Substance abuse lurks at the heart of the expatriate experience - but it seems no one wants to talk about it. We report on the problem and possible sources of help.

The stressful expat lifestyle can lead to misuse of drugs

Given the lifestyle and constant change inherent in expatriate life — multiple moves, excessive work demands, travelling partners, loneliness, homesickness, stress, and peer pressure to name just a few — it isn't surprising that substance abuse is a challenge in global living.

But expats or their dependents with alcohol or drug dependencies are working their hardest to conceal their problem.

"Substance abuse is still a shame-based issue and not a popular subject in polite company," says Connie Moser, an expatriate writer living in the Netherlands.

Moser has been researching the problem among expatriates for years in order to provide more resources on the subject to expats — and especially young teenagers — living in the more liberal-minded Netherlands where coffee shops openly sell cannabis and the legal drinking age is phased in from the age 16, considerably lower than North America.

"People tend to avoid revealing that there is a problem either personally or with a family member," says Moser. "Somehow, it is seen as a failure.

"But all of those challenges relating to the expat lifestyle can lead to coping mechanisms such as self-medication through overindulgence in alcohol, prescription medication, or recreational drugs," believes Moser.
     
Convincing people to seek help, given the strong denial, secrecy and stigma surrounding these problems, can be a challenge. Too often, a family coping with a substance abuser will find it difficult to ask the company who sent them abroad for help, according to US-based family therapist Sharon Ronan who works with the mobile missionary communities.

"There are so many wrinkles in the story of seeking help," she says. "The non-substance abuser may desperately want to seek help for a family member from the organisation which sent them abroad. But they worry such action would effectively end the assignment for the employee, and the entire family would be sent home."

Alcohol is one of the substances most abused by expats

Alcohol is one of the substances most abused by expats, believes Ronan, pointing out how plentiful is the existence of both supplies and opportunities to imbibe. But alcohol, she believes, may be one key to finding help.

"Alcoholism is now officially classified as a disease, which means its treatment is typically covered by insurance," she points out. "And 'medical leave' may be a less suspicious way of taking off the necessary time to seek help. In fact, to get the ball rolling for anyone trying to get help — for themselves or a family member — the family doctor may be a good starting point."
 
Of course there are always cross-cultural challenges with a doctor's visit in a foreign country, but Ronan believes that, at the very least, an expat in trouble should try to communicate with their doctor, who may be able to suggest a treatment programme.

There are also many on-line resources to help people read up on the subject and feel they are taking steps towards recovery without discussing it with anyone. For instance, there is an extensive bookstore on addictions and substance abuse at http://www.recovery.org/Bookstore/bookstore.htm.

Anyone looking for an Alcoholics Anonymous meeting can also visit http://aa-intergroup.org. The site contains international links for meetings as does an international links section of Narcotics Anonymous at http://www.na.org/links-toc.htm.

Are expats more at risk for addictions?

Experts in the field say the prevalence of substance abuse in the expat community would be equal to that found in any general population.

"One of the most significant predictors of alcoholism is occupation. Since expats —  who are company directors, engineers, diplomats, and in general people who live or travel abroad — are dislocated from their homes, family and other support networks, this places them more at risk," says Dr Margaret McCann, a director at Castle Craig Hospital, a residential treatment hospital in Scotland for alcohol and drug dependency.

"The frequent entertaining of clients, colleagues and other expatriates in the absence of stabilising influences, which at home exert a restraining influence, will play a part," says Dr McCann.

At the end of the day, acknowledgement that substance abuse is a real problem is critical according to Moser, as she believes substance abuse all too often leads to domestic abuse which in turn leads to divorce — which means families are at risk.

"People must start speaking out and not be afraid to talk about these issues," says Moser. "Once a dialogue is initiated, people are more likely to respond, to admit that help is needed and to seek assistance."

Other useful resources:

www.soberrecovery.org
www.castlecraig.co.uk
www.school-and-drugs.org

August 2004
      
Robin Pascoe is the author of four books on global living. She can be contacted through her on-line community at www.expatexpert.com

Subject: Expats and alcoholism, expats and drugs