A Study to Evaluate the Effectiveness of Structured Teaching

DISSERTATION PROPOSAL

A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME REGARDING ALCOHOLISM AMONG THE MALES

BETWEEN 20 TO 50 YEARS RESIDING AT SULIBELI VILLAGE,

BANGLORE.

SUBMITTED BY

MR.TIRUMALESH.M

1ST YEAR M.SC NURSING

PSYCHIATRY NURSING

SMT.LAKSHMIDEVI COLLEGE OF NURSING

BANGALORE (RURAL)

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE KARNATAKA

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE

KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECT FORDISSERTATION

ANNEXURE -II

1 / NAME OF CNADIDATE AND ADDRESS / MR.TIRUMALESH.M
1ST YEAR M.SC NURSING.
MEDICAL SURGICAL NURSING.
SMT. LAKSMI DEVI COLLEGE OF NURSING.
2 / NAME OF THE INSTITUTE / SMT. LAKSHMIDEVI COLLEGE OF NURSING
3 / COURSE OF STUDY AND SUBJECT / I YEAR M.sc (NURSING)
PSYCHIATRY
4 / DATE OF ADMISSION
5 / TITLE OF TOPIC / “A STUDY TO EVTALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING ALCOHOLISM AMONG THE MALES BETWEEN 20 TO 50 YEARS RESIDING AT SULIBELI VILLAGE,BANGLORE.”

BRIEF RESUME OF INTENDED WORK

6.INTRODUCTION

“Nobody can go back and start anew beginning,

butany one can start today and make a new ending”.

Castellsague

Many societies accept the use of ethyl alcohol as psychotropic drug for adults’ .It also played an important role in the development of human civilization for last many centuries. It has been used as medicine in religious ceremonies and as a drink to enhance the social interactions. Alcohol consists of a carbon, hydrogen and oxygen .For stronger effect distillation is required. The patterns of consumption differ like, starts with social drinking only evenings and night. Individual drinking habits will differ based on the need, when get tensed, when alone, increase the frequency & increased the quality because of tolerance. 1

According to National Institution on Alcohol Abuse and Alcoholism 2006. The Alcoholism, Excessive habitual consumption of alcoholic beverages despite physical, mental, social, or economic harm. (eg cirrhosis, drunk driving and accidents, family strive, frequently missing work.) 2

Alcoholism is usually considered an addiction and a disease. The causes are unclear, but there may be a genetic predisposition. It is more common in men, but women are more likely to hide it .3

Incidence 50 of cirrhotic patients, up to 90 % of who have a history of alcoholism. Biliary cirrhosis (15% to 20% Of patients) results from injury or prolonged obstruction. The suicide rates are 52% of people are getting due to alcoholismAmong alcoholics, mortality is 2.5 Times the expected. In the United States, active alcoholics account for as many as 25 of the patient. delirium tremens can last from 3 to 10 days, ranging from to 5to 20%. Fatty liver is present in only 3% of the general population. Alcoholism are 2- to fold increases in driving and sexual offenses, petty crime, child and spousal abuse, and divorce. Homicides, homelessness, and chronic unemployment are several times more common among than non alcoholics.4

India is one of the fastest growing youth population in the world with an estimated 320 Million are adults among 1200 Crudes population. According to NIAAA estimated the prevalence of alcoholism among adults estimated 15.1 million people: are alcohol abuses. or alcohol dependents. Nearly 14 million Americans are alcoholic abuse. Based on National Institution on Alcohol Abuse and Adult,30% of people with psychotic disorder also had a medical history of alcohol abuse or alcohol dependency in Australia (Australia’s health 2004).5Death from alcoholism:

•1. 19,171 Persons died of alcohol induced causes in 1999 USA

•2. 100,000 deaths each year in the US (Mayo clinic)

•3. 19,817 Alcohol induced deaths, excluding accidents and homicides, each year in the US 2001 More than 15% of American adults have a problem with alcohol use, and about 5% to 10% Of male and 3 %to 5% of female drinkers are alcohol dependent, accounting for about 12.5 million people.6

Alcohol related disorder cuts across all social and economic groups, involves both sexes, and occurs at all stages of the life cycle, beginning as early elementary school.7

There is no known cause of alcohol abuse or alcoholism. Other people who may likely to abuse alcohol or become dependent include those who are under peer pressure, especially teens and college aged students. Have depression, bipolar disorder, anxiety disorders or schizophrenia, have easy access to alcohol have low self esteem or problems with relationship.8

The prevalence of alcohol intake and related problems is rising. Data indicate that about 15% of people in the united states are problem drinkers, and about 5% to 10% of male drinkers and 3% to 5% of female drinkers could be diagnosed as alcohol dependent symptoms of alcohol abuse signs of physical dependence include alcohol related physical illness like alcoholic liver disease. Cirrhosis of liver and alcohol withdrawal symptoms when alcohol use is stopped. Memory lapses blackouts after heavy drinking, some of the symptoms and behaviors of alcohol include continuing to drink, even when health, work or family are being harmed, drinking alone episodes of violence which drinking, lack of control over drinking missing work or school, or a decrease in performance neglecting to eat not caring for physical appearance secretive behavior to hide alcohol use shaking in the morning.9

Intervention in the past, treatment providers believed that alcoholics should be confronted about their drinking problems. Now research has shown that compassion and empathy are more effective. The ideal approach is to help people realize how much their alcohol use is harming their life and the lives of those around them. long term recovery after detoxification alcohol recovery or rehabilitation programs can help people stay off alcohol .These programme usually after counselling ,mental health support ,nursing ,and medical care therapy involves education about alcoholism and its effects. Cognitive behavioral therapy (CBT) uses a structured teaching approach and may help people with alcoholism. Patients are given instruction and home work assignments to improve their ability to cope with basic living situations, control their behavior, and change the way they think about drinking.10

Medications are sometimes prescribed to prevent relapses. They are often used along with cognitive – behavioral therapy or an ongoing recovery programmeAcamprosate is a drug that has been to lower relapse rates in those who are alcohol dependentDisulfiram (Antabuse) produces very unpleasant side effects if you drink small amount of alcohol within 2 weeks after taking the drug.Naltrexone (Visitor) decreases alcohol cravings. It is available in an injectable form11.

Alcoholics Anonymous is a self–help group of recovering that offers emotional support and a model of abstinence for people recovering from alcohol dependence. Learn that it is possible to participate in social functions without drinking12.

Alcoholism can also affect those around the person with the alcohol problem, family members often need counseling. Expectations (prognosis) only 15% of people with alcohol dependence seek treatment for this disease. Drinking again after treatment is common, so it is important to maintain support systems in order to cope with any slips and ensure that they don’t turn into complete reversals.13

The National institute on alcohol abuse 2004 and alcoholism recommends that women have no more than I drink per day and men than 2 drinks per day. One drink defined as a 12 – ounce bottle of beer, a 5ounce glass of wine, or a 1 ½-ounce shot of liquor.14

NEED FOR THE STUDY:

. The Alcohol use is related to wide range of physical, mental, and social harms Most health professionals agree that alcohol affect practically every organ in the human body. Alcohol consumption was linked to more than 60 disease conditions in a series of recent meta-analyse.15

According toresearch done by the National Institute on Alcohol abuse and Alcoholism. Adolescents who begin drinking before age 15 are four times more likely to develop alcohol dependence than those who begin drinking at age 21 years. In addition, drinking at an early age can also be associated with alcohol related violence, not only among persons under the age of 21 but amon1g adults as well.16The purpose of the study was to assess the age of onset to begin drinking in relation to family history of alcoholism using survival analysis, and to examine the importance of selected risk factor in predicting out come.17

A study was conducted on 52 children of low risk families for developing alcoholism and 73 children from high risk families with the ages of 7 to 18 years old and evaluated annually to provide 2.1 waves of longitudinal data concerning ages of onset along with a number of predictors children of alcoholics are typically considered to be at greater risk for developing alcohol problems due to the presence of alcoholism in one or more members of their unclear or extended family.18

The biochemical effect of alcohol may influence chronic disease either in beneficial way (e.g. protection against blood clot formation of moderate consumption) which isprotective for coronary heart disease or harmful way (eg toxic effect on acinon cells triggering pancreatic damage.19

The database will be helpful for the organization to record the incidence of alcoholism worldwide. In fact, there are approximately 18 Million alcoholics in Maraca. In 1995, the estimated annual cost of alcohol abuse in the United States was $ 166.5 billion, where alcohol use disorders cost $56.7 billion more than the estimated annual economic cost of illegal drug use and $ 36.5 billion.20

Alcohol dependence is powerful mechanism sustain alcohol consumption and consequences of alcoholism, thought it is also a consequence of drinking it self.21

It has been reported that the three leading cause of death for 15 to 24 year old are auto mobile crashes, homicides and suicides, and alcohol is a leading factor in all three.22

Moreover, alcohol use among adolescents has been associated with considering ,planning , attempting , and completing suicide whether drinking causes suicide behavior , only that the two behaviors are correlated. Suicide is also related ton depression and anxiety, for these behavior some show trigger alcoholics to suicide. In addition, these behaviors can also become severe with the influence of alcohol.23

Estimated 15.1 million alcohol abusing or alcohol dependent individuals and 4.6 millions are women nearly 14 million. After deaddiction, alcohol recovery or rehabilitation programs can help people stay off alcohol.24

There is a need to improve the strategies and quality of life by preventing alcoholism in health care system. At present, most alcohol de addiction services are available at tertiary care hospitals. There is need to enhance deaddiction service at primary and secondary level services also.There is a need to set up alcohol deaddiction ward to full fill the needs of the population. At tertiary level a multi disciplinary and specially trained team is needed.25

Nursing persons are having responsibility of take care of all preventive aspects of illness of individuals, family and community so it is important for the nurse to take care adults in community. During clinical experience, the investigator come across many adult males experiencing liver failure, alcohol intoxication , gastritis and psycho, social & economical health status and also detoriation in their quality of life.28

In view of above the investigator want to assess the knowledge regarding alcoholism, hazards, clinical manifestations, prevention and treatment modalities ,rehabilitative services of adult through the structured teaching programme among males .The main intention of investigator is to help or make males to lead quality of life with their own dependency. 29

6.2 REVIEW OF LITERATURE

A review of literature on the research topic makes the researcher familiar with the existing studies and provides information, which helps to focus on a particular problem lay a foundation up on which to base new knowledge. it creates accurate picture of the information found on the found on subject.30

A study was conducted on “High school drinking mediates the relationship between parental monitoring and college drinking a longitudinal analysis” This studyexamined whether parental monitoring indirectly exerts a protective effect college drinking by reducing high school alcohol consumption The researcher used method longitudinal cohort study on 1,253 males and females students, ages 17 to19, attending a large ,public ,mid Atlantic university was studied at two time points. Multiple regression models tested the relationship between parental monitoring and past year alcohol use(i ,e, number of drinks per drinking day).The resultsthat holding constant demographic sat score and religiosity ,parental monitoring had a significant protective effect on both high school and college drinking level. However, the association between parental monitoring and college drinking level became non significant once high school drinking level was held constant. Families with alcohol and drug problems usually have high level of stress: high stress family environments are a risk factor for children early and dangerous substance use, as well as mental and physical health problems. Children of parents who misuse alcohol and other and drugs have a diminished capacity for school success and adequate social development. 31

A studywas conductedon “Genetic and Pharmacogenetic aspects of alcohol dependence” .The objectiveof study is alcohol dependence is frequent and complex disorder involving both genetic ( h2 = 0.5 ) and environmental factors. Shared liability has been detected with other addictive disorders (mainly nicotine dependence),and certain psychiatric disorder ( such as bipolar disorder) and or personality disorders( specifically antisocial personality). Investigats that genome wide scans, analyses of alcohol metobolism and reward circuits have identified many candidate genes or locations. some genes linked to the reward pathway of alcohol, may have pharmacogenetic relevancy, such as the GABRA 6 gene (regarding the role of benzodiaxepine in alcohol withdrawal),SLC 6A4 gene (as serotonin reuptake inhibitors may reduce alcohol intake in subgroups of patients),CB1Gene (because the cb1 Agonists modify alcohol consumption ,at least in rodents),and the OPRM 1 gene (the 118G allele being associated with increased chances of Naltrexone efficacy). High throughput approach for genotyping of polymorphism, Transcriptomics are useful tools that will help to identify susceptibility and protection genes for alcohol diseases. Together, these tools could be used to develop a rational pharmacogenetics strategy to test specific individual treatment for alcohol dependence.32

.A studywas conducted on “Expectancies using functional magnetic resonance imaging with adolescents”. The main objective of the study is personality and alcohol expectancies have been examined as risk .factors for the initiation and maintenance of alcohol use in adolescents and young adults .Differences in processing appetitive stimuli are seen as a mechanism for personality influence on behaviorand that mechanism predisposes individuals to form more positive expectancies for alcohol. The go /no - go task .gds been used to show how personality differences influence responding to appetitive stimuli in adolescents and adults. And functional Magnetic Resonance Imaging has been used to examine the relation of go /no -go responding to personality in adult males. Researcher used that 46 adolescents (aged 12- 14yrs: 61%: ) with minimal substance use histories completed measures of Neuroticism. Extraversion, and alcohol expectancies, and performed a go/ no -go task during MRI acquisition. Resultsthat greater blood oxygen level dependent (BOLD) response to inhibition predicted fewer expectancies of cognitive and motor improvements but more expectancies of cognitive and motor impairment from alcohol. In addition extraverted youths reported more positive alcohol expectancies . However , BOLD response did not predict neuroticism or extraversion.33.

A study was conductedon “Environmental influences on young adult drinking”. The objective of the study that policy measures intended to control alcohol use and related problems have seldom been specifically targeted toward the entire group of young people between the ages of 18 and 25. Researcher used cross sectional method. Research evaluating these policies also tends not to focus on the 18- 25 age group but, rather, on 18-to - 20 Year olds or the adult population as a whole. Further more, the results of the study that, some studies of alcohol control policies are cross sectional and thus can offer only tentative information about the causes of results observed. Despite theselimitations, the current literature does offer evidence for the effectiveness of particular alcohol control measures deserving of trails and further study among young adults. These measures affect the availability of alcohol, social messages about alcohol, and enforcement of current laws.34

A study wasconducted on “Alcohol Use and Violence Among Young Adults” Approximately 40 percent of people experiencing violence are young adults ages 18 to 30; this translates into a greater risk for violence in this age group than in any other segment of the population (Perkins 1997). (Only 50 percent of these violent crimes are reported to the police, however [see Hart and Rennison 2003].) Leonard and colleagues (2002) found that 44 percent of men ages 18 to 30 in a community sample reported having experienced physical aggression, either as the target or initiator of aggression, in the past year. Among women of this age in the same sample, 28 percent reported experiencing some form of physical aggression in the past year. In a separate sample of college students (Leonard et al. 2002), 33 percent of males and 22 percent of females reported experiencing physical aggression in the past year. Two locations—bars and homes—stood out as the most likely settings for violence (Leonard et al. 2002). Men were more likely to be the target of severe violence in bars: 30 percent of the most severe incidents involving men as victims, from both the general population and college samples, occurred in or around a bar. For women, bars were less frequently the scene of severe violent victimization: 22 percent of the most severe episodes reported by women in the general population sample and 23 percent of the most severe episodes reported by women in the college sample occurred in or around a bar. Women were more likely to be targets of severe violence at home (50 percent of the most severe episodes reported by women in the community sample and 63 percent of the most severe episodes reported by women in the college sample occurred in the home). Fewer men reported experiencing their most severe episode of violence at home (16 percent of the most severe episodes reported by men in the community sample and 31 percent of those reported by men in the college sample occurred in the home). 35.