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Millions of patients: Substance abuse in China

March 1, 2007
by DAVID J. POWELL, PHD
| Reprints
Few Chinese are receiving the addiction services they need

China will be a major player on the world stage in the 21st century. Business knows well the impact of 1.3 billion customers on the world economy. China is a vast country with 22% of the world's population. But in recent years alcohol use, alcohol-related problems, and drug abuse have grown in China. HIV cases are on the rise. If the current trend continues, substance abuse will prove to have a major impact on this growing nation.

In a crowded marketplace in Gansu province, as the winds whip sand into your eyes, an old man shuffles up politely and asks, “Are you a foreigner?” “Yes, I am,” you admit. He says, “I am from the hills, up there,” and he invites you to travel to the mountains with him. Soon, you're jammed in a car with the old man, driving up rutted paths to the village. It is the home of the Dongxiang people, an ethnic minority descended from Muslim traders who rode the Silk Road. Veiled Muslim girls swarm everywhere. You meet a representative of the local government. They clasp hands and touch their hearts, in the Muslim manner. After small talk about the weather and politics, the conversation turns to business. The 78-year-old councilman says the price is $24 per gram—very cheap, with a 55% purity. “Better than Beijing or New York,” he says. Such is the drug trade in remote China.

China has a long history of drug use, with addicts who filled opium dens. When the Communists took over in 1949, they eradicated drug use in a matter of years. Opium had no place in this new state. But today, as China hurtles into the 21st century, bypassing the 20th, common people are making their own choices again. For some, the biggest lure is the greatest taboo: drugs.

Alcohol use and abuse always have been an integral part of Chinese culture. The West, though, has long held to common myths about substance use and abuse in China. Here are a few of the myths:

  • Myth: Asians do not use or abuse alcohol. Reality: Asian countries, specifically Korea, Japan, and China, have the highest alcohol consumption rates worldwide. The Chinese see alcohol as a representation of happiness and auspiciousness.

  • Myth: Asians have a heightened “flushing phenomenon,” an internal warning system to alert them to drunkenness. Reality: At professional dinner meetings, heavy alcohol consumption occurs, with the purpose of obtaining an edge in negotiations by getting your customer intoxicated. Drinking is socially accepted and plays a significant part in major events of daily life such as the New Year Festival, weddings, birthday celebrations, etc.

  • Myth: Drug abuse does not exist in Asia. Reality: Although Asian countries have strict penalties for drug abuse, significant drug problems are present. Best estimates state that there are more than 10 million drug abusers in China, especially in southern provinces.

  • Myth: Addiction treatment is available in China. Reality: There are very few beds for addiction treatment nationwide. Most drug abusers are sent to labor camps for extended periods (one to three years), and few if any treatment services are provided at these sites.

  • Myth: Medical personnel in China and Nepal have been trained in addiction treatment. Reality: As in most countries, physicians in these nations receive little or no training in addictions.

  • Myth: Chinese people view addiction as a disease. Reality: As in most nations, substance abuse is seen as “a bad habit” in China, to be overcome by willpower.

Although the West estimates 7 to 12 million drug addicts in China, and although that figure pales in comparison to the United States’ on a per-capita basis, the number of addicts climbs each year. If the trend continues, China could end up having the most addicts per capita of any major economy.





David j. powell, phd


David J. Powell, PhD


More than 80% percent of the nation's drug addicts are under age 35, according to the Chinese government, which keeps meticulous—if questionable—statistics. Until recently, the Chinese Center for Disease Control and Prevention has focused most of its attention on tobacco use, and now seeks epidemiological data on drug and alcohol use and abuse.

In the chic clubs of Shanghai, a city of 20 million, teens now pop candy-colored Ecstasy pills. Many truck drivers use “ice” to stay awake on the ride home. But these days, the most alluring drug in China is a derivative of that ancient curse, opium. More than 70% of the nation's drug addicts use heroin, known in slang as “China White.” Nestled beside the drug kingdoms of Myanmar (Burma) and Afghanistan, China has long been a major transit route for drugs on their way to other parts of Asia and beyond. Half of the heroin from the Golden Triangle now travels through China's southern provinces of Yunnan, Guangxi, and Guangdong before reaching international seaports. Today, a new pattern is emerging: Based on Chinese government estimates, 25% of the heroin entering the country stays in the mainland for use by addicts at home, up from 10% in 2000.

International drug analysts estimate that up to 15% of heroin consumed in China is now homegrown, and that percentage is expected to rise as domestic demand continues to surge.

Alcohol consumption rates

The Chinese consume a wide range of alcoholic beverages, from distilled liquor (about 54% ethanol), to less strong liquor (32 to 44%), wine and yellow rice wine (12 to 18%) and beer (4 to 6%). China is now the second largest beer-producing country in the world. Beer accounts for 73.1% of beverage alcohol sales.

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