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CHAPTER 11

REVIEW OF LITERATURE
2.1.0 Introduction
Concern about the effect of alcoholism on wives, chldren in family and Marital functioning has been fiequently expressed by clinicians and by others in recent research literature. Apart fiom wives' disturbed personality model and coping behavior, efforts to understand and explain the emotional experience of wives of alcoholics are still calling in h s field. Literature dating back to the mid - nineteenth and early 2om century reflects a moralistic view. Alcoholics were regarded as villains and farmlies as victims. Approaches to assistance type cast the drinker as character defective and, thus incomgible. Helping efforts were geared toward other members of the family, wives and chldren (Bailey, 1 963)'. Early studies of the wives of alcoholics in a family- agency setting described them as often equally as sick as their husbands with a need to dominate, to suffer, to punish, or to belittle their mates. Such a wife and frequently the daughter of an alcoholic father may also suffer fkom feelings of basic anxiety and inadequacy whch can be denied or assuaged by feeling superior to her husband (Fox, 1 968)2. Women are emotionally more open than men to the concerns of their loved a ond therefore experience more distress in events that occur to that person and are therefore more vulnerable. (Kessler, et 1 This has been considered to be part of the chronic stress associated with the tradtional role functioning of women. However apart fiorn being providers of support (Belle, 1 it has been found that women resort to social support as a salient coping strategy to a much hlgher degree than men (Defares, et a1 19 851~A. ll these facts must be taken into consideration whlle intervention process of alcoholics and his farmly members are done. To date efforts to understand and explain the experiences of wives of alcoholic S have generated three different perspectives. The earliest published model (Futterrnan, 1 9 5 3)6 called the ' disturbed personality model' held the view that a woman who is in some way psychologically maladjusted dependent, hostile, domineering, masochistic and sadistic marries the alcoholic to llfil her own neurotic needs. In the 1950's a second model was proposed which stated that wives of alcoholic may di splay maladaptive behaviour in response to their husband' S d m h g (Jackson, 1954)'. According to this position the wives' pathologcal behaviour is an attempt to resolve the alcoholic crisis and to retum the family to its former stability. The second model was called 'stress model ' . Consequently a third model called psychosocial model (Orford and Guthne. 1968)~w as evolved whch stated that a broad variety of variables, including both personality and situational factors seem to be important (Tyler and SchafTer, 1979)'.

In h sch apter, an attempt is made to briefly review some of the important findings re1 ated to wives of alcoholic' S especially the emotional disturbance they are facing and the factors leading to it. For the purpose of the present review, the significant findings and observations are written as follows: 1. Personality ofwives of alcoholics. 2. Coping behaviour in wives of alcoholics. 3. Stressfbl situations in wives of alcoholics. 4. Familial andmarital interactions and chldrenof alcoholics. 5. Anxiety, Depression, Adjustment, Sel f-concept and Assertiveness in wives of alcoholics. 6. Treatment.

2.2.0 Personality of Wives of Alcoholics


Earlier only a few studies were carried out on wives of alcohol dependent individuals in the form of observation of wives who were directly involved in the treatment of alcohol dependent indtviduals in the family agency settings. Lewis (1 937)" endeavored to ln wives personality to the husband's the i k alcoholism. He believed that wives of alcohol dependent individuals found an outlet for aggressive impulses in their marital relationship with men who are dependent and force her to punish him. Both partners alternated between 'Masculine' and 'Feminine' roles. Price (1945)" after studylng the personality of 20 wives of alcohol dependent individuals, concluded that they are basically dependent people who became hostile or aggressive towards their husbands on finhng them also dependent. Whalen (1 953)12 placed wives of alcohol dependent kdtviduals into four categories. 1. Suffering Susan: who, to putllsh herself, chooses a husband who would make her life miserable. 2. Controlling Catherine: who needed to dominate someone and choose a weak inept husband. 3. Wavering Winnifiiend : who to be loved sought a weak inept husband who needed her desperately. 4. Putvtive Polly : who needed an emasculated husband to control and punish. Saugy, D. de, (1964)13 studied the personahty of wives of alcohol dependent individuals. The author took 100 couples in which the husbands were alcoholics. The study was carried out by clinical interview. The study did not use any psychological tools. However, on the basis of th~s inte~ew,th e c linical author found that, the wife was dominant from the beginning of the marriage. There was no single personality type but most common traits were dependency, fiigidi ty, sadomasochistic tendencies, and 0th er manifest ations of neuroticism and need to find fault. Tarter, Ralph (1976)'~ administered the MMPI and the California Psychological Inventory (CPI) to 38 women (mean age 43 years) whose husbands

were parhcipants ininpatient treatment program for alcoholism. Data from the an MMPIs completed by all 3 8 women and from California Psychological Inventory completed by 23 women inheate that wives of alcoholics are not impaired psychologically and that they do not exhibit any distinct personality characteristics. Tomelleri, Hejanic, Wetbel (1 97 5 the personality of the wives studied 71 ) along with other aspects llke (1) psychatnc diagnosis in d e , (2) family h s t q of psychlatnc disturbances (3) and type of marriage. The tools used were Cali fomi a Personality Inventory developed (Gough, 1 95 9) and a structured and scaled interview to assess maladjustment (SSIAM). Natera, G. et al, (1 988)" studied physical, social and family behavioural characteristics of wives of alcoholics. Their sample size was 25 each and age group was between 20 and 50 years. All the samples were:- Mexican adults. Group- l wives of alcoholics attending Alcoholics Anonymous meeting. Group I1 wives of alcoholics attendmg hospital or clinic rehabilltation or treatment s e ~ c e. s Group I11 wives of non- alcoholics. All the samples underwent a structured interview that included the Health and Daily Living Questionnaire (R. Moos, et al, 1983) and the Alcohol Consumption Questionnaire. An analysis of variance (ANOVA) was conducted. Avila Escribano and Ledesma Jimeno (1 990)" stu&ed personality characteristics of wives of Spanish alcoholism patients. Human samples: 35 female Spanish adult (aged 26- 5 9 years) spouses of alcoholics in treatment. Samples completed a structured interview, the Minnesota Multiphasic Personality Inventory (MMPI) and Instrument I (A. Ledesma, Jimeno , et al ) - a measure of aggression. Troise, F. P. (1 992)18 compared the experienced level of intimacy in 160 wives of alcoholics with 80 wives of non alcoholics in their relationship with their best or closest fiend, using the Miller Social Intimacy scale by R.S. Miller and H.M. Lefcourt (see PA, Vol. 69: 46. hypothesized that there would be a It 5 7was ) lower experienced level of intimacy in wives of alcoholics' relationship with their best or closest hends outside of the marital dyad. The hypothesis was not supported. Findings offer cautious support of reaction to stress theories regarding wives of alcoholics. They also suggest that sane wives of alcoholics may marry an alcoholic with a pre-existing incapacity for intimacy. Grubi, et al, ( 1 998)'%investigated the personality d 1 00 of wives i of alcoholics in comparison to 100 wives of non-alcoholics and compared these two groups according to psychiatric treatment fi-equency. The groups were identical with respect to their age, working and marital status. Eysenck Personality Questionnaire was used for measuring the main personality dimensions. A structured psychiatric interview based on ICD -1 0 and DSM-IIR and self-assessment of behaviour before marriage (extroverted Vs introverted) was also used. The result showed that the wives of alcoholics were less extroverted than the wives of non-alcoholics. There were no differences in the

neuroticism and psychoticism. Accordmg to the self-assessment of their behaviour before marriage wives of alcoholics also manifested less extroverted behavior before marriage. The wives of alcoholics were p sychatncally treated more often during their marriage than the wives of non-alcoholics. Moreover, the group of the wives of non-alcoholics had fewer psychatric treatments during their marriage than before the maniage. More psychatric treatments during mamage of the wives of alcoholics can be interpreted in accordance with the "stressed wife" theory.

2.3.0 Coping Behaviour in Wives of Alcoholics


Jackson, J. A. (1954)" outlined seven successive stages of family adjustment to alcoholism. They are denial of the problem, chsoryanization, and attempts to reorganize in spite of problem, efforts to escape the problems and reorganization of the whole family. m l e Jackson's stage theory may not be applicable to all alcoholic families (Lemert, 1 90" disorganization of the family 6 ) system and reorganization along other lines occur, to some extent in the majority
of alcoholic families (Block, 1 965). James and Goldman ( 1 9 7 1 ) ~fo~u nd out that the wives used all sorts of coping, they themselves were more quarrelsome, they felt angry, they felt helplessness on other occasions, they adopted a strategy of withdrawin g, or avoiding the husband altogether, they had tried to get drunk themselves to show them what it was like or they had locked the husband out of the house. Orford and Guthne (19751~a~im mistwed a coping with di r n questionnaire to the 1 9-60 years 01 d wives of 1 00 males referred to the outpatient department of a psychiatric hospital because of a suspected drdmg problem. Other measures included evaluations of husband's treatment outcome, husband's job status, the neuroticism scale of the Eysenck Personality Inventory, a l 0-item symptom scale, and 10 item hardshp scale. Results indicate that hg frequency i h coping behaviour is associated with a relatively poor treatment outcome, whatever the nature of coping behaviour used. The coping components, which are most uniformly associated with a poor prognosis, were those that suggested a withdrawal or msengagement from the marital bond (e.g.: avoidance, feeling hghtened or seeking outside help). Husband's job status was significantly negatively correlated with symptoms, hardship, and wife neuroticism. Llke, Orford, and Guhe (1975)' Tyler and Schaffer (~9) a1 o l9 s ~ 7 predicted poor outcome for behaviours that suggested withdrawal or disengagement from marital bond. The elements are those of avoiding, refbsing to talk, feeling helpless, refusing to sleep together, feeling fhghtened, m h g special financi a1 arrangements, seekmg special outside help and contemplating terminating the bond together. Tyler and Schaffer (1 979)' conducted a study with a view to studying the degree of sobriety in male alcoholics and the coping styles used by their wives.

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The major hypothesis was that, the wives' coping behaviour would be significantly related to the husband's drinking behaviour. The results showed that the coping styles used by wives of alcoholics are related to dnnking outcome in their husbands. Those modes of coping in which the wife commutllcates her feelings of &stress and hstration to the drinking husband in a way which is minimally threatening for him seem to be most positively related to his attainment of sobriety. Chakravarthy, et (1985)~ the cuping behaviour of the at, ex~ mined a wives of alcoholic men who were admitted into a therapeutic programme for giving up alcohol dnnkmg. 46 samples , aged (22-43 years) were administered a questionnaire designed by J. Orford and S. Guthrie (1975) for measuring coping behaviour of alcoholics as well as Eysenck' s Personality Inventory . Demographc details were also collected . Ten styles of copkg behaviour were used by all samples: &scord, feadbl withdrawal and avoidance were the styles used most. The combination of styles used by wives at a particular time seemed depedent on the age, extroversion and neuroticism in the wife and the duration of the husband' S drinking . Rychtarik, et a1 ( 1 9 8 82 stuhed situational assessment of alcohol-related ) 7 coping slulls in wives of alcoholics. He used a situation-specific inventory for h s purpose, and it was administered to 45 middle aged wives of alcoholics. Generalisabil ity analysis indicated that most of the variance in performance was accounted for by cross-situational differences ao samples. Al- Anon m n experienced samples scored significantly higher than those with little or no AlAnon experience. Situational assessment of alcohol related coping skdls shows promise as a refined method for identifjmg specific shll deficits in wives of alcoholics. Sathyanara Rao Kuruvilla (1992)'~ report that the most common and coping behaviour resorted to by the wives is discord, avoidance, indulgence and
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fearfid withdrawal. They said, the husband's alcoholism in turn causes the coping behaviour of the wde. They also noted that wives who reported that their husbands had become violent and aggressive had reacted with qumelling avoidance, anger and helplessness, pretendmg to be duk themselves, loclung r n the husband out of the house and seelung a separation. Simpson and Arroy Judrth (1 used multiple regression analysis to predict alcohol related consequences and consumption f?om background characteristics and coping with stress in 2 life domains (work / school). 192 females aged 1 8-46 years, who reported being raised by at least biological parent and who consumed alcohol at least once during a typical month in the past year completed the following questionnaire: the Demographic Information Inventory, the Substance Use Inventory and the Coping was associated with consequences across the life domains but not with consumption. Relylng on avoidant coping to handle stressors at work or school, in conjunction with being single and reportmg

a greater family hstory of alcohol problems, accounted for of the variance 1 8-3% in alcohol consequences. Avoidant coping and acceptance of responsibility for personal stressors, along with being relatively younger and reporting a relatively greater family hstory of alcohol problems accounted for 1 77the variance in of% . alcohol consequences. Evidence of bt cross-situational consistency and o h specificity in coping associated with problematic alcohol use was found.

2.4.0 S Situations in Wives of Alcoholics t


It is frequently noted that the situation of having an alcoholic member in the family is a source of confusion and stress. The research conducted by Margret Bailey in USA (1967)~' showed the that the proporhons of women who had scores indicating at least a moderate degree of psychological disturbance were 66% for wives still living with dnnking alcoholic husbands, 43 % where the formerly a1 wholic husbands were now abstinent, and roughly 3 3% for control women in Manhattan. She also found that the time, which had elapsed since the wife had been living with a drhkmg alcoholic, was related to level of disturbance. Jackson (1962)~' describes the stages of adjusting to the alcoholic husband. Early in the marriage there may be an occasional overstepping of bounds with heavy drinking. As the frequency of such occurrence increases, the wife begins to feel humiliated and ashamed. She curtails their social life and is under the impression that she has somehow failed in her marriage. There is hostility, hstration, f threats of leaving. The wife reacts to the alcoholic's and i violence by crying in tenor, retaliating or calling the police. Wisanan, Jacqueline (1 95' describes the self-reported lives of 75 7~ 1 women mamed to alcoholics. m l e all wives attempted to help their husbands, eventually 40% isolated themselves fo marriage adopting an independent their r m workmg and social existence. If the husband of such a wife attempted to stop drinking after thi S separation occurred, his wife might be placed under stress by the choice she faced. In the early days of the development of alcoholism, the family may go through, a long period of indecision and confusion. The second aspect related to it is role management. The functions normally carried out by the husband have to be taken over by the wife which will add to her p ychologcal stress (Orford, 1 976P3. Montgomery and Johnson (1992)~re~p orted that lustorically wives of alcoholics have been described as having disturbed pathological personalities that were instrumental in causing and maintaining their husband's drinking. More recently researches have tended to support the view that the behaviour of these women reflects their stressful circumstances. The women in study reported the interpersonal, extrapersonal and intrapersod stressors. The most frequently reported and ranked stressor was t hghest relationships with their husbands. h Sobriety does not necessarily mean that stressors disappear 2.5.0 Familian and Marital Interactions and Children of Alcoholics

The impact of an alcoholic behaviour on the family, especially on wives chldren and is the primary focus of most researchers. Families with alcoholic member are characterised by a variety of structural dysfunction, includmg chaotic or rigid patterns of adaptability (Steinglass, 1 97 5 :5 Anderson and Henderson, 1983") and dtsturbed interactional boundaries (Anderson and Henderson, 1983, Seixas and Youcha, 1 985)37. Marital interaction is one of the crucial areas, whch helps in delineatmg . Psychopathology underlying various psychiatric illnesses. A number of marital relationslups have been stuhed like interpersonal communication, understanding, well being emotionality and love, problem solving and supportiveness, personal growth activities and structured arrangements. Chlldren of alcoholics are more llkely to have conduct or behavioural problems, rather than the neurotic type. A study by Haberman (1 96613* found out that conduct problems and truancy were more common in children of alcoholics than in control chldren. Drewery, J. and Rae (1 969)39 report that the interpersonal relationship between the alwholic and h s wife is characterised by a clear evidence of conflicting dependence- independence needs. The weight of the evidence favours the interpretation that it is the patient's neurotic difficulties rather than any psychopathology in his wife, which has determined the interpersonal dilemma. Sabhaney (9 died the family and social b alcohol s~ 1 tu 7 of a dependent individuals. In this study the two groups of families were taken. The sample consisted of 3 0 families of alcohol dependent individuals and 30 fmilies of normals. The wives of alcohol dependent individuals and nomals were studied m d y in family. Different variables were taken to study. They are the personality, family interaction and family attitude to drinking. The tools used in the study were (1) Multi-phasic Personality Questionnaire (Murthy, et at, 1969). (2) Semi-structured Interview. Ther concluded that, the families of ato u h alcoholics were more disorganized, more clinically hagnosed cases were seen in the family in comparison with the families of normal individuals. With regard to family i author found that, the alcoholic's family is having more the n dtsharmony, in terms of resentment, anger, arguments and or physical verbal fights. Along with h s both overt and covert forms of hostility also were seen. The perception of other's needs was minimurn in family members of alcohol dependent individuals. Among alcohol dependent individual' S families out of 3 0, 9 families showed family lustory of alcoholism. As seen on M.P.Q. test the anxiety, depression, mania, paranoia, sclumphreni a and psy chopahc deviate are more common among wives of alcohol dependent individuals than aog the m n wives of n o d s . Kumar and Rohatgi (9und that to achieve a better adjustment in fo8 1 marriage both the husband and the wife should be intelligent and share common

extroversive interests. However, as far as the dominance variable is concerned, the husband should be dominant whereas the wife should be somewhat submissive, in keeping with the expected cultural role for better adjustment in marriage. Edwards, D. M. and Zandr, T. A. (1985)" discussed the impact of the alcoholic family experience on the development of children. Although there is no typical alcoholic family, often family life is inconsistent with a generally disruptive atmosphere. There may be role confusion and stress. Alcoholism and m-alcoholism (the pre occupation of the non-alcoholic parent with the alcoholic spouse) leads to a lack of responsiveness to the child by either parent. The child is robbed of attention, consistent disciphe, and a trustworthy environment. Role reversal oflen occurs between parent and chld, with the chld taking on the parenting role. Inconsistency in the family leads to denial by the chldren and lack of attention and leads to depression. Four role patterns that chtldren of interest alcoholics may exhibit include the responsible one, the adjuster, the placater and the actmg-out child. Elementary school counselors need to observe symptomatic behavioural patterns in identifjrmg chldren of alcoholics. Counsehg strategies for chldren of alcoholics include establishing a trusting relationship, helping the child overcome denial of parental alcoholism, explaining alcoholism to child, and helping the chld develop positive relationhp with others. To compare adults raised in an alcoholic home (N-409) Black, et aI (1986)" conducted a study on the interpersonal and emotional consequences of being an adult child of an alcoholic, with those adults raised in a non alcoholic home (N=179) on their perceptions of alcohol related differences in the home, violence, sexual abuse, communication and interpersonal differences experienced as adults. The adults who were raised in alcoholic families reported significantly less utilization of interpersonal resources as a child, had significantly more family ksruptions characterized by a higher divorce rate and premature parental and sibling death, reported more emotional and psychologcal problems in adulthood, experienced more physical and sexual abuse as children; and more frequently become alcoholic and married alcoholics when compared to adults raised in non alcoholic families. Desai (1986)~in~ h s empirical study on the efficiency of family therapy found that, the wives of alcoholics commonly responded with complaining, disapproving and derogatory comunication styles. Feedback and imparting positive comrn unication skills were found to be uel techniques. su f Dunn and Nancy, et al, (1 987)" studed the relation between alcohol consumption and marital stability, assessed longtudinally in two gops ofumale r alcoholics: in home (n=4) and out of home (=) drinkers. Through the use of n 4 univari ate and bivariate time series analysis, the shdy identified a causal relation, between alcohol consumption and marital stability and sigruficant impact of cl.nnkmg location on obtained relations. Findings suggested in terms of

Steinglass's suggestion that alcohol can have adaptive consequences for the marriage and family life of alcoholics. Clair and Genset (1f~ und ~ t children of alcoholic fathers as 9 ) ~ tha 7 o opposed to those of non-alcoholic fathers described their families as more dysfunctional and reported receiving less guidance than the others receive. They reported engagng in more avoidant coping behaviour. Based on the review of literature related to parental alcoholism and childhood psychopathology, West and Prinz (1 9g~ substantive o7' r 8 & 1 findings around eight areas of outcome, (a) hyper activity and cn chsorder (b) o d substance abuse, delinquency and truancy (c) coptive hctioning (d) social inadequacy (e) somatic problems (f) anxiety and depressive symptoms (g) physical abuse and (h) dysfunctional family interactions. The literature as a whole supported the contention that parental alcoholism is associated with a heightened incidence of child symptoms of psychopathology, in comparison with no increased incidence in offspring of non-hsturbed parents. Evaluation of the psychosocial and cognitive status of school-age children may help to identify individuals who are at greater risk for adult conditions such as alcoholism. Bennet, et a1 , (1 998)48 felt that it is not only the alcoholic parent who is inextricably involved in the disorder, but the entire family is part of a system that has implications for the course and consequences of alcoholism and or the hcttoning of all family members. A study on alcoholic's housewives and role satisfaction by Farid, a1 et ,( 19 891r~e~ve aled a strong relationshp between dissatisfdon with the role of housewife and severity of alcoholism. On a range of sexual satisfaction variables the alcoholic and maritalconflict couples &d not differ with both groups of couples reportmg less sxa el u satisfaction than non-marital conflict couples (Farrel, Choquette and 0 '

Birchler,
1991)~'.

Knibbe and Abbenhuis (1991)~' stuhed the followmg: husband-wife social relations at the beginning of marriage, the effect of alcoholism on social relations outside the nuclear family, the effect of chronic alcoholism on the d e '
s

social position, andhelp offered by l ay people and professionals. [ (un the ss:a H m 14 normal female Dutch adults aged 22-53 years ) (wives of alcoholics who were receiving outpatient treatment for addiction)]. Open interviews lasting 1 - 1 .5 hrs were conducted. MC Kay, James, et al, (1 993)52 investigated the Merences between 8 pairs of alcoholic patients and their spouses or spouse equivalents who were living together in the same household in their perceptions of the functioning of

their families or households. Family functioning was evaluated by completing


the family Assessment Devise. Agreement between alcoholic patients and their spouses or spouses equivalent S was moderate on the affective responsiveness, communication, problem solving, roles and general functioning scales. However, there was little or no agreement the behaviour control and affective on involvement scales. These results inhcate that although al coholic patients and spouses or spouse equivalents tended to agree about how well family members work together and share thoughts and feelings, they &sagreed about how well boundaty issues wee dealt w i h their families. Mathew, et al, (1993)" examined the differences in the prevalence of psychahc msorders in indviduals who &d or &d not have alcoholic parents. They used data from the National Institute of Mental Health Epidemiologic Catchment Area Project, specifically from the Piedmont of North Carolina. Prevalence of p sychatri c disorders was estimated in 408 participants who reported problems of drdmg in their mother, their father or both in 14.77 ageand sex matched subjects who did not report having alcoholic parents. The results showed that the adult children of alcoholics had sigdicantly higher current (6 month) prevalence rates of simple phobia and agoraphobia and. lifetime rates of dysthymra, generalized anxiety dsorders and panic disorder. Adult children of alcoholics also had significantly more anti - social symptoms. Male children of alcoholics had a significantly hgher rate of lifetime hagnoses of alcohol ai drug r d abuse ta who were not chrfdren of alcoholics. More female children of men h n alcoholics had generalized anxiety disorder than women who were not chldren of alcoholics. Sons of alcoholic fathers had a hgher rate of substance abuse and more anti-social symptoms than did daughters of the alcoholic fathers. Daughters of alcoholic fathers had a hgher rate of generalized anxiety hsorder. Rodney, H. E. and Rodney, L. (1996)e~x~am ined gender hfferences and relationship between students who were adult chldren of alcoholics. (ACDAS), students who were not children of alcoholics regarding level .of self-esteem, and health in the family of origin and social support during adolescence. Samples were 500 &can American undergraduates (aged 18-24 years) who respond to 5 surveys. Results inchcate level of dmkmg was sigtllficantly related to the selfesteem of the ACOAs. A sigmficant positive correlation between self-esteem and social support for the children of alcoholics and negative correlation adult between self esteem and health in the family were also found. The findings are consistent with earlier reports in whlch an association was found between mother support and health of the family. Murphy, C. M. and Farrel, (1.996) 55 discussed initial studies that 0' showed a h& proportion of male alcoholics seeking treatment had been violent

towards their wives and that identified factors that may help to explain h s association. The author argued that male alcoholics who physically abuse their partners differ in important ways kom alcoholics who do not, &splaying a cluster of signs associated with a severe, early onset form of alcoholism, includmg an urheritance pattern largely limited to male relatives and previous arrests. The marit ally violent alcoholics are also more llkely to binge, have more negative styles of communicating with their spouses, and maintain strong beliefs about the negative influences of alcohol on marriage. Initial evidence suggested that cessation of problem drinking after alcoholism treatment involving the spouse is associated with sllficant and substantial reductions in marital violence, whereas relapse to dndung &er such treatment is associated with continued marital violence. Mothersead Philip, et al, ( 1 998)56 in their study, hypothesized parental attachment was as a mediational variable, explaining the relationship between parental alcoholism, family dysfunction, and interpersonal &stress. Structural analysis was used to specify the relation among measured constructs. Parental alcoholism was not a significant prediction attachment to or interpersonal distress; however the medtating role of parental attachment was evident when family dyshction was examined. As the level of family dysfhction increased, partxipant Seported less parental attachment and more interpersonal distress. r Post Phyllis a Robinson, B. E. (1998)'~s ought to fbrher clarify three n major psychological dimensions among school aged young children of alcoholics (YCOAS) in a public school setting. Self-esteem, anxiety level and locus control were compared in 108,9- 1 5 year olds with or without alcoholic parents. Measures used were the Children of Alcoholic Information Test, StateTrait Anxiety Inventory, Nowicki-Stnckland Locus of Control Scale, and Cooper Smith self-esteem Inventory- Internal consistency reliability estimates were calculated for all measures. Results indicate that young children of alcoholics reported a more external locus of control ta non-young children of alcoholics. h n Signrficant dif3Ferences emerged in total self-esteem such that non young chldren of alcoholics reported hgher levels of anxiety than did. yug chldren of o n alcoholics. 2. 6.0 Wives' Responses to Alcoholism Wives of alcoholics are always in s situation, whch gives them t frustration, ao emotional msturbances and disturbed personality, emergence g n of matt etc. and gradually they become neurotic patients or develop personahty or adjustmental problems. Jackson (1 954) as a participant observer for several years of the women Alin Anon and family group, believed that the neurotic manifestations showed by the wives of alcoholics may be a relation to the stress of living with an alcoholic, rather than de pre-existing personality defect (Fox, 1 9681~'. any t o u

Rae and (1966)60stu&ed the personality of wives of alcohol Forbes dependent individuals. The sample consisted of 26 wives of alcohol dependent indwiduals. Details regarding the age, duration of marriage and other sociodemographic data are not provided by the author. The wives were tested ui s n M.M.P.I. The results showed that these wives were showing elevations on psychopahc deviance scale and they were reacting to stressfd situations with depression and anxiety. Te further showed that, the spouse personality is as h y important as that of the patient in maintaining subsequent abstinence. In this study comparison group had no taken a study conducted by Rae and Drewey (196%~t'h e interpersonal In perception technique had be applied to two groups of manied couples; one a e n group of 22 male alcoholic patients and wives and the other a non their psychatric sample of 26 married couples similar to the patients in social class and occupational status. The most stnking difference between the groups relates to the wife's description of their husbands in a way which accords well with the husbands self-description, whlch the wives of the patients do not. The interpersonal relationdup between the alcoholic and h s wife is characterized by clear evidence of socio-sexual role c by d i c t m g dependenceindependence and o needs. Thus it proves that it is the patient's neurotic mfficulties rather than any pathology in his wife whch has determined this interpersonal dilemma. Edward, Harvey, Whitehead (1973)~st~ud ied the personaltty of wives of alcohol dependent individuals. The sample size and demographic data were not provided. The study was carried out mainly on the basis of clinical interview. The authors concluded that women undergoing stress as a consequence of lvn with ig i an alcoholic husband manifest neurotic traits of psychological disturbances. In their opinion wives of alcoholics appear to be women who have essentially normal personalities of mfferent types. They may suffer personality dysfunction and react to their situations wag int cie hh n coping methods and roles w i t h the family when their husbands are dmkmg in excess; but if their husbands become abstment they will experience progressively less dysfunction. Thu seem they s much like other women with marital problems. Another study carried out by Orford (1976)~us~in g Eysenck Personality Inventory showed that 1 00 wives of alcoholics had abnormally raised neuroticism (anxiety) scores not as highly raised as their alcoholic husbands but none the less sipficantl y raised in comparison with the general population control sample. Humitz, J. I. an Daya, D. .K. (9 o studed about the wives d w~ 1 h 7

(mean age 50.3 years) of 23 alcoholic blue-collar employees completed the MMPT, Interpersonal Check List, and The test results show that the public TAT. behaviour of a m the samples (as well as their conscious and of a preconscious self-unag es, underlying character structures, and perceptions of men and women) was dominant rather than submissive. However a majority of the samples had submissive ideal self-images which were interpreted as ' dependent' in 1 2 and 'masochistic' 5. 12 of the samples perceived men as ' sdstic' and 10 in had preconscious self-images described as sadistic. It is suggested that (a) non-help-seelung wives have strong egos; @) the y may constitute a single personality type; (c) many of them view men as sadistic, and many develop preconscious hostility towards their husbands as stress reactions; and (d) their ideal self-images reflect weariness with their dominant roles rather than a need to be dependent. Jacob Theodore, et al, ( 1 9851~'a ttempted to replicate in 2 experiments the h h g s P. Steinglass (1981) l h g social behavioral cnu of ofss oee q e c n dnnking with the non alcoholic spouse's psychiatric symptunatology. Exp. I involved families with alcohoIic husbands and 50 families with non-alcoholic husbands. Eq. II involved 27 families with alcoholic husbands. Age range for husbands and wives in Exp. I was 31-63 years and 19-57 years respectively; in Exp. I were 27-56 years and 28-58 years respehvely. The Minnesota they I Multiphasic Personality Inventory (MMPX) and the Beck Depression Inventory were administered to samples. Results indicate weak support for the original finhgs. Bepco (1 986)66 discussed the special needs and characteristics of women affected by alcoholism. The use of alcoholism to adjust self-image and interactions within the family was discussed in detail. The effect of female role expectations on self-image and vnages of the alcoholic woman and the alcoholic wife and daughter was chscussed. Kutty and Sharma (1 9 8 8 1i~n~ve stigated the characteristics of 3 5 wives of alcoholics and 35 wives of non-alcoholics. Samples completed a Malayalarn version of a temperament scale that measures maladjustment, gregariousness and thoughtllness. Wives of alcoholics scored high in maladjustment and low in gregariousness and thoughtfiess compared with controls. Asher, Rm Brissett, Dennis (98r viewed 52 wives of and a i~8 nt) 1~ e alcoholics, focussing on the d e ' S in adopting a new identity as a means of role interpreting and comprehending her thoughts, feelings, and behaviours as well as the use of her husbands. Findmgs reveal a taken for granted use of the tenn

'codependent' ambiguity as to what codependency is. Athough most of the wives agreed that codependency involved care takmg and existed by virtue of their association with an alcoholic, they &sagreed widely as to its impact on the self, its locus as to personal or social, its disease status, its longevity, and whether or not it was distinctive to alcohol-complicated marriages. It is suggested that selflabeling and identification occurred through retrospective reinterpretation of their lives with their alcoholic husbands, guided and legitnnated by rehabilitation personnel. These reconstructions then served as self-evidence of m-dependency. Weinberg, T. S. and Vogler, C. C. (1 90 examined how 38 women, 9 ) manied to alcoholics, managed the resulting fiom the behaviour of their stigma husbands and adjusted to this behaviour. Questionnaire data reveal that samples learned about their husband's dnnking early in relationship and responded to the this with anger, hostility, and resentment. Fa included concerns for the e r husband's health and effects on children and hls job. Over time fears have their decreased but problems in the marriage remain. Most samples had participated in their husband's drmkmg. Although one third of the samples rated ter marriages h i as happy, most samples reported unsatisfactory sexual adjustments. Support group membership helped samples to cope with their situation and develop self-esteem. Self-esteem was related to amtudes towards husband' S Feelings of drinking . control were related to coping ability Levkovich and Zuskova (1 99 1)" examined the influence of husband's habitual drinking resulting in &sorganization of marital relations. on a family, Data are presented concerning conflicts in 50 families in whlch the husband was a habitual drinker. were characterized by a sharp aggravation of the Conflicts contradictions in the needs, lack of understanding by them of the s p relationship between dnnking and destabilization of family relations and in appropriate choice of the methods to settle conflicts. Husband's dridung also adversely affected the wives' health, such that wives suffered fiom various disorders such as insomnia, depression and neurosis. Pitman and Taylor, R. G. ( 1 9921~a' nalyzed the personality characteristics of the female partners of incestuous sexual abusers (= female partners of the n 1 alcoholics (=5 women of control group whose spouses were neither and n) 1 sexual offenders nor alcoholics (igMMPI and the) u=5 s n n 1 a demographic questionnaire that included sample' s sexual abuse hstories . Si@cant differences were found on Depression, Psychopathic Deviate, Paranoia, and Psychastenia scales. Analyses ~f Hams sub- scales found that elevations could be explained by situational, rather than characterological factors. No significant differences were found in the occurrence of physical, emotional, or sexual abuse in sample's backgrounds, inhcating that there is no support fbr the notion that

abused women tend to enter an alcoholic or sexually abusive relationhp. It has be noticed that wives of alcoholics tend to show an unhealthy e n relation to their husbands characterized by addiction, whch might hamper the recovery of their husbands fiom alcohol dependence. So, Ino, A. et a1 , (1 92' 9~ 1 studied about the addiction trends seen aogwives of alcoholics. He used a the m n standadzed fom of questionnaire, which consists of 24 questions. The test was carried out at various stages of sobriety. A total of 78 married employees of the Mie prefectural government were tested as control. More detailed assessments were done in tarns of the 60 employed wives. The majority of working wives reported normal negative impact of their husbands drinking on all areas of their work -functioning, with a small sub- set indicating impairment attributable to the These wives were very satisfied wt curren and d r their positions i h t described work as a positive experience. However, unobstructive measures that alcoholism in a family member introduces into the work place were apparent, including changing jobs, absenteeism, and discussing husband's drinking at work. Further, these women scored closer to a sample of depressed women than a cornunity sample on measures of physical and mental health, depressed mood, and smokmg symptoms. Possible reasons for the chscrepancy between subjective reports and objective indxators are chscussed. and Smn Naglakshrm (1993)73 examined the personality dunensions of u a alcohol dependent individuals (ADIS) and their soe Eysenck ons p the u Personality Questiomaire; 40 alcohol dependent inhviduals and their spouses and 10 normal couples in India were stuhed. Samples were 25-45 years old. Results reveal high neuroticism in spouses of alcohol dependent inhviduals. The spouses of alcohol dependent individuals were sigmficantly less extroverted than normal wives, who were more sociable, carehe and relaxed in interpersonal relationship S. The spouses of alcohol dependent individuals were more mhibited, more withdrawn and less assertive in interpersonal relationship S. Okazaki, et al, (1994)'~ conducted a study ta involves an analysis of h t health problems and psychosomatic disorders between wives of alcoholics and those of non-alcoholics. The subjects of the study were 122 wives of alcoholics who accompanied their husbands for outpatient alcoholism treatment at Kurihama National Hospital. For an appropriate comparison, 88 aged-matched wives of non-alcoholic h were asked to co-operate as controls. The subject S were u given Cornell Medical lndex (CM) and the original questionnaire on their own their and husband's health problems on their first outpatient visit. The controls were also gven to them during the same research period. The results are briefly summarized as follows: (1) The most obvious health problem of wives of alcoholics with an incidence significantly higher than that of wives of nonalcoholics was gn disease. e i l

Moskalenko and KO (1 994)" examined clinically 2 15 wives of Gun' alcoholic divorced women who had been previously married to alcoholics, none of the women abused alcohol. Only 12 of them were officially registered as psychiatrist' s patients. Borderline psychopathological c were diagnosed o in 174 women who had long been married to alcoholic husbands or lived with them in one apartment. Of them, psychopathy, neurotic personahty, neurosis, and reactive depression were identified in 27%, 24.7%, 23%, and 15% respectively. All divorced women living apart fiom former alcoholic husbands had no psychopathology at the moment of the Borderline neurotic disorders in study. alcoholic husband's wives should be considered in familial analyfor made si s subjects seekmg genetic advice. Ino, et (1 994)" in study try al, their to evaluate the ASTWA (Adhtion Screening Test for Wives of Alcoholics) scores obtained from the wives, which consists of a ' total score', ' caring trends', ' dominating trends', 'obsessive traits', and 'trends towards lowering of self-esteem', between normal and abnomal shifhng trends with the help of a normal control study. The results are demonstrated graphically is in the Y G test. In h s the reliability, the valichty, way, and the usefulness of ASTWA were confirmed in the process of ths study. A prospective study c prognosis of alcoholism of their husbands in the o relation to the results of ASTWA was carried out. In the non-intervened group, wives of abstinence group tended to show a lower score, the dominatmg trends the obsessive traits, and the trends toward lowering of self-esteem. In the group in which three months of initial therapy for wives have be completed, a significant e n parallel correlation was found between the ASTWA results and the prognosis of abstinence of their husbands. These results suggest that the total score, the caring trends, dominating trends, and the involved traits would indicate a degree of healthiness or unhealthiness in the marital relationship particularly in of a terms circular cause and effect relation in developing alcoholism, and also would be a prospective inchcation of the prognosis of alcoholism of their husbands. Banister , E. M. and Peavy, R.(on ducted a V. c~4 1) 9 9 ethnogrqhic n study of 5 women married to alcoholics to develop knowledge about how these women lived out, interpreted, expressed the experience of living with tm alcoholic husband. Samples were interviewed and interviews were analyzed according to the Developmental Research Sequence Method by PJ Spradley (1979) to . . &scover the cultural experiences of SS, b e ec o ~ mthem es were identified that represented sample' s lives: constantly being on guard, being a pit (weakening in

of self), and push and pull (disillusionment with cultural norms). The experience of samples married to alcoholics was a complex interaction of culture that involved the internalization of cultural expectations, weakening of self, and embeddedness in an alcohol dependent marriage that encouraged samples to be passive, dependent self-sacrificing , and self-blaming . Brennan , Penny, et al, (1994)'~w ho conducted a prospective study focused on spouse of late-life problem drinkers. At initial assessment, 87 spouses of late-life problem dnnkers reported poorer health related and social functioning and more reliance on cognitive cp strateges, and shared cogmtive o i more avoidance coping ta 87 spouses of nun problem drinkers. They also did h n reported more stressful less supportive family contexts. 22 spouses of individuals who would remit over a one-year interval &d not appear to provide their partners with an impetus for recovery. However, spouses of remitted problem drinkers improved in several areas over the one year follow up. By c spouses of 65 o non-remitted partners continued to fimction more pmly and reported less supportive relationship with partners and escalating conflicts with children. Crisp and Barber (95 studied about the hardship experienced by the 1) 9 wives of alcoholic. He used the Drinker's Partner Distress Scale @PDS). Two dimensions of alcohol induced problems i.e. depression and hscord are marital measured. Both sub-scales demonstrated internal consistency and prehctions of convergent and chstxkninant valihty were supported in relation to both subscales. Assh and Byers (1 996)80 investigated factors related to the co-occurrence of marital distress (MD) and depression using a community based sample of 1 28 women. Maritat &stress and depression were assessed at two levels of analysis: the global level and the level of daily marital satisfaction and dysphoric mood. Low rates of pleasing and rates of ihspleasing marital exchanges were hgh related to h l y dysphoric mood and marital dissatisfaction as well asglobal to marital &stress and depression. Marital exchanges were also related to both marital distress and depression at both levels of analysis when each Qsorder was considered separately. However, the association between depression and the quality of marital exchanges was accounted for by the degree of marital distress. The quality of non-familial social interactions was not related to the COoccwence of marital distress and depression. All these findmgs suggest that, in women the co-occurrence of marital &stress and depression reflects the specific effects of marital exchanges. Dysfunctional beliefs were found to be common to both global

marital distress and depression. Kodandaram (1997)~' examined the personality profiles of wives of alcohol dependent individuals and of normal controls. 30 wives (mean age 34.1 years) of alcohol dependent inhviduals and 30 wives (mean age 36 years) of normal indwiduals participated in study. Samples completed the General the Health questionnaire and the Sixteen Personality Factar Qeo (16PF) use ti i n r a n Form C. Results show that wives of alcohol dependent inhviduals Mered sipficantly fiom the wives of n o d indwiduals. Wives of alcohol dependent ben wr glum, silent, timid, eccentric and were group iud fe t e o n dependent, to have a lack of contr01, and will ax dse tot sp oi i n

2.7.0 Treatment
The importance of family members in treatment process is getting momentum for many reasons. Most of the family members do not recognize the extent to wluch their responses to alcoholics have resulted in dysfunctional behaviour, i. e. isolation, enabling and depression, anxiety, personality problems or physical illness. Thus, treatment of the wives as well as the family members is important in and of itself regardless of whether or not the alcoholic is in a recovery program. Sulzer (1965) companionship and spouse attention c m~~ e peer ad o upon non-alcohol drinking behaviour. The wife and the therapist socially reinforced sober behaviour. Results showed that the subject discontinued use of alcohol and was functioning more efficiently. Cheek, et al, (1971)~tr~ai ned wives of alcoholics to use behaviour modification techmques to change family interactions. Wives received an instruction to program contingencies more objectively. Most wives who completed the program reported at least moderate improvement marital in communication. Several case stuches reported that management of speclfic behavioural contingencies by significant others can alter an alcoholic' S drmkmg behaviour in the natural evn Differential social reinforcement from peers and wives ni. re o m t n helps in the successful management of alcoholism. Contingency contractmg between the alcoholic and his wife served to establish and maintain a stable pattern of controlled drinking (Mdler, 1 972)84. Ester (1 974)85 describes helpfd approaches to counseling women with alcoholic husbands. The major goals of such cuunseling are to improve the wife's response to the husband and to break the vicious circle that exists. Problems faced by families with alcoholic members in dealing with day-to-day living are discussed. The unpredictability of the alcoholic is especially upsetting to family members who attempt to respond to him. In the early phase of counselling, the wife is often bewildered and fearful and has misgivings about In. many hrthe e middle phase she becomes goal-oriented and explores, with the therapist, the

wihn family coping behaviour that is often destructive. The final phase of h approach occurs with an increase in dealing with the situation. In adhtion, gains occur in the wives reaction to the husband, which can facilitate a bethe ina rk alcoholic cycle. Hedbery and Campbell (1974)" compared four behavioural treatments in alcoholism. In this study, 49 outpatient alcoholics were randomly assigned to one of these treatments: ( 1 ) behavioural family counseling (2) systematic desensitization (3) covert sensitization and (4) avoidance con&tioning (electric shock ueconditional s 6 months follow up, 74% of clients asd s At t received behavioural family counseling, 67% of those were given systematic desensitization, 40% of those were given covert sensitization and none f?om the avoidance conditioning go showed improvement. From thls study the author r u concluded that out patient treatment programs employing behavioural counseling techniques could be successful at least for six mns . oh t Ester and &son (1 976)* conducted group therapy with 1 0 white middle class 31-60 years old wives, whose alcoholic husbands had recently become sober. Analysis of process recordmgs fiom group sessions led to the derivation of 5 major problem areas including (a) reinstatement of husband into family roles (b) difficulties sunounding communication (c affective responses of the wife (d) disruptive traits and behaviours of the husband and (e) handling situations involving alcohol or alcohol related problems. In the group therapy didactic, experimental and role modeling approaches were utilized with major emphasis on the promotion of congruent ~mmunicationA. summary techque, incorporating all three approaches, was developed and implemented as a joint presentation by both therapists. Orford and Guthrie (19761%a~ls o emphasized the importance of stable marital bond. In their study about alcoholism, they found the marital interaction to be the determining factor in the treatment outcome. Steinglass (o~ d that alcoholism might serve as a stabilizing n~te 1 9 7 factor in the family, whch produced e patterned, prdctable and rigid x sets of interaction. A better outcome could be seen, only if the treatment focused on nurturing family growth, rather than on a reduction in drinkmg. He emphasized that the entire family should be viewed as the patient. Fridman, et al, (1 976)" stded 100 wives of alcoholics (52 trg the hu o use of indvidual and 48 through the use of group treatment methods) to assess their role in development of positive treatment motivation with their alcoholic the husbands. There was a sipficant correlation between the wife's attitude to treatment (active /passive) and the patient ' S abstinence, particularly in the group of wives included in group therapy. There was also a significant difference in the

improvement of family relationships dependmg on whether the wives were treated through individual or group therapy. Specifically , a statistically significant improvement of family relationship S noted with those patients whose wives was pmcipated in the group therapy. Fewell Cbnstine and Bissel Leclair examined the role of ( 1 denial in alcoholics and those close to them (wives & family members), describing it as
a

major obstacle to treatment. Alcoholism occurs in all personal@ types, and similar traits in alcoholics result fkom effects of dmikmg. Detailed information obtained by interview is needed to confront denial directly. The therapist must bring reality - testing to the alcoholic by reflecting back, arousing anxiety and mobilizing hope for change, because drinkmg weakens reality testing and memory. Absbnence is essential to overcome denial. Family members participate in the disease and need to bewme aware of this. Al-Anon provides support and peer confrontation, whch e spouses to step out of care talung roles and n instead confkont te problems. own hr i Berger (1 98 1 Q2 investigated to find out an association between client's completion of treatment and the involvement of his family in the treatment. Famdy members were involved in the treatment by their participabon in out patient meeting. Session was conducted, four tunes a week dr 14 weeks the u i of the alcoholism treatment program. The hfference between the nature of involvement of relatives of 100 program completers and 300 dropouts was significant. Fmell, Timothy, et al, (1984)~d~es cribes the clinical procedures 0' involved in a l 0-session behavioural marital therapy couples group (BMTCG) for male alcoholics and their wives. The BMTCG uses behavioural rehearsal and weekly homework assignments to help couples. (1) Decrease dnn and ni k alcohol related interactions; (2) plan shared recreational activities; (3) ntc oe i acknowledge and initiate daily caring behaviours; (4) learn the commUtlLcations slalls of listening and expressing feelings dlrectly and use planned communications sessions and (5) negotiate desired changes. Te describe also h y methods for recruiting and preparing couples for therapy and for dealing with resistance and non-compliance . Sisson and (v~l uated a method of teaching &stressed Azrin e~a 1 9 8 family members of problem d to minhze their own distress, reduce how r the drinking, increase the motivation of the alcoholics to obtain formal treatment and assist in the treatment program. Twelve family members were gven either community redorcement counseling or a t r d t i d type of counsehg (conbol group). The reinforcement counseling resulted in more alcoholic persons

obtammg treatment than did the ttdtional type and a greater reduction i drinking before the formal treatment was obtained; drinking was reduced fbrther during the ji treatment of the family members and problem drinkers. These o n results suggest that counseling concerned family members in use of the appropriate reinforcement procedures can the dmkmg of motivated reduce alcoholic persons and can lead to the initiation of formal treatment. MC Crady, et al, (19 861~pr~ov ided treatment to 53 alcoholics and their spouses in one following outpatient behavioural treatment conhtion. (1) of the minimal spouse involvement (MSI), (2) alcohol-focused spouse involvement (AFSI), or (3) alcohol focused spouse involvement plus behavioural mra at i therapy (ABMT). Clients were followed-up for 6 months. All clients markedly decreased their d reported increased life satisfaction. ABMT clients and r were more compliant ta clients without conjoint homework assignments AFSI h n decreased their dmkmg more quickly during treatment; relapsed more slowly after treatment and maintained better marital satisfaction. ABMT clients were quicker to stay in the treatment process and maintain better marital satisfaction, MS1 the clients after treatment. Farid, et a1 , (1 986)% report on the results of group therapy for the wives of alcoholics, where the alcoholics themselves were offered no treatment. The reason for running such a group is based on the idea that wives might seek help before their husbands, might attend sessions regularly arid by acquiring better knowledge of alcoholism and improving them, use of coping strateBes might favorably influence their husband's behaviour. At 6 months follow-up it was evident that coping styles were learned quickly; the sessions also provided support and fiiendship. Attendance at the group induced change, though not always positive all marriages. Mishra and Kummaiah (19893' used behavioural counselmg to sigmficant others as a component in the multi-model treatment program. They found that of 263 alcoholics treated, 50% were abshnent at least for a period of 1 -3 months. Smil Datta, et a1 , (1991)" described the community treatment for alcoholism in a village near Vellore. They reported that there was a surprisingly good abstinence rate which c sharply with other hospital based studies o (Edward, et al, 17~gad~a,e t al, 1982'"; Jellinek, 1960)'~'.T he good B; 9 a 7 response may be attributed to the following factors: 1. The pre-treatment motivational program which brought about an increase in the awareness and desire to give up alcohol in the patients and te families. h i

The "Qsease concept" also was helpll as it enabled many fadies to look upon these people as patients requiring help - rather than as 'b people". ' a 2. The fact that the patients entered treatment in batches and all experienced detoxification and abstinence in groups (Brandha, et al, 18) ~ (The 9' 5 patients who relapsed, when their reasons for wanting to cm and stop back o e further dmikmg said that "they felt bad having let their group down"). Thls group become close fiends and even had outings and (alcohol fiee) parhes together. When one member of the group did not attend the AA, the others would go to his house and enquire about hs whereabouts and health. They feel that &IS probably the most important part of their treatment program. was 3. The involvement of the wives and the other members of the community put an extra social pressure on the patients to continue abstmence. 4. The multi-disciplmary nature of the treatment group was also, essential for the success of the program. The psychiatrist was one of the person who take the details of the patient's urges to dn the techniques used to avoid the and n k same were discussed. The female counselor was the one who was contacted by the wives andother members of the farmly for support. Feedback about the treatment failures also ot from this source. came f e Farrell and Murphy (1995)''" assessed the prevalence and frequency of 0' marital violence in 88 male alcoholics and wives at entry and 1 year aRer their to completing a behavioural marital therapy (BMT) program. the year before In BMT, both the alcoholics and tbeir wives had a sipficantly and substantially hgher prevalence and frequency of marital violence than reported by a demographically matched non-alcoholic comparison sample. A violence l decreased sigmficantly elevated, relative to the matched controls, when the entire sample of alcoholics were considered. However, extent of violence, after BMT was sigudicantly associated with the alcoholic's ddung outcome status. Mer treatment, remitted alcoholics no longer had elevated marital violence levels whereas relapsed alcoholics &d.

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