A 12-session relapse prevention program vs psychoeducation in the treatment of Japanese alcoholic patients: A randomized controlled trial.

AIM: Alcoholism is the most prevalent substance use disorder in Japan; the estimated number of patients and high-risk drinkers is in the millions. Although studies in the West have shown that cognitive behavioral therapy (CBT) is one of the most effective treatment strategies for alcoholic patients, there is a dearth of efficacy studies of CBT-based intervention for those patients in the non-Western setting. The aim of this study is to investigate the efficacy of a 12-session CBT-based relapse prevention program for Japanese alcoholic patients. METHODS: Forty-eight alcoholic patients (M = 36, F = 12) who were admitted to an addiction treatment unit were randomly allocated either to a 12-session relapse prevention (RP) program (n = 24) or a 12-session psychoeducation (PE) program (n = 24). Both treatment programs were conducted in a group format once a week for 12 weeks. Other aspects of inpatient treatment (group meetings, etc) were the same in both groups. Self-rating scales, which measure behavioral and cognitive coping, coping response, self-efficacy, and cognition of drinking, were administered at pretreatment, mid-treatment, and posttreatment periods. The proportion of participants who relapsed at 3 and 6 months after discharge was evaluated. RESULTS: Both RP and PE groups showed significant improvement in self-efficacy and cognition of drinking at posttreatment. However, there were no significant differences in the self-rating scales between both groups. In addition, there were no significant differences in relapse rate at 3 and 6 months after discharge between both groups. CONCLUSIONS: The 12-session CBT-based relapse prevention program and the psychoeducation program may be equally efficacious for alcoholic patients. Several factors that influenced the results are discussed.

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.

A randomized controlled study of the effect of ifenprodil on alcohol use in patients with alcohol dependence.

AIM: This prospective, randomized, controlled, rater-blinded study investigated the effect of G protein-activated inwardly rectifying potassium (GIRK) channel inhibitor ifenprodil on alcohol use in patients with alcohol dependence. METHODS: The participants were 68 outpatients with alcohol dependence who were assigned to an ifenprodil group (administered 60 mg ifenprodil per day for 3 months) or control group (administered 600 mg ascorbic acid and calcium pantothenate per day for 3 months). The participants completed a questionnaire that included the frequency of alcohol drinking and presence of heavy drinking before the study period (time 1) and 3 months after the start of the study period (time 2). The alcohol use score was calculated using these two items. RESULTS: Valid data were obtained from 46 participants (25 in the ifenprodil group and 21 in the control group). The alcohol use score at time 2 in the ifenprodil group was significantly lower than that in the control group after adjusting for the score at time 1 and some covariates. The intention-to-treat analysis of multiply imputed datasets indicated similar results. Group differences in the frequency of alcohol drinking were significant in the multiply imputed datasets but not in 46 participants. The ifenprodil group had a significantly lower rate of heavy drinking at time 2 than the control group. CONCLUSIONS: This study found an inhibitory effect of ifenprodil on alcohol use in patients with alcohol dependence. The results support the hypothesis that GIRK channel inhibitors ameliorate alcohol dependence. TRIAL REGISTRY: This trial was registered in the UMIN clinical trial registry (UMIN000006347).

[Effectiveness of brief intervention for substance use disorder in Japan--a pilot study].

BACKGROUND: Relatively few hospitals can treat substance use disorder in Japan and the options for treatment are limited. Previous studies in the West have shown the effectiveness of brief intervention for substance use disorder. However, such treatment has not been sufficiently implemented in Japan. For this study, we developed brief intervention tools for substance use disorder, and conducted a pilot study to evaluate the efficacy of treatment. METHODS: Participants in this study were recruited from those admitted for substance use disorder in the addiction treatment unit of Tokyo Metropolitan Matsuzawa Hospital, and the recruitment period was from October 2013 through March 2014. The brief intervention consisted of one 30-min individual session. Four self-rating scales measuring motivation, relapse risk and self-efficacy were administered pre- and post-intervention: SOCRATES-8D, Stimulants Relapse Risk Scale, Drug Abuse Self-efficacy Scale and Visual Analogue Scale. RESULTS: Forty patients participated in this study. Subscale Scores at post-intervention that improved significantly compared to those at pre-intervention were Recognition (SOCRATES-8D); Total score and Anxiety and intention to use drug (Stimulants Relapse Risk Scale); Generalized self-efficacy (Drug Abuse Self-efficacy Scale); and Knowledge about drug abuse (Visual Analogue Scale). CONCLUSION: These results indicate that brief interventions may offer effective treatment for substance use disorder. A randomized controlled trial that contains an evaluation of abstinence rate in the follow-up period is needed to ascertain the efficacy of brief intervention for substance use disorder in Japan.

[A study of the rehabilitation support system for illegal substance use disorder patients from the viewpoint of the designated hospital. 4 case studies focusing on judicial treatment and drug urine monitoring].

This study was designed to reveal the current status of the rehabilitation support system for patients with Illegal Substance Use Disorder (ISUD). From among 465 patients who had been admitted to a psychiatric hospital in Tokyo within the past 10 years by order of the prefectural governor, 65 patients with ISUD were selected for inclusion in this study. Based on whether or not the person was arrested at the time of discharge, whether or not urine drug monitoring was ordered, and the results of the monitoring, each subject was classified into one of the following four types: 1) Arrested; 2) Not arrested and no urine drug monitoring; 3) Not arrested and positive urine drug monitoring results; and 4) Not arrested and negative urine drug monitoring results. In Group 1, every subject underwent urine drug monitoring prior to an involuntary examination; however, even though 10 percent of the subjects in this study were found to have positive results on urine drug monitoring, none of them were arrested. Moreover, 40 percent of the study subjects were not subjected to urine drug monitoring, and about 30 percent of non-arrested subjects were shown not to have used any illegal substances. Based on these results, it appears to be ideal for patients in Group 1 to apply to a diversion program, followed by medical treatment for addiction. To avoid the elimination of patients from medical services due to the vagueness of the classifications, whether or not judicial administration is required at the time of police intervention should be clearly and appropriately clarified for patients in Groups 2 and 3. Patients in Group 4 may experience a relapse of psychiatric symptoms, even if they do not use illegal substances; therefore, it is necessary for designated hospitals to perform medical treatment interventions responsibly for both endogenous psychosis and substance abuse, and to collaborate with appropriate social support facilities within the community regarding the medical discharge of such patients.

[A change of patients with methamphetamine-related disorders admitted to Tokyo Metropolitan Matsuzawa Hospital--the comparison between the second and third epidemics of methamphetamine abuse in Japan].

OBJECTIVES: Methamphetamine (MAP) is one of the most commonly abused drugs in Japan. Japan has experienced three major epidemics of MAP abuse. The characteristics of abusers have changed between the second and third epidemics; however, few epidemical studies have investigated these changes. The purpose of this study is to describe the differences in the characteristics of MAP abusers between the second and third epidemics. METHODS: We surveyed the medical records of patients admitted to Tokyo Metropolitan Matsuzawa Hospital for MAP-related disorders between 1989 and 1993 (n=60; second epidemic group) and between 2004 and 2008 (n=119; third epidemic group). We compared patients' backgrounds and issues related to MAP abuse between the two groups. RESULTS: Compared to the second epidemic group, more abusers in the third epidemic group were similar to the general population of young people in terms of education level and criminal activity; were on welfare; had dependence syndrome; smoked MAP; and co-abused legal drugs. In contrast, abusers who exhibited antisocial tendencies and injected MAP were more likely to be in the second epidemic group. CONCLUSIONS: We confirmed changes in the characteristics of MAP abusers between two of the three epidemics of MAP abuse in Japan. These findings suggested that the change of environments from the second epidemics of MAP abuse to the third one influenced the characteristics of MAP-related disorders. So, it is necessary to provide accurate and updated knowledge about MAP for the drug prevention to young people, and the treatment of dependence syndrome will become more important in the future.

[Study on risk factors of suicidal ideation in people with drug abuse].

In Japan, the target mental disorders of preventive strategies for suicide had been limited to be mood disorder, but recently drug abuse are known to be significant as a cause of suicide because some researches has found the association between substance use disorder and suicidal behavior in Japan. However, the preventive plans for suicide of drug abusers has not been developed yet. In this study we would like to examine the risk factors of suicide ideation in Japanese drug abusers. We analyzed the data of 445 drug addicts from the Nationwide Research of Drug Addiction Rehabilitation Centers by Tokyo DARC and compared many variables including demographic factors, drug use status, family history, psychopathologies, treatment and daily life satisfactions between people with suicide ideations and without ideations. It was found that 182 cases (43.8%) had suicide ideations in a recent month, and that addicts who had suicide ideations had significantly shorter abstinence time, higher prevalence of victimized experiences before 15 years age, and more mental symptoms such as insomnia, depression, and psychotic symptoms, and more tendencies to use prescribed psychotropic drug than those without suicide ideation. These results suggested that to prevent suicide of drug abusers, we should pay attention to family histories, insomnia and abstinence periods, and help them recovery from psychological damages caused by childhood trauma without inappropriate medications.

Family dysfunction differentially affects alcohol and methamphetamine dependence: a view from the Addiction Severity Index in Japan.

We investigated the differential influence of family dysfunction on alcohol and methamphetamine dependence in Japan using the Addiction Severity Index (ASI), a useful instrument that multilaterally measures the severity of substance dependence. The participants in this study were 321 male patients with alcohol dependence and 68 male patients with methamphetamine dependence. We conducted semi-structured interviews with each patient using the ASI, which is designed to assess problem severity in seven functional domains: Medical, Employment/Support, Alcohol use, Drug use, Legal, Family/Social relationships, and Psychiatric. In patients with alcohol dependence, bad relationships with parents, brothers and sisters, and friends in their lives were related to current severe psychiatric problems. Bad relationships with brothers and sisters and partners in their lives were related to current severe employment/support problems, and bad relationships with partners in their lives were related to current severe family/social problems. The current severity of psychiatric problems was related to the current severity of drug use and family/social problems in patients with alcohol dependence. Patients with methamphetamine dependence had difficulty developing good relationships with their father. Furthermore, the current severity of psychiatric problems was related to the current severity of medical, employment/support, and family/social problems in patients with methamphetamine dependence. The results of this study suggest that family dysfunction differentially affects alcohol and methamphetamine dependence. Additionally, family relationships may be particularly related to psychiatric problems in these patients, although the ASI was developed to independently evaluate each of seven problem areas.

[Correlation between childhood traumatic stress and present drug abuse: results of a nationwide survey of drug addiction rehabilitation facilities in Japan].

Child abuse is known to correlate with drug abuse and interferes with recovery from substance-related disorders. To determine the prevalence and severity of child abuse among drug addicts, we conducted a nationwide cross-sectional survey of residents and outpatients at drug addiction rehabilitation centers (DARC) in Japan. A total of 445 participants gave informed consent and completed a self-reporting questionnaire. Sixty-eight percent of participants had experienced some kind of child abuse by the time they reached junior high school. The kinds of abuse experienced were physical (53.7%), psychological (60.4%), sexual (5.4%) abuse and neglect (24.5%). Comparison of female and male participants revealed that more female than male participants had experienced psychological (76.9% vs. 58.2%) and sexual (17.5% vs. 4.0%) abuse. Comparison of participants who had experienced some kind of child abuse ("Abused" group 68.3%) and those who had not experienced abuse ("Non-abused" group 24.3%) revealed that the "Abused" group was younger than the "Non-abused" group (35.7 SD9.0 vs. 39.7 SD10.8). Participants in the "Abused" group were found to have more severe psychological difficulties than those in the "Non-abused" group for the following: anxiety (73.0% vs. 61.1%), delusional atmosphere (48.0% vs. 28.7%), lack of energy (53.9% vs. 40.7%), ideas of persecution (48.7% vs. 29.6%), depression (62.2% vs. 43.5%) and suicidal ideation in the previous year (50.7% vs. 24.3%). The present results suggest that additional program that prepared to care the drug addicts who experienced child abuse and are experiencing suicidal ideation is needed. Furthermore, intervention for families with risk factors for child abuse should be developed in order to prevent the victim from suffering not only from post traumatic stress disorder but also from substance related disorders.