Alcoholism is a problem both in the developed and in the developing countries. Concern about the effect of alcoholism on spouses, children in the family and marital functioning has been frequently expressed by clinicians and others in research literature. Alcohol dependence is defined by American Medical Association as “A primary chronic disease with genetic, psycho social and environmental factors influencing its development and manifestations”. 

According to Burger et al  alcoholism has negative effects on the spouse of an alcoholic. The spouse might develop feelings of hatred, self-pity, avoidance of social contacts, may suffer exhaustion and become physically or mentally ill .  Alexithymia and depression in family members of alcoholics was noticed.  The results showed that the prevalence of alexithymia is 47.9% and depression is only 6.3%. No significant correlation between alexithymia and depression was found. 

Expressiveness and conflict are significantly lower in families with alcoholics than in healthy families without alcoholics, although families with alcoholics do have strong conflicts.

Retrospective studies showed that spouses of alcoholics were diagnosed with borderline psychopathological conditions  like psychopathy 27%, neurotic personality  24%, neurosis 23% and reactive depressions 15% as per S.S.Korsakova et al. Apart from the wives disturbed personality model and coping behaviour efforts to understand and explain the emotional experience of wives of alcoholics are still lacking in this field. Approaches to assistant type, cast the drinker as character defective and thus incorrigible. Helping efforts were geared towards other members of the family, spouse and children (Bailey, 1963).

Studies show that the wives of alcoholics in a family agency setting described them as often equally as sick as their husbands with a need to dominate, to suffer, to punish or belittle their maids. Such a wife and frequently the daughter of an alcoholic father may also suffer from feelings of basic anxiety and inadequacy which can be denied or assuaged by their feeling superior to their husband (Fox, 1968).

Alcohol abuse affects couples relationships in a variety of negative ways. Studies show that spouses of alcohol dependent persons have higher rates of psychological, stress-related medical problems (Hypertension, Diabetes). The current understanding indicates differences in consequences among various family members. Children as well as spouses are exposed to considerable stress  as per Moos et la. Women who are married to alcoholics are three times more likely to abuse alcohol themselves compared to wives of non-alcoholics, according to new research. Family members of alcoholic’s very often become codependent; Codependency is an unconscious addiction to another person’s abnormal behaviour. This leads to isolation, depression, emotional problems and suicide attempt.

REVIEW OF LITERATURE

There have been number of Indian and western studies conducted on the family members of alcoholics showing significant psychiatric morbidity. Concern about effects of alcoholism on spouses and children in the family and marital functioning  Apart from spouses’ disturbed personality model and coping behaviour, efforts to understand and explain the emotional experience of spouses of alcohol dependence syndrome are still lacking in this field  Dr. Marc Schuckit, director of the Alcohol Research Centre in the Veterans Affairs San Diego Healthcare System, has conducted study on women who are married to alcoholics, study revealed that spouses of alcoholics are three times more likely to abuse alcohol themselves and three times more likely to work outside their home, compared to wives of non-alcoholics, according to new research. The study also found that wives of alcoholics experience no more depression than women who are married to non-alcoholics. Women are emotionally more open than men to the concerns of their loved ones and therefore experience more distress in events that occur to that person and are therefore more vulnerable, (Kessler, et 1985) this has been considered to be part of the chronic stress associated with the traditional role functioning of women. However apart from being providers of support (Belle, 1982) it has been found that women resort to social support as a salient coping strategy to a much higher degree than men (Defaces, et al 1985). All these facts must be taken into consideration while intervention process of alcoholics and his family members.

Psychological distress among female spouses of male at-risk drinkers: A retrospective analysis conducted using data from a Quebec community health survey showed the Symptoms of anxiety, depression, aggression and cognitive impairments. Scores of > or = 22 (out of 100) were indicative of a high level of psychological distress. This study confirmed higher levels of psychological distress in female spouses of male lifetime at risk drinkers in the general population.  National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional, survey  showed  that women whose partners had alcohol problems were more likely to experience mood disorders, anxiety disorders,  and being in fair or poor health than women whose partners did not have alcohol problems (odds ratio [OR]: 1.7-4.5). They also experienced more life stressors and had lower mental/psychological quality-of-life scores.

Another study shows that 327 women who were married to men who had been developed alcohol abuse and dependence. The data compared the characteristics of the 235 women (71.39%) whose husbands had never developed alcohol abuse and dependence, and women with husbands meeting the criteria for alcohol use and dependence the 92 (28.1%) women for whom these disorders had been documented. Results showed, the women who married men with an AUD were less likely to be homemakers, were more likely to meet criteria for alcoholism (especially abuse) themselves, were more likely to report use of illicit substances, and to be current smokers.  However, spouses of men with AUDs in this highly functional sample had no history of alcohol use, had higher risk for other major psychiatric disorders. Fukinish et al alexithymia and depression in family members of alcoholics were examined among 48 families. Results were as follows: The prevalence of alexithymia was 47.9%. Whereas that of depression was only 6.3% no significant correlation between alexithymia and depression was noted. Expressiveness and conflict were significantly lower in families with alcoholics than in healthy families without alcoholics, although families with alcoholics do have strong conflicts. The results suggest the possibility that half of them forcefully suppress their conflicts, unconsciously deny the existence of alcoholics and finally manifest secondary alexithymia.  The wives of alcoholics and their experiences in the study of psychopathology.

The authors examined clinically 215 wives of alcoholics or divorced women who had been previously married to alcoholics. None of the women abused alcohol. Only 12 of them were officially registered as psychiatrist’s patients. Borderline psychopathological conditions were diagnosed in 174 women who had long been married to alcoholic husbands or lived with them in one apartment. Of them, psychopathy, neurotic personality, neurosis, reactive depressions were identified in 27%, 24.7%, 23%, 15% respectively. 41 divorced women living apart from former alcoholic husbands had no psychopathology at the moment of the study. Borderline neurotic disorders in alcoholic husbands’ wives should be considered in familial analysis made for subjects seeking genetic advice.

According to a new study out of Texas, it was suggested that the characteristics of women married to alcoholic men may play a role in the problem. Clinical and Experimental Research, found women married to alcoholics tend to be less likely to be homemakers and more likely to meet the criteria for alcoholism themselves. They also were found to more likely to smoke and use illicit drugs. 

On the other hand, the study determined women married to alcoholics are no more likely than other women to have other major psychiatric disorders and did not report a higher rate of alcohol abuse themselves. Marc A Schuckit and colleagues from the Healthcare System interviewed 250 women whose husbands had been involved in an earlier study of sons of alcoholics. Ninety-two of the women had husbands who developed alcoholism. They were compared with the other 140 women whose husbands did not go on to become alcoholics.

Written and verbal consent was taken from the family members   of alcoholics. The data was collected using the semi structured interview schedule. A total of 54 families (fifty-four patients their spouses were interviewed for screening of alcohol abuse by using AUDIT questionnaire for the patients. General Health Questionnaires, (GHQ-30) questionnaire was used for identification of psychiatric morbidity in spouses of alcoholics.  

The data was collected and subjected to statistical analysis using descriptive statistics using mean, standard deviation and median. For discrete variable contingent table depicting number and percentages, bar diagrams were used.

TABLE-1: AUDIT for the patient

The mean score for AUDIT in the study is 25.2777.

TABLE-2: Age of patient distribution

 Table 2 depicts age of Patients. The mean age of patient is 36.40 years with standard deviation of 5.9077.

TABLE-3: Age of spouse distribution:

Table 3 depicts age of spouses. The mean age of spouses is 32 years with standard deviation of 5.08.

TABLE-4: Educational status of spouses:

Table 4 depicts that educational status of spouses is 31(57.40%) spouses were illiterates, 8(14.81%) had primary education, 8(14.81%) had secondary education, 5(9.25%) had education till intermediate, 1(1.85%) had education till diploma,  1(1.85%) has been graduated. 

TABLE-5: Occupation of spouses:

TABLE-6: Socio economic status of patient according to kuppu swamy classification:

 Table 6 depicts Socio Economic Status. 1.85% was from lower group, 22.22% were from upper lower group, 6.66% were from middle group, 7.40% were from upper middle group, 1.85% was from upper group.

TABLE-7:  History of alcohol use in spouses:

The table 7 depicts that the 54(100%) of spouses have no history of alcohol use.

TABLE-8: General Health Questionnaire: 30

 Table 8 depicts the count of persons above norm on GHQ-30 with cut off score 45. It shows that out of 54 family members of alcohol dependant persons 23 members had mild to moderate psychiatric morbidity. And 18 members had severe psychiatric morbidity.

TABLE-9: Wife occupation GHQ 30

Table-9 shows the psychiatric morbidity in the spouse measured by GHQ as significant effect in the labourer group.

This is a cross sectional conducted to study the psychopathology on spouses of alcohol dependent persons at Government Medical College, Anantapur during the period January 2024 to March 2024.  Patients who abuse alcohol, attending the - Out Patient and In patient clinic were screened by AUDIT, and those fulfilling the criteria for Alcohol dependence syndrome were taken for the study. Thorough description of the study was done to the patient and his spouse and written consent was taken. Psychiatric morbidity in the spouses was studied using the General Health Questionnaire (GHQ-30)  

The present study shows the mean age of the patients 36.40 years mean age of spouse 32 years. Most of patients were from rural back ground about 64.8% belonging to middle socio economic status according to Kuppu Swamy Classification. Family history of alcoholism reported was 81% in patients family members, medical co morbidities with which the patients presented were 78%. Socio demographic status of spouses showed 57.4% of the study were illiterates, 42.59% were labourers,5.5%were farmers 50% were home makers and 2% being non-professionals by their occupation. The present study has found no alcohol abuse in the spouses and children of alcohol dependent subjects showed no history of alcohol use which does not correlate with the study with results, women who are married to alcoholics are three times more likely to abuse alcohol themselves compared to wives of non-alcoholics, according to new research. Family members of alcoholic’s very often become codependent; Codependency is an unconscious addiction to another person’s abnormal behaviour.  About 66% of the sample was constituted by Middle socio economical status according to Kuppu swamy classification. It has been well documented that alcohol abuse and dependence was one of the most important determinants of the financial status of the family with an alcohol abuse person in the family due to the toll on health expenditures, productive work hours and social support as was reported in WHO Global state report on alcohol 2004.The fact that persons belonging to low socio economic status prefer to consult at Government health facilities in view of lower treatment  cost.  

The present study has not found alcohol abuse in wives of alcohol dependent persons. However western studies by Marc Schuckit (2004), showed that women who married to alcoholics were three times more likely to be abusing alcohol. However stigma, attached to female alcoholism, wives might not have been willing to acknowledge their alcoholism, more so in Indian Context, especially local in context.

The present study found mild to moderate psychiatric morbidity of in the family members (in 23 spouses out of fifty-four spouses) of alcohol dependent subjects on general health questionnaire (GHQ-30). The findings are similar to the study conducted by Fukunish.I et al. (2004), alexithymia and depression was in families with alcoholics. In Indian context  the study conducted  at Kasturba Hospital, Manipal on the Mental Health status of spouse of alcohol dependent patient and its correlation  to  psychiatric disorders in their children  in 2003,  it was found that  the psychiatric morbidity among spouse of alcohol dependent subjects  in the form of current depression was  4.6% and  dysthymia  was 3.7%. There are limited Indian studies available regarding the consequences of alcoholism on the mental health of wives of alcohol dependents patients. In the present study though mild to moderate psychiatric morbidity was found in family members of alcoholics on GHQ-30. 

It is concluded that when treating alcohol dependent patients, there is a need to screen the family members for potential ill health. Family members especially wives need psychosocial interventions on the merit of individual psychosocial problems if not as a part of the general plan of psychosocial management of alcohol dependence.

SUMMARY AND CONCLUSION

The present study is a cross-sectional study conducted at Government Medical College and Hospital; Anantapur with aim to study the psychopathology in the spouses of alcohol dependence syndrome patients.  The alcohol dependence syndrome patients were taken from fifty-four families constituting fifty-four spouses they accompanied the patient at the time of admission or outpatient clinic, GHQ-30 was used. The data was collected using the semi structured interview schedule and was subjected to statistical analysis.

1)       Mean age group of the patients in the study was 36.40 years.

2)       Mean age group of the spouses in the study was 32 years.  

3)       It was found that psychiatric morbidity as measured using GHQ-30 was 46% of spouses had mild to moderate and 36% of spouses had severe psychiatric morbidity in family members of alcohol dependent patients.

4)       No significant difference was observed in psychopathology in various age groups.

5)       Psychiatric morbidity is higher in labours and home makers.

6)       Psychopathology was higher in the middle socio economic status group.

Alcohol dependence needs to be justifiably viewed as a disorder afflicting the family unit as a whole. The present study supported the findings of previous studies on psychopathology in mental health of the spouse. This study brings out association between alcoholism in patient and psychopathology in their spouses. These findings agree with previous studies

Current study lends support to the emphasis on treating alcohol dependence individuals’ not in isolation but treating the family of alcoholics as a unit which has been emphasized in the literature. 

1.       Burger, A hill (1981) family involvement and alcoholic completion of a multi phasic treatment programme, journal of studies on alcohol, 42, 517-521.

2.       S.S.Korsakova 1994: 94 (1): 51-54. The wives of alcoholics experience in the study of psychopathology.

3.       Bailey, M.B (1967). Psycho physiological impairment in wives of alcoholics as related to their husbands drinking and sobriety. 

4.       Stanton, D. and W. Shadish (1997) "Outcome, attrition and family-couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies" Psychological Bulletin, 122(2):1

5.       Velleman, R.B., L.J. Templeton and A.G. Copello (2005) "The role of the family in preventing and intervening with substance use and misuse: A comprehensive review of family interventions, with a focus on young people" Drug and Alcohol Review, 24:93-109.

6.       Belle, D. (1982). The Stress of Caring: Women as providers of social support. In. Goldberger. L. and Breznitz. S. (Eds.), Handbook of Stress 

7.       Fukinish. I, Ichikwa, M. LidaY. Tabe. T Alexithymia and Depression in families of alcoholics. Tokyo Institute of Psychiatry, 2001 Japan.                                  

8.       Moskalenko VD, Gun'ko AA: The wives of alcoholics: experience in the study of psychopathology; Zh Nevrol Psikhiatr Im S S Korsakova. 1994;94(1):51-54 

9.       Grubi si C-Ili c M; Ljubin T; and Kozari C Kova ci c D (1998). Personality dimensions and Psychiatric treatment of alcoholic ' S wives, Crmt M, Journal, March, 39 (l), 49-53.

10.    Saunders JB, Aasland OG , Babor TF et al. Development of the alcohol use disorders identification test (AUDIT):WHO collaborative project on early detection of persons with harmful alcohol consumption-II Addiction 1993,88 : 791-803.

11.    Goldberg DP, Hellier HF A scaled version of the General Health Questionnaire psychology Med 1979; 9:139-145.

12.    Cornelius JR, Salloum IM, Mezzich J, Cornelius MD, FabregaHF Jr, Ehler JG, Ulrich RF,Thase ME, Mann JJ: Disproportion-ate suicidality in patients with comorbid major depression and alcoholism. Am J Psychiatry 1995; 

13.    Shelly F. Greenfield  Alcohol and Drug Abuse Program, McLean Hospital, Belmont, ass., and the Department of Psychiatry, Harvard Medical School, Boston, Mass. Women and Alcohol Use Disorders  2002, Vol. 10, No. 2.