LIPETSK, Russia -- Worn out by the daily battle for survival, impotent in the face of overwhelming economic and social upheaval, more and more Russians are finding solace in an old fashion.
They're getting drunker than ever.
An epidemic of alcohol abuse is sweeping the nation, with costly consequences.
Here in Lipetsk, a typical city of 500,000 and center of a region of 1.2 million, doctors estimate that nearly half the adult male population is alcoholic. And this is a place where they are trying to do something about it.
For Russia, alcohol has become a deadly enemy, although one often overlooked in the general chaos of post-Communist life.
Experts attribute a dramatic drop in life expectancy -- unprecedented for a developed country -- largely to the steadily rising drinking of the last few years.
Six years ago, life expectancy for Russian men was nearly 65. Now it is 60, heading steadily to ward 59. In contrast, a newborn U.S. male can expect to live to 72.
"We're the heaviest drinkers in the world," says Alexander V. Nemtsov, head of the drug and alcohol department for the Russian Institute of Psychiatry in Moscow. "And our people don't consume it gradually. They take it in shock amounts."
While other people, such as the French, drink nearly as much alcohol as Russians, they do so leisurely, sipping wine. Russians throw back vodka until they can't stand up.
Alarmed by the toll that drinking was taking, Mikhail S. Gorbachev launched a tough anti-alcohol campaign in the mid-1980s. But Russians reacted perversely to the rather heavy-handed approach.
While fellow workers turned each other in for drinking, and bottle factories were smashed apartand vineyards uprooted, Russians cranked up home breweries and began drinking even more.
"As a result of the anti-alcohol campaign, the sale of alcohol was reduced by 60 percent," Dr. Nemtsov said. "But actual consumption increased by 20 percent."
Today, the campaign has been largely forgotten. The problem grows.
According to government statistics, the death rate has been steadily rising since 1988, particularly among working-age people. In 1988, the mortality rate for people between the ages of 30 and 44 was 30 deaths per 10,000 people. The 1992 figure was 46 per 10,000.
The major cause of death among that age group, Dr. Nemtsov said, is alcohol, which is causing more illness and is increasingly a factor in rising car and workplace accidents and in homicide. He estimates that about 25 percent of the work force's potential working hours was lost in 1991 because of alcohol-related illness or death.
"I think it's only getting worse,"he says. When the drinkers themselves reflect on their addiction, he says, they often mention the word "toska," which means an oppressive sickness of the heart, the feeling that might envelop you if you were alone in the middle of the endless steppe, caught in loneliness, darkness and despair.
And they nearly always begin with perestroika, the period in the middle 1980s when Mr. Gorbachev began loosening the controls on society, when people began to feel the first stirrings of freedom but discovered more loss of security than promise for the future.
"Take journalists," said Andrei Alexandrovich, a Muscovite who drinks every day. "We used to be first-class people, giving important information to the Communist Party, the Central Committee, the government. We went abroad and we were necessary and useful to the KGB and the country.
"Now we have only a very second ary role. We're not making enough money to survive. We're quite well aware we'll never have enough money to buy a car or apartment or dacha. So there's no reason not to spend it on drinking.
"And when you're drinking you're not thinking about all that. You can communicate with your colleagues. You can escape the problems, drug yourself, kill yourself as quickly as possible."
Others are less eloquent about it.
Standing in the street in Moscow, a little wobbly from his daily ration of a bottle and a half of vodka (750 ml), a professional driver named Ilya said that drinking is the only way he can relax. "I'm under stress every day. Vodka is the only way out."
His neighbor, Yuri, who works for the traffic police, said he started drinking as life became more unpredictable. About three or four times a week, he downs two bottles (one liter) of vodka. "I don't drink because I feel pleasure but to drown my emotions," he says.
Here in Lipetsk, 250 miles and a 10-hour train ride from Moscow, life is better and simpler in many ways than in the big city. Nikolai I. Malyukov, head of the health department, has valiantly kept a system running that is collapsing elsewhere.
Every day, patients are undergoing kidney dialysis or laser treatments. Helicopters fly in emergency cases from the outskirts, with up to six landings per day.
While Moscow ambulance drivers were striking for working vehicles, those in Lipetsk were driving a new, meticulously maintained fleet.
"Life goes on here," said Dr. Malyukov. "We're getting things done. You have to keep solving one problem at a time."
Two years ago, Lipetsk began sending psychologists into the schools to talk to teen-agers and teach them about the perils of drinking.
"Until then, we only dealt with registered alcoholics," said Dr. Mikhail I. Korostin, who is in charge of drug and alcohol problems. "Now we're trying to reach people before they're sick."
At first, he said, the exercise was somewhat awkward and unrewarding. Now the psychologists are trying to avoid lecturing youngsters and instead involve them in conversations about how they're feeling -- a revolutionary concept in this society.
Local officials have even enforced a ban against alcohol and tobacco advertisement on local television and in newspapers, which is better than officials in Moscow have been able to do, even though a law banning such ads was passed last summer.
Still, they face a superhuman task in a society where vodka is revered. The name vodka, in fact, is an endearing term for water. Even many doctors believe it can offset the effects of radiation. It is an indispensable mark of hospitality. And more and more people cannot live without it.
"In the last 30 years, alcohol consumption has increased 12 times," said Dr. Korostin. "The figures are very dangerous. It means we have an epidemic."
Extrapolating from the number of alcoholics who get treatment in his city, Dr. Korostin estimates that 120,000 of the adult male population of 250,000 is alcoholic.
"That's disastrous," he says.
One of Lipetsk's major employers is the Novolipetsk Iron and Steel Corporation, which has 48,000 workers. It runs its own hospital and clinic, with 1,170 beds, 350 doctors and 1,000 nurses, who last year treated 30,000 patients.
Vyacheslav V. Muratov, the head doctor, said many factory employees were indeed drinking more.
"They've cut production 40 percent in some parts of the factory," Dr. Muratov said. "Workers have more free time. They're drinking out of boredom."
Russia's thirst has not been at all slaked by the kind of individual health-consciousness seen in the United States. There's little information about a healthy diet -- most people think the more fatty sour cream the better.
"Russia is not an information-driven society," says Andrei K. Demin, a medical adviser to the National Security Council. "This is only our dream.
"We were brought up on an ideology that didn't consider the individual," Dr. Demin said. "One had to sacrifice everything -- his healthand all resources for the state. Life had little value."
Getting sick was something of a blessing. You could get official permission to stay home from work and perhaps even be sent to a sanitarium to recuperate.
Turned into a small silent cog in the giant Soviet wheel, the average person was left with a feeling that he could do very little to control his life.
But he could always get drunk, as reflected in a popular saying here: "Drink in the morning and you're free all day."
There are advocates in government, such as Dr. Demin and Alexei Yablokov, who chairs a commission on health and environment and has worked hard to publicize the hazards that lead to a virtual death sentence for Russians.
But amid the financial and political chaos, they have a difficult time making themselves heard.
"I hope this situation will not last more than a year or so," Dr. Nemtsov says. "After all, it can't go up indefinitely. Where in history has a whole population ever drunk itself to death?"