With Poland's freedom, comes rise in alcoholism


WARSAW -- In the Polish countryside it is best to drive slowly at night, lest you plow into an increasingly common hazard of darkened highways. If there were a sign for it, it would read Caution: Sleeping Drunk Ahead.

"The situation is everywhere the same," says Dr. Jerzy Mellibruda, director of the State Agency for Prevention of Alcohol Related Problems. "People are drinking very heavily."

Since the arrival of democracy and free-market economics, Poles are drinking more than they have in years. Drunk tanks have record numbers of overnight guests, alcoholism treatment centers are overflowing, and the country has generally gone on an unhealthy binge.

According to international health officials, alcoholism is a trend in much of Europe's former East Bloc. In Hungary and the former East Germany, the death rate from chronic liver disease and cirrhosis -- a commonly used indicator of excessive drinking -- has more than doubled since 1980.

The rate has increased by about 25 percent in Romania and 65 percent in Bulgaria. The number of people treated for alcohol-related psychoses has climbed during each of the past five years in Russia, Latvia, Estonia and Belarus.

It wasn't supposed to happen like this.

During the Cold War, the West pointed to drinking problems in the Soviet Union, Poland and other East Bloc nations as results of the despair inevitably bred by Communist rule.

"But, you know," Dr. Mellibruda says, "in every time and place there are always reasons for drinking." And the latest reason, he says, is "the cost of the social-economic transformation -- unemployment, instability and the fear of the future for the post-middle age generation."

The transformation to a free-market economy has also brought advertising and price competition for the hard-drinking consumer, making alcoholism cheaper and more convenient.

In the early 1980s, the average monthly salary in Poland would buy 30 half-quart bottles of vodka. Now it buys 65, and there are nearly seven times as many places to buy from than before -- about one alcohol outlet for every 300 people. Instead of waiting in the chronically long lines of the state-run stores, a bottle can be bought around the corner.

The drones of Communist bureaucracy also never thought of marketing alcohol with the sort of flashy billboards one now sees around Warsaw, featuring leggy women who make a drink seem like the next best thing to sex.

"All that advertising you see is against the law," Dr. Mellibruda points out.

But even if the law were enforced, the penalty would be only about $220 for a violation, a small cost when pitted against the $1,300 charge for a full-page newspaper ad, and even smaller when compared to the potential of additional sales.

Drinking seemed anything but sexy on a recent bleary-eyed morning at the 130-bed Warsaw Municipal Sobriety Chamber, a drunk tank that is breaking admission records.

One generally must pass out in the street, drive a car off the road or get mixed up in a brawl to earn an overnight stay at the center. Those who want to continue their brawling after arriving are met by beefy orderlies in padded rooms. Troublemakers are put into straitjackets or strapped to beds.

Since 1989, when 11,630 people were admitted to the center, the number of admissions has risen every year. The 1993 total was 22,805 and broke the record that dated from 1980, in the Communist era. In 1994 the number rose again -- to more than 28,000 -- and the center is on track to set another record by the end of this year.

"With all of the unemployment there is a feeling of being threatened, of uncertainty about tomorrow," Sobriety Chamber Director Aleksandra Sapiezynska said on a recent morning.

It was 10:30 a.m., and the first six clients of the morning had already stumbled in, four from the same street brawl.

Eight customers from the night before were in another hallway and walking soberly toward the exit, with wrinkled clothes, bloodshot eyes and uncombed hair.

"They are leaving now because, you know, they are very thirsty," Assistant Director Wojciech Wachol said.

If the trend of increasing admissions continues, Ms. Sapiezynska said, "perhaps a new sobriety center will have to be built. There is already talk of plans for another one on the outskirts of Warsaw."

Poles' consumption of alcohol has grown by 50 percent since 1989, and they now drink it at roughly five times and average consumption levels of Western countries. Poles consume an average of 11.6 quarts of alcohol a year, up from about 7.4 in 1989. That is roughly five times the average consumption levels of Western countries. But the consumption levels are even more devastating than they appear because of how people drink.

The habit here is not a glass of wine a day, or one beer at a meal. "The structure of consumption is very bad," Dr. Mellibruda says. "Sixty percent of it is spirits. . . . It is often a drinking-to-get-drunk approach, with more aggressive behavior in the family."

But Poland at least appears to be in the lead among its Eastern European neighbors in trying to get a grip on the problem.

Dr. Mellibruda has traveled to the United States to study successful treatment strategies in Minnesota and Pennsylvania at facilities with success rates of 50 percent and better (determined by the number of patients still sober six months after treatment).

The result is that Polish treatment centers which several years ago had success rates of only about 10 percent have increased their rates to about 30 percent.

The biggest problem is getting enough money to have an impact. Even when filled to the brim as they are now, the treatment centers can accommodate only 150,000 of Poland's 1 million alcoholics, and in rural areas there are virtually no facilities either for treatment or sobering up overnight.

Dr. Mellibruda said that's why so many rural alcoholics end up sleeping it off on the road, stretched out likes snakes that are drawn to the nightly warmth of the pavement.

"We just don't know how to reach these people," he says, "not unless we increase our potential for coping with these problems nationwide."

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