natural disasters and alcohol consumption in a cultural context: the great hanshin earthquake in...

Addiction (2000) 95(4), 529–536

RESEARCH REPORT

Natural disasters and alcohol consumptionin a cultural context: the Great HanshinEarthquake in Japan

SHINJI SHIMIZU,1 KATSURO ASO,2 TETSURO NODA,3

SO RYUKEI, 2 YOSHIRO KOCHI4 & NORIYA YAMAMOTO5

1National Institute of Mental Health, 2So Mental Clinic, 3Osaka Prefectural Mental Healthand Welfare Center, 4 Kofu Hospital of Hyogo Prefecture & 5Tarumi Mental Hospital, Japan

AbstractAims. To assess changes in alcohol consumption attributable to the Great Hanshin Earthquake to test theassumption that alcohol consumption increases after natural disasters. Methods. Quarterly alcohol sales� gures were compared for three periods: before, immediately after and subsequent to the Great HanshinEarthquake in three areas of the Hyogo prefecture: the severely affected area, the moderately affected area andthe unaffected area. Possible confounding by population movement, damage to retail outlets and normalvariation in sales, was assessed. Findings. The quantity of alcoholic beverages consumed in the heavilydamaged areas as well as throughout the prefecture decreased from the 1994 pre-disaster level, bothimmediately after the Great Hanshin Earthquake (January–March 1995) and 2 years after the disaster.This � nding remained once possible confounding factors were taken into consideration. Conclusions. Moreattention should be placed on drinking in the cultural context where a disaster occurs. It may sometimes deter,rather than encourage, drinking among the affected population.

IntroductionMany studies have been conducted on the rela-tionship between disaster-induced stress and al-cohol in an attempt to show that arti� ciallyinduced stress promotes consumption of al-coholic drinks (Pohorecky & Brick, 1983; Po-horecky, 1991). Classic studies by Horton(1943) and Bales (1946) have given rise to thebelief that social stress increases the consump-tion of alcoholic drinks and the rate of alco-

holism. In addition, many studies have beenconducted on speci� cs of the relationship be-tween stress and alcohol consumption (e.g. Mar-latt & Gordon, 1985; Linsky, Colby & Straus,1987; Breslin, Hayward & Baum, 1995; Brownet al., 1995).

In Europe and the United States there havebeen numerous studies on the behavioural ef-fects of disaster-induced stress in survivors of awide range of natural disasters and accidents,

Correspondence to: Shinji Shimizu, National Institute of Mental Health, Khonodai 1-7-3, Ichikawa-shi,Chiba 272-0827, Japan. Fax: 1 81 47 3 75 4786; e-mail: [email protected]

Submitted 27th November 1998; initial review completed 19th February 1999; � nal version accepted10th September 1999.

ISSN 0965–2140 print/ISSN 1360-0443 online/00/040529–08 Ó Society for the Study of Addiction to Alcohol and Other Drugs

Carfax Publishing, Taylor & Francis Ltd

530 Shinji Shimizu et al.

including the Buffalo Creek Dam Collapse(1972), the Great Earthquake in Armenia(1988), the San Francisco Earthquake (1989),Hurricane Hugo (1989), the Baltic Sea ferryaccident (1991) and the North Ridge Earth-quake (1994). In one study it was reported that,2 years after a community was destroyed by theBuffalo Creek Dam Collapse in 1972, alcoholconsumption among residents increased by 30%compared with pre-� ood levels (Gleser, Green &Winget, 1981). A survey conducted in the area14 years later reported persisting alcohol anddrug abuse problems (Green et al., 1992). Afterthe eruption of Mount Saint Helens, alcoholconsumption by local residents reportedly in-creased (Adams & Adams, 1984). Alcohol con-sumption increased in 73% of the survivors ofthe Baltic ferry disaster for 6 months immedi-ately after the accident, and in 58% of the sur-vivors for as long as 30 months after the accident(Joseph et al., 1993). Attention has also been alsodrawn to the fact that the number of alcohol anddrug abuse cases 1 year after the North RidgeEarthquake (1994) exceeded 8300. On the otherhand, after the accident at the nuclear powerplant on Three Mile Island, alcohol consump-tion by residents did not increase signi� cantly(Kasl, Chisholm & Eskenazi, 1981).

The Great Hanshin Earthquake (M7.2, HyogoPrefecture) struck central Japan on 17 January1995. As a result of this natural disaster 5493residents died immediately and 905 residentsdied later from their injuries. More than 100 000houses were destroyed. At most the 300 000disaster-affected residents sought refuge outsideHyogo prefecture and a full year after the earth-quake, Hyogo residents were still being evacu-ated to other prefectures (123 000, or 3% of thepopulation at 1 January 1996). Initially, the ef-fect of the disaster on mental health, and inparticular post-traumatic stress disorder(PTSD), was the focus of attention. Approxi-mately 6 months after the earthquake, however,alcohol abuse in evacuation sites began to attractattention (Aso, 1995; Noda, 1996; Isa et al.,1996; Ueno, 1997) and after 12 months it wasnoticed that many of the solitary deaths of singleresidents in temporary evacuation dwellings ap-peared to be associated with alcohol. In view ofthese developments, experts on mental healthand alcoholism as well as the mass media beganto shift their attention from PTSD to alcohol-re-lated problems.

The purpose of this paper is not to discusspossible links between the stress of disaster vic-tims and their drinking practices at an individuallevel. Rather, it is aimed at examining changes inalcohol consumption among disaster-affectedresidents at an aggregate level, through a before-and-after comparison of alcohol sales data.

MethodsIn Japan, illegal alcohol beverage productionceased almost completely in the mid-1970s andtherefore of� cial alcohol sales statistics are con-sidered reliable. Data on alcohol sales were ob-tained from of� cial sources for the prefecture inwhich the earthquake occurred (Hyogo) and aneighboring prefecture (Osaka) where a largenumber of Hyogo residents relocated after thedisaster. Figure were compiled on a quarterlybasis over three time periods: (1) before thedisaster, a period extending up to the end of thefourth quarter of 1994; (2) during the disaster,covering the � rst quarter (January–March) of1995, immediately after the earthquake hap-pened; and (3) after the disaster, covering sub-sequent quarters.

Alcohol sales statistics were obtained from theAll Japan Liquor Retailers Association (AJLRA).AJLRA statistics include all types of alcohol bev-erage such as spirits, wine, beer and sake, whichis a traditional Japanese alcoholic drink. Alcoholtax statistics from the National Tax Administra-tion Agency (NTAA) were utilized as supple-mentary data.

In addition comparisons were made betweenthree areas within the Hyogo Prefecture: (1) theheavily damaged area; (2) the moderately dam-aged area; and (3) the unaffected area. Theheavily damaged area includes the cities of Kobe,Ashiya and Nishinomiya. The moderately dam-aged area includes Amagasaki, Itami, Akashi andAwaji, cities surrounding area 1. The thirdarea—virtually unaffected by the disaster—includes mostly rural areas, other than areas 1and 2.

Three possible confounding factors were con-sidered: (1) the effects of population movementof the disaster-affected residents who sought ref-uge outside Hyogo prefecture were controlled forby assessing sales for each time period for eacharea per 1000 head of population. (2) The ef-fects of changes in the level of business activity ofdamaged alcohol retail shops and restaurants

60 000

Osa

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1994kl

Hyo

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Hyo

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Hyo

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80 000

100 000

120 000

140 000

160 000

180 000

200 000

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240 000

1995

Earthquake and decrease of alcohol consumption 531

were assessed by interviewing a leading memberof the AJLRA and from a business-resumptionsurvey of AJLRA members. This revealed thatthe effect of this factor was considerable for 1year after the earthquake and it took until 1996for business activity to recover to 90% of itspre-disaster level. Therefore we assumed that wecould control for the effects of reduced businessactivity by comparing alcohol sales data in 1994with those in 1996. (3) The effects of the normalvariation in liquor sales were assessed by examin-ing the average alcohol consumption values ofthe 5 preceding years from 1990 to 1994 and byassessing the level of alcohol consumption in1995 and 1996 compared with the consumptiontrend from 1990 to 1994. In addition, an analy-sis of variance, using the mean values from 1990to 1994 and the values for alcohol consumptionafter the disaster was undertaken.

ResultsGeneral trends in alcohol consumption: annualstatistics from the NTAADuring the � scal year of 1995 (April 1995–

March l996), alcohol consumption per adultover the age of 20 was 92.0 kl in volume forHyogo Prefecture (100.0 kl for all Japan). Com-pared with the previous � scal year, consumptionwas down by 5.5% (1.6% for all Japan).

Quarterly statistics from the AJLRAHyogo Prefecture. Figure 1 compares alcohol salesby volume for 1994 and 1995. In 1995 sales fellnot only in the � rst quarter (during the disaster)but also throughout the year. Quarterly de-creases were 5.7%, 5.1%, 6.0% and 5.5%,respectively.

Osaka Prefecture. Alcohol sales increased in theOsaka prefecture, adjacent to Hyogo prefecture,throughout the whole of 1995 (Fig. 1). Theincrease was especially marked in the � rst quar-ter, “during the disaster”, given that in Japan the� rst quarter is, under normal circumstances, aquiet period for alcohol sales.

Analyses correcting for confounding factorsThe alcohol consumption � gures correcting forpopulation movement and other factors are givenin Table 1.

In the heavily damaged area in 1995, alcoholconsumption showed a clear decrease comparedwith 1994 in all quarters. Especially in the � rstquarter of 1995, a sharp reduction was observedfrom 16.12 kl to 13.17kl (an 18.3% decrease).Alcohol consumption values in each quarter of1995 were all found to be below the 5-yearaverage value preceding the disaster. Althoughconsumption eventually began to recover overlater quarters in 1995, it appeared simply to bere� ecting seasonal trends.

The results were the same for 1996; moreoveralcohol consumption in the third and the fourthquarter of 1996 fell below that of 1995. Theexpected values for 1995 by a linear trend analy-sis, based on the actual values from 1990 to1994, were calculated. The observed values bothin 1995 and in 1996 were below the expectedvalues in every quarter (Table 2). Thus, a cleardecrease in the heavily damaged area was evi-dent.

In the moderately and lightly damaged areasalcohol consumption in 1995 generally de-

Figure 1. Absolute volume of alcohol sales before and afterthe year of the earthquake in Hyogo and Osaka by quarter.


Table 1. Alcohol consumption (kl per 1000 inhabitants) by quarter and by type of area

Period Heavily damaged Moderately damaged Unaffected Whole Hyogo Prefecture

1990–94*1st quarter 16.4619 13.7626 12.2554 14.21762nd quarter 20.0441 18.1380 14.4884 17.53213rd quarter 22.7217 19.1473 17.1481 19.74844th quarter 22.2106 18.9001 17.3962 19.5799

19941st quarter 16.1238 13.1331 11.8421 13.76982nd quarter 17.9087 17.7715 14.3068 16.57593rd quarter 20.8088 19.2606 17.0103 19.02184th quarter 19.8725 20.5605 15.9202 18.6385



* 5 years average from 1990 to1994

creased (with some exceptions: see Table 1).Compared to alcohol consumption in 1995 the5-year average, the second quarter in the moder-ately damaged area and the � rst quarter in theunaffected area exceptionally showed an increasein consumption. The whole of Hygoto prefecturefollowed the same trend as in the heavilydamaged area.

Extending the comparison to 1996 showedsimilar trends (see Tables 1 and 2). Osaka Pre-fecture, which showed an increase in absolutealcohol consumption in 1995 against the pre-vious year (Fig. 1), showed a decrease per adultpopulation.

The decrease in alcohol consumption was as-sessed by ANOVA, using two different compari-sons, the � rst 1994–96 and the secondcomparing 1995–96 with the average of the 5preceding years (Table 3).

The consumption decrease in 1995–96 in theheavily damaged area and consequently in thewhole prefecture was statistically signi� cant,while it was not for two other areas. Taking the1994 value as a reference using the Dunnett test,the p values for the difference between 1994 and1995 and for 1994 and 1996 were 0.03 and0.008, respectively, which means that alcoholconsumption in the heavily damaged area

showed a statistically signi� cant decrease both in1995 and 1996. Comparing these data with theaverage for the preceding 5 years, similar resultswere obtained.

Alcohol consumption recovered gradually andconsistently after the sharp decrease in the � rstquarter of 1995, “during the disaster”, but re-mained below the level obtaining before the dis-aster. Following restoration of damaged alcoholretail shops, alcohol consumption would havebeen expected to return to the pre-disaster level(1994) by 1996. However, the expected recoverywas not observed.

DiscussionSeveral factors may limit the estimation of thechange in the alcohol consumption of residentsaffected by the earthquake. Only some of thesecan be corrected for. Nevertheless, the results ofthis study indicate that the quantity of alcoholbeverages sold in Hyogo Prefecture after theGreat Hanshin Earthquake decreased, as was thecase after the accident at the nuclear power planton Three Mile Island and the snow avalanchedisaster which destroyed villages in northern Ice-land (Asmundsson, 1998). Interestingly, alcoholconsumption decreased under socially traumaticconditions, whether among Japanese residents in


Table 2. Observed alcohol consumption (kl per 1000 inhabitants) in 1995 and 1996 and expected values from trend from1990–94


1st quarterExpected value 1995 16.7304 13.3970 12.2903 14.2313Observed value 1995 13.1682 12.5669 12.9184 12.9144Observed value 1996 13.8986 13.7428 12.8953 13.4812

2nd quarterExpected value 1995 18.9312 18.1326 14.9874 17.2921Observed value 1995 16.1252 18.4031 13.5613 15.8141Observed value 1996 16.5026 17.6061 12.1612 15.1863

3rd quarterExpected value 1995 21.8710 18.9897 16.6952 19.2266Observed value 1995 19.3986 18.6017 16.3354 18.0427Observed value 1996 18.1371 18.6488 15.8577 17.4279

4th quarterExpected value 1995 20.9830 20.4676 17.2054 19.4821Observed value 1995 19.1383 18.5852 16.4732 17.9924Observed value 1996 16.7777 18.4144 15.9960 16.9404

a big metropolitan area such as Kobe or amongvillagers in northern Iceland.

This conclusion appears to con� ict with otherresearch � ndings, which point to a positive rela-tionship between disasters and alcohol consump-tion. Many of the studies cited in theintroduction have found that social stress in-creases the frequency of drinking and theamount of alcohol consumed, often encouragingpeople who have had a drinking problemto drink more heavily or to resume drinking.A few studies in the United States and Europehave reported that social stress reducesalcohol consumption (Holroyd, 1978; Pihl &Yankofsky, 1979; Robins et al., 1986; As-mundsson, 1998).

Many factors could underlie the differencesbetween these studies, including the populationsin question, the types of stressor, severity andacuteness of the event and whether the disasterinvolved drastic community disorganization.Such factors need to be investigated further.

In laboratory studies it has been reported thatrats tend to avoid taking ethanol when they areexposed to stress, but after being freed from suchstress they tend to increase ethanol intake (Nash& Maickel, 1985; Volpicelli et al., 1987). Thismight suggest a biological level of explanation forwhy residents in the area severely affected by theearthquake showed a decrease in alcohol con-

sumption, but extrapolating from short-term lab-oratory studies to long-term populationexperiences is obviously highly speculative.Moreover, the model might suggest an increasein the year following the earthquake and this wasnot observed.

One may look for an explanation in terms ofcultural context: that is, in the general disciplineof Japanese society and the Japanese themselves.Foreign journalists expressed great surprise thatthere was no robbery or looting during the disas-ter period. This is in spite of the fact that, unlikein the United States, there were no restrictionson alcohol use at evacuation shelters.

During the boom economy of the late 1980s,when alcohol consumption was at an unprece-dentedly high level, pure alcohol consumptionper capita suddenly declined in 1989 to 6.3 l,falling from 6.7 l in the previous year and risingagain to 6.5 l in 1990. This sudden drop coin-cided with the death of the Showa Emperor in1989. A similar phenomenon was observed inthe course of the present investigation. Evenareas unaffected by the disaster recorded a de-crease in alcohol consumption during and afterthe second quarter of 1995 despite some increasein the evacuee immigrant population. This de-crease may have been the result of the strongself-discipline induced by the disaster. In onestudy on disaster-affected residents by the City


Table 3. Change in alcohol consumption (kl per 1000 inhabitants) for 1995 and 1996 compared with 1990–94


1st quarter5 YA 16.4619 13.7626 12.2554 14.21761994 16.7304 13.3970 12.2903 14.23131995 13.1682 12.5669 12.9184 12.91441996 13.8986 13.7428 12.8953 13.4812

2nd quarter5 YA 20.0441 18.1380 14.4884 17.53211994 18.9312 18.1326 14.9874 17.29211995 16.1252 18.4031 13.5613 15.81411996 16.5026 17.6061 12.1612 15.1863

3rd quarter5 YA 22.7217 19.1473 17.1481 19.74841994 21.8710 18.9897 16.6952 19.22661995 19.3986 18.6017 16.3354 18.04271996 18.1371 18.6488 15.8577 17.4279

4th quarter5 YA 22.2106 18.9001 17.3962 19.57991994 20.9830 20.4676 17.2054 19.48211995 19.1383 18.5852 16.4732 17.99241996 16.7777 18.4144 15.9960 16.9404

Compared with 1994df 5 2 2 2 2F value 22.605 1.461 2.246 19.462p 5 0.002 0.304 0.187 0.002

Compared with 5YAdf 5 2 2 2 2F value 29.917 1.280 2.893 21.264p 5 0.001 0.344 0.132 0.002

5YA stands for the average values of alcohol consumption in 1990–94.

of Kobe, for instance, residents were asked aboutchanges in the quantity and frequency of theiralcohol consumption after the disaster; 28.1% ofthe respondents answered that there was an in-crease in their alcohol use, but 23.8% reported adecrease. In a homogeneous society such asJapan, it can happen that suspension of drinking,instead of increasing alcohol use, is an alternativecoping behavior responding to the tragedyshared in the community. It is also conceivablethat this coping style is related in part to thegenetic ALDH-II de� ciency seen in nearly halfthe Japanese population (Harada, Agarwal &Goedde, 1985). In any event, in conventionalmental health studies, virtually no attention hasbeen paid to the cultural context of the drinkingbehavior of residents affected by disasters.

Regardless of the drinking culture, it is alsoimportant to pay attention to the degree of socia-bility of drinking. When people drink to be socia-

ble, rather than drinking alone, drinking andeven intoxication is not simply individual behav-ior but a social act of interpersonal expressionwhich sometimes defeats econometric demandmodels (Shimizu, 1990; Partanen, 1991, 1995).Social messages and personal emotions are com-municated through drinking. This is closelyrelated to the fact that drinking behavior at anaggregate level is strongly affected by the sociallyshared sentiments which arise from a symbolic“incident” such as a community or nationaltragedy.

This assertion, that a disaster can foster aclimate of heightened self-discipline resulting inreduced alcohol consumption, might seem ab-surd. Having compared many communities,Bales (1946) once described three conditionsthat can lead to increased alcohol consumption:(1) the presence of social stress, (2) a permissivedrinking culture and (3) the absence of alterna-


tive means of coping with stress. Conditions 1and 2 are applicable to the Great Hanshin Earth-quake. As for 3, excluding sleeping drugs andtonic drinks (Vaughn, Huang & Ramirez, 1995),drug use in Japan is not very common (Konuma,Shimizu & Koyanagi, 1998). According to thetheory outlined by Bales alcohol consumptionshould have increased after the Great HanshinEarthquake, but this did not happen.

In the future, it may be important to dis-tinguish between the change in alcohol con-sumption among disaster-affected residents ingeneral, those who lost their families in the disas-ter and those who are already alcohol-depen-dent. In addition, to build on the conclusionsreached in this study, it is necessary to considerthe issue of stress vulnerability and theidenti� cation of groups at high risk of alcoholproblems associated with a disaster. In the mean-time, our data call into question the generality ofthe idea that alcohol consumption rises as aresult of large-scale disasters or accidents andraise the issue of cultural and social factors indetermining changes in alcohol use as a conse-quence of these events.

AcknowledgementThis study was supported by a research grantfrom the Alcohol Health and MedicalAssociation.

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