The particular problem of getting help here
Thailand is one of the largest destinations in the world for residential addiction treatment. People fly in from Europe, Australia and the Gulf specifically to use it, and some of it is genuinely excellent.
Which creates an odd situation for the expatriate who already lives here. World-class residential treatment is twenty minutes away, and he will not go anywhere near it.
Not because of the distance or the cost. Because walking through that door is a public statement about himself, made in a country he came to precisely so that no such statement would ever be required.
So the decision quietly becomes: not yet. And not yet becomes years, and by the time something forces it there is usually a great deal to repair.
The tuk-tuk
Anyone who has spent a week here knows the arrangement. You get into a tuk-tuk and you name where you want to go. The driver agrees, cheerfully. And then he takes you to a tailor. After the tailor, a jewellery shop. After that, a massage. He is paid to deliver you to each of them, and not one of them is where you asked to go.
Addiction works in precisely that way.
You get in to go somewhere. To relax. To be less anxious. To be able to talk to people. To stop feeling a particular thing for an hour. And for a while it takes you there, reliably, which is the part nobody says out loud — it works, or nobody would keep getting in.
Then, gradually, it stops taking you where you asked and starts taking you where it is going. The stops get longer. The destinations are increasingly not yours. And at some point you notice you have spent five years being driven around a city you never chose, in a vehicle you cannot get out of while it is moving.
The work is not really an argument with the driver. It is about where you were trying to get to in the first place, why that mattered, and whether there is another way of arriving.
What the drinking and using are doing here
Very little of the addiction work I do with Thailand is really about the substance.
The pattern is consistent. A man arrives having decided, in some fashion, to start again. The environment removes every external brake at once: alcohol is cheap and permanently available, nobody is counting, there is no colleague to notice, no partner at home to answer to, and no consequence arrives for a long time.
Underneath that there is usually an unanswered question about meaning, which has its own page, and very often something older still: a trauma from long before Thailand that leaving the country removed the reminders of without processing any of it.
Treating the drinking while leaving those two alone is why people stop for six months and start again.
What I work with
Cocaine, which in expatriate Bangkok almost always travels with the drinking rather than separately from it. The two run on each other: the cocaine extends the drinking, the drinking takes the edge off the cocaine, and the night continues far longer than either would allow alone.
Alcohol, particularly the functioning drinker whose consumption looks entirely unremarkable against everyone around him.
Sex and pornography, which in this environment are unusually easy to arrange and unusually hard to name as a problem.
Chemsex, where crystal methamphetamine and sex have become one behaviour rather than two.
Gambling, cannabis, and behavioural compulsions including overwork.
Combinations, which are the norm. Addiction, trauma and often an eating disorder are usually one psychological profile presenting in three directions rather than three separate conditions.
Alcohol: what is different about drinking here
Thailand consumes roughly 7.99 litres of pure alcohol per person a year among those aged fifteen and over, on World Bank and World Health Organization figures. That is not extreme; it is lower than Ireland or much of Europe. The national average is the wrong number to look at.
What matters is the expatriate environment, and in that environment every external brake has been removed at once. Alcohol is inexpensive. It is permanently available. Drinking is not optional but socially compulsory. There is no colleague who will notice on a Tuesday morning, no partner at home asking questions, and no consequence for a long stretch of time.
The comparison group is the problem. A functioning drinker is difficult to identify anywhere. It is far harder in a place where your own consumption looks entirely unremarkable against the people you see every week. If everybody you know drinks the way you drink, nothing has visibly gone wrong. The work still gets done. Nobody has said anything. And the group you unconsciously measure yourself against was not chosen at random: over time it comes to be made up of people who drink as much as you do, or more. Nobody decides this. It is one of the reasons expatriate drinking runs for years before anybody names it.
The markers that actually mean something are not quantity. Consequences accumulate and nothing changes. Promises keep failing — not to anybody else, to yourself, in the morning, about tonight. It has become scheduled: no longer a decision made in the moment but a fixture the day is arranged around. And there is unease when it is delayed; the flight is late, the bar is shut, and something rises that the inconvenience does not justify.
Alcohol is also, chemically, liquid sugar, and for a good number of men a drinking problem is sitting on top of an untreated relationship with food. Treating the two together is often what allows recovery to hold.
Before residential treatment, and after it
Thailand is where a great many people are sent to get sober, and some of those clinics are genuinely good. This is not one of them and does not pretend to be.
Before. For the person who will not go — and most of the people I work with here will not — this is the senior specialist option rather than a lesser substitute for it. Weekly, one to one, no absence anyone has to explain, nothing that appears on any record.
After. Residential treatment is a controlled environment, and it is very good at producing change inside one. The difficulty arrives at the point of return, when the structure is withdrawn, nobody is watching, and the environment that produced the drinking is exactly as it was. That is where the relapse happens, and it is the part that is least well provided for anywhere.
And where residential treatment is what you actually need, you will be told so at the assessment rather than six months in. I trained in addiction at the Hazelden Foundation and spent close to a decade working inside private residential treatment, so that recommendation comes from knowing what the setting does well and where its limits are.
What the work is
Not primarily about stopping. Stopping is the beginning of the question rather than the answer to it.
Most people who come here about alcohol or cocaine have stopped before, often many times. The work is about what the substance has been doing: what it manages, what it makes bearable, and what would have to be felt if it stopped. That is the part residential treatment reaches least well and one to one work reaches best.
The part that is not psychological
Some of what happens here is not a matter for psychotherapy, and it would be dishonest to write about drug use in Thailand without saying so plainly.
Thai drug law is severe and it is enforced. Possession of small quantities can bring heavy fines or imprisonment, and the UK Foreign Office states that possession of Class A drugs can carry the death penalty. Prison conditions are described as harsh, with limited access to healthcare, and detainees have died in custody. Cannabis is restricted to prescribed medical use, and the assumption that it is simply legal here has put a considerable number of people in serious difficulty.
The Foreign Office also records something directly relevant to this work: British nationals in Thailand have suffered severe psychiatric problems as a result of drug use, in some cases leading to suicide. That is the stimulant psychosis end of prolonged methamphetamine use, and it is a medical emergency rather than a therapeutic question.
Money goes in its own way. Foreign nationals are regularly caught in property arrangements they did not understand and cannot enforce, and some who have subsequently alleged fraud have found themselves facing criminal defamation charges for saying so.
None of this happens to the reckless minority. It happens gradually, to people who arrived sensible, over a period in which each individual step looked reasonable and the direction of travel was not visible from inside.
The reason for putting it here is not to frighten anyone. It is that a good deal of what gets treated as weakness of character is in fact the late stage of a process with a clear structure, and people are entitled to see the structure.
Why from outside Thailand
Bangkok has capable clinicians and there are English-speaking therapists here. The problem is not competence.
It is that expatriate circles are small and heavily overlapping. The person you would be seeing may know your employer, your friends, or the bars you drink in. That is nobody’s fault; it is arithmetic.
I am not in it. I do not know anyone you know, and nobody I know will be in the room when your name comes up.
When medical treatment comes first
This is psychotherapy, not medical treatment. Withdrawal from alcohol or benzodiazepines can be dangerous and occasionally life threatening, and needs to be managed by a GP, an addiction psychiatrist or a medically supervised detox rather than attempted alone. Where that is what is needed, it is said at the assessment and the referral is made.
The same applies where a psychiatric assessment should come first or run alongside the work, and where the right answer is residential treatment rather than weekly sessions. Therapy does the work that follows stabilisation, and it does that work better once stabilisation is in place.
Practicalities
Sessions are fifty minutes, weekly, by secure video, from anywhere in Thailand. In English or French.
I trained in addiction at the Hazelden Foundation and at Hope-One, spent close to a decade working inside private residential treatment, and continue to supervise clinicians who work in it.
Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His Doctorate of Professional Practice at the University of Essex examined male eating disorders from the perspective of analytical psychology. Registration can be checked on either public register.
In crisis in Thailand: Samaritans of Thailand English line 02 113 6789, press 2. Department of Mental Health hotline 1323. Alcoholics Anonymous runs English-language meetings in Bangkok, Chiang Mai, Pattaya, Phuket and Udon Thani, and online.
Legal and safety information: UK Foreign, Commonwealth and Development Office travel advice for Thailand, and Overseas Business Risk: Thailand. This page is for information and does not constitute legal advice.
Common questions
Can I get addiction treatment in Thailand without going to rehab?
Yes, and for most expatriates it is the only version they will actually accept. Thailand has some of the largest residential treatment facilities in the world, and people fly in from everywhere to use them. The expatriate already living here rarely will, because walking through that door is the public admission he moved a long way to avoid making. One to one work weekly, confidentially and without an absence, is the realistic alternative.
What addictions do you work with?
Cocaine, alcohol, cannabis, gambling, sex and pornography, and behavioural compulsions including overwork. Combinations are the norm rather than the exception here, and they are treated together. Where crystal methamphetamine and sex have fused into a single behaviour, that is treated as chemsex, which has its own page.
Why is cocaine specifically an expatriate drug in Thailand?
Because it is expensive here, considerably more so than in Europe, and that is part of its function. It signals that you are not using what the local market uses. Methamphetamine is the drug that saturates Thailand; cocaine is the drug that saturates the expatriate bars, and in this practice it almost always arrives alongside the drinking rather than separately from it.
Is it confidential? Bangkok is a small place.
That is exactly the difficulty, and it is why a large proportion of the people I work with here chose someone outside the country. Expatriate circles overlap heavily. A local therapist may know your employer, your friends or the bars you drink in, through no fault of their own. I do not.
Do I have to stop drinking before we start?
Not necessarily, but sequencing matters. Processing trauma while a substance is doing the regulating tends to destabilise rather than resolve, so the order of the work is part of what the assessment decides. Where withdrawal needs medical supervision, that comes first.
How do I know if my drinking is a problem when everyone here drinks like this?
Quantity is the wrong test in an environment like this, because the group you measure yourself against is not a random sample. Four markers matter more. Consequences accumulate and nothing changes. Promises keep failing, not to anyone else but to yourself, in the morning, about tonight. It has become scheduled rather than decided. And there is unease when it is delayed, out of proportion to the inconvenience. If you are already doing arithmetic about units, that is worth noticing too.
I am thinking about residential treatment in Thailand. Where does this fit?
Either side of it. Before, for the person who is not going to walk into a clinic and needs the specialist work anyway. After, for the person who has completed a programme and found that the hard part starts at home, where the structure is gone and nobody is watching. Both are one to one work with one clinician rather than a programme.
What if I actually do need residential treatment?
You will be told at the assessment rather than six months in. I trained in addiction at the Hazelden Foundation and spent close to a decade working inside private residential treatment, so the recommendation comes from knowing what that setting does well and where its limits are.