The magnitude of drug dependence and abuse problems has increased in recent years. In particular, problems related to stimulant drugs are said to have entered a third peak of abuse. Meanwhile, although most patients we encounter clinically are dependent on stimulant drugs and volatile solvents the types of drugs addicted patients depend on are increasingly varied.
This paper discusses drug abuse and dependence on those drugs prescribed by doctors at hospitals' general departments, not drugs prescribed psychiatric departments or drugs sold over the counter at drug stores.
The terminology of drug-related problems includes: abuse; acute poisoning: dependence and chronic poisoning. These words should be accurately used and properly distinguished from one another. When we look at the dependence on sleeping pills, anti-anxiety drugs and tranquilizers, we are concerned mainly with bromides, barbiturates, non-barbiturates and benzodiazepine (BZ) that are used to treat insomnia or to reduce anxiety and pain. BZ-type drugs are widely prescribed because these are effective and safe when used as directed. When we deal with the dependence on these BZ-type drugs, we should separately discuss the following three different types of the problems: 1) high dose dependence; 2) clinical dose dependence and 3) the use of the drug along with alcohol and/or other drugs.

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The Japanese government has stated that specialized institutions for treating drug dependence are necessary and that developing such institutions should be a matter of national policy. However, in the entire country, there is only one state-run ward specialized in treating drug dependence. If we include those institution that a alcoholism, there are just two more state-run wards, three public ones and ten private ones. Despite the fact that treatments for drug dependence are an extension of the treatment system for alcohol dependence, there has been a tendency to emphasize the uniqueness of drug dependence.
At our institution, we have viewed our treatment system for drug dependence as an extension of our alcohol dependence treatment system. Thus, we placed our Drug Dependency Rehabilitation Program (DRP) in the alcoholic dependence treatment ward. If other hospitals do the same, we expect that the number of institution that offer specialized treatment for drug dependence can drastically be increased. In our DRP, we have placed emphasis on consideration of the psychology of adolescents, diversion from punishment, and the importance of self-help groups.

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One of the particular factors which divides volatile solvent abuse from other kinds of drug abuse is that it is mainly confined to adolescents. In the treatment process, this factor has to be taken into consideration, giving special priority to adaptation to society. Treating the problem only within the psychiatric service is not enough. Rather the family, school and criminal justice system should be able to deal with the problem in a more effective way. Each professional has to understand his own function and limitations and also those of the other professionals involved. A collaborative effort of which is “the treatment of the whole problem” a common goal has to be set up in order to treat volatile solvent abuse.

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Stimulant drugs were placed under the regulation of the Stimulants Control Law enacted in 1951 and there include amphetamine, methamphetamine and other salts. Most abused in Japan is methamphetamine. Stimulant drugs are mainly abused orally, through intravenous injections, and in the form of inhaling of mist. Repeated use of stimulants leads to dependence syndrome. In a typical methamphetamine dependence case, periodic drug use is often observed and the patient's symptoms develop through three stages. When the cycle of periodic drug use is repeated, the patient will experience hallucinations and delusions. Such toxic psychosis induced by stimulant drugs can be medically treated relatively easily if it is caught at an early stage. However, if drug abuse does not cease after the patient receives treatment, then each subsequent use of the drug will be accompanied by hallucinations and delusions.

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Anti-hepatitis C virus (HCV) antibody was measured by a second-generation EIA in the residents of two sanatoriums of leprosy (A, B) in Japan. The prevalence of anti-HCV antibody (HCV+) was 60.5% in sanatorium “A”, and at least 23.1% in sanatorium “B”. It was inferred that having past history of leprosy and institutionalized lifestyle for long period had some influence on the extraordinary high prevalence of HCV infection. The cases of LL and BL, classified by leprosy classification, had significantly higher prevalence of HCV + than the cases of other forms of leprosy. The HCV-carrier rates in HCV + were relatively low as of 44.9% (A: high antibody titer) and 48.4% (B: HCV-RNA positive) than that shown in previous studies. The risk of HCV infection in the married couples could not be considered high. Significantly more cases with low platelet count and the cases with liver dysfunction were found in HCV-carrier group than in non-carrier or HCV-group. In HCV-group, significantly more cases with low platelet count and the cases with high γ-GTP were found in male than in female. Although there was no significant difference in the results of urinalysis between the three groups such as HCV-carrier, non-carrier and HCV-, hematuria was more prevalent than proteinuria in all three groups. Hence the disease of leprosy than HCV infection might have affected the renal function more. The residents in sanatoriums should be followed-up considering HCV infection and the past history of leprosy.

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The constituent of diseases of the hospitalized patients in the National Minami-Fukuoka Chest Hospital from 1994 to 1998 was analyzed. The patients in the ward of children and serously handicapped persons excluded. The number of hospitalized patients were increased in recent two years. The number of patients with bronchial asthma and malignancies were increased. The proportion of tuberculosis were decreased. The average age was increased by 2.6 years old from 1994 to 1998. Among the patients of chronic respiratory failure, pulmonary emphysema was increased, pulmonary fibrosis was dereased, and the sequelae of pulmonary tuberculosis was unchanged.
Although the standard international classification such as ICD-10 is principle for the proper cording system, some additional coding system was required to obtain more information representing the characteristics of the particular hospital. As far as our hospital was concerned, chronic respiratory failure which constitute about 30% of all was to be separated and coded in more detail especially for sequelae of pulmonary tuberculosis. Besides the etiologic coding, multiple cording system to clarify functional and therapeutic differences is desirable.

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A 18 year-old adolescent girl with obese type diabetes and hypomenorrhea was admitted to our hospital. She was hirsute due to ovarian hyperandrogenesis, caused by hyperinsulinemia via insulin resistance. No abnormal findings were detected by CT scan or echography in her ovarian and adrenal glands. She was not diagnosed as polycystic ovary syndrome (PCOS). However, her metabolic and endocrine features are identical to those seen in adult woman with PCOS. A new insulin-sensitizing agent, troglitazone, improved insulin action, ameliorated glucose intolerance and also decreased insulin and androgen levels. Troglitazone is a novel useful drug for PCOS-like adolescent female.

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