One of the alcohol-related goals in Japan's health promotion campaign called Health Japan 21 (secondary term) is to reduce the number of high-risk drinkers (20 years old or above) who consume 40g or more pure alcohol/day in men and 20g or more in women by year 2022. To achieve this goal, a further expansion of screening and brief intervention (SBI) in the medical setting is essential. In this research, realistic and cost-effective SBI scenarios in Japan were investigated based on international systematic review and clinicians' opinions from a semi-structured interview. Several SBI scenarios were built with 2 levels of intervention based on the AUDIT scores of 8-15 (brief advice) and 16-19 (brief advice and counseling, continuous intervention), and a simulation was conducted by applying different probabilities and success rates into the scenarios. Information associated with preparation and implementation of SBI at the 2 levels was also estimated and annual costs of SBI per drinker were calculated. It was found that approximately 2,390,000 and 530,000 high-risk drinkers require brief and extensive interventions, respectively. Furthermore, incremental costs per quality-adjusted life year (QALY) gained were calculated at 723,415 yen for brief intervention and 944,762 yen for extensive intervention, suggesting cost-effectiveness of SBI in Japan. Given the limited national healthcare budget and operational challenges such as time to provide SBI especially in the primary care setting in Japan, roles of healthcare providers and wider use of information technology were discussed with some suggestions. Furthermore, lighter and more frequent interventions at various levels and not only at the medical setting but also at multiple social settings (such as workplace and among family and friends) were discussed to increase the cost-effectiveness of SBI and to keep the number of high-risk drinkers who have successfully reduced their alcohol consumption.
PURPOSEThe purpose of this study was to evaluate the efficacy of the Serigaya Methamphetamine Relapse Prevention Program (SMARPP), which is the workbook-based group therapy for individuals with drug dependence, through investigating 1-year follow-up outcomes.METHOD AND SUBJECTSThe sample was drawn from 231 outpatients diagnosed as DSM-IV substance use disorder, who had firstly consulted the drug dependence clinic of the Center Hospital, National Center of Neurology and Psychiatry between September 2009 and June 2013. Of the 231 potential subjects, 79 had participated in SMARPP at least once, and finally 37 who had continued contact this clinic for more than 1 year after due-day of finishing the first SMARPP course were determined as the subjects. We collected the outcome information retrospectively based on clinical records.RESULTAt the 1-year follow-up point, 67.6% of the subjects had continued abstinent at least for a month, and 60% of them had continued full-abstinent for more than 1 year. One of the factors which influenced their abstinence was "having no experience of using new psychoactive substances" (p = 0.029). As for 70.3% of subjects, drug-use frequency decreased and the only factor for their improvement was "participating in SMARPP many times" (p = 0.040). Of the subjects, 23 patients corresponded to methamphetamine use disorder, and 65.2% of them had continued abstinent at least for a month at the 1-year follow-up point. Additionally, 60% of them had continued full-abstinent for more than 1 year.DISCUSSION AND CONCLUSIONOur study demonstrated possible effectiveness of SMARPP for patients with drug use disorder, especially methamphetamine-use-disorder. The factors of abstinence or decrease of drug-use frequency may be to participate in SMARPP many times, not to abuse "not illegal" drugs such as new psychoactive substances or hypnotics/anxiolytics and to continue treatment for more than 1 year after due-day of finishing the program.
A cognitive behavioral therapy program entitled "STEM" was implemented with 42 drug dependent outpatients at Okayama Psychiatric Medical Center. Characteristics of 1 group who completed the program were examined, with the effectiveness of the program evaluated through monitoring longitudinal changes over a period of 8.5 months. Results showed that the percentage of patients who completed the program was 52.4% (22 out of 42 people), those who completed had a longer educational history than the dropouts, a high proportion of those who completed held some form of employment and that their motivation to recover was high. Evaluation results of the program effectiveness showed significant improvement in short-term drug self-efficacy, with a tendency for later improvement in feelings and emotions also observed. While a certain level of effectiveness was proven, approximately half the group dropped out; so it is necessary to consider alternative options at an early stage for participants with a high risk of dropout, such as strengthening individual support based on their specific characteristics.
An autopsy case of caffeine intoxication related to the consumption of caffeinated products, such as energy drinks and caffeine contained drugs, was reported. Case report: A male in his early twenties was working a night shift job. After work one morning he came home and was not feeling well. He was vomiting a great deal and could not move, so his family had him lay down to rest. That afternoon they discovered his death. Although the decedent was examined by postmortem computed tomography, his cause of death could not be determined. A forensic autopsy was performed to investigate his cause of death. Autopsy findings: There were no obvious injuries on his whole body. Only slight brain edema and congestion of other organs were observed, but no significant lesions were found in his organs. A yellowish granular substance was observed in the stomach, duodenum, and small intestine. Alcohol concentration was 0.01mg/ml in the blood and urine. GC-MS and LC-MS/MS analyses did not detect any chemical substance except caffeine from his blood and urine. By LC-MS/MS analysis, the caffeine level (p g/mL) was 182, 71, and 10700 in the blood, urine, and gastric contents, respectively. Results and discussion: The fatal level of caffeine in blood has been reported as >100 u g/ mL. Thus, the cause of death was diagnosed as caffeine intoxication. It was revealed that he had consumed many energy drinks to stay awake and alert. Because he had a history of feeling ill and vomiting, it is suspected that he had an excessive intake of caffeine. Energy drinks, unlike most medicines, are able to be consumed repeatedly, and caffeine intoxication is a possible result. The reporting of this case will enlighten the danger of repetitious and chronic consumption of caffeinated products, such as energy drinks and caffeine contained drugs.
Previous researches suggest that addressing alexithymia and emotional dysregulation in patients with alcohol and drug addiction is important. However, interventions focused on emotional problems in Substance Use Disorder (SUD) patients are rare in Japanese hospital settings. In 2014, we developed and implemented an intervention called the Serigaya Collaboration for Open heart Project (SCOP) for those SUD inpatients who have difficulty recognizing and expressing their emotions. The SCOP consists of a series of emotion-focused group psychotherapies provided by psychologist, occupational therapist, and nurse. The purpose of this preliminary study is to assess the efficacy of.SCOP in SUD patients. A total of 65 inpatients (37 alcohol and 28 drug use disorder) participated in the research. Thirty-two patients consented to receive the SCOP intervention concurrently with treatment as usual (TAU), while the rest of the patients (n = 33) received only TAU. TAU consists of cognitive-behavioral group therapy, psychoeducational group sessions, occupational therapy, and on-site self-help group attendances. Based on medical records, we assessed retrospectively the 6 months prognosis after discharge. A comparison was made between the SCOP and TAU groups in terms of treatment retention, attendance at self-help group meetings, -and alcohol or drug relapse. No dif- ference in post-discharge treatment retention was observed between the groups. The SCOP group had more self-help group attendees and fewer patients with alcohol or drug relapse than the TAU group. Although our present study is retrospective in design, our preliminary findings suggest that the SCOP intervention which focuses on emotions may be effective in encouraging SUD patients to join self-help groups, and helped prevent alcohol or drug relapses.
Caffeine-containing drinks are popular daily beverages worldwide and highly concentrated caffeine in the form of tablets is easily obtainable in local chemists. It is common to detect caffeine in toxicological screens in autopsy cases, but we always have to take in account that caffeine itself possesses toxicity which may sometimes lead to death The case was a 44-year-old woman who was found dead in her room one day in June. Empty packages of 'Estaron Mocha 12®, accounting for 14 tablets, were found at the scene. The autopsy showed nothing remarkable suggesting external forces, apart from white granules in her stomach. Toxicological analysis revealed 127 mg/L of caffeine concentration in the deceased's blood, which was considered to be fatal. Caffeine intoxication cases have been reported from many countries. Some are caused by accidental overtake of energy drinks, and many others are caused by intentional intake of caffeine tablets. We think that some restrictions will be effective to prevent this kind of death.
Individuals with an inactive acetaldehyde dehydrogenase 2 have an. elevated level of serum acetaldehyde after drinking alcohol, and this may cause an alcohol flushing response with symptoms such as facial flushing, tachycardia, headache, and nausea. Recent studies have suggested that the flushing response influences the association between alcohol consumption and various health-related outcomes. In the present study, we investigated the impact of the flushing response on the relationship between alcohol consumption and serum y -GTP levels in Japanese drinkers. We conducted a cross-sectional study of 521 Japanese drinkers (260 men and 261 'vomen) to examine the impact of the alcohol flushing response on the relationship between alcohol consumption and serum y -GTP levels. The subjects were divided into three groups according to the amount .of daily alcohol consumption. (low, <20 g; moderate, 20-39 g;. and high, >40 g). Multiple adjustments were performed with linear regression models to examine the association between daily alcohol consumption and serum y-GTP levels, adjusting for potential con- founders including the flushing response. We found that the proportion of flushers was significantly lower in the high alcohol consumption group than in the low consumption group. The results of a multivariable analysis showed that,serum y -GTP levels were significantly higher in the moderate and high consumption groups than in the low consumption group after. adjusting for all potential confounders other than the flushing response. In addition, the association between serum y -GTP levels and alcohol consumption was unchanged after adjusting for the presence of the flushing response. In conclusion, serum y -GTP levels increased with increasing alcohol-consumption regardless of the flushing response. Screening for heavy drinkers using serum y-GTP levels was very important to prevent alcohol-related diseases or health problems in health examination.
This article is an extension of a presentation with the same title given at the Japanese Alcohol, Nicotine & Drug Addiction Conference in Kobe on October 13th 2015: Firstly, a brief overview of support activities and services within Proyecto Hombre is given outlining the advanced assistance programs for supporting and treating addiction. problems. Secondly, it lays out the profile of persons with alcohol and drug problems as taken from "Proyecto Hombre Observatory Report 2014" vhich has informed the reality of adult users' life situation based on a series of indicators from the EuropASI, while they were being treated at Proyecto Hombre 27 Centers in Spain between 1 January, 2014 and 31 December, 2014. The sample consists of 1941 people treated during 2014 after application of the criteria for validation of the questionnaire. The profiles so obtained enable the design of treatment programs according to their specific situation in Proyecto Hombre. In order to allow some guidance to Japanese investigators and social workers regarding the design of treatments programs based on current user situation, this article draws attention to general sociodemographic data as well as data notable for its variation by gender and also by substance, and draws limited conclusions based on these.
While many Japanese nationals are considered to have problems with pachinko and pachisuro (Japanese slot machines), the factors contributing to the process by which gambling disorder-is aggravated remain unclear. Therefore, the aim of this study was to establish baseline data for measures to prevent the further escalation of this gambling disorder; To elucidate the contributing factors, a self-administered questionnaire was distributed to pathological gamblers. The survey items were composed of the following basic attributes; scores on the South Oaks Gambling Screen (SOGS); gambling motivation; matters arising, after gambling behavior; remedies for excessive gambling; the Kessler 6 (K6); the CAGE (Cut down, Annoyed, Guilty, Eye opener) questionnaire; and the 8-item Family Adaptability and Cohesion Evaluation Scale at Kwansei Gakuin IV (FACESKGIV-8). The results of hierarchical multiple regression analysis using SOGS scores as the dependent variable indicated that the variables determined to contribute to the aggravation of gambling addiction were age, sex, past employment experience in the service sector, obtaining money as a motivation for gambling, and seeing limits as a remedy for excessive gambling. Because gamblers tend to fixate on money and experience increasing difficulty devoting attention to other matters as gambling problems grow more serious, the results of this study suggest the need to provide environments that will enable affected individuals to reflect on their own style of gambling at the stage at which their gambling behavior begins to exceed the scope of their own revenue.
A 48-year-old Japanese woman with >10 years history of alcoholic had been falling repeatedly during 1 week before her death. She complained of nausea and did not eat or drink for 2 days. Thereafter, she became drowsy and she was transferred to the hospital. On arrival at the hospital, she had cardiopulmonary arrest and died soon after. Although blood tests showed metabolic ketoacidosis, a hemorrhagic lesion was also found in the brain by computed tomography. To determine the cause of death,. a forensic autopsy was performed on the next day. At autopsy, cerebral contusion, skull fracture, and subdural hemorrhage caused.by the head injury received after falling were found. Histological examination showed fatty changes and Mallory bodies in the liver. There was a marked increase in ketone bodies, especially β -hydroxybutyrate, in postmortem blood examination. Therefore, the cause of death was diagnosed as alcoholic ketoacidosis. Accurate diagnosis of mild trauma and metabolic disease is difficult by postmortem computed tomography; therefore, autopsy is required for sudden death. In this case, the cause of death and accompanying traumatic lesions that were compatible with her history was clarified by autopsy. Furthermore, because the blood was taken at the time of cardiopulmonary arrest, we.obtained reliable data from the terminal stage of alcoholic ketoacidosis. This case demonstrates the physiological and pathological changes in sudden death of a patient with alcoholic.
The purpose of the present review is to explain the mechanism of alcohol-induced asthma in Japanese. An oral ethanol provocation test was performed in Japanese asthmatics to measure pulmonary function, blood ethanol, acetaldehyde and histamine. Acetaldehyde dehydrogenase 2 (ALDH2) genotype was determined by polymerase chain reaction (PCR) and ethanol patch test. Human bronchi and mast cells were stimulated with acetaldehyde in vitro. Approximately half of the asthmatic subjects developed bronchoconstriction with concomitant increases in blood acetaldehyde and histamine, which was associated with genetically reduced ALDH2 activities. In vitro acetaldehyde stimulation induced bronchoconstriction and degranulation of human mast cells. Collectively, as a metabolite of alcohol, the elevation of acetaldehyde following alcohol consumption induces airway mast cells to release histamine, which result in exacerbation of asthma in susceptible population.
With the popularization of the internet, internet addiction among the youth has received a lot of attention in recent years. While.the internet is an effective tool for: communication, the youth, who find real-life communication difficult, reportedly overuse,this aspect of the internet However, this is more of an impression based on clinical cases, with few factual findings. Therefore, the aim of this research was to study the reality of internet addiction -among university students and to examine the multilateral relationship between internet addiction and interpersonal relationships. We conducted a questibnnaire stirvey among 221 uriiversity students, analyzing the level of internet addiction, relevant interpersonal relationships, personal "charcteristics, and other factors associated with internet use. We found that the number of students who were dependent on the internet was 10 (4.7%) and the number of students with a tendency toward dependency was 98 (45.6%). In interpersonal relationships, internet addiction was significantly correlated with parental overprotection, a sense of contentment from the present parent-child rela- tionship, relationships with friends, number of friends, and availability of free time. In personal characteristics, internet addiction was significantly correlated with social skills and feelings of self-esteem. In other factors, internet addiction was significantly correlated with typing on a message board, video browsing, online gaming, use of a personal computer, desire to escape, distraction, pleasure, and connecting with others. Furthermore, we conducted a multiple regression analysis to consider the effects of these three aspects associated with internet addiction. The results suggest that internet addictionl is promoted by parental overprotection, low self-esteem, having few friends, and passive internet service usage. Thus, education is required to promote careful use of the internet to prevent internet addiction from escalating. Further, it is important to understand and support interpersonal relationships to prevent internet addiction from making life worse.
A large body of literature indicates that neural adaptations induced by cocaine in the mesocorticolibic system cause addictive behaviors. Emerging evidence suggests that the laterdorsal tegmental nucleus (LDT), which contains cholinergic, glutamatergic and GABAergic neurons and innervates the ventral tegmental area (VTA), might also contribute to the development of cocaine addiction. In this review, we summarize our recent findings showing that neuroplasticity elicited by cocaine administration in LDT cholinergic neurons is involved in the expression of addictive behaviors. Ex vivo electrophysiological recordings obtained from repeatedly cocaine administered rats revealed and increased excitatory synaptic transmission to and enhanced intrinsic membrane excitability in LDT cholinergic neurons. The former depended on enhanced glutamate release probability form presynaptic terminals and the latter was mediated by increased persistent sodium conductance. Additionally, intra-LDT administration of AMPA/HMDA receptor antagonists or a persistent sodium channel blocker attenuated the expression of cocaine-induced conditioned place preference. These findings suggest that chronic cocaine exposure-induced neuroplasticity in LDT cholinergic neurons may activate LDT cholinergic neurons, which in turn may enhance the activity of dopamine neurons in the VTA, leading to the development of cocaine addiction.
Chronic alcohol consumption is a major public health problem that frequently leads to the development of liver steatosis, fibrosis, and eventually cirrhosis and hepatocellular carcinoma. Hyperhomocysteinemia is a pathological consequence of alcoholic liver disease (ALD) and is attributed to hepatic endoplasmic reticulum (ER) stress and insulin resistance. However, the regulatory function of nuclear receptors in ALD associated with dysregulation of homocysteine metabolism remains largely unknown. Nuclear receptor small heterodimer partner (SHP, NROB2) is a pleiotropic transcriptional repressor involved in regulating various metabolic path-ways in the liver. This study investigated a critical role of SHP in alcohol-induced hyperhomocysteinemia. . The expression and enzymatic activities of betaine-homocysteine S-methyltransferase (BHMT) and cystathionine y -lyase (CTH) were significantly increased in the liver of SHP- knockout (SKO) mice as compared to the wild-type mice. The substrates of BHMT and CTH, such as betaine, choline and cystathionine, were decreased in SKO liver while their products including hydrogen sulfide and cysteine were increased. However, methionine and homocysteine were not altered by SHP- deficiency, suggesting that the methionine cycle is activated in SKO mice. Forkhead box A (FOXA)- binding site was identified in both the BHMT and CTH promoters. Luciferase assay demonstrated that FOXAI, but not FOXA2, activated both BHMT and CTH promoters through the FOXA-binding site. Overexpression of FOXA1 induced BHMT and CTH expression in Hepal-6 cells, which was inhibited by SHP coexpression. Consistently, alcohol-induced hyperhomocysteinemia, and homocysteine-induced hepatic ER stress and glucose intolerance were abrogated in SKO mice. These novel findings identified SHP and FOXA1 as important regulators of hepatic homocysteine metabolism. Because hyper-homocysteinemia is a risk factor for cardiovascular disease and insulin resistance, and is often associated with ALD and metabolic syndrome, SHP and FOXA1 could be used as potential targets for hyperhomocysteinemia and its related diseases. Taken together, these results shed light on the regulatory mechanism of homocysteine metabolism in the liver.
This study sought to ascertain the association between alcohol consumption by Japanese high school students and their reasons for drinking. Monitoring the Future is a U.S. survey of substance abuse that features a core question that asks about reasons for drinking. This study translated that question into Japanese to survey 2,283 students (1,404 males and 879 females; 1,142 freshmen and 1,141 sophomores) at 3 Japanese high schools from November to December 2014. The original question had 15 possible answers, but 2 were eliminated and the answer "I don't drink" was added. Responses were analyzed overall and by sex and year. Results indicated that 9.4% of male students drank in the past 30 days, 28.4% drank in the past year, and 43.0% had drunk at some point in their lives. Similarly, 6.5% of female students drank in the past 30 days, 23.8% drank in the past year, and 36.7% had drunk at some point in their lives. Of the sample, 58.1% answered that they "don't drink. " Given reasons for drinking were "because it tastes good" (15.8%), "to-experiment-to see what it's like" (14.5%), "to have a good time with my friends" (14.1%), "to relax or relieve tension" (10.2%), "to feel good or get high" (7.9%), and "to fit in with a group I like" (5.2%). Respondents who drank in the past 30 days, in the past year, or at some point in their lives did so for different reasons. As alcohol consumption increased, respondents drank "because it tastes good" markedly more often. Reasons for drinking were ranked by frequency to compare Japanese high school students and U.S. 12th graders. Japanese students were more likely to drink "to fit in with a group I like" while U.S. students were more likely to drink "because of boredom, nothing else to do."
Our findings indicate that SOCRATES is the most useful psychological outcome scale in assessing the effectiveness of. relapse prevention guidance for drug offenders in Japan. However, evidence is lacking, as most studies were before-and-after studies that only assessed psychological outcomes. More follow-up studies after release that include comparison groups and investigate behavioral outcomes are needed.
This study sought (1) to determine the significant associations between measures of drug abuse and lifestyle variables in high school students in Japan, and (2) to ascertain common lifestyle variables in relation to associations between lifestyle and eight measures of drug abuse. Four measures were use of an inhalant, marijuana, an amphetamine-type stimulant (ATS), or MDMA (ecstasy) over the past year, and four measures were use of those drugs over one's lifetime. Data were from a combined sample (aggregate sample) from the Japanese School Survey Project on Alcohol and Other Drugs (JSPAD). The aggregate sample consisted of 75, 726 1st-, 2nd-, and 3rd-year students (37,697 males and 38,029 females) at high schools nationwide who were selected by stratified, single-stage cluster sampling during surveys in 2004, 2006, and 2009. Eight measures of drug abuse were predicted with logistic regression analysis based on lifestyle variables. Six lifestyle variables jointly predicted those measures: "get- ting up at the same time every day," "eating breakfast," "enjoying school,'' "hours worked at a part-time job," "having close friends to hang out with", and "talking with one's parents about one's problems". The six lifestyle variables were associated with the measures of drug abuse in similar ways, regardless of which drug was abused. Those associations indicated that students whose parents were not at home had a markedly higher level of drug abuse. Students who lacked close friends to hang out with, students who did.not enjoy school, students who rarely ate breakfast, and students who did not get up at the same time every day had a higher level of drug abuse. Several indicators of associations yielded findings, and these findings could presumably help to determine if "individuals who abuse drugs display characteristics as a group" and if "individuals who abuse drugs tend to abuse multiple drugs".
In this review, current progress of neurobehavioral research using animal model of dependence and/or addiction is described in light of DSM-5. Although the terms "dependence" and "abuse" are deleted in DSM-5, the concept of dependence and the related animal experiments, drug self-administration, conditioned place preference, and drug discrimination are still useful to predict abuse liability of chemical substances. At the same time, it is necessary to model addictive nature of behavior in animals. Impulsivity, compulsivity, and comorbidity of addiction to other mental disorders are the major topics of such research area. At the same time, basic research aimed at treatment of dependence/addiction has been progressed. For example, a methamphetamine monoclonal antibody, a new chemical acting on DARPP-32 (dopamine and c-AMP-regulated phophoprotein-32), a galanin analogue, oxytocin, and others are included in such attempt. As DSM-5 mentioned the brain reward system as the major site of substance-related and addictive disorders, clinicians would be more interested in biological substrates of dependence/addiction. It is expected that the emergence of new diagnostic criteria promotes mutual communication between basic and clinical researchers.
