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BACKGROUND: Despite evidence regarding the effectiveness of screening and brief interventions for excessive alcohol use in primary care, these tools are not a part of routine practice. It has been suggested that using these tools at the workplace may be critical to alcohol-associated harm; however, evidence for this claim is unclear. The aim of this article is to develop a study protocol which evaluates the effect of brief alcohol intervention at the workplace to reduce harmful alcohol drinking. METHODS: A randomized controlled trial involving employees (aged 20–74 years) of five Japan-based companies who were screened “positive” by Alcohol Use Disorder Identification Test (AUDIT) is on-going. Participants were randomized into “Patient Information Leaflet” (control group), “Brief Advice and Counselling,” and “Five-minute Brief Advice” groups. A self-administered questionnaire was used to assess alcohol consumption, lifestyle behavior, health status, work performance, and consequences of alcohol use. Data of laboratory markers were collected from routine health checkups. RESULTS: A total of 351 participants were randomized into Patient Information Leaflet (n = 111), Brief Advice and Counselling (n = 128), and Five-minute Brief Advice (n = 112) groups. Participants were mostly men with a median age of 49 years. Median AUDIT score and weekly alcohol consumption were 11 points and 238 g/week, respectively. Two-thirds of the participants were manufacturing workers. CONCLUSION: This study protocol developed the first trial in Japan to investigate the effect of brief alcohol intervention combined with a recommended screening tool at the workplace. Our findings can provide evidence on the effectiveness and relevance of these tools to occupational health.

ObjectivesThis study aimed to assess trends in the prevalence of alcohol use depending on smoking behaviours and that of smoking depending on drinking behaviours among Japanese adolescents.DesignThis was a retrospective study using Japanese school-based nationwide surveys conducted between 1996 and 2017.SettingSurveyed schools, both junior and senior high schools, considered representative of the entire Japanese population, were sampled randomly.ParticipantsWe enrolled 11 584–64 152 students from 179 to 103 schools yearly. They completed a self-reported and anonymous questionnaire on smoking and drinking behaviour.ResultsSince 1996, the prevalence of alcohol use and smoking among adolescents decreased in each survey (pConclusionsAlcohol use and smoking among Japanese adolescents seem to have reduced. However, certain groups showed poor improvements, and health risk behaviour disparity exists, which may widen further. We need to focus on high-risk groups and implement appropriate measures or interventions accordingly.

Background In areas affected by the tsunami of the great East Japan Earthquake, smoking behavior may have deteriorated due to high stress and drastic changes in living environment. Surveys were conducted to reveal changes in smoking behaviors among victims. Methods A population-based random-sample home-visit interview survey of victims in Iwate and Miyagi Prefectures affected by the tsunami disaster was conducted in 2012 (n = 1978), while a population-based nationwide survey was conducted in 2013 (n = 1082). A panel survey in 2014 was conducted with respondents of the 2012 survey (n = 930). Multiple logistic regression analysis was performed to reveal factors related to smoking status after the disaster. Results There was high smoking prevalence of both sexes in the tsunami disaster area (current smoking rate in coastal area, 50.0% for male, 21.4% for female; inland area, 34.7% for male, 7.6% for female). Low prevalence of male quitters was observed (quitter rate in coastal area, 20.8% for male, 8.0% for female; inland area, 23.4% for male, 5.5% for female). The prevalence of nicotine-dependent people assessed by FTND (Fagerström Test for Nicotine Dependence) in the coastal area was also higher than in the inland area or other areas of Japan. Smoking behavior among victims worsened after the disaster and did not improve 3 years from the disaster. Post-disaster factors related to smoking were living in coastal area, complete destruction of house, and living in temporary housing. Conclusions Smoking prevalence and the level of nicotine dependence of tsunami victims were still high even 3 years after the disaster. It is important to emphasize measures for smoking control in the disaster areas for an extended time period.

BackgroundThe presence of large or multiple esophageal distinct iodine-unstained lesions (DIULs) is a strong predictor of field cancerization in the upper aerodigestive tract. Several risk factors for DIULs, including genetic polymorphisms of alcohol and aldehyde dehydrogenases (ADH1B, rs1229984; ALDH2, rs671), have been demonstrated in Japanese alcohol-dependent men. However, few evaluations of alcohol-dependent women have been conducted in this field.MethodsUsing multiple logistic regression models, we investigated the results of screening using esophageal iodine staining and the identification of determinants for esophageal DIULs in 472 Japanese alcohol-dependent women.ResultsDIULs ≥5 mm, multiple DILUs, and both characteristics were observed in 35 (7.4%), 31 (6.6%), and 16 (3.4%) patients, respectively. DIULs ≥5 mm were histologically diagnosed as low-grade intraepithelial neoplasia in 26 patients and superficial squamous cell carcinoma in 9 patients. Although the inactive heterozygous ALDH2*1/*2 genotype was more common (33.3% vs. 11.4%, p = 0.002) in the group with DIULs ≥5 mm than in the group without DIULs ≥5 mm, no significant differences in the results of a questionnaire asking about current and past facial flushing after a glass of beer were seen between the groups with and without DIULs ≥5 mm. When individuals with current or former flushing were assumed to have inactive ALDH2, the sensitivity and specificity of current or former flushing to identify the presence of inactive ALDH2 were 50.0% and 93.5%, respectively; these values were previously reported to be 88% and 92%, respectively, in a Japanese general female population. The low sensitivity in the present study suggests that a lack of alcohol flushing may play a crucial role in the development of alcohol dependence in women with inactive ALDH2. No significant differences in age, usual alcohol consumption, or smoking habits were observed according to ADH1B and ALDH2 genotypes. Multiple logistic regression analyses showed that the slow-metabolizing ADH1B*1/*1 genotype (odds ratio [95% confidence interval], 12.5 [4.82-32.4] and 9.89 [3.50-27.9]), the inactive heterozygous ALDH2*1/*2 genotype (2.94 [1.18-7.38] and 3.79 [1.40-10.3]), a lower body mass index per -1 kg/m2 (1.17 [1.02-1.35] and 1.38 [1.14-1.67]), and a mean corpuscular volume ≥106 fl (3.70 [1.56-8.81] and 3.27 [1.24-8.64]) increased the risk of DIULs ≥5 mm and multiple DIULs, respectively. The combination of ADH1B*1/*1 and ALDH2*1/*2 markedly increased the risk of esophageal DIULs ≥5 mm (39.3 [10.6-146]).ConclusionsJapanese alcohol-dependent women shared several common risk factors for esophageal squamous cell neoplasia with alcohol-dependent men, but with considerably different magnitudes.

Alcohol use disorder is a common and complex disorder with a well-documented highly hereditary nature (Higuchi et al., 2006; Roh et al., 2008). Subjective response to alcohol is also known to be a genetically influenced characteristic (Schuckit et al., 2007; Viken et al., 2003). This suggests that genetic influences on individual variation in subjective response to alcohol may underlie the effects of genes on alcohol-related disorders. A low level of response to the acute effects of alcohol has been associated with an increased risk of both excessive alcohol intake (Hinckers et al., 2006; Schuckit et al., 2007) and alcohol dependence (Schuckit, 1994; Schuckit and Smith, 1996; Schuckit et al., 2004), which are well known to be highly heritable (Kendler, 2001). There is consistent evidence that the GABAA receptor regulates the alcohol self-administration in animal models, probably by stimulating reward circuitry in the mesolimbic system (Chester and Cunningham, 2002; Eiler and June, 2007; Harvey et al., 2002; June et al., 2003). Several GABAA receptor subunits have been implicated in alcohol effects, so that the specific subunit composition of the receptor may be an important determinant of alcohol’s CNS effects. The α2 subunit of the GABAA receptor mediates the anxiolytic effects of benzodiazepines (Low et al., 2000; Rudolph et al., 1999) and enhances the hypnotic, but not the sedative, effects of combined exposure to alcohol and benzodiazepines (Tauber et al., 2003). Two genome-wide scans in humans have provided evidence of linkage of alcohol dependence to a region of chromosome 4p that includes a cluster of 4 genes encoding γ-aminobutyric acid A (GABAA) receptor subunits (Long et al., 1998; Reich et al., 1998). A previous study (Edenberg et al., 2004) found that 31 single nucleotide polymorphisms (SNPs) in GABAA receptor α2 subunit gene (GABRA2), but only 1 of the 20 SNPs in the flanking genes, showed significant association with alcohol dependence. Additional studies have provided the replication of this association in a region of GABRA2 among various ethnic groups (Covault et al., 2004; Fehr et al., 2006; Lappalainen et al., 2005; Soyka et al., 2008); though, there is a negative association study between GABRA2 and alcohol dependence (Matthews et al., 2007). Previous studies have also provided evidence that GABAA receptors mediate several behavioral effects of alcohol such as ethanol self-administration and motor impairment (Davies, 2003; Grobin et al., 1998; Hanchar et al., 2005). GABRA2 gene was associated with the differences in the subjective effects of alcohol including blushing sensations, stimulant and sedative effects (Pierucci-Lagha et al., 2005), and the variance in drinking behavior (Bauer et al., 2007). In the former study (Pierucci-Lagha et al., 2005), the more common A allele of the rs279858 SNP within the GABRA2 gene showed greater subjective effects of alcohol than did individuals with 1 or 2 copies of the alcohol dependence–associated G allele. These findings underscore the potential contributions of variation at GABRA2 to the differences in the subjective responses to alcohol, the variance of drinking behavior, and the risk for alcohol dependence. This study examined the moderating effects of GABRA2 alleles on subjective and physiologic effects of alcohol in healthy social drinkers. We used the alcohol clamp method for alcohol administration, which uses an intravenous infusion of alcohol at rates adjusted online to close the gap between measurements of breath alcohol concentration (BrAC) and the target concentration. The clamp method reduces experimental variance in BrAC (O’Connor et al., 1998) which can be caused by the substantial pharmacokinetic variability following oral alcohol administration. Therefore, the alcohol clamp used in this study is a more exhaustive objective measure than the oral loading of alcohol that was used in the previous study of the effects of GABRA2 on the subjective effects of alcohol assessed only during the ascending limb of the BrAC (Pierucci-Lagha et al., 2005). Our method allowed the evaluation of the initial response to alcohol following the ascending limb of the BrAC as well as the adaptive response to alcohol during the clamped BrAC interval. Based on the previous studies, we hypothesized that GABRA2 alleles would moderate the subjective responses to alcohol measured during not only the ascending limb of BrAC curve but also the clamped BrAC interval. As we expected, subjects with ALDH2*1/*2 showed higher initial response than those with ALDH2*1/*1 (Matsushita et al., manuscript in preparation). Therefore, we divided subjects by ALDH2 genotype and performed further analyses separately in each ALDH2 genotypic group.

Aims The purpose of this paper is to outline alcohol availability, alcohol consumption and related harm, alcohol control policy and prevention programmes in Japan, few of which have been discussed in either the Japanese or English literature. Methods Data were collected primarily from the following two sources: statistics and survey results issued by the national government, including surveys funded by the government; and papers published since 2000, identified by searching the MEDLINE and Igaku-Chuo-Zasshi databases. These data were assessed regarding their quality and summarized. Some data presented here were produced specifically for this review. Results Although per capita alcohol consumption has tended to decline for more than 10 years, it has remained at a high level. Diversification of the drinking population has progressed rapidly, specifically in women, among whom alcohol consumption has increased sharply. Cross-sectional data suggest that alcohol consumption is associated with serious health and social consequences. Existing longitudinal data suggest that alcohol-related problems, especially health problems, have increased steadily over the past several decades, with few exceptions, including alcohol-related fatal road traffic accidents. Alcohol policy and prevention programmes have not developed to a level that can control these problems adequately. Specifically, the high availability of alcoholic beverages, including the lack of restrictions on sales and advertising and decreasing prices, are noted. Conclusions This review provides basic information regarding alcohol availability and alcohol consumption and related harm that may facilitate the improvement of existing alcohol control measures in Japan and encourage the development of new alcohol control measures. This research revealed the scarcity of longitudinal data regarding alcohol consumption and its consequences, and the lack of several important variables, such as disability adjusted life years, for improving our understanding of the comprehensive status of alcohol in Japan. Language: en

Aims: This study evaluated the acceptance of controlled drinking (CD) goals among physicians specializing in the treatment of alcohol dependence (AD) in Japan. Methods: A mailed questionnaire survey was sent to physician members of the Japanese Society of Alcohol-Related Problems ( n = 232) who were specialists in the treatment of AD in Japan. The evaluated items included the acceptance of CD goals, the definition of CD, the reasons for accepting or rejecting CD and the patient factors used to make treatment-goal decisions. Results: CD as an interim goal on the way toward abstinence was accepted by about two-thirds of the specialists, while CD as a final goal was accepted by about one-third of specialists. Specialists supported harm-free drinking and a satisfactory quality of life, rather than alcohol consumption limits, as the definition of CD. Of note, a significantly higher percentage of specialists who rejected CD, compared with those who accepted CD, supported the disease model of AD as grounds for their decision. Specialists who accepted CD relied mostly on factors such as the severity of dependence, attitude toward CD and abstinence, and the level of psychological dependence and social stability, when making treatment-goal decisions. Conclusion: CD was accepted as an interim goal by two-thirds and as a final goal by one-third of Japanese physician specialists. Despite differences in drinking cultures and treatment circumstances, great similarities were found between this study and those conducted in Europe and North America with regard to the reasoning of treatment providers and the use of patient characteristics to make treatment-goal decisions.

Human twin studies have shown that certain responses to alcohol, including subjective perceptions, are genetically influenced. Previous studies have provided evidence that a low level of response to alcohol predicts future alcohol use disorders in humans. Recent genetic studies suggest an association between alcohol dependence and genetic variation in the γ-aminobutyric acid A (GABA(A)) receptor α2 subunit gene (GABRA2). Based on a haplotypic association of alcohol dependence with GABRA2, we investigated whether GABRA2 alleles are associated with the subjective responses to clamped alcohol concentration.One hundred and ten healthy social drinkers (53 men) underwent the alcohol clamp. Fifteen minutes after the start of an intravenous infusion of alcohol, the breath alcohol concentration was clamped at a target of 50 ± 5 mg/dl for 165 minutes. Subjective physiologic responses to alcohol and stimulant and sedative effects of alcohol were measured repeatedly during the alcohol clamp. Because aldehyde dehydrogenase 2 (ALDH2) has been shown to have a great impact on the subjective responses to alcohol, we divided subjects by ALDH2 genotype for further analyses. To examine the role of genetic variation in GABRA2, 7 single nucleotide polymorphisms (SNPs) that were informative in association studies were included as factors in the analysis.Among these 7 SNPs, 3 SNPs (rs279869, rs279858, and rs279837) located in the middle of the GABRA2 gene showed significant associations with subjective effects of alcohol. Subjects with 1 or 2 copies of the more common allele showed greater subjective responses to alcohol than did individuals homozygous for the alcohol dependence-associated allele regardless of ALDH2 genotype.These findings confirm and extend the observation that the GABRA2 alleles affect the subjective responses to alcohol, and suggest that the genetic variations in GABRA2 might play a role in the risk of alcohol use disorders by moderating the subjective effects of alcohol.

INTRODUCTION: In Japan, volunteer fire departments (VFDs), which are fire departments composed of volunteers who fight fires and provide other related emergency services for a local jurisdiction, have been organized, especially in rural areas. During the Great East Japan Earthquake on March 11, 2011, VFDs in disaster areas engaged in various activities to aid disaster victims. The aim of this study was to elucidate changes of alcohol use among VFD members. METHOD: We sent self-administered questionnaires to 1044 VFD members. The questionnaire included Alcohol Use Disorder Identification Test [AUDIT] and questions regarding changes in each member's drinking habits after the earthquake. RESULT: Overall, 683 (65.4%) members responded to our survey. The percentage of VFD members who scored ten or above on the AUDIT was higher among members with experiences losing families and/or friends (33.7%) compared with those without such experiences (22.5%) (P Language: en

Introduction. A meta-analysis of 119 studies performed in North America found that the lifetime prevalences of pathological gambling in adults are 1.6 percent. We conducted national surveys on addictive behavior to estimate the prevalence of pathological gambling.Methods. A survey of 7,500 men and w

Introduction. It is known that patients with alcohol dependence frequently have comorbid psychiatric diseases and the profile of the comorbidities varies among countries. This study aims to estimate the prevalence of psychiatric comorbidities using semi-structured interview in Japanese alcoholics. Methods. This study was approved by the local Ethics Committee of Kurihama Medical and Addiction Center. The subjects were 258 alcoholic patients admitted to Kurihama Medical and Addiction Center and 355 healthy controls. The diagnosis of alcohol dependence and other psychiatric disorders was assessed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). Results. The prevalence of the history of major depression was significantly higher in alcoholics (21.2% in male, 44.6% in female) than in controls (10.0% in male, 13.6% in female). The prevalence of nicotine dependence was 40.2% in male alcoholics and 37.8% in female alcoholics. In addition, the occurrence of comorbid panic disorder and/or agoraphobia was higher in female alcoholic group (24.3%) than in male alcoholic group (4.3%). Conclusion. These results suggest that the psychiatric disorders which are likely to coexist with alcohol dependence are major depression and nicotine dependence in Japanese patients. In addition, the prevalence of panic disorder or agoraphobia was relatively high in female alcoholics.

Introduction. Despite the potentially severe reactions, some individuals with inactive ALDH2 go on to become alcoholics. We compared the characteristics of such alcoholics with those carrying active ALDH2, and attempted to identify risk factors for the development of alcohol use disorders (AUDs). Methods. The subjects were male alcoholics with inactive ALDH2, male alcoholics with active ALDH2, female alcoholics with both inactive and active ALDH2 and healthy males and females as the control groups. To identify the risk factors, we assessed the psychological characteristics, significant life-events and coping skills. In this study, we focused on coping skills and compared the results among five groups. Results. Male alcoholics with inactive ALDH2 and female alcoholics were recognized as possessing particularly poor coping skills. Comparing these five groups, it was revealed that in terms of exhibiting maladaptive coping skills, the five groups could be listed in the following descending order; female alcoholics, male alcoholics with inactive ALDH2, male alcoholics with active ALDH2, female controls, and male controls. Conclusion. This study identified poor coping skills as one of the risk factors for the onset of AUDs and indicates gender differences in the risk factors for the development of alcohol dependence.

The treatment of alcohol use disorder (AUD) is influenced by the culture of each society, the policy of the medical systems, and the difference in clinical characteristics of the patients. In Japan, a hospitalized treatment for comparably longer (2–3 months) period is more likely to be selected. Japanese alcoholic patients tend to develop AUD later in their life and comorbid antisocial personality disorder and polydrug addiction exist less frequently compared to Western countries. Japanese therapists have developed several unique treatment programs such as Naikan therapy and Morita therapy, which are inspired by Buddhism and Zen meditation. Danshukai, a self-help group of AUD, was established in Japan based on AA, but there are some differences between Danshukai and AA. The comparison of such differences between Japan and other countries would make clear the effect of the cultural aspects on the treatment of AUD. We would like to present the unique Japanese treatment of AUD and discuss the influence of the culture, which would lead to increase the outcome of the treatment of AUD among different cultural societies.

Individuals with inactive aldehyde dehydrogenase-2 (ALDH2) show adverse reactions after ethanol intake, which is known to suppress the occurrence of alcohol use disorders (AUDs), nonetheless, some individuals with inactive ALDH2 do become alcoholics. It has been suggested that these individuals may carry factors facilitating the development of AUDs. In this series of studies, we attempted to identify the risk factors for AUDs, and to replicate the validity of existing factors, using the unique characteristics of alcoholics with inactive ALDH2 or the AIA model. The subjects were hospitalized male alcoholics with inactive ALDH2 (N = 91), male alcoholics with active ALDH2 (N= 81), and 201 age-matched healthy males. To examine the risk factors, we assessed the psychological characteristics of the study participants, and compared the results among the three groups. Among 15 known self-reported questionnaires, we employed the Temperament and Character Inventory (TCI) for this study. TCI is a 230-item self-reporting questionnaire used to assess the following four temperament dimensions: Harm avoidance (HA), Novelty seeking (NS), Reward dependence (RD), and Persistence (P); in addition, it is also useful to measure the following three character dimensions: Self-directedness (SD), Cooperativeness (C), and self-transcendence (ST). The score for HA was higher, while the scores for P, SD and C were lower in the alcoholics than in the control subjects. These results suggest that these personality characteristics may play a role in facilitating the development of AUDs.