Drinking Culture in the Thai-Isaan Context of Northeast Thailand

Drinking Culture in Thai-Isaan Context

DRINKING CULTURE IN THE THAI-ISAAN CONTEXT OF NORTHEAST THAILAND

Jirawat Moolasart1 and Siriporn Chirawatkul2

1Department of Psychiatry, Sappasitthiprasong Hospital, Ubon Ratchathani; 2Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand

Abstract. Ethnographic research aimed to explore drinking context, drinking behaviors, and perception of lay people about their drinking and drinking-related behaviors in Thai-Isaan context. The study was conducted in a suburban village in the northeast of Thailand during 2008. Participant observation and informal interview were employed for data collection throughout the year. Findings of the study revealed that alcoholic beverages and drinking were woven into everyday life and integrated into various social events and traditional rites as part of social life. Alcohol consumption was permitted overtly with positive attitudes toward drinking and a low level of restriction. Enjoyment and social functions of drinking were recognized by direct experience in real life. Conversely, problem drinking and overt intoxication with loss of self-control or lack of responsibility were not expected or acceptable. Drinking was rarely perceived as a social distress. From an insiders’ view, their drinking was less correlated to alcohol abuse or alcohol- related social problems. In the context of a permissive drinking culture, the existing alcohol regulation measures may be neither supported nor conformed as expected. An alcohol policy that aims to reduce the overall volume of consumption or to indicate the negative consequences may dispute local perceptions and norms. The challenge for public health within this culture is how to persuade the drinkers to realize such negative potential and how to raise societal awareness of negative consequences. Positive local norms and values should be emphasized and strengthened to promote a more healthy drinking culture. Keywords: alcohol drinking, drinking culture, drinking context, local perceptions, Northeast Thailand

INTRODUCTION (WHO, 2004a). The proportion of drinkers also increased from 31.5% in 1991 to 35.3% In Thailand, alcohol consumption in 2004 (Ekachampaka and Wattanamano, by Thai youth and adults has increased 2007). In 2007, the proportion of Thai over time. The estimation of per capita adults (age 15+) who drank in a 12-month consumption of pure alcohol showed a period was 30.02%, while the north and fourfold increase between 1970 and 2000 the northeast regions had higher propor- Correspondence: Jirawat Moolasart, Depart- tions than the whole kingdom (NSO, ment of Psychiatry, Sappasitthiprasong Hospi- 2008). To alleviate negative alcohol-related tal, Ubon Ratchathani 34000, Thailand. consequences, the Thai government has Tel: 66 (0) 45 255848 employed various strategies to reduce the E-mail: [email protected] alcohol consumption level and to prevent

Vol 43 No. 3 May 2012 795 Southeast Asian J Trop Med Public Health alcohol-related harm that have ranged moderated by patterns of drinking. from regulation of access and availabil- Conversely, drinking is inherently ity, partial regulation on advertisements, social and usually a social act (Douglas, drink-driving countermeasures, to the 1987). The consumption of alcohol reveals promotion of “no alcohol’’at religious- the cultural processes and concerns rather related events (Sornphaisan, 2006; Thama- than the determination of the chemical rangsi, 2006). However, these efforts have effects of alcohol (SIRC, 1998). Alcohol been of limited success. Public awareness consumption is influenced by the role of regulatory measures has been raised, of alcohol in daily life, beliefs and val- but not the conformity, while enforce- ues of drinking in the culture, drinking ment of laws seems to have been limited norms and expectations about drink- in scope and intensity (Suriyawongpaisal ing, and the relationship of drinking to et al, 2002; Thamarangsi, 2006). The pro- other aspects of the culture (Heath, 2001). portion of everyday drinkers and regular Drinking practices vary from culture to drinkers has increased in the last decade culture because of the distinction of at- among both men and women, includ- titudes among different cultures, which ing the proportion of female drinkers include the appropriateness of drinking (Ekachampaka and Wattanamano, 2007; or particular forms of drinking in various Sornphaisan, 2008), and the per capita socio-demographic groups and in various consumption trends have not decreased contexts (Simpura, 1991), and the attitudes (WHO, 2011). The National Household to behavior while drinking or intoxicated Survey for Substance and Alcohol Use in (Room and Mäkelä, 2000). The identifica- 2007 estimated that about 23.6% of Thai tion of normal drinking and alcohol-use population aged 12-65 years could be clas- problems are also culturally constructed, sified by the AUDIT as hazardous drink- and differs across societies and drinkers, 3.3% as harmful drinkers, and 2.0% as ing cultures (Bennett et al, 1998; Room alcohol dependents (The Administrative et al, 2001). Problematic drinking, or the Committee for Substance Abuse Research problem drinker, is framed by cultural Network, 2008). definitions and judged within a cultural From the public health perspective, al- value-system (O’Nell and Mitchell, 1996). cohol use is related to wide range of physi- The differences between normal and path- cal, mental, and social harms through the ological drinking may reflect the socially physiological and psychological effects acceptable level of drinking and cultural of alcohol (Rehm et al, 2004). Two main expectations of drinking-related behavior. variables correlated to alcohol-related An understanding of the socio-cul- consequences are pattern of drinking and tural context of alcohol consumption in average volume of consumption. How- a society is essential to comprehend their ever, drinking patterns among the general drinking behavior and to predict possible public can be affected by the customs of consequences (Jernigan, 2002). Neverthe- drinking among individuals or different less, knowledge about social and cultural groups, the social customs surrounding context of drinking in Thailand is limited, it, or the attitudes and norms regarding particularly in the northeastern or Thai- drinking behaviors by society (Jernigan, Isaan culture (Center for Alcohol Studies, 2002). Moreover, the impact of the average 2008). The existing data are mainly derive volume on such consequences is partly from epidemiological studies. Although

796 Vol 43 No. 3 May 2012 Drinking Culture in Thai-Isaan Context epidemiological surveys can show levels were born there, while only few people and trends in alcohol use, they may not migrated into the village by marriage. explain how individuals and society per- Most villagers still have strong kinship ceive or think about alcohol consumption ties, as well as adhering to traditional and act of drinking behaviors in particular culture. Conversely, there is evidence of cultural contexts (Room et al, 2001). There- modernization, such as motorcycles and fore, this ethnographic study was con- cars, styles of housing, and a satellite ducted to examine the drinking context receiver. However, there are no modern and drinking behaviors within everyday public drinking places, such as bars, clubs life and society in the Thai-Isaan context. or karaoke parlors. Perceptions of lay people about their Participant observation and informal drinking and drinking-related behaviors interviews were employed for data col- were explored from the insider’s view. lection. There were 80 events observed throughout the year, both drinking and MATERIALS AND METHODS non-drinking related events. The research- er participated in fifty-eight social events This research was part of an ethno- and special occasions, whether personal graphic study that was conducted during or public occasions, with permission or in- 2008 in a village of northeast Thailand. vitations from the hosts. Eight traditional A suburban village was purposefully rites and fourteen communal activities selected based on the characteristics of were involved in the study. the community, which was a traditional Thai-Isaan community with evidence of Informal interviews were conducted modernization and urbanization. Another at the time of the social and cultural events reason was indications of alcohol con- or as soon as possible after the events, and sumption in everyday life, and in social recorded by note taking or audio recorder and cultural events. The village is 20 km after permission was obtained. Audio from the municipal area, located on the recording was transcribed into concrete bank of a river, and covers an area of 4.5 descriptions as soon as possible. The key km2. The village was established more informants were people who were born than 100 years ago. The population is and had lived in the village for most of quite homogeneous, of Thai-Isaan origin, their life. The ages of all interviewees were and all are Buddhist. Around 900 people more than 20 years old. More than 50 men live there, and 73.8% of people are more and 30 women were selected purposefully, than 18 years old. The numbers of adult according to drinking experience, includ- men and women are comparable. Today, ing the drinker, the abstainer, spouse of the occupations of most people are in the the drinker, and the host of the events. food and drink service business–work- The elderly were also interviewed for the ing in traditional restaurants on bamboo history of the village and other aspects of rafts on the sandy beaches and the bank socio-cultural life. In addition, chatting of the river–and in fisheries or fishing. and talking with other people provided A small number of people work outside information of the village life and other the village, for example, as construction alcohol-related issues. laborers, company employees, or civil Data were analyzed by content analy- servants. Most people living in the village sis and thematic analysis (LeCompte and

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Schensul, 1999; Ryan and Bernard, 2003). alcohol. Some people may mix lao khao Statements from field notes and transcrip- with an energy drink to make it easier tions were read thoroughly, coded, and to drink because of its sweet taste and categorized. Code and categories were fragrance. Another type is a wine cooler, based on the objectives of the study and which is made from wine and grape juice. emerging issues from field experience. The headman estimated that about Conceptual models and emerging themes 90% of the adult males in the village were hypothesized and identified. Then, had consumed alcohol once in a year, core themes were created from connected and more than one-half of them drink categories. Fig 1 demonstrates such an frequently, at least 1-2 times a week. The example of a pathway of data analysis. volume and frequency of drinking tends The project was approved by the Eth- to be highest among young and middle ics Committee of Khon Kaen University, aged men and declined with increasing Thailand (No HE501123, 2007 Dec 20). The age. However, there were a number of protocol and process of the study were frequent drinkers among the elderly. So- given verbally to the village headman and cial and cultural events are the primary the advisory committee of the village and opportunities for occasional drinkers to discussed in detail. drink and sometimes drink in a greater amount than is a usual practice. The RESULTS common type of beverage among men The presented findings emphasized is whisky, followed by lao khao and beer. the drinkers and types of beverage in the Although the number of adult men who village, drinking occasions throughout the abstained is quite low, their abstinence is year, the functions of alcohol and drinking not considered to be offensive by drinkers. on each occasion, drinking practices in To drink or not to drink is accepted as the village life, and local perceptions. decision of each individual. The drinkers and types of beverage: “Our For women, around 40% of adult fe- village drinks quite a lot, not only men males were estimated to be the drinkers. but also women” Most women are occasional drinkers, but Walking around the village, there was a number of women drink at least once a much evidence of alcohol drinking among week. They usually drink at their house villagers, such as empty bottles or cans or at social and cultural events. Women of beer in household garbage and caps of drink less per occasion and with less both whiskeys and beer lying along the frequency than men. The proportion of pathways. All alcoholic beverages are women who drink generally increases Thai branded commercial beverages that with age, but decrease among women are distributed throughout the country. over the age of 50. The preferred drinks The most common type of beverage is for women are beer, followed by whiskey. whisky, which is usually drunk by mixing Adolescent drinking usually occurs with ice and soda water, or soda and still in communal activities associated with water. Beer is the second preferred drink. religious or cultural events. Birthday Beer drinkers usually pour it from a bottle parties are another occasion, where peers into a glass with ice. Lao khao is a local, gather at the host’s house. They usually colorless distilled liquor that contains 40% drink to a limited amount and in front of

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Should not drink alone. a way of marking the life Drinking contexts Should not drink in the morming. cycle, and a part of cultural

You must keep your responsibility events or traditional rites. and do your job. In each context, alcohol and If you drink, you need to assess your Self-control drinking have specific func- competence. tions and meaning for those I had many more obligations, so I could not drink like before. who drink. A good drinker Drinking in everyday life Just for enjoyment. Should drink moderately. In the evening, hard Should not get (overtly) drunk. Responsibility workers or laborers may stop at a grocery shop in the Frequent drunkenness is not a good practice. village to buy a small bottle It would be bad if you can’t control yourself. of lao khao or a bottle of beer You must not get into a quarrel or a fight. before returning home. They may drink together at some- Fig 1–Example of pathway data analysis. one’s house before returning their houses. Drinking the elders. Beer and wine coolers are the is considered as a relaxation after a hard favorite drink among them. day’s work or relief ’from’ their muscle The choice of beverage is a personal aches, as well as socializing with others. preference. Some people may drink any Dinner is a time for drinking too. Some type of alcoholic beverage, but some villagers buy a small glass of lao khao may drink only a specific type or specific (30 ml) and drink at the grocery shop brand. Specific types of beverage are not before they have a dinner to stimulate linked to drinking occasions. The strength their appetite. Many people drink to of beverages is perceived by flavor and accompany the meal, particularly when taste rather than real alcohol content, also relations or close friends gather together. influences beverage choice. Although lao It is again considered as a way of relax- khao and whisky are similar in alcohol ing and facilitating social contacts and content, several lao khao drinkers said that relationships. whisky cannot satisfy their thirst. Con- Alcohol may be consumed for me- versely, several whisky drinkers said “lao dicinal purposes. In this context, it is khao is too strong to drink.” Beer and wine consumed in a small amount and not cooler are considered to be the lighter al- regarded as a liquor or intoxicant. For coholic beverages. However, wine cooler example, a man who identifies himself is sometimes not considered to be “a real as an abstainer drank a can of beer to re- drink” for adult men because of its sweet lief his dizziness. Another woman drank taste and the belief that it has low alcohol occasionally when she felt faint. She ex- content; although it contains 5% alcohol, plained, “It’s just a little amount, for the the equivalent concentration of beer. blood circulation” (F, 64 years, occasional drinker). Alcohol is also used for mood Drinking is regarded as a part of daily alteration. It is supposed to enhance mood life and socio-cultural events and facilitate fluent speaking. Drinking is Drinking can occur throughout the expected to bring cheerfulness and plea- year as a part of daily life, a social activity, sure to the drinkers.

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Drinking in social activities Drinking on special occasions of the life Celebration is the most common cycle reason for drinking alcohol. Each signifi- Besides the significant moments of life cant occasion in daily life can be marked cycle, su khwan ceremony is an important by a celebratory drink, such as when custom that is performed in several socio- someone has obtained new property, a cultural events. In general, this ceremony new car or motorcycle, after renovation is held to recall one’s khwan (soul or living of a house, or at a birthday party. New essence) to one’s body. It may be carried Year is another significant occasion for out at times of crisis such as a curing ritual celebration. The celebration may involve for illness or after recovery from illness, only the family members or relatives personal tragedy, or ill fate. The ceremony and close friends who are invited to is also performed as a warm welcome or participate. congratulation at time of a good fortune When groups of friends or relatives or success. During the ritual, a tray of food go to a river site or to a pond for fishing and a bottle of alcoholic beverage may and picnicking, drinking is expected, and be presented to the ancestors and spirit frequently, it becomes the central feature for inviting them as the witness or for of the event. Alcoholic beverages are blessing the participants. The ceremony regarded as a social lubricant for socia- usually concludes with participants eat- bility, mediating relationships between ing and drinking together. In the event individuals, or establishing friendships. of welcome or congratulation, guests are Some guests may bring alcohol with them usually encouraged to drink by the host. to drink together. It is considered a recip- Each moment of the villagers’ life rocation for the invitation. cycle is associated with drinking alcohol. When relations or friends are asked to When a couple has a baby, relatives and assist in personal work, they are treated close friends will be invited to the “month- to food and drinks as an expression of ly birthday celebration” to congratulate thanks for their generous participation. and celebrate with the family. On a wed- After a work feast, at which groups of ding day, alcoholic beverage is shared by people volunteer to work for a communal relatives as a sign of reciprocity between project, participants are treated likewise the bride’s and the groom’s families. After after work. One elderly person added su khwan ritual in late morning, food and that alcohol could make the atmosphere drinks are served to all participants to cel- of working more enjoyable, but it should ebrate the moment. Alcohol is an essential not be drunk too much. part of a wedding party. In an ordination Drinking is also an adjunct to hospi- ceremony of someone to be a Buddhist tality. When one’s long-separated friends monk, relatives and close friends are in- or relatives visit, the host and visitor vited to participate in celebration where usually drink together. Even one who food and drink are served after the su defines himself as an abstainer said that khwan ritual. Drinking is also a part of he should drink at least a glass of alcohol celebration in a religious ceremony to on this occasion. Encouragement to drink bless a house and a housewarming party. by the host seems to be an extension of the The funeral ceremony, which is usu- hospitality of a good host. ally held between three to five days later

800 Vol 43 No. 3 May 2012 Drinking Culture in Thai-Isaan Context at the house of the deceased, also is related Alcoholic beverage is expected to be to drinking. Food and drinks are served drunk during the event, and everyone after the religious ritual in the evening. should be cheerful. As one elderly man After the cremation ritual, all guests are explained, “It is the joyous day. They invited to have a meal at the deceased’s drink from morning ‘til the end of the house where food and beverages are festive period, both men and women”. served. However, alcoholic beverages are (M, 73 years, occasional drinker). In drunk to accompany the meal and not in Pu ta (spirit) worship, food and alcoholic a large amount. It appears to be a part of beverage, one tray from each family, are the hospitality. presented to worship pu ta for the village’s Drinking in traditional rite security and peacefulness in the coming year. The offerings are shared for eating According to Thai-Isaan culture, there and drinking after the ritual. Both food are 12 traditional annual rites or heed sib and alcoholic beverages are consumed, song, one of which is conventionally held not only for a celebration of the event, but each lunar month. However, in this vil- also a blessing for those who drink. lage, only 8 out of 12 rites are performed, including in the 4th, 5th, and 7th-12th Drinking is accepted in specific times lunar months (around March, April, and spaces and June-November): boun phawet, boun Drinking times vary by the nature of songkran or songkran festival, boun sam the occasion. In everyday life, drinking hah, boun khao phansa, boun koaw pradub time is usually in the evening, or from din, boun koaw sak, boun ok phansa, and evening until nighttime. Alcohol may be boun kathin. Most of these ceremonies are consumed throughout the day at cultural a form of merit-making that encompass events. Drinking can occur at the time the values of religion and community. of specific social events, for instances, in Another ceremony, which is held on an the morning or evening at a wedding cer- auspicious day in the sixth lunar month, is emony, in the afternoon after a cremation pu ta (the village guardian spirit) worship. ritual, or during or after a work fest. For Among the traditional annual cer- hospitality and sociability, alcohol may be emonies, there are only three that drink- offered and consumed at any time. ing is considered as a part of the events, Villagers usually drink within the including boun phawet, boun songkran, boundary of the village, particularly when and pu ta worship. These ceremonies they drink in large amounts. In daily consist of two parts, religious-related or drinking and social events, it may take spirit-related rituals, when celebration or place in front of a house, in a courtyard, hospitality drinking have roles. or at a location close to a house, but rarely Boun phawet is a great rite of the year, in a closed space, such as living room and drinking is expected during the event. or kitchen. A drinking group may settle Several villagers said that this was a great nearby a pathway or at the waterfront occasion of drinking, more than any where they can be easily seen by others, other occasion in the year when alcohol and sometimes the passers-by may be was usually consumed in large quantity. invited to drink together. On special occa- Boun songkran,–the traditional Thai New sions, drinking also occurs at the location Year,–is another occasion of great festivity. of the event, regardless of whether it is a

Vol 43 No. 3 May 2012 801 Southeast Asian J Trop Med Public Health private or a public space. In a communal a problem of the community. Drinking activity or a traditional rite, drinking is regarded as a social activity and social mainly occurs in public or open spaces. relationship enhancer. Drinking tends to Drinking is considered to be a social intensify harmonious relations, promote activity which should be done with others. social cohesion, and affirm kinship ties. It is unusual to drink alone, particularly Several former drinkers realize that drink- in a large amount. It is considered inap- ing is an essential component of enjoy- propriate if someone drink alone until ment and socializing. Even non-drinkers drunk. Even a regular drinker said that or spouses of drinkers also recognize “I’ve never drunk alone. I can’t imagine it. positive outcomes. I hesitate to do it without friends”. (M, 40 I drink just for fun. I always drink years, regular drinker). Solitary drinking with my friends. Drinking, eating, and may be found in everyday life, but usually chatting are all that we do in a drink- just a small amount is consumed. ing session. If I do not drink, I think I On every occasion related to drink- won’t have any friends to enjoy with. ing alcohol, both sexes and various gen- If we do not drink, how can we have erations can participate in those events a good time together? (F, 42 years, whether they drink or not. Children and occasional drinker). adolescents are allowed to stay or play Alcoholic beverages are made nearby a drinking group in all alcohol-re- for drinking, so, drink it when you can lated occasions. But, in a drinking group, drink (M, 67 years, former drinker). there are some restrictions. In general, Physical health consequences are men usually drink with the same gender major issues associated with drinking that or male friends, while women usually concern villagers; however, they usually drink with family members, relatives, or are concerned with health consequence close friends. Women may be present at only when they do not feel well or get an or join in a male drinking group only if illness. It is a major reason for quitting they are with their spouse, or relatives. among several drinkers, but they usually Both men and women may join together return to drinking when they feel well in a drinking group only at a traditional again. ceremony or communal activity. Drinking alcohol is rarely perceived Drinking is permitted under self-control as a social distress or raised as a public Drinking is generally accepted as a issue. Family problems related to alcohol way of the villagers’ life and is regarded as consumption, such as high household ex- a norm in most social and cultural events. penses or potential family violence, may Several villagers concluded that, in their be raised only when someone is drinking village, alcohol is consumed more than heavily or in a problematic pattern. From nearby villages. Local perceptions and at- the headmen’s point of view, drinking titudes can affect both drinking practices rarely leads to a fight or a brawl. Most and drinking behaviors. fighting is because of annoyance with Positive outcomes of drinking are per- drunken person who is hit by a sober one. ceived more than negative consequences It is the drinkers that are criticized, but Most villagers agree that drinking not alcohol or drinking. Although women brings them an enjoyment, and it is not and abstainers tend to perceive lack of

802 Vol 43 No. 3 May 2012 Drinking Culture in Thai-Isaan Context responsibility for family obligations and event, they can drink and get drunk accident as the consequences of drinking, all day long or for several days. (M, they also realize the social benefits from 74 years, abstainer). drinking, particularly moderate drinking. Problematic drinking does not pri- A drinker should control his/her drinking marily depend on the quantity or fre- behaviors quency of consumption, but rather to the Most villagers emphasize the value interference with personal responsibility of moderate drinking. Overt drunkenness or obligations during and after a drinking with physical signs and loss of control is session and the ability to control one’s be- not accepted, but ridiculed and scorned. havior. It emphasizes the negative effects Some degree of drunkenness may be that drinking can have on social wellbe- accepted on occasions associated with ing, or the family and work obligations. celebration or traditional ceremonies. It One can be defined as a problem drinker is tolerated if a person can control his or if he/she frequently gets drunk and can- her behavior and takes responsibility for not take the responsibility, or frequently themselves. Many villagers agree that, “If behave in a problematic drinking pattern. you enjoy drinking, you need to assess Nevertheless, the consensus is that the your competence.” Drunkenness is not number of villagers who abuse alcohol, an excuse for failure to control their be- characterized by continual problematic haviors. One woman who is an occasional drinking, is low. drinker explained: Alcohol consumption among women Drinking is both good and bad. tends to be more acceptable both in pri- It would be good if you drink mod- vate and public spaces. Nevertheless, erately. It would be bad if you can’t women are expected to drink infrequently control yourself. Though you get a and to not get drunk. Drinking alone or bit drunk, it doen’t a matter if you getting drunk are improper and criticized. just have fun with your friends. It’s It is considered as inappropriate if a an enjoyment. But, you mustn’t get woman drinks with a group of men. From a women’s viewpoint, drinking with men into a quarrel or a fight.(F, 62 years, can be followed by sexual harassment, occasional drinker). particularly when someone gets drunk. In general, normal drinking is de- It’s OK for women to drink al- fined without reference to quantity of cohol. Many women here drink. But consumption. It depends on the ability of it’s not the same as men when they the individual to know when and how to get drunk. It’s not so good if they get drink, actual drinking practice, and how drunk and lose their control. (M, 38 to behave even slightly intoxicated. years, former drinker). If you drink, you must take re- It’s not good if a woman drinks sponsibility and do your job. Not just with a group of men. You may be walk around, looking for drink. (M, 35 harassed by a drunken man…grab years, regular drinker). your hand or say something dirty. It’s A problem drinker? They love OK to drink in a group of women or to drink, any kind of alcohol. They with female friends. But you must not usually get drunk. When there is an get drunk. You can lose your control,

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do an awful thing, or do something ing, social approval, and expectations of unashamedly. If you drink you must benefits are the reasons for initiating and aware of yourself. (F, 62 years, oc- reinforcing drinking behaviors (Rimal and casional drinker). Real, 2005). In general, drinking in this village DISCUSSION can be considered as a drinking culture which is less correlated with alcohol Among the typologies of drinking abuse or dependence, and alcohol-related that use culture to explain and classify, social problems (Peele and Brodsky, 1996; alcohol consumption in the studied vil- Research New Zealand, 2006), at least lage can be defined as ‘the permissive from insider’s viewpoint. Constraints culture,’ which Pittman (1967, cited in on consumption with drinking norms Room and Mäkelä, 2000) described. Al- and values are passed and learned com- cohol consumption is integrated into sev- fortably within the domain of kinship. eral aspects of villagers’ lives and overtly While positive attitudes promote alcohol accepted. People seem to have positive consumption, drinking norms, drinking attitudes towards alcohol consumption. contexts, and drinking behaviors can Although some degree of drunkenness is decrease the potential for harm. Moder- tolerated, society does not accept intoxica- ate drinking, by a lay definition, is more tion or overt drunkenness with a loss of evident than overt intoxication. Heavy self-control, even in social and cultural drinking, which may lead to accidents or occasions where heavy drinking or some injuries, usually occurs within the village degree of drunkenness is expected. An environment, where norms are recognized individual’s responsibility and obliga- and shared. Fig 2 summarizes the charac- tion are concerned. Drinking places also ter of drinking culture and the impacts on reflect the permissive attitude of the vil- drinking behavior. lagers towards alcohol (SIRC, 1998). They usually drink in open and highly visible Although findings from this study spaces, whether on private or public oc- may not represent drinking culture in all casions. Conversely, drinking in open Thai-Isaan communities, to some extent, spaces where the others can join together it demonstrates that there is a permis- also facilitates social bonding among the sive drinking culture as a subculture in drinkers and familiarity for witnesses and Thai society and reveals the influence of the young. culture on the perceptions, beliefs and Drinking has several functions in shaping drinking behavior. Conversely, specific contexts (Sulkunen, 2002). So- it could reflect the effect of alcohol policy cializing, celebration, hospitality, and and explain the low conformity rate in a reciprocity are the most common social particular culture. functions of drinking. Therefore, drink- In Buddhism, refraining from alcohol ing has become the norm during several consumption is one of the five precepts to events. The more drinking functions in which all Buddhists are expected to con- a particular context the more it encour- form, while alcohol policy also attempts ages increased consumption or heavy to promote a ‘no alcohol’ strategy during drinking, and promotes more drinking religious-related events. Our findings in the society. The prevalence of drink- demonstrate that drinking is associated

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and consumption volume, Positive attitudes; a large number of social functions, enjoyment and socializing, and beliefs about alcoholic provide positive outcomes more than beverage and drinking in negative consequences. society also influence public Values; should not get (overtly drunk, Permissive opinion on alcohol policy do not get drunk frequently, individual’s responsibility and self-control. drinking culture (Hemström, 2002; Green- Drinking contexts; a part of everyday field et al, 2007; Holmila life, a norm of several social and cultural et al, 2009); therefore, the events, drink in open space, both sexes and existing alcohol regulatory several generation are presented. measures may not be sup- Overt drinking practice but, overt drunkenness ported or conformed to as is not expected and lack of responsibility and/or loss of self-control are unacceptable. expected by policy maker. The integration into Less problematic drinking, social distress, or dependence. sociocultural life of the high frequency of drink- Fig 2–Drinking culture and the impacts on drinking behavior. ing occasions can lead to an increase in community tolerance to drinking and with several religious-related occasions. related behaviors (McIlwaine and Moser, However, it is considered as an essential 2004). Therefore, societal responses to part of the feast or social activity on these the consequences of drinking is limited, occasions, but not the religious activity. and alcohol-related problems at an indi- Studies in other parts of Thailand have vidual level can belatedly be noticed by shown that drinking which involves reli- the public (Cottino, 1995). It may be dif- gious activities or practices seems to affect ficult to raise alcohol-related problems as drinking behaviors among Thai Buddhists a societal concern or a public awareness, less than expected (Assanangkorchai et al, which are the indicators of the success 2002; Newman et al, 2006). They noted that of harm reduction strategies (Roche et al, the fifth precept may be interpreted dif- 2005) and the key elements in initiating ferently among Buddhist laymen; several and establishing local measures (WHO, people interpret it as a total abstinence, 2004b; ICAP, 2006). while others may perceive it as moderate In the context of a permissive drink- drinking. ing culture, alcohol control measures Observation of positive effects in real and law enforcement may not be the life may influence perception and frames only suitable strategies. As alcohol con- of reference for interpreting risks and sumption is permitted overtly and social consequences more than general public benefits are recognized by direct experi- information. Enjoyment and excitement ence, alcohol policies that aim to reduce of drinking can encourage more drink- the overall volume of consumption or ing and can induce the young to become to indicate the negative consequences involved and expect positive outcomes may interfere with local perceptions and or social reinforcement. The perception norms. The challenge in a culture like this of there being benefits that are more is how to persuade the drinkers to realize than risks, high frequency of drinking negative potential and to raise the societal

Vol 43 No. 3 May 2012 805 Southeast Asian J Trop Med Public Health awareness of negative consequences. behaviors. In: Wibulpolprasert S, ed. Thai- Public information of related conse- land health profile 2005-2007. Nonthaburi: quences or recommendation about alcohol Bureau of Policy and Strategy, Ministry consumption should be concerned about of Public Health; circa 2007: 109-60. drinking culture and lay perceptions [Cited 2012 Jan 6]. Available from: URL: http://www.moph.go.th/ops/thp/index. about risks and benefits from drinking. php?option=com_content&task=view&i Positive local norms and values should be d=6&Itemid=2&lang=en emphasized and strengthened along with Greenfield TK, Ye Y, Giesbrecht N. Alcohol a harm reduction strategy to promote a policy opinions in the United States over more healthy drinking culture. a 15-year period of dynamic per capita consumption changes: implications for ACKNOWLEDGEMENTS today’s public health practice. Contemp Drug Prob 2007; 34: 649-80. This article is a part of a doctoral the- Heath DB. Culture and substance abuse. Psychi- sis for the degree of Doctor of Philosophy atr Clin North Am 2001; 24: 479-96. in Public Health, Khon Kaen University. Hemström Ö. Attitudes toward alcohol policy The project was funded by Center for in six EU countries. Contemp Drug Prob Alcohol Studies, Thailand. The authors 2002; 29: 605-18. would like to thank all the villagers for Holmila M, Mustonen H, Österberg E, Raitasalo their sincerity and support. K. Public opinion and community-based prevention of alcohol-related harms. Ad- REFERENCES dict Res Theory 2009; 17: 360-71. International Center for Alcohol Policies Assanangkornchai S, Conigrave KM, Saunders (ICAP). Drinking in context: a collective JB. Religious beliefs and practice, and responsibility (ICAP Reviews 2). Wash- alcohol use in Thai men. Alcohol Alcohol ington, DC: International Center for Al- 2002; 37: 193-7. cohol Policies, 2006. [Cited 2009 May 15]. Bennett LA, Campillo C, Chandrashekar CR, Available from: URL: http://www.icap.org/ Gureje O. Alcoholic beverage consumption LinkClick.aspx?fileticket=D5NlIamtoe4% in India, Mexico, and Nigeria: a cross- 3d&tabid=76 cultural comparison. Alcohol Health Res Jernigan D. Alcohol in developing societies: a World 1998; 22: 243-52. public health approach [Summary]. Ge- Center for Alcohol Studies. Alcoholic bever- neva: World Health Organization, 2002. age control in Thailand during 1950-2007: LeCompte MD, Schensul JJ. Designing and review of the literature. Bangkok: Center conducting ethnographic research. Walnut for Alcohol Studies, 2008. Creek, CA: Altamira, 1999. Cottino A. Italy. In: Heath DB, ed. International McIlwaine C, Moser CON. Drugs, alcohol and handbook on alcohol and culture. West- community tolerance: an urban ethnog- port: Greenwood, 1995: 156-67. raphy from Colombia and Guatemala. Douglas M. A distinctive anthropological Environ Urban 2004; 16: 49-62. perspective. In: Douglas M, ed. Construc- National Statistics Office (NSO), Thailand. tive drinking: perspectives on drink from Report of smoking and alcohol consump- anthropology. Cambridge, UK: Cambridge tion survey 2007, (Table 2.1). Bangkok: University Press, 1987: 3-15. NSO, 2008. [Cited 2009 Feb 20]. Available Ekachampaka P, Wattanamano N. Situations from: URL: http://web.nso.go.th/survey/ and trends of health determinants: health smoke/ad.pdf

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