you 

very accurately. But about one in five said that they’d recently drunk heavily. 

So it’s not just a question of lack of information. 

Dr. ZUBKOV. Also one comment on the prison system and the gravity of the situation. 

We—our guest—we had Vitaly Mozikov, who’s currently—he’s working for the President’s 

administration in Moscow. But he was the DA for the prison system in St. Petersburg, 

20,000 beds, pretty big system. And he provided numbers—I think that was 1997 or 

1998—that 82 percent in prisons of northwest were there because they committed their 

crimes while being under the influence of alcohol. Eighty-two percent alcohol induced 

crimes. So that was 1997. 

Mr. PARKER. Do we have other questions? Please. 

QUESTIONER. Pat Starix with the Commission. Two questions. So when I was reading 

about this topic, I came across an interesting statistic. During the—at least in the 1980s, 

when Gorbachev introduced the ‘‘end the alcohol’’ campaign, a significant amount of 

deaths were attributed to the drinking of—I don’t know if this might fall under your 
19 

counterfeit alcohol—or rather vodka—topic, but I think it’s industrial alcohol, as in, like, 

ethanol, or maybe sometimes even perfume, like that people would be driven to drink this 

when vodka wasn’t available. I was wondering if that’s still fairly prevalent today, and 

also, like, what the Government can do, if anything, to regulate that in society, like regulate people drinking those industrial alcohols. 

And also, how in the Russian public is alcoholism viewed in, like, comparison with, 

say, heroin addiction, which I know is—I think Russia is the No. 1 country in the world 

in terms of heroin addiction? Is it viewed as less, like, important? Because I know there’s 

been various efforts to stem the flow of heroin from Afghanistan in recent years since the 

war began. 

So it’s two questions: namely, how can they restrict industrial alcohol use for 

drinking, and also how is alcoholism viewed in comparison with other drug addictions. So 

thank you. 

Mr. PARKER. Ms. Bender? You had a question? We can take them in a row. 

Ms. BROWN. You’re absolutely right. That’s one of—the consumption of substitutes for 

vodka is much more common in Russia, and I think it’s sort of—when you hear about it, 

it’s quite shocking when you hear about what people put in their bodies, because they’re 

so desperate for alcohol. Antifreeze is one of them, and cologne, like you mentioned, and 

medicines; anything that has alcohol in it. 

Now, it really depends upon who you talk to. The man who’s the expert on the 

counterfeit vodka industry is one of the only people in the country who tracks consumption numbers of vodka. But he also sells his statistics to people who produce vodka to 

liquor companies. You know, unfortunately he’s not completely objective. 

But his position and of course the position of the alcohol lobby in Russia is that when 

you make vodka too expensive, people turn to substitutes. So they argue that taxes should 

be dropped or lowered on vodka. They think vodka should be made more economically 

accessible. And I haven’t heard any other argument or suggestion in my reporting about 

another way to prevent that, unfortunately, other than to treat addiction; other than to 

help people cope with their addiction to alcohol. 

I can’t comment on the heroin issue. Genya, will you comment on the heroin addiction? 

Dr. ZUBKOV. Well, I think heroin addiction is much more communogenic in Russia. 

Therefore, heroin definitely viewed differently than alcohol. And alcohol is almost—it’s a 

household phenomenon. People don’t criminalize. I mean, they—you know, if you’re on a 

bus, I mean, they might let you—the seat, they might let you sit if you’re drunk. They 

will sympathize with you. There’s, you know, a lot of tolerance of drinking in public, even 

the alcoholics. 

And heroin addiction is very heavily stigmatized, and, you know, any addiction, for 

that matter. And it also gets a lot of attention in the media recently for, you know—as 

drug addiction, because a lot of children or rich people, they—you know, they get addicted. 

They get addicted to cocaine. And therefore, you know, the campaign is spearheaded. 

Even, you know, some officials from your departments and, you know, from the President’s administration, they have cocaine addictions and heroin addiction, and that’s very 

difficult to fight. And therefore there is a lot of attention, official attention to the problem. 

Though it’s not a major killer of population in Russia. 

Mr. PARKER. Thank you, Dr. Zubkov. 
20 

We’re pleased to be joined by Dr. Margaret Murray from NIH to give us the U.S. 

perspective on how we treat alcoholism in the United States. Again, we’ve constructed this 

briefing to be a two-way street. And one of the questions I do hope we can address is, 

we’ve heard a lot about the problems in Russia. I’m wondering, what can we here in the 

United States—you know, how can we benefit from Russia’s experience? Are there treatment modes or things that are happening in Russia that we’re not doing, things we can 

learn. And hopefully after Dr. Murray’s presentation we can perhaps explore that a little 

bit. 

We will set up a PowerPoint here, and while we’re doing so, I’d like to take a moment 

and introduce Dr. Murray, who’s the Director of International Research Programs at the 

National Institute on Alcohol Abuse and Alcoholism at NIH. Dr. Murray directs NIAAA’s 

efforts in international research collaboration, spanning each of the institute’s priorities 

in biomedical, epidemiological, prevention, and treatment research. And this includes 

serving on the U.S. Science and Technology Committees, NIH and governmentwide initiatives in global health, representing NIAAA to multilateral organizations such as the 

World Health Organization and the National Academies of Science Committees. She’s primarily responsible for facilitating collaborative relationships at the individual institute 

and scientist level; is well published on the subject. 

And Dr. Murray, are you involved in the BPC health working group that we do have 

with Russia? 

Ms. MURRAY. Yes. 

Mr. PARKER. OK. And also involved in—as I had thought, in the BPC discussions. 

We can begin your presentation. 

Ms. MURRAY. So you want me to cue you for the—— 

Mr. PARKER. Yeah, sure, we’ll work it out. 

Ms. MURRAY. I’m sorry I’m late, because I’ve been told before to visit this program 

called the House of Hope. And I haven’t—when I’m—the last time I was in Russia, I had 

absolutely no time to do so. But I will do it, I promise, the next time I’m there, which 

is going to be in a few months. 

The National Institute on Alcohol Abuse and Alcoholism is 1 of the 27 Institutes that 

make up the U.S. National Institutes of Health. We can move to the next slide. And basically our mission is to do research on every aspect of alcohol. We cover everything from 

the cell to taxes, so tax policy that has to do with the price, which we were just—I just 

heard a question when I came in—talking about, as well as what happens on the cellular 

level when alcohol is ingested. 

Next slide. So why do we have a special focus on alcohol? Whoops, we can kind of 

rush through these, because alcohol—first of all, it’s legal, widely used, easily obtained. 

And it’s part of the social context of the United States as well as many other countries. 

Alcohol has both beneficial and harmful health effects. It’s used by most people, actually, 

without causing harm to themselves or others. So there’s not a huge number of people 

that will become addicted from alcohol use. 

However, because it interacts with the whole body and risky drinking produces 

intoxication, even people who aren’t addicted can have problems from it. And it’s a leading 

risk factor for morbidity and mortality throughout the world. 

This next slide shows alcohol consumption. This is from the World Health Organization. It was published in Lancet a few years ago. And the latest numbers from WHO don’t 
21 

change it much. But you can see this is consumption of alcohol in pure liters of adults 

aged 15 and older. You can see the—I don’t know if the colors are coming through really 

clear. But with few exceptions, it’s the high-income countries that have the most alcohol 

consumption. And Russia is one of those exceptions. 

Next slide. And of course, because of—is this the next slide? Yeah. OK. Because of 

alcohol consumption, the burden of disease associated with alcohol is spread out in the 

same pattern, as you see in this slide, also with data from the World Health Organization. 

OK, next. So there’s two distinct patterns of drinking that we have to be concerned 

about. One is binge drinking, which is drinking too much too fast. And we define that 

in the United States as about five drinks for men and four drinks for women over a period 

of 2 hours. And that’s because it raises the blood alcohol level to—the BAC to 0.08, which 

is our legal intoxication limit in the United States. And that’s based on an average BMI, 

so an average-sized man or woman. And of course there’s variations in those. 

This is a particularly prevalent pattern of drinking among young adults in the United 

States. And it’s associated with a lot of morbidity and mortality. The other part is heavy 

drinking, which is drinking too much too often. So it’s the frequency of use. And we say 

if you’re drinking more than 5 drinks for men and 4 for women in a day, and if you’re 

drinking more than 7 drinks in a week for women and 14 in a week for men, that your 

frequency of drinking is too high. And it’s associated with all of the more chronic conditions that can arise from alcohol use. 

This next slide shows the frequency of risk drinking in the U.S. population. And 

because we define it that way—and that’s based on a population study of 40—more than 

40,000 individuals that we do in the United States. And we’re one of the few countries 

in the world—in fact, I’m not sure of any others—that do a population study. In the past, 

we always study treatment populations. You know, we looked at people who came in for 

alcoholism treatment. And our understanding of the disease was based on that. 

Now, because we look at a general population, we’ve had a very different view and 

a very different picture of alcohol—problems in alcohol addiction. So 65 percent of the U.S. 

adult population are current drinkers, and about 59 percent of those drinkers did not 

report risky drinking. So they’re not drinking over those limits. 

You can see in the graph on the—well, OK, we’ll go on to the next slide. [Off mic]— 

go back—you see the graph on the right: As you increase your drinking, you also increase 

your risk for alcohol dependence. And that’s what we’re talking about when we talk about 

the disease of alcoholism. 

OK, next slide. 

So what we’ve done in the United States, at least since 1990, when we had the 

Institute of Medicine take a look at alcohol problems across the country, we started to 

look at a continuum of problems and the chronic dependence, which is around 1 percent 

of the population, is a very small portion, but that’s the portion that we talk about when 

we talk about either inpatient or outpatient treatment. 

Now, severe dependence—likely those—that group will be treated in outpatient treatment. But the other groups, the mild to moderate group, that, nowadays, we’re treating 

in primary-care settings. So these are people that won’t even enter the treatment system. 

And we started doing that because only a small percentage of people who meet the criteria 

for alcohol problems actually ever go into treatment. 
22 

And the other important fact to remember is that people might recognize they have 

a pretty heavy problem with alcohol. It might be 10 years before they get into the treatment system. And it’s not because—well, it has to do with a lot of things. Stigma is one. 

Another is that, you know, the—they—people just—it interrupts their lives to such a 

point. So they have to—start having problems with family and legal problems and work 

problems, and sometimes be forced to get into that treatment system. 

So we think that we have a better approach by starting to look at problems early 

on when they’re in that mild and moderate phase. And we have interventions that work 

very well when delivered by primary-care physicians in hospital settings and in primarycare treatment, where an individual might not even think they have a problem with 

alcohol yet, but they go in and they get an opportunistic intervention. 

OK. We look at alcohol-use disorders themselves. About 7 percent, little over 7 percent of the U.S. population currently would meet the criteria in the Diagnostic and Statistical Manual for substance abuse or dependence. So those people would have an alcoholuse disorder, we would say. They meet the criteria. And of those, an awful lot have comorbid drug use and also psychiatric disorders. So when we talk about treatment, we 

often have to talk about treating all of these things at the same time. 

We’ve done a lot of research over 40 years on different treatments. And I think today 

we’re focusing more on the behavioral treatments. And if you see those listed here—the 

cognitive-behavioral therapy, the 12-step—what we call 12-step facilitation, which would 

be any program that’s based on a 12-step method; motivational enhancement, community 

reinforcement, and marital behavioral therapy. All these have been proven to be effective. 

They all work. 

We need to know more at this point about which patients do better with which treatment. And that’s where we’re focusing our research today. But all of them work, I would 

say, more or less equally well. 

The other treatment I call—we have up here called ‘‘screening and brief intervention,’’ that’s what we do in the primary-care settings. And that’s actually got the strongest 

evidence base for it; that’s got the strongest treatment effects. 

We can go on to the next one. The other area that we’re working on very much, we’re 

very focused, is on medication development. And there are a few medications that are 

approved currently. And I know they’re approved in Russia as well. Vivitrol is approved 

in Russia. They’re not widely used by treatment programs in the United States; I don’t 

know about Russia. I think there are a number of reasons for that. And I think the biggest one is that our treatment system is sort of based on a non-medical model in the 

United States, so we don’t do enough with the current medications that we have. 

But also, the treatment effects, while they’re good, and they work better for some 

people than others, they’re not strong enough yet that we have a lot of people convinced. 

So we’re continuing to look at new compounds based on what we’re learning about how 

alcohol affects the receptor system in the brain and how we can develop medications that 

can reduce craving and reduce that continual desire or addiction to alcohol. 

So in the United States, when we look at residential versus outpatient care, most of 

our treatment is outpatient, although about 27 percent of facilities offer inpatient care. 

And there are insurance programs that will pay for inpatient care in the United States, 

although the managed-care policies pretty much favor the outpatient care. These are the 
23 

28-day programs that you hear so much about. They use a variety of the treatments that 

I went through very quickly. 

So in a given facility, you would have 95 percent of them that offer individual therapy 

and 89 percent that offer group therapy, and a little less offer family counseling. So all 

these take place within the same facility. You see that pharmacotherapy number is only 

at 42 percent, and that includes patients who are getting help for their comorbid mentalhealth disorders, so they might be getting antidepressants to treat depression or an antianxiety medication. And only about 24 percent are using the medications that we currently have available to treat dependence. 

Alcoholics Anonymous has been an extremely important mainstay of treatment in the 

United States. And most programs offer AA to patients who, while they’re in the inpatient 

and outpatient setting, but also for—they provide the aftercare that’s needed for most 

people. I’ve been in this field for a while and I’ve seen a lot of scientists, especially the 

people working on medications, try to say, well, AA, what does it really do, and, you know, 

there—you’ll see reviews in the literature; especially Cochrane Review has a famous one 

where they say, well, you can’t say that AA really helps or that it—or that it doesn’t help. 

But that’s not really true. While there have not been studies that compare AA to no 

treatment—and that’s because the Alcoholics Anonymous people don’t want a study like 

that—they don’t want to have people not have the option to go to AA, which I think is 

a good, ethical decision. 

But when you compare it with other treatments, it’s actually showing that it does 

have an effect and it does have a positive benefit. And those positive benefits, it seems 

from researchers that are focusing on AA—and it took a while to find people who were 

willing to, you know, research AA—it’s both the social support for abstinence that AA provides, as well as enhancing an individual’s spirituality, which we know is key to recovery 

for a lot of people. 

So when we’ve actually looked at AA in studies in the way that it is ethical that we 

can, we see positive benefits. 

And the other thing is, AA is so accessible. There are some people who say they never 

find a meeting that they, you know, can feel comfortable in. But most people can find an 

Alcoholics Anonymous meeting where they don’t have to miss time from work, they’re 

around people that they feel are their peers, they like the anonymity and they like that 

social support that they get. 

And there are meetings—I live right across from Grace Methodist Church in 

Gaithersburg, MD. It’s one of the oldest AA meetings in Montgomery County. There are 

three meetings a day in that church, and there have been for almost 100 years—or actually, I can’t say that, because AA—the church is 100 old, but AA’s been around for 70- 

some years. And Christmas Day, Thanksgiving Day. And it’s open, it’s accessible, and 

people can go, and nobody has to know that they’re there. You know, they—you don’t have 

to tell your employer, you don’t have to access your insurance program. Morning, noon, 

and evening you can find an AA meeting. 

So in spite of some of the scientists who say, well, we really don’t know if AA’s effective or not, I would have to say that it is. And the research that we’ve done shows that. 

OK. NIAAA is 40 years old, so we try to take a look at the next 40 years. And what 

we’re hoping is for a more complete repertoire of medications that will actually be more 
24 

effective than the ones we have now and reach those people where current medications 

are not doing so much. 

And finally, personalized treatment. Because there are so many treatment options, 

we need to know about individuals and how they match up with treatments and what 

would be the most effective treatment for people. So that’s what we’re working on now, 

is to be able to say to an individual, you know, based on your genetic makeup and, your— 

you know, your profile, we can recommend this type of treatment. And that’s what we’re 

hoping to have available from our research. 

Thank you. 

Mr. PARKER. Well, thank you, Dr. Murray. That was quite a presentation and gives 

us a lot of meat to chew on and discuss here. 

I will start and turn it over if there are any questions here now that we’ve had the 

full panel and learned a bit about both approaches. 

I would just mention here, we focus on the OSCE region. And alcoholism, of course, 

isn’t unique to Russia or the United States. I can recall some months ago the World 

Health Organization study listed Moldova as the highest consumption in terms of liters 

per capita of alcohol. But of course Russia is the biggest country, and the United States 

has double the population. So I would hope that if you get these two heavyweights 

together on their approaches, there can be benefits even beyond treating this disease. 

And I really hope that if anyone has comments on what might we learn, what might 

we take from the Russian treatment model, one of the things we haven’t discussed today 

much at all and I don’t know that we’ll have the time to, are all of these alternative treatments that are beyond the medications we’re seeing, you know, hypnotism and—and I 

know they often get rolled eyes, but the alternative approach. There have been recent 

reports in our own media about alternative medicine in the United States being used 

extensively and possibly working maybe because of placebo effect, but again, getting a 

result. 

And there was a news report I saw in Russia that looked at Russians accessing 

health care and found that a lot of the health care they were accessing was indeed the 

nontraditional health care that was often provided by a primary-care provider who was 

a traditional doctor but was offering something by way of acupuncture, herbalism, hypnotism, other types of things. 

Also, Dr. Murray, on the BPC, one of the things that I heard from colleagues at HHS 

was that, first, not a whole lot has been discussed in the health working group on this 

at the BPC, and that some of what has been discussed involves what seem to be 

euphemistically termed ‘‘harm minimalization’’ programs involving methadone clinics, 

needle exchanges, and noting Russian resistance to that approach. 

One of the reasons we focus on the 12 steps here today—apart from the big reason 

that they work—is that, one, they don’t cost anything. They’re not nearly as controversial 

as some of the other approaches. And also, interestingly enough, AA doesn’t really even 

take a position on alcohol itself. It’s not a temperance society. It’s not aiming to do away 

with or even tell people not to drink. It seems to be saying, if you’ve gotten sick, here’s 

what we have. And if you like what we have, come and listen to what we do and take 

what you need, leave the rest, etc. 
25 

But I’m wondering if you could comment a little bit on that. Again, what does the 

United States have to learn from Russia? How do we benefit in this two-way relationship 

with our Russian partners? 

Ms. MURRAY. Well, NIAAA has done a number of collaborative research projects with 

investigators in Russia over the years. While we haven’t focused on treatment—and 

that—you know, that’s interesting that it’s an omission. I was thinking about that on the 

way over. We’ve worked on, actually, an interesting study in the 1990s on the topology 

of alcoholism. And what we basically found out—that alcoholism is the same whether 

you’re in the United States or you’re in Russia or in any other country. We’ve also worked 

on alcohol’s involvement in HIV epidemic, as well as we’ve done a lot of work in fetal— 

probably the most work has been in fetal alcohol syndrome and prevention of fetal alcohol 

syndrome. 

I think there’s a lot that the United States can learn from methods of treatment. And 

I know that Russian scientists are also looking at medications to treat addiction. The fact 

that Russia has a medical specialty in narcology that we don’t have in the United States— 

so it’s a branch of psychiatry—I think that’s very important. We don’t have that. We’re 

starting—we do have addiction psychiatry, and we’re working with the—some other 

groups of physicians on developing a specialty in addiction medicine. But we don’t have 

it currently, and Russia’s had it for a long time. 

So Russia has always taken a medical view of alcoholism, whereas it took the United 

States a long time to come around to that. Russia also, you know, has, I would say, 

almost—at least, you know, when times are good, the treatment system in Russia is good 

because it’s inpatient and it’s over a long enough period of time. 

One issue that I would like to explore, whether it’s a deterrent or not, is the fact that 

alcoholics have to be registered in Russia, people who receive a diagnosis of alcoholism. 

And I don’t know how much—how much that deters people going into treatment. But I’d 

be interested in learning about that. 

QUESTIONER. A bit on the question that you had in regards to the Bilateral Presidential Commission and alcohol and other addiction-related activities. I’m actually the 

person at NIH who coordinates the NIH activities on BPC, and you rightly mentioned that 

there is perhaps a little bit more information on the drug abuse activities because of 

SAMHSA’s part in the BPC, in the health working group, because SAMHSA has kind of 

this whole separate activity that they’re doing with Russia. 

So NIH being bottom-up—you know, scientist-to-scientist driven, a little bit of a different approach in what we are able and are doing with Russian scientists. So some of 

the activities that Peggy just described as far as the collaborations with Russian scientists 

are the things that we’re doing. And the needle exchange programs, they’re obviously not 

a research thing. They are a programmatic question. 

So there are studies that are evaluating their efficacy. But, as you know, in Russia 

that is against the law, to do needle exchange. So a lot of those programs had to be 

stopped in Russia. 

The one thing that we’re doing actually together with NIAAA, we are organizing a 

scientific forum, which will happen in Moscow this coming November. And there will be 

a whole section on alcohol, mostly focusing on prevention and other related aspects—not 

necessarily treatment, because again, NIH does more research. So we could study the 

treatments but not actually provide them. So that’s kind of a difference. 
26 

And I think some of these kind of discussions that we get into is that we’re often 

asked, you know, why aren’t you supporting treatment programs in country A or country 

B? Because that’s not what NIH actually does. We can study those approaches that are 

used by these different methodologies, but not actually provide the resources to fund 

them. 

Peggy will be going together with the Director for NIAAA in November. So hopefully 

we’ll have some more details to report after that meeting. But that’s—— 

Mr. PARKER. Thank you. That’s very interesting. And I would note, SAMHSA, as you 

mentioned in a recent report singled out none other than the national capital region for 

being, I think, the highest in terms of alcohol and drug abuse. 

So this is a topic and an issue that’s directly relevant right here, even in this town— 

especially in this town. 

We are up against the time that we have allotted. Are there any last-minute questions to go into the record before we close the record? 

Mr. BENTLE. I want to thank the Commission for including Dr. Zubkov and Heidi, 

and in particular thank Dr. Zubkov for his tireless work over in Russia over the last 20 

years. My dad started that as a means of keeping himself sober. And in addition to the 

4,500 patients we’ve had there, we’ve had about an equal amount go through the family 

program, which I think—you know, if we can break the cycle of alcoholism for generation 

to generation, at least that’s a great start. 

I’m also involved with Father Martin’s Ashley up in Havre de Grace, and we’re 

working on a program with our returning men and women in the service. And the drug 

and alcohol abuse in terms of our recovering vets is something that I think is germane 

both to the Russian population and the U.S. population. 

But I want to thank the Commission, Kyle, Mike, and the rest of you for bringing 

attention to this issue. The pharmacological and the other aspects, working in the different facilities that I’m involved with, and it’s growing, it’s coming. 

But at the end of the day, I think as long as you can get the recovering alcoholic 

a sense of hope and that someone else cares, that’s what I found out when I was over 

in Russia last month, putting my dad’s ashes in the ground over there, is the sense of 

belonging and knowing that there’s someone else out there that cares really makes a difference, and getting that person to make that first step out. 

And to anybody else in the room that has ideas in terms of how to get EAP programs 

going over in Russia, to help us with the children’s—the family planning programs or 

make us better aware what other resources might be available to ensure that the continuance of House of Hope is a beacon of help for the Russian people and for a less—to be 

able to expand to the other regions, as Dr. Zubkov had referred to—there’s a great need, 

there’s a great desire. 

Just given where philanthropy is in Russia, it’s very, very difficult to work. And 

again, I applaud Eugene for 20 years not paying any graft, not paying any takes, and 

working in a very difficult political-social-economic environment in order to keep the 

house alive. 

So thank you, Eugene, and thank you, Commission. 

Mr. PARKER. Thank you for your perspective. Do we have any last-minute—any 

burning desires, as they might say? I am glad you mentioned the veterans aspect. You 

know, our Chairman, Chris Smith, was Chairman of Veterans Affairs and did some inter-
27 

esting work on these questions, particularly homeless veterans, which, again, you know, 

alcoholism and drug abuse are issues that are found in that milieu as well. 

With that, I will thank everyone and turn it over to Mark for the last word. 

Mr. MILOSCH. Once in a while I get the last word. You know, I would like to turn 

the last word into the last question. I was reflecting on what we’ve been doing here. And 

it seems that—this is a bit different from the usual Helsinki Commission event. You 

know, usually we do something that has a clear U.S. foreign policy take, or hooks into 

a clear U.S. foreign policy issue and is a foreign policy goal, affected. And, you know, 

action items come out of our hearings and briefings. 

And that’s a good thing. The Commission was created for—to promote change, and 

especially in human rights and humanitarian affairs. And alcoholism certainly fits in with 

the humanitarian concern. 

This briefing is a little bit different. It’s not exactly so clear. If I were to say, you 

know, where does Congress go from here on this issue, it’s really far from clear. We’re, 

you know, very happy to provide a forum on this issue. And I’m sure the Congressman— 

the Chairman strongly supports what each of you are doing on this. 

But before I close, I would like to ask you this question of, you know, what Congress’s 

role might be, where we might go from here. Is there a—perhaps a programming element 

to what we’re talking about here? Would some other sort of Congressional action be called 

for, other than the forum that we’ve provided today? You know, it would be very helpful 

to hear about that. 

So one last question, and I’d like to hear from each of you, please. Thanks. 

Ms. BROWN. I don’t think I’m going to comment on that. I mean, I think this is a 

great start. We started the conversation here. You know, before Dr. Murray came, we 

were talking about the benefits of therapy. You talked about the benefits of pharmacological treatments. Seems like there’s a lot more discussion that has to happen before 

we can talk about Congress taking steps or taking any action, in my personal opinion. 

Mr. MILOSCH. Mr. Zubkov? 

Dr. ZUBKOV. I also think that this could be a beginning. Because we have a lot of 

contacts and opportunities in Russia. And, you know, while I was talking about the 

House, I wanted to say what initiative one person can do. But if the recent organized 

group—you know, which will deal with the situation—you know, the situation can be 

changed critically. I mean, one person did what he did, you know? Thousands of people, 

you know, hundreds of meetings started in the country. But this was an effort of one person alone, international effort. 

You know, there’s a group cooperation, there’s a group effort. And, you know, 

Bilateral Commission, a lot—many positive things could happen if it’s in the focus of 

attention of two countries. 

Mr. MILOSCH. Thank you, Doctor. 

Dr. Murray? 

Ms. MURRAY. You know, it’s an interesting question, because I think that, you know, 

Congress probably could do something to, you know, formalize some of the discussions 

that go on between the United States and Russia. We’ve been working—trying to work 

together with Russian scientists and, you know, Russian investigators that study alcohol 

over a number of years. It is, as Maria explained, a bottom-up approach. But to have some 

top-down to go along with that I think could possibly be helpful. 
28 

So even—you know, just some kind of a formal statement about, you know, the 

encouragement of the two countries working together because we don’t have enough scientists studying alcohol in the world. And so any place where we can have groups working 

together, we’re going to get closer to getting better answers. 

Mr. MILOSCH. Thanks very much. There is a Congressional Caucus on substance 

abuse and alcoholism. And we’ll be sure to get the transcript of our briefing to them. I 

want to thank all of you for participating, and thank Kyle for organizing this, and Josh 

Shapiro and everyone else for participating. 

Thank you very much. We’re adjourned. 

[Whereupon, at 4 p.m., the briefing ended.] 
29 

A P P E N D I C E S 
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1WHO European Regional Office, European Health for All Database, http://data.euro.who.int/hfadb/. 

2David Zaridze, Paul Brennan, Jillian Boreham, Alex Boroda, Rostislav Karpov, Alexander Lazarev, Irina 

Konobeevskaya, Vladimir Igitov, Tatiana Terechova, Paolo Boffetta, and Richard Peto, ‘‘Alcohol and CauseSpecific Mortality in Russia: A Retrospective Case-Control Study of 48,557 Adult Deaths,’’ The Lancet, June 

27, 2009, pp. 2201–2214. See also David Leon, Vladimir Shkolnikov, and Martin McKee, ‘‘Alcohol and Russian 

Mortality: A Continuing Crisis,’’ Addiction, October 2009, pp. 1630–1636; Artyom Gil, Olga Polikina, Natalia 

Koroleva, David A Leon, and Martin McKee, ‘‘Alcohol Policy in a Russian Region: A Stakeholder Analysis,’’ 

European Journal of Public Health, October 2010, pp. 588–594. 3 ITAR–TASS, June 30, 2009; July 4, 2009. 

MEMORANDUM 

January 10, 2010 

To: Commission on Security and Cooperation in Europe 

Attention: Kyle Parker 

From: Jim Nichol 

Specialist in Russian and Eurasian Affairs 

Subject: Information on Alcoholics Anonymous in Russia 

The following information on Alcoholics Anonymous in Russia is provided at your 

request. If you have questions, please contact me at 7–2289. 

BACKGROUND

Alcohol consumption in Russia remains much higher than in most of the world, 

according to the U.N. World Health Organization.1

Alcohol consumption in Russia declined briefly in the mid-1980s as a result of a 

sobriety campaign, but rose thereafter. Beginning in 1993, there was a large increase in 

male alcohol poisoning in Russia, along with increases in male homicide and suicide, 

traffic accidents, and circulatory and respiratory diseases. In June 2009, the Lancet 

reported that alcohol poisoning and alcohol-induced heart failure were among the major 

causes of early death of Russians aged 15–54, and that other causes of death related to 

alcohol consumption included depression, pancreatic disease, tuberculosis, and pneumonia. 

The report claimed that excess alcohol and tobacco usage among Russians accounted for 

most of the divergence between Russian and West European life expectancy, 62 years for 

Russian men and 72 years for Russian women in 2008, compared to, for example, 77 years 

for German men and 82 years for German women.2

In 2009, Russian President Medvedev became increasingly concerned about the 

prevalence of alcoholism in the country. At the end of June 2009, he stated that he was 

‘‘surprised to learn that we now drink more than we did in the 1990s, even though those 

were very difficult times.’’ A few days later, he warned that about 18 liters of alcohol are 

being consumed per capita per year, and that ‘‘this is a monstrous figure. 

After 9–10 liters [of alcohol per person per year], gene pool problems arise, and degradation begins.’’ 3 Some observers warn that the actual per capita consumption is even 

higher than the officially-cited 18 liters, since samogon (home-brewed alcohol) and surrogate alcohol (mainly ethanol) are not included. In September 2009, he ordered the government to develop policies to reduce alcohol consumption. The Health Ministry drafted a 

plan for discussion, and in November 2009, the Federal Service for Regulating the Alcohol 

Market (Rosalkogolregulirovaniye) drew up proposals to increase the minimum price of 

vodka, crack down on the illicit production of alcohol, increase penalties for selling alco-
64 

4 ‘‘Russians See Substance Abuse as Biggest Threat—Poll,’’ Central Eurasia: Daily Report, Open Source 

Center, September 3, 2010, Doc. No. CEP-950157. 5Peter Finn, ‘‘Russia’s 1-Step Program: Scaring Alcoholics Dry,’’ Washington Post, October 2, 2005. 6 Eugene Raikhel, ‘‘Post-Soviet Placebos: Epistemology and Authority in Russian Treatments for Alcoholism,’’ Culture, Medicine and Psychiatry, March 2010, pp. 132–168. 7Daria Khaltourina and Andrey Korotayev, ‘‘Potential for Alcohol Policy to Decrease the Mortality Crisis 

in Russia,’’ Evaluation and the Health Professions, September 2008, pp. 272–281. 8The Soviet Ministry of Health permitted a San Francisco-based AA group, working through the Center 

for Citizen Initiatives, a U.S. nongovernmental organization, to hold an officially-sanctioned AA meeting in 

Moscow in April 1986. See ‘‘Creating a Sober World Program,’’ Center for Citizen Initiatives, at http:// 

www.ccisf.org/about/casw.htm. See also ‘‘75 Years of Growth: The Spread of A.A.’s Message,’’ A.A. Around the 

World, Fall 2010; ‘‘A Visit to the Soviet Union,’’ A.A. Grapevine, July 1989; and Stephen White, Russia Goes 

Dry, Cambridge: Cambridge University Press, 1996, p. 173. 

holic beverages to minors, and develop sports and other programs advocating healthy lifestyles. 

In January 2010, Prime Minister Putin approved the anti-alcohol campaign. As per 

his decree, alcohol consumption per capita is to be reduced by 15% by 2012 and 55% by 

2020. In the second stage of the campaign, from 2013–2020, sports and healthy living will 

be stressed. Reportedly, legislation to carry out the campaign has bogged down in the 

legislature because of resistance from corrupt officials and commercial interests that rely 

on revenues from alcohol sales. In October 2010, Interior Minister Rashid Nurgaliyev 

stated that drinking by minors had increased and posed a national security threat, and 

in late 2010, both President Medvedev and Prime Minister Putin directed the legislature 

to soon enact increased penalties for the sale of alcohol to minors. A majority (57%) of 

Russians polled in August 2010 indicated that alcohol and drug abuse was the most 

pressing issue facing Russia.4

TREATMENT

Alcohol treatment in Russia has been dominated by concepts from the medical discipline of narcology, a subspecialty of psychiatry from the Soviet era. Treatment has consisted of detoxification, perhaps followed by a course of antipsychotic medications or barbiturates. A hypnotic technique has been heavily used to implant the idea in the addict 

that if they drink or use drugs again, they will die.5 Another aversion treatment has 

involved prescribing disulfiram—which induces nausea if alcohol is consumed while taking 

it (as used in the West, the drug is taken under supervision as part of a comprehensive 

treatment program)—or a placebo that is described as being like disulfiram.6 Some alcohol 

rehabilitation centers have included restraints such as shackles and bars. Most Russian 

regions have lacked alcohol treatment facilities. Western treatment and prevention 

methods have faced resistance, including from alcohol producers, organized crime, and corrupt officials, but slowly are being introduced.7

ALCOHOLICS ANONYMOUS IN RUSSIA

The growth of Alcoholics Anonymous (AA) in Russia began in 1986, through exchange 

visits between AA members and representatives of the former Soviet All-Union Voluntary 

Temperance Promotion Society.8 The General Service Foundation of AA in Russia was 

registered in 2000 as the national organization for purposes of taxation, banking, and 

signing contracts. Early supporters of AA included Yurii Svenko, president of the Russian 
65 

9 ‘‘A Cursory look at AA: What is AA?’’ at www.aarus.ru/pdf/glance.pdf, and ‘‘AA Groups in Russia,’’ at 

www.aarus.ru/index.php/groups-aa-russia.html. On U.S. data, see ‘‘A.A. Fact File,’’ General Service Office, 

2010, at http://www.aa.org/pdf/products/m-24laafactfile.pdf. 10 ‘‘The Problem of Alcoholism in Russia and the Society of Alcoholics Anonymous,’’ Radio Freedom, April 

19, 2006. 11 ‘‘Alcoholics Anonymous: Who are they?’’ Orthodox Church International Religious News Portal, October 

4, 2010, at cerkov.by/page/anonimnye-alkogoliki-kto-oni. 12The House of Hope, at http://www.houseofhope.ru/English/default.htm; Heidi Brown, ‘‘Russian Alcoholics’ Dying Hope,’’ Forbes, June 4, 2010; Heidi Brown, ‘‘Hi, My Name Is Boris,’’ Forbes, October 15, 2007. 13Tatyana Titova, ‘‘Alcoholics Anonymous Controversial in Russia,’’ Keston News Service, February 9, 

1999; Eugene Protsenko, ‘‘Christian Public Charity ’The Old World,’ ’’ Round Table: Education for Change and 

Diaconia, Department for External Church Relations of the Moscow Patriarchate, at http:// 

www.rondtb.msk.ru/info/en/alcohollen.htm#2. 14 ‘‘Russia: The Background,’’ Confident Kids, at http://www.confidentkids.com/Russia.htm#The%20Background; Mary Webb, ‘‘Russian Church-Based Alcoholism Treatment and Prevention,’’ 

East-West Church & Ministry Report, Summer 1999. 

Association of Independent Psychiatrists, who in 1999 stated that AA was ‘‘a highly valuable movement in Russia.’’ By 2000 there were at least 270 groups in more than 100 

cities, and by 2010 there reportedly were about 320 groups in nearly 150 towns and cities 

in most of the regions, republics, and territories of Russia (by comparison, AA reports that 

it has 56,694 groups and a total of 1,264,716 members in the United States).9 There is 

a national AA magazine and a newsletter. An All-Russian Convention is held each 

December in rotating locales and an annual General Services Conference is held in 

Moscow. There also are regional Intergroups in Magadan, Moscow, Omsk, Samara, St. 

Petersburg, Tomsk, and Yekaterinburg, where volunteers compile and disseminate 

meeting information and carry out other services. 

Some participants in an AA group in St. Petersburg stated in 2006 that about 6,000- 

7,000 individuals participate in AA meetings country-wide. They also reported that about 

50% of those coming to AA meetings stick with the program, that more young people and 

women are entering the program, and that many churches country-side provide space for 

AA meetings. Although there was some opposition to AA in previous years among some 

members of the hierarchy of the Orthodox Church, the relationship has improved, they 

stated.10 Another article states that many in the Orthodox Church hierarchy, including 

Kirill, Patriarch of Moscow and All Russia, have endorsed AA as a treatment method that 

may assist Orthodox Christians and bring atheists and others to Christ.11

The House of Hope on the Hill non-profit foundation was established in 1997 near 

St. Petersburg by the late U.S. businessman Louis Bantle as a residential rehabilitation 

center dedicated to providing free alcohol treatment based on the 12-step program of AA. 

The House of Hope has treated thousands of Russians and has received vocal support 

from Valentina Matviyenko, the governor of St. Petersburg.12

There are other treatment programs similar to AA in Russia. Yevgeniy Protsenko 

established the Old World Foundation in 1992, based on Orthodox Church doctrine and 

training he received at the American International Research and Training Institute for 

Alcoholism. Principles of the AA program are incorporated into his treatment program.13

In 1997, a U.S. Presbyterian missionary established the ‘‘Oporo’’ (Support) Christian 

Prevention and Training Program, based on the AA’s 12-step program. The Russian Ministry of Health reportedly was supportive in founding Oporo. In 1999, Russian officials 

reportedly asked Oporo to help launch a prevention program in secondary schools.14 The 
66 

15 East-West Church & Ministry Report, Summer 1999. 16Scott Peterson, ‘‘Where Russians Go to Dry Out,’’ Christian Science Monitor, May 2, 2005; Jane L. 

Emery, ‘‘Trends in Russian Addiction Treatment’’ Counselor, July 31, 2003, pp. 34–39. 

Salvation Army also operates a Christ-centered addiction prevention and treatment program in Russia.15

In 1993, Mikhail Morozov started informal alcohol treatments out of his home in the 

village of Durakovo, south of Moscow. His treatment program was based on AA’s 12-step 

program. The Orthodox Church has since sponsored and subsidized his efforts. Priests 

refer patients for treatment, and patients follow the traditional practice of working in the 

village for free as part of their treatment.16
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