Susumu Higuchi National Alcoholism Center Kurihama Hospital 5-3-1 Nobi Yokosuka Kanagawa 239–0841 Japan E-mail: firstname.lastname@example.org Tel: 81 46 848 1550 Fax: 81 46 849 7743
This paper presents an outline of the Japanese Society of Alcohol-Related Problems. The precursor of the Society was the Japan Alcoholism Treatment Research Group, inaugurated in 1979, by merging two local research groups in the Tokyo and Osaka areas, both of which were exclusive gatherings of psychiatrists associated with alcoholism clinics. The Research Group developed into the Society in 1992, as the number of participants including those from other medical professions increased yearly, and the subjects of the group widened to include all addictive behaviours. In reflecting the process of establishment, it is unique in many aspects as a scientific society. The Society is not a science-orientated body for presentation of new research findings. The main programme of the annual meeting is therefore a set of symposia in which members participate and discuss clinical and/or social problems arising from dependency on alcohol or drugs. Perhaps because of its content, the annual meeting is attended each year by the largest number of participants among all the societies in Japan concerned with alcohol and drugs. For the next several years, the Society's activities will be directed at (1) establishment of guidelines for early identification of and intervention in alcohol-related problems; (2) expansion of its membership to include those in related fields of medicine and non-medical professions; (3) improvement of the system of journal publication; and (4) creation of a system for timely adequate response to social problems associated with drugs and alcohol.
Apart from the Society, other organizations in Japan associated with alcohol and drug addiction include the Japanese Medical Society of Alcohol and Drug Studies, the Japanese Society of Biomedical Research on Alcohol, the Japanese Society of Psychiatric Research on Alcohol and the Japanese Society of Addictive Behavior. Although there are exchanges of personnel between the Society and these other organizations, the Society is unaffiliated with any of them and operates independently.
The precursor of the Society was the Japan Alcoholism Treatment Research Group, inaugurated in 1979, by merging the Kansai Alcoholism Treatment Research Group and the Kanto Alcoholism Treatment Managers Group, both of which were exclusive gatherings of psychiatrists associated with alcoholism clinics. The major objectives in establishing the Group were as follows: (1) to provide a forum for exchange of information among specialists involved in clinical treatment of alcohol-related problems; (2) to pursue activities for protecting the human rights of patients with alcohol-related problems; (3) to establish a network encompassing the government, medical organizations and self-help organizations, with emphasis on regional activities; and (4) to stress activities in each district, based on a division of the entire nation into seven blocks (Hokkaido, Tohoku, Kanto/Koshin-etsu, Tokai/Hokuriku, Kansai, Chugoku/Shikoku, Kyushu). Thereafter, the Japan Alcoholism Treatment Research Group met once a year in one of the seven blocks on a rotational basis. At the 13th convention of the Japan Alcoholism Treatment Research Group (Kumamoto Assembly), it was agreed that the name of the organization would be changed from the next fiscal year to the Japanese Society of Alcohol-Related Problems. A number of circumstances account for this change, including the following: (1) the number of participants in the Research Group increased yearly, and as the Group grew into a large body it became difficult to manage without establishing an organization; (2) the subjects of the Group widened to include all addictive behaviours in general, not just alcohol-related problems; and (3) organizing the Group into the Society made it easier for members to participate. Although the Group was replaced by the Society, its objectives were adopted by the Society without modification. In the following year, 1992, the first scientific meeting of the Japanese Society of Alcohol-Related Problems was held in Sapporo (14th meeting). An outline of the Society is given in Table 1.
Table 1. Outline of the Society.
Title of Society
The Japanese Society of Alcohol-Related Problems
Office of the Japanese Society of Alcohol-Related Problems
Katsuya Maruyama, Director, National Alcoholism Center Kurihama Hospital
Yoshihiro Kosugi, Director, Kosugi Clinic
Susumu Higuchi, Deputy Director, National Alcoholism Center Kurihama Hospital
Criteria for membership
The rules of the Society stipulate that society members shall have the qualifications and shall be approved by the Board of Directors (Table 2). Regular members consist of directors, auditors, trustees and general members. Members include not only physicians but also nurses, hygienists, social workers and psychotherapists. Members can be of any profession so long as they endorse the objectives of the Society.
Table 2. Criteria for membership.
Persons who are concerned about alcohol-related problems and who endorse the objectives of the Society
Individuals or organizations that endorse the objectives of the Society and support its activities
Members who have contributed to development of the Society over a number of years, who have been recommended by the Board of Directors, and who have been approved by the Board of Trustees and the General Meeting
Members must pay annual dues in the amounts stipulated in the provisions of the bylaws. The amounts are ¥10,000 for directors and auditors, ¥5000 for trustees, ¥2000 for general members and ¥30,000 for supporting members. Members who fail to pay dues for 2 years or more, who impair the honour of the Society, or who commit acts in violation of the Society's objectives will be expelled from membership. Members who wish to resign may do so if they notify the Society's Administration Office and pay their dues for the current fiscal year.
Benefits of membership
Membership benefits are as stipulated below.
1Members are entitled to receive the Society's journal and newsletter (described below).
2Members can take part in general meetings, in scientific meetings and in other activities carried out by the Society.
3Members can present papers at scientific meetings.
SIZE OF MEMBERSHIP AND PUBLICITY OF MEMBERSHIP LIST
Size of current membership
As of 20 August 2003, the number of members totalled 543 with 34 directors, two auditors, 110 trustees, 388 regular members and nine honorary members. Several directors (mainly physicians) are from each of the seven blocks. In addition, two members are selected as representatives of each of the following four professions: nurse, public health nurse, social worker and clinical psychologist. The trustees are essentially the same in makeup as the directors.
Publicity of membership list
To protect privacy, the membership list is not publicized.
OVERALL AIM OF THE SOCIETY
The overall aim of the Society is to contribute to the resolution of alcohol-related problems in Japan by promoting research and mutual exchanges among physicians who work to ameliorate alcohol-related problems, among co-medical staff and among various other professionals and by strengthening affiliations with other related societies.
HISTORICAL ACCOUNT OF DEVELOPMENTS IN THE SOCIETY AND ITS WORK SINCE ITS INCEPTION
With the founding of the Society in 1992, the bylaws were formulated and the Administrative Office was established at the National Alcoholism Center Kurihama Hospital. In the days of the Japan Alcoholism Treatment Research Group, members were limited to representatives from the seven blocks and affiliated physicians. There were no regular members and participants at scientific meetings, held once annually, were treated as members for that day only. With the founding of the Society, qualifications were established for directors, auditors, trustees and regular members; dues became collectible annually and the Society could be administered on a stable basis. Members are not limited to physicians alone, but include a wider range of professionals, not only those involved in clinical treatment of alcohol and drug dependency but also government-related personnel, educators, members of citizen's groups or self-help groups, alcoholic beverage makers and others. Initially, there were approximately 300 members, but the number has gradually increased and now exceeds 500. After the Society was founded, the Journal of the Japanese Society of Alcohol-Related Problems was published together with a Society newsletter, and the functions of the Society as such were augmented. The Society now also engages in social activities. If a major alcohol-related problem arises within the country, for instance, the Society submits petitions to various government and/or related organizations.
PRESENT AND RECENT ACTIVITIES
Structure and meetings
As mentioned previously, the Society is distinguished for its decentralized organization and administration by region and by profession. Research groups of each regional block and professional groups are subordinate functions of the Society, as depicted in Fig. 1. In conjunction with the Society, regional block research groups engage in their own independent activities. Levels of such activities are quite diverse, but at least scientific meetings are held once annually in virtually all the blocks. Professional groups are nation-wide gatherings of people in the same profession, irrespective of block, at which activities specific to the profession are pursued. Currently, scientific meetings of nurses and of social workers are being held once annually. The majority of members, excluding medical doctors, belong to both regional block and professional groups.
Scientific meetings (annual meetings) of the Society are held once annually in each of the seven blocks by rotation. Immediately after the Society was founded the 14th annual meeting was held in Sapporo, supervised by the Hokkaido District. The 15th and subsequent meetings were held by the Hokuriku District (Kanazawa), by the Chugoku/Shikoku District (Okayama), by the Kanto/Koshin-etsu District (Kofu), the Kansai District (Kyoto), the Kyushu District (Fukuoka), Tohoku District (Yamagata), Kanto/Koshin-etsu District (Yokohama), Chugoku/Shikoku District (Yamaguchi), Hokkaido District (Sapporo), Kansai District (Osaka) and Kyushu District (Miyazaki). The 26th general meeting will be held next year, supervised by the Tokai/Hokuriku District, in Nagoya.
Each year, the meeting is held for a 2-day period over a weekend in May or June The Society is not a science-orientated body for presentation of new research findings. The main programme of the meeting is therefore a set of symposia in which members participate and discuss clinical and/or social problems arising from dependency on alcohol or drugs. Concurrently, educational courses for novices are also provided. On the second day of the meeting, special lectures are given, primarily on clinical or social-related subjects. Perhaps because they are clinical- and education-orientated in content, the annual meeting of the Society is attended each year by large numbers of single-day members, totalling anywhere from 800 to 1000 participants, far exceeding the number of regular members. This is the largest number of participants among all of the societies in Japan concerned with alcohol and drugs.
Since 1999 a single issue of the Society's professional journal, The Journal of the Japanese Society of Alcohol-Related Problems, has been published each year. Its content includes symposia, educational lectures and special lectures given over the previous year at the annual meeting. Because approximately 10 symposia and educational lectures are held at the same time at the annual meeting it is not possible to attend all of these programmes, even though they take up many interesting topics. The Journal is intended to make up for this deficiency by presenting the contents of all lectures held, including discussions. However, the Journal is published only once annually and in order to cover the gap between its publications, the Society has begun from this year to issue a newsletter twice yearly. Nevertheless, as will be discussed below, the Society is planning to increase the frequency of Journal publications and to publish, based on a peer-review system, papers submitted to the Society.
Given the conditions of the Society discussed earlier, i.e. (1) there are no qualifications for becoming a member and (2) the scientific meetings are not science-orientated and present educational lectures, the annual meeting serves as a forum for public education. Public lectures are also provided as a distinct programme or as satellite symposia of the annual meeting of the Society and other scientific meetings. For example, a public lecture was given under the theme, ‘Present-day Alcohol-Related Problems and Prevention Thereof’, sponsored by the Society's Administrative Office, at the 12th World Congress of Psychiatry held in Yokohama in August 2002. During this lecture, a ‘Message of Life’ exhibition was held concurrently at the exhibition hall. On display were roughly 20 panels of life-sized human figures replicating victims of sudden, large-volume, alcohol consumption, or of alcohol-related traffic accidents, brutal crimes or bullying. Also displayed were photographs, shoes and other articles left by the victims.
As mentioned previously, whenever a major alcohol-related problem arises in Japan the Society, in cooperation with other organizations, publishes declarations and submits petitions to government and other related organizations.
Consider a recent example. On 26 January 2001, a grave accident occurred at Shinokubo Station on the Yamanote-line in Tokyo. After drinking sake on the station platform, a man became dizzy and fell onto the railroad tracks. Two other men jumped down onto the tracks to save him from an oncoming train, but all three were killed. Thereafter the Society, together with the Japan Alcohol Problem Liaison Conference (12 organizations as members) and the Japan Housewives’ Association submitted a petition to the government and to the railway company (East Japan Railway Company, or JR East) calling for a prohibition on the sale of alcoholic beverages at commuter line train stations. In response, JR East decided on 16 February of the same year to voluntarily refrain from selling alcoholic beverages on Yamanote-line station platforms and on the station platforms of two train lines that run within the Yamanote-line loop. After 2 years of self-restraint, however, sale of alcoholic beverages reportedly resumed on 15 February 2003. Accordingly, the same three organizations submitted a petition in February 2003, again calling for prohibition of the sale of alcoholic beverages at commuter line train stations. The effect of this petition has not yet appeared, but a campaign to gain more signatures from Japanese citizens is under way, and results are expected to be forthcoming at an early date.
SOURCES OF INCOME
The main income source is dues from members, the amounts of which have already been indicated. In addition, funds are obtained from advertisements placed in the Journal and from sale of the Journal to non-members.
SUCCESSFUL POINTS, DIFFICULTIES AND FUTURE DIRECTIONS
As mentioned previously, what distinguishes the Society is the fact that it is unlike a regular science-orientated academic body. There are no de facto qualifications required of members, and the Society is open to numerous professions. For this reason, the Society's scientific meetings are readily accessible and attract many participants. In Japan, treatment of alcohol and/or drug dependency has customarily come under the province of psychiatric therapy. Yet until recently, even many specialists in psychiatry thought that alcohol dependency could not be treated, or that it was a personality problem rather than an illness. The Society has been working to spread proper understanding of alcohol dependency among a wide range of people active in psychiatric therapy, and it has contributed much toward overcoming prejudices about the disorder.
Difficulties and future directions
Recently, a committee was established within the Society to identify problems faced by the Society and to investigate the proper orientation of future advancement by the Society. Two points are being considered: increasing the number of members and bolstering the Society's activities. Although the committee has not yet compiled a report, in view of the content of its discussions, the following topics are of special importance in relation to problems and their countermeasures.
Scope of diseases covered by the Society
Aside from alcohol or drug dependency there are numerous diseases that can be classified as addictions, including eating disorders and pathological gambling. For some time now, it has been argued strongly that the scope of diseases covered by the Society should be expanded to include all addictions in general, including those just cited. The advantage of such expansion is that it would most probably bring about an increase in members of the Society. On the other hand, some argue that rather than expand its scope of disease, the Society should focus only on alcohol and drugs, the major sources of addiction, and explore them in greater depth. For example, in addition to alcohol dependency, treatment of harmful use of alcohol (ICD-10) and of alcohol abuse (DSM-IV), which have not been treated actively in the past, should be considered by the Society and guidelines or manuals on such treatment should also be prepared. The Society is still debating which option to pursue, but opinions predominately support the latter.
Expansion of membership
The majority of the Society's medical-related members are active in the field of psychiatric therapy. Nevertheless, as is well known, to ensure that treatment of alcoholism is implemented properly, cooperation with other fields of medicine, notably internal medicine, is imperative. Not only in Japan but elsewhere, alcoholics and harmful users usually go first to internal medicine clinics for treatment. Thus, in order to make it possible to discover such people early and quickly direct them to proper treatment, there must be cooperation between the fields of internal medicine and psychiatry. Given this situation, the Society is striving to expand its members to include those in related fields of medicine, including internal medicine. What is more, there are many potential members in non-medical professions involved in the treatment of alcohol-related problems or in preventative education such as those in occupational therapy, in schools or education and in the government. Such people are being encouraged to participate in the Society and become members.
At present, the Journal is published once annually, but this is clearly a low publication rate. Increasing the publication frequency to four or six times per year is being considered, as is the presentation of papers through public appeals based on a peer-review system.
Society approval system
A proposal for introducing an approval system by the Society is being studied for the purpose of elevating the level of medical treatment for alcohol and drug related problems. The subject of approval currently under consideration is the skills involved in early problem detection and in introduction of therapy.
Response to social problems associated with drugs and alcohol
Another subject of investigation is establishment of a committee within the Society and creation of a system that will make it possible to quickly release declarations and petitions in response to the social problems referred to above, and to provide specialized support as necessary.