J.S.S COLLEGE OF NURSING
1ST MAIN SARASWATHIPURAM, MYSORE
SYNOPSIS SUBMISSION
BY,
Mr. NAGESH V.A.
1ST YEAR M.Sc NURSING
J.S.S COLLEGE OF NURSING
1ST MAIN, SARASWATHIPURAM
MYSORE- 570009
GUIDE:
Dr. N V MUNINARAYANAPPA
PROFESSOR AND VICE PRINCIPAL
J.S.S COLLEGE OF NURSING
1ST MAIN, SARASWATHIPURAM,
MYSORE- 570009
BATCH: 2009-2011
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATEAND ADDRESS
(IN BLOCK LETTERS) / Mr NAGESH V. A.
1ST YEAR MSc NURSING
J.S.S COLLEGE OF NURSING,
1stMAIN, SARASWATHIPURAM
MYSORE – 570009.
2 / NAME OF THE INSTITUTE / J.S.S COLLEGE OF NURSING
MYSORE
3 / COURSE OF THE STUDY
AND SUBJECT / 1ST YEAR MSc NURSING
PSYCHIATRIC NURSING
4 / DATE OF ADMISSION TO THE COURSE / 06.04.2009
5 / TITLE OF THE TOPIC / A STUDY TO ASSESS THE STRESS AND COPING AMONG THE WIVES OF ALCOHOLICS ADMITTED IN SELECTED DE-ADDICTION CENTRES OF MYSORE DISTRICT.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“Mankind has used two powerful weapons to destroy its own powers and enjoyment, Wrong indulgence and wrong abstinence” - Sri Aurobind.
Alcohol is a depressant drug that contains absolutely no nutrients, slows down the activity of the brain and does not help relieve tension, induce sleep or solve problems. All alcoholic beverages contain the same mood-changing agent - ethyl alcohol though in varying percentage. Alcohol needs no digestion and is absorbed rapidly into the blood stream. Cold showers or coffee do not remove the effect of alcohol from the body only the liver can. It takes the liver about one hour to break down one drink of alcohol1. Drinking a small amount is not harmful for most people, but regular drinking of a lot of alcohol can cause health, personal and social problems2.
Alcoholism is one of the major health and social problems all over the world. In India, alcohol has been consumed since the Vedic period of 2000–800 BC and was allowed in Hinduism, particularly among the ruling classes3. Some religions like Buddhism, Jainism, and Islam did not allow their followers to drink. Although alcohol became more freely available in the Indian subcontinent under British rule, Indians did not generally incorporate drinking alcohol into their social or religious activities4.
India is traditionally perceived to be a 'dry' culture, but alcohol use in some form has always existed in the country. The view of alcohol as impure and polluting, that many middle class Indians have been predominantly influenced by Western temperance campaigners in the 19th century. A view which acquired greater popularity during the Nationalist movement - and was shaped into a generally held belief that drinking alcohol was alien to Indian culture5.
When India became independent in 1947, Mahatma Gandhi and the Indian National Congress Party campaigned against liquor production and sales on the grounds that it was injurious to health3. Although, several states enacted prohibition again during the 1990s as a response to pressure from lobby groups concerned about the social and health consequences of consumption, the result has been mixed at best6.
Alcohol is one of the commonly consumed intoxicating substances in India. It has traditionally been drunk in tribal societies, although it has got increasing social acceptance among other groups, urban males being the prime example. It is easily available and widely used, among male family members. 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. Down the centuries, numberless women across the globe have been coping with husbands who come home drunk, wives and children and make everyone’s life miserable. Surprisingly most women timidly adjust to their husbands, ways rather than raising their voices in protest7.
There are many forms of excessive drinking that cause substantial risk or harm to the individual. They include high level drinking each day, repeated episodes of drinking to intoxication, drinking that is actually causing physical or mental harm, and drinking that has resulted in the person becoming dependent or addicted to alcohol. Excessive drinking causes illness and distress to the drinker and his or her family and friends. It is a major cause of breakdown in relationships, trauma, hospitalization, prolonged disability and early death. Alcohol-related problems represent an immense economic loss to many communities around the world8.
It is important to understand the characteristics of the drinker and the relationship between alcohol dependence and its negative consequences that may help to clarify the development and prevention of alcohol related problems. Some people are more likely than others to experience the consequences of alcohol use. These tend to be associated with being male having high perceived stress and anxiety; dissatisfaction and poor quality of life; lack of social support; economic strains and chronic stress9
These are the obvious marital problems alcoholism causes, but there are many other issues that are faced, and must be dealt with, by the women who are the wives of alcoholics. Some women may blame themselves for their husbands' drinking. They may worry they haven't done enough to make their husbands happy, or that something they've done (or didn't do) led to their husbands' drinking. These feelings of guilt may cause wives to feel stressed, anxious, or depressed. Other not too bright people may also blame a wife for her husband's drinking, which feeds into the feelings of guilt she already has10. Historically, been blamed and pathologies for their partner's drinking, although more recent theories have adopted a stress and coping paradigm, thus normalizing individuals and their behaviours11.
6.1 NEED FOR THE STUDY
Alcohol dependence is a common psychiatric disorder in the general population, has a significant impact on public health. In recent years, alcohol dependence has become a major social and personal menace in most societies9.
According to the World Health Organization (WHO), alcohol use disorders accounted for 1.5% of the global disease burden. Globally, alcohol consumption causes 3.5% of deaths (1.8 million) and 4.0% of the disability-adjusted life years lost (58.3 million) 12.
According to United Nations Office on Drug and Crime (UNODC) and Govt. of India report in 2004, 62 million alcoholics were reported in India13. In northern India, alcohol use has been estimated as 25 to 40% in the general population, where as in southern India this rate has been estimated as 30 to 50%. In southern India, the prevalence of alcohol use is higher among people of lower socio-economic status and those who have lower levels of education14. A large-scale survey over 32,000 people performed in 2001 found alcohol use rates of 20 to 38% in males and 10% among females. There is a paucity of literature investigating the relationship between family interactions and alcohol dependence15.
Both pathological and chronic alcohol dependence are directly linked to marked impaired family interactions, and other serious problems like domestic violence and spousal abuse. Chronic alcohol dependence is associated with interpersonal violence and worsening patterns of interaction. Certain behaviors, such as aggression and impulsivity, are common in people with chronic alcoholic dependence9.
The family has increasingly been recognized as an important component in the development, maintenance, and treatment of alcoholism. A study was conducted to examine alcoholism within a family context. Since wives now typically work outside the home, this study focuses on the 60 employed wives. Employment was examined as a source of stress as well as social support. The majority of working wives reported minimal negative impact of their husbands' drinking on all areas of their work functioning, with a small subset indicating impairment attributable to the drinking. These wives were very satisfied with their current positions and described work as a positive experience16.
The second national family survey (1998-1999) results indicate that among the Indian population, 17% of men and 2% of women aged 15 and above are consuming alcohol 17. Addiction is a family problem and is a major source of stress for family members. Family disruption related to alcoholism is a serious, complex and pervasive social problem. Alcoholism is linked to violence, disrupted family roles, and impaired family communication and partly to physical and psychological illness. The consequences of alcoholism all too often result in chaotic, disorganized and dysfunctional families 18. Families of alcoholics experience guilt, stress, coping problem, shame, resentment, insecurity, delinquency, financial troubles, isolation, fear and violence19.
Some researchers viewed stressors as threats that tax or exceed personal resources and defined coping as constantly changing cognitive and behavioral efforts to manage specific external and internal demands20. Some researchers felt that discord, avoidance, indulgence and fearful withdrawal were the commonest coping behaviors and marital breakdown, taking special action, assertion and sexual withdrawal were least coping behaviours21.
Profile of clients in addiction treatment centers in 23 states showed that alcohol was the first or second major drug of abuse in all except one state. Trauma, stress, coping problem, violence, organ system damage, various cancers, unsafe sexual practices, premature death and poor nutritional status of families with heavy drinking fathers are associated with alcohol use. Hazardous drinking was significantly associated with severe health problems such as head injuries and hospitalizations. 15 to 20% of traumatic brain injuries were related to alcohol use. Thirty seven percent of injuries in a public hospital was due to alcohol. Seventeen point six percent of psychiatric emergencies were caused by alcohol Thirty four percent of those who attempted suicide were abusing alcohol1.
Twenty percent of absenteeism and 40% of accidents at work place are related to alcohol. Annual loss due to alcohol was estimated to be Rs.70 000 to 80 000 million In a public enterprise, number of workplace accidents reduced to lesser then one fourth of the previous levels after alcoholism treatment1.
Eighty five percent of men who were violent towards their wives were frequent or daily users of alcohol. More than, stress, coping problem, influence of alcohol. An assessment showed that domestic violence reduced to one tenth of previous levels after alcoholism treatment. 3 to 45 % of household expenditure is spent on alcohol. Use of alcohol increases independents and reduces the ability to pay for food and education. Alcohol abuse leads to separations and divorces and causes emotional hardship to the family. The emotional trauma cannot be translated in terms of money but the impact it has on quality of lives is significant1.
Majority of the wives of alcoholic have coping problems and facing stressful situations. Hence, Researcher felt that to identify various coping strategies adapted by wives of alcoholics and help the wives of alcoholics to perceive the stressful situations as manageable challenging and non threatening is necessary.
6.2 REVIEW OF THE LITERATURE
A study was conducted on the coping behaviors of 30 wives of alcoholics in vellore, 1991. Tool used for study was Orford-Guthrie's 'coping with drinking' questionnaire. Results found that commonest coping behavior reported was discord (72.4%), avoidance (68.9%), indulgence (82.7%) and fearful withdrawal (70.8%). Marital breakdown, taking special action, assertion and sexual withdrawal were least frequent. There was no significant correlation between the coping behaviors’ and the variables like duration of marriage, duration of husband's alcoholism, socio-economic and educational status. Implications of these findings are discussed and a cross cultural comparison is made. This study concludes that alcoholism can have serious consequences on families, perhaps as important as the impact of alcoholism on the alcoholics21.
A cross sectional, descriptive study was conducted to assess the ways of coping among the wives of alcoholics who were staying with their husbands during de-addiction treatment. Convenience sampling was done to select 200 wives of alcoholics (WOA) from the two de-addiction centres in Chennai. Coping among the WOAs was measured by ways of coping questionnaire, a 66-item scale. Descriptive and inferential statistics were used to analyse the data. The findings of the study shows that majority of the wives of alcoholics used positive reappraisal (83.5%), planful problem solving coping (82.5%), escaping avoidance (74.5%), accepting responsibility (72%), confrontive coping (68.5%), self controlling (64%), and seeking social support coping moderately (58.5%) to cope up with the stressful situations; 45% and 53.5% of them used distancing coping moderately and minimally respectively. The study concludes that majority of the wives of alcoholics use all coping strategies during stressful situations16.
A descriptive study was conducted to assess the self perception of women who live with alcoholic partner. The main purpose of the study was to learn about the self-perception of women who live with alcohol-addicted partners. It was hoped that avoiding to label the women in advance as codependent would facilitate a better understanding of their lives and self-perceptions. The qualitative naturalist methodology used was based on a feminist framework. In-depth interviews with 10 women living with alcoholic partners were conducted and analyzed. The findings revealed that 3 central dialogues around which the women's self-perceptions evolved—with deviance, with strength, and with self-fulfillment. Findings are discussed relative to the ongoing discourse between the codependency approach and other social, psychological, and gender conceptions in this domain. Clinical implications and directions for future research are offered22.
A study was conducted on home interactions of high and low antisocial male alcoholics and their families. The aim of the study was to investigate the naturalistic interactions of two alcoholism subgroups during home dinnertime conversations. Dinnertime conversations of 96 alcoholic and 47 control families were audio taped and subsequently assessed via a multi component coding system involving trained raters who were blind to psychiatric status of participating families. To examine potentially important alcoholism types, two subgroups were formed on the basis of the male alcoholic's level of anti sociality. Across all groups, mothers' rate of communication to children was greater than fathers' to children for all communication variables; similarly, children's rate of communication to mothers exceeded their rate to fathers across all communication variables. Findings revealed that families of alcoholics reflecting higher levels of anti sociality expressed lower levels of positivity, disagreement and instrumentality than did families of alcoholics who exhibited lower levels of antisociality23.