Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : VC08 - VC12 Full Version

Assessment of Level of Motivation, Locus of Control and their Associated Factors among Alcohol Dependent Males: A Longitudinal Study


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60930.17286
Kamatchinathan Premkumar, Chinnaian Sivagurunathan, Mani Ezhilvanan, Ashokkumar Vikram

1. Assistant Professor, Department of Psychiatry, Tagore Medical College and Hospital, Rathinamangalam, Chennai, Tamil Nadu, India. 2. Associate Professor, Department of Community Medicine, Tagore Medical College and Hospital, Rathinamangalam, Chennai, Tamil Nadu, India. 3. Assistant Professor, Department of Community Medicine, Tagore Medical College and Hospital, Rathinamangalam, Chennai, Tamil Nadu, India. 4. Assistant Professor, Department of Community Medicine, Tagore Medical College and Hospital, Rathinamangalam, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Ashokkumar Vikram,
Assistant Professor, Department of Community Medicine, Tagore Medical College and Hospital, Rathinamangalam, Chennai, Tamil Nadu, India.
E-mail: vkrmashokkumar90@gmail.com

Abstract

Introduction: Alcohol dependence is a major health problem across the globe. Relapses are a characteristic feature of Alcohol Dependence Syndrome (ADS) with various factors studied to identify the ideal management options. Motivation levels are a reflection of an individual’s readiness to act on a new healthy behaviour. Locus of control reflects individuals’ beliefs about the degree of control they exert over their life events.

Aim: To assess the motivation level and locus of control in alcohol dependent males and determining their relationship with successful recovery.

Materials and Methods: This hospital-based, longitudinal was conducted at the Psychiatry Ward of a Tertiary Care Medical College and Hospital, Puducherry, India. Total 150 adult males, who fit the criteria for alcohol dependence as per International Classification of Diseases (ICD-10). The motivation level and drinking pattern were assessed by the application of Readiness to Change Questionnaire and Rotter’s Locus of Control scale. Categorical data were presented as frequency and proportions. The Fisher’s-exact test was used to evaluate differences between groups for categorised variables.

Results: Total 150 patients were recruited for this study, the mean age was 37±5.6 years. Overall, 94 (62.7%) participants had their first drink at 18 to 24 years of age and 64 (42.7%) participants reported onset of dependence at the age of 26-30 years. Overall, 70 (46.7%) participants were in the precontemplation level of motivation, as assessed by the Readiness To Change Questionnaire. A majority (n=126, 84%) of the cases had an external locus of control and a majority of lapses happened during 1st and 2nd months of the study. Age and educational status were found to have statistically significant association with motivation. Level of education, socio-economic class, motivation, pattern of drinking and locus of control had statistically significant association with lapsed cases.

Conclusion: The locus of control of an individual, motivation level, and the pattern of drinking serve as prognosticators of lapse in patients with ADS. Individuals with poor motivation to change and those with an external locus of control require intensive follow-up and specific intervention programmes to prevent relapse.

Keywords

Behavioural disorder, Drinking pattern, Substance abuse

Alcohol use disorders are a group of disorders marked by compulsive, heavy use of alcohol along with loss of control over the intake of alcohol. The high prevalence of alcohol use disorders notwithstanding adequate treatment is not provided partly due to the stigma associated with alcohol use and insufficient screening in healthcare settings (1). Alcohol dependence is a major health problem across the globe (2). According to the National Mental Health Survey (NMHS) of India 2015-2016, prevalence of alcohol use disorders in India was 9% (3). Relapses are a characteristic feature of Alcohol Dependence Syndrome (ADS) with various factors studied to identify the ideal management options (4). Relapse is the return to regular abuse of alcohol subsequent to a period of abstinence. Timely relapse prevention measures can be instituted for those at high risk of early relapse (2). Relapse is dynamic and determined by a complex interaction between biological, psychological and social factors (5).

The transtheoretical model of behaviour change assesses an individual’s readiness to act on a new healthy behaviour and provides the processes of change to guide the individual through the stages of change to action and maintenance. Precontemplation, contemplation, preparation, action and maintenance are the five stages that lead to successful change (6). Recognising that patients vary in their readiness to change, researchers have shown increased interest in the concept of motivation and its role in management of alcohol dependence.

Locus of control is a variable that reflects individuals’ beliefs about the degree of control they exert over their life events (7). Individuals with an internal locus of control believe that the events in their life derive primarily from their own actions whereas people with external locus of control tend to attribute their life events to external factors like chance or others’ actions (8).
There is a paucity of literature assessing the motivation level and locus of control in alcohol dependent individuals, and evaluating their relationship with successful recovery. This study aims to fill this gap, particularly in an Indian setting. Previous studies have shown that people with alcohol use disorders seeking treatment vary in their levels of motivation to change. Locus of control has been demonstrated as a predictor of duration of abstinence (9),(10),(11). The study was conducted at Puducherry, India, since it is a popular tourist destination in south India and the alcoholic beverages are relatively cheaper in price due to lower taxation rates compared to other parts of India. Due to easy accessibility and affordability of alcohol, consumption of alcohol is high and ADS is a significant problem in Puducherry, India. The present study aimed to assess motivation level and locus of control in alcohol-dependent males and identify their association with the lapse in such a setting.

Material and Methods

This hospital-based, longitudinal study was conducted in a Tertiary Care Medical College and hospital, Puducherry, India, among (150 alcohol dependent males, admitted from January 2016 to April 2016 to the Psychiatry Ward. Sample collection was done after obtaining IEC approval (SMVMCHEC/DAO/AL/392/2014). Before initiation of the study, informed consent has been obtained in the local language from the study participants.

Inclusion criteria: Consenting males belonging to the age group of 18 to 65 years and resident of Puducherry, India, who fit the criteria for alcohol dependence as per International Classification of Diseases (ICD-10) (12), admitted in the Psychiatry ward were included in the study.

Exclusion criteria: patients with complicated alcohol withdrawal, with co-morbid psychiatric disorders were excluded from the study.

Study Procedure

The motivation level and locus of control were assessed on the first day of admission by the application of following scales:

1. Readiness to Change Questionnaire, which is a 12-item questionnaire with subjects choosing one among the following responses: strongly disagree, disagree, unsure, agree, strongly agree (13).
2. Rotter’s Locus of Control, which is a 29-item scale, with each question having two possible responses (14).

Motivation enhancement therapy was given after the application of the scales in the psychiatry ward and also during subsequent follow-up visits in Psychiatry Outpatient Department (OPD). Four sessions were given for each patient, once every 15 days. Each session lasted 15-60 minutes and was given by a psychiatrist The psychiatrist administering the first session for a patient, was assigned the same patient for subsequent sessions.

Following discharge, the patients were advised to report at Psychiatry OPD for follow-up, once every 15 days. Those who did not turn up for two consecutive follow-ups were contacted by telephone. Patients who couldn’t be reached by telephone were paid a personal home visit, once every three months. As there were no specific markers to reliably identify lapses, patient’s self-reporting was corroborated with attender’s history. A patient who has started drinking again was marked as lapsed and the duration of abstinence was noted.

Statistical Analysis

Data entry was done in Microsoft Excel software and analysis was done using Statistical Package for the Social Sciences (SPSS) software version 24.0. Categorical data were presented as frequency and proportions. The Fisher’s-exact test was used to evaluate differences between groups for categorised variables. All tests were performed at a 5% level of significance, thus, an association was considered significant if the p-value was less than 0.05.

Results

The mean age of the population was 37±5.6 years. Majority of study participants were in the age group 31-35 years (32%), followed by 35-40 years (29.30%) (Table/Fig 1). Overall, 45.3% of the participants had studied up to middle school and majority of the participants (41.3%) belonged to socio-economic class II, as per the updated BG Prasad classification (15). About 62.7% of the participants had their first alcohol consumption at 18 to 24 years of age and about 42.7% of the participants reported onset of dependence at the age of 26-30 years. About 46.7% of the participants were in the precontemplation level of motivation, while only 8% were in the action stage, as assessed by the readiness to change questionnaire. A majority of the cases who were admitted for alcohol dependence had an external locus of control (84%) (Table/Fig 2). About 24% of the study participants followed abstinence during the entire period of study i.e., six months. Majority of lapses happened during 1st and 2nd month (Table/Fig 3).

Age and educational status were found to have statistically significant association with motivation (Table/Fig 4). Level of education, socio-economic class, motivation, pattern of drinking and locus of control had statistically significant association with lapsed cases (Table/Fig 5). Age and education had a statistically significant association with locus of control (Table/Fig 6). Motivation to quit and duration of abstinence had a statistically significant association with marital status but other factors of alcohol dependence had no statistically significant association with marital status (Table/Fig 4),(Table/Fig 5).

Discussion

The present study highlights the influence of the level of motivation and locus of control on the duration of abstinence. Motivation influences patients to seek and comply with treatment, thereby playing a crucial role in the treatment of ADS. Internal locus of control has been associated with better treatment results than those with external drinking related control beliefs (16). Therefore, those with an external locus of control may require more intensive therapeutic interventions to maintain abstinence.

In this study, about 46.7% of the participants were in the precontemplation level of motivation, while only 8% were in Action stage, as assessed by the Readiness to Change Questionnaire. Prochaska JO et al., identified the following stages in the process of behavioural change-precontemplation (i.e., not yet considering change), contemplation (i.e., considering change but not taking action), preparation (i.e., planning to change), action (i.e., making changes in one’s behaviour), and maintenance (i.e., changing one’s lifestyle to maintain new behaviour) (17). A study conducted by DiClemente C et al., revealed that the majority of the participants seeking treatment for alcohol related problems were in the precontemplation stage, with progressively decreasing numbers in higher levels of motivation (18). Individuals with lower motivation levels are more vulnerable to problematic alcohol use and frequent relapses. Hence, such persons are more likely to present to healthcare settings with physical and psychological problems associated with alcohol dependence.

A majority of cases who were admitted for alcohol dependence had an external locus of control. The finding is consistent with study conducted by Prakash O et al., that used locus of control scale to determine if an individual had an external or internal locus of control. Although, a different scale was used, Prakash O et al., found that alcohol-dependent individuals display a higher external locus of control than normal population (19). Since those with internal locus of control believe that events are primarily influenced by their own actions, rather than external factors, such individuals are less likely to rationalize their alcohol use by attributing them to external events. Therefore, persons with internal locus of control are less vulnerable to alcohol dependence, which could explain the above finding.

This study found that lower the level of readiness to change (motivation) in an individual, greater is the risk of early lapse. The finding is consistent with study conducted by Senn S et al., which concluded that higher level of readiness to change is a predictor of abstinence (20). A person at a higher level of readiness to change is more likely to recognise the harmful consequences of alcohol use and remain abstinent for longer periods.

The findings in this study suggest that those with an external locus of control were prone to early lapse, while those with internal locus of control remained abstinent longer. Similar results were observed in a study conducted by Dahal P et al., (21). A study conducted by Saini DS concluded that internal locus of control is implicated in positive treatment outcome (22). Those with external locus of control are likely to attribute their alcohol consumption to external factors like peer pressure, family conflict, work pressure, etc. Those with internal locus who believe that events are due to their own actions are more likely to take responsibility for harmful consequences of alcohol consumption, thereby remaining abstinent for longer duration.

The findings in this study suggest that binge drinkers lapse sooner, while non binge drinkers remained abstinent for longer duration of time. A systematic review conducted by Lannoy S et al., demonstrated emotional deficits in binge drinkers (23). A systematic review by Lees B et al., concluded that binge drinkers were vulnerable to neurobiological and cognitive deficits (24). These findings explain why binge drinkers tend to have poorer treatment outcomes and lapse sooner than non binge drinkers.

This study reveals that lower motivation levels, external locus of control and binge drinking are associated with early lapse. The findings in this study conducted in Puducherry, India, are consistent with the results from studies conducted in other parts of the world. These findings enable us to identify patients who are vulnerable to early lapse and offer them targeted therapeutic interventions.

Limitation(s)

The present study was done on small scale with patients attending a tertiary care hospital due to the limitation of resources. Large scale multicentric mixed method studies are required to know about the actual status of condition across the country.

Conclusion

The study revealed that level of education, socio-economic class, higher levels of readiness to change and internal locus of control were having significant association with duration of abstinence. The locus of control of an individual, motivation level, and the pattern of drinking serve as prognosticators of relapse in patients with ADS. Individuals with poor motivation to change and those with an external locus of control require intensive follow-up and specific intervention programmes to prevent relapse. Qualitative research works are recommended to explore and understand the locus of control in detail.

References

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Subash P, Nagarajan P, Kattimani S. Risk of relapse in clients with alcohol dependence syndrome in a tertiary care hospital. Indian J Public Health. 2018;62(3):218-20. Doi: 10.4103/ijph.IJPH_57_17. PMID: 30232972. [crossref] [PubMed]
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Ministry of Health and Family Welfare. Government of India. National Mental Health Survey of India, 2015-16. [Internet]. 2022 [cited 28 September 2022]. Available from: https://main.mohfw.gov.in/sites/default/files/National%20Mental%20Health%20Survey%2C%202015-16%20-%20Mental%20Health%20Systems_0.pdf
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Yadav P, Saini R, Chauhan VS, Sood S. Personality traits associated with alcohol dependence syndrome and its relapse. Medical Journal Armed Forces India. 2021. https://doi.org/10.1016/j.mjafi.2021.01.025. [crossref]
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DOI and Others

DOI: 10.7860/JCDR/2023/60930.17286

Date of Submission: Oct 19, 2022
Date of Peer Review: Nov 11, 2022
Date of Acceptance: Dec 07, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 19, 2022
• Manual Googling: Dec 02, 2022
• iThenticate Software: Dec 05, 2022 (5%)

ETYMOLOGY: Author Origin

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