Practice report

Support for reducing alcohol consumption in disaster-affected areas: Salon
initiatives and development of support for reducing alcohol consumption
Community Support Division, Stem Center, Miyagi Disaster Mental Health Care Center

Yukie Oba, Mebuki Sasaki, Akemi Ozaki
1. Introduction
After the Great East Japan Earthquake, cases of alcohol-related problems became apparent at evacuation shelters andtemporary housing, and the number of alcohol consultations that were received by the Community Support Division,
Stem Center, MDMHCC (“Division”) tripled in the two-year period from 2013. Many of the cases were already severeat the time of the first consultation, and there were many days when we realized the difficulty of recovery fromalcoholism. We began to feel the need for early intervention and preventive measures to address this problem.
The Division launched a salon mainly for heavy drinkers in collaboration with the city and public health centers,
where we worked to support sobriety. It was there that we were convinced of the effectiveness of sobriety support. We
later developed a public awareness project on sobriety support. Here, we report on efforts to address alcohol-relatedproblems in disaster-affected areas, with a focus on efforts to reduce alcohol consumption at salons and the developmentof support for reducing alcohol consumption.
2. Responding to alcohol-related problems: From addiction support to sobriety support(1) Raising public awareness and support for supporters with a focus on alcohol dependence support
The number of consultations on alcohol-related problems that were received by the Division tripled in two years
from the start of support (206 cases in 2013, 442 cases in 2014, and 656 cases in 2015). Many of the cases had alreadybecome severe by the time of the first consultation, and there was a long period in which we felt the difficulty inproviding support. We felt that supporters and residents were becoming increasingly interested in alcohol-related
problems. However, since the earthquake disaster, there has been a larger number of supporters compared with normal
times, and there were many who had never dealt with alcohol-related problems. We thought that this explained theincreasing number of consultations to the Division. Therefore, the Division held workshops in each region to raise
public awareness of alcohol-related issues, particularly addiction support, and to train supporters.
(2) Establishment of the “Meeting for stopping drinking” and exploring secondary prevention efforts
As we provided support in response to requests from local residents and supporters, an idea was born: to establish
a new meeting in regions where there were no danshukai in the surrounding area. Preparatory meetings were held at
the prefectural danshukai, public health centers, health centers, hospitals specializing in alcohol, and the Division. InJune 2015, we held a lecture for setting up a danshukai, which was called “Let’s listen to people who stopped drinking.”
This was attended by 60 people. Hence, we called for the establishment of meetings, and from the following monthonward, we started the monthly meeting called “Meeting for stopping drinking.”
As a new effort, we aimed to create a forum that can be used by a wide range of people, including those who wishedto stop drinking, their supporters, and their families. We felt the difficulty of supporting severe cases and realized theneed for early intervention and preventive measures. Thus, this forum was an attempt to create a venue for learningand sharing for people who do not have an alcohol dependence but have a problem with drinking, supporters, andresidents. However, the actual operation of the venue was difficult. The expectations of the meetings differed greatly
between those who wished to quit drinking and those who did not, and the environment was not good for either typeof participant. Subsequently, we decided to launch a separate “salon (meeting for sobriety),” which had the aim oflearning to reduce alcohol consumption and prevent the progression to addiction. After a one-year preparatory period,
the “Meetings for stopping drinking” for those who wished to quit drinking were held once a month since 2016, andits operation has been continued by the prefectural danshukai.
3. Beginning of sobriety support: Launching of “salons (meetings for sobriety)”(1) Launching of “salons (meetings for sobriety)”
In response to the comments of the participants of the abovementioned lecture and their supporters, we launched asalon for heavy drinkers and those who were willing to learn to drink in moderation. Among them were referrals
from specific health guidance (high-risk liver function patients) and from groups for bereaved families of disastervictims. An overview is shown in Table 1.

－ 38 －− 4 −Table 1. Overview of “salons (meetings for sobriety)”
PurposeTargets
Opportunities forparticipation
Number ofparticipants

Learn and practice to reduce alcohol consumption while having fun, with the aim ofmaintaining a healthy mind and body
Men who drink excessively or are likely to do so, or men who want to learn about sobriety(excluding those with addictions)Lecture questionnaires, invitations from supporters, bereaved families of disaster victims,
specific health guidance, etc.
13 registered members, average number is 10

Salon activities in the morning (cooking classes, health lectures, etc.), HAPPY program in
the afternoon *1 (applicants)
Hosting frequency Once a month
Cooperation between three organizations: health center (venue, relationship with specifichealth guidance), public health center (HAPPY program), and Division (secretariat)
Management
Detailed roles needed for meeting management are divided among members and handled byeach member: director, deputy director, leaflet creation, accounting, shopping, events,transportation, etc.
*1 HAPPY program: package program of evaluation, education, and intervention of alcohol problems, with an aim towardmoderation rather than abstinence
Composition

The characteristics of the salon activities and sobriety programs are summarized below.

<Salon activities>① We targeted middle-aged and older men, with participants limited to men so that it would be easier for participants
to talk; those with addiction were excluded.
② We conducted a wide range of activities that were useful for maintaining mental and physical health (exercise,making well-balanced meals, etc.) in addition to those relating to sobriety.
③ The events should be a place of interaction where it is fun and easy to make friends (includes victims’ bereaved
families and lonely people).
④ The members shared roles (e.g., director, deputy director, leaflet creator, accounting, shopping, events, andtransportation) to facilitate the transition to independent activities.

<Sobriety program>① The HAPPY program was arranged and expanded. In the first fiscal year, three sessions were provided, after which
the program content was divided into 20-minute sessions, and opportunities for reflection were provided according
to the situation of the target person.
② Participation was initially limited to those who wished to participate, but a year later, all salon participants wereallowed to participate (even those who did not keep a drinking diary were able to participate in learning andinformation exchanges and share their peers’ practices).
③ Owing to group implementation, the events were an opportunity for exchanging tips on how to drink in moderationand its effect, and to sympathize and encourage one another in troubled times.
The “salons (meetings for sobriety)” involved learning and practice on how to cut down on alcohol consumption
through salon activities. As a salon in a disaster-affected area, it was also a forum for exchanges to prevent loneliness,and learning was not limited to sobriety—salon activities in the morning broadly covered health promotion as a theme.

(2) Effect of alcohol sobriety on salon participants
In the sobriety program, participants kept a drinking diary and set goals for each month and continued to practice.
The goals were, for example, “provide a liver rest day once a month” or “make a bottle of whiskey intended to be drunkin three days last for four days.” There were times when the monthly goals could not be achieved, but there was anatmosphere in the salon where the participants could openly talk about their situation, and the overseeing staff understoodand accepted the individual’s goals and situations, and sought to sympathize and encourage. The salon was also a placefor mutual respect and exchange of information about non-alcoholic beverages and tips for making liver rest days while
talking and drinking tea. Stories of experiences during the disaster were also occasionally shared.
Three years after the start of the salon, 10 out of 13 members continued alcohol sobriety, and two were able to continue
alcohol abstinence. The average number of drinks among drinkers was 6.6 in July 2016, which decreased to 4.1 drinks inNovember 2019. The average AUDIT (*2) score decreased from 12.5 to 9.6 points during this time.
－ 39 －− 5 −Changes in average number of drinks (for all members)

Averagenumber ofdrinks

Changes in average number of drinks and number of liver rest days

Liver restdays/month
Nov
2016
Average numberof liver rest days
Average numberof drinks

Feb
2017

May
2017

Aug2017

Nov
2017

Feb
2018

May
2018

Aug2018

Nov
2018

Feb
2019

May
2019

Aug2019

Nov
2019

Dec
2019

6

56

4.3

5.6

5.3

4.5

6

4.6

5.3

3

2.6

5.6

3.4

6.6

5.8

5.52

5.6

5.1

5.14

5.47

4.306

3.938

4.5

4.26

4.37

4.12

4.442

Participant A’s course of sobriety is summarized below.
Mr. A was living a stressful life owing to the big changes in his family and lifestyle after the disaster. He had diabetes
and had been taking medication for many years, and alcohol consumption appeared to be one of his stress relievers. He
began to participate in salons with new friends met in the neighborhood of their temporary housing. He realized thatmoderation would improve his physical condition, and he acquired a healthy drinking habit.
Course of sobriety of Mr. A (man in his 70s who was receiving diabetes treatment)
June 2017 AUDIT 13 points
Average number of drinks 6.6

Startinggoals(1) Liver rest day once a week(2) Cut volume in half when wanting another drink (1.8 drinks less)“Feeling in good shape” “Food tastes good”

Number of liver rest days and average number of drinks“Head feels clear the day after a liver rest day”

December 2018 AUDIT 7 points
Average number of drinks 4.7

Changegoals(1) Continue liver rest day oncea week(2) Around four drinks a day

Average number of drinks 4.7(1) Liver rest day once a week(2) Around four drinks a day“Learned that diabetes is a curable illness”

DecemberNovemberMay

AugustNovemberMay

AugustNovemberMay

Liver rest days

February 2019

Goal
“maintainstatus quo”

February 2018

September 2020

AugustHbA1c and blood glucose levels improved and no longer needto take medication for diabetes

February 2017

November 2016

“Body has changed, get drunk faster”

Average number of drinks

・Number of drinks is kept at four drinks
・Began to pay more attention to food eaten

The “salons (meetings for sobriety)” that were held from December 2016 to 2020 had high average participation rates,and participants continued to reduce alcohol consumption at their own pace. In 2020, with the end of salon managementby the Division, the momentum for voluntary grouping increased and preparations began, but this was not achieved owing
to the COVID-19 pandemic.
4. Development of sobriety support
The Division, which was convinced of the effectiveness of sobriety support following its experience at the “salons(meetings for sobriety),” subsequently proceeded with raising public awareness for sobriety support. The implemented
support contents are shown below.
*2 AUDIT: Screening test for drinking habits created mainly by the WHO. Targets for reduced alcohol consumption
are those who score 10–19 points (in the absence of disease).
(1) Implementation of basic training: We implemented training for supporters and general residents. We repeatedly
hosted basic training of “Sobriety support in 10 minutes!’ training by Takahiro Fukuda, formerly at the Hizen
Psychiatric Center,” which builds on the HAPPY program but is simpler and easier to use in daily health care.
(2) Implementation of transfer training: Division staff conducted transfer training in multiple cities and towns forsupporters who were unable to participate in basic training despite wishing to do so.
(3) Implementation of follow-up training: Follow-up training was held for supporters who had taken the basic training in(1). We aimed to provide a forum where supporters working on sobriety support could share information while
confirming the key aspects of support, and where supporters who wanted to start such efforts in the future could getpointers.
(4) Accompanied visits: We conducted visits with the municipal public health nurse and implemented individual sobriety
support.

－ 40 －− 6 −(5) Implementation of demonstrations: We conducted individual demonstrations of sobriety support upon request andpracticed and examined actual interview scenes with support staff.
(6) Support for the creation of checklists and public awareness materials: We cooperated in the creation of checklists,drink conversion tables, etc., that matched the situation of the municipality so that the AUDIT is easy to use, andsupporters can smoothly calculate drinks. Additionally, we created fliers for raising awareness on sobriety according
to the circumstances of the requesting municipality so that the fliers can be used when supporting people at high risk
according to the drinking items in the disaster victim health survey. We also cooperated in efforts to support thereduction of alcohol consumption.
From the outset, we were also conscious of co-sponsoring the workshops with the Mental Health and Welfare Centerand public health centers so that it would be easier to raise public awareness throughout the prefecture. Since then, bothhave held training sessions for supporters throughout the prefecture.
5. Discussion
The sobriety support at the salons yielded the result of 10 out of 13 participants continuing sobriety three years after
starting the events. Factors that are thought to have affected this include limiting the target audience to those with a low
degree of alcohol dependence and those with a desire to cut down on alcohol consumption, participants being able to
make friends while having fun at the salons as well as “empathize” and “work hard and encourage each other,” andsupporters being able to work more easily as a result of using a packaged sobriety program. Furthermore, the fact that thethree organizations were able to jointly manage the events—with the health center providing the venue and referring theindividuals, the public health center implementing the HAPPY program, and the Division serving the role ofmiscellaneous secretariat—may have been another factor for the effective provision of sobriety support by the local salons.
Initially, we had the impression that alcohol problems were increasing (after the earthquake) based on the increase in
the number of consultations. However, there were subsequently many consultations from supporters who had trouble
dealing with alcohol problems, and it was not uncommon for supporters to have little experience in dealing with alcoholproblems. We first focused on addiction support, shifted to sobriety support, and then began to work on alcohol problems
that centered on support for supporters. We were able to hold sobriety support training sessions in various regions within
the prefecture by cooperating with public health centers and the Mental Health and Welfare Center, and we also provided
support per the request and situation of the municipalities while imagining that the supporters could seize opportunities
in their normal work duties and intervene at an early stage.
Most post-disaster alcohol use disorder cases are known to have had drinking problems before the disaster. In otherwords, interventions for alcohol-related problems during normal times are the best prevention for alcohol-relatedproblems after a disaster. In the future, we would like to continue to provide the support that meets the requests of theprefecture and municipalities in an effort to continue to provide support for alcohol-related problems, particularly in thehope that our new initiative of sobriety support will become widely established as an essential component of daily healthsupport.
This paper includes additions to what was presented at the 56rd Japanese Alcohol, Nicotine & Drug Addiction
Conference on December 18, 2021.
6. References
Matsushita, S., Kimura, M., Maesato, H., et al. (2017). “Alcohol-related problems in the areas affected by the Great
East Japan Earthquake,” Journal of the Japanese Society of Alcohol-Related Problems, Vol. 19, No. 2, pp. 19–24.

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