Taking Back Control Over Alcohol (Japan Version)

As a psychotherapist working in Japan, I've witnessed firsthand the role that alcohol plays in the cultural and social landscape here. In a country where emotional restraint is often the norm, alcohol has become, for the whole society, a kind of self-administered “therapy.”

This normalization of excessive drinking - whether at after-work parties or even from convenience stores on the streets - can mask the very real struggles and dangers of, let's put it simply, “alcoholism.”

#nomisugi

While alcohol consumption is dropping in many industrialized countries, Japan stands apart. Binge drinking is practically woven into the fabric of corporate life. While refusing a drink from a boss or colleague no longer carries career-ending repercussions like it once did, these drinking parties (“nomikai”) are still viewed as a core part of company bonding and networking.

A recent campaign in Tokyo (ironically sponsored by a popular nightclub chain) bears the hashtag #nomisugi - “too drunk.” It's an important reminder that thousands of people pass out in public spaces every weekend, revealing a deep disconnect between the pressures of professional life and the ways people cope.

What Causes Alcohol Use Disorder?

Researchers don't know all the reasons why someone develops alcoholism, but we do know some of the risk factors:

Genetics: People with a family history of alcoholism are more likely to develop it themselves. Indeed, research show that genetics influences how we respond to alcohol. For example, a 2012 study found that people with certain variations of the OPRM1 gene experience more intense rewarding effects of alcohol and are thus at higher risk of developing an addiction.
Mental health conditions: Depression, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD) can raise the risk.
Environmental influences: Social pressures and cultural norms - like the strong drinking culture in Japan - can play a role.

Alcohol and the Self-Medication Trap

One of the most frequent patterns I see in my practice is the cycle of self-medication. Some of my clients wouldn't call themselves “alcoholics” in the traditional sense - they drink to excess only during stressful periods, then seem to revert to moderate drinking when life calms down. Alcohol becomes a temporary balm for anxiety, grief, or loneliness.

To all of you who turn to alcohol to cope: you did your best. You found a way to feel better in the moment, and you deserve compassion for that.

But here's the catch: self-medication doesn't work for long. Alcohol might soothe pain in the moment, but in the long run, it fuels a vicious cycle. Alcohol not only masks trauma but also creates its own trauma: shame, health issues, broken relationships. And so, paradoxically, the very substance people use to numb their pain becomes a primary source of it.

Alcoholics Are Not Powerless

In my experience, what people are grappling with isn't alcohol itself - it's their own overwhelming feelings: helplessness, shame, grief. Alcohol becomes the focus of the struggle, but it isn't the cause. And because of this, change is absolutely possible.

What Are My Options?: Evidence-Based Approaches

If you're worried about your drinking, or someone you care about, know that there are many paths to healing. Some of the most effective treatments include:

Cognitive Behavioral Therapy (CBT): Helps you identify and change harmful thought patterns and behaviors.
Dialectical Behavioral Therapy (DBT): Teaches emotional regulation and distress tolerance.
12-Step Facilitation: Offers structured peer support, even if the concept of “powerlessness” doesn't resonate with you. English-speaking AA groups like AA Tokyo are available across Japan and are free to join.
Medications: Options like nalmefene, acamprosate, and disulfiram can reduce cravings and support recovery. A psychiatrist or addiction-specialized doctor can help decide if medication is a good fit.

Don't hesitate to book a free consultation with a psychologist before deciding. You'll find some recommended options below.

Alternatives and Complementary Approaches

Yoga and Meditation: These practices can help manage cravings and stress, serving as powerful tools to support recovery. Some rehab centers in Japan offer classes, or you can try apps and online videos in Japanese and English.
Art and Music Therapy: Artistic expression can help people access and process emotions that might be hard to put into words. In treatment settings, these therapies can reduce depression and anxiety while fostering creativity and healthy coping.
Online Therapy: Online therapy has grown tremendously since the COVID-19 pandemic, offering flexibility and privacy. CBT, motivational interviewing, and even trauma-focused therapies like EMDR can be adapted to virtual formats. Just remember: severe withdrawal should always be handled with medical supervision.

Emerging Treatments

Exciting new approaches - like neurofeedback, ketamine-assisted therapy, and psilocybin trials - are being explored. These options aren't widely available in Japan yet, but they show promise for the future of treatment.

My Personal Advice: Small Steps, Big Changes

Healing isn't about dramatic transformations. It's about small, practical steps:

Set realistic goals - like limiting drinking days each week.
Build new habits - even small routines, like morning walks or journaling, can reinforce healthier coping.
Identify triggers - and learn healthier ways to handle them.
Involve loved ones - social support is one of the strongest buffers against relapse.

Hope and Help Are Within Reach

I truly believe, as a therapist and as someone who's walked alongside many clients on this journey, that no one is truly powerless. Alcohol may have become the center of your life for a while, but it doesn't have to stay that way. Change is possible - and you don't have to go it alone.

If you're in Japan and want to explore how therapy might help, or if you're just ready to talk about what's going on, I warmly invite you to consider a free consultation with a therapist. Here are a few resources:

therapyjp.com - Professional, English-speaking therapists in Japan
tell.jp - Free and confidential English-language support in Japan
AA Tokyo - English-speaking Alcoholics Anonymous meetings across Japan
Yoga with Wen - Open-air Yoga classes in Tokyo.
SAMHSA Recovery Resources - Global resources in English