A successful anti-alcohol policy

If your starting position is a totalitarian society in which on-the-job drunkeness has little penalty and is one of the ways of avoiding the world in which you live, alcohol consumption will be high. If that totalitarian society starts easing up on the totalitarianism on other margins while clamping down hard on alcohol consumption, using the tools of a totalitarian society to do it, you can achieve large reductions in alcohol consumption and reduce mortality rates. If your totalitarian society then collapses and imposes a whole lot of uncertainty on people who had previously had we-pretend-to-work jobs for life, while getting rid of the totalitarian forms of alcohol control, alcohol consumption then goes back up and so does mortality.

That's my take-away from the new Bhattacharya et al piece on Gorbachev's anti-alcohol campaign. [Ungated version via SSRN]

Alcohol consumption in the Soviet Union prior to Gorbachev's campaign exceeded 14 litres per capita - New Zealand hovers around 9 - 10 litres. Gorbachev's campaign included:

• Reductions in state production of alcohol in a country where state production was the only legal production;
• Restrictions on alcohol sales: no sales of vodka or wine before 2PM on business days, restaurants couldn't sell hard liquor, an increase in the drinking age to 21. Prohibition on sales near factories, schools, hospitals and airports; [airports?]
• Two 25% price increases;
• Penalties for public drunkenness; new alcohol-related offences. Heavy fines for being drunk at work: one to two times the average weekly wage. Large fines or imprisonment for home production or for possession of home brew equipment;
• Subsidisation of substitutes for alcohol: leisure facilities and the like;
• Propaganda and health education campaigns; "bans on glamorous media depictions of drinking";
• Creation of a national temperance society;
• Compulsory treatment for alcoholism; physician-supervised treatment for up to five years.

Official alcohol sales dropped but home production increased substantially; total alcohol consumption was estimated to have dropped from 14.56 litres to 11.46 litres. They note that sales of glass cleaners and alcohol-based glue increased substantially, as did theft of industrial alcohol. 

There were substantial declines in death rates and alcohol-related harms during the campaign, which brought Russian consumption down to a level more than ten percent higher than current New Zealand consumption. 

Notably, it looked like heavy drinkers' consumption was more affected than that of moderate drinkers: I strongly expect that the penalties for public drunkenness, penalties for being drunk on the job, and compulsory treatment were here doing the bulk of the work, though the authors correctly note that their data doesn't really let them tell which elements of the campaign were most effective. 

They conclude:

Overall, a key implication of our main findings is that Russia’s transition to capitalism and democracy was not as lethal as commonly suggested (Stuckler, King, and McKee 2009). However, our findings also do not necessarily imply that alcohol prohibition raises welfare (in Russia or elsewhere), even if it saves lives. Health is only one argument of welfare, and health-improving restrictions on individual choices can cause harm as well as do good.