Self Esteem and Substance Abuse

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 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.

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

Statement of the Problem:

Promotion of self esteem activities among alcoholic dependants

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.

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

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.

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

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).

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)

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.

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.

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)

COMPARISON OF PRETEST AND POSTTEST LEVEL OF SELF-ESTEEM AMONG ALCOHOLIC DEPENDANTS

In order to find out the significant difference between pretest and posttest scores of level of self-esteem, paired‘t’ test was compared to test the significance, the hypothesis was stated. Hypothesis: There is a significant difference in level of self-esteem before and after promoting self-esteem activities. t = d/SD/n SD = (d-d)/n-1 (d-d) = 65.25 SD= (65.25)/30-1 SD= 65, 25/29 SD= 2.25 SD=1.5 t=d/SD/n =21.5/1.5/30 =21.5/1.5/5.4 =21.5/0.27 t=79.62 df=n-1 =30-1 =29 As the calculated value is 79.62, which is greater than table value (3.66)at the degree of freedom of 29.It is significant at the level of 0.001,and hypothesis is accepted. Hence there is significant improvement between mean pretest and posttest score of self-esteem.

Influence of demographic variables on Alcoholic dependants with low self-esteem:

4.6.1Influence of age on pretest score of alcoholic dependants with low sel-esteem: Karl Pearson co-efficient of correlation between age and pretest self-esteem score of alcoholic dependants. Hypothesis: Age positively influence low self-esteem among alcoholic dependants. There is a relationship between age and level of self-esteem. r= XY/(x-x)(y-y) =3068/1715(49) =3068/84035 =0.0365 =0.191 The calculated value is 0.191 that there is a positive correlation between age and level of self-esteem. Hypothesis is accepted hypothesis. 4.6.2Influence of hours of work on pretest score of alcoholic dependants with low self-esteem: Karl Pearson co-efficient of correlation between hours of work and pretest self-esteem score of alcoholic dependants. Hypothesis: Hours of work positively influence low self-esteem among alcoholic dependants. There is a relationship between hours of work and level of self-esteem r= XY/(x-x) (y-y) =157.92/81.76 (49) =157.92/4006.28 =0.03941 =0.198 The calculated value is 0.198 that there is a positive correlation between hours of work and level of self-esteem..Hypothesis is accepted hypothesis. 4.6.3 Influence of duration of alcohol intake on pretest score of alcoholic dependants with low sel-esteem: Karl Pearson co-efficient of correlation between age and pretest self-esteem score of alcoholic dependants. Hypothesis: Duration of alcohol intake positively influence low self-esteem among alcoholic dependants. There is a relationship between duration of alcohol intake and level of self-esteem. r= XY/(x-x)(y-y) =572/405(49) =572/19845 =0.028 =0.169

The calculated value is 0.169 that there is a positive correlation between duration of alcohol intake and level of self-esteem. Hypothesis is accepted hypothesis. 4.6.4 Influence of quantity of alcohol intake on pretest score of alcoholic dependants with low self-esteem: Karl Pearson co-efficient of correlation between quantity of alcohol intake and pretest self-esteem score of alcoholic dependants. Hypothesis: quantity of alcohol intake positively influence low self-esteem among alcoholic dependants. There is a relationship between quantity of alcohol intake and level of self-esteem. r= XY/(x-x)(y-y) =565908/547890(49) =565908/268466 =2.1 =1.4 The calculated value is 0.14 that there is a positive correlation between quantity of alcohol intake and level of self-esteem. .hypothesis is accepted hypothesis. 4.6.5Influence of age on pretest score of alcoholic dependants with low sel-esteem: karl Pearson co-efficient of correlation between age and pretest self-esteem score of alcoholic dependants. Hypothesis: Age of Alcoholic dependants positively influence low self-esteem among alcoholic dependants.

There is a relationship between r= XY/(x-x)(y-y) = 4289/1891.2(70.8) = 4289/132370 = 0.032 = 0.18 The calculated value is 0.18 that there is a positive correlation between age and level of self-esteem. .hypothesis is accepted hypothesis. 4.6.6Influence of hours of work on posttest score of alcoholic dependants with low sel-esteem: karl Pearson co-efficient of correlation between age and pretest self-esteem score of alcoholic dependants. Hypothesis: hours of work positively influence low self-esteem among alcoholic dependants. There is a relationship between hors of work and level of self-esteem. r= XY/(x-x)(y-y) =320/1715(70.8) =320/121422 =0.0026 =0.05 The calculated value is 0.05 that there is a positive correlation between hours of work and level of self-esteem. .hypothesis is accepted hypothesis. 4.6.7 Influence duration of alcohol intake on posttest score of alcoholic dependants with low sel-esteem: karl Pearson co-efficient of correlation between age and pretest self-esteem score of alcoholic dependants. Hypothesis: Duration of alcohol intake positively influence low self-esteem among alcoholic dependants. There is a relationship between hors of work and level of self-esteem. r= XY/(x-x)(y-y) =1175.5/405(70.8) =1175.5/28674 =0.04 =0.20 The calculated value is 0.20 that there is a positive correlation between duration of alcohol intake and level of self-esteem. .hypothesis is accepted hypothesis. 4.6.9 Influence of quantity of alcohol intake on posttest score of alcoholic dependants with low sel-esteem:karl Pearson co-efficient of correlation between age and pretest self-esteem score of alcoholic dependants. Hypothesis: hours of work positively influence low self-esteem among alcoholic dependants. There is a relationship between hors of work and level of self-esteem. The calculated value is 0.157 that there is a positive correlation between quantity of alcohol intake and level of self-esteem. .hypothesis is accepted hypothesis.

RESULTS AND DISCUSSION

The main aim of the study was to assess the level of self-esteem among alcoholic dependants and to promote self esteem activities. The study was conducted in Kasthuriba Gandhi De-Addiction centre at Coimbatore. A total of thirty patients were selected for the study .each patients baseline information was collected to understand the background of the patient and also some of the factors such as age, occupation, income which are expected to have an impact on alcoholism.

General Profile of the Alcoholic Dependants:

The young age of alcoholic dependant who started intake of alcohol at the age of 21years was six and in the age of 65years are two. Many research studies says that, alcohol abuse and alcohol Dependence are not only adult problems they also affect a significant number of adolescents and young adults between the ages of 12-20,eventhough drinking under the age of 21 is illegal(Joseph.A,2008). Study shows seven alcoholic dependants were having only primary level of education others were completed their secondary, higher secondary and graduates. An individual receives less than or up to 12 years of education can the causative effect of Alcoholism. "This finding implies that improving educational levels has the potential to counteract the risk factors and help to prevent alcoholism" said Wan. Most of the alcoholic dependants were heavy workers such as drivers, civil engineers; farmer’s etc. Some study shows occupation has higher alcoholism rates, High risk occupations attract problem drinkers or create them through job pressures. One hundred and fifty male manual recruits to Scottish breweries and distilleries were interviewed and compared with similar men in lower risk jobs. The alcohol producers reported poorer employment records and were significantly heavier drinkers than the controls. The alcohol producers were also more likely than the controls to have drunk more since recruitment.

These results suggest that the drink trade attracts a disproportionate number of people likely to develop alcohol-related problems and indicates that drinking habits may be strongly influenced by work environment. In this study some alcoholic dependants started taking alcohol by learning from peergroups, work environment. The culture of the workplace may either accept and encourage drinking or discourage and inhibit drinking. A workplace's tolerance of drinking is partly influenced by the gender mix of its workers. Studies of male-dominated occupations have described heavy drinking cultures in which workers use drinking to build solidarity and show conformity to the group (4, 5). Some male-dominated occupations therefore tend to have high rates of heavy drinking and alcohol-related problems (6, 7 In my study four Alcoholic dependants are having monthly Income Rs.1000-4000,Most of the alcoholic dependants are having the monthly income of more than 6000-20000.The more income people have higher social status or class, more likely theirhigh socio-economic status induces to drink alcoholic beverages. Marital disharmony also one of the risk factor for consuming alcohol, here in general practice alcoholism should be considered, when the doctor detects marital disharmony, repeated sickness absenteeism, repeated aggressive behavior, patients presenting with anxiety and depression, and those who smell of drink.( B. D. Hoer and R. H. Wilkins). Psychological factor plays a major role in consumption of alcohol, most of the alcoholic dependants in this consumes alcohol due to psychological factors. some research studies says that people turn to alcohol during periods of stress, frustration e.g. as a result of failure in an exam, loss of dear one, marital breakup, loss of personal property, etc as a way of trying to overcome the stress or depression.

Assessment of Problem Index Among alcoholic Dependants:

Among thirty alcoholic dependants, majority of alcoholic dependants are not able to work, had inability to carryout responsibilities, had fight with relatives, were neglected by relatives,were 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 as previous one, and felt physically and psychologically dependant on Alcoholism.

Assessment of level of self-esteem among Alcoholic dependants:

Data on level of self-esteem pointed out that most of the alcoholic dependants are having low self-esteem. Their level of self-esteem was assessed by using self-esteem scale .Most of them scored the item very often(3) that inability to accept criticism, poor social interaction, afraid to try new things, difficulty to look people in the eye, uncomfortable in the presence of strangers, Feeling embarrassment when others are praising etc. There is a significant amount of research on the relationship between self-esteem and focusing on how self-esteem influences who is likely to consume alcohol. Research shows that low self-esteem is negatively correlated with alcohol consumption. In a study on adolescent drinking behavior, adolescents with high self-esteem reported consuming less alcohol than adolescents with low self-esteem and reported smaller increases in alcohol consumption over time (Gerald, Gibbons, Bergen, 2000). In addition in a study on college students. Students with low self-esteem became more intoxicated than students with high self-esteem (Glindemann, Geller, and Fortney, 1999).Although research shows a relationship alcohol and self-esteem.

It was found in the assessment that the level of self-esteem was improved after promotion of self-esteem activities. Alcoholic dependants who scored the item very often (3) in the pretest were scored sometimes (2) or occasionally (1) after promotion of self-esteem activities. Patients were actively participated in self-esteem activities, before promoting self-esteem activities alcoholic dependants had the problems like becoming angry for criticism, poor interaction, inability to try new things, having difficulty looking people in the eye, difficulty making small talk, etc.But after promoting self-esteem activities alcoholic dependants showed an improvement in accepting criticism, trying new things, facing other people’s in the eye, good social interaction.

SUMMARY AND CONCLUSION

The present study was conducted in selected De-Addiction Centre, Coimbatore from 28.6.10-25.7.10.Alcoholic dependants were selected by sample free technique. The level of self-esteem was assessed by using self-esteem scale. alcoholalcohol induced psychiatric illness and dependants with high self-esteem were excluded. After initial assessment of self-esteem, self-esteem activities were promoted which include Individual and Group activities. Reassessment was done after a gap of fourteen days using the same scale to identify the enhancement in promotion of self-esteem of alcoholic dependants. The data collected during assessment and was revealed that the level of self-esteem had significantly improved after promotion of self-esteem activities. The demographic variables like age, hours of work, quantity of alcohol intake, and duration of intake of alcohol were analyzed by using Karl Pearson’s co-efficient of co-relation to identify the influence of these variables on the level of self-esteem and alcoholic dependants. The results indicated that there is a positive relationship between age hours, quantity, duration of alcohol intake and pretest self-esteem score of alcoholic dependants. The results also indicated for posttest. The significance of level of self-esteem on pretest and posttest level of alcoholic dependants were calculated using paired’t’test.The results showed that after promoting self-esteem activities the alcoholic dependants had a significant improvement in level of self-esteem.

 

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