[Reduction in alcohol consumption: therapeutic goal in alcohol dependence treatment]

Abstract

Mean per capita consumption of alcohol for Japanese adults has been gradually decreasing for more than15 years, while it still remains at a high level. It is pointed out that those who consume alcoholic beverages become more diversified and that the proportion of male drinkers tends to gradually decrease. On the other hand, it is estimated that the proportion of female drinkers, especially, young generation, remarkably increases. The existing cross-sectional and longitudinal studies suggest that alcohol consumption causes a variety of health- and social-related problems with accelerating increase over the past few decades except for some exceptions. The results from a patient survey show that the number of patients with alcohol dependence who receive medical treatment tends to increase. However, the percentage of patients who receive medical care is estimated to be only 5% of total number of patients with the disease, which means that there exist many untreated patients or potential patients who undergo treatment for complications only. Treatment for alcohol dependence can be divided into psychosocial and pharmacological treatment. The former is a mainstream of the treatment. Although medications available in Japanese clinical practice are limited to so called anti-alcoholic drugs, disulfiram and cyanamide, pharmacological treatment is expected to become more accessible because many potential patients can benefit from pharmacotherapy. Treatment outcomes for alcohol dependence are not necessarily high in Japan as shown by the fact that abstinence rate 1 - 3 years after treatment is 7% - 30%, while mortality rate is extremely high. However, not a few individuals are able to maintain a reduced alcohol consumption, and some are able to do so for a long period of time. It is shown that many risks of health-related problems including cancer, hypertension and intra cerebral haemorrhage and social-related problems including suicide increase with the increasing alcohol consumption in a dose-dependent manner. A certain types of disease including ischemic heart disease and cerebral infarction are indicated to have a J-shaped relationship with alcohol consumption. On the other hand, once alcohol consumption exceeds a certain level, the risks increase with the amount of alcohol consumed. Thus, reduction in alcohol consumption can lead to decrease in a large number of health-related and social-related problems in general population. Many studies indicate that reduction in alcohol consumption in patients with alcohol dependence can also lead to the improvement of these problems. In recent years, in Japan, there have been some discussions as to whether "harm reduction" approaches that target reduction in alcohol consumption are needed and the approaches should be aggressively introduced into clinical practice, stimulated by requests from clinicians, the established efficacy of novel therapeutic approaches on reduction in alcohol consumption and trend of various countries. The results from a survey on therapeutic goals in alcohol dependence treatment show that many experts in alcohol dependence answered that they could accept reduction in alcohol consumption (controlled drinking) as a stepwise/interim treatment goal for guiding abstinence if the patient rejects abstinence as a therapeutic goal. Regarding effective medications for reduction in alcohol consumption, most experts answered that they found the medications clinical significant and that they would use them for controlled drinking or abstinence form alcohol when available. In Japan, available drugs for alcohol dependence are extremely limited. Comments in the column for unreserved opinions on the survey questionnaire reveals that many experts hope novel agents will be developed to improve the current treatment as much as possible.