Breaking out of the bottle in China
CHINA - Alcoholism is on the rise in China but is rarely recognised as a disease. And those who realise they have a problem are often reluctant to seek help because of the stigma. China Daily reports.
Lu Lu had her first drink around the same time she said her first word. Family members at her home in a northeastern Chinese province often gave her sips of alcohol for the amusement of her reaction.
They were proud she liked the taste. "They loved a baby girl drinking. A drinking girl was a hero," says Lu, who asks not to use her real name.
Drinking culture in China predates its recorded history, artifacts show. And it has become more widespread since the 1980s, following the reform and opening-up, reports say.
A nationwide Wiley-Blackwell study that surveyed 50,000 people found 56 per cent of men and 15 per cent of women were drinkers. Nearly 60 per cent of male drinkers and 30 per cent of female drinkers were classified as binge drinkers, consuming alcohol five to seven days of the week.
"What makes China unique among other heavy drinking countries is that drinking frequency, quantity and binge drinking increase with age. The heaviest Chinese drinkers are middle-aged or beyond, while drinking levels in other countries tend to peak in people's late teens and early twenties," the study says.
Despite frequent exposure, Lu can count on one hand how many times she got drunk in her younger years. And despite her proud family, she says, the social stigma attached to women who drink kept her away from the bottle.
"The gender difference in China is big," Lu says.
"A publicly drunken woman looks lousy."
But when she left home to study in France, her alcoholic tendencies began to surface.
"It was just so convenient to get alcohol, and everyone was drinking," she says.
"France has a horrible drinking culture."
A study conducted by France's Observatory on Drugs and Addiction found "repeated drunkenness" among young French has risen 10 per cent since 2000. The study found "repeated drunkenness" among young women has doubled during the same period.
Lu admits it was never about the culture or country. She drank because she liked her drunken self more than her sober self - a shy person, afraid of other people and life's responsibilities.
"I was so smart when I was drunk," she says.
"I could talk with anyone, and my speech was excellent. I loved the feeling of freedom and knowing I didn't need to control myself anymore."
Beijing United Family Hospital clinical psychologist George Hu says there are plenty of advantages to using alcohol, such as its tendency to be a social lubricant.
"We want alcohol to be useful," he says. "We want it to be something that serves a person, rather than them being enslaved by it."
When Lu lived in New York City, she drank so she could fall asleep. She had a toothache but had neither health insurance nor the $800 it would have cost to fix. So she self-medicated.
"I drank one bottle of vodka every day. And after a week the pain was gone," she says.
"I thought it was a great thing, surviving the pain without a doctor."
By the time she moved back to China, she was dependent on alcohol and couldn't maintain a job. She began hiding from others, isolating herself to drink alone. She looked for solutions outside of the bottle but always went back to alcohol.
The country's booming economy and growing middle class has been producing more drinkers. Between 1978 and 2000, alcohol consumption rose 320 per cent in China, according to a World Health Organisation report. There are an estimated 40 million people with alcohol-abuse problems, which amounts to nearly 4 per cent of the population.
The stigma of being not only an alcoholic, but also a female alcoholic, prevented Lu from seeking help.
"Alcoholism is not a defined disease in China," she says.
"When you search for help, you get so many answers, a lot of which are wrong."
Hu says two schools of thought exist regarding alcoholism treatment - abstinence and harm reduction.
The abstinence solution, endorsed by Alcoholics Anonymous, holds that alcoholics must give up all drinking forever in order to properly recover. Harm reduction, on the other hand, aims to shift alcohol into a pleasure rather than a crutch. Advocates of this method argue that alcohol abusers can learn to consume "normally".
Hu says both methods share the theme of accountability.
"In AA, accountability comes in the form of a sponsor - someone to talk to in times of weakness so they don't fall down a slippery slope," Hu says.
"In harm reduction, people must also identify someone to keep them accountable and remind them about their commitment."
Hu stresses that there's no universal solution for everyone.
After attending AA meetings in Beijing, Lu knew the only solution was to stop drinking for the rest of her life. She has been sober for three and a half years.
Lu says she wants to spread awareness of AA and chip away at the stigma of alcoholism as well as the misconceptions of how to deal with it. She wants to invite those who need help into a community that saved her life.
"A big part of AA is carrying the message. We have a lot of work to do to spread the message further," she says.
"I don't think enough Chinese people use AA."
Kurt Nagl contributed to this story.
A sobering reality
Studies suggest expatriates, including those living in China, are perhaps more prone to alcoholism, among other mental health problems. China Daily looks at how some overcome their addictions.
Jim can remember slouching in the corner of a dark bar alone with his head in his arms, feeling the alcohol spilling through his veins, teetering on the brink of a blackout.
Once he gathered the strength to raise his spinning head, he would call out to the barkeep for another round.
"That is the essence of being powerless," says Jim, a recovering alcoholic who has asked to use a fake name to protect his identity.
After the bar, Jim would drag himself to his apartment bathroom, turn on a flickering light and stare into the mirror. What stared back were the bloodshot eyes of a trembling man losing his battle with alcohol.
Jim continued this same ritual for about three and a half months, during what he calls "the hundred days of rock bottom".
Every morning he would pray to God to stop the pain swelling in his head.
"I didn't even pray for help to stop drinking," Jim says.
"Drinking was so important to me that I would never turn my back on it."
Only after seeking help would he realise others felt the same way.
According to the World Health Organisation, there are at least 140 million alcoholics in the world, the majority of whom are untreated.
The rate of alcohol consumption is increasing rapidly among low- and middle-income countries, particularly in Asia and Africa, Dr Shekhar Saxena explains in a WHO podcast.
Jim's battle with alcohol began in the United Kingdom when he was 14 years old.
He remembers stealing money from his mother's purse and giving it to a friend's older brother to buy booze for him. Whenever Jim walked down the street with a brown bag full of assorted alcohol, he "felt like a man".
He considered the behaviour normal. He was young and naive, and the UK has the highest number of underage drinkers in the world, a recent Organisation for Economic Cooperation and Development study says.
But when Jim moved to Hong Kong at age 16, alcohol became his worst enemy disguised as his best friend. It became easier and easier to binge drink but nearly impossible to tell it was a problem.
"If you didn't drink, people thought you were weird," he says. "Parents would stock their house with alcohol for house parties so their kids wouldn't lose face."
It was not until his early 20s that he realised something was wrong, although he struggled to figure out what it was. He consulted a psychiatrist who happened to be part of the British armed forces.
"Of course, the army had a big drinking culture, too," Jim says.
"So, when I told him I thought I was drinking too much, he looked at me kind of confused and said: 'What's the problem here?'"
Dr George Hu, a clinical psychologist at Beijing United Family Hospital, says society has come a long way in understanding alcohol abuse, but it still has a very strong stigma.
"Alcoholism in general is looked at as less of a problem in Chinese culture," says Hu, who helps expatriate patients struggling to adapt to a vastly different life in the country.
"It is ingrained in the culture. So not many people are willing to admit they have a problem."
Life stresses, such as moving to another country, often give rise to anxiety, depression, excessive worry and other issues, Hu says. Alcohol is often used as an escape.
The findings of a 2012 study, published in the International Journal of Mental Health, suggest expatriates working abroad may be more prone to mental health problems and substance abuse than their domestic counterparts. Dr Sean Truman and Dr David Sharar surveyed 950 US expatriates working in Latin America, Asia and Europe. They compared their survey results with those of 1,450 US workers who stayed in their homeland and found some telling trends.
The study found that more expats fell into the high and moderate categories for substance-abuse problems.
"There tends to be higher use of substances in the expat community because of environmental stress and the fact that most of these people do not have their family with them and factors that would generally govern substance use," Truman says.
Sharar says: "Many who need help do not seek professional help, as expats tend to be a very resilient group and do not readily believe that professional assistance will make a difference."
When Jim moved to Beijing for work in 1992, he was completely dependent on alcohol but unwilling to admit he was an alcoholic.
A few more years of blurry nights and morning migraines ensued. All the while, Jim felt like "an empty eggshell of a human being, devoid of any sense of meaning".
Alcohol had seeped into every aspect of his life.
"I believed drinking was a very important part of my job," he says. "I used to write off business expenses as 'drinking with customers'."
Drinking had become necessary not only to fuel his addiction but also to keep his business afloat. Saving face and forging friendships often relied on knocking back beers and baijiu shots with clients.
"Drinking is socially sanctioned and very often viewed as necessary when conducting business," Hu says. "There is a lot of stigma attached to being an alcoholic but especially in China."
Hu says there's not so much a lack of resources for alcohol abusers in China as there is a lack of recognition of the disease. Not many are willing to risk careers and reputations by admitting their problems.
"They may know in their heart they need help and know in their heart they are addicted to alcohol, but a lot more is on the line if they give it up," he says.
Near the end of Jim's "hundred days of rock bottom", he would stare into that bathroom light and see his body deteriorating.
But he began to understand the problem was deeper than depression or drinking.
"Alcohol was my god," he says.
"I needed to give my life over to a higher power. I had made a big mess of my life, so I knew my power was useless."
So, Jim made a call to the Beijing Fellows AA group that he believes saved his life.
Then he went to a meeting, not knowing at the time that he had taken the first step toward escaping rock bottom.
"I listened to all these people tell stories that made perfect sense to me," he says.
Afterward, Jim shared his own stories with the first group of people who could relate to them.
He explained how he would binge drink with coworkers, then run off to the rest room to vomit and empty his stomach, just to be certain nobody could drink more than him.
And he told members about the time he was riding his motorcycle in Hong Kong when he came up to a police checkpoint. He was so drunk that he fell off his bike and couldn't even get his license out of his pocket. The police officer helped him back onto his bike and told him in a "fatherly voice" to be careful.
Now 16 years sober, Jim recalls his drunken escapades with a laugh.
He swaps stories with other AA members every week over breakfast in a Sanlitun cafe, sandwiched between a wine shop and a bar, where coffee is now his drink of choice.
"We laugh a little bit at each other's tragedies," he says. "I don't know why. But we do."
He credits AA for saving his life and helping him put alcohol 12 steps and a decade and a half behind him.
Jim says he "loves life and wishes he could live forever".
"If I had continued to drink, I would have died. Or, even worse, I would still be alive and living like a zombie," he says.
"It is no longer a struggle to stay sober because all I have ever (had) after is peace and contentment in my head. I have found it."
Kurt Nagl contributed to this story.