Source: http://www.psychosocial.com/IJPR_21/Behavioural_Problems_Srinath.html
Timestamp: 2019-04-18 18:50:43+00:00

Document:
S.M.O. at World Health Organization (WHO), Calicut, India.
While alcohol use is deeply embedded in many societies, recent years have seen changes in drinking patterns across the world. Rates of consumption, drinking to excess among the general population and heavy episodic drinking among young people are on the rise in many countries. Health problems associated with alcohol consumption have reached alarming levels, and alcohol use contributes to a wide range of diseases, health conditions and high-risk behaviors, mental disorders, loss of productivity, road traffic injuries, liver diseases and spousal violence. Although the prevalence of alcoholism among rural males in Tamil Nadu, India had been reported, but there is a lack of information regarding the prevalence of various types of alcoholism and problem drinking along with the psychosocial and economic aspects of drinking, especially in this part of the region. To highlight these problems the various types of alcoholism and problem have been extensively analyzed in this study.
The economics of alcohol has a multidimensional approach looking from the consumption patterns both at the national level, the stake-holders level and at the individual level. Mere estimation of the alcoholics in a community in not warranting without assessing the social, psychological menace it creates and measuring the economic burden it gives to the individual, family and in turn the entire nation. This prompts the importance of taking up this study which will be an eye-opener for the public to get the awareness regarding the real burden of the alcoholism and to the policy makers, public health leaders and government agencies regarding the importance of focusing on the intervention and prevention strategies of alcoholism.
Alcoholism is defined as chronic disabling addictive disorder characterized by dependence on alcohol or repeated excessive use of alcoholic beverages or development of withdrawal symptoms on reducing or ceasing intake or morbidity including cirrhosis or decreased ability to function socially and vocationally (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001). WHO regions show wide range of difference in terms of the prevalence. European Union has the highest prevalence of 87.4%, followed by America with 84.4%. SEAR has a prevalence of 31.6% among adult males (Casswell & Thamarangsi, 2009). Prevalence of alcoholism is affected by various factors such as culture, religion, educational status, occupation, economic status and status of living of the people.
Varma et al reported that 41% prevalence of alcoholism among males in northern India, with 49.5% of alcoholics doing unskilled or semi-skilled work (Vijoy K Varma, Malhotra, & Dang, 1985). Sundaram et al reported the prevalence of alcoholism among rural males above 15 years as 36.1% (Sundaram, Mohan, Advani, Sharma, & Bajaj, 1984). The same study also reported the vulnerable group for alcoholism as illiterate married men, in an age group of 20-35, living in a nuclear family and doing unskilled or semi-skilled occupation. Ghulam et al reported a prevalence of alcoholism among urban males above 18 years as 32.9% (Ghulam, Rahman, Naqvi, & Gupta, 1996). Srinivasan et al reported 20.5% prevalence of alcoholism among hospital patients (Srinivasan & Augustine, 2000). Hazarika et al reported the prevalence of alcoholism among rural males in the border area of Assam and Arunachal Pradesh as 39.4%, with 47.4% of the illiterates (Hazarika, Biswas, Phukan, Hazarika, & Mahanta, 2000).
The harmful effects of alcohol use on health and the possibility of developing dependence have been recognized as issues of great concern for a long time. Alcohol related problems (Girish, Kavita, Gururaj, & Benegal, 2010)(Casswell & Thamarangsi, 2009) can be classified as, Effects of alcohol on day-to-day functioning and Consequences of alcohol use.
In this study, the alcoholics were assessed for psychosocial problems. The psychosocial problems found out were further grouped into behavioral problems perceived by the drinker himself and his family, social problems, health and psychological problems.
In this study, 72.8% alcoholics had a false perception that they are a normal drinker and 93.7% of alcoholics were not seeking anyone’s help to bail them out from their drinking problem. Among the alcoholics, 67.4% admit that their wife or parents complaint to them about their drinking habit. Meanwhile, 56.8% of alcoholics were unable to stop with one or two drinks and 35.4% had the habit of hangover drinking.
Among the alcoholics in this study, 45.1% had problem with their wife including violence. Only 1.9% had lost their friends because of their drinking habit. In this study, 28.6% of the alcoholics had trouble in their workplace and 13.1% had lost their job because of their drinking habit. Alarmingly, 10.1% of the alcoholics had been arrested because of their drunken behavior whereas 13.1% had the habit of drunken driving.
In this study, 19.4% of the alcoholics had liver disease or cirrhosis and 51.5% of alcoholics had withdrawal symptoms including tremors, hallucinations, delirium tremens etc. In this study, 21.3% of the alcoholics had been admitted in the hospital due to their drinking habit and 18.9% of them had been admitted to a psychiatric centre.
The health seeking pattern (place and type of health care services along with the reason for their health care visit) among the current drinkers for their alcohol-related problems were found out.
In this study, the economic impact of the alcohol was calculated for all the current drinkers (320). The economic impact of drinking was classified into cost of drinking and the alcohol-impact expenses. Cost of drinking includes the cost of alcohol, refreshments, travel expenses and cost of tobacco. Alcohol-impact expenses include health costs (costs for injuries and hospital admission), work related expenses (loss of pay due to absenteeism and borrowing in work place) and social costs (debts, mortgages, gambling and damage to properties). The cost of drinking including the expenses for alcohol related consequences for a current drinker of alcohol was found to be 21,053 INR (Indian Rupee Rate) during the study period of past 12 months.
This cross-sectional study was done to find out the prevalence of alcoholism and various risk levels of drinking among rural males and its psychosocial and economic impact. Rural males of age 18 years and above were included in the study as it is the legal age for drinking in the state of Tamilnadu. The mean age of the study population was 41.9 ± 15.4 years, with 87.3% literates, 67.2% married and 51% doing unskilled and semi-skilled occupations. The mean monthly per capita income of the study participants was 3072 ± 1697 INR with 50.8% of them having high standard of living.
In this study, 72.8% of the alcoholics had a false perception that they were just a normal drinker. Ghosh et al had a similar finding were 84% of the alcoholics had this perception (Ghosh et al., 2012). Ironically 93.7% of the alcoholics weren’t seeking help from anyone regarding their drinking problem. Grant et al, Pal et al and Well et al had explained the reason for why these alcoholics weren’t seeking help from others to bail them out from this problem (Grant, 1997)(Pal, H.R. et al., 2003)(Wells, Horwood, & Fergusson, 2007). Main reason behind it was the feeling of shame and disbelief in the benefit of the treatment. Meanwhile most of the alcoholics were not aware of their problem and not concerned about their drinking habit. They weren’t considering their alcoholism as a burden and even do they concern about it, they were not ready to seek the help of others to bail them out of it, thinking that they can deal it with themselves. These false perceptions can indeed keep them deep into the abyss of alcoholism.
In this study, 73.3% of the alcoholics were unable to limit their drinking to certain places and time while 56.8% of them were unable to stop with one or two drinks. Mohan et al had a similar finding with 58.5% of the alcoholics were unable to stop their drink with few drinks (Mohan, Chopra, Ray, & Sethi, 2001). In this study 35.4% of alcoholics had the habit of hangover drinking and 33.1% were unable to recollect the events in the morning after a heavy drinking on the previous night. Varma et al reported that 15.5% of alcoholics had hangover drinking (V K Varma, Singh, Singh, & Malhotra, 1980). These findings revealed the level of dependence the rural men were reeling under the alcohol. These problems tempt them to do binge drinking, drink at public places and workplace drinking which would lead to social and legal issues.
In this study, 51.5% of the alcoholics had admitted that they have withdrawal symptoms including tremors, hallucinations, delirium tremens etc. Similar finding was reported by Mohan et al with 40.4% (Mohan et al., 2001). This finding is much greater than the one reported by Ghosh (Ghosh et al., 2012). With this huge proportion of alcoholics having withdrawal symptoms, it makes the physicians’ job of managing them cumbersome along with the policy makers’ role of reducing the alcohol menace. In this study, 21.3% of the alcoholics had been admitted in hospital for their drinking problem, in which 19.4% were diagnosed to have liver disease or cirrhosis and 18.9% were admitted in a psychiatric/de-addiction ward. These findings reveal the chronicity of the alcohol menace and its strong roots among the rural men.
Findings from this study reveal the magnitude of the alcohol menace among the rural males in India. With one half of the rural males be drinkers and one-third to be alcoholics, the burden it gives to the family and society is huge. Psychosocial problems along with the health problems faced by the alcoholics not only affect himself but also his family and in turn the society. With one-fifth of the rural males are problem drinkers, the burden it generates is substantial. With majority of rural population having low standard of living, a current drinker by spending a hefty portion of his annual income for alcohol and alcohol related expense, further depletes his economic status. Improved systems for monitoring and surveillance at different levels, and more effective dissemination and application of information for advocacy, policy development and evaluation purposes. For all this to happen, a vital first step is for health planners and other stakeholders to debate and draft an explicit and rational alcohol policy, appropriate for India. The finding of high prevalence of alcoholism and problem drinking among rural males and the magnitude of psychosocial and economic impact on them warrants the need for a cost-effective, community based alcohol policy at the national level.
Funding for this study was not provided by any organization. No organization had a role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Both the authors have participated in the research and/or the manuscript preparation.
Role of Dr.S.Sendilvelan: Data collection, Conducted literature searches and Analysis of Samples.
Authors declares that he/she has no conflict of interest not received any fund for this work. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee.
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