Nonsmoking after simultaneous alcohol abstinence and smoking cessation program was associated with better drinking status outcome in Japanese alcohol-dependent men: A prospective follow-up study.

BACKGROUND: Growing evidence suggests that intervention for smoking cessation enhances alcohol abstinence in treatment settings for alcohol dependence. However, research in this field is rare in Asians. METHOD: We prospectively investigated the association of smoking status with drinking status using 9 surveys mailed during a 12-month period in 198 Japanese alcohol-dependent men (70 never/ex-smokers and 128 smokers) who admitted for the first time and completed a 3-month inpatient program for simultaneous alcohol abstinence and smoking cessation. RESULTS: Nonsmoking during the first month after discharge and at the end of follow-up was reported in 28.9% and 25.0% of the baseline smokers, respectively. Kaplan-Meier estimates showed that a 12-month alcohol abstinence and heavy-drinking-free status were more frequent among never/ex-smokers (45.1% and 59.8%, respectively) and baseline smokers who quit smoking during the first month after discharge (59.0% and 60.8%, respectively), compared with sustained smokers (30.0% and 41.2%, respectively). Among the baseline smokers, the multivariate odds ratio (95% confidence interval) for smoking cessation during the first month were 2.77 (1.01-7.61) for alcohol abstinence during the period and 2.50 (1.00-6.25) for use of varenicline, a smoking cessation agent, during the inpatient program. After adjusting for age, drinking profile, lifestyle, family history of heavy or problem drinking, lifetime episodes of other major psychiatric disorders, and medications at discharge, the multivariate hazard ratios (HRs) for drinking lapse were 0.57 (0.37-0.89) for the never/ex-smoking and 0.41 (0.23-0.75) for new smoking cessation groups, respectively, compared with sustained smoking, while the corresponding HRs for heavy-drinking lapse were 0.55 (0.33-0.90) and 0.47 (0.25-0.88), respectively. The HR for drinking lapse was 0.63 (0.42-0.95) for the nonsmoking group (vs. smoking) during the observation period, while the HR for heavy-drinking lapse was 0.58 (0.37-0.91) for the nonsmoking group (vs. smoking) during the observation period. Other significant variables that worsened drinking outcomes were higher daily alcohol intake prior to hospitalization, family history of heavy or problem drinking and psychiatric medications at discharge. CONCLUSION: Nonsmoking was associated with better outcomes on the drinking status of Japanese alcohol-dependent men, and a smoking cessation program may be recommended to be integrated into alcohol abstinence programs.

Alcohol dependence severity determines the course of treatment-seeking patients.

BACKGROUND: While accumulating evidence suggests a relation between the severity of alcohol dependence and the risk of its recurrence, the impact of dependence severity on the course of the disorder has not been carefully evaluated. The present study examined the impact of several severity indices of alcohol dependence on the drinking course after inpatient treatment. METHODS: This prospective study was conducted over a 12-month period following alcohol treatment at a specialized hospital. A total of 712 consecutively admitted alcohol-dependent patients were targeted for enrollment at the time of their hospitalization, with 637 patients registered and followed. The characteristics and severity of the subjects were assessed using multiple methods at admission, with their course after discharge followed continuously using mailed questionnaires that queried them regarding their drinking behavior. RESULTS: Greater severity of dependence, assessed using the number of ICD-10 diagnostic criteria met, was associated with a lower rate of abstinence during the study period (p = 0.035). The rate of abstinence also decreased significantly as the baseline blood gamma-glutamyl transferase value and Alcohol Dependence Scale (ADS) score increased (p = 0.031 and p = 0.0002, respectively). In multivariate Cox proportional hazards analyses, the group with the most severe ADS scores had a significantly greater risk of relapse to drinking than the group with the least severe scores (HR = 2.67, p = 0.001). Dependence severity also associated with the drinking pattern; participants in both the controlled drinking group and the abstinence group had lower ADS scores at admission and a later age at first drinking (p = 0.001 and p < 0.001, respectively) than those with poorer drinking outcomes. CONCLUSIONS: The present study showed that more severe alcohol dependence predicts a poorer course after alcohol treatment, as reflected by findings on multiple measures. These results suggest that assessing the dependence severity at the outset of treatment could be useful both in predicting treatment outcome and targeting interventions to alcohol-dependent individuals who need additional support in their recovery.

Development and validation of the Pachinko/Pachi-Slot Playing Ambivalence Scale.

BACKGROUND: A scale aimed at measuring ambivalence among people with pachinko/pachi-slot playing disorder, the Pachinko/Pachi-Slot Playing Ambivalence Scale (PPAS), was developed and its reliability and validity ascertained. METHODS: A total of 522 participants (average year: 48.0) who were residing in Tokyo Metropolitan Area, and had played pachinko within the previous year completed questions relating to demographics, four gambling-related scales (including South Oaks Gambling Screen) and two general ambivalence scales (including Ambivalence over Emotional Expressiveness Questionnaire). RESULTS: Internal consistency (α = 0.87) and test-retest reliability (r = 0.66) were confirmed. The PPAS's score was associated with each related scale's score (r = 0.37-0.62). CONCLUSIONS: The PPAS was shown to be consistent with previous scales and useful in clinical settings.

Exploration of Core Symptoms for the Diagnosis of Alcohol Dependence in the ICD-10.

BACKGROUND: The classification of alcohol use disorder has changed over the past century. Now, the conceptualization of alcohol dependence is still controversial. Accumulating evidence has shown the reliability and validity for the diagnosis of alcohol dependence in the ICD-10 and DSM-IV. However, the meaning and association of the respective diagnostic items, which are descriptive of representative symptoms, have hardly been examined. The core symptom of substance use disorder has been debated in various situations, but has never been elucidated logically. METHODS: We consecutively registered 192 patients with alcohol-related problems who visited our hospital for the first time during a certain period. The relations and principal components among the checked items of the ICD-10 diagnostic criteria were examined statistically. RESULTS: Three diagnostic items in the ICD-10 were strongly correlated with each other and were thought to form the core symptoms of alcohol dependence: "strong desire," "difficulties in controlling," and "neglect of pleasures." One major physical phenomenon, "withdrawal," seemed to complement the core symptoms in the diagnosis of alcohol dependence. Another physical phenomenon, "tolerance," was demonstrated to be a relatively independent item. The principal component analysis also demonstrated that the diagnostic item "difficulties in controlling" had the maximum component loading value, followed by 2 items, "neglect of pleasures" and "strong desire." CONCLUSIONS: The core symptomatic elements in the diagnosis of alcohol dependence were statistically suggested in this study. Knowledge of the relations and components among the diagnostic items of alcohol dependence might also be applicable to other forms of substance use dependence and behavioral addiction.

Dependence/addiction/use disorder from a therapeutic perspective -A preliminary study of preference for terms describing the condition.

This study focused on patients receiving specialized outpatient (n=26) care to improve addiction behavior (mainly patients with alcohol dependency) and investigated their preferences for terms that describe the relationship between a patient and the object of his or her addiction and how those preferences correlated with the patient's current stage of recovery. The results showed a correlation between a preference for the term "dependence" and a stagnated recovery and a correlation between a preference for the term "overindulgence" and recovery progress (p<0.05). This was a correlation study, so it did not reveal the existence of a causal relationship. It did, however, suggest that terms implying self-directedness, such as "overindulgence" or "addiction," are preferable to the term "dependence" when providing treatment, because they allow.the patient to have a more autonomous self-image. However, the words "use disorder" and "habit" are safe in the sense that they are neutral, so these words are useful when beginning treatment, etc., in a patient-centered care setting, such as one that utilizes Shared Decision Making (SDM).

[Effects of autism features on alcoholism--especially from the aspect of recovery promoting factors].

OBJECTIVE: It is important to evaluate and classify individual features of patients to select an appropriate treatment for alcoholism. In this study, we classified alcoholism types according to strength/weakness of autism features and investigated how these features were associated with onset, course, and especially continuation of abstinence. SUBJECTS AND METHODS: The subjects were 102 man outpatients diagnosed with alcoholism. The investigations were made on 3 areas: 1. Basic background including age, family and occupational information, 2. Medical variables including the number of years since the first visit, with/without juvenile onset, psychiatric complications, hospital admission history, self-help group participation, and the longest abstinence period, and 3. Autism-spectrum Quotient (AQ) scores. The AQ test is a self-administered test of autism features on a maximum scale of 50 points, based on the concept of "autism spectrum". RESULTS: The mean (standard deviation) of AQ scores of 102 subjects was 22.6 (7.18) with normal distribution. 78 subjects who had been followed-up for more than 2 years were classified into the low score (0-15) group of 11 subjects, the average score (16-29) group of 51 subjects, and the high score (30-50) group of 16 subjects, according to their AQ scores. No significant difference was observed in terms of patients' background and medical variables, but the number of subjects with stable abstinence (more than 2 years) was higher in the high score group compared to the average and low score groups (p = 0.0208). CONCLUSION: At least for men, it was presumed that continuation of alcohol abstinence was more difficult in the average score group (general type) and the low score group (over-empathy type) compared to the high score group (autism type) (odds ratio: 5.76); treatment approaches should be managed appropriately for these 3 types. It was also shown that the AQ test was a useful indicator for abstinence prognosis.

[Study on the perception of influencing factors in the course of alcoholism--a comparison among alcoholics, families, and health care professionals].

(1) We prepared a questionnaire modified from that of Edwards, G. et al, to investigate the factors influencing drinking behaviors. Responses of the questionnaire were filled out by the alcoholics, their families, and health care professionals in four psychiatric hospitals having intensive alcoholic rehabilitation programmes. Clinical course of them were traced back for at least two years. (2) We examined the relationship between the course of alcoholism and the differences in perceptions among alcoholics, their families, and health care professionals. (3) We obtained sufficient responses from 76 alcoholics. Those were divided into two groups; one is a group of alcoholics with a history of continuous abstinence of over one year (50 cases), and the other is the group of less than one year of recent abstinence period (26 cases). (4) As the overall results from the participants, items on "self-help group" were favorably responded for the improvement of drinking behavior. Families tend to perceive more sensitively into the internal psychological changes of the alcoholics than the health care professionals, whereas the health care professionals tend to make general and common responses regardless of any alcoholics. We, health care professionals should be aware of such a limit to promote more efficient collaborative works with alcoholics and their families. (5) We compared these two groups ("over one year group" vs. "less than one year group") with regard to their demographic and family backgrounds, clinical features, treatment, self-help group attendance, employment, etc. (6) A significant accordance of responses among three groups (alcoholics, family, health care professionals) was found in the "over one year group" than in the "less than one year group". Such a high level of accordance is considered to reflect a favorable family adaptation along with the recovery from alcoholism, deep understanding on the part of health care professionals, progress in the treatment and in the relationship in a self-help group. (7) As regards the "less than one year" group, it includes more single individuals and less frequent attendances to self-help groups. For this group of alcoholics, group therapy in a smaller group, individualistically oriented approaches for their needs including various supportive resources in the society should be addressed.