Does Addiction Follow You Around the World?

As a counseling student, my focus of study is on addictions. I saw my trip to China as a unique opportunity to see how different cultures view the concept of an addiction. Do they see addiction as a disease? Is addiction a well-known problem? Do they have counselors to help people battle their addictions? What qualifies as an addiction? These are the questions I asked myself while I was on the 14 hour plane ride to China.

Observations made in Beijing

My first interaction with Chinese students.

My first interaction with Chinese students.

During my first few days in Beijing, I asked around to see what the “college drinking scene” is really like. Something in my head told me that they don’t really have anything like the Jersey Shore in China. I asked our tour guide, Robert, what he thought of addictions. As far as Robert knew, there was no such thing as addiction in China. People just don’t go out and binge drink because it is so negatively viewed. Drugs? Nothing could be more preposterous! Beijing doesn’t have drugs. No way. People rarely drink at all, including during celebrations. On birthdays, students may go out and have 1 or 2 drinks, but that is really the limit. Really. Very rarely does a person ever drink to get drunk. That would just be absurd. Since the Chinese are so “well behaved,” there are no drinking rules in China. These rules are just not necessary. Americans need rules because we can be animals when it comes to drinking. But never the Chinese. The shunning that comes from others in the Chinese society is enough of an incentive not to drink. You never see people drinking out in the streets, Robert told me. It’s not because there is a law against drinking out in the open. It’s because of the social mores that prohibit such acts. People look at you as if you should be in a zoo if you’re drinking out in the sidewalk. I found this to be very interesting, but I wondered how much of it was true. I know that I may, at times, try to paint a better picture of my own country to foreigners. I embellish certain details about my country because I wouldn’t want anyone to view America in any sort of a negative light. I began to wonder if perhaps I was receiving the same kind of thing going on from the Chinese. I then began my own little research during my free time. I wanted to discover whether or not the Chinese ever come across drugs.

 

This is the Chinese idea of something that is actually fun to drink...chrysanthemum tea.

This is the Chinese idea of something that is actually fun to drink…chrysanthemum tea.

 A reality on drugs–a look at China’s past and present according to research

According to Lin Lu and Xi Wang, drugs do in fact exist in China.  In actuality, drugs have been an issue in the past among the people. Now, we’re onto something! With its large population, the Chinese do have a good number of people who do use. Drugs such as opium have caused many severe issues in the country. China was able to secure itself against the demon drugs for quite a long time. However, with a more flexible international policy that came up in the 1980s, the issues with illegal drugs arose, with opium acting as the largest demon.

In addition to the opium, there has also been a long history of alcohol abuse, which had never been mentioned to me by Robert or the other students. “Alcohol use became an important part of Chinese culture, where alcohol production, trade, and use are closely linked with many social activities, such as ceremonies and festivals. Many Chinese people see the consumption of alcohol as symbolizing luck, health, and long life. Alcohol is also an integral part of traditional Chinese medicine and is closely related to traditional art and poetry” (Lu & Wang, 2008, p. 305). Due to the problems that arose from alcohol, laws had been put into place during various dynasties. Perhaps, alcohol and drug use are a little less common nowadays due to the history of issues. Maybe the Chinese culture has learned from its past, which explains the mores that exist now.

What about drug use in the present day? According to Lu & Wang, the use of illegal drugs, especially heroin, has grown to become an epidemic in recent years. “The number of drug abusers registered by security agents increased from 70,000 in 1990 to 1.16 million at the end of 2006, a rate of increase of about 122% per year. The estimated total number of users, including unregistered drug abusers, is much higher; in 2004 the estimated number of actual abusers was 3.5 million” (Lu & Wang, 2008, p. 306). In addition to these statistics, the article continues on to say that drug use has expanded from the urban areas to the rural parts of the country. This struck me as interesting since Robert made it sound as though drugs were rarely used in Beijing but they may be used more in the rural areas.

According to Lu & Wang, many problems stem from this drug abuse, primarily the spread of the HIV/AIDS virus. I talked to a student in Shanghai who was interested in helping out victims who were suffering from HIV/AIDS. I wish I had been able to connect the dots and asked her why she thought patients were contracting the virus. It seems as though needle usage is the primary reason for the transfer of the disease. In America, we seem to assume that unsafe sex is a reason why the illness is transmitted. In China, on the other hand, it seems to be caused by a completely different factor. The student I talked to in Shanghai also told me that patients who have HIV/AIDS are very ashamed of their disease and often try to hide it. Perhaps, they are also trying to hide the fact that they could be addicted as well.

Although “China is the second largest beer-producing country in the world,” (Lu & Wang, 2008, p. 308) the rate of consumption in China is much less than other parts of the world. Ah, finally some consistency between my findings on the internet and my conversations with Chinese students and citizens. “Customarily, alcohol consumption is acceptable only during meals, and solitary drinking is unacceptable” (Lu & Wang, 2008, p. 308). So drinking excessively is obviously something that is viewed very negatively in China. It’s viewed so negatively that the people pretend not to take notice, which became apparent when talking to my new Chinese friends.

Personal experiences in Beijing with regards to substance use

I then went a little more personal and asked students in Beijing about their own drinking habits. They mentioned that drinking just doesn’t appeal to them. They too also stated that they may go out and have a couple of drinks for someone’s birthday celebration, but it never exceeds one or two beers. I then asked about drug usage and they informed me that Beijing “doesn’t have a problem.” Here we go again with drugs not existing. Perhaps a philosophy of “Hear no evil, see no evil, speak no evil” exists in the Chinese culture. However, the students stated that there are other parts in the country that are a little more isolated and do have a slightly larger problem, although “it never gets too out of hand,” which again runs into conflict with my findings in the article I read.

 

How the Chinese apparently react to drugs and drinking.

How the Chinese apparently react to drugs and drinking.

I then inquired about addictions in general in China. As we all know, addiction does not have to be limited to drugs and alcohol, although that is often the first thing that comes to mind when we are discussing the topic. Robert, the tour guide, did mention that several people in China do have a “gaming addiction,” which IS a process addiction. A process addiction is defined as a behavioral addiction. This could include eating disorders, sex addiction, gambling addiction, and gaming addiction, to name a few. Although the Chinese seem to phase out any possibility of any members being addicted to a particular substance, it appears that they are more open about the behavioral addictions. This could run parallel to our society because we often place a less negative stigma on something like eating disorders. We more often see the person with an eating disorder as someone who actually has a disease instead of making the choice not to eat. As far as substances go, our own society continues to face a lesser acceptance of the disease model.

Our exquisite tour guide.

Our model tour guide, Robert.

Oh where art thou Liquor Stores?

While I was out walking the streets of China, I noticed that there were liquor stores. However, they were relatively hidden and I didn’t even see them at first. When I did finally notice the stores, I observed that they were very small and they pretty much blended in with surrounding stores. I feel like our liquor stores stand out in America. They always have plenty of neon lights and arrows on the outside of the building, as though we are proud of our (sometimes imported) liquor. China, on the other hand, does have its fair share of liquor stores, but they’re TINY. They’re extremely compact and you have to be really looking for them in order to find traces of these stores in the streets. They’re so tiny that I didn’t even notice them until someone brought it to my attention that we were indeed passing by several “alcoholic convenience stores.”

Liquor store

Liquor store

Drinking among older individuals?

During my trip, I kept asking about drinking among populations that are my age. I feel as though my age partakes in most of the recreational drinking in America so I figured it would be the same in China. At the end of the trip, I realized that I had been asking all of the wrong questions. In actuality, my age group doesn’t drink all that much. The adults, on the other hand, drink very often, especially the males who work in government-type jobs. Maintaining strong relationships with others, especially your colleagues, is something that is very much desired in the country. According to a certain student in Shanghai, government officials will have important meetings and then all go out and have some drinks afterwards to instill continuity among relationships. Consequently, individuals who go out and drink often gain promotions in office. Something that I found incredibly interesting was the fact that men are the ones who actually go out and do the drinking. Women, on the other hand, are looked down upon if they engage in the same activities. As a result, men get more promotions than the women. Sounds as though the feminism movement has not quite reached China yet.

Us with a student in Shanghai.

Richelle and I with a student, Echo, in Shanghai.

A more anecdotal piece of my trip was also given to me during my trip to Shanghai. During my conversation with the same Chinese student who told us about the drinking events after meetings also mentioned that her father partakes in a little bit too much of drinking. Unfortunately, they do not have a name for it. They just see it as him “drinking too much” and they are extremely “unhappy about it.” However, the family feels as though there is nothing they can do about it and so they minimize the effects of the behavior (which in itself would be considered enabling in this country).

 

If you drink or do drugs, this bear will be sad.

If you drink or do drugs, this bear will be sad.

An experience with Chinese Karoake

So after hearing all this information about how the younger Chinese people “don’t drink,” our last night in Shanghai was spent at a Karoake studio. I felt like I was back in America. The Karoake studio was certainly “alcohol heaven” with people belting out to their favorite songs like Kelly Clarkson’s, “Since U Been Gone” and Taylor Swift’s “We Are Never Ever Getting Back Together” with a subtle Chinese accent thrown in there for a twist that was all too adorable. Perhaps the government officials decided to have their end of the meeting party at KTV studio? I don’t think so. It seemed to me as though the other participants were certainly from my age group, which was an introduction to another piece of the Chinese lifestyle. Perhaps the Chinese are a little better at hiding their drinking activities than we are. This was certainly a unique experience in that I probably never would have seen it unless I spontaneously joined our “singing/screaming crew.”

KTV Studio--Karaoke Nation

KTV Studio–Karaoke Nation

Counseling in general

What about counseling in general in China? Is addictions counseling even in existence? Due to the negative stigma placed on addictions in general, counseling for this specific issue is also negatively viewed. Right now, it appears that the most accepted view of counseling is what takes place in schools. Addictions counseling is not even close to being well accepted in China. People who go to a counselor must “really have problems,” according to the students I interviewed.

However, the teachings of all kinds of counseling are very similar to our system. I came to China expecting there to be vast differences between the two countries. We look so different on the outside and our countries are run by a completely different system, why wouldn’t our counseling systems be unique from one another? It turns out our paradigms of counseling are extremely similar. So similar, it’s almost scary.

The idea of counseling is relatively new. It’s only been in development in our own country for about 50 years. During those 50 years, the field of counseling has grown and made some major improvements. In China, the counseling field is even more new as the idea has expanded and moved from our country. The major schools began to be established in China within the past 15 years. During that time, there has been a decreased resistance to the idea of going to a counselor to talk about their problems. However, according to the individuals I talked to in Xi’an, the negative stigma of taking your problems out of the household “is starting to fade.”

In America, the counselor was initially seen as the expert. Over time, however, it became more accepted for the client to be the expert on his/her own life with the counselor serving as a “helper” in aiding the person to guide their own path towards a desired change in his/her life. In China, the counselor is still seen as more of the expert but, according to the individuals we interviewed, they are beginning to stray away from that view as well.

While my discussion with the individuals in Xi’an, we found out that they hold ethics in the exact same light we do. They have their own code of ethics, just like what we have when we practice. However, they do see us as being more strict with our ethical guidelines since a violation could lead to losing your counseling license.  Due to the fact that the counselor is seen as more of the “expert” in counseling, they don’t want to go against what the counselor has said/done. Since the counselor is not seen as much of an expert here, the client is more willing to challenge the counselor if something is seen as awry.

As far as confidentiality goes in China, their guidelines are very similar to our own. They protect confidentiality unless a person is suicidal and homicidal. I was slightly surprised to hear this since I had originally thought that they were a little looser with their rules regarding confidentiality. Before going to China, I was told that a lot of information the client discloses is discussed externally with other people. I was surprised to find out that this was not the case at all.

So how important is counseling these days? Due to the rapid economic and social changes that have been made in China recently, the Chinese have faced a multitude of stressors they have never previously experienced. According to the article, The Trajectory of Counseling in China, “mental illness accounts for 20% of the total patients in hospitals, making it the most widespread disease in China” (Lim, Lim, Michael, Cai, & Schock, 2010, p. 4). The person that I interviewed in Xi’an also mentioned that the sudden increase in mental health issues has persuaded people to use counseling as a form of therapy. “In addition to mental illness concerns, there are many other reasons for the Chinese to seek psychological help; among the most common are mental distress, school-related problems, financial worries, family/relationship difficulties and ‘anxiety about adapting to the changing demands of the marketplace’” (Lim, Lim, Michael, Cai, & Schock, 2010, p. 4). In order to find out more about counseling in China in general, check out Richelle Joe’s blog at http://chinese.blogs.wm.edu/2013/04/13/changing-attitudes-saving-lives/.

A country of perceived wellness on the surface.

A country of perceived wellness on the surface.

 

Lim, S-L., Lim, B., Michael, R., Cai, R., & Schock, C. (2010). The trajectory of counseling in China: Past, present, and future trends. Journal of Counseling & Development, 88, 4-8.

 

Lu, L. & Wang, X. (2008). Drug addiction in China. New York Academy of Sciences, 304-317.

Photo Credit: Katharine Sperandio