Psychosocial characteristics of the general population who habitually use hypnotics: Results from a national survey on drug use among the Japanese.

Aim: The aim of this study was to examine the characteristics of habitual hypnotic users in Japan. Methods: This nationwide, cross-sectional survey used self-administered questionnaires. Data were collected from four national surveys conducted every 2 years between 2015 and 2021. The participants were Japanese individuals who had taken prescription hypnotics in the past year or had never taken them. We divided 13,396 participants into three groups to compare the social background and status of taking medication and controlled drugs, drinking, and smoking among the three groups: people who use hypnotics habitually daily (habitual hypnotic users [HUs]), people who use them only occasionally (occasional hypnotic users [OUs]), and people who do not use them (hypnotic non-users [NUs]). We compared the perception of using hypnotics between the HU and OU groups. Results: HUs were more likely to be older, unemployed, and to habitually use anxiolytics and analgesics than NUs. The main reasons for taking anxiolytics in HUs were alleviating insomnia and reducing anxiety, whereas the main reason for taking analgesics was improving joint pain. Additionally, the HU group had a higher proportion of habitual smokers than the OU group. There was no difference in drinking status or taking of controlled drugs among the three groups. HUs were more likely to use hypnotics and to have concerns about their side-effects than OUs. Conclusion: HUs were more likely to be unemployed, habitually use anxiolytics and analgesics, smoke heavily, and take hypnotic drugs with concerns regarding side-effects. These results may help encourage the appropriate use of hypnotics.

Prospective multicenter study of the epidemiological features of emergency patients with overdose of over-the-counter drugs in Japan.

Aim: To investigate the epidemiological characteristics of patients presenting to the emergency department with an overdose of over-the-counter (OTC) drugs. Methods: A questionnaire survey was conducted to examine the sociodemographic characteristics of patients with OTC drugs overdoses visiting emergency departments at eight sites across the country. The patients were divided into "habitual" and "nonhabitual" groups according to their history of OTC drugs overdose. Student's t-test or Welch's t-test was performed for numerical variables, and Pearson's χ 2 test was performed for dichotomous and nominal variables between the two groups. Results: Of the 124 patients included in this study, 79% were women. The habitual (26.6%) and the nonhabitual (73.4%) groups showed no differences in sex, occupation, cohabitants, history of mental illness, or history of alcohol consumption or smoking; however, those in the habitual group were significantly younger. The proportion of OTC drugs obtained from physical stores was higher in the habitual group, whereas the nonhabitual group used more household medicines. Suicide and self-harm were more common reasons for overdose in the nonhabitual group. Antipyretic analgesics were significantly more common in the nonhabitual group, whereas antitussive expectorants and antihistamines were significantly more common in the habitual group. Conclusion: This is the first multicenter study to determine the status of OTC drugs overdose patients treated at emergency departments of medical facilities in Japan. To prevent new overdoses of OTC drugs, continued detailed epidemiologic studies of patient backgrounds and drug acquisition routes, and investigation of the components of OTC drugs that cause dependency are necessary.

Situational factors affecting abstinence from drugs: Panel data analysis of patients with drug use disorders in residential drug use treatment.

Aim: To identify situational factors that can predict drug abstention in patients with drug use disorders undergoing residential drug use treatment. Methods: Patients with drug use disorders admitted to drug addiction rehabilitation centers (DARCs) in 2016 were involved in this study. Longitudinal panel data were used, with eight follow-up surveys over 6 years, approximately every 6 months. Of the 2752 samples from the eight follow-up surveys, 2293 were analyzed as the complete panel data set. The primary outcome was drug abstention for approximately 6 months. The influences of situational factors during this period on the primary outcome were also assessed using a generalized linear mixed model in which inter-individual differences were controlled as variable effects. Results: The use of residential DARCs positively influenced the primary outcome (adjusted odds ratio [AOR] 3.33, 95% confidence interval [CI] 1.79-6.21) when compared to no DARC usage. The cessation of drinking also positively affected the primary outcome (AOR 3.10, 95% CI 1.79-4.62), while employment status (AOR 2.22, 95% CI 1.12-4.41) and the cessation of drinking (AOR 4.92, 95% CI 2.77-8.72) positively impacted the primary outcomes of patients not using DARCs. Conclusion: The use of residential DARCs and the cessation of drinking positively affected drug abstention rates. Employment and the cessation of drinking for patients who were not using the DARCs also had a positive effect. This information will aid in the development of social recovery strategies for people with drug use disorders.

Comparison of patients with benzodiazepine receptor agonist-related psychiatric disorders and over-the-counter drug-related psychiatric disorders before and after the COVID-19 pandemic: Changes in psychosocial characteristics and types of abused drugs.

AIM: To investigate changes in the clinical characteristics of patients who abused benzodiazepine receptor agonists (BZRA) or over-the-counter (OTC) drugs before and after COVID-19 based on the 2018 and 2022 data of the "Nationwide Psychiatric Hospital (NPH) Survey on Drug-related Psychiatric Disorders." METHOD: A total of 446 and 155 cases, and 435 and 273 cases, who mainly abused BZRAs or OTC drugs, respectively, were extracted from the database of the two NPH Surveys. Demographic variables, education, employment, criminal record, drug use during the previous year, psychiatric diagnosis, and types of abused drugs were compared between 2018 and 2022. RESULT: A comparison of BZRA abusers revealed a decreased number of users during the previous year and an increase in the comorbidity rate of other disorders (F3 and F4 in ICD-10) in 2022. Etizolam, flunitrazepam, triazolam, and zolpidem were used most in both years, with an increase in zolpidem and a decrease in triazolam in 2022. A comparison of OTC drug abusers revealed a higher proportion of women and young patients in 2022. An increase in the comorbidity rate of F3 and F9 and a significant increase in the use of dextromethorphan products were observed in 2022, although codeine products were in the majority in both years. CONCLUSION: By comparing NPH Surveys before and after the COVID-19 pandemic, both BZRA abusers and OTC drug abusers present complex pathologies, requiring tailor-made treatment. The younger OTC drug abusers were particularly evident among women, and the abuse of dextromethorphan-containing OTC drugs has increased alarmingly.

Sex differences in the characteristics of stimulant offenders with a history of substance use disorder treatment.

We analyzed the results of a nationwide questionnaire administered to 699 stimulant offenders and examined sex differences in the association between various psychosocial problems and treatment history for substance use disorder. Based on their attributes, we predominantly evaluated the treatment and support provided to women with substance use disorder. The rates of childhood (before the age of 18) traumatic experiences (physical, psychological, and sexual abuse and neglect) and lifetime intimate partner violence were significantly higher in women than in men. The history of treatment for substance use disorder was also significantly higher in women than in men, at 15.8% for men and 42.4% for women [χ2 (1) = 41.223, p < 0.001]. Logistic regression analysis was performed using the treatment history of substance use disorder as the dependent variable. The results showed that treatment history was significantly associated with the total drug abuse screening test-20 score and suicidal ideation in men and with survivors of child abuse and eating disorders in women. A comprehensive assessment is required for several issues, such as child abuse, domestic violence, trauma symptoms, eating disorders, and drug problems. Moreover, an integrated treatment for substance use disorder, trauma, and eating disorders is required for female stimulant offenders.

Prevalence of adverse childhood experiences and their association with suicidal ideation and non-suicidal self-injury among incarcerated methamphetamine users in Japan.

BACKGROUND: Adverse childhood experiences (ACEs) are distressing and/or traumatic events that occur during childhood that increase the risk of negative health outcomes in adulthood. OBJECTIVE: This study estimated the prevalence of ACEs in a nationwide sample of Japanese methamphetamine users in prison and examined associations among ACEs, suicidal ideation, and non-suicidal self-injury. PARTICIPANTS AND SETTING: Participants were 636 inmates (418 male and 218 female) who were newly incarcerated in Japan for Stimulants Control Act violations. METHODS: First, 699 participants completed an anonymous self-report questionnaire. Of these, 636 participants who did not have any missing responses were included in the analysis. After calculating descriptive statistics, the associations between ACEs and suicidal behaviors were assessed using binary logistic regression analyses. RESULTS: Results showed that 76.1 % of the participants reported at least one ACE before the age of 18, and female participants reported a significantly higher number of adversities than their male counterparts. The most common ACEs were parental death or divorce, followed by psychological abuse. Logistic regression analyses revealed that ACE scores significantly increased the risk of suicidal ideation (SI; adjusted odd ratio [AOR] = 1.18, p < .001) and non-suicidal self-injury (NSSI; AOR = 1.18, p < .001) after controlling for possible confounding variables. CONCLUSIONS: Findings suggest the importance of early prevention and intervention for traumatic experiences, and have implications for the recommendation of gender-responsive, trauma-focused interventions, especially for female inmates in the criminal justice system, to break the intergenerational chain of abuse. Future research directions and treatment are discussed.

Gender Differences in the Relationship between Methamphetamine Use and High-risk Sexual Behavior among Prisoners: A Nationwide, Cross-sectional Survey in Japan.

This study aimed to examine the relationship between methamphetamine (MA) use and high-risk sexual behavior among newly incarcerated prisoners in Japan. We conducted a secondary analysis using cross-sectional survey data, which constituted a nationwide prison sample surveyed between July and November 2017. In total, 699 participants (462 male and 237 female prisoners), who completed the self-administered questionnaire during imprisonment were recruited for the study. The prevalence of high-risk sexual behaviors was as follows: inconsistent condom use (78.4% male, 81.7% female), multiple sexual partners (61.3% male, 41.3% female), history of sexually transmitted diseases (14.1% male, 23.6% female), and trading sex for drugs (15.6% male, 17.7% female). A logistic regression analysis showed that MA use during sex increased the likelihood of high-risk sexual behavior in both male (adjusted odds ratio [AOR] = 5.86; 95% confidence interval [CI] = 3.41-10.07) and female prisoners (AOR = 2.58; 95% CI = 1.33-5.00). Additionally, in female prisoners, a history of sharing MA injection (AOR = 1.60; 95% CI = 1.06-2.42) increased high-risk sexual behavior. Our results indicate that harm reduction programs tailored according to the specific necessities of each gender to reduce high-risk sexual behaviors among MA users should be included in Japanese drug policies.

Does cognitive behavioral therapy for anxiety disorders assist the discontinuation of benzodiazepines among patients with anxiety disorders? A systematic review and meta-analysis.

Long-term use of benzodiazepines (BZD) is not recommended for the treatment of anxiety disorders. Cognitive behavioral therapy (CBT) is an effective treatment option for discontinuation of BZD in patients with anxiety disorders. This systematic review and meta-analysis sought to clarify whether CBT is effective for discontinuing BZD anxiolytics in patients with anxiety disorders. This study was preregistered with PROSPERO (registration number: CRD42019125263). A literature search of major electronic databases was conducted in December 2018. Three randomized controlled trials were included in this review, and meta-analyses were performed. The proportion of discontinuing BZD anxiolytics was significantly higher in the CBT plus gradual tapering group than in the gradual tapering alone group, both in the short term (3 months after allocation; number needed to treat: 3.2, 95% confidence interval [CI]: 2.1 to 7.1; risk ratio: 1.96, 95%CI: 1.29 to 2.98, P = 0.002, three studies) and long term (6 to 12 months after allocation; number needed to treat: 2.8, 95%CI: 1.9 to 5.3; risk ratio: 2.16, 95%CI: 1.41 to 3.32, P = 0.0004, three studies). CBT may be effective for discontinuing BZD anxiolytics, both in the short term and in the long term after the allocation. Further studies with larger sample sizes are necessary to draw definitive conclusions regarding the efficacy and safety of CBT for discontinuing BZD anxiolytics in patients with anxiety disorders.

The relationship between severity of drug problems and perceived interdependence of drug use and sexual intercourse among adult males in drug addiction rehabilitation centers in Japan.

BACKGROUND: Consuming drugs in conjunction with sexual intercourse may shape the perceived interdependence of drug use and sexual intercourse (PIDS). Additionally, the severity of drug problems may have a significant impact on PIDS. However, this relationship remains unverified. Therefore, this study investigates whether the severity of drug problems is associated with PIDS among adult males in drug addiction rehabilitation centers (DARC) in Japan. METHODS: This study was a secondary analysis of the "DARC Follow-Up Study in Japan" conducted by the National Center of Neurology and Psychiatry in 2016, in which participants from 46 facilities completed a self-report questionnaire. A total of 440 males with drug dependence were included in the analysis. We analyzed participants' demographic characteristics, history of sexually transmitted disease diagnoses, and responses to questions related to drug use (e.g., primary drug use and PIDS). Additionally, we measured the severity of drug problems using the Japanese version of the Drug Abuse Screening Test-20 (DAST-20). RESULTS: The median age of the participants was 42 years. The median DAST-20 score was 14.0, the primary drug was methamphetamine (61.4%) and new psychoactive substances (NPS: 13.6%). Multivariate analysis indicated that participants' experiences with unprotected sexual intercourse ("mostly a non-condom user": adjusted odds ratio (AOR) = 4.410), methamphetamine use (AOR = 3.220), new psychoactive substances use (AOR = 2.744), and the DAST-20 score (AOR = 1.093) were associated with PIDS. CONCLUSIONS: This study indicated that the frequency of unprotected sexual intercourse under the influence of drugs, methamphetamine and NPS use were strongly associated with PIDS. The severity of drug problems was also significantly associated with PIDS. It is necessary to develop culturally appropriate treatment programs adapted to the needs of patients who experience strong PIDS.

Gender Differences in Triggers of Stimulant Use Based on the National Survey of Prisoners in Japan.

BACKGROUND: There are a few studies on gender differences in terms of reasons and motives for methamphetamine use. Purpose/Objectives: To examine gender differences in triggers of methamphetamine use Methods: We provided a questionnaire survey to 699 inmates who were incarcerated because of violation of the Stimulants Control Act. Results: The results of DAST-20 (the severity of drug dependence) moderately correlated with the applicable numbers of the 37 situational triggers and 34 emotional triggers for stimulant use, respectively. Regarding gender differences, items including "when having sex" [46.3% (men) vs. 25.3% (women)], "when I have some money" (39.4% vs. 25.3%), and "after getting paid from work" (22.1% vs. 11.4%) were applicable in a significantly higher proportion in males (p < 0.001 and p = 0.008, respectively), whereas items including "worried about the body shape" (3.5% vs. 31.2%) and "after quarreling with someone" (11.7% vs. 29.1%) were applicable in a significantly higher proportion in females (p < 0.001 for both comparisons). Further, most trigger (emotions) items that exhibited gender differences were significantly higher in females. Many females answered that they had used drugs to relieve discomfort symptoms associated with menstrual periods. Conclusions/Importance: Thus, the awareness of important factors including learning how to deal with negative emotions (e.g. depression), repairing self-image, and recognizing physical and emotional changes associated with the menstrual cycle is helpful in providing proper care and treatment of drug addiction in females.

Parental drinking according to parental composition and adolescent binge drinking: findings from a nationwide high school survey in Japan.

BACKGROUND: Alcohol problems in parents have been revealed to affect adolescent alcohol misuse. However, few studies examine the effects of parental drinking on adolescent risky drinking (including binge drinking) in the general population. In particular, previous study findings are inconsistent regarding the influence of parental drinking according to parental composition. In this study, we aimed to examine the relationship between parental drinking, according to parental composition, and binge drinking among high school students in Japan. METHODS: We performed a secondary analysis of the Nationwide High School Survey on Drug Use and Lifestyle 2018, Japan. A total of 46,848 valid surveys from high school students of 78 schools were included for analysis. Logistic regression analysis with a generalized linear mixed model was conducted with binge drinking as the dependent variable and "parental drinking according to parental composition" (e.g., father's drinking, mother's drinking, father's absence, mother's absence, both parents drinking, and neither parent at home) as the independent variable, after adjusting with covariates. Binge drinking was defined as five or more alcoholic drinks for male adolescents or four or more alcoholic drinks for females on the same occasion within two hours. RESULTS: In the fully adjusted models, adolescents whose mothers drink (adjusted odds ratio (AOR): 1.50, 95% confidence interval (CI): 1.06-2.12) were significantly associated with adolescent binge drinking. This risk was significantly higher among students with neither parent living at home (AOR: 4.35, 95% CI: 2.10-9.02). CONCLUSION: Parental drinking and absence do affect adolescent binge drinking; our findings show that adolescents are more likely to engage in binge drinking if their mothers drink or if they are not living with either parent. Therefore, it is important to engage parents and non-parental family members in future programs and interventions to prevent adolescent binge drinking.

Risk factors for the onset of dependence and chronic psychosis due to cannabis use: Survey of patients with cannabis-related psychiatric disorders.

AIM: The objective of the current study was to identify risk factors that affect the onset of dependence and chronic psychosis due to cannabis use. METHODS: We examined clinical genetic factors, psychiatric disorders prior to cannabis use, starting age of cannabis use, duration and frequency of cannabis use, types of cannabis products used, combined use of other psychoactive substances, and the psychiatric diagnosis of 71 patients with cannabis-related psychiatric disorders who underwent treatment at nine mental health hospitals in Japan. Information was collected from cross-sectional interview surveys conducted by each patient's attending psychiatrist. RESULTS: For the diagnosis of dependence syndrome due to the use of cannabis, we found associations with the number of years of cannabis use and the use of cannabis products with a high Δ9-tetrahydrocannabinol (THC) content. However, we found no association between diagnosis of residual and late-onset psychotic disorders and clinical genetic factors, presence of preceding psychiatric disorders, duration and frequency of cannabis use, starting age of cannabis use, or combined use of other psychoactive substances; an association was found only for the absence of use of cannabis products other than dried cannabis. CONCLUSION: The onset of cannabis dependence was related to long-term cannabis use and the use of cannabis products with a high THC content. However, chronic psychosis was not associated with total THC intake or psychiatric vulnerability. Thus, unknown factors appear to be involved in the onset of chronic psychosis.

[Current Situation of Cannabis Use in Japan: Based on Data from the Nationwide General Population Survey on Drug Use in Japan 2017].

This study aimed to review the current state and trends in cannabis use in Japan, using data from several national epidemiological surveys. The number of cannabis users in the general population was estimated approximately 1.3 million people. Cannabis use increased between 2015 and 2017. In 2017, the lifetime prevalence of cannabis use was greater than that of inhalants, and cannabis had become the most abused drug in Japan. The increase in cannabis users is thought influenced by increased access to illegal cultivation and positive thinking about cannabis use among many people, especially younger individuals.

The influence of tightening regulations on patients with new psychoactive substance-related disorders in Japan.

AIMS: This study aimed to investigate the influence of tightened regulations on new psychoactive substances in patients with disorders related to these drugs in Japan. METHODS: We used a biennial nationwide survey on drug-related psychiatric disorders to examine why individuals who had previously used new psychoactive substances as their primary drug (the drug that had the greatest impact on their psychiatric symptoms) had switched to other drugs, how they had used drugs in the last 12 months and what type of drugs they were now using. We compared the clinical features of these individuals with patients who mainly used new psychoactive substances and had used these drugs at least once in the last 12 months. RESULTS: A total of 2262 people were included, and 399 had used new psychoactive substances. Of those, 71 people had switched to another drug as primary drug, mostly stimulant drugs (35.2%), hypnotics and anxiolytics (15.5%), and cannabis (14.1%) and used these drugs during the previous 12 months. The majority, 53.3%, had switched "because new psychoactive substances were no longer available." In total, 25 people mainly used new psychoactive substances. The group that had changed drugs had more experience of using methamphetamine and were more likely to have abused other drugs before using new psychoactive substances. They had often switched to illegal or prescription drugs after regulations had been tightened. CONCLUSION: The number of patients abusing new psychoactive substances decreased after drug regulations were tightened, but new psychoactive substances-related problems still exist. It is therefore not enough to tighten regulations. Drug dependence treatment and recovery support are also needed.

[The Pharmacist as Gatekeeper of Prescription Drug Abuse: Return to "Community Scientists"].

  The non-medical use or abuse of prescription drugs, including benzodiazepines, is a growing health problem in Japan. An association between prescription drug overdose and suicide risk has also been reported. The Japanese Ministry of Health, Labour and Welfare has expected pharmacists to act as "gatekeepers", facilitating early identification of individuals at high risk of prescription drug abuse including overdose, supplying medication counseling to patients, and helping to introduce these patients to appropriate medical care. Prescription drugs such as benzodiazepines are widely used in psychiatry. However, these drugs are prescribed not only by psychiatrists but also by other healthcare professionals including primary care physicians. Moreover, in recent years, the dispensing of prescriptions has moved rapidly from inside to outside hospitals, with prescription drugs being dispensed mainly at community pharmacies. Although all healthcare professionals including hospital pharmacists can play a role in preventing prescription drug abuse, the role of the community pharmacist is vital in addressing this problem. Formerly, community pharmacists were recognized as "community scientists", low-threshold accessible healthcare advisors. Now, community pharmacists should return to the role of community scientists to prevent prescription drug abuse. This article begins by reviewing the current situation of prescription drug abuse and dependence in Japan. The role of pharmacists as gatekeepers in preventing prescription drug abuse is then examined. Finally, this article discusses the effect of intervention in the form of gatekeeper training for community pharmacists.

Survey design and outcome measures to evaluate the effectiveness of relapse prevention guidance for drug-dependent inmates in-Japan: A review.

PURPOSE: . In the last-decade, the treatment of drug offenders in Japanese prisons has changed from severe punishment to a therapeutic approach. This study aimed to review studies that evaluated the effectiveness of relapse prevention guidance for drug- dependent inmates in Japan. METHODS: We searched three databases: Ichushi; the Japanese correctional library database; and- PubMed. The inclusion criteria were: 1) the guidance was conducted in prisons in Japan; 2) the participants were Japanese adult inmates; 3) the evaluations were reported in quanti- tative investigations and original articles in Ichushi and PubMed; and, 4) the evaluations were reported in quantitative investigations in the Japanese correctional library database. RESULTS: In total, we identified 13 studies. Three studies.used comparison groups, and two studies included follow-up after the inmates' : release. Two studies-used recidivism and one used treatment persistence as behavioral outcomes. Almost all of the studies used psychological scales. Self-efficacy measures were the most commonly used, and the second most common scale was the Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES). CONCLUSION: 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.

[Kiken drugs: current status of abuse among youth in the nightlife areas of Tokyo].

The abuse of "Kiken drugs," including synthetic cannabinoids, is a serious and growing social problem in Japan. Kiken drugs is the general term for novel psychoactive substances that have not been designated as illegal by Japanese law. The aim of this article is to describe the current status of the abuse of Kiken drugs by youth in the nightlife areas of Tokyo. An anonymous field-based survey was conducted using laptop computers at four dance parties in Tokyo, Japan. The questionnaires were completed by 307(44% female, mean age 30.9 years) young adults at the dance parties. Among the survey participants, 24.4% reported Kiken drug use (herbs 22.8%, powders 7.2%, and liquids 3.3%) in their lifetime. The primary reasons for Kiken drug use were peer pressure (37.3%), and avoiding penalties for possession of illegal drugs under Japanese laws (28.0%). In addition, 61.3% reported obtaining Kiken drugs from close friends. Our results clearly suggest that young adults at dance parties have a higher lifetime prevalence of Kiken drug use than the Japanese general population (0.4% reported in 2013). As the social stigma associated with drug use is extremely high in Japan, avoiding illegal drugs prohibited by law by using easily available Kiken drugs may be more socially acceptable among youth in the nightlife areas.

[Reliability and validity of the Japanese version of the DAST-20].

OBJECTIVE: Assessing the degree of problems related to drug abuse is important in each treatment setting. The Drug Abuse Screening Test-20 (DAST-20) is a brief, simple 20-item instrument to measure the degree of problems related to drug use. The objective of the present study is to examine the reliability and validity of the Japanese version of the DAST-20. METHODS: We translated the DAST-20 into Japanese using back translation. The anonymous self-administered questionnaire was completed by 310 drug users at the Drug Addiction Rehabilitation Centers (DARC group, n = 113) and at HIV/AIDS regional hospitals (HIV group, n = 197) in Japan. RESULTS: The average DAST-20 score was 7.6 (DARC group = 14.7, HIV group = 2.8). Each item score was highly correlated with the total score (r = 0.45-0.88). A high internal consistency (Cronbach's α = 0.95) was observed (men = 0.95, women = 0.84). Overall test-retest reliability was 0.86 (men = 0.85, women = 0.90). The total DAST-20 score was strongly positively correlated with the Severity of Dependence Scale-J score (r = 0.85), but moderately positively correlated with the Alcohol Use Disorders Identification Test score (r = 0.41). In addition, confirmatory factor analysis indicated an acceptable fit to the data (goodness-of-fit index [GFI] = 0.893, adjusted goodness-of-fit index [AGFI] = 0.854, comparative fit index [CFI] = 0.948, root mean square residual [RMR] = 0.008, root mean square error of approximation [RMSEA] = 0.073). CONCLUSION: Our results clearly suggest that the Japanese version of the DAST-20 has sufficient internal consistency and acceptable levels of concurrent validity and construct validity.