International Journal of Applied Research & Studies ISSN 2278 9480

Original Research Article

QUALITY OF LIFE OF ALCOHOL DEPENDENTS AFTER COMMUNITY BASED CAMP INTERVENTION IN THE TREATMENT OF PERSONS WITH ALCOHOL DEPENDENCE SYNDROME

Authors

UmeshTonse1, Sinu. E2

Junior Research Fellow, 2Assistant Professor in Psychiatric Social Work, Department of

Psychiatry, Kasturba Medical College, Manipal University, Manipal, India

INTRODUCTION Alcohol consumption is the worlds third largest risk factor for disease and disability; in middle-income countries. Alcohol is a causal factor in 60 types of diseases and injuries. Almost 4% of all deaths worldwide are attributed to alcohol, greater than deaths caused by HIV/AIDS, violence or tuberculosis. Alcohol is also associated with many serious social issues, including violence, child neglect and abuse, and absenteeism in the workplace. Quality of life has become a dominant theme in planning and evaluating services for people with alcohol dependence. It is recognised increasingly as an important component in the evaluation of alcohol treatment processes. Alcohol misuse is a major cause of morbidity and mortality and an important health care burden, the Quality of Life (QoL) of alcohol misusing subjects has been little studied to date. There are few studies of Quality of Life measures (QoL) in alcohol-misusing patients. When the literature was reviewed there were only 24 studies from 1993 2012 related to quality of life of alcohol dependents. These studies have shown that quality of life (Qol) is improved significantly when subjects do not relapse to heavy drinking, and QOL deteriorates significantly on prolonged relapse (Foster, 2000).

Subjects who sustained 30% or greater decrease in drinks per month reported improvement in physical and mental health component and had fewer alcohol-related consequences when compared to those with a <30% decrease (Kraemer 2002). The most important predictors

Corresponding Author: Dr.E.Sinu, Assistant Professor in Psychiatric Social Work, Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, India -576104. Email: esinu27@gmail.com

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of baseline quality of life were severity of alcohol dependence, employment status, psychiatric history, quantity and frequency of alcohol consumption, attendance at Alcoholics Anonymous(AA), global alcohol health status, age, gender, and education (Morgan, 2004). Alcohol dependents attending AA group meetings experiences better quality of life (93.38 12.91) than the Non AA group(75.06 12.08, t=7.323, p<.001)(Savitha et al 2011). Quality of life of alcohol dependents attending AA group meetings was better when compared to patients attending other psychosocial treatments (Singh et al 2004). Frequent heavy drinking or episodic heavy drinking (five or more drinks per occasion) patterns were associated with reduced QoL. Alcohol dependents had significantly lower levels of QoL compared with general population or with other chronic health conditions (George et 2007).. Quality of life appears to be moderated by socio-demographic and client characteristics, such as age, education, gender and co-occurring psychiatric disorders. Alcohol-dependent individuals experience improvements in QoL across treatment with both short-term and long-term abstinence. Despite these improvements, many alcohol dependents QoL is unlikely to exceed that of normative groups. Among hazardous and harmful drinkers, achieving and maintaining a marked reduction in drinking is associated with significant increases in QoL (Dennis et al, 2005). AUDIT-positive patients reported more physical and psychological health problems and poorer QoL (Richard et al 2006). Alcohol dependents found to have lower quality of life due to high state anger, trait anger and high expression and experience of anger than the abstainers and social drinkers (Sharma et al 2012). Alcohol dependents have significantly adverse effects on their spouses in terms of marital satisfaction, family environment and quality of life(Sangeetha et al).

Treatment and Quality of Life of Alcohol Dependents At treatment initiation, alcohol dependent patients had lower QoL total scores and they scored lower on several subscale scores than those without ADS. Contingency Management treatment was associated with improvement in QoL (Andrade, 2012). Extended-release naltrexone 380mg in combination with psychosocial intervention was associated with improvements in QoL, specifically in the domains of mental health, social functioning, general health, and physical functioning (Pettinati, 2009). As an adjunct to medication compliance enhancement treatment, Topiramate (upto 300mg/d) was superior to placebo at not only improving drinking outcomes but increasing overall well-being and quality of life and lessening dependence severity and its harmful consequences (Johnson, 2004; 2008). Combinations of naltrexone and combined behavioral intervention (CBI), and acamprosate and CBI, each predicted significantly improved physical QoL (Prisciandaro 2012). Treatment with acamprosate and psychosocial support, by promoting abstinence, improves the quality of life profile to levels comparable to those observed in healthy individuals.

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SUMMARY OF THE STUDIES ON QUALITY OF LIFE AMONG ALCOHOL USERS
Sl.No AUTHOR 1. Beccaria (2012) METHODS Investigated the relationship between alcohol consumption and quality of life (QoL) on adults aged 25-34 living in France, Italy and Netherlands. (n=4841) Evaluated longitudinal associations between treatment status, alcohol consumption and QOL in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study Examined the association of alcohol use and health related quality of life. N=1532(56% M; 44% F) in different hospital out-patient settings Quality of life of alcohol dependents (N=390) RESULTS QoL depends mainly predominant consumption and drinking culture on style

2. Prisciandaro 2012

Combinations of naltrexone and combined behavioral intervention (CBI) and acamprosate and CBI, each predicted significantly improved physical QOL Alcohol dependence was associated with poorer quality of life in physical, general health and mental health areas of functioning. At treatment initiation, Alcohol dependence patients had lower QOL total scores and they scored lower on several subscale scores Alcohol dependents with PD had lower quality of life over the entire course of the treatment compared to patients without PD. Quality of life and craving at the initiation of the treatment predicted alcohol use during the first 3 months. Patients with personality disorder perceive poorer quality of life in areas such as health status, mood, and social relations. Self-perception of quality of life is affected by psychological adjustment and beliefs about craving Among alcohol-dependent men with lifetime PTSD, a history of childhood emotional abuse contributes to impairment of QoL Female gender, age > 45 yrs, living alone, working as a labourer, somatic co-morbidity were associated with a low physical Component of QOL. psychiatric co-morbidity, smoking and suicidality were associated with a low mental component of QOL. Ex-Drinkers and high-risk drinkers generally had lower life satisfaction and low health-related quality of life.

Peltzer et al 3. 2012, South Africa 4. Andrade et al 2012

5.

Martinez et al 2011

Quality of life of alcohol dependent persons with personality disorder

6.

Martinez et al 2010

Quality of life in patients with alcohol dependence disorder with personality disorders: relation to psychological adjustment and craving

7.

Evren 2011

et

al

Lifetime PTSD and quality of life among alcohol-dependent men: impact of childhood emotional abuse

Lahmek et al 8. 2009

Quality of life of alcohol-dependents during an inpatient withdrawal programme. N=414; prospective study Effects of alcohol consumption in spousal relationships on health-related quality of life and life satisfaction. n=3110 couples couples living in partner relationships.

Livingston et al 9. 2009

10.

LoCastro et al 2009

Alcohol treatment effects on secondary non-drinking outcomes and quality of life: the COMBINE study

A higher percentage of heavy drinking days, more drinks per drinking day, and lower percentage of days abstinent were associated with lower quality-of-life measures.

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Clinical and psychosocial factors associated with quality of life in alcohol-dependent men with erectile dysfunction. N=101 Men; 18 -50 yrs ED and self-rated depressive symptoms, emotional distress, selfesteem, and perceived social support were found to be significantly associated with QoL of persons with Alcohol dependents Quality of life is low in alcohol dependence syndrome patients with depression. It was found high in alcohol dependence syndrome patients without depression or anxiety. There is no significant difference between hospital based treatment and community based treatment with regard to quality of life of persons with alcohol dependence syndrome. Longer recovery time was significantly associated with lower stress and with higher quality of life

11.

Ponizovsky al 2008

et

12.

Saatcioque et al (2008)

Impact of anxiety and depression on quality of life of persons with alcohol dependence syndrome

13. Mary (2008)

Cross sectional study on disability and quality of life respondents with alcohol dependence in hospital based deaddiction services. N=60 Role of Social Supports, Spirituality, Religiousness, Life Meaning and Affiliation with 12-Step Fellowships in Quality of Life Satisfaction among Individuals in Recovery from Alcohol & drug problems (N = 353)

Laudet et al 14. 2006 New York

Kalman et al 15. 2004

Alcohol dependence, other psychiatric disorders, and health-related quality of life N= 127,308

Respondents with a history of alcohol dependence plus one or more other psychiatric disorders had significantly lower HRQoL in domains pertaining to psychological and social functioning than respondents with alcohol dependence only Health-related quality of life is severely impaired in dependent drinkers. The most important predictors of quality of life is abstinence duration QoL improves with abstinence and deteriorates with relapse. QoL in females is worse than in males, for comparable levels of dependency. Disturbed sleep with depression is a particular feature of the impaired QoL in female alcohol misusers Increase in alcohol related problems associated with lower quality of life

16.

Morgan et al 2004

Improvement in quality of life after treatment for alcohol dependence N=1216; 77% male;

17.

Peters et al 2003

Quality of life in alcohol misuse: comparison of men and women

Patience et al 18. 1997

SECCAT Survey: II. The Alcohol Related Problems Questionnaire as a proxy for resource costs and quality of life in alcoholism treatment. N=212

19. Volk et al 1997

Alcohol use disorders, consumption patterns, and health-related quality of life of primary care patients. N=1333

20.

Daeppen et al 1998

Evaluating health-related quality of life in alcohol-dependent patients N=147; 77% males; 26 -78 yrs

Persons with alcohol dependence scored lower (poorer HRQOL) on the mental health component. Binge drinkers and frequent, high-quantity Drinkers showed markedly lower scores in the areas of role functioning and mental Health Severity of alcohol dependence and depression seemed to influence the perception of HRQoL negatively.

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Factors associated with poor quality of life among alcohol dependents From the above table following inferences can be made; Quality of life of alcoholdependents was very poor but improved as a result of abstinence, controlled or minimal drinking. Important factors associated with poor QoL of alcohol-dependents are psychiatric co-morbidity such as anxiety, depression(Saatcioque 2008; Daeppen et al 1998; Peters et 2003), personality disorders (Martinez 2010; 2011), binge drinking, frequent drinking, high quantity drinking (Volk et al 1997), severity of alcohol dependence, increased alcohol related problems (Patience et al 1997), higher percentage of heavy drinking days, more drinks per days(Locastro 2009), more than one psychiatric disorders (Kalman et al 2004), relapse, disturbed sleep(Peters et al 2007), social environment, erectile dysfunction, emotional distress, reduced self-esteem (Ponizovsky 2008), female gender, persons aged above 45 years, living alone, labourers, smoking, somatic comorbidity (Lahmek et al 2009), life time PTSD and childhood emotional abuse (Evren et al 2011). Factors associated with better quality of life among alcohol dependents Among the factors which predicted better quality of life were abstinence duration (Morgan 2004; Peters 2003), longer recovery (Laudet 2005), and perceived better social support (Ponizovsky 2008). Attenuated physical QoL improvements for patients with alcohol abuse histories are related to greater pain and physical deficits (Eshelman 2010). QoL improvement after a residential treatment was related to low QoL scores at admission. Improvement in physical component of QoL was related to baseline alcohol intake and good somatic status (Lahmek 2009). Greater alcohol use was related to poorer prescribed insulin injection compliance and stronger expectations of immediate, positive consequences of drinking alcohol were related to several indices of lower quality of life (Cox 2002). Alcohol use was shown to be associated with impaired levels of health-related quality of life in adolescents (Chen, 2007). PTSD, major depression, and alcohol use disorders all adversely influenced adolescent QOL (Clarke 1996). Children and youth with Fetal Alcohol Spectrum disorder have significantly lower HRQL than children and youth from the general Canadian population (Stade 2006). Apart from above inferences there were also few contradictory findings in the literature such as persistent moderate drinkers had higher initial levels of health-related quality of life than persistent nonusers, persistent former users, decreasing users, unstable pattern of drinkers(Kaplan 2012). Regular alcohol consumption is associated with increased quality of life in older men and women (Chan 2009). Being a nondrinker of alcohol was associated with greater risk of mortality and poorer physical HRQoL. Moderate alcohol consumption was not harmful, and may carry some health benefits for older women (Furya 2008). Negative associations between alcohol and well-being were observed on several measures for women consuming more than 173g and men more than 229g per week. For men, statistically significant associations between moderate drinking and well-being disappeared when socio-demographic factors and were controlled. For women, moderate alcohol use associated with better self-rated health as compared to abstainers. Possible health utility benefits of moderate alcohol use were clinically insignificant; it suffices to investigate mortality, when estimating the public health impact of moderate alcohol consumption using quality-adjusted life iJARS Vol. 1(3): Dec 2012: 277 http://www.ijars.in 5

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years (Saarni 2008). Alcohol drinkers rated their health as good in comparison with non-drinkers (Saitp 2005). Low level of alcohol consumption was associated with a better HRQOL and possibly with better lung function (Tang 2005). In a 29 year cohort study; male subjects of high socioeconomic status, only the highest alcohol consumption (>3 drinks/d) affected mortality and it was associated with worse quality of life in old age. Moderate alcohol consumption in middle age offered no special benefits compared with abstinence over the long term (Standberg 2004). Alcohol drinking was associated with significantly better physical and role functioning and better global HRQL(Allison 2002). MATERIALS AND METHODS: Study was conducted in 2 places; Study group was taken in Sasthanavillage, Kundapur Taluk, Udupi District (community based de-addiction camp (CBC) conducted by Shri Kshethra Dharmasthala Rural Development Programme) and comparative group was taken in Dr.A.V Baliga Memorial Hospital, Doddanagudde, Udupi District, Karnataka (hospital based de-addiction camp (HBC). Quasi-experimental research design before and after with control group was adopted. Study was approved by the ethics committee of the hospital. The objective was to assess the quality of life of the person with alcohol dependence syndrome, before and after the deaddiction camp intervention in community as well as in hospital based camp intervention. Hypothesis: There would be a significant improvement in quality of life in persons treated for ADS in hospital based de-addiction camp. 30 Respondents were drawn from community based deaddiction camp(CBC) and another 30 were drawn from hospital based de-addiction camp (HBC), Inclusion criteria: Persons who give consent for the study, Age ranged from 18 years to 65 years, who met the criteria of alcohol dependence syndrome according to ICD 10 and AUDIT. Exclusion Criteria: Persons with history of any psychiatric disorder other than anxiety and depression, persons with mental retardation, with other substance use disorder other than NDS, persons with Severe medical complications and cognitive impairments. Study was conducted from January 2012 to April 2012. Sampling process: Census Method was used in the study. Tools used: Alcohol Use Disorder Identification Test (AUDIT), (World Health Organization, Department of Mental Health and Substance Dependence, 1992).Who Quality Of Life (BREF)-1998. Statistics Procedure: student t test, Effect Size analysis, correlation and regression analysis. Quality of Life: World Health Organization defines Quality of life as an individuals perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the persons physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment (WHO, 1993). Procedure: Alcohol dependent patients were contacted on the day of admission in both community camp and hospital based camp subsequently and explained about the nature of the study and its objectives. The respondents who fulfilled the inclusion criteria were selected and written informed consent was taken from them. Confidentiality of the information was assured. The study was done in the month of January 1st to 10th in Dr.A.V.Baliga hospital and February 10th to 17th in Dharmasthala de-addiction camp in Sasthana, Kunadapura. After the pre iJARS Vol. 1(3): Dec 2012: 277 6 http://www.ijars.in

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assessment part patients were also followed up at their monthly meeting in the community which occurred in Shri Kshethra Dharmasthala Rural Development Office, Sasthana. In the hospital based camp all patients from 2nd month of the camp were contacted through phone and were asked to come to hospital for follow up in a day comfortable for them. For other respondents those who were not willing to come for follow up were contacted at their workplace and in their home itself. RESULTS: Mean age of the respondents in Community based de-addiction camp was 35 years and 40 years in Hospital based de-addiction camp respondents. Mean years of education in CBC was 5 whereas in HBC it was 8 years. In the both group, majority of the respondents were married (63%), 93% in HBDC and 100% in CBDC were Hindus. In the family developmental stage, more than one-third of the respondents in both groups were in the stage of family with launching young adult stage. Majority of the respondents in the both the groups were employed, were semiskilled labors and getting daily payment, satisfied with their work and most of them were working in private sector. Mean age at alcohol initiation is 21 years in both groups and had 8 to 11 years of duration of alcohol dependence. 66% in CBC and 69% in HBC respondents had late onset of dependence and 63% in CBDC and 89% in HBDC had family history of alcohol dependence and no past de-addiction treatment before this camp.

TABLE 1: PRE AND POST ASSESSMENT COMPARISON OF QUALITY OF LIFE OF THE RESPONDENTS IN COMMUNITY AND HOSPITAL BASED DE-ADDICTION CAMP
Camp Quality of life Physical Health Psychological Health Social relationship Environment Total Physical health Psychological Health Social relationship Environment Total Test Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post Mean 23.4 21.2 19.0 19.4 10.2 10.6 26.2 27.9 82.0 86.2 22.10 20.66 17.40 19.00 10.46 9.73 24.90 27.00 86.56 83.60 S.D 3.82 .88 3.73 1.65 1.87 2.18 3.95 1.78 9.08 5.42 2.57 2.24 2.64 2.08 2.68 2.14 4.11 2.36 11.7 7.82 t value 2.99 .39 .244 1.88 2.22 2.18 2.57 1.47 2.75 1.38 p value .006* .693 .809 .70 .034** .037** .016* .152 .010* .176 Effect size r=0.3 ---r=0.2 r=0.28 r=0.31 -r=0.29 --

CBDC

HBDC

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Table 1 shows the respondents quality of life before and after CBC and HBC intervention. During the pre-assessment mean score of QoL was 82.06(S.D=9.08) in CBDC and 86.56(S.D=11.70) in HBDC, which indicates both the group had neither good nor poor quality of life. Paired t test result showed that there was statistically significant difference wi thin CBC respondents quality of life during pre and post assessment (t=2.22, p=.034). Respondents mean score on total quality of life in CBDC during pre-assessment was 82.06(S.D=9.08) and in post assessment it increased to 86.26 (S.D=5.42) But in HBDC; it was 86.56 (S.D=11.70) during the pre-assessment and in post assessment it was decreased to 83.60(S.D=7.82).When compared to respondents in HBDC, respondents in CBDC have shown improvement in overall quality of life after the camp. There is medium effect size in CBC with regard to physical health between before camp and after the camp approach (r=0.37), whereas in HBC it was found small effect size in physical health. In psychological health the HBC respondents had medium level effect size (r=0.31) and small effect size in environment quality of life (r=0.29). It was also found that there is small effect size in overall quality of life of the respondents in CBDC (before and after camp intervention) TABLE 2: QUALITY OF LIFE OF ABSTAINERS AND RELAPSERS IN HOSPITAL AND COMMUNITY BASED DE-ADDICTION CAMP
Group Quality of life Physical health Psychological health CBDC Social relationship Environment Total Physical health Psychological health HBDC Social relationship Environment Total Alcohol use status Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers Abstainers Relapsers N 22 8 22 8 22 8 22 8 22 8 17 13 17 13 17 13 17 13 17 13 Mean 21.45 20.50 19.90 18.00 10.77 8.50 28.63 25.87 88.77 79.37 21.52 19.53 20.23 17.38 10.58 8.61 28.35 25.23 88.82 76.76 S.D .73 .92 1.23 1.92 1.90 2.13 1.39 .99 3.59 3.02 1.06 2.87 .97 2.06 1.80 2.10 1.16 2.38 2.57 7.07 t test p value 2.928 3.218 2.805 5.110 6.574 2.638 5.034 2.763 4.722 6.512 .007** .003** .009** <.001* <.001* .013* .00 .010** <.001* <.001* Effect size 0.48 0.51 0.46 0.69 0.72 0.44 0.68 0.46 0.66 0.77

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Table 2 shows the quality of life of abstainers and relapsed respondents. Mean score of the social relationship 8.50(S.D=2.13) in CBC respondents who are relapsed during 2 months and it is comparatively less when compared to the respondents who are maintaining abstinence 10.77(S.D=1.90). It shows that when respondents relapsed after a camp; their social relationship was decreased. Overall quality of life of the respondents who were relapsed was less (mean=79.37, S.D=3.02) when compared to the respondents who were maintaining abstinence (mean=88.77, S.D=3.59). Mean score of the relapsed respondents in HBC was less compared to abstainers in all the subdomains (Psychological 17.382.06 Vs (20.23.97, social relationship 8.612.10 vs 10.58=1.80) In HBC also the mean score of the overall quality of life of the relapsed respondents was found to be less (6.767.07) compared to abstainers (Mean=88.82, S.D=2.57). CB Camp intervention had medium effect on physical health (r=0.48), social relationship (r=0.46) and large effect size on psychological health(r=0.51), environment quality of life (r=0.69) and in overall quality of life(r=0.72). HB Camp intervention had medium level of effect on physical health (r=0.44), social relationship (r=.010), and large level of effect size on psychological health(r=0.68), environmental quality of life(r=0.66) and in overall quality of life (r=0.77) of the respondents. There is a positive correlation between number of days of abstinence and physical quality of life (r=.387, p<0.001), psychological health (r=.409, p<0.001), and social relationship (r=.451, p<0.001), environment life (r=.628, p<0.001), overall quality of life(r=.654, p<0.001). Regression analysis revealed duration of abstinence predicts abstinence (F=16.52, p=<.001) in hospital and community based camp (F=30.85, p=<0.001). Duration of Abstinence (R Square) explains 52% variance in Abstinence in CBD camp and 37% variation in HBD camp.

Discussion
Quality of Life of persons with alcohol dependence With regard to quality of life; both group scored less (82 in CBC and 86 in HBC) during preassessment. This finding is in parallel with Andrade et al (2012) where they reported during treatment initiation alcohol dependents had scored low scores in total QOL and subscales of QOL. Present study found that there was no significant difference between both the camp respondents with regard to the overall quality of life before the camp intervention. This is in concordance with Mary & Pandian study (2008) in which they observed that there was no significant difference between respondents who were availing hospital based de-addiction service and community based de-addiction service. There was noteworthy finding from this study that overall quality of life of the respondents increased in community based de-addiction camp during post-assessment but not in Hospital based camp. After the camp intervention both group respondents significantly scored less physical health QOL when compared pre-assessment score. It may be due to their physical withdrawal symptoms. Respondents in HBC showed significant improvement in their psychological, environmental quality of life during post-assessment. Parsimonious the reason could be that they get their family members love and affection; investing their money. In the community based deiJARS Vol. 1(3): Dec 2012: 277 http://www.ijars.in 9

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addiction camp majority of the respondents maintained abstinent and very few people had relapse; this may be the due to the community camp respondents involvement among themselves and their interest to help other group member to recover. In the present study it was found that majority of the respondents in hospital based de-addiction camp had low quality of psychological health. Quality of life and Abstinence In the present study it was found that respondents in both the camp who maintained abstinence had shown significant improvement in quality of life than relapsers. There was significant difference between abstainers and relapsers with regard quality of life. Similar findings were reported by (Peters et al, 2003) they reported that quality of life improves with abstinence and deteriorates with relapse. There was a noteworthy finding from the study that there was inverse relationship between severity of alcohol dependence and quality of life. This is in concordance with previous studies. Where Daeppen et al (1998) reported that severity of alcohol dependence influenced lower health related quality of life and Patience et al (1997) reported that increase in alcohol related problems associated with poor quality of life. Present study revealed that duration of abstinence alone predicts 52% (R square) quality of life in CBC camp and in HBC it was 37% (R Square). This is finding is supported by Morgan et al (2004) in which they have stated that duration of abstinence is important predictor of quality of life of alcohol dependents. Changes in overall quality of life after camp approach After the camp intervention it was observed that community based de-addiction camp respondents had high score (x=86.26) than the hospital based de-addiction camp respondents (x=83.60) it might be due to the treatment approach in community camp and the support they get from the community leaders and the support from whom they identify Nava Jeevana(New life) group but it was lacking in the respondents who were treated in hospital based de-addiction camp. CONCLUSION Both the camp approach intervention is effective in helping the people with alcohol dependence syndrome in maintaining abstinence. Community based de-addiction camp intervention shown effective in enhancing quality of life of the alcohol dependents compared to the counter parts in hospital based camp. References 1. Allison, P. J. Alcohol consumption is associated with improved health-related quality of life in head and neck cancer patients. Oral Oncol. 38(1), 81-86. 2002. 2. Andrade, L. F., Alessi, S. M., &Petry, N. M. (2012). The impact of contingency management on quality of life among cocaine abusers with and without alcohol dependence. Am.J.Addict., 21, 47-54. 3. Byles, J., Young, A., Furuya, H., and Parkinson, L. A drink to healthy aging: The association between older women's use of alcohol and their health-related quality of life. J.Am.Geriatr.Soc. 54(9), 1341-1347. 2006. iJARS Vol. 1(3): Dec 2012: 277 http://www.ijars.in 10

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Acknowledgement: Shri K.shethra Dharmasthala Rural Development Programme and Dr.A.VBaliga

Memorial Hospital, Doddanagudde, Udupi District, Karnataka, India.

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