Influence of family on substance abuse - A cross sectional descriptive study

 

 

Abstract               Background: The study has been carried out to find out the influence of family on pattern of substance abuse, among under trial murder and sexual assault accused in Raichur district prison, Karnataka. Materials and Methods: It is a cross sectional descriptive study, designed and carried out among under trial murder and sexual assault accused in Raichur district prison, Karnataka. With their consent, information about influence of family on substance abuse was assessed by the use of WHO-based ASSIST 1 questionnaire (Alcohol, Smoking, and Substance Involvement Screening Test) to screen problem or risky use of tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives, hallucinogens, inhalants, opioid, and “other drugs” that do not fall into the previous nine categories. Later with the help of tables the results are explained in terms of number of cases and percentage. Prior permission from concerned jail authority was taken. Results: Among the 117 under trail prisoners interviewed, 96 persons had one or the other form of substance abuse whereas 21persons had no history of any substance abuse in their life time. Among 96 accused, 45 subjects (46.87%) give family history of substance abuse. The presence of substance abuse was common among joint family (57.29%). Among family member, the father (60%) has influenced more compared to the other family members. It is also observed that, the substance abuse was common among family with income of Rs.2001-3000 per month. Conclusion: This bio-psychosocial problem, which has attained a dangerous proportion in our society as in turn, increased the burden on the family with respect to health, harmony among family members, financial problems, accidents and legal problems. Taking the matter into serious note its responsibility of all of us including government, society, media and family to educate and spread awareness about ill effects of substance abuse.

Key Word: family, substance abuse

 

 

INTRODUCTION

Substance abuse is often used interchangeably with “substance dependence,” though abuse and dependence occupy different ends of a continuum of destructive behavior. Substance abuse is persistent or sporadic excessive drug use, inconsistent with or unrelated to acceptable medical practice. It arises out of a maladaptive pattern of substance use, manifested by recurrent and significant adverse consequences related to the repeated intake of the substance. These problems must occur recurrently during the same 12 months of period. It includes only harmful consequences of repeated use. Substance dependence arise out of a maladaptive pattern of substance use, leading to a cluster of behavioral, cognitive and physiological phenomenon that develops after repeated intake. It includes strong desire to take drug, difficulties in controlling its use, persisting in its use despite harmful consequences; a higher priority is given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state. Abuse refers to use of alcohol or drugs that interferes with daily functioning or that jeopardizes important relationships, but does not involve tolerance with continued use or withdrawal symptoms if substance use is suddenly discontinued.² Raichur is one of the backward districts in Karnataka. The main source of income in the district is from the agriculture sector and per capita income is Rs. 76,498/year. The literacy rate in the district is 59.56%, in male it is 70.47% and in female 48.73%³. Tradition of joint family is still there, the younger generation will grow under the influence of elders. Family members will influence among themselves in all the aspects of life. Alcohol and tobacco are commonly abused substances in the district, with some incidence of abuse with chloral hydrate powder and cannabis. Substance abuse among the family member’s one or the other way influences the other members. To throw a light on this subject we conducted a cross sectional study on under trial accused in district jail of Raichur, Karnataka.

 

MATERIALS AND METHOD

Information about the influence of family members on substance abuse was assessed by the use of WHO-based ASSIST ¹ questionnaire (Alcohol, Smoking, and Substance Involvement Screening Test) to screen problem or risky use of tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, sedatives, hallucinogens, inhalants, opioid, and “other drugs” that do not fall into the previous nine categories (with few modifications).

Question 1 asks about history of substance abuse among any family members

Question 2 asks about the type of family

Question 3 asks about the specific family members who influenced the substance abuse in him/her.

Question 4 asks about the family members who actively/personally pushed him/her in to substance abuse.

Question 5 asks about family income

All the 117 prisoners completed the study. Results are expressed as number of cases, mean and percentages. Prior to the start of the study, visited the district jail Raichur, Karnataka and explained about proposed study to the district jail superintendent and got the permission letter.

RESULTS

Table 1: Prevalence Of Substance Abuse

Out of 117 jail inmates who are interviewed, 96 people (82 %) gave history of substance abuse and 21 people (18%) are free from any form of substance abuse.

 

Table 2: history of substance abuse in family

Out of 96 cases of substance abuse, 45 people gave history of substance abuse in the family (46.87%) which is significant. This indicates that one or the other family members strongly influence the substance abuse among junior members of the family.

 

Table 3: Type of family

In our study it was observed that, Substance abuse was common among joint family (57.29%). Nuclear family with 40.62% was also not less common. The spectrum of reasons in both is entirely different. In joint family the budding people grow under the shadow of elder ones, they usually follow or copy the action or habits of their parents/brothers sisters/relatives. In nuclear family it may be due to marital disharmony, financial problems, conception problems etc. Since substance abuse has multi-factorial angle, it is difficult to pint out single factor for starting the abuse.

 

Table 4: family member who influenced substance abuse

Substance abuse suffers told that, they are more influenced by father (60%), followed by brother (28.88%) and husband (11.11%). Everyone believes that their parents are their role models, so young generation in the family will blindly follow the parents. If parents attitude and rules are strict and pro-social, then children will stay away from the substance abuse. When parents themselves involved in substance abuse then automatically it will adversely affect the mindset of the children.

Table 5: Monthly Income of Family

It was observed that, substance abuse was most commonly observed among income group of Rs.2001-3000/- (65.62%), followed by income group of Rs.3001-6000/- (17.70%) and Rs.1000-2000/- (10.41%). From this it is clear that more than 90% of the substance abuse prisoners have income of Rs.1000-6000/- i.e low income group. Directly this will destabilise the financial condition of the family leading to stress and unhappiness resulting in substance abuse. This vicious cycle will continue and family will never recover back to normal life.

DISCUSSION

Generally, positive family influences, such as family bonding and consistent rules, appear to reduce the risk of tobacco, marijuana, and other drug abuse among teens, while negative family influences tend to increase risk. Substance use disorders (SUDs) are associated with significant morbidity and mortality that affects individuals and their families.⁴ Clinicians and researchers have long observed that SUDs frequently affect multiple members within families over different generations. Researchers have found that approximately 50% of the risk of substance abuse or dependence in adolescence is genetically influenced. The transition between stages of use, from regular use to abuse and dependence is also genetically influenced, although the relative genetic contribution compared with environmental influences varies by substance.⁵ Young and colleagues found that a common genetic influence accounts for comorbid substance use during adolescence, specifically problem use of tobacco, alcohol, and cannabis.⁶Behavioral modeling of substance use through exposure to parental substance use early in life also accounts for part of the familial association in SUDs. The association between exposure to parental SUDs and the development of an SUD in offspring is consistent with social learning theory.⁴ A review by Petraitis and colleagues further described social learning theory as the hypothesis that children model their behavior on people who are important to them and those they frequently interact with, such as their parents. The researchers also reviewed social control theory, which hypothesizes that children who are closely attached to their parents are less likely to break rules because they want to connect with their parents. Children who are closely monitored by their parents and have clear rules are also more likely to conform to their parent’s rules and are less likely to act out by abusing substances.⁷ There is evidence that supports the principles of social learning theory and social control theory. Researchers have examined components of both theories by assessing the relationship between adolescent substance use and parental attitudes toward substances, parental substance use, the quality of the relationship between parent and child, and parental monitoring.⁴ Bahr and colleagues found that the family factors that were most strongly associated with an increased prevalence of binge drinking, cigarette use, cannabis use, and illicit drug use were tolerant parental attitudes and sibling substance use. In addition, adolescents who had parents who were tolerant of substance use interacted with higher-risk peers and were more likely to have friends who were substance users.⁸ In a larger longitudinal study of predominantly males with and without ADHD, Biederman and colleagues found an association between exposure to parental SUD and SUD in offspring after controlling for both family history and ADHD.⁹ In another study of 552 individuals of whom 71% were female, a specific association was found between exposure to maternal drug use disorders (primarily cannabis) and drug use disorders in female offspring after controlling for family history and ADHD. In other words, mothers who abused drugs increased the likelihood that their daughters would also abuse drugs. Interestingly, research findings have not shown consistent sex patterns when the risk associated with exposure to parental substance abuse was examined.^10,11 The specific risk between mothers and daughters may reflect the greater impact that interpersonal relationships have on an adolescent girl’s risk of using substances relative to the risk in adolescent boys.¹² It is also important to consider whether the developmental timing of exposure to parental substance use may influence the chances that the child will develop an SUD. For instance, Biederman and colleagues assessed offspring risk of developing an SUD connected with exposure to parental SUD during different developmental stages. Predominantly, boys were at significantly greater risk for developing an SUD when they were exposed to parental SUDs during adolescence than when they were exposed during preschool and latency years. It is unclear why adolescents are particularly vulnerable to exposure to parental substance use; it may be that behavioral modeling of use at a time when adolescents have greater ease of access to substances partially accounts for their increased risk.⁹ The extent of bonding to family, family involvement (time spent interacting with parents), family conflict resolution and parenting practices (monitoring, rules, and consistent discipline), and their pro-social and antisocial activities will definitely influence the drug abuse among younger family members.¹³ Singh GP at al. Observe that, the median monthly family income of the subjects was found to be 20,000 per month and “the problem is prevalent in middle-class family.¹⁴ Another report says that, drug use on a national level is most noticeable “among the working poor.¹⁵

 

CONCLUSION

Substance abuse can negatively affect all aspects of a person’s life, impact their family, friends and community, and place an enormous burden on society. There are several socio-demographic factors which are responsible for or instigate person for substance abuse like living conditions, family, employment, marital status and mental health, taking the matter into serious note its responsibility of all of us to spread awareness about ill effects of substance abuse and let’s start it from family level. SUDs in adolescents interfere with emotional and cognitive development and can be associated with long-term medical and legal consequences. There is a substantial genetic influence on the development of SUDs. The aggregate data also show that other familial factors that can be modified, such as exposure to parental SUDs particularly during adolescence, are significant as well. Conscious efforts to screen for parental SUDs and educate families about exposure risk may help prevent the onset of substance abuse during adolescence.

Limitations: The major limitation of the study is, it is done in under trail jail inmates and belongs to a single prison. Study involving large population with uniform distribution and involving all strata of the people will definitely bring more important demographic findings.

 

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