Expats and Addiction

castlecraigBeing 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.

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).

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.

This article first appeared on the website expatica.com

5 Responses to Expats and Addiction

  1. Julian says:

    Rupert, you draw attention to a very important topic. From my time in Romania I do recall very many people (including some expats) who drank a lot and compulsively. Being drunk in public was perfectly acceptable. One was viewed as quite strange if a drink was refused. Even the reason ‘I’m going to drive’ didn’t convince most fellow drinkers, though ‘I can’t because of medication that I have taken’ was effective. All in all there is a huge temptation for expats – though their tendency to drink is, I believe, a problem that they import.

    The link between alcohol and depression was not well understood in Romania. Over eight years in a village several neighbours died of alcohol-related problems and four more were suicides. There is a mental health issue lurking in Romania (though on the whole a Romanian village seemed like a pretty sane place). The insult ‘you are not normal’ (‘nu esti normal’) says it all really – there is social pressure to conform, making admission of mental problems really rather embarassing. Hence there are few specialists. It is difficult for anyone – local of expat – either to ask for help or to obtain the help that they need.

    Hard-drinking Romanian neighbours did not exhibit the aggression that is characteristic of the Western alcoholic. (I have it on authority from a mental health expert that latent aggression is a hallmark of the current and past alcohol abuser.) In that sense Romanians seemed relatively well adapted to a lifestyle including copious alcohol in a way that Westerners often are not. Perhaps that ‘safe drinking culture’ is especially tempting for expats?

    In fact are we looking at a psychological ‘North’ meets ‘South’ – dark brooding emotionally repressed North Europeans meeting lively emotionally open South Europeans? The former may be higher achievers in a material sense but emotionally and socially they are the poor relations.

    I wonder too whether expats are, by their nature, outsiders – people who have, for whatever reason, rejected the ‘normality’ of dull Western suburban conformity. I went to Romania for adventure and variety, and was not disappointed. Someone who is inclined by nature to look within for strength may turn to drink rather than lean on friends. The expat, then, may be especially vulnerable to addiction problems.

    Perhaps therefore your research could usefully be widened to include the availability of psychiatric help in general? How would one find, for instance, a good psychoanalyst in Romania?

    One last thing – I am puzzled by your statement that ‘consuming alcohol is part of Orthodox religious practice’. Almost every church of any denomination uses communion wine. The Orthodox practice – a tiny piece of bread soaked in wine – uses less wine than most.

  2. Very interesting comment above and full of truths. The only point I would dispute is the last one about the Orthodox Church. While they do indeed use very little wine in the actual service they use a lot at ceremonies such as the “pomana” (40 days after death) where a lot of alcohol is consumed under the auspices of religion. Compare this to Islam which has been quite effective in generally banning alcohol — although the ex-pats and the rich do seem to consume to excess in some Islamic countries.

  3. Julian says:

    On reflection, yes, a lot of alcohol was consumed at weddings. At the other services such as those connected with death, my experence in a Transylvanian village was that diluted palinca was brought out – perhaps because it was the women who made the arrangements and they tended not to like the ‘hard stuff’. Perhaps it is different in the Regat? However, in my experience, Romanians handle their drink far better than, say, the English.

    As for the Islamic world, we could ask why alcohol was prohibited? I gather that the Koran shows a development from tolerance via disapproval to an outright ban. Did that have to do with distilation having been invented round about the time that Islam was founded? (If Medina was becoming like Lanark on a Friday night one could rather understand why some people sought a ban! Was there a Levantine ‘proto-Buckie Belt’?) However what this shows is a difference between fundamentalism and liberal viewpoints – whether to ban something that some see as ‘bad’ or to allow people to make a choice knowing that some will get it wrong? Does one follow rules because strict adherence is promised to lead to the divine, or is one allowed to choose which path to follow on that quest based on broad guidance? The former admits the possibility that all adherents are wrong (the prescriptive rules actually lead nowhere). The latter allows for some to fail but permits a maturing and intellectually coherent belief system to develop. The former takes responsibility off the shoulders of individuals (is this why their ‘system’ is allowed to repress women and nurture terrorism?) whilst the latter tells people (the one who are prepared to listen) that their choices count.

    Against this background the Romanians are in a better position intellectually and socially than some would credit them for.

  4. Thanks for this wide ranging comment Julian. Some people say “the comments are more interesting than the article” and this may be a case in point.

  5. Julian says:

    Rupert, we were talking about why people do (or don’t) live in RO and about the cost of living. It’s getting a bit tangential concerning addiction, but its interesting nonetheless.

    I don’t find anything about Britain particularly cheap nowadays. It’s not, by and large, a good value country. That is the legacy of not really making anything to sell abroad. I suppose that a difference between the UK and RO is that here corporations rip one off whereas there a proportion of individuals try to rip one off. An advantage of the latter is that sometimes one has a bit more choice as to who one deals with. But where one has no choice then very often one really will be screwed over.

    I suppose that, were I to venture reasons as to why I live in the UK, they would be:
    – it’s easy for me;
    – moderately well paid and very interesting job;
    – good health care that is free at point of delivery;
    – good veterinary care is available for my animals;
    – comprehensive cultural life, at least in and around the cities;
    – fairly good environmental protection; and
    – the unquantifiable point of a spiritual link with the land and my heritage.

    For RO, I would write something like:
    – it’s cheap if one has a good job;
    – good local food and drink;
    – a lot of open space in rural areas;
    – many interesting things happening in and around the villages;
    – people are hospitable;
    – sense of vitality within many people;
    – it’s a relatively spiritual nation (which matters to me since I am Orthodox).

    The negatives from my experience would be as follows.

    UK:
    – expensive;
    – crowded;
    – materialistic and unspiritual;
    – psychologically repressed;
    – many welfare scroungers funded by high taxes;
    – a sense that the country has lost its way.

    RO:
    – bureaucracy and corruption;
    – litter and environmental degradation;
    – limited intellectual life;
    – poor medical and vet care (certainly where I lived);
    – animal cruelty;
    – ugly socialist cities (I don’t like big urban areas anyway);
    – prevailing apathy and lack of engagement.

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