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ON LEVEL OF AWARENESS REGARDING THE ILL EFFECTS OF

SUBSTANCE ABUSE AMONG SUBSTANCE ABUSERS AT

SELECTED SETTING

By

Mrs.DEVI C.G

A Thesis submitted to

THE TAMIL NADU DR. M.G.R. MEDICAL UNIVERSITY,

CHENNAI

In fulfillment of the requirement for the degree of

DOCTOR OF PHILOSOPHY IN NURSING

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ON LEVEL OF AWARENESS REGARDING THE ILL EFFECTS OF

SUBSTANCE ABUSE AMONG SUBSTANCE ABUSERS AT

SELECT SETTING.

Approved By

Dr. N. KOKILAVANI, M.Sc. (N), M.Phil, M.A. (Pub. Adm), Ph.D., PRINCIPAL,

ADHIPARASAKTHI COLLEGE OF NURSING, MELMARUVATHUR,

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CERTIFICATE

This is to certify that the thesis entitled “A study to assess the effectiveness of counselling on level of awareness regarding the ill effects of substance abuse among substance abusers at selected setting” is a bonafide work of Mrs. DEVI C.G and submitted in fulfillment of the requirement for the Degree of Doctor of Philosophy in Nursing to THE TAMIL NADU DR. M.G.R MEDICAL UNIVERSITY, CHENNAI under my guidance and supervision.

Dr. S.Rajasankar, M.Sc., Ph.D., Research Guide,

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CERTIFICATE

This is to certify that the thesis entitled “A study to assess the effectiveness of counselling on level of awareness regarding the ill effects of substance abuse among substance abusers at selected setting” is a bonafide work of Mrs. DEVI C.G and submitted in fulfillment of the requirement for the Degree of Doctor of Philosophy in Nursing to THE TAMIL NADU DR. M.G.R MEDICAL UNIVERSITY, CHENNAI under my guidance and supervision.

RESEARCH CO-GUIDE:

Dr. N. KOKILAVANI, M.Sc. (N), M.Phil, M.A. (Pub. Adm), Ph.D., Principal,

Adhiparasakthi College of Nursing, Melmaruvathur,

Kancheepuram District,

Tamil Nadu, India – 603 319.

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DECLARATION

This is certify that the Thesis entitled “A study to assess the effectiveness of counselling on level of awareness regarding the ill effects of substance abuse among substance abusers at selected setting” submitted to THE TAMIL NADU DR. M.G.R MEDICAL UNIVERSITY, CHENNAI in January 2015 for the Degree of Doctor of Philosophy in Nursing, is the original and independent work carried out during the period from July 2011 to JANUARY 2015 under the guidance and supervision of Dr.S.Rajasankar, M.Sc., Ph.D., Research Guide, Adhiparasakthi College of Nursing, Melmaruvathur.

This thesis does not contain any part of work that has been submitted for the award of any diploma, degree, associateship or other similar title in this university or any other university without citation.

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My most heartfelt gratitude is articulated to HIS HOLINESS, ARUL THIRU AMMA, FOUNDER, Adhiparasakthi Charitable, Medical, Educational and Cultural Trust, Melmaruvathur for his lavishing blessings, love and unseen force behind all the efforts.

I am grateful to SAKTHI THIRUMATHI LAKSHMI BANGARU ADIGALAR, VICE-PRESIDENT, Adhiparasakthi Charitable, Medical, Educational and Cultural Trust, Melmaruvathur , for her valuable caring spirit and

enduring support by giving all facilities throughout the study.

I wish to thank the Correspondent SAKTHI THIRUMATHI E. SRILEKHA SENTHIL KUMAR, M.B.B.S, D.G.O, Adhiparasakthi College of Nursing for giving an opportunity to undergo my Degree of Doctor of Philosophy in nursing career in this prestigious institution and for undertaking my research study.

I have immense pleasure in thanking the university Vice-Chancellor Dr.D.SHANTHARAM M.D., D.Diab., The Tamilnadu Dr.MGR. Medical University, Chennai, for giving me an opportunity and accepting me to join as a Ph.D. candidate in Nursing, under this university

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DEVI M.D. (Path), D.G.O., The Tamilnadu Dr.MGR. Medical University, Chennai, for giving me an opportunity and accepting me to join as a Ph.D. candidate in Nursing, under this university.

I extended my sincere gratitude to Dr.S.RAJASANKAR, M.Sc., Ph.D., Research Guide, Adhiparasakthi College of Nursing, Melmaruvathur, for his untiring support, scholastic suggestions and constant encouragement in the completion of my thesis. He has been instrumental in inspiring me throughout my Ph.D.

I wish to extend my wholehearted thanks to Dr. N. KOKILAVANI, M.Sc. (N), M.Phil, M.A. (Pub. Adm), Ph.D., Principal, Co-Guide, Adhiparasakthi College of Nursing, Melmaruvathur for her dexterous, constructive and critical guidance, logistic support, valuable suggestions, affectionate and enduring support, timely motivation and inspiration throughout the study. This holds me strong in all places I flattered and all these kept me working towards the completion of this successful thesis.

I wish to extend my immense thanks to our Dr.Mrs.A.V.Raman, M.Sc(N), Ph.D, Director of Nursing, Education and Research, Westfort College of Nursing, Wahe, Thirissur, Kerala, for enduring support and encouraging advice, valuable guidance which enlightened my path to complete the work systematically and helped me a lot to come forward successfully in all my endeavors.

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Dhanvantri College of Nursing, Pallakkapalayam, Namakkal and Mr. B. ASHOK

M.Sc., M.Phil., Assistant Professor in Biostatistics, Adhiparasakthi College of Nursing, Melmaruvathur, for their valuable guidance in statistical analysis and presentation of data.

I wish to express my sincere thanks to Mr. A. SURIYANARAYANAN M.A., M.Phil, Lecturer in English, Adhiparasakthi College of Nursing and Mrs.C.V.RANIMARAGATHAVALLI, B.T Asst., Govt Higher secondary school Pallakkapalayam, Nammakkal, for their timely help and advice in taking forward my study.

I take this opportunity to thank the entire FACULTY MEMBERS RESEARCH COMMITTEE AND LIBRARIAN, Adhiparasakthi College of Nursing for their support in each step of this thesis work.

I would like to thank LIBRARIAN, The Tamilnadu Dr.MGR. Medical University, for reference books and journals for my thesis.

Especially I thank my STUDY SUBJECTS for their sincere co- operation and interest which showed upon the successful completion of the study, without which my venture would not be a fruitful one.

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daughter C.SHANMITHA, for their constant encouragement and support throughout this study

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ABBREVIATIONS

WHO - World Health Organization

IMFL - Indian Made Foreign Liquor

INIL - Indian Made Indian Liquor

DALYS - Disability Adjusted Life Years

AUDIT - Alcohol Use Disorder Identification Test

SCORATES - Stage of Change Readiness and Treatment Eagerness Scale

CI - Confidence Interval

AIDS - Acquired Immuno Deficiency Syndrome

HIV - Human Immunodeficiency Virus

CAGE - Cut, Annoyed, Guilt, Eye-opener

ICD10 - International Classification of Disease

OR - Odds Ratio

TASMAC - Tamil Nadu State Marketing Corporation

SEAR - South East Asian Region

COPD - Chronic Obstructive Pulmonary Disease

MDGS1 - Millennium Developmental Goals

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BPL - Below Poverty Line

FBS - Fasting blood sugar

CHD - Coronary heart disease

SD - Standard Deviation

MI - Motivational Interviewing

ANOVA - Analysis of Variance

M - Mean

MCV - Mean Corpuscular Volume

NFHS - National Family Health Survey

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CHAPTER

NO. TITLE

PAGE NO.

1. INTRODUCTION 1 – 4

1.1 Background of the study 5 – 17

1.2 Need and Significance of the study 17 – 23

1.3 Statement of the Problem 23

1.4 Objectives of the Study 24

1.5 Research Hypotheses 24

1.6 Operational Definitions 24

1.7 Assumptions 26

1.8 Delimitations 26

1.9 Conceptual framework 27 – 32

2. REVIEW OF LITERATURE 33

2.1 General Concepts of alcohol abuse and related intervention in

treatment of alcohol abuse individual. 34 – 41

2.2.1 Review related to studies on prevalence of alcoholism 41 – 54 2.2.2 Research studies related to ill effects of alcohol abuse. 54 – 72

2.2.3 Research studies on effectiveness of counselling on reducing

ill effects of alcohol abuse. 72 – 85

3. MATERIALS AND METHODS 86

3.1 Research Approach 86

3.2 Research Design 86 – 87

3.3 Variables of Study 88

3.4 Research Setting 88

3.5 Population 89

3.6 Sample and Sample size 90

3.7 Sample selection criteria 90 – 91

3.8 Sampling Technique 91 – 92

3.9 Data collection instruments 93 – 95

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NO. NO.

3.11 Content validity 96

3.12 Reliability of the tool 96 – 97

3.13 Ethical Considerations 97

3.14 Pilot Study 98

3.15 Data Collection Procedure 99 – 100

3.16 Data Analysis Procedure 101

4. RESULTS AND ANALYSIS 102–103

4.1 Description of demographic variables of the substance

abusers 104–108

4.2 Assessment of pretest level of awareness regarding ill effects

of substance abuse among substance abusers 109–111

4.3

Assessment of post test counselling level of awareness regarding ill effect of substance abuse among substance abusers

112–115

4.4

Comparison of pretest and post test counselling level of awareness regarding ill effects of substance abuse among substance abusers.

116–124

4.5

Association between mean differed score of post test counselling level of awareness regarding ill effects of substance abuse among substance abusers with their demographic variables.

125–136

5. DISCUSSION 137–146

6. SUMMARY, CONCLUSION, IMPLICATIONS,

RECOMMENDATIONS AND LIMITATIONS 147–155

REFERENCES 156–174

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S. No. Title Page No.

1.1.1 Direct and indirect effect of alcohol on individual, family and

community level 7

1.1.2 Alcohol consumption is related to major disease, injury condition 9 1.1.3 Mortality and morbidity related to alcohol, Age standardized

death rate and alcohol attributed fraction in India

11

1.1.4 State wise Alcohol consumption In India 12

1.1.5 Mortality rate due to consumption of illicit alcohol in year 2003 to 2010 in India

13 – 14

4.1.1(a)

Frequency and percentage distribution of subjects according to their age in years, educational status, marital status, type of family, presence of family members with habits of substance abuser

104

4.1.1(b)

Frequency and percentage distribution of demographic variables of substance abusers according to their monthly income, type of alcohol, duration of alcohol consumption, frequency of alcohol consumption, occupation and grams of alcohol intake

106

4.2.1 Frequency, percentage and pretest level of awareness regarding ill effects of substance abuse among substance abusers

109

4.2.2 Assessment of the pretest counselling level of awareness regarding ill effects of substance abuse among substance abusers

110

4.2.3 Mean and standard deviation of pretest level of awareness regarding ill effects of substance abuse among substance abusers

111

4.3.1

Frequency and percentage distribution of post test 1 counselling level of awareness regarding ill effects of substance abuse among substance abusers

112

4.3.2

Mean and standard deviation of post test 1 counselling of awareness regarding ill effects of substance abuser among substance abusers

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4.3.3

Frequency and percentage distribution of post test 2 counselling level of awareness regarding ill effects of substance abuse among substance abusers

114

4.3.4

Mean and Standard deviation of post test 2 counselling of awareness regarding ill effects of substance abuse among substance abusers

115

4.4.1 Comparison of pre test and post test 1 Mean, S.D, Mean difference of recognition level and its significance

116

4.4.2 Comparison of pre test and post test 2 Mean, S.D, Mean difference of recognition level and its significance

117

4.4.3 Comparison of pre test, post test 1 and post test 2 Mean, S.D, Mean difference of recognition level and its significance

118

4.4.4 Comparison of pre test and post test 1 Mean, S.D, Mean difference of ambivalence level and its significance

119

4.4.5 Comparison of post test 1 and post test 2 Mean, S.D, Mean difference of ambivalence level and its significance

120

4.4.6 Comparison of pre test, post test 1 and post test 2 Mean, S.D, Mean difference of ambivalence level and its significance

121

4.4.7 Comparison of pre test and post test 1 Mean, S.D, Mean difference of taking steps level and its significance

122

4.4.8 Comparison of post test 1 and post test 2 Mean, S.D, Mean difference of taking steps level and its significance

123

4.4.9 Comparison of pre test, post test 1 and post test 2 Mean, S.D, mean difference of taking steps level and its significance

124

4.5.1

Association between the mean differed score of recognition post test 2 counselling level of awareness regarding ill effects of substance abuse among substance abusers with their demographic variables such as age in years, educational status, marital status, type of family, presence of family members with habit of substance abuse and monthly income in rupees

125

4.5.2 Association between the Mean differed score of recognition post test 2 counselling level of awareness regarding ill effects of

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substance abuse among substance abusers with their demographic variables such as type of alcohol, duration of alcohol consumption, frequency of alcohol consumption, occupation and grams of alcohol intake

4.5.3

Association between the Mean differed score of ambivalence post test 2 counselling level of awareness regarding ill effects of substance abuse among substance abusers with their demographic variables such as age in years, educational status, marital status, type of family, presence of family members with habit of substance abuse and monthly income in rupees

129

4.5.4

Association between the Mean differed score of ambivalence post test 2 counselling level of awareness regarding ill effects of substance abuse among substance abusers with their demographic variables such as type of alcohol, duration of alcohol consumption, frequency of alcohol consumption, occupation and grams of alcohol intake

131

4.5.5

Association between the Mean differed score of taking steps post test 2 counselling level of awareness regarding ill effects of substance abuse among substance abusers with their demographic variables such as age in years, educational status, marital status, type of family, presence of family members with habit of substance abuse and monthly income in rupees

133

4.5.6

Association between the Mean differed score of taking steps post test 2 counselling level of awareness regarding ill effects of substance abuse among substance abusers with their demographic variables such as type of alcohol, duration of alcohol consumption, frequency of alcohol consumption, occupation and grams of alcohol intake

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[image:17.612.107.525.104.472.2]

Fig. No. Title

1.1.1 Alcohol marketing and regulatory policy environment in India. 1.1.2 Stage of Change

1.1.3 Conceptual framework based on Modified Prochaska & Dielemente Stage of Change

3.15.1 Schematic representation of Data Collection Procedure

4.1.1 Frequency and percentage of monthly income of Alcohol abusers

4.1.2 Frequency and percentage of type of alcohol preferred by alcohol abusers 4.1.3 Frequency and percentage of Duration of alcohol consumption by subjects 4.1.4 Frequency and percentage of alcohol consumption by subjects

4.1.5 Frequency and percentage distribution of subjects by occupation 4.1.6 Alcohol intake level in grams by Alcohol abusers

4.4.1 Comparison of Mean scores of Recognition at the level of pretest, post test 1 and post test 2

4.4.2 Comparison of Mean scores of Ambivalence at the level of pretest, post test 1 and post test 2

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S. No. Title A Ethical Clearance Certificate

B Permission for conducting the study in the Data Collection Setting C Certificate for Basic Counselling

D Related Research Work Executed E Content Validity Experts

F English and Tamil Editing Certificates G Tool in English and Tamil

H Intervention Tool – English & Tamil I Photos

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A Quasi experimental time series design was used to assess the effectiveness of counselling on level of awareness regarding ill effects of substance abuse among substance abusers at selected settings.

The objectives of the study were.

1. 1 to assess the pretest level of awareness regarding the ill effects of substance abuse among the substance abusers.

2. to assess the post test counseling level of awareness regarding ill effects of substance abuse among substance abusers.

3. to compare pre and post test counselling level of awareness regarding ill effects of substance abuse among substance abusers.

4. to associate the mean difference score on post test counselling level of awareness regarding the ill effects of substance abuse among the substance abusers with their selected demographic variables.

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abuse(alcohol) was measured by SCORATES 8A –Personal drinking Questionnaire .

The major findings of the study was

In pretest, level of awareness regarding ill effects of substance abuse by using AUDIT Scale, majority 113(32.3%) were at risky or hazardous level, 81(27%) were at high risk or harmful level, 71(23.7%) were certainly dependence, 35(11.7%) of them were at low risk level and pretest counselling level of awareness regarding ill effects of substance abuse by Socrates 8A scale, majority 179(59.7%) had low Recognition, 112(32.3%) of them had medium Ambivalence, 179(59.7%) had low level of Taking steps towards their drinking behaviour.

The post test 1 counselling level, 143(47.67%) had medium Recognition, 127(42.33%) had medium Ambivalence, 168(56%) had medium level of Taking steps. In post test 2 counselling level, 166(55.33%) had high Recognition, 139(46.33%) had medium Ambivalence, 160(53.33%) of them Taking steps towards reducing the ill effects of alcohol.

The overall mean difference between pretest, post test 1 and post test 2 Recognition was F = 136.80, taking steps was F = 107.79 at p<0.001 which was highly significant but at Ambivalence level F = 0.175 which was not significant at p<0.001 level.

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ill effects of substance abuse among substance abusers shows statistical significance with demographic variable such as education status at Recognition level and occupation at Taking steps.

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CHAPTER – 1

INTRODUCTION

Substance abuse means the harmful abuse of substance such as alcohol and illicit drugs. Unlimited use of these substances produce the dependence with behavioural, higher mental functioning, physiological changes when abused continuously and repeated strong desire, to ingest substance despite of its harmful consequences. The abusers give first priority or preference to the substance alone and not involving in other activities and leading to development of tolerance and sometimes a physical withdrawal state. Restoration of the health of the substance abusers mainly dependent on the policies related to alcohol and intervention planned to reduce the pattern of substance abuse and related harm, can be significantly reduce the alcohol related problems at public health level and helps the health care professionals to implement the policies relevant to the benefit of the individual in reducing further alcohol related mortality and disability.1

People abuse variety of substances such as alcohol, cocaine, tobacco and other drugs for reasons, but it is clear that our society plays dynamic role in meeting the significant cost related to the abuse of substance. There is an increased in incident of number of cases can be seen reporting to causality units of the hospitals and emergency departments through direct damage to health especially physical injury. Currently there is a decline in abuse of some drugs like cocaine but the abuse of alcohol as increased nowadays.

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People have different meaning to the word alcohol. Government runs alcohol outlets for the purpose of revenue and economists views that alcohol is a product. Public health professional view it as a causative factor of death, injuries and for a common man alcohol is a pleasurable commodity. Today alcohol has entered into the lives of young adults in unrestricted manner because it is available easily in several local outlets and within the easy reach of today’s young generation.2

Definition

Ethyl Alcohol is an ingredient found in various alcoholic beverage preparation is a toxic substance which act on central nervous system producing depressant effect and is observed from the stomach and small intestine into the bloodstream. One standard drink is equal to standard beer 300-400ml, strong beer 100-150 ml, wine 100-250 ml, fortified wine 60-90ml, distilled spirit 30ml, Arrack 40ml, IMFL spirit -30ml and 1 standard drink equal to 10 ml absolute alcohol. 3,4

Chemical Composition of alcohol

Alcohol, a psychoactive substance, has an organic compound refer to ethanol produced by fermentation from grain, vegetables, fruits, cereals with chemical formula C2H50H having high sugar content used in preparation of perfumes ,sweetness fuels, pharmaceuticals and also used in sterilization of hospital instruments according to its carbon bounded to hydroxyl group .

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Classification of alcoholism

Alcoholism refers to the consumption of alcohol, viewed as alcohol addition, with compulsion and un-controlled drinking behaviour usually causing ill effects to the individual health, their family and personal relationship, social mal adjustment. There are various terms used to define alcoholism specially alcohol abusive, alcohol use disorder but they have slight different definition.6 Alcohol abuse lead to potential damage to almost every organ system in human. The toxic effect of alcohol for a longer duration can cause more physical illness and psychiatric problems.7

Various terms were used to define alcoholism but currently this term was dropped and known as Alcohol dependence .over decades the classification of Alcohol dependence had various changes, then classified based on pattern of use as alpha alcoholism, Beta alcoholism, Gamma delta and epsilon alcoholism, then arises the DSM & ICD 10 classification were currently used in diagnosis of Alcoholic dependence has acute intoxication, withdrawal state, dependence syndrome and Harmful use. 4

Alcohol dependence defined as Chronic progressive disease brings changes in behavioural, cognitive and physical, psychological functioning, when abused repeated for long time period of the time includes craving, unable to control the drinking behaviour, knowing the harmful effect still consume alcohol and given first priority than other activities leading to increase in tolerance, withdrawal state (WHO 2014).1

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and possible damage to the patient and his environment. Use of alcohol appears to be "misconduct", and the severity of the pathological process is growing slowly.

In beta alcoholism, Socio-cultural factors are the leading cause. Drunkenness is dictated by the traditions and customs micro social environment. In the course of the disease may appear in certain physical effects of alcohol abuse, certain social consequences like arrests, antisocial behaviour.

Alcoholism, this is a more severe form of the disease. The patient first psychologically and then physically (in the terminology of Jellink) becomes dependent on alcohol and the disease progresses in significant pace. The most important characteristic of gamma alcoholism is loss of control over the quantity of alcohol consumed and the state of the expressed intoxication. Multiday heavy alcoholic excesses alternate with intervals. The whole range of negative consequences of alcohol use, this type is common in the Nordic countries, where preference is given to the consumption of liquor.

Historical context of Alcoholic consumption

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of alcohol use emerged in the Indian society. This practice of alcohol consumption grower tremendously due to globalization, urbanization and due to easily availability, affordability.8

1.1 BACKGROUND OF THE STUDY

Alcohol has been used in human societies throughout the time, arguing about its merits and demerits whether it is good or bad, but the consensus is that alcohol is both a tonic, poison and ticking bomb. According to recent concepts on alcohol ,which is considered as a” disease producing agent” causing the acute and chronic intoxication.

Factors influencing alcohol consumption and related harm in the adults.

As per various Literature suggestion that there is no one single influencing factor for Alcohol consumption but there are many vulnerable factors in individuals to develop alcohol abuse manifested in the form of physical, mental and social problem, these factors are listed below.

Age

Early age initiation of alcohol abusers are more prone for dependence at later age. Those who are considered as vulnerable population are children, adolescents and elderly people. This age related vulnerability generates the high risk behaviours

Gender

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prevalent in adult men in age between 15-59 years were more frequent drinker in larger quantities.

Familial factor:

One of the major important vulnerability factors is genetic factor, DRD2gene is responsible for alcohol use initiation, reinforcing the abuse activities and metabolism with family history of alcoholism ,there are greater chance of children developing the habit of drinking alcohol.

Socio economic factors

The pattern of drinking varies from higher to lower socio economic group, Abstainer. Grading from more drinker to low risk drinker is prevalent in higher socio economic status but severe alcohol-related health problem is more in low socio economic status, were most vulnerable to alcohol related problem .The reason behind this was lack of network support and awareness., increasing in market liberalization, availability of alcohol and affordability among lower socio economic group especially in developing countries.

Economic development:

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Other factors includes

Habitation, peer pressure, pleasure seeking activities, psychological problems like depression low self esteem, Abusing alcohol for promoting sleep, relieve pain, occupation, overcome financial and family problem were the other factors contributing to alcohol addiction.9

Effect of alcohol on individual, family and community level

There are direct and indirect effect of alcohol on individual, family and community described in Table 1.1.1.10

Table 1.1.1: Direct and indirect effect of alcohol on individual, family and

community level

Effect of Alcohol

Individual level Family level Community level

1.Harmful effect produces toxic effect on vital organs, tissues.

2.Intoxication

Leading to changes in cognition, behaviour, consciousness, impairment of physical co-ordination, perception.

3. Alcohol dependence and tolerance develop.

Alcohol a family disease

More domestic violence, household expenditure is spent on alcohol, separation and divorce, default social role.

1. Addressed in term of burden of disease, alcohol attributed death.

2. Socio economic cost. Unemployment, drunk driving, damaging other property, Vehicle crashes, damage to other property.

3.Societal cost

Less productivity, absenteeism, unemployment, reduced earning potentials.

4.Intangiable cost

Cost related to pain, suffering and poor quality of life.

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Ill effects of Alcohol abuse

Alcohol has marked effects on the central nervous system, produces psychic dependence of varying degrees from mild to strong. Worldwide estimation that alcohol related cause and death in people were 2.3 million, of all the people death were 3.7% in men 6.1% death and women 1.1% death, 64.9 million DALYs was due to alcohol related causes. 2 billion people worldwide consume alcoholic beverages, various ill effects and disorders arising out of alcohol abuse were 76.3 million.11

Alcohol constitutes a chemical ethanol, when consumed, has a multiple effects on the individual life involving the family, society causing emotional, physical, behavioural and social problems. The harmful use was a causative factor for more than 200 disease and injury condition, the most important five risk factor for alcohol related illness and disease, disability, death in the world.2

Harmful drinking is a major determinant for neuropsychiatry disorder such as alcohol use disorders, epilepsy and other non communicable disease, associated with many serious social, developmental issues like child neglects, abuse. Alcohol addiction increases the degenerative disease that includes craving, physical dependence, tolerance and loss of control. 12

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[image:30.612.111.526.93.645.2]

Table 1.1.2 Alcohol consumption is related to major disease, injury condition

Disease Condition Men Women Both

1. Neuro psychiatric disorder Unipolar disorder Epilepsy

Alcohol use disorder: Alcohol dependence and harmful use.

3% 23% 100% 1% 12% 100% 2% 18% 100%

2. Malignant neoplasm

Cancer of oral cavity and pharynx Cancer of oesphagus.

Cancer of liver Cancer of breast

22% 37% 30% - 9% 15% 13% 7% 19% 29% 25% 7%

3. Diabetes Mellitus and cardiovascular disorder

Ischemic heart disease Hemorrhage stroke Ischemic stroke 4% 18% 3% -1% 1% -6% 2% 10% -1% 4. Gastrointestinal disease

Liver cirrhosis 39% 18% 32%

5. Unintentional injury Motor vehicle accident Drowning Falls Poisonings 25% 12% 9% 23% 8% 6% 3% 9% 20% 10% 7% 8% 6. Intentional Injury

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Magnitude of Alcohol dependence –Global Scenario:

According to WHO Global Alcohol Report 2011, death related to alcohol constitute nearly 4%. Globally alcohol related all male deaths were 6.2% compared to 1.1% of female death. Annually alcohol related death were 320,000 among young people aged 15 – 29 yrs resulting in 9% of all death in the age group. Global information on alcohol and health report reveals that the harmful use of alcohol, annually results in death of 2.5 million people, causes illness and increasingly affects younger generation drinkers in developing countries.14

Health consequence on alcohol dependence global statistics 2012, of all global death, 3.3 million deaths were related to alcohol abuse. There were significant differences in sexes in relation to alcohol attributed death globally. 7.6% of deaths was among males and females deaths were 4.0% attributable to alcohol. In 2012, DALYs (disability-adjusted life years) and global burden of disease and injury, related to alcohol was 139 million (WHO 2012)15

Magnitude of Alcohol dependence – Indian Scenario

In the modern lifestyle, alcohol consumption is increasing and emerging economy in India with increase in number of consuming spirit. In South East Asia Region, India is dominated with 65% of producer of alcohol and 7% of alcohol beverage are imported into the region, 10% to 15% steady growth rate each year in alcohol use is from south part of the India.16

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wine. The pattern of drinking from least risk to most risky scored from 1 to 5. Alcoholic in Indian population scored 3, with prevalence of alcohol use disorder in Male was 4.5% female were 0.6% and 2.6% of prevalence rate in both sexes. When compared with South East Asia region prevalence rate and Alcohol use disorder with India (SEAR-2.2%, India-2.6%) shows the magnitude of alcohol use disorder in India was high. Alcohol dependence in Male was 3.8%, females were 0.4%. Both sexes were 2.1% and SEAR region Alcohol dependence was 1.7.17

The mortality and morbidity related to alcohol, Age standardized death rate and alcohol attributed fraction in India summarized in the table 1.1.3.17

Table 1.1.3: Mortality and morbidity related to alcohol, Age standardized death rate and alcohol attributed fraction in India

Source: WHO Global Status Report of Alcohol and Health 2014

Based on years of life lost score from least to most (1 to 5 score), the mortality rate due to alcohol use above 15 years were Scored 4, which indicate the seriousness of the alcohol dependence (WHO 2014).

Health problem

Age standardized death rate per 100,000 population above

15 years

Alcohol attribution fraction

Male Female Male Female

Cirrhosis of Liver 39.5 19.6 62.9 33.2

Road traffic accidents

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Alcohol consumption in India-state wise among the young men. Total alcohol consumption in young men is 21%. In India there is a state wise variation in consumption level exist, depicted in Table 1.1.4 .18

Table 1.1.4 State wise Alcohol consumption In India

Alcohol consumption in India statewise Percentage Delhi 19 Tamilnadu 24 Andra Pradesh 29 Kerala 26 Karnataka 13 Arunachal Pradesh 49

Source: National Family Health Survey NHF-3, 2009

Alcohol consumption among young men higher in age 20-24years, who are married. In southern region of India men were twice likely to consume alcohol than men from north region and the factor related to alcohol consumption is rural residence.18

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Illicit alcohol brew which is adulterant contain methanol an industrial solvent is a causative factor for death among people and various of hooch tragedies in India is elicited in Table 1.1.5shows the mortality rate in year 2002 to 2010 .20

Table 1.1.5: mortality rate due to consumption of illicit alcohol in year 2002 to 2010

in India

Place Year Death or Cases Remarks

Thiruvallur Tamil Nadu 2003 Numbers of death were 13, 92 individual males

fallen ill.

Cuddalore 2004 Number of death

were 46 .

120 males were treated and 29 individuals lost

vision

Villipuram 2005 Number of death

were 5 .

-

Nelamangala (Bangalore)

2005 Number of death were 21 .

-

Hoskote (Bangalore)

2005 Number of deaths were10 .

-

Rewari (Haryana)

2005 Number of deaths were 8 .

-

Menambedu (Tamil Nadu)

(2005) Number of deaths were 13 .

Intoxication worth Rs.170,000 and 15,175

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Place Year Death or Cases Remarks Dharmapuri

(Tamil Nadu)

2006 45 deaths 125 admitted for

treatment

Jharkand 2007 6 deaths -

Bihar 2007 3 deaths -

Bangalore 2008 83 deaths -

Ahmedabad 2009 143 deaths -

Chikkaballapur 2010 12 deaths 40 unwell -

Source: Media reported hooch tragedies in India updated from Bangalore study 2006.

According to National Crime Record Bureau data (2013) the total number of alcohol related deaths has been continual rise from the period ranging from 2008 to 2018, a steep rise of 27% from the level of 4308 to 5478, city wise analysis of 2012 data showed that Chennai has registered the maximum deaths (140 deaths) and least was in Jaipur with 16 deaths.2

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According to Project conducted by Integrated Disease Surveillance on non communicable disease risk factor survey from the year 2007 – 2008, among 5000 households in urban/rural area of Tamil Nadu regarding alcohol consumption ,15% of the adults for past 12 months were drinking alcohol , for 30 days 11% of adults were consuming alcohol, 6% male were past drinkers. Men had higher habits of consuming alcohol than women (30% in men compared with women is 0.1%), on a drinking day 2 drinks was consumed as an average. 21 years were the starting age (mean age) for adults in the age group between 15 – 34 years. The respondents average age of drinking was 25 years and their occupation was agriculture.22

Laws governing the prevention of alcohol related problem in India.

Every state in India has legal age for drinking, it vary from state to state and the legal age for drinking is regulated by laws enforced by the government. In india there are few . were alcohol completely prohibited such as Manipur, Kerala, Nagaland, Gujarat and in Lakshadweep but at the same time all other states allows the consumption of alcohol with a fixed legal drinking age. Drinking age differs according to alcoholic beverages 23,24

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Education programme, and mass media on Harm reduction in Alcohol abuse in India

Tackling of problems of Alcohol various programmes were conducted by Ministry of social justice and empowerment in central sector scheme of Assistance for prevention of Alcoholism and substance in collaboration with Nehru Yuva Kendra sangath, young affairs and sport were involved in gathering the volunteers for creating awareness among youth on ill effects of alcohol abuse. Through rally, poster making surveys, wall writings financial assistance are given to these agencies in rehabilitation of Alcoholic addicts and funds are allocated for performing projects related to alcohol use disorder problem. The total number of project from 2012-13 in Tamilnadu is 1(one) and fund released for the project was 6.5 lakhs. Alcohol web India site was designed by the All India institute of Medical science and National drug dependence treatment centre for supporting the patient with Alcoholic use disorder and health care provide by giving necessary information related to alcohol harm, (Report from ministry of social Justice and Empowerment 2014).25,

For policy Implementation and prevention of Alcohol related harm, alcohol education is an essential comprehensive approach to identify the high risk population, culturally appropriate, realistically achievable goals should be clearly defined will be an essence of creating awareness on ill effects of alcohol among the rural community.

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with integration of balance policy approach about weighing the rights, responsibility, regulation which should be intended to minimize harm.26

Use and abuse of alcohol at all economic level, present in all walks of life in both gender has directly or indirectly decreased the average life expectancy by 10 to 12 yrs (7%). Critical role of health service is to tackling alcohol attributable harm, hence global strategy is needed to reduce the harmful use of alcohol suggesting for

1. Early identification, screening and brief intervention for harmful and hazardous drinking.

2. Identify gap, supporting rapid assessment and main principle areas for intervention at the rural community level.

3. Recognition and increase the awareness on alcohol related harm at local level. 4. Drinking driving counter measures.

5. Regulating and marketing the availability and restriction 6. Reducing the negative drinking consequences

Involving the community leaders of the rural village in creating awareness to prevent underage drinking, and develop alcohol free environment especially for at risk group and youth.21

1.2 NEED AND SIGNIFICANCE OF THE STUDY

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The Indian alcohol industry focuses mainly two preferred form of alcohol in India i.e., Indian Made Foreign Liquor (IMFL) and Indian Made Indian Liquor (IMIL or Country Liquor). IMIL spirits alcohol content is 42.8% (v/v volume to volume) sold under government license, regional distribution of IMFL in India in 2011 showed in fig.1.1.1 where 49% were target in South region in India .27

Fig.1.1.1: Alcohol marketing and regulatory policy environment in India, 2013 Source: Alcohol marketing and regulatory policy environment in India (2013). According to TASMAC Wikipedia report, the impact of alcohol trade in Tamil nadu and growth rate of revenue for year 2013-2014 was 23,401 crores with 6800 retail liquor shop with 4271 bar attached outlets and Taminadu stands number one rank among all the states in India, with raise in no. of death due to consumption of illicit liquor, adulteration, over pricing and black marketing, this shows the monopoly and double blindness of government policy not showing interest in the harm reduction related to alcohol consumption.28

Kavanagh AM (2011) conducted a study among 2334 subject who were male with age 18 to 75 years to find an association between the alcohol density outlets and increase harm related to alcohol abuse. Finding revealed that density of alcohol outlets

49%

12% 9%

30%

South

North

East

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was associated with increased risk of harm and more number of alcohol outlets in the local premises is more prone for increase risk of harm and alcohol abuse pattern in that area.29

Decreasing the number of off premises alcohol outlet can reduce the risk of harmful alcohol abuse pattern. How can this be implemented, only by growing role of research, identifying gaps in the alcohol policies of the country, fill their gap by new knowledge base, including increasing assessment of the cost effective intervention and special efforts to improve the awareness regarding harmful effect of alcohol through counselling regarding harmful effects to younger generation, the family and society.

Many approaches to educate and help people to take action enhance their intention to reduce the alcohol related harm, community initiatives of challenge norms about alcohol consumption and distribution, with providing these information and action taking perennially in attractive manner as an intervention for reducing the alcohol related harm but there is a need to achieve sustained change in behaviour particularly in an environment where marketing competition and norms in the society supporting drinking as alcohol is accessible and affordable at their ease.

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The nurses should be aware of these unique positions to enhance the motivate and facilitate, encourage behavioural change while caring for alcoholic dependent client in primary, acute care setting and at community level. When alcoholic abusers seeks care of their drinking problem related to their substance abuse habit which led them to hospitalization and interfere with normal living. Even though they are aware of the problem associated with addictive behaviour, ambivalence still persists to decide for the change in drinking behaviour.

In a recent studies in India, by Ruma Dutta et al., conducted a cross sectional study on 157 adult male, were selected by simple random sampling technique. questionnaire were used to collect information on background characteristic, history of alcoholism; social factor. The study result shows that the mean age of the adult were 37.2 years, 35.7% prevalence of alcoholism among adults, 4.5% adult presented with symptoms of chronic alcoholism and underwent treatment, 55.2% adults did not take treatment for alcoholism due to these family problems. The study concluded that there is a need to raise awareness regarding ill effect of alcoholism, necessary rehabilitation self help programme to bring down prevalence of alcoholism.30

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Geshi M et al., conducted a study to find out the effect of alcohol related health education in decreasing alcohol problems, drinking behaviour among Japanese Junior College students. 38 students were assigned to experimental group and 33 students to control group The experimental group received 90 min of alcohol related health education session which includes ethanol patch test, videos on alcohol related teaching , and an ex-alcoholic lecture . While Control group received information on smoking. The student knowledge on alcohol drinking and problem behaviour were assessed by self administered questionnaire at baseline, were followed for 2 month period. The study finding revealed that alcohol related education was effective intervention in creating knowledge and awareness related to alcohol abuse problem at p= 0.035 in the intervention group at the follow up.32

Atree. D (2013) examined the effectiveness of motivational interviewing in decreasing the depressive symptom in adults with substance use. 104 participants above 18 years had hazardous drinking more than 3 drinks and scored more than 15 on the Beck Inventory II scale for Depression were assigned to receive 3 session of motivational interviewing, printed information on alcohol was delivered as adjunct to depressive patient and follow up interview was carried out at 3 and 6 months over telephone. The result of the study was 73 participants were at hazardous drinking baseline. Motivational interviewing were less likely to report hazardous drinking (60.0 V/s 81.8% p = 0.43). Motivational interviewing was an effective intervention in reducing the hazardous drinking among depression patients33.

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or educational procedure randomly. SOCRATES – 8A readiness to change questionnaire were used to measure motivation for change – after one week post intervention, motivational participant had significant greater level of problem recognition. The motivational group post intervention scores were significantly higher on taking steps scale and lower in ambivalence scale. The result supported the efficacy of motivational intervention for decreasing self reported levels of ambivalence about changes and for increasing problem recognition and taking steps towards change.34

Prevalence of poverty in India was the major Risk factor for Non communicable disease. World Bank report 2011 reveals that when compared to poverty line of International for US$ is 1.25%, 32.7% of Indians are living in below poverty line, which was less than Indian national poverty line and Indians live on less than US$ 2 per day constitute to 68.7%.35,36,37

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control of NCD and alcohol consumption.35 Community Mental health nurse should conduct various alcohol education programme to the at risk, Vulnerable group heightened the risk of harm and need to emphasise the importance of integration of alcohol education into general health education which should be delivered to the rural community by nursing professional.

The investigator aim is to harm reduction , reduce the adverse health effect, to prevent the early onset or delaying the onset of abuse of alcohol, preventing misuse of abusing substance in the rural community, help alcoholic to provide relevant information for early intervention with at risk alcohol users before the acquire more severe, multiple consequences. This made the investigator to select the on alcoholism and do counselling intervention for increasing the awareness about the hazards related to alcohol use among the members of the general community especially alcoholics.

1.3 STATEMENT OF THE PROBLEM

A study to assess the effectiveness of counselling on level of awareness regarding ill effects of substance abuse among the substance abusers at selected setting.

1.4 OBJECTIVES

1. to assess the pre test level of awareness regarding the ill effects of substance abuse among the substance abusers.

2. to assess the post test counselling level of awareness regarding ill effects of substance abuse among substance abusers.

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4. to associate the mean difference score on post test counselling level of awareness regarding the ill effects of substance abuse among the substance abusers with their selected demographic variables.

1.5 HYPOTHESES

RH1 There is a significant difference in pre and post counselling level of awareness

score regarding ill effects of substance abuse among substance abuser.

RH2 There is a significant association of post counselling level of awareness regarding

ill effects of substance abuse among substance abusers with their demographic variable.

1.6 OPERATIONAL DEFINITION 1.6.1 Effectiveness

Refers to the outcome of counselling on awareness regarding ill effect of substance abuse among the substance abusers.

1.6.2 Counselling

Refers to motivational interviewing technique given in individual session to alcohol abuser to identify the risk level, promote the desire to change by providing psycho education on the ill effect of alcohol through flash card and enhancing the strategy for the change in behavioural through rethinking drinking and reinforcing with the tips of reducing alcoholic consumption.

1.6.3 Level of Awareness

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their behaviour by reducing the frequency of taking alcohol, reducing the risk of dependency by counselling is measured by SCORATES SCALE -8A

1.6.4 Ill Effects of substance abuse

It refers to problems due to Alcohol use such as Physical, Mental health problems, Family, Occupational and Social problems.

Physical problems- it refers to harmful effect of alcohol system wise and its complication.

Mental Health problems- it includes Anxiety, Depression, Abuse of spouse, parents and neighbour, Antisocial behaviour, alcohol induced jealousy, suicidal intention and attempt.

Social problem- loss of friends circle, misbehaviour with others, bad social reputation, loss of position in their friend circle , social isolation, borrowing money frequently, and unable to pay the borrowed money, fights, involving in thefts and quarrels, low self esteem.

Family problem- family members experiencing shame, feeling of guilt , anger. presence of alcohol abuser in family lead to feeling of isolation and fear in family members , conflict, broken family, frequent fight, long absence and runaway, rejection.

Occupational problem- absenteeism for longer period , not punctual at work , poor work efficiency, loss of skill in performing skilled jobs or accidents while working with heavy machines, pay day drinking problem.

1.6.5 Substance abuse

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1.6.6 Substance abusers

Refers to those who take alcohol more than a period of 1 year with intake of alcohol above 20 grams/60 ml per day resulting in harmful to oneself or ability to work or establishing IPR.

1.6.7 Selected setting

Refer to Arikampedu & Kollumedu village at Thiruvallur district.

1.7 ASSUMPTIONS

1. Counselling on ill effects of substance abuse has an impact on intake of alcohol and its consumption.

2. Substance abuser require counselling to maintain quality of life.

1.8 DELIMITATION

The study is delimited to the men who were identified as alcoholic from Kollumedu and Arikampedu village during the period of study.

1.9 CONCEPTUAL FRAMEWORK

1.9.1 CONCEPTUAL FRAMEWORK BASED ON PROCHASKA AND DIELEMENTE STAGE OF CHANGE THEORY FOR THE PRESENT THEORY

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Enhance the positive behaviour to modify the individual problem behaviour ,focus on the decision of the individual and uses various behaviour modification technique s and help the individual feel the success of the motivational interviewing both physical and psychological problem. . The heart of Model is stage of change where the individual move through a several series of stages which requires behaviour modification.

The stages of change are 1. Precontemplation

During this stage, the individual is not seriously thinking about the problem behaviour that needs to be changed and not ready to get help for the problem behaviour and they are defensive if other people’s place their efforts by pressuring them to quit the bad behaviour (or) habit.

2. Contemplation

Here the individual is more aware of the harmful consequence of their bad habits but not yet ready to make change, they are ambivalence about change and weighs the pros and cons of quitting (or) changing their behaviour. Here they think about both positive and negative aspects of their bad habits and doubt whether that the positive benefit associated with quitting will outweigh the short term negative cost. Individual are ready to receive information about their bad habits and use psycho educational information thought concerning about their bad habits.

3. Preparation/Determination

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4. Action Stage:

Individual believe that they have ability to change and involved in taking step to quit their behaviour by using variety of technique. They make effort to quit or bring behaviour change but at the same time they are risk of developing relapse.

5. Maintenance Stage

Avoidance of temptation by maintaining the behaviour change, the ultimate goal is to maintain status quo and try to remind their achievement and progress. They have made reformulate and acquire new skill to deal with tackle bad habits and avoid relapse during this stage individual reevaluate the progress they made in moving up and down through these stages.

6. Relapse

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[image:50.612.228.448.81.367.2]

Fig.1.1.2: Stage of Change

1.9.2 APPLICATION OF THE CONCEPTUAL FRAMEWORK BASED ON PROCHASKA AND DICLEMENTE STAGE OF CHANGE MODEL FOR THE PRESENT STUDY

Precontemplation

During this stage the alcoholic abusers are not seriously thinking about the drinking behaviours and the investigator confirms the readiness to change, encourage them, identify the current behaviour, maintaining the trust building, concern confidentiality and proceeding the assessment and screening of alcohol client and help them to realize risk level personally and proceed to the next stage.

Contemplation

During this stage the alcohol abusers are in ambivalence stage, the investigator raise the awareness regarding the ill effects of alcohol abuse based on risk level and

Precontemplation

Contemplation

Preparation

Action

Maintenance

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make the alcoholic client, to use positive behaviour change outcome and proceed for the next stage.

Preparation stage

The alcoholic abusers are ready to change their drinking behaviour, planning and commitment is there, the investigator enhances their readiness to change through counselling—motivational interviewing by providing psycho education on ill effect of alcohol abuse by using flash card.

Action stage

During this stage the alcoholic abusers proceed for the next measure, to reduce their risk level and the investigator assess their motivational level and counsel them by intensifying by enhancing the strategy for rethinking drinking, counselling on tips of reducing alcohol consumption and reinforcement of psycho education on ill effect of alcohol abuse, now the client follows the counselling advice and goes for the next stage.

Maintenance stage and relapse

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Precontemplation Contemplation Preparation Action Maintenance & Relapse

Alcoholic Abuser Not aware of their problem related to drinking. Assessing their demographic variables and screening the risk

level related to alcohol abuse by

AUDIT SCALE Investigator Maintain trust building, consent confidentiality Proceeding the assessment and screening of alcohol abuse Raising the awareness on ill effects of alcohol

abuse based on AUDIT Risk level.

Pretest counselling level of awareness

on ill effects of alcohol by SOCRATES 8A Personal Drinking

Questionnaire To assess their motivational level

of change.

Alcoholic abuser are ambivalence about the drinking

habit.

Alcoholic abuser are preparing for a

behavioural change Investigator gives counselling – motivational interviewing by providing psychoeducation

on ill effects of alcohol abuse by

using flash card

Alcoholic abusers proceed for the next measure to reduce their risk

level. Investigator Assess the Post Test counselling 1

and intensify the counselling by

enhancing the strategy for rethinking drinking

Counselling on tip of reducing

alcohol consumption and

reinforcement of psycho education

on ill effects of alcohol abuse

Investigator Assess the alcohol abusers motivation level of change by Socrates __ Scale by

post test counselling 2 Post Test Counselling 2 Socrates Scale Score of

alcoholic abuser Recognition low Recognition medium Recognition high Recognition Ambivalence low ambivalence medium ambivalence high ambivalence Taking Steps Low Taking Step Medium Taking Step

[image:52.792.58.760.106.516.2]

High Taking Step

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SUMMARY

This chapter has dealt with Introduction, need for the study and statement of the problem, objective, operational definitions, hypothesis, delimitation and conceptual framework of the study.

OUTLINE OF THE REPORT

Further aspects of the study are presented in the following chapters. Chapter II: Review of related literature.

Chapter III: Review Methodology which includes research approach design, setting, population, sample, and sampling technique, data collection, description of tools, validity and reliability of tools, development of counselling session package, pilot study, data collection procedure, and plan for analysis of data.

Chapter IV: Analysis and data interpretation Chapter V: Discussion

Chapter VI: Summary, conclusion, nursing implications, recommendations and limitations of the study.

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CHAPTER – II

REVIEW OF LITERATURE

Conduction research is based on thorough undertake of review of literature which

familiarize the researcher themselves with the knowledge base. The most important of

research literature review is written part of summary on state of evidence related to

research problem.41

Review of literature serves as essential background for any researcher for

understanding current knowledge of the topic, eliminate the significance of new study,

formulating and delimit the problem, suggesting a theoretical framework to choose most

appropriate design for study, throws light on the flexibility and reveals constraints of

data collection .42,43

The major steps in preparing written research review include formulating a

question, conducting a search through relevant resource retrieving, abstracts and

encoding information, analyzing the aggregated information and critiquing the studies,

and involves written summary preparation. The review of literature related to present

study were from, unbound Medline, Alcohol Web India, books and published articles

search to broaden the understanding and gain insight into the selected problem under

study.41

The review of literature is divided in to two parts.

2.1 Part 1: Review of literature related to general concepts of alcohol abuse and related

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2.2 Part 2: Review literature on studies related to

2.2.1 Review related to studies on prevalence of alcoholism.

2.2.2 Research studies related to ill effects of alcohol abuse.

2.2.3 Research studies on effectiveness of counselling on reducing ill effects of

alcohol abuse.

Part-I

2.1 General concept of alcohol abuse and related intervention in treatment of

alcohol abuse individual

Alcoholism is referred to as pre occupation with a compulsion towards the

consumption of alcohol or impaired ability to recognize the negative effect of excessive

alcohol consumption which includes four symptoms.

1. Craving- Compulsion or a strong desire to drink.

2. Loss of control-On any given occasion the individual’s inability to limit the one’s

drinking.

3. Physical dependence- includes the withdrawal syndrome which occurs after stopping

the use of alcohol after an episode of heavy drinking.

4. Tolerance - increasing the alcohol consumption amount in order to feel the earlier

effects.

Phases of alcoholic pattern of drinking

Phase I – Prealcoholic phase

Adults drink alcohol to relieve tension and stress of life end up in tolerance and

amount of consumption of alcohol increases to achieve the desired effect.

Phase II – Early alcoholic phase

Begins with black outs, pre occupation with drinking individual feels guilt and

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Phase III – Crucial phase

Completely physiological dependent and lost control to decide whether or not to

drink, here drinking become the total focus.

Phase IV – The chronic phase

More of emotional and physical disintegration the individual is usually

intoxicated and life threatening, physical manifestations is evident.

Harmful effects of alcohol

Alcohol is a toxic substance which causes harmful effects in individual who

abuse it. The various ill effect of alcohol on individual sphere of life includes the

physical and psychosocial effects.

Physical effect:

Gastro intestinal system:

• Slows down aggressive functioning

• Gastric ulcer

• Acute and chronic pancreatitis

• Stealosis or fatty liver

• Cirrhosis

• Alcoholic hepatitis

• Liver cancer

• Esophageal varicies

• Colitis and enteritis

• Gastric or duodenal ulcers

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Cardiovascular system

• Alcoholic cardiomyopathy

• High blood pressure (Arrhythmias)

• Interfere with normal health system

• Alcohol abuse leads to weaken heart muscles, damage blood vessel

Genitourinary system

• Prostate gland enlargement

• Prostate cancer

• Sexual dysfunction – decrease libido

• Impotency

• Infertility, decreased menstruation in female

Metabolic changes

• Hypoglycemia, hyperglycemia

• Hyperlipidemia

• Hyperuricemia

• Osteoporosis

Haematological changes

• Anemia and increased risk of infection

• Abnormal red blood cell, white blood cell and platelets

Neurological changes

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• Peripheral neuropathy

• Pricking sensation and pain in hand , feet

• Dementia

• Short term memory loss

• Seizure

• Polyneuropathy

Respiratory system

• Cancer of oropharynx

• COPD, infection and tuberculosis

• Pneumonia

Cancer risk

Cancer of mouth, throat, liver, colon, breast

Social Effects

• Marital disharmony and domestic violence

• Criminal behaviour

• Financial problem

• Unsafe sex

• Family problems

• Poor work performance

• Absenteeism

• Poor relationship with colleagues

• Discipline problem

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Alcohol warning signs

Twelve warning signs of problematic drinking.

• Alone and secret drinking

• Inability to maintain the limit amount of alcohol to be consumed

• Black out

• Ritual drink – habit of taking drink before and after food

• Loss of interest in daily activities (or)unable to find the pleasure

• Compulsion to drink

• Irritability occur when normal drink of time approaches

• Keeping alcohol at unlikely place such as work place, home, bags, vehicle, cars

• Gulping drinks

• Experiencing legal problem or problem with relationship and employment

• Developing tolerance

• Experience physical withdrawal .44

Treatment approaches

Treatment may vary according to individuals, the goal of treatment includes

Immediate goal, Short term goal, long term goal.

Immediate Goal – Detoxification, psycho social intervention

Short term Goal – Management of psychiatric co-morbidity ,medical problem and to

reintegrate with family and to community

Long term Goal – Mainly rehabilitation, relapse prevention, improve the quality of life

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Pharmacotherapy

It is used to reduce problematic drinking in individuals with alcohol dependence

withdrawal symptoms and craving (e.g. Disulphiram, Naltroxene, Acamprose,

Topiramite)

Brief Intervention

Brief intervention employed with a hazardous or harmful use of alcohol, here

client is in early stage of drinking, associated with medical condition, those unaware of

real or potential harm related to alcohol use. It is based on Frame approach: providing

feedback, personal responsibility, providing advice about changing the drinking pattern

following an empathetic and understanding approach.

Motivational interviewing

Centers on the idea that individual with problematic drinking pattern will

recognize the negative consequence related to their drinking. But need assisting in

making the decision to change. Here the therapist help the client to recognize the

discrepancy between the current problem or behaviour and their future goal. Various

motivational strategies are there for benefit of client, to make change at each stage of

motivational interviewing session. Strategies are resolving ambivalence facilitation

feedback developing coping skill, enlisting society and family support identify high risk

situation. Motivational technique encourage the patient to get realistic and attainable

goals using positive feedback, encourage and sustain progress as well as change with

Figure

Fig. No.
Table 1.1.2 Alcohol consumption is related to major disease, injury condition
Fig.1.1.2: Stage of Change
Fig.1.1.3: Conceptual framework based on Modified Prochaska & Dielemente Stage of Change
+7

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