hankyoreh

A shopper passes by shelves filled with liquor at a big-box grocery store in Seoul on Jan. 7. (Yonhap)

The majority are probably shabby-looking elderly people. With no job or source of regular income, they drink day and night. Occasionally, one will stumble around and lash out violently at anybody nearby — or engage in other harmful behavior. They are lonely, isolated people. With little willpower, they are incapable of fixing the habit of constantly reeking of alcohol. This is the typical media portrayal of an alcoholic, especially in Korea. 

This is actually far from the truth. The above description applies only to a small fraction of alcoholics. 

“South Korea is a country full of working, or functional, alcoholics,” said Lee Hae-kook, the director of the Korean Academy of Addiction Psychiatry and a doctor at the Uijeongbu St. Mary's Hospital. These alcoholics work full-time jobs and even achieve professional success. They have stable families. Superficially, there’s no problem at all. Highly functional or highly adaptive alcoholics can go for several years without realizing that they have a problem. 

On Jan. 5, the Hankyoreh met with Lee at the Catholic University of Korea Hospital’s research center for addiction. Lee is one of South Korea’s foremost authorities on addiction and the psychiatry of addiction. 

“South Korea has a culture that generally tolerates alcoholism, so the problem stays under the rug for longer, compared to other countries. But it’s still a problem,” Lee said. 

Nothing wrong on the surface, drinking frequency and habits a serious problem

Hankyoreh: How do you differentiate between a social drinker and an alcoholic?

Lee: What people struggle with is the question of “How much and how often do I have to drink to be considered an alcoholic?” With alcoholism, it’s certain drinking patterns that are the problem — rather than the alcohol itself. It’s the inability to regulate combined with prioritizing drinking above anything else. 

For instance, if excessive drinking makes you late for work the next day, results in you injuring yourself, or if you have anger management issues when you drink — but continue to drink anyway, you’re probably an alcoholic. As animals with survival mechanisms, people usually have an innate ability to avoid self-harming behavior. It’s the loss of this innate ability that forms the crux of any addiction. Yet South Korea isn’t the most sensitive of countries when it comes to diagnosing addiction and addictive behaviors. Getting drunk and injuring yourself. Getting drunk and spending money you shouldn’t spend. Being late for work because you’re too hungover. People just pass these off as funny stories.

Hankyoreh: Some people get drunk and do something they regret. They’ll avoid drinking for several months afterward, but then start drinking again. Do these people also lack the ability to regulate?

Lee: If you get drunk and hurt yourself, or make a serious mistake. Or if your health suffers, then you probably won’t drink for a month or two afterward. But habitual drinkers will return to old patterns once they start drinking again. When it comes to alcohol, certain perceptive factors have been hardwired into their brains. When they start drinking, old patterns and learned behaviors are automatically turned on again. If the brain reactivates the circuit associated with a positive reaction from drinking to relieve stress or social drinking, then that circuit will override the initial desire to refrain from drinking.

That is why anybody who has had a drinking problem will say that they need to quit, rather than cut back. Because regulating their intake is nearly impossible. The brain’s addiction circuit is like an automatic reflex. Just one circuit that leads to your past drinking habits will throw you back into old patterns, regardless of your will. 

Lee Hae-kook, the president of the Korean Academy of Addiction Psychiatry, speaks to the Hankyoreh at the addition policy lab at Uijeongbu St. Mary's Hospital. (Ryu Woo-jong/The Hankyoreh)

Women in 30s more susceptible to alcohol use disorder than men

Hankyoreh: There are people who drink every day but are more or less functional. For example, people who have a drink or two before bed every night. Is that also a form of alcohol use disorder, or alcoholism?

Lee: Currently, they exhibit the patterns of alcoholism, but don’t suffer the problems. Because drinking does not negatively affect their day-to-day functionality, there’s a chance that it can’t be classified as alcohol abuse or alcohol use disorder. But if they continue drinking every day, there’s a high chance that they’ll develop problems down the road. That’s because you develop a tolerance. 

When introduced to a foreign chemical, our brains are designed to respond with its own counter-chemicals. You start drinking because it makes you feel relaxed or peaceful. But if you keep drinking, you need more and more to feel the same effect. Once it becomes a habit, you develop a tolerance, and once you develop a tolerance, you increase the dose and frequency. If that continues, you will develop problems. There’s no way around it. South Korea has a culture that tolerances alcoholism, so the problem simply stays under the rug for longer. But it’s still a problem. It’s addiction. Plain and simple.

Hankyoreh: You’ve warned about a rise in drinking among women in their 20s and 30s. What’s the reason?

Lee: Worldwide, women drink less than men — especially in East Asian countries. That’s why alcohol-induced liver disease or health problems caused by alcohol were relatively rare among women. Of course, there are social factors to consider, some of which can be labeled as sexist, but generally, we had a culture that shielded women from having to drink too much. 

But times changed, and women increasingly entered the workforce. Traditional boundaries were blurred, and women adopted the drinking culture of men. Alcohol companies aggressively targeted women in their marketing campaigns, lowering the alcohol percentage and adding sweeter flavors. Data shows that drinking among men has more or less stayed the same, or diminished slightly, while drinking among women has exponentially increased throughout the past 10 years.    

A 2021 survey on mental health showed that the prevalence of alcohol-induced disorders among women in their 30s over the previous year surpassed that of men. If a woman drinks the same amount of alcohol as a man, her chances of developing alcoholism or sustaining organ damage are, conservatively, twice as greater, or liberally, five fold.   

Social conditions and factors determine 40%-50% of alcohol-related behavior

Hankyoreh: What kinds of policies do other countries have regarding alcohol?

Lee: There are pricing mechanisms that drive up the price as alcohol gets stronger, making hard liquor relatively more expensive.  Ultimately, the drinking issue is determined by the concentration of alcohol in the blood, which is largely determined in turn by how much hard liquor people drink. By raising alcohol prices, you can prevent drinking-related issues as people have less access to highly alcoholic beverages, and the tax money you get from that can be used toward efforts to prevent problems associated with drinking.

Most countries also have bans on drinking in public places. There have been some attempts in Korea, but they aren’t going about them properly.

One thing that pretty much every country does and only Korea doesn’t is restricting alcohol availability. We have no restrictions at all on when you can sell alcohol or which places it can be sold or consumed. If you look at the US, beer and wine are sold in supermarkets there, but the hard liquor is sold at designated liquor stores.

Socio-environmental factors are about 40%–50% responsible for issues related to alcohol. If you look at the research, declines in indicators for drinking-related health problems, accidents, and deaths are associated with how many establishments are selling liquor in a given region and how strict the regulations of alcohol are.

Alcohol is an addictive substance and a Group 1 carcinogen. Because it’s an addictive substance, people will consume lots of it in the absence of any controls, and that translates into an increase in related problems.

This is why states need to play the role of positive mediator, and you can see the governments of different countries working to develop appropriate social policies. This is the reason the advanced nations are holding the alcoholic beverage industry socially accountable and developing different alcohol-related policies that still allow people to drink but cut down on the associated problems.
 
Budget for drinking prevention efforts down from 16 years ago

Hankyoreh: Compared with other countries, Korea’s alcohol-related policies seem focused less on prevention than on treating individuals who are already struggling with problems.

Lee: Korea’s alcohol-related policies rank toward the bottom among members of the Organisation for Economic Co-operation and Development. In reality, we don’t even have policies for treating individuals. Can you call it a “treatment policy” when we’re basically telling people, “If you want to get treated, go to a hospital”? It’s something hospitals are doing, not the state.

The proportion of people diagnosed with alcohol abuse disorders who actually get treatment is less than 10 percent. Not only are there social prejudices regarding alcohol addiction, but people don’t really recognize it as a disease. We need to have activities to improve awareness and support for treatment, but we don’t have any policies like that.

In the case of something like severe schizophrenia, we have mental health welfare centers doing case management to allow people to get treatment within the community. But when it comes to addiction, we only have around 50 management and support centers nationwide that are performing that role.

Meanwhile, the budget for projects to prevent and manage the harm associated with excessive drinking has declined over the last 16 years. As of 2008, it stood at 2.358 billion won. That dropped to 1.46 billion won in 2011, and it remained in the range of roughly 1.4 billion won until 2023, when it fell again to 1.255 billion won.

In 2018, the Ministry of Health and Welfare announced a separate plan for preventing harm from excessive drinking. That one came to an end in 2021, and no new plan has yet been developed.

The commission to prevent health hazards from drinking, which was established according to the National Health Promotion Act, was essentially reduced to nominal status with the current administration’s plan to abolish and integrate government committees.

When you consider the various social impacts and the damages suffered by the public, drinking-related issues are a much more serious problem than ordinary mental health issues. But it seems like the people talking about how serious these issues are view them as essentially a constant in society.

By Seo Hye-mi, staff reporter

Please direct questions or comments to [english@hani.co.kr]