Rupert Wolfe Murray of Castle Craig Hospital discusses why some expats are tempted by alcohol and how cultural differences can make it difficult to find help.
Being an addicted expat is no joke. A typical expat has a demanding job and a family that may be extended across two countries. They tend to come under a lot of pressure and many find escape in drink or drugs.
Back home it’s easier to confront the problem and get help. It’s easier to approach a doctor, priest or therapist about an addiction when there are no linguistic and cultural barriers in the way. It’s less scary to confront the boss if both of you are living in the same town, as compared to a skilled expat in whom the company has high expectations. The tendency among expat addicts is to conceal their addiction, suppress their sense of shame, avoid discussing the problem or getting professional help, and to indulge in 'self-medication'.
In western countries, the support networks for addicts have been around for generations; Alcoholics Anonymous was founded in 1935. Alcoholism is classified as a disease, which means western health insurers can cover the costs of treatment. Most GPs have experience dealing with addicts and there is a well established network of treatment centres in most countries. Above all, families, friends and work colleagues often provide the backup and support that are instrumental in helping so many addicts recover.
Druming therapy at Castle Craig
None of this is available to the typical expat, whose whole lifestyle is constructed away from the familiar support networks of home. Behind the seemingly idyllic expat lifestyle of wealth and success often lies the grim reality of addiction. Writing in The Times, Jan Battles describes 'the stereotype that won’t go away'. "Ireland’s reputation as a hard-drinking nation is borne out by new figures showing expats living in Britain are more than twice as likely to die from alcohol-related causes than the general population.”
If the situation for Irish expats in London is difficult, imagine how hard it can be for expats living in Eastern Europe or the Middle East where there is less tolerance and understanding of mental health problems in general, and about addictions in particular. In many Arab countries there is zero tolerance of alcoholism, while in others the policy towards alcohol is ambiguous, and even asking about professional help for an addiction could be risky. (Click here for a fascinating insight into the “return of alcohol” to Baghdad).
Art therapy at Castle Craig
I live and work in Romania, an ancient country where alcohol is woven deep into its culture and history. Alcohol plays a key role in Christian Orthodox rites. Many of the village homesteads make their own spirits. Cheap moonshine is available at every corner shop and the modern beer and wine industries have invested in new production facilities to serve this emerging market of 20 million potential drinkers.
In a fancy bar in downtown Bucharest, you can get a glass of beer for less than USD 2 and a bottle of local wine can be bought for less than USD 1 in a corner shop. Bucharest is dotted with Irish bars and comfortable, modern restaurants and one of the first things that expats notice is the good quality and low price of the alcohol, as well as how friendly the locals are. In Eastern Europe, alcohol is not only cheap but it is socially acceptable and the newly arrived, or lonely, expat can easily plug into a seemingly supportive social network.
If getting alcohol is easy, getting treatment is not. I am researching the availability of treatment for expat addicts in Romania and I have only found four addiction experts in the whole country. In addition, the expat agencies I spoke to seemed to find the addiction issue somewhat embarrassing. I believe the situation is similar across the former Communist Republic and the Arab world, where addiction tends to be considered as a personal, rather than a public health, problem.
Dr. Eugen Hriscu, a Romanian psychiatrist, recently told me: “Addiction therapy needs well established support networks, like the family, and many expats in Romania only have a loose network of friends – and a lot of the socializing is done in places where drinking takes place. The prospect of giving up drink raises the prospect of being cut off from one’s only friends.”
What I have found in Romania – that there is a small network of highly skilled, well trained, English speaking addiction therapists – may well be true for other less developed parts of the world. Help is often closer than we think. The big problem with addiction is the reluctance to ask for help, and the power of denial.
Rupert Wolfe Murray is the East European representative of Castle Craig Hospital, a leading British rehab clinic that offers abstinence based treatment to addicts.
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