TheAssociation between Alcohol Dependence and Depression before andafter Treatment for Alcohol Dependence
Kuria,M. W., Ndetei, D. M., Obot, I. S., Khasakhala, L. I., Bagaka, B. M.,Mbugua, M. N., & Kamau, J. (2011). The association betweenalcohol dependence and depression before and after treatment foralcohol dependence. InternationalScholarly Research Network, 2012 (2012).doi: 10.5402/2012/482802
Depressionand alcohol dependence are significantly correlated. With thetreatment of alcohol dependence, depression fades awayautomatically.
Depressioncomes as one of the key determinants of the effectiveness of thetreatment process and outcomes in alcohol-dependent individuals. Asmuch as not every depressed alcohol-dependent individual requires tobe treated with anti-depresants, it is imperative that depression isidentified. Of particular note is the fact that the treatmentprocess of alcohol dependence is hindered if depression co-occurswith alcohol dependence. Therefore, research was carried out tofind out the association between Alcohol Dependence and Depressionbefore and after treatment for alcohol dependence. Further, it may benoted that the causal role that alcohol use disorders play indepression is stronger compared to the causal role that majordepression plays in alcohol use disorder. The objective of the studywas to determine the prevalence of depression among individuals thatare alcohol dependent prior to and after alcohol detoxification andrehabilitation.
Purposivesampling was used along with experimental design. Clinical trialswere done with pre and post measurements i.e. depression and alcoholuse were assessed before and after treatment. Participants werechosen from Kangemi informal settlement located in the west Nairobicity in Kenya. The number of participants was 188 who were positivelyidentified by AUDIT (Alcohol Use Disorder Identification). Participants from both genders were included. Only legal agedindividuals were included (i.e. above 18 years), who participatedvoluntarily. The research was carried out for six months withrehabilitation and detoxification. This was done to find out the costeffectiveness of institution based or community based rehabilitationand detoxification.
Theassessment measures used were sociodemographic questionnaire designedby the researcher Alcohol Smoking Substance Use IdentificationScreening Test (ASSIST) to screen out alcohol and substance userelated problems PAPI version of the Composite InternationalDiagnostic Interview (CIDI) to screen for psychiatric morbidity. TheASSIST and CIDI were administered at intake and at six months.
Medicationwas used during detoxification for ten days. Heavy sedation wasavoided by giving benzodiazepine. The follow up sessions were takenat home of the participant by the community health care takers. Sixmonth follow up procedure was followed, along with the administrationof follow up questionnaire to determine whether the participants wereabstaining from alcohol, as well as the symptoms that they may beexhibiting. The questionnaire was filled by the principle researcherand the community based health worker and discrepancy was evaluatedby home visits.
Therewas highly significant relation between depression and alcohol use.Individuals suffering from depression have an urge for alcohol. Theprevalence of depression among the alcohol using individuals is alsohigh. Of particular note is the fact that a large proportion of theparticipants were men, which could be as a result of the fact thatthere is a higher prevalence of alcohol consumption amongst men.However, this also brings into question the applicability of thestudy findings in populations of women. Majority of the participantswere men, which shows that there is a higher prevalence of alcoholuse in men. Majority of the participants were below age 40 years andused alcohol before 18 years of age. No significant relation wasfound between depression and demographic variables. The participantswere using substances other than alcohol cannabis (21.3%), tobacco(50%) and other substances (<1%).
Thisresearch has a number of conclusions from the findings made. First,it was concluded that there is a high prevalence of depression amongindividuals that are alcohol dependent. This is irrespective of thegender of the individuals although men are deemed to be more alcoholdependent than their female counterparts. In addition, it wasdetermined that as much as there existed recovery from depressionfollowing rehabilitation and detoxification, a large proportion ofthe cases never necessarily require that the depression be treated.Further, depressed individuals were seen as having considerablyhigher craving for alcohol following rehabilitation anddetoxification. Of course, this brings into question what causes theother as it had been noted that alcohol dependent individuals havehigher likelihood for depression, just as is the case that depressedindividuals have higher cravings for alcohol. It may be noted,however, that the later comes up after rehabilitation anddetoxification. All in all, the results of the study underline theimportance of screening for depression and assessing the patient soas to determine the treatment needs in the course of detoxificationand rehabilitation.
Thestrengths of the study were that the hypotheses of the study wereproven. Only those individuals were chosen who volunteered.Participants were aged below 40 years which helps in the way thatpeople above 40 years of age are usually suffering from depressiondue to various stressors in life and might indulge in alcohol usemore. Legal aged individuals were included in the study and informedconsent was obtained. There were not many drop outs from the study.Rehabilitation was provided to the participants and all the rightswere protected. The participants reported to have been using alcoholbefore age of 18 years, which means that there were no new usersincluded in the sample and that the sample was representative.Medication was used during the intervention program.
However,purposive sampling was used i.e. only those individuals were includedwho fulfilled the criteria. This might have affected the results ofthe study. The participants were chosen from the informal area of thecity which shows that individuals from upper class were not included.The researcher also did not obtain past psychiatric history orhistory of psychiatric disorders in the family this might haveaffected the prevalence rate of depression among the participants.The follow up was done at the participant’s home by filling out aquestionnaire only. Also it was not done by the principle researcheronly, help of the community based health workers was taken who mighthave limited knowledge on tool administration, research interviewingetc.
Similarly,there are pretty much contradictory results where depressedindividuals are found to have high rates of alcohol craving followingthe rehabilitation and detoxification, just as alcohol-dependentindividuals were also found to have high prevalence for depression.This finding is not well explained as to determine which precedes theother or rather what exactly causes the other.
Withthe help of these results further studies can be carried out to findthe causal relation between depression and alcohol use. These resultsare also helpful in the intervention of alcohol use and depression.The findings of the current study can be used by professionals, whichwould help them in designing the intervention programs for suchindividuals. The research findings can be used to promote awarenesscampaigns on the harmful effects of alcohol use and the craving foralcohol during depression. Pamphlets can be distributed and treatmentprograms can be readily available for the people in the community.
Onthe same note, it may be acknowledged that a large proportion of theparticipants in the study were men, which should not necessarily betaken to be indicative of the prevalence of alcohol use among menthan women. However, this also affects the applicability of theresearch among groups that have a higher proportion of women thanmen. As much as the writers underline the fact that there is nogender link or connection between the alcohol use disorders anddepression, it would be more appropriate to use more representativenumbers so as to make this conclusion.