http://doi.org/10.33698/NRF0272-Aparajita Guin, Karobi Das, Sunita Sharma, Abhishek Ghosh
ABSTRACT
Background: Addiction inuences performance of an individual as well as viability of his life. It also intensies the physical and psychological problems. From psychological perspective, the devastating inuence of substance addiction is exceptionally signicant as the major consequences not only cuddle the individual but also ruin the personality facets, social functioning, neighboring environment, family, friends, and overall quality of life. Objective: To assess self-esteem of the patients attending the DDTC unit of PGIMER, Chandigarh. Methodology: The descriptive study was conducted among 60 male patients with substance use disorder aged between 18-50 years by using Consecutive sampling technique in the DDTC unit, PGIMER, Chandigarh. The self-esteem of the patients was assessed from July to October, 2018 by interviewing the participants using an interview schedule comprising of a) socio demographic and clinical prole and b) Rosenberg self-esteem scale. Descriptive statistics (mean, frequency, percentage) were applied to analyze the data. Results: The participants were in the age range of 18-50 years with the mean age 30.45±8.59 years. One fourth of the participants had started abusing substance before 18 years. The mean age for starting substance abuse was 22.98±6.04 years and range varies from 12 years to 40 years. Majority of the participants (73%) had moderate self-esteem and one fourth of them reported to have low self- esteem. The mean self-esteem score of the participants was 22.17±4.49 with the range of 11-34. Conclusion: Patients with substance use disorder mostly have low or moderate self-esteem. Adolescent period is vulnerable for starting the substance abuse as reported in the present study.
Key words: Substance Use Disorder; Self-esteem.
Address of correspondence:
Dr. Karobi Das
Lecturer, Clinical psychology NINE, PGIMER, Chandigarh
Introduction:
Substance abuse refers to a form of malec or hazardous use of any substances in order to lighten the mood. Substances include any kind of psychoactive substances such as alcohol or drugs may be illegal or not and some other substances that may not be drugs typically. Abuse can be the result of unfair usage of any substance in such a way that is not recommended, inscribed or prescribed.1According to WHO (World Health Organization), “substance abuse is persistent or sporadic drug use inconsistent with or unrelated to acceptable medical practice”.2
In India, the commonest used substance is alcohol (80-90%) followed by using cannabis (4-20%). Nearly more than half of the males reported using substances once or more in their lifetime. But the type and percentage of substance abuse varies from region to region. About 70% people are using some or the other substance daily. It was found that in the rural community of Uttar Pradesh 38.3% were habitual substance users. In the rural population of Bihar, it shows the prevalence of drug use was 28.8%.3-5 While investigating about the contributory factors of substance abuse, self-esteem has been identied as an important contributory factor to substance use as well as substance abuse. According to Rogers self-esteem is the self-valuing and acceptance of oneself. How much worthy or valuable a person is in his/her own eyes that we can refer to as self-esteem. It is a dynamic concept and largely inuenced by signicant others in one’s life.6
According to Kaplan’s Theory a person with low self-esteem is more prone to committing asocial behavior like substance abuse. Moreover, several studies concluded that low self-regard is a key factor of social incompatibilities of an individual. The individual who has control over their life seems to be mentally healthy, they consider themselves to be a worthy living, have high self-esteem that leads to a favorable quality of life comparing to those who lacks such control over their life.7 To date, research on self-esteem among the patients with substance abuse is scarce, though available literature is there regarding self-esteem among specic substance users like alcoholics or cannabis users. So, the researcher attempts to assess the self-esteem of the patients with substance use disorder in the present study.
Objective:
To assess self-esteem of the patients attending the DDTC unit of PGIMER, Chandigarh.
Materials and Methods:
A descriptive study was done to assess the self-esteem of the patients attending the DDTC unit of PGIMER, Chandigarh from July to October 2018. Total 60 patients with substance use disorders, selected from DDTC unit, PGIMER, Chandigarh by using consecutive sampling technique, were enrolled in the study. Tool used for data collection was an Interview schedule comprising of a) socio demographic & clinical prole and b) Rosenberg self- esteem scale. For assessing self-esteem Rosenberg’s self-esteem scale was used. It is a standardized ten item Likert scale with items answerable on a four-point scale – from strongly agree to strongly disagree. It has total 10 items, among which 5 are positive and another 5 are negative items. For positive items (1, 3, 4, 7& 10) the scoring was 4 for strongly agree, 3 for agree, 2 for disagree and 1 for strongly disagree. For the negative items (2,5,6,8 & 9) the scoring was reverse. Scores of the individual items are summed to obtain the total score. The total scores are interpreted as follows: 10 to 20 score was interpreted as Low self-esteem, 20 to 33 was moderate Self-esteem and 33 to 40 was High self- esteem. “Higher the score, higher the self- esteem.” The tool was available in the open domain. Ethical permission was taken from the Institute Ethics Committee, PGIMER, Chandigarh. Participants were made comfortable during the interview and interview was done only after taking informed consent from them. Interview was conducted in a separate room of DDTC unit for duration of 20-30 minutes for each patient. Descriptive statistics (mean, frequency, percentage) were applied to analyze the data. participants (92%) were taking the substances on a daily basis, 43% reported that they used to spent less than Rs. 500 per day for buying substance, whereas 35% used to spent more than Rs.2000/- per day for substance(s). 50% participants had the previous history of drug de addiction
Table 1: Socio Demographic Profile
| Sl.
No. |
Variables | n(%) |
| 1. | Age (In years)
18-27 28-37 “38 |
28(46.7) 18(30.0) 14(23.3) |
| 2. | Educational status Primary education Secondary education Higher Secondary
Graduate & above. |
6(01.0) 18(30.0) 19(31.7) 17(28.3) |
| 3. | Occupation Professional/semiprofessional Skilled worker
Unskilled worker Unemployed |
10(16.7)
14(23.3) 21(35.0) 15(25.0) |
| 4. | Marital status
Single Married |
29(48.3)
31(51.7) |
| 5. | Per capita income
“5000 >5000-10000 >10000-15000 >15000-20000 >20000 |
17(28.3)
22(36.7) 5( 8.3) 4( 6.7) 12(20.0) |
| 6. | Religion
Hindu Muslim Sikh |
26(43.3) 3(05.0) 31(51.7) |
| 7. | Locality
Rural Urban/Semi urban |
24(40.0) 36(60.0) |
| 8. | Type of family
Nuclear Joint/Extended |
31(51.7) 29(48.3) |
| 9. | Family history of substance abuse | 10(16.7) |
Results:
T h e s o c i o d e m o g r a p h i c d a t a summarized in Table 1 shows that participants were in the age group of 18-50 years with the mean age of 30.45±8.59 years. One third (32%) participants were educated up to the higher secondary level, 25% participants were unemployed and 35 % were unskilled worker. Half of the participants were married. One third of them had per capita income within a range of Rs. 6000-10000. More than half of the participants (51.7%) belonged to Hindu community. Almost one third of the participants were resident of an urban/semi urban area. Almost half of the participants were from joint families and 16.7% participants had a positive family history of substance abuse.
Table 2 shows half of the participants (50%) were multiple substance abusers, 30% are alcohol abusers, 18.4% were Opioid abusers. One fourth of the participants had started abusing substance in the age of less than 18 years. The mean age for starting substance abuse was 22.98±6.04 years and range varies from 12 years to 40 years. Most of the participants (around 60%) were abusing the substance(s) from more than 5 years. The mean duration for substance abuse was 8.80±7.71 with a wide range of 2
of the Participants
|
N= 60
months to 30 years. Majority of the
*Mean±SD (range) : Age: 30.45±8.59 years (18-50 years)
Income: Rs.14792.50±18959.33 (1200-100000)
Table 2: Clinical profile of the Participants
N=60
| Sl.
No. |
Variables | n(%) |
| 1. | Type of substance abuse
Alcohol Cannabis Opioid Multiple |
17(28.3)
2(03.3) 11(18.4) 30(50.0) |
| 2. | Age of starting substance abuse (years)
<18 18-28 >28 |
15(25.0)
39(65.0) 6(10.0) |
| 3. | Duration of substance abuse(years)
Less than 1 year 1-5 >5 |
4(06.7)
21(35.0) 35(58.3) |
| 4. | Frequency of using substance
Everyday Several times a week |
55(91.7)
5(08.3) |
| 5. | Money spent per day
<500 501-1000 1001-1500 >1500 |
26(43.3)
8(13.3) 2(03.4) 24(40.0) |
| 6. | Previous history of drug Deaddiction treatment | 30(50.0) |
Mean±SD (Range): Age of initiation of substance abuse: 22.98±6.04(12-40) Duration= 8.80±7.71 (2 month-30 years)
Mean±SD (Range): Money spent per day= 1984.05±2291.11 (Rs. 3-10000) treatment including inpatient and OPD treatment.
Table 3 depicts that majority of the participants (73%) had moderate self- esteem. only 1 participant had high self- esteem and rest of the participants (25%) had low self esteem.
Table 3: Self esteem of the participants assessed by Rosenberg Self Esteem Scale
| Self Esteem (score) | n (%) |
| Low (10-20) | 15 (25%) |
| Moderate (20-33) | 44 (73.3%) |
| High (34-40) | 1 (1.7%) |
The mean score of self-esteem was 22.17±4.49 with a range of 11-34.
Table 4 depicts that majority of the participants (67%) agreed or strongly agreed that they are not satised with themselves. Sixty percent participants felt that they are not able to do things as well as most other people. More than half of the participants (63.33%) said that they think they are no good at all. Seventy percent participants did not have much to be proud of. Almost 89% of them wish to have more respect for them and half of the participants felt that they are failure in their lives. There was no association found between the socio demographic or clinical prole and self esteem of the participants.
Table 4: Individual item wise comparison of Self Esteem of the participants
N=60
| Sl.
No. |
Items | Strongly
agree |
Agree | Disagree | Strongly
disagree |
| 1 | On the whole, I am satised with myself. | 4( 6.7) | 16(26.6) | 13(21.7) | 27(45.0) |
| 2 | At times I think I am no good at all. | 30(50.0) | 8(13.3) | 20(33.3) | 2( 3.3) |
| 3 | I feel that I have a number of good qualities. | 4( 6.7) | 35(58.3) | 20(33.3) | 1( 1.7) |
| 4 | I am able to do things as well as most other people. | 3(05.0) | 21(35.0) | 21(35.0) | 15(25.0) |
| 5 | I feel I do not have much to be proud of. | 35(58.3) | 7(11.7) | 14(23.3) | 4(6.7) |
| 6 | I certainly feel useless at times. | 30(50.0) | 13(21.7) | 15(25.0) | 2(3.3) |
| 7 | I feel that I’m a person of worth, at least on an
equal plane with others. |
6(10.0) | 17(28.3) | 16(26.7) | 21(35.0) |
| 8 | I wish I could have more respect for myself. | 53(88.4) | 2(3.3) | 2(3.3) | 3(05.0) |
| 9 | All in all, I am inclined to feel that I am a failure. | 18(30.0) | 12(20.0) | 19(31.7) | 11(18.3) |
| 10 | I take a positive attitude toward myself. | 16(26.7) | 27(45.0) | 10(16.7) | 7(11.6) |
Discussion:
In today’s scenario no part of the world is free from the curse of substance abuse including addiction, dependence and drug trafcking. India is also caught in the vicious cycle of drug abuse and the numbers of drug addiction are increasing day by day. To date, research on self-esteem among the patients with substance abuse is scarce, though available literature is there regarding self- substance abuse over a period of one year. The result depicted that the age of starting substance use was 11- 20 years for majority of the participants (76.8%). The study showed commonly used substances was nicotine (94.4%), medicinal opioids (65.7%), cannabis (63.6%), benzodiazepines (45.5%), other prescription medications (43.4%), alcohol (32.5%), inhalants (11.1%), and cocaine (7.5%). Multiple substance abuse esteem among specic substance users like was present in 91.9% of patients.9 In the alcoholics or cannabis users. So, need was felt to assess the self-esteem of the patients with substance use disorder in the present study. For assessing self-esteem, Rosenberg self- esteem scale was used in this study as this scale is used and recommended in various studies previously.1,2
In the present study the mean age of the substance abusers was 30.45±8.59 and mean age for starting substance abuse was 22.98±6.04. One fourth of the participants reportedly started using substance before the age of 18 years. This nding is similar with the study conducted in Ahmadabad, India with 560 patients with substance use over a period of one month, where the mean age of the participants was 32.8±1.6 years, the mean age for initiation was 23.9±5.63 years and 39.6% patients started using substance at the age of 16-20 years. So, it can be seen that though the initiation of substance abuse starts at a very early age, but the patients come for treatment at later ages. The study results also conclude that adolescents time period is most vulnerable for starting substance abuse. Peer pressure, being one of the major factors for initiating substance abuse at such an earlier age.8
Many studies have reported about multiple substance abuse. A study, that reported such results, was done in Jammu & Kashmir, India on 198 patients with present study the age range of starting substance abuse was 12 years to 40 years. Half of the participants (50%) were multiple substance abusers, 30% are alcohol abusers, 10% only opioid abusers. The mean duration of substance abuse was reported as 8.80±7.71 years with a wide range of 2 months to 30 years. Most of the participants had per capita income of Rs. 1000-10000. A positive family history always inuences the addiction. By following the theory of modeling we can say that by seeing the parenting gures or siblings one develops the habit of substance, though in the present study very few participants (16.7%) reported of having positive family history of substance abuse.
In the present study majority of the participants had low or moderate self-esteem. only one participant showed high self- esteem. This result can be correlated with a descriptive correlation study to predict the tendency of substance abuse on the basis of self-esteem and components of emotional intelligence which revealed that there is a signicant negative relationship between self-esteem and tendency to drug abuse. With 153 participants in the study the mean self- esteem score was found to be 18.73±4.49, as measured by Rosenberg’s self-esteem scale.10 Based on the ndings of the study it is recommended to implement interventions to improve the self-esteem especially of the youth to keep them away from the devil of drug abuse. A person with low self-esteem is afraid of facing the ‘ups and downs’ of life rather like to ‘escape the self’ through many escapist behaviors, substance abuse being one of the important among them. So, by improving the self-esteem substance abuse can be reduced and nurses working in the psychiatric unit can play an important role here by helping the patients with substance use disorders with the activities to improve self-esteem.
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