The International Journal of Indian Psychology ISSN 2348-5396 (e) ISSN: 2349-3429 (p) Volume 4, Issue 3, DIP: 18.01.241/20170403 http://www.ijip.in April - June, 2017 Original Research Paper A Study on Effectiveness of Clinical Psychologist in De-Addiction Centers Kamble Jyoti 1 *, Agarwal Harish 2, Agarwal Deeptanshu 3, Agarwal Pranjal 4 ABSTRACT Alcoholism is a severe problem in large, in India. In India nearly 30% of men 5% of women are regular consumers of alcohol. India is identified as the 3rd largest market for alcoholic s beverages in the world and it is an attractive market for multi nationals. Alcoholism results in deterioration in physical health, conflicts within the family, problems on the job, violence and breakdown of moral values, lack of awareness of magnitude of the problem, coupled with lack of the treatment facilities which results in the alarming growth of the problem in rural and urban areas. Now-a-days the de-addiction center s play a vital role towards the upliftment of alcoholic dependents by involving themselves in Intervention and Counseling. The objectives of the study intends to find, the role of clinical psychologist in de-addiction Centre (NIRVAN Hospital, Ismailganj, Lucknow), to study the screening and motivation of client to take help, to assess the aftercare treatment through therapy. Keywords: Effectiveness, Clinical Psychologist, De-Addiction Centers Alcohol has been showing an increasing trend in India. Alcoholism remains a serious and prevalent health problem in contemporary society. The disease concept of alcoholism has gained popularity over the years. According to the variability of drinking, alcohol passes through identifiable stages of the withdrawal symptoms. Alcoholism has been an important problem of global concern. The impact of alcohol not only disturbs the physical health of an individual it also affect the people who are surrounded by him. Research has shown that men compromise a large proposition of the alcohol consuming population in our country. They may drink in order to relieve their stress, but the problem is that drinking to relieve stresses this may lead to further social, emotional and physical problem, also emerge source of stress and further decrease a person s self-esteem and confidence. 1 Clinical Psychologist, Nirvan Hospital, Ismailganj, Lucknow, India 2 Associate Professor, Department of Psychiatry, Hind Institute of Medical Sciences, Safedabad, Lucknow, India 3 Junior Resident, Department of Psychiatry, Era s Lucknow Medical College, Safarzganj, Lucknow, India 4 Consultant, Nirvan Hospital, Ismailganj, Lucknow, India *Responding Author Received: March 6, 2017; Revision Received: May 21, 2017; Accepted: June 29, 2017 2017Kamble J, Agarwal H, Agarwal D, Agarwal P; licensee IJIP. This is an Open Access Research distributed under the terms of the Creative Commons Attribution License (www.creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any Medium, provided the original work is properly cited.
Intervention The patient gets motivation and better understanding about the problem, and the therapist acknowledge the patient with craving management techniques. Emphasis was given on the 5 D s that is Delay, Deep breathing, Distraction, Drink water and Discussion. It was explained to the patient that craving occurs for a particular time and it reaches its peak, if that particular time could be targeted and engage in some other pleasurable work. Refusal skills and Assertiveness skill training was provided to the patient in order to prevent relapses in the future and to cope with day to day to situation. Counseling A professional counselor is a highly trained individual who is able to use a different range of counseling approaches with their clients. Behavioral therapy and Motivational Enhancement Therapy was used in the patient. In Behavioral Therapy patient was engaged in Daily routine activities like Yoga, Yagya, Gym and Exercise, Group Discussion, Musicand Relaxation Therapy. Depending on the scope of the program, motivational enhancement therapy refers to the medical, psychotherapeutic, educational, and/or social treatment processes required for alcoholism recovery. Motivational Enhancement Therapy (MET)attempts to enhance a patient s desire to change by asking about the pros and cons of the patient s behaviors, by considering the patient s goals and the ambivalence associated with reaching those goals, and by attentively listening to the patient. As would be expected, this form of treatment may be of benefit primarily to patients who are not already highly motivated to change. Objectives To study the effect of activities in the ward (Intervention and Counseling) with effectiveness of clinical psychologist in de-addiction centers. MATERIAL & METHODS The sample consists of 100 alcoholic patients among them 50 patients were diagnosed Moderate dependence of alcohol on ICD-10 criteria along with on SAD-Q and 50 patients were diagnosed to have severe dependence of alcohol was taken. The data was taken from Nirvan Hospital, Ismailganj, Lucknow. Duration of study is 6 months. Tools applied were, Severity of Alcohol Dependence Questionnaire by Stockwell and Semi-structured socio-demographic details. The inclusion criteria included alcoholic patient who were taking alcohol above 5 years. Those with age ranging between 20 to 50 years of age, those patients who were in action phase in the MET. The patients were willing to give informed consent. Those excluded were either taking multiple substances, whose age range was outside 20 to 50 years of age and patients not willing to give informed consent.spss version 20 was used for statistical analysis Mean, S.D., Frequency calculated. For the purpose of the study, subjects were selected and tests were conducted by taking prior appointment.rapport was established with each of the subjects and the entire query regarding the study. Thequestionnaires were collected as per the convenience and the study took 30-60 minutes per patients. The International Journal of Indian Psychology, ISSN 2348-5396 (e) ISSN: 2349-3429 (p) 2
RESULT Table 1 Socio-Demographic Details(N=100) S.No. Details Frequency 1. 21-30 yrs 31-40 yrs Age 41-50 yrs 51-60 yrs 61-70 yrs 2. Illiterate Primary Education High School Intermediate Graduation Post-graduation 3. Lower Socio-econonmic status Middle Upper 4. Marital Status Married Unmarried 5. Occupation Farmer Business Executives Professionals Familial Vocation Unemployed Pvt. Job 6. Duration of Drinking 1-5 yrs 6-10 yrs 11-20 yrs 21-30 yrs 31-40 yrs 20 38 28 8 6 4 7 16 14 42 17 24 42 34 88 12 5 37 3 10 1 41 3 14 23 35 21 7 The tableno.1 shows about the detailed information of study. The patients between age range of 31-40 years are more in the study but young age of onset of drinking alcohol was common in the above age group. Most of the respondents are graduated from a government college. The most of the respondents were from the middle socio-economic status according to the Kuppuswamy classification of the socio economic status. The significant results were found that (n=41) patients were unemployed and they responded well during the study. Most of the patients were married (n=88) in the study, there was a significant correlation between the married and the unmarried group. Young age of initiation and the duration in years of drinking alcohol was more, between 11-20 years (n=35), but there was no significant difference between them. The relationship between pre-test and post-test assessment is positively significant (0.904**) at 0.01 levels. The Correlation between pre-test and post-test, the results revealed that the (t= 22.8,p=0.00), i.e very small probability of this result occurring by chance. There is strong The International Journal of Indian Psychology, ISSN 2348-5396 (e) ISSN: 2349-3429 (p) 3
evidence that the effect of activities in the ward with the effectiveness of clinical psychologist show the significance difference between the pre and post assessment results. DISCUSSION Suman Borahetal, revealed that Psychiatric social work assessment and intervention was provided to the person with alcohol dependence syndrome, focusing on building motivation for change and strengthening commitment to change. The psycho social intervention was provided to the patients and his family members. Sessions on Admission counseling, Family intervention, Supportive therapy, Psycho education, Motivation enhancement therapy, Brief intervention, Relapse Prevention therapy, Pre discharge counseling, Discharge Counseling and Social Group Work was conducted. At the end of the therapy, the client improves knowledge regarding the illness and motivation level was enhanced to action phase and achieved the coping skills to recover from relapse. Stephen et al, revealed in their study that the effect of counseling on the ward in reducing the level of consumption among such patients after discharge. They evaluated brief counseling to reduce alcohol consumption among male heavy drinkers identified on general hospital wards. Male patients were screened on wards of four teaching hospitals in Sydney, Australia. Identified heavy drinkers (n=174) showing predominantly low levels of alcohol dependence were allocated to one of two forms of brief counseling (skills-based counseling or brief motivational interviewing) or to a non-intervention control group. Blind follow-up for 123 patients (71%) was carried out approximately 6 months after discharge from hospital and self-reports of alcohol consumption were compared with collateral sources of information. Patients who received counseling showed a significantly greater mean reduction in a quantity-frequency measure of weekly alcohol consumption than controls but there were no significant differences in reduced consumption between the two intervention groups. Suresh et al, studied that alcoholism can increase the risk of depression and suicide and play a role in violent crimes, including homicide and domestic violence (abuse of a spouse or child). They found that Experimental group the sum of squares between the groups was 40.467 and within the group was 35.133. Hence they concluded that group therapy should be conducted for alcohol dependents in order to promote psychological wellbeing. CONCLUSION Alcohol is a severe problem in a large number of families in India. Abuse of alcohol and the consequent problems accompanying it, have become one of the major issues of concern especially in Indian villages. Alcoholism results in deterioration in physical health, conflict within the family, problem in the job, violence and breakdown of the moral values, lack of concentration. Patient had gained insight regarding his illness. Patient s motivation has been enhanced. Family members have better understanding about patient s illness. Thus it can be said that psychosocial interventions play an important role indetermination of treatment outcomes. It has been shown to improve patient compliance to medication and the retention of patients in treatment. It has also been shown to increase alcohol abstinence rates and quality of life in persons with alcohol dependence. Psychiatric social work can play a key role in working with person with alcohol dependence syndrome, educating, enhancing motivation and teaching skill for recovery and also The International Journal of Indian Psychology, ISSN 2348-5396 (e) ISSN: 2349-3429 (p) 4
working with the family. So we can conclude that treatment and rehabilitation of patients with alcohol dependence has been an important area of psychiatric social work. Psychosocial intervention can enhance pharmacological treatment efficacy by increasing medication compliance, maintenance in treatment, and attainment of skills. SUGGESTIONS To inculcate alcohol awareness among younger adults and children. To educate them & to accept that the addiction is a serious problem this requires professional help. So there is a need of Clinical Psychologist in the de-addiction centre. And to promote effective positive changes towards enhancing the quality of life of Alcohol dependents (Behavioral Therapy, Group Therapy and Motivational Enhancement Therapy). To promote regular follow-up through centre. The center has take efforts to contact patients who do not maintain follow-up. To promote regular home visits and rehabilitation programs. Acknowledgement I am deeply indebted my parents who help me and give me immense support in my work. My deepest regard to Mr.Vivek Kumar Jaiswal, who stood by me and trusted me despite all odds, challenge and delay that I faced. I extend my sincere gratitude towards Nirvan Hospital who gives free rein to conduct the study in their premises without any disturbance Conflict of Interests The author declared no conflict of interests. REFERENCES Bhatti, R. S. (1982). Family Therapy in Alcoholism. Paper presented at the International Consultation on Christian Response to Alcohol and Drug Addiction, held at ECC, Bangalore, India on November 22-27. Borah S et al. A case study of Person with Alcohol dependence Syndrome with Poor motivation, International Research Journal of Social Sciences,Vol. 5(3), 74-79, March (2016) 74 Heather N. etal. Effects of brief counseling among male heavy drinkers identified on general hospital wards. Vol. 15, issue1, pages 29-38. Manickam, L.S.S. (1988): Attitude of Protestant Priests towards Alcoholism. National Council of Churches Review, 48, 507-510. Miller W.R., Taylor C.A. and West J.C. (1980). Focused versus broad spectrum behavior therapy for problem drinkers. Journal of Consulting and Clinical Psychology,48(5), 590 601. Miller W.R., Taylor C.A. and West J.C. (1980). Focused versus broad spectrum behavior therapy for problem drinkers. Journal of Consulting and Clinical Psychology, 48(5), 590 601. Miller, W. R. (2000) Motivational Enhancement Therapy: Description of Counseling Approach. in Boren, J. J. Onken, L. S., & Carroll, K. M. (Eds.) Approaches to Drug Abuse Counseling, National Institute on Drug Abuse, 2000, pp. 89 93.7 October 2015 National Institute on Alcohol Abuse and Alcoholism (1995).The Physicians' Guide to Helping Patients with Alcohol Problems. NIH Publication No. 95-3769. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. Stockwell, T. Sitharan, T. MCGrath. D and Lang (1994). The measurement of alcohol dependence and impaired control in community samples, Addiction, 89,167-174. The International Journal of Indian Psychology, ISSN 2348-5396 (e) ISSN: 2349-3429 (p) 5
Suresh et al. Effectiveness of group therapy on psychological wellbeing among alcoholic dependents at selected De-addiction Centre in Ahmedabad. IOSR Journal of Nursing and Health Science. Volume 3, Issue 5 Ver. I (Sep.-Oct. 2014), PP 35-39. How to cite this article: Kamble J, Agarwal H, Agarwal D, Agarwal P (2017), A Study on Effectiveness of Clinical Psychologist in De-Addiction Centers, International Journal of Indian Psychology, Vol. 4 (3), DIP:18.01.241/20170403 The International Journal of Indian Psychology, ISSN 2348-5396 (e) ISSN: 2349-3429 (p) 6