절주가 아닌 단주를 지지하는 경험적 이유와 과학적 증거

김한오 한국중독정신의학회 2019 중독정신의학 Vol.23 No.2

Objectives : It has long been advocated that abstinence is the only way to realistically and effectively cope with alcoholism. In opposition to controlled drinking (moderation), the valid reasons for abstinence were reviewed. Methods : A search was conducted through PubMed using the keywords abstinence and/or moderation. And related books were also sought. Results :Alcoholics should not practice moderation but abstinence instead for the following reasons. 1) The core concept of the definition of addiction is ‘loss of control.’ 2) Disruption of orbitofronto-striatal functional connectivity underlying perseveration in alcoholics makes them rigid and incapable of controlling drinking. 3) To prevent brain damage caused by repeated excitotoxicity. 4) Long-term follow up studies on alcoholics’ drinking have revealed the inevitable failure of moderation. 5) Due to the reinstatement phenomenon. 6) Moderation is a step towards another relapse. 7) As addicts attach to alcohol, detachment from alcohol makes them form a healthy attachment. 8) For the sake of their loved ones. 9) Abstinence is safer and simpler than moderation. 10) Moderate drinkers do not stand for alcoholics. Conclusion : Moderation is a fit for a few addicts but abstinence is a better fit for the majority of addicts. Although abstinence should be an imperative goal of alcoholics, it should not be forced but instead chosen.

마샬, 험프리, 볼 공저 『음주문제의 치료』

김한오(Hano Kim) 한국중독정신의학회 2012 중독정신의학 Vol.16 No.2

12단계 촉진치료 개괄

김한오(Hano Kim) 한국중독정신의학회 2016 중독정신의학 Vol.20 No.2

Since the emergence of Alcoholics Anonymous (A.A.) in 1935 and 12-step program in 1939, many addicts have been helped by attending the program. Some addicts, however, have resis-tance against attending A.A. meetings. Twelve Step Facilitation Therapy (TSF), developed through the Project MATCH Re-search in 1989, has helped the addicts overcome barriers to at-tend the meetings. Considering the effectiveness and worldwide use of TSF in treating addicts, several aspects of TSF were re-viewed in this study : 1) differences between TSF and A.A. 12-step program, 2) the effectiveness of TSF, 3) the roles and desired characteristics of TSF therapists, 4) the structure and contents of TSF, 5) a case of TSF group therapy, and 6) complementary re-lationship among 12-step program, Motivational Interviewing (Five Stages of Change), and Cognitive Behavioral Therapy. Clinicians are recommended to understand the importance and effectiveness of TSF and use it for treating addicts.

중독의 12단계 영적 치료

김한오(Hano Kim),박선희(Sun-Hee Park) 한국중독정신의학회 2013 중독정신의학 Vol.17 No.2

Objectives : Alcoholics Anonymous began in America 1935 and conceptualized their recovery principles as Twelve Steps. Twelve Step Program (TSP) uses spirituality for addiction treatment, which is a differential aspect to the other major addiction treatment tools such as pharmacotherapy, cognitive behavioral therapy and motivational interview. This study is to establish the concept of TSP as a spiritual treatment. Methods :A spiritual treatment is a treatment by God. Therefore the spiritual treatment must depend on the characteristics of God. God has characteristics of creativity, humility, and omnipresence. Thus, I tried to consider and explain TSP in the light of God’s three aspects. Results : First, TSP is ‘a treatment of God’s Power’ based on God’s creativity so that all the processes during treatment are guided under the trust in God. Second, TSP is ‘a treatment of resemblance to God’s humility’, where addicts reach humility from arrogance with the help of ‘the Reversed 12 Steps’. Third, TSP is ‘a holistic treatment’ based on God’s omnipresence, therefore, addicts can possibly restore all aspects of life. Conclusion : TSP is a spiritual treatment led by God and could be a useful treatment tool for addicts.

만성정신병환자의 재활치료를 위한 주간보호 모델

이규항,김한오,이후경,윤성철,성상경,함웅,윤배중 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.5

목 적 : 본 연구는 전문병원 위탁형 정신보건센터에서 실시한 주간보호의 전체적인 체계, 운영, 프로그램에 관한 모델을 소개하고, 이 모델을 주간보호에서 시행한 후 그 결과와 시행과정에서 나타난 특징을 분석하여, 우리 실정에 맞는 주간보호 모델을 발전시켜 만성정신병환자의 생활유지와 재활을 촉진시키기 위한 목적으로 실시되었다. 방 법 : 본 주간보호 모델(이하 본 모델이라 함)을 1997년 3월부터 1998년 2월까지 의왕시 정신보건센터에서 총 23명의 환자를 대상으로 실시하였다. PANSS, Quality of Life, 삶의 만족 척도를 주간보호 전과 주간보호 실시 3개월 이후에 조사하였다. 프로그램 유익성 척도, 13가지 치료요인 척도를 주간보호 1개월째와 주간보호 실시 3개월 이후에 조사하였다. 결 과 : 1) 본 모델은 만성정신병환자의 증상을 감소시키고 삶의 질을 향상시켜, 환자의 생활유지 및 재활에 도움을 주었다. 2) 본 모델은 다양한 형태의 집단치료들을 사용하여 만성정신병환자에게 유익을 주었으며, 특히 예술치료와 활동치료가 환자의 신체적, 심리적, 사회적 기능회복을 위해 중요한 역할을 하였다. 3) 본 모델에 작용하는 치료요인의 특징을 보면 주간보호 초기와 후기에 모두 중시된 치료요인은 치료자와의 동일시, 치료자의 조언, 일차가족집단의 교정적 감정경험이었다. 주간보호 초기에 중시된 치료요인은 집단응집력, 이타심이었으며, 주간보호 후기에는 희망의 고취가 중시되었다. 4) 본 모델은 여러 분야의 치료자들과 다양한 치료방법들을 전체적으로 통합하여 사용하는데 유용하였다. 결 론 : 본 모델은 만성정신병환자의 생활유지와 재활을 위해 우리 나라에서 효과적이면서 효율적으로 적용될 수 있을 것으로 생각된다. Objectives : The purpose of this study was to present general system, operation, and program of a day care model managed by a psychiatrist, to evaluate the results of performing this model, and thus to develop a day care model applied to Korean situation appropriately for promoting maintenance and rehabilitation of chronic psychotic patients. Methods : We performed this day care model(hereinafter called as this model) from March 1997 to February 1998. The subjects were composed of 23 psychotic patients. PANSS, Quality of Life Scale, Life Satisfaction Self-Rating Scale were used before beginning this model and after three months of performing this model. Program Helpfulness Scale, 13 Therapeutic Factors Scale were used at one months of day care and after three months of day care. Results : 1) This model helped maintenance and rehabilitation of chronic psychotic patients through reducing their symptoms and increasing quality of life. 2) This model used the various group therapy, especially creative art therapy and activity therapy, played an important role for recovering physical, psychological, and social functions. 3) Important therapeutic factors at early and late period of this model were identification with therapists, guidance of therapists, and the corrective recapitulation of the primary family group. Important therapeutic factors at early period were group cohesiveness and altruism, and at late period instillation of hope. 4) This model was useful for integrating the multidisciplinary therapeutic team and the various therapeutic methods. Conclusion : This model would be applied to day care in this country effectively and efficiently for maintenance and rehabilitation of chronic psychotic patients.

남성 알코올 의존 환자의 삶의 질과 정신-사회-영적 특성과의 관계

최삼욱,나란희,김한오,최성빈,최영숙 大韓神經精神醫學會 2006 신경정신의학 Vol.45 No.5

Objectives : This study was designed to evaluate the relationship between quality of life (QOL) and psycho-socio-spiritual characteristics in male patients with alcohol dependence. Methods : The sample consisted of 109 men with alcohol dependence defined by DSM-IV criteria. We assessed QOL by the WHO QOL assessment instrument-BREF (WHOQOL) and SmithKline Beecham QOL (SBQOL). Sociodemographic and alcohol related data were collected, and 7 questionnaires were administered : MAST, BDI, STAI, Drinker Inventory of Consequences (DrInC), Scale of Social Support (SSS), Religious Beliefs and Behaviors (RBB) and Spiritual Well-being Scale (SWBS). The correlations between each QOL score and other variables were examined, and stepwise multiple regression analysis was performed. Results : The WHOQOL score positively correlated with education level, SSS (support) and RBB and negatively correlated with MAST, DrInC, BDI, STAI (trait) and SSS (conflict) scores. In stepwise regression analysis, the scores on the STAl and BDI contributed to the score on the WHOOOL. The SBQOL score correlated with the income level, and negatively correlated with BDI and STAI score. STAI score was a weak predictor of SBQOL score. Conclusion : The significant predictors of QOL in patients with alcohol dependence were psychological factors such as anxiety and depression.

소아기 주의력결핍 과잉행동장애 양상이 성인기 알코올 사용장애에 미치는 영향

은태경(Tae-Kyung Eun),김한오(Hano Kim),박선희(Sunhee Park),임재영(Jae-Young Lim),정재경(Jae-Kyung Chung),김의중(Eui-Joong Kim),이규영(Kyu Young Lee),방수영(Soo-Young Bhang),이진경(Jin-Kyung Lee),주은정(Eun-Jeong Joo) 한국중독정신의학회 2017 중독정신의학 Vol.21 No.1

Objectives : To find a possible association between childhood Attention Deficit Hyperactivity Disorder (ADHD) features and adulthood alcohol use disorder, we investigated the scores of the Wender-Utah Rating Scale (WURS) in Korean male patients with alcohol use disorder. Methods : Seventy-one adult male patients with alcohol use disorder and 71 normal adult male controls were included in the study. The ADHD features of childhood were determined using the WURS. The total score and three Factor Sum Scores (Impulsivity score, Inattention score, Mood instability score) were analyzed. In addition, we investigated the scores of the Adult ADHD Self-Report Scale-V1.1 (ASRS) and clinical characteristics in association with childhood ADHD features. Results : Childhood ADHD and adulthood ADHD features were found 28.2% and 14.1% in the patient group, respectively. The WURS scores were significant-ly higher in the patient group, as compared to the control group. Familial loading of alcohol use disorder and depression, ASRS, education, occupational status, and previous suicidal attempts were associated with one or more Factor Sum Scores. Higher inattention score was associated with previous suicidal attempts in the patients group (p=0.038, OR=1.16). Conclusion : The study results indicated that childhood ADHD features are the risk factors of adulthood alcohol use disorder in the Korean male population. Especially, childhood inattention could be a significant risk factor for suicidal behavior in patients with alcohol use disorder.

한국어판 병동매일행동척도 개발

임호섭,신경철,함웅,채정호,김한오,정찬호 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.2

Objectives : Patient's behavior features are important factors which influences the clinical judgement including diagnosis. However, most psychiatrists build up a picture of patients' behavior from an amalgamation of their own brief observations and nurses' reports, which often lack in the objectiveness. Several behavioral scales have been developed to alleviate this difficulty, but the poor efficiency and reliability of these scales have made them less useful. The recently developed Ward Daily Behavior Scale is an objective tool for evaluating all the daily noteworthy behaviors of patients, and is easily applicable to wide ranges of diagnoses and ages. This study tried to prove the reliability and validity of the Ward Daily Behavior Scale-Korean version. Methods : The 112 patients, 63 males and 49 females, at a chronic psychiatric inpatient ward were selected as subjects. Experienced and unexperienced nurses rated patients' behaviors independently with the Ward Daily Behavior Scale-Korean version, after observing behaviors of subjects for 8 hours during day duty time. And then we tested the inter-rater reliability, internal consistency, and concurrent validity of this scale. Results : The Ward Daily Behavior Scale-Korean version proved to be both reliable and valid for measuring of behaviors of psychiatric inpatients. Conclusions : The Ward Daily Behavior Scale-Korean version will be a valuable tool to observe and quantify patients' behavior in psychiatric wards.

알코올리즘 입원치료프로그램 참가자들의 퇴원 후 경과에 대한 연구

최성빈(Sung-Bin Choi),박병권(Byung-Kwon Park),김한오(Han-O Kim),원민혜(Min-Hye Won),손인기(In-Ki Sohn),함 웅(Woong Hahm) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.1

Objectives:The purpose of this study is to evaluate the outcome of alcoholics who participated in an inpatient alcoholism treatment program of a mental hospital. At the same time, We studied the various clinical variables affecting the recovery of alcoholism. Methods:The 261 subjects who were diagnosed as alcohol dependence took part in the treatment program at the alcohol center in Keyo hospital at least for 2 weeks between January 2004 and December 2004. The subjects were followed up by faceto-face or telephone interview, and medical records were reviewed to obtain data on demographic characteristics, alcohol-related clinical characteristics, treatment process, etc. Results:1) the mean follow-up period was 19.67 months. 2) 141 of the 261 subjects were followed up, so the follow-up rate was 54.02% 3) 43 of the 141 subjects (30.5%) were classified into abstinent group, 23 (16.3%) into controlled drinking group, and 75 (53.2%) into relapse group. Abstinent and controlled drinking groups were called recovery group. So 66 (46.8%) of the 141 subjects were classified into recovery group. 4) By the comparison of relapse and recovery groups, education, socioeconomic status, occupation, and marital status are significantly different between groups. 5) Recovery group had a longer duration of abstinence before admission than relapse group. 6) Completion of alcoholism treatment program during admission and a return to work after discharge from hospital were associated with recovery of alcoholism. 7) In a stepwise regression model, four risk factors were significantly correlated with the recovery:a return to work after discharge from hospital, completion of alcoholism treatment program during admission, marital status, and duration of abstinence before admission. Conclusion:The variables above mentioned were thought to be the points to be duly considered for the better outcome of alcoholism.

입원 및 외래 알코올중독 환자의 병식 차이에 대한 연구

성상경(Sang-Kyung Sung),이학구(Hak-Koo Lee),김한오(Han-O Kim),이규항(Kyu-Hang Lee) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.1

Objectives:The goals of this study were to estimate level of insight in alcoholic patients and provide the fundamental data for which can be used for development of effective treatment programs. With this purpose, we compared insight status between inpatient alcoholics and outpatient alcoholics. Methods:The subjects participated in this study were 65 inpatient alcoholic patients who were admitted to alcohol/drug abuse treatment center in Kyungido between February and June, 2001 and 38 outpatient alcoholics who were undergone outpatient alcohol treatment program after discharge. We investigated demographic data, clinical characteristics, past alcoholic history by questionary survey and measured insight status by NAST (National Alcoholism Screening Test) and HAIS (Hanil Alcohol Insight Scale). Results:The outpatient alcoholic patients showed statistically significant higher NAST numbers, NAST scores and mean HAIS scores than inpatient alcoholics. In addition, outpatient alcoholics were statistically significant higher frequency of past admission, and more recognized addiction and necessary of treatment than inpatient alcoholics. Conclusion: We suggest that the necessity to adjust inpatient alcohol treatment program to insight status of individual alcoholic patient more flexibly. Further studies on correlation among other variables such as the independent program’s impact on each patient, guide goals which can increase insight status through inpatient alcohol treatment program, and development of the level of insight to abstinence may be required.