Publications by authors named "Kiyoshi Wada"

71 Publications

Parental drinking according to parental composition and adolescent binge drinking: findings from a nationwide high school survey in Japan.

BMC Public Health 2020 Dec 7;20(1):1878. Epub 2020 Dec 7.

Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.

Background: Alcohol problems in parents have been revealed to affect adolescent alcohol misuse. However, few studies examine the effects of parental drinking on adolescent risky drinking (including binge drinking) in the general population. In particular, previous study findings are inconsistent regarding the influence of parental drinking according to parental composition. In this study, we aimed to examine the relationship between parental drinking, according to parental composition, 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 with a generalized linear mixed model was conducted with binge drinking as the dependent variable and "parental drinking according to parental composition" (e.g., father's drinking, mother's drinking, father's absence, mother's absence, both parents drinking, and neither parent at home) as the independent variable, after adjusting with 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 two hours.

Results: In the fully adjusted models, adolescents whose mothers drink (adjusted odds ratio (AOR): 1.50, 95% confidence interval (CI): 1.06-2.12) were significantly associated with adolescent binge drinking. This risk was significantly higher among students with neither parent living at home (AOR: 4.35, 95% CI: 2.10-9.02).

Conclusion: Parental drinking and absence do affect adolescent binge drinking; our findings show that adolescents are more likely to engage in binge drinking if their mothers drink or if they are not living with either parent. Therefore, it is important to engage parents and non-parental family members in future programs and interventions to prevent adolescent binge drinking.
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http://dx.doi.org/10.1186/s12889-020-09969-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720457PMC
December 2020

[Current Situation of Cannabis Use in Japan: Based on Data from the Nationwide General Population Survey on Drug Use in Japan 2017].

Yakugaku Zasshi 2020 ;140(2):173-178

Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry.

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.
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http://dx.doi.org/10.1248/yakushi.19-00195-1DOI Listing
August 2020

Comparison of legislative management for new psychoactive substances control among Taiwan, South Korea, and Japan.

Kaohsiung J Med Sci 2020 Feb 23;36(2):135-142. Epub 2019 Oct 23.

PhD Program in Toxicology, Kaohsiung Medical University, Kaohsiung, Taiwan.

For decades, the three United Nations drug conventions have served as the basis for member states' obligations and international cooperation on drug control. However, the emergence of new psychoactive substances (NPSs) poses a new risk to public health and a challenge to drug policy because of their unknown toxicological effects and easy modification of chemical structures to shun legal control. So far, there is no international consensus on legislative control of NPSs. Therefore, we compared the legislative management on NPS control among Taiwan, South Korea, and Japan. Drug-related information was obtained from the authorities of these three countries. The results indicate that despite geographic proximity and similar legal attitudes toward illegal drug use, the legislative criteria, and responses for NPS control in these three countries were quite different. Ketamine has been the major used NPS in Taiwan but seldom found in South Korea and Japan. The difference in the number of controlled NPSs in Taiwan (91) and South Korea (245) might be due to the implementation of temporary designation systems and analog controls in South Korea. The recent surge of newly controlled NPSs in Japan was because of the promulgation of designated drug regulation and subsequent control of "dangerous drugs." Although NPS use has become a potential social and medical problem among these three countries, the outcomes of NPS legislation control remain to be scrutinized. To minimize harm from NPS use, development of legislative mechanism(s) on NPS scheduling is the first step for early identification and control of NPS problems.
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http://dx.doi.org/10.1002/kjm2.12140DOI Listing
February 2020

Reasons for alcohol consumption among Japanese high school students overall and by sex and year in school: An exploratory study.

Nihon Arukoru Yakubutsu Igakkai Zasshi 2016 Oct;51(5):302-322

This study sought to ascertain the association between alcohol consumption by Japanese high school students and their reasons for drinking. Monitoring the Future is a U.S. survey of substance abuse that features a core question that asks about reasons for drinking. This study translated that question into Japanese to survey 2,283 students (1,404 males and 879 females; 1,142 freshmen and 1,141 sophomores) at 3 Japanese high schools from November to December 2014. The original question had 15 possible answers, but 2 were eliminated and the answer "I don't drink" was added. Responses were analyzed overall and by sex and year. Results indicated that 9.4% of male students drank in the past 30 days, 28.4% drank in the past year, and 43.0% had drunk at some point in their lives. Similarly, 6.5% of female students drank in the past 30 days, 23.8% drank in the past year, and 36.7% had drunk at some point in their lives. Of the sample, 58.1% answered that they "don't drink. " Given reasons for drinking were "because it tastes good" (15.8%), "to-experiment-to see what it's like" (14.5%), "to have a good time with my friends" (14.1%), "to relax or relieve tension" (10.2%), "to feel good or get high" (7.9%), and "to fit in with a group I like" (5.2%). Respondents who drank in the past 30 days, in the past year, or at some point in their lives did so for different reasons. As alcohol consumption increased, respondents drank "because it tastes good" markedly more often. Reasons for drinking were ranked by frequency to compare Japanese high school students and U.S. 12th graders. Japanese students were more likely to drink "to fit in with a group I like" while U.S. students were more likely to drink "because of boredom, nothing else to do."
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October 2016

Recent changes in the clinical features of patients with new psychoactive-substances-related disorders in Japan: Comparison of the Nationwide Mental Hospital Surveys on Drug-related Psychiatric Disorders undertaken in 2012 and 2014.

Psychiatry Clin Neurosci 2016 Dec 29;70(12):560-566. Epub 2016 Sep 29.

Department of Addiction Research and Treatment, Saitama Psychiatric Center, Saitama, Japan.

Aim: The aim of this study was to examine changes in the psychosocial backgrounds and clinical features of patients with psychiatric disorders associated with new psychoactive substances (NPS) between 2012 and 2014 in Japan.

Methods: Clinical features of patients with NPS-related disorders were compared using data from the Nationwide Mental Hospital Surveys on Drug-related Psychiatric Disorders undertaken in 2012 and 2014. NPS patients were compared with a control group comprising patients with methamphetamine-related disorders, using data from the same period.

Results: In NPS patients, changes were observed in the following three areas between 2012 and 2014: (i) a decrease in the number of employed patients; (ii) an increase in the ratio of patients diagnosed with dependence syndrome; and (iii) a decrease in the ratio of patients diagnosed with psychotic disorder. In methamphetamine patients, only one change was observed: protective custody or arrest record relating to the Pharmaceutical Affairs Act.

Conclusion: This study suggests that the number of patients dependent upon NPS, and those exhibiting social dysfunction, increased between 2012 and 2014. There is a need to focus future measures against NPS dependence: not only on stopping the supply of drugs, but also on reducing the demand for them.
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http://dx.doi.org/10.1111/pcn.12434DOI Listing
December 2016

Common aspects of the lifestyles of high school students in Japan and their associations with drug abuse: Findings from an aggregate sample of the Japanese School Survey Project on Alcohol and Other Drugs in 2004, 2006, and 2009.

Nihon Arukoru Yakubutsu Igakkai Zasshi 2016 Aug;51(2):118-138

This study sought (1) to determine the significant associations between measures of drug abuse and lifestyle variables in high school students in Japan, and (2) to ascertain common lifestyle variables in relation to associations between lifestyle and eight measures of drug abuse. Four measures were use of an inhalant, marijuana, an amphetamine-type stimulant (ATS), or MDMA (ecstasy) over the past year, and four measures were use of those drugs over one's lifetime. Data were from a combined sample (aggregate sample) from the Japanese School Survey Project on Alcohol and Other Drugs (JSPAD). The aggregate sample consisted of 75, 726 1st-, 2nd-, and 3rd-year students (37,697 males and 38,029 females) at high schools nationwide who were selected by stratified, single-stage cluster sampling during surveys in 2004, 2006, and 2009. Eight measures of drug abuse were predicted with logistic regression analysis based on lifestyle variables. Six lifestyle variables jointly predicted those measures: "get- ting up at the same time every day," "eating breakfast," "enjoying school,'' "hours worked at a part-time job," "having close friends to hang out with", and "talking with one's parents about one's problems". The six lifestyle variables were associated with the measures of drug abuse in similar ways, regardless of which drug was abused. Those associations indicated that students whose parents were not at home had a markedly higher level of drug abuse. Students who lacked close friends to hang out with, students who did.not enjoy school, students who rarely ate breakfast, and students who did not get up at the same time every day had a higher level of drug abuse. Several indicators of associations yielded findings, and these findings could presumably help to determine if "individuals who abuse drugs display characteristics as a group" and if "individuals who abuse drugs tend to abuse multiple drugs".
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August 2016

[Efficacy of the Serigaya Methamphetamine Relapse Prevention Program (SMARPP): for patients with drug use disorder: A study on factors influencing 1-year follow-up outcomes].

Nihon Arukoru Yakubutsu Igakkai Zasshi 2016 Feb;51(1):38-54

Purpose: The purpose of this study was to evaluate the efficacy of the Serigaya Methamphetamine Relapse Prevention Program (SMARPP), which is the workbook-based group therapy for individuals with drug dependence, through investigating 1-year follow-up outcomes.

Method And Subjects: The sample was drawn from 231 outpatients diagnosed as DSM-IV substance use disorder, who had firstly consulted the drug dependence clinic of the Center Hospital, National Center of Neurology and Psychiatry between September 2009 and June 2013. Of the 231 potential subjects, 79 had participated in SMARPP at least once, and finally 37 who had continued contact this clinic for more than 1 year after due-day of finishing the first SMARPP course were determined as the subjects. We collected the outcome information retrospectively based on clinical records.

Result: At the 1-year follow-up point, 67.6% of the subjects had continued abstinent at least for a month, and 60% of them had continued full-abstinent for more than 1 year. One of the factors which influenced their abstinence was "having no experience of using new psychoactive substances" (p = 0.029). As for 70.3% of subjects, drug-use frequency decreased and the only factor for their improvement was "participating in SMARPP many times" (p = 0.040). Of the subjects, 23 patients corresponded to methamphetamine use disorder, and 65.2% of them had continued abstinent at least for a month at the 1-year follow-up point. Additionally, 60% of them had continued full-abstinent for more than 1 year.

Discussion And Conclusion: Our study demonstrated possible effectiveness of SMARPP for patients with drug use disorder, especially methamphetamine-use-disorder. The factors of abstinence or decrease of drug-use frequency may be to participate in SMARPP many times, not to abuse "not illegal" drugs such as new psychoactive substances or hypnotics/anxiolytics and to continue treatment for more than 1 year after due-day of finishing the program.
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February 2016

[Abuse, dependence and intoxication of substances].

Authors:
Kiyoshi Wada

Nihon Rinsho 2015 Sep;73(9):1450-6

As for substance-related disorders, there were several differences between ICD-10 and DSM-IV, however, the concept of "dependence" had been essential for both criteria. DSM-5 published in 2013 had erased dependence. This confuses us. It is important to recognize dependence again. "Abuse" is the self-intake behavior of drug against the social norms. Repeated abuse results in dependence. Dependence is a state of loss of control against drug use due to craving. Abuse can produce "acute intoxication", and repeated abuse under dependence can produce "chronic intoxication". It is important to understand abuse, dependence and "intoxication" based on their relationship from the point of time course.
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September 2015

[Response to treatment of patients abusing the "dappou drug" who participated in a group relapse prevention program: a comparison with patients abusing methamphetamine].

Nihon Arukoru Yakubutsu Igakkai Zasshi 2014 Dec;49(6):318-29

In this study, we compared the efficacy of a group relapse prevention program using the cognitive behavioral therapy-based workbook, Serigaya Methamphetamine Relapse Prevention Program (SMARPP), between patients abusing the so-called "dappou drugs" (designer drug in Japan, and those abusing methamphetamine (MAP). Both groups participated in the SMARPP at the Center Hospital, National Center of Neurology and Psychiatry. Results showed that, no significant differences were found in the rates of participation in the program or self-reported frequency of drug or alcohol use between the patients abusing "dappou drugs" or MAP. However, patients using "dappou drugs" reported no significant increase in their confidence in their ability to resist the temptation to use drugs on the self- report drug abuse scales after the SMARPP intervention, while patients abusing MAP reported a significant positive difference in their ability to resist temptation. In addition, insight into substance abuse problems and motivation to participate in further treatment slightly declined in those using "dappou drugs," while there was a significant increase reported by the patients using MAP. These results suggested that the SMARPP might not be as effective for patients abusing "dappou drugs" as for those abusing MAP. The development of a relapse prevention program specifically designed for patients abusing "dappou drugs" is required.
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December 2014

Current status of substance abuse and HIV infection in Japan.

J Food Drug Anal 2013 Dec;21(4):S33-S36

Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Toyko, Japan.

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 number, homosexual transmission accounted for 63% of the 11,146 HIV-positive patients and 40% of 5,158 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.
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http://dx.doi.org/10.1016/j.jfda.2013.09.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179209PMC
December 2013

Clinical behavior of Japanese community pharmacists for preventing prescription drug overdose.

Psychiatry Clin Neurosci 2015 Apr 23;69(4):220-7. Epub 2014 Sep 23.

Department of Drug Dependence Research, National Center of Neurology and Psychiatry, Tokyo, Japan.

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 explored the possibility of overdose prevention by community pharmacists.

Methods: We surveyed all registered community pharmacies with dispensing functions (nā€‰=ā€‰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 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).

Conclusion: 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.
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http://dx.doi.org/10.1111/pcn.12232DOI Listing
April 2015

[The association between extracurricular activities and exercise and substance abuse among high school students in Japan: results for an aggregate sample from the Japanese School Survey Project on Alcohol and Other Drugs in 2004, 2006, and 2009].

Nihon Arukoru Yakubutsu Igakkai Zasshi 2013 Dec;48(6):426-44

The purpose of this study was to clarify the subgroup differences in the association between participation in school-based extracurricular activities and exercise and levels of cigarette, alcohol, or marijuana use during one's lifetime and in the past year. This study also sought to determine the optimal classification of subgroups based on four variables (participation in school-based extracurricular activities, exercise, gender, and school year). Data consisted of a combined sample (aggregate sample) from the Japanese School Survey Project on Alcohol and Other Drugs (JSPAD) conducted in 2004, 2006, and 2009. The aggregate sample consisted of 75,726 1st-, 2nd-, and 3rd-year students (37,697 males and 38,029 females) at full-time high schools nationwide that were selected by stratified, single-stage cluster sampling during each survey. The aggregate sample combined randomly selected samples of the same size from each year the survey was conducted. Results indicated that 63.4% of the entire sample participated in school-based extracurricular activities, 64.8% of males did so, and 61.9% of females did so. Results also indicated that 66.4% of the entire sample exercised outside of PE class, 79.2% of males did so, and 53.8% of females did so. In addition, the prevalence of cigarette, alcohol, or marijuana use was predicted from the four variables by multiple logistic regression analysis. Results yielded optimal subgroups for the prevalence of each drug's use. Results revealed (1) that participation in school-based extracurricular activities and gender were more predictive, whereas exercise was least predictive, (2) that the association between exercise and substance use measures varies subtly for each subgroup, suggesting the existence of a great variety of opportunities for high school students to exercise, and (3) that school year had a substantial and positive effect on drinking among students who actively participated in school-based extracurricular activities.
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December 2013

Clinical features of patients with designer-drug-related disorder in Japan: a comparison with patients with methamphetamine- and hypnotic/anxiolytic-related disorders.

Psychiatry Clin Neurosci 2014 May 9;68(5):374-82. Epub 2014 Jan 9.

Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.

Aim: The aim of this study was to clarify the clinical features of designer-drug-abusing patients through comparisons with methamphetamine-abusing patients and hypnotics/anxiolytics-abusing patients.

Methods: Information on 126 designer-drug-abusing patients, 138 methamphetamine-abusing patients, and 87 hypnotics/anxiolytics-abusing patients was extracted from the 2012 database of 'The Nationwide Mental Hospital Survey on Drug-related Psychiatric Disorders' and the clinical variables of designer-drug-abusing patients compared with those of the other two groups.

Results: Multivariate analysis indicated the following significant differences between designer-drug-abusing patients and the other two types of patients: designer-drug-abusing patients were younger, included more men, had higher education and fewer relationships with antisocial groups, and included more patients meeting ICD-10 F1 sub-classification categories of 'Harmful use' and 'Psychotic disorders' than methamphetamine-abusing patients. Compared with hypnotics/anxiolytics-abusing patients, designer-drug-abusing patients were younger, included more men and more patients meeting criteria for 'Psychotic disorders', and more frequently cited 'peer pressure', 'unable to refuse', and 'seeking stimulation' as reasons for using the drug.

Conclusion: The advent of designer drugs has created a new class of drug abuse, and abuse of designer drugs may carry a strong psychosis-inducing risk, exceeding that of methamphetamine.
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http://dx.doi.org/10.1111/pcn.12140DOI Listing
May 2014

Evaluation of a relapse-prevention program for methamphetamine-dependent inmates using a self-teaching workbook and group therapy.

Psychiatry Clin Neurosci 2014 Jan 19;68(1):61-9. Epub 2013 Sep 19.

Department of Drug Dependence Research, National Institute of Mental Health, Tokyo, Japan.

Aim: The aim of this study was to evaluate the effect of a relapse-prevention program for methamphetamine (MAP)-dependent inmates in a prison.

Methods: Participants were 251 male inmates with MAP-abuse problems. We compared scores on the Self-efficacy Scale for Drug Dependence (SSDD) and the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) before and after intervention with a self-teaching workbook and group therapy.

Results: For all participants, only SSDD scores increased during the pre-intervention period. SOCRATES-8D scores increased after the start of the intervention using the self-teaching workbook, and both SSDD and SOCRATES-8D scores increased when group therapy was implemented. Changes in scores in participants with moderate and high MAP dependence were considerably different from the scores of those with low dependence during the pre-intervention and the self-teaching workbook periods.

Conclusion: Intervention using a self-teaching workbook and group therapy in prisons might be effective for inmates with more than moderate severity of MAP abuse.
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http://dx.doi.org/10.1111/pcn.12084DOI Listing
January 2014

[Clinical characteristics of dappou herb use--disorder patients at the drug dependence clinic: a comparison with methamphetamine use-disorder patients].

Seishin Shinkeigaku Zasshi 2013 ;115(5):463-76

Chiba Hospital.

Background And Purpose: Use of the so-called "dappou herb," a street drug typically produced by mixing herbs with synthetic cannabinoid (estimated to be the pharmacologically effective ingredient), has recently spread to young people in Japan who consider it a new recreational drug. It is not legally regulated because no illicit ingredients have been detected in the drug by conventional screening tests. It is easily obtained via the Internet or from street vendors. As the population abusing this drug has grown, medical problems such as psychosis, disturbances of consciousness caused by acute intoxication, and social problems such as traffic accidents while under the influence of the drug have been increasingly reported. However, few psychiatric symptoms associated with it have been identified, and little is known about the psychosocial features of abusers. The purpose of the present study was to examine the clinical and psychosocial features of outpatients with dappou herb use disorder.

Methods: Subjects were 15 male outpatients with dappou herb use disorder who had their first medical examination at the Drug Dependence Clinic in the Center Hospital, National Center of Neurology and Psychiatry between November 2009 and April 2012. The control group comprised 28 age-matched oupatients who had methamphetamine use disorder, the most serious drug-related problem in Japan since the 1950s. They underwent their first medical examination at the same clinic during the same time frame as the study subjects. Clinical and psychosocial information on subjects and controls including life histories (educational, occupational, and criminal) and clinical information (history of psychoactive substance use, access to the mainly abused drug, and DSM-IV diagnoses of substance use disorder and comorbid psychiatric disorders) were collected from medical records. These variables were compared between the two groups.

Results: Analyses revealed differences in the life history and clinical characteristics between the subjects and controls. The subjects had a higher level of education, more work experience, and a less marked history of anti-social behavior other than illicit drug use and possession than the controls. However, a clinical history of psychiatric disorders, other than substance-related disorders, before drug abuse began was more frequently found in the subjects than in the controls.

Conclusions: The present study demonstrates that patients with dappou herb use disorder may differ from those with methamphetamine use disorder in terms of their background, psychosocial factors, and clinical features. These findings suggest that the dappou herb may be creating a new type of drug abuser in Japan. Our study also indicates that some patients abusing this herb may have been "self-medicating" for symptoms of other psychiatric disorders such as depression or anxiety, given that they were more likely to have received psychiatric treatment before the start of drug abuse. This suggests that the legal regulation of this drug as well as early comprehensive intervention for adolescents with mental health problems may be required to prevent abuse of the dappou herb. Two limitations of this study should be noted. The definition of the dappou herb was vague because the ingredients are still unclear. In addition, the sample size of this study was very small. However, no studies using larger samples have been reported in Japan. Future studies that overcome these limitations are needed.
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September 2013

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

Nihon Arukoru Yakubutsu Igakkai Zasshi 2012 Dec;47(6):317-30

National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan

Background And Aims: The aims of present study are to clarify the clinical features of patients with benzodiazepine use disorder (BZsUD), and to examine the characteristics of psychiatric treatments which may cause BZsUD.

Methods: We conducted a medical chart and interview survey to 87 outpatients with benzodiazepine use disorder, who had consecutively visited the four hospitals, specialized in addiction problems, located in metropolitan area, during a month of December, 2011.

Results: Consequently, 88.5% of the patients with BZsUD reported to obtain BZs to be abused from general psychiatric clinics, and 83.9% contracted BZsUD in process of general psychiatric treatment. Among the patients who contracted BZsUD in process of psychiatric treatment, 43.8% were speculated to have the other substance-related disorders such as methamphetamine or alcohol-related disorder at start of the psychiatric treatment. Further, approximately 70% of them reported that surplus BZs were prescribed without consideration of storing drugs, and over 40% also reported that BZs were prescribed without a medical examination.

Conclusions: The findings of the present study may let us to propose the following four measures to be taken for prevention of BZsUD: First, latent substance-related disorders should not be overlooked, second, short-acting and high-potency BZs should not be prescribed if possible, third, storing and abusing BZs should always be considered, and finally, BZs should be prescribed with a medical examination.
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December 2012

Prevention of overlapping prescriptions of psychotropic drugs by community pharmacists.

Nihon Arukoru Yakubutsu Igakkai Zasshi 2012 Oct;47(5):202-10

Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8553, Japan.

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.
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October 2012

Ecstasy (3, 4-methylenedioxymethamphetamine) use among Japanese rave population.

Psychiatry Clin Neurosci 2013 Jan;67(1):12-9

Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.

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.
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http://dx.doi.org/10.1111/j.1440-1819.2012.02402.xDOI Listing
January 2013

Unhealthy lifestyle, poor mental health, and its correlation among adolescents: a nationwide cross-sectional survey.

Asia Pac J Public Health 2015 Mar 18;27(2):NP1557-65. Epub 2012 Jul 18.

National Institute of Public Health, Saitama, Japan.

Objectives: The objective was to study the relationship between mental health and lifestyles of adolescents using samples representative of Japanese adolescents nationwide.

Method: The survey was conducted between December 2004 and January 2005 among students enrolled in randomly selected junior and senior high schools. Self-administered questionnaires addressed lifestyles, sleeping habits, and mental health status. Of 103 650 questionnaires collected, 85 158 were analyzed.

Results: Population characteristics associated with poor mental health were being female, being a senior high school student, skipping breakfast, not participating in extracurricular activities, not consulting parents about personal matters, parental smoking, students' smoking or alcohol use, poor subjective sleep assessment, and short or long sleeping duration.

Conclusion: Smoking and anxiety disorders are associated with an elevation in acculturative stress in adolescents. Prepossessing adolescents are in subclinical depression. Results suggest that lifestyles approaches in preventions that target students can be effective in reaching high-risk populations.
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http://dx.doi.org/10.1177/1010539512452753DOI Listing
March 2015

[Current situation and clinical characteristics of sedative-related disorder patients in Japan: a comparison with methamphetamine-related disorder patients].

Seishin Shinkeigaku Zasshi 2011 ;113(12):1184-98

National Institute of Mental Health, National Center of Neurology and Psychiatry.

Purpose: The purpose of the present study was to examine the current situation regarding sedative (mainly benzodiazepines)-related disorder in Japan and the clinical characteristics of Japanese patients with this disorder.

Subjects: Subjects were 671 drug-related disorder patients diagnosed according to the ICD-10 classification as "F1: mental and behavioural disorders due to psychoactive substance use," who abused psychoactive substances other than alcohol. Of all the psychiatric hospitals in Japan between September and October 2010, these drug-related disorder patients had consecutively consulted or were admitted to 153 psychiatric hospitals.

Methods: The present study was conducted by means of a mail survey. Subjects' clinical information, including history of psychoactive substance use, means of access to the primary drug of abuse, other ICD-10 diagnoses including the F1 subcategory and comorbid psychiatric disorders, and recent history of self-destructive behavior, were collected from the attending psychiatrists of each subject. The data thus gathered concerning sedative-related disorder patients were compared with those of patients with methamphetamine-related disorder, which has been the most serious drug-related problem in Japan since the 1950s.

Results: Out of the 671 subjects, 119 patients mainly abusing sedatives (SRD group) were identified, while 361 patients were identified as mainly abusing methamphetamine (MRD group). The MRD group was the largest population (53.8% of the total subjects), followed by the SRD group (17.7%), and then the inhalant-related disorder group with 56 patients (8. 3%). Compared with the MRD group, the SRD group was younger, contained more female patients, and had a lower incidence of a history of involvement with anti-social societies and anti-social behavior. Patients in the SRD group were more likely to have started abusing drugs with the intention of reducing the unpleasant symptoms of insomnia (42.9%), anxiety (26.1%), and depression (16.0%), and to acquire the drugs they abused from medical institutions such as psychiatric or primary care clinics (82.1%), while patients in the MRD group were more likely to have started out of curiosity (35.1%) or in response to peer pressure (47. 1%), and to acquire their drugs from a "pusher" (32.8%). Additionally, in the SRD group, the ICD-10 F1 subcategory diagnoses that were the clinically most important were "dependence syndrome" (64.0%), "harmful use" (16.2%), and "acute intoxication" (16.2%), while the most important subcategory diagnosis in the MRD group was "psychotic disorder" (34.3%) and "residual disorder and late-onset psychotic disorder" (32.9%). Further, comorbid psychiatric disorders were more frequently found in the SRD group than in the MRD group; notably, co-occurrence of mood disorder was found in 45.0% of the SRD group in contrast to the MRD group (11.9%). Recent episodes of deliberate self-harm behavior were also more frequently found in the SRD group than the MRD group (33.6 vs. 10.5%, respectively) ; the major means by which these patients harmed themselves was by overdosing on prescribed drugs (23.5 vs. 4.7%, respectively).

Conclusion: The present study suggests that sedative-related disorder is an important clinical issue in the field of drug-related disorders in Japan today, and that SRD patients may represent a distinct type of drug abuser whose clinical characteristics are different from those of MRD patients. The development and spread of treatment programs for "dependence syndrome" and "harmful use" will help SRD patients, and educating psychiatrists about SRD will help prevent future sedative abuse.
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April 2012

Possible effectiveness of intervention using a self-teaching workbook in adolescent drug abusers detained in a juvenile classification home.

Psychiatry Clin Neurosci 2011 Oct;65(6):576-83

National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.

Aims: The purpose of the present study was to examine whether the possible effectiveness of the juvenile version of the Serigaya Methamphetamine Relapse Prevention Program (SMARPP-Jr.) self-teaching workbook we developed for relapse prevention of drug abuse depends on the severity of the subject's drug-related problems.

Methods: Subjects were 85 adolescent drug abusers who were detained in a juvenile classification home. We compared changes between the subjects' scores on rating scales administered both before and after interventions with the self-teaching workbook, and we examined associations between the effectiveness of the intervention and the severity of the subjects' drug-related problems.

Results: Regardless of the severity of their drug-related problems, the subjects' rating scale scores were significantly different after the intervention, which suggests that use of the workbook increased their awareness of the problems caused by drug dependence and their motivation to obtain treatment. However, use of the workbook did not significantly change their confidence in their capacity to resist drug craving.

Conclusion: Although the self-teaching workbook is a convenient intervention tool that can increase subject awareness and motivation for treatment, it is likely that continuous community-based support systems are required to prevent relapse.
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http://dx.doi.org/10.1111/j.1440-1819.2011.02267.xDOI Listing
October 2011

[Evaluation of the Relapse Prevention Guidance for drug-dependent inmates: the intervention using self-teach workbook and group therapy in a "Private Finance Initiative" prison --the second report].

Nihon Arukoru Yakubutsu Igakkai Zasshi 2011 Jun;46(3):368-80

Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawa-Higashi 4-1-1, Kodaira-city, Tokyo 187-8553, Japan.

Background: There has been no relapse prevention program for drug dependent inmates in Japanese prisons. Recently, "Relapse Prevention Guidance" program is provided to the adult male inmates in Harima Rehabilitation Program Center (HRPC), one of the newly founded "Private Finance Initiative" prisons.

Aims: To evaluate the effectiveness of the program by comparing the outcomes between groups of inmates with different severity level of dependence.

Methods: The program was provided to 89 subjects in HRPC. Inmates were classified into 4 groups according to the severity measured by the Drug Abuse Screening Test (DAST). After a month of waiting period, self-teaching workbook was provided to each inmate for 4 weeks. The educational program consisting of 8 weekly psychoeducational group therapies was then provided to each group of 10 inmates. The evaluation was conducted both at the beginning and at the end of the workbook and the educational program intervention by administering 2 self-reporting questionnaires; the Self-efficacy Scale for drug dependence (SES), and the 8th version of the Stages of Change Readiness and Treatment Eagerness Scale for drug dependence (SOCRATES-8D).

Results: Only the "mild" group showed significant increase in SES during waiting period. After the workbook intervention, "moderate" group showed significant decrease in SES, and increase in the recognition and the ambivalence subscale of the SOCRATES-8D. The same increase in the subscales of SOCRATES-8D was noted in "Severe" group. Educational program produced increase in the recognition and the taking steps subscales of SOCRATES-8D in "mild" group, increase in SES score and the taking steps subscale in "moderate", increase in SES score and total score of SOCRATES-8D in "severe" group. No significant change was noted in "very severe" group in any of the interventions.

Conclusion: The "Relapse Prevention Guidance" is sufficiently effective, improving self-efficacy and motivation for change in drug dependent adult male inmates.
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June 2011

[Evaluation of the relapse prevention guidance for drug-dependent inmates: the intervention using self-teach workbook and group therapy in a "private finance initiative" prison--the first report].

Nihon Arukoru Yakubutsu Igakkai Zasshi 2011 Apr;46(2):279-96

Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawa-Higashi 4-1-1, Kodaira-city, Tokyo 187-8553, Japan.

Background: In Japan, methamphetamine (MAP) abuse has been a serious problem for 60 years, and many of MAP abusers have been incarcerated in prisons as a violator of the Stimulant Control Law in Japan.

Aims: The purpose of the present study is to evaluate effectiveness of the relapse prevention guidance for drug-dependent inmates using a self-teaching workbook for drug-abusing adolescents and group therapy, conducted in the Harima Rehabilitation Program Center, one of the new prisons which the Ministry of Justice founded cooperating private enterprises as a "Private Finance Initiative" project.

Methods: We provided for 89 male drug-dependent inmates, incarcerated in the Harima Rehabilitation Program Center, with the relapse prevention guidance consisting of a self-teaching workbook and group therapy, and implement pre-and post-evaluations by the Self-efficacy Scale for Drug Dependence (SES) and the Stages of Change Readiness and Treatment Eagerness Scale, 8th version for Drug Dependence (SOCRATES-8D).

Results: After a waiting term, the participants were provided with a self-teaching program, subsequently with a group program. At the point of completing the waiting term, no significant changes were observed in the SES and SOCRATES-8D scores. However, at the point of completing the self-teaching program, the SES scores significantly fell, while the total SOCRATES-8D score and the scores of the two subscales, the "Recognition" and "Ambivalence," significantly rose. Further, at the point of completing the group program, the total scores of the SES and SOCRATES-8D, and the score of the two SOCRATES-8D subscales, the "Recognition" and "Taking Steps," significantly rose.

Conclusion: The relapse prevention guidance consisting of a self-teaching workbook and group therapy, conducted in the Harima Rehabilitation Program Center, were supposed to bring same internal changes as the "Stage of Changes" model, proposed by Prochaska and DiClemente, to drug-dependent inmates.
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April 2011

Association of parental factors with student smoking and alcohol use in Japan.

Nihon Arukoru Yakubutsu Igakkai Zasshi 2011 Apr;46(2):270-8

Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan.

A nationwide survey was conducted on smoking and alcohol use among junior and senior high school students and their parents in Japan. The analyses were performed to assess whether parents' smoking or drinking behavior, health knowledge, and attitude toward their children's smoking or drinking behavior influenced their children's behavior using linked datasets of students and parent answers. The number of schools that responded was 24 out of 40 sampled schools. A total of 11,362 questionnaire data sets from students and parents were applied to the analyses. The influence of parental factors including smoking, alcohol use, knowledge, and attitudes were used as the covariates on students' smoking or alcohol use as independent variables. The data were analyzed using a multiple logistic analysis. The analysis revealed that the parental attitudes of children's smoking or alcohol use were important risk factors as well as parental smoking or drinking behaviors. Conversely, the parental attitude toward warning children of the hazard of smoking or alcohol use was a significant preventive factor for the outcome of their children's behavior.
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April 2011

Comparisons of methamphetamine psychotic and schizophrenic symptoms: a differential item functioning analysis.

Prog Neuropsychopharmacol Biol Psychiatry 2011 Jun 4;35(4):959-64. Epub 2011 Feb 4.

Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand.

The concept of negative symptoms in methamphetamine (MA) psychosis (e.g., poverty of speech, flatten affect, and loss of drive) is still uncertain. This study aimed to use differential item functioning (DIF) statistical techniques to differentiate the severity of psychotic symptoms between MA psychotic and schizophrenic patients. Data of MA psychotic and schizophrenic patients were those of the participants in the WHO Multi-Site Project on Methamphetamine-Induced Psychosis (or WHO-MAIP study) and the Risperidone Long-Acting Injection in Thai Schizophrenic Patients (or RLAI-Thai study), respectively. To confirm the unidimensionality of psychotic syndromes, we applied the exploratory and confirmatory factor analyses (EFA and CFA) on the eight items of Manchester scale. We conducted the DIF analysis of psychotic symptoms observed in both groups by using nonparametric kernel-smoothing techniques of item response theory. A DIF composite index of 0.30 or greater indicated the difference of symptom severity. The analyses included the data of 168 MA psychotic participants and the baseline data of 169 schizophrenic patients. For both data sets, the EFA and CFA suggested a three-factor model of the psychotic symptoms, including negative syndrome (poverty of speech, psychomotor retardation and flatten/incongruous affect), positive syndrome (delusions, hallucinations and incoherent speech) and anxiety/depression syndrome (anxiety and depression). The DIF composite indexes comparing the severity differences of all eight psychotic symptoms were lower than 0.3. The results suggest that, at the same level of syndrome severity (i.e., negative, positive, and anxiety/depression syndromes), the severity of psychotic symptoms, including the negative ones, observed in MA psychotic and schizophrenic patients are almost the same.
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http://dx.doi.org/10.1016/j.pnpbp.2011.01.014DOI Listing
June 2011

The history and current state of drug abuse in Japan.

Authors:
Kiyoshi Wada

Ann N Y Acad Sci 2011 Jan;1216:62-72

National Center of Neurology and Psychiatry, National Institute of Mental Health, Department of Drug Dependence Research, Kodaira, Japan.

Drug abuse in Japan began after World War II and has been characterized by three epidemics of methamphetamine abuse; in addition, solvent abuse has been prominent for a long time. Since 1995, with the beginning of the third epidemic of methamphetamine abuse, drug abuse or dependence in Japan changed, with a marked decrease in solvent abuse, stabilization of methamphetamine abuse, an increase in the abuse of such drugs as cannabis or 3,4-methylenedioxymethamphetamine (which do not have high potential of causing drug-induced psychosis), and the emergence of designer drugs. Furthermore, the abuse of medical drugs such as Ritalin became a major issue in 2007. These changes reveal an increase in the abuse of drugs that do not as easily produce a psychotic state, underlain with a shift from personal conduct that leads to arrest to conduct that does not. Japan, therefore, needs to deal with drug abuse and dependence using not only a medical model, but also a criminal model as well.
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http://dx.doi.org/10.1111/j.1749-6632.2010.05914.xDOI Listing
January 2011

[Efficacy of the treatment program for substance use disorder under the Medical Treatment and Supervision Act in Japan].

Nihon Arukoru Yakubutsu Igakkai Zasshi 2010 Oct;45(5):452-63

National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan.

In Japan, the Medical Treatment and Supervision Act (MTSA) has been in effect since 2005 as a new system for treating mentally disordered offenders. This system was anticipated to aim at treating schizophrenia, while preparing no treatment programs for Substance use disorder (SUD). However, unexpectedly 30% of the inpatients, who a court judged to be treated in this system, have co-occurring SUD in addition to mental disorders. This is the reason why we have provided the inpatients under the MTSA with the treatment program for SUD (TPSUD). The purpose of the present study is to evaluate efficacies of the TPSUD provided in the MTS Award of the Center Hospital, National Center of Neurology and Psychiatry. Subjects were the 15 inpatients admitting to this ward, who participated in had the TPSUD due to co-occurrence of SUD. A self-reporting questionnaire, which consisted of the Self-Efficacy Scale for Drug Dependence (SESDD), and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), and some clinical information, was administered before and after the program. Consequently, the subscale score of the SOCRATES, "recognition," was significantly elevated after the TPSUD in alcohol related problems, while the subscale score of the SESDD, "global change of self-efficacy for drug dependence," was significantly elevated in drug-related problems. Additionally, either rate of the subjects who started to the anti-alcohol drugs or who manifested to participate in self-help groups for SUD was also significantly elevated. Our findings suggest that the TPSUD may be effective to SUD which co-occur in mentally disordered offenders, and that this program may involve some clinical implication in forensic psychiatry practices under the MTSA.
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October 2010

[Factor structure and validity of the Japanese version of SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) in adolescent delinquents placed in detention home].

Nihon Arukoru Yakubutsu Igakkai Zasshi 2010 Oct;45(5):437-51

National Center Hospital of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira 187-8553, Japan.

Objective: Assessment of the degree of motivation for change in drug abusers is important in determining the optimal treatment modality for each patient. The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) is a 19 item instrument designed by Miller and Tonigan to provide quantitative assessment of the motivation for change in substance abusers. The object of the present study is to examine the factor structure and validity of the Japanese version of SOCRATES-8D (version 8 for drug abusers).

Methods: One hundred and five adolescent delinquents (81 male and 24 female) in a detention home were included in the study. The most frequently abused drug was cannabis in 43 percent of the delinquents, followed by methamphetamine in 20 percent and organic solvent in 18 percent. Exploratory factor analysis and validity analysis was performed to determine the factor structure and criterion-related validity.

Results: The two factor structure of the 13 item Japanese version was confirmed, namely 6 item "Ambivalence" and 7 item "Taking steps". Internal consistency was acceptable with the value of a over 0.85. Criterion-related validity was confirmed with significant negative correlation between the Self-Efficacy Scale (Morita et al.) and "Ambivalence" factor, and significant positive correlation with "Taking steps" factor. Also, there was significant positive correlation between the Japanese version of the Drug Abuse Screening Test (Skinner) and "Ambivalence" factor. The external validity of "Recognition" factor was not confirmed. Presumably the factor related to the recognition of oneself as an addict was absorbed in "Ambivalence" factor, due to the relatively less severe degree of drug dependence that is characteristic of the juvenile delinquents in detention homes.

Conclusion: The 13 item Japanese version of the SOCRATES-8D is valid and applicable to the substance abusing juvenile delinquents in detention homes. Further research with the inclusion of adult samples from addiction clinics is necessary to confirm the generalizability of the version.
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October 2010
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