A Study on Alcoholism in a Residential Treatment Centre Kolkata

Drugs are now a days not only a national problem but a global problem that is increasing, risk every day. Reportedly ages between 15-64 had been a target users with most of them having Drug Abuse Disorder. In recent days addiction to drugs and alcohol is considered a vital health problem that has detrimental consequences on an individual and their surrounding society [1]. Psychoactive drugs can be referred to those substances which when taken by someone it affects the mental process of an individual. These processes are perception, consciousness, emotions and cognition. Psychoactive drugs include a wider range of substances like alcohol, nicotine, cocaine, marijuana. Personality has an important role to play in a person’s life. Generally people who use drugs can be characterized to have high Neuroticism, low conscientiousness, low agreeableness etc. 

An individual suffering from personality disorder mostly does not know how to cope effectively with the situation and might turn to drugs or alcohol. An individual having avoidant personality disorder may use drugs to hide their feelings. Personality disorder can be defined as the most disorienting condition for families and close ones where they might seem like complete strangers and in such cases seeking help from drugs and alcohol might seem to help them hide their feelings. Psychodynamic psychology, in its broadest sense, is an approach that emphasizes a systematic study of, psychological factors underlying human feelings, behavior and emotions and how they might relate to early experience focusing in the dynamic relations between our conscious and unconscious motivation.

Psychodynamic psychology is an approach that was developed by Sigmund Freud [2]; he was inspired by the theory of thermodynamics and used the term psychodynamics to describe the processes of our mind and as flows of psychological energy (libido or psi) in an organically complex brain. It is the study of the interrelationship of various parts of the mind (psyche), personality as they relate to mental, emotional, or motivational forces especially at the unconscious level [3,4]. 

Even though substance use and abuse may have prominent impact on our brain and behavior, yet the answer is not simple, as to why some people become addicted and others do not. Psychoanalysis understands addiction through a relational perspective wherein there is an underlying failure in affect regulation, a capacity shaped in early development. In contrast to early psychoanalytic theory, which stressed pleasurable/aggressive drives and the symbolic meaning of drugs to explain their appeal, a modern psychodynamic perspective of Substance-Use Disorders (SUDs) places greater emphasis on intolerable and painful or confusing affects that make addictive drugs compelling. Psychotherapeutic relationship in Psychodynamic approach provides valuable data on the nature of a person’s distress and problem in psychological (ego/self) structures that makes an individual susceptible to addiction [5]. 

The goal of the present review is to evaluate psychodynamic perspectives to inform our understanding of addiction [6], particularly substance-use disorders.

• Does Substance Use by Family Members and Community Affect the Substance Use among Adolescent Boys? Evidence from UDAYA study, India [7] 

The present study examined whether substance use among family member and in community is associated with the substance abuse behaviour of the adolescent boys of Uttar Pradesh and Bihar. To understand the association between adolescent boys and substance use behaviour in regards to familial and community context a three level logit model was utilized to predict it. Data of 5969 adolescent boys ages between 10-19 years from the Understanding the Lives of Adolescent boys and young adults (UDAYA) survey conducted in 2016. It was found that 16% of adolescent boys were using substances like tobacco or alcohol. The use of substance was significantly high among adolescent boys who were school dropouts (40%) and who were working (35%) than those currently in school. It was also found that adolescents who come from families where at least one family member consumed tobacco, alcohol and drugs. Thus it was apparent that being exposed to substance use in family and community can increase the susceptibility of substance use in adolescent boys. 

• Pathways to Recovery Model of Youth Substance Misuse in Assam, India [8] 

This article aimed to understand the pathways to recovery from SUD in the youth of Assam, India. They recruited 15 participants (11 men and 4 women) via two rehabilitation facilities. All were addicts-in-recovery aged 19-24 years. Materials of the study were generated through interviews which were photo-led. This was analyzed using an inductive variant of thematic analysis. The resulting model was also clarified by an expert and participants. The model enhanced psycho-socio-cultural insights into the experience of risk and recovery, and informed prevention and treatment for youth substance misuse in Assam. This is the first model of its kind and an important public health resource. 

• Applying Network Analysis to Understand Depression and Substance Use in Indian Adolescents [9] 

Network analysis has been used to better understand relationships between depressive symptoms and substance abuse. Data was gathered from 13,035 participants all adolescents (52.5% male) residing at Bihar, a low-resource state in India was taken. For measuring depression, the Patient Health Questionnaire-9 was used and for substance a questionnaire was taken from the World Health Organization. A network of depressive symptoms and a network examining connections between depressive symptoms and substance use was developed. The most common symptoms being reported were sleep disturbances, loss of appetite and poor appetite, depressive episodes and low energy. Emotions like, feeling like a failure and low mood were the most commonly addressed symptoms in the depressive phase which also includes somatic features. In contrary depressive symptoms were only weakly associated with substance use.

• Case History Format: Case history is one of the important types of non- experimental or descriptive research. Case study refers to an in depth study of one situation or case which maybe one subject, group or event [10,11]. The purpose of the case study method is to understand aspects of life cycle of the unit. In fact, such study deeply analyzes and interprets the interaction between the different factors that influence the change or growth of the unit. It is basically a longitudinal approach which studies a unit over a period of time. A review of literature in this field reveals that case studies are not confined to the study of individuals and their important behavioural characteristics rather case studies have been made all types of communities and of all types of individuals. In case study data are gathered though several methods or techniques like: the observation of behaviour, questionnaires, inventories and other psychological tests. 

Sample: The demographic features are as follows. They were admitted in a residential treatment center. 

Case I

Age: 40

Economic Class: Lower Economic class

Education Level: 8th

Marital Relation: Married

Background: Bus Driver

Family Background: Father- Bus Driver (Expired) Mother- Maid and Wife- Receptionist

Living Arrangements: With Family

Case II

Age: 29

Economic Class: Middle Economic Class

Education Level: B.Com Graduate

Marital relationship: Separated

Background: Currently working at toll tax

Family Background: Father- runs a small scale business, Mother- Housewife, younger brother- business

Living Arrangements: With family

Case III

Age: 35

Economic Class: Lower Economic Level

Education Level: 8th

Marital Relation: Married

Background: Rickshaw puller

Family Background: Father- labour, mother- housewife and wife - nurse

Living Arrangements: With family

• Test Administered: BG 

Case I Psychological Features:         i) Uncontrolled need for sustaining interpersonal relation. ii) Gross emotional disturbances.

Case II Psychological Features:       i) Conflict with authority figure. ii) Emotional disturbances but no gross psychopathology.

Case III Psychological Features:      i) Uncontrolled need for sustaining interpersonal relation. ii) Immaturity. iii) Regression. 

Interpretation: The psychological features can be corroborated with findings such as: 

Case I: The client thought that everyone in his family avoided him due to his work and action.

Case II: The client even though greatly emotionally dependent on his father, still did not agree with the kind of decisions he took for the client. They also differed in the line of work, where the father wanted the client to join family business but the client wanted to work in a company.

Case III: The client wanted to go on a trip and so without telling anyone he went along with unknown people. He also did not think about his family.

Considering case history, test behavior and findings it appears that they all have emotional disturbances which inhibits them and enable them to consume alcohol. 

Limitation of the study:   

i) Sample size small.

ii) Unable to administer projective test like Rorschach and TAT due to impoverishment.

To start with, I would like to thank Almighty for his mercy and guidance in giving me full strength to complete the research study. Without his will and blessings nothing would have been possible. 

I feel to acknowledge my indebtedness and deep gratitude to Dr. Debapriya Mallick and Human Development and Research Institute to help me in this journey. 

I feel to acknowledge my indebtedness and deep gratitude to my mentor Dr. Tinni Dutta whose valuable guidance and kind supervision given to me throughout that shaped the present work as it is shown.

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