STRESS AMONG ALCOHOLICS FOLLOWING DE-ADDICTION TREATMENT: A THREE YEAR FOLLOW UP STUDY
Alcoholism is matter of serious concern, not confined to any group, culture or country. Universally it creates professional, social, financial, legal, medical, psychological, and familial problems. The cost of alcoholism to the society is staggering by any calculations. Lost working days, accidents and related disability, family disrupts and resulting juvenile problems, and direct medical complications of alcohol abuse add up to a significant proportion of loss to nations” economy and well being. Alcoholism thus becomes a complex phenomenon deserving attention from deferent angles. Problem drinking within a family can lead to many types of stress and hard ships for family members. Increasing social isolation due to alcoholism is difficult for children to cope up. They behave increasingly withdrawn form peer group activities. Financial hardships become a factor and reductions are made to general standard of living. Physical hardships are seen either violence towards family members or in destruction of household things. Family members especially spouse may be subjected to emotional deprivation and may perceive drinking as a form of rejection. This in turn causes the drinker to become increasingly preoccupied and plays a diminished role in family life and affairs.
Glassner and Loughlin (1987) emphasized on three aspects of parent-child relationships that are studied in alcoholics families; basic care, consistency of expectations, and communications. Children find it difficult to cope with parental unpredictability or with unexplained withdrawal and sudden change in mood and temperament. Hence, the tragedy of alcoholism lies in its detrimental effects on future generation. Alcoholism of the individual affects not only the family but also even the basic fabric of the society. Alcohol causes poverty leading to crimes and prostitution that in turn ends up in the break down of any society’s integrity and existence. Studies have reveled those alcoholics” families acquire certain typical coping strategies within the family system (Orford et. al 1975). This invariably evokes further stress, feelings of hopelessness, withdrawnness and depression in alcoholics. Thus, a vicious cycle of alcohol, stress and maladjustment is found to exist. In the post de-addiction treatment phase, the situation is expected to change. The treatment as such and its positive out come should bring new atmosphere in to the family. In spite of differences, all treatment modalities for de-addiction aims at improved family relations and better social adjustments. Psychotherapy, family counseling, rehabilitation counseling, and group therapies are deferent methods of attaining this goal. Do these techniques work in the long run? Does participation in AA meetings reduce stress?
The present study therefore attempts to investigate the nature of change in stress among alcoholic patients in the immediate three years following de-addiction treatment.
OBJECTIVES
The central theme of the present investigation is to study the nature of stress among alcoholics in the immediate three years following de-addiction treatment.
1 To find out stress among alcoholics in the immediate three years following de-addiction treatment.
2 To find out whether deferent treatment methods vary in their efficacy to reduce stress among alcoholics in the immediate three years following de-addiction treatment.
SAMPLE
Sample of the study consisted of 166 male alcoholics admitted in deferent dead diction centers in kerala. Their age ranged from 26 to 53 (mean 34, SD12.5). All subjects belonged to middle socio economic class. Duration of alcohol consumption ranged from4 to 23 yrs. (mean 14.5, SD 9.6)
TOOLS
Hari`s Stress Inventory (HSI)
Hari`s Stress Inventory assesses eight major aspects of stress. The test is reported to have high degree of content validity. The coefficient of reliability (split half) is 0.59, (Chandran, 2000)
RESEARCH DESIGN
Present investigation is an experimental study with two independent variables and a dependent variable. First independent variable is the participation of Ss in AA meetings, Second independent variable is the Relaxation training given to the Ss. Dependent variable is stress. A sample of 166 alcoholics who were admitted for de-addiction treatment was chosen for the study. Out of the sample,60 Ss were randomly assigned to the first group ( Exp Gr.1, participation in AA meetings), another 60 Ss were randomly assigned to the second group (Exp Gr.2, Relaxation training).They were given training on relaxation technique, viz. Jacobson’s relaxation and Bensons relaxation, and Ss were advised to continue it regularly. Rest of the sample, (n 46) was kept as control group.
HSI was administered to the whole sample at the time of admission and base line data on maladjustment was obtained. During the study, Ss were assessed on stress after 2 months, 1 year, 2 year and three year periods.
The final sample consisted of only those subjects who were regular for follow-ups. Exp Gr.1, Exp Gr.2, and control group for final analysis consisted of 46, 48, and 32 Ss respectively. It may be noted that the size were 60, 60, and 46 respectively for the three groups.
3 X 5 Univariate analysis was conducted on scores on maladjustment among the three groups during the three year period. A graph was plotted.
RESULTS AND DISCUSSION
The group were found to vary significantly on stress (F=7.92, P<0.01). The variation of the scores on stress over different time intervals was also found significant. (F= 40.71, P<0.01). No interaction was observed between treatment and interval.
Table 1: Means and SDs of the three groups on stress at different durations of treatment
Group N Baseline 2 months 1 year 2 years 3 years
mean SD mean SD mean SD mean SD mean SD
Exp. Group1 46 188.8 44.8 176.7 30.7 172.4 30.2 170.3 32.3 158.1 27.3
Exp. Group2 48 207.7 39.2 191.1 35.4 186.1 31.2 180.7 30.3 178.4 31.7
Control group 32 212.5 42.7 210.3 31.3 196.3 31.9 193.1 36.9 183.8 28.8
Table 2: 3x5 univariate F tests conducted on scores on stress at different durations of treatment
Source Hyp. Ss DF Error Ss DF Hyp. MS Error MS F
Among Groups (A) 67176.8 2 521344.3 123 33588.4 4238.6 7.92**
Among interval(B) 62040.6 4 187442 492 15510.1 381 40.71**
Interaction (A&B) 3726 8 187442 492 465.7 381 1.22 NS
**P<0.01 NS- Not Significant
Exp.gr.1, Exp.gr.2 and the control groups vary significantly on stress. This result reveals that the different treatment viz. attendance in AA meetings and relaxation influences S’s scores on stress in different ways. Irrespective of treatments, the three groups vary significantly on their scores on stress among different intervals. This shows that there is significant reduction on stress among alcoholics with time following de addiction treatment. No interaction effect could be noted between treatments and duration, influencing the scores on stress.
Considering the mean scores on stress among the three groups during the three year period of study (refer graph), Exp.gr1 (attending AA meetings) scores lowest on stress. This reduction is gradual following de addiction treatment, maximum benefit was obtained after three year’s regular participation in AA. These points to the direction that stress experienced by alcoholics show specific characteristics which were managed by the fellowship shared in AA. Normally stress experienced by an alcoholic is associated with his drinking habit and its outcomes. These aspects might have been brought down by sharing of experience in AA meetings, their mutual trust and supportive relationships.
Exp. Group 2 (practicing relaxation) also shows significant reduction in stress. The practice of relaxation has brought down the arousal system, and as a result, the person experience reduced stress compared to the control group. This result indicates that relaxation training is effective in the management of stress among alcoholics. Maximum efficiency was noted when relaxation practice was continued for a period of 2 years.
Irrespective of the treatment, all the three groups vary significantly on stress among the different time intervals. Stress is found to reduce significantly following de addition treatment and the reduction is gradually maintained during the period of follow up. During this period S’s might have learned better coping patterns to stress and must have received supportive and warm assurance from family which may have accounted for this significant reduction on stress.
Comparing the two types of treatments, attendance to AA is found superior in reducing stress. This is due to the specific characteristics of the sample under study. AA is designed with the objective of reducing a person’s craving towards alcohol through unique methods which are appropriate for alcoholics.
It was also observed that a person has to attend AA for long time to obtain optimum stress reduction. Relaxation training as described by Catterton (1990) leads to reduced adrenalin levels, slower respiration, slower heart rate, dilation of blood vessels and reduced blood pressure which invariably manages the experiences of stress. The results go with the findings of Blake (1967) and Freed berg and Johnson (1978) who observed a significant level of stress reduction among alcoholics receiving relaxation training. As noted earlier, all the three groups show a general trend of reduction of stress with time. This is a common effect of intervening variables like possible reduction in financial crisis, availability of more time in productively tackling problem situations, emotional support, social expectations and feelings of importance which invariably accompany abstinence.
CONCLUSIONS
A general trend of reduction in stress was noted following de addiction treatment.
Attendance in AA meetings and the practice of relaxation were found effective in managing stress among alcoholics.
Attendance in AA meetings is found superior to practice of relaxation in managing stress among alcoholics.
REFERENCES
Blake R.G (1967) A follow- up of Alcoholics treated by behavior therapy, 5, 89-99.
Catterton N (1990) Unpublished paper, University of Virginia (Cited from) Sutherland, V.J and Cooper, C.L. Understanding stress, Psychological perspective for Health professionals, London, Chapman & Hall, Chandran, H.S, (2000) Behavior engineering: Management of Stress and maladjustment among alcoholics, Ph.D thesis, School of Behavioral Sciences, M G University. India.
Friedberg E.J and Johnson W.E, (1978) The effects of relaxation within the control of multimodal alcoholic treatment program for employed alcoholics; Ontario: Alcoholism and Drug Addiction Research foundation.
Glassner, B and Loughlin, B (1987) Drugs in Adolescent Worlds: Burnout to Straight, London: Macmillan Press.
Orford,J, Guthrie,S, Nicholls,P, Openheimer,E, Egert,S,and Hensman,C,(1975)Self reported coping behavior of wives of alcoholics and its association with drinking out come. Journal of Studies on Alcohol, 36-1254-67
Dr. Hari S.Chandran, M.Phil (Psy), Ph.D, PGDPC is working as Cons. Psychologist, Department of Deaddiction&Mental Health, St.Gregorios Mission Hospital, Parumala. Kerala, dr_hari@sancharnet.in
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