What is different about drinking here
Thailand consumes roughly 7.99 litres of pure alcohol per person a year among those aged fifteen and over, on World Bank and World Health Organization figures. That is not extreme; it is lower than Ireland or much of Europe.
The national average is the wrong number to look at.
What matters is the expatriate environment, and in that environment every external brake has been removed at once. Alcohol is inexpensive. It is permanently available. Drinking is not optional but socially compulsory. There is no colleague who will notice on a Tuesday morning, no partner at home asking questions, and no consequence for a long stretch of time.
The comparison group is the problem
A functioning drinker is difficult to identify anywhere. It is far harder in a place where your own consumption looks entirely unremarkable against the people you see every week.
If everybody you know drinks the way you drink, then nothing has visibly gone wrong. The work still gets done. Nobody has said anything. And the group you unconsciously measure yourself against was not chosen at random: over time it becomes made up of people who drink as much as you do, or more.
Nobody decides this. It simply happens, and it is one of the reasons expatriate drinking runs for years before anybody names it.
The markers that actually mean something
Not quantity. These:
Consequences accumulate and nothing changes. Something has gone wrong at work, in the body, in a relationship, and the drinking carries on exactly as before.
Promises keep failing. Not to anybody else. To yourself, in the morning, about tonight.
It has become scheduled. No longer a decision made in the moment but a fixture the day is arranged around.
There is unease when it is delayed. The flight is late, the bar is shut, and something rises that the inconvenience does not justify.
If you are doing arithmetic about units, that is worth noticing too. The arithmetic is rarely the behaviour of somebody who is not already worried.
What is usually underneath
In this practice, with expatriates in Thailand, almost always two things.
An unanswered question about meaning, which is dealt with on the midlife crisis page, and which the drinking is anaesthetising rather than answering.
Something older, from long before Thailand. Leaving a country removes the reminders of a trauma without processing any of it, and that works well enough for long enough that nobody connects the two. Where that is present it is treated as trauma, including with EMDR.
Alcohol is also, chemically, liquid sugar, and for a good number of men a drinking problem is sitting on top of an untreated relationship with food. Treating the two together is often what allows recovery to hold.
What the work is
Not primarily about stopping. Stopping is the beginning of the question rather than the answer to it.
Most people who come here about alcohol have stopped before, often many times. The work is about what the drinking has been doing: what it manages, what it makes bearable, and what would have to be felt if it stopped. That is the part residential treatment reaches least well and one to one work reaches best.
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 Bangkok, Chiang Mai, Phuket or anywhere else in Thailand. In English or French. No absence, no admission, nothing that appears anywhere.
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.
Figures: World Bank and World Health Organization alcohol consumption estimates. This page is for information and does not replace medical assessment.
Common questions
How much is too much when everyone around you drinks the same?
The question cannot be answered with a number, and in an expatriate environment the number is the least useful measure available. The honest markers are consequences and choice: whether costs are accumulating in your work, health or relationships while the drinking continues unchanged, and whether promises to stop or cut down keep failing. When you are no longer choosing, the quantity has stopped being the point.
Why does drinking escalate so quickly for expatriates in Thailand?
Because every external brake is removed at once. Alcohol is inexpensive and permanently available. Drinking is socially compulsory rather than optional. There is no colleague who will notice, no partner at home to answer to, and no consequence for a long time. And crucially, the people you measure yourself against all drink the same way, so nothing about your own consumption looks unusual.
Can I be treated without stopping work or telling anyone?
Yes. Sessions are weekly, fifty minutes, by secure video. There is no admission, no absence to explain, and nothing that appears anywhere. For most expatriates that is not a compromise; it is the only version of treatment they will actually agree to.
Is it safe to stop drinking on my own?
Not always. Withdrawal from alcohol can be dangerous and occasionally life threatening, and it needs to be managed by a doctor rather than attempted alone. Bangkok has excellent international hospitals for this. Where medical supervision is needed it comes first, and it is said at the assessment rather than discovered later.
What if I drink heavily but only at weekends?
Frequency is not the test. There is chronic drinking, where alcohol is in every day and has become part of the structure of a life, and there is binge drinking, where nothing happens for a week and then one night ends in an accident, a hospital or something that has to be explained. If it is making a mess of your life, it is a problem regardless of the calendar.