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Wednesday, 24 October 2012

Marital Adjustment and coping strategies of spouse of alcohol dependence patients: A comparative study

Alcoholism is a complex disorder with physical, psychological and social aspects, having far reaching harmful effect on the family and society, as well as on the physical and mental health of the alcoholic himself. (Edwards and Grant, 1976)
Alcoholism is one of the major health and social problems all over the world. The study on Global burden of disease (Murray & Lopex 1999a, 1999b) identified alcohol use as one of the global risk factors, accounting for 15% of all deaths in the world and 35% of disability adjusted life years and 40% of the global burden of disease (as cited in Jurgen Rehm, et al., 2004).
The second national family survey (1998-1999)results indicate that among the Indian population, 17% of men and 2% of women aged 15 and above are consuming alcohol (Saibaba, 2001). Epidemiological studies conducted in India showed that 20-30% of our population is using alcohol at a harmful level (Ponnudurai R, Jay Kumar J, Raju B, Pattamuthu R., 1991). Alcoholism has been called the ‘family illness’ because of its impact on the entire family unit. For every case, there are multiple victim, Apart from the alcohol dependent person, the prime victim is his wife as there is no way she can escape as ignore the alcohol dependent husband. So in the day to day interaction of family life, she is confronted with alcoholic behavior. As the husband’s addiction gets worse day by day, she is compelled to face several unmanageable problems. Unable to cope with there problems, she constantly lives under severe tension and pressure, This result in her becoming desperate, anger, frustrated, nervous, afraid and guilty.
The relationship between marriage and alcohol abuse has been the topic of numerous studies in the west over the past three decades though these issues have not been extensively investigated in India. Ranjana Tiwani et al., (2010) studied the presumptive stressful life events among spouses of alcoholics on sample 100 spouses of alcoholics (experimental group) and 100 spouses of non alcoholic (control group). They found various problems faced by spouses of alcoholics that 73.0% wives of alcoholics were facing physical abuse while spouse of non alcoholics were facing only 17% different types of emotional problems present were 89% in alcoholics spouses while 32% present alcoholics spouse of non alcoholic. 91% alcoholics spouse were having insecurity problem related to self. Their children and husband while it was present 27% in non alcoholics. Spouse of alcoholics had 68.0% financial problem whereas only 35% spouse of non alcoholics were facing financial problem. The spouse of alcoholic suffer from elevated rates of depression, anxiety and somatic complains, report low levels of relationship satisfaction (Halford et al., 1999) and often are subjected to verbal and physical abuse (Leonard & jacob, 1988; Van-Hasselt, Morrison & Bellack, 1985; Leonard & Serchak, 1993).
Adjustment to an alcohol problem of husband may result in an increased in the wive’s emotional and physical illness (Bloom, 1985) and altered familial function and experience considerable psychological distress. (Kogan & Jackson 1965: Orford et al., 2001).
Sangeeta, Arya Tanwar & K. Ranga Swamy (2010) studied the effects of alcohol dependents on the dimensions of marital satisfaction, family environment and Quality of life on sample of 30 wives under the influence of their partner’s alcohol dependence. They found that excessive drinking and alcohol dependence can exert severe negative effect on the life partners in terms of marital satisfaction, family environment and quality of life perceived by them.
Alcohol problems are related to increased rates of marital violence, poor communication, and feelings of marital distress that lead to a greater risk of divorce (Leonard & Mudar, 2003). Marital satisfaction is realted strongly to a couple’s ability to communicate effectively. But heavy alcohol use is associated with more expression of anger, and less warmth and unity in the relationship. These factors decrease a couple’s satisfaction in their marriage and create greater tension (Jacob and Jennison, 2001).
Sathya Narayana Rao & Kuruvilla (1992) found that discord, voidance, indulgence and fearful withdrawal were the commonest coping behaviors and marital breakdown, taking special action, assertion and sexual withdrawal were least coping behaviors.
Appropriate or inappropriate coping strategies adopted by the wives to deal with the stress depend partly on the social adjustment of the individual with alcoholic. The coping strategies used by them include pleading, threatening, arguing, avoiding, withdrawing sexually, being indulging, taking help and taking step towards separation (Orford and Guthrie, 1976).
More research is needed for Psychiatric social worker to have the knowledge necessary to help the wives of alcoholics to cope with their stressors. In order to design the interventions to help these women to cope with the stress of being married to an alcoholic, Psychiatric social worker need to learn more about their experiences and coping strategies. So dearth of information in Indian setting this study was designed to assess the ways of coping strategies and psychological well-being among wives of alcoholics.
Moos and Moos (1984) found that greater use of avoidant coping behaviors in response to a recent stressful event was associated with greater alcohol use, anxiety, depression, physical symptoms and medication use among spouses of alcoholism, present study was also found that spouses of alcohol dependent patients used more of maladaptive focus coping, not problem focus coping and adaptive focus coping behavior however we did not examine the effect of the mention factor in them.
The families with alcohol dependent people even more support from the family members especially from the spouses is required. So, important things like Psychological well-being, strengthening of the coping mechanism of the spouses (wives) of the alcohol dependent persons can be applied to make the family situations more conductive for these dependent people and successful application of different therapeutic interventions than the normal control group.

Edwards, G. and Grant, M., 1976: Alcoholism: Ne w knowledge and new Responses, Baltimore: Park Press.
Jurgen Rehm, et al (2004). Alcohol use In: Ezzati, Lopez, Rodgers 7 Murray ed. Comparative Quantification of Health Risks (Vol.1pp 959-961) Geneva: WHO
Saibaba (2001). Stemming alcoholism through IEC. Health Action, 15(12): 32-35.
Ponnuduria r, Jayakar J, Raju B, Pattamuthu R. An epidemiological study of alcoholism. Indian J. Psychiatry 1991; 33:176-9.
Tiwari, Ranjana, Srivastava, A.s., Kaushik, S.S. (2010). Indian Journal of Social Science Researches, march, 7(1), 41-46.
Halford, W.K., bouma, R.O., Kelley, A.and Young,, R.M. (1999) The interaction of individual psychopathology and marital problems: Current findings and clinical implication. Behavior Modification, 23, 179-216.
Leonard, K.E., & Jacob, T. (1988). Alcohol, alcoholism and family violence. In van Hasselt, V.B., Morrison, R.L., Bellack, A.S., and hersen, M. (Eds) handbook of Family Violence, pp 383-406. New York: Plenum Press.
Sangeeta Arya Tanwar & K. Ranga Swamy (2010) Alcohol Dependence and its influences on marital satisfaction, family environment and quality of life of the spouses. Indian Journal of Clinical Psychology.
Leonard, K., & Mudar, P. (2003). Peer and Partner drinking and the transition to marriage. A Longitudinal examination of selection and influence processes. Psychology of Addictive Behaviors, 17,115-125.
Jennison, K., and Johnson, K (2001). Parental alcoholism as a risk factor for DSM IV defined alcohol abuse and dependence in American women: The protective benefits of dyadic cohesion in marital communication. Journal of Drug Abuse, 27, 349-374. 
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