A smartphone app-based intervention combined with face-to-face sessions for alcohol dependence at internal medicine clinics: A randomized controlled trial.

BACKGROUND: Addressing the limited access to treatments for alcohol dependence, we developed ALM-002, a therapeutic application to be "prescribed" for non-abstinence-oriented treatment in internal medicine settings. Our objective was to preliminarily assess the efficacy and safety of ALM-002. METHODS: In a multicenter, open-label randomized controlled trial, participants aged ≥20 with alcohol dependence and daily alcohol consumption exceeding 60 g for men and 40 g for women, without severe complications, were randomly assigned to either the intervention group using ALM-002 or the treatment-as-usual control group. Participant in both groups received individual face-to-face sessions by physicians at weeks 0, 4, 8, and 12. The primary endpoint was the change in heavy drinking days (HDDs) from week 0 to week 12. A mixed model for repeated measures was employed. RESULTS: We enrolled 43 participants: 22 in the intervention group and 21 in the control group. A significant reduction in HDDs every 4 weeks from week 0 to week 12 was observed, with a between-group difference of -6.99 days (95% CI: -12.4 to -1.6 days, standardized mean difference: -0.80). CONCLUSIONS: These results indicate the potential of ALM-002 as a viable treatment for alcohol dependence. Further studies are needed to evaluate the clinical potential of ALM-002.

Prevalence of hazardous drinking and suspected alcohol dependence in Japanese primary care settings.

OBJECTIVE: We aimed to assess the prevalence of hazardous drinking and potential alcohol dependence among Japanese primary care patients, and their readiness to change and awareness of others' concerns. METHODS: From July to August 2023, we conducted a multi-site cross-sectional study as a screening survey for participants in a cluster randomized controlled trial. The trial included outpatients aged 20-74 from primary care clinics. Using the Alcohol Use Disorders Identification Test (AUDIT) alongside a self-administered questionnaire, we evaluated the prevalence of hazardous drinking and suspected alcohol dependence, patients' readiness to change, and their awareness of others' concerns. RESULTS: Among the 1388 participants from 18 clinics, 22% (95% confidence interval (CI): 20% to 24%) were identified as engaging in hazardous drinking or suspected of being alcohol dependent. As the AUDIT scores increased, so did their readiness to change. However, only 22% (95%CI: 16% to 28%) of those with scores ranging from 8 to 14 reported that others, including physicians, had expressed concerns about their drinking during the past year. For those with scores of 15 or higher, the figure was 74%. CONCLUSIONS: This study underscores the need for universal or high-risk alcohol screening and brief intervention in Japanese primary care settings. Trial registry UMIN-CTR (https://www.umin.ac.jp/ctr/) (UMIN000051388).

Guided versus unguided chatbot-delivered cognitive behavioral intervention for individuals with moderate-risk and problem gambling: A randomized controlled trial (GAMBOT2 study).

BACKGROUND: Internet-based interventions can be a promising option for individuals with problem gambling facing barriers to seeking help. This study aimed to directly compare the effects of therapist-guided Internet interventions with unguided ones on gambling-related behavior, cognition, and stage of change including help-seeking intention. METHODS: We conducted a participant-blinded randomized controlled trial of therapist-guided versus unguided groups with a 12-week follow-up. Both groups received self-help chatbot-delivered cognitive behavioral therapy. Additionally, at baseline and weeks 1, 2, 3, and 4, the guided group received personalized feedback messages from therapists based on their gambling diary and questionnaire responses. The unguided group received reminders of assessments from research assistants. The primary outcome was the change in scores on the Gambling Symptoms Assessment Scale (G-SAS) over 12 weeks. Secondary outcomes included the stage of change including help-seeking intention, money wagered, gambling frequency, and gambling-related cognitions. RESULTS: We included 139 participants with a mean Problem Gambling Severity Index total score of 14.6 and a mean G-SAS total score of 27.0 who sought information about gambling problems. Both groups demonstrated substantial decreases in their G-SAS scores from baseline to week 12 (-10.2, 95% CI: -7.67 to -12.7 for the guided group, and 11.7, 95% CI: -9.05 to -14.3 for the unguided group). However, we did not find a significant between-group difference (1.49, 95% CI: -2.20 to 5.17). Regarding the stage of change including help-seeking intention, there were also no between-group differences. CONCLUSIONS: Minimum therapist support did not have an additive effect on the self-help chatbot intervention on gambling symptoms, behavior, and the stage of change including help-seeking intention.

A randomized controlled trial of the web-based drinking diary program for problem drinking in multi workplace settings.

OBJECTIVES: To assess the effectiveness of a web-based brief intervention (BI) program to record daily drinking among people with problem drinking in workplace settings. METHODS: A two-armed, parallel-group, randomized controlled trial were conducted at six workplaces in Japan. After obtaining written consent to participate in the study, workers with an Alcohol Use Disorders Identification Test (AUDIT) score of 8 or higher were randomly assigned into two groups. The participants allocated to the intervention group recorded their daily alcohol consumption for 4 weeks using the program, while those allocated to the control group received no intervention. Outcome measures included the amount of alcohol consumption in past 7 days using the Timeline Follow-Back method in the program at baseline, 8th week, and 12th week and written AUDIT score at baseline and 12th week. RESULTS: Hundred participants were assigned to either the intervention group (n = 50) or control group (n = 50). The results of two-way repeated measures ANOVA showed a statistically significant interaction between the group and the week factors in the two primary outcomes (number of alcohol-free days, total drinks) and secondary outcomes (AUDIT score) (p = .04, .02, and .03, respectively). The between-group effect sizes (Hedges' g; 95% CI) of the outcomes at 12th week were 0.53; 0.13-0.93 (total drinks), 0.44; 0.04-0.84 (AUDIT score), 0.43; 0.03-0.83 (number of alcohol-free days). CONCLUSIONS: The web-based BI program for problem drinking was considered to be effective in reducing alcohol consumption and the AUDIT score in workplace settings.

A clinical risk analysis of early post-operative delirium after laparoscopic colorectal cancer surgery in elderly patients: a retrospective study.

PURPOSE: Early post-operative delirium (EPOD) is a frequent complication following colorectal surgery. The present study investigated the risk factors for EPOD after laparoscopic colorectal surgery in elderly patients. METHODS: A retrospective study was conducted among 208 patients ≥70 years old who underwent laparoscopic colorectal surgery. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with the EPOD. RESULTS: The overall incidence of EPOD was 10.1% (21/208). The univariate analysis showed that an older age (≥80 years old; P=0.002), sleeping pill medication before surgery (P=0.037), a history of dementia (P=0.030) and cerebrovascular disease (P=0.017), elevated levels of D-dimer (P=0.016), maximum intraoperative temperature ≥37 °C (P=0.036), and non-continuous usage of droperidol with analgesia (P=0.005) were associated with EPOD. The multivariate logistic regression analysis revealed an older age (≥80 years old; odds ratio [OR]: 6.26, 95% confidence interval [CI]: 1.94-20.15, P=0.002), sleeping pill medication before surgery (OR: 5.39, 95% CI: 1.36-21.28, P=0.016), history of cerebrovascular disease (OR: 3.91, 95% CI: 1.12-13.66, P=0.033), and maximum intraoperative temperature ≥37 °C (OR: 5.10, 95% CI: 1.53-16.92, P=0.008) to be independent risk factors. When the patients were divided into groups according to the number of positive risk factors, the prevalence rate was 6.5%, 16.0%, and 63.6% for patients with 1, 2, and 3 positive risk factors, respectively. CONCLUSION: Our findings suggest that an older age, sleeping pill medication before surgery, history of cerebrovascular disease, and maximum intraoperative temperature ≥37 °C are independent risk factors of EPOD after laparoscopic colorectal surgery in elderly patients.

Changes of clinical symptoms in patients with new psychoactive substance (NPS)-related disorders from fiscal year 2012 to 2014: A study in hospitals specializing in the treatment of addiction.

AIMS: The use of new psychoactive substances (NPS) has become increasingly widespread over the last decade, in Japan and internationally. NPS are associated with a range of increasingly serious clinical, public, and social issues. Political measures to ameliorate the effects of NPS in Japan have focused on tightening regulation rather than establishing treatment methods. The current study sought to compare the neuropsychiatric symptoms of patients with NPS-related disorders across several years. We examined patients who attended specialized hospitals for treating addiction, to elucidate the impacts of legal measures to control NPS. METHODS: Subjects (n = 864) were patients with NPS-related disorders who received medical treatment at eight specialized hospitals for treating addiction in Japan between April 2012 and March 2015. Clinical information was collected retrospectively from medical records. RESULTS: Among psychiatric symptoms, the ratio of hallucinations/delusions decreased over time across 3 years of study (first year vs second year vs third year: 40.1% vs 30.9% vs 31.7%, P = 0.037). Among neurological symptoms, the ratio of coma/syncope increased over the 3-year period (7.8% vs 11.0% vs 17.0%, P = 0.002), as did the ratio of convulsions (2.8% vs 4.3% vs 9.7%, P = 0.001). CONCLUSION: The symptoms associated with NPS were primarily psychiatric in the first year, while the prevalence of neurological symptoms increased each year. The risk of death and the severity of symptoms were greater in the third year compared with the first year, as regulation of NPS increased.

[Treatment outcome of alcoholics in a general hospital alcoholic clinic: effects of adopting moderation as a practical treatment goal].

It's almost 50 years since medical treatment for alcoholism began to be practiced in Japan in 1960s. Since then, treatment goal for alcohol use disorders has always been absolute abstinence, and only severe cases have been treated. Recently, many people are concerned about lifestyle-related diseases, suicides, depression, and drunken-driving accidents. Reduction in alcohol consumption of heavy drinkers began to draw attention, and brief motivational intervention study was launched at last in 2007 in Japan. In 2009 we set up alcohol clinic in a general hospital in order that the alcoholics may get easier access to their treatments. The basic roles of our alcohol satellite clinicare as follows: 1. Assessment and diagnosis of patient's alcohol-related problem are our primary role. 2. Referral to a specialized hospital is offered in case special treatments for alcohol dependence are needed. 3. Our standard treatment is a brief intervention, not exceeding 3 sessions, to enhance the patients' self-efficacy. 4. Our treatment goal is not limited to total abstinence. Moderation of drinking can also be a goal. We examined the treatment outcome to verify these roles and meanings. Of all the patients visited this hospital from 2009 to 2011, 77 patients were diagnosed as alcohol dependent. Out of those 77 patients, 21 patients set up a moderation of drinking as their temporal treatment goal and 10 achieved good outcome at the inquiry point of 8 to 41 (average: 22) months after intervention. This result suggests that moderation can be a practical treatment goal in some alcoholics.

[Effectiveness of drinking plan and drinking diary in intervention program (HAPPY program) for heavy drinkers].

We examined the effectiveness of a drinking plan (goal setting), and a drinking diary (self monitoring), in the intervention program (HAPPY program), for heavy drinkers in the workplace. 115 people participated, and 80 people were evaluated three months later and 31 people were evaluated one year later. We classified the drinking plans in the limitation of the quantity, non-drinking days, and the device of low risk drinking model. 75 people made the drinking diary for 12 weeks after brief intervention and studied three months later and 31 people were analyzed one year later. We evaluated on heavy drinking days of 28 days, and non-drinking days of 28 days and standard drinks of 7 days. The limitation of the quantity model is effective for low risk drinking. The non-drinking day model is easily achieved, but not effective for low risk drinking. The device of low risk drinking model improved drinking habits for a long-term. The drinking diary for 12 weeks after intervention improved drinking habits for a long-term. The drinking plan (goal setting), and drinking diary (self monitoring), in intervention program for heavy drinkers were effective for prevention of lifestyle-related disease and alcoholism.