INTRODUCTION:

In 2014, the World Health Organization released its global status report on alcohol and health. According to report about 38.3% of world’s population is reported to consume alcohol regularly. On an average, individual consumption amount to 6.2 L of alcohol each year. The report only considers individuals over 15years of age. The report says that about 30% of Indian population, just less than a third of the country’s population consume alcohol regularly (as of 2010). Some 11% are moderate to heavy drinkers. An average Indian consumes about 4.3 L of alcohol/annum, says the report. The rural average is much higher at about 11.4 L a year. According to an organization for economic cooperation and development (OECD) report released in May 2015, alcoholism increased by about 55% between 1992 and 2012. It is a quickly rising concern among the youth of the country¹.

Alcohol dependence syndrome (ADS) is defined as a cluster of physiological, behavioural, and cognitive phenomena in which the use of alcohol takes on a much higher priority for an individual than other behaviours that once had greater value. It is also known as alcoholism. This syndrome may develop as a result of genetic inheritance, environmental and peer influence. It is a serious health issue and despite being deeply studied, this disorder is difficult to spot. It is not a static disease, but a phenomenon which depends on biological and cultural factors. Alcohol dependence is characterised by the symptoms such as strong need or compulsion to drink, no control over the quantity of drinking, withdrawal symptoms if alcohol is not consumed for a longer period of time and the body develops tolerance it causes behavioural problems such as mood swings, impaired judgement, and speech orientation changes and there is poor coordination. Memory gets affected and “blackouts” often occur. Very high alcohol levels in blood also may lead to coma and death. Alcohol affects not only the alcoholics, but also may affect other members of the family.²

The alcoholic family members very often become co-dependent. Co-dependency is types of dysfunctional helping relationship were one person supports or enables another person’s alcoholic addiction. It is an emotional and behavioural condition that affects an individual ability to have a mutually helping relationship also known as relationship addiction. Because people with co-dependency often form or maintain relationship that are one sided, emotionally destructive and are abused. A co-dependent may feel shame about, or try to change, his or her most private thoughts and feeling if they conflict with those of another person. Co-dependency describes a pattern of behaviour were by one or both partners lack autonomy and depend on the other for happiness and approval. Co-dependency often becomes an issue for those in relationship with people who suffered from alcohol dependency. Individual who are co-dependent base their identity and self worth on their partner in an alcoholic family system. A co-dependent spouse or child gets all the self worth and values from the alcoholic. They need the alcoholic to approve of them so they can feel good. Co-dependence enables alcoholics. They make it possible for the alcoholic to drink more and for longer by the way they behave towards them. Also since the wife is dependent on the husband’s alcoholic behaviour, she may actually feel disturbed, she feel threat to her position. As a co dependent she might unconsciously resist the husband’s steps towards recovery.^3,4

The impact of alcoholism in marriage is profound. Alcohol abuse increases family conflicts and decreases the satisfaction of marital life because alcoholics become irresponsible in their everyday house hold activities. Also heavy alcohol use is associated with more negative and hostile communication, more expression of anger and less warmth and unity in their relationship. These factors lead to greater stress on the non drinking spouse and decreases satisfaction in the marriage.

OBJECTIVES:

1. To determine the level of codependency among spouses of patients with ADS.

2. To asses the quality of marital life among spouses of patients with ADS.

3. To explore the relationship between level of codependency and quality of marital life among spouses of patients with ADS.

4. To find the association of codependency with selected socio personal variables among the spouses of patients with ADS.

HYPOTHESIS:

H1: There will be a significant relationship between level of co-dependency and quality of marital life among spouses of patients with ADS.

H2: There will be significant association between level of codependency and selected socio-personal variables among spouses of patients with ADS.

OPERATIONAL DEFINITIONS:

Co dependency:

Co dependency is defined as a dysfunctional behaviour that are evident among members of family of a chemically dependent person .In the present study co dependency refers to the dysfunctional enabling behaviour among spouses of patients with alcohol dependence syndrome attending the de addiction unit of MOSC MM Hospital, Kolenchery which is measured using Spann Fischer co dependency scale.

Quality of marital life:

Quality of marital life is the subjective evaluation of a married couple’s relationship on a number of dimensions and evaluations. In the present study quality of marital life refers to the subjective evaluation of marital relationship among spouses of patients with alcohol dependence syndrome attending the de addiction unit of MOSC MM Hospital, Kolenchery which is measured using ENRICH marital satisfaction scale.

Alcohol dependence syndrome:

Alcohol dependence is defined as a cluster of behavioural, cognitive and biological phenomenon that may develop after repeated alcohol use which is diagnosed on the basis of ICD10 diagnostic guidelines.

RESEARCH APPROACH:

The study adopted a quantitative research approach.

RESEARCH DESIGN:

The study employed an observational analytical research design.

SETTING:

The study was conducted among spouses of patients with alcohol dependence syndrome admitted in the de-addiction unit of MOSC MM Hospital, Kolenchery.

POPULATION:

The study was conducted among spouses of patients with alcohol dependence syndrome attending the de-addiction unit of MOSC Medical mission hospital Kolenchery.

SAMPLING AND SAMPLING TECHNIQUE:

The sampling technique used for the present study was a convenient sampling technique.

SAMPLE SIZE:

The sample size was estimated for estimation of proportion with relative precision and the study samples included 80 spouses of patients with alcohol dependence syndrome admitted in the de-addiction unit of MOSC MM Hospital, Kolenchery.

INCLUSION AND EXCLUSION CRITERIA:

Inclusion criteria:

Spouses of patient with alcohol dependence syndrome who are:

Ÿ Able to read and understand Malayalam.

Ÿ Married for a period of greater than one year.

Exclusion criteria:

Ÿ Spouses with significant physical and mental disorders.

Ÿ Spouses of patient who remain sober for more than one year.

TOOLS AND TECHNIQUES:

Individuals who fulfilled the inclusion criteria and willing to participate in the study were enrolled in the study and data were collected from them using a structured socio -personal performa, Spann-Fischer co-dependency scale and ENRICH Marital satisfaction scale.

Tool 1:- Socio – Personal Performa:

It is a structured self report performa which is usedto collect the socio – personal information of the spouses of patient with alcohol dependence syndrome. Items in socio – personal performa include age, gender, type of family, religion, education, occupation, income, number of children and duration of marriage, history of previous de-addiction treatment, duration of addiction and family history of substance use.

Tool 2: Spann- Fischer Codependency Scale:

Co-dependency was be measured using Spann Fischer co-dependency scale. It is a standardized 16 item self report scale to measure co dependency. Individual items are rated on a 6 point likert scale to describe co dependency on a scale from high score of 96 to a low score of 16. The scale was found to have test retest correlation of 0.87 and internal consistency, Cronbach’s alpha value of 0.86. The scale is scored such that high score reflect greater co-dependency.

Tool 3: ENRICH Marital Satisfaction Scale (EMS Scale):

Marital satisfaction was measured using ENRICH Marital satisfaction scale. It is a self reported questionnaire to assess the marital satisfaction. The EMS scale is a 15 item scale comprising the idealistic distortion (5 items) and marital satisfaction scale. It correlates highly with other scales that measures marital conventionalization and has an alpha coefficient of 0.92 and a 4- week test retest reliability of 0.92. The EMS scale provides a score for each partner. This score is derived by first scoring the marital satisfaction and idealistic distortion scale, then correcting the marital satisfaction score downward on the basis of the person’s idealistic distortion score. High score reflects greater marital satisfaction.

PILOT STUDY:

Pilot study was conducted among 30 spouses of patients with alcohol dependence syndrome to ascertain the feasibility of the study prior to actual data collection.

METHODS OF DATA COLLECTION:

A formal administrative permission was obtained from Principal, MOSC College of nursing; Administrative Director, MOSC MM Hospital and HOD, Department of psychiatry, MOSC MM Hospital. After obtaining administrative permission, the subjects were selected using a convenient sampling technique. Informed consent was obtained from the participants and data were collected using structured socio-personal Performa, Spann Fischer co-dependency scale and ENRICH marital satisfaction scale.

RESULTS:

Description of socio personal variables of spouses of patients with alcohol dependence syndrome:

The study results showed that majority (33.75%) of the samples belonged to the age group of 46-65 years. All the subjects were females and the majority (75%) belonged to nuclear family. With regard to the religion, most of the subjects (52.5%) followed Hindu religion. 32% of the subjects were having primary education and 43.75% subjects were unemployed. Most (47.5%) of the subjects were having a monthly income between 5000-15000 and majority of subjects (52.5%) had duration of marital life more than 20 years. Majority (52.5%) of subjects had previous history of abstinence and most (78.75%) of subjects had family history of substance use. (Table: 1)

Table 1: Frequency and percentage distribution of socio personal variables n=80

Demographic variables

Frequency

Percentage (%)

Age in years

25-35

36-45

46-55

>55

22.50

27.50

33.75

16.25

Family structure

Nuclear family

Joint family

75.00

25.00

Religion

Hindu

Christian

Muslim

52.50

43.75

3.75

Education

Primary education

High school

Higher secondary

Post graduate

32.50

30.00

20.00

17.50

Monthly income

<5000

5000-15000

16000-25000

>25000

43.75

47.50

6.50

2.50

Duration of marital life

1-5 years

6-10 years

11-15 years

16-20 years

>20 years

6.25

13.75

7.50

21.25

52.55

Previous history of abstinence

Yes

52.50

47.50

Family history of substance abuse

Yes

78.75

21.25

Level of co-dependency among the spouses of patients with alcohol dependence syndrome:

It was observed that the mean level of codependency is around 64.07 with standard deviation of 13.14 [Table 2].

Table 2: Mean and standard deviation of level of codependency among the spouses of patients with alcohol dependence syndrome n=80

Variable	Mean	Standard deviation
Codependency	64.07	13.14

The level of co-dependency was categorized into three categories viz: mild (score between 16-42), moderate (score between 43-69) and severe (score between 70-96). It is observed that the majority (48.75%) of the subjects were moderately co-depende: 1nt; 41.25% of subjects were severely co dependent and only 10% had mild co-dependency. (Fig:1)

Fig: 1: Level of codependency among the spouses of patients with alcohol dependence syndrome

Category wise Mean and Standard Deviation of age, education, duration of marital life and previous history of abstinence:

Among the age groups, samples in the age group < 55 and samples in the age group 46-55 had the highest mean codependency score 72.92 with standard deviation 9.34 and 66.51 with standard deviation 11.48 respectively. Samples with primary education had highest mean codependency score with a standard deviation of 11.5 when compared with others having more education. Moreover, samples with duration of marital life >20 years (µ= 68.19, SD= 10.79) and samples with no history of abstinence in the past (µ= 67.84, SD= 12.59) had highest mean codependency scores. [Table 3]

Table 3 : Categorywise Mean and standard deviation of socio personal variables. n=80

Variable	Category	Mean	Standard deviation
	25-35	63.66	12.57
Age	36-45	56.18	13.66
	46-55	66.51	11.48
	>55	72.92	9.34
	Primary	68.19	11.57
	High school	66.79	10.11
Education	Higher secondary	59.87	14.18
	Post graduate	56.57	15.09
	1-5Years	48.80	6.18
	6-10Years	65.45	8.53
Duration of marital life	11-15Years	45.16	15.35
	16-20Years	64.14	13.42
	>20Years	68.19	10.79
	Yes	60.66	12.82
Previous history of abstinence
	No	67.84	12.59

Quality of marital life among spouses of patients with alcohol dependence syndrome:

The mean level of quality of marital life was found to be 36.75 with a standard deviation of 19.54. (Table:4)

Table 4: Mean and standard deviation of level of codependency among the spouses of patients with alcohol dependence syndrome n=80

Variable	Mean	Standard deviation
Marital satisfaction	36.75	19.54

Relationship between level of co-dependency and quality of marital life among spouses of patient with alcohol dependence syndrome:

Relationship between level of codependency and quality of marital life was computed using Pearson’s correlation coefficient (r) as data followed normal distribution. There is a moderate negative correlation between codependency and quality of marital life (r=-0.302, p=0.006) which is found to be statistically significant. (p=0.006) (Table:5)

Table 5: Relationship between level of codependency and quality of marital life among spouses of patients with alcohol dependence syndrome n =80

Variable	Mean	SD	r value	p value
Codependency	64.07	13.114	-0.302	0.006
Quality of marital life	36.75	19.54

Association between co-dependency among the spouses of patients with alcohol dependence syndrome and socio personal variables:

Association between level of co-dependency and socio personal variables were computed using Independent sample ‘t’ test and ANOVA based on the number of categories in the socio personal variables. Chi square was also computed which showed the same results.

Significant (p=0.017) association were found between co-dependency with gender (p=0.0012), education (P=0.017), duration of marital life (0.00002) and previous history of abstinence (0.0138). No significant association were found between co-dependency with occupation (p=0.64), religion (p=0.22) and family history of substance use (p=0.89).

DISCUSSION:

Present study findings revealed that 48.75% of the subjects had moderately co dependent; 48, 25% of the subjects had severely co dependent and only 10% had mild co dependency. A supportive study conducted to assess depression and codependency among souses of alcoholics revealed that majority 72.2% of the samples had medium level of co dependency and majority 32.1% wives of alcoholics had mild depression.⁵

Present study also revealed that there is a moderate negative co relation between co dependency and quality of marital life(r= -0.302, p=0.006). This finding is also supported y another study conducted by Ravindran R et.al which showed a significant relationship between level of co-dependency and quality of marital life among spouses of patients with alcohol dependence syndrome.⁶

A contradictory study was conducted by Dr Senthil M to assess family interaction pattern and co-dependency among spouses of patients with alcohol dependence syndrome reported that spouses of individual with alcohol dependence syndrome had significantly higher scores in family interaction pattern scale; especially in the domains of re enforcement and the role as compared to spouses of individuals. It also suggests that the level of co-dependency was significantly higher to the individuals with alcohol dependence syndrome as compared to spouses of normal individual.⁷

CONCLUSION:

The study concluded that majority of spouses of alcohics had moderate to severe co-dependency and as the co-dependency score increased, the quality of marital life score reduced moderately. The study therefore clearly identified the higher prevalance of co-dependency among spouses of alcoholics, which is proved to facilitate the drinking behaviour of addicts. The major finding of the study which proved the negative correlation between co-dependency and quality of marital life brings in a notion that in addition to other psycho-social problems, co- dependent spouses have an additional burden of marital dissatisfaction.

^REFERENCES:

1. World health organization. Global status report on alcohol and health.2014; 27-42.

2. Townsend M C. Psychiatric mental health nursing. 5th edition. 2007; 442-43.

3. Jiji TS. Co dependency of the families of Alcoholics. Health Action. 2011; 16 -17.

4. Natalie B. Six common family roles in an addicted household. (Internet) 2017 (Cited 2017 June 23). Available from https://www.rehabs.com/6-common-family-roles-in-an-addicted-household/

5. Kaur S. Depression and co-dependency among wives of alcoholics.(internet) AJNER, vol-6, issue-2, 2016.

6. Ravindran R, Varghese K, George K R. relationship between the level of co-dependency and quality of marital life of spouses of patients with alcohol dependence syndrome. Kerala nursing forum. 2016; 11: 17-24.

7. Dr Senthil M family interaction pattern and co dependency in spouses of alcohol dependence in comparison with normal control. International Journal of Research Ganthaalagath. Vol. 4, No.4 (2016):121-128.

Received on 05.07.2018 Modified on 21.09.2018

Int. J. Nur. Edu. and Research. 2018; 6(4):374-378.

DOI: 10.5958/2454-2660.2018.00091.1