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    388 JAMC 20 AOT 2002; 167 (4)

    When darkness falls and blinking neon brightens the often drab cities andtowns of Japan, white-collar workers crowd into tiny bars there are 15 000 in Tokyo alone and unwind by sipping Suntory Gold whisky andwater at $15 a shot. Tradesmen and labourers head for standbars and gulpdown plastic cups of shochu, cheaper distilled spirits dispensed from vendingmachines. And although there is little absenteeism in Japan due to drinking,the countrys doctors are worried problem drinkers numbered 3 million atthe last tally.

    Japans thirst has continued unabated long after the economic twilight fell onthe Land of the Rising Sun. There is no question that alcoholism is increasingin Japan, says Dr. Hiorakai Kono, former director of the National Institute ofAlcoholism in Tokyo. What astonishes us is the size of the problem.

    Problem drinking cuts across all levels of society, according to the lateststudy by the Leisure Development Research Centre in Tokyo. Sixty percent ofproblem drinkers are salaried businessmen who claim that getting drunk withclients or coworkers is part of their job and a mark of company loyalty. Torefuse a drink from the boss is a terrible insult that can damage a career. And al-though alcohol consumption is now decreasing in most industrialized countries,it has quadrupled in Japan since 1960.

    Drinking is not a moral issue here, since there is no religious prohibitionagainst alcohol consumption, and the temperance movement has never had an im-pact. And unlike many Westerners, the Japanese dont regard alcohol as a drug.

    Traditionally, there hasbeen an indulgent attitudetoward those who drink toomuch and for good rea-son. In a tightly knit societywhere concealing emotionsand frustrations is a highlydeveloped and necessarypart of maintaining con-sensus, getting drunk is asocially sanctioned safetyvalve. Alcohol here playsthe role of psychiatry in theWest, says CharlesPomeroy, former presidentof the Foreign Correspon-

    dents Club of Japan and a Tokyo resident for 45 years. I think the countrywould explode without it.

    Japan lags far behind Western countries in recognizing and treating alco-holism. Fewer than 1200 hospital beds are available for alcoholic patients, andthe countrys 2 national mental hospitals provide only 200 beds. Private treat-ment centres are becoming more common, but no medical credentials or ac-creditation are required to operate them.

    There are 5 halfway houses, all run by religious groups, but for the most partfollow-up and rehabilitation services do not exist. Instead, families, aided bygroups such as Japans version of Alcoholics Anonymous, take on the burden ofrehabilitation. Dave Milne, Tokyo

    DI S PAT C H E S

    Alcohol consumption in Japan:different culture, different rules

    One for the road

    The number of Canadians who smokecontinues to drop, the Canadian Tobac-co Use Monitoring Survey (CTUMS)indicates. In 2001, 22% of Canadiansaged 15 and over 5.4 million people were smokers, compared with 24% in2000 and 31% in 1994.

    CTUMS, conducted by StatisticsCanada on behalf of Health Canada, foundthat the percentage of women smokersdropped from 23% to 20% between 2000and 2001; the percentage of men whosmoke remained constant at 24%.

    Progress was also made among youthaged 1519, with rates declining from25% in 2000 to 22.5% in 2001. Adultsaged 20 to 24 still have the highestsmoking rate of any group, 32%, andthis remained unchanged from 2000.

    Respondents were also asked theiropinion on smoking in bars and restau-rants. Although most (77%) thoughtthere should be severe restrictions inrestaurants, only 55% favoured severerestrictions in bars. The survey also re-vealed that Canadians are smoking only16 cigarettes a day today, compared with21 in 1985. CMAJ

    Tobacco use up in smoke

    The 130-bed Dartmouth General Hospi-tal, which has run an extensive recyclingprogram for at least 5 years, has beennamed Nova Scotias Environmental In-stitution of the Year. Everything that canbe recycled is recycled, says Jane Pryor,who oversees the operation of the hospi-tal. It even recycles fryer fat last yearmore than half a tonne was sent to a localfirm that cleans it for use in animal feed.

    The hospital was also praised for re-ducing waste. Last year it recycled 13 000kg of cardboard, a 19% reduction fromthe previous year, while the amount ofrecycled newspaper declined by 32% andthe amount of organic material sent forcomposting fell by 19%. Pryor thinks thedeclines reflect, in part, efforts to placemore emphasis on environmentallyfriendly packaging, reusable material andreduced use. Donalee Moulton, Halifax

    Hospital is Nova ScotiasEnvironmental Institutionof the Year


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