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Background: To understand the clinical situation of GD who visited medical institutions and to clarify the effectiveness of treatment programs in Japan. Methods: Subjects were recruited with the cooperation of 20 medical institutions treating GD in Japan. Baseline data were acquired at their respective medical institutions, and an online follow-up survey using ICT was conducted. Results: 202 subjects were enrolled (men = 96.5%). The average age was 36.2 ± 8.7 years for men and 39.1 ± 9.8 years for women. The average age at which gambling began for the participants was 19.1 ± 3.3 years for men and 20.1 ± 3.1 years for women. Pachinko was the most common form of gambling, with an experience rate of 64.1% for men and 85.7% for women. The median total amount of debt each participant carried was ¥5 million for men and ¥5.75 million for women. All the subjects met the diagnostic criteria for GD on the DSM-5--36.4% of men and 42.9% of women had severe symptoms (a score of 8 points or more). A total of 144 (71.2%) subjects responded to the survey 6 months after the first visit. 78 patients (54.6%) remained on treatment. 81 cases (56.3%) were not gambling 6 months after the examination. Conclusions: A follow-up study using ICT investigated the prognosis of GD treatment. In the symposium, a follow-up survey after 12 months will be added to discuss the factors that influence prognosis. [ABSTRACT FROM AUTHOR]

While gambling is highly profitable for corporations and governments, gambling causes serious harms for some individuals, and one of the most serious harms is gambling disorder (GD). Besides GD, gambling is associated with various adverse consequences, called gambling-related harms, including significant monetary losses or bankruptcy, criminal behavior, domestic violence, and suicide. In order to reduce the public health burden of gambling-related harms, early detection and intervention are required. There is growing evidence to suggest that individuals with problem gambling are over-represented in primary care, substance use services, and psychiatric services, as well as in other services such as family violence counselling and financial counselling. Although screening for problem gambling in these areas is especially important, health and legal service providers tend to have negative attitudes towards screening because of lack of time and skills. Therefore, a gambling screen that is easy to use and requires minimal administration time should encourage those service providers to screen their clients for problem gambling. The purpose of this study is to develop a brief screening instrument for problem gambling. A total of 533 internet monitors who gambled at least once a month were recruited and completed a questionnaire including existing screening tests, such as Problem Gambling Severity Index, as well as 11 original questions. Diagnosis of GD was based on online interview using SCID-5-RV. Multiple logistic regression analysis revealed six items that differed significantly between participants with GD and non-GD. The ROC analysis indicated a cut-off point of three to differentiate GD and non-GD. [ABSTRACT FROM AUTHOR]

Pachinko is a type of mechanical gambling game that originated in Japan and resembles an upright pinball machine. Pachinko parlors are located in many parts of Japan and are open to anyone of legal age (18 years old). Due to the availability of pachinko, gambling in Japan is unique. The Integrated Resort Bill, which was passed in Japan in 2018, attempted to institutionalize casinos; however, they remain illegal to date since no corporations have government permission to operate. Although gambling is harmless for most individuals, in some cases it can be addictive and problematic, with severe negative consequences. Therefore, the expansion of legalized gambling is an important public health concern. Researchers worldwide have investigated the epidemiology of gambling to reveal the incidence of gambling disorders and the effectiveness of policies implemented to prevent harmful gambling. However, in Asia, studies within this field are relatively scarce. This symposium aims to present data on the current situation of gambling, prevalence of gambling disorder and gambling disorder treatments and their outcomes in Japan. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: Brain-derived neurotrophic factor (BDNF) influences dopamine and serotonin neurotransmitters that are heavily linked to addiction. A quantitative trait loci study indicated that genes localized to 11p13, where the BDNF gene is mapped (11p13–15), increase the risk for severe alcohol withdrawal. Moreover, a recent study using a pooled-sample microarray suggested that the BDNF gene locus was included in the loci that were shown to be associated with drug abuse. These lines of evidence suggested that BDNF might play some role in the development of or vulnerability to alcoholism and/or clinical characteristics of alcoholic individuals.METHODS:: The alcoholic subjects consisted of 377 male Japanese patients. A structured interview was used to obtain social background, drinking history, history of violence while intoxicated, history of alcohol withdrawal, and family history of alcoholism. The control group consisted of 336 nonalcoholic male subjects. Genotyping of the G196A polymorphism of the BDNF gene was done by polymerase chain reaction (PCR)–restriction fragment length polymorphism method.RESULTS:: Genotype and allele distributions of the BDNF gene polymorphism did not differ significantly between alcoholic and control subjects. However, comparing clinical characteristics across G196A genotypes, we found that alcoholic subjects with violent tendencies and a history of delirium tremens had a significantly higher frequency of AA genotypes and A allele frequencies than those without them. Moreover, alcoholic subjects with the A allele had earlier onset of the disease than those without it.CONCLUSIONS:: These results indicate that BDNF gene polymorphism might modify phenotypes of alcoholism. [ABSTRACT FROM AUTHOR]

Background: Since the Integrated Resort Bill was passed in 2017, Japan has been preparing to open casinos in Osaka and Nagasaki. Previous studies have shown that accessibility to casinos is positively correlated with the prevalence of gambling disorders. In response, the Japanese government has enacted the Basic Law against Gambling Addiction, and has started a fact-finding survey on gambling addiction every three years. This study aims to understand the prevalence of pathological gambling (PG) and gambling-related problems (e.g., multiple debt, child-rearing difficulties, suicide, depression and harm from significant others gambling, adverse childhood experiences; ACEs, etc.). Methods: A self-administered (paper and pencil or internet) questionnaire was mailed to 17,955 people from October to December 2020 using a random sampling based on the Basic Resident Register. PG was assessed using the South Oaks Gambling Screen (SOGS). In addition, gambling behavior (gambling experience, frequency, and bet amounts) and original or standardized scales regarding gamblingrelated problems were examined. Results: A total of 8,223 valid responses (3,955 men and 4,268 women) were obtained. The age-adjusted past-year prevalence of PG was 2.2% overall (95% confidence interval = 1.9-2.5); however, the prevalence was higher among those who responded on the Internet. A comparison of respondents with and without PG found that those with PG had higher rates of depression, suicidal ideation, suicide attempts, and ACEs. Conclusions: The prevalence of PG in Japan is relatively higher than in other countries. A survey method is necessary to obtain comparable yearly prevalence rates. [ABSTRACT FROM AUTHOR]

Background: The clinical characteristics and prognosis of gambling disorder (GD) seeking treatment at Japanese addiction medical institutions are unknown. Therefore, we conducted a multicenter 1-year follow-up study of GD outpatients. In the current study, we focused on gambling-related cognition (GRC) and aimed to clarify the relationship between the distortions of GRC and treatment prognosis. Methods: A total of 202 patients who were diagnosed with GD by DSM-5 (male = 96. 5%; mean age = 36.3 ± 8.7) were enrolled from February to September 2021. The facility's medical staff conducted baseline interviews and distributed questionnaires. During the follow-up period, self-administered questionnaires were e-mailed or mailed to the registered address at 1, 3, 6, 9, and 12 months after enrollment. The 12-month follow-up rate was 72.7%. The gambling-related cognition scale (GRCS) was used to measure cognitive distortions. The GRCS consists of five subscales: Illusion of Control (IC), Predictive Control (PC), Interpretative Bias (IB), Gambling Expectancy (GE), and Perceived Inability to Stop Gambling (IS). The evaluation of the treatment prognosis included gambling behavior and social functioning. Results: Mean scores for all GRCS except IC decreased when compared at baseline and at the 6-month follow-up. IC=6.70→7.15, PC=18.8→13.9, IB=15.99→11.0, GE=13.42→9.94, IS=19.9→14.8. Moreover, at the 6-month follow-up, higher mean GRCS scores were associated with more frequent gambling behavior. The oneyear prognosis will be explained on the day of the presentation. Conclusions: Delayed GRC recovery in GD may be associated with a negative prognosis. [ABSTRACT FROM AUTHOR]

Background: Gambling disorder is often comorbid with mood or anxiety disorder. Individuals with these disorders are known to have distorted cognitions that worsen the symptoms. Hence, we hypothesized that gambling disorder symptoms with cognitive components are experienced much earlier and more frequently by those with high depression/anxiety symptoms than those in low symptom group. Methods: Participants were randomly selected young adults (age 18-24) from the Japanese Basic Resident Register in 2019, and the final sample size for this study was 1078. The Japanese version of the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA) and the Japanese version of the Kessler-10 (K-10) were used. Based on K-10 scores, high and low depression/anxiety groups were created. For analysis, item response curves with the two-parameter logistic model were used to compare high and low depression/anxiety groups. Results: Our hypotheses were partially supported. The two symptoms with cognitive component were experienced much earlier (i.e., lower difficulty parameter values) by individuals in high depression/anxiety group, but the discrimination parameter values were not enough to differentiate the two groups. Surprisingly, items regarding borrowing and stealing money discriminated the high depression/anxiety groups from the low group. Discussion: This study successfully identified pathological gambling symptoms that are more likely to be experienced by young adults with high depression/anxiety problems. Possible factors influencing those results will be discussed. [ABSTRACT FROM AUTHOR]

Aims: To identify determinants of hyperuricemia in alcoholics. Methods: The serum uric acid (UA) levels of 1759 Japanese alcoholic men (≥40 years) were measured on their first visit or within 3 days after admission; ADH1B and ALDH2 genotyping on blood DNA samples were performed. Dipstick urinalyses for ketonuria and serum UA measurements were simultaneously performed for 621 men on their first visit. Results: Serum UA levels of >416 µmol/l (7.0 mg/dl) and ≥535 µmol/l (9.0 mg/dl) were observed in 30.4 and 7.8% of the subjects, respectively. Ketonuria was positive in 35.9% of the subjects, and a multivariate analysis revealed that the ketosis level was positively associated with the UA level. The presence of the ADH1B*2 allele and the ALDH2*1/*1 genotype increased the odds ratio (OR; 95% confidence interval) among subjects with a high UA level of >416µmol/l (vs. ≤416µmol/l; 2.04 [1.58-2.65] and 1.48 [1.09-2.01], respectively) and those with a high UA level of ≥535 µmol/l (vs. ≤416 µmol/l; 2.29 [1.42-3.71] and 3.03 [1.51-6.08], respectively). The ADH1B*2 plus ALDH2*1/ *1 combination yielded the highest ORs (2.86 [1.61-5.10] and 6.21 [1.49-25.88] for a UA level of >416 µmol/l and ≥535 µmol/l, respectively), compared with the ADH1B*1/*1 plus ALDH2*1/*2 combination. The presence of diabetes and the consumption of Japanese sake rather than beer were negatively associated with the UA levels. Conclusions: The faster metabolism of ethanol and acetaldehyde by the ADH1B*2 allele and ALDH2*1/*1 genotype and higher ketosis levels were associated with higher UA levels in alcoholics, while diabetes and the consumption of sake were negative determinants. [ABSTRACT FROM AUTHOR]

To identify determinants of hyperuricemia in alcoholics.~Aims~Objective~The serum uric acid (UA) levels of 1759 Japanese alcoholic men (¿40 years) were measured on their first visit or within 3 days after admission; ADH1B and ALDH2 genotyping on blood DNA samples were performed. Dipstick urinalyses for ketonuria and serum UA measurements were simultaneously performed for 621 men on their first visit.~Methods~Methods~Serum UA levels of >416 ¿mol/l (7.0 mg/dl) and ¿535 ¿mol/l (9.0 mg/dl) were observed in 30.4 and 7.8% of the subjects, respectively. Ketonuria was positive in 35.9% of the subjects, and a multivariate analysis revealed that the ketosis level was positively associated with the UA level. The presence of the ADH1B*2 allele and the ALDH2*1/*1 genotype increased the odds ratio (OR; 95% confidence interval) among subjects with a high UA level of >416 ¿mol/l (vs. ¿416 ¿mol/l; 2.04 [1.58-2.65] and 1.48 [1.09-2.01], respectively) and those with a high UA level of ¿535 ¿mol/l (vs. ¿416 ¿mol/l; 2.29 [1.42-3.71] and 3.03 [1.51-6.08], respectively). The ADH1B*2 plus ALDH2*1/*1 combination yielded the highest ORs (2.86 [1.61-5.10] and 6.21 [1.49-25.88] for a UA level of >416 ¿mol/l and ¿535 ¿mol/l, respectively), compared with the ADH1B*1/*1 plus ALDH2*1/*2 combination. The presence of diabetes and the consumption of Japanese sake rather than beer were negatively associated with the UA levels.~Results~Results~The faster metabolism of ethanol and acetaldehyde by the ADH1B*2 allele and ALDH2*1/*1 genotype and higher ketosis levels were associated with higher UA levels in alcoholics, while diabetes and the consumption of sake were negative determinants.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Aims: Genetic polymorphisms of alcohol dehydrogenase-1B (ADH1B, rs1229984) and aldehyde dehydrogenase-2 (ALDH2, rs671) affect ethanol (EtOH) metabolism and susceptibility to alcoholism. Methods: We evaluated associations between ADH1B/ALDH2 genotypes and the blood EtOH levels of 805 Japanese alcoholic men in the morning after they had drunk within the previous 34 h. Results: Age-adjusted usual alcohol consumption did not differ according to ADH1B/ALDH2 genotypes. Higher blood EtOH levels persisted for longer periods in the ADH1B*1/*1 carriers (n = 246) than in the ADH1B*2 carriers (n = 559). Blood EtOH levels did not differ by ALDH2 genotype. The blood EtOH levels =0.3 mg/ml (criterion for drunk driving in Japanese law) were observed (40% vs. 14-17%, P < 0.0001) in a higher proportion of the ADH1B*1/*1 carriers than of the ADH1B*2 carriers after a 12.1-to-18-h interval since the last drink. Multivariate analyses showed that the EtOH levels heightened by 0.500 mg/ml in the presence of ADH1B*1*1 and by 0.248 mg/ml in the presence of cirrhosis, and lowered by 0.120 mg/ml per 10-year age increase, by 0.087 mg/ml per 10-kg body-weight increase and by 0.673 mg/ml per 10-h interval since the last drink. The odds ratio (95% confidence interval) for an EtOH level =0.3 mg/ml was 3.44 (2.34-5.04) in the presence of ADH1B*1/*1, 2.01 (1.28-3.14) in the presence of cirrhosis, 0.59 (0.49-0.71) per 10-year age increase, 0.80 (0.68-0.95) per 10-kg body-weight increase and 0.10 (0.07-0.15) per 10-h interval since the last drink. Conclusion: The longer-than-expected EtOH lingering in the blood of the ADH1B*1/*1 alcoholics may exacerbate alcohol-related problems, including drunk driving. [ABSTRACT FROM AUTHOR]

SUMMARY: BACKGROUND NRH-quinone oxidoreductase 2 (NQO2) along with glutathione S-transferase M1 (GSTM1) and NAD(P)H-quinone oxidoreductase 1 (NQO1), which is involved in phase II detoxification reactions, is thought to be important for detoxification of catechol o-quinones in the central nervous system. Our previous study revealed that the human NQO2 gene is highly polymorphic. In this study, we investigated a possible association between polymorphisms of the GSTM1, NQO1, and NQO2 genes and alcohol withdrawal symptoms such as delirium tremens, hallucination, and seizure.METHODS A total of 247 Japanese male alcoholic patients with alcohol withdrawal symptoms or without the symptoms, and 134 age-matched Japanese male controls (nonhabitual drinkers), were examined by using polymerase chain reaction (PCR), PCR restriction fragment length polymorphism, PCR-based single-strand conformational change polymorphism, and PCR direct sequencing analyses.RESULTS A significant difference was found between alcoholic patients and controls in genotype frequency at an insertion/deletion site in the promoter region of the NQO2 gene (p = 0.0014). The frequency of the homozygous genotype for the D allele at this locus was significantly higher in delirium tremens-positive patients (p = 0.0004) and in hallucination-positive patients (p = 0.0001), and in patients displaying both delirium tremens and hallucination (p = 0.0002), than in controls. The values were still significant after Bonferroni correction. On the other hand, no significant difference was detected for allele frequencies or genotype frequencies for the other polymorphic loci of the NQO2 gene. Moreover, GSTM1 gene deletion and missense mutation (Pro187Ser) of the NQO1 gene showed no significant association with alcohol withdrawal symptoms.CONCLUSION Present data suggest that an insertion/deletion polymorphism in the promoter region of the NQO2 gene plays an important role in the pathogenesis of alcoholism and alcohol withdrawal symptoms. [ABSTRACT FROM AUTHOR]