ABSTRACT
PURPOSE: This study was done to assess effects of women focused relapse prevention program on abstinence self-efficacy and depression in alcoholic women. METHODS: This study was a non-equivalent control group non-synchronized design with two groups, an experimental group (13 patients) and a control group (16 patients). The instruments were the Situational Confidence Questionnaire (SCQ-39) and the Beck depression Inventory (BDI). Data collection was done between July and December, 2008, during which a pre-test, the total of 8 group sessions for four weeks, and a post-test were given to alcoholic women who were admitted to K hospital in U city and D hospital in G city. The collected data were analyzed using descriptive statistics, Fisher's exact test, Mann-Whitney U test and ANCOVA with SPSS/WIN program. RESULTS: The scores for abstinence self-efficacy were significantly higher and for depression lower, for the experimental group after the women focused relapse prevention program. CONCLUSION: This study shows that the women focused relapse prevention program can be applied as an effective nursing intervention by clinical nurses.
Subject(s)
Female , Humans , Alcoholics , Data Collection , Depression , Nursing , Surveys and Questionnaires , Recurrence , Statistics, NonparametricABSTRACT
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Summary: Alcoholism is among the main worldwide public health problems and it affects men and women differentially. Several studies show that, when compared to men, women develop more severe dependence, more family and social consequences and experience more difficulties to stop drinking. Differences on the impact that substance abuse has on women's life and health are related to the roles, functions and social expectancies placed on them concerning the continuity and care for the rest of the family. For this reason, alcohol intake constitutes a special problem since it affects the health of both the mother and her offspring. Alcoholic women have a higher risk of suffering obstetric complications during pregnancy, such as placenta insufficiency, intrauterine development retardation, early placenta detachment, spontaneous abortion, stillbirth and pre-term delivery. Alcohol abuse during pregnancy is also associated with low weight offspring, congenital abnormalities and further behavioral and learning difficulties. In some countries, drinking during pregnancy is considered an offense which requires legal action. In some cases, women may be put in jail until delivery and lactation. In other regions, children welfare authorities view drinking during pregnancy as a form of aggression or neglect. Such measures prevent women from searching prenatal attention which in its case might lead to severe health consequences for the mother, the embryo and the society. Estimates of alcohol consumption during pregnancy around the world vary considerably and figures range from 4.1% to 83%. However, the variation might be related to the amount of alcohol units and the period of time considered in each measurement. A case-control study in Naucalpan, Mexico, found that 11% of the women interviewees admitted having drank during pregnancy, 5% of the mothers in the control group and 2% of the case group stopped drinking during lactation. Still, any of the considered variables was found to predict postnatal mortality through logistic regression analyses. Another study performed with data from the 1988 National Survey on Addictions documents that alcohol intake during pregnancy is a risk factor for congenital abnormalities (OR=3.4). The available data about the risks associated with drinking during pregnancy in Mexico comes from research in general population, while little is known about clinical population. For this reason, the objectives of this article are: 1. to analyze the characteristics of alcohol consumption in a group of women who sought help to stop drinking, 2. to identify family history of alcohol abuse in this group and 3. to explore the consequences of drinking on their offspring. In this case study, interviews were held with 200 women who attended two treatment agencies in Mexico City due to alcohol consumption problems. The questionnaire used includes the Spanish version of the CIDI-SAM and other sections to explore drinking during pregnancy and lactation, as well as family history of alcoholism. Selection criteria were: 1. aged 18 or older, 2. seeking help for the first time, 3. physical and mental conditions that would allow to answer the questionnaire, 4. having drank during the previous year. Women agreed to participate voluntarily once the objectives of the study were explained and confidentiality assured. Personnel of both treatment agencies administered the questionnaire and interviews lasted 60 minutes average. The diagnostics of alcohol dependence were obtained according to DSM-IV criteria. Data were analyzed with the statistical program SPSS v. 10, for Windows. A total of 134 women reported having been pregnant at least once, and 57.5% of them admitted having drank alcoholic beverages during pregnancy. Age ranged from 18 to 61 years (mean=40), 50% were married or living with a partner, 18% were divorced or separated and 13% had never married. The number of children ranged from 1 to 12 with a mean of 3. High percentages of family history of alcohol abuse were found among this group (93.5%): mostly the father (72.7%), siblings (63.6%) and the partner (48.1%). Significant differences in family history of alcohol use were found between women who drank during pregnancy and those who did not drink. Around 66% reduced alcohol intake after the confirmation of pregnancy; however, 26% continued drinking as usual and 6.5% started drinking at this period. The mean number of drinks consumed per drinking occasion during pregnancy was 3.5, being the traditional beverage pulque (48.8%) and beer (34.9%) the preferred beverages. In addition, 9.2% also took medical drugs. At least three out of the seven criteria proposed in DSM-IV for alcohol dependency were met by 70.3% of the women who drank during pregnancy. More severe dependence was found among the women who drank during pregnancy than among the group of women who abstained. As to the consequences of drinking, 12% of the women reported spontaneous abortion, 13.7% pre-term deliveries, 5.5% stillbirth, 6.8% congenital abnormalities and 13.7% low birth weight. When comparing women who drank and those who did not during pregnancy, significant differences were found in the percentage of pre-term deliveries (X2=5.63; p=0.01) and congenital abnormalities (X2=4.22; p=0.05). A number of logistic regression models was assessed using three independent variables: drinking during pregnancy, frequency of alcohol consumption and severity of dependence. Dependent variables, on the other hand, were spontaneous abortion, pre-term delivery, stillbirth, congenital abnormalities, low birth weight, alcohol use by the offspring and drinking problems in the offspring. The analysis shows that alcohol consumption during pregnancy is related to pre-term deliveries (OR=7.9), and alcohol use by the offspring (OR=2.1). Severity of dependence is related as well to low birth weight (OR=3.7) and further drinking problems in the offspring (OR=2.7). Likewise, drinking every day or almost every day is also related to later drinking problems in their children (OR=2.9). Finally, having siblings who drink (OR=2.11) and meeting alcohol dependency (OR=2.21) criteria are factors that predict alcohol consumption during pregnancy. These results are consistent with other studies that report positive family history of alcohol abuse among alcoholic women. The proportion of women who stopped drinking during pregnancy (42.5%) is higher than the one reported by other authors. Prevalence of spontaneous abortion, stillbirth and congenital abnormalities are higher than the prevalence reported among general population. These findings suggest that women with severe dependence face more difficulties to stop drinking during pregnancy in spite of the social stigma imposed to future mothers who drink. The results provide some elements that support an association of alcohol abuse during pregnancy with adverse pregnancy outcomes. Nevertheless, the impact of fetal alcohol exposure responds to a complex model where a number of interacting factors, longitudinal reaserch is needed to determine the weight of each participating variable and the underlying relationship between them.
ABSTRACT
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Summary The main objective of this paper is to describe the way in which the Alcohol Dependence Syndrome is manifested, according to the criteria and indicators proposed by the DSM-IV, in a female sample that sought help at a treatment center due to alcohol consumption-related problems. A comparison was made with the results obtained in a previous 211-male-sample at the same treatment center. Method: This project is a case study in which a sample of 100 females was interviewed at the Clínica para Atención de Problemas Relacionados con el Alcohol (CAPRA) (Clinic for the Attention of Alcohol Related Problems) at the Hospital General de México (the main general hospital for patients who do not have social security benefits and come from different regions of the country including rural areas). The criteria for inclusion were: being aged 18 or over, female, having sought help for the first time (at these centers) due to alcohol problems and being physically and mentally able to answer the questionnaire correctly. Females that had previously been treated were included. However, one of the requisites was that they had to have drunk alcohol during the year before the interview to warrant recent and current consumption, regardless of being exposed to prior treatments, since the questionnaire includes the previous 12 months as a parameter. The instrument used to conduct this study was the Composite International Diagnostic Interview, Substance Abuse Module (CIDI-SAM). This instrument has been widely used with excellent results on various population samples in the U.S., as well as on the male population receiving treatment in Mexico. The instrument included the following sections: sociodemographic characteristics, amount and frequency of consumption; physical, psychological and social problems; symptoms of alcohol dependence, and pathways to health services. A few new sections were incorporated with specific characteristics for women, such as the effects of alcohol on women, alcohol consumption during pregnancy and nursing, partner's alcohol consumption and violent behavior in the couple and their associated risks. Results: The average age of the women interviewed was 47 years old, ranging from 22 to 91. Thirty-two percent were either married or living with a partner, 20% were divorced, 26% were widows and 22% were single. Seventy-four percent of them had children and they had 4.5 children in average. The average educational level was 4.7 years. Fifty-two percent of the respondents reported drinking alcohol every day and 19% almost every day (five or six days a week), with an average of 4.2 drinks per occasion (52% of the women reported having three to four drinks per occasion). The preferred reported beverage was «pulque¼ (28%), followed by beer (25%) and distilled beverages (21%). Other traditional drinks and «96° proof" alcohol also showed a significant percentage (20%). As for the Alcohol Dependence Syndrome, 50% of the women met the dependency criteria proposed by the DSM-IV, compared with 82% of the 211 men interviewed in the same center with a statistically significant difference (X2= 34.22; p = 0.000). Women with alcohol dependence syndrome presented an average of five symptoms. A more detailed analysis was carried out based on the severity of the dependence syndrome, measured by the number of reported symptoms (1-2, 3-4, 5-7). The most frequently reported symptom across all levels of severity was the presence of physical and/or psychological problems. In the group of non-dependent women (those who reported less than 3 symptoms), an important difference between men and women was observed. The most frequent symptoms reported by men, after the presence of physical and psychological problems, were withdrawal symptoms (34.2%) and loss of control (15.8%). In the case of the women, unsuccessful efforts to reduce alcohol intake (16%) and withdrawal symptoms (16%) appeared in the second place. The group of women with low dependence (three to four criteria reported) presented similar characteristics to those observed in the group of non-dependent women. In men with low levels of dependence, the most frequent symptom presented were: giving up or reducing activities (social, occupational or recreational) in order to drink and withdrawal symptoms. In the groups with the highest severity level (5-7 symptoms), differences between men and women were less evident. Conclusions: The most important differences in dependence symptoms between men and women are probably related to gender-specific cultural expectations and social norms regarding alcohol use. This situation is reflected in the type of symptoms presented more frequently in women and men. Women reported more symptoms related to unsuccessful efforts to reduce alcohol intake; whereas men presented symptoms related to the time spent drinking or recovering from the effects of alcohol and giving up or reducing activities (social, occupational or recreational) in order to drink. The information presented evidences the need to conduct more specific studies that take in consideration biological and psychological, as well as social conditions underlying female alcohol use in order to provide appropriate and effective treatment to meet their gender needs and expectations.