A Comparitive Study to Evaluate the Stress Level among Wives of Alcoholics and Wives of Non-Alcoholics in a Hospital in Chennai

Substance abuse is regular consumption of large amounts of substance (alcohol or drugs) that are harmful to themselves or others. More than half of substance abuse patients are diagnosed with a psychiatric diagnosis - major depression, personality disorder, anxiety disorders, and dysthymia. Among other substance or drugs, alcohol is the most frequently abused drug. Alcoholism is one of the major problems in this country and the world in general. This problem is affecting not only the person between level of stress and domestic violence and duration of alcohol consumption. The present study also shows that there is severe stress level in wives facing with domestic violence and husband excessive alcohol consumption shows severe stress in wives.


INTRODUCTION
A Japanese proverb says -First the man takes the drink, then the drink takes the drink, then the drink takes the man. Alcoholism is chronic liberal and often fatal disease. It is a primary disorder and not a symptom of other disease or emotional problems. In addition to this ingestion of alcohol his whole family down. Substance abuse disorders, especially alcohol, are a matter of concern around the world. It has a strong impact on individual health, familial and social consequences, criminal and legal problems, and the effects on the national productivity and economy. Nimesh G Desai, (1988) states that to completely wipe out or to minimize the usage of any kind of substance addiction, strategies covering many fields need to be designed [1]. Alcoholism has been a global health and social problem. Claimed to be one of the global risk factors, accounting for 1.5% of all deaths in the world and 3.5% of disability adjusted life years and 4.0% of global burden of disease, alcoholism is a huge challenge to any society even now [2].
The continuous use of alcohol to the point of causing damage to the individual, society or both is known as Alcoholism [3]. Physical and psychological illness of alcoholism is connected to disrupted family role, decreased family communication, the problem of excessive alcohol consumption is a major cause of public health concern both in urban and rural areas. It is the third leading mental health problem in the world today. Apart from affecting the physical and mental health of the individual consuming it, it largely affects his family in more than one way making alcohol-related family disruption a serious, complex and pervasive social problem [4]. Majority of the alcohol addicts belong to the male gender in our country. The reason for consumption maybe to overcome stress (caused due to familial, financial and psychological problems) but instead it turns out to become a vicious cycle which further stresses and burdens the individual and his family. Alcoholism seems to further decrease a persons self esteem and confidence [5]. In the words of Raymond Chandler, an alcoholic, a real alcoholic, is not the same man at all. You cant predict anything about him for sure except that he will be someone you never met before. Recent developments and high paid jobs have in turn made consumption of alcohol a social pride. This raises concerns about the health and the social consequences of excessive drinking [6]. This addiction may affect people of any age group, social back ground or religion. Very often alcoholism affects highly educated people. Often the consumer does not feel that he is addicted [7].
The Prevalence of Alcohol use is still considerable in India according to the studies done across the country with a National house hold survey of drug use showing the prevalence of alcoholism to be 7 to 75% in different states [8]. Alcohol addiction or dependence is a more serious disorder and involves excessive or maladaptive use of alcohol. Any individual with 3 or more criteria given by the ICD 10 is considered as ADS (Alcohol Dependence Syndrome).
1. Tolerance changes (need for more to achieve desired effect, or achieving effect with lesser amounts of alcohol). 2. With drawl symptoms following a reduction or cessation of drinking. 3. Drinking more alcohol or drinking. 4. Drinking more alcohol or drinking over a longer period of time than intended. 5. Inability to cut down or stop. 6. Spending a great deal of time drinking or reoccurring from its effects, 7. Giving up impotent social occupational or recreational activities. 8. Continuing to drink knowing alcohol use has caused or worsened problems. International classification disorder (1992).
Married individuals in which one or both spouses of alcoholic report higher levels of marital distress [9]. Effective communication is necessary for a successful marriage. But alcoholism is often linked with aggressive communicationthrough anger and indifference thereby affecting a good marriage and creating tension. As alcoholics are not able to do their daily chores, the complete burden on running the family falls on the spouse which increases their stress level enormously [6] and increases feelings of hatred, self-pity, avoidance of social contacts, exhaustionboth physically and mentally. This also affects the family financially and finally may lead to divorce [9]. Based on this, the present study was designed to evaluate the stress levels among wives of alcoholics and nonalcoholics.

Setting of the study
The present study was conducted in a Government Hospital in Chennai. From here we selected psychiatric outpatient department (OPD) where wives of alcoholics patients come to the clinic and male medical ward where patients with no history of alcoholism were admitted along with their wives.

Population
In this study Population consists of wives of alcoholics who are visiting to psychiatric OPD along with their alcoholic husbands and wives of non alcoholics who are staying along with their husband in male medical ward.

Sample and Sampling Technique
Non probability convenience sampling technique was selected for this study. OPD wives who are all available were selected as study participants.

Pilot Study
Pilot study conducted from 3-1-2012 to 8-12-2012. Formal permission was obtained from the medical superintendent of the Government hospital, Chennai. 10 samples were selected for pilot study 5 wives of alcoholic and 5 wives of non-alcoholics. A brief introduction about self and study was given to the wives and informed verbal consent obtained and the confidentiality of the response is maintained. Result of the pilot study shows p value=0.009 as p value <0.05 there is a significant difference in level of stress between wives of alcoholics and wives of non-alcoholics.

Data Collection Procedure
The data collection was planned for only four weeks i.e. from 15-12-12 to 15-1-13. Time schedule was planned from 10am to 4pm everyday minimum 5-6 members per day. Everyday demographic information was collected using the tool with demographic variables questionnaire through interview method, followed by the Sheldon Cohen perceived stress scale analysis, we assessed the stress level in both wives of alcoholics and wives of non-alcoholics.

Statistical Analysis
Mean and standard deviation used to assess the level of stress. Chi-square test used to associate the level of stress with their selected demographic data.    The data presented in the Table 1.3 shows that majority of the wives of alcoholics 42.86% were 11 and above of duration of marital life, 34.28% were of 6-10 years, 22.86% wives were of 0-5 years. Wives of non alcoholics majority 45.71%

RESULTS
were of 11 and above duration of marital life, 28.57% were of 0-5 years of duration of marital life, 25.71% were of 6-10 years of duration of marital life.  wives of alcoholics wives of non alcoholics

Fig. 5. Distribution of wives according to monthly income
The data presented in the Table 1.5 shows the distribution of wives of alcoholics based on monthly income 14 getting 3000-5000rs salary per month, 12 getting 5001-7000rs, 5 getting <3000rs, 4 earning 7001 and above and in wives of non-alcoholics 13 getting < 3000rs, 10 getting 3000rs -5000rs, 7 getting 7001 and above,5 getting 5001-7000rs.                                Hindus and 34.2 Muslims. The Chi-Square 0.019 shows that there is significant relationship between religion and level of stress in wives of alcoholics.  -----

DISCUSSION
The purpose of the study was to assess the level of stress in wives of alcoholics and in wives of non-alcoholics. This comparative study will tell us if we there is a significant difference in the stress of the wives of alcoholics and non-alcoholics.  [11]. Similarly, Revathi.E (2007) stated that majority of wives experienced mild to severe psychological stress and social burden in wives of alcoholics than in wives of non alcoholics [12]. In a study done in Canada, 90% of the female spouses of alcoholics exhibited high level of stress [13].
The study result showed that the obtained mean score of wives of alcoholics is 38.3 and in wives of non alcoholics it is 11.2, the mean difference of wives of alcoholics is 19.57 and mean difference of wives of non alcoholics is 19.45. The obtainedt value is 11.2 and p value is 0.0001 as p value is < 0.05 the study statistically significant. In Hanumanahalli village, Kolar district, Karnataka, a significant difference between stress level score of wives of alcoholics and wives of non alcoholics was reported [14]. In Japan, the wives of alcoholics had health problems -genital disease, cardio vascular problems and psychometric disorders like stress, anxiety [15]. Over consumption of alcohol has a stronger association with partner violence than with non-partner violence may be a matter of access, with partners having more contact and thus more opportunities for violent encounters.
The chi-square value 0.001 shows that there is significant association between levels of stress with history of domestic violence. The chi-square value 0.001 shows that there is a significant association between levels of stress with history of duration of husband alcoholic consumption. In Salem, significant high level of domestic violence and suicidal risk was reported in the wives of alcoholics [16]. In accordance with the present study, it was reported that excessive partner alcohol use increased the risk of mental disorders in wives like depression, anxiety, stress [17]. In wives of alcohol dependent males versus abstainers/ social drinker wives in urban slum areas in north ward Mumbai, it is shown that there was a significant higher abuse in wives of an illiterate husband and the abuse was higher in illiterate and unemployed women [18]. Wives with higher level of domestic violence showed higher level of stress [19]. The aim of study was to assess empirically suicide risk and domestic violence of the wives of alcoholics and nonalcoholic. Retroactive design was used to portion local violence and suicide risk of the wives of alcoholics and non-alcoholics by using suitable psychological scales.
The present study shows that there is severe stress level in wives facing with domestic violence and husband excessive alcohol consumption shows severe stress in wives. Families of alcoholics experience guilt, shame, resentment, insecurity, delinquency, financial troubles, isolation, fear and violence. Women whose partner frequently or always consumed alcohol before having sex faced risks of domestic violence almost five times higher than those whose partners never drank. The impact of alcohol dependence on marital functioning and the psycho-social development of the members are the challenged problems to research. Among all the family members of alcoholic wives will face more problems. The wife of an alcoholic usually becomes exhausted and may go through a variety of stressful experience and emotional responses like feelings of guilt, hurt, hopelessness, etc.

CONCLUSION
The present study shows that there is severe stress level in wives facing with domestic violence and husband excessive alcohol consumption shows severe stress in wives. In future, the study can be replicated on a large sample in different rural or urban slum area.

CONSENT
A brief introduction about self and study was given to the wives and informed verbal consent obtained and the confidentiality of the response is maintained.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).