For many, the holiday seasons involve a lot of alcohol wrapped up in fun and good times with family and friends. But when the party ends, is it time to take a critical look with a clear head, and ask if the lifestyle is getting out of hand? With this in mind, we spoke to Dr Suresh Joseph, Head Counsellor at The Cabin, about addiction.
“My personal observation is that some aspects of the expat lifestyle really lend themselves to pushing the envelope,” says Suresh, a Singaporean who knows the expat life well, having spent over 20 years living in the UK for his schooling, university and later career. “Many people have access to higher disposable incomes, and they may feel they are in a bubble, with a perception that what they do here will get left here. So they drink more and party harder, because there is something about expat life that makes this easier and somehow more acceptable.”
The physical distance from family and friends, and a disconnection from familiar social and cultural norms can, over time, lead to behaviour that would be taboo in one’s home country. And it works both ways. “For spouses away on work trips there is the drinking, which is an accepted way of doing business in Asia, while for the accompanying spouses at home, the availability of domestic help means they have a lot of time for socialising. You ally that with a drinking culture, and it’s very easy to slip into substance abuse,” says Suresh.
What is addiction?
Addiction is a disorder that causes malfunction of the brain’s reward circuits, resulting in people reinforcing their blunted reward feelings with substances or processes that will increase pleasurable feelings. Once this happens, it creates a knock-on effect for someone with a genetic susceptibility to the disorder, or chemical cascades to other parts of the brain affecting things like judgement and impulse control. This is why “addicts” or alcoholics cannot control their using. The American Society of Addiction Medicine refers to addiction as a chronic condition, which means that symptoms will return if it isn’t treated. The US National Institute of Drug Abuse says up to 60 percent of addiction sufferers have probably inherited the disorder genetically, while others may have damaged their reward system by overusing it.
Not only alcohol
The most common addiction amongst the expat clients that Suresh sees in Singapore is alcohol, followed, in order, by sex, the internet, drugs and gambling. In some cases Suresh sees two addictive processes in one individual. “The most common combination is alcohol and sex, and the two augment each other,” he says. In other people there is what is known as a dual diagnosis, which is the presence of a second, undetected health issue – for example, anxiety, depression, psychosis or bipolar.
High levels of sex addiction in the male expat community could in part be explained by increased accessibility. “Men can visit places like Orchard Towers, and have mistresses; I wouldn’t say that expat society is necessarily accepting of this, but there does seem to be a certain resignation that this is what expat men in Asia do, and that is perhaps part of the reason they develop a fascination.”
Suresh notes that there are female sex addicts, though the numbers are much lower, and their behavior doesn’t usually become dangerous – it’s mainly restricted to viewing pornography, excessive masturbation and voyeurism, for example. “Dangerous sexual behaviour in women tends to be connected to their alcohol consumption. They are much more likely to make poor decisions when drunk than they otherwise would. They make sexual choices they might later regret, but seldom have I seen them cross into full sex addiction.”
Gaming gone wrong
The numbers are still small, but addiction to gaming is growing, typically among males in their late teens to early 20s. Parents see the signs: they fail grades and miss school, and show signs of mood disorders and aggression. Some may also have substance abuse issues, for example with marijuana.
Suresh says that the problem with gaming for up to 14 hours a day is that it excludes everything else. The young (mostly) men become locked into a virtual, first-person gaming environment, where their alter ego develops a personality, and even clothing preferences, and takes over. “I had one client say, ‘Why would I want to be myself? I can be so much cooler online!’” says Suresh. “When parents try to intervene and disengage children from their devices, they can go into a type of withdrawal and suffer cravings.” It can turn nasty too; Suresh tells of one boy who threw his father down the stairs, resulting in a broken ankle from the fall.
Denial and alarm bells
“As human beings we all utilise denial – it’s a cognitive device that we use as a means of coping with a reality that we might otherwise find intolerable,” says Suresh. In the case of addicts, denial enables them to rationalise and legitimise a set of behaviours that is completely at odds with their morals and principals; that they would otherwise adjudge to be completely unacceptable; that they would never ordinarily countenance in themselves or others; and then continue doing it. Those with alcohol addiction find clever ways to hide their drinking, and create a perception that there isn’t a problem. For example, they may say to themselves, “I don’t have a problem with alcohol; I have a problem with my wife (or boss, kids, parents, siblings, colleagues). If she would just get off my case then there wouldn’t be a problem.”
Suresh explains that the maximum recommended units of alcohol consumption in one week is 21 for men and 14 for women, which is roughly standard for most government health advisories worldwide. “If you drink substantially more than that, you need to ask yourself why,” he says.
People can also ask themselves questions that follow the CAGE acronym. Have you had thoughts about cutting down? Do you feel annoyed or angry when people say you drink too much? Do you feel guilty about what your drinking is doing to those around you? Do you require an eye-opener to get out of bed in the morning?
While there are numerous counselling and treatment options in Singapore – many specialising in helping expatriates – finding the appropriate one, where you can establish a positive, trusting relationship, is up to the individual. The treatment recommendation, whether it’s for outpatient or residential referral, will depend on the severity of the addiction, and the presence of any underlying health conditions. Most treatments include individual and group therapy sessions.
Suresh is Head Counsellor at The Cabin’s recently opened outpatient facility. It’s an extension of the residential facility in Chiang Mai, Thailand, where the care is likened to the well-known US rehab facilities that we hear about when celebrities are in trouble. A minimum stay is 28 days, in resort-like surroundings, with 24-hour support. Clients go for the integrative counselling that includes cognitive behavioural therapy, twelve-step facilitation and mindfulness, all of which have worldwide support as effective techniques for addiction. Those who don’t require this intensive treatment, or high-functioning clients who can’t get time off work, can receive intensive treatment in Singapore, without a residential stay.
A new way
Suresh says successful treatment outcomes depend on the following important factors: the motivation of the individual, strong family support, a commitment to stay in treatment for the long haul and a solid alliance between client and counsellor. “There is absolutely no reason why an individual should not recover if these conditions are met.”
He strongly emphasises that recovery involves learning healthy methods of managing emotion and stress, and navigating life without the addictive substance. “Essentially, recovery is about finding a new way to live.”
Signs to look for
Where is the line when it comes to alcohol dependence? How can loved ones spot an addiction in someone who seemingly experiences few of the stereotypical consequences? The following are some typical indicators that suggest someone is a high-functioning addict.
- Considering substance use as a reward for their hard work.
- Using substances to cope with daily stress.
- Frequently referencing the next drink or high.
- Leading a double life – keeping up appearances but struggling internally with cravings and failed attempts to cut back.
- Often drinking more than planned.
- Denying the consequences of substance abuse, and using their ability to achieve success and power as further denial that they don’t have a drinking problem.
The Cabin | thecabinsingapore.com.sg
Alcoholics Anonymous Singapore | singaporeaa.org
DrinkAware UK | drinkaware.co.uk
National Council on Problem Gambling | ncpgambling.org
Narcotics Anonymous | nasingapore.org
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This article first appeared in the January edition of Expat Living. Subscribe.
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