COLUMN ONE : A Country Besieged by the Bottle : Russians’ traditional love of drink has turned into a national scourge. The post-Soviet flow of cheap liquor has brought soaring death rates, social problems and a generation of orphans.

Dima is 5 years old but has only just begun to speak. He parrots words but seems to understand little of what is said to him. He walks on tiptoe, and his hooded eyes, eyebrows and mouth all slant downward, pulling his tiny face into an unhappy crescent moon.

A child of the new Russia, Dima has been cursed by this nation’s ancient, now resurgent enemy: alcoholism.

Born to an alcoholic father and a hard-drinking mother in a period when vodka was cheaper and more available than at any time in Soviet memory, Dima has lived at Children’s Home No. 12 since he was 2 weeks old. Doctors say his deformed features and severe mental retardation are classic signs of fetal alcohol syndrome.

No one knows exactly how many alcohol-damaged babies are born every year in Russia. But experts agree that alcohol consumption has increased dramatically in recent years, blighting millions of lives and casting a pall over Russia’s social and economic revival.

Vodka has long been the scourge of Russia. Heavy drinking was usually celebrated, sometimes bemoaned, but mostly ignored by czars and Bolsheviks alike.

President Boris N. Yeltsin’s 4-year-old government has been especially tolerant, allowing cheap, potent spirits to be sold virtually unregulated.

But now public health officials have begun to point to alcohol abuse as a key factor in an alarming decline in public health since the demise of the Soviet Union.

That decline is fueled not only by drinking but also by a host of other problems that have conspired to make the new Russia an ailing society. Other hazards include smoking, a traditionally unhealthy diet made worse by many Russians’ new poverty, rampant chemical and radioactive pollution, widespread contamination of drinking water, a surge in infectious diseases, a general decline in health care, increasing violence, and the stress and despair bred of the economic and social convulsions of the past five years.

Child mortality is more than twice as high as in Western countries. Congenital birth defects are reportedly increasing, and last autumn only 20% of first-graders were declared completely healthy.

Russian women are dying of cancer at more than double the American rate. And men are dropping dead in the prime of life in ominous numbers.

“If the situation doesn’t improve in our country, then some half of the men of working age will be in cemeteries, and the rest will be invalids,” said Dr. Alexander S. Karpov, a Health Ministry alcoholism specialist.

A report by the State Research Center of Preventive Medicine recently concluded that the worsening health of Russians threatens the quality of life here, normal reproduction and the people’s ability to improve the socioeconomic situation in Russia.

The most worrisome statistics document an abrupt plunge in life expectancy.

In 1990, Russian men lived an average of 64 years; by 1994, life expectancy had plunged to 57, comparable to the rates in Bolivia, Pakistan and India. American men live on average to 72.

Russian female life expectancy dropped from 74 in 1989 to 71 last year. For American women, the life expectancy is 79.

Deaths here have outpaced births since 1992.

“There is absolutely no precedent outside of war or famine” for such a stunning drop, said Judith Shapiro, a University of London economist who studies Russian health trends.

Life expectancy “is so far below achievable levels for a country of this wealth, education and urbanization that it’s bizarre,” she said.

More than half of the increase in male mortality can be attributed to cardiovascular diseases, in which alcohol and tobacco play lethal roles, said Vladimir Shkolnikov of the Center for Demography and Human Ecology.

An additional 20% of the deaths are caused by accidents, suicide, alcohol poisoning from contaminated or poor-quality spirits--which killed 53,000 Russians in 1994 alone--and murder, which has jumped nearly fivefold since 1970.

“Russia is now a top-row homicide country,” Shkolnikov said. “In 1993, the death rate [for males] from homicide was the third-highest in the world, after Colombia and the black population of the United States. Now it’s even higher.”

World’s Top Drinkers

To soothe Russia’s painful passage to a post-Communist economy, many of its citizens have been dosing themselves with their favorite anesthetic.

Today, Russians are believed to be the heaviest-drinking people in the world, consuming an average of 14.5 liters of pure alcohol per capita in 1993, up from 10.6 liters in 1986, said Shkolnikov’s collaborator, Dr. Alexander Nemtsov of the Russian Federation Institute of Psychiatry.

The French, by comparison, imbibe 13 liters per year. The World Health Organization warns of health risks when per-capita alcohol consumption exceeds five liters per year.

Russian men do most of the drinking, belting down on average a half-liter bottle of vodka (about a pint) every other day.

Shkolnikov blames the Russian custom of quaffing straight vodka with a minimum of zakuski , or snacks, for causing quick inebriation and loss of self-control, which in turn explains the high rate of accidents and violence among drinkers.

“Russians drink a lot in a short period, and usually vodka,” he said. “The French drink slowly, and mostly wine. So [the] French are at risk for cirrhosis of the liver, and the latent period is 20 years. Russians are at high risk for accidents and violent death.”

With more Russians owning cars than ever, and drunk-driving laws flouted by any motorist who can afford to bribe a traffic officer, motor vehicle fatalities have nearly doubled since 1970.

The most common traffic death involves a driver running over a pedestrian. One or the other is usually drunk.

Alcohol is often the spark for the violence that has increased in the anarchic, stressful period since the demise of the Soviet Union.

About 70% of crimes are committed under the influence of alcohol, said Col. Georgy G. Zaigrayev of the Russian Interior Ministry’s research institute.

Last year, Zaigrayev said, 53,000 Russians died of alcohol poisoning caused by binge drinking or guzzling ersatz vodka that turned out to be industrial alcohol; about 25,000 murders were committed by intoxicated people; about 12,000 died in auto accidents caused by drunk drivers, and at least 1,500 died in fires known to be caused by drunks.

“We’re losing more than 100,000 people a year just from the direct effects of alcohol,” Zaigrayev said. “About 65% of these people are men between ages 30 and 45. This is the most productive time of their lives. They are working, and most are supporting children. It’s a huge loss for the nation.”

But alcohol abuse cuts a far wider swath through Russian society than statistics can show.

Orphanages are overflowing with abandoned, neglected and abused children. Some children end up parked in hospitals, since there is nowhere else to house them.

In Moscow alone, more than 500 newborns were rejected or dumped by their parents last year.

No more than 5% of the children under state care are truly orphans; most are the children of alcoholics, refugees, criminals or the vodka-perfumed armies of new homeless living on Russia’s streets.

The staff at Dima’s orphanage say about 70% of the children there have parents who drink.

“Before, they [parents] drank too, but they didn’t abandon their children,” said Larisa N. Savchenko, as she supervised a group of mostly undersized toddlers on the playground. “Now they sell their apartments, and their kids end up on the street. They come here because they are homeless. They get picked up from train stations, from basements.”

Like Dima, many of the orphans have developmental problems.

An impish 5-year-old named Natasha is bouncy and sociable, if terribly small for her age. But the staff say she is often hyperactive, irritable and difficult to control.

“Her mother drank and I think also used drugs,” Savchenko said.

Natasha has a 3-year-old half sister by a different father. She too has been stashed in the orphanage.

“The legacy of alcoholism in children will continue to burden Russia for decades,” Nemtsov warned.

Dima’s future looks especially grim. Children of alcoholics are particularly stigmatized in Russia, and a mentally disabled child such as Dima is considered un-adoptable.

He probably will be placed in one institution or another for life--a prospect made even more dismal by the deteriorating conditions of such establishments.

“He’ll be all right while he’s here. We want to keep him here as long as possible,” said Alla G. Moskalenko, the clinical psychologist at the children’s home.

When the staff of the home go to visit former wards who have been transferred to the orphanages that cater to older children, she said, “they always come back here upset.”

It is not hard to understand why drinking has spun out of control since the collapse of the Soviet Union.

In the seven Soviet decades--when the collective good took precedence over individual desires, personal initiative was often punished, and excellence brought few rewards--there was little motivation for sobriety or personal responsibility.

Social norms were enforced by a smothering, all-pervasive system of laws, rules and controls. Chronic drunks were locked up in hospitals for treatment; if that failed, they were sentenced to stints in special labor camps for alcoholics.

Now, suddenly, there is no totalitarian state to brake antisocial or self-destructive behavior.

The labor camps for alcoholics have been closed; drunk tanks continue to operate, but enforcement of the disorderly conduct laws is spotty.

Soviet-style treatment centers were so widely despised that few alcoholics checked themselves in voluntarily, and other than the growing Alcoholics Anonymous movement, little help is available for those who want to stop drinking.

Drunks can be spotted on the streets of nearly every nation. But in Moscow, it is not unusual to see a well-dressed young businessman unabashedly quaffing a beer with breakfast.

Nor is it rare to see a woman covered with bruises that her makeup cannot disguise, the legacy of a beating by a drunken husband or lover.

Grubby teen-agers who earn money peddling newspapers, maps or cigarettes on Moscow’s ever-meaner streets do not need to enlist a sympathetic adult to buy them liquor or cigarettes. Old rules banning the sale of alcohol to minors are virtually never enforced, and youngsters simply buy what they want from street stalls that stay open round-the-clock.

Ask an ordinary Russian why he indulges in a potentially lethal habit and the reply is likely to be a hoary proverb: “He who does not smoke and does not drink will die healthy.”

Social Pressure

Nondrinkers are social misfits in Russia. Guests risk causing serious offense if they decline a host’s offer of a toast--or two, or five.

“Chut, chut!” the host will reply, insisting that the guest have just a tipple. “A hundred grams is good for the health.”

A deal isn’t always a deal until the partners have drunk on it; double-crossing a person with whom one has shared a bottle is doubly villainous.

Consequently, Russians tend to be tolerant, or at least philosophical, about drunken transgressions.

Most of them only sigh when drunken seamen run ships aground, befuddled drivers wrap cars around trees, buildings slapped together by addled construction workers collapse like blinis, vodka-crazed soldiers rampage, or the newspapers report another ghastly industrial accident of the sort a society tolerant of on-the-job drinking is especially prone to. Russians raise their chins high and tap their throats with the third finger in a symbol for intoxication. No further explanation is required.

Even when Yeltsin has appeared on national television looking disoriented, slurring his words, waving his arms wildly to conduct a German marching band and nearly tumbling down the steps of his plane into the steadying arms of a waiting head of state, Parliament has not ordered hearings to probe the sobriety of the man whose finger rests on Russia’s nuclear trigger.

When Yeltsin slept through a scheduled meeting with the Irish prime minister and blamed his bodyguards for not rousing him, fellow citizens sighed and cracked jokes.

“Our Kremlin Loves to Drink,” declared the October issue of Ogonyok magazine. “In a month, they drink more than a year’s dose during the Brezhnev era.”

Only Yeltsin’s most bitter enemies dare accuse him of heavy drinking.

One of his most formidable rivals, presidential candidate Alexander I. Lebed, recently announced that he had given up drinking, remarking that “there should be at least one man in Russia who is sober.”

History’s Influence

From earliest times, Russians have been drinkers.

Popular legend has it that Prince Vladimir of Kiev, the 10th-Century bon-vivant-turned-saint, considered converting to Islam but decided to adopt Orthodox Christianity when he learned that Muslims were required to be abstemious.

Historically, though, most drinking here was done only during Orthodox church holidays, when a carnival spirit prevailed, and on Sundays, said Vladimir S. Yelistratov, a Moscow University linguist who studies alcohol and culture.

Everyday drinking became common only after urbanization.

The Soviet Union conducted periodic anti-alcohol campaigns, beginning with the Bolsheviks in 1919 and ending with a crusade by the last Soviet leader, Mikhail S. Gorbachev, in 1986 and 1987.

These crackdowns on drinking limited the availability of liquor but never addressed the motivation for drinking.

“The aim of drinking in Russia has always been to get drunk,” Yelistratov said. “We don’t understand why one should drink just for the heck of it without getting drunk.”

Now, amid economic crisis, widespread social instability, shorter life expectancy and a pervasive fear about what the future may bring, Russians have little reason to give up vodka or chain-smoking in hopes of a healthier future.

“Alcohol is a general tranquilizer for our people,” said Alexander A. Sergeyev, chief doctor of Hospital No. 17, Moscow’s main inpatient alcohol treatment center. “And it’s cheaper than food.”

Booze has been a major beneficiary of price deregulation.

Between 1990 and 1994, inflation and price decontrols together caused the consumer price index to multiply by 2,020.

But while food prices were multiplied by 2,154, Nemtsov noted, alcohol prices rose by a factor of 653. That means alcohol is three times cheaper relative to other products.

Today, a half-liter bottle of the cheapest vodka--not distilled but made from synthetic alcohol--can be purchased at any kiosk for about $1. It is now so cheap that traditional home brew, known as samogon , has all but vanished; the sugar it is made from is too expensive to make moonshine worth the bother.

“We have become free to drink,” said Tatyana Kiryakova, 43, who drank from age 14 until she joined the Moscow chapter of Alcoholics Anonymous nearly five years ago. “It’s easier to drink, and cheaper. When I started drinking, it was so hard to get alcohol.”

In the Brezhnev era, opening time for liquor stores was delayed until 11 a.m.; under Gorbachev, it was delayed to 2 p.m.

Lines stretched for hours, and stores often ran out of vodka or closed before shoppers reached the counter.

Desperate alcoholics such as Kiryakova drank eau de cologne, rubbing alcohol or window-washing fluid to assuage hangovers.

Novelist Venedikt Yerofeyev immortalized the agony of the dry age in a story about Moscow life, writing: “Oh, the most helpless and shameful time in the life of my people is the time from dawn until the liquor shops open.”

Now, early-morning drinkers need only venture to Kiev Station in downtown Moscow, where crowds of babushkas make ends meet by selling a bottle or two to customers who can’t wait until the stores open at 9 a.m.

AA member Kiryakova said she drank heavily throughout her second pregnancy and that, on the day her son was born, she and her husband spent the morning drinking beer.

She said her son, now 21, has emotional problems and is an alcoholic.

But getting money and alcohol was always a struggle for her.

Now, she said, alcoholics are free to sell their newly privatized apartments, drink away the proceeds and live on the streets.

“I once sold my refrigerator for money to drink, and my family lived without a refrigerator for two years,” she said. “Now, you can’t imagine what’s become of the people I used to drink with. Some people have sold their apartments and drunk themselves to death.”

Gorbachev was derided as “the mineral secretary” for his advocacy of mineral water over vodka.

Though his anti-alcohol campaign was short and much reviled, it sharply lowered the rate of accidents, absenteeism and death from alcohol poisoning and alcohol psychosis.

It also won the support of some women, who reported that domestic abuse declined thanks to their husbands’ enforced sobriety.

Significantly, male life expectancy rose from 62 years in 1984 to 65 years in 1987 before alcohol restrictions eased. By 1992, it was back at 62.

“The anti-alcohol campaign was carried out dreadfully but, nevertheless, 1 million fewer people died during that period,” Nemtsov said.

Public health officials are most alarmed to see young people drinking more and at younger ages.

“Young people are starting to drink not at 15 or 16, but at 13 and 14,” said the Interior Ministry’s Zaigrayev, lamenting what he called “the alcoholization of Russian society.”

In a 1987 survey of adolescent boys, 40% said they did not drink; by 1992, only 20% were abstainers.

Adolescents can form a physical and psychological dependence on alcohol much faster than adults--in some cases in as little as two years, alcoholism experts said. They warn that the trend threatens the health of a whole new generation of Russians.

But public health officials face a daunting task in trying to change attitudes about the legendary Russian vice.

Recently, the Moscow Times published an article, “Why Russia Must Drink,” arguing that alcohol gives the long-suffering people the strength to go on living.

“The business of Russia and vodka is a little like the chicken and the egg: Did Russia’s wretched history lead to alcoholism or did alcoholism lead to our wretched history?” the article asked. “Nobody knows.”

Monday: Old diseases pose new threats as Russia’s sickly health care system starts to collapse.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

GRIM PROGNOSIS: DISEASE, DEATH RAVAGE NEW RUSSIA

A Population in Decline

For he past three years, the number of deaths has outstripped births in Russia. Figures for 1994:

Population of Russia, 1994: 147.9 million

Number of births: 1.4 million

Number of deaths: 2.3 million

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Alcohol Abuse: A Lethal Problem

Russian male life expectancy at birth

Alcohol Consumption, annual liters per capita of pure alcohol

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Death by Vodka and Cigarettes

Rate of death per 100,000 Russian males, from causes linked to alcohol and/or smoking:

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1970 1984 1993 Cardiovascular and circulatory diseases 814 975 1089 Cancer of lip, mouth and larynx 5 9 13 Cancer of lung and bronchus 72 92 106 Cirrhosis of liver 16 24 24 Acute alcoholism 0.7 1.5 2.1 Motor vehicle accidents 23 31 42 Alcohol poisoning 30 35 54 Homicide 11 19 50

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Sources: Russian Federation State Statistics Committee; Vladimir Shkolnikov, Center for Demography and Human Ecology, Russian Academy of Sciences; estimates of alcohol consumption by Alexander Nemtsov, Dept. of Narcology, Russian Federation Institute of Psychiatry.