JIN-439 -- Alcoholism in Japan

J@pan Inc Newsletter

The 'JIN' Japan Inc Newsletter
A weekly opinion piece on social, economic and political trends
in Japan.
Issue No. 439 Wednesday November 7, 2007, Tokyo

Alcoholism In Japan

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One of the most alcohol friendly countries in the world, Japan
has a strong drinking culture, ranking 6th in the World for the
largest consumption of beer after China, the U.S., Germany,
Brazil and Russia. From 'Settais' (business dinners) to
'Bounenkais' (end of year parties-or literally 'forget the year'
parties), all social occasions in Japan require a large
consumption of alcohol to fit in with your peers.. According
to a World Health Organization (WHO) survey in 2002, nearly
50% of men habitually consume alcohol

So it wouldn't be surprising to hear that alcoholism is on the
rise in Japan. The latest statistics show that the problem
drinking rate in Japan currently stands at roughly 2.4 million according
to the National Hospital Organization, Kurihama Alcoholism Center.
Even Prince Tomohito of Mikasa, the 61-year old cousin of
Emperor Akihito, has admitted that he suffers from alcoholism
after repeated hospitalization for the problem. 'I am Prince
Tomohito, dependent on alcohol," he said at a speech in July.
He went on to say that 'I have been drinking alcohol since my
days in university and am dependent on it, so I find it rather
surprising that I am seen to have been hit by it now.'

Dr Hiorakai Kono, former director of the National Institute of
Alcoholism in Tokyo, told us that 'there is no question that
alcoholism is increasing in Japan.' However, he goes on to say
that 'what astonishes us is the size of the problem.' It seems
that alcoholism in Japan has largely been an undetected problem
and whether there is enough spotlight and support available on
the issue now is something that needs to be looked at thoroughly.
Dave Milne, an expert on alcohol related problems in Japan, says
that 'although alcohol consumption is now decreasing in most
industrialized countries, it has quadrupled in Japan since
1960.' However, according to Milne, Japan still 'lags far
behind Western countries in recognizing and treating alcoholism.
Fewer than 1200 hospital beds are available for alcoholic
patients, and the country's two national mental hospitals
provide only 200 beds. Private treatment centers are becoming
more common, but no medical credentials or accreditation are
required to operate them.'
Of the 2.4 million alcoholics in Japan, only 23,800 of them are
reportedly having treatment.

Moreover, it is very hard to admit someone into an alcoholism
clinic - even if it is a very severe case and their
families and friends are in danger. The alcoholic patient
would either have to decide to get help and admit himself
into hospital or their families would have to take the
drastic action of forcefully committing them to a mental health
institute. We spoke to a relative of an alcoholic, Tomomi,
who told us of her problems dealing with the Japanese system.
The alcohol dependent person was in a state of complete
dependency, consuming at least a 2 liter bottle of 'shochu'
(strong Japanese liquor) a day. He would often, in his
intoxicated state, lash out at the people around him, causing
a severe threat to others as well as himself. Upon calling the
police, they replied that 'Unless he actually severely hurt
someone, we would be unable to intervene in a domestic such as
this.' The first hospital Tomomi took him to admitted him
for one night for malnutrition but, despite the dangers and
the threats of abuse from the alcoholic, released him the
following day. Tomomi rang all the other alcoholism specialist
clinics and they all said that the patient would have
to admit himself and they would not be able to contain him.
Unfortunately, the alcoholic was in complete denial and refused
to go into such a place. Because of the dangers of living with
him, Tomomi decided that the only action to be taken was to
have her relative committed to a mental health institute, a place
that did not specialize in alcoholism and the only thing they
could offer was prohibiting any alcohol intake and some general
counseling. After 4 months, the alcohol dependent relative left
the institution and quickly resumed drinking again.

Clearly, there is a lack of support for alcoholics and their
families in the Japanese system. However, what, if any, systems
are in place for foreign residents in Japan?
We spoke to Alcoholics Anonymous (AA) Tokyo who have been in
Tokyo for about 50 years, supporting foreign residents in Japan
who either want help coming off alcohol or support in staying
sober once treated for alcoholism.
Currently, they hold meetings on average twice daily in Tokyo
with more at the weekends. They can also hold Skype meetings
for those who do not live close by. Most members are originally
from the US, Canada and Australia and about 80% of the members
seek the AA for support in staying sober after having already
come off the alcohol. Nick E, the public service relations
officer for AA Tokyo finds that most members complain of
'Japan's social obligations to drink, and the ease in getting
liquor,' as well as the fact 'that drunkenness for a man is
often blamed on the spouse for not keeping him in line.'
However, Nick also stresses that as well as feeling solidarity
with one another due to sharing an alcohol problem, with AA
Tokyo, 'there is definitely an ex-pat camaraderie.' Speaking to
a member and former alcoholic, John, he told us he was able to
get sober in Japan after having failed in the US. 'Stopping
drinking is hard anywhere…but if you really want to stop, you can
do it whatever country you're in.'

By Anna Kitanaka

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In the last few lines of the article the writer quotes a person saying if one wants to quit they can.
I'm not an alcoholic but when I first came here in 1987 I was a heavy consumer. I did stop for a year, my goal, to get it under control and I did. I don't drink that heavy any longer.
The current issue here in Japan is where the US was some years back.
You couldn't force anyone into treatment and the police wouldn't arrest someone , at times even for drunk driving, unless they caused bodily injury, property damage or death.
Until the culture changes, the attitude of seniors and peers forcing co-workers and subordinates to go drink rather than go home to family I think the birth rate will remain low and alcohol problems will rise.
This is not to say drinking should be band, prohibition won't work, but the attitudes that surround it must change.

As an American who has spent my youth in Japan and in the US, it has been very apparent that the Japanese view on Alcohol consumption and the American view is very different. In Japan, much like in Europe, young adults are exposed to Alcohol at a much younger age than in the US, and usually it is a family member who introduces alcohol to the young people. I feel this pracitce is very good as it reduces the number of kids who go crazy and drink too much in college or high school which is the pattern in the US. But on the other hand because people are more lenient in Japan, there is more opportunity for underage drinking and the risk of alcohol abuse. Alcoholism as a disease is most definitely genetic, and if a child is born to two alcoholics they are more likely to become one themselves. But the tendencies toward alcohol abuse are really just an expression of addictive personalities. Alcoholism and other expressions of addiction such as excessive cigarettes, shopping, sex, religion are activities that people have done for generations and will continue to do. There is no way to "rid the world of alcoholics", one, because you would still have all the other addicts; and two because everybody has their vices.

What still amazes me after almost 15 years in Japan is the high number of highly functional alcoholics here, relative to what I observed in the U.S., where I'm from.

I used to work for a Japanse company and only a tiny handful of the male staff members were not nightly hard drinkers. These men, by the way, mostly seemed like they had been shunned by the in group for one reason or another but, I now know, were actually just smart enough not to get dragged into the drinking sessions, even when it cost them politically within the office.

Yet even these hard drinkers were seldom late to work. Almost none of them were what you would call spectacular producers but they all maintained a significantly taxing workload day after day--many worked six days a week!--and seemed to be able to maintain their health.

What is it? Green tea? Few Westerners I know can drink that much night after night and still function well at a stressful job. Eventually, their health would decline.

The only theory I can come up with is that in America, there are far more dangerous, tempting behaviors that go hand in hand with heavy alcohol consumption.

The salaryman gets sh*tfaced in a pub with his co-workers who, more or less, care about him and will even go as far as physically carrying him to a capsule hotel or a coffee shop to sober up before the last train home.

The American heavy drinker is more likely to drink alone, or, to seek out other heavy drinkers in public who are not his friends and are unlikely to expend much of their own time or effort to help him if he needs it.

American heavy drinkers are perhaps also like to engage in binge eating while drunk and, certainly, to turn to harder drugs, which are usually easily purchased once a person becomes a regular at a hard drinking establishment. In Japan, your co-worker enablers are unlikely to be able to sell you some cocaine, even if you wanted it, which probably never even occurs to many salarymen.

I suspect as well Japanese salarymen are more likely to combine drinking with commercial sex, be it in the astonishing variety of strip clubs, "snack" pubs, hostess bars, soaplands or with call girls. But here again, the environment for this is all fairly middle class and, even, semi-respectable in Japan. A salaryman could be involved in that kind of thing on a fairly regular basis without being exposed directly to the worlds of drugs and organized crime.

An American heavy drinker who also starts spending his remaining money on prostitutes is in the fast lane to an early grave. I'm just guessing that a far greater percentage of U.S. prostitutes are also drug addicts and they are also more likely to take advantage of the fact that the john must keep his habit completely secret from his work associates and and his friends.

What a weird world we live in.

When I first arrived in Japan, I recall reading the first sentence of a book on Japan that went something like:

The Japanese are the world's lewdest prudes, healthiest drunks, safest gamblers, calmest emotionalists, reasonable irrationalists and so on and so forth.

The longer I stay here, the more I see these mysterious contradictions...

"The number-one enemy today is the ready availability of beer and liquor from hundreds of thousands of vending machines strategically deployed throughout our five islands, enabling anyone with a few yen to drink anytime, anywhere," Shigeru Sakuraba, Ph.D., of Hamamatsu University School of Medicine, told Psychiatric News.
I suggest that the most promising route to effective strategies for the prevention of adolescent alcohol , drug rehab and other drug problems is through a risk-focused approach. This approach requires the identification of risk factors for drug abuse, identification of methods by which risk factors have been effectively addressed, and application of these methods to appropriate high-risk and general population samples in controlled studies.