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IMPACT OF TSUNAMI ON ALCOHOL
ABUSE IN COASTAL CHENNAI,
TAMIL NADU, INDIA
SUMMARY REPORT
C-DOT (Community Development
Organization Trust), Chennai
TNTRC, Chennai
UNDP
Research Consultants
Prof. L. S. S. Manickam Ph.D.
Dr. Josh Basil Ph.D.
_
2
Contents
1. Executive Summary
2. Introduction
3. Methodology
4. Results
5. Key findings
6. Plan of Action
3
1. Executive Summary
This report is a summary of the methodology and findings of the Impact of
Tsunami on alcohol abuse in coastal Chennai, Tamil Nadu India. The study
was conducted to assess the extent of abuse of alcohol and its impact on
the population at Tsunami affected coastal areas of Chennai. The study
was conducted between the end of 2005 and in the first part of 2006 for
UNDP. C-DOT (Community Development Organization Trust), Chennai
had conducted this study and was funded by TNTRC and UNDP. The
research consultancy was undertaken by Dr. L. S.S. Manickam, Hon.
Director, Centre for Applied Psychological Studies, and Dr. Josh Basil.
The C-DOT in Chennai intended to assess the extent of alcohol abuse
among the men population, to analyze the impact of Tsunami on the
drinking behavior of those who abuse alcohol, to evaluate the impact of
the drinking behavior on the women to examine the effect on adolescents
to assess the effect of the alcoholism on the children and to explore the
needs of the population in relation to drinking behavior in the coastal areas
of Chennai. The core indicators on which the data were collected included
the behavioral indicators related to alcohol drinking behavior. The
measurements of indicators received in this study serve as a baseline
indicator for providing services and guideline for plan of action in the
Tsunami affected coastal areas of Tamil Nadu.
The data was provided not only by those who are have drinking behavior,
but also by the significant members in the family- the women, the
adolescents and children in the community. The criteria for establishing
alcohol dependence was based on the International Classification of
Disorders (ICD-10).
Methodology
Sample and research design:The sample consisted of 320, drawn from
two regions, one from locally displaced population and the other from
temporarily displaced population who were affected by the tsunami. The
two regions were from the Chennai, Tamil Nadu. Proportionate sample
was drawn from the population of the two regions. An equal number of
adults, (both gender) adolescents and children (both gender) were
included. The sample was drawn from 4 different strata-Adult men, Adult
women, Adolescents and Children and the data about the index person in
the family/household was gathered. The data was collected through
interview using a survey schedule and through focus group discussion
after the initial discussions with the key community members.
4
Implementation: Qualitative exploratory research was conducted with the
people in the community and other professionals working in the area of
alcohol dependence to gain information to the questionnaire development.
After pretest, the interview schedule was used for collecting the data. The
implementation team had received extensive training in data collection and
a supervisory team monitored the quality of data collection. Informed
consent was obtained from the participants and in case of adolescents
shared informed consent was obtained from both the participant and one
of the parents. In case of children, the informed consent was obtained
from the parents.
Findings: Among the Tsunami affected coastal population majority of the
adult men 74.06% were having drinking behavior and 52.8% were
dependent on alcohol. The age of onset of drinking was reported to be 10
years and the duration of drinking was 14.6 years. The were abusing
branded liquor and majority, 51.05% were abusing illicit liquor also. There
was a decrease in consumption immediately after Tsunami and it
increased when the relief money was disbursed. Though it was reduced,
the current consumption was higher than the quantity of intake before
Tsunami. However, 19.39% reported that the behavioral problems of the
index persons worsened Tsunami, though there is no change in 61.8% of
them. The average income of the total sample was Rs. 1970. 47 and on an
average they were spending Rs. 840.40,42.65% of their monthly income
and 20.63% of them were financially dependent on the women. In
addition, majority of them, 81.88% were experiencing one trauma
response or the other and 34.37% were ‘using’ alcohol to cope with the
trauma. As result of drinking behavior, the women, adolescents and
children were having different types of impact and the major ones were the
psychological abuse and physical abuse by the index persons. The
common emotional reactions felt by them were frustration, anger and
increased irritability.
Plan of Action: Majority of the sample interviewed including the index
persons had expressed the need for drinking and 28.17% wanted the
index persons to take treatment. Since there are no treatment centers that
are easily accessible, establishing a de-addiction centre with sufficient
staff for counseling need to be provided. The ‘de-addition’ centers often
focus on the addiction related issues. Since majority of the adult
population are experiencing trauma, the possibility of other members in
the community also would need trauma counseling. Apart from the de
addiction counseling there is a need to focus on the other areas of help
trauma counseling, counseling focused on economic independence,
vocational counseling and empowering the women, especially the
adolescent girls in the community should be the priorities. People centre
approach in providing alternate ways of engaging the leisure time activities
and provision of services within the community would be most helpful. The
snowball effect could help build healthy communities among the fishing
and non fishing coastal population.
5
2. INTRODUCTION
The coastal people of Tamil Nadu, who were affected by Tsunami of
December 26,2004 had added trauma of different types of loss and local
displacement. Some of them were locally displaced temporarily whereas
some others had to be relocated for safety reasons. While some of them
could get back to their original place of living there are several families
who are yet to be rehabilitated on permanent basis. In this process people
had undergone and some were still undergoing through different types of
hardships and trauma other than the trauma of Tsunami. The problem of
drinking behavior is likely to be aggravated due to the increasing stress,
though its abuse was minimized immediately after the disaster, when
people were rushing for safety and stabilization.
One of the questions that researchers ponder over is the influence of
disaster on the coping mechanisms and its influence on the behavior. It
would be worth exploring the impact of Tsunami on those people who are
already having problems related to alcohol drinking, that got aggravated
as a result of the trauma.
C-DOT, is a community development organization, based at Chennai and
working with the coastal population in Tamil Nadu. C-DOT aims at the
comprehensive development of the coastal population. It was observed
that the development activities initiated by the NGO’s were being
adversely affected by the increased incidence of alcohol related issues in
the coastal areas. Moreover, the traumatic event of Tsunami had ruined
the growth of the development process. Therefore it was decided to study
the impact of alcohol dependence on the community in the context of
Tsunami. It was also conceptualized that identifying the magnitude of the
problem among the coastal population and the extent it affected the
community would help plan strategies for further action. While working
with the coastal population, different sections of people in the community
expressed frustration on the unattended issue. Hence a study was
conducted to explore the extent of the problem and its impact in order to
plan intervention strategies for the community. The data would also help
plan strategies of intervention in the coastal areas of Tamil Nadu, worst
affected by the Tsunami.
It is worth exploring the impact of Tsunami on the coastal population in
Chennai in relation to the alcohol-related problems and the trauma. Since
family is a key factor in the Indian culture, the impact of drinking behavior
on the members of family, including the women, adolescents and children
requires investigation.
C-DOT a community-based organization explored the unattended serious
disease of alcoholism and its relation to trauma.
6
3. METHODOLOGY
3.1 RESEARCH TEAM
Design team
Research Consulting
Team
Prof. L.S.S. Manickam and Dr. Joshi Basil
Dr. K.V. Sreenivasan, Psychiatrist.
Mr. Satheesh Chandran, Social Work.
Dr. Immanuel Thomas, Prof, of Psychology.
Dr. B.H. Helen Joy, Educationalist.
Research Team Leader
Prof. L.S.S. Manickam
Research
Co-coordinators
Mr. B. Senthil and Mr. N. Suresh Kumar
Field Study Team
Data Analysis and
Report Writing
Mr. Amal Thomas, Mr. D. Vijayaraghavan,
Mr. G. Arul Kumar, Ms. S. Gomathi,
Mr. Raja and Ms. Rajeswari
Prof. L.S.S. Manickam and Dr. Joshi Basil
7
3.2 OBJECTIVES
3.2.1 Major Objective
To assess the extent of abuse of alcohol and its impact on the
population at Tsunami affected two coastal areas of Chennai.
3.2. 2 Specific Objectives
1 .To assess the extent of alcohol abuse among the male population.
2. To analyze the impact of Tsunami on the drinking behavior of those
who abuse alcohol.
3. To evaluate the impact of the drinking behavior on the women.
4. To examine the effect on adolescents.
5. To analyze the effect of the alcoholism on the children.
6. To explore the needs of the population in relation to drinking
behavior.
3.3 RESEARCH DESIGN
3.3.1 Stratified Random Sampling.
Stratified random sampling was used.The first stratum was the regions I
and II.
3.3.2 Sample
Two coastal areas were chosen.
3.3.2.1. Region I- Locally Displaced Population
One of them was Ennore, where people were living in 3 housing
settlements and housed 2297 population. The people at Ennore, who were
living near Kasimedu, were shifted after Tsunami for safety reasons.
Initially they were resettled at Kargil Nagar, which was a low-lying area.
However, the flood
in
havoc
N o v e m b e r December, 2005
displaced them
again and the
Government
189 HH
-. 'Hi __
resettled them at
the
presently
occupied place at
Ennore. The three settlements were maintained like a close community.
But since the housing areas were not provided with boundary walls fully,
outsiders and social miscreants could easily creep in.
1500
2297
No. of Families
■ Men
Women
Total Population
iOOO
1500
1133 ‘>M
1120
1000
791
■
574
500
378
413
378
181
Phase I
197
Phase II
554
Phase 111
583
TOW
3.3.2.3 Region II
This coastal area is a belt that houses 4946 population. This area was hit
by Tsunami and the loss of people in this area was estimated to be 57.
The people who were on the seashore on temporary sheds were affected
8
and the survivors resettled in safer region. But the people who were living
in permanent houses were also
6000
affected. They had loss of lives
and property, and many of them
4946
Number of Families
5000
■ Men
ran for their life during the tide.
■HI
'
Women
« Total Population
But majority of the houses were
4000
inhabitable with severe and trivial
3000
2505
maintenance. Majority of the
2441
people in this area came back to
2000
their own houses. In other words,
1143
1000
this area has population who are
still living near the sea, as they
0
Number of
Men
Women
Total
had lived before Tsunami. Except
Population
Families
for the clearance of the sea
shore occupation where some
people used to brew illicit liquor, the people are back to their ‘normal’
functioning.
There is no clear-cut demarcation between the neighboring coastal
communities, except the bylines. It is not an exclusive community and it is
within the city limits of Chennai.
I
H
I
3.3.3 Rationale for choosing the areas
The coastal communities were worst affected by Tsunami compared to
other geographical areas of Chennai.
Region I Ennore, was chosen since it houses people who were locally
displaced from coastal area.
Region II Srinivasapuram is also a coastal area, but the population in this
area was temporarily dislocated, but could occupy their own houses where
they were living before Tsunami.
Moreover, C-DOT had been working with these communities addressing
their various issues including livelihood and rehabilitation. The rapport of
the NGO with the community would also help collect the data that are very
personal.
3.3.4. Exploratory Sample Survey
It was decided to interview stratified samples from the population from
region I and Region II.
3.3.5. Focus group discussion
It was also decided to conduct a focus group discussion with specific
questions.
9
3.4. Sample Size and Description of the Sample
From region I, 30 samples of the
250
each stratum of adult men, adult
200
200 women, adolescents and children
Region I
Region II
were drawn. From region II, 50
150
samples of each stratum were
120
drawn. Equal representation of
100 both genders was provided for
50
50
50
50
50
adolescents and children.
30
30
30
30
■
Proportionate sample was drawn
__
0
Total
Adult
Adolescents
Children
Adult (Men)
from the population of the two
(Women)
regions.
From the region I, a sample of 120
was drawn and in region II the sample consisted of 200. The second
stratum was the age group. An equal number of adults, (both gender)
adolescents and children (both gender) were included. The sample was
drawn from 4 different strata-Adult men, Adult women, Adolescents and
Children.
3.5 Tools
Interview as a method was chosen since majority of them were found to
be illiterate. The semi-structured interview would also facilitate free flow of
conversation that would ease the process of data collection.
3.5.1. Interview Schedule
Interview schedule was prepared to collect the data in discussion with the
research team that constituted two clinical psychologists and one
psychiatrist who had worked in the area of de addiction. Though several
screening scales are available to screen the problem of alcohol, in order to
assess the impact of alcoholism on women and the families, an interview
schedule was preferred. The items were finalized after several round of
discussions. It was tried out in a setting other than the study area and the
appropriate modifications were made.
The tool had separate components for assessing the impact on women,
adolescents and children.
Often the substance dependent persons tend to deny their drinking and its
impact on spouse and children. Hence it was decided not to ask the
dependent persons about the impact of their own behavior on specific
issues of children and adolescents.
10
The following were the components of the tool.
Adult Men
1. Personal Data
2. Family status
3. Impact of Tsunami
(Personal loss,
Personal hurt,
Physical loss)
4. Trauma responses,
5. Coping with the Trauma)
6. Pattern of Drinking
7. Quantity of in take
8. Number of days of drinking
9. Money spent
10. Type of drink
11. Attributed reasons
12. Dependence on alcohol
(Physical dependence,
Psychological dependence,
Increased tolerance
and Craving)
13. Family
14. Health
15. Abstinence
16. Relapse timings
17. Other substances
18. Need
19. Leisure
20. Leisure activities
21. Leisure availability
Women
in addition to the above, the following
components were added.
1. Effect of drinking
2. Change in behavior( before
Tsunami and After Tsunami)
3. Emotional reactions
4. Effect on Children
5. Current Concerns
Adolescents
1. Effects of drinking
2. Change in behavior( before
Tsunami and After Tsunami)
3. Emotional reactions
4. Effects on Mother
5. Current Concerns
Children
1. Effects of drinking
2. Change in behavior( before
Tsunami and After Tsunami)
3. Emotional reactions
4. Effects on Mother
5. Current Concerns
3.5.2. Focus Group Discussion
Specific questions were designed for the Focus Group Discussion by
research team.
The Research Questions For The Group
1. What is the extent of problem drinking in their community?
2. What is the attitude towards drinking alcohol?
3. How has it affected them?
4. What impact it had made on the spouses and children?
5. What are reasons stated for alcohol use or abuse?
6. How Tsunami has influenced the pattern of alcohol abuse?
7. What is the community’s perceived need in tackling the issue of
abuse of alcohol?
11
4. RESULTS
4.1 Profile of the respondents
The sample consisted of 320 respondents. The sample was drawn from
region I Ennore (N 120) and region II, Srinivasapuram (N 200). It consisted
of 80 adult men, 80 adult women, 80 adolescents (40 from each gender)
and 80 children( 40 from each gender). The sample characteristics are
given below.
4.1.1 Adult Men
The age ranged from 21 to 73 years and the mean age was 39.98. There
is no significant difference between the two samples in relation to age. The
Educational level of the sample at Srinivasapuram was higher than the
one at Ennore. When both were taken together, almost half of the
population had education up to 6 - 10 years of schooling. Though the two
regions were in close proximity to the urban area, the reasons for the
educational level remaining low requires further exploration. The majority
of the sample was engaged in unskilled (23.75%) or semi-skilled job
(32.5%). But 31.25% were engaged in fishing and they were from region I.
However there were 6 (7.5%) of the sample that were engaged in
occupations like trading or maritime related jobs. On an average, majority
of them earned between Rs. 2001 to Rs. 3000 every month and the
average income was Rs. 2237.50. Majority (71,88.75%) were married and
there was no widower or separated men. 71(88.75%) hailed from nuclear
family and only 9 (11.25%) were living in joint families. The majority of the
sample had family income above Rs. 2000 per month, though it was
irregular. However 26.25% (21 n) had income less than Rs. 2000 per
month.
4.1.2. Adult Women
A sample of 80 adult women was interviewed from the region I and II.
Their mean age was 31.69 years and the age ranged from 20-52 years.
Thirty six (45%) of them were illiterate. However majority of them had
schooling from 1 to 10 years. The women at region II were more literate
than the women at Region I. A significant number of them were
housewives (35, 43.75%). However majority of them (56.25%) were
engaged in some work or the other. Their earning capacities were less
since many of them were employed in unskilled job or in small scale
vending. Sixty three (78.75%) were married, 7(8.75%) were widowed, 1
(1.25%) was separated and 9 (11.25%) were unmarried. Sixty one
(76.25%) hailed from nuclear family units, 5(6.25%) were from extended
family and 14(17.5%) were from joint family units. It showed that the
majority of the sample has income above Rs. 2000. per month. There was
only one (1.25%) who had income below Rs. I000. However there were 4
(5%) who had income above Rs. 5000.
12
4.1.3 Adolescents
The age ranged from 13-19 years and the mean age was 15.74 years.
There were equal number of males and female of 40 each. The
adolescents had education above 6-10 years of schooling. However 3
(3.75%)were illiterate and 14 (17.5%) had education only 1-5 years of
schooling. Majority, (79, 98.75%) hailed from nuclear families. Only 1
(1.25%) hailed from extended family. The majority of the sample had come
from families with income above Rs. 2000 per month.
4.1.4 Children
The average age was 10.69 years and their mean age ranged from 7
- 12 years. There were 40 boys and 40 girls. All the children were
attending schools and were studying in class 2-7. Majorities of
them were in classes 1-5. Out of the 80, 67(83.75%) hailed from
nuclear family units. 7(8.75%) were from extended families and 6
(75%) were from joint families. Compared to the adult population,
children reported that the family size was large. Majority of the
sample belonged to families that had income above Rs.2000 per
month, though it was irregular. However 21(26.25%) were from
families with income between Rs. 1001 - 2000 and 12(15%)
reported that their family income was above Rs. 5001.
4.2. Profile of the Index Persons (Data from the 320 respondents)
4.2.1. Age
The mean age of the index persons was 38.66 years. The age of the index
persons ranged from 20 to 73 years. The mean age of the index persons
provided by the adolescents were higher, whereas those provided by the
children were low. Since the children were in the age group of 8-12, it is
likely that the parent’s or the relative’s age would be younger than the total
sample.
4.2.2. Education
Majority of the index persons were educated. However, 37.5% of the index
persons were illiterate. The predominance of the illiterate persons was
from region I. There was no one who had education at the college level.
Men N (80)
140 -I"
120 100 ■
80 60 ■
40 ■
20 -
!:
H
S Women N
(8°)
I
R
Adolescent N
□ Children N
i
■ To^a. N(32Q)
_____ ,
0 ■■
Illiterate
1-5std
6-10std
11-12std
Above 12
Graduate
13
4.2.3. Occupation
27.19 % were occupied in fishing, and majority of them were from region I.
But the total sample showed that majority of them were employed in
unskilled or semiskilled occupations. A 120
small percentage of 14.06 were occupied 100
in skilled job. Similarly 8.75% were 80
engaged in self-employment or maritime 60
40
job.
20
Flshlnfl
■ Unskilled
Semi-skilled
Skilled
■ Others
>///
✓
4.2.4. Income of the index person
Majority of the index persons had income between 2000-4000. However,
10.62% had
income below
15017—
Rs. 1000 per
100month. The
50average income
0
was Rs. 2070.
300140015001 &
0-1000
10012001Men N (80)
Bl Women N (80)
i
Adolescents N(8
| □ Children N (80)
i ■ Total N (320)
-EUBhJ DM
2000
3000
4000
5000
Above
4.2.5 Marital
Status
Majority (89.38%) of them were married, 5.62% were single, 4.06% were
widowed and 1.56% were separated.
□Men N (80)
350
300 ■
250 ■
200 ■
150 •
100 •
50 •
0 •
a Women N (80)
Adolescents N (80)
Children N (80)
■ Total N(32O)
□%
Single
Married
4.2.6 Family Unit
86.88% hailed from nuclear families, 9.1% were
from joint families and 4.1% belonged to
extended families.
Widow
Separated
Total (N - 320)
14
4.2.7 Impact of Tsunami
25.62% had personal loss. Men from
region I had more personal loss when
compared to the men from region I. The
I
sample of Men reported personal loss
more than the other samples. The
’ ' "1
personal loss included loss of friends,
other than relatives. Therefore men
would have reported more personal loss
than perceived by the other samples.
More men than the other three groups
reported personal hurt to the index
persons. Out of the 320 men, 20.63% had personal hurt. 85.93% had lost
their household articles (HA), and 49.1% their houses. Considerably low
percentage lost their most valuable articles (MVB) and 13.12% reported
loss of pets. Personal hurt was affected in more number of people when
compared to physical loss and personal loss. The women reported that the
number of index persons having physical loss was more when compared
to personal loss and physical hurt. However the impact of personal loss is
likely to be more traumatic than the physical loss.
______
Phy»ic» iom
Personal Lo*»
Number or person.
Personal hurt
0
SO
100
ISO
200
250
300
4.2.7.1 Trauma (Extent of Trauma)
The mean percentage
showed that 81.88% are
currently experiencing one
trauma response or the
other. The adolescents
reported more number of
the index persons having
trauma responses, whereas
children reported the lowest
number of people with
trauma.
However
significant number of men
also reported having trauma
from both the regions.
Any other
Fear that Tsunami may recur
Feeling Tired
Recurrent dreams
!■%
■■
Flash backs
H
Recurrent thoughts
■
n 320
■
Unable to eat properly
. - Sleep Disturbance
■■■
0
.B
4.2.7.2 Trauma responses
Out of the trauma responses, 52.88% of the index persons were reported
to be having fear of another Tsunami. Since 27.19 % of the total population
were involved in sea related occupation or fishing, it is likely they are
15
venturing in to the sea with this fear, which could emotionally affect them
adversely in the long run.
The majority of the index persons were reported to be having sleep
disturbance (51.25%) and recurrent thoughts (50%). When the data of the
men alone were considered, sleep disturbance, recurrent thoughts and
fear of Tsunami predominated. Since one or the other trauma responses
were present in 81.88% (table in the previous page, 13.7.4) of the adult
men who were also involved in sea related job, it can be concluded that
the adult men require professional help for getting over the trauma.
Disaster preparedness programs may be arranged in the community in
order to allay the fear of Tsunami. Those who are intensely affected may
be provided with specialized counseling services.
Trauma
While narrating the trauma responses of the index persons, some of the children talked
about their own trauma also. Some of them did not know whether the index persons were
having trauma responses or not. Therefore, it is likely that the trauma responses reported by
them about the index persons may not be very accurate. Since, the adults themselves and
the adult women had also reported similar trend in the extent of trauma of the index persons,
the data provided by children may represent the trauma response of the adult men.
4.2.7.3 Coping
50% of the men reported that they
were abusing alcohol to cope with
the trauma. This is a significant
observation, which substantiates
%
the need for providing intervention
programs for coping with the
trauma. There is a need to provide
psychological forms of treatment to
get over the trauma. 37.5% of the
women also reported that the
index persons were using alcohol
Men
to cope with trauma, which is a
significant percent of the
population. When all the strata
were considered, 34.27% were using or abusing alcohol to cope with the
trauma.
85
■ Cope with alcohol
0
Women
Adolescents
3.75
>
Children
Total
16
4.2.8 Extent of Alcohol Abuse
The percentage of people with
drinking behavior was 74.06. The
number of men (83.75%) from
both the regions with drinking
behavior was more than that of
the other three groups.
250
200
■ Extent of drinking
behaviour
«%
150
100
83.75
(4.06
68.75
Women during the focus group
55 Mi
discussions reported that more
than 90.48% of the men of the
total population having drinking
behavior. Even in the men’s
group, during the focus group discussions, the percentage of people with
drinking behavior was reported to be 90.48. Probably the present finding
that 74.06% of the coastal population abusing alcohol may be a more
accurate estimate.
Children
Adolescents
Women
Men
Total (N-320)
4.2.9 Number of days of drinking
66 (52.8%) of the sample with drinking behavior were abusing alcohol on
four or more than 4 days in a week and were having alcohol dependence
disorder.
1201 MW®
Total (N-125)
■ Woman (N-58)
• Man (N-67)
100
..
80
22.4
■-
60
40
38
28
13.6
8.8
20
17
9.6
16
12
11
19
0 *-
12.8
1
13
2
3
5
6
7
4.2.10 Duration of Drinking
Men reported the average duration of drinking as 17.62 years, which was
significantly higher than what the women reported. The average duration
of the drinking when the sample of men and women were combined
together was 14.6 years.
Sample
Minimum
Maximum
Average duration
of Drinking
Men (N-67)
1
54
17.62
Women(N-58)
2
30
11.12
Total(N-125)
1
54
14.6
17
There is a wide variation in the maximum duration of drinking as reported
by women and men. Men reported the drinking period to be more than 54
years. The number of people who started drinking after Tsunami was as
low as 1 (0.8%), and may not be attributed to Tsunami alone.
4.2.11 Age of onset of Drinking
The minimum age of drinking reported by men in both the regions was 10.
The women also reported that the index persons had started drinking
during their adolescent period. This is a significant observation, which may
warrant to plan prevention programs for the adolescents.
Minimum age
Maximum age
Average age
Men (N-67)
10
43
22.47
Women(N-58)
14
39
18.59
Late onset drinking could be related to the existing co-morbid psychiatric
disorder, mainly depression. Careful psychiatric screening might help
identify those with co-morbid disorders. As long as one continues to abuse
alcohol, it may not be easy to identify the underlying disorder or the comorbid condition as alcohol could camouflage the mental status.
Though the adult men and women reported the onset of drinking during
the adolescent and childhood days, none of the adolescents who were
interviewed reported having drinking behaviour. The women or the men
did not report any member in their family below 20 years ‘using’ or
‘abusing’ alcohol. It is likely that the adolescents might be experimenting
with ‘alcohol’ as reported by the adult men.
4.2.12 Type of Drink
While 91.98% of the samples were abusing branded liquor, 51.05% were
abusing illicit liquor. 14.76% were abusing toddy and 3.37% were abusing
other types of liquor, other than the common illicit liquor.
18
More number of index persons from region I were
abusing illicit liquor. One of the reasons could be its
availability and the second could be the cost factor.
Third reason could be the increased content of ethyl
alcohol in the illicit liquor that produces quick
intoxication. But the health hazards of abusing the illicit
liquor are often neglected.
The locally brewed
Toddy
substances in unhygienic
Toddy is also considered as
conditions had led to
a ‘health drink’ by some,
several hooch tragedies
since the palmyrah juice, a
variant form tapped from
within the state and
the same tree
is
outside. However, there
traditionally considered as
appears to be no
a ‘health drink’. But with
regulatory mechanism to
fermenting, the percentage
check the illicit brewing and trading. Abrupt
of content of ethyl alcohol
stopping without rehabilitating or providing
increases and that leads to
intoxication. However,
alternate employment to those who are
toddy
sold in the coastal
involved in the illicit liquor brewing and
areas is often adulterated
trading could harm the ‘harmony’ within the
in order to get more ‘kick’
community. People participatory programs,
and leads to health hazard.
without affecting those engaged in the
:
‘cottage industry’ and reducing the
consumers through promoting alcohol free life
style might be helpful.
4.2.13 Current Quantity of intake
The adolescents and children were not aware of the quantity of intake the
index persons. However there was significant difference in the quantity of
intake as reported by those who abused alcohol (286.92 ml.) and the
women (414.92 ml.).
Even the reported
Current quantity of
quantity by men showed
N*
Sample
in take in ml.
that they were abusing
alcohol in excessive
65
286.92
Men (N-67)
quantity. The average
57
414.92
Women (N-58)
quantity of current
122*
346.72
Total (N-125)
intake per day was
346.72 ml of alcohol.
4.2.14 Pattern of alcohol Consumption
The index persons were abusing 329.64ml before Tsunami, 229.18ml
immediately after Tsunami, 407.14 ml when the relief money was
disbursed and 346.72ml currently. The average quantity of alcohol the
index person consumed a day, before Tsunami was reported to be
329.64ml. And there was not much variation in the report of men and
19
women. Immediately after Tsunami, the women felt that the men were
drinking much less, as low as 139.82mL
Tsunami
I mm.After
Tsunami
When relief
money was paid
Current
consumption
Men
325.38 (N-65)
3l8.54(N-58)
466.76(N-5I)
286.92(N-65)
Women
333.89(N-57)
l39.82(N-56)
347.51 (N-56)
4l4.92(N-57)
Average
329.64
(N-I22)
229.I8(N-114)
407.14(N-IO7)
346.72(N-I22)
Period
Before
But men did not report much decrease in their level of consumption. Men
especially at region II, continued drinking, irrespective of the traumatic
event and the personal loss, but the average quantity of intake reported by
men and women showed a remarkable decrease in quantity. When the
relief money was paid, the quantity went up to 407.14 ml per day. However
men reported much higher quantity than women.
There were people who had spent 100% of the relief money that they
received on alcohol. But it is not sure whether they shared the drink with
friends or they drank for themselves.
The average quantity of current intake was 346.72 ml, which is
significantly higher than the intake before Tsunami. But the report of the
men alone suggested a decrease in quantity. This decrease in quantity
could be due to the fact that 2 of them (67N) were not drinking currently
and some of them had reduced their quantity of drink due to health
reasons.
4.2.15 Financial Analysis
The average income of the index person as reported by men was Rs.2237
and the income reported by women was Rs. 1662. The money spent was
Rs. 891.42 and Rs. 755.54 respectively of their monthly income. The
average income of the total sample was Rs. 1970. 47 and on an average
they were spending Rs. 840.40. that was 42.65% of their monthly income.
Money spent
Average
Income
% spent on
alcohol
Amount spent
Men (N-67)
Rs.2237.50
39.84
Rs.891.42
Women
(N-58)
Rs. 1662.00
45.46
Rs.755.54
Total (N-I25)
Rs. 1970.47
42.65
Rs.840.40
4.2.15b Relief Money and Spending on alcohol
Out of the 102, who had received the relief money and had the drinking
behaviour, 35.29% did not spend any money on alcohol. 64.71% spent the
20
money on alcohol in varying proportions from 1-100%. However, 7.24%
spent all the money they received as relief on alcohol.
4.2.16 Financial Dependence
20.63% of the men depended on the money earned by the spouse and
16.88% depended on their friends, 2.5% depended on the relatives and
1.87% depended on other sources.
This was an additional burden on the 20.63% of the women population, in
the coastal areas. 20.63% of the women probably had to earn money to
run their family and in addition they had to financially support the index
persons who were abusing alcohol.
4.2.17 Health
52.32 % of the total sample had reported that their health had been
affected. Adolescents reported more number of index persons having
health problems, whereas men themselves reported it to be as low as 26
(38.81%).
In the total sample that was abusing alcohol, majority (52.32%) had health
problems.
From the public health perspective, this is a significant observation that
could have bearing on the health providers, health economists and policy
makers.
4.2.18 Family
Out of the four strata of sample, the sample of adult men and women were
considered. 6.25% had suspicion, 34.4% quarreled at home, 33.12%
physically abused the spouse and 13.8% physically abused the children.
However there was a significant difference between the report of men and
women. The women sample reported that 8% of the index persons had
suspicion, 44% physically abused their spouse and 17.32% physically
abused their children. Fewer men reported problems in all the areas.
Probably this is due to their denial (a defense mechanism) or it could be
manifestation of neuropsychological impairment that occurred as a result
of long duration of abuse of alcohol that they were not able to retrieve the
information. Or it could also be due to the phenomenon of ‘black out’
where in they do not recollect the events or their actions during the period
of high intoxication.
21
4.2.19 Attributed Reasons
(As perceived by the index persons)
In the rank order, men tend to perceive tiredness, (49) body pain (32)
pleasure (33) and sleep disturbance (32) as the major reasons for their
drink. The women on the other hand reported that the index persons had
attributed it to, body pain (20) tiredness, hazardous job and sleep
disturbances.
80
68
70
Men (N-67)
■ Women
Total (N-117)
62
?>.12
60
49
50
(N-SO)*
48
48
42
41.02
41.02
40
33
32
27
30
21 18
19
mu
20
16
:LL
4.Sleep Disturbance
1.Tiredness
24
20
21
■ ifc a I
S.Sad Mood
6.Family quarrel
13
T.Peer group
pressure
IS
iJL
B.Unemployement
9.Pleasure
0
I0.Any ottwr
* 8 women did not know the perception of the index persons.
The average percentage showed that tiredness (58.12%) body pain (53%)
pleasure and sleep disturbance (41.02%) to be the important reasons for
depending on alcohol.
These may point to the need for detoxification and pharmacological
management of the dependent persons.
4.2.20 Attributed reasons by others
As perceived by women, adolescent and children, body pain (58.23%)
tiredness (49.4%) hazardous job and family quarrel (34.11%) were the
major reasons.
120
.................... ............;-y;—........
............. --■■"T"’-......
99
100
Women (N-58)
■ Adolescents (N-55)
Children (N-57)
Total (N-170)
84
80
62
58.23
60
58
54
■%
55
49.4
41
27<
20
39
3637
40
r
21“
16
0
1.Tiredness
2.Hazourdous Job
I26 L
11
3Body Pain
ii.8
12.4
25
23
18
4.Sleep
Disturbance
S.Sad Mood
27
I ■ I i'
19 10 10 :
6.Famlly quarrel
7.Peer group
pressure
B.Unemployement
9.Pleasure
10.Any other
But 31.8% perceived that drinking may be due to sleep disturbance and
32.4% attributed it to peer pressure. Peer Pressure and pleasure being the
attributed reasons by children and adolescents may point to the need for
intervention among them.
Most often the significant family carer or member of the dependent
persons are considered to be reliable persons to give an accurate account
of the index persons. Out of the 57 children, 26(45.61%) felt that the index
piS-3bO
22
persons drink due to body pain. 17 (29.82%) felt that they drink to cope
with work hazard and 16 (28.07%) felt that they drink due to tiredness.
These observations may generate a positive attitude towards drinking of
alcohol in children. It gives the impression that alcohol is a substance that
smoothens the body, and the children when they grow up are likely to use
the same rationale when coerced to use alcohol or other substances.
14(24.56%) felt that they drink due to sleep disturbances and 11(19.29%)
attributed it to sad mood. These observations of children point to the need
for evaluating the addicted persons for any co-morbid psychological
disorders. This demands for educating the children and the family
members of the alcohol dependent persons about the co-morbid
conditions and to help them identify and seek treatment for those
conditions, which often goes unnoticed.
2(3.5%) felt that the drinking behaviour was due to their “dependence”.
These children may be trained to peer educate about the illness concept
of alcoholism, which may be an effective way of transforming a community
that thinks alcohol abuse is the ‘tradition’ and the ‘norm’.
4.2.21 Abstinence
49.6% have abstained in the past, which is a positive sign. The reasons for
abstinence are usually health related. When the dependent persons get
admitted in the hospital for health reasons or seek the consultation with
the physician, on their advice one may abstain.
Men
(N-67)
Women
(N-58)
Total
(N-125)
%
37
25
62
49.6
Or the relapse could be related to religious orientation-like stopping
alcohol before the pilgrimage or as part of a religious ritual. However,
unless the dependent person is provided with adequate counseling to
adapt a healthy life style and support systems, the possibility of relapse is
quite high.
23
4.2.22 Duration of Abstinence
9.6% of those with drinking behaviour abstaining for more than a year are
also a significant observation. The reason for abstaining or how they were
able to maintain their drug free life was not enquired in to.
Duration of
Abstinence
Men
(N-67)
Women
(N-58)
Total
(N-125)
%
0
18
30
48
38.4
Less than 1 month
28
9
37
29.6
1 -6 months
9
11
20
16
7-12 months
3
5
8
6.4
More than 1 year
9
3
12
9.6
If there are persons with skills for providing support to others among those
who were abstaining, they may be effectively used to help other
dependent persons for recovery. Studies had shown that recovering
dependent person could effectively function as peer counselors, since they
know the ‘hard way’ of maintaining the sobriety. However the number of
people who could not abstain for more than 6 months was as high as 68%.
4.2.23 Relapse Timings
Among those who relapsed, more men reported relapse after Tsunami,
and in total 31.2% had relapsed after Tsunami, whereas only 12.8% had
reported relapsing before Tsunami. The assumption that tsunami had led
to relapse may not be very accurate, since there are various reasons for
relapse.
_____________________________________
Sample
No
Relapse
Relapse after
Tsunami
Relapse after
Tsunami
Men (N-67)
38
25
2
Women (N-58)
30
14
14
Total (N-125)
68
39
16
%
54.4
31.2
12.8
However the significance of Tsunami for causing a relapse cannot be
minimized since the index persons had reported sleep disturbance, sad
mood and other trauma responses. The trauma responses they still
experience could explain the high rate of relapse after Tsunami.
24
4.2.24 Attributed reasons for Relapse
52.14% had attributed sleep disturbance as the reason for relapse. When
compared to the reasons by all the groups, sad mood (34%) comes as the
fifth reason in the rank order for relapse, apart from body pain, tiredness
and hazardous job. The physical comfort during the initial period of
abstinence does not last long. Either the co-morbid problems surfaces or
the craving for alcohol crops up or the overwhelming peer pressure, which
the recovering person is not able to resist, or the behavioral cues might
lead
to
relapse,
unless the
person and
“M
..
the
family
members
bring
about
life
style
changes. In order to bring about life style changes to the dependent
person and the family carer or carers, professional support or a social
support network is very helpful.
SZ14
- Mcn<H-27)
• women(N-29)
Totet(N-S6)
3?3
J4
32.14
30.35
1.
" “I
111 ill Mi a
l.TlrodneM
36ody P*n
a.Hajouroout X®
.
■
■■
:
4.SMcp O.aturbance
■
S.M Mood
ft.Fomilv quarrel
7.Pc«r group
0
a.unempioycment
'
Relapse of Treated Alcohol Dependent Person
One of the men was treated twice for alcohol
dependence but he was continuing to abuse alcohol.
However the possibility of a co morbid psychiatric
problem cannot be ruled out. It was not sure whether
the reason for the relapse was the added trauma the
person underwent which may be complicating the
dependence behaviour.
9
0
10Any other
25
4.2.25 Types of other substances Abused
Of the total sample of 320, 64.38% were reported to be abusing tobacco. It
appeared that when compared to alcoholism, less percentage of people
were abusing tobacco.
The gateway drugs like hans, pan parag and the other tobacco related
products were also being abused by 18.75% and 17.5% respectively.
Some of them abused different types of substances at the same time.
■
-
'
,
<
Other
substances
Tobacco
Ganja
Hans
PresDrugs
Others
Men (N-80)
49
4
23
0
18
Women(N-80)
48 Y.
lllfl 23
0
14
Adolescents
(N-80)
65
3
12
0
6
Children (N-80) , 44 r ■ '77;
1
17
0
18
Total (N-320)
10 '
60
0 .
56
3.13
18 75
0
17.5
206
ij;'-
7
64.38
3.13% are probably addicted to ganja. Ganja (cannabis) induced
psychosis is a condition that could affect the
mental health of the person, though it does not
Smoking cessation
have any withdrawal features. From a
programs and other
preventive perspective, the addictive nature of
substances cessation
the substances should be informed to the
programs may have to
be initiated for those
community, especially to the adolescents. For
who are addicted.
those who were addicted, treatment strategies
Preventive programs
need to be planned and they have to be
targeting
the
followed up, like other alcohol dependent
adolescents
and
persons. If any co-morbid psychiatric disorders
children could in the
had set in, those also need to be treated. Only a
long run pave way for a
I
comprehensive treatment would help them I drug free community
\J
recover from the addiction.
4.2.26 Money spent for other addictive substances
The average amount spent for the substances before Tsunami was
Rs. 15.09 and immediately after Tsunami, it decreased to Rs. 12. When the
relief money came in, it got to its peak with the men spending Rs.21 on
average for the substance.
26
Period
Before Tsunami
Rupees
AfterTsunami
In Rupees
Relief money
In Rupees
Currently
in Rupees
Men (N-80)
11 28
11.89
19.13
11.23
Women (N-80)
18.9
12.26
23.22
22.4
W (N-160)
SQ.IS
2415
42.35
;i3.63/'
Average^ 15.09
12.1
21.2
16.8
Though it reduced to Rs. 17, which is currently spent for the substance, it is
much higher than what they were spending before Tsunami. And the
average amount spent per month for other substances is about Rs.510.
4.2.27 Need in relation to drinking behavior
78.05% of the sample wanted the index persons to stop drinking. However
among the men, a good number (26.16) preferred to drink less quantity
than to stop drinking. Some of them (7.17%) wanted their drinking not to
affect the social functioning or family life, but wanted to continue their
drinking behaviour
200
185
180
Men (N-67)
160
■ Women (N-58)
Adoletcent(N-55)
140
ChMdren (N-57)
■ Total (N-237)
%
120
100
P8.05
80
62
Ml
60
40
19
Slop drinking
IB
Drink lai
16.16
B
* SM7-17.
Social
8-,2 3 MB717
Fam»v
710
16^m “I
Treatment o< Alcohol
Out of the 237, (27.8%) wanted the index persons to seek treatment for
the dependence on alcohol. Adolescents and children appeared to be
keener than the index persons to get the dependent persons treated.
Sixteen (28.17%) children wanted the index person to take treatment to
get out of the dependence. Significantly a considerable number of
children were aware of the treatment for alcohol dependence disorder. The
children who have awareness about the treatment of alcohol dependence
can be provided with further training to educate their peer group about the
same. Probably they may also be able to motivate the index persons to
seek treatment.
What about those who do not want the index persons to stop
drinking?
One possibility is that the adolescents and children feel that those men
who were drinking only once in a week need not stop their drinking
27
behaviour. But since which social drinker could or could not be moving on
to the phase of dependence is unpredictable, it is important to educate the
community especially the children and adolescents about the hazards of
experimenting with alcohol.
The adults reported that
some of them started
drinking as early as their 10th
age.
Some
of the
adolescents who could be
experimenting with the
alcohol would have justified
themselves with the drinking
behaviour of the index
persons.
Children appeared Helpless
Children seemed helpless when asking about
need in relation to drinking, “Will he listen to us
if we say?” Another one commented, “He will
stop when he wants to.” Another one said, “He
drinks at home in front of us and if we ask him
to stop he would beat us”
But the fact that 78.05% wished that the index persons need to change the
drinking behaviour is a positive sign and could facilitate in motivating the
index persons to take action to achieve a drug free life style.
4.2.28 Leisure
54.06% of the total sample in the region I and region II reported the
availability of leisure time of the index persons.
4.2.29 Leisure activities
While 22.81% were interested in hobbies, 21.87% preferred alternate
employment. The leisure activities of games and literary activities were
preferred by 17.5% and 18.75% respectively. But majority of them had not
reported any leisure activity, though 54.06% reported that they have
leisure time.
Leisure activities
Men
(N-80)
Women
(N-80)
Adolescents
(N-80)
Children
(N-80)
Total
(N-320)
%
Alternate employment
26
13
16
15
70
21.87
Engage in play/
games
12
10
22
12
56
17.5
Hobbies
13
26
18
16
73
22.81
Reading/literary
activities
17
4
31
8
60
18.75
Any other
15
0
4
0
19
5.93
u
28
It is also possible that the population at region I got locally displaced and
they are yet to explore new types of leisure activities at the new housing
settlement.
Population at region II, majority of them work in unskilled and semiskilled
jobs and were unable to find an appropriate leisure activity.
Since 74.06% are having drinking behaviour, replacing the problem
behaviour with a pleasurable leisure activity / behaviour assumes great
importance.
4.2.30 Leisure Availability
However, even among those people, who are interested in leisure
activities, the availability of the activities in the community does not tally
with the interest in all the areas. Only 19.06% reported the availability of
leisure activities like alternate employment and hobbies. 14.68% reported
about the availability of facilities for engaging in play and games and
4.68% reported the availability of facilities for reading and literary activities.
Men
(N-80)
Women
(N-80)
Adolescents
(N-80)
Children
(N-80)
Total
(N-320)
%
Alternate employment
II
23
12
15
61
19.06
Engage in Play/Games
8
5
23
II
47
14.68
Hobbies
7
15
18
II
61
19.06
Reading/Literary
activities
13
0
2
0
15
4.68
Any other
13
0
2
0
15
4.68
Availability
of facilities
Provision of leisure activities would not only help the recovering persons
who are addicted to substances, but also those are sober. Moreover it
would facilitate the adolescents and children to learn to engage their
leisure time effectively from early days of their development.
4.2.31 Effects on women
89.65% of the women reported psychological abuse and 62.06% reported
physical abuse. In contrast, only 28.57% the men reported that they
physically abused their spouse.
100
89.65
90
80
70
60
50
40
30
20
10
0
Id
62.06
Physical abuse
Psychological
abuse
N-58
■%
29.31
24.13
jjjl JI JL i
13.79
15.51
Disturbs
Demands money Persuades me to Sells house hold
articles
work/duarrel at
that 1 earn
borrow
work place
15.51
Suspicion
O
0
Sexual abuse
O
0
Any other
29
Some of the impacts of the drinking behaviour of the index persons are
related to the economic aspects of drinking. 29.31% reported that they
were being persuaded to borrow money, 24.13% reported that the index
persons demanded money that they earned and 13.79% were worried
about behaviour of selling of house hold articles, mainly for the drink. In
addition, the work of the women was also affected since 15.51% of the
index persons disturbed or quarreled
at the work place.
Focus of Counseling to Women
Whether it is part of the suspicion
In some situations the personality
(15.51%) that prompted the men to
traits of the women could be a
give trouble at the work place of the
XTJ^frerHfe^lT'aScS
women or whether the craving for
person. Some of them may need
money to get the drink is not sure.
training to evaluate and correct
However the impact is felt in diverse
themselves, which can be part
ways,
and it not only affects the selfcounseling focused on women. The
esteem
of the women, but also in the
behavior of the women/wives of the
economic front.
alcohol dependent persons surfaces
more prominently, when the treated
alcohol dependent person is
4.2.32 Change in behavior after
followed up along with the spouse
Tsunami
over a period of time.
61.8% of the women, adolescents and
children reported that there had been
no change in the behaviour of the index persons before and after Tsunami.
However,
19.39%
reported worsening of
the problems after
B?15. ’•09
Tsunami and another
9.69%
reported
worsening of the
problems, but currently
K16 9 i9
*
the problems are
decreased. However
9.09% felt that the
behavioral problems were more before Tsunami and the problems had
decreased following the event.
No change
61.8
More before Tsunami now
decreased
■ Women (N-58)
■ Adolescent. (N-5S)
■ Children (N-S2)
; « Total (N-165)
Leu Before Tsunami now
Increawo
less before Tsunami, Increased
after Tsunami, But now
decreased
0
SO
100
150
200
250
300
4.2.33 Emotional reactions of women
The emotional reactions of women showed that 48 (82.75%) of them were
frustrated. 45 (77.58%) had expressed anger as an emotional reaction and
30
39 (67.24%) had increased
90 ■
82.75
irritability. Nine (15.51%)of 80
77.58
N (58)
them felt like leaving their 70
67.24
B
homes. In addition 4 60
B
(6.89%) had suicidal 50 48
45
&
39
ideations. Nine (15.51%) 40 •
■
30
•
had different emotional
H
15.51
15.51
reactions that included 209
10
4
6
89
being very sad about the
state in which they are.
Frustration
Anger
Increased
Feels like
Feels like
Any other
ending life
Irritability
leaving home
The emotional reactions of
the women could be
independent of the drinking behaviour of the index persons. However
research had shown that the wives of alcoholics, as result of living with
their husbands who have long history of drinking tend to develop different
emotional disorders.
II ■ B
■
i
I
4.2.34 Effects on Children & Adolescents
69.64% of the adolescents and children reported psychological abuse and
50% of them reported physical abuse also. In contrast only 9.52 % of the
men had reported physical abuse of their children.
n
so
MoMKcnlt (N 55>
• ChMrwn (N S?)
ToUI (N il2)
70
56
:l I
PhyBKai abuM
&
. tyi T
1
Faruada* mt to borrow SaM houathoid arbetet
!, .»■
Dtaturba Mudtei
nion
» 5.JS
3 2.6?
Sexual abuM
Panuadm ma to buy
OaMkai
to School
31
Effects on Children
In contrast to adults’ report, 32 (56.14%) of
the children reported psychological abuse
and 29(50.87%) reported physical abuse
by the index persons.
14 (24.56%) also reported that their
studies being disturbed by the dependent
person and that is of great concern. In a
community where the literacy rate is quite
low and traditionally considers drinking as
a ‘norm’, the possibility of drinking affecting
the education of the future generation is
very high. 8(14.03%) reported that the
index persons demanded the money
earned by the mother, and 6(10.52%)
reported that they or their mothers were
persuaded to borrow money.
Though the men did not report about
selling household articles, 5(8.77%)
reported that the index persons do sell the
household articles for drinking. 3(5.26%)
reported they being asked to procure
alcohol and an equal number disliked
going to school, though there is no school
refusal.
Healthy Disciplining of
Children
In contrast to the reports of
the adults, the children
reported that the index
persons abused them
psychologically and physically.
Corporal punishment is
considered as the ‘right’ of the
parents by many sub-cultures
in Indian setting. However,
educating the parents against
using physical punishment at
the moment is a Herculean
task. Though, physical
punishment can cause great
harm to children, there are
many parents who request the
teachers to give physical
punishment even for tnv.al
reasons to their children are
attending schools. “Healthy
Disciplining of Children" is a
topic for discussion to be
included
in the treatment
program of alcohol dependent
persons and their families. It
may be included as a topic
during the training of women
groups in the “neighborhood”
meetings in the community.
4.2.35 Emotional reactions of Adolescents & Children
Frustration (66.07%) is the predominant emotional reaction of children,
followed by anger (58.03%) and heightened irritability (54.46%).
However 11.06%
felt like leaving
cohome and 7.14%
so.
| '
had suicidal
Hi
rumination. The
lips
suicidal
rumination was
10 H
■
seen among
adolescents but
children had not
expressed any idea. One of the children was very depressed. Childhood
depression is a possibility since the children of alcohol dependent
80 |
^.07
n-
61
58.03
54.46
:i-
'{f'J
40
|
I II
.LI__ ■
Frustration
■ Adolescents (N-55)
■ Children
(N-57)
■ Total
(N-112)
36
13 11.6
8
8 7.14
0
Ang<
Angar
IncraAMd Irritability
Full aka IMvino
homa
F««l» Oka ending iir«
1
1 0.89
■■■
Any «n<w
Y-li
' II
09708
po6
§ (
O (
BA
32
persons, are likely to develop emotional disorders of various nature, the
predominant one being depression.
The emotional reactions of children have to
be addressed. In addition to the trauma of
the tsunami the children experiencing
physical abuse and psychological abuse of
the father who is dependent on alcohol are
likely to hinder their emotional growth.
Programs on ‘How to live with an alcohol
dependent person’ may have to be initiated,
if the addiction persons refuse to get treated
and choose to continue their drinking
behaviour.
Adolescent Who Retaliates
Another adolescent reported
that he had to beat up his
father, who is alcoholic to
prevent him from physical
assault of his mother. He said,
0 No other effort to control his
drinking is effective”.
Adolescent Leaves Home
One of the adolescents
reported that he absconded
from home because of
father’s alcoholism and was
brought back by the
relatives. He felt like
committing suicide also. But
he came back home
because of mother’s plea.
4.2.36 Current concerns
The women and adolescents were worried
about their future, whereas children were
not that concerned about their future at the
moment. The concern of children was more
about the mother. While the women were
more worried about the health of the index
persons, adolescents and children seem to
be less concerned about it. Women were
anxious about the children too.
33
4.3 Focus Group Discussion
On the day of visit to the community at Ennore, the people at one of the
house settlement (Phase II ) were highly disturbed. The women and men
were vehemently complaining about an incident that occurred the previous
day. Mr. A a young person from the community after getting drunk tried to
molest an adolescent girl and the youth was caught by the men in the
community and was warned. In the ruffle, another adult member in the
community was physically hurt on the head. The injured person lodged a
complaint with the local police the next day morning. When Mr. A came to
know about the police complaint against him, he along with a group of
friends from another housing colony got drunk and threatened the
community that, “ all of you will be killed if you protest”. The community
members complained to us that they did not receive any protection from
the police and therefore they were worried about the safety and security of
women folk. They asked, “How will we go to sea when the security of our
women folk is at risk? How can we be peaceful when we are in the deep
sea?”
When the Focused Group Discussion was held later, this issue came up in
both the groups of men and women. Therefore it was easy to open up the
topic of alcohol dependence and its impact in the community.
4.3.1 Men’s Group at Ennore (Region I)
Since it was held on a Sunday those who were occupied in other
occupations other than fishing also were present. 21 members from the
community participated. Their age ranged from 21 to 64 years.
4.3.2 Women’s Group at Ennore (Region I)
From this area, 19 women in the age range of 20 to 54 years participated.
In the women’s group the initial theme of discussion was about the
incident that had happened. Many women were weeping and expressed
the concern that, “If this is happening to our grown up daughters in this
colony, what safety do we have here. This has happened to one girl and
what is going to happen to our children and us. Is it the way to respond to
an issue that was brought to the notice of the authorities? If some one can
get drunk and bring in his friends who are also drunk and do whatever
they want to do and threaten us that they would thrash all of us, how will
our men go to the sea peacefully”?
4.3.3 Men’s Group at Srinivasapuram (Region II)
20 men took part in the group and their age ranged from 22 to 48 years.
The extent of drinking was high. But many were hesitant to talk about it.
Since many of them were engaged in different work settings, they felt that
alcohol abuse was not a problem of serious concern. Many felt that though
it sometimes led to absenteeism and frequent hospital visits, it had not
affected their health or caused any psychological problems to them.
34
l
The Story of a young unmarried man
One unmarried young man reported that, “Many of us living here are unable
to forget the event. We are not scared that Tsunami would come again or
not. But I lost my elder sister and we could not save her” He moved to tears.
On further enquiry he reported that even now he is unable to sleep properly,
gets up in the middle of the night, and is unable to forget the issues. “ But
how can we get over these issues? The only resort is alcohol and I continue
to drink from morning till I sleep in small quantity when I am not engaged in
work. My friends also follow the same pattern. Further enquiry, he reported “
I was listening to a favorite song of mine when Tsunami occurred. Even after
so many months, whenever I hear that song again, I get some kind of fear. It
is difficult for me to bear that. But if I am intoxicated, I can withstand that”.
4.3.4 Women’s Group at Srinivasapuram (Region II)
This is a predominantly non-fishing population. The loss of life and
property was quite high, but most of them could get back to their homes
after maintenance. Out of the 20 women who attended the meeting, 18
(90%) were married and excepting one, all of their marital partners (17,
85%) were reportedly abusing alcohol.
4.3.5 Major Observations
1. The extent of drinking was widespread and was considered as an
acceptable behaviour by the men.
2. The men had different psychological trauma reactions.
3. The men had psychological dependence on alcohol, but did
recognize it as part of the dependence.
4. The men and women were equally worried about the security and
safety of the adolescent girls among the locally displaced
population. But they failed to see the relationship between drinking
and the drunken behaviour.
5. Availability of the illicit liquor and its trading within the settlements
posed a problem to the community in the housing settlements.
6. The women were concerned about the drinking behaviour and the
verbal abuse of men.
7. As a result of living with addicted persons for a long period of time,
they also reported change in their behaviour, which in turn lead to
marital problems.
8. The women were worried about the harm drinking behaviour may
cause to the children, especially when the children became fearful
while seeing the father who comes home intoxicated.
9. Though men did not perceive the need for treatment, the women
felt that some action has to be taken to stop the drinking
behaviour of men.
35
10. The women at Region II felt the need for providing treatment
facility at close proximity to help addicted persons within the
geographical area and the neighborhood communities.
11. Apartment from the treatment of alcohol dependence a need was
felt to provide counseling services to help the men to cope with
the trauma.
36
5.KEY FINDINGS
5.1 Among the coastal sample 74.06% were reported to be having drinking
behaviour. It is likely that 74.06% of the coastal population is having
drinking behaviour.
5.2 Among the people with drinking behaviour, 52.8% of them have
alcohol dependence. Probably 52.8% of the coastal population is
dependent on alcohol.
5.3 There was a wide variation in the duration of drinking and the age of
first drink was reported to be 10 years.
5.4 91.98% of the sample of people with drinking behaviour were abusing
branded liquor, 51.05% were abusing illicit liquor. 14.76% were
abusing toddy and 3.37% were abusing other types of liquor, other
than the common illicit liquor.
5.5 The average quantity of current intake per day was 346.72 ml of
alcohol.
5.6 The study showed that the index persons were abusing 329.64ml
before Tsunami, 229.18ml immediately after Tsunami, 407.14 ml
when the relief money was disbursed and 350.92ml currently.
5.7 The average income of the total sample was Rs. 1970. 47 and on an
average they were spending about 42.65% of their monthly income
which is Rs. 840.40.
5.8 20.63% of the index persons financially depended on the spouse and
it is an additional burden on them to earn money to run their family
and financially support the index person who is abusing alcohol.
5.9
In the total sample that was abusing alcohol, 53.32% had health
problems.
5.10 On an average 6.25% of those with drinking behaviour had suspicion,
34.4% quarreled at home, 33.12% physically abused the spouse and
13.8% physically abused the children. There was a significant
difference between the report of men and women and fewer men
reported problems in all the areas.
5.11 The index persons attributed that tiredness (58.12%) body pain (53%)
pleasure and sleep disturbance (41.02%) to be the important reasons
for depending on alcohol.
37
5.12 As perceived by women, adolescent and children, body pain
(58.23%) tiredness
(49.4%) hazardous job and family quarrel
(34.11%) were the major reasons.
5.13 Though 9.6% of the index persons could abstain for more than 1
year in the past, 68% could not keep their abstinence for more than 6
months.
5.14 More men reported relapse after Tsunami, and in total 31.2% had
relapsed after Tsunami, whereas only 12.8% had reported relapsing
before Tsunami.
5.15
2.14% had attributed sleep disturbance as the reason for relapse.
When compared to the reasons by all the groups, sad mood (34%)
comes as the fifth reason in the rank order for relapse, apart from
body pain, tiredness and hazardous job.
5.16 8.05% of the sample wanted the index persons to stop drinking.
5.17 Out of the 237, (27.8%) wanted the index persons to seek treatment
for the alcohol drinking behaviour.
5.18 Of the total sample, 67.7% were reported to be abusing tobacco. It
appeared that when compared to alcoholism, less percentage of
people were abusing tobacco.
5.19 The gateway drugs like hans, pan parag and the other tobacco
related products were also being abused by 19.7% and 18.42%
respectively. Some of them abused different types of substances at
the same time.
5.20 3.28% of the total population was probably addicted to ganja.
5.21 There is a marginal increase in the money spent for procuring other
addictive substances before Tsunami (Rs. 15.09) and currently (Rs
16.80).
5.22 However among the men, a good number (26.16%) preferred to drink
less quantity than to stop drinking.
5.23 Some of them (7.17%) wanted their drinking not to affect the social
functioning or family life, but wanted to continue their drinking
behaviour.
5.24 Adolescents and children appeared to be keener than the adults to
provide treatment to the index persons for stopping the drinking
behaviour.
38
5.25 The fact that 78.05% wished that the index person to change the
drinking behaviour is a positive sign and could facilitate in motivating
the index persons to take action to achieve a drug free life style.
5.26 While 22.81% were interested in hobbies, 21.87% preferred alternate
employment. The leisure activities of games and literary activities
were preferred by 17.5% and 18.75% respectively. But majority of
them had not reported any leisure activity, though 54.06% reported
that they have leisure time.
5.27 Since 74% are dependent on alcohol, replacing the drinking
behaviour with a pleasurable leisure activity assumes great
importance.
5.28 Only 19.06% reported the availability of leisure activities like alternate
employment and hobbies. 14.68% reported about the availability of
facilities for engaging in play and games and 4.68% reported the
availability of facilities for reading and literary activities.
5.29 Among the sample, 61.8% of the women, adolescents and children
reported that there had been no change in the behaviour of the index
person before and after Tsunami.
5.30 The women, adolescents and children, 19.39% reported worsening
of the problems after Tsunami and another 9.69% reported
worsening of the problems, but currently the problems were
decreased.
5.31 However 9.09% felt that the behavioral problems were more before
Tsunami and the problems had decreased following the event.
5.32 With respect to the effect of alcohol drinking behaviour, 69.64% of
the adolescents and children reported psychological abuse and 50%
of them reported physical abuse also. In contrast only 9.52 % of the
men had reported physical abuse of their children.
5.33 The emotional reactions of women showed that 48 (82.75%) were
frustrated. 45 (77.58%) had expressed anger as an emotional
reaction and 39 (67.24%) had increased irritability. Nine (15.51%)of
them felt like leaving their homes. In addition 4 (6.89%) had suicidal
ideations. Nine (15.51%) had different emotional reactions that
included being very sad about the state in which they are.
5.34 Regarding the impact of Tsunami, 25.62% had personal loss,
20.63% had personal hurt. 85.93% had lost their household articles
(HA), and 49.1% their houses. Considerably low percentage lost their
most valuable articles (MVB) and 13.12% reported loss of pets.
39
5.35 The data showed that 81.88% were experiencing one trauma
response or the other.
5.36 Among the adult men sample, 50% of them reported that they were
abusing alcohol to cope with the trauma.
40
6. PLAN OF ACTION
6.1. EDUCATION ABOUT ALCOHOL DEPENDENCE DISORDER
(‘Illness’ concept of Alcoholism)
6.1.1 Majority of the women, adolescents and children want the index
persons to stop the drinking behaviour. Some of the dependent
persons are also motivated to stop their drinking behaviour.
6.1.2 Probably they are not fully aware about the treatment programs that
are available. In one of the focus group discussions, when one of the
women narrated her efforts in getting her husband being treated and
he being sober for 8 months, only one person showed interest to
know more about it.
6.1.3 It is imperative to educate the target population about the treatment
facilities so that they could access the treatment.
6.1.4 This is also supported by the fact that women and other groups also
think that the drinking behaviour is due to tiredness, body pain or
work similar to the addicted persons. This might hinder the
motivation programs in helping the dependent person and the family
members to seek professional help for de addiction and counseling.
6.1.5 Some of the women, adolescents and children wished that the index
persons reduce their quantity of intake or the drinking pattern so that
their livelihoods is not affected. This points out to the fact that
educative programs be conducted in the coastal area to motivate the
women and the children about the need for treatment to help the
addicted persons to be sober and to rebuild their lives.
6.1.6 The second preferred objective of the dependent persons is to
achieve controlled drinking. However in Indian situation, it has been
observed that controlled drinking, as a treatment objective does not
seem to be a desired one, since many of them are finding it difficult
to maintain control over their drink, even though they are re-trained in
controlled drinking. (Manickam and Kuruvilla, 1989)
6.2 ESTABLISHING DEADDICTION CENTRE
6.2.1 Establishing de addiction centers in the area would help not only the
population of the study area, but also the neighborhood coastal
community that is likely to be affected by the alcohol abuse.
6.2.2 One of the methods in maintaining alcohol free life is the contact the
treatment centre or the support people at the treatment center
establishes with the person the dependent person and their key
family members.
41
6.2.3 Establishing a treatment center at a place that is accessible to the
community members would ensure the continued support that a
recovering alcohol dependent person requires.
6.2.4 The de addiction centers may also take care of the co morbid
psychiatric disorders that go undetected in alcohol dependent
persons because of their continued use of alcohol.
6.2.5 The services of member of Alcohol Anonymous and Al-Anon could
be utilized to strengthen the programs.
6.3.
Men wanted to know
about smoking cessation
program
6.3.1 The counseling centre also has to
introduce innovative approaches.
abusing olher addictive
substances like tobacco also
ESTABLISHING COUNSELING
CENTRE-Counseling for economic
independence
tfcSdSSdS
6.3.2 Provide alternate banking facilities
or micro economic planning system
stopping. They were asking
that would ensure financial stability
about the centers available
for the fishing community. The
for
stopping their smoking
fishermen tend to ‘finish off’ the
money that they earn.
6.3.3 If adequate banking or saving
for stopping the smoking
facilities are available link between
behavior.
the community members and the
banking institutions may be
facilitated.
6.3.4 Alternate /Substitute Livelihood- Co-operative ventures could be
initiated that would ensure the participation of members of the
community and inclusion of all the community members to ensure
economic freedom.
6.3.5 Majorities of the families have financial difficulties and the policy of
subsidizing services or disbursing further money could again lead to
increased intake of alcohol as seen at the time of delivery of relief
money following Tsunami. Therefore different strategies may have to
be planned with the participation of the community in giving
economic freedom.
6.4 TRAUMA OF TSUNAMI-Counseling for overcoming trauma
6.4.1 The counseling services should aim at resolving the trauma-related
issues, along with counseling for alcohol dependence.
6.4.2 It has been observed that among a considerable number of persons,
the relapse has occurred after the Tsunami and they also have
traumatic responses that are unresolved and the impact of trauma
appears to be unresolved.
42
6.4.3 Professional help through counseling may help them get over the
trauma which may facilitate a drug free life style.
6.5 WOMEN-Counseling to empower women
Focus of Counseling to Women
In some situations the personality
traits of the women could be a
stumbling factor in maintaining the
alcohol free life of the addicted
person. Some of them may need
training to evaluate and correct
themselves, which can be part
counseling focused on women. The
behavior of the women/wives of the
alcohol dependent persons surfaces
more prominently, when the treated
alcohol dependent person is
followed up along with the spouse
over a period of time.
6.5.1 Most of the de addiction centers in India take a family oriented
approach and aim at involving the spouses of the dependent persons
in the treatment programs.
6.5.2 There is an increased need for emotionally supporting the women in
these geographical areas.
6.5.3 A significant number of them are affected not only economically, but
they seem to be affected physically and emotionally.
6.5.4 Though they seem to have reconciled to the fact that alcohol abuse
is the norm, instilling a hope might help them take care of themselves
and their children.
Deliberate Self-Harm of Women
A young lady who was separated from herhusband attempted suicide twice, once after
Tsunami. Another widow whose husband died 7
years ago due to excessive use of alcohol
attempted suicide.
6.5.5 Their emotional reactions and the concerns demands professional
help to cope with the alcohol dependent persons.
43
6.6 ADOLESCENTS-Adolescent Counseling
6.6.1 To help them break the cognition that ‘ alcohol as a substance is the
means to cope with personal problems', which they have been
hearing from their childhood days.
6.6.2 To instill confidence in them by providing living skills training and
facilitate them to develop alternate ways of earning their livelihood
apart from their tradition employment
6.6.3 To educate them about the ill effects of alcohol and to keep them
away from using alcohol and other substances.
6.6.4 The adolescent girls were anxious about their safety and future and
require counseling to cope with stress of day-to-day living.
"
■
-
■
Diverse issues affect adolescent girls
Adolescent Girls narrated different stories. Though the interview was time limited,
they wanted to continue and share their problems. The threat of rape was felt among
them, especially after an incident of attempt to rape had happened in the settlement.
They felt insecure, “Any thing can happen to us at any time and there is no one to
protect us!” (since the father is either at sea or comes home drunk). They were
anxious about what would happen each day.
Some of the questions they raised were, ■
“Will I get married T
“Why was I born ?”
“I have number of problems and to whom can I share?. This is not only my problem,
many of us are experiencing this.”
Regarding drinking behaviour one of them said,
“ They only have to stop it and what can we do about it?”
■
■
6.7 CHILDREN-counseling to Children
6.7.1 Children are equally traumatized and require professional help to get
over the trauma.
6.7.2 The children have to be provided help to cope with the stress caused
by their father’s behaviour under intoxication.
6.8. TRAINING OF LAY COUNSELORS
6.8.1 The counseling center may aim at training lay counselors of both the
genders who could provide services like, identifying the dependent
persons, motivating them and the family members for taking
treatment and providing social support to those who were treated to
keep their sober life style.
6.8.2 The lay counselors from the community would be easily accessible
for the addicted persons when they have craving for alcohol or while
they are in crisis.
6.8.3 Those who are abstaining for more than a year and who have the
skills for effective communication may be trained as peer counselors.
44
6.8.4 Children and adolescents who have understanding about the
‘disorder’ concept of alcohol dependence may be trained as peer
educators.
6.9 COMMUNITY PARTICIPATION
6.9.1 The participation of all the community members has to be ensured to
make the program successful since the ‘norm’ of the community is to
‘ use alcohol’.
6.9.2 Striving a community towards a drug free society is a difficult task.
6.9.3 There could be strong opposition from the within and outside, since
the community members are influenced tremendously by the
neighboring community which equally follows the same pattern. One
could expect a positive snowball effect, provided, the programs are
planned strategically.
6.10 RECREATION FACILITIES
6.10.1. Leisure time management is an important component of a
successful treatment program.
6.10.2 Appropriate facilities for recreation should be ensured within the
community , that are culture specific and need based.
6.10.3 Adequate space needs to be provided for the recovered persons
as well as others in the community to access different recreational
facilities at different time periods.
6.11 PEOPLE CENTRED APPROACH
6.11.1 A balanced people centered approach should be evolved since a
number of external factors interplay.
6.11.2 Alcohol is offered as reinforcement for different services provided.
6.11.3 So there is a possibility of strong opposition within the community,
even though the women, adolescents and children could be
supportive.
6.11.4 A well-designed Project Implementation Plan (PIP) that would take
care of the culturally and religiously diverse population might help the
program achieve the objectives.
6.13 AVAILABILITY
6.13.1 Majority of them depend on the liquor shops or the illicit liquor that
are available nearby.
6.13.2 None of the sample interviewed or who participated in the FGD
suggested the closure of the shops or stoppage of selling of illicit
liquor in the housing areas.
6.13.3 This is a complicated issue since many in the Region I are
depending on the illicit liquor that is less expensive and is easily
available and accessible.
45
6.13.4 The people involved in brewing and trading have to be rehabilitated
by providing alternate employment since many of them would be
jobless if this is stopped abruptly.
6.13.5 Unless the government/policy makers take a strong step, it would
be difficult to stop the trade since many of the abusers also are likely
to support the traders.
Position: 1796 (3 views)