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Year : 2019  |  Volume : 20  |  Issue : 2  |  Page : 141-143

A study to assess the insight and motivation towards quitting alcohol among patients with gastrointestinal and hepatological conditions

College of Nursing, CMC, Vellore, Tamil Nadu, India

Date of Submission28-Oct-2018
Date of Acceptance09-Sep-2019
Date of Web Publication01-Jun-2020

Correspondence Address:
Mrs. Sumathy Jayaraman
College of Nursing, CMC, Vellore, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCN.IJCN_15_20

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Alcoholic beverages have been a part of social life for thousands of years, yet societies have always found it difficult to restrain its use. Alcohol dependence syndrome and alcohol abuse are the dreaded alcohol-related morbidity. In India, 20%–30% of hospital admissions are due to alcohol-related problems, and the burden is rising. Realising the need to seek treatment forms an important bridge between the problem and its solution among those with alcohol-related morbidity. Therefore, a descriptive study was done to assess the insight and level of motivation to quit alcohol consumption among alcoholics affected with gastrointestinal and hepatological conditions admitted in inpatient general ward of a tertiary care hospital. Participants who were enrolled for the study using total enumerative sampling technique were 25. The Readiness to Change Questionnaire developed by Prochaska and DiClemente and the Hanil's Alcohol Insight Scale were used to collect data. The study results showed that 12% were in pre-contemplation stage, 32% were in contemplation stage and 56% were in action stage. About half the proportion of the participants (56%) had fair insight regarding their dependency in alcohol and none had good insight. Poor insight on alcohol as the risk factor of their disease was identified in 44% of the participants. This study highlights the need for an effective education and support programme for individuals with alcohol dependence and alcohol-related morbidity.

Keywords: Alcohol dependence, gastrointestinal conditions, hepatological conditions, insight, motivation

How to cite this article:
Pillai B, Jayaraman S. A study to assess the insight and motivation towards quitting alcohol among patients with gastrointestinal and hepatological conditions. Indian J Cont Nsg Edn 2019;20:141-3

How to cite this URL:
Pillai B, Jayaraman S. A study to assess the insight and motivation towards quitting alcohol among patients with gastrointestinal and hepatological conditions. Indian J Cont Nsg Edn [serial online] 2019 [cited 2020 Jul 11];20:141-3. Available from: http://www.ijcne.org/text.asp?2019/20/2/141/285583

  Introduction Top

Alcohol consumption, at present, is ubiquitous and has been consistently increasing throughout the world. An estimated 2 billion people worldwide consume alcoholic beverages and 76.3 million of them suffer from health problems related to alcohol use.[1] Globally, harmful use of alcohol causes approximately 3.3 million deaths every year (5.9% of all deaths), and 5.1% of the global burden of disease is attributable to alcohol consumption. It causes more than 60 different disorders and is the third most important risk factor for the global burden of disease.[2]

The 32nd World Health Assembly declared that 'problems related to alcohol and particularly to its excessive consumption rank among the world's major public health problems and constitute serious hazards for human health, welfare and life'.[3] In 2012, 139 million disability-adjusted life years, or 5.1% of the global burden of disease and injury, were attributable to alcohol consumption.[1]

The WHO report released in 2014 also states that the per capita alcohol consumption in India has risen from 1.6 l in 2003–2005 to 2.2 l in 2010–2012. In the southern state of Kerala, the average intake of alcohol per person over the age of 15 years/annum is over 8 l.[1] A study done in Kerala reported prevalence of problem drinking as 12.8% across all age groups and found that drinking behaviour was highly prevalent among men under 40 years of age.[4] A community survey in rural Puducherry showed an average prevalence of alcohol use as 9.7% among adults above 18 years.[5] Alcohol-related morbidity is directly associated with alcohol dependence syndrome. Chronic diseases, such as cancer of the mouth, oesophagus and larynx, liver cirrhosis and pancreatitis, and social consequences, such as road traffic accidents, workplace-related problems, family and domestic problems and interpersonal violence, have been associated with alcohol abuse.[1] The absence of awareness or insight related to alcohol abuse influences the diagnostic as well as the treatment process. Optimal insight, as well as motivation to discontinue, is needed to quit alcohol use. In this study, insight refers to the self-awareness of the study participants regarding their dependency in alcohol as expressed and measured by the Hanil's Alcohol Insight Scale (HAIS).[6] The level of insight reveals the sense of reality that alcoholics have about their drinking behaviour. Motivation refers to the willingness of the study participants to change their dependency on alcohol assessed by the 'Readiness to Change Questionnaire' (RCQ).[7]

The objectives of the study were to:

  • Assess the insight of alcohol dependence among patients with gastrointestinal and hepatological diseases
  • Assess the motivation to quit drinking alcohol among patients with gastrointestinal and hepatological diseases.

  Methodology Top

A quantitative research approach with a descriptive design was used for the study. The study population consisted of patients with alcohol-dependent gastrointestinal and hepatological conditions admitted in general ward of the tertiary care hospital. Patients with altered sensorium and critically ill were excluded from the study, and 25 participants who fulfilled the inclusion criteria and gave informed consent were included in the study. Data collection instrument consisted of four parts. Part A included sociodemographic variables such as age, gender, marital status, residence, educational qualification and occupation. Part B included clinical variables such as duration of alcohol dependence, diagnosis, family history, age of first drink and previous attempt to cut down alcohol. Both these parts had no scoring.

Part C is RCQ developed by Prochaska and DiClemente, which is based on the 'Stages of Change' Model. It is a 12-item instrument for measuring the 'Stages of Change' reached by an excessive drinker of alcohol which describes the stage through which a person moves in an attempt to resolve an addiction problem.[7] Test–retest reliability was good (P: r = 0.81, C: r = 0.87 and A: r = 0.86). Within the three scales, RCQ items showed fair consistency in terms of Cronbach's alpha (P: 0.58, C: 0.75 and A: 0.80).

In pre-contemplation stage, the client has no awareness of their problem, and they do not express the intention of changing their behaviour in the foreseeable future. Such individuals do not view their behaviour as a problem and may be defensive when asked about their behaviour. Contemplators are aware that they have a problem, but they have not yet made a commitment to change. In general, they are weighing the pros and cons of continuing as well as giving up their problem behaviour. In action stage, individuals have formulated plans for change and often have taken steps to monitor their problem behaviour and initiate behaviour change. All items in the scale are scored on a 5-point scale ranging from strongly disagree (−2), disagree (−1), unsure (0), agree (1) and strongly agree (2). The scores were added. The score range of each stage is − 8 through 0 to + 8. Negative scoring indicates overall disagreement, whereas positive score indicates agreement to change.

Part D is HAIS which is a 3-point scale of 20 statements with negative and positive insights. Positive insight statements are scored as 2 (agree), 1 (unsure) and 0 (disagree). Negative insight statements are scored as agree (−2), unsure (−1) and disagree (0). It has a sensitivity of 76.9%–100.0% and a specificity of 83.3%–94.9% for the insight assessment, and the Cronbach's alpha of HAIS was 0.82–0.89. The insight of alcohol-dependent patients reflects the sense of reality for the disease.[6] On the basis of total score, individuals who score from −20 to 3 are classified as having poor insight, scores from 4 to 15 indicate a fair level of insight and scores from 16 to 20 indicate a good level of insight.

  Results and Discussion Top

All the study participants were male, and majority of them belonged to the age group above 50 years. This is not surprising as the health effects of alcohol overuse are overtly manifested in the middle or older age group. Studies have shown that alcohol use is common among men younger than 40 years.[4],[8] Majority of the participants in this study (84%) had duration of alcohol dependence as more than 4 years and had been alcoholics from the age of 20 years. About 40% of them had taken their first drink at or before the age of 30 years. A study conducted by Kumar et al.[8] on alcohol prevalence in Tamil Nadu similarly shows that the mean age of initiation of alcohol was 25.3 ± 9.0 years. Age on initiation can be an influencing factor in the current behaviour of alcohol abuse and the prevalence of morbidity. A similar study revealed that heavy drinking correlated with age of initiation of drinking around 20 years and also found a relationship between age of initiation and adverse effects such as accidents and illness.[4] There was an equal distribution (40%) of skilled and unskilled workers, respectively, in this study, and both had alcohol abuse. Even though 68% of them did not have a strong family history of alcohol dependence in this study, all had continued to abuse alcohol until their admission to the hospital. The study findings also show that 60% of the participants attempted to cut down on alcohol use at least 1–2 times and 40% had tried more than 5–6 times. None had succeeded in abstinence.

The assessment of insight about alcohol use in this study revealed that 56% of the participants had fair insight, 44% had poor insight and no participants had good insight [Figure 1]. The present study findings are similar to the study done in Taiwan by Yen et al.,[9] which showed that 72.6% of the participants had poor insight into alcohol-related problems and 27.4% had fair insight and no participants had good insight. Although none had good insight in this study, as mentioned earlier, the participants had failed attempts to withdraw from using/abusing alcohol showing the importance of having optimal insight to hold on to abstinence from alcohol. Abstinence adherence was found significantly (P < 0.01) related to good insight in a Korean study.[7] Therefore, improving insight among patients with alcohol dependence needs to take precedence when addressing health and social issues related to alcohol use/abuse. Simple interventions such as insight enhancement sessions in which they are assisted in identifying the discrepancy between their present behaviour and their goals may prove effective in improving the insight in patients with alcohol dependence.[10]
Figure 1: Distribution of participants based on the Hanil's Alcohol Insight Scale (n = 25).

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With regard to readiness to change, the study results showed that 12% were in pre-contemplation stage, 32% were in contemplation stage and 56% were in action stage, as shown in [Figure 2]. The present study findings are similar to the study done by Lakra,[11] which showed that 61.3% of the participants were in action phase, 37.5% were in contemplation stage and 1.3% in pre-contemplation stage. Understandably, there appears to be a relationship between the proportion of patients who had poor insight (44%) and the proportion who were either not motivated or just contemplating to change behaviour (44%) compared to those with fair insight (56%) and the proportion who were in the action stage (56%). It is unfortunate that this study did not report the actual correlation between the insight and readiness to change. A significant relationship between insight and motivation has been established, and insight enhancement intervention has proved effective in improving motivation in patients with alcohol dependence in another study.[10]
Figure 2: Distribution of participants based on stages of motivation (n = 25).

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  Conclusion Top

A maladaptive pattern of alcohol use despite a persistent or recurrent social, occupational, psychological or physical problem is found common in our society. This study findings show that poor insight and lack of motivation were common among patients who were admitted in the hospital with alcohol-related problems. Family support and illness may have forced the participants to take efforts to cut down alcohol use. However, personal insight and motivation are needed to quit from alcohol use/abuse. There is a dire need to introduce insight-enhancing interventions for such patients, so their motivation will improve, and the alcohol dependence can be positively addressed. This study further highlights the need for planning effective education programs.

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Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. Global Status Report on Alcohol and Health; 2014. Available from: https://apps.who.int/iris/bitstr eam/hand le/10665/112736/9789240692763_eng.pdf; jse ssionid=4B5C03ED0BEC3FAAEBFDC4F74BC474F5?se quence=1. [Last accessed on 2019 Feb 18].  Back to cited text no. 1
Girish N, Kavita R, Gururaj G, Benegal V. Alcohol use and implications for public health: Patterns of use in four communities. Indian J Community Med 2010;35:238-44.  Back to cited text no. 2
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World Health Organization. WHO Expert Committee on Problems Related to Alcohol Consumption. World Health Organization; 2007. Available from: https://www.who.int/substance_abuse/expert_committee_alcohol_trs944.pdf. [Last accessed on 2019 Feb 18].  Back to cited text no. 3
Rajeev A, Abraham SB, Reddy TG, Skariah CM, Indiradevi ER, Abraham J. A community study of alcohol consumption in a rural area of South India. Int J Community Med Public Health 2017;4:2172-7.  Back to cited text no. 4
Ramanan VV, Singh SK. A study on alcohol use and its related health and social problems in rural Puducherry, India. J Family Med Prim Care 2016;5:804-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
Kim JS, Kim GJ, Lee JM, Lee CS, Oh JK. HAIS (Hanil Alcohol Insight Scale): validation of an insight-evaluation instrument for practical use in alcoholism. J Stud Alcohol 1998;59:52-5.  Back to cited text no. 6
Heather N, Rollnick S. Readiness to Change Questionnaire: User's Manual. National Drug and Alcohol Research Centre; 1993. Available from: https://ndarc.med.unsw.e du.au/sites/default/files/ndarc/resources/TR.019.pdf. [Last accessed on 2019 Dec 21].  Back to cited text no. 7
Kumar SG, Premarajan KC, Subitha L, Suguna E, Vinayagamoorthy VK. Prevalence and pattern of alcohol consumption using alcohol use disorders identification test (AUDIT) in rural Tamil Nadu, India. J Clin Diagn Res 2013;7:1637-9.  Back to cited text no. 8
Yen CF, Hsiao RC, Ries R, Liu SC, Huang CF, Chang YP, et al. Insight into alcohol-related problems and its associations with severity of alcohol consumption, mental health status, race, and level of acculturation in southern Taiwanese indigenous people with alcoholism. Am J Drug Alcohol Abuse 2008;34:553-61.  Back to cited text no. 9
Jung JG, Kim JS, Kim GJ, Oh MK, Kim SS. Brief insight-enhancement intervention among patients with alcohol dependence. J Korean Med Sci 2011;26:11-6.  Back to cited text no. 10
Lakra P. Insight, Motivation, and Factors Influencing Motivation among Patients with Alcohol Dependence Syndrome. (Unpublished master's thesis). College of Nursing, Vellore: Dr. M.G.R University Tamil Nadu, India; 2014.  Back to cited text no. 11


  [Figure 1], [Figure 2]


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