Impulsivity and High Risk Behaviour among Male and Female Alcohol Dependent Patients

Article Information

Anupama K*, 1 and Pawankumar Reddy CM2

1Assistant Professor, Department of Psychiatry, Gandhi Medical College and Hospital, Hyderabad, Telengana State, India

2Professor, Department of Psychiatry, Shadan Institute of Medical Sciences, Hyderabad, Telengana State, India

*Corresponding author: Anupama K, Assistant Professor, Department of Psychiatry, Gandhi Medical College and Hospital, Hyderabad, Telengana State, India

Received: 09 April 2022; Accepted: 18 April 2022; Published: 06 May 2022

Citation: Anupama K and Pawan kumar Reddy CM. Impulsivity and High Risk Behaviour among Male and Female Alcohol Dependent Patients. Fortune Journal of Health Sciences 5 (2022): 243-253

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Abstract

Background: Impulsivity as a personality trait is associated with high risk behaviour among alcohol dependents but the relationship between these two variables has been largely overlooked in addressing Alcohol Dependence Syndrome

Objectives: To study the relationship between impulsivity and High Risk Behaviour among alcohol dependent patients

Methods: The study was conducted in a clinical setting using an explorative study design and non-probability sampling method on 178 male and 22 female alcohol dependent patients in 2011. The tools used prior to sample selection include; ICD-10, CIWA-AD, MMSE, SOADQ, and the HRBQ and BIS were used to assess high risk behaviour and impulsivity respectively.

Results and Discussion: Significant association was found between all the three variables i.e., High impulsivity (p-value=0.000), Low impulsivity (P-vale=0.000), Severity of alcohol dependence (p-value=0.000) and High risk behavior (Road Traffic accidents, Crime and violence, Self-injurious behavior, Risky sexual behavior) in the sample. In addition, significant difference between the groups of Severity of alcohol dependence questionnaire (SADQ) scores and high impulsivity (p-value=0.049) was observed. Patients scoring high on personality constructs such as impulsivity were particularly vulnerable to indulge in high risk behaviour.

Conclusion: The findings of the present study allows to conclude that there was significant influence of gender (-3.260**) and education (-2.350*) on High Risk Behaviour of the sample and impulsivity as a personality construct is significantly associated with the high risk behaviour and severity of alcohol dependence. These results also indicate a strong need for intervention to address the personality traits related to severity of alcohol dependence to control relapses in treatment of Alcohol Dependence.

Keywords

Alcohol dependence, Impulsivity, High risk behaviour, women alcohol dependents, SADQ

Alcohol dependence articles, Impulsivity articles, High risk behaviour articles, women alcohol dependents articles, SADQ articles

Article Details

1. Introduction

Impulsiveness is viewed as a multifaceted construct comprising of elements like mindfulness, actions and perceptions. Impulsivity is contemplated to be a potential risk factor of alcohol and drug abuse, which by itself is considered as a indicator of risky behaviors [1, 2, 3, 4]. Behavioral impulsivity is connected with inability to withhold a reaction that has already began ; cognitive impulsivity - with incapacity to perceive  the consequences of a person’s  behavior [5] and attentional impulsivity – with inability to be focused on a particular task [6]. In all types of impulsivity, conceptual and intuitive relationships with risky behaviors and accidents can be explained very well [7] Impulsivity and alcohol consumption are both contemplated as potential predictors of unintended as well as intentional injuries. Impulsivity seem to increase the frequency of risky behaviors in alcohol-dependent individuals [8] Disablement in self-control , such as poor impulse regulation and  inability to take decisions, play a key role in the formation and persistence of substance use habits in general and alcohol dependence in specific [9, 10, 11].  Even though the past researches mainly focused on the individualistic influence of impulsivity and craving on outcome factors, lately more importance is given to the relationship between these two phenomena. Research has shown that self-reported attribute impulsivity was positively associated with craving in individuals with cocaine-dependence [12, 13] individual with methamphetamine-dependence, substance dependent women seeking treatment [14], alcohol dependent men [13], and habitual smokers [14, 15, 16] In general, these findings reflect that individuals with high impulsivity experience more craving in several substance use disorders. Both impulsivity and craving need to be regarded as factors that influence the alcohol addiction and relapse succeeding abstinence. Impulsivity is a crucial correlate of risky behaviors in alcohol dependent individuals, together with global psychopathology and gravity of alcohol dependence [7]. Alcohol has been shown to increase the death risk due to various health problems such as cancer, Heart disease, and liver disease and around five percent of total deaths worldwide are related to severe alcohol consumption [19]. Approximately 140.6 thousand persons died due to liver cirrhosis caused by alcohol consumption in India in 2016. Road traffic accidents and cancer were also observed among alcohol users during the assessment time period [20] with this background an effort was made to study the relationship between impulsiveness and High risk behaviour among alcohol dependent patients as part of Doctor of Medicine (MD) research.

2. Methods and Materials

The study was conducted in clinical setting using an explorative study design and non-probability sampling method on 178 male and 22 female alcohol dependent patients. The patients admitted with Alcohol dependence syndrome to Psychiatric ward of Mamata Medical College and Hospital, (Khammam, Telengana State) during one year period (2011) were selected for the study.  The tools used prior to sample selection include; ICD-10 for Psychiatric diagnosis, Clinical Institute Withdrawal Assessment for Alcohol (CIWA-AD) [21] to know that patients are not in withdrawal state,  Mini Mental Status Examination(MMSE) [22] to ensure that the patient has no cognitive impairment, Severity of Alcohol Dependence Questionnaire(SOADQ) [23] for severity of alcohol dependence . Thus a total sample of 200 comprising of 178 men and 22 women were selected for the study using convenience sampling method. The High Risk Questionnaire was translated into Telugu, standardized and   used to examine the high risk behaviours among the sample, they were; Road Traffic Accidents (RTA), Risky Sexual Behaviour (RSB), Self-Injurious Behaviour (SIB) and Crime and Violence (C&V).  Barratt’s Impulsive Scale (BIS) [24], version 11 was translated in to Telugu language, standardized and used to study the impulsiveness among the sample. The BIS -11 measures impulsivity in terms of three domains; Motor impulsiveness, Non planning impulsiveness and Cognitive impulsiveness. The BIS-11 is self-administered questionnaire with 30 items scored on a four point scale ranging from 1= rarely/ never to 4= almost always /always. Possible scores range from 30 to120, administration time is not specified but is estimated to be 10-15 minutes. The BIS-11 was translated in to Telugu language, standardized and administered to the sample under study.

The data was analyzed using  a computerized statistical software -SPSS version 21 of IBM  ;  to examine the  association  among the High risk behaviour ,Impulsivity levels  and Severity of alcohol dependence the  Chi-square test was used, to know the difference between men and women with regard to impulsivity  the t-test was applied,  using the F-test  the difference  among the  categories of SADQ scores ( low, medium and high) and Impulsivity was assessed and Logistic Regression was used to test the strength of associations among socio demographic variables , clinical variables and high risk behaviour of the sample.

3. Results

Table 1: Association between high risk behaviour and personality variables &severity of  alcohol dependence

Table icon

Table 2: summary of independent t sample t-test by gender

Levels of Impulsiveness

Gender

N

Mean

Std. Deviation

t-value

p-value

High

Impulsivity

Male

178

30.90

26.519

2.316*

0.022

Female

22

17.23

22.473

Low

Impulsivity

Male

178

16.31

14.277

0.614

0.540

Female

22

14.27

18.022

Table 3: Summary of one way ANOVA by SADQ scores

BIS

SADQ

scores

N

Mean

Std. Deviation

F-value

p-value

High

Impulsivity

< 20

Low

30

49.43a

15.147

2.475*

0.049

21-30

Moderate

76

50.24a

12.441

31-40

High

14

41.29b

18.223

Total

120

48.99

14.063

Low

Impulsivity

< 20

Low

30

25.50

8.549

0.516

0.598

21-30

Moderate

76

27.16

8.043

31-40

High

14

27.79

10.445

Total

120

26.82

8.434

Table 4: Logistic Regression – Demographic characteristics, clinical variables as predictors of high risk behaviour

Variables

Classification

B

Age

15 – 25 years

26 – 35 years

-0.648

36 – 45 years

-0.066

49 – 55 years

-0.836

Gender

Male

Female

-3.260**

Marital Status

Unmarried

Married

-0.853

Divorced

22.605

Window/separated

2.112

Religion

Hindu

Muslim

40.430

Christian

-0.781

Education

Illiterate

Up to 5th standard

18.304

5th – 10th standard

0.100

12th standard

-2.350*

College/Technical Education

-1.425

Occupation

Unemployed

0.189

Family type

Nuclear

Joint

-21.808

Extended

-20.898

Single

19.295

Age at initiation of drink

<18 Years

18 – 25 Years

0.504

26 – 35 years

1.070

>35 years

-38.557

Age at dependence

<20 years

21-30 years

0.593

31-40 years

0.348

>41 years

-20.660

Years of dependence on alcohol

1 – 10years

11 – 20 years

-0.712

21 – 30 years

0.441

>30 years

19.885

Constant

1.622

4. Discussion

The table 1 exhibits that there was significant association found between all the three variables i.e., High impulsivity (p-value=0.000), Low impulsivity (P-vale=0.000), Severity of alcohol dependence (p-value=0.000) and High risk behavior (Road Traffic accidents, Crime and violence, Self-injurious behavior, Risky sexual behavior) in the sample. These findings compare well with a study done by Walton and Roberts, where the researcher studied the relationship between substance use and personality traits in 118 undergraduate students from a large Midwestern University were assessed using both self-reports and structured measures [25]. Several items from the Behavioral Risk Factors Surveillance Systems (BRFSS) and the Youth Risk Behavior Survey were used to assess substance use and heavy drinkers. The quantity of alcohol used to determine these groups of abstainers, moderate drinkers and heavy drinkers. The quantity of alcohol used to determine these groups were: no alcohol in the past year, not more than 12-16drinks per week and more than this amount respectively. Personality traits were assessed using the Goldberg’s IPIP-AB5C Inventory that assessed the Bid Five dimensions of personality namely extraversion, agreeableness, and conscientiousness, emotional stability and intellect. Results showed that Heavy users compared to abstainers or moderate users had lower scores on measures of conscientiousness t (70) =4.18, p<0.001. This corroborated significantly with a higher BIS-11 score total score. This study results was consistent with findings that heavy users of alcohols and substances were more disagreeable, irresponsible and neurotic compared to abstainers or even moderate drinkers [25] Thus, the present study gave credence to the findings that impulsivity is associated with High Risk Behaviors (HRB).  According to Korlakunta [26] the presence of high-risk behavior was considerable among patients with alcohol dependence syndrome. Event analysis method revealed that road traffic accidents indicated significant association with prior heavy alcohol drinking. The severity of alcohol dependence was significantly related to the presence of high-risk behavior. Among the independent variables, younger age group, male gender, married people, lower level of education, and alcohol dependence of 1- to 10-year duration are correlated with an increased occurrence of high-risk behavior among patients with alcohol dependence syndrome.

The table2, indicates the independent sample t-test carried out to observe, whether Male and Female differed from one another with regard to their impulsivity or not. Result showed that, the p-value (0.022) corresponding to high impulsivity suggests that there was significant impact of gender on high impulsivity in which Male showed more (mean value-30.90) high impulsivity than Female (Mean value-17.23). Whereas p-value (0. 540) for low impulsivity reveals that males and females have the same gender (male and female) with regard to their scores for high impulsivity. But the men and women understudy did not differ significantly with regards to their scores for Low Impulsivity. Men are over represented in socially problematic behaviors such as aggression and criminal behavior, which have been linked to impulsivity predicted that sex differences would be most pronounced in risky activities with men demonstrating grater sensations seeking, grater reward sensitivity, and lower punishment sensitivity [27]. In addition, the patients with scores high on personality traits like sensation seeking and impulsivity were particularly vulnerable and prone to indulge in high risk behaviour [28]

From table 3 it is evident that there was significant difference between the groups of Severity of alcohol dependence questionnaire (SADQ) scores and high impulsivity (p-value=0.049). There was no significant difference between SADQ scores and low impulsivity (p-value=0.598) at 0.05 level. Hence it can be concluded that in the present study there was significant influence of Severity of alcohol dependence on high impulsivity but not on low impulsivity. Similar observations were made in a study conducted by Poulose, 3 where the Logistic Regression analysis showed significant association with an Odds Ratio of 1.08 for Addiction Severity Index (ASI) composite score.  Which indicated that for every one percent increase in Composite ASI score the risk of associated high risk behaviour increases by about eight percent.  Severity of alcohol dependence is positively correlated with high risk behaviour and heavy drinking seems to be an indicator for the occurrence of the high risk behaviour. Furthermore, as more factors are being explored for effective management of Alcohol Dependence Syndrome (ADS) routine personality profiling is accomplished easily and can give valuable insight into clear and designed management plan [29].

The Logistic Regression  (table 4) was done on High Risk Behaviour by means of  gender, age , marital status, education, occupation, family type, age at initiation of drink, age at dependence and years of dependence on alcohol. The results reflect that there was significant influence of gender (-3.260**) and education (-2.350*) on High Risk Behaviour of the sample. There was no significant influence of age, marital status, occupation, family type, age at initiation of drink, age at dependence and years of dependence on alcohol on High Risk Behaviour of the sample. These findings were similar to the findings of a research carried out by Mattoo et al., [30] where 200 men undergoing treatment for substance dependence at the Drug de addiction and treatment Centre, showed that relapse in persons with alcohol and opioid dependence is related to similar precipitants of relapse but a divergent dysfunction and life events in terms of the frequency and type of events and associated stress in lifetime and during the past one year. The substance dependent persons in a family affect the quality of family life of other members also. This causes problems, difficult situations and stressful events in the family affecting the lives of family members and increases the burden of family caregivers [31] there is every need to identify, screen and counsel youth about alcohol use and to implement policies and programmes that delay alcohol consumption [32]. The early identification of personality constructs such as impulsivity and sensation seeking associated with alcohol dependence among men and women at the family and community level is highly valuable in providing appropriate therapies to control these traits, which further requires health care personnel support to seek the relevant mental health care from professionals.

5. Conclusion

The presence of both alcohol dependence and personality traits as important indicators of High Risk Behaviour lends support the hypothesis that alcohol dependents with both these variables may be prone for risk taking, probably with a common genetic variability. Patients scoring high on personality constructs such as impulsivity were particularly vulnerable to indulge in high risk behaviour. The findings of the present study allows to conclude that there was significant influence of gender (-3.260**) and education (-2.350*) on High Risk Behaviour of the sample and impulsivity as a personality construct is significantly associated with the high risk behaviour and severity of alcohol dependence. These results also indicate a strong need for intervention to address the personality traits related to severity of alcohol dependence to control relapses in treatment of Alcohol Dependence.

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