by Edwin Quinabo
Researchers found two shifts in alcohol use among Filipino Americans: first, long shaped by male dominated norms, drinking is undergoing a gendered shift as Filipino women’s participation rises alongside societal changing roles; second, findings also show a troubling change in why Filipinos drink, with alcohol moving beyond celebration toward a coping tool for economic hardship, unemployment, social stress and pandemic-era disruption, according to PLOS One, a peer reviewed open access mega journal published by the Public Library of Science.
While alcohol has historically been central to fiestas and group-based social activity, studies show this second trend among Filipinos of drinking alone and as a coping mechanism, could lead to future higher rates of alcohol use disorder (AUD) or alcoholism.
A new study from Carnegie Mellon University found drinking alone to cope with stress, depression or hardship is a more troubling predictor of alcoholism because it is tied to emotional distress and later alcohol-use problems.
US-born Filipino Americans rank second in AUD, and ranks first among adolescents with AUD in Asian subgroup
Marel R. Ver, MD, Surgeon, Past President, Philippine Medical Association of Hawaii (PMAH) provided statistics for the Hawaii Filipino Chronicle on AUD and drinking patterns of Filipino Americans.
“Hawaii-specific, population-wide alcohol use disorder (AUD) rates disaggregated by every local ethnic group are not well established in the retrieved literature, but several sources provide relevant figures for the groups that predominate Hawaii – Native Hawaiian/Pacific Islanders, Filipinos, and other Asian subgroups. Most of the ethnicity-specific data come from national surveys rather than Hawaii-only samples, so the number below should be interpreted as best available estimates for these ethnic groups rather than certified state-level statistics,” she said.
Dr. Ver shared two findings from the National Survey on Drug Use and Health (2015-2018). “Filipino Americans repeatedly rank among the highest-risk Asian American subgroups: US-born Filipino Americans have among the highest rates of binge drinking (25.9%) and AUD (6.9%) among Asian American, comparable to groups traditionally considered high-risk. Among Asian American adolescents, Filipino youth have the highest prevalence of lifetime (29.3%) and past-month (10.3% alcohol use) and the highest AUD prevalence (3.5%),” she said.
Earlier pooled NSDUH data from 2002–2008 tell a similar story: Filipino Americans had a past-month binge-drinking rate of 14.5%, second only to Korean Americans, and Filipino American adolescents showed the highest alcohol use disorder prevalence 3.5% — of all Asian youth groups studied.
Dr. Ver said, “Several cultural and social factors appear to contribute to elevated alcohol use among Filipinos, though the available literature is more descriptive than casual, and much of the strongest ethnic-specific data comes from Filipino Americans rather than the Philippines itself.” She reiterated the NSDUH findings and added, “This [data] challenges the stereotype of Asian Americans as a uniformly low-risk group.”
Male bravado, family modeling, and western acculturation all contributes to sustaining heavy drinking patterns among US-born Filipinos
Studies in PLOS One show social expectations play a powerful role in Filipino American drinking patterns. Refusing alcohol can carry social consequences, from being ignored to feeling excluded, while drinking signals belonging and, for young men, displays of toughness or bravado. PLOS One research also points to strong parental, and grandparents’ drinking habits are closely mirrored by their children, creating early exposure and passing alcohol use behaviors from one generation to the next. Both pressures help reinforce heavy-drinking norms.
NSDUH data reveals a clear acculturation pattern. U.S.-born Filipino Americans drink at significantly higher rates than those born abroad, suggesting that assimilation into American drinking culture increases risk beyond levels typically seen in the Philippines.
Pakikisama and Hiya, cultural traditions that discourage AUD
Apollo Tamayo, Training Coordinator, Kapolei, believes Filipinos have lower alcohol consumption and binge drinking rates relative to other ethnicities based on social gatherings he has attended. He explains that two Filipino cultural traditions discourage AUD. Pakikisama is the importance of maintaining smooth interpersonal relationships. Hiya is shame.
“Traditional Filipino culture emphasizes pakikisama which frequently manifest during social gatherings, fiestas and family celebrations where alcohol is used as a bonding tool,” Tamayo said.
“While sharing drinks is a major element of communal hospitality, cultural structures also strongly emphasize family reputation and hiya (shame), which can serve as an informal deterrent against visible excess. However, acculturative stress, generational shifts and changing social environments can sometimes weaken these protective communal checks, particularly among younger generations,” he added.
While Tamayo doubts the high prevalence of alcohol use, he said “I have witnessed the impacts of alcoholism on family members and friends but have also seen several of them recover. Eventually, alcoholism affects their health and well-being.
“I have seen how alcohol can damage relationships. Hopefully, alcoholics will one day realize how drinking affects their lives and cut back or completely eliminate alcohol. I’ve seen the deteriorating health effects on those unable to overcome this addiction. Overall, I’ve noticed that the younger generation doesn’t consume that much alcohol as compared to the older generation.”
Drinking starts out innocently then progresses, affects entire family
Melanie Basuel, Teacher’s Aide, Pearl Harbor, said “I have seen the impacts of alcohol. Sometimes it starts out very innocently — having a few drinks socially, on weekends, or at family gatherings. But over time, drinking begins to become something more. It starts affecting relationships, responsibilities, finances, work, health, and interaction with others. Alcoholism affects entire families and results in worry, frustration, disappointment, and sometimes feelings of helplessness.”
She said sometimes the social environment can make it easier for a person to drink more than they normally would, especially if everyone around them is drinking. “But whether that develops into an alcohol problem involves much more than culture. Every person and family is different,” Basuel said.
Weekend binge drinking happens, but work and religiosity dissuade alcohol abuse, Pulutan-drinking tradition
Hermie Gaspar, nurse, said some reasons why Filipinos avoid alcohol abuse are for religious reasons and work. “Filipinos work so hard, often have double jobs. Filipinos have lesser consumption of alcohol because they are busy working to support their families.”
However, she admits that Filipinos tend to do binge drinking on weekends, celebrations or social gatherings or after work. She describes what happens at some of the gatherings she’s attended, “what I see at social functions at residences. Some will bring alcohol — beer or liquor — as gifts to drink at a party. A host might have a cooler of assorted beers for the men. I always see a separate table setup for pulutan (food) paired with beer or other alcohol drinks. Pulutan can lead to excessive drinking. Most men do these socializations [drinking and eating pulutan] to show a sense of brotherhood especially if they have not seen each other for a while.”
Asian flush, wine associated with Roman Catholicism
Linda Jocson, retired, Waipahu believes rates of AUD is lower among Asians than other ethnicities because of “Asian flush,” a physiological response to drinking alcohol that includes facial flushing, nausea, headaches and a faster heart rate. Studies show this intolerance to alcohol is common among East and Southeast Asians.
“Also, a lot of Filipinos are Roman Catholics with strong virtues and values. In Mass, wine is represented and turned to the blood of Christ. I grew up with the respect and knowledge of wine being special. So, abusing alcohol was not something I even thought of. Most of my family realized that and have not become alcoholics,” Jocson said.
Alcoholic family members
Fidel Hufana, retired Drug Consultant, Waipahu, believes drinking in the Philippines is more culturally-accepted. “Filipino brands like Tanduay, San Miguel, Red Horse, etc are as common as Pepsi and Coca-Cola.
He recalls alcohol use disorder in two of his family members, an uncle and cousin. “I had an uncle in the Philippines who was an alcoholic. At breakfast, he would have a bottle of Tanduay next to his Coca-Cola. It was only 8 a.m. but his eyes were already bloodshot. My aunt constantly asked him to quit drinking, but he wouldn’t listen. One day, he fell while on a walk in the neighborhood, hit his head and never recovered. I also have a cousin who works as a merchant mariner for an international cargo ship. He drinks heavily while not on duty because he says there’s nothing else to do. He is in his 50s and still drinking,” Hufana said.
Husband is alcoholic
Liz, who wanted to be anonymous, former Hawaii resident now living in Seattle, said her husband has been a functional alcoholic since they met in their twenties. They’re now in their fifties. “My husband has a high-paying, high-responsibility career. But almost every weekend he drinks. I don’t like to drive. When we go to social functions I always worry about my husband driving back home while intoxicated. He puts our life at risk. I get stressed and worry if we’re going to make it home. We’ve had many fights over this and talked about getting a divorce. When my kids were younger in their teens and knew that their dad was drunk, they’d be very upset and scared to get in the car. Now, they’re older and have their own cars. Today, if my husband knows he will drink at a party, at least sometimes we take an uber to and from that party or concert. I thank God that we survived those days,” Liz said.
“I think there are a lot of functional weekend alcoholics and if the bills are paid and there is stability in the household, the drinking problem gets overlooked, unfortunately. But there is also the health factor that is not as forgiving. My husband has had several health problems related to his drinking,” Liz added.
Five Signs of Alcoholism
For those self-identifying as functional weekend binge drinkers or are flat-out in self-denial, here are five widely recognized signs of alcoholism according to Alcoholawareness.org.
*Increasing tolerance and physical dependence — needing more alcohol to feel the same effects, experiencing tremors, sweating, or insomnia when not drinking.
*Loss of control over drinking — repeatedly drinking more than intended or being unable to cut back despite trying.
*Social and behavioral problems — neglecting responsibilities, strained relationships, irritability, or acting unlike oneself.
*Health decline — bloodshot eyes, unexplained injuries, weight changes, or other physical deterioration linked to heavy drinking.
*Risk-taking or disruptive behavior — drunk driving, missing work, asking others for money to support drinking, or other harmful actions.
Dr. Nestor Herana told the Hawaii Filipino Chronicle the transition from social or moderate drinking to Alcohol Use Disorder (AUD) is defined not simply by the amount of alcohol consumed, but by patterns of drinking, impaired control, and the consequences of alcohol use.
“AUD is characterized by multiple symptoms, including impaired control over drinking. This may be manifested by drinking larger amounts or for a longer period than intended, having a persistent desire or making unsuccessful efforts to cut down or control alcohol use, spending a great deal of time obtaining, using, or recovering from alcohol, and experiencing cravings or a strong desire or urge to drink. AUD may also present as social impairment. AUD is primarily defined by drinking behavior and its consequences rather than by quantity alone. Therefore, a person may consume relatively large amounts of alcohol without meeting criteria for AUD, while another person may meet diagnostic criteria despite consuming smaller amounts.”
Seeking help and treatment
While alcoholism is a problem, Hawaii data shows rates are not on the rise. Still, the State Epidemiological Profile 2024 shows that alcohol remains one of Hawaii’s most widely used substances across all ethnic groups.
There are many alcoholic treatment and rehabilitation centers for Hawaii residents. Experts say the first step is to talk to your personal physician for advice. 90.8% of adults with alcohol use disorder did not receive treatment, indicating a major care gap.
Dr. Seiji Yamada Medications for alcohol use disorder are underused, and many primary care providers are not familiar with their use. There are three Food and Drug Administration (FDA)-approved medications for AUD: naltrexone, acamprosate, and disulfiram. A fourth medication, topiramate, is not FDA-approved, but is recommended by the Veterans Administration.
He explains, “Naltrexone is the usual first-line medication chosen. It acts by blocking the pleasure receptors in the brain that are stimulated by alcohol consumption. There are few reasons not to use naltrexone, but these include being treated with medications for opioid use disorder. Acamprosate also works on the brain by stabilizing neurotransmitters which have become out of balance because of regular alcohol consumption. It cannot be used in those with significant kidney problems. In general, both naltrexone and acamprosate can be used in the setting of liver disease, including early stages of cirrhosis.”
As for the third medication, he explains “Disulfiram is an old medication that has been around since the 1950s. Disulfiram works by causing a severe hangover-like reaction (nausea, vomiting, headache, dizziness) if the person taking it then drinks alcohol. It is only meant for the person who intends to stop drinking alcohol completely.”
He said, Topiramate, the last drug, was originally an anti-seizure medication. One problem with topiramate is that it has to be started at a very low dose, then titrated up slowly. Another problem is that patients often feel ‘brain fog’ with topiramate.
Basuel said, “Recovery is very personal. What works for one person may not work for another. Some need professional treatment or counseling, while others find strength through support groups, family, faith, or changing the people and situations around them. One necessary step is admitting your problem and being willing to accept help. We need to be careful about judging people who struggle with alcohol. There can be a lot of shame surrounding alcoholism, which can sometimes prevent people from getting help.”
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