On Sept. 28, 2004, Casey “dropped dead” on his kitchen floor. He had been on a two-day bender, mixing alcohol and some drugs, returned home and promptly passed out. After regaining consciousness, he somehow managed to call his wife who, in turn, called an ambulance.

Luckily for Casey, who along with others interviewed for this article has asked to be identified by just his first name, his story has a happy ending. After hitting rock bottom and spending almost three months in jail, he embarked on a long, slow journey to recovery. Today he is sober, healthy and remains happily married.

A culture of drinking

According to a 2013 survey by the health ministry, an estimated 5.93 million people in Japan suffer from alcohol-related problems. On top of that, some 2.92 million are suspected to be alcoholics. The government budgeted ¥810 million to deal with addiction-related issues in 2019, of which alcoholism is one.

For many non-Japanese alcoholics who live in Japan, their addiction started before moving to this country.

“In high school, my pals and I would have weekend parties and drink as much as we could,” recalls Casey, who grew up in California. “I would actually have blackouts and the day after I’d remember nothing.”

He eventually decided that it might be better to escape what he thought was a toxic environment.

“Moving to Japan was part of my plan to try to get sober,” he says. “I heard about a teaching job in Japan, so I packed my things and came over, thinking that the new environment would help me stay sober.”

What Casey didn’t realize was that moving to Japan was like jumping out of the frying pan and into the fire.

“At the time I didn’t know it, but the drinking culture is pretty big here, so after a while it didn’t really work,” he says. “I would go to an izakaya (Japanese pub) with my friends and colleagues and, again, everybody would drink the whole time.”

The Tokyo Meguro Counseling Center warns people coming to Japan that “the environment and culture of Japan can be a factor in the development of alcohol abuse or dependency.” It points out that social and work functions often revolve around alcohol consumption, and that places such as bars, restaurants and karaoke establishments often have all-you-can-drink options. When combined with the usual stresses of moving to a new country, this atmosphere can lead to a method of coping that can potentially result in alcohol abuse or dependence.

A few false starts

Alcoholics living in Japan can seek help for their addiction in a number of ways. Two years ago, for example, the Kurihama Medical and Addiction Center in Yokosuka, Kanagawa Prefecture, opened the nation’s first “controlled drinking” outpatient clinic. The center employs a “soft approach” to alcoholism based of the idea that patients can improve their alcoholism-related health problems without kicking the habit entirely.

In January, Otsuka Pharmaceutical Co., Ltd. received regulatory approval for the manufacture and sale of Nalmefene, a therapeutic drug designed to gradually reduce alcohol consumption. According to Otsuka, Nalmefene prevents the alcohol-induced release of dopamine in the brain and reduces the desire to drink, though tests overseas in the past have not always been conclusive. [The Japan Times recommends consulting a professional before embarking on any health-related treatments.]

“A big problem in Japan is that a lot of people don’t consider alcohol dependency to be an illness,” says Dr. Katsuya Maruyama from the Kurihama center. “This is a country where lots of people drink lots of alcohol every day. If you have a problem (they figure), it’s because you have a weak character. That’s why many people feel discouraged from seeking the appropriate treatment.”

Doctors and drugs may help people fight their addictions, but neither proved effective for Brian.

“All the doctors I saw said I needed to stop drinking, and I really wanted to stop, but of course it’s easier said than done,” Brian says. “I think a big misconception many people have with addictions is that people like me lack willpower. But once you are addicted to something, it’s not a matter of willpower. An alcoholic can show tremendous willpower in getting his next drink of alcohol. Nothing will stop him!”

Brian began drinking in junior high school and, by the time he got to university, it had become a regular activity. After he left university the people around him made comments about his excessive drinking, but Brian couldn’t see that things were out of control. Like Casey, he also moved to Japan to escape what he believed were unhealthy surroundings back home.

Things got serious when Brian’s wife became pregnant and she asked him to stop drinking.

“Of course I said OK, and I really meant it,” Brian says. “But within a week I was drinking every day. I was so scared because I really wanted to stop and, until you try, you delude yourself into thinking that you can control your drinking or stop whenever you want, but you just can’t.

“When my son was born, my wife had an emergency procedure and the baby almost died. As a result she developed severe postpartum depression. It was really intense, and I kept drinking a lot in order to deal with that situation, which was overwhelming. For example, the baby would wake up at night and I would just drink. When you reach that level of drinking it really affects not only your body but your mental and spiritual health. I became selfish, not really concerning myself with others. The worst thing was that my wife needed my help and I wasn’t available. I just wanted to distance myself from that situation.”

Eventually Brian spent a month in rehab.

“They put me on an IV drip and monitored me for one week, but there was very little psychological counseling,” he says. “So on one side I was sober, because there’s no way you can drink when you are in rehab, but my mind didn’t really change. I was still insane and as soon as I got out, I resumed drinking.

“All the red flags that should alert you are in front of you, but you always find a way to rationalize them in such a way that doesn’t interfere with your drinking. Shaky hands? I must have a nervous disposition. Gastritis? It’s obviously from stress — better cut out the coffee and switch over to tea. Crippling depression? It couldn’t possibly have any connection to drinking.”

Casey went through a similar process.

“You reach a stage where alcohol affects your sleep,” he says. “You can’t sleep because you drink too much and in order to sleep you drink again. It’s that kind of vicious circle. I was conscious that I was doing something I wasn’t supposed to, and a sense of shame took over. After a while, I started drinking alone. I would go to a convenience store, buy a few beers and chūhai (a shōchū highball) and then go home or find a place where I could drink, like behind a shrine or under a bridge. I was always changing stores because I didn’t want them to think I was an alcoholic. My wife, of course, couldn’t stand the situation and moved back in with her parents. We even considered getting a divorce.”

Reaching out for help

Both Brian and Casey eventually realized that just wanting to stop wasn’t enough. They needed something more substantial; a community of friends and like-minded people who are always there for you and with whom you can share your problems. That’s when they contacted a Japanese chapter of Alcoholics Anonymous.

AA calls itself “a fellowship of men and women who have lost the ability to control our drinking and (…) attempt — most of us successfully — to create a satisfying way of life without alcohol.” It was founded in Akron, Ohio, in 1935 by Bill Wilson, who created the group’s well-known 12-step program.

AA’s Japan chapter will celebrate its 45th anniversary next year and, according to Jordan, there are between 100 and 130 active members in the Kanto area alone. Jordan is the current chair of the Tokyo English Language Intergroup, an umbrella organization that provides services (website, meeting lists, and email and telephone contact points) for the AA community and helps people connect with them. Jordan has been part of Tokyo’s AA community for around 4½ years and has served as Intergroup chair (“Not a position of authority, just a service position coordinating and communicating between groups,” he points out) for the past year.

“The English-language fellowship here is quite international, with members from all over the world, not necessarily native English speakers, and includes a number of English-speaking Japanese. We include people who are still struggling to stop drinking to those who haven’t had a drink for over 40 years.”

There are many ways to get in touch with AA and join its meetings. Apart from regular meetings held across the country, daily meetings are held via Skype. People who live in or visit certain areas — Hiroshima, Sapporo, Okayama, among others — can also contact local members directly for support.

For the uninitiated, reading AA literature can often look like a sermon. Terms referencing a “power greater than us” and other religious imagery come up quite a few times. However, Brian is quick to say that the program is not rooted in Christianity.

“That’s a misconception I had too when I came across the program,” he says, noting references to a “higher power” in the literature. “There are many atheists and agnostics in AA, the important point is that this higher power can be anything but you. For many members, it’s the group who make up AA.”

Moving forward with life

Above all else, AA has helped save many lives and, according to Jordan, it’s a source of lasting friendships and positivity for many.

“Alcoholism is a deadly disease, so we have had to bury some who just couldn’t figure out how to stay sober,” he says.

It’s that thought that helps Brian and Casey to understand how lucky they are.

“For most alcoholics, the endgame is either insanity or death,” says Brian, who has been sober for the past three years. “I was close to both, but I got lucky. I honestly don’t know if I would have recovered if it wasn’t for AA.

“If people want to drink, that’s cool. It doesn’t really affect me anymore. Even my wife has a drink a few nights a week. I only ask her not to keep any booze in the fridge or where I can find it. I used to wake up dreading every day, but now I’m excited about starting a new day and living my life as fully as I can. I’m motivated to be the best father I can be for my son.”

The last step in the 12-step program is helping other people to recover from alcoholism and Brian, like many others in AA, is doing his part by currently helping (or sponsoring, as they say in AA) a person who lives in Ireland.

Casey attends an AA meeting in Tokyo’s Roppongi neighborhood every six weeks.

“When I got out of jail in December 2004, I thought my wife would leave me for sure. Luckily, she stayed by my side,” he says. “Going to jail was the lowest, most humiliating experience of my life — and ironically something I’m now grateful for because it made me stronger. I also have to thank my in-laws because I was given a second chance. That’s something that doesn’t happen so often in Japan when you make a mistake.

“I’ve been sober for more than 14 years. I’ve repaired the damage I created, and my kids have never seen me drunk. All the good things I have in this life are all thanks to AA.”

Should you or anyone you know appear to have issues with alcohol, call the Tokyo Alcoholics Anonymous hotline at 080-4355-2285 or visit www.aatokyo.org.