Content area
This study investigates the historical dynamics of substance use disorders (SUDs) in Ukraine from 1955 to 2023. Analysis of long-term epidemiological data reveals two distinct waves of SUD epidemics occurring approximately 20 years apart: the first involving alcohol use disorders (AUDs), and the second involving drug use disorders (DUDs), which emerged at roughly one-tenth the scale of AUDs. The most influential determinants of these patterns were the anti-alcohol campaign during the Perestroika era (1985–1991) and the socioeconomic crisis that followed the collapse of the Soviet Union (1992–2001). The study explores correlations between SUD indicators and key demographic and socioeconomic variables, including crime rates, suicide rates, mortality, birth rates, and gross domestic product (GDP). Results demonstrate that Ukraine’s long-term depopulation and repeated sociopolitical upheavals have significantly influenced the incidence of SUDs. The findings underscore the importance of situating substance use trends within broader historical, political, and economic contexts to inform effective public health strategies.
Introduction
A comprehensive assessment of the dynamics underlying the spread of many non-communicable diseases—such as hypertension, obesity, and diabetes—as well as certain infectious diseases, including chronic viral infections like HIV/AIDS, requires long-term observation spanning years or even decades. This principle also applies to the proliferation of substance use disorders (SUDs), which typically unfold over extended periods. A notable contemporary example of such a long-term epidemic is the opioid overdose crisis in the United States, characterized by multiple “waves” of mortality spanning several decades [1, 2].
Over extended periods not only can the epidemiological landscape of substance use disorders (SUDs) undergo substantial transformation, but so too can the social, economic, and political conditions within a given country. This is particularly evident in nations experiencing major historical transitions—such as Ukraine. Since the mid-twentieth century, the people of Ukraine have witnessed profound systemic upheavals: from being citizens of the Soviet Union, they experienced the death of dictator Joseph Stalin [3], Nikita Khrushchev’s “Thaw” [4], Leonid Brezhnev’s “Stagnation” [5], Mikhail Gorbachev’s “Perestroika” and the accompanying anti-alcohol campaign [6, 7], the collapse of the USSR and the ensuing socioeconomic crisis [8], the 2014 Revolution of Dignity [9], the Russian Federation’s occupation of part of Ukraine’s territory [10], the COVID-19 pandemic [11], and, most recently, the full-scale Russian invasion that began in 2022 and continues to the present day [12].
Addiction proliferation is heavily influenced by a country’s sociopolitical and historical context [13, 14–15]. This study will examine these processes within Ukraine’s specific historical circumstances.
Another necessary condition for the success of such studies is a stable system of data collection and analysis that maintains the continuity of the methodology over many years or even decades. It must be said that in Ukraine this condition was met. Despite the historical turbulence described above, since the 1950 s, the Department of Medical Statistics of the Ministry of Health of Ukraine has carefully collected information on the incidence and prevalence of SUD and compiled annual statistical reports on its basis. In turn, the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine” studied these reports and summarized the information contained in them in the form of regular analytical re-views.
All this created the necessary prerequisites for achieving the main purpose of this study, namely to describe the dynamics of the incidence and prevalence of SUDs in Ukraine over the past seven decades in their historical context.
Methods
Measures
The primary focus of this study is the long-term dynamics of substance use disorder (SUD) indicators in Ukraine, specifically the incidence and prevalence of alcohol use disorders (AUD; ICD-10 code F10) [16], psychotic alcohol use disorders (PAUD; ICD-10 codes F10.4–F10.5), and drug use disorders (DUD; ICD-10 codes F11–F19), where “drugs” refers to all psychoactive substances excluding alcohol. In addition to SUD-specific indicators, the study also examines the dynamics of key demographic and socioeconomic variables—used as proxies for societal well-being—including population size, birth rate, mortality rate, suicide rate, crime rate, and gross domestic product (GDP). The interaction between these contextual indicators and the epidemiological trends in SUDs constitutes a central analytical dimension of this research.
The following operational definitions were used for the variables analyzed in this study:
Incidence. The number of newly registered cases of a disorder within institutions of the Ministry of Health (MoH) of Ukraine during a given calendar year.
Prevalence. The total number of individuals diagnosed with a disorder and registered in MoH institutions at the end of the reporting year.
Population (in thousands). The total number of residents in Ukraine as of the end of the reporting year. Territorial scope note: For data from 1955 to 2014, estimates are based on Ukraine’s internationally recognized borders (as of 1991). For 2015–2023, estimates reflect only the territory under the control of the Government of Ukraine, excluding areas occupied by the Russian Federation.
Birth rate. The number of live births per 1,000 population in the reporting year.
Mortality rate. The number of deaths per 1,000 population in the reporting year.
Suicide rate. The number of deaths by suicide per 100,000 population in the reporting year.
Crime rate. The number of officially registered criminal offenses per 1,000 population in the reporting year.
Gross Domestic Product (GDP). The total GDP expressed in constant 2015 U.S. dollars.
Recovery. Defined according to national drug treatment service standards: a patient is considered “recovered” and removed from the treatment register if they have not sought medical care for a substance use disorder for at least five years following their last recorded treatment episode.
Data sources
Data on the incidence and prevalence of AUD, PAUD and DUD in Ukraine from 1955 to 2023 were obtained from the annual official statistical reports of the Ministry of Health (MoH) of Ukraine. Prior to 1991, these reports were produced under the jurisdiction of the Ukrainian Soviet Socialist Republic (Ukrainian SSR), then a constituent republic of the Soviet Union [17, 18, 19, 20–21]. These statistics are based on medical records of individuals who sought treatment and were officially registered at narcological and psychiatric facilities during the corresponding reporting year. It should be noted that individuals with substance use disorders who did not seek medical assistance in a given year were not captured in these data, representing a fundamental limitation inherent to this collection method. From 1955 until 1991, the reports were compiled by the Department of Medical Statistics of the Kharkiv Research Institute of Neurology and Psychiatry named after V. P. Protopopov—now the State Institution “Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine” [17, 18]. Since 1991, this responsibility has been transferred to the Center for Medical Statistics of the MoH of Ukraine, which, Since 2022, operates under the name Center for Public Health of the MoH of Ukraine [19, 20–21].
While these reports were distributed only for official use during the Soviet era among the heads of psychiatric and drug treatment institutions of the MoH of Ukrainian SSR, in the years following Ukraine’s independence they became publicly accessible. As of today, they are also available through the official website of the Public Health Center of the MoH of Ukraine [22].
Data for this study were obtained from several open electronic resources (Opendatabot, Dostup do pravdy, New Criminal Code. Statistics), all of which operate in accordance with the Law of Ukraine No. 2939-VI “On Access to Public Information.” These resources draw on data from official state registers, including the Unified State Register of Legal Entities, Individual Entrepreneurs and Public Organizations, court registers, and the Unified Web Portal of Open Data. To ensure the integrity of this data, the authors conducted selective verification checks by cross-referencing the information with primary sources, confirming the validity of the data used in this study.
Data on the population of Ukraine from 1955 to 2021 were obtained from the annual statistical reports of the Ministry of Health of Ukraine [17, 18, 19, 20–21]. For the years 2022 and 2023, population estimates were sourced from the International Monetary Fund (IMF) [23], as the figures provided in the corresponding MoH reports did not account for the substantial number of refugees who fled the country as a result of the ongoing Russian military aggression. This is another sociopolitical factor in the modern history of Ukraine that significantly influences the dynamics of the substance use disorders.
Data on the number of births and deaths in Ukraine over the period 1990–2023. were obtained on the specialized websites “Opendatabot” and “Dostup do pravdy” (“Access to the truth”) [24, 25–26]. Data on the number of births in Ukraine before 1991 were obtained from the Demoscope-Weekly website [27]. Data on the number of deaths in Ukraine in 1955, 1960, 1965, 1970, 1975, 1980 and 1985 were obtained from the website “Mortality in Ukraine” [28], and the gaps in them were filled by linear interpolation.
Data on the number of births and deaths in Ukraine for the period 1990–2023 were obtained from specialized open-data platforms, including Opendatabot and Dostup do pravdy (“Access to the Truth”) [24, 25–26]. Birth data for the period prior to 1991 were sourced from the Demoscope-Weekly website [27]. Information on the number of deaths in selected years—1955, 1960, 1965, 1970, 1975, 1980, and 1985—was obtained from the Mortality in Ukraine database [28]. Missing annual data points between these reference years were estimated using linear interpolation.
Data on the number of suicides in Ukraine in 2005–2020 and 2021 were taken from the websites “Opendatabot.ua” [29] and “Dostup do pravdy” (“Access to the truth”) [30], respectively. Data for 2022 and 2023 were unavailable at the time of writing. Suicide data for the period 1991–2004 were taken from the analytical publication “Epidemics of alcoholism and drug addiction mirrored by medical statistics of the MoH of Ukraine” (2009) [31], while 1990 data were obtained from Kalabekov I.G.’s monograph The USSR and the countries of the world in numbers (2015) [32].
No suicide data specific to the Ukrainian SSR prior to 1990 were found in the available literature. However, both Kalabekov’s monograph [32] and the website Suicides in the USSR [33] provide data on suicide mortality in the Soviet Union—of which Ukraine was a part—for the years 1923–1926, 1965, 1970, 1975, 1980, and 1984–1990. These sources also note that in 1990, the suicide mortality rate in Ukraine closely approximated that of the entire Soviet Union (20.6 vs. 21.0 per 100,000 population). Therefore, to estimate suicide mortality in the Ukrainian SSR before 1990, the study used all-Union data as a proxy and applied linear interpolation to fill in the gaps.
Data on the number of crimes in Ukraine for the periods 2003–2012 and 2013–2023 were obtained from the websites New Criminal Code. Statistics [34] and About Registered Criminal Offenses and the Results of Their Pre-Trial Investigation [35], respectively. Crime statistics for 1991–2002 were sourced from the analytical publication Epidemics of Alcoholism and Drug Addiction as Mirrored by Medical Statistics of the Ministry of Health of Ukraine (2009) [31], originally published in Ukrainian.
No direct data on crime rates in the Ukrainian SSR prior to 1991 were available in the reviewed literature. However, relevant data for the Soviet Union—of which Ukraine was a part—were found in E.V. Kuritsyna’s article Crime in Soviet Society in 1953–1964 (Socio-Criminological Aspect) [36] and on the website Crime in the USSR (1960–1990) [37], covering the years 1956–1964 and 1960–1990, respectively. These sources indicate that in 1990, the crime rate in Ukraine was approximately 73.9% of the corresponding rate for the entire Soviet Union (7.13 vs. 9.65 per 1,000 population). Therefore, for the purpose of estimating crime trends in the Ukrainian SSR from 1955 to 1990, this ratio (73.9%) was applied to the available all-Union data, with missing values interpolated as needed.
Data on the dynamics of gross domestic product (GDP) in Ukraine for the period 1987–2023 (expressed in constant 2015 U.S. dollars) were obtained from the World Bank [38], the United Nations Conference on Trade and Development (UNCTAD) [39], and the International Monetary Fund (IMF) [40]. Comparable data for the Ukrainian SSR prior to 1987 were not available in the reviewed literature. However, Angus Maddison’s monograph The World Economy (2006) provides historical GDP estimates for the Soviet Union (of which Ukraine was a constituent republic) for the years 1950–1991, in constant 1990 U.S. dollars [41].
A partial overlap in GDP data for the period 1987–1991 between Maddison’s Soviet Union numbers and the World Bank’s Ukrainian estimates enabled the calculation of the Ukrainian SSR’s approximate share of Soviet GDP. Accounting for price level differences between 1990 and 2015, Ukraine’s share during this period ranged from 7.91% to 8.23%, with an average of 8.20%. This average proportion was then applied to the Soviet Union’s GDP figures to generate a rough estimate of the Ukrainian SSR’s GDP (in constant 2015 U.S. dollars) for the years 1955–1990.
A narrative review of statistical data was conducted, contextualized within distinct sociopolitical periods in Ukrainian history. This qualitative analysis was complemented by quantitative correlational analysis. Data processing was performed using Microsoft Excel 2019 [42], and Spearman’s rank correlation coefficients were calculated to assess the strength and direction of associations between substance use disorder indicators and relevant demographic and socioeconomic variables.
This study employs a combined Results and Discussion format rather than separate sections. Given the panoramic nature of our epidemiological data spanning multiple decades of Ukrainian history, the significance of our findings is is deeply intertwined with their historical and sociocultural context. Presenting results apart from discussion would require substantial repetition and could disrupt the narrative coherence essential for understanding the complex interplay between substance use trends and sociopolitical developments. By integrating results with historical interpretation, we are able to present specific epidemiological patterns immediately alongside the analysis of their relationship to relevant sociopolitical correlates, creating a more direct and accessible argument for readers seeking to understand how Ukraine’s unique historical trajectory has shaped substance use disorder dynamics over time.
Results and discussion
Data on the dynamics of substance use disorders in Ukraine—along with key demographic and socioeconomic indicators and their correlations—are presented in Tables 1 and 2 and visualized in Figs 1 through 9. A comprehensive analysis of these data is best conducted in chronological order, corresponding to the major sociopolitical periods Ukraine has experienced over the past seven decades.
Prehistory
The totalitarian regime [43] established in the USSR under Joseph Stalin [3] exercised strict control over information that could potentially undermine the authority of the Communist Party. Within official Soviet ideology, alcoholism—the most prevalent form of substance use disorder in the USSR—was framed as “the most harmful relic of capitalism” [44]. This ideological stance likely contributed to the absence of official data on the prevalence of alcoholism in the Ukrainian SSR prior to 1955.
“Ottepel’“(“The Thaw” − 1953–1964)
The period following the death of Joseph Stalin on March 5, 1953, became known unofficially as the “Thaw.” This era, associated with the leadership of Nikita Khrushchev [4], was marked by a series of political and social reforms: the denunciation of Stalin’s cult of personality and his repressive policies, the release of political prisoners, the dismantling of the GULAG system, and a general shift from totalitarian rule toward a more lenient authoritarianism. These changes were accompanied by a relaxation of censorship, a modest increase in freedom of expression, and the ongoing post-war economic recovery [45]. Also, the first official Ministry of Health (MoH) data on the incidence of substance use disorders (SUDs) in the Ukrainian SSR emerged at the beginning of this period, in 1955 (see Table 1; Figs. 1 and 6).
During this period, attention is drawn to the initially very low incidence rates of SUDs, followed by a rapid increase. Specifically, over the course of the “Thaw,” the incidence of alcohol use disorders (AUD), psychotic alcohol use disorders (PAUD), and drug use disorders (DUD) rose by factors of 6.62, 4.86, and 4.63, respectively. This sharp growth occurred alongside moderate increases in other indicators of social distress, such as crime and suicide rates, which rose by 17% and 15%, respectively.
Table 1. Trends in substance use disorder indicators and demographic and socioeconomic variables in the Ukrainian SSR/Ukraine, 1955–2023
Years | Substance use disorder indicators | Demographic and socioeconomic indicators | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Incidence 1) | Prevalence 2) | Population (thousands) | Birth rate (per 1000 people) | Mortality rate6) (per 1000 people)US$ | Suicide mortality Rate 7) (per 100,000 people) | Crime Rate8) (per 1000 people) | GDP (constant 2015 US$):9) | ||||||||||
AUD (F10): 3) | PAUD (F10.4-F10.5): 4) | DUD (F11-F19): 5) | AUD (F10): 3) | DUD (F11-F19): 5) | million US$ | US$ per Capita | |||||||||||
persons | per 100,000 people | persons | per 100,000 people | persons | per 100,000 people | persons | per 100,000 people | persons | per 100,000 people | ||||||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 1410) | 1510) | 16 | 17 | 18 |
1955 | 854 | 2.16 | 605 | 1.53 | 64 | 0.16 | 2961 | 7.49 | 303 | 0.77 | 39612.6 | 20.21 | 7.40 | 14.40 | - | 53142.3 | 1341.55 |
1956 | 964 | 2.40 | 704 | 1.76 | 87 | 0.22 | 3500 | 8.73 | 324 | 0.81 | 40236.3 | 19.88 | 7.28 | 14.60 | 2.15 | 58229.8 | 1447.20 |
1957 | 1274 | 3.13 | 692 | 1.70 | 86 | 0.21 | 4377 | 10.76 | 391 | 0.96 | 40869.8 | 19.55 | 7.17 | 14.90 | 2.47 | 59411.1 | 1453.67 |
1958 | 2585 | 6.27 | 1519 | 3.68 | 148 | 0.36 | 6376 | 15.46 | 477 | 1.16 | 41513.2 | 19.22 | 7.06 | 15.20 | 3.15 | 63869.8 | 1538.54 |
1959 | 2727 | 6.53 | 1448 | 3.47 | 91 | 0.22 | 10,358 | 24.80 | 582 | 1.39 | 42135.6 | 18.89 | 6.96 | 15.50 | 2.16 | 63164.9 | 1499.09 |
1960 | 4378 | 10.35 | 1638 | 3.87 | 198 | 0.47 | 14,770 | 34.93 | 688 | 1.63 | 42767.3 | 20.46 | 6.90 | 15.70 | 2.27 | 69166.9 | 1617.29 |
1961 | 3968 | 9.27 | 1887 | 4.41 | 113 | 0.26 | 16,324 | 38.15 | 793 | 1.85 | 43365.2 | 19.58 | 6.66 | 16.00 | 3.00 | 73130.2 | 1686.38 |
1962 | 3411 | 7.87 | 1910 | 4.41 | 140 | 0.32 | 17,562 | 40.53 | 769 | 1.77 | 43924.8 | 18.78 | 6.81 | 16.30 | 2.96 | 75111.9 | 1710.01 |
1963 | 6546 | 14.93 | 2567 | 5.85 | 234 | 0.53 | 23,425 | 53.42 | 1103 | 2.52 | 44445.9 | 17.60 | 6.87 | 16.60 | 2.63 | 73397.0 | 1651.38 |
1964 | 6338 | 14.29 | 3300 | 7.44 | 326 | 0.74 | 28,598 | 64.49 | 1488 | 3.36 | 44941.4 | 16.22 | 6.80 | 16.80 | 2.47 | 82886.0 | 1844.31 |
1965 | 10,416 | 23.24 | 4876 | 10.88 | 349 | 0.78 | 48,376 | 107.94 | 1743 | 3.89 | 45387.1 | 15.61 | 7.60 | 17.10 | 2.42 | 87592.4 | 1929.90 |
1966 | 10,208 | 22.55 | 5704 | 12.60 | 373 | 0.82 | 68,154 | 150.53 | 1998 | 4.41 | 45809.1 | 15.28 | 7.37 | 18.30 | 2.83 | 91841.5 | 2004.87 |
1967 | 14,287 | 31.22 | 7356 | 16.08 | 396 | 0.87 | 87,931 | 192.16 | 2253 | 4.92 | 46235.4 | 14.83 | 7.44 | 19.50 | 2.74 | 95900.0 | 2074.17 |
1968 | 21,819 | 47.21 | 9003 | 19.48 | 419 | 0.91 | 116,712 | 252.55 | 2508 | 5.43 | 46635.2 | 14.43 | 7.68 | 20.70 | 2.92 | 101521.1 | 2176.92 |
1969 | 27,770 | 59.63 | 12,908 | 27.72 | 395 | 0.85 | 143,597 | 308.36 | 2453 | 5.27 | 46990.9 | 14.52 | 8.15 | 21.90 | 2.98 | 102950.1 | 2190.85 |
1970 | 29,417 | 62.71 | 15,187 | 32.37 | 418 | 0.89 | 177,144 | 377.61 | 2554 | 5.44 | 47279.1 | 14.79 | 8.90 | 23.10 | 3.18 | 110857.6 | 2344.75 |
1971 | 30,540 | 64.64 | 17,086 | 36.17 | 441 | 0.93 | 202,359 | 428.33 | 2654 | 5.62 | 47597.8 | 15.37 | 8.98 | 23.60 | 3.19 | 113811.0 | 2391.10 |
1972 | 45,685 | 96.05 | 18,568 | 39.04 | 464 | 0.98 | 241,284 | 507.28 | 2755 | 5.79 | 47974.2 | 15.21 | 8.79 | 24.20 | 3.18 | 114458.9 | 2385.84 |
1973 | 51,827 | 108.26 | 18,283 | 38.19 | 487 | 1.02 | 280,061 | 585.03 | 2856 | 5.97 | 48301.5 | 14.71 | 9.09 | 24.70 | 3.10 | 124081.3 | 2568.89 |
1974 | 64,030 | 133.06 | 17,647 | 36.67 | 511 | 1.06 | 336,368 | 699.02 | 2956 | 6.14 | 48602.7 | 14.85 | 9.42 | 25.30 | 3.34 | 127682.5 | 2627.07 |
1975 | 75,589 | 156.28 | 18,473 | 38.19 | 534 | 1.10 | 399,039 | 825.01 | 3057 | 6.32 | 48892.2 | 14.77 | 10.00 | 25.80 | 3.48 | 128044.6 | 2618.92 |
1976 | 74,034 | 152.17 | 19,098 | 39.25 | 557 | 1.14 | 459,620 | 944.72 | 3531 | 7.26 | 49144.5 | 14.76 | 10.03 | 26.40 | 3.55 | 134046.6 | 2727.60 |
1977 | 86,005 | 175.79 | 19,648 | 40.16 | 580 | 1.19 | 524,413 | 1071.90 | 3955 | 8.08 | 49357.4 | 14.53 | 10.39 | 27.00 | 3.46 | 137209.6 | 2779.92 |
1978 | 90,211 | 183.41 | 18,970 | 38.57 | 603 | 1.23 | 589,159 | 1197.86 | 4328 | 8.80 | 49536.6 | 14.77 | 10.85 | 27.70 | 3.70 | 140658.5 | 2839.49 |
1979 | 95,793 | 193.78 | 19,185 | 38.81 | 626 | 1.27 | 652,258 | 1319.47 | 4165 | 8.43 | 49739.7 | 14.89 | 11.02 | 28.30 | 4.02 | 139991.6 | 2814.48 |
1980 | 97,317 | 195.92 | 18,349 | 36.94 | 729 | 1.47 | 705,557 | 1420.46 | 4267 | 8.59 | 49973.9 | 14.84 | 11.40 | 28.90 | 4.25 | 140163.1 | 2804.73 |
1981 | 99630 | 199.67 | 18404 | 36.88 | 970 | 1.94 | 755148 | 1513.41 | 4663 | 9.35 | 50221.0 | 14.60 | 11.03 | 29.10 | 4.44 | 141439.7 | 2816.35 |
1982 | 101468 | 202.48 | 16977 | 33.88 | 1211 | 2.42 | 796588 | 1589.63 | 5056 | 10.09 | 50384.0 | 14.80 | 11.60 | 29.30 | 4.53 | 144926.7 | 2876.44 |
1983 | 102983 | 204.82 | 15588 | 31.00 | 1452 | 2.89 | 830545 | 1651.87 | 6296 | 12.52 | 50564.0 | 16.00 | 11.93 | 29.50 | 5.47 | 149556.8 | 2957.77 |
1984 | 105571 | 209.27 | 15902 | 31.52 | 965 | 1.91 | 866265 | 1717.19 | 7543 | 14.95 | 50754.0 | 15.60 | 11.88 | 29.70 | 5.45 | 151481.3 | 2984.62 |
1985 | 107003 | 211.41 | 12320 | 24.34 | 2418 | 4.78 | 881745 | 1742.09 | 10437 | 20.62 | 50917.0 | 15.34 | 12.10 | 24.60 | 5.55 | 152834.1 | 3001.63 |
1986 | 94670 | 186.34 | 6293 | 12.39 | 1931 | 3.80 | 862669 | 1697.98 | 12692 | 24.98 | 51097.0 | 15.50 | 12.01 | 18.90 | 5.24 | 159122.1 | 3114.12 |
1987 | 89443 | 175.20 | 5436 | 10.65 | 4352 | 8.52 | 849998 | 1665.00 | 16606 | 32.53 | 51293.0 | 14.80 | 12.10 | 19.10 | 4.70 | 161179.9 | 3142.34 |
1988 | 73519 | 143.38 | 4449 | 8.68 | 1931 | 3.77 | 832298 | 1623.22 | 19229 | 37.50 | 51521.0 | 14.40 | 12.01 | 19.50 | 4.84 | 164609.7 | 3195.00 |
1989 | 67160 | 130.53 | 5279 | 10.26 | 2809 | 5.46 | 776950 | 1510.05 | 20970 | 40.76 | 51773.0 | 13.30 | 12.03 | 21.00 | 6.33 | 167067.6 | 3226.93 |
1990 | 66133 | 127.19 | 4403 | 8.47 | 3002 | 5.77 | 760380 | 1462.38 | 22466 | 43.21 | 51891.4 | 12.60 | 12.13 | 20.60 | 7.13 | 161488.0 | 3112.04 |
1991 | 57343 | 110.25 | 5783 | 11.12 | 4226 | 8.13 | 750935 | 1443.77 | 25025 | 48.11 | 52000.5 | 12.10 | 12.88 | 20.70 | 7.80 | 147438.5 | 2835.33 |
1992 | 54875 | 105.22 | 6480 | 12.42 | 4758 | 9.12 | 744358 | 1427.25 | 27691 | 53.10 | 52150.4 | 11.40 | 13.37 | 22.50 | 9.21 | 132842.1 | 2547.29 |
1993 | 59742 | 115.00 | 8367 | 16.11 | 8365 | 16.10 | 739089 | 1422.71 | 33735 | 64.94 | 51949.5 | 10.70 | 14.28 | 24.10 | 10.38 | 113978.5 | 2194.03 |
1994 | 55802 | 108.12 | 7851 | 15.21 | 9195 | 17.82 | 736122 | 1426.23 | 39268 | 76.08 | 51613.0 | 10.00 | 14.82 | 26.90 | 11.09 | 87877.4 | 1702.62 |
1995 | 63573 | 123.98 | 11433 | 22.30 | 12318 | 24.02 | 736215 | 1435.77 | 46515 | 90.71 | 51276.6 | 9.60 | 15.46 | 28.40 | 12.52 | 77156.4 | 1504.71 |
1996 | 58630 | 114.78 | 11020 | 21.57 | 12906 | 25.27 | 726423 | 1422.14 | 52362 | 102.51 | 51079.4 | 9.20 | 15.21 | 29.90 | 12.08 | 69440.8 | 1359.47 |
1997 | 55558 | 109.71 | 9583 | 18.92 | 10631 | 20.99 | 715790 | 1413.52 | 55429 | 109.46 | 50638.8 | 8.70 | 14.89 | 29.60 | 11.64 | 67357.5 | 1330.16 |
1998 | 52172 | 103.83 | 9187 | 18.28 | 10866 | 21.63 | 702733 | 1398.61 | 62006 | 123.41 | 50245.2 | 8.40 | 14.33 | 29.60 | 11.46 | 66077.7 | 1315.11 |
1999 | 51495 | 103.30 | 9397 | 18.85 | 10380 | 20.82 | 698451 | 1401.08 | 68078 | 136.56 | 49850.9 | 7.80 | 14.83 | 29.00 | 11.21 | 65945.6 | 1322.86 |
2000 | 51774 | 104.69 | 10657 | 21.55 | 11153 | 22.55 | 687730 | 1390.59 | 74187 | 150.01 | 49456.1 | 7.80 | 15.33 | 29.40 | 11.48 | 69836.4 | 1412.09 |
2001 | 52309 | 106.67 | 10878 | 22.18 | 11456 | 23.36 | 679289 | 1385.27 | 79919 | 162.98 | 49036.5 | 7.70 | 15.21 | 27.00 | 10.49 | 75982.0 | 1549.50 |
2002 | 51949 | 107.69 | 10525 | 21.82 | 10620 | 22.01 | 668894 | 1386.57 | 83868 | 173.85 | 48240.9 | 8.10 | 15.65 | 26.00 | 9.54 | 80039.1 | 1659.16 |
2003 | 52714 | 110.31 | 10411 | 21.79 | 8600 | 18.00 | 658972 | 1378.97 | 85448 | 178.81 | 47787.3 | 8.55 | 16.02 | 25.80 | 11.64 | 87656.2 | 1834.30 |
2004 | 56165 | 118.39 | 10611 | 22.37 | 6579 | 13.87 | 656001 | 1382.74 | 85006 | 179.18 | 47442.1 | 9.01 | 16.05 | 23.70 | 10.96 | 97995.5 | 2065.58 |
2005 | 57025 | 121.07 | 10421 | 22.13 | 6314 | 13.41 | 650188 | 1380.43 | 84325 | 179.03 | 47100.5 | 9.05 | 16.60 | 22.60 | 10.31 | 101005.2 | 2144.46 |
2006 | 53921 | 115.34 | 8677 | 18.56 | 5781 | 12.37 | 643185 | 1375.82 | 82863 | 177.25 | 46749.2 | 9.85 | 16.22 | 21.40 | 9.00 | 108652.7 | 2324.16 |
2007 | 59022 | 127.02 | 9598 | 20.66 | 5177 | 11.14 | 636608 | 1370.06 | 81179 | 174.71 | 46465.7 | 10.17 | 16.42 | 21.60 | 8.64 | 117579.4 | 2530.46 |
2008 | 60158 | 130.23 | 9362 | 20.27 | 5974 | 12.93 | 633483 | 1371.40 | 83089 | 179.88 | 46192.3 | 11.05 | 16.33 | 20.50 | 8.32 | 120217.3 | 2602.54 |
2009 | 48328 | 105.14 | 6237 | 13.57 | 6290 | 13.68 | 618840 | 1346.38 | 81782 | 177.93 | 45963.4 | 11.15 | 15.38 | 21.10 | 9.46 | 102020.7 | 2219.61 |
2010 | 42733 | 93.34 | 4890 | 10.68 | 6251 | 13.65 | 607461 | 1326.84 | 80589 | 176.03 | 45782.6 | 10.87 | 15.25 | 19.90 | 10.94 | 106195.4 | 2319.56 |
2011 | 40706 | 89.27 | 4215 | 9.24 | 5860 | 12.85 | 597789 | 1310.99 | 77105 | 169.10 | 45598.2 | 11.02 | 14.57 | 19.70 | 11.31 | 111978.0 | 2455.75 |
2012 | 39445 | 86.78 | 3794 | 8.35 | 5354 | 11.78 | 584961 | 1286.95 | 76366 | 168.01 | 45453.3 | 11.46 | 14.59 | 19.90 | 9.76 | 112148.5 | 2467.34 |
2013 | 37780 | 83.27 | 3405 | 7.50 | 4645 | 10.24 | 573821 | 1264.68 | 75157 | 165.64 | 45372.7 | 11.10 | 14.60 | 20.60 | 12.42 | 112199.5 | 2472.84 |
2014 | 30920 | 72.07 | 2305 | 5.37 | 3732 | 8.70 | 484115 | 1128.38 | 60587 | 141.22 | 42903.5 | 10.86 | 14.75 | 18.60 | 12.33 | 100891.0 | 2351.58 |
2015 | 28921 | 67.64 | 2026 | 4.74 | 3591 | 8.40 | 471859 | 1103.51 | 60187 | 140.76 | 42759.7 | 9.63 | 13.91 | 17.70 | 13.22 | 91031.0 | 2128.90 |
2016 | 29381 | 68.98 | 2157 | 5.06 | 3719 | 8.73 | 470196 | 1103.98 | 60696 | 142.51 | 42590.9 | 9.32 | 13.70 | 16.20 | 13.91 | 93253.0 | 2189.51 |
2017 | 28314 | 66.75 | 2301 | 5.42 | 3938 | 9.28 | 463896 | 1093.71 | 60906 | 143.60 | 42414.9 | 8.58 | 13.54 | 15.30 | 12.35 | 95453.8 | 2250.48 |
2018 | 27362 | 64.81 | 2544 | 6.03 | 3830 | 9.07 | 456158 | 1080.51 | 60686 | 143.75 | 42216.8 | 7.96 | 13.92 | 14.90 | 11.54 | 98783.5 | 2339.91 |
2019 | 25068 | 59.71 | 2597 | 6.19 | 3592 | 8.56 | 452003 | 1076.62 | 61122 | 145.59 | 41983.6 | 7.36 | 13.84 | 14.70 | 10.58 | 101944.1 | 2428.19 |
2020 | 17921 | 42.94 | 2117 | 5.07 | 3782 | 9.06 | 441700 | 1058.40 | 62419 | 149.57 | 41732.8 | 7.17 | 14.78 | 14.60 | 8.64 | 98118.4 | 2351.11 |
2021 | 16981 | 40.88 | 1956 | 4.71 | 4080 | 9.82 | 437061 | 1052.06 | 64650 | 155.62 | 41543.5 | 6.59 | 17.19 | 14.20 | 7.74 | 101499.1 | 2443.20 |
2022 | 13674 | 39.25 | 1465 | 4.20 | 5164 | 14.82 | 393154 | 1128.46 | 61182 | 175.61 | 34840.0 | 5.91 | 15.55 | - | 10.41 | 71962.9 | 2065.53 |
2023 | 14516 | 43.73 | 2188 | 6.59 | 5039 | 15.18 | 365963 | 1102.56 | 62066 | 186.99 | 33192.0 | 5.65 | 14.95 | - | 14.33 | 74961.2 | 2258.41 |
1) Incidence – the number of new cases of the disease registered by the MoH of Ukraine during the year. 2) Prevalence – the number of patients registered in MoH of Ukraine institutions at the end of the year. 3) AUD (F10) – alcohol use disorders (ICD-10 code F10). 4) PAUD (F10.4-F10.5) – psychotic alcohol use disorder (ICD-10 code range F10.4- F10.5). 5) DUD (F11-F19) – drug use disorders, where the term "drugs" includes all psychoactive substances except alcohol (ICD-10 code range F11-F19). 6) Mortality – the total number of deaths per 1000 population during the year. 7) Suicidality – the number of suicide deaths per 100,000 population during the year. 8) Criminality – the total number of crimes per 1000 population during the year. 9) GDP (constant 2015 US$) – gross domestic product (GDP) at constant 2015 prices in US dollars. 10) Columns 14 and 15: 1955–1985 data based on five-year intervals; intermediate years calculated by linear interpolation.
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Fig. 1
Dynamics of incidence (per 100,000 people) of alcohol use disorders (AUD), psychotic alcohol use disorders (PAUD) and drug use disorders (DUD) in Ukrainian SSR-Ukraine during 1955–2023, define “crisis”
“Zastoy” (“The stagnation” − 1965–1984)
In Soviet historiography, the unofficial term “Stagnation” typically refers to the period beginning with Leonid Brezhnev’s rise to power [5] in the mid-1960s and lasting until the onset of “Perestroika” in the latter half of the 1980s. This era marked a reversal of the modest liberalization achieved during the “Thaw,” with increased suppression of dissent and the gradual rehabilitation of Stalin’s image. Although the economy continued to grow during this time, it developed deep structural problems, including technological stagnation relative to developed nations, intensified militarization, declining labor productivity and product quality, persistent consumer goods shortages, and an increasing dependence on raw mineral exports [46].
These growing dysfunctions were mirrored in public health and social well-being metrics. According to the Ministry of Health of the Ukrainian SSR, the incidence of alcohol use disorders increased ninefold over these two decades, reaching 105,571 new registered cases by 1984. In contrast, the incidence of psychotic alcohol use disorders peaked earlier in 1977 at 19,648 cases—3.69 times higher than in 1965—before declining by 27% by the end of the stagnation period (1984). This decline in PAUD cases, despite the continued rise in overall AUD incidence, likely reflects the 1976 establishment of a specialized narcological service [47], aimed at improving care for individuals with substance use disorders (narcology, a subspecialty of psychiatry in the USSR and post-Soviet states, focuses on addiction treatment). Drug use disorders also increased significantly during this era, growing by a factor of 2.45. Simultaneously, other social indicators deteriorated: total mortality increased 1.56 times, crime rates rose 2.25 times, and suicide rates grew by 1.74 times.
“Perestroika” (1985–1991) and anti-alcohol campaign (1985–1990)
The period from 1985 to 1991 in the Soviet Union was marked by significant political and economic reforms known as Perestroika, initiated by Mikhail Gorbachev [6]. These reforms were aimed at democratizing public life (glasnost), introducing market-oriented mechanisms into the centrally planned economy, and reducing geopolitical tensions through a shift in foreign policy priorities. However, the reform process lacked coordination and ultimately contributed to the intensification of systemic crises across political, economic, and social domains, culminating in the dissolution of the USSR [6].
Concurrently, the Soviet government launched a large-scale anti-alcohol campaign (1985–1990) [7] in response to escalating alcohol consumption, which had reached approximately 14 L of absolute alcohol per capita by 1984 when including illegal production [48]. The campaign encompassed a broad range of measures: reductions in the production and availability of alcoholic beverages, restrictions on retail sale hours and venues, enforcement against illicit distillation, destruction of vineyards, public temperance initiatives, and the censorship of alcohol-related references in cultural products, such as movies and music [49].
As a result, official production of alcohol declined significantly, from 230.3 million decaliters in 1980 to 198.9 million in 1986, and 92.8 million by 1987 [32]. Importantly, available data suggest that illegal alcohol production did not fully compensate for the reduction in legal supply, particularly in the early three to four years of the campaign. Epidemiological data for the Ukrainian SSR indicate a marked reduction in alcohol-related health harms during this period. Between 1985 and 1991, the incidence of alcohol use disorder decreased by 1.92 times, while the incidence of psychotic forms of AUD declined by 3.63 times between 1985 and a local minimum in 1988. However, the PAUD incidence subsequently increased by 1.28 times by 1991, mirroring a rebound in other indicators. This two-phase pattern was also observed in alcohol poisoning (ICD-10: F10.0) and alcoholic cirrhosis (ICD-10: K70.3) [50].
Social indicators demonstrated similar dynamics. The incidence of suicide and reported crimes declined during the early years of the campaign, reaching local minima in 1987 (by 1.55 and 1.16 times, respectively), before rising again through 1991 (by 1.08 and 1.66 times, respectively, compared to 1987). In contrast, the incidence of DUD continued to increase throughout the period, peaking in 1987, potentially reflecting intensified detection efforts following the introduction of the “Regulations on the Medical and Educational Dispensary for Drug Addicts” in 1986 [51].
Notably, population mortality—which had exhibited a long-term upward trend—stabilized during the anti-alcohol campaign. Between 1985 and 1990, mortality in the Ukrainian SSR remained within a narrow range (12.01–12.13 deaths per 1,000 population) (see Table 1; Figs. 1–4). Comparable patterns were observed in other Soviet republics. For example, in the Russian Federation, mortality decreased from 10.6 per 1000 in 1985 to 9.7 in 1986, and it is estimated that approximately 1.22 million premature deaths were prevented during 1986–1991 as a result of reduced alcohol consumption [52, 53].
Despite these public health gains, the anti-alcohol campaign had significant economic consequences. State revenues from alcohol sales constituted a substantial portion of the Soviet budget, and their decline contributed to fiscal strain. According to estimates from Gorbachev’s advisor Georgy Shakhnazarov, the campaign’s economic cost was approximately 100 billion rubles [54]. Mounting economic difficulties and growing public dissatisfaction ultimately led to the abandonment of the campaign by the end of the decade. Alcohol production and sales resumed, along with corresponding increases in alcohol-related harms [54].
The crisis following the collapse of the USSR and ukraine’s recovery (1992–2007)
The dissolution of the Soviet Union [54] triggered a profound socio-economic crisis across the former Soviet republics, including Ukraine. The severing of inter-republic economic ties disrupted the integrated national economy, leading many enterprises to bankruptcy or severe downsizing [54]. By 1999—the nadir of Ukraine’s post-Soviet economy—the nation’s gross domestic product (GDP) had fallen to only 39.47% of its 1989 level (Table 1; Figs. 2–4).
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Fig. 2
Dynamics of gross domestic product (GDP), incidence of psychotic alcohol use disorders (PAUD), drug use disorders (DUD). *- GDP- gross domestic product per capita in US dollars (at constant 2015 prices); ** - Other indicators: Suicidality – the number of suicide deaths during the year (per 100,000 population); PAUD – incidence of psychotic alcohol use disorder (per 100,000 people) and DUD – incidence of drug use disorders (per 100,000 people)
This economic collapse was accompanied by a sharp rise in unemployment and a significant decline in household income [55]. Simultaneously, the ideological vacuum left by the fall of communism, following decades of enforced atheism and suppression of religion, precipitated a widespread existential crisis and a sense of hopelessness. By 1995, only 35% of Ukrainians reported being generally satisfied with life.
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Fig. 3
Dynamics of gross domestic product (GDP), birth rate, mortality and criminality in Ukrainian SSR-Ukraine during 1955- 2023. * - GDP per capita - gross domestic product per capita in US dollars (at constant 2015 prices); ** - Other indicators: Birth rate - total number of children born during the year (per 1000 population); Mortality – the total number of deaths during the year (per 1000 population); Criminality – the total number of crimes during the year (per 1000 population)
These socio-economic and psychological stressors were mirrored in the epidemiological data. Between 1992 and 1996, the incidence of PAUD and DUD increased by 1.74-fold and 2.77-fold, respectively. Other markers of social distress also worsened: crime and suicide rates rose by 31% and 33%, respectively (Table 1; Figs. 2 and 3). The gradual economic recovery in the late 1990 s and early 2000 s was accompanied by a stabilization in AUD incidence and modest reductions in suicide and crime rates, as well as a decline in DUD incidence.
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Fig. 4
Dynamics of gross domestic product (GDP) and incidence of alcohol use disorders (AUD) in Ukrainian SSR-Ukraine during 1955- 2023. * - GDP per capita - gross domestic product per capita in US dollars (at constant 2015 prices); ** - AUD per 100,000 people - incidence of alcohol use disorders (per 100,000 people)
Global economic crisis (2008–2013)
The global economic crisis of 2008–2013 [56] was associated with notable declines in the incidence of PAUD (− 63.00%), AUD (− 36.06%), DUD (− 20.80%), and overall mortality (− 10.59%). In contrast, the annual number of suicides remained relatively stable, while the annual number of recorded crimes increased by 49.28% (Table 1; Figs. 1–4).
The fact that crime was the only major indicator of social ill-being to increase during this period may suggest that, unlike the systemic crisis of the 1990 s following the collapse of the USSR, the 2008–2013 crisis lacked an ideological dimension. That is, by this time, the Ukrainian population had largely adapted to the new capitalist system and the absence of communist ideology. Consequently, the stressors experienced during this period were primarily economic in nature. Moreover, the economic severity of the 2008–2013 crisis in Ukraine was considerably less than that of the 1990s. Specifically, the maximum GDP contraction from the last pre-crisis year was 15.14% during the global financial crisis, compared to a 60.53% contraction in the 1990 s (Table 1; Figs. 2 and 3).
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Fig. 5
Correlation of the GDP per capita with PAUD; DUD; mortality; suicidality and criminality (A) as well as with AUD and Birth rate (B) in Ukrainian SSR-Ukraine during 1955-2023. GDP – gross domestic product per capita in US dollars (at constant 2015 prices).; AUD (F10) – alcohol use disorders (ICD-10 code F10); PAUD (F10.4-F10.5) – psychotic alcohol use disorder (ICD-10 code F10.4- F10.5); DUD (F11-F19)– drug use disorders, where the term "drugs" includes all psychoactive substances except alcohol (ICD-10 code F11-F19); Mortality – the total number of deaths per 1000 population during the year; Suicidality – the number of suicide deaths per 100,000 population during the year; Criminality – the total number of crimes per 1000 population during the year; Birth rate, per 1000 people.
The Russian aggression and the COVID-19 pandemic (2014–2023)
The Russian aggression against Ukraine [10] began with the annexation of the Crimean Peninsula in 2014 and continued with prolonged armed conflict in the Donetsk and Luhansk regions. In the years preceding the COVID-19 pandemic, this period was characterized by a continued decline in the incidence of AUD (a 17.15% decrease between 2014 and 2019), an increase in PAUD incidence (by 15.27%), and a relatively stable incidence of DUD (Table 1; Fig. 1).
During the same period, overall mortality decreased by 6.17%, and the annual crime rate declined by 14.19%. Most notably, the suicide rate dropped by 20.97% (Table 1; Figs. 2 and 3). This pattern offers additional support for Émile Durkheim’s classic thesis (1897), which posited that societal cohesion during wartime suppresses suicidality [57]. Numerous subsequent studies have confirmed this phenomenon [58]. A commonly cited explanation is that the existential threats posed by war—experienced by both combatants and civilians under constant shelling—activate the instinct for self-preservation, thereby reducing suicidal behavior. A possible explanation for this phenomenon is that the existential threats to life posed by war (both for the military and for civilians who are under regular shelling) activate the instinct of self-preservation and thus suppress suicidal tendencies.
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Fig. 6
Dynamics of prevalence (per 100,000 people) of alcohol use disorders (AUD) and drug use disorders (DUD) in Ukrainian SSR-Ukraine during 1955-2023
The COVID-19 pandemic began in Ukraine on March 3, 2020, with the confirmation of the first case of infection. During the pandemic years (2019–2021), the incidence of both AUD and PAUD continued to decline, by 31.54% and 23.91%, respectively. In contrast, the incidence of DUD resumed its upward trend, increasing by 14.72% during the same period (Table 1; Fig. 1). As expected during a public health crisis of this magnitude, overall mortality rose significantly—by 24.21% between 2019 and 2021. Interestingly, the suicide rate decreased slightly (by 3.40%), while the crime rate dropped substantially (by 26.84%) (Table 1; Figs. 2 and 3).
The full-scale Russian invasion of Ukraine, which began on February 24, 2022 [12] and is still ongoing, has introduced an entirely new dimension of psychosocial strain. From 2022 to 2023, the absolute number of new AUD cases declined by 14.5%, while the incidence rate per capita increased by 7.0%. This apparent contradiction is explained by a significant population decline due to mass displacement and emigration (Table 1; Fig. 1).
During the same period, the incidence of PAUD rose sharply, both in absolute terms (11.9%) and relative terms (40.0%). Even more pronounced was the increase in DUD incidence, which grew by 23.5% in absolute terms and by 54.6% in relative terms. These trends are likely attributable to the widespread psychological trauma and chronic stress associated with the ongoing war. Indeed, recent data shows that in Ukraine, the prevalence of post-traumatic stress disorder (PTSD)—a condition often comorbid with excessive alcohol use—ranges from 11.1% to 50.8% in various studied groups [59].
Paradoxically, the data indicate a decrease in overall mortality during the first two years of full-scale war: a 30.5% drop in absolute terms and a 13.0% decline in relative terms compared to 2021. This seemingly counterintuitive result is likely an artifact of unrecorded combat-related deaths (which are classified) and a sharp reduction in the civilian population due to emigration.
As anticipated, crime rates escalated during this period, increasing by 48.0% in absolute numbers and 85.2% in relative terms. However, data on suicide rates during 2022–2023 were not available from publicly accessible sources (Table 1; Figs. 2 and 3).
Correlational dynamics across sociopolitical periods
To better understand how socio-economic conditions influence the spread of substance use disorders and other markers of social distress, correlation analyses were conducted between GDP and the indicators described above, as well as among the indicators themselves. Based on repeated correlation analyses with varying parameters, three distinct periods were identified in which the nature of correlations between GDP per capita and the other studied variables differed qualitatively (Table 2; Fig. 5).
Table 2. Spearman’s rank correlations between substance use disorders, demographic, and socioeconomic indicators in the Ukrainian SSR and Ukraine (1955–2023), by historical period
Time periods | Indicators | Spearman’s rank correlation coefficients 7) | |||||||
|---|---|---|---|---|---|---|---|---|---|
GDP per capita | AUD | PAUD | DUD | Mortality | Suicidality | Criminality | Birth rate | ||
The last 30 years of the USSR before the start of “Perestroika” (1955–1984) | GDP per capita 1) | - | |||||||
AUD 2) | 0.97* | - | |||||||
PAUD 3) | 0.93* | 0.84* | - | ||||||
DUD 4) | 0.97* | 0.95* | 0.90* | - | |||||
Mortality 5) | 0.93* | 0.93* | 0.85* | 0.93* | - | ||||
Suicidality 6) | 0.99* | 0.95* | 0.93* | 0.98* | 0.94* | - | |||
Criminality 7) | 0.91* | 0.91* | 0.77* | 0.90* | 0.88* | 0.92* | - | ||
Birth rate 8) | −0.59* | −0.59* | −0.83* | −0.67* | −0.61* | −0.70* | −0.46* | - | |
The period around the collapse of the USSR: “Perestroika”, the actual crisis after the collapse of the USSR and the time of exit from it (1985–2007) | GDP per capita 1) | - | |||||||
AUD 2) | 0.75* | - | |||||||
PAUD 3) | −0.62* | −0.17 | - | ||||||
DUD 4) | −0.97* | −0.72* | 0.66* | - | |||||
Mortality 5) | −0.69* | −0.43* | 0.74* | 0.74* | - | ||||
Suicidality 6) | −0.91* | −0.64* | 0.61* | 0.87* | 0.49* | - | |||
Criminality 7) | −0.93* | −0.65* | 0.60* | 0.91* | 0.65* | 0.89* | - | ||
Birth rate 8) | 0.88* | 0.84* | −0.51* | −0.88* | −0.77* | −0.74* | −0.80* | - | |
The period after the liquidation of the consequences of the crisis due to the collapse of the USSR (2008–2023) | GDP per capita 1) | 1.00 | |||||||
AUD 2) | 0.44* | 1.00 | |||||||
PAUD 3) | 0.50* | 0.89* | 1.00 | ||||||
DUD 4) | −0.04 | 0.21 | 0.44* | 1.00 | |||||
Mortality 5) | 0.19 | 0.22 | 0.33 | 0.61* | 1.00 | ||||
Suicidality 6) | 0.16 | 0.76* | 0.71* | 0.66* | 0.22 | 1.00 | |||
Criminality 7) | −0.39 | −0.20 | −0.34 | −0.27 | −0.69* | 0.04 | 1.00 | ||
Birth rate 8) | 0.35 | 0.78* | 0.62* | 0.10 | −0.04 | 0.97* | 0.04 | 1.00 | |
1) GDP per capita – gross domestic product per capita in US dollars (at constant 2015 prices).
2) AUD (F10) – alcohol use disorders (ICD-10 code F10).
3) PAUD (F10.4-F10.5) – psychotic alcohol use disorder (ICD-10 code F10.4- F10.5).
4) DUD (F11-F19) – drug use disorders, where the term “drugs” includes all psychoactive substances except alcohol (ICD-10 code F11-F19).
5) Mortality – the total number of deaths per 1000 population during the year.
6) Suicidality – the number of suicide deaths per 100,000 population during the year.
7) Criminality – the total number of crimes per 1000 population during the year.
8) Birth rate, per 1000 people.
9) *Cells with significant correlation coefficients (p < 0.05)
Analysis of the final three decades of the USSR prior to the onset of Perestroika (1955–1984) revealed strong, direct correlations between GDP per capita and all indicators of social disadvantage, except birth rate. Spearman’s rank correlation coefficients (ρ) for these associations ranged from + 0.91 to + 0.99. Similarly, strong positive correlations were observed among the indicators themselves (ρ = +0.77 to + 0.98), indicating that the steady increase in GDP per capita during this period was accompanied by concurrent rises in substance use disorders (SUD), overall mortality, suicide rates, and criminal activity (Table 2; Fig. 5A). These findings likely reflect the adverse psychosocial impacts of urbanization and suggest early signs of systemic sociopolitical crisis in the late Soviet era.
In contrast, the period from 1985 to 2007—encompassing Perestroika, the post-Soviet economic collapse, and the beginning of economic recovery—exhibited an inverted pattern. During this time, strong negative correlations emerged between GDP per capita and most indicators of social ill-being (except for alcohol use disorders [AUD] and birth rate), with coefficients ranging from − 0.62 to − 0.97. At the same time, moderate to strong positive correlations were observed among the indicators themselves (ρ = +0.49 to + 0.91) (Table 2; Fig. 5A). These patterns reflect a two-phase economic trajectory characterized by steep GDP decline through 1999, followed by gradual recovery. The dynamics of PAUD, DUD, mortality, suicide, and crime mirrored this trajectory in reverse, indicating heightened vulnerability to socio-economic distress during the crisis period (Table 1; Figs. 2, 3). These findings suggest that between 1985 and 2007, the key determinant of social disadvantage was the deep systemic crisis that followed the Soviet Union’s dissolution, with GDP per capita serving as a reliable proxy for its impact.
The third period (2008–2023), which followed the stabilization of Ukraine’s market economy, showed a pattern more akin to the late Soviet era. A modest positive correlation re-emerged between GDP per capita and PAUD incidence (ρ = +0.50). However, associations between GDP and DUD, overall mortality, suicide, and crime weakened considerably and no longer reached statistical significance (Table 2; Fig. 5A). These patterns suggest that Ukrainian society had adapted to the structural changes brought by the post-Soviet transition, even amid continued external shocks such as political unrest, pandemics, and war.
Across the full period (1955–2023), AUD incidence maintained a direct correlation with GDP (ρ = +0.65), with the strongest association observed during the Soviet era (ρ = +0.97). This relationship likely reflects the affordability and availability of alcohol as a legal psychoactive substance, with consumption patterns closely tied to purchasing power. It is worth noting that the anti-alcohol campaign launched by Mikhail Gorbachev in 1985 likely induced an artificial dip in AUD incidence prior to the GDP collapse of the early 1990 s (Table 1; Figs. 4 and 5B). Overall, AUD incidence may serve as a reliable proxy for population-level economic well-being, assuming the presence of a consistent monitoring system. In other words, the incidence of AUD registered by Ukrainian health authorities fluctuated in accordance with GDP and, correspondingly, with the purchasing power of the country’s citizens. Thus, in contrast to the incidence of DUD (associated with the use of illicit psychoactive substances) and the incidence of PAUD (i.e., the most severe forms of alcohol dependence, whose incidence dynamics are not always proportional to the total number of alcohol consumers), the incidence of AUD (associated with the use of a permitted legal psychoactive substance—alcohol) can be considered an indicator of the material well-being of the country’s citizens. This relationship holds provided that a national drug treatment service systematically records such patients. As previously noted, such a national service has existed in Ukraine Since 1976 [47]. Prior to its creation, the systematic treatment and recording of patients with substance use disorders were conducted by the country’s psychiatric service.
The birth rate displayed a distinct pattern of correlations with GDP. During the Soviet era (1955–1984), it showed a moderate negative association (ρ = − 0.59), consistent with trends in industrialized nations linked to urbanization, expanded access to contraception, and the prevalence of family planning. In the following period (1985–2007), this association shifted to a strong positive correlation (ρ = +0.88), while in the final period (2008–2023), the relationship weakened (ρ = +0.35) (Table 2; Figs. 4 and 5B). These shifts may reflect the growing dependence of reproductive behavior on socio-economic stability in the post-Soviet context, including crises and war-driven uncertainties.
Taken together, these changing patterns of correlation suggest qualitative differences in the sociopolitical and economic context of each historical period. The Soviet era (1955–1984) was characterized by evolutionary change under a stable regime, while the period between 1985 and 2007 involved radical transformation due to the dismantling of the centrally planned economy. The most recent period (2008–2023), though marked by turbulence (protests, epidemics, wars), unfolded within the framework of an established market system. Consequently, the direction and strength of correlations between GDP and social indicators varied dramatically across these epochs, with the third period representing an intermediate state between the previous two.
Prevalence of substance use disorders
While the preceding analysis focused on the incidence of SUD—i.e., the number of new cases annually—Ministry of Health data also provide information on prevalence, or the cumulative number of registered cases. Although prevalence is more susceptible to data artifacts due to regional variability and inconsistencies in discharge criteria, it offers valuable insights. During the Soviet period, clinical guidelines stipulated a five-year observation period post-recovery; however, the operationalization of “recovery” varied widely, as did the practical enforcement of observation periods.
Despite these limitations, prevalence data reveal two major epidemic waves of SUD in Ukraine over the past seven decades (Table 1; Fig. 6). The first wave, centered on AUD, began in the mid-1960s and peaked in the mid-1980s during the late Soviet period. The second wave, associated with DUD, began in the mid-1980s, peaked in the mid-2000s, and occurred entirely within the period of Ukrainian independence. Notably, the magnitude of the second wave was approximately ten times smaller than the first—likely due to cultural norms and the greater availability of alcohol compared to illicit drugs.
Despite their difference in scale, both waves followed similar dynamics: an S-shaped curve of rise and stabilization, followed by a decline. The ascending phases of both epidemics (up to 1985 and 2003, respectively) fit the logistic growth model proposed by Belgian mathematician Pierre Verhulst, which is widely used in population ecology and demography to model growth under resource constraints [60, 61–62]. After reaching their respective peaks, the prevalence of both AUD and DUD began to decline, no longer conforming to Verhulst’s logistic curve. This shift likely reflects changes in the external sociopolitical environment and treatment systems, rather than inherent limits on SUD population growth.
A marked decline in the birth rate (Table 1; Fig. 3) has led to a demographic shift, characterized by a decreasing proportion of young individuals within the population—an age group generally at elevated risk for developing substance use disorders (SUD) [63, 64]. In the case of alcohol use disorders (AUD), a further contributing factor to the post-1985 downward trend may have been the nationwide anti-alcohol campaign initiated during that period, as previously discussed [6, 7].
These demographic and policy-related shifts contributed to a gradual transformation in the structure of SUD prevalence recorded by national health authorities (Table 1; Fig. 7). In the decade following the collapse of the Soviet Union, the proportion of drug use disorders (DUD) within the total SUD prevalence increased significantly, rising from 3.2% in 1991 to 10.5% in 2001. Although the rate of increase subsequently slowed, the upward trend continued, and by 2023, DUD constituted 14.5% of all recorded SUD cases. Conversely, the relative share of AUD within the total SUD prevalence declined from 96.8% in 1991 to 85.5% in 2023 (Fig. 7B).
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Fig. 7
Dynamics of prevalence of alcohol use disorders (AUD) and drug use disorders (DUD) in absolute (A) and relative (B) values in Ukraine during 1991- 2023
These data suggest that in the context of modern Ukraine, various categories of psychoactive substances appear to be in competition for consumer preference, with non-alcohol drugs increasingly prevailing. This trend may continue in the coming years, particularly given the ongoing liberalization of national legislation regarding the regulation of certain narcotic substances—most notably, cannabinoids [65].
Additionally, as shown in Table 1; Fig. 8A, the composition of SUD prevalence has shifted significantly over the past 25 years, with a notable increase in the proportion of non-opioid drug use disorders and a corresponding decrease in opioid use disorders among all diagnosed SUD cases. Specifically, from 1999 to 2023, the share of non-opioid-related SUDs rose by a factor of 4.12—from 7.7% to 31.7% (Table 1; Fig. 8A). This shift indicates a diversification in the types of psychoactive substances being consumed and likely reflects broader changes in drug availability, societal attitudes, and regulatory policy.
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Fig. 8
Dynamics of prevalence of opioids and non-opioids drug use disorders (DUD) in absolute (A) and relative (B) values in Ukraine during 1991- 2023
Accordingly, during the same 25-year period, the proportion of opioid use disorders within the total prevalence of SUD declined significantly—from 92.3% in 1999 to 68.3% in 2023 (Fig. 8B). These trends further support the conclusion that, even within the broader category of drug use disorders, there is an observable competition among psychoactive substances for consumer preference, with non-opioid substances increasingly prevailing.
A comprehensive analysis of the internal dynamics of non-opioid drug use disorders lies beyond the scope of this article. However, it is worth noting that, in recent years, the majority of these cases have involved the combined use of multiple psychoactive substances, which now account for approximately 80% of all non-opioid SUD diagnoses [20, 21–22]. Among these, synthetic cathinones—commonly referred to as “salts”—are particularly prevalent. These substances often include compounds such as cathinone, 3,4-methylenedioxypyrovalerone (MDPV), methylone, or mephedrone. Nonetheless, their chemical composition can vary significantly, and products marketed under the same name may also contain derivatives of pyrovalerone or pipradrol.
Regarding cannabinoid-related disorders, recent data indicate that they comprise approximately 20% of the non-opioid drug use disorder group [20, 21–22]. This trend may be partially explained by evolving public perceptions of cannabis and the ongoing legal reforms related to its regulation.
Finally, this article concludes by considering the broader contribution of substance use disorders to the total incidence and prevalence of mental and behavioral disorders in Ukraine (Fig. 9).
[See PDF for image]
Fig. 9
Structure of incidence (A) and prevalence (B) of various mental and behavioral disorders in Ukraine (2019). Abbreviations: MBD – mental and behavioral disorders; PAS – psychoactive substances
Our analysis of the most recent available data from 2019 demonstrates that substance use disorders constitute the majority of new cases within the broader category of mental and behavioral disorders in Ukraine (Fig. 9A). Specifically, SUD account for 61.17% of the total incidence of such disorders. Of this, acute SUD—primarily involving acute intoxication or poisoning (i.e., overdoses) caused by various psychoactive substances—represent 41.77%, while chronic SUD—mainly drug addictions—account for an additional 19.40% (Fig. 9A).
For context, as demonstrated in Fig. 9B, the incidence of schizophrenia, schizotypal, and delusional disorders ranks only sixth among mental and behavioral diagnoses, contributing a comparatively modest 3.1% to the overall incidence. In terms of prevalence, SUD also comprise a substantial share—46.70% of all registered mental and behavioral disorders—of which 10.76% represent acute conditions and 35.94% are chronic (Fig. 9B).
These findings underscore the critical importance of prioritizing the prevention and treatment of SUD in Ukraine. Strengthening national policies regarding alcohol and other psychoactive substances should be considered a key component of comprehensive efforts to improve the overall mental health of the Ukrainian population.
Legal and regulatory framework
Throughout its history, the legal and regulatory framework surrounding substance use in Ukraine has undergone significant transformations, directly influencing epidemiological dynamics. During the Soviet era (pre-1991), policies were highly punitive, viewing addiction primarily as a social and criminal offense to be managed through a state-controlled “narcological” service model. Following independence, a gradual shift began as Ukraine aligned its legal framework with international public health and human rights standards. This transition included moving towards harm reduction strategies and a more treatment-oriented approach, though the legacy of the Soviet system’s reporting and treatment methods persisted for some time. More recently, there has been a continued push for reforms that distinguish between personal use and trafficking, influencing how cases are registered and how data is officially collected. These changes in policy and practice are a crucial contextual factor for interpreting long-term trends in incidence, prevalence, and treatment-seeking behavior. The transition towards a public health and human rights-oriented framework also makes the more recent epidemiological data more comparable with international standards, providing a crucial context for cross-country analysis.
Limitations
This study relied exclusively on data recorded by medical institutions under the Ministry of Health of Ukraine to assess the incidence and prevalence of substance use disorders (SUD). As such, the findings reflect only those individuals who sought medical assistance and do not incorporate data from community-based or population-level (“field”) research. It is widely recognized that such clinical data represent only the “tip of the iceberg” in terms of the actual prevalence of SUD in the population.
Nevertheless, the official medical data provide a unique advantage: continuity and methodological consistency over an extended historical period. While these data may underestimate the true burden of SUD, the long-term trends can still serve as an approximate marker of changes in the broader prevalence of these disorders. To extend the iceberg analogy, the height of the visible “tip” is influenced by the size of the submerged portion, suggesting that shifts in recorded incidence and prevalence may reflect underlying population-level dynamics.
The authors of this work are aware that the correlations observed in this study may be spurious, potentially resulting from chance, unmeasured confounding variables, or other contextual influences. Therefore, the patterns described herein should be viewed as an initial step toward identifying and investigating the causal mechanisms underlying these associations.
Conclusions
Over the past seven decades, Ukraine has endured numerous socio-economic and political upheavals. Despite these challenges, a continuous and functioning system of epidemiological data collection has been maintained, allowing for the long-term monitoring of substance use disorder (SUD) incidence and prevalence, as well as analysis of their relationship with broader societal indicators.
Between 1955 and 2023, two major epidemic “waves” of SUD were observed in Ukraine, each separated by approximately 20 years. The first wave, associated with alcohol use disorder (AUD), began in the mid-1960s and peaked in the mid-1980s during late Soviet times. The second wave, linked to drug use disorder (DUD), began in the mid-1980s, reached its peak in the mid-2000s during Ukraine’s independence, and involved approximately one-tenth the number of individuals compared to the first wave.
The most substantial changes in SUD incidence and prevalence occurred during two key periods: (1) the anti-alcohol campaign during the Perestroika era (1985–1991), which led to a notable—albeit temporary—decline in AUD, PAUD and related mortality (especially among men), and (2) the socio-economic crisis following the collapse of the Soviet Union (1992–2001), which was marked by sharp increases in the incidence of PAUD, DUD, and other indicators of social distress.
Correlation analyses indicate that PAUD, DUD, criminality, suicidality, mortality, and birth rate are significant indicators of social disadvantage, particularly during the post-Soviet crisis and recovery period (1985–2007). These variables were inversely correlated with GDP and positively correlated with each other. In contrast, AUD incidence consistently showed a strong positive correlation with GDP throughout the observation period, suggesting that AUD may serve as an indirect marker of citizens’ material well-being—assuming the presence of a robust, nationwide addiction treatment registry.
Over the past two decades, a dramatic decline in birth rate—and, consequently, in the proportion of young people most susceptible to developing SUD—has acted as a significant factor suppressing the spread of SUD in Ukraine. However, recent crises—including the Russian Federation’s annexation of Ukrainian territory (2014), the COVID-19 pandemic (2019–2021), and the ongoing full-scale invasion of Ukraine (beginning in 2022)—have further deteriorated the country’s demographic and public health conditions. The long-term impact of these events on mental health and SUD prevalence remains difficult to fully assess at present, given that the war is ongoing.
Acknowledgements
The authors express their most sincere gratitude to the employees of the medical statistics department of the State Institution “P. V. Voloshyn Institute of Neurology, Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine”, the employees of the Center for Medical Statistics of the MoH of Ukraine, the employees of the Public Health Center of the MoH of Ukraine), as well as the employees of the State Statistics Service of Ukraine, only thanks to whose many years and painstaking work this research became possible.
Author contributions
Conceptualization, Methodology: I.L., O.M.; E.G.; investigation: I. L., O.M.; E.G.; V.B. and O.S.; Formal analysis, Visualization: I.L., O.M.; E.G.; Writing - original draft preparation: I. L., O.M.; E.G.; V.B. and O.S.; Writing - review and editing: I. L., O.M.; E.G.; V.B. and O.S.; Project administration: I.L. and O.M. All authors have read, reviewed and agreed to the submitted version of the manuscript. The corresponding author have read the journal policies and is submitting manuscript in accordance with those policies.
Funding
This work did not receive any funding.
Data availability
All data generated or analyzed during this study are included in this published article. Table 1 presents data on trends in substance use disorder indicators and demographic and socioeconomic variables in the Ukrainian SSR/Ukraine, 1955–2023. References for the open-source data repositories from which these data were extracted are presented in the reference list.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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