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Quality of Life of Alcohol Dependents after Community Based Camp Intervention in the Treatment of Persons with Alcohol Dependence Syndrome
Authors
1UmeshTonse, 2Sinu.
INTRODUCTION Alcohol consumption is the worlds third largest risk factor for disease and disability; in middle-income countries. Alcohol is a causal factor in 60 types of diseases and injuries. Almost 4% of all deaths worldwide are attributed to alcohol, greater than deaths caused by HIV/AIDS, violence or tuberculosis. Alcohol is also associated with many serious social issues, including violence, child neglect and abuse, and absenteeism in the workplace. Quality of life has become a dominant theme in planning and evaluating services for people with alcohol dependence. It is recognised increasingly as an important component in the evaluation of alcohol treatment processes. Alcohol misuse is a major cause of morbidity and mortality and an important health care burden, the Quality of Life (QoL) of alcohol misusing subjects has been little studied to date. There are few studies of Quality of Life measures (QoL) in alcohol-misusing patients. When the literature was reviewed there were only 24 studies from 1993 2012 related to quality of life of alcohol dependents. These studies have shown that quality of life (QOL) is improved significantly when subjects do not relapse to heavy drinking, and QOL deteriorates significantly on prolonged relapse (Foster, 2000).
Subjects who sustained a 30% or greater decrease in drinks per month reported improvement in Physical and Mental health component had fewer alcohol-related consequences when compared to those with a <30% decrease( Kraemer 2002). The most important predictors
Email: esinu27@gmail.com , Corresponding &2nd author, contact in case of any consultation iJARS/ Vol. I/Issue III/Dec, 2012/277 http://www.ijars.in 1
of baseline quality of life were severity of alcohol dependence, employment status, psychiatric history, quantity and frequency of alcohol consumption, attendance at Alcoholics Anonymous, global alcohol health status, age, gender, and education (Morgan, 2004). Frequent heavy drinking or episodic heavy drinking (e.g., five or more drinks per occasion) patterns were associated with reduced QoL. Alcohol dependents had lower levels of QoL compared with general population norms or with other chronic health conditions. Quality of life appears to be moderated by a number of socio-demographic and client characteristics, such as age, education, gender and co-occurring psychiatric disorders. Alcohol-dependent individuals experience improvements in QoL across treatment and with both short-term and long-term abstinence. Despite these improvements, many alcoholic individualsQoL is unlikely to equal or exceed that of normative groups. Also, among hazardous and harmful drinkers, achieving and maintaining a marked reduction in drinking, even without complete abstinence, is associated with significant increases in QoL (Dennis, 2005).
Treatment and Quality of Life of Alcohol Dependents At treatment initiation, Alcohol dependent patients had lower QOL total scores and they scored lower on several subscale scores than those without AD. CM treatment was associated with improvement in QOL regardless of Alcohol dependent status (Andrade, 2012). Extended-release naltrexone 380 mg in combination with psychosocial intervention was associated with improvements in QOL, specifically in the domains of mental health, social functioning, general health, and physical functioning (Pettinati, 2009). As an adjunct to medication compliance enhancement treatment, Topiramate (up to 300 mg/d) was superior to placebo at not only improving drinking outcomes but increasing overall well-being and quality of life and lessening dependence severity and its harmful consequences (Johnson, 2004; 2008). The combinations of naltrexone and combined behavioral intervention (CBI), and acamprosate and CBI, each predicted significantly improved physical QOL (Prisciandaro 2012). Treatment with acamprosate and psychosocial support, by promoting abstinence, improves the quality of life profile to levels comparable to those observed in healthy individuals. Literature Review
Sl.No AUTHOR 1. Beccaria (2012) METHODS Investigated the relationship between alcohol consumption and quality of life (QoL) on a representative sample of adults aged 25-34 living in France, Italy and Netherlands. (n=4841) evaluated longitudinal associations between treatment status, alcohol consumption, and QOL in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study RESULTS Impact of alcohol consumption on QoL depends mainly on predominant consumption style and drinking culture
2. Prisciandaro 2012
combinations of naltrexone and combined behavioral intervention (CBI) and acamprosate and CBI, each predicted significantly improved physical QOL
Examined the association of alcohol use and health related quality of life (HRQOL). N=1532 (56% M; 44% F) in different hospital out-patient settings
4.
Andrade et al 2012
5.
Martinez et al 2011
6.
Martinez et al 2010
Quality of life in patients with alcohol dependence disorder with personality disorders: relation to psychological adjustment and craving
7.
Evren 2011
et
al
Lifetime PTSD and quality of life among alcohol-dependent men: impact of childhood emotional abuse Determinants of improvement in quality of life of alcohol-dependent patients during an inpatient withdrawal programme. N=414; prospective study Effects of alcohol consumption in spousal relationships on health-related quality of life and life satisfaction. n=3110 couples couples living in partner relationships. Alcohol treatment effects on secondary non-drinking outcomes and quality of life: the COMBINE study Clinical and psychosocial factors associated with quality of life in alcohol-dependent men with erectile dysfunction. N=101 Men; 18 -50 yrs Impact of anxiety and depression on quality of life of persons with alcohol
8.
Lahmek et al 2009
Livingston et al 9. 2009
10.
LoCastro et al 2009
11.
Ponizovsky et al 2008
12.
Saatcioque et al (2008)
A higher percentage of heavy drinking days, more drinks per drinking day, and lower percentage of days abstinent were associated with lower quality-of-life measures. ED and self-rated depressive symptoms, emotional distress, selfesteem, and perceived social support were found to be significantly associated with QoL of persons with Alcohol dependents Quality of life is low in alcohol dependence syndrome patients with
Cross sectional study on disability and quality of life respondents with alcohol dependence in hospital based deaddiction services. N=60 Role of Social Supports, Spirituality, Religiousness, Life Meaning and Affiliation with 12-Step Fellowships in Quality of Life Satisfaction among Individuals in Recovery from Alcohol & drug problems (N = 353)
Alcohol dependence, other psychiatric disorders, and health-related quality of life N= 127,308
Respondents with a history of alcohol dependence plus one or more other psychiatric disorders had significantly lower HRQoL in domains pertaining to psychological and social functioning than respondents with alcohol dependence only Health-related quality of life is severely impaired in dependent drinkers. The most important predictors of quality of life is abstinence duration QoL improves with abstinence and deteriorates with relapse. QoL in females is worse than in males, for comparable levels of dependency. Disturbed sleep with depression is a particular feature of the impaired QoL in female alcohol misusers Increase in alcohol related problems associated with lower quality of life
16.
Morgan et al 2004
Improvement in quality of life after treatment for alcohol dependence N=1216; 77% male;
17.
Peters et al 2003
The SECCAT Survey: II. The Alcohol Related Problems Questionnaire as a proxy for resource costs and quality of life in alcoholism treatment. N=212
Alcohol use disorders, consumption patterns, and health-related quality of life of primary care patients. N=1333
20.
Daeppen et al 1998
Evaluating health-related quality of life in alcohol-dependent patients N=147; 77% males; 26 -78 yrs
Persons with alcohol dependence scored lower (poorer HRQOL) on the Mental Health Component. Binge drinkers and Frequent, High-Quantity Drinkers showed markedly lower scores in the areas of Role Functioning and Mental Health Alcohol-dependent patients perceived their problems more as psychological than physical. Severity of alcohol dependence and depression seemed to influence the perception of HRQoL negatively.
Factors associated with Better quality of life among alcohol dependents Among the factors which predicted better quality of life were abstinence duration (Morgan 2004; Peters 2003), longer recovery (Laudet 2005), and perceived better social support (Ponizovsky 2008). Attenuated physical QoL improvements for patients with alcohol abuse histories are related to greater pain and physical deficits (Eshelman 2010). QoL improvement after a residential treatment was related to low QoL scores at admission. Improvement in physical component of QoL was related to baseline alcohol intake and good somatic status (Lahmek 2009). Greater alcohol use was related to poorer prescribed insulin injection compliance and stronger expectations of immediate, positive consequences of drinking alcohol were related to several indices of lower quality of life (Cox 2002). Alcohol use was shown to be associated with impaired levels of health-related quality of life in adolescents (Chen, 2007). PTSD, major depression, and alcohol use disorders all adversely influenced adolescent QOL (Clarke 1996). Children and youth with Fetal Alcohol Spectrum disorder have significantly lower HRQL than children and youth from the general Canadian population(Stade 2006). Apart from above inferences there were also few contradictory findings in the literature such as Persistent moderate drinkers had higher initial levels of health-related quality of life than persistent nonusers, persistent former users, decreasing users, unstable pattern of drinkers (U-shaped users, and inverted U-shaped users). (Kaplan 2012). Regular alcohol consumption is associated with increased quality of life in older men and women (Chan 2009). Being a nondrinker of alcohol was associated with greater risk of mortality and poorer physical HRQoL. Moderate alcohol consumption was not harmful, and may carry some health benefits for older women (Furya 2008). Negative associations between alcohol and well-being were observed on several measures for women consuming more than 173 g and men more than 229 g per week.
MATERIALS AND METHODS Study setting: This study was conducted in 2 places for study purpose like study group and comparative group. Study group was taken in Sasthanavillage, KundapurTaluk, Udupi District (community based de-addiction camp (CBC) conducted by Shri K. shethra Dharmasthala Rural Development Programme) and comparative group was taken in Dr.A.VBaliga Hospital, Doddanagudde, Udupi District, Karnataka (hospital based de-addiction camp (HBC)).It was a QuasiExperimental Research Design pre and post test with control group was adopted. This study was approved by the ethics committee of the hospital. The objective of the study was to assess the quality of life of the person with alcohol dependence syndrome, before and after the de-addiction camp intervention in community as well as in hospital based camp intervention.
Quality of Life: World Health Organization defines Quality of life as an individuals perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the persons physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment (WHO, 1993).
Sample:30 Respondents were drawn from community based de-addiction camp(CBC) conducted by ShriKshethraDharmasthala Rural Development Programme, Sasthana Village KundapurTaluk, Udupi District and another 30 were drawn from hospital based de-addiction camp (HBC), conducted by Dr.A.VBaliga Hospital, Doddanagudde, UdupiDisitrict, Karnataka. Inclusion criteria:Persons who give consent for the study, Age ranged from 18 years to 65 years, Persons who meet the criteria of alcohol dependence syndrome according to ICD 10 and AUDIT. Exclusion Criteria:Persons with History of any psychiatric disorder other than anxiety and depression, Persons with mental retardation, Persons with other substance use disorder other than NDS, Persons with Severe medical complications and cognitive impairments. Study period: study was conducted from January 2012 to April 2012. Sampling process: Census Method was used in the study. Tools used: Socio Demographic Details; This was prepared by the investigator to get the details regarding name, age, educational status, occupation, socio economic status, religion, marital status and family type and head of the family and age of onset of alcohol consumption and age of dependence. Alcohol Use Disorder Identification Test (Audit)- Interview Version. (World Health Organization, Department of Mental Health and Substance Dependence, 1992).Who Quality Of Life (BREF)-1998 Procedure: After approval from the Kasturba Hospital ethics committee, alcohol dependent patients were contacted on the day of admission in both community camp and hospital based camp subsequently and explained about the nature of the study and its objectives. The respondents who fulfilled the inclusion criteria were selected and informed consent was taken from the subjects. Confidentiality of the information was assured. The study was done in the month of January 1 st to 10th in Dr.A.V.Baliga hospital and February 10th to 17th in Dharmasthala de-addiction camp in Sasthana, Kunadapura. The study was in a period of 4 months, from January of April.
CBDC
HBDC
Table 1 shows the respondents quality of life before and after CBDC and HBDC intervention. Mean score of the physical health of the respondents of both CBDC and HBDC decreased in post assessment. In CBDC the mean score of QOL in physical health was 23.46(S.D=3.82) and in post assessment it was 21.20(S.D=.88) whereas in HBDC it was 22.10(S.D=2.57) during the pre-assessment, it decreased during the post assessment 20.66(S.D=2.24). t test revealed that there is statistically significant difference within the g roup with regard to the physical quality of life. In HBDC respondents psychological health during the preassessment was 17.40 (S.D=2.64) and in post assessment the mean score was increased to 19.00(S.D=2.08) which shows that respondents psychological health improved after hospital deaddiction camp. In the HBDC; the environmental health mean score was 24.90(S.D=4.11) during pre- assessment and in post assessment it was increased to 27.00(S.D=2.36), this reveals that there is improvement in respondents environmental quality of life. The same result was found in CBDC respondents. iJARS/ Vol. I/Issue III/Dec, 2012/277 http://www.ijars.in 9
Respondents mean score on total quality of life in CBDC during pre-assessment was 82.06(S.D=9.08) and in post assessment it increasedto86.26 (S.D=5.42) But in HBDC; it was 86.56 (S.D=11.70) during the pre-assessment and in post assessment it was decreased to 83.60(S.D=7.82).When compared to respondents in HBDC, respondents in CBDC have shown improvement in overall quality of life. There is medium effect size in CBDC with regard to physical health between before camp and after the camp approach (r=0.37), whereas in HBDC it was found small effect size in physical health of the respondents. In psychological health the HBDC respondents had medium level effect size (r=0.31) and small effect size in environment quality of life (r=0.29). It was also found that there is small effect size in overall quality of life of the respondents in CBDC (before and after camp intervention)
TABLE 2: Quality of life of Abstainers and relapsers in hospital based de-addiction camp and community based de-addiction camp
GROUP QUALITY OF ALCOHOL LIFE USE STATUS Physical health Psychological health CBDC Social relationship Environment Total Physical health Psychological health HBDC Social relationship Environment Total Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers N 22 8 22 8 22 8 22 8 22 8 17 13 17 13 17 13 17 13 17 13 MEAN 21.45 20.50 19.90 18.00 10.77 8.50 28.63 25.87 88.77 79.37 21.52 19.53 20.23 17.38 10.58 8.61 28.35 25.23 88.82 76.76 S.D .73 .92 1.23 1.92 1.90 2.13 1.39 .99 3.59 3.02 1.06 2.87 .97 2.06 1.80 2.10 1.16 2.38 2.57 7.07 t p EFFECT TEST VALUE SIZE 2.928 3.218 2.805 5.110 6.574 2.638 5.034 2.763 4.722 6.512 .007** .003** .009** <.001* <.001* .013* .00 .010** <.001* <.001* 0.48 0.51 0.46 0.69 0.72 0.44 0.68 0.46 0.66 0.77
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Discussion
Quality of Life of persons with alcohol dependence With regard to quality of life of the respondents in both group scored less (82 in CBC and 86 in HBC) during pre-assessment. This finding is in parallel with Andrade et al (2012) where they reported during treatment initiation alcohol dependents had scored low scores in total QOL and subscales of QOL. There was no significant difference between both the camp respondents with regard to the overall quality of life before the camp intervention. This is in concordance with Mary &Pandian study (2008) in which they observed that there was no significant difference between respondents who were availing hospital based de-addiction service and community based de-addiction service. Overall quality of life of the respondents increased in community based de-addiction camp during postassessment but not in Hospital based camp. After the camp intervention both group respondents significantly scored less physical health QOL when compared pre-assessment score. It may be due to their physical withdrawal or iJARS/ Vol. I/Issue III/Dec, 2012/277 http://www.ijars.in 11
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