What is it about that time in the evening when the sun is going down, perhaps after a long day at work or a busy afternoon, and a thought subtly arises in your brain and all of a sudden you are itching for a cold beer or a soothing glass of wine? Often living in Thailand expats may feel tempted to drink more than in their home country, many foreign friends have told me they either do, or could, drink every day here. Boredom, loneliness, cheap alcohol, warm weather, an abundance of bars, too much free time, pretty bar maids, drinking pals, a great social scene, a stressful job or life are all contributing factors that may lead expats to drink more in Thailand. But for some expats alcohol is more than just a temptation and poses a threat of addiction with damaging effects to mental and physical health, personal relationships and work life.
Connie Moser, an expatriate writer living in the Netherlands has been researching the subject of alcoholism among expatriates. In a recent article in Escape from America Magazine Moser says substance abuse is a common issue for expats and their dependents, unsurprisingly due to the expat lifestyle, characteristically involving numerous moves and changes, demanding careers, adapting to new cultures, languages and places. Often living alone in a foreign country, individuals feel isolated, lonely, homesick, and can face culture shock, loss of self worth and peer pressure. Moser believes, "All of those factors and more can lead to coping mechanisms such as self-medication through overindulgence in alcohol, prescription medication, or recreational drugs."
A recent study of expats living in Thailand found expats drank because it was easily available in the places they spend time in and that drinking was a popular free time activity. The study found disparities in the amount of money expats spent on alcohol, some spending 2,000,-5,000, or up to 30,000 baht per month.
Often expat social scenes are based around drinking occasions, and for those employed in certain industries, drinking is part of the profession, whether it be wining and dining clients or after work drinks with colleagues. Despite very harsh drug laws in Thailand, alcohol is readily available and relatively cheap. There is a big bar culture in Thailand especially for expat males. Drinking alcohol is an easy habit to pick up when it constitutes as the main social interaction in an expat's life.
In an interview with Paul Garrigan an expat writer resident in Thailand and author of Dead Drunk, a novel influenced by personal experience, about a teenager who lost himself to alcohol addiction, Paul says "In Thailand people have fewer commitments such as a job, family, friends, or a long term partner compared to in their home country, so things that grounded them before no longer hold them back from drinking." Garrigan adds, "For some people Thailand is like being let loose in a sweet shop, they feel like they are invincible, for example, you would never ride around on a motorbike without a helmet on in England."
Realistically how much is being an expat really to blame for reaching for the bottle? Sensationalists may equate the expat lifestyle in Asia to excesses of drink, drugs, sex or gambling, but next to Thomas, Dougal, and Scotty, an English man, an Irish man, and an American man, all members of Chiang Mai's Alcoholics Anonymous (AA) group a contrasting story develops. "Nah we were all drunks before we came here." says Scotty. The group members tell me most alcoholics in the expat community did not develop their problem with alcohol from one too many beers at some expat club, it was something that they had battled since living in their home country.
It is evident the expat lifestyle in Thailand can increase social drinking and perhaps excessive drinking, however, more often than not it is neither the place nor the situation that makes someone an alcoholic, but rather the person. Having a family with a history of alcohol abuse, emotional and psychological issues and addictive tendencies comprise significant factors leading to substance abuse and addiction. Experts on the subject, including Simon Mott, head counsellor at the Cabin rehabilitation centre in Chiang Mai, said, "Although in living an expat life, there may be more chances to drink, expats are no more at risk for addictions that any general population."
At the back of McCormick hospital is a humble wooden building, in this meeting room a group of expats join others with similar problems to form a support network and social group for recovering alcoholics. The articulate group members each had a different story to tell, they agreed that in Thailand there were many temptations to drink, but that the main causes of their problems were related to biological predetermination, personality types, childhood influences, post traumatic stress, depression, and emotional difficulties.
"I came to AA meetings to borrow money off someone I knew who went to them." says Tom an American national, "I never knew I was an alcoholic, how was I supposed to when everyone in my family drank lots. I continued going to the meetings and after 6 months I realised I was an alcoholic."
"When I started going to AA I stopped trying to kill myself, crashing my car and getting arrested by the cops." said Billy an American ex-Vietnam service man.
Often people who are diagnosed as alcoholic get a dual diagnosis and are also diagnosed with depression or other psychological disorders. Alcoholics typically self medicate, many use alcohol to make them feel better but it usually makes the situation far worse.
Author Garrigan tells me about his familiarity with alcoholism and getting sober in Thailand. "Thailand is a great place to get drunk, and it's also a great place to get sober". Garrigan told me about his time spent in Wat Tham Krabok in Saraburi, a temple famous in the western media for images of projectile vomiting rehab patients. Substance abuse patients are given a herbal detoxifying remedy which induces vomiting.
Like many alcoholics, Garrigan was a 'high-functioning' alcoholic, who held down a professional job, was able to maintain family, friends and social relationships and was seen as a responsible adult. After relocating various times to escape addiction, another alcoholic trait known as 'geographical move', and trying various treatments Garrigan found the methods in Wat Tham Krabok successful in curing his addiction. "There is no revolving door at the temple, there is only one chance." states Garrigan.
In July last year a BBC article suggested Tham Krabok had a higher success rate than Britain's National Health Service. However, other experts doubt the long term success rate of the temple. Mott an experienced addiction counsellor says "This practice may be more beneficial for Thai people who are spiritually linked to Buddhism, also especially if they continue to live as a monk after treatment. However, it is vital to find and deal with the root of the problem causing addiction, which is better sought through psychology, counselling, and cognitive behavioural therapy. It is important to examine the way people think about things, and try to adapt thinking patterns to heal addictions."
In Thailand, already famous for medical tourism, Tham Krabok is one place people visit as part of the growing niche market dubbed 'rehab tourism'. Rehabs in Thailand vary from budget Buddhist temples giving spiritual healing, to luxury retreats offering western approaches of counselling and holistic therapies for the rich and famous.
High-functioning expat substance addicts make up the majority of patients at The Cabin, one of Asia's most respected addiction treatment centres in Chiang Mai. The Cabin has previously treated expatriates from the region, including wealthy business men working in Singapore or Hong Kong who have been sent by their employers to help sober up, as well as high profile international celebrities. The centre offers a high value rehabilitation programme and is cutting edge in their approach to dealing with addiction patients, gaining an exemplary reputation amongst medical professionals from its practices and many success stories. The Cabin is a luxury rehab centre run by a team of western trained and licensed professional alcohol and drug counselling specialists. Mott and Alastair Mordey, the programme director, believe it is important for rehab patients to enter into rehab for at least one month, as the brain takes time to adapt to new habits. The Cabin prides itself on preparing patients for when they go back into the 'real world' with the skills they need to avoid relapsing. Mordey says "Being in rehab in Thailand has a positive effect on patients. With us patients feel safe and relaxed away from trigger sources, the beautiful surroundings, warm climate and hospitable nature of Thai people also contribute to guests' recovery."
So what help is out there for expats dealing with addiction? It seems that to fight addiction a willingness to change and seek help must come from within the individual themselves. The saying, 'You can lead a horse to water but you cannot make it drink,' takes on a pertinent twist here. Often it can take an addict to hit rock bottom before they take action. One of the main points raised at the AA meeting was honesty. If addicts can be honest with themselves and others, admitting they have a problem, that is the first fundamental step towards sobriety, then they can begin the process.
'Each group has but one primary purpose - to carry its message on to the alcoholic who still suffers.' one of the twelve traditions of AA.
(Some names have been changed for confidentiality reasons)
AA meetings are held at 9.30 a.m. and 6.30 p.m. at
134 Kongsai Road (see attached map-DIRECTIONS)
082 186 2518