Moving into Finland's Drinking Culture by diu11902

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									                   Moving into Finland’s Drinking Culture


Tracey Powers -Erkkilä

1. Introduction

The drinking habits here in Finland are something that I, as a foreigner, have always
regarded as a defining feature of Finnish culture. The Finnish drinking culture is ever
present in the society, whether seen on the streets or experienced in social settings. It
permeates work, school and home life, regardless whether one uses alcohol or not. It is
something that has placed me at times as a “foreigne r” situated outside of the Finnish
social scene, either positioning me as a bit of an oddity, unsocial or too up-tight. This
has led to a lot of self-reflection concerning my ideas about alcoholism, what
constitutes socially appropriate drinking habits and how my different opinions position
me as a resident of Finland. Moving to Finland from the United States in the mid-
1990s, though an exciting experience at times, sometimes felt strained due to the many
aspects of cultural differences that I was not aware would exist. One of these aspects
was the role drinking plays in the Finnish social fabric and the problems that can
emerge when trying to adjust to these new standards, expectations and ways of dealing
with others. Drinking plays a unique role in the social life of Finland that can be
difficult for newcomers to navigate, especially when trying to connect with the flow of
Finnish life.


Cultural differences strongly factor into the identification of problem consumption
rates and an individual’s inclination to seek help for excessive alcohol use. Different
levels of tolerance, acceptance and social drinking standards do exist between cultures,
religious traditions and historical periods, but are these differences great enough to
have a serious impact on newcomers’ lives here? Furthermore, does the Finnish
drinking culture have a negative impact on the acculturation process and lives of
immigrants? I’ve chosen for this paper an immigrant population defined as western
European or US-based. It wasn’t my intention to restrict the study to an all “white”
population (which is not constructed as a comprehensive definition of European or
American groups resident in Finland), but in the end those who responded turned out to
be white. I decided to incorporate that component into my study with the idea that


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there is a difference immigrating to Finland as a white western than as a person of
color. To be white in Finland enables the individual not to have to instantly disclose
their ethnic or cultural differences, possibly alleviating some of the strain of
integrating. Throughout this paper I define my respondents as immigrants, though they
are perhaps not those commonly associate with that term. Viewed as a more privileged
or welcome group here in Finland, these groups of “white” people are often mistakenly
labeled or written off by Finnish society as having no adjustment needs or difficulties.
My experience here is that the re are few social service structures or services for these
groups to access easily and little is know about how these immigrant groups are coping
in Finland.


In this article, I explore how the integration process of “low-risk” groups is affected by
the Finnish drinking culture. What factors of the Finnish drinking culture should be
taken into consideration in examining of the everyday coping abilities of these groups
in Finland? What coping strategies have people adopted to deal with this drinking
culture? Has this adaptation changed them or had an impact on their perceived quality
of life? In this study, I have examined these questions by asking what white US and
Western European residents here in the Helsinki metropolitan area think about the
Finnish drinking culture and how it has had an impact on their social relationships
within the home, work and or community environment. Despite the variety of
responses, my findings indicate that immigrants from western European and North
American countries do find the Finnish drinking culture foreign to their own cultural
background. This paper thus offers a point of departure to explore how predominantly
low risk ethnic groups (due to race, socio-economic and employment status, etc.)
assess their own views of the role that Finnish drinking culture has played in their lives
as immigrants. As a social worker with clinical work experience in the US, I draw on
the North American research tradition which is rich in information about cultural
diversity, integration and its impact on the risk behaviors of newcomers.


Connections between ethnic background and addiction are more widely discussed in
US addiction literature than here in Scandinavia, especially in relation to addiction’s
more modern definition as a “disease.” Research conducted in the US suggests that
attitudes toward drinking and socially sanctioned drinking practices stem from an
individual’s cultural makeup and are important aspects in the development of problem


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consumption as well as effective treatment interventions (Hudak, 2004). This is based
on the notion that cultures have different ways of defining social behavior,
acknowledging problematic behaviors and reacting to them or seeking help. Currently,
the US has 53 categories describing groups of European ethnicity, with the largest
groups being German, English and Irish. The impact of culture can be seen when
examining the descendants of these early European immigrant groups, since “ethnic
drinking subcultures” can still be found (Hudak, 2004). Members of these groups
predominantly define themselves as “American” and have largely surpassed the
discrimination struggles of their early days in the US. These Americans are no longer
defined by their ethnicity, marry outside of their ethnic group and have fully
acculturated into today’s mainstream (white) America (Hudak, 2004). Yet, clinical
studies have shown that even for these settled groups, clinicians are able to detect
cultural nuances linked to client s’ ethnic heritage which heavily influences their
treatment process. Examples of these nuances include issues about emotional
accessibility, individual freedom versus group affiliation, the network of family
relations and methods of dialogue. Another example of how culture can be seen is in
attitudes of stoicism or the inability to show feelings or pain. This outlook was found
to be a learned survival tool for many people from these immigrant groups and was
connected strongly with the ir relationship to alcohol, which was often used as an
inhibitor to express painful feelings (Hudak, 2004).


It is important to note that these immigrant groups were often able hide their ethnic
background in the United States with their white skin, which provided certain
advantages that were not available to people of color. The interconnection between
acculturation and risk behaviors is complex. Some researchers have argued that
increased patterns of at risk behavior can be seen in ethnically identified groups that
are further advanced in the integration process and have become more assimilated into
majority group norms (language, religion, intermarriage, etc.) (Cherpitel & Borges,
2002). In summary, there appears to be a relationship between risk behaviors and
cultural background. Despite the fact that ethnic groups may appear to be acculturated
into their new host country, research has shown that socio-cultural patterns of dealing
with emotions, for example, can have an influence on alcohol use and risk behavior
over the several generations. Hence groups that appear to be acculturated, or “low
risk,” may indeed face real challenges with alcohol use due to cultural background.


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2. The importance of socializing to the integration process


Knowing how communities socialize is an important key to understanding how to fit
into a new cultural and social environment. Each culture has its own social codes of
conduct that emerge in many forms, such as verbal cues, body language and greetings.
How social norms or standards are defined and how communities deal with those who
go against these rules is important yet often difficult information to obtain. An integral
part of the integration process is entering the new community as a social participant.
As an immigrant socializes into the new socio-cultural environment, he or she starts to
obtain the necessary information to operate symbiotically with the new community or
host group. In this article, I explore the impact a different drinking culture can have on
the socialization process of an immigrant coming from a somewhat similar cultural
background. My point of departure is that the ability to socialize is a very significant
part of the integration process.


3. Project idea


The first two years I lived in Finland I worked for a national addiction treatment
foundation as a project coordinator. During that time, I became familiar with Finnish
addiction policies and treatment services and the groups that were utilizing these
services. It seemed to me that certain gaps existed with various immigrant groups,
especially here in the Helsinki metropolitan area regarding access to services and
perceived needs. When I started at the foundation, all information provided to the
public was available only in Finnish, with some in Swedish.


The initial project idea for this paper was to interview immigrants who have had
experience with Finnish addiction services in the role of a client, either in the past or
currently. I therefore visited a variety of organizations and surprisingly couldn’t find
any immigrant clients, or at least none that would talk to me. It is possible that my
English language was a barrier for some potential informants, but the main response I
received from practitioners was that addiction was too sensitive a subject to address
given people’s status here as immigrant. I then decided to focus my attention on a more
English speaking population in the Helsinki metropolitan area to rule out language
barriers, I therefore attended a few English AA meetings which surprisingly were


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dominated by Finns. My presence attracted no interest in participating in the study,
though when I introduced my project at the meetings many agreed that there was a
great need for stronger services targeted at a more multicultural clientele.


At this point, heavily frustrated, I turned inward and thought about how I felt about the
drinking that existed here in Finland. Was it to me a bother? I decided to ask the
question to my American friends living in the Helsinki metropolitan area. The
question generated a great deal of discussion so I opened the topic up to a more
general, less familiar audience via a survey that involved questions concerning
people’s impressions of the Finnish drinking culture, its impact on them and their
families and their knowledge of the addiction services here in Helsinki. This was
disseminated beyond my circle of friends utilizing the snowball technique through
various internet channels targeting Helsinki metropolitan area residents.


A key interest behind the questioning was to see if different socializing habits have had
an impact on the quality of life as an immigrant, and if so, whether there were
particular areas that were more sensitive than others. Targeting English speaking
western European and American populations provides a glimpse of various ethnic
groups that are often overlooked within the welfare system since they tend to come
here voluntarily, have employment and financial means, and for the most part are
welcomed as a new addition by Finnish society. It was by chance that all respondents
were “white,” though it does further define the characteristics of the group. I thought
that if this group feels that problems exist, the situation must be even more difficult for
immigrants coming from more culturally and racially diverse backgrounds as well as
those living in more vulnerable circumstances. Another reason for choosing this group
is that most people would assume that people from this group, which are largely from a
western European-North American cultural background, would not face such a great
cultural shock in Finland as immigrants coming, for example, from Middle Eastern,
Asian or African cultures.


I found during various informal discussions and through the surveys that people from
cultures supposedly similar to Finnish culture often considered socializing here to be
challenging. Inevitably, these challenges have an impact on one’s adjustment to their
new culture. Furthermore, the special role of drinking within Finnish culture


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continually came up in discussions. I therefore decided to focus this project on
exploring the thoughts and experiences of this group, particularly with regard to the
Finnish drinking culture, to see how this phenomenon is defined and understood in
everyday life as an immigrant in Finland. Since I am a member of this particular
immigrant group, I provide an insider’s view of this topic. The questions I asked
respondents stemmed from questions I’ve asked myself during my time here. On a
personal level, it was reassuring and interesting to hear that my concerns were similar
to the concerns of others with whom I’m culturally connected.


4. The Finnish drinking culture


A complex cluster of historical events shaped the development of the Finnish drinking
culture. While there is not sufficient space to go into this interesting history, I will
highlight some important factors that render the Finnish drinking culture distinct from
other cultures. Finnish drinking habits can be viewed as different not only from the rest
of Europe but also from those of its Nordic neighbors. The Finnish drinking culture has
been forged by a multitude of factors including the role of the temperance movement at
the turn of the century, societal acceptance of restrictive alcohol control systems,
strong ties to a rural lifestyle and a lack of consumption patterns as a normal part of
everyday life with accompanying structured social forms (Sulkunen, et al., 2000).
Drinking was saved more for special, out of the ordinary events, so excess was more
tolerated and possibly more public. During the tolerance movement many drinking
establishment were closed causing people to partake more “in the streets,” hence
drinking became more of a public event. Drink preference was for spirits (often
homemade) as opposed to wine and beer. Despite the fact that overall consumption
rates have been historically quite low compared to other countries, Finland’s rates of
public intoxication as well as arrests for drunkenness have been extraordinarily high
(Sulkunen, et al., 2000). Although this is a much larger topic than to be explored within
this paper, it is worth mentioning that Finnish drinking behavior might be seen as an
oddity among western cultures because its characteristics are deeply rooted in its
unique historical context, combining aspects of culturally specific religious as well as
socio-economic and political processes. The historical and cultural complexity that has
shaped Finnish drinking culture should be taken into consideration when discussing



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ways of socializing in Finnish society and their impact on immigrants’ integration into
Finnish society.


4.1 The Finnish addiction treatment system today


The main legislative foundation of the Finnish welfare service system for intoxicant
abusers is the Act on Welfare for Substance Abusers which came into force in 1987.
The aim of the Act is to prevent and reduce the problematic use of intoxicants and
accompanying social and health problems by promoting coping skills and increasing
the safety of problem users as well as their family members. It is the responsibility of
the social and health care authorities in each municipality to ensure that sufficient
services are provided. The core of these special services consists of A-clinics, youth
centers, day centers and sheltered housing options (outpatient care), detoxification
units and rehabilitation centers (inpatient) maintained by several co-operating
municipalities, organizations or private facilities. The AA methodology dominates the
field. Workers are qualified as social workers, nurses, doctors and social advisors.
Other theoretical tools include cognitive-behavioral, motivational, systemic, solution-
focused and neuro- linguistic programming.


Finnish law does not differentiate between intoxicants so services are equally available
to alcoholics, drug users and mixed users. All people with intoxicant problems have
equal rights to support and treatment under the law. Municipalities aim at low-
threshold welfare services for intoxicant users according to community needs. Services
are provided on a voluntarily basis and all interactions are confidential. Outpatient care
services are free but the financial cost of inpatient care is agreed on in cooperation with
the social and health care authorities of the municipality. Treatment is viewed
holistically and includes all family members and extended relations. Involuntary
treatment is possible based on potential hazard or violence, as outlined in the Act on
Welfare for Substance Abusers, and requires the intervention of local health care and
social service authorities. For special reasons, the violence criteria can be applied also
to adolescents aged 15 - 17, but apart from this exception the law only applies to
people over 18 years of age. However, involuntary treatment is seldom used in
Finland.



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5. Research approach


5.1 Research approach


As I was unsuccessful in contacting immigrants who have participated in the Finnish
addiction services, I thought about my own views on the Finnish drinking culture and
informal discussions I have had with others. To make sense of these discussions I
constructed a questionnaire to thematically organize thoughts about drinking here in
Finland. My target group came from western European and North American origins
and relocated to Finland for various reasons stemming from work, education to
personal relationships. I developed the questions from my own experiences,
observations while working for a large national addiction NGO here in Helsinki, and
ideas about effective ways to integrate. My aim is to explore what impact a different
drinking culture has on the acculturation process of an immigrant? What aspects of the
Finnish drinking culture are regarded as problematic by western European and North
American immigrants, which are accepted and what changes (if any) has respondents
had to undergo to reach this acceptance?


I took a qualitative approach to the data generated for this study. I have therefore read
the responses to the survey as an “involved observer” who has both subjective
experience of Finnish drinking culture as an immigrant as well as insider knowledge of
the challenges of socializing as a member of the English speaking community in
Helsinki (Reissman 1994). I used both multiple choice and open-ended questions in my
survey. My analysis is based on the respondent’s own reflections on the personal
impact of the Finnish drinking culture.


The survey is divided into four parts. First, questions are directed at how the
respondents view Finnish drinking culture as well as how they see it as different from
their own native country. Second, the respondents are asked about their own personal
consumption of alcohol in relation to how those native to Finland drink socially. Third,
I ask about how they perceive the impact of the Finnish drinking culture to be on their
children. Finally, I explore their knowledge of Finnish addiction services.




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5.2 Participants


A survey consisting of 30 questions was initially distributed to generate discussion
during informal focus groups of North American women currently living in Helsinki.
To further expand my respondent pool, the survey along with an introduction note, was
distributed via email to various companies and organizations in Helsinki. Here I
utilized the snowball method, whereby the survey was forwarded to potentially
interested participants (See Appendix 1). At that time, I kept my respondent criteria
vague in order to generate the greatest number of responses. My criteria for
participation were that the respondent currently lives in Finland and holds non-Finnish
nationality. People were asked to identify their nationality, race, age, length of time in
Finland and reason(s) for immigrating. Responses were received from 42 individuals.
Respondents came from Canada, the United States, various EU countries and
Australia. The gender distribution was 40% male and 60% female. The age range was
from 20 - 46+ years of age, with the majority in their mid- to late 30s. The length of
time residing in Finland ranged from a few months to over 10 years. 44% of the group
had lived in Finland for less than 5 years and only 15% resided here for more than 10
years.


6. Findings


From the onset it is important to note that this is a relatively small sample that
precludes any grand statements or generalizations regarding the Finnish drinking
culture, its impact on non-Finnish residents and the community’s efforts to provide
access to treatment services. This study does, however, target a small community of
English-speaking immigrants, both newcomers and established residents, which have
come to this country voluntarily, often with the promise of employment as a spouse or
student. Though they are a part of those grouped as immigrants in Finnish society,
little is often known about the everyday lives of these residents, their alcohol
consumption habits or the daily struggles that exist within these communities.
Perceived to be less at risk while integrating into Finnish society, various social and
public health networks are not open to targeting these particular immigrant groups.




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6.1 Perceptions and experiences of drinking in Finland


According to the questionnaire responses, overall 88% of the respondents (n = 42) felt
there were differences between the Finnish drinking culture compared to their home
country, with 76% claiming that the Finnish drinking culture sometimes or all the time
made them feel uncomfortable. 86% of respondents felt the Finnish social scene relies
heavily on drinking, with 52% abstaining from going out due to being bothered by the
way people might be drinking. 57% felt they spent more time here discussing the topic
of drinking than if they lived in their home country. 31% felt drinking was more a part
of their social scene compared to life in their home country. Overall, 76% stated that
they have experienced mental strain stemming from the drinking habits within their
new Finnish environment. Drinking in association with the workplace and among
strangers seemed to cause the greatest mental strain to the respondents. Respondents
thus clearly felt that the Finnish drinking culture is an important element of socializing
in Finland and saw it as different from the drinking cultures of their native countries.


       I consider alcohol as a drink of enjoyment and I still deal like that. As
       German it is normal to sometimes in a week drink ONE beer. This
       however seems to be very difficult for many people here (Finland),
       especially the young ones…I think more about this since I am here and I
       am pretty sure that my habits and consumption rate has changed into
       the one or other direction. I do feel more uncomfortable being or
       getting drunk here since the amount of drunken people in the streets in
       the weekend is very high…In this way I maybe even consume a little less
       alcohol even though I was not often drunk when living in Germany.
       (German male in Finland 3 years)

Respondents viewed the impact of the Finnish drinking culture on their personal
consumption in diverse ways:


   •   31% said that they have changed their thoughts regarding their drinking habits
       during their stay in Finland.
   •   50% felt they think more about their own drinking behavior since coming to
       Finland.
   •   55% have begun to think more about the drinking behaviors of family
       members/friends since living in Finland.




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    •   71%, however, reported no complications (regarding their drinking behavior)
        and easily readjusted to the drinking habits of their home country when they
        returned for visits.
    •   33% have questioned their personal drinking habits more since moving to
        Finland (versus 17% less, 50% no difference).


When asked whether they questioned their drinking habits more in Finland than in their
own country, there were two general reasons for this response. Some respondents said
that their increased self-questioning was due to a greater pressure to drink more heavily
in various social settings. Limits of what constituted “appropriate consumption” had
changed from their traditional norms. This especially stood out in work settings where
behavior is perhaps more socially monitored and there were different expectations as to
what constituted correct behavior. They felt that this pressure was often non- verbal and
they had the sense that they would be perceived as prudish or uptight if didn’t join in
heavy drinking. Even if their levels of alcohol consumption didn’t change, many
respondents felt that were getting signals that they did not fit into the social situation if
they didn’t drink more, which often led them to disengage from the social scene.
Another comment that emerged when asked about reflections on one’s own drinking
patterns since moving to Finland, some respondents discussed periods of emotional
strain that came out of questioning their own drinking behavior when trying to act
within the Finnish norm. Some respondents began to question themselves and their
newly learned socializing behaviors but within the mindset of what would be
considered appropriate behavior if they were in their home country. This potentially
then led to greater mental strain and sometimes eventual total abstinence.


        Was I becoming an alcoholic? It started to really bother me that a
        typical night out would lead to consuming what seemed to me to be a
        large amount of alcohol, but then again I was the only one that seemed
        bothered by it. My (Finnish) boyfriend thought I was being silly…
        (American female, in Finland 7 years)

        Since moving here I’m more glad I don’t drink. Seeing all the drunks on
        the streets has definitely caused me to think more about my drinking
        habits and I worry more about others (regarding drinking) since
        coming here. (American female in Finland 4.5 years)




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Respondents that found it difficult to cope with the Finnish drinking culture listed
work, spousal relationship, relationships with children, meeting new people, and
feeling adjusted to their new home as the areas that had been most greatest affected by
the drinking culture here in Finland.


Some respondents felt completely separate from the Finnish drinking culture:


       I guess I have always seen excessive drinking (falling over in the street
       type of drunk, or unable to cope with family or work drunk) as a purely
       Finnish population problem and have put myself outside the box. I don’t
       see it as concerning myself, husband or children -- but maybe I’m being
       naïve… (American female, in Finland 5 years)

Due to the yo ung age of most respondents, concerns about raising children within the
Finnish drinking culture were relatively minimal. Many of the respondents either
didn’t have children or had such young children that they hadn’t thought about
potential conflicts. Nonetheless, 31% of respondents claimed to be concerned about
explaining the high level of social drinking here in Finland to their children. 14% said
that they had already experienced some frustration in explaining the public reality of
Finnish drinking behavior to their children.


       I never really thought about it until my 5 year old interrupted a
       conversation I was having with an out-of-town guest regarding public
       drinking here in Helsinki to point out the drunk asleep in the bushes. It
       was something we never talked about before but she seemed to get why
       the man was asleep on the streets. (American female, in Finland 4
       years)

As respondents found the Finnish drinking culture to be distinct, and often
problematic, from the perspective of their native culture as well as their own
socializing behaviors here, I asked about respondents’ knowledge of addiction services
in Finland. Respondents had a very limited understanding of the various addiction
services available in the Helsinki metropolitan area. 86% said that they did not know of
any services for addiction treatment in the metropolitan area. Those that knew of
addiction services mentioned AA (Alcoholics Anonymous), the church, visiting a




208
physician, the A-Clinic Foundation1 , the Crisis Prevention Center (in conjunction with
the Finnish Mental Health Association) and the student health service. No reference
was made to occupational health services.


    •   79% felt that metropolitan addiction services were not effectively reaching out
        to the non-Finnish community.
    •   79% said that they could not describe the process of how to gain access to
        addiction treatment services, though they speculated that the telephone book
        and the local health center could be potential starting points for help.
    •   16% reported that they had immigrant friends with a drinking problem here in
        Finland.


6.2 Variations between nationalities


All of the respondents were from western cultures with almost half coming from
various EU countries (45%, n=19), followed by Americans (38%, n=16) then
Canadians (14%, n=6), and one Australian. Nationality appeared to have some
influence on responses, though all groups reported some level of discomfort stemming
from the Finnish drinking culture. Within US (37%) and EU (36%) groups, both
reported similar accounts of a change in attitudes towards personal consumption stating
their habits had changed and both respondent groups (50% of the Americans versus
63% of EU citizens) claimed to think more about their consumption patterns. Both EU
and US groups evenly described the Finnish drinking culture to be “ever present”
(roughly 50%) though Americans were more likely to link it to “overwhelming” versus
Europeans claim that it was “adaptable.” All of the Canadians and the Australian
respondent for the drinking culture here to be “no big deal.” The most problematic area
listed by Americans was a strain on relations with family members (mainly spouse).
Americans also had greater negative side effects felt at work and adjusting to overall
life in Finland. Difficulty meeting new people was strongly underlined by both groups.


Changes in one’s actual consumption or personal perceptions of consumption seemed
less stressful or problematic for EU citizens and other non-American respondents.

1
  The non-governmental organization, the A-Clinic Foundation, is the largest national substance abuse
treatment provider.


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Americans reported more social conflicts or discomfort resulting from contact with the
Finnish drinking culture than the other groups. Americans (81% versus 42% of EU
citizens) were far more likely to avoid going out in the evening due to the amount of
public drinking. They were also more likely to report adjustment difficulties in
connection to the Finnish drinking culture. 16% of those from the EU versus 56% of
those from the US reported that adjusting to the Finnish drinking culture has affected
them negatively in various aspects of their life (work, home, with friends, etc.). This
data indicates that the Finnish drinking culture is experienced by people with various
EU and North American nationalities differently.


6.3 The impact of gender


The gender of the respondent played a decisive role in how the impact of drinking was
viewed. Female respondents (n= 25) tended to view the Finnish drinking culture more
negatively than men (n= 17). Gender has long been considered an important factor in
alcohol cultures. The cultural acceptance of alcohol use can be gendered, influencing
how drinking norms are understood, observed and disclosed. In many western cultures,
the profile of the typical alcoholic is a white male. Females are predominantly at risk
for substance abuse problems primarily in conjunction with their relationships to men
(Kresten, 2000). Alcohol abuse therefore tends to entail different risks for men and
women.


Though both genders felt the Finnish social scene revolved heavily around drinking,
95% of women found heavy drinking to be pervasive in comparison to 62% of men.
Women were also more likely not to go out due to the potential public drinking.
Females reported more that they had changed their opinion about their own drinking
habits and acted on this by moderating their consumption. Women also said that
drinking had become more of an issue for them personally since coming to live in
Finland. 74% of women (versus 38% males) thought more about the drinking habits of
family members or friends since moving to Finland.


Two questions were asked to try to pinpoint possible areas of concern with regard to
the drinking scene in Finland. One question was about the personal mental strain that
was experienced with others in connection within the Finnish drinking culture. This


210
section was answered far more by women than men. Mental strain that emerged from
interacting with strangers was the most common response felt by 56% of the women.
Coworkers and friends were the next highest categories identified by 28% of the group.
The drinking culture in connection with marriage or the home was experienced as
stressful by 24%. Men reported emotional strain in the context of drinking mostly
from interacting with co-workers (29%) followed by strangers (23%).


However, the impact of these negative experiences didn’t seem to affect the men’s
adjustment to life in Finland. A second question concerning areas of adjustment that
were negatively affected by the Finnish drinking culture was again answered more
frequently by women than men. Only one man said he has had troub le adjusting, the
remaining men reported no problems. For the men in the survey it appears the Finnish
drinking culture is something different, and though at times bothersome, did not cause
them problems living in Finland. Women appeared to feel quite different ly since
mental strain from others due to the drinking culture did seem to have an impact on
their adjustment process. Though 44% reported “no effect,” the remainder cited
adjustment concerns when dealing with one’s spouse and meeting new people. The
drinking culture in Finland was mentioned as straining capacities to meet new people,
adjusting to the workplace and neighborhood and causing marital stress. 16% of the
women discussed problems within their marriage in connection with Finnish drinking
styles.


Concern about the Finnish drinking culture in connection with child rearing was more
frequently expressed by the women in the group. 48% of the women (versus 11% of
the men) reported concerns about explaining the drinking culture here to their children,
with 16% already experiencing frustration in dealing with images that their children
see on the streets. Both sexes demonstrated an equal lack of awareness of addiction
services and potential methods of gaining access to these services, though the threshold
into these services seemed higher from the female perspective because women reported
far more barriers to immigrants’ utilizing treatment facilities.


It is worth noting that the responses could be shaped by the reasons for being in this
country. Many of the women interviewed, though sometimes employed, were married
to Finnish men and therefore resided here because of their marriage. The male


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respondents were predominantly here for work purposes, not family reasons. Many of
them did not have children. I spoke to two of the female respondents after they
completed the survey and they described marital arguments that had not occurred
before the couple moved back to Finland. These arguments were about the (Finnish)
husband’s drinking behavior. The women also said that it was difficult to confront
these issues within the marriage because societal views on social drinking condone
what they described as binge or excessive drinking, especially at work related
functions. The wives said that they felt frustrated and somewhat powerless to approach
their husbands about their alcohol consumption patterns.


       I hate the drinking culture here! My (Finnish) husband gets very drunk
       at least once a week. I have since stopped drinking as it has had such a
       negative effect on my life. My husband has even put our child’s life in
       danger being drunk while caring for him. But then again we’ve been to
       these countryside parties and it’s no different with other (Finnish)
       families, so how can I confront him? This I’m told is normal
       behavior…you get to a point when it’s not worth it to fight anymore and
       just accept that’s the way it is. (German female, in Finland 9 years)

6.4 The impact of length of time living in Finland


The length of time respondents had lived in Finland had little impact on their answers
to the survey, though a few participants remarked that their responses would have been
different had they answered this survey during the early stages of their lives in Finland.
What was described to be shocking regarding Finnish consumption norms and high
volume public intoxication in the first few years of living here became normalized over
time. These respondents overall were quite satisfied with their life in Finland and
claimed to be active participants in the community, while at the same time remained
strongly linked to their native culture. They were settled and had no plans or desire to
return to their home country. The respondents appeared to have effectively integrated
into Finnish society for the most part.




212
7. Discussion


7.1 Towards acculturating in Finnish society


In examining these particular immigrant groups that are generally welcomed here in
Finland, it is interesting to see how the national drinking culture plays a role in the
acculturation process. One striking finding in this study is that respondents reported
that they avoided social settings due to the prevalent drinking culture.


Respondents that appeared to be highly integrated in Finland said that they had to learn
how to mediate the Finnish social scene and achieve some type of acceptance in the
midst of different patterns of behavior and rules of conduct. This can also be described
as an unlearning process of established childhood cultural patterns and may pose
psychological stress if it is not handled appropriately. This phenomenon could be seen
in some of the respondents when discussing their adjustment process to the Finnish
drinking culture. Some respondents accepted the social norms in Finland and also
expressed less stress living here, saying that they had no real desire to return home.
Over time they had begun to culturally adapt to the Finnish drinking culture by
accepting that “this is the way it is” but without having bad feelings about it.
Respondents claimed to have learned how to mediate the Finnish social scene, what to
avoid and what to expect from various settings (holidays, office parties, etc.) and how
to interpret social signals. Respondents who lived in Finland for similar lengths of
time (over 5 years) who were still having a hard time dealing with the Finnish drinking
culture had more areas within their lives that they felt were impacted negatively by it,
viewed living in Finland less favorably and expressed the desire to return to their home
country. Many of these respondents had chosen to stay within familiar “territory” in
Finland and had few Finnish friends. They also were more than likely to not speak
Finnish and actively chose to communicate only in English.


Many studies (Verkutyten, 2003; Phinney, et.al, 2001; Cherpitel & Borges, 2002) have
indicated that the healthiest and most successful coping strategy for adapting to a new
culture is finding a personal accommodation between the native and new culture.
Strong ties with one’s ethnic identity, supportive and active ethnic communities as well
as the acceptance of cultural differences by host countries reinforce a sense of self-


                                                                                          213
esteem and adjustment within their new environment. In this way, an individual is able
to maintain aspects of their own cultural background and uniqueness, while interacting
with their new community (or the dominant group) as an equal participant. For this
process to be successful, however, an inclusive approach to cultural difference from
the dominant society is needed. This can be very difficult, particularly in countries with
little experience of immigration such as Finland (Phinney et al., 2001; Pitkanen &
Kouki, 2002). Within the target group of this study, I would speculate that this balance
is generally easier to achieve since cultures coming from a more western background
tend to be more appreciated and valued within Finnish society, especially in the job
market.


The process of integrating into a new community cannot be seen as a flat, step-by-step
linear movement, but is usually more like a spiral that embodies various stages of
personal growth that are interconnected with the social attitudes and experiences within
the new cultural environment (Berry, 1995; Oguntuyi, 1998). Yet, if acculturation is
viewed along a continuum, then one end can represent separatism, in which
immigrants strongly hold onto their native cultural values and lifestyles and avoid all
contact with their new environment; with the opposite pole being assimilation, which
reflects a complete break from the previous cultural identity, with the immigrant
assuming all cultural aspects of their new community (Phinney, et al 2001). Most
commonly, immigrants frequently move along the continuum and do not remain in one
static position of integration. This could be seen in the responses of the participants,
particularly in regard to socializing capacities. On one extreme I found respondents
with very active social lives who were not bothered by the Finnish drinking scene and
claimed to have many Finnish friends. Others exclusively interacted with people like
themselves. They made little attempt to speak or learn Finnish and withdrew from
Finnish social settings. Many migrated between the two realms.


I do not claim that the drinking culture in Finland is the sole reason why people do not
feel at home here. The characteristics of immigrant groups, areas of settlement and
integration policies into the new host society have been identified as strong factors that
determine which acculturation strategy is chosen by the newcomer as well as their
level of success (Phinney, et al 2001). This study suggests that the drinking culture
here is only one aspect of the much larger issue living in the midst of cultural


214
difference, communication problems and the issues surrounding being an active
participant within one’s new community. The majority of respondents in this survey
were white, so they cannot be represented as a visibly distinct group from mainstream
Finnish society. These respondents have not had to face the everyday dangers of racist
behavior. A different group of racially, ethnically and culturally diverse people, visibly
different from mainstream Finnish society, and in more vulnerable socio-economic
circumstances, may have very different experiences and perceptions of the Finnish
drinking culture. Nonetheless, difficulties exist within these less distinctive groups
which produce personal strain and diminished capacity to achieve a level of comfort
within the Finnish drinking culture.


7.2 As immigrants here are we more at risk?


Studies in the United States have shown that immigrants sometimes more readily adapt
the more negative behaviors of the host country, which can be seen, for example, in the
higher substance use and abuse statistics (Krestan, 2000; Bhattacharya, 2002; Cherpitel
& Borges, 2002) among immigrant communities. It may be that dominant group values
have an unhinging effect and detach individuals from learned coping mechanisms and
supportive frameworks commonly used within one’s own cultural group. As this study
has shown, the dominant group values of Finland do seem to differ from the values of
the EU-North American respondents regarding acceptable alcohol consumption rates
and tolerance for drunken behavior. It is unclear, however, whether these differences
lead to more risky behavior by immigrants. It is possible that broader commonalities
between the cultures protect these specific immigrant groups. Currently, Finnish
addiction services do not keep records regarding the cultural or citizenship
backgrounds of its patients. Hence it is not evident how immigrants are doing when
looking at the public health care sector. There appeared to be knowledge of the
supportive frameworks prevalent in western European, North American and Finnish
addiction treatment services such as AA, but there seemed to be little knowledge or use
of these services in Finland. When I started this project, I had the impression that few
members of the target communities required support and help with substance use
issues, yet within this sample 16% of the respondents knew of an immigrant in Finland
currently coping with an alcohol problem.



                                                                                         215
Since there are no records of how many immigrants utilize addiction treatment
services, it is not really known if negative affects of the Finnish drinking culture
enhance addiction rates among immigrant populations here. Studies from other
countries and the experiences of their immigrants, however, tend to show that there is a
connection between immigrant status and risky behavior. One case study, for example,
examined substance use among emergency room patients in California. This research
suggested that immigrants more integrated into the mainstream US lifestyle tended to
mirror the risk behaviors of the dominant group (Cherpitel & Borges, 2002). Previous
urgent care studies focusing on alcohol use and injury reported that American whites
use alcohol in a more destructive way than blacks or Hispanics. One significant factor
in substance abuse appears to be the level of integration into the host community.
Cherpitel & Borges’s (2002) study of Hispanics found that those who participated
more in mainstream US life (spoke English, intermarried, lived in more non-Hispanic
communities) took on substance abuse patterns similar to that of whites, meaning they
were more likely to report use of a substance within recent months. The reverse held
true for Hispanics who scored low on their level of integration.


Differing values concerning drinking habits and socially appropriate behaviors in
relation to children surfaced somewhat in the survey, though it was not the main focus
of study. It would be interesting to study the development of drinking behaviors among
the second generation of immigrants in Finland. Studies of second and third generation
immigrant youth in the US again suggest that minority groups tend to mirror the
behavior patterns of the dominant group if they had largely integrated into American
society (Chi, Lubben & Kitano 1989). Bhattacharya (2002) studied the substance use
of US-born Asian Indian adolescents. The study found that substance use was
significantly less within this group, identifying protective factors such as active
communication about the harms of drugs within families, parents’ support of peer
networks and a strong emphasis on academic achievement (Bhattacharya, 2002).
Strong ties to family appear to lessen negative patterns stemming from the dominant
norm and show that different culture groups embrace different aspect of their host
country. How this plays out in Finland, especially as the country deals with the more
diverse forms of deviant youth behavior found in the new drug cultures that are
emerging, will be of interest in the coming years.



216
Immigrant youth often adapt faster than their parents to the values and practices of the
dominant culture (Verkuyten, 2003; Bhattacharya, 2002). It does seem important for
families to identify which values they share that differ from their children’s peer
networks (and dominant culture values) and to open a dialogue within the family to
address these differences.


7.3 The importance of being social


One essential aspect of integrating into a new culture is socializing with people from
the host country. Socializing requires social and cultural communication skills which
extend beyond simple fluency in the language and can take place in very diverse
situations, depending on social class, gender, race and profession. It involves behaviors
learned since birth, including social norms, rules of interpersonal conduct and so forth.
Through reading both verbal and non-verbal cues, immigrants come to understand how
members of the new cultural community socialize and communicate, thus learning how
to function in this new environment.


The use of alcohol tends to follow culturally defined norms. To illustrate the difference
between cultural norms of drinking behavior, I draw on my own cultural framework to
give an example of how cultures can consider acceptable drinking behavior and
addiction treatment very differently. A typical American scenario of socially accepted
drinking patterns sees a period of binge drinking in the early 20s, which people “grow
out of” before adapting into more moderate social drinking practices, as normal. Public
drunkenness is generally frowned upon and not tolerated. Though contemporary
language tends to define alcoholism as a disease, it has also been viewed as a weakness
and socially stigmatized (especially for women), and not discussed outside of family
circles. The American drinking culture is therefore distinct from the Finnish drinking
culture.


Many respondents in this survey found the drinking culture to be a barrier or an
exclusionary element to socializing in their new culture as well as integrating into
overall Finnish life. The prevailing drinking culture appeared to hinder participants’
ability to act as social beings, leading to feelings of isolation, awareness of being
“different” and/or the sense of inability to connect with Finns. These barriers could


                                                                                         217
also be described as the inability to communicate or enhancing an experience of being
silenced within the host cultural environment. Socializing in the context of work,
moreover, was indicated to be a particularly problematic area. Respondents also noted
emotional strains in bicultural relationships stemming from different socializing
standards or norms.


The respondents did not report having adapted to abusive drinking patterns here in
Finland. This was in part due to the structure of the questionnaire, which did not ask
participants how much they drink. Considering the sensitivity of the topic, though,
information of this nature would probably best be gathered from a more personal
interview format rather than electronically. Despite the limited nature of this survey,
over half of the respondents said that they questioned their drinking habits more now
than before they came to Finland. The information collected does not indicate,
however, whether this questioning is due to increasing excessive drinking patterns that
were becoming problematic or the prevalence of the Finnish drinking culture in social
life.


7.4 Notions of power and powerlessness


North American alcohol treatment theories are primarily derived from the traditional
Alcoholics Anonymo us (AA) and family systems theory (Krestan, 2000). In the AA
concept, an individual admits that he/she is powerless over his/her addiction in order to
achieve the strength to regain power over his/her life. This very western view breaks
the two core ideas of addiction into the categories of power and powerlessness. To
understand these concepts deeper within a more multicultural context it is important to
consider what it means to have power, to be powerless, whether these relationships
stem from equality or dominance (versus subordination) and how these prevailing
views of power add to addictive behaviors (Krestan, 2000).


The dominant discourse on power in the US is “power over” as opposed to “power to.”
(Krestan, 2000) These views emerged from ideologies that came with the first wave of
Western European immigrants to the US in the 19th century (Krestan, 2000, Hayton,
1994). The “power over” discourse promotes competition, individuality, youth, health,
ability, and material success (key elements of the notion of the American dream) and


218
can be seen in how power as filtered through individual, interpersonal, social-cultural
and spiritual dimensions. (Krestan, 2000)


The contemporary American immigrant pool is indoctrinated into this dominant
discourse through the educational system, labor market and prevailing cultural values
in the media, which can distort the cultural values of the immigrant group. The process
of “westernization” thus has the capacity to detach immigrants from non-western
countries from familiar coping mechanisms, relationships and life skills, leaving them
potentially vulnerable and at greater risk of self- harming behaviors. Many cultures tend
to be more spirituality-based or exist in greater harmony with their environment,
placing sharing as the basis of community rather than controlling. Many non-western
cultures have a collective basis, which values the group over the individual (Krestan,
2000). Emotional stress, the sense of loss and insecurity can occur when people from
minority cultural groups try to cope in the midst of unfamiliar cultural surroundings
that provide little personal support and may even exhibit discriminatory behaviors.


This cultural disruption can take place even among immigrants from different western
cultures. Though these immigrants may possibly have more in common with Finnish
culture than immigrants from other cultural frameworks, living in Finland is not like
living a typical western lifestyle. Finland has become more globalized since the 1980s
through the emergence of Nokia and other international businesses, membership in the
EU and growing immigration trends. Life in Finland as a North American (especially a
white person), though arguably more privileged than some other cultural groups, is still
life as a minority; and as a minority, one is bound to come across more situations that
exposes the newcomer to feelings of powerlessness. Does this role reversal or new
status for someone from a firmly established, dominant group (such as, a white,
western male) place some more at risk than others, especially when considering the
social acceptance and/or high tolerance towards heavy drinking? The male respondents
claimed that they had only minor conflicts between the Finnish drinking culture and
their own capabilities, as social participants in Finland. Yet they did report tensions,
especially within the workplace. It is not clear whether these tensions play out into
problematic drinking behavior, but the topic is certainly worth further study. Through
informal discussions with respondents during the research process, many said that their
tolerance or capacity to drink had increased since living in Finland. Though not viewed


                                                                                        219
as problematic, some acknowledged that they drank more than they would if living in
their home country. This was not regarded as a stressful idea but more as a matter of
fact. Some respondents remarked that they know of fellow immigrants who got
“caught up” in the Finnish drinking behavior, leading to out of control behavior
resulting in loss of family or job and forcing them to return back to their home country.


As we could see in the findings of this study, the role of gender has a significant
impact on the stress associated with the Finnish drinking culture. Women reported
being much more affected by the Finnish drinking culture than men. Life in Finland for
many of the women surveyed sounded more restrictive or guarded in comparison to
their life at home due to the public drinking within the social Finnish scene. The
women seemed to experience a greater sense of powerlessness over certain social
situations leading them to disengage with others and separate themselves from
interpersonal relationships with Finns.


From the small pool of respondents that I surveyed, most men claimed not to have any
trouble with the Finnish drinking culture (however, I should point out the AA meetings
I attended were definitely male dominated). The prevalent discourse on addiction
which views it in terms of having “power over” one’s own circumstances and actions
creates a dynamic where those with power inevitably fear losing it and those without it
experience shame for not having it. As addiction researcher Jo-Ann Krestan has noted:


       Addiction can seem like a near-perfect defense against reality for a
       while, a seemingly effective denial of limitation. Heroin can anesthetize
       the despair of powerlessness. Cocaine can create an illusion of
       invincibility. Alcohol can do both. Gambling’s illusion of limitlessness
       can be exciting. Addiction becomes a means of overcoming feelings of
       powerlessness and, temporarily at least, eliminating fear and shame.
       (Krestan, 2000)

Part of one’s overall integration process includes the gradual acquisition of views
about what power “is” in the new host countries’ context and who has it. Whether
personal empowerment is understood and experienced as cooperation or competition
may have an impact on how immigrants adjust to the new culture and see their own
role in it. The complex role of alcohol and other substances can be a significant factor
in the integration process of an immigrant. This can be seen particularly in Finland


220
where its unique drinking culture is a prevalent feature of social life. How these
differences are dealt with was touched on within the survey. When immigrants exist on
the margins teetering between their own cultural structures of support and social
control and new, less restrictive, as well as less supportive, forms of socializing, the
risk of substance abuse can be increased due to the lack of a normative compass to
assess acceptable drinking behaviors. Addictive behavior is thus a special risk for
newcomers, though as possibly acknowledged other cultural groups might be more
strongly affected. This could be an interesting question to pursue in addiction studies,
particularly when considering western values regarding power, what it means to be
powerful, who has power and what happens when they lose it.


7.5 Thoughts on the alcohol service structure in Finland


Within the addiction field, new ideas have emerged in recent years regarding treatment
methods that bring a client’s multicultural background into the rehabilitation process.
Ethnicity, nationality and cultural background are all significant factors that appear to
enhance the treatment process by viewing the client holistically. The alcohol service
structure can be defined as the range of policies and services, such as inpatient care as
well as outreach work, community housing and harm reduction initiatives. Various
studies have shown that public health service structures are more effective reaching
and then treating immigrant groups if the cultural characteristics of groups are taken
into consideration (Gonzalez, 2002, Lynn, 2002, Watters, 2002). This becomes even
more critical working the addiction field.


The effective development of programs, including multicultural self-awareness training
and promotion of more holistic, culturally focused treatment, has proven beneficial in
the US when working with minority groups. In my experience working within the
Finnish treatment system, these ideas did not appear to be emphasized when looking at
program planning and mandated skills for therapeutic staff. Taking into consideration a
client’s stage of integration or worldview (Gonzalez, 2002) along with possible
language barriers, religious beliefs and cultural barriers all tend to enhance the success
of the therapeutic treatment processes. Language extends beyond words and includes
body language and cultural communication styles, are often not addressed simply by
hiring bilingual practitioners. Though it is impossible to assume that practitioners


                                                                                           221
should know all things about all cultures, a general sensitivity to cultural issues is
necessary along with a willingness to learn. Greater multicultural competence could
enhance therapist-client rapport, which has proven to being a key aspect to successful
treatment (Saarnio, 2002). During a review of the treatment facilities within one of the
national Finnish treatment services (Powers-Erkkilä, 1999), evidence showed that the
ability to provide treatment for immigrant communities here in Finland was hindered
by language barriers and paucity of knowledge of immigrant community needs, yet no
multicultural competency trainings existed and limited information was available to
staff. This lack of interest in enhancing multicultural treatment capabilities was
acknowledged but management felt that since immigrants were infrequently utilizing
services there was no real need. Enhancing current services to be of a more culturally
sensitive fashion was not a current concern. 2


The limited results of this study suggest that there are some non-Finnish communities
within the Helsinki metropolitan area who know very little about how to gain access to
alcohol services if needed. Information about the alcohol service structure, as well as
methods of utilizing these structures, is limited and not available to this portion of the
public. This finding correlates with a 1999 study on the use of a national treatment
facility by immigrant populations and the abilities/comfort levels of these clinics to
work with non-Finnish client s (Powers-Erkkilä, 1999). This study found that there had
been no outreach or public awareness campaigns in languages other than Finnish and
Swedish (though currently efforts have been initiated to serve Russian speaking
immigrants). Information on substance abuse in languages other than Finnish and
Swedish was limited, and often non-existent. Furthermore, a majority of clinicians
reported that they did not feel secure in their therapeutic skills to work with the special
needs of immigrants groups. The prevailing attitude among practitioners in this study
seemed to be that since minority groups were not using the facilities, why should the
facilities accommodate or provide outreach to these groups? Exceptions were found in
the responses from two clinics tha t were dealing with an increasing Russian-speaking
clientele. Nonetheless, these clinics lacked resources, staff and received only limited
support from upper management to provide real efforts to do more than simply give lip

2
 It should be noted at that time of writing, the rates of drug use within various immigrant populations
were making various headlines in the Finnish press.



222
service to the idea of including immigrant groups in the service structure. The change
that occurred was viewed as necessary only to target specific immigrant groups (often
with stigmatizing effects), instead of increasing overall multicultural competence.


If immigrant populations continue to rise as projected, the lack of culturally competent
practice skills could prove problematic as existing services are pressured by more
challenging cases. The emotional strain and stress associated with establishing a
positive integration stage, along with the influence of the Finnish drinking culture on
socializing behaviors, could lead to increased risky, self- harming or addictive
behaviors among immigrants. Trying to maneuver through and adapt to Finland’s
drinking culture, as highlighted within this small population group, can be a difficult or
challenging process in social, work and family life. Moreover, responses clearly
highlighted the lack of familiarity with existing supportive services. The threshold to
gain access to these services appears to be high. How this has an impact on members of
this particular immigrant groups in crisis still remains unclear but it appears reasonable
to assume that it is difficult for them to find help.


8. Conclusions

The English speaking western community is a relatively new phenomenon in Finland.
This community tends to be well educated, professional, employed or married, and
relatively young. A couple of qualifications should be made regarding the conclusions
of this study. Firstly, it should be pointed out that few people with drinking problems
would probably be able to immigrate in the first place. Secondly, it should be
underlined that given its size, this study cannot claim to give a comprehensive picture
of the social experience of North American and western European immigrants here in
the Helsinki metropolitan area, but rather is intended as an opening to a potentially
much broader dialogue.

From the information given by respondents in this survey, the following four main
conclusions can be made:

    1. The Finnish drinking culture is viewed by EU-North American immigrants as
        different than that of their home countries and is frequently considered a stress
        to newcomers as well as a barrier to socializing with Finns.


                                                                                        223
   2. Many respondents thought more about their own drinking habits since coming
       to Finland and were concerned about family members and friends. Disengaging
       from the Finnish social scene appears to be a common tactic in dealing with the
       Finnish drinking culture.

   3. Female respondents were more concerned about alcohol use than men and
       reported more personal areas of discord specifically due to drinking since
       coming to Finland.

   4. Few respondents knew anything about addiction services available in the
       metropolitan area and service gateways were acknowledged to be lacking and
       with some cultural complications (e.g. language).

Further study of this topic would provide beneficial information that could alleviate
unnecessary integration strain. Identifying which aspects of the Finnish drinking
culture are problematic for immigrants might help establish red flag or warning tools
useful in various environments, workplaces, schools and public health service
structures. A distinct Finnish drinking culture does exist and is something new
residents to this society must address, or at the very least acknowledge. How this
drinking culture has an impact on minority groups with greater cultural differences to
mainstream Finnish culture, as well as how these groups deal with these differences
(both for themselves and their children), would be of interest on many levels
(community development, immigration policies, addiction treatment, public health
services and prevention). If the addiction services here are unable to be inclusive to its
new members that are considered not so different from the Finns and who have come
here voluntarily, how will it be able to effectively reach out and help those with more
complex differences who have not chosen to come to Finland ?




224
References

Berry, J. “Immigration, acculturation and adaptation.” Applied Psychology: An
International Review, 46 (1997): 5+.

Bhattacharya, G. "Drug abuse risks for acculturating immigrant adolescents: case study
of Asian Indians in the United States." Health and Social Work, 27.3 (2002): 175+.

Chi, I.; Lubben, J.E.; and Kitano, H.H.J. “Differences in drinking behavior among
three Asian-American groups.” Journal of Studies on Alcohol, 50 (1989): 15+.

Cherpitel, C., and G. Borges. "Substance use among emergency room patients: an
exploratory analysis by ethnicity and acculturation." American Journal of Drug and
Alcohol Abuse, 28.2 (2002): 287+.

Cortes, D. E.; Rogler, L. H., and Malgady, R.G. “Biculturality among Puerto Rican
adults in the United States.” American Journal of Community Psychology, 22.5 (1994):
707+.

EMCDDA. “Update and complete analysis of drug use, consequences and correlates
amongst minorities”. Centre for Ethnicity and Health, University of Central
Lancashire, UK (2000).

Gonzalez, M. “Mental health interventions with Hispanic immigrants: understanding
the influence of the client’s worldview, language, and religion.” Journal of Immigrant
and Refugee Services, 1, 1 (2002): 81+.

Haydon, R. “European American perspectives: some considerations.” In J.U. Gordon
(ed.) Managing Multiculturalism in Substance Abuse Services. Thousand Oaks, CA:
Sage (1994): 99+

Hudak, J. “Addiction and groups of European origin.” Bridges to Recovery: Addiction,
Family Therapy, and Multicultural Treatment. New York: The Free Press (2000):
284+.

Krestan, J. “Addiction, power, and powerlessness.” Bridges to Recovery: Addiction,
Family Therapy, and Multicultural Treatment. New York: The Free Press (2000): 15+.

Lynn, D. B. ”Forging creative partnerships: the alliance of public health and public
safety among immigrant populations.” Policy Studies Journal, 30,1 (2002): 132+.

Oguntuyi, O. Finnish language as an agent to integration for immigrant woman.
Joensuu: Suomen Kansantietouden Tutkijain Seura (1998)

Phinney, Jean S., et al. "Ethnic identity, immigration, and well-being: an interactional
perspective." Journal of Social Issues, 57.3 (2001): 493+.

Pitkanen, P., and S. Kouki. "Meeting foreign cultures: a survey of the attitudes of
Finnish authorities towards immigrants and immigration." Journal of Ethnic and
Migration Studies, 28.1 (2002): 103+.


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Reissman, C. (ed.) Qualitative studies in social work research. Sage: London.(1994)

Saarnio, P. “Factors associated with dropping out from outpatient treatment of alcohol-
other drug abuse.” Alcohol Treatment Quarterly, 20, 2 (2002): 17+.

Sulkunen, P.; Sutton, C.; Tigerstedt, C.; Warpenius, K. Broken spirits: power and
ideas in Nordic alcohol control. NAD Publication No. 39 (2000).

Verkuyten, M. "Positive and negative self-esteem among ethnic minority early
adolescents: social and cultural sources and threats." Journal of Youth and
Adolescence, 32.4 (2003): 267+.

Wagner, E. F. Lloyd, D.A.; and Gil, A.G. “Racial/ethnic and gender differences in the
Incidence and onset age of DSM-IV alcohol use disorder symptoms among
adolescents.” Journal of Studies on Alcohol, 63.5 (2002).

Watters, C. “Migration and mental health care in Europe: report of a preliminary
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226
Appendix 1

Questionnaire

Moving into the Finnish drinking culture

Thank you for your participation! The following information is part of an overall look
at the non-Finnish access/use and understanding of various components of health care
here in Finland. The final version will be put together into a book by the University of
Tampere, Department of Social Policy and Social Work.

Your age
-24
25-35
36-45
46+

Gender
female
male

Nationality:

Race:

Length of time living in Finland :

Reason(s) for immigrating to Finland:
work
education
relationship/family/partnership
political reasons
other

Can you feel differences between the drinking culture in Finland and your home
country?
Yes          no            never thought about it

Have these differences ever made you feel uncomfortable or uneasy?
All the time sometime      never

Have your thoughts changed regarding your drinking habits since moving to Finland?
Yes         no           never thought about it

Do you think more or less about your drinking habits since moving to Finland?
More         less         never thought about it

Do you think more or less about the drinking habits of a family member or your friends
since moving to Finland?
More         less          never thought about it


                                                                                     227
Is drinking more or less a part of your social setting here in Finland?
More         less           no different

Do you feel you have experienced more mental strain due to the drinking culture of
Finland? (check all that apply)

   •   in your relationships/marriage
   •   with friendships
   •   with your children
   •   with your friends back home
   •   with your family back home
   •   with strangers
   •   with co-workers/ work mates

When returning to your home country do you find your drinking habits no longer fit
into your culture’s norm?
Yes           no          never thought about it

While living here have you questioned your drinking habits more or less than if you
lived in your home country?
More          less        never thought about it

Do you find the drinking culture here (check all that apply)

   •   overwhelming
   •   easy to adapt into
   •   ever present
   •   not much to think about/no big deal

Do you think the social scene here relies heavily on drinking?
Yes          no            never thought about it

Have you ever thought twice about going out in the evening because you are bothered
by the way people might be drinking once you’re out?
Yes          no

Do you think you spend more time here discussing the drinking habits of your
environment than if you lived in your home country?
Yes           no           maybe
Has adjusting to the Finnish drinking culture affected you negatively (check all that
apply)

   •   at your place of work
   •   with your spouse
   •   with your children
   •   with your friends
   •   meeting new people
   •   to feel adjusted to your new home
   •   no affect


228
Are you at all concerned how you will explain the Finnish drinking culture to your
children?
Yes           no           never thought about it

Have you ever experienced frustration explaining images of the Finnish drinking
culture to your children?
Yes           no

Are you at all familiar with the addiction services here in Finland?
Yes           no

Could you name some local facilities that would be able to offer you help if needed?

If someone asked you would you be able to explain how one would access the
addiction services if needed?
Yes           no

Would you feel comfortable with your child receiving treatment for an addiction here
in Finland?
Yes       no    unsure not applicable

What things do you think could hinder you from seeking help for an addiction here in
Finland?

   •   Langua ge barriers
   •   Worried about confidentiality
   •   Worried about skilled staff
   •   Worried about getting involved in the system
   •   Too different cultures
   •   Negative stigma
   •   Other

Have you ever seen any media anti-drinking campaign that included you as a “non-
Finn” while living here in Finland?    Yes         no

Do you think the addiction services here in Finland effectively reach out to its non-
Finnish citizens?
Yes           No   somewhat          not sure
Do you have any immigrant friends who have experienced problems with drinking
here in Finland?
Yes           No

Other comments and reactions:




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