효율적인 적정음주기준의 개발

이해국(Hae-Kook Lee),이정태(Chung-Tai Lee),권용실(Yong-Sil Kweon) 한국중독정신의학회 2006 중독정신의학 Vol.10 No.2

Alcohol consumption has been associated with favorable as well as adverse health effects. Alcohol is an addictive substance, therefore some individuals who drink alcoholic beverages develope alcoholism and others experience various alcohol problems. We have a permissive cultural background to alcohol drinking, so the prevalence of alcoholism and alcohol problems are generally high. Therefore, it is needed to develope effective guideline for moderate drinking to prevent drinking related harm. Many countries have moderate drinking guidelines to prevent heavy drinking and drinking related harm. Generally, guidelines recommend 35-50 gram of alcohol as a tolerable level of daily consumption. But, developing and application of guidelines are very carefully considered because even small amount of alcohol can cause various risk by individual’s vulnerabilities and different sociocultural background. And, it is not recommended that the abstinences start drinking to obtain health effect of moderate drinking. We reviewed some drinking guidelines of other countries, and suggested several principles of conducting moderate drinking guidelines. First, considering our permissive legal and cultural environment, we need a more strict guidelines. Second, to developing effective drinking guidelines, the efforts to increase public awareness of drinking related harm need to be conducted. Third, the intensive researches which is related to pharmcokinetics and toxic effects of alcohol in Korean should be followed.

신체건강진료 환경에서의 음주문제에 대한 개입전략

이해국 ( Hae Kook Lee ) 대한간학회 2018 Postgraduate Courses (PG) Vol.2018 No.1

우리나라의 성인의 월간 음주율은 2016년 기준 61.9%로 전년 대비 1.3% 증가하였으며, 최근 5년간 꾸준한 증가 추세를 보이고 있음. 우리나라 음주문제 및 치료역학 중 특징적인 것은 중년남성이 되어도 유병율이 크게 감소하지 않는다는 점, 여성의 음주율이 급격히 상승하고 있다는 점, 그리고 전반적인 치료경험율이 낮다는 점 등을 들 수 있음1. 또한 치료와 관련해서는 알코올사용장애로 치료를 받는 시기가 40대 이후로 늦다는 점, 여성의 치료율이 증가하고 있다는 점 등을 들 수 있음. 이러한 유병율과 치료경험의 양상은 사회적으로 음주로 인한 폐해 및 그 치료의 필요성에 대한 인식이 낮기 때문이라 볼 수 있음. 따라서, 일차보건의료 및 음주관련 신체질환에 대한 진료환경에서 음주문제 자체에 대한 치료적 개입이 요구되는 것임. 알코올사용장애의 유무와 관계없이 고위험음주에 대한 근거기반 개입은 단기개입(Brief Intervention)으로, 우리나라에서도 2013년 한국형 매뉴얼이 개발된 바 있음. 외래 환경에서 현재 상태에 대한 객관적 평가결과와 이에 근거한 조언을 짧게 반복적, 지속적으로 전달함으로써, 음주로 인한 건강폐해를 줄일 수 있을 것으로 기대함.

알코올중독에 대한 포괄적 치료 체계의 개발

이해국(Hae Kook Lee),이명수(Myung-Soo Lee),기선완(Seon Wan Ki),최삼욱(Sam-Wook Choi),조근호(Keun Ho Joe),박애란(Aeran Park),정인원(In-Won Chung),김석범(Seok Beom Kim),이정태(Chung Tai Lee),권용실(Yong Sil Kweon) 대한사회정신의학회 2007 사회정신의학 Vol.12 No.2

Alcoholism is complex primary physiological disease with unique therapeutic interventions, and neither a primary behavior disorder nor ay symptomatic manifestation of any other disease process. And, it is highly prevalent disease with important impact on public health perspective. Therapeutic approach for alcoholism need to be organized by integrative and comprehensive systems, because that development and course of alcoholism are influenced by complex interaction between biological and environmental factors. We tried to developing effective intervening systems for alcoholism in seoul by evaluating the current state of service for alcoholism and referring to advanced treatment system in other countries. The problems of current state are lack of public awareness for seriousness of alcoholism, difficult access to treatment system and weak capacities to managing alcoholic patients in the community. Integrative and comprehensive intervening system for alcoholism are accomplished by developing system of matching services to alcoholic subjects in the community level based on seriousness and needs of alcoholic subjects. Referring to current state of alcoholism service in Seoul, treatment system should be developed based on continuum of care system in which the different intensity of service is placed and organized in the community level. First, the rehabilitation centers for chronic alcoholics and intensive outpatients centers should be newly established. Second, it is needed to strengthen the function of alcohol counseling centers and community mental health centers as coordination centers for alcoholics. Third, legal and political support should be established to induce improvement of inpatient and outpatient treatment service quality. Finally, setting up a committee to support and organize these integrative treatment systems is needed.

알코올 금단 환자에서 금단 섬망 발생의 위험요인

권용실(Yong-Sil Kweon),이해국(Hae-Kook Lee),이정태(Chung Tai Lee),이지현(Ji-Hyun Yi) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.2

Alcohol withdrawal syndrome occurs in alcohol dependent patients who discontinue or decrease their alcohol consumption. Delirium tremens, is not a frequent, but serious complication of alcohol withdrawal in patients with alcohol dependence. To identify clinical characteristics associated with development of delirium tremens, we performed retrospective case-control study among discharged with diagnosis of alcohol dependence. Seventy six patients discharged between June 2002 and June 2003 were enrolled to this study. Among 76 subjects, 29 patients developed delirium tremens during hospitalization. Bivariate analysis indicated that age, duration of current episode, days since last drinks, comorbid medical illness and presence of brain vulnerability were associated with development of delirium tremens. In a stepwise multiple regression model, four risk factor were significantly correlated with the development of delirium tremens:days since last drinks, brain vulnerability, age, pulse rate (Percentage correct=82.9%). Prediction of alcohol withdrawal delirium by evaluation of several readily available clinical variables can be useful in effective management of alcohol withdrawal patients.

코로나19 팬데믹과 중독

정슬기(Sulki Chung),이해국(Hae Kook Lee) 한국중독정신의학회 2022 중독정신의학 Vol.26 No.1

Objective: The outbreak of the coronavirus disease 2019 (COVID-19) that began in early 2020 has caused widespread stress and psychological distress. The lockdown and social distancing aggravated the state of loneliness and psychological distress. The purpose of this study was to ex mine the changes in the various addictive behavior reported since the outbreak of the pandemic. Methods: Authors reviewed studies and reports published between March 2020 and January 2022 that examined changes in addictive behavior. Results: The restriction of pleasure-seeking activities due to social distancing has increased the use of addictive substances and digital media. Globally, many studies have examined the increase in addictive behavior and disorders related to COVID-19. Although mainly cross-sectional, studies have consistently reported that alcohol consumption, alcohol use disorder, substance abuse, and the use of digital media such as the Internet, Internet games, online gambling, pornography, and social media have increased. Such increase in addictive behavior during the COVID-19 pandemic is related to a combination of biopsychosocial factors. These include the need for intrinsic reward due to isolation and loneliness, the increase in psychological vulnerability that triggers depression, anxiety, and addiction, and the lack of environmental resources that provide alternative ways to satisfy pleasure-seeking desires. Conclusion : This review calls for an integrative strategy that includes education, campaign, and therapeutic intervention at the individual level, and efforts to change our environment and emphasize social responsibility of the related industry at the institutional level.

정신의료기관 폭력발생현황에 대한 연구

배준호(Jun-Ho Bae),이해국(Hae-kook Lee),정정엽(Chung-yeob Chung) 대한사회정신의학회 2020 사회정신의학 Vol.25 No.2

최근 정신의학 분야에서 의사들이 죽거나 다치는 일이 빈번하게 발생하고 있다. 정신의학 분야는 자타해 위험이 높은 정신질환자를 치료해야 때문에 다른 의학 분야보다 폭력에 노출될 가능성이 높다. 중증정신질환자의 경우 현행법상 보호의무자 2명과 정신건 강의학과 전문의 2명의 동의 하 보호입원(과거 강제입원)을 진행할 수 있다. 하지만 상기 과정에서 환자 본인의 의사에 반하는 치료 절차가 공권력의 명확한 지원 없이 이루어지고 있다. 또한 취약한 인력, 시설여건 때문에 치료에 대한 순응도가 떨어지고 있으며, 환자와 의료진 모두의 안전과 인권을 보호하지 못하는 정신의료환경이 유지되고 있다. 본고에서는 위와 같은 문제에 직면하여, 정신질 환자와 대면하게 되는 정신건강의학과 소속 보건의료종사자에 대한 폭력의 실태와 위험성의 정도가 어떠한지 살펴보고, 폭력 발생의 맥락을 파악하여 시사점을 도출하고자 한다. 이어 우리나라의 정신건강의학과 소속 보건의료종사자들을 보호하기 위하여 추가 적으로 필요한 대응방안으로 무엇이 있을 수 있는지에 관하여 고찰해보고자 한다. Recently, numerous doctors have been killed or injured in the psychiatric field. The likelihood of being exposed to vi-olence is greater in psychiatry than other fields of medicine due to its nature of treating people with high-risk mental ill-ness. In the case of protective hospitalization (formerly referred to as forced hospitalization) for such patients with severe mentally illness, treatment procedures may be carried out against their will without clear support from the public authority. In addition, due to poor manpower and facility conditions, compliance with treatment is declining, and a psychiatric medical environment that does not protect the safety and human rights of both patients and medical staff is maintained. This paper, in light of the problems mentioned above, examines the actual condition and degree of risk of violence against health care workers belonging to the Department of Mental Health, who are confronted with mentally ill patients. Furthermore, it will be considered whether there are additional necessary countermeasures to protect health care workers belonging to the Department of Mental Health in South Korea.

한국 남성 알코올의존 환자에서의 COMT 유전자 다형성

권용실(Yong-Sil Kweon),이해국(Hae-Kook Lee),이정태(Chung Tai Lee):배치운(Chi-Un Pae) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.1

Catechol-O-Methyltransferase (COMT) is an enzyme which play a crucial role in the metabolism of dopamine. It has been suggested that COMT provide molecular role in development of alcohol dependence because of its genetic polymorphism associated with 3-4 fold variation in enzymatic activity. We carried out an association study to verify the relationship between COMT gene polymorphism and alcohol dependence with violent behavior in Korean population. Ninety seven (97) male alcoholics and 94 male normal controls who did not have history of psychiatric illness were enrolled in this study. After amplifying COMT genes by polymerase chain reaction and assessed genotype and allele by Restriction Frag-ment Length Polymorphism (RFLP). Distribution of COMT genotype and allele frequencies between patients and controls was not significantly different. However, the differences between violent group and nonviolent group were significant in frequencies of COMT genotype (χ 2 =7.977, df=2, p=0.019) and allele (χ 2 = 6.832, df=1, p=0.012). Additionally, the differences between nonviolent groups and controls were significant in frequencies of COMT allele (χ 2 =4.481, df=1, p=0.040). This result suggest that COMT gene polymorphism is not associated with the development of alcohol dependence, but may affect a susceptibility to clinical heterogeneity of alcohol dependence, at least in the Korean population.

중독관리통합지원센터에서 조사한 지역사회알코올 사용문제 실태

김성환(Sunghwan Kim),이해국(Hae Kook Lee),이정태(Chung-Tai Lee),전광용(Kwang Yong Jeon),윤창교(Chang-gyo Yoon),원은옥(Eun Ok Won),박승일(Seung-il Park),이승엽(Seung-Yup Lee) 한국중독정신의학회 2018 중독정신의학 Vol.22 No.2

Objectives : We aimed to investigate the prevalence of problematic alcohol use screened with Alcohol Use Disorders Identification Test (AUDIT) by a community addiction management center and provide data on descriptive comparison with the overall prevalence investigated by the community health survey 2012-2016. Since the community health survey does not utilize a standardized test, there is a need to examine whether it accurately captures the problematic alcohol use in the community. Methods : We analyzed the 2013-2017 data of 6888 people screened by the Uijeongbu Community Addiction Management Center with AUDIT. The prevalence was compared with the overall prevalence investigated by the community health survey 2012-2016. Results : Hazardous drinking behavior (male 53.8%, female 35.4%) and suspected alcohol use disorder (male 19.6%, female 6.7%) were significantly higher in males than females and the odds ratios of males were 2.13 and 3.40, respectively. The age groups from the twenties to the fifties reported high problematic alcohol use. The results revealed that hazardous drinking and suspected alcohol use disorder rate were higher at the center screening as compared to the general population based on the community health survey conducted during the similar period. Conclusion : Young and middle-aged adult males were the identified risk group for problematic alcohol use that re-quires more public health resources for the prevention. It is hypothesized that utilization of established screening tools in the community health survey may improve the accuracy of problematic alcohol use detection in the community.

웹 기반 플랫폼을 활용한 고위험음주 예방 및 치료 개입 체계 구축

강경화(Kyonghwa Kang),이해국(Hae Kook Lee),조근호(Keun Ho Joe),전종설(JongSerl Chun),박신구(Shin Goo Park),조선진(Sun-Jin Jo),이보혜(Bo-Hye Lee),이수비(Soo-Bi Lee) 한국중독정신의학회 2016 중독정신의학 Vol.20 No.2

Misuse of alcohol can have major healthcare cost. However, problem drinkers without seeking treatment is a challenging issue. To address this problem, this study aimed to develop a web-based alcoholism prevention program based on scientific literature provide preventive intervention for high-risk drinkers in a timely manner. Based on previous literature, it was found that alcoholism prevention intervention program was success-fully delivered on the Internet. In addition, a reduction in alcohol consumption was noted as the potential effect of web-based intervention in many studies. The program development pro-cess included adult over 19 years to draw a motivation for drink-ing behavior change. It was created using the following step-by-step modules : 1) assessments for overall drinking behavior and motivation level, 2) normative and objective feedbacks based on users responses and 3) planning for drinking behavior change. Participants reported that changes in the level of awareness on problem drinking and drinking behavior were significant. How-ever, they pointed out the need of having a practicable strategy for behavioral changes. More improvement is warranted to ful-ly addressing users’ needs.

중추신경흥분성 식욕억제제 사용의 부작용에 관한 신속 체계적 문헌고찰 : 의존 및 정신병 중심으로

조선진(Sun-Jin Jo),이해국(Hae Kook Lee),박병주(Byung-Joo Park),강훈철(Hoon-Chul Kang),이승엽(Seung-Yup Lee),조중범(Joong-Bum Jo) 한국중독정신의학회 2021 중독정신의학 Vol.25 No.2

Objectives: Although psychostimulants for suppressing appetite have indications for a short-term use, long-term prescriptions are also frequently encountered in clinical practice. The objective of this study was to overview the empirical evidence on the safety of such psychostimulants. Methods : A rapid systematic review was conducted using existing systematic review articles or clinical guidelines developed by adopting systematic review methodology. Results : Four systematic review articles or clinical guidelines were reviewed. Studies on the safety of diethylpropion were all short-term. Six case reports reported psychotic symptoms. Phentermine, phendimetrazine, and diethylpropion have been withdrawn in most countries due to their side effects such as drug abuse and cardiotoxicity. Long-term prescription safety for phentermine or diethylpropion was not addressed in existing clinical guidelines for pharmacological management of adult obesity. Moreover, studies on the efficacy and safety of psychostimulants in the childhood and adolescence obesity management have not been reported yet. Conclusion : The number of studies on the long-term safety of antiobesity psychostimulants prescriptions was too limited to conclude their efficacy and safety for long-term use. Thus, long-term prescriptions of antiobesity psychostimulants should be avoided and closer monitoring is needed even for short-term use of psychostimulants in subjects with mental health risk.