| Research Article |
Open Access |
|
| Perceive Family Environment among Parents, Spouses and Siblings of Alcohol Dependence Patients: A Comparative Study |
| Narendra Kumar Singh*, Dipanjan Bhattacharjee, Nishant Goyal, Sanjay Kumar Munda and S.H. Nizamie |
| Department of Psychiatric Social Work, Central Institute of Psychiatry, Jharkhand, India |
| *Corresponding author: |
Narendra Kumar Singh
Department of Psychiatric Social
Work
Central Institute of Psychiatry, Kanke
Ranchi-834006, Jharkhand, India
Tel: +91-651-245115/+91-651-2450822
E-mail: narendrapsw@gmail.com |
|
| |
| Received May 19, 2012; Accepted June 23, 2012; Published June 26, 2012 |
| |
| Citation: Singh NK, Bhattacharjee D, Goyal N, Munda SK, Nizamie SH (2012)
Perceive Family Environment among Parents, Spouses and Siblings of
Alcohol Dependence Patients: A Comparative Study. J Addict Res Ther 3:126.
doi:10.4172/2155-6105.1000126 |
| |
| Copyright: © 2012 Singh NK, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited. |
| |
| Abstract |
| |
| Background: The family is the primary unit of the society to take care the material, physical and emotional needs of
people. Drug addiction and alcoholism causes significant intimidation to entire family system and the family environment
tends to be become strained because of this problem. This study was carried out to know how the parents, siblings and
spouses of individuals with alcohol addiction perceive the quality of family environment. |
| |
| Methods: In this study 90 participants (30 parents, 30 spouses and 30 siblings) of the patients diagnosed with
alcohol dependence syndrome were selected purposively. Tools like socio-demographic data sheet, Family Environment
Scale (FES), and General Health Questionnaire- 12 were used for data collection. |
| |
| Limitation: The present study has some limitations e.g. small sample size, samples were collected from a single
place and impact of culture was not controlled, influence of psychosocial factors on family interaction pattern and family
environment (as stigma, express emotions, codependency etc.) were not assessed. |
| |
| Conclusion: Spouses revealed lower level of family environment in the domain of expressiveness as compared to
parents and siblings of alcohol dependence. Finding also indicated that Parents and spouses group reported to have
more negative experiences in the domain of control as compared to siblings of alcohol dependence. |
| |
| Keywords |
| |
| Spouses; Family environment; Alcohol Dependence
Syndrome (ADS) |
| |
| Introduction |
| |
| Family plays a key role in the healthy development of an individual’s
personality. The presence of a positive family environment is a
prerequisite for the healthy growth and development of the members
from a given family unit. In addition, a positive family environment
ensures appropriate fulfillment to the needs and demands of the family
members. Dependence on psychoactive substances by one or more
family member could dampen positive experiences within the family
environment to a significant extent. The environment of families with
an addicted member becomes grossly unsupportive for all members.
In the long run, these families tend to become markedly pathological.
In general, pathological families have an unsupportive and unhealthy
family environment which works as a detrimental factor in the
family’s global functioning. Finney et al. [1] mentioned that married
individuals with alcoholic spouses tend to have marked impairment
as well as a sense of discontentment in one or more dimensions of
their day to day function. Brinson [2] used FES (Family Environment
Scale) [3] in their study to examine the nature of family environment
in the families with chronic alcohol abusers. They suggested that in
the areas of FES e.g. cohesion, conflict, and achievement, intellectual
and moral religious emphasis were dysfunctional. Barry and Fleming
[4] reported significantly poor cohesion and expressiveness, and more
conflict in addicts’ present families than did either non–alcoholic with
a family history of alcoholism or non–alcoholics with no family history
of alcoholism. Filstead et al. [5] found that alcoholic families perceive
a higher level of conflict and less cohesive family environment. These
authors also noted that in families with alcohol addicted individuals
less emphasis were given to independence, cultural and recreational
activities and organizational tasks. |
| |
| It is noted that two factors play a very crucial role in the course
and outcome of alcohol dependence syndrome, e.g. personality
characteristics of addicted individuals and their family environment. In
the past, several studies demonstrated the importance of assessment of family environment in relation to understanding the breadth of alcohol
addiction. According to Barry and Fleming [4] family history of alcohol
abuse is associated with lower cohesiveness among family members.
These authors used the Family Environment Scale [3] to assess the
family environment. They found lower FES cohesion scores and
higher FES conflict scores in individuals with family history of alcohol
addiction than individuals who belonged to normal families. Later
Wilson et al. [6] also used the same tool, i.e. Family Environment Scale
[3] to assess family environment of alcohol addicted individuals. They
found that individuals with a family history of alcohol addiction scored
significantly lower in certain domains of FES, e.g., ‘intellectual-cultural
orientation’, ‘activity’, and ‘organization’ than individuals without family
history of alcohol addiction. Harvey and Dodd [7] used the FES to
make a comparative assessment of the family environments of a sample
of sixth-grade children of individuals with alcohol dependence and
children of normal individuals. These authors found that scores in two
domains of FES, i.e. ‘conflict’ and ‘cohesion’ were the best predictors of
early exposure of these children to psychoactive substances like alcohol,
drugs and tobacco. Family related factors like family’s environment,
structure, intra-family interactions, family’s value and belief systems all
have some roles in inducing as well as prolonging addictive behaviours
in individuals [6-8]. Alcohol addiction to one partner is a detrimental
factor in marriage. In families with alcohol addicted individuals
maladaptive marital outcomes and poor family functions are two common features. It is quite obvious from previous researches that
prolonged heavy and problematic alcohol use is associated with negative
marital outcomes like ‘reduction of marital satisfaction level’, ‘increase
in maladaptive marital interaction patterns’, and ‘higher occurrences
of marital violence’ [9-13]. Pathological family environment or faulty
family structure not only damages marital relationship but also works
as major risk factor to cause substance addiction in adolescents and
youths [14-16]. |
| |
| The present study was intended to do a comparative assessment
between the perception of the parents, siblings and spouses of
individuals with alcohol addiction regarding family environment
quality. |
| |
| Method |
| |
| Participants |
| |
| The sample consisted of 90 participants (30 parents, 30 spouses
& 30 siblings) of the respective patients diagnosed with alcohol
dependence syndrome as per ICD-10 DCR [17] criteria and having no
other significant and enduring physical and/or psychiatric co morbidity
and caregivers who scored less than three on GHQ-12 [18]. Staying
with the person with alcohol dependence syndrome for ≥ 2 years at the
same household were taken for the study. Education & family income of
the selected samples were matched appropriately. For assessing family
environment the Indian adaptation of FES [3], i.e. Family Adaptation
Scale-Indian Adaptation Joshi and Vyas [19] were used. |
| |
| Venue of the study |
| |
| This study was carried out at the Central Institute of Psychiatry,
which happens to be a Government of India owned premier mental
hospital. This hospital is situated in the city of Ranchi, which is the
capital city of the Jharkhand state of the republic of India. |
| |
| Procedure |
| |
| Informed consents were taken from spouses, parents and siblings
after considering the inclusion and exclusion criteria taken for the study.
After filling of the socio-demographic data sheet, Family Environment
Scale [19] was administered. For normal control group, GHQ-12 [18]
was administered and those who scored less than three had been taken
in the study. |
| |
| Instruments |
| |
| Socio-demographic data sheet: A socio-demographic data sheet
was developed to record the necessary socio-demographic information
like age, sex, monthly income, education, occupation, domicile and
religion etc. |
| |
| Family Environment Scale- Indian adaptation of FES [19]:
In present study the Family Environment Scale-Indian Adaptation
form was used to assess the family environment. The original Family
Environment Scale of Moos and Moos [3] was translated into Hindi
(the dominant Indian Language) as well as standardized by Joshi and
Vyas [19]. The Hindi version of FES has 79 items, which are answered
in a 5 point Likert type scale. There are total of ten subscales, that are
broadly grouped into three dimensions (i) relationship (it is further
divided in three sub scales: cohesion, expressiveness and conflict), (ii)
personal growth (it is further divided in five sub scales: independence,
achievement orientation, intellectual cultural orientation, active
recreational orientation and moral religious emphasis) (iii) systems
maintenance dimensions (it is further divided in two sub scales: organization and control). The scale has moderate to high test retest
reliability and internal consistency [19]. |
| |
| The GHQ-12 was developed by Goldberg and William [18]. It is
12-item questionnaire; it is widely used for screening people for the
presence of psychiatric distress. |
| |
| Data analyses |
| |
| Kolmogorov Smirnov test was used to test the normality of data.
Descriptive statistics were used to calculate percentage profiles of
different socio-demographic and clinical variables Chi-square tests
used to compare categorical variables across three groups One-way
ANOVA was used to calculate the various socio demographic variables
across three groups for continuous variables Post-hoc analysis was used
to compare three groups amongst each other. Statistical analysis was
done by Statistical Package for Social Sciences (SPSS-16) [20]. |
| |
| Results |
| |
| Results showed that most of the respondents were male in the
parents and siblings groups. However there were no significant
difference with regards to domicile and occupation among these three
groups, viz. spouses, parents and siblings. Age of the respondents of the
parents group was higher compared to spouses and siblings of persons
with alcohol dependence. No significant difference has been found
in other areas like; education, family income and informant income
among the three groups of alcohol dependence (Table 1a and 1b). |
| |
|
Table 1a: Socio-Demographic Profile of the Selected Samples (Categorical
Variables). |
|
| |
|
Table 1b: Socio-Demographic Profile of the Selected Samples (Continuous
Variables). |
|
|
| |
| Findings also indicated that spouses of the persons with alcohol
dependence perceive poor expressiveness as compared to parents and
siblings these people. In this study, spouses had scored significantly
lesser than parents and siblings in the ‘expressiveness’ domain of FES
[19]. In present study, parents and spouses had scored significantly
higher than siblings. However, no statistically significant differences
was observed in the others domain of Family Environment Scale [19]
among these three groups (Table 2) |
| |
|
Table 2: Perceived family Environment Profile of the Sample Population (N=90): Post-hoc Comparison |
|
| |
| The present study was carried out on total 90 subjects [30 spouses,
30 parents & 30 siblings of the patients diagnosed with Alcohol
Dependence Syndrome (ADS)]. The groups were appropriately matched
on the various socio- demographic parameters like that education
and family income. For the data collection, purposive sampling
technique was used. This study was carried out at the Central Institute
of Psychiatry, which is a Government of India owned referral mental
hospital and research centre located in the outskirts of the Ranchi,
the capital city of the state of Jharkhand. The principal purpose of the
study was to understand the perception of family environment among
the spouses, parents and siblings of patients with alcohol dependence
syndrome (ADS). Most of the respondents of the study were married,
belonged to urban background and unemployed within the parents
and spouses group. In the present study, significant difference was
seen among these three groups on two demographic parameters, e.g.
‘age’ and ‘sex’. However, no significant differences were found on the
socio-demographic data (e.g., ‘education’ and ‘total family income’).
The difference in age occurred because the parents’ age was higher than
that of other caregivers and within the spouse group all spouses were
wives of the alcohol dependent individuals. In this part of the world
females with substance dependence are much fewer than males with
substance dependence and, at the same time, female with substance
dependence usually do not present themselves at larger mental health
centre like the Central Institute of Psychiatry for treatment. Generally,
females with a history of clinically proven addiction are found in larger
metropolitan areas. However, the number of female addicts has been
growing and future researchers will have to address this issue. In case of
age as parents were taken in this study their mean age was much higher
than remaining two groups. |
| |
| Spouses reported poor levels of family environment in the domain
of expressiveness as compared to parents and siblings. Our finding is
consistent with a recent Tempier et al. [8] study, which also found higher
levels of psychological distress in the area of ‘expressiveness’ prevailing
in female spouses of male lifetime at-risk drinkers, although, in this
previous study parents and siblings were not included as in the present
study. Similar findings were observed by Wilson et al. [6]. These authors
noted that wives of alcohol addicted persons tended to score significantly
lower in the ‘expressiveness’ domain of Family Environment Scale [3].
Most studies on families with addicted members have reported that
wives are usually on at the receiving end of psychological and physical stress; tend to be the worse off than the addicted individual [9-11]. In
the present study, the parents and spouses group reported having more
negative experiences in the domain of ‘control’ as compared to siblings.
Mckay et al. [12] have reported that problems in the family functioning
domains like ‘control’ and ‘affective involvement’ were markedly
pathological in families with alcohol addicted individuals. It is well
documented that pathological or problematic family environment,
because of alcoholism, may be a triggering factor in generating this habit
in youths or younger generations [14-16]. And, at the same time, such
family cannot provide the care and assistance to the addicted person
as it is already riddled by numerous other problems [13]. Findings of
this study can be helpful in examining the dynamic interplay between
family pathology and alcoholism, within the Indian context, as well as
in the management of families with alcohol dependent member(s). |
| |
| The present study has some limitation like small sample size,
samples were collected from a single research site and cultural variations
may have introduced confounds. Another important limitation is the
‘gender’ of the ‘parents’ and ‘siblings’ groups. In present study only wives
were kept in ‘spouse’ group but gender differentiation was not done in
both ‘parents’ and ‘siblings’ groups. Gender of parent and sibling might
as well have some bearing on the perception of family environment.
Additionally, other psychosocial factors influencing family interaction
pattern and the family environment (e.g., stigma, express emotions,
codependency etc.) were not assessed. In future, researchers should
carefully consider the above-mentioned factors while carrying-out
addicted family studies in India. |
| |
|
| References |
| |
- Finney JW, Moos RH, Cronkite RC, Gamble W (1983) A conceptual model of the functioning of married persons with impaired partners: spouses of alcoholic patients. J Marriage Fam 45: 23-34.
- Brinson JA (1992) Perceived Family Environment of Black Adolescent Alcohol Users and Nonusers. J Black Psychol 18: 37-46.
- Moos RH, Moos BS (1986) Manual: Family Environment Scale. Consulting Psychologists Press: Palo Alto.
- Barry KL, Fleming MF (1990) Family cohesion, expressiveness and conflict in alcoholic families. Addiction 85: 81-87.
- Filstead WJ, McElfresh O, Anderson C. (1981). Comparing the family environments of alcoholic and “normal” families. J Alcohol Drug Educ 26: 24-31.
- Wilson SE, Bell RW, Arredondo R (1995) Temperament, family environment, and family history of alcohol abuse. Alcohol Treat Q 2: 55-68.
- Harvey JM, Dodd DK (1995) Children of alcoholics, negative life events, and early experimentation with drugs. J Sch Psychol 33: 305-317.
- Tempier R, Boyer R, Lambert J, Mosier K, Duncan CR (2006) Psychological distress among female spouses of male at-risk drinkers. Alcohol 40: 41-49.
- Jacob T, Leonard KE (1988) Alcoholic-spouse interaction as a function of alcoholism subtype and alcohol consumption interaction. J Abnorm Psychol 97: 231-237.
- Quigley, BM, Leonard KE (1999) Husband alcohol expectancies, drinking, and marital-conflict styles as predictors of severe marital violence among newlywed couples. Psychol Addict Behav 13: 49-59.
- Leonard KE, Rothbard JC (1999) Alcohol and the marriage effect. J Stud Alcohol Suppl: 139-146.
- McKay JR, Maisto SA, O’Farrell TJ (1993) End-of-treatment self-efficacy, aftercare, and drinking outcomes of alcoholic men. Alcohol Clin Exp Res 17: 1078-1083.
- Jang KL, Vernon PA, Livesley WJ, Stein MB, Wolf H (2001) Intra- and extra-familial influences on alcohol and drug misuse: A twin study of gene–environment correlation. Addiction 96: 1307-1318.
- Hawkins JD, Catalano RF, Miller JY (1992) Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychol Bull 112: 64-105.
- Flewelling RL, Bauman KE (1990) Family structure as a predictor of initial substance use and sexual intercourse in early adolescence. J Marriage Fam 52: 171-181.
- Schuckit M (1998) Biological, psychological and environmental predictors of alcoholism risk: A longitudinal study. J Stud Alcohol 59: 485-494.
- World Health organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic criteria for research. World Health Organization: Geneva.
- Goldberg DP, Williams P (1978) A User's Guide to the General Health Questionnaire. Windsor: NFER-Nelson.
- Joshi MC, Vyas OM (1987) Hindi adaptation of Family Environment Scale, Rajasthan, India.
- Statistical Package for Social Sciences (SPSS)™. Version 16 for Windows. IBM Ltd.
|
| |
| |
|
|
|
This article |
DOWNLOAD |
|
CONTRIBUTE |
|
SHARE |
|
EXPLORE |
|
 |
 |
| |
|
| |
| |
| |
|
Untitled Document
|
|
|
|
|
