6 BRIEF RESUME OF INTENDED WORK
6.1 INTRODUCTION
“Alcohol causes the drinker to have strange and adulterous thoughts, produces willfulness, and prevents reformation.”
The term anxiety has become a part of our everyday life. The concepts of anxiety may differ according to the individual’s state of contexts and interpretations. It is recognized that certain amount of anxiety is desirable, productive and can facilitates the individuals to grow but when the anxiety exceeds disturb the normal functions.
The word anxiety is derived from the Latin "anxietas" (to choke, throttle, trouble, and upset) and encompasses behavioral, affective and cognitive responses to the perception of danger. Anxiety is a normal human emotion. In moderation, anxiety stimulates an anticipatory and adaptive response to challenging or stressful events. In excess, anxiety destabilizes the individual and dysfunctional state results. Anxiety is considered excessive or pathological when it arises in the absence of challenge or stress, when it is out of proportion to the challenge or stress in duration or severity, when it results in significant distress, and when it results in psychological, social, occupational, biological, and other impairment.(1)
Anxiety is a normal emotion. All human beings develop it as a means of protection from danger and threat when we perceive danger. Human body undergoes a number of autonomic physiological changes such as perspiration, restlessness, discomfort, palpitation and tightness in the chest. Normal level of anxiety may lead to perfume well or improve one’s performance. But when anxiety become excess it is described as an anxiety disorder.(2)
Status of anxiety disorder research from India in relation to epidemiology, phenomenology, course, outcome and management are lacking. Most of the studies have tried to replicate the findings from the West. Despite rapid advancement in the field of psychopharmacology, the researches in the field of anti-anxiety and antidepressant drugs are dismally low from India. Furthermore research is lacking in the areas of non-pharmacological management like relaxation therapies, yoga, other meditation techniques and psychotherapies despite India being the birth place of many such techniques.(1)
Substance use disorders are a major public health problem facing many countries. "The most common substance of abuse/dependence in patients presenting for treatment is alcohol. In the United Kingdom, the number of 'dependent drinkers' was calculated as over 2.8 million in 2001.About 12% of American adults have had an alcohol dependence problem at some time in their life. The World Health Organization estimates that about 140 million people throughout the world suffer from alcohol dependence.(2)
The United Nations Drug Control Programme, UNDCP survey report gives a list of effects of drug and substance abuse. The effects of drug and substance use on the subjects includes, health problems including aches and pain 26.5%, weight loss 29.6%; psychological problems include depression 43%, anxiety 54.7%, sleeplessness 46.9%, neglect of self 22.9%; occupational problem includes, neglect of work 20.1%, neglect of household work 34.6%, absence from work 22.3%; economic problems include loss of income 39.7%, depts. 15.6%, less money available at home 42.5%; Family environment problems include disruption of family routine 43.6%, disturbance of family activity 51.4%; problems related to violence are physical 42.5%; and verbal 49.7 %.
Studies on alcohol abuse among general population in India have indicated that 30% of the males and less than 5% of the females are alcohol users. Studies in northern India found that 1year prevalence of alcohol use to be between 25 and 40%. In southern India the prevalence varies between 33 and 50% with a higher prevalence among the lesser educated and the poor. Survey 2001 in 3 districts (Central, north and North east India) which involved 32000 people reported a prevalence of current alcohol use of 20-38% in males and of 10% among females. Between 15 and 20 per cent of Indian people consume alcohol and, over the past twenty years, the number of drinkers has increased from one in 300 to one in 20. According to The Hindustan Times, it is estimated that of these 5 per cent can be classed as alcoholics or alcohol dependent. This translates into about five million people addicted to alcohol. Studies shows the alcoholic patients had a high level of anxiety. Researches claims that in alcoholics with anxiety disorder the relapse rate is also high.(3)
6.2NEED FOR THE STUDY
Individuals face anxiety on a daily basis. Anxiety, which provides the motivation for achievement, is necessary force for survival. The term ‘anxiety’ is often used interchangeably with the word ‘stress’; however, they are not the same. Stress, or more properly, a stressor, is an external pressure that is brought to bear on the individual. Anxiety is the subjective emotional response to that stressor.(4)
Relaxation has a significant psychological impact. Through relaxation we can improve specific aspects of our personality, strengthening the positive qualities and changing unwanted habits and attitudes. In a state of relaxation various physical phenomenon occurs, which are accompanied by a sense of response and pleasure. These feelings reinforce emotion stability because in a state of relaxation we react calmly and reasonably and adjust more easily to new situations. Our disposition is therefore more stable and we are less given to mood swings.(5)
Researches has shown that if left untreated anxiety disorders may lead to poor scholastic performance, poor social skills and are more vulnerable to substance abuse. The treatment of anxiety disorders will depend on the severity of the problem, psychological forms of treatment, along with drugs are advisable in successfully treating anxiety disorders. Specific strategies used in psychotherapy include graded exposure and relaxation techniques. Anxiety is the main cause which leads to many psychiatric disorder. Anti-anxietic drug affects slowly and have many side effects seen in patients, it is better to provide a simple relaxation technique to reduce the anxiety. Progressive muscle relaxation training will help to reduce the anxiety.(2)
Many members of the public have negative attitudes towards antianxietics. Psychological interventions are more acceptable but require considerable therapist training. Acceptable psychological interventions that require less training and skill are needed to ensure increased uptake of intervention. A potential intervention of this sort is relaxation techniques. Many empirical studies have found progressive muscle relaxation training beneficial in reducing the psychological effects of anxiety. Progressive muscle relaxation training is also effective in reducing the distress symptoms associated with the anxiety. Studies shows a close relationship between anxiety and alcoholism.(7)
Progressive Muscle Relaxation (PMR) is a great technique for reducing overall body tension. As we practice tensing and relaxing all the muscle groups in our body, we can move to a shortened procedure, Deep Muscle Relaxation where we rapidly relax our whole body. As we reduce the tension we carry in our body, our whole being will feel less stress and we will enjoy increased physical and emotional health. The dynamics of relaxation: some skills are used when you are in touch with your internal world, in a state of relaxation.(5)
Psychological effect of relaxation: Relaxation has a significant psychological impact, through relaxation we can improve specific aspects of our personality, strengthening the positive qualities and changing unwanted habits and attitudes. In a state of relaxation, various physical phenomenon occurs which are accompanied by a sense of response and pleasure. These feelings reinforce emotional stability because in a state of relaxation we react calmly and reasonably and adjust more easily to new situations. Our disposition is therefore more stable and we are less given to mood change.(5)
In addition relaxation brings about a positive change in our way of thinking, directing us towards an open approach. The first step towards anxiety management should be aimed at terminating identifiable stimuli. In some cases anti-anxiety drugs or agents may be necessary. Regular relaxing exercises and meditation are helpful in preventing relapse.(8)
So this study is selected to help the patient to reduce their anxiety with a simple relaxation technique without any side effects
6.3REVIEW OF LITERATURE
A study was conducted on the relation between alcohol problems and anxiety disorders shows high co-morbidity rates of alcohol and anxiety problems.(9)
Experimental Analysis of Drinking Patterns of Alcoholics: shows that Contraryto commonly-held impressions concerning alcoholics, most ofthe subjects experienced an increase rather than a decreasein anxiety and depression.(10)
A study was conducted on the Effect of Alcohol on Social Phobic Anxiety shows that current and past drinking habits did not significantly alterthe effect of alcohol on anxiety. The belief that one receivedalcohol was significantly related to levels of subjective anxietyand negative cognitions. Alcohol does not directlyreduce social phobic anxiety. The belief that one received alcoholmay reduce social anxiety. (11)
A study was conducted about alcohol dependence and anxietydisorders: what is the relationship? It shows that the high rates of comorbidity in somestudies likely reflect a mixture oftrue anxiety disorders among alcoholicsat a rate equal to or slightly higher than that for the general population,along with temporary, but at times severe, substance-induced anxietysyndromes.(12)
Study was conducted on a study on psychological assessment of alcoholism in males. The study concludes that alcohol dependent individual show significantly high neuroticism, extroversion, anxiety, depression, stressful life events and significantly low self esteem compared with control group.(13)
A study was conducted on how social anxiety impacts willingness to participate in addiction treatment. The study says that socially anxious substance abusers were 4-8 times more likely to endorse that shyness interfered with addiction treatment activities.(14)
The study was conducted on complaints of insomnia in hospitalized alcoholics shows that the prevalence of chronic insomnia complaints was 56.8% (33/58); anxiety symptoms 65.5% (38/58); depressive symptoms 75.9% (44/58) with variations in distribution by gender. The scale used to assess the anxiety in that study was Zung’s anxiety scale.(15)
The study was conducted on Depression and social phobia secondary to alcohol dependence says that depression and social phobia secondary to ADD are independent conditions that do not completely remit after cessation of drinking. Specific treatments are needed to reduce residual depressive and anxiety symptoms in abstinent alcoholics.(16)
A study was conducted on Sleep, anxiety, and depression in abstinent and drinking alcoholics shows that sleep variables, anxiety, and depression are considered as possible markers of relapse in persons treated for alcoholism.(17)
A study was conducted by Alcohol Research Center, San Diego Veterans Administration Medical Center, California on The history of anxiety symptoms among 171 primary alcoholics. This study used patient and resource person face-to-face interviews to explore the history of anxiety symptoms and syndromes in 171 primary alcoholic male veterans on an alcohol treatment program. Almost all men (98%) reported at least one symptom of anxiety during drinking or withdrawal.(18)
Comorbid anxiety and affective disorder in alcohol-dependent patients seeking treatment: the first Multicentre Study in Germany says that among the patients with comorbidity, affective and anxiety disorders were most frequent. Female patients with anxiety disorder consumed more alcohol and started earlier than females without this comorbid disorder.(19)
A study was conducted on psychosocial problems of alcohol users, the result of the study reveals that the psychosocial problem of the subjects are depression 80%, anxiety 60%, antisocial personality disorder 61.54%, adjustment disorder 43.75%, elated mood 23%; and hostility 30.77%.Similarly in a study conducted about, a high rate of anxiety disorders among youth with substance use disorders were seen. Another study identified Panic disorder among substance use individuals. The researcher revealed in her study that 92% of the studied sample had at least one psychiatric co morbid condition, personality disorders were also found in 21% of the sample, 4% of the sample were found suffering from sexual dysfunction and 2% of the sample were detected as having schizophrenia.(20)
6.4STATEMENT OF PROBLEM
A study to assess the effectiveness of progressive muscle relaxation on anxiety among the patients with alcohol dependence syndrome in selected de-addiction centers at Bangalore.
6.5OBJECTIVES OF THE STUDY
· To assess the level of anxiety in patients with alcoholic dependent syndrome in selected de-addiction centers at Bangalore.
· To assess the effectiveness of progressive muscle relaxation on anxiety on experimental group with alcoholic dependent syndrome from in de-addiction centers at Bangalore.
· To associate the level of anxiety with different demographic variables.
6.6 RESEARCH HYPOTHESES
· H0: There will be no significant change in scores obtained from alcoholic dependent patient with anxiety before and after the administration of progressive muscle relaxation therapy.
· H1: There will be significant change in the scores obtained from alcoholic dependent patient with anxiety before and after the administration of progressive muscle relaxation therapy.
6.7 OPERATIONAL DEFINITION OF TERMS AND VARIABLES .Assess: It means to make a judgement about situation or something.
. In this study assess refers to physiological and psychological responses
of the patient.
· Effectiveness: It means the degree to which something is successful in producing a desired result.
· In this study effect refers to the physiological and psychological responses as experienced by the patient.
· Progressive: It means moving forward, proceeding step by step, cumulative rapid reform, increasing in severity or extent.
· In this study progressive refers to progressing towards total mind and body relaxation.
· Muscle: It means fibrous tissue producing movement in or maintaining position of human body.
· In this study muscle refers to an organ which produces movement of the limbs and body parts in humans by contractions.
· Relaxation: It means become less stiff, rigid, tense or reduce tension.
· In this study relaxation refers to recreation by relieving tension. This is evident by change in physiological and psychological response.
· Anxiety: It means state of feeling nervous or worried that something bad is going to happen.
· Here the study is done on alcohol dependence patients who feels nervous and worries that something bad is going to happen to them.
· Alcohol Dependence Syndrome: It is a group of symptoms that occurs in people who are addicted to alcohol.
· Here study is done on patients who are admitted in de-addiction centers with alcohol dependence syndrome from last two weeks.
· De-addiction Center: It is a center where the alcoholic patients are admitted for treatment and rehabilitation.