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Millions of patients: Substance abuse in China

March 1, 2007
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Few Chinese are receiving the addiction services they need

A 2001 World Health Organization survey estimated annual alcohol consumption in China to be 4.5 liters per adult (ages 15 and older). This is an increase from a level of 1.03 liters in 1970. Although China's annual alcohol consumption rates remain well below European rates (8.6 liters), these statistics may be affected by the number of rural poor residents in China. With their ability to purchase alcohol being limited, home brewing and illicit alcohol production and sales are made more appealing.

It is important to examine trends in China over time. Beer consumption (in million tons) has gone from 6.92 in 1990 to 22.89 in 2001. Spirits and wine consumption have stayed relatively stable during this timeframe. While it is useful to look at drinking-related harm, such as medical complications related to alcohol use and abuse, social indicators, etc., this unfortunately has not been studied systematically in China. But with rapid social and economic change, it is fair to assume that there will be a steady increase in alcohol-related health and social problems.

12-Step and other treatment

There are very few centers for treatment of alcohol and drug abuse in China. In a country this vast, there remain only a few hospitals offering treatment. Doctors seem reluctant to diagnose alcohol and drug abuse, seeing it either as a sign of character defect or a bad habit. A social stigma remains a major barrier to recognition of the disease. Hence, hospitals treat primarily late-stage alcoholism, and almost exclusively in men. Women are rarely treated for alcohol problems, given a more intense stigma surrounding use in women.

A key step in addressing substance abuse issues in China was to begin 12-Step programs. AA has long existed in China in the English-speaking, expatriate communities. In the mid-1990s a Korean-speaking AA group began north of the border of China and North Korea. The first Chinese-language AA meetings began in Beijing in 2000. Since then, AA meetings in English and Mandarin are held daily in Beijing and an increasing number of other cities. It is roughly estimated that there are 60 AA members in Beijing. Big Books and AA pamphlets have been translated into simplified Chinese and are readily available in several cities.

Al-Anon meetings also have begun in several cities, although Al-Anon members find it difficult to sustain meetings with the turnover of the expatriate community from which sponsors are drawn. NA has begun in Shanghai and Beijing, although it is difficult for a drug addict to attend meetings given the legal consequences of “being public” with one's drug abuse.

The Municipal Mandatory Rehabilitation Center in the sand-swept, northwestern city of Yinchuan houses 200 addicts/inmates who have been through the cycle: addiction, arrest, detox, rearrest. There are 695 similar mandatory centers in China, and in 2005 they “treated” 216,000 addicts. An additional 56,000 repeat offenders were sent without trial to “detoxification-through-labor” camps. In these grim places, inmates toil for 16 hours a day making products such as stuffed animals, Christmas ornaments, and paper valentines. HIV abounds in the centers; the government estimates that 69% of Chinese AIDS patients are heroin users. There is an abundance of heroin inside the rehab centers.

The central government admits that 90% of Chinese addicts relapse once they leave the centers. The question can be raised as to whether these individuals ever got clean in the first place. Even in rehab centers where drugs are less abundant, officials make little effort to address the physiological and psychological needs of a heroin-addicted brain. Addicts are treated as criminals. With drug addiction soaring nationwide, the Chinese government has sought alternatives to the state-run detox centers. Expensive and unorthodox remedies alike have flooded the market.

There is light at the end of the tunnel, though. In 2007, nearly 150 addiction professionals will be trained and credentialed by the newly formed China Association of Addiction Professionals. A faculty of 40 addiction experts from throughout the world will provide this training in Beijing, Shanghai, and Kunming (southern China, Yunnan Province). In March and April courses will be offered to 150 participants from throughout China on the 12 core functions of addiction counseling.

The first program for children of alcohol- and drug-abusing parents will begin at Beijing Medical University, with the assistance of Jerry Moe of the Betty Ford Center and Zhang Qiuling of BMU. Epidemiological research into the prevalence and incidence of alcohol and drug abuse will begin at BMU's National Institute of Drug Dependence and the Chinese Center for Disease Control and Prevention, in cooperation with the Pacific Institute on Research and Evaluation. Discussions are under way to open a freestanding treatment center outside of Beijing, staffed by Chinese medical personnel and recovering addicts and alcoholics, modeled on programs such as Hazelden and High Watch Farm in the United States.

China likely will become the major player on the world stage in this century. How it deals with its growing alcohol and drug abuse problems will be a significant factor in how its growing role plays out.

David J. Powell, PhD, is President of the International Center for Health Concerns, Inc. He is a global consultant who has advised more than 70 nations on treatment delivery systems and manpower development. He helped to establish Alcoholics Anonymous and Narcotics Anonymous in China. Powell wrote on trends in the addiction counseling profession in the March 2005 issue. His e-mail address is