RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA – BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE
AND ADDRESS / Ms. SUNANDA. CH
1st YEAR M.Sc., (NURSING)
HARSHA COLLEGE OF NURSING,
NH-4, SONDEKOPPA CIRCLE,
NELAMANGALA - 562 123.
BANGALORE.
2 / NAME OF THE INSTITUTION / HARSHA COLLEGE OF NURSING
3 / COURSE OF STUDY AND SUBJECT / 1st YEAR M.Sc., (NURSING)
COMMUNITY HEALTH NURSING
DEPARTMENT
4 / DATE OF ADMISSION / 6th June 2009.
5 / TITLE OF THE TOPIC :
A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE REGARDING MANAGEMENT OF ALCOHOL RELATED PROBLEMS AMONG FAMILY MEMBERS OF ALCOHOLICS IN SELECTED RURAL COMMUNITY AT BANGALORE.

6. BRIEF RESUME OF THE INTENDED WORK:

6.1. INTRODUCTION:

"Drink takes the drunkard first out of the society, then out of the world".

(Seneca T.Younger, 2004)

Alcohol abuse is the root cause of all evils in the society. Alcohol problems vary in the severity from mild to life threatening it will affect the individual, family and society in numerous adverse ways. The pattern of alcohol intake around the world in constantly evolving and alcohol is omnipresent today. Research has contributed substantially to our understanding of the relation between drinking and specific disorders, and has shown the relation between alcohol consumption and health outcomes is complex and dimensional. (1)

There is a strong justification for health professional to step up its health advocacy with respect to policies to reduce rate of alcohol consumption. Therefore researcher’s clinicians and public health officials attempting to develop affective preventives and treatment approaches must consider the population attitudes and expectations regarding alcohol consumption and its affects. (2)

Alcohol has been in common use since before records began. From the earliest time to the present, alcohol has played many crucial roles likes thirst quencher for enhancing enjoyment and the quality of life. Alcohol is used as a social lubricant and relaxation facilitator, which provides pharmacological pleasure but when the same alcohol is misused, it turns into an evil, which is sufficiently inflammable to burn the families, society and country. For most of the people, drinking alcohol is nothing more than a pleasant way to relax. Once the person starts drinking alcohol he gets addicted to

it, which makes him to repeat the activity to feel the same pleasure. The addiction can be physical, psychological or neurochemical. (3)

Families of alcoholics are more disturbed in all areas of their family environment and family burden when compared to non-alcoholic families. The consequences of alcoholism in the family are role rearrangements or role transfer. The wives of the alcoholic husbands have to take over the family responsibilities and in some; young children are the victims. (4)

Alcoholism is the family problem and the most devastating impact occurs when the abuser is a parent. It affects the family members with the same intensity with which it affects the dependant person. The effects of alcoholism on the family are emotional symptoms like shame, anger, rage, low self-worth, stunted emotional development, irresponsibility as well as over responsibility, suppressed feelings, and dishonesty. Relational symptoms include things like intimacy issues, manipulation, codependency, domestic violence, sexual issues, lack of trust, and difficulty communicating. (5)

Children who are born without birth defects and live with a father and/or mother who is an alcohol abuser or addict experience severe effects like Low self-esteem, Feelings of guilt and despair, Loneliness and fear of abandonment , Chronic depression , High levels of anxiety and stress. Once children become adults, the effects of alcoholism on families continue to impact their lives. They experience difficulties trusting others and have relationship issues. Depression is common, as is anxiety, aggression and impulsive behaviour. Adult children of alcoholics continue having a negative self-image, which causes them to make poor choices and accumulate failures in their work, social and family lives. (6).

Alcoholism has a transforming effect on the spouse or partner that can create significant mental trauma and physical health problems. Divorce rates among couples where one or both partner’s drinks are much higher than average. As alcohol abuse or addiction progresses, the non-drinking spouse often grows into a compulsive care-taking role, which creates feelings of resentment, self-pity and exhaustion. The marriage suffers from: Poor spousal communication, increased anger and distress, reduced intimacy and sexual desire, increased marital abuse, depleting finances spent on alcohol. (7)

The effects of alcoholism in families are difficult to overcome; yet without treatment, they can be devastating for the long-term. With the right approach and support, positive steps can be taken to improve lives. (8)

6.2. NEED FOR THE STUDY:

Alcoholism is one of the leading causes of a dysfunctional family. As of 2001, there were an estimated 26.8 million children of alcoholics (COAs) in the United States, with as many as 11 million of them under than age of 18. Children of addicts have an increased suicide rate and on average have total health care costs 32 percent greater than children of nonalcoholic families. (9)

A study was estimates that there are about two billion people world wide who consume alcoholic beverages and 76.3 million with diagnosable alcohol use disorders. Alcohol causes 1.8 million deaths (3.2% of total) and a loss of 58.3 million (4% total) of Disabled Adjusted Life Years (DALYs). Exposure was higher among women (46.2 percent) than among men (38.9 percent) and declined with age. Exposure to alcoholism in the family was strongly related to marital status, independent of age: 55.5 percent of separated or divorced adults had been exposed to alcoholism in some family member, compared with 43.5 percent of married, 38.5 percent of never married, and 35.5 percent of widowed persons. Nearly 38 percent of separated or divorced women had been married to an alcoholic, but only about 12 percent of currently married women were married to an alcoholic. (10)

World Bank Report states that in India alcoholism and drug dependence account for 25.7% of the DALYs in men and 6.5% in women. Many studies conducted in India report that the use of alcohol among men varies from 16.7% to 58.3% with the average 60% male being abstinent and all female abstinent. India occupies the 150th position among the 184 countries when it comes to alcohol consumption. That may not look so bad but the fact is that more and more people especially the youngsters of both the sexes are taking to alcohol these days. (11)

The present epidemiological survey was conducted to estimate the pattern of alcohol and other substance dependence in rural and slum dwellers population

of Chandigarh. In this survey 6.88% individuals of the total population surveyed (2992) fulfilled dependence criteria. Alcohol was the primary substance of dependence for majority of urban slum substance users and rural areas users. Age at first drug use was 20.89 ± 5.31 years (mean ± S.D) among rural population and 19.75 ± 5.4 years (mean ± SD) in urban slums. Majority of them reported having health related complications (85.71%) followed by family problems (77.31%) due to drug dependence. This survey reflects the need to intensify efforts at the community level to reach the unreached. (12)

Around 15 to 20 per cent of Indians consume alcohol and over the past twenty years, the number of drinkers has increased considerably. According to a survey done by the Hindustan Times, an estimated 5 per cent of Indians can be classified as alcoholics which projects that at least five million people in India are addicted to alcohol. Some data from India are Alcohol used by 50 to 75% of all adult male and about 5% of all adult females. However alcohol dependence is less than 2% of the population .(13)

A study on prevalence of alcohol use in Karnataka shows 15% of

all the adults sampled over 5 districts in Karnataka reported any alcohol use over the past

12 months. Prevalence of drinking appears significantly higher in rural areas compared to

urban areas, with (61% vs. 39%) or without (52% vs. 48%) the inclusion of the tribal

sample in the rural sector. Tribal areas had the highest prevalence of alcohol use in both

men and women.(14)

A study was conducted on Alcohol and Injuries, noted that a very high

proportion of the injuries reporting to an emergency department in Bangalore city, were

alcohol related. Almost a fourth of all persons [31% of all males and 4% of all females]

presenting with injuries to the ED had alcohol use prior to the occurrence of their injury.

This is much higher than that reported in international studies where between 10 and 18

percent of injury cases were found to be alcohol-related. (15)

The family members of the chemically dependant person suffer in the background of the sick person. These people are rarely treated as individual who need help. A nurse working with the family where alcohol and drugs are used must become familiar with the dynamics of alcoholism and its impact on the family and the means to assist family members even when the addicted individual refuses help. Hence the family as a unit would have to be assessed to delineate its strength and weakness in order to meet their well being. Therefore this study was aimed to assess the knowledge and attitude regarding management of alcohol related problems among family members of alcoholics. The investigator is interested to carryout this study in the rural area where the family awareness is poor on the management of alcohol related problems.

6.3 REVIEW OF LITERATURE:

Review of literature is a systematic identification, location, scrutiny and summary of written materials that contain information on research problems. It is frequently found as a sub-section of a published research study. Reviews of literature are also published as free standing explorations of a body of knowledge.

The researcher presents the review of related literature which helps to study the problem in depth. It also serves a valuable guide to understand what has been done and what is still unknown and untested.

The review of literature is presented under following aspects:-

Studies related to

Ø Assessment of effects of alcoholism on family relationships.

Ø  Effects of the alcoholism on an individual psychological aspect.

Ø  Alcoholism affects on financial status of the family.

Ø  Effects of alcoholism on social relationships.

Alcohol accounts for 1% to 11% expenditure of overall family budget, greater for families with frequent drinkers. Besides loss in family income, the burden on the family is worsened when the drinker falls ill, cannot work and requires medical attention.

A study was conducted to describe partner-related and other psychosocial risk factors for common mental disorders in women and examine interrelationships between these factors. Data are reported on 821 women aged 18–49 years from a larger population study in north Goa, India. Logistic regression models evaluated the risks for women’s common mental disorders and tested for mediation effects in the relationship between partner alcohol use and these disorders. The result is excessive partner alcohol use increased the risk for common mental disorders two- to threefold. Partner violence

and alcohol-related problems each partially mediated the association between partner excessive alcohol use and these mental disorders. (16)

The study conducted on the effects of physical and verbal aggression, depression, and anxiety on drinking behavior of married partners: a prospective and retrospective longitudinal examination. In an ethnically diverse sample of 195 married couples, conducted a latent factor growth analysis to investigate the longitudinal link (4 time points over 4 1/2 years) between marital aggression (physical and verbal aggression self- and partner-reports) and individual internalizing symptoms (depression and anxiety) as they relate to trajectories of alcohol use among husbands and wives. Alcohol use was operationalized as a latent factor with self- and partner reports of problem drinking as measured by the Michigan Alcoholism Screening Test and the Alcohol Dependence Scale. Verbal aggression by husbands or wives, by itself, has no effect on their alcohol use over time. (17)

A cross sectional study was conducted on Harmful alcohol use in Goa, India, and its associations with violence. In this cross-sectional study of ten general practices in Goa, India is considered. A total of 1567 general practice attendees were recruited. A total of 338 men (41%) and 597 women (81%) reported that they never consumed alcohol. One hundred and twenty-eight people or 8.2% scored >or=8 on the AUDIT [123 (15%) men and five (0.7%) women] and were classified as harmful or dependent drinkers. The population attributable fraction of harmful drinking in the perpetration of any physical violence by men over 12 months was 0.36. The population attributable fraction of moderate drinking (vs. abstention) in the perpetration of any physical violence by women over 12 months was 0.27. Doctors identified almost 60% of problem drinkers but misidentified approximately 5% of moderate drinkers as problem drinkers. (18)

A study was conducted to identify risk factors for physical intimate partner violence against women in Chile, India, Egypt and the Philippines. Population-based household survey. Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum and Vellore in India and Metro Manila, Philippines. Women aged 15-49 years of age who care for at least one child younger than 18 years of age. The number of participants was 442 in Chile, 631 in Egypt, 506 in Lucknow, 700 in Trivandrum, 716 in Vellore and 1000 in the Philippines. Risk of and protective factors

against lifetime physical IPV. Significant associations were found between several risk factors like regular alcohol consumption of the husband/partner, past witnessing of father beating mother, the woman's poor mental health and poor family work status, with any lifetime physical IPV. (19)

An explorative quantitatively study on whether alcohol consumption behavior spreads from person to person in a large social network of friends, coworkers, siblings, spouses, and neighbors, followed for 32 years. 12,067 persons assessed at several time points between 1971 and 2003. Self-reported alcohol consumption (number of drinks per week on average over the past year and number of days drinking within the past week) and social network ties, measured at each time point. Clusters of drinkers and abstainers were present in the network at all time points, and the clusters extended to 3 degrees of separation. These clusters were not only due to selective formation of social ties among drinkers but also seem to reflect interpersonal influence. (20)