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Looking beyond abstinence, Kanagawa facility opens Japan's first 'controlled drinking' program

by Tomoko Otake

Staff Writer

Have a drinking problem? Don’t worry, you can keep drinking while working to get over it.

That’s the message put out by the Kurihama Medical and Addiction Center in Yokosuka, Kanagawa Prefecture, which opened the nation’s first “controlled drinking” outpatient clinic last month.

And it works — according to recent research and a growing consensus among medical experts.

Dr. Yosuke Yumoto, a psychiatrist at the national hospital, said the facility has adopted a “soft” approach so more people with alcohol-related problems can seek professional help. Only 6 percent of an estimated 1.07 million people with alcohol addiction see doctors, according to 2013 research led by Yoneatsu Osaki of Tottori University.

“There’s this perception that, if you seek treatment of your problems, you would be branded an alcoholic or be forced to stick to abstinence,” he said. “But in reality, in daily clinical practice, doctors seldom criticize patients or come down hard on them if they keep drinking, because the most important thing is for them to be honest about their habits.”

Excessive drinking causes a range of health problems, including cirrhosis of the liver and increased risks of cancer, strokes and dementia. It is often associated with car crashes, depression and insomnia, which can ultimately result in suicide, domestic abuse, loss of jobs and debt.

By tolerating moderate drinking, the hospital wants to reach out to a majority of heavy drinkers who have started to experience problems but have not acknowledged them as worthy of treatment.

It’s an approach that has gained wide acceptance abroad since the 2000s, with many studies concluding that people with drinking problems can still improve their health without kicking the habit entirely and avoid falling into a relapse, Yumoto said.

The 2010 guidelines on alcohol dependence by the European Medicines Agency acknowledge this, though the agency also cautions against recommending such programs to those who are severely dependent.

“Currently, some treatment programs aim at controlled alcohol consumption as a first step in the healing process,” the EMA guidelines state. “However, due to the developed addiction memory and impaired control of drinking, clinically significant reduction of consumption may be difficult to be achieved in alcohol dependent patients, at least for severely dependent ones.”

The hospital’s new outpatient service, called the Alcohol Harm Reduction Program, targets anyone who is concerned about their relationship with alcohol and who wants to improve it.

The program, which is covered by public health insurance, starts with a health check-up and an interview with a specialist doctor. The check-up includes blood and urine tests as well as a bone density test, because excessive drinking is known to cause osteoporosis.

For those who seek one, the hospital also takes an MRI brain scan at an additional cost, “for motivational reasons,” Yumoto said. He said patients can see how the frontal lobe, which shrinks due to alcohol dependence, grows back after going through sessions for about two years.

After diagnosing the level of dependence using international criteria, which are classified into three degrees — mild, intermediate or severe — psychiatrists propose three different options: reducing harm in drinking, cutting back on the amount of alcohol and cutting alcohol out entirely.

Participants will be asked to keep a detailed drinking record and set their target, Yumoto said, adding that the key is to set the number of days per week when patients will stay away from alcohol.

Disulfiram, an alcohol antagonist drug, and Acamprosat, which helps fight cravings for alcohol, can also be prescribed, he said.

Doctors have long considered any solution besides abstinence as a failure to live up to their responsibilities, he said.

“But controlled drinking can be the first goal of alcohol addiction treatment, from which the goal can be changed to abstinence,” he said.

A Matter of Health is a weekly series on the latest health research, technology or policy issue in Japan. It appears on Thursdays.

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