SEXUAL DYSFUNCTION AND PSYCHOLOGICAL WELL BEING IN PERSONS WITH ALCOHOL DEPENDENCE

INTRODUCTION

Alcohol dependence has been emerged as a major public health problem in modern world. India is not also free from this menace. Alcohol dependence is thought to be influenced by plethora of psychological, sociocultural and socio-economic factors and some innate biological/genetic factors. Earlier substance addiction, including Alcohol dependence was referred as the sign of marked “social deviation”, but later the medical model or the disease model was applied on this problem to understand its facets more accurately. It is often termed as “family illness”, owing to its tremendous impact on the overall structure and functions of the family system (Fox, 1968). Chronic and persistent alcohol use is known to induce sexual dysfunction, which leads to marked distress and interpersonal difficulty. This, in turn, is known to worsen the alcohol abuse. Sexual dysfunction in the alcoholic may be due to the depressant effect of alcohol itself, alcohol-related disease or due to a multitude of psychological forces related to the alcohol use (Gelder et al., 1996). The spectrum of sexual dysfunction encompasses: Decreased sexual desire, Sexual aversion disorder, Difficulty in erection, Difficulty in achieving orgasm and Premature ejaculation (Arackal et al., 2007). Alcohol abuse is the leading cause of impotence and other disturbances in sexual dysfunction (Mendelson et al., 1979). Although the frequency of sexual intercourse declines with age, sexual activity remains an important part of the lives of the majority of middle-aged and elderly people throughout the world. In some men, the psychosocial distress associated with erectile dysfunction may develop into ‘‘secondary’’ depression or aggravate depressive tendencies (Nicolosi et al., 2004). ED and loss of erection hardness have a profoundly adverse effect on their emotional well-being (Litwin et al., 1998).The emotional consequences of ED include depression, anxiety, and loss of self-esteem. ED has positive effects on a man’s mood, self-esteem, self-confidence, and quality of sex life (Steidle et al., 2006). At the same time, the loss of self-esteem and associated feelings of inadequacy may have an impact on a man’s day-to-day relationships with friends and work colleagues. Many men feel too embarrassed to confide in their male friends about their erectile problems and report feeling that they are ‘‘the only one’’ affected by ED or that they are ‘‘old before their time (Tomlinson et al . 2004). The present study was undertaken with the aim of assessing the sexual dysfunction in persons with alcohol dependence syndrome and to explore the relationship between amount of alcohol consumed as well as severity of alcohol dependence and sexual dysfunction. We also aimed to find the association of sexual dysfunction and psychological wellbeing in person with alcohol dependence and control group controls in the Indian context.  

MATERIALS & METHOD 

Design

This study was a cross-sectional one and aimed to examine the sexual dysfunction and psychological well-being in persons with alcohol dependence and control group controls. This study was conducted at the Out and Inpatient department at Centre for Addiction Psychiatry at the Central Institute of Psychiatry, Kanke, Ranchi. Jharkhand, India. The samples of the study were recruited through purposive sampling method and diagnoses were made by the consultant psychiatrists of the institute as per the standard diagnostic guidelines, e.g., ICD-10-DCR [WHO, 1996]. The samples consisted of 30 persons with alcohol dependence diagnosed by the consultant psychiatrists as per the ICD-10-DCR [WHO, 1996] and 30 control group persons.  

Only married men taking alcohol for more than two years were included. Age, income and education of the individual were matched with control group controls. But respondents with others co-morbidities like major psychiatric illness, substance abuse and comorbid general medical illness were excluded in the study.

Participants

The samples consisted of 30 Persons with alcohol dependence diagnosed by the consultant psychiatrists as per the ICD-10-DCR [WHO, 1996] and 30 control group persons were selected after matching them with study group with three parameters (e.g. age, occupation, education and income of the family).

Procedure

Persons with alcohol dependence and control group persons were briefed about the purpose of the study. After that written informed consent was taken from the both groups and necessary data instruments i.e specially designed socio-demographic data sheet, Psychological general well- being index (Dupuy ,1984) and International Index of Erectile Function (IIEF) (Rosen et al., 1997) were applied on both group. 

Measures

The measure used in the present study included Socio-demographic data sheet, Psychological general well- being Index (Dupuy,1984) and International Index of Erectile Function (IIEF) (Rosen et al., 1997).

The Psychological General Well-Being Index (PGWBI) is a measure of the level of subjective psychological well-being. In detail, it assesses self-representations of intrapersonal affective or emotional states reflecting a sense of subjective well-being or distress and thus captures what we could call a subjective perception of well-being. Consisting of 22 standardized items (6 items for the short form), the tool produces a single measure of psychological well-being. The full measure also provides subscales to assess the following domains: anxiety, depression, positive well-being, self-control, general health, and vitality. The validity of the PGWBI was evaluated in a large number of studies. In the 1971 NHANES, the PGWB Schedule was significantly correlated with the items that assessed the needs and utilization of mental health services, with the sociodemographic variables and the items of medical history. Cronbach’s alpha, was calculated for each study. The smallest value was 0.80 and the highest 0.92, indicating that the summary measure showed good internal reliability. 

The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in persons with erectile dysfunction.

STATISTICAL ANALYSES

Descriptive statistics (mean and standard deviation) were used to describe sample characteristics. Inferential statistics like the Chi-square and t-test and were used to compare the sexual dysfunction and psychological wellbeing of the two groups. Correlation-coefficient was used to see the relationship Psychological General Well Being Index and International Index of Erectile Function (IIEF).

RESULT

The Table-1 and 1.1 shows the comparison of two groups (e.g. Study and Control Group) in different socio-demographic parameters. After statistical analysis it was noted that both these groups were comparable to each other and there was no difference in any socio-demographic parameter.

The Table-2 is showing the clinical profile of the persons with alcohol dependence syndrome. The mean age of onset of alcohol addiction was found to be 22.86±4.99 years. The average spending for procuring alcohol in a given month was found to be Rs. 3030.40±1564.19 and maximum amount spending for alcohol was found Rs. 4516.00±2051.24. The duration of taking alcohol was found 11.80±5.15.

The Table 3 indicates that there was no significant difference of International Index of Erectile Function (among all domains) between persons with alcohol dependence and control group persons.

The Table 4 showing the comparative finding of Psychological general well- being Index of the persons with alcohol dependence and control group control. The persons with alcohol dependence syndrome had significantly lesser level of psychological wellbeing i.e., ‘anxiety’, ‘Depressed Mood’, ‘Positive Well Being, ‘Self-control’, ‘General Health’ and ‘Vitality’ than the individual of control group persons.

The table 5 indicates that significant positive correlations were seen between the scores obtained by the persons with alcohol dependence in various domains of Psychological general well- being Index and domains of International Index of Erectile Function.

DISCUSSION 

This study had been planned to assess the sexual dysfunction and psychological wellbeing in person with alcohol dependence. So, 30 persons with Alcohol Dependence Syndrome [Henceforth it will be referred as ADS] were selected in accordance with the criteria of the study and thereafter 30 control group persons were selected after matching them with Study Group with three parameters (e.g. age, occupation, education and income of the family).  For assessing the sexual dysfunction International Index of Erectile Function (Rosen et al., 1997) was used. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction). Higher scores denote more support available. The Psychological general well- being Index (Dupuy, 1984) was used for assessing the psychological scale of the selected subjects (i.e. ADS persons and control group individual). In past both these scales were used in two studies and authors had found them to be suitable for their research protocols (e.g. Hanbury, Cohen &, Stimmel., 1997). 

The mean ages of the ADS persons and control group individual were found to be 34.46 ± 5.26 and 35.83 ± 7.04 years respectively; in this study age range of the persons was 25-45 yr. Past Indian studies also had similar observations( Jeevitha & Suman, 2010; Bhowmick, et al, 2001). Although in this present study both Study (ADS Persons) and Control group Control Group were found to be comparable in most of the socio-demographic parameters but with regards to the educational status ADS persons had significantly lesser educational level than control group (Table-1, 1.1). Addictive behavior has traditionally been held as a deleterious factor for educational performance and academic achievements. These factors are associated to alcohol consumption and alcohol-use disorders in a number of ways. It was noted by few researchers in past that persons with the history of heavy drinking do perform poorly in classes and are at risk of shunning their education prematurely. Their addictive behaviors tend to have negative interferences on school and academics related prosocial activities (Hawkins et al., 1999; Guo et al., 2001). The mean age of onset of the alcohol addiction was found to be 22.86 ± 4.99 years. The age of onset has been found to be little older than Western countries (Johnston et al., 1998; Substance Abuse and Mental Health Services Administration [SAMHSA], 1999; NIAAA, 2000). But in India Bhowmick, et al (2001) had almost similar findings.  The average spending for procuring alcohol in a given month was found to be Rs. 3030.40±1564.19. Although the recorded alcohol consumption per capita has shown steady decline since 1980 in most developed countries, but in India the picture is different. Here it has risen steadily. The per capita consumption of alcoholic beverages among adults in India is increased by 106.7% between 1970–72 and 1994–96.

Finding of the present study revealed that persons with alcohol dependence do not have significant difference in sexual dysfunction than control group persons. It might be the effects of alcohol use by an individual are widespread and noticeable in all spheres (physical, psychological, social, and economical) of an individual’s life. Alcohol consumption has health and social consequences via intoxication (drunkenness), alcohol dependence. In addition to chronic diseases that may affect drinkers after many years of heavy use, alcohol contributes to traumatic outcomes that kill or disable at a relatively young age, resulting in the loss of many years of life due to death or disability.  Results also indicated that persons with alcohol dependence had having lower level of psychological wellbeing in the areas of Anxiety, Depressed Mood, Positive wellbeing, Self-control, General Health, & Vitality as compared with control group persons. The findings indicate that persons with alcohol dependence are vulnerable to psychological problems & intervention to prevent more serious psychopathology from developing. Previous studies also found similar findings i.e. a lack of the social support  ranging from poor self-esteem, low status, disturbed family relations, psychological  problems and distress  have been reported among the  alcoholic individual (Parthasarathy, 2013). Significant positive correlation was observed between various domains of Psychological general well- being Index and domains of International Index of Erectile Function of patient with alcohol dependence. Findings indicate that less anxiety is good predictor for better erectile functions, orgasmic function and sexual desire of individual with alcohol dependence. There is positive correlation between positive well-being and sexual desire it might be that good wellbeing produces sexual desire. It also found that better self-control is sound predictor for good orgasmic function.  Present study also found positive correlation between general health and overall sexual dysfunction. May be good general health increases overall sexual satisfaction. In this study there is positive correlation between vitality domain of psychological wellbeing and various domains of sexual dysfunction i.e. erectile function, sexual desire, intercourse satisfaction and overall satisfaction. In this way it can be said that if individual is having good psychological well-being and good energy it leads to better sexual life and sound relationship. The results of this study have implications in terms of awareness creation, improvising de-addiction services, training and further research on this special population with alcohol dependence syndrome and their spouses/partners. It has paved the way for understanding the need for comprehensive, feasible, and psychosocial/sexual services for patients with alcohol dependence having sexual dysfunction. Moreover, this study also enlightens the need to regularly assess sexual function in ADS patients. Planning of similar studies in urban and rural areas of India and also in female gender as well as at the community level can be done. Sensitization programs at schools and colleges highlighting this aspect, as well as interventional programs and treatment effectiveness studies, comparing the various methods to correct alcohol-induced sexual dysfunction, can be tried. Our sample size was small larger sample size would be required for better generalization of the results. We used nonrandomized sampling technique in this study. A comparison with appropriate age- or sex-matched sober individuals as controls would have given more reproducible results. There is a major need for long-term prospective research. The personality, psychopathology, and coping strategies, family dynamics, marital functioning, and other environmental and psychosocial elements which may be additional contributory factors for sexual dysfunction in alcohol dependence syndrome, were not explored in the current study. The study included only 30 participants and the participants could not be followed up after proper psychosocial interventions. In future, a study that overcomes these limitations could throw more light on the current findings.

CONCLUSION

The study indicates that good psychological well-being is predictor of good overall sexual satisfaction and that persons with alcohol dependence have poor psychological well-being in all domains as compared to control group persons. Therefore treating alcohol dependence in such persons would not only improve their psychological well-being, but also increase the overall sexual satisfaction.

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Conflict of interest: None
Role of funding source: None