Author: Judi Shaw, MD.

Definition of “alcoholism”, now called “alcohol use disorder“ is an addiction to the consumption of alcoholic liquor or the mental illness and compulsive behavior resulting from alcohol dependency (Oxford). it is a long-term addiction to alcohol and generate the person with this condition does not know when nor how to stop drinking. they usually spend a lot of time thinking about alcohol and cannot control how much they consume even if it causes serious problems at home, work or financially (Medical News today). Some people can be classified as high functioning Alcoholics , meaning that you can have a lot of activity going on uh from an outside life and be able to hold wow well-paying job down and function at home and within family and relationships adequately despite drinking excessive amounts of alcohol . A functional alcoholic could be very responsible and productive and high achiever but generally is in denial of his or her condition because there ‘vision ‘ maybe obscured by the fact that they’re able to hold down a good job pay bills have a lot of friends and seemingly function well , they usually provide a lot of excuses for their drinking and play the comparative game with other people who also drink and may not be as functional . heavy drinking can be considered for women to have more than 3 drinks per day or more than Seven in a week and for men more than 4 drinks per day or 14 per week, it’s considered that if you drink more than the daily or weekly limit you’re at significant risk.

Traveling alone often requires a certain degree of responsibility, vigilance, and awareness of your circumstances in addition to the ability to interpret cultural differences and variation and nuances in interpersonal relationships. Although in some cultures drinking can be accepted as a social norm in particular in some of the Asian cultures during formal and informal gatherings, being inebriated to the point of lacking the ability to be responsible for oneself does not bode well in any culture.  Additionally, drinking excessively from a female perspective and losing ability to monitor, manage or control one’s actions can be misinterpreted in different cultural environments.

Other concerns have to do with health-related matters in other countries. detoxification and treatment of the consumption of excess alcohol may not be treated as rapidly in a foreign country , may not be thought of as important as other medical conditions, and treatment options available in more developed countries may not be available you know they’re less developed countries. as such negative effects and consequences of being inebriated could become more pronounced. Additionally, the concern of mixing are there medications even as simple as Tylenol or acetaminophen could result in negative consequences.

Lastly, problems with Immigration and Customs could result if law enforcement from any culture is required to intervene or assist with any condition arising as a result of alcohol excess. Visa applicants can be found inadmissible to the United States and other countries due to physical or mental disorders with associated harmful behaviors to themselves, others, or property and alcohol abuse is considered to be one such mental disorder even if addiction or alcoholism is not present. (Berardi Immigration Law). According to the Foreign Affairs Manual (FAM) Title 9,40.11 N11.2, alcohol abuse itself is not enough to cause a finding of inadmissibility according to immigration rules. One may be required to be examined by one or a panel of physicians according to guidelines provided by the CDC, and based on the discretion of the panel an immigrant  waiver from the CDC, ( not the US customs and Immigration Services), can be issued. In order for a waiver to be granted, the applicant may need to arrange to report to a mental health facility in the US in advance of entry and must prove how this treatment will be paid for. This process can be difficult, lengthy and expensive. Of note these decisions can be appealed and a medical review board can be convened to refute and investigate any decisions made. of note a visa applicant may also try to contest the findings of the panel physician and an applicant outside of the US may have the counselor officer file a request for an advisory opinion with the CDC. However, it is noted that if the council officer refuses to file the advisory opinion request, nothing can be done further as the CDC rarely overturns the decision of the panel physicians.

Because you have a relationship with your primary care physician and he or she knows your history and has had a professional relationship with you over many years it’s important to include this person in your decision-making. Part of the reason for including your primary care physician in your decision-making as it relates to medical care being sought abroad is that he or she is familiar with you and is incentivized to steer you in one direction or another. The recommendations will be solely based on what is in the best interest of you and your health.

What is important to note is that for various reasons complications can occur upon returning home to your original country. You may need extensive follow-up care on return. This situation can be very problematic for your primary care physician upon your return. It may be necessary just to monitor the course of an uneventful recovery however problems can arise when confronted with the fact that returning medical tourists often do not have records of the procedures that you underwent and/or the medications that you received nor contact information for the foreign health care professionals who provided the services. When your primary care physician at home is asked to make right what went wrong when you have experienced complications as a result of the medical travel, this can be very difficult and problematic. The reason is, if your primary physician has not been previously informed about your plans or about your travel or your procedure and he/she has not been a part of the decision-making process.

Some of the risks involved in travel overseas for medical care as mentioned involve the post treatment care which will then be the responsibility of the medical care system in your home country under your primary physician. If your physician is not willing to assume this responsibility, then you may have to return to the country that provided the medical care initially. This could obviously pose a lot of problems for you. Other concerns are that foreign laws governing medical liability are not as strict as those in the United States which is one of the reasons why their costs are so low, but this could leave you with limited recourse for compensation if medical malpractice is suspected. Additionally, there is no one to complain to because many of these physicians over in other countries are not regulated by the same organizations and boards that your primary care physician may be.

Lastly, having a team to coordinate your care that has worked with the physician and team who provided your care to begin with cannot be emphasized enough. Preferably if your physician had been involved in the decision-making process in the beginning this following through afterwards especially with coordinating care with the doctors in the foreign country, this could provide a seamless course of care upon your return.