Development of group psychotherapy focused on emotion for Substance Use Disorders: Serigaya Collaboration for Open heart Project (SCOP).

Previous researches suggest that addressing alexithymia and emotional dysregulation in patients with alcohol and drug addiction is important. However, interventions focused on emotional problems in Substance Use Disorder (SUD) patients are rare in Japanese hospital settings. In 2014, we developed and implemented an intervention called the Serigaya Collaboration for Open heart Project (SCOP) for those SUD inpatients who have difficulty recognizing and expressing their emotions. The SCOP consists of a series of emotion-focused group psychotherapies provided by psychologist, occupational therapist, and nurse. The purpose of this preliminary study is to assess the efficacy of.SCOP in SUD patients. A total of 65 inpatients (37 alcohol and 28 drug use disorder) participated in the research. Thirty-two patients consented to receive the SCOP intervention concurrently with treatment as usual (TAU), while the rest of the patients (n = 33) received only TAU. TAU consists of cognitive-behavioral group therapy, psychoeducational group sessions, occupational therapy, and on-site self-help group attendances. Based on medical records, we assessed retrospectively the 6 months prognosis after discharge. A comparison was made between the SCOP and TAU groups in terms of treatment retention, attendance at self-help group meetings, -and alcohol or drug relapse. No dif- ference in post-discharge treatment retention was observed between the groups. The SCOP group had more self-help group attendees and fewer patients with alcohol or drug relapse than the TAU group. Although our present study is retrospective in design, our preliminary findings suggest that the SCOP intervention which focuses on emotions may be effective in encouraging SUD patients to join self-help groups, and helped prevent alcohol or drug relapses.

[Treatment approaches for synthetic drug addiction].

In Japan, synthetic drugs have emerged since late 2000s, and cases of emergency visits and fatal traffic accidents due to acute intoxication have rapidly increased. The synthetic drugs gained popularity mainly because they were cheap and thought to be "legal". The Japanese government restricted not only production and distribution, but also its possession and use in April 2014. As the synthetic drug dependent patients have better social profiles compared to methamphetamine abusers, this legal sanction may have triggered the decrease in the number of synthetic drug dependent patient visits observed at Kanagawa Psychiatric Center since July 2014. Treatment of the synthetic drug dependent patients should begin with empathic inquiry into the motives and positive psychological effects of the drug use. In the maintenance phase, training patients to trust others and express their hidden negative emotions through verbal communications is essential. The recovery is a process of understanding the relationship between psychological isolation and drug abuse, and gaining trust in others to cope with negative emotions that the patients inevitably would face in their subsequent lives.

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

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.

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

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.

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

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.

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

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.

[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].

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.

[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].

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.

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

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.

[Treating drug dependent patients through outpatient group therapy-Serigaya Methamphetamine Relapse Prevention Program (SMARPP)].

Drug addiction in Japan is a field of clinical psychiatry that occasionally poses questions concerning legal status of the patients abusing illicit drugs. In other countries, continuing care perspective and harm reduction policy is gradually becoming the main current of the addiction psychiatry. There are several clinical projects in Japanese psychiatric hospitals and public health centers attempting to motivate and treat drug dependent patients through outpatient group therapy. SMARPP is one of such projects with promising results concerning the efficacy on treatment retention.

[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].

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.

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

[Development and evaluation of a relapse prevention tool for drug-abusing delinquents incarcerated in a juvenile classification home: a self-teaching workbook for adolescents, the "SMARPP-Jr].

AIMS: The purpose of the present study is to develop a relapse prevention tool for drug-abusing delinquents incarcerated in a juvenile classification home, and to evaluate effectiveness of the tool. METHODS: We prepared a self-teaching workbook for drug-abusing adolescents named "SMARPP-Jr." referring to the workbook used in the "SMARPP (Serigaya Methamphetamine Relapse Prevention Program)", and consulted about the contents of the workbook to the director, the medical doctor, and the psychologists of a juvenile classification home. After establishing the final version, we provided 59 drug-abusing delinquents incarcerated in the juvenile classification home with a relapse prevention program by this workbook, and conducted pre- and post-evaluations by the Self-efficacy Scale for Drug Dependence and the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). RESULTS: The scores of SOCRATES were remarkably elevated after finishing the self-teaching workbook, while those of the Self-efficacy Scale for Drug Dependence were hardly changed. Additionally, over 60% of the participants reported that the contents of the workbook were not difficult to be understood, and approximately 90% of them also answered that this workbook was useful. CONCLUSION: The findings of the present study suggest that intervention in drug-abusing delinquents incarcerated in a juvenile classification home using the self-teaching workbook "SMARPP-Jr." may be effective to obtain insights of their drug-abuse problems and to become aware of necessity of treatment for their drug abuse.

Profiles associated with treatment retention in Japanese patients with methamphetamine use disorder: preliminary survey.

AIMS: To identify profiles associated with treatment retention in Japanese patients with methamphetamine use disorder. METHODS: The study used a retrospective design based on clinical records. The subjects were 101 patients at the Kanagawa Psychiatric Center, Serigaya Hospital, who were diagnosed as having methamphetamine use disorder. They were divided in two groups, namely those who remained in treatment 3 months after the initial assessment, and those who did not. The primary analysis compared patient profiles between the two groups to detect discriminating variables, which were then submitted for secondary analysis using logistic regression to determine the most relevant predictor of retention. RESULTS: Primary analysis indicated that older age, having psychotic symptoms, receiving public assistance, and history of incarceration were associated with treatment retention after 3 months. Secondary analysis showed that positive history of incarceration was the most significant predictor of the outcome. CONCLUSIONS: History of incarceration had the most significant treatment-retention effect on Japanese patients with methamphetamine use disorder. The development and introduction of integrated programs that link methamphetamine-dependent offenders to drug treatment is recommended in outpatient treatment for Japanese patients with methamphetamine user disorder.

[What is the Japanese mental health service lacking for drug dependence rehabilitation?].

Methamphetamine (MAP) has been one of the most popular abused drugs in Japan since 1950s. Nevertheless, although some of the psychiatric hospitals in Japan have treated psychosis caused by MAP, few have committed to rehabilitation for MAP dependence, which most of the individuals with MAP psychosis suffer from. This paper described the actual situation around the rehabilitation for MAP dependence in Japan, and proposed the necessity of establishing the new outpatient programs for the individuals with MAP dependence in Japan, introducing the Matrix Model, the outpatient program which has been served for individuals with MAP dependence since the middle of 1980s in the West Coast area in U.S.A. Additionally, we also introduced the principle and contents of our new outpatient program, the Serigaya Methamphetamine Relapse Prevention Program (SMARPP), which we have tried to conduct in Kanagawa Psychiatric Center Serigaya Hospital, consisting of the three a week groups sessions including relapse prevention program, motivational interviewing attitudes, and urine-monitoring following the Matrix Model. We discussed the future model of rehabilitation systems for drug dependence in Japan, and insisted that the current practices of the modified SMARPP starting in four psychiatric hospitals and one mental health and welfare center will be expected to establish the future outpatient program for MAP dependence in Japan.

[A preliminary study on outpatient relapse prevention program for methamphetamine dependent patients: Serigaya Methamphetamine Relapse Prevention Program (SMARPP)].

Although methamphetamine use disorder has been prevalent in Japan for more than fifty years, there have been hardly any effective medical treatment modalities other than improving methamphetamine-induced psychosis through hospitalization and/or participation in self help groups and private rehabilitation centers. As such limited social resources for recovering methamphetamine dependents are insufficient to prevent patients from relapse, there are growing needs for developing effective outpatient treatment program based on a chronic care perspective. We have developed a relapse prevention program for Japanese methamphetamine abusers, modifying "Matrix" model and incorporating other treatment materials. Then a preliminary study on implementing the program was conducted in an outpatient setting at Kanagawa Psychiatric Center, Serigaya Hospital. Of sixty eight methamphetamine dependent patients who visited the hospital for the first time between September 2006 and February 2007, four agreed to participate in the study. The program was manual- and workbook-based, and we suggested participants to attend to the session three-times per week for two months. Also participants were asked randomly to turn in urine samples once a week. The participants consisted of a female and three males, with an average age of thirty. The length of abstinent period since the last use varied substantially, from five days to more than four years. Three had the experience of serving in prison for violating the Stimulant Drugs Control Law. The results of the present study were that all four completed the program, and presented with negative urine samples throughout the period. However, in terms of treatment retention, two out of the four dropped out of the outpatient treatment within a month after the program termination. These outcomes suggest that a relapse prevention program may successfully be provided for Japanese methamphetamine abusers in an outpatient setting, with a favorable, treatment retaining effect during the program period.