Nihon Arukoru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence最新文献

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.

We investigated the outcome of the patients with alcoholic liver cirrhosis who had visited our hospital from 2007 to 2013. We compared them with the patients with type C liver cirrhosis, matched in gender and in age. The patients with alcoholic liver cirrhosis who dropped out accounted for 19.3% (17 cases) of the whole. In 401 days of mean treatment period, the median value of the dropout patients was 43 days, indicating that a number of the patients dropped out in an early stage. The percentage of abstinence from alcoholic drinking was 35.3% in the dropout groups, whereas it was 67.6% in the non-dropout groups. It was conceivable that the abstinence was difficult for the dropout groups to perform. The percentage of the dropout in patients receiving livelihood protection was 35.7%, which was higher than that in general patients. There were no differences of the rate of dropout in general patients between alcoholic and type C liver cirrhosis. Since none of the patients with type C liver cirrhosis receiving livelihood protection dropped out, it was speculated that the cause of liver cirrhosis may be related to the rate of dropout. In summary, a number of patients with alcoholic liver cirrhosis have a difficulty in abstinence from alcoholic drinking. We also have to be careful to the high rate of dropout in patients with alcoholic liver cirrhosis receiving livelihood protection. In addition, it was thought that early incentive and education were important for these patients.

Opioids, such as morphine and fentanyl, are widely used as effective analgesics for the treatment of acute and chronic pain. In addition, the opioid system has a key role in the rewarding effects of morphine, ethanol, cocaine and various other drugs. The authors have focused on G-protein-activated inwardly rectifying potassium (GIRK) channel subunits, GIRK2 and GIRK3, that are important molecules in opioid transmission, and found that the single-nucleotide polymorphisms (SNPs) within the GIRK2 and GIRK3 gene regions were significantly associated with postoperative requirements of analgesics including opioids in patients who underwent abdominal surgery and mRNA expression of these genes in postmortem specimens, one of which was also associated with vulnerability to methamphetamine (METH) dependence. Further, by conducting a multistage genome-wide association study (GWAS) in healthy subjects, the authors found that genetic polymorphisms within a linkage disequilibrium block that spans 2q33.3-2q34 were strongly associated with the requirements for postoperative opioid analgesics after painful cosmetic surgery. The C allele of the best candidate SNP, rs2952768, was associated with more analgesic requirements, and consistent results were obtained in patients who underwent abdominal surgery. In addition, carriers of the C allele in this SNP exhibited less vulnerability to severe drug dependence in patients with methamphetamine dependence, alcohol dependence, and eating disorders and a lower 'Reward Dependence score on a personality questionnaire in healthy subjects. Furthermore, the C/C genotype of this SNP was significantly associated with the elevated expression of a neighboring gene, CREB1. The results show that SNPs in this locus are the most potent genetic factors associated with human opioid sensitivity known to date, affecting both the efficacy of opioid analgesics and liability to severe substance dependence. These outcomes provide valuable information for the personalized treatment of pain and drug dependence.

Although the involvement and plasticity of the mesocorticolimbic dopamine (DA) system in cocaine-induced addiction have been studied extensively, the role of the brainstem cholinergic system in cocaine addiction remains largely unexplored. The laterodorsal tegmental nucleus (LDT) contains cholinergic neurons that innervate the ventral tegmental area (VTA) and is crucial for regulating the activity of VTA DA neurons, implying that LDT may also be associated with cocaine addiction. In this review, we summarize our recent findings showing that cholinergic transmission from the LDT to the VTA is involved in acquisition and expression of cocaine-induced conditioned place preference and that, after repeated cocaine exposures, these neurons exhibit synaptic plasticity, which is dependent on NMDA receptor activation, nitric oxide production, and the activity of medial prefrontal cortex. The findings strongly suggest that LDT cholinergic neurons may critically contribute to developing cocaine-induced addiction.

In the medicolegal field, whether a victim was under the influence of ethanol at the time of an accident or injury is an important issue. However, trauma victims may have lost a large amount of blood, or received cardiopulmonary resuscitation or infusions of fluid or blood, making it difficult to interpret the ethanol concentration at the time of sampling. We, therefore, investigated changes in ethanol elimination in a rat model in which variations in circulating blood volume were induced by means of slow hemorrhage or infusion. Animals were divided into four experimental groups: hemorrhage (H), infusion (I), hemorrhage and infusion (H&I), and control (C). All rats were administered ethanol (1 g/kg body weight) intravenously over a period of 5 minutes. Blood (group C and group I: 0.2 ml, group H and group H&I: 0.5 ml/300gBW) was collected from rats in each group every 10 minutes for 4 h. Every 10 minutes after 30 minutes to 4 h of the ethanol administration, the rats in the infusion groups were administered saline (group I: 0.5 ml/300gBW, group H&I: 1.0 ml/300gBW). The concentration of ethanol in the blood samples was determined by using head-space gas chromatography. We found that the ethanol elimination rate did not differ between the groups, indicating that variations in body fluid due to bleeding or infusion have little to no effect on blood ethanol concentrations. Blood ethanol levels obtained after a prolonged state of shock or agonal, however, may need to be cautiously interpreted.

To facilitate elucidation of the pathogenesis of alcohol dependence, we investigated the relationship between a genetic variant of diazepam biding inhibitor (DBI) C/A polymorphism (rs2276596) and alcohol dependence. We determined the DBI genotypes using a novel method involving PCR-RFLP in healthy controls and alcoholics with a diagnosis of alcohol dependence by ICD-10 (F10.20). There was a significant difference in the rs2276596 polymorphism C/A allele frequency of the DBI gene (P < 0.0001) between alcoholics and healthy controls. The present data suggested that a mutant allele of the DBI was one of the risk factors for alcohol dependence as for the rs2276596 polymorphism.

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.

Peripheral arterial disease (PAD) is defined as an atherosclerotic disease in the lower extremities and is characterized by its symptom of intermittent claudication with discomfort and pain at posterior cruris. Various abnormalities of vascular endothelial cells, smooth muscle cells and platelets induced by risk factors of PAD are involved in its pathogenesis. The most important risk factors are ageing, smoking and diabetes mellitus. Dyslipidemia and hypertension are also classical risk factors of PAD. A lesion of PAD in the lower extremity is prone to be more distal in patients with diabetes than in non-diabetics and to be more proximal in smokers than in nonsmokers. In addition, race/ethnicity, increased inflammatory marker levels, homocysteinemia and abdominal obesity are known to be risk factors of PAD. Light-to-moderate alcohol drinking has been demonstrated to reduce the risks of coronary artery disease and ischemic type of stroke, while excessive alcohol drinking increases the risks of hemorrhagic type of stroke (cerebral hemorrhage and subarachnoid hemorrhage), hypertension, cardiac arrhythmia and sudden cardiac death. In most previous epidemiological studies, the risk of PAD has been shown to be lower in light-to-moderate drinkers than in abstainers. Moreover, drinkers with PAD reportedly showed lower mortality than did nondrinkers with PAD. On the other hand, heavy drinking has been reported to be positively associated with the risk of PAD. Increase in HDL cholesterol, decrease in LDL cholesterol, inhibition of platelet aggregation, decrease in blood coagulability, increase in blood fibrinolitic activity, and increase in insulin sensitivity are known as mechanisms for suppression of atherosclerosis by alcohol drinking. These mechanisms are also thought to contribute to reduction of the risk of PAD by alcohol drinking. Further studies are needed to clarify pathophysiological mechanisms for dose-dependent diverse effects of alcohol on the risk of PAD.

Aim: Therapeutic attitudes of health care professionals toward people with substance abuse are predictors of better health care. This quasi-experimental study aimed to examine changes in therapeutic attitudes of health care professionals who offered the Serigaya Methamphetamine Relapse Prevention Program (SMARPP). The SMARPP was developed based on the Matrix Model in Japan and is a new cognitive behavioral therapy for drug abusers.

Methods: We compared therapeutic attitudes toward drug and alcohol abusers at baseline and a 6-month follow-up between health care professionals who provided the SMARPP to patients (the SMARPP group, n = 38) during the follow-up and professionals who did not (control group, n = 67). These health care professionals worked at the same workplace. Therapeutic attitudes were measured using scores of the Drug and Drug Problems Perception Questionnaire (DDPPQ) and the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ). We conducted repeated two-way analysis of covariance of the scores with group and time as factors. We calculated the effect sizes of mean differences between the groups at the follow-up survey.

Results: There was a significant interaction between group and time (p < 0.05). The average scores of the DDPPQ and the AAPPQ in the SMARPP group were significantly higher than those in the control group (p < 0.05). The effect sizes (Cohen's d) of the four subscales in the DDPPQ ranged from 0.37 to 0.55, and the effect size of the one subscale in the AAPPQ was 0.21.

Conclusions: Therapeutic attitudes of staff who offer the SMARPP are improved, especially regarding attitudes toward people with drug abuse. Professionals who offer the SMARPP may acquire knowledge and skills to deal with drug problems and have increased satisfaction and confidence in their work.

The objective of this study was to identify how staff working in institutions for the treatment of and recovery from alcoholism view the relationship between heterosexuality and recovery on the part of alcoholics, how they deal with this relationship, and issues the staff face. Data were collected from 89 staff members (36 men, 52 women, 1 unknown gender) residing in the Kanto region and working at hospitals or local institutions. Over half the staff reported dealing with the issue of heterosexuality respectfully, but in terms of their views, a large majority of the staff was highly concerned about relapse due to heterosexuality. Half of the staff believed that heterosexuality might prevent continued abstinence. They also believed that the risk of relapse was increased further if the period of abstinence was short, the person was unemployed, both partners were alcoholics, the person had yet to admit their alcoholism, or if the relationship was an extramarital affair or with someone in the early stages of recovery. Medical staffs were more likely than other staff to respect the heterosexuality of alcoholics while being highly concerned about the risk of relapse. The results also showed that as alcoholics were unlikely to refrain from heterosexuality even if advised to do so, staff would probably use an appropriate method of guidance if one were available. These findings indicate the need to develop more practical and firmly held specialist therapies for heterosexuality among alcoholics, which has been regarded negatively as frequently leading to relapse, based on studies from the perspectives of both alcoholics and staff.