1. Introduction to the Kurihama Medical and Addiction Center
The National Hospital Kurihama Alcoholism Center is the largest treatment facility for alcoholism in Japan, and at the same time, it also a center for research and training on alcoholism. Especially in recent years, the Center has become very active internationally and is closely involved in the policies of the Japanese government related to alcoholism.
1) Site of the Kurihama Alcoholism Center
The Center is located in Kanagawa Prefecture south of Tokyo. The total land area is 143,000 square meters and the buildings cover 24,000 square meters.
The hospital was founded as a naval hospital in 1941 and was transferred to the Ministry of Health and Welfare after the end of World War II in 1945, when it became the Kurihama National Hospital for the treatment of tuberculosis. However, in 1961, the Law concerning Drunken Behavior Causing a Public Nuisance (Intoxication Control Law) was enacted. A special alcoholism ward was established in 1968 for the treatment of alcoholism and return to society. From that time, the Kurihama National Hospital changed mainly to a hospital to treat alcoholism. In 1989, the World Health Organization (WHO) designated the Hospital as a research and training center for alcohol-related problems.
3) Outline of the facilities
As of May 2010, there were 291 beds in use, of which 246 are in the psychiatric wards and 45 in the internal medicine ward. The number of inpatients changes with time but as of May 2010, there were, mainly alcoholics. In the outpatient clinic, the number of new patients was in 2009, and the Kurihama Alcoholism Center is now the largest medical institution in Japan for both outpatient and inpatient treatment of alcohol-related diseases.
II Roles of the Center
The Center has four roles: 1) treatment, 2) surveys and research, 3) education and training and 4) prevention.
a) Basic concept
The core concepts of treatment of alcoholism in the Center are based on (1) alcoholism is a disease and abstinence is possible through appropriate treatment and (2) only the alcoholic himself or herself has the right to decide to stop drinking and the role of the therapist is to provide support for abstinence and not force treatment on the patient. Based on these core concepts, the treatment is characterized by (1) special treatment in open wards, (2) a treatment contract specifying the inpatient period, (3) independent ward management by the patients and (4) stress on group therapy. Treatment in this hospital has become the standard treatment for alcoholism in Japan and is known as the Kurihama method.
1. Course for middle-aged male alcoholics (less than 65 years of age)
This course consists of about 60 inpatients who are first hospitalized for 3 weeks in the internal medicine ward where they are subject to general testing and treatment including management of alcohol withdrawal symptoms, endoscopic examinations of the upper and lower digestive tract and head MRI. For the last seven weeks, the patients are moved to the special open psychiatric ward for middle-aged alcoholics to participate in a program consisting mainly of group therapy including cognitive behavior group therapy and group occupational therapy.
2. Course for elderly male alcoholics (65 years of age and older)
There are currently about 60 inpatients, mainly elderly men over 65. On admission, they undergo the same general conservative testing and treatment as the middle-aged alcoholics. They are then moved to a special open psychiatric ward for elderly male alcoholics, where they are mainly treated individually. The program is less intense than that for middle-aged alcoholics and consideration is given to the characteristics of the elderly.
3. Training to prevent resumption of drinking
A six-week program is provided with stress on coping skills training specifically for recidivists who have been admitted repeatedly.
4. Course for female alcoholics
This is an inpatient program of about 10 weeks based on the male program. Since female alcoholics include many women with domestic problems such as abuse by husbands, individual case management is undertaken by female caseworkers. Female alcoholics also participate in this program as outpatients. Closed meetings only for women are also held.
2. Treatment of pre-alcoholics
In this Center, problem drinkers who (1) have some alcohol-related problems, (2) have not experienced extended binge drinking to date and (3) who have not experienced withdrawal symptoms are referred to as pre-alcoholics. This concept is a combination of harmful use in IDC-10 and alcohol abuse in DSM-IV. Such problem drinkers participate in monthly special pre-alcoholic meetings after they have been abstinent for 6 months. They also make monthly outpatient visits. Patients who remain abstinent for 6 months are then allowed to drink alcohol after consultation as a rule, but about half of them continue to remain abstinent voluntarily. The other half start drinking again but reduce their drinking frequency to about one fifth and their monthly average alcohol intake to one tenth.
2) Surveys and research
The Center undertakes wide-ranging research and survey activities from epidemiological to basic research in collaboration with universities and other research institutes as the Japanese National Center for Alcohol-related Problems. The main research is as follows.
a) Surveys of actual status of alcoholics
Regular nationwide surveys are performed as part of the Health Sciences Projects of the Ministry of Health, Labor and Welfare.
b) Research on genetic polymorphisms of alcoholism and alcohol metabolic enzymes
Research is performed on the relation between polymorphisms of the alcohol dehyrogenase 2 (ADH2) and aldehyde dehydrogenase 2 (ALDH2) genes and the pathophysiology of alcoholism.
c) Development of the ethanol patch test and simplified flushing questionnaire
This is a simple method for identification of inactive ALDH2 carriers who are common in East Asia. The test is also used in schools for identification of minors who are carriers.
d) Development and spread of treatment programs centered on cognitive behavioral therapy
Cognitive behavioral therapy for alcoholism is being introduced in Japan and prognosis surveys are performed.
e) Research on eating disorders and alcoholism in women.
A history and complications of eating disorders are characteristic of female alcoholics, and this field is being studied.
f) Research on clarification of the actual status and prevention and treatment of drinking problems in young and old people
A large-scale epidemiological survey is being conducted on drinking in minors and the elderly.
g) Clarification of the pathophysiology of brain and neurological diseases, hepatic disorders and pancreatitis caused by alcohol
Pathophysiological research based on clinical findings of alcoholic hepatic disorders using hepatic fibrosis markers and other diseases is underway.
h) Research on drinking-related carcinogenicities
Studies and surveys are being performed on the incidences, mechanism of drinking-related carcinogenesis, prediction, prevention and early treatment of oral cavity and throat cancer and cancer in the upper and lower digestive tracts in alcoholics.
3) Education and training
a) Training of physicians concerning alcoholism
The Alcoholism Clinicians Training Course sponsored by the Mental Health and Welfare Division, Ministry of Health, Labor and Welfare, has been held in the Center since 1975 with the aim of training physicians in measures against alcoholism. The participants are physicians and comedical staff and the period is 3-5 days for each course. Courses are held twice a year. As of September 2006, 4,747 persons in total had completed the course. This is the only official training of this type in Japan. When hospitals request insurance premiums for inpatient care of alcoholics, one condition is that the hospital staff involved have completed this training course.
b) Lectures on alcohol-related problems
Lectures on prevention, early discovery and early intervention for alcohol-related problems are held four times a year for health professionals. The topics in 2009 were (1) brief interventions, (2) current status of alcohol-related education, (3) measures related to the life cycle, and (4) measures against life-style diseases. Many participants are in the occupational health field.
c) Research meetings on alcohol-related problems
Study meetings on prevention and early discovery and treatment of alcohol-related problems have been held once a month in Yokohama since September 1992. At present, about 180 people attend these meetings and participants include a wide range from health professionals to people from the alcoholic beverages industry.
This Center has a Center for Prevention of Alcohol-related Problems and undertakes the following activities in addition to the above-mentioned lectures on alcohol-related problems and research meetings on alcohol-related problems.
a) Forum on alcohol consumption by minors
Since 1994, these forums have been held to prevent consumption of alcohol by minors. The Center for Prevention of Alcohol-related Problems serves as the secretariat for these forums.
b) Special meetings for pre-alcoholics
These meetings are held in conjunction with the pre-alcoholic treatment program described previously.
c) Educational program for drink drivers
An educational program specifically related to drink driving is held for drink drivers.