INTRODUCTION
Self esteem is all about how much we feel valued, loved, accepted and thought well of by others and how much we value, love and accept ourselves. People with healthy self-esteem are able to feel good about them, appreciate their own worth and take pride in their abilities, skills and accomplishments. People with low self- esteem may feel as if no one will like them or accept them or that they can’t do well in anything
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People with high self esteem tend to be ambitious in what they want to experience in Life, they have a drive to express them and to communicate openly and honestly about their needs and desires. People with low self esteem rarely live their life to the full, they distance themselves from others, denied their love and support, and uncomfortable with success, some of them even take alcohol and drugs.
We all experience problems with self esteem at certain times in our lives-especially during our teens figuring out, where we fit in the world. The level of self esteem determines how we operate in life -how we interact with others such as spouse, children, friends, and strangers .It determines our achievements, and our satisfaction and happiness.
Self esteem has long been believed to play an important role in the use of alcohol; People with alcohol problems often have low self esteem. They judge themselves negatively-not just for their addiction, but also for other parts of their behavior or their personality.
Most of the individuals who are addicted to drugs and alcohol are not happy with their lives and live a life of despair and hopelessness, the major symptom is poor self esteem. Poor self esteem is at the heart of an individual’s addiction and dependency and there is an inverse relationship between alcohol dependency and self esteem, that if a person’s self esteem improves the individual’s addictive behavior.
1.1. Need For The Study:
Low self esteem is one of the causative factor that vast majority of alcohol addicts share in common, low self esteem is challenging in four areas. First they feel that they lack personal power, secondly many with low self esteem feel lacking the affection and attention of others, thirdly low self esteem results when people feel that they lack virtue, often feel unloved, unappreciated and lastly those possessing low self esteem hold themselves as incompetent in one or more areas.
Several researchers have argued that self esteem poses high risk for alcohol abuse in some populations, including adolescents, college students, and females (Donnelly, 2000).
Another area of life that Alcoholics with low Self-Esteem often struggle with their occupation. Perhaps they may lack education, information, skill sets, or the belief in their ability to obtain a worthwhile job and so they self-sabotage and then get to the right about the fact that no one wants to hire them. Seeking continuous education is hopeless to those who have such low self-esteem since they see themselves as incapable of excelling in the process of studying, taking exams, and achieving success in all the systems.
Low self- esteem can also manifest as a result of one’s inability to generate wealth, they see themselves struggling to survive in a world marked by competition, often struggle with their occupation. Those with low self esteem often resort to addictive behaviors in an effort to numb out the pain and escape to a world that allows them a temporary release from their sufferings and problems
1.2. Statement of the Problem:
Promotion of self esteem activities among alcoholic dependants
1.3. Objectives:
1.3.1 Assessment the self esteem level among alcoholics
1.3.2 Association of self esteem and Alcoholism
1.3.2 Assessment of the effectiveness of self esteem activities in promotion of self esteem among alcoholics.
1.4. Assumptions:
1.4.1. Self esteem level may be low among alcoholic dependants.
1.4.2. Practice of self esteem activities may improve the self esteem level among alcoholic dependants
1.5. Operational Definitions:
1.5.1. PROMOTION- refers to the improvement in level of self esteem among Alcoholic dependants.
1.5.2. SELF ESTEEM- perceived self concept of an alcoholic individual
1.5.3. ALCOHOLICS- a person craves alcohol, is unable to limit his or her drinking.
1.6. Promotion of Self-Esteem Activities Among Alcoholics Dependants:
Conceptualization is the process of specifying what we mean when we use particular terms (Giemman)
The conceptual framework is derived from Pender’s health promotion Model. In this study Individual characteristics and experience by physical, social psychological and occupational problems may change the level of self-esteem of the Alcoholic patients. Self-Esteem activities are promoted based on the patient’s problems may bring change in the level of self-esteem. It includes perceived benefit of Self-Esteem activities like Individual and Group activities.
PENDER’S HEALTH PROMOTION MODEL
CHAPTER 2
REVIEW OF LITERATURE
1. Studies related to low self esteem and alcoholism
2. Studies related to self esteem activities and alcoholism
1. Studies related to low self esteem and alcoholism:
A study conducted on self esteem and Alcohol use on 61 Alcoholic dependants who were admitted in a rural Midwestern medical centre. An individual’s reactions to his or her social environment are mediated by a sense of self esteem, low levels of self esteem are develop during Socialization. Results suggest that specific form of social support is important to recovering alcoholic dependants (Steffennhagen and Burns, 2006).
A Pearson correlation was calculated examining the relationship between the amounts of alcohol consumed in the past 30 days and self esteem. A low to moderate correlation was found (r (23) =.250, p>.05). (Jeremy W.Lawing, 2006).
A Study conducted on drinking problems and self-Esteem of college students,148 lower division college students were given the following paper and pencil tests: The Michigan Alcoholism Screening Test, and the “Personal Self” section of The Rosenberg Self-Esteem Scale. College Students are having low self Esteem (F = 4.23, p = .04). Tabulation of the incidence of heavy drinking (31%).Result shows an drinking behavior of college students are having low self esteem(()swego,2005).
A study was conducted on the effects of self esteem on substance abuse among homeless men. This experimental study involving 305 samples of homeless men was assigned randomly to the treatment group and Control group. Control group was referred to community based services, experimental subjects were exposed to individual therapy, group interventions, life skills and relapse prevention training residing in a 24 Hour shelter for three months. Results indicated that self-esteem was increased in experimental group than in control group (Brandon, 2004).
A descriptive study was conducted on self-esteem and alcohol dependants. Study comprises of two groups such as alcoholic dependants as one group and non-alcoholics in another group. Study shown that alcoholic dependants have lowered self esteem compared to non alcoholics self esteem (Donnelly, 2003)
A study was conducted to compare the level of self esteem among 30 alcoholics and 30 non alcoholic persons. They are assessed for self esteem using self esteem scale. The results showed that alcoholics had low self esteem when compared to non alcoholics(P<001).Alcoholic dependants were perceived as less loving and less dominant as compared to non alcoholics, they also perceived alcoholics to be aggressive and sadistic(Neeliyara,2003).
A study conducted to identify the relationship between alcohol consumption and self esteem. Study comprises of 26 Samples (Employees of local retail store), their self esteem was assessed by using Rosenberg’s self esteem scale. Results showed that alcohol consumption is strongly related to self esteem (T.F.Heatherson,2000).
A Study conducted on how self esteem influences alcohol consumption Study comprises of 61 samples. Over the course of two weekends self esteem was measured using Rosenberg’s self esteem scale. Study showed the results that self esteem is negatively correlated with alcohol consumption. In a study on adolescents drinking behavior, adolescents with high self esteem reported consuming less alcohol than adolescents with low self esteem. (Gerrerd, Russell, 2000
A cross-sectional survey design investigated the relationship of substance use and self esteem. Self -esteem was assessed using Hare Self-esteem Scale. Four hundred and eleven samples were completed the survey. Results revealed that there is a direct relationship between alcohol use and self-esteem (F=12.8,df=2,343,p,.00001).Regardless recent alcohol abusers had the lowest self-esteem scores and never users had the highest scores(F.X.Gibbons,2000).
A study says that low self-esteem is the universal common denominator among all people suffering from addictions. Low self-esteem is the true disease and it is the underlying origin of all problematic behaviors that plagues the world (Candito, 1996).
A prospective study of self-esteem and Alcohol Use Disorders in Early Adulthood. The relation among Self-esteem and Alcohol use disorder diagnoses was examined in a sample of 240 men evaluated at four annual assessments over the college years. The results support clinical observations that low self esteem plays a particularly important it eological role in alcohol problems in men (Fromme.K, 1989).
A number of studies have indicated that adolescents who refrain from drinking alcohol have higher self-esteem than do adolescents who drink. The questionnaire used in this study included the Adolescent Alcohol Involvement Scale which has fourteen questions about alcohol use, the Rosenberg (1965) Self-esteem Scale, (Mendel son, Mock, & Erbaugh, 1984).
2. Studies related to self esteem activities and alcoholism
A Study conducted on how group activity has an impact on self esteem among alcoholics. Study comprises 40 samples, 20 patients undergone group activities for 12 weeks in an inpatient setting and 20 patients as control groups. Patients in the intervention group showed significant enhancement in self esteem, social skills and self confidence where as there is no changes observed in control group (John Wiley, 2009)
A Study was conducted how utilization of self esteem programs (Holistic Addiction Treatment Programme) plays an important role in Relapse prevention. Study comprises of 145 samples. Results show that 70 to 90 percentages, self esteem programs are effective in Relapse prevention and over all well-being to the treatment of recovering alcoholics (Harry Henshaw, 2007).
A Study conducted on self esteem activities among Alcoholic patients. Study comprises of 43 samples, volunteers in the group undergone self esteem activities along with drug treatment, the other group only underwent drug treatment. Pretest-posttest comparison on a variety of physiological parameters indicated that significant improvements had occurred in psychological wellbeing including self esteem, self awareness, lifestyle adaptation and relapse prevention skills. Results suggest that promotion of self esteem activities improves self esteem among alcoholic dependants (Michael Peterson, Bryan johnstone, 2003)
A study conducted on self-esteem and alcoholism among high school students total sample was 140(55males and 85 females) high school students. The questionnaire used in this study included the Adolescent Alcohol Involvement Scale (Moberg, 1983) which has fourteen questions about alcohol use, the Rosenberg (1965) Self-esteem Scale, and the Beck Depression Inventory (Beck, Ward, Mendel son, Mock, & Erbaugh, 1961). Study has showed that indicated that adolescents who refrain from drinking alcohol have higher self-esteem than do adolescents who drink (Butler, 1980; Young, Werch, & Brakeman 1989)
CHAPTER 3
MATERIALS AND METHODS
Designing a research involves the development of plan or strategy that will guide the collection and analysis of data. The present study is designed to promote the Self-esteem among Alcoholic Patients. The methodology of the study constitutes research design, setting, population and sampling criteria for the selection of samples and tool for data collection.
3.1. One Group Pre Test Post Test Design:
3.2. Setting: This study was conducted in Kasthuriba Gandhi De-Addiction Centre, Coimbatore. The De-Addiction centre consists of 25 bedded
3.3. Population: The overall population for the study was alcoholic patients who were admitted in the Kasthuriba Gandhi DE-Addiction Centre from 28.06.2010 to 25.07.2010.
3.4 Sample size And Sampling Technique: Purposive sampling Technique was used to select samples who were admitted in the Kasthuriba Gandhi De-Addiction Centre during the period of study.30 patients were selected as samples during the study.
3.5. Criteria for Selection of the Sample:
Inclusion Criteria:
Patients who were admitted in Kasthuriba Gandhi De-Addiction Centre
Alcoholic patients with Low self esteem
Exclusion Criteria:
Patients who are not willing to participate in the study.
Alcoholic dependants associated with Psychotic symptoms.
3.5. Instruments and Tool for Data Collection: The tool was prepared based on review of literature and guidance of experts from the field of Psychiatry.
Section I: This section includes demographic variables like age, education, family Income, occupation, marital status, marital disharmony, Type of Family Duration of Alcohol intake Consumption of alcohol, physical and psychological problems.
Section II: This section consists of modified Rutgers’s Alcohol Problem Index scale. It is a useful tool to assess the problem index among alcoholic patients. It consists of 15 questions.
Section III: This section has an index to measure person’s self-esteem. It consists of 20 statements to assess the level of self-esteem of alcoholic dependants.
Score Interpretation: Self -Esteem Assessment Scale consists of 20 statements of assessment of patient’s level of self esteem.
The total score is 60, patient who scores the item ‘3’ and more than 46 is having low self-esteem.
Section IV: This section consists of intervention for Low self -Esteem such as Individual activities and Group activities.
Individual Activities: Promoting individually performing activities. The patients are encouraged to do individual activities such as Art writing and Reading Newspapers.
Group Activities: Group activities is two or more individuals unite together to promote an same activity. Patients are encouraged to do psychodrama (Group was given a theme, group members act out based on the theme) and Outdoor games (Tenniequots)
3.6. Variables of the study:
Independent variable: Self-esteem activities.
Dependant variable: Alcoholic dependants.
3.7. Techniques for Data Analysis and Interpretation:
The tables were formulated for base line information such as age, education, occupation, type of family, marital disharmony, income per month, amount of alcohol intake, duration of alcohol intake, physical and psychological symptoms.
Paired’ test was used to analyze the significant difference in the level of self-esteem before and after promoting self esteem activities.
3.7.1. Paired’t’test: The test was used to point out the effect of promotion of self esteem activities among alcoholic patients.
t=d
SD/ n
SD= (d-d)
Here d=Mean difference between pretest and posttest score.
SD=Standard Deviation of the Pre test and post test Sore
n=Number of Samples.
Pilot study report
Pilot study was conducted for a period of 2 weeks, from 28th May 2010 to 11th May 2010, to test the practicability of the tool and feasibility of conducting the main study. Study was conducted in Psychiatric ward of P S G Hospital. For pilot study 5 samples were selected. Data were collected by interview method.
Through the pilot study it was proved that self esteem activities in promotion of self esteem. The researcher would like to continue the study to promote self esteem among alcoholic dependants.
Changes brought after pilot study
During the pilot study, self esteem level was assessed and found to be low among alcoholic dependants.
CHAPTER 4
DATA ANALYSIS AND INTERPRETATION
The process of evaluating data using analytical and logical reasoning to examine each component of the data provided. This form of analysis is just one of the many steps that must be completed when conducting a research experiment. Data from various sources gathered, reviewed, and then analyzed to form some sort of finding or conclusion. There are a variety of specific data analysis method, some of which include data mining, text analytics, business intelligence, and data visualizations.
4.1. General Profile of alcoholic Dependants
1. Age
Among thirty alcoholic dependants, six patients were at the age of 21-30 years, fifteen patients were at the age of 31-40years, seven patients were at the age between 41-50 years and two patients were between 51-60years.
2. Education
Most of the alcoholic dependants were completed their secondary education, seven patients had completed primary education, six patients completed higher secondary education and seven had graduate degree.
3. Occupation:
A. Type of Work
It was found that ten were doing business, five were farmers, four were engineers, two were bus drivers and there was one from each category like tailor, rashion shop, goldsmith, shopkeeper, hotel supervisor, massion, mandapam decorator, Carpentor, cable TV Manager.
B. Hours of Work
Hours of work for alcoholic dependants were varying from6-15 hrs. Most of them nineteen were working between 11-15 hrs and eleven patients were working 6-10 hours per day.
C. Income per Month
Income of alcoholic dependants varied depends upon their occupation, fifteen were earning between Rs.6000-10000 per month, eight patients were earning between Rs.11000-15000 per month, four were earning between Rs.1000-5000 per month, three patients were earning between Rs 16000-20000 per month.
D. Conflict in Work Area
Majority of alcoholic dependants, twenty expressed no conflict in work area and ten had conflict in their work area.
4. Family history
A. Marital status
Twenty four patients were married, six patients were unmarried.
B. Marital disharmony:
Thirty alcoholic dependants came out with the problem of and only eleven patients had no such problems.
C. Relationship with spouse:
Among the alcoholic dependants, twelve patients were maintaining good relationship with their spouse and twelve patients were not maintaining good relationship with spouse.
D. Relationship with children:
Twenty two were maintaining good relationship with their children and two patients were not maintaining good relationship with children.
E. Type of Family:
Among twenty four alcoholic dependants, six patients were from joint family and eighteen from nuclear family.
F. Family History of Alcoholism:
There is no family history of alcohol intake among twenty five alcoholic dependants and only five patients were having the family history of alcoholism.
5. Social History:
A. Social Support:
Among thirty alcoholic dependants, one had Peer group support, three had support from friends, and twenty six had family support.
6. Alcoholic History:
A. Duration of Alcohol Intake In years:
Duration of 11-15-years of alcohol intake was found among fifteen alcoholic dependants, 6-10years among ten alcoholic dependants, 1-5years among three alcoholic dependants and 16-20 years among two alcoholic dependants.
B. Consumption of Alcohol started by:
Most of the patients twenty five were started consuming alcohol through friends, three started by their relatives and two started by their family members.
C. Quantity of Alcohol when started (Bear in ml):
Majority of the alcoholic dependants, twenty three started with 100-300ml of bear while seven alcoholic dependants were stated with 700-900ml of bear.
D. Quantity of Alcohol at present (Hot):
At present eleven alcoholic dependants was consuming 700-900ml of hot which is more than nineteen alcoholic dependants consuming 400-600ml.
E. Time of drinking Alcohol:
Among thirty alcoholic dependants, twelve patients were taking alcohol in the evening, four were taking alcohol in the morning and evening, fourteen were taking alcohol throughout the day.
F. Money spent on Alcohol Consumption:
Among thirty alcoholic dependants, most of them twenty two spent Rs 4000-6000per month for alcohol consumption seven spent Rs7000-9000 per month and one spent Rs 1000-3000 per month.
G. Motivation for treatment of Alcoholism:
Maximum number of patients thirteen were motivated by self, seven were motivated by already treated patients in de-addiction centre, five were motivated by family members and five were motivated by Relatives.
H. Reason for Alcoholism:
Seventeen patients were started on alcoholism due to psychological factors such as wife’s death, job stress etc, thirteen patients were started due to peer group pressure and none had the reason of physical and psychiatric illness.
TABLE 4 1
DEMOGRAPHIC DATA OF ALCOHOLIC PATIENTS
1
AGE IN YEARS
21-30
6
31-40
15
41-50
7
51-65
2
2
EDUCATION
Primary
7
Secondary
10
Higher secondary
6
Graduate
7
3
OCCUPATION
A.TYPE OF WORK
Business
10
Farmer
5
Tailor
1
Accountant in Rashionshop
1
Goldsmith
1
Hotel Supervisor
1
Driver
2
Construction Worker
1
Engineers
4
Mandapam Decorator
1
Carpenter
1
Cable T.V. Manager
1
B.HOURS OF WORK
6 – 10
11
11 – 15
19
C.INCOME PER MONTH
1000-5000
4
6000-10,000
15
11,000-15,000
8
16,000-20,000
3
D.CONFLICT IN WORK AREA
Present
10
Absent
20
4
FAMILY HISTORY
A.MARITAL HISTORY
Married
24
Single
6
B.MARITAL DISHARMONY
Present
13
Absent
11
C.RELATIONSHIP WITH SPOUSE
Maintains good relationship
12
Not maintains good relationship
12
D.RELATIONSHIP WITH CHILDREN
Maintains good relationship
22
Not maintains good relationship
2
E.TYPE OF FAMILY
Joint family
6
Nuclear family
18
F.FAMILY HISTORY OF ALCOHOLISM
Present
5
Absent
25
SOCIAL HISTORY
A.SOCIAL SUPPORT
Neighbors
0
Peer group
1
Friends
3
Family
26
5
ALCOHOLIC HISTORY
A.DURATION OF ALCOHOL INTAKE IN YEARS
1 – 5
3
6 – 10
10
11 – 15
15
16-20
2
B.CONSUMPTION OF ALCOHOL STARTED BY
Friends
25
Family members
2
Relatives
3
Self
0
C.QUANTITY OF ALCOHOL WHEN STARTED (BEAR) ML
100-300
23
400-600
7
700-900
0
D.QUQNTITY OF ALCOHOL CONSUMPTION AT PRESENT(HOT)ML
100-300
0
400-600
19
700-900
11
E.TIME OF DRINKING ALCOHOL
Morning
0
Evening
12
Both
4
Throughout the Day
14
F.MONEY SPENT ON ALCOHOLISM
1000-3000
1
4000-6000
22
7000-9000
7
G.MOTIVATION FOR TREATMENT OF ALCOHOLISM
Family members
5
Relatives
5
Self
13
Treated patients
0
H.REASON FOR ALCOHOLISM
Physical Illness
0
Psychiatric Illness
0
Psychological Illness
17
Peer group Influence
13
4.2. Assessment of Problem Index among Alcoholic Dependants:
Among thirty alcoholic dependants, Majority of alcoholic dependants are not able to work, inability to carryout responsibilities, had fight with relatives, neglected by relatives, advised by relatives and friends, to stop alcohol, noticed a change in personality, most of them felt guilty,neede more alcohol to get the same effect previous one, and felt physically and psychologically dependant on Alcoholism.
TABLE 2
ASSESSMENT OF PROBLEM INDEX
n=30
S.No
PROBLEM STATEMENTS
1
2
3
4
1
Not Able To Work
10
15
5
0
2
Neglected Responsibilities
10
15
5
0
3
Had Fight With Others
20
5
5
0
4
Neglected By Relatives
10
14
6
0
5
Advised By friends, neighbours, relatives to stop alcohol
0
20
10
0
6
Kept Promised To Stop Drinking
10
12
8
0
7
Noticed A Change In Personality
12
16
2
0
8
Felt Guilty
0
23
7
0
9
Forgetting Places
16
14
0
0
10
Fainted Suddenly
26
4
0
0
11
Gone Suddenly
26
3
1
0
12
Needed More Alcohol To Get The same Effect As Of previous One
0
20
6
4
13
Tried To Control Drinking
16
8
6
0
14
Stopped Drinking Because Of Withdrawal Symptoms
20
10
0
0
15
Felt physical or Psychologically dependant On Alcohol
0
16
10
4
Score Interpretation: 1.None of the Time, 2.1-2 Time, 3.3-4 Times, 4.More than five times
4.3. Assessment of Level of Self-Esteem among alcoholic Dependants:
Fifty one patients were got admitted in kasthuriba Gandhi de-Addiction Centre, Coimbatore in the month of July. Among them thirty alcoholic dependants were selected for the study based on the exclusion criteria. Level of self-esteem was assessed for each patient by using self-esteem assessment tool. All thirty alcoholic dependants were having low self-esteem that they become anger when criticized, afraid to try new things, showing difficulty in performing social activities and social interaction. All the alcoholic Dependants were scored the level of self-esteem score between50-60.
4.4. Promotion of Self-Esteem Activities:
Self-Esteem activities are promoted by scheduling as individual and group activities. Individual activities are promoted in the morning and group activities are promoted in the evening to boost up self-esteem among Alcoholic dependants.
TABLE 3
Self-Esteem Activities Protocol
S. No
Time
Activities
1
Morning
Individual Activities
8.30-9.30am
A. Self Reporting
11.00-12.00Noon
B. Art Writing
2
Afternoon
Group Activities
1.30-3.00Pm
A. Psychodrama
3.30-5.00Pm
B. Tenniquoite
TABLE 4
ASSESSMENT OF SELF-ESTEEM BEFORE PROMOTING SELF-ESTEEM ACTIVITIES
n=30
S. No
Level of Self-Esteem
No. of. Patients Pre test
1.
Self- Esteem Score (>46)
30
SCORE INTERPRETATION: Problems with low self-esteem are indicated by a total score higher than 46
TABLE 5
ASSESSMENT OF SELF-ESTEEM AFTER PROMOTING SELF-ESTEEM ACTIVITIES
n=30
S. No
Level of self-Esteem
No. of. Patients
Pretest
Post test
1.
Self-Esteem Score(<46)
30
0
TABLE 6
COMPARISON OF SELF-ESTEEM BEFORE AND AFTER PROMOTING SELF-ESTEEM ACTIVITIES
n=30
S. No
Level of Self-Esteem
Pre test
Post test
1
Self-Esteem Score(>46)
30
30
2.
Self-Esteem Score(<46)
0
30
INTERPRETATION: Thirty alcoholic Dependants were scored > 46 before promoting Self-Esteem activities. But after promoting Self-Esteem Activities they have scored <46
TABLE 7
Difference in pretest and Posttest Self-Esteem Score of Alcoholic Dependants
S. No
Pretest Score
Posttest Score
Difference
1
56
33
23
2
54
36
22
3
56
32
24
4
56
32
24
5
55
30
25
6
54
33
21
7
52
34
22
8
52
33
21
9
55
33
22
10
55
32
23
11
54
31
23
12
54
30
24
13
56
33
23
14
54
31
23
15
55
32
23
16
56
33
23
17
56
33
23
18
54
33
21
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The health promotion model was developed in 1982 by Dr. Nola J. Pender. Pender believed that the goal of nursing care was to help patients achieve optimal health and well-being. The model was created following Pender’s work examining health promoting and preventative behaviours.
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