RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

SYNOPSIS

FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of The Candidate ANUPAMA. K

2. Name of The institution

Diana College of NursingNo.68,Chokkanahalli,Jakkurpost,

Bangalore - 64

3. Course of Study and SubjectMasters of Science in Nursing

Psychiatry Nursing Speciality

4. Date of Admission to Course 28.06.2008

5. Title of the topic

Assess the quality of life (QOL) of patients with alcohol dependence syndrome (ADS) Who are attending out patient department of selected de-addiction center, Bangalore.

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6. Brief resume of the Intended Work

Introduction

Alcoholism is a world wide problem not continues either to developing nations.

The adverse consequences of alcohol not only affect the individual user, but society as a

whole. Alcoholism continues to be a grouping nuisance among all the strata of society.

Alcohol is the commonly used and abused substance especially in the western world.

Alcohol dependence is the most debilitating psychiatric illness afflicting 5% of people

who consumes alcohol. In US alone, alcoholism ranks related disorder constitute the

third largest health problem in the united stares today (Carlton Erickson 2008).1

Alcohol consumption in many countries high. The World Bank estimated that

diseases affected 5-10% of the world’s population each year, causing approximately 2

million deaths and accounted for 3% of the global burden of disease. In various states of

India, average annual consumption of alcohol has increased significantly. Alcoholism

posses difficulties and problems for the drinker, his family as well as the society (Health

action 2002).2

Quality of life is the subjective component of well being. Quality of life is a composite

measure of physical, mental, and social well being as perceived by each individual or by

group of individuals that is to say, happiness, satisfaction and gratification as it is

experienced in such life concerns as health, marriage, family, work financial situation,

self-esteem, belongingness and trust in others (K. Park 2002).3

Quality of life (QOL) covers both medical and non medical aspects of life including

physical, psychological functioning (e.g. emotional and mental well being) social

function (e.g. relationship with others and participation in social activities &perception

of health status, pain &overall satisfaction with life (Berlim et al 2003).4

Background of the Problem

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Patrick (2003)5 stated that the history of alcohol stems from the most primitive times

mentions of alcohol consumption are present in bible. In 2067-2025 BC, the king

Hammurabi of Babylonia popularized the sale &consumption of alcohol. Beer & wine

are know to have been used around 6400 BC. The word alcoholism was first used by

Magnus Huss.

The word alcoholism is derived from the Arabian term ‘AL-kuhal’ which means

‘finely divided spirit’. Ethyl alcohol is what commonly used. Alcohol is clear, thin

highly volatile liquid with a harsh burning taste. Approximately 70% of adults in United

States drink alcohol. Of these individuals, 10 percent are described as heavy drinkers and

5-10 percent as problem drinkers’ francers 1994)6 Substance abuse is a problem that has

the potential for impairment, in an individual social, occupational, psychological and

physical function. The use of alcohol beverages by almost all societies, ancient as well as

modern, as a stimulant, anesthetics, social lubricant and ceremonial substances. Alcohol

covers a variety of organic chemical substances. Heavy drinking, if prolonged, causes

serious physical damage such as cirrhosis, heart disease and brain damage (National

family health survey 2007).7

A gram alcohol yields 7 calories whereas, these are empty calories and are of no

nutritional consequences. After consumption, alcohol is absorbed by the body from the

stomach and intestine. It is absorbed better and acts faster when taken in an empty

stomach. The absorbed alcohol has to be metabolized. 80 percent of the alcohol is

breathed out or excreted in the urine. Alcohol weakens the cell membrane and makes

the cell, more vulnerable to injury. It can cause degeneration of the nervous system. This

is usually due to vitamin B deficiencies and direct toxic effect on cerebral cortex.

Alcohol is identified as one of the ten risk factors accounting for 3.5 percent total global

disease burden. Alcohol currently causes heaviest burden to men in both developed and

developing regions (Placida, 2002).

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Great problems may be created within the family of alcoholics. Children may

also be affected by relative poverty. Alcohol is also associates accident at work and in

the home. Alcohol misuse is strongly associated with crimes, both those against the

person and those against the property (Health action, 2002).

6.1 Need for the Study

Global trade and liberalization of sociocultural interaction of society had made easy

access to use and spread of substances (Murry &Lopez, 1997)8 .progressive increase

of substance abuse in developing countries not only add to increasing morbidity pattern

but also has been forming a nidus for several dreaded infections of recent times

(Neuneark & Anthony,1997)9

It has been found in studies from different countries that geographical

distribution of substance abuse co-related with the availability of drug (Goosop &

Grant 1990) 10

(Sachdev1989)12 in his survey in 1986 in rural areas of faridkot, it was found

that about 1.5 percent populations were addicts and majority of the drugs used were

alcohol. In another survey done in 1989, the number of addicts has risen to 9 percent.

About 30-45 percent of all have had at least one transient episode of alcohol related

problems. About 2 lakhs death each year are directly related to alcohol. The common

cause of death among person with alcohol related disorders are suicide, cancer, heart

disease and hepatic disease.

Alcohol abuse reduces life expectancy by about 10 years. The second national

family health survey results (1998-1999) indicate the percent of Indian population

consuming alcohol. It was found that 17 percent of men and 2 percent of women, aged

above 15 are consuming alcohol. The proportion of men who drink alcohol, one half

times high in rural areas, 31 percent than in urban areas 20.8 percent (National

Institute on Drug Abuse 1991).

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Increased stressors and adverse events such as over crowded and polluted

environment ,poverty and dependence on cash economy ,high level of violence and

reduced social support have deleterious consequences for mental health in general &

substance use problems in particular area ,increasing the risk of heavy drinking . while

substance misuses can contribute to social disintegration, it is also clear that social

deprivation invite substance use to alleviate emotional stress, thus perpetuating a

vicious circle (Ambros uchtenhagen, 2004).13

WHO shows that in Bangalore 20% of women reported domestic violence

94.5% women identified their husband’s alcohol consumption as a significant risk

factor in incidents of domestic violence. So people indulging in alcohol use are much

more likely to skip work & college as well as indulge in gambling &lottery (WHO,

2007).

The first description of alcohol dependence syndrome was in 1976by Edward &

Gross who emphasized the inability to control consumption, salience of drink seeking

behavior & narrowing of drinking repertoire as the characteristic besides the phenomena

of tolerance and withdrawal (Mary G Kinney 1997).14

In 1960 professor Jellinek first considered alcohol dependence as a disease like other

disease concept of alcoholism. (Jellinek 1997).15

In he next 5-6 years the age is expected to come down to 15 yrs. the rising

income level of youngsters is one of the major reason for increasing consumption of

alcohol (National family health survey 2007).7

A primary example is domestic violence much of which is directed against

women and children. Keeping this emerging problem in mind it was decided by the

researcher to undertake this study to assess the quality of life an alcohol dependence

syndrome patients. Nursing is an enabling process where by nurse’s function with the

aim of providing highest quality care to patient. Nurses contribute quality of life

(QOL) by measuring it in various areas of the individual needs. In the field of medicine

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&science there is an increased need to measure Quality of life today due to increased

cost of medical care and the awareness of the patient of their rights (Nurses of India

2004).16

Unless the nurses know about the quality of life as perceived by the patients, it would

be difficult to improve the life style of the patients. Many people have done study on

quality of life of alcohol dependence syndrome .but the present study is carried out by

the researcher to assess the quality of life of alcohol dependence syndrome patients

because:

Growth of the problem is increased in India

Alcohol use is rapidly rising in India

Aggressive marketing of alcohol increase the risk of problematic use especially

among young people.

Develop adoptive coping behavior to improve quality of life

6.2 Review of Literature

A review of literature is an essential aspect of research .one of the major function of

review of literature is to ascertain what is already know in relation to the problem of

interest and will help in developing a broad conceptual framework in to which a research

problem will fit (Polit and Hungler 1995)16

Literature will organize and presented under the following section

1. literature related to quality of life

2. literature related to alcohol dependence syndrome

3. Literature related alcohol dependence syndrome with de addiction centre.

1. Literature related to quality of life

Johanson B. et. Al., (2004)17 conducted study on quality of life with alcohol

dependence syndrome that oral topiramate reduces the consequence of drinking and

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improves the quality of life dependent individual. Sample of 150 alcoholics. Result

shows that topiramate increasing overall well being and quality of life.

Investigate the relationship between alcohol and health related quality of life in

people with and without psychiatry disorders. 127 and 308 samples were

selected .results show that alcohol dependence plus one or more other psychiatric

disorders had significantly low health related quality of life Kalman D.et al

(2004).18

Cohn T. (2003)19 conducted study on alcoholics to see the quality of life they

found that alcoholics have shown severely disturbed and impaired quality of life.

Peters J. et. al., (2003)2 studied quality of life in alcoholics of men and women.

Comparison of quality of life in males and female indicate that for nearly all

parameters, Quality of life in females is worse than in males.

Andersen NJ et al (2000)21 designed 5 days treatment to relive psychological

pain with alcohol. The basic principle behind the treatment was holistic and

restoring the quality of life. The study showed increase in quality of life or an

improvement in quality of life of people, it is possible the quality of life and health.

Conducted study on the evaluation of the QOL among professional soldiers with

diagnosed alcohol dependence syndrome. Results confirm the lower quality of life

within estimated group. Quality of life have decreased in relation to physical limits

in role perform, social function, emotion limits (Polak K, 2001).22

Rudolf H et al (1999) 24 conducted study to examine the quality of life of

alcoholic women. The results show that alcoholic’s women differ in their subjective

quality of life. Subjective quality of lie predicts relapse.

2. Review of literature related to alcohol dependence syndrome (ADS)

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In this study they assessed level of alcohol dependence patients with severe

alcohol dependence. Results show that the population of alcohol misuses is likely to

require different approaches for effective detection, intervention and treatment

(Sheren 2006).25

Morgan M et al (2004)26 conducted study to observe outcome in dependent

drinkers, treated for 6 months. It concluded that health related Quality of life

severely impaired in dependent drinkers.

Found that patients with alcohol dependence syndrome are vulnerable for self

harm. Results show that all the samples had life stressors commonest being

financial, followed by job related stressors (Deshpande et al 2003).27

Conducted study on alcohol dependence syndrome patients by providing family

intervention therapy. Results show that family intervention therapy significantly

reduced the severity of alcohol intake. (Suresh Kumar PK 2007).28

Manjunatha Narayana (2008)29 conducted on alcohol dependence syndrome

patients to see the chronology of criteria and they analyzed age wise and order wise

chronology. Results show that age wise chronology analyzed a better understanding

of the course progression.

3. Review of literature related to ADS with de addiction centre

Foster JH et al (2002)31 collected the information from 52 currently drinking

moderately dependent alcohol misuses attending an out patient clinician south

London. This study shows, the health related Quality of life of this group was

poorer compared to general population.

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Ahauhan et al (2004)31 conducted study at de addiction clinic at Manipal. 100

samples selected with diagnosis of alcohol dependence syndrome. The results show

that the major physical illness was patient with alcohol dependence syndrome.

Statement of the problem

Assess the quality of life (QOL) of patients with alcohol dependence syndrome

(ADS) who are attending out patients department of selected de-addiction center,

Bangalore.

6.3 Objectives of the Study

1. Assess the quality of life of patients with alcohol dependence syndrome

2. To Associate quality of life of patients with alcohol dependence syndrome and

their selected demographic variables

Operational definitions

Assess: Statistical measurement of quality of life of patients with alcohol dependence

syndrome. Quality of life will be measured in terms of good, poor and very poor.

Quality of life: Quality of life is the subjective satisfaction experienced by an

individual in his physical, mental, social, and spiritual situation.

Patients with Alcohol dependence syndrome: An individual between 21-60 years of

age suffering from alcohol dependence and attending de-addiction center, Spandana

Bangalore.

.

De-Addiction centre: It refers to specialized medical care unit to treat the Patents with

alcohol dependence syndrome.

Hypothesis

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H 1: There will be a significant association between quality of life and patients with

alcohol dependence syndrome.

Assumptions

1. Patents with Alcohol dependence syndrome may have poor quality of life.

2. The quality of life of patients with alcohol dependence syndrome will be

influenced by alcoholic habits.

3. The quality of life can be measured by using structured questionnaire

Limitations

Study will be limited to

1. Patients with alcohol dependence syndrome.

2. Patients who are above 21 to 60 years.

3. The patients who will give consent to participate in the study.

4. Patients who will understand Kannada.

7 Materials and Method

Source of data: Patients with alcohol dependence syndrome who are attending out

Patients department of de- addiction centers.

7.2 Method of data Collection

Research Design

The research design selected for the study will be non experimental, descriptive in pattern made to assess the quality of life of Patients with alcohol dependence syndrome.

Setting Selected de-addiction center, Banglore

Population Patients with alcohol dependence syndrome

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Sample Size The sample size in the study will be 90.

Sampling Technique

Purposive sampling technique will be used by the researcher to select the patients with alcohol dependence syndrome.

Tools

Structured Questionnaire will be used to assess the level of quality of life of patients with alcohol dependence syndrome.

Data Collection

Written permission will be taken from the Selected de-addiction center, Bangalore for conducting study & with the co operation of the doctors & nursing personnel in the unit. Adequate care will be taken for protecting the subject from the potential risk .the data will be collected by the investigator herself

Data analysis,Presentation and

Interpretation

The data obtained will be analyzed in terms of using descriptive and inferential statistics. Mean, median, mode, percentile standard deviation will be used for descriptive statistics. Chi square test will be presented in the form of tables, diagrams, graphs based on the findings.

7.3 Does the Study require any Investigation to be conducted on patients or other

Human or Animals?

Yes, study will be conducted on patients who are attending out patient department to

assess the quality of life of alcohol dependence syndrome patients.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, informed consent will be obtained from concerned subjects &authority of

institution.

Privacy, confidentiality &anonymity will be guarded

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Scientific objectivity of the study will be maintained with honesty

&impartiality.

Ethical committee

Title of topic

Assess the quality of life (QOL) of patients with alcohol

dependence syndrome (ADS) patients who are attending

out patients department of selected de-addiction centers,

Bangalore.

Name of the candidate ANUPAMA. K

Course & the subject M. Sc Nursing Psychiatry Nursing speciality

Name of the guide

Ethical committee Approved

List of References

1. Dr Cartlon Erickson, mental health from the national institute on alcohol abuse and

alcoholism (NIAAA), World health organization.

2. Health Action 2002, Health Accessories for all, published by Placida,

Secundarabad, A.P, India.

3. Park, “Text Book of preventive and social medicine”, 19th edition/

Banarsidas Bhanot

4. Brilim et al, suicidal and life threatening Behavior”, Guilford publications,

vol-33, 2003, page no 242-248

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5. patrick,1952,ancient wine the search for the origin of viniculture, penceton

university press ,314,ISBN.

6. Francers & Franklin, alcohol dependence in the world, American journal of

medical genetics 1994, published in 2002, pp 186-89

7. National family health suvery, sponserd by WHO

8. Murry lopez ,global burden of disease, world health forum Cambridge, Harvard

University 1997, pp 189-92,

9. Anthony & Neunerk, epidemiology & drug dependence, Inm, Tsuang,

M.johen & G. zahner, 1997, Newyork, pp 361-407.

10. Goosp and grant alcohol and drug abuse and dependence classification

and co morbidity, In B.S, Mc crudy & E.E Epstein, A comprehensive guide,

1990, new York, oxford university, pp 9-29

11. Ambrose uchtenhagen, drug and alcohol service council. 2004.

12. MCkinny.W., Psychology and psychiatry nursing, a philosophic matrix,

archives of psychiatry nursing, 1997, pp255-261.

13. Jellinek, phases of alcohol addiction, Quarterly journal of the studies on

alcohol, 1952, pp 13,672.

14. Nurses of India, measuring quality of life if alcoholics, New Delhi, India.

15. Polit & Hungler, nursing research, 6th edition, lippincot, Philadelphia, 2003, pp 114-

116,289-311.

16. Johnson BA et al, oral topiramate reduce the consequence of drinking and improves

the quality of life of alcoholic dependent individuals,” Archives if general

psychiatry, Sep 2004, 61(9):905-12.

17. Cohn TJ et al, sleep disturbed quality of life in alcoholics, Northwing, St. Thomas

hospital, London, 2003.

18. Kalman D et al, alcohol dependence, other psychiatry disorder and health related

quality of life, ” American journal of drug alcohol abuse, may 2004, (2),:437-87.

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19. Peters TJ et ;al , quality of life , sleep, mood and alcohol consumption: a complex

interaction , addict boi., Jan 2002, 7 (1), : 55-65.

20. Anderson et al, quality of life as medicine, quality of life and health care 42 to 52.

21. Polka K, the evaluation of the quality of life among professional soldiers with

alcohol addiction syndrome , psychiatry poi., Nov-DEC 2001 , 35, (6):1057-70.

22. Marashall et al, measurement of quality of life in alcohol dependent subject by a

cancer symptoms checklist, alcohol, Feb, 2000, 20 (2), 105-10.

23. Rudolf H et al, similarities and difference in subjective quality of life alcoholic

women, psychiatry prax, may 1999 , 26 (3): 116-21.

24. Sheren, journal drug and alcohol dependence, TNSMI, health news, 2006.

25. Morgan MY et al, improvement of quality of life after treatment for alcohol

dependence, alcohol clinic. Res, Jan 2004, 28 (1):64-77.

26. Deshpande et al , alcoholism and dependence, IBG research associates, 2003

27. Suresh kumar, family intervention therapy in alcohol dependence syndrome,

institute of mental health and Neuro Science, Kerala, 2008.

28. Manjnanth narayana et al study on chronology of criteria in alcoholics, 2008.

29. Foster JH et al, sequential studies of sleep disturbances and quality of life in

abstaining alcoholics, addict bio, Dec 2003, 8 (4), :455-62.

30. Ashutosh et al, study on alcohol dependence, Hindustan times, maniple 2004.

Website searches

http/:www.pumbed

http/:www.medline.com

http/:www.google.com

htpp/:www.yahoo.com

Members of ethical committee

1. Prof. Veda vivek

Principal and HOD

Department of community health nursing

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Diana College of Nursing, Bangalore – 64

2. Prof. Elizabeth Dora

Head of the Department

Department of child health nursing

Diana College of Nursing, Bangalore – 64

3. Prof. Kalaivani

Head of the Department

Department of obstetrics and gynecological nursing

Diana College of Nursing, Bangalore – 64

4. Mrs. Kalaiselvi. SPsychiatry Nursing Head of the Department

Department of Psychiatry nursing

Diana College of Nursing, Bangalore

5. Prof. Surendra

Biostatistician, GKVK

Jakkur, international Airport Road

Bangalore

9 Signature of candidate

10. Remarks of the guide

The research topic selected for this candidate is significant and feasible. The study is related to quality of life among alcoholics. Hence, there is a need to assess the quality of life of patients with alcohol dependence syndrome.

11. Name & Designation of Guide

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Mrs. Kalaiselvi. SPsychiatry Nursing Head of the Department

Department of Psychiatry nursing

Diana College of Nursing, Bangalore

Signature

12. Remarks of the chairman and principal

The study is researchable and forwarded for needful action.

Signature

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