Japanese alcoholics bamboozled in battle against the bottle

06/13/2011
By

TOKYO (majirox news)- Serenity dumps the knapsack he’s been lugging around all day, gazes at the burning sun shining directly above a statue of the Virgin Mary in a suburban Tokyo church garden and lets out a sigh.

“I’d love a beer,” he says.

But Serenity won’t imbibe. At least not today.

“I get the strength to continue in sobriety through my nakama (buddies),” 42-year-old Serenity says, the pseudonym he uses to maintain his privacy as a member of Alcoholics Anonymous (AA), a self-help fellowship for those who want to quit drinking.

Meeting time draws close and arriving in dribs and drabs — sometimes in groups, more often alone — are Serenity’s nakama: a word that assumes almost mystical powers among Japan’s recovering alcoholics relying on peer therapy to achieve and maintain sobriety. Serenity has already seen some of the incoming nakama earlier in the day, but others he’s met at similar gatherings in recent months, weeks or days he’ll never see again. He never knows exactly who will turn up for meetings or how many.

In fact, nobody knows exactly how many such nakama – potential or otherwise – are in Japan. Japan does not have official statistics on the number of its alcoholics. The Ministry of Health, Labor and Welfare estimates the number to be at least 800,000, but it increases to about 4.4 million if pre-alcoholics are included.

The World Health Organization (WHO) recognizes alcoholism as a disease that can affect anybody. Prince Tomohito of Mikasa, the Emperor’s cousin who revealed his alcoholism publicly four years ago, is probably Japan’s highest profile alcoholic, but the disease affects all strata of society. Some people are more susceptible. Risk factors include unstable social environments, stress, genetic predisposition and age.

This incurable disease is destructive, often obliterating families, homes, careers and health. Physically, alcohol abuse affects every organ of the body. Mental illnesses such as depression and panic disorder frequently accompany the disease, which is also a typical symptom of post-traumatic stress disorder. What’s more, alcoholism destroys the most precious possession of all – life. The WHO says an alcoholic’s average life expectancy is 52, or 30.6 years shorter than average for Japanese.

The average annual alcohol consumption for Japanese peaked at a little more than 8 liters during the economic “bubble” era of the late 1980s and early 1990s and has gradually declined since. With its Health 21 plan, the Health Ministry aims to cut alcohol consumption in 2014 by 20% of the 2000 level.

“Recently, the annual consumption rate’s fallen to just over 7 liters, which is about the same as in the United States,” Dr. Susumu Higuchi of the Institute of Clinical Research at the National Alcoholism Center Kurihama Hospital – Japan’s foremost facility for the treatment of alcoholism – told Majirox News, before sounding a warning: “Japanese have smaller bodies than Americans and many are predisposed to difficulty in metabolizing alcohol. This creates worries they are more susceptible to the effects of drinking.”

Also alarming is what the statistics hide between the lines. Reduced overall consumption has come largely at the expense of hard liquor, beer and spirits, but since the mid-1990s there has been steadily increasing intake of cheaper yet equally or sometimes more potent alternatives like shochu, a cheap vodka-like liquor, and happoshu extra-malt beverages.

Alcoholism develops when drinking patterns shift from social to chronic. This is often accompanied by a shift from consumption of expensive to cheap alcohol as physical dependence develops. Increased wine consumption, also on an almost exclusively upward trend for 15 years, may be behind Higuchi’s finding of a 53% rise in the number of women undergoing treatment for alcoholism at national hospitals from 1997 to 2007.

Yurakucho in Tokyo

Japan is a breeding ground for alcoholism. Alcohol is widely available at convenience stores that never close and street-side vending machines; it’s heavily advertised in all media with few restrictions, and drinking is seen as a social lubricator, as illustrated by the term nomyunikeshon, a Japanese-English portmanteau from nomu, to drink, and communication.

Public intoxication, while frowned upon, is often ignored despite its visibility, as frequently demonstrated by inebriated salarymen left to sprawl across seats or floors on late-night trains. Japan has no religious constraints on drinking. Moreover, alcohol is not widely viewed as a potentially lethal drug.

The combination of an economy that has been in the doldrums for two decades, the rising divorce rate, one of the world’s highest suicide rates and March 11’s triple disasters in Tohoku and a virtual blueprint for increased alcohol dependence.

Medical assistance is available, not only at the 14 national hospitals specializing in alcoholism treatment nationwide but also at dozens of other private hospitals. But only about 20,000 alcoholics are treated annually across Japan. Medical treatment concentrates on physical care, starting with detoxing and the healing of physical effects before moving on to rehabilitation through education and various types of individual and group therapy.

Yet prospects of recovery are bleak. Statistics from Komagino Hospital, an outer suburban Tokyo facility that treats alcoholics, show that only about 20% of its rehab patients maintain sobriety 12 months after being discharged.

Rehab patients are taught to observe the three pillars. These are: outpatient treatment, prescription of alcohol deterrent drugs like cyanamide and nocbin (which block the alcohol metabolic process and induce hangover-like symptoms in alcoholics if they drink); and active participation in self-help groups like AA and the All Nippon Sobriety Association (Danshukai), a body derived from AA but without its religious connotations or 12-step addiction recovery program.

Critically hampering treatment of Japanese alcoholics is the onus on the individual seeking help. But these people, by definition, have lost control over their drinking. Most treatment occurs on a voluntary basis, but not all alcoholics are willing to admit their condition and do not seek help. Government financial assistance and subsidies are available, and treatment is covered by national health insurance, but such coverage usually continues only as long as the alcoholic stays dry.

Support networks comprised largely of NPOs and Christian organizations also play key roles in helping recovering alcoholics. Yet these require the alcoholic to seek care and none of these bodies actively engage in getting alcoholics sober until they are asked to. Moreover, despite its widespread tolerance of drinking, wider Japanese society – like that of most other countries — tends to take a dim view of alcoholism, seeing the afflicted as lazy, self-indulgent people – for lack of a better word – the dregs of society. It limits the avenues of opportunity for recovery.

With medicine unable to provide a cure, self-help groups provide alcoholics with the statistically greatest hope of recovery. Yet their situation remains grim. Only a small percentage of alcoholics join, and many who do pull out within months of first attending.

AA does not collate statistics, but a generally accepted anecdote among regulars is that only about 5% of those who join maintain sobriety permanently through the fellowship. The Danshukai, Japan’s biggest self-help group for recovering alcoholics, has a membership of about 9,500, while AA estimates its numbers to be around half that. Both groups have daily meetings at hundreds of locations across the nation.

“I don’t know when I’ll drink again, but I won’t drink today because I’ve seen my nakama. Society is not sympathetic toward alcoholics, but nakama understand. I can see with my own eyes that there are nakama here who have recovered and made it back into society,” Serenity says as he uses the towel draped around his neck to swab the perspiration from his brow. “And being here shows me that just because it’s hot and sunny I don’t always have to have a beer.”

kenji@majiroxnews.com

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