Monday, June 19, 2006

Taiwan Alcoholics: No Place to Dry Out

The teaser reads:

Doctors say that alcoholism is on the rise and that the age of habitual drinkers is falling, but Taiwan only has one inpatient clinic dedicated to alcohol dependency
and leads to an interesting article on alcoholism and treatment in Taiwan.

Ganbei (乾杯), the Chinese phrase for "bottoms up," is the standard toast of the Mandarin-speaking world. Anybody taking part in the toast had better drain their glass or risk committing a faux pas.

As in the West, alcohol in Taiwanese culture is a social lubricant, the imbibing of which is seen by many as a measure of fortitude and spunk -- particularly if drinkers knock down a shot of hard liquor like kaoliang in one gulp.

Such a macho approach to alcohol may be fueling widespread addiction.

Lin Shih-ku (林式穀), director of the Taipei City Psychiatric Center (台北市立療養院), told the Taipei Times that 5 percent of Taiwan's population could be addicted to alcohol.

The article notes that the disease paradigm for understanding alcohol has not yet become widespread in Taiwan.

A Taiwanese AA member, who spoke to the Taipei Times on the condition that he be identified only as "Jeff," agreed that shame makes it difficult for Taiwanese alcoholics to face their condition.

Jeff also said that a lack of understanding of alcoholism as a disease translates into too few options for alcoholics in need of specialized treatment.

"A decade ago, AA meetings were mostly attended by Westerners," said Jeff, a longtime a member who attends meetings almost everyday. "Now there are more Taiwanese members than foreign members."

He said that the number of alcoholics in Taiwan is rising, and the average age of those with drinking problems is falling.

Applying the Western paradigms of disease and recovery to alcoholism initially posed a problem for Jeff.

"Some of what the Western AA members told me about drinking was difficult for me to accept at first. However, my being Taiwanese and they Westerners didn't change the fact that our experiences with alcohol and [the nature of our addiction] were very similar," Jeff said.

Meanwhile, a "chemical approach is the only effective approach":

Winston Shen (沈武典), director of Wanfang Hospital's (台北市立萬芳醫院) psychiatry department in Taipei, said that Taiwan lacks rehabilitation clinics. "As far as I know, there is only one [inpatient] rehab for alcoholics in Taiwan -- Taipei City Psychiatric Center," Shen said. Wanfang Hospital, according to Shen, treats alcoholics as outpatients. "Most of my patients are celebrities -- movie stars or reporters," Shen said, adding that many alcoholic and drug-addicted Westerners seek him out as well due to his American training.

Shen's treatment program for alcoholics at Wanfang Hospital is pharmacologically-based -- meaning that powerful psychoactive drugs like sedatives and anti-depressants constitute his treatment plan. "Talking doesn't go anywhere," Shen said, referring to talk therapy. "If a person follows my treatment plan [and takes the pills I prescribe], trust me, they won't drink."

Alcoholics who come to Shen to kick their habit are first prescribed sedatives as a substitute for alcohol. Once patients cross over from booze to a drug like Valium, they are weaned off that drug, after which Shen treats his patients with medications which reduce cravings and treat depression.

"Alcoholism is caused by depression or anxiety. Every alcoholic needs to take anti-depression drugs [if they are to stop drinking]," Shen told the Taipei Times. "A chemical approach is the only [effective] approach."

But many dispute this, noting that chemistry does nothing to address the underlying sociopsychological issues:

In a country with a healthcare system that pays scant regard to alcoholics' special needs, temples have been known to double up as unofficial detox wards, providing alcoholics with a place to dry out.

"Detoxing at a Buddhist monastery is more along the lines of what alcoholics need," one AA member said, adding that hospital treatment focuses on the physical consequences of drinking, and skips over psychological issues such as addiction.

1 comment:

David said...

I think there is really a lack of understanding of alcoholism and what constitutes alcohol abuse in Taiwanese culture.

I have observed this to be even more so in Thailand, a country which has a much bigger drinking problem (in fact one of the world's worst). Even though many people there would be alcoholics they are never referred to as such and abuse of alcohol is generally accepted as a social norm.