Drinking in the Context of Health-Sustaining Habits / 가정의학회지

The comprehensive medical care delivered by family physicians should involve education and practice of health-sustaining habits such as diet, exercise, relaxation etc. as well as drug prescription. Among those, problem drinking is one of the most frequent issues encountered in health promoting sessions. However they are not competent to cover the realm of counseling in problem drinking in a continuous way. The drinking problems go up, unnoticed and uninhibited, to the self-destructive stages by the process of denial and avoidance on the part of patient as well as therapists. The explanation by which moderate drinking can't be easily embedded into healthy life styles and the practical strategies for dealing with problem drinkers and alcohol dependents will be presented in the context of health-sustaining habits.

The Role of Alcoholics' Insight in Abstinence from Alcohol in Male Korean Alcohol Dependents

This study was performed to examine the relationship between the abstinence results of alcohol dependents after discharge and the level of insight at the time of discharge. 117 male Korean alcohol dependents discharged from a community-based alcohol treatment center were followed up to determine the initial months of abstinence on a successive basis (IMA), total months of abstinence during 12-month period (TMA), and complete abstinence for one full year after discharge. Analyses of abstinence results with adjustment for the differences in baseline characteristics were performed for subjects' insight levels (poor, fair and good). The mean IMA of patients with good insight was significantly (p<0.01) longer than that of patients with poor insight and TMA of patients with good insight was significantly (p<0.001) longer than that of others. Using patients with good insight as the reference, patients with poor insight showed an adjusted odds ratio (OR) of 0.07 (95% confidence interval [CI]=0.01-0.75, p<0.05) for complete abstinence for one full year after discharge and patients with fair insight, adjusted OR of 0.17 (95% CI=0.03-0.81, p<0.05). These results suggest that alcohol dependents' insight could be regarded as a factor related with abstinence.

Behavioral Medicine Approach for Lifestyle Diseases

No Abstract available.

Behavioral Medicine Approach for Lifestyle Diseases

No Abstract available.

Drinking Problems of Hepatitis B Virus Healthy Carriers in Korean Population

BACKGROUND: Heavy drinking may be a cause of serious health problems in hepatitis B virus carriers. The aim of this study was to reveal the degree of drinking problems in the Korean hepatitis B virus healthy carriers. METHODS: The subjects were 218 hepatitis B virus healthy carriers (124 males and 94 females) recruited from those who visited the Health Promotion Center of Chungnam National University Hospital for a general health check-up. Drinking problems of the subjects were evaluated by the AUDIT (Alcohol Use Disorders Identification Test) questionnaire. RESULTS: The AUDIT scores (mean+/-SD) of the male subjects (9.6+/-7.9) were significantly (P <0.001) higher than those of the female subjects (2.7+/-5.2). The individuals with heavy drinking (more than 14 drinks in males and 7 drinks in females per week) are 24 (19.4%) in males and 5 (5.3%) in females. Alcohol use disorders were suspected in 36 (29.0%) males and 4 (4.3%) females. CONCLUSION: It is suggested that, in Korea, clinical attention in primary health care should be focused on reducing the alcohol consumption among the hepatitis B virus carriers, considering a large proportion have drinking problems and the possible harmful effect on their health by heavy drinking.

Can Carbohydrate-Deficient Transferrin (CDT) Reflect Alcohol Consumption in Korean Male Drinkers?

BACKGROUND: It has been suggested that CDT is a potential biological marker in the Western countries to reflect the degree of past alcohol consumption. This study was performed to compare CDT, AST (aspartate transaminase), ALT (alanine transaminase), and GGT (gamma- glutamyl transferase) as a biological marker reflecting drinking amounts in Korean patients. METHODS: The 25 males with moderate drinking(21 drinks/week) were studied for the relationships between their weekly drinking amount and the blood levels of CDT, AST, ALT, and GGT. RESULTS: Only CDT was significantly correlated (P=0.001) with weekly drinking amount among heavy drinkers, while both CDT (P=0.029) and GGT (P=0.000) were significantly correlated in moderate drinkers. Stepwise multiple regression revealed that GGT had R2 of 49.1% in moderate drinkers and CDT had R2 of 38.9% in heavy drinkers for the weekly drinking amount. CONCLUSION: The results described above suggested that CDT can be a potential biological marker for the purpose of quantitative monitoring the drinking behavior of heavy drinkers in Korea.

Understading and Management of Alchohol-related Diseases

No abstract available.

Influence of alcoholic's insight on their abstinent outcomes for one year after discharge

BACKGROUND: This study was intended to present the importance of insight status concerning the abstinence of alcoholics. METHODS: The 214 subjects, who participated in insight improving programs during hospitalization in an alcohol treatment center, were followed up for their abstinent status during the 12 month period after discharge. The relation between their abstinence results and insight status was investigated. To find out the influence of other factors upon abstinence, stepwise multiple regression was performed over variables including disease severity, sociodemographic, therapeutic and familial features. RESULTS: The 73 individuals (34.1%) had 'no remission', 110 (51.4%) 'early full remission', and 31 (14.5%) 'sustained full remission'. The insight degree was significantly correlated with both 'initial consecutive months of sobriety'(IMS) after discharge and 'total months of sobriety'(TMS) during the follow up. The 153 subjects (71.5%) relapsed within four months after discharge, and the rate of continuous abstinence at each month differed significantly among three insight groups. On the inter group shifts during hospitalization, the abstinent months were greater in the group whose insight changed from 'poor ' to 'good insight' than the one from 'fair ' to 'good insight'. By stepwise multiple regression analysis, the higher insight scores, older age and shorter hospital days, in a decreasing order of association, the longer IMS and TMS, while absence of religion and lower MAST scores was associated only with IMS, with their overall R2 value of 18.5% and 20.8%, respectively. CONCLUSION: The insight degree was related to the length of abstinence and thus it is necessary to develop insight improving programs which can be of help to recovering patients.

Improvement of insight in patients with alcohol dependence by treatmen programs

BACKGROUNDS: The first step for the recovery of alcoholics is the formation of true insight which enables them to admit that they are alcoholic. This study was designed to analyze the changes in insight status by treatment programs. METHOD: The subjects were 214 alcohol dependents who participated in the insight-oriented treatment programs for at least 1 week. Their insight status were measured through HAIS before and after treatment. RESULTS: Of 214 subjects, 83 (38.8%) were in poor-, 103 (48.1%) in fair-, and 28 (13.1%) in good-insight before treatment, and 56 (26.2%) in poor-, 97 (45.3%) in fair-, and 61 (28.5%) in good-insight after treatment. Mean HAIS scores of the subjects were 5.35 (SD=8.33) before treatment and significantly increased to 9.00 (SD=8.04) after treatment. The magnitude of insight-improvement was negatively correlated with the HAIS scores before treatment in poor-insight group and positively correlated with the duration of participation in treatment in fair-insight group. CONCLUSION: We confirmed the fact that the insight status of patients could be improved by treatment. It was also suggested that the therapeutic strategy needed an individual approach according to the insight state of a patient.

Comparison of four alcoholism screening tools based on sensitivity and specificity for DSM-IV criteria

No Abstract Available.

Screening criteria of alcoholism by alcohol use disorders identification test(AUDIT) in Korea

BACKGROUND: Such screening tools for alcoholism as MAST, NAST, CAGE focused on the alcohol-related psyhosocial problems. But some men can be exduded in a study using these tools whereas they might be at risk for alcohol related physical problems. From this perspective the new tools focusing under quantity and frequency of intake for detection of early-stage drinkers not yet manifesting evident psychosocial problems but having alcohol- related potential harms, are being developed. With focus on these aspects, 10 itemed AUDIT was developed by WHO and this study was developed to provide standard points for screening alcohol problems in Korea with cultural difference through AUDIT. METHOD: The subjects were 85 drinking men and 11 male alcohol dependents who visited Kangmung hospital af Asan foundation from July until August 1998. The team composed of 2 family physicians and 1 psychiatrist, who delivered structured interviews based on DSM-IV criteria in terms of psychosocial problems, and examined them and reviewed the patient records in terms of alcohol-related physical problems. Accordingly the subjects were classified into 'normal', 'physical problems-related drinkers' without psychosocial problems, and 'alcohol abuser' and 'alcohol dependent' according to DSM-IV criteria. Aside from physicians diagnostic procedures, they were again made to complete a questionnaire induding all the items of AUDIT, MAST, NAST and CAGE. RESULTS: As regards physicians' diagnostic results, 31 were normal, 8 had physical problems without psychosocial problems, 36 abused alcohol, and 21 were alcohol-dependent. The mean AUD1T scores of all the sub were 17.5(+/-9.5) and the mean AUDIT scores of each group were 7.1(+/-4.3), 16.6(+/-3.4), 19.9(+/-5.0), 29.3(+/-5.1), respectively and revealed significant difference among them AUDlT scores were significantly correlated with those marked from physicians' diagnostic results and also significantly correlated with MAST, NAST and CAGE, respectively. After consideration of mean AUDIT scores and standard deviations of each group according to diagnostic results, the preliminary standard AUDIT scores for detection of a broader sense of 'problem drinker' including physical as well as psychosocial problems were most possibly 12, 13, 14 points. Their sensitivity and specificity were 96.9% and 87.1% in 12 points, 92.3% and 90.8% and 90.3% in 14 points, respectively. The preliminary standard AUDIT scores concerning alcohol use disorders hased on DSM IV criteria were most possibly 14, 15, 16 with its sensitivity and specificity of 91.2% and 74.4% in 14 points, 89.5% and 79.5% in 15 points, and 84.2% and 84.6% in 16 points. The preliminary standard AUDIT scores for 'alcohol dependence' were most possibly 25, 26, 27 with its sensitivity and specificity of 85.7% and 90.7% in 25 points, 85.7% and 93.3 in 26 points, and 71.4% and 94.7% in 27 points. CONCLUSIONS: The authors recommend AUDIT cut-off scores of 12 points as the standard value for a broader sense of problem drinking including physical as well as psychasocial problems, 15 for 'alcohol use disorders' based on DSM IV criteria, and 26 for 'alcohol dependence' in Korea.

Validity of the clinical recommendation of Hepatitis B virus vaccine to adults with negative HBsAg and AntiHBs

BACKGROUND: Administration of hepatitis B vaccine has played a major part in the management of public health in this country. There were many researches to assess the immunogenecity, safety, long term effectiveness, dose, and route of administration of hepatitis B vaccine. But there was lack of validation of the recommendation that hepatit.is B vaccine should be administered in adults with negative HBsAg and AntiHBs, in an endemic area with high prevalence of HBsAg. Authors tried to establish a proper candidate for hepatitis B vaccination evaluating viral markers of hepatitis B in adults vaccinated. METHODS: 172 hepatitis B vaccinated subjects(35.0%) were drawn from 491 adults who have visited at health care center, Asan Kangnung Hospital from April 1st to May 31th, 1997. They were asked designed questions about the beginning year, frequency of vaccination, and the presence of family members with HBsAg in a direct line. RESULTS: Of the subjects(172), 2.3% were HBsAg(+), 63.4% AntiHBs(+), 68.6% AntiHBc(+). Among the HBsAg(-) adults(149) who had been vaccinated more than three times, 70.4%(105) were AntiHBs(+), of whom 66.6%(70) were AntiHBc(+) and 29.6%(44) were AntiHBs(-), of whom 56.8%(25) were AntiHBc(+). In the subjects(20) with family history of HBsAg, 80% were AntiHBc(+), which is higher than 61.2% in the group(129) without family history. Among the HBsAg(-) and AntiHBc(-) adults(54) who had been vaccinated more than three times, AntiHBs(+) group was not significantly differnt from AntiHBs(-) group in comparison of age and years after initial vaccination. CONCLUSIONS: The two thirds(68.9%) of vaccinated subjects showed AntiHBc(+), which means reflection of previous exposure to Hepatitis B virus. Accordingly, vaccination is not thought to be required for these. Consequently, all individuals are thought to have to be pretested for the presence of AntiHBc as well as HBsAg and AntiHBs in Korea.