CHAPTER - 2

REVIEW OF LITERATURE
 A literature review involves the systematic

identification, location, scrutiny and summary of written

materials that contain information on a research problem

(Polit et al, 1991). It also provides basis for future

Investigation, justifies the need for replication, throws

light on the feasibility of the study, indicates constraints

of data collection and helps to relate the findings of one

study to another, with a view to establish a comprehensive

body of scientific knowledge in a professional discipline

from which varied pertinent theories may be developed

(Abdellah and Levine, 1979). Therefore, literature was

reviewed, and relevant extract pertaining to the present
study is presented under the two broad areas :

1. Prevalence of drug abuse among youth.

2. Influencing factors leading to Alcoholism.

2.1 LITERATURE RELATED TO PREVALENCE OF DRUG ABUSE AMONG

YOUTH

Over the last several years, many research scholars and

experts have studied the prevalence and pattern of drug abuse

especially among the youth, which is known to belong to the

vulnerable age group. These studies were conducted both

among the student and other youths. Relatively, only a

limited number of studies which have scientifically

ascertained prevalence of drug abuse have been reported. A

few are quoted giving some idea to size up the problem.

While studying the prevalence of drug abuse among student

 33

youth, researchers have found a unidirectional picture in

different major cities in India. Starting from Delhi, Ranade
(1972) found a prevalence rate of 4 percent of his student

youth population addicted to morphine and 2 percent to

equibrom, while Mohan and Arora (1976) found in their survey

conducted in Delhi Colleges, a prevalence rate of 24.7

percent. Bombay showed a picture of 19.7 percent (Chitnis,

1974) prevalence rate among the university students with the

exact picture found by Varma et al (1977) among the Panjab

University students in Chandigarh (19.7%). Lucknow gave a

picture of prevalence rate of 11.5 percent of drug abuse in a

study conducted by Sethi and Manchanda (1978) among 1513

college students. Hostel resident youth in Hyderabad showed

a prevalence rate of abuse of tranquillisers as 1.6 percent

(Parameshwaran and Mashiuddin, 1980). While the rural

college and school going youth of Chandigarh and Raipur
showed that alcohol was the most commonly abused drug

(21.57%) as found by Varma and Dang (1979).

Studies conducted among youth in general showed no

untoward findings than that of the student youth population.

Varma and Dang (1979) in their study conducted among 570

youth reported that 12.1, 21.6, 4.0, 3.5, 3.2, 3.0 and 2.1

percent abused tobacco, alcohol, amphetamines,

tranquillisers, sedatives, cannabis and opium respectively.

In another study by Varma and Dang (1980), conducted among

266 non student youth, they found a large confinement to the

abuse of tobacco (39.5%), alcohol (27.87») and cannabis (7.1%)

 34

While Muttagi (1980) in his survey in Bombay found 1.76

percent of his youth population abused to painkillers. He

further observed while abuse of tobacco and alcohol was

rather high among males, painkillers was the most popular

drug among females possibly because of its use during menses.

Mohan's (1980) "multicentred prevalence study" revealed

that the use of drugs other than alcohol, tobacco and

painkillers is low in India. It is much more common among

males compared to females, though the latter is beginning to
break the tradition, and more so in metropolitan cities. Of
the drugs which are of concern, the use of cannabis and

tranquillisers is common. This study comprised of 4,200

subjects in each centre and with the help of a questionnaire

pertaining to the abuse of drugs revealed that the use of

tranquillisers among males in Delhi were 4 percent and 2.7

percent in Varanasi, whereas, the use of painkillers was more

among females, (Bombay 16.97o, Delhi 20.17., and Varanasi

11.57.) .

Jaffe (1989) while doing a National Household survey,

for the National Institute of Drug Abuse in the U.S. found

data which revealed that the use of illicit drugs like

cocaine, heroin and marijuana is far more prevalent among

young adult population (18-25 yrs). For example, only 6

percent of the older adults (above 26 years) reported having

used marijuana or cocaine, compared to 22 percent of those

between 18-25 years. He further classified his data as

follows :
 35

18-25 years 26+ years

32,490,0Q0(N) 136, 600,000 (N)
Drugs Ever used/Current Ever• used/Current
user (7.) user (7o)

Marijuana 60 22 27 6
Hallucinogens 12 2 6 -

Cocaine 25 8 9 2

Sedatives 11 2 5 0.7

Tranquillisers 12 2 7 1
Analgesics 11 2 6 0.9

Alcohol 93 72 89 61

Cigarette 76 37 80 33

Jaffe further stated that epidemiological studies

conducted between 1981-83 in the young adult population

revealed the drug abuse estimation of amphetamine, cocaine,

cannabis, hallucinogens, opioids, sedatives and anxiolytics

as 2, 0.2, 4, 0.3, 0.7 and 1.1 percent, respectively.

Studies conducted in the slum areas in India are no

exception to be mentioned. Kartikeyan et al (1992) conducted
a simple survey among 9863 subjects out of the total 70,000
population of a slum pocket in Bombay. The study revealed
drug abuse among 104 persons. Out of 104, 83.65 percent

smoked 'brown sugar', 10.68 percent abused cannabis and 5.77

percent opium. Another study, was conducted by Kushwaha et
al (1992) in Gorakhpur among college youth and slum dwelling

youth. The study was designed by means of a questionnaire to

detect the prevalence rate of psycho-active drug abuse. It

 36

was found that tobacco was the most frequently abused

substance (50.37. among college going youth and 72.57. among
slum dwelling youth) followed by alcohol (11.77> and 16.27. in
college going and slum dwelling youth, respectively).

Cannabis was also abused by a little fraction (0.67.).

Rural based studies also cannot be overlooked in the

matter pertaining to drug abuse among youth. Sethi and

Trivedi (1979) studied 2415 rural based population and

found only male abusers with alcohol being the commonest
(35%) drug abused, in the age group of 34-44 years with the
second highest frequency among the age group of 25-34 years
(16.5%). Most abusers were illiterate or only with primary
education, and less intake among educated and higher income
group. They further found 46.5 percent of scheduled caste
abusers and 32.8 percent of upper caste. Later Mohan et al
(1986) conducted an epidemiological study of drug abuse in 24

rural villages in Punjab, bordering Pakistan, covering 1276

households. The majority of the households had atleast one

abuser and the commonest drug abused being alcohol (58.37.)

followed by tobacco (19.3%), opium (6.37.) and cannabis

(1.27.).

There are also studies conducted in the drug

de-addiction centres. They may be mentioned as Bhatt and

Bhatt's (1992) study conducted in a counselling centre for

drug addicts in Kurukshetra and Karnal. The sample comprised

of all age groups, but they found that the occurrence rate
was 60.04 percent and 67.53 percent below the age group of 40
 37

years in Kurukshetra and Karnal, respectively. Another study

conducted by Malhotra et al (1993) among the patients
admitted in the Drug de-addiction centres in PGIMER,
Chandigarh showed that out of 116 patients, 74 (64%) were
drug abusers and 42 (36%) were alcohol abusers. Alcohol as

well as certain other intoxicating drugs like opium and

cannabis have been used in India as evidenced by the

references. A large proportion of youth has been found to

use alcohol than any other habit forming drugs. Besides,
amphetamines, barbiturates, cannabis and tranquillisers were

also found to be extensively abused by the youth population.

2.2 LITERATURE RELATED TO FACTORS INFLUENCING ALCOHOLISM

The literature available in the field of

psycho-socio-cultural factors as influencing variables in
alcoholism are very much limited in comparison to the

biological consequential factors. However, the literature

relevant to the present study are presented in accordance to
the areas considered in the present study.

2.2.1 AGE

During the past several decades there has been a

growing concern about both drug and alcohol use among young

people. By the late 1970's the use of alcohol by youth had

become so pervasive and socially tolerated that its potential

destructiveness was sometimes overlooked (Estes et al 1980).

Hasin and Glick (1992) in their study on alcohol dependence

in the United States observed that the greatest population

 38

of alcoholic cases were concentrated in the youth in all the

three groups under study as mid, moderate and severe
dependent cases. Sethi and Trivedi (1979) in a survey in one

rural area near Lucknow found 32.1 percent of their

population to be male above 10 years of age, and in another

similar study found the alcohol abuse being highest ( 357.) in

the age group of 35-44 years, and second highest among 25-34

years (16.57.) of age. Whereas Lai and Singh (1978) in their

study in Punjab found the alcohol abusers to be as young as

15 years and above.

Loxley et al (1992) observed that alcoholic in

Australia fall in the age group below 25 years while Sengupta
et al (1992) reported a mean of 35 years of age in a study

done in Indian setting.

A retrospective study (Condes et al 1990) among

alcoholic subjects revealed a higher rate of alcohol abuse in

the age group 35-44 years while Deiz et al (1991) found the

younger age group out numbering the other. Latham and Napier

(1992) seemed to agree with their findings with a mean of

37.6 years, with the above mentioned findings of Condes et al

(1990).

2.2.2 SEX
Most investigators agree that alcoholism is more among
men then women. Edwards et al (1967) recorded a ratio of 7:1
and Moss and Davies (1968) recorded 4:1 in their studies in
separate areas of alcohol information centres. Whereas,
 39

Nystrom (1992) reported that women are not lagging behind now
in any respect of drinking alcohol under condition of
anxiety, depression and stress.

Roman (1988) reported in his study in USA population

that fewer women drink alcohol in comparison to men and the
volume of consumption is also less than that of men. Bennet
et al (1991) later supported this with their findings of 29

percent men and 9 percent women drinking alcohol in excess of

the recommended safe limit (<. 21 unit for men and < 14 unit

for women).

Occurrence of alcoholism is more among males than

females because of associated stress like unemployment and

working condition (Romelsjo et al,1992), where Janlert and

Hammerstrom (1992) agreed that there is also a positive

correlationship between unemployment and alcoholism in women.

2.2.3 ECONOMIC STATUS

Economy, i.e. the financial problem is thought to be an

important contributing factor in creating drinking habits in
individuals (Fletcher et al 1991), Stacey and Davis (1973)
found that the heaviest drinkers came from families of low
rather than high occupational status group. This is because,

children from the low occupational status group tend to leave

school and go to work earlier and also are likely to have

part time jobs while still at school. This finding got

further support from Kushwaha et al (1992), because they

reported that among the slum dwellers in Gorakhpur,

 40

alcoholics mostly belonged to low family income group.

Further there is a report that a significant association
between abstinence from alcohol and higher income among the
alcohol dependent men, rehabilitated in a special unit in

developing countries, exist (De Silva et al 1992). However,

according to Coombs et al (1986) and Monarca et al (1991)

there is a poor relationship between increased alcohol

consumption and social class, whereas Glatt (1961) and Moss

and Davis (1968) observed increased occurrence of alcoholism

among the middle class people.

Another aspect of alcohol consumption was found to be

higher in youth with long standing unemployment (Janlert and
Hammerstrom, 1992), with a contrast finding by Hammer (1992)
that there is a decreasing trend of alcohol consumption among
unemployed youth which affects their economy.

2.2.4 RESIDENTIAL STATUS (URBAN AND RURAL)

Variability in drinking depends on the environment in

which an individual lives. The contracts and nature of the
social interaction and the attitudes and values of the people

living in these environment influences drinking habits

(Whitehead and Simpkins, 1983). This environment may be
urban or rural.

Parr (1957) and Moss and Davies (1968) observed higher

prevalence of alcoholism among the rural populace while

conducting comparative studies among the rural and urban

population. Latham and Napier (1992) reported 27 percent
alcohol abusers from rural environment. Singh (1991), Mohan
 41

et al (1986), Sethi and Manchanda (1978) conducted similar

studies in India, and found 58 percent and 23 percent of the

alcoholic population belonged to rural background in their

respective studies.

Varma et al (1980) conducted a study on 103 respondents

by self administered questionnaire, above the age of 18 years
of both rural and urban background of Chandigarh and

Jallandhar. They found the population of alcoholics were

greater in the rural sample.

Deb and Jindal's (1974) study in Punjab villages found

alcohol abuse in 74 percent of the adults, while Singh (1978)
found a prevalence of 26 percent and Sethi and Trivedi (1979)
covering a population of 2,000 persons found 82 percent of

prevalence rate on alcoholics.

In contrast to the above findings, Martin and Pritchard

(1991) observed that white males living in Urban and

Sub-urban areas consume more alcohol than the rural whites.

2.2.5 ETHNICITY

Drinking pattern and habits are influenced by the

ethnicity of an individual to which he belongs. Tsunoda et
al (1992) and Kitano et al (1992) reported significant

differences of drinking pattern among the ethnic group of

Japanese in Japan and Japanese Americans in Hawaii and

California. They observed that religion along with

enculturation and acculturation might be the contributing

factors for this difference.

 42

Engs (1977), Martin and Pritchard (1991) and Catalano

et al (1992) studied the differences in rates of alcohol

abuse among the Whites and the Blacks. They found that
Whites drank more than the Black. While Bailey et al (1965)
earlier found a contrast picture that incidence of alcoholism
were more among the blacks than the whites. In tune with
them Welte and Barnes (1992) also found that black abused
more alcohol than the whites and the Hispanics in a sample of

homeless and marginally housed men.

Bailey et al (1965) reported a low prevalence of

alcoholism among Jew population to Roman catholics while
Barnea et al (1992) observed no difference in alcohol abuse
in Israeli youth from their European counterpart.

2.2.6 PHYSICAL FACTORS

Physical and health related variables play an important

role in alcoholism which in turn accentuates with death

anxiety among drug addicts. Some clinicians and

investigators hold that most human behaviour of consequence
is in response to the problem of death (Becker, 1973, Fiefel,
1971, 1977). These observations were further supported by
Ma^hool (1991).

Meyer et al (1975) and Fiefel (1977) observed that

physical illness with the perceived fear of death plays an

important role in depression, psychosomatic and

psychopathologic disorders, which is responsible for taking
alcohol, as a means to overcome it.
 43

Ashley et al (1976) while comparing continuous and

periodic alcoholics found that both the group conformed to
the physical disease complication as the reason for alcohol
consumption.

Wilson (1980) found the same proportion of heavy

drinkers in managerial/junior professional class as amongst

manual workers.

2.2.7 PSYCHOLOGICAL FACTORS

Sigmund Freud Father of Psychiatry, thought that

alcohol allowed the expression of repressed urges because of

its ability of releasing inhibition. He hypothesized that

these repressed tendencies including oral dependency,

developed during childhood because of problems in the parent

child relationship. However, McCord and McCord (1960)
reserved that alcoholism is a striving for power to
compensate for feelings of inferiority and bolster feelings
of self esteem.

Wood and Duffy (1966) observed that lack of self

confidence among female was a contributing factor leading to

alcoholism. They further reported that alcoholic tend to
show some distinctive traits like low stress tolerance, a
negative self-image, feeling of isolation, insecurity and
depression. These findings were further supported by Irwin

(1968) and Weingold et al (1968) in their subsequent studies.

Kollar and Castonos (1969) while studying the family

background and life situation of alcoholics found that
parental loss, institutionalisation (indicating isolation and
 44

boredom) were few causes for their taking to alcohol.

Winokur et al (1976) however pointed out depression and

family problem, criticism and reaction to failure with marked

feelings of hurt and inferiority were the reasons leading to

alcoholism in certain subject.

Jones (1971) in his study among female alcoholics

observed inadequate coping mechanisms prior to their drinking

problems.

Schuckit et al (1972) reported that psychological

dependency develops because alcohol calms down anxiety and
help people to relax. While McClelland et al (1972) reserved
that men drink because they need to have personal power and
choose drinking as an outlet for this need.

Lawrence (1973) embraced that non medical use of drug

like alcohol include relief of anxiety, tension, depression
and relief of psychological and personal problems. He

further described an array of motives like search for self

knowledge and for meaning of life and religion. The cult of

'experience' including aestheticism, sex and 'genuine',

'sincere' interpersonal relationship and 'belongingness'.

Rebellion against or despair about orthodox social values,
fear of missing something, and conformity with own social
sub-group along with fun, amusement, recreation, excitement

and curiosity are often reasons of abuse.

Stacey and Davis (1973) found that young people drink

to avoid labels such as 'cissy' or 'weakling' which they and
their fellows attach to those who do not drink.
 45

Burkhalter (1975) identified a few significant traits

that have been associated with alcohol abuse. The need to be
dependent and the need to be independent conflict, anger and
frustration, feeling of omnipotence, depression and defence
mechanisms were denial, rationalisation and projections were

associated with.

A retrospective study of over 5000 U.S. soldiers

(Rennant et al 1975) indicated that parental structure and

control assisted the avoidance of drug and alcohol abuse.

Non use was associated with Parental discipline by spanking,

church attendance, no consumption of alcohol before 15 years

and a secure parental marriage.

Hoffman and Noem (1975) also observed that the death of

a close one, anticipated or realised responsibility and

changes associated with ageing could have precipitated

alcoholism in the subjects under his study.
Engs (1977) determined the trigger situation for
alcohol abuse on environmental especially among university

students and situational where social pressure is on the

rise.

Coleman (1979) observed that when significant changes

occur in an individual's life, for instance social

instability, confusion and stress, death of spouse etc. the

individual's normal coping methods prove inadequate and he

resorts to heavy consumption of alcohol to alleviate stress.

While Litman & Stapleton (1980) in their study on

alcoholics gave a high risk situation of a subject in his
 46

available coping behaviour and individual attributes as

influencing pointers.

Analysing the life history of alcoholics Frances et al

(1980) found that alcoholics having a childhood history of
attention deficit disorder, antisocial personality
characteristics and familial alcoholism tend to begin problem
drinking at an earlier age and to develop more severe
disabilities related to alcohol abuse.

Bry (1953) while reviewing the literature on antecedent

factors of alcoholism listed a few psychological correlates
as :

1. Perceived distance in family relationship

2. Psychological stress
3. Low self esteem
4. Low achievement

5. High sensation seeking.

Reuband (1985) studied that 26% of the drug and alcohol

abuses had broken home, and the need for conformity to
interpersonal role expectations played a big role among them
in the abuse.

Kubica and Kozeny (1988) found a few of the following

variables as statistically significant predictor of alcohol
use:

1. Separated from parents in first 5 years.

2. High number of siblings.

3. Bad marks for conduct in elementary school.

4. Delinquency in adolescence
 47

5. Unstable relationship with women

6. Hedonistic value orientation.

Seeman et al (1988) studied alienation and alcohol use.

Powerlessness, work alienation and social isolation on the

abuse of alcohol was analysed. They found that powerlessness

is directly related to drinking problems and not work and

social alienation.

Stammer (1988) found in his study that inability to

cope with various stressors were the underlying causes to
take to alcohol among his subjects of nurses, mainly with

family conflict.

Abrams et al (1991) reported that alcohol users had

higher urges to drink, and they were found to be less
skillful, more anxious, and problem prone.

Fletcher et al (1991) collected data from 103

alcoholics through SADQ and GHQ (severity alcohol dependence

questionnaire and general health questionnaire) and found 557o

of them had childhood problems which triggered them towards
alcoholism.

Nystrom (1992) in his study conducted among young

Finnish University students, found that 74.6 percent female

and 80 percent male agreed on their reasons for drinking in

order to attain positive consequences like overcoming

anxiety, depression, stress or reduction in tension.

O'Callahan and Callan (1992) reported in a study

comprising of 122 student youth through a structured

 48

questionnaire, that the subjects rated their drinking as

significantly more satisfying, comforting, and exciting,
which helped them to fall closer to their close friends and
home.

Jones and Hont (1992) observed that lack of attention

and feelings by parents together with less emotional support
led the youth to alcoholism.

2.2.8 SOCIO-CULTURAL FACTORS

Researchers believe that a family with an environment

where alcohol consumption exists, carries more chances to
influence the offsprings to take to alcohol. McCord and
McCord (1960) noted that sons of alcoholics were twice as
likely to become alcoholics as the sons of non-alcoholics.

The presence of alcoholism in a community has been

hypothetically correlated with a degree of social stress. In
this framework, the more that people experience social
deprivation, the more they are likely to consume alcohol
excessively in response. Associated with this is the degree
to which the society offers alternatives to the release of
tension and provides substitute means of satisfaction. A
society that offers few alternatives to drinking as a tension
releaser will have a high rate of alcoholism. The
consumption of alcohol then takes precedence over alternate
ways to handle life problem (Gorad, 1971).

Culturally derived explanations have been sought for

the greatly varying rates of alcoholism among different

 49

cultural groups. Italians and Jews, for example

traditionally have low rates of alcoholism. Speculation as
to reason include observations like alcohol being used with

meals, drinking is taken for granted and given no special

significance and positive value is associated with amounts
consj’nnc, and drunkenness is discouraged (U.S. Dept. 1974).

Although the study of different cultures' attitudes

towards and use of alcoholism may be enlightening, it is not

clear what effects it might have in altering rates of

alcoholism. Different researcher have different findings in

their studies.

Engs (1977) observed that students living in a

university environment where there was social pressure to
drink, where heavy drinking was approved and where alcoholic
beverages and places to consume them were readily available,
would drink relatively heavily on an average.

Penick et al (1978) reported that presence of a family

history of alcoholism as well as the number of individuals
affected lead to increased severity of alcoholism among their

children. Similar findings were reported by Volicer et al

(1985) and Hill (1992).

Marlatt & Nathan (1978, 1980, 1985) consistently

determined the trigger situation for alcohol abuse on

environmental and situational factors like peer pressure and

inter personal temptation.

Lied and Martell (1979) observed interesting findings

in their study. According to their observation, many people

 50

probably learn to drink by observing the drinking behaviour

of their family. Chepperfield and Vogel-Sprott (1988) also
reported similar findings among alcoholics.

Whitehead and Simpkins (1983) observed that the living

environment was an important factor towards drinking due to
the contact and nature of the social interaction, and the
attitudes and nature of the people living.

Bry (1989) while reviewing the literature on %nticedent

factors of alcoholism listed the following few social
correlates.

1. Misuse of substance in the family

2. High drug use among peers.

3. Easy availability of alcohol.

Eeuband (1985) studied school children and found 26

percent with broken homes, 96 percent were merely influenced
by peer pressure, and conformity to interpersonal
expectations played a big role among the youth in the abuse
of alcohol or other drugs.

Engs (1977), Whitehead and Simpkins (1983), Neeliyara

et al (1988), Singhal (1989) studying various aspects of
alcohol use found social pressure and interpersonal

temptations being a contributory factor for abuse and relapse

of alcohol intake.

Kubica and Kozeny (1988) found a few socio-cultural

variables as statistically significant prediction of alcohol

abuse.
1. Early start of regular drinking
 51

2. Early alcohol induced euphoria

3. Friends drinking norm

4. Acceptance of alcohol in social functions

5. Hedonistic value orientation.

Allamani et al (1988) in their studies in Florence and

surrounding areas of Italy found the culture of drinking to

be more rooted in the country among agricultural workers than

among the factory employees. The average per capita per day

alcohol consumption was double among the agricultural

workers.

Welder (1990) investigated a group of student youth for

factors influencing alcoholism and nicotine and found that

the peer pressure greatly influenced alcohol and nicotine

abuse.

Brenman et al (1990) while comparing problem drinkers

with non-problem drinkers found the problem drinkers

reporting stressors involving friends.

Fletcher (1991) reported positive history of alcoholism

in the family in his study of 103 alcoholics. Hill (1992)

also observed that children of alcohol dependent parents were

more likely to be heavy drinkers and showed more symptoms of

alcohol dependence.

2.2.9 OCCUPATIONAL FACTORS

In a random sample interview in an Irish town 1 percent

of those classified as light drinkers reported that they had

been sacked or threatened to be sacked by their employer

 52

(Blaney and Redford, 1973).

Murray (1974) reported that joblessness was associated

with deterioration in psychological well being leading to

drinking behaviour.

Plant (1979) found that occupations such as commercial

trades, traveller, journalist, or hotellier appear more in a

sample of alcoholic. He found an increased number of

alcoholic among these new recruits of drinking traders.

Jeffs and Saunders (1983) investigated the involvement

of alcohol in police work and said that a considerable

proportion of police work was alcohol related.

People concerned with manufacture, distribution and

sale of alcoholic drink together with those in ancilliary
trades are particularly at risk. Executive with expense
accounts who do much work in hotel lounges are no exception.
Freedman and Kaplan (1986) stated that waiters, bartenders
long shoreman, musicians, authors and reporters have high

rates of alcoholism.

Researchers have found other factors responsible for

alcoholism, including unemployment and loss of job (Coleman,

1979). But Temple et al (1991) observed an interesting

finding in relation to employment status in individuals.

According to their study, there was no positive relation

between chronic unemployment and alcohol consumption at a

follow up study among older male and younger females.

Becoming unemployed between measurement was homogeneously and

positively related to later consumption among all groups

 53

except female.

De Silva et al (1992) observed significant association

between abstinence from drinking and regular employment.

However, they could not notice significant association

between abstinence and type of employment.

However, Hammer (1992) observed a contrast finding. He

noticed that unemployment does not appear to influence the
consumption of alcohol. According to his observation there
was no increase in the use of alcohol or drugs in response to

stress as a result of unemployment, though unemployment may

lead to a stronger identification with or joining
marginalized or deviant subcultures which in turn may lead to

an increased use of canabis.

Janlert and Hammerstrom (1992) reported a positive

correlation between longstanding unemployment and alcohol

consumption in man. The correlation was still present when

earlier alcohol consumption and socio-economic variables were

controlled.

Gurnack and Hoffman (1992) analysed 800 patients

records to identify factors related to problem drinking in
older adults. The study revealed that alcoholism had a
significant relationship with employment status and emotional
distress, 21% of the sample were employed in part or full
time.

2.2.10 FINANCIAL FACTORS

Hoffman and Noem (1975) observed that financial events

precipitated alcoholism in their subjects.
 54

Forcier (1988) in his review on unemployment and

alcoholism felt that superficially unemployed may be at risk

for abusing alcohol as a means of coping with financial

stress, triggered by joblessness. While Huffine et al (1989)

found in their sample of alcoholics that use of alcohol

increased with income.

Financial problem like debts was found to be an

important contributing factor in creating drinking problem

(Fletcher et al 1991). Brenman et al (1990) also comparing

middle aged problem drinkers and non-problem drinkers, found

the problem drinkers reporting stressors involving finances.

Further De Silva et al (1992) reported a significant

association between abstinence from alcohol and high income
among the alcohol dependent men rehabilitated at a special
unit in a developing country.

2.2.11 MARITAL FACTORS

Individuals without marital partner (either divorced or

separated) show higher incidence of alcoholism. Moss and

Davies (1968) reported significantly high incidence of

alcoholism in unmarried and divorced people of either sex.

Coleman (1979) observed that when significant changes

occurred in an individual's life for instance marital

instability, an individual's normal coping mechanisms proved

inadequate and he resorted to heavy consumption of alcohol to

alleviate stress.

Condes et al (1990) in their retrospective study among

 55

the alcoholic subjects comprising of 433 samples, found that

2.6 percent of the alcoholics were loners in married life.

Brenman et al (1990) while comparing middle aged

problem drinkers with non-problem drinkers, found that women
reported their problem drinking due to stressors related to
marital stress.
3)059-2-
Lammerpas et al (1990) while investigating 3000 treated
alcoholics, found that underlying family problems related to
spouse in 45 percent of the cases, and broken family in 36
percent of the cases were the causes of alcoholism.

Hwa Hu et al (1991) found in their study on Taiwan

Aborigines that problematic marriages were higher risk for

alcoholism, while Stammer (1988) also found the family

conflicts to be causes which contributed towards alcoholism.

Tejera et al (1991) in their study in a rural setting

in the south of Jenerife in Spain observed a positive

correlation between marital status and higher consumption in

male population.

Miller et al (1991) reported a decline in the alcohol

consumption in individuals prior to their actual transition

to marital status with the trend continuing into the first

year of marriage. The decline in alcohol use stabilized

shortly thereafter, apparently within one year after

marriage.
Bennenberg et al (1992) in contrast observed that

marriage plays not only an important role in the reduction of

alcohol drinking, but also helps in the treatment of

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alcoholism.

2.2.12 SUBJECTIVE WELL BEING OF THE ALCOHOLIC

Literature on well being and positive health, including

mental health, is relatively scant, when compared with the
wealth of literature of disease, disability and disorders.
The Subjective Well Being Inventory scale is a new one,
developed in 1992 by Sell and Nagpal and is yet to be used in

Indian setting. Those which were used so far must be still

unpublished, more so in alcoholics.

Therefore, the review on this area will be focussed on

findings on other tools because subjective well being has

been reported as a composite measure of independent feelings

about a variety of life concerns, in addition to an overall

feeling about life in positive and in negative terms i.e.,

general well being and ill being. Not surprisingly, general

well being in its positive effect, and to somewhat lesser

degree, its negative affect, appear to be stable over time to

an extent that they can probably be called personality traits

(Sell and Nagpal, 1992). Further, Sell and Nagpal (1985)

suggested that there were a number of 'personality traits'

related to subjective well being or quality of life.

Gerard and Kornetsky (1955) studied male addicts and

concluded that the addicts showed greater personality

deviation than the controlled group. They found them

chronically depressed, need for instant gratification,

perhaps to relieve unbearable psychic pain, emotionally

immature, weak ego and superego, deeply convinced that they

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have no power of creativity. They also defined the etiology

of addiction being layed in a complex personality structure,

life history and family and peer group interaction.

Clinebell (1964) reported that alcohol dependent

individuals showed significantly low esteem which means they

have less positive feelings and more for alienation. This

finding was further supported by Brown (1980), Puskash and

Quereshi (1980), Blum (1981), Thompson (1981) and Neeliyara

et al (1988) in their respective studies.

Butcher (1971) found his sample of addicts that they

were of disorganized thinking, experiencing internal

conflicts. They had superficial and impoverished

inter-personal-relationship, having a distrust towards
authority figures. In addition, the drug abusers felt
inadequate and insecure.

Schukit (1973) and Lewis et al (1983) observed that

alcoholic individuals were antisocial in their personality.

Neeliyara et al (1988) using the Psychopathic State

Inventory on alcoholic found that they were pleasure seeking,

egocentric as indicated by self centered and impulsiveness.
They had feelings of insecurity, negative feelings state and
were often unhappy. They further reinforced that alcoholic

individuals considered themselves to be unhappy, depressed

and hence resorted to drinking. This was in conformity with

the earlier findings of McCord and McCord (1964), Buss

(1966), Craft (1978), Cleckly (1978), Craig (1980), Lewis et

al (1983) and Cadonet et al (1984).

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Dejong et al (1991) compared normal Dutch population

with alcoholics and found the alcoholics scored higher on

rejection, overprotection and considerably lower scores on

emotional warmth.

Singh (1991) while doing a study among college youth to

outline some personality and adjustment factors, using tools

like Bell's Adjustment Inventory, Maslow's

Security-insecurity scale, Sinha's comprehensive Anxiety

scale and Mandesly personality Inventory, found the results

indicating that alcoholics were high on neuroticism, anxiety,

insecurity and adjustment at home, health, social, emotional

and overall, while low on extraversion in comparison to

non-alcoholics.

Schall et al (1992) in their study of 731 subjects, on

a biopsycho-social matrix to determine the influencing factor

of alcoholism stated that personality characteristic

contributed to the approach-avoidance conflict that

determined abstinence on varying amounts of alcohol

consumption.

Reviewing the literature it was seen that influencing

variables of alcoholism is multi causal and multi factorial.
Therefore, the study of it cannot be compartmentalized. A

multiple model needs to be developed to probe into the area.

An attempt is therefore being made, to study the
psycho-socio-cultural together with occupational, physical,

financial and marital factors in the present study, devoting

to the objectives, methodology is developed as followed

subsequently.