A. Yoshimura

Estimates of alcohol-related oesophageal cancer burden in Japan: systematic review and meta-analyses

Abstract Objective To refine estimates of the burden of alcohol-related oesophageal cancer in Japan. Methods We searched PubMed for published reviews and original studies on alcohol intake, aldehyde dehydrogenase polymorphisms, and risk for oesophageal cancer in Japan, published before 2014. We conducted random-effects meta-analyses, including subgroup analyses by aldehyde dehydrogenase variants. We estimated deaths and loss of disability-adjusted life years (DALYs) from oesophageal cancer using exposure distributions for alcohol based on age, sex and relative risks per unit of exposure. Findings We identified 14 relevant studies. Three cohort studies and four case-control studies had dose–response data. Evidence from cohort studies showed that people who consumed the equivalent of 100 g/day of pure alcohol had an 11.71 fold, (95% confidence interval, CI: 2.67–51.32) risk of oesophageal cancer compared to those who never consumed alcohol. Evidence from case-control studies showed that the increase in risk was 33.11 fold (95% CI: 8.15–134.43) in the population at large. The difference by study design is explained by the 159 fold (95% CI: 27.2–938.2) risk among those with an inactive aldehyde dehydrogenase enzyme variant. Applying these dose–response estimates to the national profile of alcohol intake yielded 5279 oesophageal cancer deaths and 102 988 DALYs lost – almost double the estimates produced by the most recent global burden of disease exercise. Conclusion Use of global dose–response data results in an underestimate of the burden of disease from oesophageal cancer in Japan. Where possible, national burden of disease studies should use results from the population concerned.

Acceptance of Controlled Drinking Among Treatment Specialists of Alcohol Dependence in Japan

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.

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

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

SY16-3THE CHARACTERISTICS OF THE TREATMENT SYSTEMS OF ALCOHOL USE DISORDER IN JAPAN

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.

SY18-2EFFICACY OF DISULFIRAM FOR THE TREATMENT OF ALCOHOL DEPENDENCE ASSESSED WITH A MULTI-CENTER RANDOMIZED CONTROLLED TRIAL

Introduction. The efficacy of disulfiram in preventing an alcoholic relapse has been controversial. The aim of our study was to assess the efficacy of supervised disulfiram for the treatment of alcohol dependence with a multi-institutional study in Japan. Methods. In a single-blinded, randomized placebo-controlled study, we recruited 109 patients diagnosed with alcohol dependence under ICD-10 criteria. The patients were randomly allocated to four treatment groups, depending on whether they took disulfiram (200 mg daily) or a placebo or whether they received adjunctive therapy consisting of mailed letters which delineated and emphasized the harmful effect of alcohol and the management of alcohol craving. The proportion of abstinence among the four groups at 26 weeks after discharge was the primary outcome measure. Furthermore, we examined the proportion of abstinence in patients with inactive aldehyde dehydrogenase-2 (ALDH2). Results. There were no significant differences among the four groups in terms of abstinent patients or study drop-outs. Patients with inactive ALDH2 significantly sustained abstinence with the use of disulfiram (P = 0.044). Conclusions. Supervised oral disulfiram use followed by intervention via letters seems to be ineffective for increasing abstinence. We indicated the effectiveness of disulfiram for the maintenance of abstinence in patients with inactive ALDH2.

P-10ALCOHOL-RELATED PROBLEMS AMONG VOLUNTEER FIREFIGHTERS IN A DISASTER AREA HIT BY A HUGE EARTHQUAKE

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 members 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