Substance Abuse in Expatriate Life

Substance abuse by expats and their dependents contributes to assignment failure. However, convincing people to seek help, given the strong denial or secrecy surrounding these problems, can be a challenge reports Robin Pascoe.

You won’t find global companies shouting this news from the hilltops, but it’s hardly a secret: there’s always an employee or family member abroad on assignment who regularly has too much to drink at a party, consumes his or her first gin and tonic long before the sun sets, or is addicted to prescription drugs easily purchased over the counter or to recreational drugs readily on offer.

But expats or their dependents with alcohol or drug dependencies are working their hardest to conceal their problem. “Substance abuse is still a shame-based issue and not a popular subject in polite company,” says Connie Moser, an expatriate writer living in the Netherlands.

Moser has been researching the problem among expatriates for years to provide more resources on the subject to expats—and especially young teenagers—living in the more liberal-minded Holland where coffee shops openly sell drugs and the legal drinking age, 15, is considerably lower than North America.

“People tend to avoid revealing that there is a problem either personally or with a family member,” says Moser. “Somehow, it is seen as a failure.”

Substance abuse has contributed to failures in international assignments. This isn’t surprising given the lifestyle and the many changes inherent in expatriate life: multiple moves, excessive work demands, travelling partners creating ‘single’ moms coping alone in a foreign country, loneliness, loss of self-worth, homesickness, stress, and peer pressure to name a few.

“All of those factors and more can lead to coping mechanisms such as self-medication through overindulgence in alcohol, prescription medication, or recreational drugs,” believes Moser who cautions that both adults and teens need to be aware of the threats to health and the social and economic consequences of their actions.

Are expats more at risk for addictions?

Experts in the field say the prevalence of substance abuse in the expat community would be equal to that found in any general population.

“One of the most significant predictors of alcoholism is occupation. Since expats—who are company directors, engineers, diplomats, and in general people who live or travel abroad—are dislocated from their homes, family and other support networks, this places them more at risk,” says Dr. Margaret McCann, a director at Castle Craig Hospital , a residential treatment hospital in Scotland for alcohol and drug dependency. “The frequent entertaining of clients, colleagues and other expatriates in the absence of stabilizing influences, which at home exert a restraining influence, will play a part,” she says.

“However it’s helpful to view addiction as the result of a number of interactive forces such as environmental and cultural influences and the inherent addictive properties of drugs and alcohol. But there are other factors that exist in the individual, such as family history. We do know definitely now that vulnerability to alcoholism is in part genetically determined. So if there was a history of alcoholism in the family and one is now exposed to these inclement environmental pressures, than one could consider oneself in a more at-risk situation.”

Adds Tom Bruce, deputy head therapist at Castle Craig Hospital: “Substance abuse in the life of expats is as treatable as it is for those living in the same country all their lives. It is a matter of identification and a willingness to do something about the problem as it presents, and not allow it to fester.”

Convincing people to seek help, given the strong denial or secrecy surrounding these problems, can be a challenge. However, resources for treatment are growing as companies begin to recognize and respond to the need.

Cigna International, the global health care insurer and provider, recently launched a new global Employee Assistance Programme (EAP). It has also undertaken a pilot programme for an American company (which remains anonymous for now) which will follow the entire posting cycle, from candidate selection through to repatriation to get more information on the incidence of mental health challenges, according to Cigna’s international medical director Dr Lyndon Laminack.

“Employers are now feeling they have the duty of care to offer more support,” says Dr Laminack. “Post 9/11 we have had more questions from our customers and not necessarily about terrorism, but about mental health challenges which I believe are underreported,” he said in a recent interview.

Not everyone agrees that EAPs are the way to address substance abuse, despite the fact that the forerunner to EAPs was called ‘occupational alcoholism programmes’.

“The name change from occupational alcoholism to EAP in 1973 was undertaken to both de-stigmatize the programme and to increase referrals through a less threatening broad brush approach,” reported EAP specialist Ken Burgess to a 2001 counselling conference held in Taiwan.

Burgess, who is Managing Director of Solutions, a Latin American employee assistance consultancy, pointed out that EAPs may not be the proper model of support for employees with substance abuse.

“Expatriates and their families are even more protective of their privacy than are employees and families in the United States. From my own experience I have found expatriates to be extremely reluctant to reach out on their own and very reluctant to use EAP until their problems become completely unmanageable,” he reported.

Preferring to call his services ‘family support’ which includes a process for pre-screening candidates for overseas assignments which can head off trouble in areas such as substance abuse, Burgess nevertheless noted in his report: “It is absolutely essential to understand that expatriates and their family members will only call your service when they feel completely safe to do so.”

Regardless of how it may be termed, acknowledgement that substance abuse is a real problem is critical, according to Connie Moser.

“Substance abuse is only the beginning, for it all too often leads to domestic abuse which in turn leads to divorce which means families are at risk,” she says.

“People must start speaking out and not be afraid to talk about these issues. Once a dialogue is initiated, people are more likely to respond, to admit that help is needed and to seek assistance.”

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