Feasibility, acceptability, and preliminary efficacy of cognitive processing therapy in Japanese patients with posttraumatic stress disorder.

Cognitive processing therapy (CPT) is one of the most widely tested evidence-based treatments for posttraumatic stress disorder (PTSD). However, most studies on CPT have been conducted in Western cultural settings. This open-label, single-arm trial investigated the feasibility, acceptability, and preliminary efficacy of CPT for treating Japanese patients with PTSD. A total of 25 outpatients underwent 12 CPT sessions. The primary outcome was the assessment of PTSD symptoms using the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV); secondary outcomes included the assessment of subjective PTSD severity, depressive and anxiety symptoms, trauma-related cognitions, and subjective quality of life. All outcomes were evaluated at pretreatment (i.e., baseline), posttreatment, and 6- and 12-month follow-ups. On average, participants attended 13 sessions of CPT (SD = 1.38), with a completion rate of 96.0%. One serious adverse event (hospitalization) occurred. Significant within-subjects standardized mean differences in CAPS-IV scores were found from baseline to treatment completion, g = -2.28, 95% CI [-3.00, -1.56]; 6-month follow-up, g = -2.95, 95% CI [-3.79, -2.12]; and 12-month follow-up, g = -2.15, 95% CI [-2.89, -1.41]. Moderate-to-large effects, gs = -0.77 to -2.45, were found on secondary outcomes. These findings support the feasibility, acceptability, and preliminary efficacy of CPT in a Japanese clinical setting.

Establishing norms on the Japanese version of the Eyberg Child Behavior Inventory.

BACKGROUND: The Eyberg Child Behavior Inventory (ECBI) is one of the standardized parent rating scales used to identify disruptive behavior problems in children in Western countries. This study aimed to determine norms for the Japanese version of the ECBI, including clinical cutoff scores among the general population in Japan. METHODS: This study established norms for the Japanese version of the ECBI using a sample of 1,992 parents of children aged 2-7, living in Japan. The research evaluates the validity and the reliability of the ECBI scores for the Intensity Scale and the Problem Scale. After validation, a clinical cutoff value of the ECBI scores was calculated, setting the cutoff to above the +1 standard deviation (SD) level based on the population distribution. RESULTS: The means of the Intensity and Problem Scale scores were 100.07 and 6.57, respectively. Cronbach's α for both the Intensity and the Problem scores was 0.91. At this point, we propose cutoff scores of 125 for the Intensity Scale and 14 for the Problem Scale. CONCLUSIONS: Our results suggest that the Japanese version of the ECBI is highly reliable and may be useful as a tool for assessing behavior problems in children.

The Prevalence of Binge Drinking and Alcohol-Related Consequences and their Relationship among Japanese College Students.

Binge drinking is a common and risky behavior among college students. In Japan, however, research on the prevalence of binge drinking and alcohol-related consequences, and the relationship between them, is currently scant. The aim of this study is to examine the status of binge drinking and alcohol-related problems, and the relationship between them, among Japanese college students. We conducted a cross-sectional survey of college students who participated in a health seminar or lecture including alcohol-related contents from December 2018 to January 2019. Drinking patterns and alcohol-related consequences were assessed using the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ) and demographic data. A total of 382 students participated in the seminar, of whom 280 agreed to cooperate in this study and 249 had drinking experience. A total of 88 men (67.7%) and 42 women (32.2%) were classified as binge drinkers. Binge drinkers more significantly experienced various consequences, such as hangover, feeling remorse and embarrassing behavior and some of them were suspected of physical dependence. Furthermore, logistic analysis revealed that among men, the B-YAACQ scores of binge drinkers were 2.01-fold higher those of non-binge drinkers. The findings of this study indicated that binge drinking may cause not only physical consequences but also mental and social problems, especially among men. It is important to tell college students these risks properly not to engage in binge drinking.

The Use of All-You-Can-Drink System, Nomihodai, Is Associated with the Increased Alcohol Consumption among College Students: A Cross-Sectional Study in Japan.

Excessive drinking by college students is a major public health problem in Japan. However, data on heavy episodic drinking (HED) and nomihodai, a several-hour all-you-can-drink system, are scarce. We surveyed the drinking behavior of undergraduate and graduate students at 35 colleges, and examined the association between HED and use of nomihodai. The study used a cross-sectional design conducted by a self-administered questionnaire. From December 2016 to March 2017, we sampled undergraduate and graduate students aged 20 or older at 35 colleges in the Kanto area, including Tokyo. The following items were measured: 1) frequency of drinking; 2) frequency of binge drinking in the past year; 3) nomihodai use; 4) the number of drinks consumed when using or not using nomihodai; and 5) sex and age for demographic data. Paired t-test was used to compare means between use and non-use state of nomihodai. The Fisher's exact test was used to evaluate the significance of the distribution difference between the two types of states. A total of 511 subjects completed the questionnaire, including 274 men and 237 women. The amount of drinking was increased 1.8-fold (85.9 ± 49.7 g vs. 48.2 ± 29.5 g) among men and 1.7-fold (63.7 ± 39.3 g vs. 36.5 ± 26.7 g) among women during nomihodai use, comapred with non-use states. Among them, 109 (39.8%) men and 71 (30.3%) women reported HED only at nomihodai states. These data suggest that the use of nomihodai system may lead to excessive drinking among college students.

Reasons for Drinking among College Students in Japan: A Cross-Sectional Study.

Binge drinking by college students is a problematic behavior. However, data on binge drinking and the reasons for drinking by college students in Japan are scarce. We explored the reasons for drinking among college students. The study used a cross-sectional design and a self-administered questionnaire. From December 2016 to March 2017, we sampled undergraduate and graduate students aged 20 or older at 35 colleges in the Kanto region of Japan. The questionnaire addressed 1) frequency of drinking alcohol, 2) amount of drinking per day, 3) frequency of binge drinking in the past year, and 4) reasons for drinking (with 12 possible responses). The t-test was used to compare the means between binge drinkers and non-binge drinkers. Logistic regression analysis was conducted on binge drinking and the reasons for drinking. The participants included 303 men and 260 women. Significant differences between men and women included the presence of binge drinking (men: 74.9%; women: 59.6%). Among male students, the statistically significant reasons given for binge drinking were "to feel happy or be in a good mood" and "to relieve stress," whereas among female students, the reasons were "to feel happy or be in a good mood," "to facilitate interpersonal relationships," "to forget something bad," and "to relieve stress." The reasons for drinking associated with binge drinking were identified. It is important to incorporate these results into preventive education about binge drinking aimed at college students in Japan.

Cumulative risk effect of household dysfunction for child maltreatment after intensive intervention of the child protection system in Japan: a longitudinal analysis.

BACKGROUND: Building an effective casework system for child maltreatment is a global issue. We estimated the effect of household dysfunction (i.e., interparental violence, caregiver mental health problems, and caregiver substance abuse) on child maltreatment to understand how to advance the current framework of child welfare. METHODS: The sample comprised 759 children (1- to 17-year-old; mean age was 10.6; 404 boys and 355 girls) placed in temporary custody units (one of the strongest intervention of the Japanese child protection system). Caseworkers from 180 units across 43 prefectures completed questionnaires on children and their family and were asked whether a child maltreatment report had been made after cancelation of custody in a 15-month follow-up period. The relations of household dysfunction and maltreatment reports were assessed using the Cox proportional hazard model. RESULTS: About half (48.4%) of the children had been placed in the unit because of maltreatment, and 88.3% had a history of victimization. Seventy-six cases had maltreatment reports after cancelation. We entered household dysfunction variables individually into the model, and each had a significant relationship with maltreatment reports (hazard ratios for interparental violence, caregiver mental health problem, and substance abuse were 1.69, 1.69, and 2.19, respectively) after covariate adjustment. When treating these three variables as cumulative risk score model of household dysfunction, the hazard ratio increased with increasing number of score (1.96 for score two; 2.35 for score three; score 0 as reference). CONCLUSIONS: Greater household dysfunction score is a risk of maltreatment after intensive intervention. It is imperative to construct systems facilitating cooperation between child and adult service sectors and to deliver seamless services to children and families. Our findings provide child protect services with risk-stratified interventions for children at victimization risk and promote adult-focused services to be proactive in prevention or intervention for adults with perpetration risk.

Evaluation of the relationship between internet addiction and interpersonal relationships in university studentsin Japan.

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 study of factors contributing to the aggravation of gambling disorder.

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 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.

[Study on job support programs for drug addicts in japan: results of a nationwide survey on drug addiction rehabilitation centers (DARC)].

In Japan, many drug addiction rehabilitation centers (DARC) provide various types of recovery programs for drug addiction. The purpose of this study was to clarify the attitudes of DARC staff and users regarding job support programs. A nationwide questionnaire survey was conducted in 2009. The staff of 46 facilities and 606 users returned questionnaires. The results indicated that many (92.1%) users had work experience before entering the recovery programs provided by DARC and about half (49.3%) of the users reported being motivated to work. Although many DARC have established various job support programs, the users faced various levels of anxieties to get employed and 60.4% of the users expected to learn more detailed and concrete methods for finding a job. Through the DARC programs, the users gradually realize the significance of basic daily living skills such as maintaining their rhythm of life or neat and presentable appearance. And the more they get recovered the more they understand the significance of "self-care" and "interpersonal relationship skills". These findings indicate that job support programs for drug addicts should also focus on these recovery processes. More extensive job supports dealing with more practical issues and covering a wide variety of anxieties would be imperative.

Meta-Analysis of Internet Gaming Disorder Prevalence: Assessing the Impacts of DSM-5 and ICD-11 Diagnostic Criteria.

With the inclusion of Internet gaming disorder (IGD) in both the DSM-5 and ICD-11, understanding the prevalence and diagnostic discrepancies is crucial for developing appropriate interventions. This study presents a meta-analysis of the prevalence of IGD based on two diagnostic criteria. We systematically searched the PubMed and Web of Science databases. A total of 22 studies were included in the final analysis. The analysis incorporated studies employing the DSM-5 and ICD-11 criteria and focused on the impact of various factors, including study location, sample characteristics, sample size, and quality score, on the reported prevalence rates using a random-effects model. The pooled prevalence of IGD is 6.7% (95% CI: 5.7-7.7%). The subgroup analysis indicated significant differences in the prevalence rates of IGD (DSM-5 criteria) and GD (ICD-11 criteria) (Q b = 38.46, p < 0.01). There were also significant differences in IGD prevalence rates between different scales (Q b = 54.23, p < 0.001). Our findings indicate that different diagnostic criteria and different assessment scales have a significant impact on the prevalence of IGD. This underscores the importance of adopting standardized methodologies to guide public health interventions. However, given the limited research based on ICD-11 diagnostic criteria, further investigation is necessary to determine the variations in prevalence rates of IGD under different diagnostic standards.

[Awareness of pre-alcoholics and changes process in their awareness--analysis of narratives by patients and their families].

This study aimed to compare the process of changes in the recognition of pre-alcoholism between alcoholic patients and their family members, and examine the timing and methods of intervention for patients and their families. We conducted semi-structured interviews with 15 patient-family pairs, consisting of inpatients on the alcoholism ward and their family members in the same household. Our analysis of interview data showed that the process of changes in the patients' drinking behavior, i.e., from healthy drinking to alcohol dependence, had the following 4 stages: "look to benefits of alcohol consumption", "escape reality that they found hard to bear", "manifest health-related impairment", and "have increasing difficulties in restraining themselves from drinking". Drinking problems became more serious when the patients went through several stages at one time, or when they moved back and forth between the stages. There was a time gap between patients and their families in recognizing drinking problems, which leads to the worsening of the problems. Behind this lied communication and emotional problems between patients and their family members. The findings suggest the need to take account of the pre-alcoholic stages, and adequately respond to and care for both patients and families from an early stage onward.

[Research on the actual conditions of alcohol dependence, the harmful use of alcohol and the optimal treatment in gastroenterological inpatients].

PURPOSE: The goal of the study was to examine the status, Stages of Change and motivation, alcohol dependence, and harmful use of alcohol in gastroenterological inpatients. METHODS: We interviewed 141 gastroenterological inpatients and analyzed their medical charts. The interviews used the Alcohol Use Disorders Identification Test (AUDIT), CAGE questionnaire and questions pertaining to drinking behavior, diagnosis, self-awareness of drinking/alcohol dependency, physician instructions regarding abstinence, and Stages of Change. The proportion of patients who screened positive was calculated based on the AUDIT, CAGE and International Classification of Diseases (ICD)-10 alcohol dependence/harmful use criteria. Alcohol dependence was defined as a score >or= 15 on the AUDIT, and harmful use as 8-14 on the AUDIT or meeting ICD-10 criteria for harmful use. Patients with alcohol dependence or harmful use comprised the hazardous drinking group. Common disorders in this group and in patients in a non-drinking group were compared by Fisher exact test. Stages of Change were also determined in the hazardous drinking group and factors regarding motivation and Stages of Change were analyzed using logistic regression analysis. RESULTS: Of the 141 patients, 18 (12.8%) scored >or= 15 on the AUDIT, 19 (13.5%) scored L 2 on the CAGE, and 48 (34%) scored >or= 8 on the AUDIT. Among those who met the ICD-10 criteria, 16.3% had alcohol dependence and 17.7% exhibited harmful use of alcohol. Significantly, common disorders in the hazardous drinking group included liver disease, colonic diverticulitis, gout/hyperuricemia, and pancreatitis. Of the alcohol-dependent patients, 52% were in the Preparation stage. After the Contemplation stage, instructions to abstain from alcohol were the most significant motivational factor. CONCLUSIONS: Many gastroenterological inpatients exhibited alcohol dependence and about half of these patients were able to prepare for behavioral changes related to drinking. Therefore, the gastroenterological ward may help in secondary prevention of alcohol dependence and harmful use.

Sex differences in risk factors for suicidality among Japanese substance use disorder patients: association with age, types of abused substances, and depression.

AIM: The aim of this study was to identify risk factors for suicide in Japanese substance use disorder (SUD) patients, adjusting for age and sex, and to examine sex differences in suicide risk among these patients. METHODS: A self-reporting questionnaire on age, sex, types of abused substances, current depression, and suicidality was administered to 1420 SUD patients who consecutively visited seven hospitals specializing in SUD treatment during the month of December 2009. Unadjusted/adjusted odds ratios of factors associated with suicidality were calculated for each sex. RESULTS: The multivariate analysis using the total sample identified younger age, female sex, and current depression as risk factors for severe suicidality in SUD patients. The multivariate analysis by each sex demonstrated that younger age and current depression were associated with severe suicidality in male SUD patients. Only current depression was associated with severe suicidality in female patients. CONCLUSION: Current depression is a risk factor for suicide in SUD patients common in both Western countries and Japan, although in Japanese SUD patients both younger age and female sex were more closely associated with severe suicidality than aspects of SUD. Additionally, young male SUD patients are speculated to have psychosocial features associated with suicidality in common with female SUD patients.

[A study on clinical features of patients with benzodiazepines use disorder (BZsUD), and characteristics of psychiatric treatments which may cause BZsUD].

BACKGROUND AND AIMS: The aims of present study are to clarify the clinical features of patients with benzodiazepine use disorder (BZsUD), and to examine the characteristics of psychiatric treatments which may cause BZsUD. METHODS: We conducted a medical chart and interview survey to 87 outpatients with benzodiazepine use disorder, who had consecutively visited the four hospitals, specialized in addiction problems, located in metropolitan area, during a month of December, 2011. RESULTS: Consequently, 88.5% of the patients with BZsUD reported to obtain BZs to be abused from general psychiatric clinics, and 83.9% contracted BZsUD in process of general psychiatric treatment. Among the patients who contracted BZsUD in process of psychiatric treatment, 43.8% were speculated to have the other substance-related disorders such as methamphetamine or alcohol-related disorder at start of the psychiatric treatment. Further, approximately 70% of them reported that surplus BZs were prescribed without consideration of storing drugs, and over 40% also reported that BZs were prescribed without a medical examination. CONCLUSIONS: The findings of the present study may let us to propose the following four measures to be taken for prevention of BZsUD: First, latent substance-related disorders should not be overlooked, second, short-acting and high-potency BZs should not be prescribed if possible, third, storing and abusing BZs should always be considered, and finally, BZs should be prescribed with a medical examination.

[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.

[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.

Impact of Short-Term Intensive-Type Cognitive Behavioral Therapy Intervention on Internet Addiction among Chinese College Students: A Randomized Controlled Trial.

The object of this study is to examine the effects of a short-term intensive-type Cognitive Behavioral Therapy (CBT) intervention to prevent internet addiction among Chinese college students. We conducted a randomized controlled trial applying a group counseling intervention program based on CBT. Data included 21 participants in the intervention group and 22 participants in the control group. The results showed that the intervention program reduced college students' internet addiction symptoms and procrastination and improved their sense of coherence. Regarding the sustained effect, internet addiction symptoms decreased and perceived social support from significant others improved in college students. However, the intervention program did not significantly reduce their average daily internet use time and psychological stress. Overall, this study developed a short-term intensive-type intervention program based on CBT theory, which is complementary for Chinese college students with internet addiction.

[Community care in home-visit nursing for drug-dependent people--questionnaire survey of home-visit nursing stations].

The present study aimed to clarify the present status of home-visit nursing for drug-dependent people and awareness among their caretakers. A questionnaire was sent to 279 stations that provide home-visit psychiatric nursing care. Among the 89 stations that responded, 24 (26.9%) are currently providing home-visit nursing for drug-dependent patients, while 36 (40.4%) had experience doing so in the past. Although many stations recognized that drug-dependent patients need home-visit nursing, their practices tended to be based on trial and error due to insufficient knowledge about the actual conditions and recovery processes of drug dependence. Compared to stations that had experience with home-visit nursing for drug-dependent patients, stations without such experience were more concerned about the safety of caretakers and their insufficient specialist knowledge about drug dependence.

Mental health and emotional relationships of family members whose relatives have drug problems.

The presence of a drug abuser in a family can seriously affect the family's mental health and relationships. This study focuses on the stress of families of drug abusers, relationships, and their relevant factors, as well as examines ways to support them. The subjects of this study were family members of drug abusers treated at drug abuser family support groups, medical institutions, or municipal mental health and welfare centers. To these institutions, 1,298 questionnaires were sent, and 543 responses with sufficient data were used for analysis. The survey consisted of the 12-item General Health Questionnaire (GHQ-12), and questionnaire items regarding disruptions to family life, relationship with drug users, and the use of family support services. The survey results showed that the mean GHQ score was 4.5, and those whose score are cut-off 3 and more, indicating poor mental health accounted for 54.7%. More than half of the subjects responded that drug problems have affected family members in terms of the health condition, daily living, and financial problems. Regarding emotional relationships with the addicts, most of the families answered that they have had negative feelings toward them, such as "being dragged into drug problems" and "being over-protective". A significant correlation was observed between the GHQ score and family members' relationship with the addict, and these variables were closely correlated with participation in the family group, the status of drug abstinence, living environment, and participation in a self-support group by the addict. As the results, most of the family members of drug users have problems with mental health and the recovery of relationships even though they have accessed support centers, and it was verified that the family support group works effectively to help solve their problems.