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The killer cure for alcoholism in Russia
Dr. Vachyeslav Davidov shows reporter Gregory Warner the chemical that he will implant under his butt cheek.
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TEXT OF STORY
Kai Ryssdal: Alcoholism and Russia have a long and destructive history together. Alcohol abuse costs that country half a million deaths a year, most of them men of working age. It also costs billions of dollars in lost productivity. Male life expectancy in Russia is just 60 years, and the Russian population is predicted to shrink nearly 20 percent by the middle of the century, in part because of the drinking. Every problem, though, creates a market for a cure.
Our health care correspondent Gregory Warner traveled to Moscow to track down one very popular cure -- and the doctors who sell it.
Gregory Warner: For me, this all started with a story I heard about a friend's ex-boyfriend. A Russian alcoholic who promised he'd never ever drink again. Story was he got a capsule surgically inserted under his skin. Some kind of chemical compound, such that if he drank that capsule would explode into his bloodstream, and kill him.
When I got to Moscow, I found out there are dozens of clinics that do this procedure. I visit one of them with my translator Anna Masterova.
Warner: So is this the waiting room?
Anna Masterova: It's a private clinic.
It's a nice place. There's a fish tank in the waiting room, lush carpet and a list of treatments on the wall.
Masterova: They have all kinds of massage, like craft therapies.
And then, we're summoned to the office of the head doctor, Vyacheslav Davidov. He's got a pinstripe suit, and bright, bright green eyes.
Vyacheslav Davidov (via translator Anna Masterova): So usually this capsule is inserted into the buttocks.
That is, under the skin of your buttocks.
Davidov: Actually that's why it was called a "torpedo" because it is placed in a person's butt and kept the way a torpedo in a submarine is kept.
And then, if you have a drink, watch out.
Davidov: One can never exclude death, but of course the doctor is not going to kill his patient. But the person will feel very bad, extremely bad. You will have pains, almost unbearable pains.
Accelerated heart rate, shortness of breath, nausea, vomiting, throbbing headache, visual disturbance, mental confusion, and circulatory collapse.
Davidov: And these medicines can remain in the body from a short period of time to three years, for instance.
Warner: Is the capsule in some way a placebo?
Davidov: Placebo?
Davidov: Nyet eta nye placebo.
Nyet, it is not a placebo.
Davidov: If you don't believe, I can give you a pill for one day.
Warner: OK.
I said I'd take the pill.
Warner: Can you give me a pill that would last three years?
Davidov: If you agree!
Here's why I agreed. I couldn't leave Davidov's office without seeing the capsule and figuring out what's in it, but the whole time we'd been in his office, he wouldn't show me the pill or any of the clinic. The only way I was going to be able to see this supposed medicine was to agree to take it.
Masterova: You will be patient, you will be a patient.
Warner: Yeah.
Davidov: You ready?
Warner: Yeah, let's go!
So we leave his office, head upstairs, down this long hallway. There's a sound of screaming. He leads me into the procedure room. Just like an exam room in a doctor's office -- got the white furniture, the sterile instruments. Except against one wall is this old green leather chair with thick straps that go on your arms and legs. He tells me he's going to strap me to that chair, give me a pill -- with the same medicine that's in the torpedo -- and then he'll test it.
Masterova: So you take a pill and he will give you a drop of alcohol.
This is called a "provocation" because he puts just a drop of vodka on my tongue. Once that drop of vodka hits my tongue, I will feel all those symptoms. Next to the chair I see a defibrillator.
Masterova: In case when we do provocation, something happened, so we'll be able to...
Warner: Like if their heart stops?
Davidov: Da.
Masterova: Just in case.
Warner: Maybe, can I take it at home?
Davidov: Nyet.
So I, uh, chickened out.
Warner: Actually, no, I don't want to take it. I can't do it. I'm not strong enough.
He at that point realized he had won, and he shows me the pill at this point.
Masterova: This is what is inserted in the body.
Warner: Really? This is it? It's so...
Davidov: Little?
Warner: Little.
Davidov: Little.
So, it turns out, that inside that little pill is a very real drug, it's called disulfuram.
Eugene Raikhel: It was actually a substance that was used in the rubber industry.
Eugene Raikhel is an assistant professor at the University of Chicago.
Raikhel: And they found that the workers in the rubber industry were unable to tolerate alcohol.
Disulferam blocks a certain enzyme from being absorbed by the liver, so when you drink it causes all these very real symptoms. But it's only in Russia that they sell these very long-acting capsules.
Raikhel: Basically they tell you that they are injecting a long-acting form of disulfuram, which is not something that exists.
It does not last three years. In fact, it barely lasts a week. But...
Raikhel: This is not fringy at all.
He says up to 80 percent of addiction treatments by Russian doctors are procedures like this torpedo.
Raikhel: Yeah.
Meaning this is more popular than Alcoholics Anonymous and every other kind of treatment combined. Even my interpreter, Anna, her uncle was an alcoholic.
Masterova: He could go fishing and then disappear for a night, and nobody knew where he was. I mean, everybody knew that he was drunk.
Then he got a procedure like the torpedo.
Masterova: I don't know how it worked, but it did work for him. Because he hadn't drunk for the rest of his life.
Raikhel says if it worked it's partly because Russians understand addiction differently.
Raikhel: Here's the distinction: in North America, the prevailing understanding of addiction is it's not about the substance as much it is about the face that you're out of touch with some truths about yourself and your condition.
Whereas in Russia, he says...
Raikhel: Many of the patients I talked to say, "I don't have to change myself in any way, I don't have to become a different person."
I just have to get rid of my addiction. Which is what Dr. Davidov offers. When he gives you that pill and he puts that drop of vodka on your tongue, he scares that part of you into submission.
Masterova: And what rules this world? Fear!
For this service he charges 5,000 rubles -- $170. And if, a few weeks later you ignore his warning, you do take a drink, and nothing happens? Then you call up Dr. Davidov and he'll tell you that...
Davidov: It's like a delayed reaction.
That torpedo poison is loose in your bloodstream. It could cause a heart attack, or cancer. And you need to purchase the antidote.
Warner: And how much is the antidote?
Davidov: Vosim.
Masterova: 8,000 rubles.
8,000 rubles. About $300.
Davidov: If you want to drink, you have to pay!
In Moscow, I'm Gregory Warner for Marketplace.
Kai Ryssdal: Gregory's story was a collaboration with Radiolab, which is produced by WNYC and distributed by NPR.
Health care in Russia is an interesting experience. Of course, if you have enough money you can buy Euro-standard healthcare and medicines. Russians I know use herbal or folk remedies as their main treatment regime. When I had a bad head cold I was offered the choice of pouring ice water over my head or heating a kilo of salt in the oven, wrapping it in a t-shirt, to make a hot compress for my head. I chose salt. Only after all else fails, will they will go to or call for a doctor to visit. Doctor's care was seen as an admission of personal failure. Your story makes a lot of sense in this context.
I agree: Self reflection and internal restraint is the long term solution, provided one can survive long enough to see over that horizon. Within the gross confines of an alcohol dependence diagnosis, there are finer distinctions between individuals, and for some who are constitutionally incapable of being honest with themselves, pharmacotherapies like disulfiram can buy the respite necessary for self-reflection. It's not for everyone--but neither is AA.
@Luba: - I am of Russian descent - and I do not find this article in anyway offensive. This is a story about different approaches to battle alcoholism in Russia as opposed to that in USA.
In short - Russia's way of treatment is brutal, but very effective - in the USA people are granted way too many freedoms - pill version of the drug allows them to repeat their offense with drinking without any repercussions.
@NPR team: great work!
Interesting, and I believe ultimately,not helpful in the long term for an alcoholic. Unfortunately, as with any compulsive behavour self reflection and internal restraint is the longterm solution. I've been sober for 25 years I've yet to see any lasting punitive shortcuts
Although I don't have medical credentials per se, I manage admissions for an addiction medicine program at an urban county hospital. The trade name for disulfiram is Antabuse. It's an oral medication that's been used in the US for decades. It inhibits expression of an enzyme the liver uses to detoxify alcohol, so if you drink on it, if you're like most people, you will become violently ill. Of course, the catch is, you have to take it for it to work, hence the efforts to devise an implantable or injectable (depot) version that'll stay active without relying on a patient's fidelity to the oral regime. Antabuse is best suited to treat impulse drinking: Some patients might be doing ok for days with their abstinence, then up jumps the devil and, before they know it, they're three days into a bender. With disulfiram on board, assuming you're mentally competent, you'll be forced to check that impulse. As far as I know, there's no depot or 'torpedo' version approved by the FDA, but an intramuscular depot injection of naltrexone, another antidipsotropic, is approved. However, naltrexone won't make you sick if you drink on it; it works differently. There are contraindications and potential side effects to both of these drugs, it should go without saying, and without concurrent psychosocial treatment, abstinence and patient retention in treatment are less impressive.
Wow! This story did not strike me at all as something offensive. I thought it was rather insightful, especially the part about how Russian culture views addiction in comparison with the US. Equating this story with an American need for superiority is really silly, and makes me think that you might be over sensitive. One story on a peculiar cultural phenomenon is in no way stereotyping an entire nation of people.
I heard this story last night on NPR and as curious as it was, it was also a mocking and stereotypical portrayal of the Russian people and the way fear motivates them. Of all the news agencies in America, I had hoped that NPR would have the intelligent sensitivity to write stories that don't rely on and reinforce (inter)national or ethnic stereotypes. Becoming more globally minded might mean that all of us consider what happens to the human psyche when it is manipulated by generations of fear. Perhaps then, the archaic actions of a doctor prescribing inappropriate and dangerous drugs for alcoholism wouldn't be treated so crassly. If I were to comment on the way I heard this story, it would be to say (stereotypically)that perhaps it was an American need for superiority that drove this story.
