Perceive family environment among parents, spouses and ...

Volume 3 • Issue 2 • 1000126J Addict Res TherISSN:2155-6105 JART an open access journal

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Singh et al., J Addict Res Ther 2012, 3:2 DOI: 10.4172/2155-6105.1000126

Perceive Family Environment among Parents, Spouses and Siblings of Alcohol Dependence Patients: A Comparative StudyNarendra Kumar Singh*, Dipanjan Bhattacharjee, Nishant Goyal, Sanjay Kumar Munda and S.H. NizamieDepartment of Psychiatric Social Work, Central Institute of Psychiatry, Jharkhand, India

Keywords: Spouses; Family environment; Alcohol DependenceSyndrome (ADS)

IntroductionFamily 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

AbstractBackground: 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.

*Corresponding author: Narendra Kumar Singh, Department of Psychiatric So-cial Work, Central Institute of Psychiatry, Kanke, Ranchi-834006, Jharkhand, India, Tel: +91-651-245115/+91-651-2450822; E-mail: [email protected]

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.

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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.

MethodParticipants

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].

ResultsResults 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).

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)

Variables Groups (n-90) χ2 pParents(n-30)

Siblings(n-30)

Spouses(n-30)

Sex Male 21 28 0 57.07 .000***Female 9 2 30

Domicile Rural 8 9 53.50 .447Semi-Urban 5 9 9

Urban 17 12 16Occupation Employed 13 18 10

4.39 .111Unemployed 17 12 20

***p is significant at <0.001 levelTable 1a: Socio-Demographic Profile of the Selected Samples (Categorical Variables).

Variables Groups (n-90) f p Parents (n-30)

Siblings (n-30)

Spouses (n-30)

Age (Yrs) 51.37 ± 7.15 31.90 ± 9.10 33.87 ± 6.55 58.41 .000***Education 10.17 ± 2.42 11.67 ± 2.70 10.09 ± 3.01 4.848 .111Income of Informant (Rs.)

4300 ± 2055 3376 ± 1555 1566 ± 655 1.412 .249

Total Family Income (Rs.)

9883 ± 5554 8763 ± 4334 8980 ± 4567 .252 .778

***p is significant at <0.001 levelTable 1b: Socio-Demographic Profile of the Selected Samples (Continuous Variables).


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DiscussionThe 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.

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VariableGroups (n-90)

F P Post-hocParents (n-30) Siblings (n-30) Spouses (n-30)

Cohesion 19.97 ± 7.69 21.63 ± 7.20 17.63 ± 8.33 1.890 .157 -

Expressiveness 16.17 ± 3.41 15.57 ± 4.08 12.63 ± 3.96 7.197 .001**a>cb>ca=b

Conflict 13.57 ± 3.91 14.60 ± 3.29 13.33 ± 3.96 .978 .380 -Independence 21.40 ± 5.84 22.07 ± 6.20 20.40 ± 6.22 .537 .586 -Achievement Orientation 17.33 ± 6.33 18.53 ± 5.27 18.13 ± 4.20 .392 .677 -Intellectual Cultural Orientation 15.63 ± 4.20 16.00 ± 3.35 14.83 ± 4.98 .596 .556 -

Active Recreational Orientation 12.17 ± 3.85 13.60 ± 3.85 12.17 ± 3.42 1.488 .232 -

Moral Religious Emphasis 18.80 ± 5.53 18.83 ± 4.75 19.17 ± 5.06 .047 .954 -Organization 19.67 ± 4.90 19.37 ± 4.82 18.40 ± 5.94 .478 .622 -

Control 19.20 ± 4.57 17.73 ± 3.82 20.87 ± 3.71 4.485 .014*a=cb<cb<a

a= parents; b= siblings; c=spouses, **p is significant at <0.01 level, * p is significant at <0.05 levelTable 2: Perceived family Environment Profile of the Sample Population (N=90): Post-hoc Comparison

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