{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T22:25:41Z","timestamp":1790202341323,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alcohol, Clinical and Experimental Research"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Relapse after inpatient treatment for alcohol dependence is a major barrier to recovery. This study evaluated one\u2010year drinking outcomes and their associations with self\u2010help group participation, nonalcoholic beer use, smoking after discharge, and other prognostic factors among Japanese men treated for alcohol dependence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective 12\u2010month follow\u2010up of 198 male patients who completed a three\u2010month inpatient program in 2014. Drinking status, self\u2010help participation, nonalcoholic beer consumption, and smoking after discharge were assessed by mailed questionnaires. Time to first drink, heavy\u2010drinking lapse, and sustained relapse were analyzed using Kaplan\u2013Meier estimates and multivariate Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One\u2010year abstinence was higher among self\u2010help participants (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200951) than nonparticipants (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009147) (52.7% vs. 36.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019) and higher among nonusers (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009143) than users of nonalcoholic beer (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200955) (51.2% vs. 15.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). In multivariate models, self\u2010help participation reduced the risk of a drinking lapse (HR 0.51, 95% CI 0.31\u20130.82) and use of nonalcoholic beer increased the risk (HR 2.30, 95% CI 1.54\u20133.44). Smoking within one month after discharge, a family history of heavy or problem drinking, and use of psychiatric medication at discharge were also associated with higher hazards. Sensitivity analyses treating dropouts as lapses did not change the results. Heavy\u2010drinking\u2010free rates and sustained\u2010relapse\u2010free rates followed similar patterns. A dose\u2013response pattern emerged: Having all three modifiable protective behaviors (self\u2010help participation, no nonalcoholic beer, and nonsmoking) offered the strongest protection against lapse and relapse [drinking lapse HR 0.18 (95% CI 0.06\u20130.50); heavy\u2010drinking lapse HR 0.13 (95% CI 0.04\u20130.48); sustained relapse HR 0.14 (95% CI 0.04\u20130.48)], two factors showed intermediate protection, and a single factor alone was not significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Strengthening self\u2010help participation and smoking cessation support at discharge is recommended, and caution is warranted regarding nonalcoholic beer as a potential jeopardy to abstinence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acer.70227","type":"journal-article","created":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T15:00:46Z","timestamp":1769958046000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Self\u2010help group participation, avoidance of nonalcoholic beer, and nonsmoking independently predict better drinking outcomes in Japanese alcohol\u2010dependent men"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1869-1359","authenticated-orcid":false,"given":"Akira","family":"Yokoyama","sequence":"first","affiliation":[{"name":"National Hospital Organization Kurihama Medical and Addiction Center  Yokosuka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Kimura","sequence":"additional","affiliation":[{"name":"National Hospital Organization Kurihama Medical and Addiction Center  Yokosuka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1995-8190","authenticated-orcid":false,"given":"Atsushi","family":"Yoshimura","sequence":"additional","affiliation":[{"name":"Division of Psychiatry Tohoku Medical and Pharmaceutical University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Yoneda","sequence":"additional","affiliation":[{"name":"National Hospital Organization Kurihama Medical and Addiction Center  Yokosuka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Maesato","sequence":"additional","affiliation":[{"name":"Department of Psychiatry National Hospital Organization Ryukyu Hospital  Kunigami Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunobu","family":"Komoto","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Yoshino Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Asahiyama Hospital  Sapporo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Sakuma","sequence":"additional","affiliation":[{"name":"Department of Psychiatry National Hospital Organization Saigata Medical Center  Joetsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Yumoto","sequence":"additional","affiliation":[{"name":"National Hospital Organization Kurihama Medical and Addiction Center  Yokosuka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Takimura","sequence":"additional","affiliation":[{"name":"National Hospital Organization Kurihama Medical and Addiction Center  Yokosuka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomomi","family":"Toyama","sequence":"additional","affiliation":[{"name":"National Hospital Organization Kurihama Medical and Addiction Center  Yokosuka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Mizukami","sequence":"additional","affiliation":[{"name":"National Hospital Organization Kurihama Medical and Addiction Center  Yokosuka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuji","family":"Yokoyama","sequence":"additional","affiliation":[{"name":"Department of Health Promotion National Institute of Public Health  Wako Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susumu","family":"Higuchi","sequence":"additional","affiliation":[{"name":"National Hospital Organization Kurihama Medical and Addiction Center  Yokosuka 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