In Chinese society, addicts are treated with moral disdain; punishment is a component of addiction treatment; rural jurisdictions ignore the central government's policy on treatment; and treatment generally is limited to acute care/detoxification while being provided by those not necessarily trained in addiction treatment. While addiction professionals in the United States could argue that they face some of the same challenges, brought on by stigma toward the addict here, one can only imagine the barriers faced by those promoting effective care in China.

Among those in China who advocate effective care and the eradication of discrimination against the addict are those in the recovery community who are active in a relatively young but growing Chinese 12-Step movement. Among them is Mr. H., an active member of the AA community in Beijing and a leader in the development of AA in his native country. When I met Mr. H., he was introduced to me as the “Bill W. of China.” His own recovery, subsequent 12-Step work, and respect as a caring helper have given him the desire to become a professional counselor. However, until recently, only those professionally trained in a helping profession have been allowed to have direct contact with patients.

I met Mr. H. and a group of other recovering alcoholics during a training program at Beijing Medical University in March. Although the main purpose of the conference was to address training needs for addiction treatment professionals in China, there was a group of about 12 recovering alcoholics who were invited to attend the training.

The conference I attended, organized by David and Barbara Powell, was the 4^th Sino-American Workshop of Psychotherapy on Substance Abuse. Most participants were Chinese professionals, including psychiatrists, psychologists, nurses, and medical students. Along with the involvement of David Powell, I shared week two of the three-week conference with two other faculty members: William Mock, PhD, LISW, of the Center for Interpersonal Development in Ohio and Mark Schorr, MA, LPC, of Cascadia Behavioral Healthcare in Oregon. One of my tasks, while my two colleagues conducted demonstrations with live patients, was to lead the group consisting of Mr. H. and the other people in recovery who were interested in becoming counselors. Since those in recovery were not permitted by the hospital to witness the demonstrations with actual patients, I spent three hours each afternoon for five days with this group.

I am sure that my experience working with these energetic and eager individuals will continue to be one of the most memorable of my professional career. The participants seemed to be doing quite well in their own recovery and were very active in local AA groups. They very much wanted to take what they were getting out of AA and their own successful recovery to others—and to help eradicate the rampant discrimination toward the addict that exists throughout Chinese society. The Chinese treatment community indeed could benefit from these enthusiastic individuals' experience and passion.

Limited help

Drug addiction is not new to China. At one time it was estimated that 27% of the male population was addicted to opium. However, this figure dropped significantly from its peak in 1906 to the establishment of the People's Republic in 1949. Changes in Chinese society in recent years have meant new freedoms and new choices. As a result, drug addiction is again on the rise and, although seemingly insignificant when compared to the epidemic of the early 1900s, reports indicate there were 1.16 million Chinese addicted to heroin in 2005.1

Currently the number of beds available for those dependent on alcohol or drugs is quite small, especially when considering the vast number of those who could benefit from treatment. In Beijing alone, a city of more than 10 million, only a few hospitals with a handful of beds currently treat patients addicted to alcohol or drugs. While effective treatment for addiction is being recognized in China, the nation is merely scratching the surface when it comes to treatment availability.

In China today, addiction is severely stigmatized, and is grouped with prostitution and gambling as a negative behavior. Chinese society today generally views drug dependence as a moral weakness and sees the addicted individual as having a character flaw. While this view is prevalent in U.S. society as well, there is little distinction in China between the views of the public and those of medical professionals, who often use punitive approaches to treatment. This goes along with a pervasive attitude in China that individuals must be held responsible for their own actions and must learn from their own mistaken behavior.1

Fortunately, 12-Step programs may be playing a major role in changing views, among both addicts and treatment professionals, about the prospects of successful recovery. The success of those in recovery through AA has apparently been evident to treatment professionals who are beginning to see that long-term sobriety is possible but cannot always be accomplished by merely offering acute care to the dependent.

Would-be counselors

With a growing number of people in recovery who are enthusiastic about providing care to those in need, China now has an increasing number of potentially effective counselors. Those I met at the workshop were no exception. Along with Mr. H., these are individuals with genuine enthusiasm and an interest in learning from faculty who can assist them in expanding their understanding of treatment.

During our time together, we had great discussions (mostly in response to earlier lectures), role-played group sessions with individuals volunteering to be the leaders, and talked about some of the challenges addicts face in developing successful recovery programs. We also laughed, cried, joked and, despite the language barrier, experienced a bond that brought us together as fellow warriors, struggling to make treatment effective for the addict.

While the “professionals” were watching my two colleagues demonstrate with live patients, I learned a thing or two from the true pioneers of drug and alcohol treatment in China. I learned that challenges faced by those in recovery in societies outside the U.S. are enormous in comparison to those in our country. I learned that one's level of passion can help overcome seemingly insurmountable barriers. And I learned that those who have the commitment to help others in any society truly speak the same language.

The individuals who participated in this workshop also benefited from the support of other U.S. faculty members. In three short weeks, these participants experienced 45 hours of didactic training, discussion, role-playing, and experiential learning—all without being allowed to witness demonstrations with patients.

Epilogue

About a month after the three-week institute, I received an e-mail from Barbara Powell with this message: Those in recovery who had participated in the training were now allowed to begin conducting groups at the hospital as volunteers. It was gratifying to hear this—I am sure Mr. H. and his fellow recovering alcoholics were well on their way to supporting the recovery of the patients with whom they are now working.

There are many challenges for those in recovery, and perhaps even more so in a country where the addiction treatment and recovery field is still at a relatively early phase of development. I am certain that Mr. H. and others who share his passion are playing a major role in battling stigma while mentoring patients on the road to recovery.

Thomas G. Durham, PhD, LADC, is Executive Director of The Danya Institute in Silver Spring, Maryland, where he coordinates training programs including those delivered by the Central East Addiction Technology Transfer Center. He has written regularly for Addiction Professional on clinical supervision issues. His e-mail address is tdurham@ danyainstitute.org.