Coping Strategies Among Spouses of Alcohol dependents at Gokarneswor, Kathmandu, Nepal

Srijana Pandey*, Kalpana Shrestha

Nepal Medical College, Nepal


Introduction: Alcoholism is characterized by an increased tolerance of and physical dependence on alcohol, affecting an individual’s ability to control alcohol consumption safely. Worldwide, researchers have been focusing on the effect of alcohol use on the family and children, which interact to diminish the individual’s ability to adapt leading to distress.

Methods: This was a descriptive cross-sectional study with convenience sampling technique in which cage questionnaire was used to identify the alcoholic family and interviewed 162 spouses of alcoholics at Gokarneswor- municipality, Kathmandu, Nepal

Findings: The study revealed that coping level among spouses of alcoholics was average that was 98.1% and well was lowest that was 1.8%. The coping strategies used was in three subscales engaged coping, withdrawal coping and tolerant coping. In three subscale, withdrawal coping scored highest (55.57_+6.74) and engaged coping scored lowest (24.61_+3.43). There was a significant association between level of coping with the duration of alcohol intake and there was no association with other socio-demographic variables such as age, education, occupation, marriage, type of family, no. of children.

Conclusion: The study showed the average coping level and three ways of coping strategy that was withdrawal coping, engaged coping and tolerant coping. Most of the respondents used withdrawal coping. The study recommends the research on identification of alcohol abusers at community and provide early treatment and counselling to the family.


Alcoholism generates tolerance of and physical dependence on alcohol as well as individual’s ability to control alcohol consumption which affects individual family and society1. The effects of alcohol abuse can cause more damage and pain than any other internal or external influence on the family unit2. On the other hand, public intervention on this issues has proved useful: a rapid evidence review of the impact of pricing and taxation policies on alcohol-related crime outcomes identified that alcohol tax and price increases were associated with reductions in overall crime, violent crime, sexual assault and criminal damage/property offences3. This study can be applied to economic valuation studies that aim to measure the benefits of programs intended to reduce the prevalence of alcohol dependence4.

Caregiver’s burden is a multi-dimensional phenomenon reflecting physical, psycho-emotional, social and financial consequences of caring for an impaired family member5. The alcoholism effects may directly or indirectly drain out caregivers of substance abusers. The magnitude from harm to people other than the drinker, therefore the overall economic burden of risky alcohol consumption across countries is underestimated6. Alcohol dependence not only reduces life expectancy, but also causes considerable loss of quality of life of the dependents of and persons around those with alcohol dependence7. Equally alarming, studies show that alcohol abuse seems to be one of the most important driving factors in the transmission of violence across contexts and social relationships—from war-violence to community-violence and from being a victim of war or intimate partner violence (IPV) to being a perpetrator of violence against children8.

One of the most affected among caregivers is the marital partners9. Spouses are particularly affected by constant exposure to the behavior of the alcoholic. The negative social consequences of alcohol consumption and stressful life events may trigger psychological, biological, behavioral responses, which interact to diminish the individual's ability to adapt10. Spouse of alcoholics is faced with many problems like mental and physical problems, lack of communication between others, financial problems, marital violence, damage to social reputation, libido towards sexual performance11,12. The wives of persons with alcoholism are known to have significant problems such as marital dissatisfaction, poor social interaction, communication problems, physical problems, and mental health disorders12.

Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap13. While studying this aspect due consideration may be given to family dynamics to include the modifying effect of other family members14.

Avoidance, discord, fearful withdrawal and sexual withdrawal were the most common coping components identified among wives of alcoholics15,17. The nature of coping behavior of them depends on the personality, degree of duration of her husband's alcoholism and duration of marriage. Jones A. Jackson et al. (1954) (27) first propounded the 'stress model’16. The coping mechanisms characteristic of alcoholic women relative to their nonalcoholic controls. The profile of coping strategies utilized by the alcoholic group is consistent with a poor quality of life and compounding of problems17. Alcoholism affect emotionally, physically, socially and psychologically. Spouses feel difficult to manage her married life and feel stress18. Engaged coping is a form of coping in which the wife of alcoholic gets vigorously engaged with an alcoholic husband through active interaction may be arguing with them to try them to stop, throwing away their drinks, telling the user that their behavior was having a negative effect on them. The withdrawal coping involves avoidance of the drinker, active involvement in other self-regulating activities and gaining independence. Tolerant coping is inactive coping by putting up with the problem19. A coping mechanism is something that helps a person deal with something that is difficult for them. While, all coping mechanisms provide the person using them with a real or perceived benefit, some coping mechanisms have more negative consequences associated with them20.

The current study aims to research the coping strategies among spouses of alcoholics in a small population in a municipality of Gokarna TM, Kathmandu, Nepal.

Research design: Descriptive, exploratory and cross sectional design

Area of study: Ward no.4, Gokarneswor- Municipality, Kathmandu, Nepal.

Study population: Spouses of alcohol dependents residing in their own house. Step-1:visiting each household. Step-2 : identification of alcohol dependents using cage questionnaire. The questions include Yes and No response. Each Yes response scores 1 and No scores 0.Two yes response will be considered alcohol dependent /abuse.Step-3:interview.

Sampling technique: Convenience sampling technique was used followed by cage questionnaire.

Sample size:173 Spouses

n=required sample size

Z=confidence level at 95%(standard value is 1.96)

P=prevalence of alcohol dependent

q=67

d=allowable error

Jmhc-19-1186-Fig1

 

 

• Dependent variables: Coping strategies

• Independent variables: Age19, gender, education, occupation, socio-economic status, religion, family income, type of family, duration of marital life, no of children, duration of spouses alcoholism.

• Inclusion criteria : Wives of alcoholics . Who are willing to participate.

• Exclusion criteria: Wives whose husbands had poly substance abuse other than alcohol and nicotine.

• Research instrument (Tools):

a. Demographic information

b. Modified tools of standard Coping questionnaire.

Step-1:visiting each household. Step-2: identification of alcoholics using cage questionnaire25-29. Step-3:interview. Modified tools of standard Coping questionnaire developed by Orford, J., Templeton, L., Velleman, R. and Copello, A. (2005). Modified version of coping questionnaire include 21 items. Each item scores as No=0, once/twice=1, sometimes=2, Often=3.I choosed this item in context to Nepal. Pre-testing was done in the similar setting and it was reliable. First coping level was identified from overall questionnaire as: well coping, average coping and poor coping. Therefore, chi-square test was used to see the relationship of coping level with independent variables. Then, mean for each subscale of coping was calculated as an average score from total score obtained by the participants in each subscale that is engaged coping, tolerant coping and withdrawal coping.

A written consent was obtained from the participants regarding their willingness to participate in the study. A formal administrative permission was obtained from the authorities of the proposed settings. The data was entered in SPSS 16. In statistical analysis, descriptive analysis was used. After completing the data, the cases was taught about coping strategies and refer the alcohol dependent for counseling and treatment.

The majority of respondents were from age group 56-70 years (59.25%) and least were from 18-35 years (12.96%). Most of the respondents education level was illiterate that was 40.12 and who obtained higher secondary education was 9.25%. Majority of the respondents occupation was agriculture (33.33%) and service holder were (2.46%). In Nepal less person have children more then three so researcher ought to classify the number of children as less then three and more than three. Most of the respondents number of children were less then three that was 88.88%. The repondents whose number of children more than three were 11.11%. Majority of respondents belong to nuclear family (60.49%). The respondents who belong to extended family were less(1.23%).Twenty eight percent of respondents were married for 11-20 years and 3.08% were for 41-50 years. The duration of alcohol intake among spouses for 1-10 years was 43.20% and for 41-50 years was .6% (Table: 1).

Table 1. Information of the respondents N=162

Variables

Frequencies

Percentage

Age

18-35

36-55

56-70

 

21

45

96

 

12.96%

27.77%

59.25%

Education

Primary

Secondary

Higher secondary

Illiterate

 

42

40

15

65

 

25.92%

24.69%

9.25%

40.12%

Occupation

Business

Agriculture

Service

Labour

Others

 

37

54

4

20

47

 

22.83%

33.33%

2.46%

12.34%

29.01%

Duration of  Marriage

1-10 yrs

11-20yrs

21-30yrs

31-40yrs

41-50yrs

 

33

46

44

34

5

 

20.37%

28.39%

27.16%

20.98%

3.08%

Number of children

<3

More then equal to 3children

 

144

18

 

88.88%

11.1%

Type of family

Nuclear

Joint

Extended

 

98

62

2

 

60.49%

38.27%

1.23%

Duration of alcohol intake of spouses

1-10 yrs

11-20yrs

21-30yrs

31-40yrs

41-50yrs

 

70

49

37

4

1

 

43.20%

30.24%

22.83%

2.46%

0.61%

The study revealed that coping level among spouses of alcoholics was average coping ( 98.1%) and well coping was lowest that was 1.9% (Table:2). The coping strategies used was in three subscales; among them withdrawal coping scored highest (55.57_+6.74) and engaged coping scored lowest (24.61_+3.43) (Table:3). There was a significant association between levels of coping with the duration of alcohol intake and there was no association with other socio-demographic variables as age, education, occupation, marriage, type of family, no. of children(table:4).

Table 2. Level of coping:

Level of coping

Frequency

Percent

Average

159

98.14

Well

3

1.85

Total

162

100

Table 3. Aspects(subscales) wise Mean Coping Scores

Aspects(subscales)

Min. Score

Max. Score

Respondents

Mean

SD

Engaged coping

13

32

24.61

3.43

Tolerant coping

27

65

50.12

2.30

Withdrawal coping

35

70

55.57

1.79

Table 4. Association of respondent’s coping level and selected demographic variables N=162

 Variable

                            Level of coping

 

Well coping

Average coping

p-value

Age

18-35 yrs             

36-55yrs              

56-70yrs              

 

0

1

2

 

21

44

94

 

 

.795

Education

primary

secondary

Higher secondary

illiterate

 

0

1

0

2

 

42

39

15

63

 

 

.636

Occupation

Business

Agriculture

Service

Labour

Others

 

0

1

0

1

1

 

37

53

4

19

46

 

 

.757

Types of family

Nuclear

Joint

Extended

 

1

2

0

 

97

60

2

 

.590

Duration of alcohol intake of spouses

1-10

11-20

21-30

31-40

41-50

 

 

0

1

1

1

0

 

 

70

48

37

3

1

 

 

.010

Alcoholism is increasing problem and family has been in problem which have impact on people around him. This study showed that level of coping was average coping that was 98.14%. Similar result was found where coping level was average 30(42.86%)in a study done by Mrs. Devi C.G, Rajasankar, Kokilavani N17.

In this study, Coping strategies used by spouses of alcoholics were in three major styles: engaged, tolerant and withdrawal coping. This study is in coherence with the study done in India19,21.

This finding of the study showed that they used more withdrawal coping and found that there was association between level of coping with the duration of alcohol intake of spouses which was contrary to findings from a study done by R t.s. Sathyanarayana and K Kuruvilia22.

In this study, most of them used withdrawal coping and then tolerant coping and very few used engage coping. This finding is contrary to the findings mentioned in subscales of coping as study done by Sharma et al23. The study found most of them used engaged coping(93%),one fourth used withdrawal coping and very few 6% used tolerant coping.

In this study, most of them used withdrawal coping and then tolerant coping and very few used engage coping. This finding is contrary to the findings mentioned in subscales of coping as study done by Sharma et al23. The study found most of them used engaged coping(93%),one fourth used withdrawal coping and very few 6% used tolerant coping.

This study finding recommends women should be taught to use more active coping as the study was done by Solomon, Laura J.; Rothblum, Esther D24.

Coping strategies used was average coping among age group of 56-70 years and less of them were from age group 18-35 years, Most of the illiterate 63 of them used average coping and less number of educated in higher secondary 15 of them used average coping. The findings of the study helps to screen the alcohol abusers, provide counseling to the spouses and early referral.

The results of this study need to be considered in relation to its limitations. The major limitation of this study was its small sample size and cannot be generalize.

Principal Investigator: Overall Proposal preparation, budgeting, assignment, checking data and analysis, report preparation and submission. Supervises the RA. Training to data collectors.

Co-investigator: Preparation of proposal, Training to research assistant, Supervisor, Initiates the assignment and report writing. Supervises the RA.Training to data collectors.

Acknowledgements: Authors are thankful to respondents, directly and indirectly who helped me in this research.

  1. Kaur D, Ajinkya S. Psychological impact of adult alcoholism on spouses and children. Med J DY PatilUniv. 2014; 7: 124-127.
  2. Lakshmana G, Pankajakshi B. A community study on violenc among wives of alcoholics. J Delhi psychiat. 2014; 17: 1-5.5
  3. Andrew B, Meier P, Shapland, et al. Alcohol pricing and criminal harm:a rapid evidence assessment of the published research literature. School of health and related research(ScHARR),The university of Sheffield.Available from: ias.org.uk.12
  4. MosqueraNogueiraJ, Rodriguez-MiguezE. Intangible costs of alcohol dependence from the perspective of patients and their relatives A contingent valuation study. Addicciones. 2018; 30(2): 111-122.13
  5. Abozead EI-Sayead S, Senthil M, Manisha K. Family interaction pattern among caregivers of patients with epilepsy and alcohol dependence. IOSR JHSS. 2015; 20(9): 1-09. Retrived from:semanticscholar.org 6
  6. Navarro HJ, Doran CM, Shakeshaft AP. Measuring costs of alcohol harm to others: A review of the literature. Drug and alcohol depend. 2011; 114(2): 87-9910.
  7. Nogueira JM, Rodríguez-Míguez E. Using the SF-6D to measure the impact of alcohol dependence on health-related quality of life. Eur J Health Econ. 2015; 16(4): 347-56.
  8. Global Perspectives Excessive Alcohol Use In Crisis-affected Societies A Weak Spot of Global Mental Health Research and Practice. https: //istss.org/public-resources/trauma-blog/2016-october/global-perspectives-excessive-alcohol-use-in-crisis11
  9. Banerjee I, Bora D, Deuri PS. Coping Strategies and Perceived Social Support in Wives of Persons with Alcohol Dependence Syndrome. Indian J PsySocl Work. 2017; 8: 28-32 16.
  10. Kishor M, Pandit VL, Raguram R. Psychiatric morbidity and marital satisfaction among spouses of men with alcohol dependence. Indian J Psychia. 2013; 55: 360-3657.
  11. Level of stress and coping among spouse of alcoholics. NNJ. 2016; 5: 36-388.
  12. Johnson PR, Britto C, Sudevan KJ, et al. Resilience in Wives of personswith Alcoholism: An Indian exploration. Indian J Psychiatry. 2018; 60: 84-915.
  13. WainbergLM, ScorzaP, Shultz MJ, et al. Challenges and opportunities in global mental health: a research to practice perspective. CurrPsychiat Rep. 2017; 19(5): 2814.
  14. Chandrasekaran R, Chitraleka V. Patterns and determinants of coping behaviour of wives of alcoholics. Indian J Psychiat. 1998; 40 (1): 30-3417.
  15. Nanjundaswamy M, Sreedevi PA, Gangadharaiah HM, et al. A study to assess the stress, coping strategies and domestic violence in wives of alcohol dependent individuals. Eur psych. 2013; 28: 1.
  16. Dr B Shanthi1, Dr K Veeramuthu MD, DPM. A Study of Female Spouses of Male Alcohol Dependence Patients. IOSR-JDMS. 2017; 16(3): 127-145.
  17. RaoTS, Kkuruvilia. A study on the coping behaviours of wives of alcoholics. Indian J Psychiat. 1992; 34: 359-365.
  18. Philip J, Michels N, Peter Johnson, et al. Coping Strategies of Alcoholic Women.1999; 20(4): 237-248.
  19. Savita, Sulekha, Dadwal S, et al. Level of stress among spouses of alcoholic men. 2014; 3(4): 1-4.
  20. Retrieved from: https://www.sandstonecare.com/resources/substance-abuse/alcohol/alcohol-use-as-a-coping-mechanism
  21. Barman H. Coping strategies used by wives of patients with alcohol related disorders. IJNER. 2019; 7(2): 25.
  22. Devi CG, Rajasanskar, Kokilavani N. A study to assess the level of stress and coping strategies among wives of alcoholics at selected settings. International Journal of Nursing education and Research.2013; 1: 12-1320.
  23. Nitashasharma, Sunitasharma, Sandhyaghai, et al. living with an alcoholic clients. J Ind psych. 2016; 25: 65-7122.
  24. Solomon, Laura J, Rothblum, et al. Stress, coping, and social support in women. The Behavior Therapist. 1986; 9: 199-20424.
  25. Retrived from: Source Dr John Ewing founding Director of the Bowles Center for Alcohol Studies University of North Carolina at Chapel Hill
  26. Retrieved from: https: z//www.healthline.com/health/cage-questionnaire
  27. Retrieved from:https://www.hopkinsmedicine.org
  28. Retrived from: https://www.fadap.org
  29. Retrieved from:https://www.uspreventiveservicestaskforce.org
 

Article Info

  • Journal of Mental Health & Clinical Psychology
  • Article Type : Original Research Article
  • View/Download pdf

Article Notes

  • Published on: January 6, 2020

Keywords

  • Coping level

  • Coping strategies
  • Coping subscale
  • Spouses
  • Alcohol dependents
  • Gokarneshwor
  • Kathmandu
  • Nepal

*Correspondence:

Srijana Pandey
Masters in Psychiatric Nursing, Lecturer, Nepal Medical College, Nepal
Email: srijanapandey2036@gmail.com.

©2020 Pandey S. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License.