INTRODUCTION:

World Health Organization (WHO) reported that about 38.3% of the population consume alcohol regularly. Among them 11% are moderate to heavy drinkers. Harmful use of alcohol kills more than 3 million people each year and most of them are men.

WHO statistics in India shows that an average Indian’s consumption of alcohol per year is 4.3 litres in 2010 and scaled up to 5.7 litres in 2018. The average rural Indian consumes 11.4 litres of alcohol per year.²Alcohol and Drug Information Centre, says the situation is going from bad to worse, especially in the big cities in Kerala. About 57-69% of the crimes in Kerala are related to alcohol and it includes murder, suicides and rapes.³Alcohol and self-esteem have a mutually destructive relationship as both mutually impact one another. Alcohol use can temporarily raise or lower self-esteem, but it typically creates lower self-esteem in the long-term. Low or high self-esteem can be a contributing factor to alcohol abuse and dependence, but an appropriate level of self-esteem is a powerful tool in the battle against alcoholism.⁴A cross sectional survey conducted in China substantiated that self esteem and coping strategies were correlated among problematic drinkers. A relationship between low self esteem and negative coping was observed in men. Problematic drinking interventions directed at males should simultaneously address low self-esteem and negative coping.⁵Quality of life, which consists of the physical, mental, and social domains, has been shown to be negatively affected by alcohol abuse and dependence. The National Council on Alcoholism and Drug Dependence (NCADD) says that alcohol affects the cognitive functions and physical capabilities, behaviour and habits of a person. This will adversely affect the quality of life, including physical functioning, psychological functioning, social functioning, perception of health status, pain and over all satisfaction with life.⁶

Present study was conducted among sixty clients with Alcohol dependence syndrome after obtaining the permission and consent from the head of the institution and from the sample to find out the effectiveness of self enhancement programme on self esteem and quality of life among patients with alcohol dependence syndrome. Quasi experimental pretest post test control group design was adopted for this study. A non probability purposive sampling was used for allotting subjects to control and experimental group. The sample comprised of 60 clients with ADS in which 30 clients were assigned to the control group and 30 clients to the experimental group. Self enhancement programme includes self introduction, preparation of self esteem brochure, mirror technique, ways to enhance self esteem and feed back session. It is given to the experimental group in five sessions of 30 minutes duration for five consecutive days to a group of 5-6 patients at a time. The data were collected over a period of 6 weeks from 1^st March to 10^thApril, 2021. The subjects were selected by purposive sampling after observing the inclusion exclusion criteria. The investigator explained the purpose of study and obtained informed consent before the commencement of the study. Socio personal and clinical data, pre test assessment of self esteem and quality of life among patients with ADS were done using Rosenberg’s self esteem scale and WHOQOL BREF 26 respectively. Pretest was done in samples on the second day of admission. Following that no intervention was given for control group. The pre and post tests were done on control group first and later on the experimental group to prevent contamination of sample. Four weeks after the pre test and continuation of mirror therapy, post test was conducted in both groups. After the completion of the study self enhancement programme was given to the clients with alcohol dependence syndrome in control group too. The collected data were analyzed using descriptive and inferential statistics. Socio personal and clinical data, self esteem and quality of life were analysed using frequency distribution and percentage. Computation of Mann Whitney U value were used to determine the effectiveness of self enhancement programme. The inter correlation between self esteem and quality of life were analysed using Spearman’s rank correlation coefficient. Association of self esteem and quality of life with selected variables were analysed by using Chi-square test. The data were analyzed using the licensed SPSS21.0 version software.

ETHICS AND CONSENT:

Approval of research project was obtained from the Institutional Ethics Committee and Scientific review committee. Permission obtained from the Head of the Institutions of the selected de addiction centres. Informed written consent was obtained from the sample prior to the data collection.

RESULTS:

Socio personal and clinical data of clients with alcohol dependence syndrome:

Regarding age group, in the control group 40% and in the experimental group 50% of participants belonged to 36-45 years. With regard to education, 40% of participants in the control group and 46.7 % in the experimental group completed high school education. Most of the patients from both the groups 43.3% in control group and 46.7% in experimental group were self employed. Majority of the participants, in control group (80%) and in experimental group (66.7%) were married. Regarding number of children, 36.7% in both the groups were not having children. With regard to their economic status, 53.3% in the control group belonged to BPL category and in experimental group, 60% belonged to APL. Most of the participants, 70% in control group and 63.3% in experimental group had family history of alcoholism. In control group, 43.3% had spouse as the support system, whereas in experimental group, 43.3% had parents as their support system. Majority of participants, 40% in both the groups had duration of alcoholism more than 15 years. Majority from both the groups consumed 251-500 ml alcohol per day. Majority spent between Rs.251 to 500 per day for alcohol in control group (40%) and in experimental group (63.3%). Brandy was the most common brand of liquor used by majority, 36.7% in control group and 66.7% in experimental group. 46.7 % in control group 40% and in experimental group were admitted for de addiction treatment for the first time. Regarding physical comorbidities, 46.7% in the control group and 56.7% in the experimental group had no comorbidities. The main reason for seeking treatment was self motivation in 56.7% of subjects in control group and 83.3% experimental group. Chi square values shows that there was no statistically significant difference between control and experimental group in terms of sample characteristics and hence the groups were homogeneous.

Self esteem among clients with Alcohol dependence syndrome:

66.7% subjects in the control group and 73.3% in the experimental group had low self esteem. Chi square value shows that there was no statistically significant difference between control and experimental groups in terms of self esteem. Hence both the groups were homogenous.

Quality of life among patients with alcohol dependence syndrome:

60% of subjects in the control group and 63.3% in the experimental group had poor quality of life. Chi -square value shows that there was no statistically significant difference between control and experimental groups in terms of quality of life. Hence both the groups were homogenous in nature.

Various domains of quality of life among patients with alcohol dependence syndrome:

Quality of life of patients with ADS under four domains – physical, psychological, social and environmental. From the table it is clear that 63.3% in control group had low level of QOL in physical domain and 53.3% in experimental group had moderate level of QOL in physical domain. In psychological domain 60% in control group and 53.3% in experimental group had felt low level of QOL. Regarding the social domain 66.7% subjects in control group exhibited low QOL whereas in experimental group 66.3% of them had moderate level of QOL. Participants in both the groups 53.3% in control group and 70% in experimental group had moderate QOL in environmental domain. Chi square value shows that there was no statistically significant difference both control and experimental groups in terms of various domains of QOL. Hence both groups were homogenous in nature.

Effectiveness of self enhancement programme on self esteem among patients with alcohol dependence syndrome:

Mean ranks, Sum of ranks and Mann Whitney U value of self esteem among patients with ADS. (n=60)

Group	Mean rank	Sum of ranks	U value
Control group (n=30)	22.2	665	200***
Experimental group(n=30)	38.8	1165	200***

*** Significant at 0.001

Effectiveness of self enhancement programme on quality of life among patients with alcohol dependence syndrome

Mean ranks, Sum of ranks and Mann Whitney U value of quality of life among patients with ADS. (n=60)

Group	Mean rank	Sum of ranks	U value
Control group (n=30)	20.9	628.5	163***
Experimental group(n=3)	40.0	1201.5	163***

*** Significant at 0.001

Correlation between self esteem and quality of life among patient with alcohol dependence syndrome:

The Spearman’s rank correlation coefficient was used for determining the correlation between self esteem and quality of life. The obtained ρ value for the correlation between taking steps and risk for relapse was statistically significant at 0.01 level. It was interpreted that there is a strong positive correlation between self esteem and quality of life. That means as the self esteem increases, quality of life also increases

Association of self esteem and quality of life among patients with alcohol dependence syndrome with selected variables:

In order to identify the association of self esteem and quality of life among patients with alcohol dependence syndrome with selected variables, Chi square test was used. The obtained chi-square value showed that there was a significant association between self esteem of patients with alcohol dependence syndrome and age (p< 0.05), quality of life of patients with alcohol dependence syndrome and age (p< 0.05).

DISCUSSION:

The present study was aimed to evaluate effectiveness of self enhancement programme on self esteem and quality of life among patients with ADS. The findings of the study were discussed in terms of it’s objectives and hypotheses in the light of previous studies.

The current study observed that self enhancement programme was effective in improving self esteem among patients with ADS. There was a significant improvement in the mean scores of self esteem of patients with ADS after the self enhancement programme. It was supported by a study conducted on effectiveness of motivational therapy on enhancing self esteem of alcoholics. Findings reported that 100% of patients with ADS had low self esteem before motivational therapy and after the therapy 100% of them had reached to normal self esteem level, which indicates that motivational therapy was effective in enhancing self-esteem levels of alcohol dependent individuals.⁶⁶ Findings of another study also was consistent with the current study that group therapy enhanced the self-esteem and quality of life of alcoholics.⁶⁷Another major finding of the present study that self enhancement programme was effective in improving the quality of life of patients with ADS. The findings are congruent with a previous study result of five days psycho therapy among alcoholics which increased the quality of life from 57.6% to 69.4%.⁷⁵ This has also been observed in another study conducted on effectiveness of yoga therapy on quality of life of alcoholics in Athma de-addiction centre, Trichy. This study finding stated that quality of life was lower among the alcohol abusers in relation to physical health, psychological wellbeing, social relationships and environment. Result has been found that yoga was effective in reducing the level of depression and improved the quality of life among alcoholics in the experimental group.⁷⁶ In the present study, it is interpreted that there was a strong positive correlation between self esteem and quality of life among patients with ADS. In comparison with a previous cross sectional research conducted in Iran, a significant and positive relationship observed between self esteem and quality of life during different treatment stages among alcoholics.⁴⁸Finding of another study also agrees with the present study result as there is a positive correlation between occupational performance, self-esteem, and quality of life among clients completing an alcohol abuse recovery program.⁶⁹ Similar result was found in another study that cognitive behaviour therapy and movie therapy were effective in improving the quality of life of alcoholics by enhancing their self esteem.⁷⁴

A statistically significant association was found between self esteem and age of patients with ADS. No association was found out between self esteem and other variables. A previous study reported that there is not a significant association between self esteem and age of alcoholic patients. But there is a significant association between self esteem and support system of alcoholic patients. Specific sources (family and friends) and forms (reassurance of worth) of social support were important to the recovery of alcoholic patients.⁷¹ These findings are not agreeing with the result of the present study. In current study, there was a statistically significant association between quality of life and age of patients with ADS. No association was found out between quality of life and other variables. A study conducted in Varanasi, Uttar Pradesh, highlighted that there is an association found out between support system and quality of life of alcohol dependent men attending de addiction clinic and no association found out between age and quality of life of alcohol dependent men attending de addiction clinic.⁶³ These findings are not agreeing with the result of the present study.

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Received on 15.05.2024 Modified on 12.07.2024

Asian J. Nursing Education and Research. 2024;14(3):217-220.

DOI: 10.52711/2349-2996.2024.00043