Translated material
Don't drink wisely
Dear editors!
In the previous issue ( TrV No. 44 ) an article by Lev Samuilovich Klein “It’s time to stop” was published. It is unlikely that this article left anyone indifferent. We can agree with much of it. What is L.S. Klein is certainly right in that alcoholism in Russia is a very serious problem.
The author is also right that alcohol is a drug and the attitude towards it should be the same as towards any drug. I have always been amazed by the inconsistency of the state on this issue. Alcohol is a hard drug. It causes strong physiological dependence and causes irreparable damage to health. Marijuana is a soft drug. It also does not bring any benefit, but the harm from it is tens of times less than from alcohol. At the same time, a person who sells marijuana is a criminal and is sent to prison. Our officials accuse people who propose introducing WHO-recommended methadone substitution therapy for heroin addicts of drug propaganda. And the same officials live on taxes from the sale of vodka. There is not a penny of logic here. It's just a matter of cultural tradition, which considers vodka quite acceptable and marijuana less acceptable.
However, this article has serious flaws. What can you expect from an article written by a scientist in a newspaper for scientists? First of all, a strict scientific approach to the facts presented and balanced recommendations based on this scientific approach. This article contains neither one nor the other.
The article outlines ideas about the biological basis of alcoholism that contradict scientific data. The author (albeit with reservations) presents the idea that the peoples of Southern Europe and the Jews, who had long cultivated grapes, acquired resistance to alcohol as a result of natural selection. On the contrary, Russians are not resistant to alcoholism, and the spread of alcohol threatens them with extinction. The article mentions the metabolism of serotonin, dopamine and endorphins as factors that determine the tendency to alcoholism.
This picture is far from reality. Of course, there is a genetic predisposition to alcoholism. For example, people with one variant of the dopamine receptor gene DRD2 have fewer dopamine receptors. Apparently, they lack the “joys in life” and are somewhat more likely to drink, smoke and develop alcoholism.
It is usually believed that carriers of the “bad” variant of this gene A1 (and the A2 variant is “good”) are predisposed to alcoholism. The frequency of the “bad” variant varies in different human populations. In all European populations it is similar and is about 0.10.25. For example, among the “southern” peoples, it is 0.23 among the Basques, and 0.27 among the French. Among “northern” Estonians this frequency is 0.20, among Russians - 0.18, among Komi - 0.12. Among two small samples of Jews from Ethiopia and Yemen, this frequency is significantly lower (0.07 and 0.08); among Ashkenazi Jews it is 0.11 (as in the Komi) [1]. The idea of selection for these genes in Europe apparently does not work. It is interesting to note that the frequency of the "bad" variant is noticeably higher (0.35-0.6) in many East Asian populations where alcoholism is rare.
The connection with alcoholism of other genes, whose products (enzymes) are responsible for the chemical transformations of alcohol, has been more clearly established. The enzyme alcohol dehydrogenase (ADH) converts alcohol into poisonous acetaldehyde, and a second enzyme, aldehyde dehydrogenase (ALDH), converts acetaldehyde into harmless acetic acid.
If the first enzyme works slowly, then the “joy of vodka” lasts longer. This option is characteristic of most Europeans (as well as such nationalities as the Chukchi and Eskimos). The "fast" variant of ADH ("the joy of vodka quickly passes") arose independently in Southeast Asia and among the Arabs of the Middle East. Among Russians, the frequency of this variant is much higher than among residents of Western Europe.
If ALDH works slowly, then even a small dose of alcohol causes extremely unpleasant sensations - “flash syndrome” (flushing to the face, nausea, palpitations, etc.). This gene “prevents you from becoming an alcoholic.” This variant of ALDH has a high frequency in Southeast Asia (Japan, some areas of China), but, unfortunately, is almost never found in other populations [2]
It should also be noted that the genes of Caucasian (and partly Mongoloid) ethnic groups are highly mixed. I’m afraid to disappoint Lev Samuilovich, but there simply are no “biologically pure Jews,” which he considers himself to be. It is widely known, for example, that a high percentage of “African” and “Asian” genes were found in James Watson’s genome, which he, apparently, was unaware of [3]. Who knows what our DNA hides...
We have to admit that the greater genetic predisposition to alcoholism of Russians and small peoples of the North compared to the French and Italians is simply a myth. Moreover, for the fight against alcoholism it is more harmful than useful (“is it my fault that I’m an alcoholic? It’s my Russian genes that are to blame!”).
L.S. Klein claims, citing unnamed doctors, that 8 liters of pure alcohol per person per year is the limit “beyond which the degradation and extinction of the entire people begins.” This common assertion also does not stand up to criticism. These are just WHO recommendations for “safe” drinking. That is, the WHO believes that if you drink less than 8 liters per year (distributing this amount evenly throughout the year), then most likely there will be no serious health problems. We emphasize “evenly distributed” and “most likely.” But there is no talk of any extinction of the people. According to the same WHO, in 1961, the consumption of pure alcohol by adults (15+ years) in France exceeded 25 (twenty-five) liters per person per year. Since then, it has steadily decreased and in 2001 it was “only” 13 L [4]. In Germany, during this entire period, alcohol consumption ranged from 10 to 16-17 liters. It seems that France and Germany did not die out, but remained prosperous countries with successful economies.
The problem for Russia is not only how much and what they drink... Much more important is how they drink. Compared to Western Europe, dangerous behavior related to alcohol (for example, drunk driving) is many times more common in Russia. The “load” of alcohol-related diseases is many times higher. It can be assumed that in Europe even drunkards care more about their health, and sometimes they receive better medical care than in Russia. So the reasons for the problems associated with alcohol in Russia (primarily high mortality) are not genetic, but social. And we can and should fight them.
But the most surprising thing in the article is the proposed L.S. Klein measures! His general idea, in my opinion, is that people are children, small and unreasonable. The state is a wise father, who with an iron hand must lead them into a bright future and make them live happily ever after. We all know well what grows out of such an attitude.
Establish actual prohibition for the majority of the population? We tried it more than once. Not only in the USA, but even in Finland this caused an increase in moonshine, smuggling and crime. Prohibition in Finland was abolished by popular vote.
Create services to combat moonshine? Such services have been fighting drugs for several years now, and the growth of heroin consumption in Russia is outpacing the growth of alcohol consumption. But planting a bag of marijuana is the best way to put “whoever needs it” in a pre-trial detention center... The problem is not the absence of a service, but who works in it and how . It’s easy to imagine how “a drunk policeman, a typical representative of the authorities,” will fight moonshine.
Take away your license for drunk driving for life? Apparently, Lev Samuilovich did not read the articles in Novaya Gazeta about how we often conduct “medical examinations” of drivers and for what purposes.
Paradoxically, among the measures proposed by the author, there is no desire to increase liability for the sale of alcohol to children (according to VTsIOM, the measure is the most popular among Russians). This measure is certainly correct. But the point, again, is not the absence of a ban, but how to transfer it from paper to real life.
None of these measures will work unless the consciousness and political system of society are rebuilt. If everything in it is handed over to officials. If neither public opinion nor scientific developments mean anything. It is a good wish to “involve pharmacologists, chemists, and doctors.” etc., what was said at the end of the article, unfortunately, radically diverges from its style and content, and most importantly, from the realities.
So what to do? Don't know. I think that first of all, study the experience of those countries where alcohol consumption has been reduced over the past 20-30 years. It would be interesting to read an article in which experts analyze this experience and evaluate its applicability in Russia.
CM. Glagolev,
Ph.D.
(non-drinker, I can’t imagine the alcohol lobby)
1. http://alfred.med.yale.edu/alfred/SiteTable1A_working. asp?siteuid=S1000144J
2. http://bio.fizteh.ru/student/files/biology/biolections/presentation/mipt_20090408_alkogol.pdf