The particular problem of getting help here
Thailand is one of the largest destinations in the world for residential addiction treatment. People fly in from Europe, Australia and the Gulf specifically to use it, and some of it is genuinely excellent.
Which creates an odd situation for the expatriate who already lives here. World-class residential treatment is twenty minutes away, and he will not go anywhere near it.
Not because of the distance or the cost. Because walking through that door is a public statement about himself, made in a country he came to precisely so that no such statement would ever be required.
So the decision quietly becomes: not yet. And not yet becomes years, and by the time something forces it there is usually a great deal to repair.
What the drinking and using are doing here
Very little of the addiction work I do with Thailand is really about the substance.
The pattern is consistent. A man arrives having decided, in some fashion, to start again. The environment removes every external brake at once: alcohol is cheap and permanently available, nobody is counting, there is no colleague to notice, no partner at home to answer to, and no consequence arrives for a long time.
Underneath that there is usually an unanswered question about meaning, which has its own page, and very often something older still: a trauma from long before Thailand that leaving the country removed the reminders of without processing any of it.
Treating the drinking while leaving those two alone is why people stop for six months and start again.
What I work with
Cocaine, which in expatriate Bangkok almost always travels with the drinking rather than separately from it. The two run on each other: the cocaine extends the drinking, the drinking takes the edge off the cocaine, and the night continues far longer than either would allow alone.
Alcohol, particularly the functioning drinker whose consumption looks entirely unremarkable against everyone around him.
Sex and pornography, which in this environment are unusually easy to arrange and unusually hard to name as a problem.
Chemsex, where crystal methamphetamine and sex have become one behaviour rather than two.
Gambling, cannabis, and behavioural compulsions including overwork.
Combinations, which are the norm. Addiction, trauma and often an eating disorder are usually one psychological profile presenting in three directions rather than three separate conditions.
Why from outside Thailand
Bangkok has capable clinicians and there are English-speaking therapists here. The problem is not competence.
It is that expatriate circles are small and heavily overlapping. The person you would be seeing may know your employer, your friends, or the bars you drink in. That is nobody’s fault; it is arithmetic.
I am not in it. I do not know anyone you know, and nobody I know will be in the room when your name comes up.
When medical treatment comes first
This is psychotherapy, not medical treatment. Withdrawal from alcohol or benzodiazepines can be dangerous and occasionally life threatening, and needs to be managed by a GP, an addiction psychiatrist or a medically supervised detox rather than attempted alone. Where that is what is needed, it is said at the assessment and the referral is made.
The same applies where a psychiatric assessment should come first or run alongside the work, and where the right answer is residential treatment rather than weekly sessions. Therapy does the work that follows stabilisation, and it does that work better once stabilisation is in place.
Practicalities
Sessions are fifty minutes, weekly, by secure video, from anywhere in Thailand. In English or French.
I trained in addiction at the Hazelden Foundation and at Hope-One, spent close to a decade working inside private residential treatment, and continue to supervise clinicians who work in it.
Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Doctorate of Professional Practice at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.
In crisis in Thailand: Samaritans of Thailand English line 02 113 6789, press 2. Department of Mental Health hotline 1323. Alcoholics Anonymous runs English-language meetings in Bangkok, Chiang Mai, Pattaya, Phuket and Udon Thani, and online.
Common questions
Can I get addiction treatment in Thailand without going to rehab?
Yes, and for most expatriates it is the only version they will actually accept. Thailand has some of the largest residential treatment facilities in the world, and people fly in from everywhere to use them. The expatriate already living here rarely will, because walking through that door is the public admission he moved a long way to avoid making. One to one work weekly, confidentially and without an absence, is the realistic alternative.
What addictions do you work with?
Cocaine, alcohol, cannabis, gambling, sex and pornography, and behavioural compulsions including overwork. Combinations are the norm rather than the exception here, and they are treated together. Where crystal methamphetamine and sex have fused into a single behaviour, that is treated as chemsex, which has its own page.
Why is cocaine specifically an expatriate drug in Thailand?
Because it is expensive here, considerably more so than in Europe, and that is part of its function. It signals that you are not using what the local market uses. Methamphetamine is the drug that saturates Thailand; cocaine is the drug that saturates the expatriate bars, and in this practice it almost always arrives alongside the drinking rather than separately from it.
Is it confidential? Bangkok is a small place.
That is exactly the difficulty, and it is why a large proportion of the people I work with here chose someone outside the country. Expatriate circles overlap heavily. A local therapist may know your employer, your friends or the bars you drink in, through no fault of their own. I do not.
Do I have to stop drinking before we start?
Not necessarily, but sequencing matters. Processing trauma while a substance is doing the regulating tends to destabilise rather than resolve, so the order of the work is part of what the assessment decides. Where withdrawal needs medical supervision, that comes first.
What if I actually do need residential treatment?
You will be told at the assessment rather than six months in. I trained in addiction at the Hazelden Foundation and spent close to a decade working inside private residential treatment, so the recommendation comes from knowing what that setting does well and where its limits are.