Social Worker Initiatives for Alcohol-Related Problems in the Wake of the Disaster
Report on the Ishinomaki Support Activities of the Japan Social Worker Association for Alcohol
Related problems
Japan Social Worker Association for Alcohol Related problems
Disaster Area Support
Project – Sakae Fujita
Introduction
The damage caused by natural disasters destroys the lives of individuals living in affected communities and creates a host of lifestyle problems between the occurrence of the disaster and the transition into the recovery period. Alcohol-related issues in disaster-affected areas first gained publicattention in the wake of the 1995 Great Hanshin-Awasji Earthquake, when these were found to havecaused the loneliness-related deaths of residents in temporary housing.
Immediately after the Great East Japan Earthquake, individuals working in the field of alcoholrelated care pointed out the necessity of responses to the alcohol-related problems they stated “wouldoccur sooner or later.” In Ishinomaki, Miyagi, since immediately after the disaster, local public healthnurses and the JASWA—an organization that specializes in alcohol-related problems—have together
endeavored to implement interventions for the alcohol-related problems that continue to occur incommunities therein. Here, we report on our support systems, support progress, and support
programming, discuss our initiatives for alcohol-related problems, and highlight future issues in thisfield.
1. Project Objectives
The objectives of this project are to provide residents of disaster-affected areas of Ishinomaki
who have been dealing with alcohol-related problems following the Great East Japan Earthquake withmental health care and reconstruction support to help rebuild a stable life. The project also seeks toequip local aid workers in the domain of alcohol-related problems with the necessary knowledge andinformation to accomplish their jobs and to equip these workers, via consultation, with the skills
necessary to provide support to individuals grappling with alcohol-related problems.
2. Project Methods
In order to achieve these project objectives, the JASWA dispatches one veteran psychiatric social
worker twice per month (second Friday and fourth Wednesday) to the city of Ishinomaki. Support
activities are performed in concert with the Ishinomaki City Health Promotion Division. Specifically,we provide three types of support to local public health nurse counseling cases in which alcoholrelated problems have come to the fore: ① case consultation, ② counseling interviews with theaffected individual or their family, and ③ accompaniment on visitations to temporary housing.
Further, we have planned and dispatched lecturers for the “Foundational Course in Alcohol-RelatedProblems” aimed at educating and raising awareness among local supporters, and have continuously
held lectures for public health nurses, medical professionals, social workers (including those from theComprehensive Community Support Center and the Community Lifestyle Support Center),psychiatric social workers, and other aid workers. The Ishinomaki City Health Promotion Division
has coordinated these events, whereas the JASWA has provided the necessary manpower. While theinitial support period for this project was set to be from April 2011 to March 2013, it was renewed fora second term in April 2013, and our support activities therein remain underway.
3. Project Progress and Results(1) Pre-Project Period: September 2011–March 2012
In the wake of the Great East Japan Earthquake on March 11, 2011, the Sendai members of theJASW received a request to participate in support activities in Ishinomaki. In response, the JASWA
began on September 2, 2011 to dispatch two members every Friday (total eight members) toIshinomaki as a special project initiative. At the time, our support activities were centered aroundvisitations to cases in temporary housing developments, as alcohol-related problems had begun to- 88 -surface among people who had been relocated there, and public health nurses were already working
with these individuals. One characteristic common to many of these cases was that the individuals
in question had developed alcohol-related problems prior to the disaster; these problems came tothe fore amidst the huge lifestyle changes they were subsequently forced to undergo. In these areas,
the Danshukai had ceased operations, and Alcohol Family Association meetings had not yetresumed; in fact, the lone specialized facility for alcohol-related problems in the entire prefecture,
located in Sendai, was the only place that had begun working with alcohol-related problems. Suchwas the situation in the area. Despite having lost a great deal of social resources and manpower tothe disaster, public health nurses in particular were forced to deal with drinking issues in temporary
housing developments. In many respects, support from external sources was sorely needed.
(2) Project Period: April 2012–March 2013
The support that the JASWA had been conducting since the disaster as a special initiative wascontracted by the MDMHCC in April 2012, and we continued to provide support to the city ofIshinomaki. Till that point, support activities had presumed a high need for visitation services todisaster survivors in their own homes or in temporary housing and had, therefore, primarily
consisted of visitation accompaniment. Afterward, based on the results of the visit, we offeredguidance to the public health nurse in charge of the case at the Public Health Center. From thesepublic health nurses, we received the following feedback: “When you accompanied me on my visit,
I was able to see how you initiated interviews and other work with individuals with drinking
problems and their families, and I learned a lot about how to work with drinkers I had struggled towork with before.” This sort of feedback highlighted the fact that future alcohol-related problems
in disaster-affected areas will inevitably require aid worker support. After much discussion with theIshinomaki Health Promotion Division, we continue to provide support, with much of it centering
around consultations with public health nurses and educational training for local personnel inrelated fields.
JASWA members have been involved in a total of 22 cases till date. These have been located in
temporary housing developments in the Monou, Hebitachuo, and Kaisei areas. The following typesof support have been provided: ① individual visitation in 11 cases, ② family interviews in threecases, ③ consultations in 18 cases, and ④ case conferences and case study sessions in four cases.
All visitations were conducted with the accompaniment of a local area public health nurse. Eightmembers were dispatched to carry out this support.
In addition, from January to May 2013, we hosted the Foundational Course in Alcohol-Related
Problems once per month. This was an educational training workshop for local mental healthworkers. The themes of the five lectures were as follows: ① What is alcoholism? ② Alcohol
counseling: early discovery and intervention ③ Aid for families with alcohol problems ④ Building
community relationships, and ⑤ Community-based aid for alcohol problems (how to support
individuals within their communities). Each of these lectures was overseen by a JASW member
with expertise in that topic, and four members in total were dispatched to serve as lecturers. Around40 individuals participated each time, including public health nurses, nurses, psychiatric social
workers from the MDMHCC, and care managers from the Comprehensive Community Support
Center. From the second session onward, we incorporated case study sessions, with the first half ofthe event consisting of a 60-minute lecture, and the second half consisting of case studies of cases
submitted by participants. Both halves of these events sparked lively discussions, and we were quite
impressed by the passion of these staff members and officials as they worked to confront alcohol
problems in disaster areas in a positive manner. We plan to continue to hold these sorts of training
events for local personnel and are looking to broaden the scope of the sessions.
(3) Counseling Topics and the Characteristics of Drinking Problems in Disaster Areas
Nearly all our case clients were living in temporary housing after being affected by the disaster,where they would be regularly visited by public health nurses, temporary supporters, andComprehensive Community Support Center staff, leading to the discovery of their drinking
problems. Most single individuals who fell under this description were elderly persons who spent
more than half their days drinking, and thus, many had advanced physical illnesses. Those who- 89 -lived with their families often had public health nurses working with them at the behest of theirfamilies, but they required specialized counseling for alcohol-related problems. Typically, we saw
individuals who had lost the homes they had been living in for a very long time and were forced tolive in the cramped quarters of temporary housing, in close proximity to their neighbors. Now thatthey had no choice but to spend long periods of time indoors, the drinking problems they had
somehow managed to avoid till now became inescapable, and they were finally referred to theprofessional help they needed.
While both specialists and survey results note that the disaster will cause community alcohol
problems, most of the cases we dealt with had experienced drinking problems since before thedisaster. These problems subsequently became more severe, and after significant forced lifestylechanges, rose to the surface. Further, in temporary housing, violence and noise caused by
drunkenness would end up disturbing other residents, who would then complain to temporary
supporters or neighborhood council chairmen. However, these individuals were rarely equipped todeal with these issues, and the culprits were often simply labeled “troublesome” and shunned bytheir neighbors. In these situations, counseling was initiated by temporary supporters or byneighborhood council chairmen, and public health nurses often worked to arrange conferences.
4. Future Issues and Outlook
Alcohol-related problems are often treated by local aid workers as problems they would “like toavoid,” and are generally not the target of proactive interventions during normal times. In addition,
there are certain communities in which drinking habits are deeply ingrained into the local culture,
leading to resistance to treating binge or daytime drinking as a problem. In the disaster-affected
regions of East Japan, even when it is the cause of high blood pressure, liver disease, or depression,
local officials are not used to treating the issue as “alcoholism.” For this reason, this project wasbegun: to deal with the cases of alcohol-related problems that had arisen after individuals were forced
into large-scale lifestyle changes in the wake of the disaster. Indeed, because many of the cases weworked with involved individuals whose drinking problems had developed before the disaster, wecan assume that local communities had trouble dealing with them. Initially, while we had someexperience providing support in temporary housing after the Great Hanshin-Awaji Earthquake, this
support endeavor began with anxiety, as we were largely unsure of how to engage with these sorts oflarge-scale disaster-related alcohol problems. However, in these disaster-affected regions, we werehelped by the passion public health nurses and most aid workers demonstrated for reconstruction, aswell as their determination to rebuild local interpersonal relationships; thus, even though much of ourwork was touch and go, we believe we were able to provide support that actually achieved something.
As the fact that the reconstruction of disaster-affected regions will take far longer than anyone
expected continues to become clearer, it is unavoidable that people’s stays in temporary housing will
also become long-term. We also predict that the stress borne by disaster-affected residents willcontinue to grow more severe. While alcohol problems and other addiction-related issues might notoccur in large numbers, they are the kind of problems that someone, somewhere is always facing.
Thus, it falls on us to ensure that these problems are not overlooked, and that the necessary long-term,
continuous initiatives are planned and executed. To do this, we believe that the task that lies ahead of
us is the achievement of support for local aid workers, support that will give rise to collaboration andsocial resources that lead to recovery.

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