Clinical and Sociodemographic Profile of Patients with Alcohol Dependence Syndrome: A Hospital Based Study

Full text

Psychiatry and Mental Health / Volume 1 Number 2 / July  December 2017
61
Original Article
Clinical and Socio-Demographic Profile of Patients with Alcohol
Dependence Syndrome: A Hospital Based Study
Khushboo Dewani
1
, Narayan R. Mutalik
2
, Shriniwas B. Choudhari
3
Introduction
Substance abuse has become a global
phenomenon
,
which is influenced by social,
economic, political and psychosocial factors [1].
It
not only includes the use of licit substances like
alcohol, tobacco but also the illicit substances such
as cannabis, heroin etc. [2].
Worldwide there is a rising trend in number of
people who resort to substance use at an early age.
The worldwide prevalence of alcohol use disorders
among the individuals at the age of 15 years and
above was estimated to range from 0% to 16% [3].
A
powerful predictor of progression to alcohol
dependence is age at first use [4].
Alcohol has been consumed in India for centuries.
The pattern of alcohol use in India has changed from
occasional and ritualistic drinking to social drinking
[5]. The prevalence of use of alcohol ranges from a
low of 7% in Gujarat (officially under Prohibition) to
75% in the Northeastern state of Arunachal Pradesh
[6].
Alcohol use disorders range from drinking alcohol
at hazardous levels to alcohol dependence[7].
Alcoholism is a progressive disease in which
individual has been unable to quit drinking and
Abstract
Background: Worldwide there is a rising trend in number of people who resort to substance use at an early
age. The percentage of population that drinks at an early age has increased from 2% to more than 14%. Research
is needed to optimize treatment strategies especially in the understudied group of Asian Indians based on local
epidemiology of alcohol use. Objectives: To study the clinical and sociodemographic profile of males diag
nosed with alcohol dependence syndrome. Materials and Methods: A descriptive study comprising of 50 subjects
attending psychiatry de-addiction clinic in a private medical college in Bagalkot, Karnataka during 1st April
2016 to 30th September 2016 was done after taking institutional ethical committee clearance. A semistructured
proforma was used to determine the sociodemographic details and clinical determinants. Descriptive analy
sis using appropriate statistical test will be done. Results: The mean age of starting drinking was 23.58 years.
Most of the patients have not sought any previous help, 48.7% patients were brought by family members for
deaddiction, withdrawal symptoms being the reason for seeking help. Most common cause (60%) for initia
tion of alcohol was peer influence followed by experimentation. Family history of alcoholism was positive in
68% of patients. Conclusion: Results showed an urgent need of interventions that are family centered. Early age
of first use of alcohol greatly increases the risk of progression to the development of alcohol dependence and
therefore is a valid target for intervention strategies. The dreadful consequences of substance abuse justify the
need to evolve a comprehensive strategy.
Keywords: Alcoholism; Peer Influence; Substance Related Disorders.
1
Junior Resident
2
Assistant Professor
3
Associated Professor, Department of Psychiatry, S Nijalingappa Medical College,
HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, Karnataka 587102, India.
Correspondence and Reprint Requests: Khushboo Dewani, Junior Resident, Department of Psychiatry, S Nijalingappa
Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, Karnataka 587102,
India.
Email: khushboo.dewani@yahoo.in
Received: April 21, 2017 | Accepted: June 28, 2017
Psychiatry and Mental Health
Volume 1 Number 2, July  December 2017

Psychiatry and Mental Health / Volume 1 Number 2 / July  December 2017
62
continues to drink even after knowing its harmful
effects. Individual might face problem in controlling
the drinking, might be preoccupied with alcohol,
might drink more to get the desired effect and if stops,
individual will face alcohol withdrawal
symptoms [8].
Substance abuse including alcohol leads to
various health problems, social issues, unprotected
sex, injuries, violence, road traffic accidents,
homicides, suicides, physical dependence, or
psychological addiction, deaths [9].
In few of the
cases, substance induced psychiatric disorders may
persist for a longer period of time even after
detoxification, such as psychosis or depression [10].
Increased susceptibility to human immunodeficiency
virus (HIV)/acquired immunodeficiency syndrome
(AIDS) and other sexually transmitted diseases has
been reported with alcohol [11].
Considering these facts and lack of such studies
from the tertiary hospital in Bagalkot, the study was
carried out to determine the sociodemographic and
clinical profile of the treatment seekers in the de
addiction clinic, in psychiatry department so as that
the problems of alcohol related co morbidities can be
prevented with appropriate preventive measures.
Aims
To study the clinical and sociodemographic
profile of males diagnosed with alcohol dependence
syndrome.
Materials and Methods
The study was conducted in DeAddiction Clinic
of the Department of Psychiatry at a private medical
college in Bagalkot, Karnataka during the period
from 1st April 2016 to 30th September 2016. All the
subjects fulfilling the inclusion and exclusion
criteria during the study period were included in
this study.
Inclusion Criteria
All subjects presenting to the deaddiction clinic
of a private medical college with alcohol related
problems were considered for this study and were
enrolled if they fulfill the following inclusion criteria:
1. Patient of age 18 years and above
2. Patient who fulfills criteria for dependence or
substance harmful use, according to ICD10.
3. Willing to give written informed consent.
Exclusion Criteria
Subjects with any of the following will not be
included in the study:
1. Presence of any major illness requiring intensive
medical/surgical intervention.
2. Not giving informed consent.
Study Procedure
The design and nature of the clinical study was
explained to the patients. Informed consent was
obtained. All patients were first examined by
consultant Psychiatrist to confirm alcohol
dependence or harmful use. Sociodemographic
details like education, occupation, socio economic
status, history of substance use, etc. and various other
clinical determinants like age of first use, reasons for
substance abuse, age of dependence were collected
using a specially designed proforma.
Results
A total of 50 patients were included in the study.
The mean age at presentation was 37.7 years (SD =
9.47). Minimum age being 20 years and maximum
being 65 years. Sixty eight per cent of patients had
positive family history of alcohol use. Most of the
patients had early onset alcohol dependence. Most
common cause (60%) for initiation of alcohol was
peer influence followed by experimentation. Most of
the patients have not sought any previous help, 48.7%
patients were brought by family members for de
addiction, withdrawal symptoms being the reason
for seeking help (Figure 1) Psychiatric comorbidities
were found in 10% of individuals (Figure 2).
Discussion
The mean age at presentation was 37.7 years (SD
= 9.47). Mean age at presentation in various studies
with similar design have ranged between 37 and 43
years [4,5].
A majority of individuals belonged to
above poverty level group socioeconomically. Most
of the individuals had education more than
secondary level. Previous studies showed lower
education status associated with alcohol
dependence [5].
Seventytwo percent of patients were
married and living with spouse. Most western studies
found the marital status of the patient to be being
separated or divorced [12].
The difference is probably
due to Indian customs and culture. Only 6% of
Khushboo Dewani et. al. / Clinical And SocioDemographic Profile of Patients with Alcohol
Dependence Syndrome: A Hospital Based Study

Psychiatry and Mental Health / Volume 1 Number 2 / July  December 2017
63
Socio-Demographic Details N (%)
No. of Participants
50
Age (average) at presentation 37.7 years
Education
No Formal Education
3(6)
Primary
3(6)
Secondary
18(36)
Higher Secondary
12(24)
Graduate
12(24)
Post Graduate
2(4)
Marital Status
Single
9(18)
Married and living with spouse
36(72)
Separated
5(10)
Occupation
Unemployed
3(6)
Unskilled
/
Farmer
/
Clerical
22(44)
Semi
-
skilled
/
Skilled work
18(36)
Professional
/
Business
7(14)
Socio- economic status
Above Poverty Line
39(78)
Below Poverty Line
11(22)
Table 1: Sociodemographic details
Fig. 1: Complaints at the time of presentation
Khushboo Dewani et. al. / Clinical And SocioDemographic Profile of Patients with Alcohol
Dependence Syndrome: A Hospital Based Study

Psychiatry and Mental Health / Volume 1 Number 2 / July  December 2017
64
Age Mean (SD) (Years) Minimum-Maximum (years-years)
At first use
23
.
58
(
6
.
92
)
11
-
42
Regular use
25
.
82
(
6
.
90
)
15
-
47
Development of tolerance
28
.
3
(
8
.
8
)
18
-
50
Development of craving
28
.
92
(
11
.
46
)
18
-
51
Table 2: Drinking history
Fig. 2: Comorbidities associated with alcohol dependence
individuals were unemployed, but most of them i.e.
44% were involved in work not requiring much
education. Study done by Vignesh BT et al [3] found
58% employment in skilled work in alcohol
dependent patients.
Positive family history of alcohol use was found
in 68% of patients. Prior study has shown that
students with parental history of alcoholism drink
more and have more alcohol related problems than
their counterparts from nonalcoholic families [13].
Another study revealed that a significantly higher
number of adolescents resort to substance abuse
when both parents are abusers (46.7%) [14].
Another
study showed that
15% of the participants consumed
alcohol due to familial status or peer pressure [15].
The most common purpose of substance abuse in the
study by Sarangi L et al was found to be peer pressure
(52.8%) [14] , whereas Bansal et al [16] found the
most common purpose of substance abuse to be
curiosity or experimentation (34.3%). In our study,
most common cause (60%) for initiation of alcohol
was peer influence followed by experimentation.
In our study mean age of first drink of alcohol was
found to be 23.6 years. Previous studies have found
early age (18.9 years) of onset of drinking.[
5]
The
difference could arise due to unwillingness of the
patients to tell the age at first drink and due to the
demographic differences present.
The Collaborative Study of the Genetics
Alcoholism (COGA) group found the mean age at
onset of alcoholism was 25 years. The mean age of
onset of tolerance was 28.3 years which was same as
the age of development of dependence found in
previous studies [5].
Singh et al. found that 44% of
the subjects developed dependence between 15 and
25 years [17].
In our study,98% of individuals seek care due to
withdrawal symptoms either delirium tremens or
withdrawal seizures. In study by Reddy MPK et al
[5],
majority of patients had presence of withdrawal
symptoms (95%) and financial strain due to alcohol
use was most commonly attributed for current
treatment seeking by key informants (92.5%).
Higher prevalence and intensity of smoking
among drinkers [18] was found in previous studies
Khushboo Dewani et. al. / Clinical And SocioDemographic Profile of Patients with Alcohol
Dependence Syndrome: A Hospital Based Study

Psychiatry and Mental Health / Volume 1 Number 2 / July  December 2017
65
and was replicated in ours (70%). Systemic illnesses
like hypertension and diabetes was found in 20% of
the participants. Tuberculosis was the most common
infection associated with alcoholics in our study.
Limitations
The study had a small sample size and was a case
series study as a result a causal relationship cannot
be drawn and only associations between the various
variables and alcohol dependence can be described.
Further the study was limited to one geographical
location so the results of the study cannot be
generalized.
Conclusion
Mean age at first drink was 23.6 years and age at
onset of tolerance was 28.3 years. The alcohol
dependence was more common in individuals with
education more than secondary level. Most of the
patients presented with withdrawal symptoms.
Measures to improve the knowledge about ill effects
of alcohol use are needed to control the alcohol abuse.
Interventions which are family centered and target
individuals who are unskilled are required.
Acknowledgements
We would like to thank the hospital authorities
for permitting us to conduct the study and all the
participants involved in the study.
Conflict of Interest: None declared
Source of Support: Self
References
1. World Health Organization Biennium Project (2006
2007). Drug abuse monitoring system, Report, India.
Available from: http://www.slashdocs.com/
kwsytw/mentalhealthsubstanceabusedrug
abusemonitoringsystem.html[Last accessed on 25
March 2014].
2. Murthy P, Manjunatha N, Subodh BN, Chand PK,
Benegal V. Substance use and addiction research in
India. IndianJPsychiatry.2010 Jan 1;52(7):189199.
3. Vignesh BT, Singh AK, Mohan SK, Murthy S, Joshi
A. Association between sociodemographics and
alcohol dependence among individuals living in
an Indian setting. Glob JHealthSci. 2014 May;6(3):16.
4. DeWit DJ, Adlaf EM, Offord DR, Ogborne AC. Age
at first alcohol use: a risk factor for the development
of alcohol disorders. Am J Psychiatry. 2000 May
1;157(5):74550.
5. Reddy MP, Babu RS, Pathak SM, Venkateshwarlu S.
The clinical and demographic profile of male
patients with alcohol dependence syndrome.
IndianJ Psychol Med. 2014 Oct;36(4):418.
6. Benegal V. India: alcohol and public health.
Addiction. 2005 Aug 1;100(8):10516.
7. Pillai A, Nayak MB, Greenfield TK, Bond JC,
Nadkarni A, Patel V. Patterns of alcohol use, their
correlates, and impact in male drinkers: a population
based survey from Goa, India. Soc Psychiatry
Psychiatr Epidemiol 2013 Feb 1;48(2):27582.
8. Hoffman PL, Tabakoff B. Alcohol dependence: a
commentary on mechanisms. Alcohol and
alcoholism. 1996 Jul 1;31(4):33340.
9. Burke PJ, O’sullivan J, Vaughan BL. Adolescent
substance use: brief interventions by emergency care
providers. Pediatr Emerg Care 2005 Nov 1;21(11):7706.
10. Isralowitz R. Drug use: A reference handbook
[Internet]. California: Santa Barbara; 2004. Available
from:http://books .google.co.in/bo oks?isbn=
157607708X. [Last accessed on 2013 May 10].
11. Chandra PS, Carey MP, Carey KB, Rao PP, Jairam
KR, Thomas T. HIV risk behaviour among
psychiatric inpatients: results from a hospitalwide
screening study in southern India. Int J STD AIDS.
2003 Aug 1;14(8):5328.
12. Rao TS, Nambi S, Shekhar HC. Marriage mental
health and Indian legislation. Forensic Psychiatry
Clinical Practice Guidelines for Psychiatrists in
India. Jaipur (India): Indian Psychiatric Society.
2009:11328.
13. Gupta PC, Saxena S, Pednekar MS, Maulik PK.
Alcohol consumption among middleaged and
elderly men: a community study from western India.
Alcohol and Alcoholism. 2003 Jul 1;38(4):32731.
14. Sarangi L, Acharya HP, Panigrahi OP. Substance
abuse among adolescents in urban slums of
Sambalpur. Indian J Community Med. 2008 Oct
1;33(4):265.
15. John A, Barman A, Bal D, Chandy G, Samuel J,
Thokchom M, et.al. Hazardous alcohol use in rural
southern India: nature, prevalence and risk factors.
Natl Med JIndia. 2009;22(3):12325.
16. Bansal RK, Banerjee S. Substance use by child
labourers. Indian J Psychiatry. 1993 Jul;35(3):159.
17. Singh NH, Sharma SG, Pasweth AM. Psychiatric co
morbidity among alcohol dependants. Indian J
Psychiatry 2005 Oct 1;47(4):222.
18. Thun MJ, Peto R, Lopez AD, Monaco JH, Henley SJ,
Heath Jr CW, et.al. Alcohol consumption and
mortality among middleaged and elderly US
adults. New England Journal of Medicine. 1997 Dec
11;337(24):170514.
Khushboo Dewani et. al. / Clinical And SocioDemographic Profile of Patients with Alcohol
Dependence Syndrome: A Hospital Based Study