RAJIVGANDHIUNIVERSITY OF HEALTH AND SCIENCES

BANGALORE – KARNATAKA

Proforma synopsis for registration of subject for dissertation

Submitted by:

VEERESHA G.V

M.SC. Nursing 1st Year

Psychiatric Nursing

Sneha College of Nursing

Bangalore – 560043

RAJIVGANDHIUNIVERSITY OF HEALTH AND SCIENCES

BANGALORE – KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / Name of the Candidate & Address / VEERESHA G.V
1st Year M.Sc. (Nursing)
SNEHA COLLEGE OF NURSING
NO.97, 5th Main. I stage, I Block, HBR Layout, Bangalore– 43
2 / Name of the Institution / SNEHA COLLEGE OF NURSING
3 / Course of study and subject / M.Sc. Nursing 1st year
PSYCHIATRIC NURSING
4 / Date of admission to course / 25.05.2010
5 / Title of the topic / “A STUDY TO ASSESS THE FAMILY SUPPORT OF ALCOHOL DEPENDENTS ON DE-ADDICTION. IN SELECTED DE-ADDICTION”
6 / Brief resume on intended work
6.1: Introduction
6.2:Need for the study
6.3: Review of Literature
6.4: Objectives of the study
6.5: Hypothesis / ENCLOSED
ENCLOSED
ENCLOSED
ENCLOSED
ENCLOSED
7 / Materials and Methods:
7.1: Sources of Data: data will be collected from in mates of selectedde-addiction center at Bangalore.
7.2: Method of Data Collection: observation check least and interview method.
7.3: Does the study require any investigation or intervention to be carried out on
Thepatients, human, or animals?
NO
7.4: Has ethical clearance been obtained?
YES

6. BRIEF RESUME OF INTENDED WORK

6.1. INTRODUCTION:

Alcohol also known chemically as ethanol, sometimes abbreviated as ETOH. Technically, the substance is ethyl alcohol (C2H5OH). It is legal drug; that is, it commercially distribution differs from the more tightly regulated sale of other drugs. (That is controlled substance).

The pharmacological properties of ethyl alcohol produce mild and mood altering affects of CNS depression (similar to barbiturates). Alcohol often is mistaken for a stimulant; the reason for these misconception is that after drinking it some people become more talkative, hyperactive, euphoric, self confident or aggressive. This behavior has been attributed to the dis-inhibiting affect produced by low dose of alcohol. Alcoholic beverages include beer, wine, and distilled spirit. The alcohol content of beverages is expressed as proof (concentration of ethyl alcohol). In United States proof is twice the ethanol concentration (e.g., 100 proof is 50% ethyl alcohol, and 80 proof is 40% ethyl alcohol). In contrast to other drugs that produce affect with small quantities, alcohol usually requires large quantities over and extended period to result in physical dependency.

With increase consumption, alcohol causes following pattern:

  1. Sedation
  2. Impaired mental and motor functioning
  3. Deepening stupor with decreased stimulation response (including painful stimulus response)
  4. Coma
  5. Eventually death from respiratory and circulatory collapse.1

Alcohol dependence is a complex behavior with far-reaching harmful effects on the family, work, society, as well as on the physical and mental health of the individual.

The incidence of alcohol dependence is 2% In India 20 to 40 percent of subjects aged above 15 years are current user of alcohol, and nearly 10 percent of them are regular or excessive users. Nearly 15 to 30 percent of patients are developing alcohol related problems and seeking admission in psychiatric hospitals.2

Heavy alcohol consumption exerts a deleterious effect on the family.The extent of the negative impact varies among family members and from family to family. It often results in serious emotional and medical problems. Family members' negative responses to the alcoholic behavior usually reinforce the individual's dependency resulting from alcoholism.An alcohol-dependent person seeks professional help mostly persuaded by his wife, family members, neighbors, co-workers, employer, etc. Need for immediate care may be due to a threat of divorce, dismissal from job, serious injury due to fall, aborted marriage proposal to his ward, health hazards, etc. Many studies conducted in the field of alcoholism have concluded that better outcome is possible when alcohol-dependent persons receive non-pharmacological therapy along with pharmacological treatment. Among the various treatment modalities.3

6.2. THE NEED FOR THE STUDY:

The field of alcohol treatment began to systematically apply family theories during the mid- to late- 1960s and early 1970s. At that time, family studies began to address the "functions" that alcohol serves in family dynamics, and began to apply a family systems perspective to the understanding of alcohol problems.

Another concern involves determining the possible family influences on how individuals develop problems with alcohol-there is consensus that children of alcoholic parents are at a greater risk for developing alcoholism (and other mental or behavioral health problems) than are others, but there is not complete consensus as to the specific mechanisms by which this increased risk is operational zed. Problems with alcohol (and other substances) have been associated with a number of different family factors, including parental substance use, substance use of siblings, family values and attitudes about substance use, family dynamics and relational patterns, and interaction effects with biological/genetic factors. Family approaches to alcohol treatment have received some research attention, as well. 4

Abuse is a family disease, which requires joint treatment of family members. Family is an important part of the diagnosis and treatment chain of alcohol and substance abuse. Abuse of alcohol and substance is a response to fluctuations in the family system. In consideration of interactions within the system, it seems an important requirement that the clinician involves, and maintains the presence of, the family in its entirety in the treatment process. A family often needs as much treatment as the family member who is the abuser of alcohol or a substance. In this regard, participation of the family in the treatment process as group members and by assuming a supportive role are assets in terms of preventing relapse, and extending clean time, and also very important for solving conflicts that give rise to abuse of alcohol or substances. 5

Family therapy approaches have been established as useful interventions for drug and alcohol abuse . In the late 1980s and early 1990s an increasing number of studiesfocused on family treatment of adolescent substance abuse. Each of the cited studies showed that family-based models could engage and retain individualabusers in drug treatment. Drop-out rates ranged from as low as 16% to a high of 28%. Studies which compared family-based treatments to peer-group therapy found thatretention rates in the family-based models (family therapy and family education) were significantly better .6

The researcher has came across with the alcoholic patent in psychiatric ward who not able to achieve abstinence. And there no active support from the family members because of which the alcoholic patients are getting into relapse even after successful treatment. Thus considering this significant role played by the family in bringing the alcoholic individual towards abstinence and the lack of sufficient similar studies except by P. N. Suresh Kumar and Biju Thomas, the investigator realized the need to take up this study in the context of family relationship because it may give better result in achieving complete abstinence of these individuals.

6.3 . REVIEW OF LITERATURE;

“Review of literature is a critical summary of research on a topic of interest often prepared put on a research problem in a context or as the basis for an implementation project”

Review of literature is an essential part of study. This help the researcher to formulate the hypothesis, aims at objective of study. It gives some idea about how to asses the problem and to adapt suitable methodology.

The Review of literature attempts to cover the broad area s required for the study is:-

1.Study related to cause and intensity of alcoholism.

2. Study related to family problem due to alcoholism.

3. Study related to importance of family intervention for the alcoholism.

4. Study related to reference of family members in supporting the alcoholic to abstain from alcohol.

According to a recent study published by The Lancet, well known medical journal, alcohol is more harmful than heroin and other drugs. The study was conducted by Prof. David Nutt along with others. It is an interesting study because it classifies drugs on the basis of harm i.e. harmful to the individual and harmful to others around. So under this classification alcohol has turned up to be most damaging to self, family, society and overall economy.7

When someone experiences alcohol problems, the negative effects of drinking exert a toll, not only on the drinker, but also on their partner and other family members. Recent data suggest that approximately one child in every four (28.6%) in the United States is exposed to alcohol abuse or dependence in the family. One of the clearest demonstrations of how alcohol use negatively impacts the family is the widely documented association between alcohol use and interpersonal violence. Family problems that are likely to co-occur with alcohol problems include: Violence, Marital conflict, Infidelity, Jealousy, Economic insecurity, Divorce, Fetal alcohol effects.

Drinking problems may negatively alter marital and family functioning, but there also is evidence that they can increase as a consequence of marital and family problems. Thus, drinking and family functioning are strongly and reciprocally linked. Not surprisingly, alcohol problems are common in couples that present for marital therapy, and marital problems are common in drinkers who present for alcohol treatment.8

Alcohol consumption is a leading risk factor for mortality and morbidity related to both intentional and unintentional injury. In 2000, 16.2% of deaths and 13.2% of disability-adjusted life years (DALYs) from injuries, globally, were estimated to be attributed to alcohol.9

Family and friends are often the most important influence on a drinker’s decision to take positive action. They should be encouraged to speak with the problem drinker individually or as a group to express their concern, suggest constructive action, and provide emotional support.10

Family’s think their problem would be solved if their loved one simply stopping using drugs or alcohol. However, they can get help even if the user refuses to do so. They also should realize that without help, many of the negative patterns of behavior developed over the year of dysfunctional family life will continue after sobriety.11

Family intervention treatment in the field of alcoholism is a relatively new phenomenon. Family members' negative responses to the alcoholic's behavior usually reinforce the individual's alienation and dependency resulting from alcoholism.
Among the various treatment modalities, family intervention is the most notable current advance in the area of psychosocial treatment of alcoholism. Family intervention is a method of understanding and encouraging the role of family, and it imparts positive effect in decreasing alcohol consumption.3

6.4. OBJECTIVES OF THE STUDY:

  1. To assess the level of existing knowledge of family members regarding the effect of alcoholism.
  2. To assess the level of existing knowledge of family members regarding the family support towards the abstinence of alcoholism.
  3. To assess the level of existing knowledge of family members regarding the family support towards the motivation for change, locus of control, family interaction pattern of alcoholism.
  4. To find out the association between the knowledge score with selected demographic variables. And the family support.

6.5. HYPOTHESES:

H1: there will be significant association between de-addiction of alcohol and support of family.

H2: there will be significant association between knowledge scores on family support on de-addiction and selected demographic variables.

6.4. STATEMENT OF THE PROBLEM:

A study to assess the family support of alcohol dependents on de-addiction, in selected de-addiction center in Bangalore.

6.6. OPERATIONAL DEFINITIONS:

  1. Family Support: In this study ‘Family Support’ refers to: The family member/members understanding and encouraging alcohol dependents to reduce the severity of alcohol intake, raise the motivation to stop the alcohol intake, and help to overcome alcohol addiction.

2Alcohol Dependents: Use of alcoholic beverages to the point of causing damage to the individuals, society or both.

3De-AddictionCenter: In this study ‘de-addiction centre’ refers to: It is a centre where the alcoholic patients are admitted for treatment and rehabilitation.

7. Material and methods:

7.1. Source of Data:

Data will be collected from selected de-addiction center in Bangalore.

7. 1.1. Research design:

Descriptive design

7.1.2. Setting

The study will be conducted in selected de-addiction center in Bangalore.

7. 1.3. Population:

In this study the target population is the alcohol dependents in selected de-addiction center in Bangalore.

7.2. METHODS OF DATA COLLECTION:

7.2.1. Sampling procedure:

Non probability, convenient sampling.

7.2.2. Sample size:

50 samples

7.2. 3. Inclusion criteria for sampling:

  1. Alcoholic patients who had positive attitude towards their family members.
  2. Alcoholic patients who is under family supervision and maintenance
  3. Alcoholic patients who could understand and read Kannada or English.
  4. Patients who are admitted to the centre and completed 72 hours without consumption of alcohol.
  5. Patients who are aged 20 years and above.
  6. Patients on de-addiction treatment.
  7. Patients who are willing to participate.

7.2.4. Exclusion criteria for sampling.

  1. Alcoholic patients who do not have their family with them.
  2. Addicts with other substance abusers.

7.2.5. Data collection method:

Socio demographic variables and mental health status evaluation with respect to alcohol addiction by

  1. Observation check least.

2. Interview method.

7.2.6: Plan for data analysis:

The researcher will use appropriate statistical technical for data analysis and present in the form of table, graphs and diagrams.

Pilot study:

10% of the population planned for the study during year of 2010. The sample will be excluded from main study.

Main study: Data will be collected by the interview method using the above tools.

Statistical analysis: In order to analyze the data descriptive statistical method. Appropriate parametric and non parametric test will be used.

Ethical issues: All the subjective will be explained about the purpose, the objective and the procedure of the study

7.2.7: Research Variables:

Dependent:

Selected Demographic Data.

Independent:

Level of family support in de-addiction of alcoholism.

7.2.8 Projected outcome:

It helps to evaluate effectiveness of the family support of alcohol dependents on de-addiction.

7.3 Does the study require any investigations or interventions to be conducted on patients, or other animals” if so please describe briefly.

NO,

7.4: Has ethical clearance been obtained from your institution in case of 7.3?

Yes,

8 . REFERENCES

1.Keltner, N. & Folks. D. 2005, psychotropic drugs, 4th edition. St. Louis, MO Mosby

2.R. Sreevani .A Guide to Mental Health and Psychiatric Nursing.2nd edition published by Jaypee Brothers Medical Publisher (P) Ltd, New Delhi, India.2006. 86.

3.Suresh Kumar PN, Thomas B. Family intervention therapy in alcohol dependence syndrome: One-year follow-up study. Indian J Psychiatry. 2007 Jul;49(3):200-4.PubMed PMID: 20661387; PubMed Central PMCID: PMC2902094.

4.Zweben, A. and Pearlman, S. (1983), EVALUATING THE EFFECTIVENESS OF CONJOINT TREATMENT OF ALCOHOL-COMPLICATED MARRIAGES: CLINICAL AND METHODOLOGICAL ISSUES. Journal of Marital and Family Therapy, 9:61–72. doi:10.1111/j.1752-0606.1983.tb01484.x

5. Saatcioglu O, Erim R, Cakmak D. Role of family in alcohol and substance abuse. Psychiatry Clin Neurosci. 2006 Apr;60(2):125-32. Review. PubMed PMID: 16594934.

6.Gabriele Schäfer Multiple Family Group Therapy in a Drug and Alcohol RehabilitationCentre: Residents Experiencess. ANJFT.

29,Nov 2.2008.88-89

7.Nutt DJ, King LA, Phillips LD; Independent Scientific Committee on Drugs. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010 Nov

6;376(9752):1558-65. Epub 2010 Oct 29. PubMed PMID: 21036393.

8.Linda J.Roberts, Ph.D.Madison, Wisconsin Barbara S. McCrady, Ph.D. ALCOHOL PROBLEMS IN INTIMATE

9.RELATIONSHIPS:IDENTIFICATION AND INTERVENTION A Guide for Marriage and Family Therapists, February 2003

10.Cheryl J. Cherpitel, GuilhermeBorges, NormanGiesbrecht, DanielHungerford,

MargiePeden, VladimirPoznyak, RobinRoom, TimStockwell. Alcohol And Injuries Emergency Department Studies in an International Perspective. World Health Organization 2009)

11.Thomas F. Babor John C. Higgins-Biddle. BRIEF INTERVENTION For Hazardous and Harmful Drinking A Manual for Use in Primary Care. World Health Organization Department of Mental Health and Substance Dependence. World Health Organization 2001.16

12.Gail Wiscarz. Stuart, PhD, PMHCNS-BC,FAAN. Principles and Practice of Psychiatric Nursing. 9th edition Published by Elsevier, a division of reed Elsevier India Private Limited, Noida, India.2009. 449.