رفتارهای پریشان کننده بیماران وابستگی به الکل: مطالعه از هند

Alcohol dependence is a chronic relapsing disorder similar to other major psychiatry disorders. Alcoholism is considered to be stressful to the family members. This study attempted to examine the behaviors family members report more distressful in frequency and also in their severities. Family members, mostly spouses of fifty males with alcohol dependence were interviewed for the behaviors which they considered distressful. Scale for Assessment of Family Distress (SAFD) for alcoholism was used to assess the frequency and severity of the distressing behaviors. Family members of all the patients (100%) reported behaviors like excessive spending and disturbance of peace at home as distressful. With regard to severity, in addition to the above two behaviors, does not working and earning, not taking responsibility, and being physically and verbally abusive were also considered as very distressful. Sexually embarrassing behaviors, legal problems or road traffic accidents were not commonly reported as distressful.

Alcohol consumption from developing countries is increasing and is becoming a major public health problem (Uchtenhagen, 2004). National household surveys from India reported 21% of the population to be current users and of them approximately one-third fulfill criteria for dependence (Ray, 2004). Alcoholism is considered an on-going stressor for family members, and is very harmful to the individuals exposed to it (Hurcom et al., 2000 and Tomori, 1994). In particular, spouses report a higher degree of depression, anxiety, and somatic complaints than the ones with nonalcoholic partners (Halford et al., 1999). The relationship between domestic violence and alcoholism has been clearly established in the literature (Cunradi et al., 2002, Fals-Stewart et al., 2003 and O’Farrell et al., 1999), which could be a significant distressing behavior for the family members. Greater psychological distress is also reported among nonalcoholic women in marital therapy with their alcoholic male partners (Kahler et al., 2003). Psychological distress reported by spouses is attributable primarily to the stress of living with an alcoholic (e.g. Jackson, 1954) has generally been supported in the literature. At the same time one needs to identify exactly which behavior(s) is/are more distressing for the family members living with the alcohol dependent person. The perception of distressful behaviors could be different and influenced by culture (Gopinath and Chaturvedi, 1992). There is no similar instrument assessing the distressful behaviors in case of alcoholism. It is important to assess the symptoms perceived as distressful by the family members, to effectively design a family intervention programme. The objective of the study was to determine which symptoms or behaviors of an individual dependent on alcohol were perceived to be distressful by the family member and to determine the severity of such distress.

A number of distressing behaviors are perceived by the family members of the person with alcohol dependence. These can be identified by a brief and simple interview using the SAFD (Appendix A) for alcoholism. The likelihood of more frequent behaviors is reported as more distressing, compared to severe behavior occurring only once. The frequency of the behavior and its association with the reported distress can be looked in future studies. Also the modified scale (SAFD) for alcoholism has some items related to psychosis which need further revision in the future. Appropriate support and counseling can be provided help to the family members to cope and deal with the distressing behaviors, which may have an impact on the outcome of alcoholism.