|Year : 2018 | Volume
| Issue : 2 | Page : 13-18
Addiction severity, social functioning, and life satisfaction of patients diagnosed with substance use disorders
Baruah Aditi1, Baruah Arunjyoti2
1 Staff Nurse, LGBRIMH, Tezpur, Assam, India
2 Professor & HOD Department of Psychiatric Nursing, LGBRIMH, Tezpur, Assam, India
|Date of Web Publication||9-Jul-2019|
Source of Support: None, Conflict of Interest: None
Aim: Present study was conducted to examine the levels of addiction severity, social functioning and life satisfaction of the patients diagnosed with Substance Use Disorders (SUDs) and to see the relationship among them. Methodology: This descriptive study was conducted at the OPD of a tertiary care psychiatric hospital, of Assam, between months of October to November, 2017. Fifty patients with SUDs who comply with the inclusion criteria were selected by purposive sampling technique and interviewed by using a Socio-demographic questionnaire, Leeds dependence questionnaire, Self-structured tool for assessment of social functioning of patients with SUDs and satisfaction with life scale. Results: There were 42% of participants who were severely dependent, their social functioning also deviated from a normal satisfactory level and 24% of them were slightly satisfied and also 24% were dissatisfied with life. A significant negative correlation between addiction severity and life satisfaction of patients with SUDs (p=0.001) and a significant positive correlation between social functioning and life satisfaction of patients with SUDs (p=0.011). Conclusion: Interventional study could be done to implement some activities, social functioning and life satisfaction of patients diagnosed with SUDs.
Keywords: Addiction severity, social functioning, life satisfaction, SUDs.
|How to cite this article:|
Aditi B, Arunjyoti B. Addiction severity, social functioning, and life satisfaction of patients diagnosed with substance use disorders. Indian J Psy Nsg 2018;15:13-8
|How to cite this URL:|
Aditi B, Arunjyoti B. Addiction severity, social functioning, and life satisfaction of patients diagnosed with substance use disorders. Indian J Psy Nsg [serial online] 2018 [cited 2020 Jun 1];15:13-8. Available from: http://www.ijpn.in/text.asp?2018/15/2/13/262434
| Introduction|| |
Substance abuse is one of the most important and concerning public health issues faced by all societies, which causes variety of problems. Substance use leads to development of physical and mental health problem, as well as it causes impairment in multiple areas of functioning. According to American Psychiatric Association (1994), substance use disorders (SUDs) are characterized as “maladaptive patterns of substance use leading to clinically severe impairment or distress” potentially affecting physical or psychological functioning, personal safety, social relations, roles, and obligations, work, and other areas.
Substance use disorders occurs when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Global Burden of Disease 2000 analysis suggests that the point prevalence of heroin and cocaine use disorders is 0.25%. It has been estimated that there are about 5 million people in the world who inject illicit drugsl. The period prevalence of drug abuse and dependence ranges from 0.4% to 4%, but the type of drugs used varies greatly from region to region. A study (Bardhan, Saikia, and Baruah2) found that prevalence of ever substance users as 37.68% and current users as 35.02% among the adolescents living in slums of Guwahati, Assam, India during February to May 2014. Prevalence of substance abuse and dependence were 8.33% and 5.13% respectively. The proportion of the substance users was found to increase significantly with age in both the sexes.
Dependence is a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value. Various studies have suggested that substance use disorder patients use to have mild to moderate level of social functioning,. There is strong evidence that social functioning is significantly impacted by methamphetamine use and that the social isolation, depression, and aggressiveness associated with chronic use is due to more than just the social withdrawal associated with addiction.
The problem of substance abuse emerges as an important social issue that negatively affects social functioning6, disrupts social harmony and causes negative social interactions4. Antisocial behaviors (having been involved in drug trafficking, having been arrested, and having had problems with justice) was significantly higher among users of marijuana, cocaine, or crack than among adolescents who were not drug users 10-11. Research is needed to prevent the increase of substance abuse and the problems it causes. Acquiring broader information on the prevalence of substance use, making retrospective assessments, making related public policies and conducting preventive studies are extremely important. According to 2016-2017 statistics, it was found that about 1036 patients with substance use disorder were attended OPD of the tertiary care psychiatric hospital and out of which 331 patients were admitted in indoor ward for further management. Most of the patients with substance use disorder admitted in drug de addiction centre had impairment in interpersonal and social relationship, and with poor work place performances. From day today practice also it has been observed that the family members of the patient diagnosed with substance use disorder often complain about decreased interest of the patient’s in self-care activities, and decreased work performance, and their irresponsibility towards family and society. Psychiatric nursing and alcohol and substance abuse nursing have a determinant role in alcohol and substance abuse (Gupta et al, 2012). Psychiatric nursing and alcohol and substance abuse nursing can help in every stage of substance abuse. Looking towards the current statistics of substance use disorder patients in the tertiary care psychiatric hospital, one can predict that this is an area which needs the special attention of the psychiatric nursing. Therefore, the study designed with the objective to assess the socio demographic profile of patients diagnosed with SUDs, and to assess the addiction severity, social functioning, life satisfaction of patients diagnosed with SUDs, and to find out relationship among addiction severity, social functioning, and life satisfaction, and also to find out the association between selected socio demographic variables with addiction severity, social functioning and life satisfaction.
| Material and Methods|| |
Study was conducted at out-patient department of a tertiary care psychiatric hospital, in Assam. Sample were drawn from the population consist of patients who is diagnosed with SUDs according to ICD-10 criteria attending OPD of the tertiary care psychiatric hospital. Fifty (50) patients diagnosed with SUDs as per ICD-10 criteria attending the OPD of the tertiary care psychiatric hospital, and fulfilling the inclusion criteria of the study were included in the study. By using purposive sampling technique, over a period of about two months study was conducted to collect required sample size. The inclusion criteria were, patients between the age of 18 and 60 years, diagnosed with SUDs according to ICD -10 criteria by the psychiatrist who knows how to read and write, and understand Assamese language (local language) and attending the OPD of the tertiary care psychiatric hospital for the second time. Patients with diagnosed co-morbid psychiatric illness, organic brain syndrome or mental retardation and patients with major physical illness and those who were not able to respond were excluded from the study. A socio-Demographic Questionnaire, Leeds dependence questionnaire (Raistrick,D.,et al 1994) to assess the addiction severity, Self-structured tool for assessment of social functioning and Satisfaction with life scale (Diener et al 1985) to assess life satisfaction, were used for data collection. All the tools were translated into local language, Assamese. Reliability of self-structured tool was 0.91(English version) and reliability of the Assamese version of the structured tool was found to be 0.67. Letter was sent to concerned authorities seeking permission to use the standardized tool. All the instruments were found reliable and valid for study.
The study was approved by the institute ethical committee of the tertiary care psychiatric hospital. Written informed consent was also collected from the participants before proceeding to data collection after explaining the purpose and objectives of the study. Confidentiality was ensured to the participants. The study utilized non-invasive procedure and it was ensured that there would be no physical or psychological harm to the participants. Appropriate descriptive and inferential statistics were used for the analysis of the data.
| Results|| |
Description Of Study Patients
As given in [Table 1] that all the patients were male and 46% (f=23) belonged to the age group of 32-43years, majority i.e., 92% (f=46) were Hindu, majority 70% (f=35) had education till secondary level, among the participants 30% (f=15) were doing government services, and 50%(f=25) of them had total monthly family income of Rs.1000-10000/. It was also found that majority i.e.,72% (f=36) of them were married, among the participants majority of them i.e., 98% (f=49) did not have family support and majority i.e., 84% (f=42) of them were living with their families. 50% (f=25) of the patients had used single substance and 50% (f=25) of them had used multiple substances. Majority 82% (f=41) of them did not have any associated physical illness and majority 70% (f=35) of them had duration of substance use more than 10 years.
|Table 1: Frequency and percentage distribution of patients diagnosed with SUDs as per socio-demographic Veriables n=50|
Click here to view
As given in [Table 2] that the average age of patients diagnosed with SUDs attending OPD of the tertiary care psychiatric hospital, were 36.68±8.85 and average total monthly family income of the patients diagnosed with SUDs were Rs. 18380/ ± 15071/. The mean age of the first substance use was 21± 4.84 years among study patients.
As given in [Table 3] that the average score of addiction severity of patients diagnosed with SUDs was found to be 16.64, ± 6.61, average score of social functioning of patients diagnosed with SUDs was 83.38, ± 8.96 and average score of life satisfaction of patients diagnosed with SUDs were 18.80, ± 6.440 respectively.
|Table 3: Levels of addiction severity, social functioning and life satisfaction of patients diagnosed with SUDs (n=50)|
Click here to view
Description of addiction severity of patients diagnosed with SUDs.
Among the participants 42% (f=21) were found to be severely dependent on substances.
As given in [Table 4] that 24% (f=12) of the study patients were slightly satisfied and 24% (f=12) were dissatisfied with their lives. Similarly, 20%(f=10) were slightly dissatisfied, 18% (f=9) were satisfied, 8%(f=4) were neutral, and 6%(f=3) were extremely dissatisfied with their lives.
|Table 4: Description of life satisfaction of patients diagnosed with SUDs (n=50)|
Click here to view
[Table 6] shows the statistically significant association with social functioning and total monthly income (p=0.004). A significant association was also found between life satisfaction and living status (p value= 0.049) and life satisfaction with nature of substance used (p value=0.048).
|Table 5: Correlation between addiction severity, social functioning and life satisfaction of patients diagnosed with substance use disorder (n=50)|
Click here to view
|Table 6: Association of selected socio-demographic variables with addiction severity, social functioning and life satisfaction of patients diagnosed with SUDs. n=50|
Click here to view
| Discussion|| |
In the present study, 42% of SUDs patients were severely dependent on substances, during their visit to the hospital and their mean score was 16.64± 6.61. It might be because of the inclusion criteria of the study, as per which patients diagnosed with substance use disorders, during their 2nd consecutive visit to the tertiary care psychiatric hospital were considered as the study sample. During each visit to the hospital patients are benefited with health education from the health personnel. And again it might be the effects of the some therapies received by the patients during their visit to the hospital. Which is consistent with the study finding of Malik et al14 study and, where they found out that the average duration of alcohol dependence was less than a decade before seeking treatment.
In this study, social functioning of patients diagnosed with substance use disorder was assessed by using a self-structured tool i.e., the self-structured tool for assessment of social functioning of patients diagnosed with substance use disorder, where the total score range is 36-108. In this study, it was found that mean score was 83.38±8.96.
In the present study, it has been found that the majority of patients diagnosed with substance use disorder have a level of social functioning which is deviated from the satisfactory level, which is also consistent with the study finding of Ersogutcu et al4. Where they had found that substance abuse patients had a medium level of social functioning. Reasonably also when a patient becomes dependent on substances, he gives more priority to the substances, neglecting his functions in other areas, especially impairment is seen in his work functioning and family functioning.
In the present study mean score of satisfaction with life was 18.80±6.440. And 24% of the patients with substance use disorder were slightly satisfied and also 24% of the patients with substance use disorder were dissatisfied with their lives.
A study conducted by Hagen et al22 also had found that the individuals with poly-substance use disorder who achieve at least one year of abstinence show greater improvements in satisfaction with life, executive functions, and psychological distress.
Correlation between addiction severity, social functioning and life satisfaction of patients diagnosed with substance use disorder
In the present study, a significant negative correlation was found between addiction severity and life satisfaction of patients diagnosed with substance use disorder (r=-0.454**, p=0.001). When the addiction severity of patients diagnosed with substance use disorder increases, then their life satisfaction decreases. Fergusson and Boden23, also found significant associations between increasing levels of cannabis use and lower levels of life satisfaction (P < 0.0001).
Significant positive correlation was found between social functioning and life satisfaction of patients diagnosed with SUD (p=0.011). Meaning thereby better performance in work, good interpersonal relationship, being responsible towards the society increase life satisfaction is dependent on social functioning of patients with SUDs.
Association of selected socio-demographic variables with addiction severity, social functioning and life satisfaction of patients diagnosed with SUDs
In the present study, a statistically significant association was found with social functioning and total monthly income (p=0.004). If a person’s monthly income is less, he will have much stress in managing the family, and remains busy in searching for sources of income rather than maintaining good relationship with others. And they are less concerned about the society. In the present study significant association was also found with life satisfaction and living status (p value= 0.049), the present study highlights that life satisfaction is related to living status. Life satisfaction of patients diagnosed with SUDs depend on their living status. Living alone or living with family, sharing and support from the members of the family affect life satisfaction.
Study findings also revealed significant association between life satisfaction and nature of substance use (p value=0.048) . It is consistent with the study finding of Rooks L10 Where they had found adolescents use of any of the three substance types (alcohol, cigarettes, and marijuana) accounted for a significant but small proportion (6%) of variance in global life satisfaction scores.
| Conclusion|| |
The consequences of substance use are countless. It has been implicated not only in health problems, but also number of social, economic, psychological, and emotional problems affecting day to day life of individuals, their families, and whole society. Various researchers had shown the relationship between addiction severity and social functioning and life satisfaction of patients diagnosed with substance use disorder. From the present study the findings only 42% of the patients diagnosed with substance use disorder attending OPD of a tertiary care psychiatric hospital, were severely dependent, they had a level of social functioning which is deviated from the satisfactory level, and 24% of them were slightly satisfied and also 24% of them were dissatisfied with their life. Important findings of the study are the negative correlation between addiction severity and life satisfaction and positive correlation between social functioning and life satisfaction of patients diagnosed with SUDs. Study also revealed that total monthly family income and social functioning, living status and life satisfaction, nature of substance use and life satisfaction were associated with each other.
Findings of the current study result will enable the nurse to plan activities to improve social functioning and life satisfaction of patients diagnosed with SUD in order to decrease their addiction. Social skill training, group therapies to teach the patient problem solving, education on moral value, spirituality, long term planning can be included as a routine program for the patients diagnosed with SUD, to improve social functioning and life satisfaction. The knowledge of the findings of present study will help the nurse educators in designing the teaching strategies. In the nursing curriculum, satisfaction with life related topic should be included and the nursing student should be well equipped with the knowledge of how to improve the life satisfaction and social functioning in practice and should be equipped with the skills to teach the ways to improve the life satisfaction and social functioning. The nurse administrator may take very important role in formulating strategies for improving social functioning and life satisfaction. The present study findings will also provide an idea to the nurse administrator regarding selecting the correct approach to adopt for the effective treatment and further improvement of SUD patients and also in developing protocol for caring of a patient diagnosed with SUD. The present study may help the nurse researcher by providing a base for the further interventional studies regarding social functioning and life satisfaction of patients diagnosed with SUD.
On the basis of the findings of present study recommends for a similar study which can be done with a larger sample in similar and different settings with different demographic variables. Comparative study for various groups can be conducted and longitudinal studies can be done to see the effectiveness of the interventions for social functioning and life satisfaction.
Acknowledgement: The authors would like to extend their thanks and appreciations to all participants who voluntarily participated in the study and shared their experience.
| References|| |
Bardhan T, Saikia AM, Baruah R. Substance Use Among Adolescents Living In Slums Of Guwahati City, Assam: A Growing Public Health Concern. International Journal Of Medicine And Public Health. [Internet] 2015 [Cited On 201 6Dec13];5(4):279-282.Available From .Http://Www.Ijmedph.Org/Article/397
World Health Organisation. The ICD-10 Classification Of Mental And Behavioral Disorders. 10th Ed. New Delhi: AITBS Indian Edition; 2007.
Hobkirk AL, Watt MH, Green KT, Beckham JC, Skinner D, Meade CS. Mediators Of Interpersonal Violence And Drug Addiction Severity Among Methamphetamine Users In Cape Town, South Africa. [Online]2015 [Cited On 2017Nov14]; 42:167-71. Doi: 10.1016/J.Addbeh.2014.11.030. Epub 2014 Nov 26. Available From Https://Www.Ncbi.Nlm.Nih.Gov/Pubmed/25479528
Barnwell SS, Earleywine M, Wilcox R. Cannabis, Motivation, And Life Satisfaction In An Internet Sample [Online]Jan 2006 [Cited On 2016Dec13]; DOI: 10.1186/1747-597X-1-2.Available From Http://Substanceabusepolicy.Biomedcentral.Com/
Rohde P, Lewinsohn PM, Seeley JR, Klein DN, Andrews JA, Small JW. Psychosocial Functioning Of Adults Who Experienced Substance Use Disorders As Adolescents. [Online] 2007 [Cited On 2017Nov1 ]; 21(2): 155-164.Doi: 10.1037/0893- 164X. 21. 2. 155. Available From Https://Www.Ncbi.Nlm.Nih.Gov/Pmc/Articles/PMC2536752/
Gupta S, Maheshwari SK, Sabith T,. Effectiveness Of Life Skills Traini ng On Self Esteem And Readiness To Change Drug Use Behavior Among School Drop Out Adolescent Drug Users. Indian Journal Of Psychiatric Nursing March 2012;Vol. 3:32-35.
Díaz-Mesa EM, García-Portilla P, Fernández-Artamendi S, Sáiz PA, Bobes Bascarán T, Casares MJ. Et Al. Gender Differences In Addiction Severity. [Online]2016 [Cited On 2017Nov5]; 28(4):221-230. DOI:10.20882/Adicciones.829. Available From Https://Www.Ncbi.Nlm.Nih.Gov/Pubmed/27391850
Kumar R, Maheshwari SK. Relapse Precipitants, Life Events & Coping Behaviors Among Substance Users. Indian Journal Of Psychiatric Nursing 12(1) July. 2016:1419.
Narvaez CMJ, Pechansky F, Jansen K, Pinheiro RT, Silva RA, Kapczinski F. Et Al. Quality Of Life, Social Functioning, Family Structure, And Treatment History Associated With Crack Cocaine Use In Youth From The General Population [Online] May 12, 2 0 1 5[C i t e d On 201 7Nov1 ]; Http://Dx.Doi.Org/10.1590/1516-4446-2014-1494 . Available From Http://Www.Scielo.Br/Scielo.Php?Script=Sci_Arttext& Pid=S1516-44462015000300005
Cantwell R. Substance Use And Schizophrenia: Effects On Symptoms, Social Functioning And Service Use. The British Journal Of Psychiatry [Online] Apr 2003 [Cited On 2017Nov5]; 182 (4) 324-329. DOI: 10.1192/Bjp.182.4.324. Available From Http://Bjp.Rcpsych.Org/Content/182/4/324.Full
Carey KB, Carey MP, Simons JS. Correlates Of Substance Use Disorder Among Psychiatric Outpatients: Focus On Cognition, Social Role Functioning And Psychiatric Status. [ Online ] 2003 [ Cited On 2017Nov10]; 191(5): 300-308. Doi: 10.1097/01 .NMD.0000066152.87832.A9 Available From; Https://Www.Ncbi.Nlm.Nih.Gov/Pmc/Articles/PMC2430931/
Hagen E, Erga AH, Hagen KP, Nesvåg SM, Mckay JR,
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]