CONTRIBUTION OF SELECTED PSYCHOLOGICAL AND SOCIAL FACTORS TO RELAPSE AMONG RECOVERING ALCOHOLICS IN ASUMBI AND JORGS ARK REHABILITATION CENTRES, KENYA

ABSTRACT
Drug abuse is a major global problem and in Kenya there has been increasing drug and alcohol abuse with serious negative effects. Treatment and rehabilitation of alcoholism is expensive and in many cases non-conclusive. Treatment not only strains the national resources allocated to health but it drives families to poverty. Deaths from alcoholism are also a major loss to families and to society. Thus this study sought to find out the contribution of selected psychological and social factors to relapse among recovering alcoholics of Asumbi and Jorgs Ark rehabilitation centres in Kenya. The study adopted the descriptive survey design. The population of the study comprised of 93 relapsed alcoholics and rehabilitation counsellors in Asumbi and Jorgs Ark rehabilitation centres in Kenya. A sample of 67 recovering alcoholics and 13 counsellors was drawn from the two purposively selected rehabilitation centres and used in the study. The study used two sets of questionnaires to collect data, one for relapsed alcoholics and another for rehabilitation counsellors. The questionnaires were piloted to establish their reliability by use of the Cronbach alfa method. A reliability coefficient of 0.84 was obtained for the questionnaires before the actual data collection. The data was then processed and analyzed using descriptive statistics including frequencies and percentages with the aid of the Statistical Package for Social Sciences (SPSS) version 20.0 for windows. The key findings of this study indicated that the selected psychological factor that mostly contributed to relapse was dwelling on resentment that causes anger due to unresolved conflict. The social factor that mostly contributed to relapse was hanging around alcoholic friends. The conclusion was that in view of the selected psychological factors, dwelling on resentment that causes anger due to unresolved conflict contributed to relapse. In the selected social factors, hanging out with alcoholic friends contributed most to relapse. Based on the major findings of this study, it is recommended that recovering alcoholics should be trained by counsellors on how to deal with anger due to unresolved conflict because it was a major reason for relapse. Rehabilitation centres are encouraged to strengthen individual counselling so as to solve these problems. It is also recommended that recovering alcoholics should be trained by rehabilitation counsellors on how to make and sustain meaningful relationships.

CHAPTER ONE
INTRODUCTION
Background of the Study
According to the United Nations Office of Drug Abuse and Crime (UNODC, 2015), drug abuse is on the increase and causes adverse social, health and economic implications. In 2012 alcohol consumption led to about 3.3 million or 5.9 percent of global deaths. The World Drug Report (2013), reports that alcohol abuse is a major global threat with serious consequences on people‟s security, economic status, heath and cultural welfare. In many parts of the world relapse rates in addiction are still very high and addictions have continued to plague many drug users. For instance the National Survey on Drug Use and Health (NSDUH, 2006) gives relapse rates at 50%- 90% in America. Alcohol use has serious health and social effects making its prevention and control a public health priority. According to WHO (2002, 2004), alcohol causes 1.8 million deaths (3.2% of total) one third (600,000) of which result from unintentional injuries. It also causes a loss of which 40% are due to neuro- psychiatric conditions.

Marlatt, Parks and Witkiewitz, (2002) explains that relapse to alcohol addiction is dependent on many factors, some are found within the individual and others found within the social milieu in which the individual lives. Treatment of addictive disorders in the recent years has focused on relapse prevention as an important component in recovery from such addictions. A supportive family is considered the strongest source of identity and social support among all contextual relationships (Beattie, 2001) and hence associated with better prognosis and successful reduction of drug use during treatment. Copello, Velleman and Templeton (2005) argue that the family plays an important role on alcohol abstinence maintenance or relapse and propose that to achieve effectiveness in alcohol treatment the alcoholics‟ family should be involved.

According to Pierce, Frone, Russell, Cooper and Mudar (2000) substance abuse and alcoholism are seen as symptoms of a dysfunctional family system, and hence the family is considered as part of the solution to the relapse problem without which the individual would not relapse. Saatcioglu, Erim and Cakmak (2006) explain that there is strong evidence to support the effectiveness of family interventions in treatment of alcoholism, which demonstrates that family therapy for alcoholics is effective in improving overall family relationships and functioning, and which in turn improves overall substance use outcomes, engagement, and retention in therapy. Family treatment also brings about marital satisfaction for alcoholics, improve communication, and improve positive couple functioning which in turn improve prognosis (Antoine, Christophe, & Nandrino, 2009). Family members‟ involvement in therapy greatly contributes to the individual alcoholic‟s motivation to change and maintain abstinence (Templeton, Velleman, & Russell, 2010). While involved in a treatment program, family members are a rich source of information about the real life interactions and experiences of the addict that may have a contribution to effective treatment planning and relapse prevention (Saatcioglu, et al., 2006).

Acccording to Emmite and Swierzewski, (2008), alcohol consumption and abuse is influenced by multiple factors including gender, family history and parental influence. Men are more likely to use alcohol with some estimates indicating a ratio of 5:1. Men are also at high risk of heavy drinking and intoxication (Gmel, Rehm, & Kuntsche, 2003). However the number of women who drink, abuse, and become dependent on alcohol is rising.

Relapse is a formidable challenge in the treatment of all behaviour disorders (Witkiewitz & Marlatt, 2004). To explain this challenge several authors have described relapse as complex, dynamic and unpredictable (Buhringer, 2000; Donovan, 1996 & Marlatt, 1996). Rasmussen (2000) noted that relapse occurs because of the building up of additional crisis including looking trivially on a certain problem, stress, weak or failed forecast, the pessimistic thinking that all issues cannot be resolved and immature actions. Relapsed addicts are also confused and overreact due to the inability to think clearly, unable to manage feelings and emotions, the difficulty to remember things, unable to control their feelings and easily angered. Moos (2007) contended that psychological factors contribute to relapse among drug addicts after abstinence. Another relapse promoting factor is self-efficacy, defined as a degree to which an individual feels confident and capable of performing a certain behavior in a specific situational context (Bandura, 1977).

Although reports on alcoholism in Africa in general are committed to giving a broad picture on health issues relating to alcohol, there is an underlying impression that relapse rates are still high in these areas. The National Campaign against Drug Abuse Authority (NACADA), in Kenya has shown that relapse rates are very high, however, it is more committed at providing statistics of areas dominated by drug use and the drug of choice in such areas (NACADA 2011). Some available data for four outpatient rehabilitation programs in Kenya from 2007 to the first quarter of 2010 estimated the overall abstinence rates for three drugs: cannabis, alcohol, and heroine as 42%, while that for alcohol and cannabis alone was 46% of users (Deveau, Tengia, Mutua, Njoroge, Dajoh & Singer, 2010).

The United Nations Office of Drug and Crime in its World Drug Report of 2010 (UNODC, 2010) ranked Kenya among the four most notorious African nations with drug problems, and the port of Mombasa as a major transit point. In Kenya, alcohol is the most abused drug with a national abuse rate of 36.3 percent followed by nicotine 17.5 percent, Cannabis Sativa - Bangi 9.9 percent, heroin 8.0 percent, Catha edulis – Miraa 2.7 percent and cocaine at 2.2 percent. According to Ndetei, Mutiso, Khasakhala, Odhiambo, Kokonya, and Sood (2004) alcohol use has been attributed to social dysfunctions and laxity in legal provisions and application. The National Agency for the Campaign against Drug Abuse (NACADA, 2004), report that of the youth population of 5,835,007 in Kenya, 60 percent abuse drugs, mostly alcohol.

The Government of Kenya has endeavored stringent law enforcement together with rehabilitation programmes for drug addicts. Indeed, the government through various agencies for instance NACADA, has put into action strategies to impede drug use parallel to the mission of attaining a drug-free society. According to NACADA (2008) the objectives of the NACADA 2009-2014 Strategic Plan, are: to strengthen the capacity of NACADA to coordinate the campaign against alcohol and drug abuse in Kenya; to develop a comprehensive prevention program for alcohol and drug abuse with a focus on demand reduction; to strengthen control mechanisms for alcohol and drug abuse focusing on supply suppression; to ensure quality treatment and rehabilitation for persons with substance use disorder; to undertake quality research on alcohol and drug abuse in Kenya; to guide policies and programmes; and to strengthen inter-sectoral coordination and collaboration.

A study on the contribution of selected psychological and social factors to relapse among recovering alcoholics in Asumbi and Jorgs Ark, Kenya is timely. Asumbi and Jorgs Ark rehabilitation centres have played a significant role in treatment and receive many relapsees. It was therefore important to get the contribution of factors to relapse from these rehabilitation centres. This study sought to give insights into development of comprehensive prevention, treatment and rehabilitation programmes. Likewise identifying factors that are associated with relapse after alcohol dependence treatment is likely to improve the effectiveness of treatment and prevent relapse.

Statement of the Problem
In Kenya, alcoholism has had serious negative effects. This has led to the establishment of treatment and rehabilitation services to tackle this problem. NACADA (2014) indicates that while 2.5 million Kenyans are in need of professional intervention in the form of treatment and rehabilitation there are only 77 facilities with an approximate bed capacity of less than 1000. Despite the increase in the number of centres and demand for the services offered in the country, there has been a simultaneous increase in the number of relapse cases. There is therefore a need to study the contribution of selected psychological and social factors to relapse among recovering alcoholics of Asumbi and Jorgs Ark rehabilitation centres, Kenya.

Purpose of the Study
The purpose of this study was to determine the contribution of selected psychological and social factors on relapse among recovering alcoholics in Asumbi and Jorgs Ark rehabilitation centres, Kenya.

Objectives of the Study
The study was guided by the following objectives:-

i) To determine the contribution of selected psychological factors on relapse among recovering alcoholics in rehabilitation centers in Kenya

ii) To determine the contribution of selected social factors on relapse among recovering alcoholics in rehabilitation centers in Kenya

iii) To establish the recovering alcoholics‟ preparedness to cope with risks to alcohol relapse after rehabilitation.

Research Questions
i) What is the contribution of the selected psychological factors to relapse among recovering alcoholics in rehabilitation centers in Kenya?

ii) What is the contribution of the selected social factors to relapse among recovering alcoholics in rehabilitation centers in Kenya?

iii) What is the recovering alcoholics‟ preparedness to cope with risks to alcohol relapse after rehabilitation?

Significance of the Study
In order to rehabilitate alcoholics, detailed studies are needed to assess the factors that contribute to relapse. This study was based on the fact that establishing the contribution of selected psychological and social factors to relapse is important in understanding the success and outcomes of rehabilitation programmes in addressing relapse among alcoholics. It was envisaged that the study may benefit NACADA, Ministry of Public Health, Mental health agencies, psychologists, counsellors, Non- Governmental organizations, policy makers, researchers, alcoholics in the study area and the country at large. NACADA may use these findings to strengthen the operations of rehabilitation centers in reducing relapse cases. The psychologists and counsellors may understand their critical role in the alcohol treatment and rehabilitation and make them more effective in the execution of their duties. The recovering alcoholics may use this study to better understand their alcohol problem, treatment and recovery. The society and country at large may understand their expected role in the treatment and rehabilitation of alcoholics through enabling social re-integration. This information may be used in the improvement of alcoholism treatment and rehabilitation programmes in Kenya.

Scope of the Study
The study was confined to Asumbi Treatment Centre, Homabay County and Jorgs Ark rehabilitation centre located in Kiambu County Kenya. Asumbi was selected because it constantly has a high number of alcoholics. Jorgs Ark was also selected because it attracted an urban clientele. This study specifically targeted the available relapse cases and service providers in the centres because of their direct involvement in alcohol treatment and rehabilitation in country. This study concentrated on the selected psychological factors, social factors and the recovering alcoholics‟ preparedness to cope with risks of alcohol relapse after rehabilitation.

Assumptions of the Study
The study was carried out under the following assumptions:

i) That the rehabilitation centres will be ready to assist to give information for the study.

ii) That the respondents selected would willingly provide accurate and true information about themselves and the problem under study.

Limitations of the Study
The study was limited by the fact that some respondents found the study to be sensitive especially due to ethical issues involved and were suspicious as to the purpose of the study. The researcher reassured them of the confidentiality of the information provided and that the information obtained was purely for research purposes.

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Item Type: Kenyan Material  |  Attribute: 68 pages  |  Chapters: 1-5
Format: MS Word  |  Price: KSh900  |  Delivery: Within 30Mins.
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