INFLUENCE OF COUNSELLING SERVICES ON BEHAVIOUR CHANGE AMONG ADULT RECOVERING ALCOHOLICS IN UASIN GISHU COUNTY KENYA

ABSTRACT
Since the escalation of alcoholism in Kenyan, many families are wrestling to cope with the costs of addiction because addiction is often defined as chronic, relapsing disorder that require comprehensive detoxification and psychosocial intervention. Alcoholism severity and relapse complexity process that involves the mental, physical, emotion and behavioural component of a person disables recovering alcoholics to achieve sobriety. Therefore, this study sought to investigate the influence of counselling services on behaviour change among adult recovering alcoholics in Uasin Gishu County. The study used descriptive survey design. Purposive sampling was used to select three rehabilitation centres for recovering alcoholics and accessible sample size 70 from these rehabilitation centres. The questionnaire was administered by the researcher to collect data. It was a self report measure consisting of 25 items scored on a likert five point scale which measured the following broad domains; counselling services, physical health, psychological well being and social functioning. The pilot study on identified subjects of similar treatment was done to find the accuracy of items. The data obtained was analyzed by Statistical Package for Social Sciences (SPSS) version 22.0 for windows. Kuder- Richardson was used to estimate the reliability. Reliability coefficient of 0.806 was obtained and this was considered acceptable for this study indicating good concurrent validity. The findings demonstrated that counselling services offered among adult recovering alcoholics influences behaviour change and improves general health, psychological well being and social functioning. The result also indicated that recovery and a fulfilling life is possible by taking positive steps towards meaningful goals setting, working on self esteem, empowerment and social support. Often there is inadequate attention placed on how to maintain abstinence in the weeks, months or even years following treatment. Given this reason, the researcher recommends for enhancement of aftercare structured counselling program among rehabilitation centres’ which has been shown to make a huge difference between the addict abstaining from his or her addiction and successful relapse management.

CHAPTER ONE
INTRODUCTION
Background Information
Alcohol has been and continues to be most available and abused substance worldwide regardless of age, race, intelligence, education, religion, profession, gender among others. Alcohol consumption has health and social consequences through drunkenness, alcohol dependence, and other related biochemical effects. Alcoholism is a disease that is characterized by the sufferer having a pattern of excessive drinking despite its negative effects on individual’s health, work, medical, legal, educational, family, and social life. At this level, the researcher will look at research studies on alcohol prevalence globally, regionally and nationally. Thereafter to find out how these statistics have influenced urgency of intervention to curb the escalating alcohol related problems.

The Global Status Report on Alcohol and health (2014) presents a comprehensive perspective on the global, regional and country consumption of alcohol, patterns of drinking, health consequences and policy responses. The World Health Organization’s (WHO) statistics report on Global Status on Alcohol (2011) estimated that there are about 2 billion people worldwide who consume alcoholic beverages and 76.3 million with diagnosable alcohol use disorders. Worldwide per capita consumption of alcoholic beverages in 2005 equalled 6.13 litres of pure alcohol consumed by every person aged 15 years and older per year. A large portion of these consumption 28.6% or 1.76 litres per person was homemade and illegally produced alcohol or, in other words, unrecorded alcohol.

In 2012, about 3.3 million deaths, or 5.9% of all global deaths, were attributed to alcohol consumption. There are significant sex differences in the proportion of global deaths attributed to alcohol, for example, in 2012 7.6% of deaths among males and 4.0% of deaths among females (WHO, 2014). In the very year, 5.1% of the global burden of disease and injury were attributable to alcohol consumption. Following the endorsement of the global strategy to reduce the harmful use of alcohol, WHO is committed to continue to monitor, report and disseminate the best available knowledge on alcohol consumption, alcohol-related harm and policy responses at all levels. WHO ensures monitoring progress in implementing the global strategy and regional action plans among its member countries. It has strengthened its actions and activities to prevent and reduce alcohol-related harm at all levels. These strategies include: leadership, awareness and commitment action, health service response, drinking-driving-countermeasures, regulating availability of alcohol, marketing restriction, pricing, reducing negative consequences of drinking, addressing illicit and informal production, Monitoring and surveillance. Many WHO Member States have demonstrated increased leadership and commitment to reducing harmful use of alcohol over the past years, as proposed by the Global Strategy to Reduce the Harmful use of Alcohol (WHO, 2014). In addition the report shows the need for communities to be engaged in reducing harmful use of alcohol. Through a global network, WHO is supporting countries in their development and implementation of policies to reduce the harmful use of alcohol. The need for intensified action was endorsed in the landmark 2011 of United Nations General Assembly meeting, which identified alcohol as one of the four common risk factors contributing to the Non- Communicable Diseases (NCDs) epidemic.

Europe has the highest level of drinking in the world, with a prevalence of heavy episodic drinking in excess of one fifth of the European population of 15 years old and over (WHO, 2010). A report from the Institute of Studies estimate that every year alcohol is responsible for 115,000 net deaths in Europe up to the age of 70 (Anderson & Baumberg, 2006). Alcohol is the leading contributor to death among young adult men with about 25% mortality. The report also estimated the tangible costs of alcohol to the EU in 2003 to be 125 billion Euros, which is 1.3% of the EU GDP (Anderson & Baumberg, 2006). In collaboration with the Department of Health, the National Institute for Health and Clinical Excellence (NICE) has published national guidelines on management of alcohol use and alcohol disorders in the UK (Drummond, Pilling, & Brown, 2011). Alcohol-use disorders, the NICE guideline on diagnosis, assessment and management of harmful drinking and alcohol dependence, builds on the conceptual framework for alcohol treatment delivery developed by the Institute of Medicine in 1990.

In the United States of America (U.S.A), alcoholic beverages are both legal and socially accepted. The study, published in the Archives of General Psychiatry (2008), postulated that more than 43,000 adults reported in 2007 found that thirty percent of U.S.A. adults have experienced alcohol abuse or alcoholism. They articulated further that fewer are getting treatment for alcohol use disorders than in the past. The recent research done on Health Statistics for U.S.A adults (2011) indicates that overall 52% of adults aged 18 and over were current regular drinkers, 14% were current infrequent drinkers, 6% were former regular drinkers, 9% were former infrequent drinkers, and 20% were lifetime abstainers. Sixty percent of men were current regular drinkers compared with 44% of women. Men were also more likely to be former regular drinkers than women. Women were more likely to be current or former infrequent drinkers or lifetime abstainers than men. In 2000 National Survey of both rural and urban populations of Mexico age group 20 years and above, the rate of current drinkers was 69.4% (male) and 59.5% (female). In reference to the 2003 World Health Survey (WHS), sample population aged 18 years and over, the rate of lifetime abstinence was 52.7%, (35.6% male and 65.2% female). World Health Survey (2003) indicates that 22,368 sample populations aged 18 years and over, the rate of heavy episodic drinking among the total population was 3% (total), 6.3% (male) and 0.7% (female). Heavy episodic drinking was defined as at least once a week consumption of five or more standard drinks in one sitting.

The treatment of alcohol problems in the United States of America can be traced back to the establishment of Alcoholics Anonymous (AA) in 1935 as Alcoholics Anonymous World Services (National Academy Press, Washington, D.C, 1990). This was recognized quickly by men like Clinton Duffy, the great “reform” warden of San Quentin, who encouraged the establishment of AA groups in his prison in 1942. The Institute of Medicine report (1990) states that Harvard psychiatrist Robert Fleming in 1944 argued that the prolonged institutionalization of alcoholics was no longer necessary instead community-based psychotherapy and AA participation was his new prescription. The growth of AA permitted the first substantial stirrings of community care since the Washingtonian Movement. During the early 1960s, some state hospitals, particularly in Minnesota, incorporated recovering alcoholics and the principles of AA into their treatment programmes. What became known as the Minnesota model of short-term inpatient care. Subsequent AA fellowship and recovery- home living spread slowly among private treatment providers such as the Hazelden Foundation, Minnesota and the Mary Lind Foundation in Los Angeles (Besteman,1991).

The most commonly abused substances in Africa are alcohol, cannabis and khat/miraa (Odejide, 2006). Africa has the second highest growth of beer consumption after Asia, with a compounded annual growth rate of 6.4 per cent over the past five years (Beer Brewer SABMiller’s 2009, Annual Report). In South Africa, alcohol consumption rate is 28%, which translates to 8.3 million South Africans 15 years and above. For both men and women the highest levels of current alcohol use were recorded among persons between 35-44 and 45-54 year age groups, and the lowest levels in the 15-24 year group. Risky drinking was defined as drinking five or more standard drinks per day for men and three or more drinks per day for women.

The heavy influence of the alcohol industry on the development of national alcohol policies favourable to alcohol advertising and distribution has recently been documented in several African countries. In South Africa, the established Inter-Ministerial Committee (IMC) reviewed extensive inputs and evidence on alcohol marketing and alcohol-related harm and then mandated the Minister of Health to draft legislation banning all advertising and sponsorships and other marketing on the basis of this evidence (WHO, 2014). The impacts of the Inter-Ministerial Committee are now beginning to be felt. The individual country can plan how best to reduce the impacts of alcohol in society and where all departments can contribute to reducing alcohol-related harm as part of a “whole of government” approach has the potential to reduce alcohol-related harm considerably. A survey conducted in Central and Southern Nigeria indicates that, 52% of male and nearly 40% of female respondents reported heavy episodic drinking in the past year, and among drinkers heavy consumption was common practice (Ibanga, Adetula, Dagona, Karick, & Ojiji 2005). Alcohol consumption in Nigeria was a gender and age based. A similar survey done in Uganda showed that 46% and 17.6% of male and female drinkers respectively engaged in heavy episodic drinking (Tumwesigye & Rogers, 2005).

Uganda is the highest consumer of alcohol per capita in the East African region, according to a newly released report. The Global Status on Alcohol and Health (2014) indicates that 23.7 litres of pure alcohol are consumed per capita by drinkers annually in Uganda. Rwanda and Burundi follow each registering 22.0 litres per capita per year. Kenyans follow with a registered 18.9 litres of alcohol consumed per capita while Tanzania consumes only 18.4 litres per capita. At least 89 per cent of the alcohol consumed in Uganda is unregulated, home brewed and illegally sold, according to the report. In Uganda, a country of more than 32 million people, alcohol dependence is among the main causes of psychiatric morbidity (Ministry of Health in Uganda, 2005). Historically, alcoholic beverages such as beer have often been used to bind different Ugandan cultures together and during celebrations of important events such as marriages (Wolf, Busza, Bufumbo, & Witworth, 2006). Uganda not only lacks a clear national alcohol policy, but has weak and poorly enforced laws, thereby providing a fertile ground for alcohol abuse. It is also evident that there is neither restriction on advertising alcohol nor sponsorship of national events including youth assemblies. Enforcement of laws on alcohol beverages in government premises, health centres and education institutions is very inadequate despite a ban on them. Similarly, there are no restrictions on opening time of bars. Some bars are open 24 hours and 7 days a week more especially in areas around institutions of higher learning, parks, streets, workplaces among others. The alcohol manufacturers successfully opposed a rise in the tax levy on alcohol introduced in 2012/13 budget. They argued that the government would lose revenue if alcohol prices and smuggling increased. Attempts by the Ministry of Health to regulate the consumption of alcohol have been opposed by the Ministry of Trade which blocked a proposal on the manufacture and consumption of local gin products, Waragi sachets (Ministry of Health in Uganda, 2005).

Alcohol is the most liberally abused substance in Kenya followed by Tobacco, Bhang, Miraa (Khat), inhalants and description drugs (NACADA, 2002). While Kenya has a lower alcohol- consuming population in the region, it has the largest number of beer consumers at 56 per cent of all alcoholic beverages consumed compared to 50 per cent in Ethiopia, Burundi’s 25 per cent, 11 per cent in Rwanda and Tanzania and only 9 per cent in Uganda (WHO,2014). All alcoholic beverages contain ethanol, which is considered a drug since it is narcotic, depressive and addictive. It is estimated 13% of people from all provinces in Kenya except North Eastern province are current consumers of alcohol (NACADA, 2011). Disaggregating by province, the lowest use was found in North Eastern (0 %) and Western provinces (6.8%) while the other six provinces were comparable with a range of 13% - 19% (Rift Valley 12.5%, Eastern 14.8%, Nyanza 17.0%, Central 17.7%, Coast 18.6%, Nairobi 18.6%). The three classes of illicit brews in Kenya according to WHO (2004) are: fermented brews (traditional Beer) such as Busaa (a grain beer), Mnazi (palm Wine), Muratina (from a local fruit known as Muratina mixed with sugar cane juice and honey) and Indali (banana beer) from ripe bananas; distilled liquors or spirits such as chang’aa in Kenya which is equivalent to Waragi in Uganda and Konyagi in Tanzania.

Findings from a National Survey on Alcohol and Drug Abuse conducted by NACADA in 2012 shows that 13.3% Kenyans are currently using alcohol. The survey further indicates that 30 % of Kenyans aged 15-65 have ever consumed alcohol in their life. This means that at least 4 million people abuse alcohol. The damage caused by both licit and illicit alcohol abuse to the society, labour force and the entire economy has been of much concern to the Kenyan government. Alcohol use has led to so many deaths in Kenya although the law penalises those found guilty of adulterating alcoholic drinks. This has however not prevented occurrence of deaths linked to illicit brews. Between April and August 2010, over 50 deaths were reported and dozens of alcohol related blindness (NACADA, 2011). This shows an urgent need to prevent and control alcohol abuse in Kenya. The Kenyan government took an action of instituting policies especially promulgation of various Acts such as; Traditional Liquor Licensing Acts and Narcotic Drugs and psychotropic substance control Act of 1994. The government also resolved to combat the menace through formation of National Agency for the Campaign Against Drug Abuse Authority (NACADA) to complement stated Acts. These Acts and policies on alcohol are purposed to control alcohol production and sales but little has been done to help alcoholics to stop abusing alcohol and other drugs.

Although Nacada has launched a massive campaign to fight alcoholism, the war is undermined by the limited number of affordable rehabilitation facilities for the recovering alcoholics. There are about 75 rehabilitation treatment centres in Kenya, both private and public. While each rehabilitation has specific goals, all rehabilitation centres in Kenya have three similar generalised goals: Reducing substance/ alcohol abuse or achieving alcohol -free life. Maximising multiple aspects of life functioning that is psychological, social and physical well being and preventing the frequency and severity of relapse among recovering alcoholics. The primary goal of counselling in regard to alcohol addiction is attainment and maintenance of abstinence. Until the client or recovering alcoholic accepts that abstinence is necessary, the treatment program usually tries to minimise the effects of continuing use and abuse through education, counselling, and self-help groups that stress reducing risky behaviour, building new relationships with alcohol-free friends, changing recreational activities and lifestyle patterns, with a goal of convincing the client of her or his individual responsibility for becoming abstinent.

For every addiction, there are recovery programmes and support groups in the rehabilitation centres to help those looking forward to change their habits. During the beginning phases of recovery, an alcoholic undergoes the process of drug detoxification to remove any unwanted chemicals from the body, followed by intensive addiction recovery counselling. Once individuals get through the initial detoxification from alcohol, they will continue through rehabilitation because detoxification alone does not address the psychological, social, and behavioural problems associated with addiction. Detoxification should thus be followed by a formal assessment and referral to psychological therapeutic intervention. This is where the clients get to the core reasons behind their addictions, addressing those issues they can effectively move on with their lives without going back to alcohol or their addictive behaviour. Therefore, counselling begins to open a line of communication during this often difficult time. It allows trained therapists to share helpful information about addiction, relapse prevention, and developing positive, healthy methods of coping to continue living a happy and alcohol-free life. These can be done through individual, group counselling and family counselling.

Statement of the Problem
Since the escalation of alcoholism in Kenyan, many families are wrestling to cope with the costs of addiction. Alcoholism severity and relapse complexity process that involves the mental, physical, emotion and behavioural component of a person disables recovering alcoholics in Uasin Gishu County to achieve sobriety. This is because addiction is often defined as chronic and relapsing disorder. Recovery from alcohol addiction is a long-term process and frequently requires multiple counselling services or approaches. For alcohol recovering people seeking help, total abstinence has been an ideal goal but given their circumstances and motivation for change, that goal may be unreachable when alcohol addicts first seek counselling services and often leave treatment prematurely, hence unable to fully resolve their alcoholism problems. Therefore there is need to investigate the influence of counselling services on behaviour change among adult recovering alcoholics.

Purpose of the Study
The purpose of this research was to investigate influence of counselling services on behaviour change among adult recovering alcoholics in Uasin Gishu County.

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

i. To identify counselling services offered to adult recovering alcoholics on behaviour change.

ii. To determine the influence of counselling services on psychological well being among adult recovering alcoholics.

iii. To determine the influence of counselling services on physical wellness among adult recovering alcoholics.

iv. To determine the influence of counselling services on health social lifestyle among recovering adult alcoholics.

Research Questions
This study answered the following research questions:

i. Do counselling services among adult recovering alcoholics influence behaviour change?

ii. Do counselling services improve psychological well being among adult recovering alcoholics?

iii. Do counselling services improve physical wellness among adult recovering alcoholics?

iv. Do counselling services impact positively on the social lifestyle of recovering alcoholics?

Significance of the Study
Significance of this study states that the research outcome may help the counselling staff in recovering rehabilitation centres to give time, effort, resources, and compassion for effective counselling demands. The research findings may assist the rehabilitation centres working team, to improve skills and adequate time of counselling options that are tailored towards the needs of each client. The results of this study also may assist the staff members in recovering rehabilitation centres distinguish between effective and ineffective counselling services and find new opportunities for treatment improvement. Finally, the results for this study may create an insight for the individual and community to be engaged and involved in helping recovering alcoholics to go through abstinence process from alcohol misuse to sobriety lifestyle.

Scope of the Study
This study was carried out to determine the influence of counselling services on behaviour change among adult recovering alcoholics. The study was conducted in Uasin Gishu County, in community based rehabilitation centres. The target population was both male and female above 18 years old admitted in these rehabilitation centres. The study focused on the influence of counselling services offered to determine the impact on behaviour change among recovering alcoholics.

Limitations of the Study
This study had the following limitations:

i. The study included small sample size and short duration of treatment for three months without follow-up. Longer duration of follow-up could have predicted the impact of certain treatment-related variables on quality of life.

ii. Some the respondents declined to give information genuinely due to guilt and fear that they would be labelled as alcoholics. This limitation was dealt with through assuring the participants on confidentiality of their information.

iii. The study did not manage to get information from family members and significant others. These family members play an important role in the treatment, care and emotional support.

iv. The finding of this study was only applied to selected rehabilitation centres hence the result would not be generalized to all rehabilitation centres within the County and give comprehensive information on the general population.

Assumptions of the Study
This study has got the following assumption:

i. This study assumed that findings suggested would contribute to modify effective counselling services, skills, planning and implementations of alcohol community based rehabilitation centres.

ii. The other assumption underlying this research was on identified recovering alcoholics to withstand temptation of falling back to drinking alcohol or abstain completely.

iii. The recovering alcoholics may manage their drinking habits that may result in improvement of individual health, social and psychological well being.

iv. Their general health might be improved and recovering alcoholics may be responsible in taking care of themselves and managing alcoholic triggers.

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Item Type: Kenyan Material  |  Attribute: 87 pages  |  Chapters: 1-5
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