Demographic profile of alcohol use disorder patient who received care from a de-addiction centre in central Kerala

INTRODUCTION

Alcohol consumption is the world’s third largest risk factor for disease and disability.¹ The harmful use of alcohol can also result in harm to other people, such as family members, friends, co-workers and strangers. Moreover, the harmful use of alcohol results in a significant health, social and economic burden on society at large.² Globally, 6.2% of all male deaths and 1.1% female deaths are attributable to alcohol.³ Mortality resulting from alcohol consumption is higher than that caused by diseases such as tuberculosis, HIV/AIDS and diabetes.⁴ A rise in alcohol use in South East Asian countries including India is reported.⁵ Prevalence rate of alcohol use in India is 21.4% with male predominance and a trend for increase in female.⁶ Large number of youth among users and peddlers warrant effective and early implementation of preventive, curative and rehabilitative strategies. They fall easily in the vicious trap of drug abuse at early age with high rates of relapse. Support for substance abuse education, prevention and treatment must come from all sides including families, community groups, schools, policymakers, and health professionals.⁷ A study conducted in Kashmir showed that a pattern of poly-substance abuse was found to be quite common in patients, and use of volatile substances at a very young age emerged as a new trend.⁸

The Ministry of Social Justice and Empowerment, Government of India, addresses the prevention and rehabilitation aspect of substance use through the establishment of “rehabilitation centers” run by nongovernmental organizations (NGOs) and guidelines for such De-addiction centres (DA Centres) are mandatory to follow, which will enable the organization for Government support and permit mobilization of community resources.⁹

Kerala once respected worldwide for significant achievements in human development, has been fast developing a dubious reputation for heavy liquor consumption. Kerala’s per capita liquor consumption of alcohol is about four times the national average.¹⁰

Aim of the research study was conducted to examine and report the demographic profile of the alcohol use disorder patients admitted in a de-addiction centre. Understanding the profile is expected to help in developing policy and programs for countering the problem.

METHODS

Study area

A retrospective, observational study conducted at Natural Empowering Survival Treatment and Research Centre (NEST), a de-addiction centre in Thrissur district of Kerala, India.

Study design

Purposive sampling technique

This retrospective study was conducted at Natural Empowering Survival Treatment and Research Centre (NEST), a de-addiction centre in Thrissur district of Kerala, India. This centre offers 21 days residential program with an eclectic approach. This includes music therapy, meditation and counseling along with the medical treatment for abused substance of concern. NEST accommodates cases from Kerala and Tamil Nadu states. This institution is run by Catholic Arch Diocese of Thrissur. This study was approved by Institutional Ethics Committee (IEC) for ethical concerns.

The socio demographic details of the all patients admitted from 1^st January 2016 to 31^st December 2016 were collected directly from the records of the Institution, using a pre designed proforma. It was entered to Google form and then to excel for further statistical analysis using SPSS version 21. The Revised Kuppuswamy’s Scale, 2017 was used for data analysis.¹¹

Selection criteria

All male patients admitted in the de-addiction centre were included in the study. Incomplete records of patients, cases with repeated registration or immediate cancellation due to non-cooperation were excluded from analysis.

RESULTS

During the year 2016, a total of 571 substance abusers were registered at NEST. Among them 398 (69.7%) were from Thrissur district where the institution is located. There were 68 (11.9 %) cases from Ernakulum and 33 (5.8%) from Palakkad, the neighboring districts on either side. The remaining 57 (10%) cases were from the other 11 districts of the state. There were 15 cases (2.6%) from other states of the country. The family status of the patients was; 401(70.2%) married, 160 (28%) single and 10 (1.8%) separated and 389 (68%) had children. Their religion wise distribution was 272 Christian (47.65%), 259 Hindu (45.4%) and Muslim 36 (6.3%).

Patients were categorized based on their educational levels. Illiterate was 5% and majority were with education below matriculation or equivalent (Table 1). Majority of the persons seeking de-addiction were skilled labors (32.92%) followed by arithmetic skilled workers (18.21%) (Table 2).

Mean age of patients was 42 years. More than half of the patients were middle aged (52%) followed by young adults (40.9%) (Table 3).

The blood groups of 297 patients were known. Of this the most common blood group was O+ (41.4%) followed by B+(23.9%) (Table 4).

DISCUSSION

For alcohol use disorder patients who seek help, three types of centres offers service. Most of the hospitals with psychiatry department offer treatment for de-addiction. This includes those in general hospital settings and those in custodial care services. In both these centres the addiction patients are cared along with other patients having mental illness in general. These centres manage patients based on disease model emphasizing medical management. The DA centres are usually stand alone institutions offering service exclusively for DA patients. Most of them have eclectic approach or emphasis on psycho-social management. The present study centre was DA centre.

In the present study, all the patients who attended the de-addiction centre were males. Similar findings were reported from de-addiction centres in Punjab and Jammu where the rate of men was higher than females.^6,7 In South India, studies from Karnataka also had similar findings.¹² All these studies show predominance of males towards substance abuse and the prevalence of the related diseases. There was a recent report of female alcohol user cared in a general hospital setting, of Kerala.¹³ Perhaps the cultural non-acceptance may be keeping the affected women away from care facilities and help seeking.¹⁴ Higher representation of Christian religion among the patients was noticeable. Though there is secular policy in care delivery and management, being run by Roman Catholics source of the case referrals would have influenced that pattern.

This study showed that more than half of the patients (52.42%) seeking de-addiction belongs to middle age group with the mean age of 42 years. Similar finding was reported from North India also.¹⁵ According to Erickson’s stages of psychosocial development, this age group people discover a sense of contributing to the world, usually through their family and work, or they may feel a lack of purpose.¹⁶ This could be a reason for seeking de-addiction among the middle aged who would have started the abuse from their early ages.

The literacy rate among persons of age seven years and above in Kerala is 96.1%, in this study 84.4% were educated at level of matriculation or below.¹⁷ Only 11.7% of population had achieved education above that level. In this study 10.4% had education at graduation level and above. Only 5.8% were illiterate. All these figures roughly correspond to that of general population. In another reported study among alcohol abusers it was found that most of the patients were school dropouts.^7,18 Our results are concordant with other studies which reported that most of the patients were educated only up to primary or secondary level.^6,19 There are contrary reports also, stating that as literacy rate increases abuse rate also increases and the highest rate was seen in graduates.^15,20,21 There is no observations from this study to comment on the reasons for that discrepancy among different studies.

In the present study, 32.9% of the patients are skilled workers. Similar observations were made in other studies also.²² This category includes drivers, carpenters, mechanics, masons and similar workers who carry high risk of drug abuse compared to other occupations. These people may consume alcohol as a way to moderate or numb the pain of physical stress and injury caused by hours of manual labor.²³ About 17% of the patients of this study are students or unemployed which is similar to other reports.¹⁵ While several studies have explored the impact of alcohol use on employment status, some studies suggest that alcohol abuse/misuse increases the probability of being unemployed, while others contradict these results or do not find a statistically significant relationship between alcohol abuse and employment status.^24-26

In terms of blood group distribution of the patients, the most observed blood group was O+ (41.4%) followed by B+ (23.9%) and A+(19.9%) and the least with AB- (0.8%). Several genetic factors have been reported related to the vulnerability to drug addiction. The relationship between blood group types and many diseases has also been reported.²⁷ However, there has been no report revealing the relationship between blood groups and alcohol addiction or drug abuse.²⁸ The blood group pattern as per the register of Immuno-haematology and Transfusion Medicine Department of Jubilee Mission Medical College, Thrissur showed similar pattern with highest frequency for O+ (35.42%) followed by B+ (26.96%), A+ (22.86%) and lowest frequency for AB- (0.70%). Hence no conclusions could be drawn regarding the relationship of alcohol use disorder with blood group. Entire sample selected for the study was only from one de-addiction center is the limitation of the study.

The main limitation of the present study was, it included male patients admitted to a single de-addiction center.

CONCLUSION

Large number of clients seeks help from de-addiction centers. In spite of remaining secular, the religious categories of the help seekers are influenced by the organizations’ background, possibly because of the source of referral. The majority belonged to middle age group explainable on the Erickson’s stages of psycho-social development. The educational status of patients was comparable with the pattern among general population. The employment status and absence of females are in line with other reported studies. Absence of any correlation with blood groups also was noted. There is necessity for further investigation in the de-addiction centers in order to evaluate pattern and trends in misuse of alcohol or substances. These types of studies are helpful to further oversee strategies employed in such centers and to understand best practices.

ACKNOWLEDGEMENTS

We would like to thank the Director and staff members of NEST for permission and valuable support. We would like to thankful to Mr. Vinu EV, Project Manager at Jubilee Mission Medical College and Research Institute, Thrissur for helping to collect data and Ms. Mridula Vellore, Research Assistant (Scientific Writer) of Jubilee Centre for Medical Research, Thrissur for editing the paper.

Funding: This study is a part of ICMR project No. Adhoc/124/2019/HSR entitled “Influence of demographic, clinical, genetic and pattern of management in maintaining long term abstinence among patients of alcohol use disorders who received treatment from De-addiction centres in Thrissur district: A prospective follow up study

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee (No:17/19/IEC/JMMC&RI Dated 26/02/19)

REFERENCES

1. 1. Katyal R, Bansal R, Goel K, Sharma S. Hazardous, harmful and dependent alcohol users according to audit in an Urban Slum, Meerut. Inter J Med Sci Pub Heal. 2013;2(1):26-31.
2. 2. World Health Organization, Alcohol, 21 September 2018. Available at: www.who.int/news-room/fact-sheets/detail/alcohol. Accessed 5 September 2020.
3. 3. Global Status Report on Alcohol and Health, 2011. Available at: www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.pdf. Accessed 5 September 2020.
4. 4. World Health Organization. The world health report 2002: reducing risks, promoting healthy life. World Health Organization; 2002. Available at: https://www.who.int/whr/2002/en/. Accessed 5 September 2020.
5. 5. Ramanan VV, Singh SK. A study on alcohol use and its related health and social problems in rural Puducherry, India. J Family Med Pri Care. 2016;5(4):804.
6. 6. Girish N, Kavita R, Gururaj G, Benegal V. Alcohol use and implications for public health: patterns of use in four communities. Indian journal of community medicine: official publication of Indian Associa Prev Soc Med. 2010;35(2):238.
7. 7. Gupta VK, Kaur P, Singh G, Kaur A, Sidhu BS. A study of profile of patients admitted in the drug de-addiction centres in the state of Punjab. Intern J Res Heal Sci. 2013;1(2):53-61.
8. 8. Rather YH, Bashir W, Sheikh AA, Amin M, Zahgeer YA. Socio-demographic and clinical profile of substance abusers attending a regional drug de-addiction centre in chronic conflict area: Kashmir, India. MJMS. 2013;20(3):31.
9. 9. Dhawan A, Rao R, Ambekar A, Pusp A, Ray R. Treatment of substance use disorders through the government health facilities: Developments in the “Drug De-addiction Programme” of Ministry of Health and Family Welfare, Government of India. Indian J Psychiatry. 2017;59(3):380.
10. 10. Punarjani Charitable Trust for De-Addiction & Rehabilitation - A Drug & Alcohol Rehab in Thrissur, Kerala. Available at: rehabs.in/rehabcentre/punarjani-charitable-trust-de-addiction-rehabilitation/. Accessed 25 August 2020.
11. 11. Sharma R. Revised Kuppuswamy’s socioeconomic status scale: explained and updated. Indian Pedia. 2017;54(10):867-70.
12. 12. Gururaj G, Girish N, Benegal V, Chandra V, Pandav R. Burden and socio-economic impact of alcohol—the Bangalore study (Alcohol Control Series No. 1). New Delhi: World Health Organization, Regional Office for South-East Asia. 2006.
13. 13. Peters TJ, Millward LM, Foster J. Quality of life in alcohol misuse: comparison of men and women. Archives of Women’s Ment Heal. 2003;6(4):239-43.
14. 14. Stein MD, Risi MM, Flori JN, Conti MT, Anderson BJ, Bailey GL. Gender differences in the life concerns of persons seeking alcohol detoxification. J Substance Abuse Treatment. 2016;63:34-8.
15. 15. Prajapati BB, Dedun MR, Jalfava HS, Shukla AA. A study of socio-demographic profile and pattern of drug use among substance abusers attending mind care de-addiction center in Ahmedabad. Inter J Comm Med Pub Heal. 2019;6(1):286.
16. 16. Erikson EH. Elements of a psychoanalytic theory of psychosocial development. The course of life: Psychoanalytic contributions toward understanding personality development. 1980;1:11-61.
17. 17. Education in Kerala. Government of Kerala, 2014. Available at: www.ecostat.kerala.gov.in/images/pdf/publications/NSS/data/nss71_education.pdf. Accessed 14 September 2020.
18. 18. Saluja BS, Grover S, Irpati AS, Mattoo SK, Basu D. Drug dependence in adolescents 1978–2003: A clinical-based observation from North India. Ind J Pediat. 2007;74(5):455.
19. 19. Gupta VK, Kaur P, Singh G, Kaur A, Sidhu BS. A study of profile of patients admitted in the drug de-addiction centres in the state of Punjab. Inter J Res Heal Sci. 2013;1(2):53-61.
20. 20. Arora H, Gupta S, Kajal KS, Padda P, Monga S, Devgan S, Gupta V. Evaluation of socio-demographic profile of the drug abusers visiting drug deaddiction centre at Faridkot, Punjab. J Adv Med Dental Sci Res. 2016;4(2):136.
21. 21. Ghosh M, Gupta R, Arya S, Rathee S, Rawat V. Factors associated with treatment seeking behaviour in adolescent substance abuser in a de addiction centre in North India. Int J Med Sci Public Health. 2014;3(11):1376-80.
22. 22. Khandhedia S, Raval CM, Thakor N. Profile of substance abusers attending at de-addiction center of GMERS medical college, Dharpur-Patan, Gujarat, India: a cross sectional study. Int J Res Med Sci. 2015;3(10):2765-9.
23. 23. Professions With The Highest Rates Of Alcoholism - Addiction Campuses. Vertava Health, 6 Jan. 2020. Available at: vertavahealth.com/alcohol/professions-highest-rates/. Accessed 14 September 2020.
24. 24. Popovici I, French MT. Does unemployment lead to greater alcohol consumption?. Industrial Relations: A J Econ Soci. 2013;52(2):444-66.
25. 25. Mullahy J, Sindelar J. Employment, unemployment, and problem drinking. J Heal Econo. 1996;15(4):409-34.
26. 26. Feng W, Zhou W, Butler JS, Booth BM, French MT. The impact of problem drinking on employment. Health Economics. 2001;10(6):509-21.
27. 27. Aflatoonian MR, Meymandi MS, Divsalar K, Mahmoudi M, Heravi G. Possible association between human blood types and opioid addiction. Ame J Addictions. 2011;20(6):581-4.
28. 28. Aflatoonian M, Ziaaddini H, Kheradmand A, Meimandi MS, Divsalar K, Mahmoodi M. Substance misuse patterns and blood types of self-introduced addicts to substance rehabilitation centers of Bam City. Addict Heal. 2010;2(3-4):95.