Transcript PowerPoint

KAAP Autumn Meeting in 2016
November 18, 2016, Seoul
Recent legislative changes related to addiction
in the Japanese context:
Suggestions for addiction psychiatrists
Susumu Higuchi
NHO Kurihama Medical and Addiction Center, Yokosuka, Japan
1
Contents
 Status of alcohol, drug and gambling
issues in Japan
 Basic Act on Measures against Alcoholrelated Health Harm
 Partial suspension of execution of
sentence
 Legalization of casino
Adult per capita alcohol consumption (age 15+ years)
(Liter / year) 9
8
7
6
5
Total
Seishu
Shochu
Beer
Wine
Spirits
Others
6.85 in 2011
4
3
2
1
0
(Fiscal Year)
National Tax Agency, 2011; Statistics Bureau, MIC, 2011.
Global distribution of adult per capita alcohol consumption
(+15 years old)
Change in per capital alcohol consumption
between 1992-2012
in OECD member states
Global distribution of frequencies of
heavy episodic drinking (HED)
HED: Drinking 60g or more at least
one occasion in 30 days
WHO: Global Status Report on Alcohol and Health, 2014.
OECD: Tackling Harmful Alcohol Use, 2015.
Recent trend and future projections on adult per capita alcohol
consumption in selected Asian countries (+15 years old)
(Liters / year)
Viet Nam
Thailand
Singapore
Philippines
New Zealand
Nepal
Myanmar
Mongolia
Malaysia
Lao P.D.R.
Korea
Japan
Indonesia
India
Fiji
D.P.R.Korea
China
Cambodia
Australia
14
12
10
8
6
4
2
0
2003-2005
2008-2010
2015
2020
2025
WHO. Global Status Report on Alcohol and Health, 2014.
Summary of recent conditions concerning
alcohol use and misuse in Japan
 Although per capita alcohol consumption has shown a tendency to decline for
more than 15 years, it still remains at a high level.
 The diversification of the drinking population has rapidly progressed, specifically
among women, for whom alcohol consumption has increased.
 A convergence phenomenon has been observed with regard to the age-gender
structure of alcohol use.
 Cross-sectional and longitudinal data suggest that alcohol-related problems,
especially health problems, have steadily increased over several decades
with few exceptions.
 Consecutive large-scale cross-sectional surveys have suggested that underage
alcohol consumption has been decreasing.
 Several factors may be involved in the downward trend of underage alcohol use.
These factors include a reduction in the drinking prevalence among family
members, limited sources of alcoholic beverages and reduced social interaction
among students.
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How has
the “Basic Act on Measures
against Alcohol-related
Heath Harm”
been established?
The 63rd World Health Assembly
May 17-21, 2010
The resolution
WHA63.13 “Global
Strategy to Reduce
the Harmful Use of
Alcohol”
was adopted.
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A Basic Act can drastically change alcohol control
measures in Japan
Ino Aro
Kasumigaura Clinic
Presented at the annual meeting of the Japanese Society of Alcohol-Related Problems in 2011.
The historic presentation
launching the discussion that
lead to the Basic Act on
Measures against Alcoholrelated Harm
Discussion started in Autumn in 2010
Alcohol and addiction-related 3
societies (JSARP, JMSAS and JSND)
Japan Alcohol Problems Liaison Council
(Umbrella organization of alcohol-related
NGOs)
January in 2012
Establishment of
the “ALHO-NET” (Basic Act Network)
Recruited
Support
Organizations
Recruited
Held hearing
sessions
Agreed to promote the
enactment of the Basic
Act in December 2011
Established in 1999
Diet Member Alliance on Alcohol Problems
Propelling body for the enactment of the new act
Support of
Diet members
Prepared the
draft bill
Related
Ministries and
Organizations
Mr. Tetsuro Fukuyama
Secretary-General, DMAAP
Former Acting Secretary
General, Democratic Party
Mr. Gen Nakatani
President, Diet Member Alliance
on Alcohol Problems (DMAAP)
Former Minister for Defense
Mr. Masaharu Nakagawa
Acting President, DMAAP
Former Minister for Education,
Culture, Sports, Science and
Technology
The ALHO-NET was quite active in recruiting support
organizations, support members in the Diet and gaining
support from local governments
As of December, 2013
 Support organizations
N=369 (including the Japan Medical
Association, the Japanese Society of
Internal Medicine and the Japanese Society
of Psychiatry and Neurology
 Support members of the Diet
108 / 722 (Lower = 475, Upper = 252)
 Support from 11 prefectural and 1
municipal assembly
Ms. Tomomi Imanari
Secretary-General
ALHO-NET
The Basic Act on Measures agaist Alcohol-Related Harm was established
Nov 21, 2013
Passed in the Lower
House
Dec 7, 2013
Passed in the Upper
House
The ALHO-NET hosted support
assemblies in many cities
throughout Japan
September 2013 in Osaka, n=1,239
May 2013 in Nagoya, n=449
December 2013 in Okayama, n=520
May 2014 in Tokyo, n=1,150
“The Basic Act on Measures against Alcohol-Related Health Harm”
consisting of 5 chapters and 27 articles
10 Basic Measures
Primary
Prevention
Secondary
Prevention
Tertiary
Prevention
General
1. Promotion of education etc
2. Preventing inducement of inappropriate drinking
3. Health Examinations and Guidance
4. Full development of medical treatment related to
alcohol-related health harm
5. Guidance for persons who have driven under the
influence of alcohol
6. Consultation and support
7. Support for rehabilitation in the society
8. Support for activities by private bodies
9. Securing staff resources
10. Promotion of research and study
Establishment of the “Basic Plan for Measures
against Alcohol-Related Health Harm”
 The Council of Experts related to Measures against Alcoholrelated Health Harm was established to prepare the Basic Plan in
October 2014 in the Cabinet Office of Japan
 It consisted of 17 members (Chair, Dr. Susumu Higuchi).
 It convened 26 times, preparing the draft basic plan in February
2016
 The draft plan was approved by the cabinet in May 2016
Basic Plan for Measures against
Alcohol-related Health Harm
May 2016
Introduction
I. About the Basic Plan for Measures against
Alcohol-related Health Harm
II. Basic concept of the Act
III. Priority measures in the basic plan
IV. Basic measures
V. Promotion systems
Priority measures
第１期基本計画で取り組むべき重点課題
1. Disseminating information on known risks associated
with drinking, and preventing the occurrence of
alcohol-related health harm in the future
(1) Education to people requiring
special consideration
★ Those who should not drink such as minors
and pregnant women
★ Young generations who are
concerned mental and physical
consequences in the future
(2) Dissemination of
appropriate knowledge
on alcohol dependence
Priority measures
第１期基本計画で取り組むべき重点課題
2. Development of support systems for prevention,
consultation, treatment and rehabilitation relating to
alcohol-related health harm
(1) Promotion of early intervention in cases of alcoholrelated health harm
(2) Establishment of consultation centers in the community
(3) Development and promotion of referral systems for persons with alcoholrelated health harm and their families for consultation, specialized treatment
and rehabilitation support
(4) Establishment of specialized medical facilities that will be the basis for
treatment of alcohol dependence
● Designating a national central facility for research, treatment and manpower
development in relation to alcohol-related health harm
● Development and promotion of specialized medical facilities for the treatment of
alcohol dependence in the community
● Improvement of treatment for alcohol-related health harm
Babor T et al. Alcohol: No Ordinary Commodity
First Edition, 2003
Second Edition, 2010
Ratings of selected policy-relevant strategies and interventions
Regulating physical availability
- Total ban on sales
- Restrictions on sales days / hours
Taxation and pricing
- Alcohol taxes
Education and persuasion
- Alcohol education in schools
- Mass media campaigns
Restrictions on marketing
- Legal restriction on exposure
Drinking-driving countermeasures
- Lowered BAC limits
- Random breath testing
Treatment and early intervention
- BI with at-risk drinkers
- Medical and social detoxification
Effectiveness
Research
support
Cross-cultural
testing
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Babor T et al. Alcohol: No Ordinary Commodity, 2010.
Introduction of a new program for prisoners
who have violated drug control acts
Control of substances - list of acts and corresponding
substances
Acts
Substances
Act of Prohibiting Minors from smoking
(1900)
Setting minimum legal smoking age at 20 years
old
Act of Prohibiting Minors from drinking
(1922)
Setting minimum legal drinking age at 20 years
old
Cannabis Control Act (1948)
Cannabis
Toxic and Hazardous Substances Control Act
(1950)
Inhalants, glue etc
Stimulants Control Act (1951)
Methamphetamine, amphetamines etc
Narcotics and Psychotropics Control Act
(1953)
Morphine, heroin, cocaine, MDMA, LSD,
synthetic cannabinoids, synthetic cathinones,
sedatives, hypnotics, anxiolytics etc
Opium act (1954)
Opioids
Pharmaceutical Affairs Law (1960)
Part of synthetic cannabinoids, synthetic
cathinones
No. of people arrested for possession, selling and use of stimulants or inhalants
（No. of people）
60000
55,664（1954）
Stimulants
50000
Inhalants
40000
36,796（1982）
30000
20000
11,127（2013）
24,372（1984）
10000
382（2013）
0
（Year）
MHLW: Outline of Administration on Narcotics and Stimulants, 2015.
National Police Agency, 2015.
No. of people arrested for narcotics, opium and cannabis
(No. of people)
3500
3000
Narcotics
Opium
Cannabis
2500
2000
N=1,616
1500
1000
500
0
N=540
N=9
（Year）
MHLW: Outline of Administration on Narcotics and Stimulants, 2015.
Drug problems in Japan
 The greatest problem with regard to illegal drug use in Japan has long been
stimulants, especially methamphetamine (MAP). This drug was legal and was
used for military purposes during World War II. After its addictive nature and ability
to produce psychotic disorders was recognized the drug was made illegal in 1951.
 The magnitude of problems associated with illegal drug use in Japan may not be
as severe as it is in other countries.
 Recently, problems associated with psychotropic drug abuse have been increasing
sharply. This type of drug addiction is now the second largest, behind MAP
addiction, at many treatment facilities for drug addiction.
 From 2014 until recently, there was a surge in the number of people abusing
synthetic cannabinoids and cathinones, but this phenomenon ended abruptly
after reclassification of these substances under the Narcotics and
Psychotropics Control Act and the Pharmaceutical Affairs Law.
Program for Partial Suspension of Sentence
 This program allows for the early probationary release of prisoners
who have committed a first offence, or those convicted of using
illegal drugs and serving prison terms of 3 years or less.
 Addiction psychiatrists were influential in bringing about this
program, following the passage of new legislation and an
amendment of the Criminal Code
 Reasons for establishing this program:
- Global tendency towards decriminalizing drug use
- Increasing evidence showing the efficacy of treatment in preventing
reuse of drugs compared to imprisonment
- Growing population of drug-related prisoners in Japan
 This program has been operating since June 2016
Percentage of new inmates who have violated the Stimulants Control
Act compared to total inmates - by gender
(%) 45
40
35
30
25
20
15
10
5
0
2006
2007
2008
2009
Males
2010
2011
Females
Males
Females
Total
Stimulant violation
5,162
829
5,591
Total
19,415
2,124
21,539
2012
2013
2014
2015 (Year)
Total
Ministry of Justice. Correction statistics, 2015
Program for Partial Suspension of Sentence (continued)
 The annual increase in the number of people released on probation
from prisons by this program is expected to be 3,000.
 The capacity of treatment and rehabilitation facilities to receive
these people is insufficient.
 Psychiatrists and other medical professionals are expected to play a
more central role in the treatment and rehabilitation of these
individuals.
- Medical treatment facilities
- Residential and daytime rehabilitation facilities such as DARC*
- Community rehabilitation facilities such as community workshops
*DARC (Drug Addiction Rehabilitation Center)
- Established by a recovered drug addict
- About 50 centers, run mainly by recovered drug addicts throughout Japan
- The largest network of drug rehabilitation facilities in Japan
Outlines of the two national surveys
 We conducted two national surveys in 2008 and 2013 using almost the
same methods. The subjects were 7,500 and 7,052 men and women,
respectively, aged 20 years or older, who were sampled from the total
Japanese adult population using a stratified two-stage random
sampling method.
 The contents of the surveys included demographic information, sociofamilial data, drinking patterns and alcohol-related problems.
 The Japanese version of the South Oaks Gambling Screen (SOGS;
Lesieur HR et al, 1987) was included to estimate the number of people
with gambling disorder (GD). A SOGS score of 5 or more was used as
the cut-off point.
 The response rates were 55% in the 2008 survey and 59% in the 2013
survey.
Prevalence of GD and the estimated number
of adults with GD in Japan
Survey year
Males
Females
Total
2008
9.6%
(4.8m)
1.6%
(0.9m)
5.0%
(5.7m)
2013
8.7%
(4.4m)
1.8%
(1.0m)
4.5%
(5.4m)
・ Numbers in parentheses are the estimated number of adults with GD.
・ m = million
Higuchi S et al, unpublished data
List of studies on GD prevalence identified
using SOGS in different countries (1)
No. of
subjects
Country
Study (Year)
Age, representation Prevalence
USA
Welte (2001)
2,638
≧ 18, National
1.9%
USA
Volberg (2002)
2,217
≧ 18, Nevada
3.5%
Canada
Cox (2004)
1,489
≧ 18, Manitoba
2.6%
Canada
Ladouceur (2005)
4,603
≧ 18, Quebec
0.9%
UK
Sproston (2000)
7,680
≧ 16, National
0.8%
Italy
Biganzoli (2004)
1,093
18-74, North Italy
0.4%
Netherland
De Bruin (2006)
5,575
≧ 16, National
1.9%
Norway
Lund (2006)
5,235
≧ 15, National
0.3%
Sweden
Volberg (2001)
7,139
≧ 15, National
1.2%
Sweden
Abbott (2013)
15,000
16-84, National
2.0%
List of studies on GD prevalence identified
using SOGS in different countries (2)
No. of
subjects
Country
Study (Year)
Age, representation
Prevalence
Switzerland
Bondolfi (2008)
2,803
≧ 18, National
1.1%
Denmark
Bonke (2009)
8,153
18-74, National
0.5%
Germany
Meyer (2009)
10,001
16-65, National
0.2%
Hungary
Kun (2012)
2,710
18-64, National
1.4%
Estonia
Laanso (2009)
2,005
15-74, National
3.4%
Australia
AIGR (2001)
276,777
≧ 18, National
1.9%
New Zealand
Volberg (1994)
4,053
≧ 18, National
2.7%
Australia
Schofield (2004)
1,029
≧ 20, Queensland
1.7%
Japan
Higuchi (2008,
unpublished)
4,123
≧ 20, National
5.0%
Japan
Higuchi (2013,
unpublished)
4,153
≧ 20, National
4.5%
The result of binominal logistic regression analyses
Females in the 2013 survey
Variables
Frequency
≧once a week
Slot machines
≧once a week
95% CI
.046
Intercepts
Pachinko
Odds
ratio
P
*PAR
.000
15.6%
5.203
3.519-7.692
.000
39.6%
3.4%
3.915
2.161-7.092
.000
9.0%
*PAR: Population attributable risk
• The dependent variable was the dichotomous classification of the subjects (GD = 1 and others = 0).
• Each type of gambling with the frequency of once a week or more versus less than once a week was
entered in the model as an independent variable
• The forward selection method on the basis of likelihood ratios was used in the construction of models.
• To estimate the contribution of each type of gambling in the development of GD, the PAR was calculated.
Higuchi S, Osaki Y et al; unpublished data
The result of binominal logistic regression analyses
Males in the 2013 survey
Variables
Frequency
≧once a week
Slot machines
≧once a week
Stock exchange
≧once a week
Bicycle racing
≧once a week
95% CI
.046
Intercepts
Pachinko
Odds
ratio
P
*PAR
.000
15.6%
5.203
3.519-7.692
.000
39.6%
3.4%
3.915
2.161-7.092
.000
9.0%
1.4%
3.184
1.093-9.274
.034
3.0%
0.6%
5.469
1.477-20.251
.011
2.6%
*PAR: Population attributable risk.
Higuchi S, Osaki Y et al; unpublished data
What is Pachinko?
Pachinko is a game that is a hybrid
between pinball and slot machines.
When played, most of the small iron
balls simply fall down into the machine
and disappear. However, if the balls go
to certain locations, they may be
captured and a sequence of events
triggered, resulting in more balls being
released.
Interior of a Pachinko parlor
Gambling is illegal in Japan, but pachinko is regarded as an exception
and treated as an amusement activity. Awarding monetary prizes to
pachinko winners is illegal, but parlors can reward players with golden
tokens which can then be sold for cash at nearby exchange centers.
Location of pachinko parlors in the capital area
External appearance of
Pachinko parlors
”Pachinko”
Pachinko machines can be found in pachinko parlors, which are spread throughout Japan.
The parlors are easily recognizable because they are bright, colorful, smoky and loud.
 The prevalence and estimated number of adults with gambling
disorder were disclosed just before the extraordinary Diet
session that discussed the legalization of casinos as part of an
integrated resort bill in Autumn of 2014.
 This may have a great impact on the passage of this bill.
 This act would contribute to a further increase in the number
of people with gambling disorder, adding to the sizeable
number of people who already have the disorder.
 The bill has not been passed.
From a psychiatrist who had a dream to establish the basic act to relieve
the unhappiness of alcoholics and to heal the agony of their families
If experts, recovering alcoholics and citizens get
together and cooperate, then congressmen, the
administration, the law and the system of society will
change!
It is possible to create a safety net for patients
and families that is supported by all organizations
concerned with alcohol-related health harm.
The keyword of this act is “cooperation”. And
so, the priority when promoting measures is
“cooperation”
Dear addiction psychiatrists in Korea - we must
try - we have nothing to lose.
Dr. Aro Ino