Svetlana, a 32-year-old self-described alcoholic, had managed to stay off the booze, but one day two years ago she just had to have a drink. This time she sat down by the phone so she could call an ambulance, then took a sip from a bottle of beer.
"I was very afraid," said Svetlana, who fully expected to asphyxiate when just one swig of alcohol hit her bloodstream. She only hoped that she would have time to make the call and that the ambulance crew would be able to revive her.
"I was absolutely sure something terrible would happen to me," she recalled.
Three months earlier, Svetlana had been "coded" -- a catchall term for a Russian method of treating alcoholism that essentially involves scaring the living daylights out of the alcoholic. Dating to the former Soviet Union, it involves the manipulation of the alcoholic's psyche to create the belief that alcohol equals death.
Alcoholics get 'coded'
In Svetlana's case, that was induced by mild hypnosis followed by injection of a temporary but powerful drug that could attack her respiratory system. Before the drug kicked in, the doctor gave her a little vodka to taste. She became dizzy and had difficulty breathing before the doctor stepped in with some oxygen to revive her.
The injected medicine, the doctor said, would stay in her system. "I've coded you for a year," he said, according to Svetlana. "And if you drink in that time, you will die." He insisted that she sign a release form saying he would bear no responsibility for her death should she drink within 12 months.
"I believed him, because we had all heard stories about people who were coded and died when they drank," said Svetlana, who didn't want her last name published because she said her co-workers didn't know she was an alcoholic.
In the last 20 years, hundreds of thousands of people in Russia and other countries of the former Soviet Union have been coded against the desire to drink. But some doctors fear that the increasing sophistication of the population and the use of the technique against other addictions, such as gambling, are draining the method of its essential ingredient: the power of suggestion.
Russian chat rooms now buzz with discussions about its fallibility, and Web sites offer methods to test whether a coded alcoholic has been administered a placebo or a real drug that can cause violent illness when mixed with alcohol. "Knowledge about unsuccessful coding is spreading, and faster than it ever has before," said Alexander Nemtsov, a psychiatrist at the Moscow State Scientific and Research Institute of Psychiatry. "But we still don't have the alternatives to replace it."
Rampant alcohol abuse
Alcohol abuse, marked by binge drinking, has soared to all-time highs in Russia. More than 50,000 people die annually from alcohol poisoning, compared with about 400 annually in the United States, according to Russian researchers. It is not unusual for Russians to consume one or more bottles of vodka at a single sitting. There is little available to alcoholics in the way of long-term counseling; 12-step programs, such as Alcoholics Anonymous, are still in their infancy here.
For many Russians, the only available treatment is coding.
After 30 minutes of waiting for a medical crisis that never came, Svetlana said, she drained the bottle of beer and then cracked open another. By the next day, she was deep into a binge that would last four months. Now two years later, she attends Alcoholics Anonymous and has been sober for 16 months.
Coding was created by a Soviet psychiatrist, Alexander Dovzhenko, who assumed a cult-like status in the treatment of alcoholism. "The Dovzhenko method is basically a form of hypnosis: You drink, you die," said Andrei Yermoshin, a private psychotherapist who no longer uses the method, preferring long-term therapy. "It's fast and cheap, and supposedly you don't have a problem for a year or two years or five years, depending on how long you have been coded for."
The method's efficacy has never been seriously studied, Nemtsov said. But some Russians swear by it.
Andrei Pavlov, a chemist at a state research institute in Vladimir, about 100 miles east of Moscow, was first coded for five years in 1995. After a group lecture that involved some relaxation techniques, he said, a doctor massaged his head for several minutes, whispering mantras about the dangers of drink.
"He said, if you drink, it might lead to paralysis or blindness," said Pavlov, 54, who was re-coded in 2000 and says he's been sober for nine years. "Coding is like a computer program inside your head. And when you start drinking, something goes wrong and it may damage your brain."
More actor than doctor
Nemtsov said he used to tell his patients that he could manipulate nerve points in their mouths that would lead them to become very ill if they drank. He said he gave them a liquid local anesthetic to swill and then placed electrodes with a very mild current in their mouths to create the belief that he was permanently removing their ability to consume alcohol safely. "I was an actor much more than a doctor," Nemtsov said. "I had a wonderful effect on them. It's a form of psychotherapy, quick, indirect psychotherapy."
Other doctors place astronaut-style helmets on their patients and tell them they are manipulating their brains. And some say they are administering potentially fatal drugs, which are in fact placebos, to convince patients that their bodies contain a substance that will be fatal if mixed with alcohol.
"It's a technological secret we're not supposed to disclose," said Alexei Magalif, a Moscow psychiatrist, when asked what drugs are administered to patients. "I can only say all these cocktails are a form of psychotherapy." He said the method is not used at the private clinic where he now works.
"You have to believe in something," said Dmitry Polyakov, 32, who has been coded four times in five years and has been sober for six months. Most recently, he had what he believes to be a drug that can't be mixed with alcohol stitched into his shoulder. "You have to have the will to stop. But coding is an auxiliary help, just in case. I want to believe in it because I don't want to drink."