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Long-term use of benzodiazepine (BZD) is not recommended for the treatment of anxiety disorders. Cognitive behavioral therapy (CBT) is an effective treatment option for discontinuation of BZDs in patients with anxiety disorders. This systematic review and meta-analysis sought to clarify whether CBT is effective for discontinuing BZD anxiolytics in patients with anxiety disorders. This study was preregistered with PROSPERO (registration number: CRD42019125263). A literature search of major electronic databases was conducted in December 2018. Three randomized controlled trials were included in this review, and meta-analyses were performed. The proportion of discontinuing BZD anxiolytics was significantly higher in the CBT plus gradual tapering group than in the gradual tapering alone group, both in the short term (3 months after allocation; number needed to treat [NNT]: 3.2, 95% confidence interval: 2.1 to 7.1; risk ratio: 1.96, 95% confidence interval: 1.29 to 2.98, p=0.002, three studies) and long term (6 to 12 months after allocation; NNT: 2.8, 95% confidence interval: 1.9 to 5.3; risk ratio: 2.16, 95% confidence interval: 1.41 to 3.32, p=0.0004, three studies). CBT may be effective for discontinuing BZD anxiolytics, both in the short term and in the long term after the allocation. Further studies with larger sample sizes are necessary to draw definitive conclusions regarding the efficacy and safety of CBT for discontinuing BZD anxiolytics in patients with anxiety disorders. This article is protected by copyright. All rights reserved.

Background Consuming drugs in conjunction with sexual intercourse may shape the perceived interdependence of drug use and sexual intercourse (PIDS). Additionally, the severity of drug problems may have a significant impact on PIDS. However, this relationship remains unverified. Therefore, this study investigates whether the severity of drug problems is associated with PIDS among adult males in drug addiction rehabilitation centers (DARC) in Japan. Methods This study was a secondary analysis of the “DARC Follow-Up Study in Japan” conducted by the National Center of Neurology and Psychiatry in 2016, in which participants from 46 facilities completed a self-report questionnaire. A total of 440 males with drug dependence were included in the analysis. We analyzed participants’ demographic characteristics, history of sexually transmitted disease diagnoses, and responses to questions related to drug use (e.g., primary drug use and PIDS). Additionally, we measured the severity of drug problems using the Japanese version of the Drug Abuse Screening Test-20 (DAST-20). Results The median age of the participants was 42 years. The median DAST-20 score was 14.0, the primary drug was methamphetamine (61.4%) and new psychoactive substances (NPS: 13.6%). Multivariate analysis indicated that participants’ experiences with unprotected sexual intercourse (“mostly a non-condom user”: adjusted odds ratio (AOR) = 4.410), methamphetamine use (AOR = 3.220), new psychoactive substances use (AOR = 2.744), and the DAST-20 score (AOR = 1.093) were associated with PIDS. Conclusions This study indicated that the frequency of unprotected sexual intercourse under the influence of drugs, methamphetamine and NPS use were strongly associated with PIDS. The severity of drug problems was also significantly associated with PIDS. It is necessary to develop culturally appropriate treatment programs adapted to the needs of patients who experience strong PIDS.

There are a few studies on gender differences in terms of reasons and motives for methamphetamine use. Purpose/Objectives: To examine gender differences in triggers of methamphetamine use Methods: ...

Adverse childhood experiences (ACEs) are distressing and/or traumatic events that occur during childhood that increase the risk of negative health outcomes in adulthood.This study estimated the prevalence of ACEs in a nationwide sample of Japanese methamphetamine users in prison and examined associations among ACEs, suicidal ideation, and non-suicidal self-injury.Participants were 636 inmates (418 male and 218 female) who were newly incarcerated in Japan for Stimulants Control Act violations.First, 699 participants completed an anonymous self-report questionnaire. Of these, 636 participants who did not have any missing responses were included in the analysis. After calculating descriptive statistics, the associations between ACEs and suicidal behaviors were assessed using binary logistic regression analyses.Results showed that 76.1 % of the participants reported at least one ACE before the age of 18, and female participants reported a significantly higher number of adversities than their male counterparts. The most common ACEs were parental death or divorce, followed by psychological abuse. Logistic regression analyses revealed that ACE scores significantly increased the risk of suicidal ideation (SI; adjusted odd ratio [AOR] = 1.18, p .001) and non-suicidal self-injury (NSSI; AOR = 1.18, p .001) after controlling for possible confounding variables.Findings suggest the importance of early prevention and intervention for traumatic experiences, and have implications for the recommendation of gender-responsive, trauma-focused interventions, especially for female inmates in the criminal justice system, to break the intergenerational chain of abuse. Future research directions and treatment are discussed.

This study aimed to examine the relationship between methamphetamine (MA) use and high-risk sexual behavior among newly incarcerated prisoners in Japan. We conducted a secondary analysis using cross-sectional survey data, which constituted a nationwide prison sample surveyed between July and November 2017. In total, 699 participants (462 male and 237 female prisoners), who completed the self-administered questionnaire during imprisonment were recruited for the study. The prevalence of high-risk sexual behaviors was as follows: inconsistent condom use (78.4% male, 81.7% female), multiple sexual partners (61.3% male, 41.3% female), history of sexually transmitted diseases (14.1% male, 23.6% female), and trading sex for drugs (15.6% male, 17.7% female). A logistic regression analysis showed that MA use during sex increased the likelihood of high-risk sexual behavior in both male (adjusted odds ratio [AOR] = 5.86; 95% confidence interval [CI] = 3.41-10.07) and female prisoners (AOR = 2.58; 95% CI = 1.33-5.00). Additionally, in female prisoners, a history of sharing MA injection (AOR = 1.60; 95% CI = 1.06-2.42) increased high-risk sexual behavior. Our results indicate that harm reduction programs tailored according to the specific necessities of each gender to reduce high-risk sexual behaviors among MA users should be included in Japanese drug policies.

Background:Alcohol problems in parents have been revealed as one factor affecting adolescent alcohol misuse, but there are few studies on how parental drinking affects adolescent alcohol misuse in the general population. The findings of previous studies are inconsistent with respect to the influence of parental drinking according to parental structure. Binge drinking among adolescents has received much attention. In this study, we aimed to examine the relationship between parental drinking in parents and binge drinking among high school students in Japan.Methods:We performed a secondary analysis of the Nationwide High School Survey on Drug Use and Lifestyle 2018, Japan. A total of 46,848 valid surveys from high school students of 78 schools were included for analysis. Logistic regression analysis was conducted with binge drinking as the dependent variable. We established nine groups, classified according to parental drinking by parental structure (e.g., both parents, single parent, neither parent at home) as the independent variable, after adjusting with demographic factors and lifestyle factors as covariates. Binge drinking was defined as five or more alcoholic drinks for male adolescents or four or more alcoholic drinks for females on the same occasion within 2 hours. Results: In the fully adjusted models, the risk of binge drinking in adolescents whose parents do not drink (adjusted odds ratio (AOR): 0.541, 95% confidence interval (CI): 0.411–0.711) and whose father drinks but mother does not (AOR: 0.696, 95% CI: 0.575–0.844) were significantly lower than that in adolescents whose parents drink. This risk was significantly higher among students with neither parent living at home (AOR: 3.746, 95% CI: 2.290–6.127). Conclusion:Our findings suggest that adolescents whose parents do not drink and whose father drinks but mother does not are less likely to engage in binge drinking. Adolescents who did not live with either parent may have greater risk of binge drinking. This research revealed that parental drinking affects binge drinking among adolescents in the general population. Engaging parents, including mothers and non-parental family members, in future programs and interventions is important, to prevent adolescent alcohol misuse.

This study aimed to review the current state and trends in cannabis use in Japan, using data from several national epidemiological surveys. The number of cannabis users in the general population was estimated approximately 1.3 million people. Cannabis use increased between 2015 and 2017. In 2017, the lifetime prevalence of cannabis use was greater than that of inhalants, and cannabis had become the most abused drug in Japan. The increase in cannabis users is thought influenced by increased access to illegal cultivation and positive thinking about cannabis use among many people, especially younger individuals.

In the last-decade, the treatment of drug offenders in Japanese prisons has changed from severe punishment to a therapeutic approach. This study aimed to review studies that evaluated the effectiveness of relapse prevention guidance for drug- dependent inmates in Japan.We searched three databases: Ichushi; the Japanese correctional library database; and- PubMed. The inclusion criteria were: 1) the guidance was conducted in prisons in Japan; 2) the participants were Japanese adult inmates; 3) the evaluations were reported in quanti- tative investigations and original articles in Ichushi and PubMed; and, 4) the evaluations were reported in quantitative investigations in the Japanese correctional library database.In total, we identified 13 studies. Three studies.used comparison groups, and two studies included follow-up after the inmates' : release. Two studies-used recidivism and one used treatment persistence as behavioral outcomes. Almost all of the studies used psychological scales. Self-efficacy measures were the most commonly used, and the second most common scale was the Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES).Our findings indicate that SOCRATES is the most useful psychological outcome scale in assessing the effectiveness of. relapse prevention guidance for drug offenders in Japan. However, evidence is lacking, as most studies were before-and-after studies that only assessed psychological outcomes. More follow-up studies after release that include comparison groups and investigate behavioral outcomes are needed.

AIM: Prescription drug abuse, including benzodiazepines, is a growing health problem in Japan. This study examined the community pharmacist's clinical behavior regarding patients who overdose on prescribed drugs, and explore the possibility of overdose prevention by community pharmacists. METHODS: We surveyed all registered community pharmacies with dispensing functions (n=1867) in the Saitama Pharmaceutical Association. An anonymous self-administered questionnaire was mailed to each pharmacy. Respondents were asked about clinical behavior such as medication counseling and referral to the prescriber if prescription drug overdose was identified. RESULTS: Among respondents, 26% of community pharmacists reported clinical experience of working with patients who overdosed on prescribed drugs in the previous year. Half of respondents evaluated their practice such as medication counseling and referral to the prescriber as "good". On multivariable analysis, a "poor" self-evaluation of referral to the prescriber was significantly associated with the following perceptions: "Insufficient confidence in communication with prescribers" (odds ratio, 2.7; 95% confidence interval: 1.4-5.3), and "To avoid trouble with prescribers" (odds ratio, 1.7; 95% confidence interval: 1.0-2.7). CONCLUSION: Our results show that Japanese community pharmacists could prevent prescription drug abuse in their practice. However, the pharmacists who have insufficient confidence in communication with prescribers and who are afraid of troubles with a prescriber, reported "poor" self-evaluation for referral to the prescribers. All prescribers should understand the importance of the referral by community pharmacists, to assist the community pharmacists to play a critical role in prevention of prescription drug abuse. Language: en

Japan has experienced an epidemic of methamphetamine (MAP) abuse three times: the first epidemic was from 1951 to 1957, the second epidemic was from 1970 to 1994, and the third epidemic started in 1995 and continues today. Fortunately, HIV infection is not as serious a problem in Japan as it is in other countries. The major route of HIV infection in Japan has been through male homosexual transmission. In cumulative numbers, homosexual transmission accounted for 63% of the 11,146 HIV-positive patients and 40% of 5158 AIDS patients as of December 30, 2011. Intravenous drug use accounted for 0.3% and 0.4% of these cases, respectively. Drug abuse has changed during the past 20 years in Japan. The changes are summarized as follows: there has been: (1) a remarkable decrease in solvent abuse; (2) a stabilization of MAP abuse; (3) a penetration of cannabis abuse; (4) an emergence of evasive drug abuse; and (5) a silent increase in medical drug dependence. This implies that: (1) there has been a change from a “solvent dominant type” of use to a “cannabis dominant type,” that is, from a “Japanese type” to a “Western type”; (2) a shift to drugs which do not have a high potential to cause drug-induced psychosis; and (3) a shift from conduct that leads to arrest to conduct that does not lead to arrest. Regardless of whether the drug use is illicit or not, drug dependence is a mental disorder. Japan is urged to deal with drug abuse and dependence using not only the criminal model, but also the medical model.

AIMS: The aim of this study was to examine the prevalence of 3, 4-methylenedioxymethamphetamine (MDMA) use and to identify characteristics of MDMA users among rave attendees in Japan. This is the first rave-population study focusing on MDMA use in Japan. METHODS: The anonymous self-administrative questionnaire was conducted using laptop computers at four rave parties at three different venues in Tokyo, Japan. Participants were asked about lifetime use of MDMA and other club drug use, characteristics of rave attendance, and their demographics. RESULTS: Questionnaires were completed by 300 rave attendees (47.3% female), 68.3% of whom were aged 20-29 years, and 92.3% of whom had completed high school. Among the participants, 8.0% reported MDMA use. Compared with 'non-drug controls' (the participants who had never used any illicit drugs), MDMA users were significantly more likely to be 30-39-year-old men. In addition, compared with 'cannabis users' (non-MDMA users who had used cannabis), MDMA users were significantly more likely to use other drugs and reported more adverse health effects due to 'polydrug use'. Furthermore, MDMA users were significantly more likely to go to raves and preferred smaller venues. CONCLUSIONS: Our results clearly suggest that rave attendees have a higher lifetime prevalence of MDMA use than the Japanese general population (0.2% reported in 2007). MDMA users are deeply involved in rave parties, and MDMA use may have high potential to generate close relationships among rave attendees. Therefore, MDMA users may have more opportunities to access MDMA than cannabis users and non-drug controls. Language: en

Assessing the degree of problems related to drug abuse is important in each treatment setting. The Drug Abuse Screening Test-20 (DAST-20) is a brief, simple 20-item instrument to measure the degree of problems related to drug use. The objective of the present study is to examine the reliability and validity of the Japanese version of the DAST-20.We translated the DAST-20 into Japanese using back translation. The anonymous self-administered questionnaire was completed by 310 drug users at the Drug Addiction Rehabilitation Centers (DARC group, n = 113) and at HIV/AIDS regional hospitals (HIV group, n = 197) in Japan.The average DAST-20 score was 7.6 (DARC group = 14.7, HIV group = 2.8). Each item score was highly correlated with the total score (r = 0.45-0.88). A high internal consistency (Cronbach's α = 0.95) was observed (men = 0.95, women = 0.84). Overall test-retest reliability was 0.86 (men = 0.85, women = 0.90). The total DAST-20 score was strongly positively correlated with the Severity of Dependence Scale-J score (r = 0.85), but moderately positively correlated with the Alcohol Use Disorders Identification Test score (r = 0.41). In addition, confirmatory factor analysis indicated an acceptable fit to the data (goodness-of-fit index [GFI] = 0.893, adjusted goodness-of-fit index [AGFI] = 0.854, comparative fit index [CFI] = 0.948, root mean square residual [RMR] = 0.008, root mean square error of approximation [RMSEA] = 0.073).Our results clearly suggest that the Japanese version of the DAST-20 has sufficient internal consistency and acceptable levels of concurrent validity and construct validity.

The non-medical use or abuse of prescription drugs, including benzodiazepines, is a growing health problem in Japan. An association between prescription drug overdose and suicide risk has also been reported. The Japanese Ministry of Health, Labour and Welfare has expected pharmacists to act as "gatekeepers", facilitating early identification of individuals at high risk of prescription drug abuse including overdose, supplying medication counseling to patients, and helping to introduce these patients to appropriate medical care. Prescription drugs such as benzodiazepines are widely used in psychiatry. However, these drugs are prescribed not only by psychiatrists but also by other healthcare professionals including primary care physicians. Moreover, in recent years, the dispensing of prescriptions has moved rapidly from inside to outside hospitals, with prescription drugs being dispensed mainly at community pharmacies. Although all healthcare professionals including hospital pharmacists can play a role in preventing prescription drug abuse, the role of the community pharmacist is vital in addressing this problem. Formerly, community pharmacists were recognized as "community scientists", low-threshold accessible healthcare advisors. Now, community pharmacists should return to the role of community scientists to prevent prescription drug abuse. This article begins by reviewing the current situation of prescription drug abuse and dependence in Japan. The role of pharmacists as gatekeepers in preventing prescription drug abuse is then examined. Finally, this article discusses the effect of intervention in the form of gatekeeper training for community pharmacists.

The abuse of "Kiken drugs," including synthetic cannabinoids, is a serious and growing social problem in Japan. Kiken drugs is the general term for novel psychoactive substances that have not been designated as illegal by Japanese law. The aim of this article is to describe the current status of the abuse of Kiken drugs by youth in the nightlife areas of Tokyo. An anonymous field-based survey was conducted using laptop computers at four dance parties in Tokyo, Japan. The questionnaires were completed by 307(44% female, mean age 30.9 years) young adults at the dance parties. Among the survey participants, 24.4% reported Kiken drug use (herbs 22.8%, powders 7.2%, and liquids 3.3%) in their lifetime. The primary reasons for Kiken drug use were peer pressure (37.3%), and avoiding penalties for possession of illegal drugs under Japanese laws (28.0%). In addition, 61.3% reported obtaining Kiken drugs from close friends. Our results clearly suggest that young adults at dance parties have a higher lifetime prevalence of Kiken drug use than the Japanese general population (0.4% reported in 2013). As the social stigma associated with drug use is extremely high in Japan, avoiding illegal drugs prohibited by law by using easily available Kiken drugs may be more socially acceptable among youth in the nightlife areas.

Background Few studies have investigated whether women can accurately recall their birthing experiences after a long period. We investigated the consistency of women’s memories of their childbirth experiences between those at a few days postpartum and 5 years later. Methods This prospective cohort study comprised 1,168 women who delivered at a maternity hospital and four maternity homes in Japan between May 2002 and August 2003. Data were collected using structured interviews and transcriptions from medical records. The childbirth experience was assessed using the Childbirth Experience Scale (CBE-Scale) at a few days postpartum and 5 years later. Results We obtained 584 (50.0%) valid responses from women who completed the survey at a few days postpartum and 5 years later. Significant differences were observed in 16 out of 18 items on the CBE-Scale when responses were compared at both time points. Women who answered "yes" to any item on the CBE-Scale at the baseline survey tended to demonstrate a more precise recollection for that item 5 years after childbirth than those who answered "no" for the corresponding item. Conclusions We conclude that women remember their childbirth experience clearly at 5 years after the childbirth.

Prescription drug abuse, including benzodiazepines, is a growing health problem in Japan. This study examined the community pharmacist's clinical behavior regarding patients who overdose on prescribed drugs, and explored the possibility of overdose prevention by community pharmacists.We surveyed all registered community pharmacies with dispensing functions (n = 1867) in the Saitama Pharmaceutical Association. An anonymous self-administered questionnaire was mailed to each pharmacy. Respondents were asked about clinical behavior such as medication counseling and referral to the prescriber if prescription drug overdose was identified.Among respondents, 26% of community pharmacists reported clinical experience of working with patients who overdosed on prescribed drugs in the previous year. Half of respondents evaluated their practice such as medication counseling and referral to the prescriber as 'good'. On multivariate analysis, a 'poor' self-evaluation of referral to the prescriber was significantly associated with the following perceptions: 'insufficient confidence in communication with prescribers' (odds ratio [OR], 2.7; 95% confidence interval [95%CI]: 1.4-5.3), and 'to avoid trouble with prescribers' (OR, 1.7; 95%CI: 1.0-2.7).Japanese community pharmacists could prevent prescription drug abuse in their practice, but the pharmacists who have insufficient confidence in communication with prescribers and who are afraid of trouble with a prescriber, reported poor self-evaluation for referral to the prescribers. All prescribers should understand the importance of referral by community pharmacists, to assist community pharmacists in playing a critical role in prevention of prescription drug abuse.

The nonmedical use of medications, including psychotropic drugs, is a growing health problem in Japan. According to a nationwide survey of mental hospitals, the proportion of patients with sedative (mainly benzodiazepine)-related disorders has more than doubled over the last decade. An association between psychotropic drug overdose and suicide risk has also been reported. Furthermore, over-the-counter drug abuse is still a serious problem in Japan. In recent years, pharmacists have been expected to act as gatekeepers, making timely identifications of suicide risk or substance abuse and directing these individuals to appropriate medical care facilities. In August 2012, the revised Comprehensive Suicide Measures Act identified pharmacists as one professional group that should act as gatekeepers. This article begins by reviewing the fundamental terms involved in understanding the nonmedical use of medications, including abuse, dependence, and intoxication. The current situation of substance abuse and dependence is then introduced through a summary of several epidemiological surveys conducted in Japan. Finally, the role of pharmacists as gatekeepers in preventing substance abuse and dependence on medications is discussed. Language: en

The nonmedical use or abuse of prescription drugs, including psychotropic medicines, is a growing health problem in Japan. Patient access to psychotropic drugs, specifically from the oversupply of medications due to overlapping prescriptions, may increase the risk of drug abuse and dependence. However, very little is known about such overlapping prescriptions. Today, the dispensing of prescriptions is generally moving from inside to outside of hospitals, with psychotropic drugs mainly dispensed at community pharmacies. In this study, we used health insurance claims (i.e., receipts) for dispensing as the main source of information in an investigation of overlapping prescriptions of psychotropic drugs. A total of 119 patients were found to have received overlapping prescriptions, as identified by community pharmacists who were members of the Saitama Pharmaceutical Association, using patient medication records, followed by medication counseling and prescription notes for the patient. According to our findings, the most frequently overlapping medication was etizolam. Etizolam can be prescribed for more than 30 days since it is not regulated under Japanese law as a "psychotropic drug." Generally, when a drug can be prescribed for a greater number of days, it increases the likelihood of an overlapping prescription during the same period. As a result, the long-term prescription of etizolam increases the risk of overlapping prescriptions. We also found that the patients who received overlapping prescriptions of etizolam were mostly elderly and the most common pattern was prescription from both internal medicine and orthopedics physicians. Etizolam has wide range of indications that are covered by health insurance. Our results suggest that patients who received overlapping prescriptions of etizolam may receive prescriptions from different prescribers for different purposes. Therefore, it may be appropriate to regulate etizolam as a "psychotropic drug" under Japanese law, thus setting a limit on the period for which it can be prescribed in order to help prevent long-term and overlapping prescriptions.

The aim of this study was to examine the prevalence of 3, 4-methylenedioxymethamphetamine (MDMA) use and to identify characteristics of MDMA users among rave attendees in Japan. This is the first rave-population study focusing on MDMA use in Japan.The anonymous self-administrative questionnaire was conducted using laptop computers at four rave parties at three different venues in Tokyo, Japan. Participants were asked about lifetime use of MDMA and other club drug use, characteristics of rave attendance, and their demographics.Questionnaires were completed by 300 rave attendees (47.3% female), 68.3% of whom were aged 20-29 years, and 92.3% of whom had completed high school. Among the participants, 8.0% reported MDMA use. Compared with 'non-drug controls' (the participants who had never used any illicit drugs), MDMA users were significantly more likely to be 30-39-year-old men. In addition, compared with 'cannabis users' (non-MDMA users who had used cannabis), MDMA users were significantly more likely to use other drugs and reported more adverse health effects due to 'polydrug use'. Furthermore, MDMA users were significantly more likely to go to raves and preferred smaller venues.Our results clearly suggest that rave attendees have a higher lifetime prevalence of MDMA use than the Japanese general population (0.2% reported in 2007). MDMA users are deeply involved in rave parties, and MDMA use may have high potential to generate close relationships among rave attendees. Therefore, MDMA users may have more opportunities to access MDMA than cannabis users and non-drug controls.

Hallucinogens are drugs that cause hallucinations, which is distortions in a person s perceptions of reality. Historically they were found in some plants and mushrooms and had been used mostly during religious rituals. Various hallucinogens came to be compounded chemically in the 20th century, and have spread among the young men in West European countries. Also in Japan, use of MDMA, or other hallucinogens is increasing in the young adult and minors. In recent years, Japanese medicine-related law were revised and most hallucinogens came to be treated as illegal drugs, but even now Japanese young men have got hallucinogens through the Internet and dance clubs, and medical and educational staffs and caregivers need to implement early intervention.

This study examines the prevalence of risky drinking and the association between risky drinking behaviors and risk groups of substance abuse among college freshmen. A total of 376 college freshmen (126 boys and 248 girls) in a Japanese university participated in the study. The subjects were asked to complete self-administered, anonymous questionnaires during their class. The number of participants who had used drugs was small. The following 2 items for substance abuse were included in the questionnaires: (1) those who had drug using peers who used drugs and (2) those who had been persuaded to use drugs by their peers. On the basis of the responses, the participants were classified into 3 groups: (1) high-risk group (HRG), which accounted for 1.4% of the subjects and comprised those who answered "yes" to both the above-mentioned two items; (2) risk group (RG), which accounted for 7.4% and comprised participants who answered "yes" to one of the two items; and (3) control group (CG), which accounted for 91.2% and comprised those who did not answer "yes" to either of the two items. Bivariate analyses were performed to evaluate the association between risky drinking behaviors and risk groups of substance abuse. The results of our study indicated that 87.0% of the participants reported lifetime alcohol use, and 69.4% reported the consumption of alcohol during the past 30 days. Of the former group, 21.4% had engaged in binge drinking, 8.6% had experienced alcohol-related harassment, 9.5% had experienced alcohol-induced blackouts, and 82.0% had experienced drinking alcohol with peers without adults. There were significant associations between risk groups of substance abuse and risky drinking such as binge drinking (p = 0.001), alcohol-induced blackouts (p = 0.020), alcohol-related harassment (p = 0.012), alcohol consumption during the past 30 days (p = 0.047). However, lifetime alcohol use (p = 0.264) and experience of drinking alcohol with peers without adults (p = 0.103) did not differ significantly. These findings indicated that risky drinking behavior such as binge drinking or alcohol-induced blackouts are associated with substance abuse among college freshmen. Substance abuse prevention programs for college students should address the health effects of risky drinking behaviors and train students how to avoid submission to peer pressure.

The purpose of this study was to investigate the psychological implications of emotionally enriching childbirth experiences for problems such as awareness of motherhood, postnatal depression, and parenting stress among women after childbirth.All women who gave birth at five study centers (four birthing homes and one maternity hospital) during May 2002 and August 2003 were asked to participate in the cohort study. All 2314 women were approached and 1004 eligible women agreed to take part. Analyses were conducted using a baseline survey and four follow-up surveys conducted at 4 months, 9 months, 2 and a half years, and 3 years after childbirth. The questionnaire included four scales to evaluate the subjects' childbirth experiences, awareness of motherhood, postnatal depression, and parenting stress and difficulties. Data were collected via structured interviews and transcription from medical records.Bivariate and multivariate analysis indicated that women who had good childbirth experiences had positive feelings concerning motherhood and parenting stress and anxiety were lower. Bivariate analysis also indicated that childbirth experience had an inverse relationship with postnatal depression.This study revealed that having good childbirth experiences inhibits negative awareness of motherhood and abusive behavior towards children. These results show that it is important for mothers to be provided with appropriate care during pregnancy and labor for preventing child abuse and parenting stress and anxiety. More research is needed to identify the determinants of childbirth

In the West, various psychological programs have been developed to treat drug dependence. Although some programs have been performed as trials in a few facilities in Japan, there are no psychological treatment programs available in many facilities, and their effects on Japanese drug abusers have not been well studied. We developed a manualized cognitive behavior therapy (CBT) program for Japanese clients with drug dependence based on a review of the literature. The program focused on the development of relapse prevention skills through role-playing, enhancement of motivation for recovery and self-care using relaxation technique. We studied the effects of the program for Japanese drug abusers. We evaluated the change after treatment, and compared findings between an intervention group and a control group. The results indicated that the program improved self-efficacies to cope with cravings and situations that increased the risk of relapse only in the intervention group, and physical complaints were decreased in the intervention group, although such complaints were increased in the control group. Seventy percent of the intervention group members indicated satisfaction and 50% indicated that the program was useful. These findings showed that the relapse prevention program was effective for Japanese clients. However, most emotional factors relevant to craving were not adequately changed in either group. We should improve the program, allowing the clients an opportunity to try the relapse prevention skills outside the facility and focus the emotion during a trial in vivo.

The aim of the present study was to determine the prevalence of tobacco use, alcohol drinking, and illicit drug use among night high school students in Japan.247 students (180 boys and 67 girls) from 3 night high schools were asked to complete self-administered anonymous questionnaires in classrooms. The average age of the participants was 18.7 years.Overall, 76.0% of the participants reported lifetime alcohol use, and 44.0% reported drinking alcohol during the past 30 days. Of the former, 24.6% reported experiencing alcohol-induced blackouts and 18.9% reported drinking alcohol without adult supervision at the age of 13 years or younger. 58.3% of the participants reported experimenting with smoking cigarettes, 42.3% reported having smoked cigarettes in the past 30 days, and 34.8% reported smoking cigarettes daily. 43.0% of the participants who had experienced smoking cigarettes had started smoking at the age of 13 years or younger. The lifetime prevalence of any illicit drugs was 9.8% for boys and 5.2% for girls; overall, it was 8.6%. The most commonly used illicit drugs were marijuana (6.4%), inhalants (6.4%), butane gas (4.5%), and nitrites (3.2%).Although the results showed that there were no significant differences in alcohol drinking experience between night high school and general high school students, problematic drinking behavior was observed. In the case of cigarette smoking, night high school students outnumber general high school students. In previous studies in Japan, the former population showed the highest prevalence of illicit drug use. These findings provide evidence that substance use represents a problem among night high school students. Based on this evidence, health education in night high schools should include not only zero tolerance for or abstinence from substance use but also secondary and tertiary prevention approaches.

DARC (Drug Addiction Rehabilitation Center) is the first and largest private half-way house agency for drug addiction in Japan, in which the programs are centered on 12 step meetings and the staff is made up of only those recovered from drug dependence. The purpose of this report is to elucidate how DARC works in the recovery from drug dependence. We made two studies: staff in 30 DARC facilities and 108 users in 7 male residential facilities. The results showed that 330 clients with drug dependence were participating in DARC programs at the time of research and about 600 clients use the programs each year. According to our research, three fourths of the users could maintain sobriety. Although many users had severe mental symptoms and socioeconomic difficulties, most users evaluated DARC programs highly to help them recover from these conditions. DARC rated highly because it provides companionship for recovered addicts and flexible frameworks to enhance drug addicts' motivation to recover, such as accepting dropouts and restarting programs, the provision of facilities away from areas where users were at high risk of relapse, and various program modalities.

DARC (Drug Addiction Rehabilitation Center) is self-help group for drug addiction with NA-based 12step meetings. The unmet needs of them were investigated among 26 facilities of DARC. The half of facilities didn't get any official supports and depending on user fee. Finally, we summarized that 1) financial problem result from lack of official supports, 2) lack of vocational opportunity, 3) lack of staffs and training of them, 4) psychiatric care of clients were common unmet needs of them. We suggested that 1) official supports would be required regarding feature of self-help group, 2) necessity of non-judgmental employment system for drug addicts, 3) recovered staff can play an important role in drug strategy, 4) mental health center can bridge a gap between DARC and psychiatric hospitals.

The purposes of this study were to estimate the prevalence of past solvent abuse among junior high school students in Saitama prefecture and to investigate smoking and drinking as "gateway drugs" for solvent abuse.The survey was conducted from Dec 2002 to Jan 2003, in 3 junior high schools in Saitama, using anonymous self-reporting to preserve privacy. A total of 2,049 (93.2%) students responded to our questionnaire. Two groups were categorized and analyzed according to history of solvent abuse in the past. To investigate "gateway effects" of smoking and drinking, we analyzed their relationship with solvent abuse, order of precedence of usage and confounding factors.The prevalence of history of solvent abuse was 1.1% of the total. There were notable differences depending on sex and grade. 1.9% of male students had some experience as compared to only 0.3% of female students. An increase was evident according to grade (grade 1-0.6%, grade 2-0.8%, grade 3-2.1%) and there was a strong association between smoking, drinking and solvent abuse. The order of precedence of solvent abuse could not be established because some users had first experienced smoking, drinking and solvent abuse in the same grade and there was also a high recall bias among the subjects. A number of respondents also reported the reverse order, of experiencing solvent abuse before smoking and drinking. The user group was habitual smokers were recommended to smoke by their parents, spent longer periods in solitude, witnessed solvent abuse and had a friend who abused solvents. After adjusting for confounding factors using multiple logistic regression analysis, a relationship between smoking and solvent abuse remained but not the relationship with drinking.The study conformed that there is solvent abuse among junior high school students, even in the lowest grade. Health education must focus on this fact and the finding that the user group reflects peer pressure and is faced with poor communication and advice from their families. Therefore health education focused on life skills and social support considering family ties must be emphasized. It could not be established which was first experienced, but a strong relationship between smoking and solvent abuse was observed even after multivariable analysis. On the other hand, the results suggested that habitual drinking is not a "gateway drug" to solvent abuse.

The purpose of the study was to develop a scale for measuring the recovery in self-help program for drug addicts. Our study sites were fourteen self-help groups for drug addicts called "DARC: Drug Addiction Rehabilitation Center". DARC activities were based on Narcotics Anonymous types of self-help program. The 25-items DASH-scale questionnaire was developed using data, which were obtained through in-depth interview among DARC staff. A cross-sectional study among recovering addicts participating in "DARC" activities was implemented from Jan 2004 to Feb 2004. 164 subjects were responded to our questionnaire. Factor analysis was carried out and items with weaker or split loadings were removed. Factor analysis of DASH-scale results produced a surprisingly clean four-factor solution. 19-items were left to form the final DASH-scale; regular life-style (6 items), acceptance of drug addiction (5 items), sympathy with member (5 items), reborn (3 items). The internal consistency (Cronbach's Alpha) of these scales was very high (0.87). Low but significant concurrent correlations were observed between the DASH-scale and the Rosenberg Self-Esteem Scale (0.22), Purpose in Life Test (0.35). Discriminant validity of the DASH-scale was supported by significant increase with exposed period of self-help program. Evidence supports the DASH-scale was possible to measure recovery in self-help program.