公衆衛生81巻9号

2017年09月発行

特集 アルコール健康障害対策の推進

アルコール依存症の重複障害

著者： 真栄里仁¹

所属機関： ¹独立行政法人国立病院機構久里浜医療センター教育情報部

ページ範囲：P.738 - P.744

はじめに
　アルコールなどの依存症には気分障害や精神病性障害などさまざまな精神障害の合併が多く，慣例的に“重複障害”と呼称されている．重複障害は依存症単独のケースに比べて，依存症症状や精神疾患の症状の増悪，治療成績低下，治療脱落などのリスクを高める．一方で，重複障害の治療手法についてはまだ手探り状態であり，臨床現場でも大きな課題となっている．

参考文献

1)Osaki Y, et al:Prevalence and potential patients of alcohol-related problems in Japanese adults. Alcohol Alcohol. 51:465-473, 2016

2)Regier D.A, et al:Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area(ECA)Study. JAMA 264:2511-2518, 1990

3)久里浜医療センター：サントリー委託研究発表会資料．2017

4)Henderickson EL:Designing, Implementing, and Managing Treatment Services for Indivisuals with Co-occuring Mental Health and Substance Use Disorders:Blueprints for Action. The Hawworth Press Inc, NewYork, 2006

5)BreakeyWR, et al:Health and mental health problems of homeless men and women in Baltimore. JAMA 262:1352-1357, 1989

6)Khantzian EJ:The self-medication hypothesis of addictive disorders:focus on heroin and cocaine dependence. Am J Psychiatry 142:1259-1264, 1985

7)エドワード・J・カンツィアン，他(著)，松本俊彦(訳)：人はなぜ依存症になるのか自己治療としてのアディクション．星和書店，2013

8)Ross S, et al:Co-occuring psychotic and addictive disorders:neurobiology and diagnosis. Clin. Neruopharm 35:235-243, 2012

9)Kessler RC, et al:The epidemiology of co-occurring addictive and mental disorders:implications for prevention and service utilization. Am J Orthopsychiatry 66:17-31, 1996

10)Ziedonis DM:Integrated treatment of co-occuring mental illness and addiction:clinical intervention, program, and system perspectives. CNS. Spectrums 9:894-904, 2004

11)Hser HI, et al:Utilization and outcomes of mental health services among patients in drug treatment. J Addict Dis 25:73-85, 2006

12)Mueser KT, et al:Dual diagnosis:a review of etiological theories. Addict. Behav 23:717-734, 1998

13)Pulay AJ, et al:Violent behior and DSM-Ⅳpsychiatric disorders:results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 69:12-22, 2008

14)Fazel S, et al:Risk factors for violent crime in schizophrenia:a national cohort study of 13, 806 Patients. J Clin Psychiatry 70:362-369, 2009

15)融道男，他(監訳)：ICD-10精神および行動の障害—臨床記述と診断ガイドライン，新訂版．医学書院，2005

16)American Psychiatric Association(原著)，染矢俊幸，他(訳)：DSM-5精神疾患の診断・統計マニュアル．医学書院，2015．

17)Sullivan LE, et al:The prevalence and impact of alcohol problems in major depression:a systematic review. Am J Med 118:330-341, 2005

18)Grant BF, et al:Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders:results from the National Epidemiologic Survey on Alcohol and Related Conditions(NESARC). Arch Gen Psychiatry 61:807-817, 2004

19)Roy A, :Aetiology of secondary depression in male alcoholics. Br J Psychiatry 169:753-757, 1996

20)澁谷治男，他：精神科合併症の診断と治療，白倉克之，他(編)：アルコール・薬物関連障害の診断・治療ガイドライン．pp93-100，じほう，2002

21)Tamerin JS, et al:The psychodynamics of chronic inebriation:observations of alcoholics during the process of drinking in an experimental group setting. Am J Psychiatry 125:886-899, 1969

22)Hasegawa, et al:Primary and secondary depression in alcoholism-clinical features and family history. Drug AlcoholDepend 27:275-281, 1991

23)Brown SA, et al:Changes in depression among abstinent alcoholics. J Stud Alcohol 49:412-417, 1988

24)松下幸生，他：薬物依存症・アルコール依存症・中毒性精神病治療の開発・有効性評価・標準化に関する研究　日本の入院アルコール依存症患者の特徴に関する研究　The Japan Collaborative Clinical Study on Alcohol Dependence(JCSA)の結果より．薬物依存症・アルコール依存症・中毒性精神病治療の開発・有効性評価・標準化に関する研究　平成16-18年度　総括研究報告書．国立精神・神経医療研究センター精神保健研究所，pp245-250, 2007

25)Schneider U, et al:Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment:the first Multicentre Study in Germany. Alcohol Alcohol 36:219-223.2001

26)Alegria AA, et al:Comorbidity of generalized anxiety disorder and substance use disorders:results from the ational Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 71:1187-1195, 2010

27)Center for Substance Abuse Treatment:Assessment and Treatment of Patients with Coexisting Mental Illness and Alcohol and Other Drug Abuse:Treatment Improvement Protocol(TIP)Series#9. Washington, DC:DHHP Publication No.(SMA)94-2078, 1994

28)RiesRK, et al:Principles of Addiction Medicine 4th ed. pp465-477, Lippincott Williams ＆ Wilkins, 2009

29)樋口進：アルコール・薬物依存症と他の重複障害の実態把握と治療モデルの構築に関する研究，平成24年度厚生労働科学研究費補助金(障害者対策総合研究事業)「様々な依存症における医療・福祉の回復プログラムの策定に関する研究(研究代表者宮岡等)総括・分担研究報告書」．pp19-89, 2013

30)Hendrickson EL, et al:Treating Co-occurring Disorders:A Handbook for Mental Health and Substance Abuse Professionals, Routledge, New York, 2004

31)Green AI, et al:Schizophrenia and co-occurring substance use disorder. Am J Psychiatry 164:402-408, 2007

32)Rosenberg SD, et al:Prevalence of HIV, hepatitis B and hepatitis C in people with severe mental illness. Am. J. Public. Health 9:31-37, 2001

33))Brunette MF, et al:Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders. Schizophr Bull 32:637-643, 2006

34)Beck AT, et al:Cognitive Therapy of Substance Abuse. The Guilford Press. NewYork, 1993

35)Gianoli MO, et al:Treatment for comorbid borderline personality disorder and alcohol use disorders:a review of the evidence and futre recommendations. Exp Clin Psychophrmacol 20:333-344, 2012

36)Root TR, et al:Substance use disorders in women with anorexia nervosa. Int. J. Eat. Disord 43:14-21, 2010

37)武田綾，他：摂食障害とアルコール依存症の合併例の発症順位と治療歴，および転機に関する研究．心身医45:765-775, 2005

38)Carr KD:Chronic food restriction:enhancing effects on drug reward and striatal cell signaling. Physiol Behav 91:459-472, 2007

39)Higuchi S, et al:Alcoholics with eating disorders:prevalence and clinical course. A study from Japan. British J Psychiatry 162:403-406, 1993

40)Suzuki K, et al:Comparative Study on the Outcomes of Treatment of Japanese Females with Eating Disorders with or without Alcoholism. Jpn. Psychosom. Med 42:513-519, 2002

41)Mitchell JE, et al:The influence of prior alcohol and drug abuse problems on bulimia nervosa treatment outcome. Addict Behav 15:169-173, 1990