Screening for harmful alcohol use with the alcohol, smoking, and substance involvement screening test in clients recruited from workplace settings of a Tertiary Care Hospital of North India

Jaison Joseph; Karobi Das; Debasish Basu; Sunita Sharma

doi:10.4103/0971-9962.181102

ORIGINAL ARTICLE

Year : 2016 | Volume : 32 | Issue : 2 | Page : 164-166

Screening for harmful alcohol use with the alcohol, smoking, and substance involvement screening test in clients recruited from workplace settings of a Tertiary Care Hospital of North India

Jaison Joseph¹, Karobi Das², Debasish Basu³, Sunita Sharma²
¹ College of Nursing, Pt. B. D Sharma University of Health Sciences, Rohtak, Haryana, India
² National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
³ Department of Psychiatry, Drug De-addiction and Treatment Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication

25-Apr-2016

Correspondence Address:
Jaison Joseph
College of Nursing, Pt. B. D. Sharma University of Health Sciences, Rohtak - 124 001, Haryana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0971-9962.181102

Abstract

Background: World Health Organization developed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) as the first screening test for rapidly detecting the harmful use of all major psychoactive substances. However, epidemiological research on substance use screening using ASSIST in Indian populations is limited. Aims and Objectives: To screen for harmful alcohol use in the Indian workplace settings using ASSIST. Subjects and Methods: In this cross-sectional study, 162 class C employees were randomly screened in their workplace settings from a tertiary care hospital based on the criteria of ASSIST. Results: The study found that nearly one-fourth (24.06%, n = 39) of the total participants as moderate and high-risk users of alcohol as per ASSIST scores. In addition, one-fifth (19.74%, n = 32) of the total participants used both alcohol and tobacco in moderate or high-risk manner. Conclusion: The results of the study indicate the alarming magnitude of harmful alcohol use in workplace settings and advocate that ASSIST is an important screening tool for detecting harmful substance use in this population.

Keywords: Alcohol, Smoking and Substance Involvement Screening Test, harmful use, workplace

How to cite this article:
Joseph J, Das K, Basu D, Sharma S. Screening for harmful alcohol use with the alcohol, smoking, and substance involvement screening test in clients recruited from workplace settings of a Tertiary Care Hospital of North India. Indian J Soc Psychiatry 2016;32:164-6

How to cite this URL:
Joseph J, Das K, Basu D, Sharma S. Screening for harmful alcohol use with the alcohol, smoking, and substance involvement screening test in clients recruited from workplace settings of a Tertiary Care Hospital of North India. Indian J Soc Psychiatry [serial online] 2016 [cited 2019 Dec 11];32:164-6. Available from: http://www.indjsp.org/text.asp?2016/32/2/164/181102

Introduction

World Health Organization (WHO) developed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) as the first screening test for rapidly detecting the harmful use of all psychoactive substances including alcohol, tobacco, and illicit drugs in response to the overwhelming public health burden associated with psychoactive substance use worldwide. The ASSIST is an interviewer-administered pencil and paper questionnaire and is specially designed for use by healthcare workers in a range of health care settings.^[1] India has a low prevalence of alcohol use disorders compared to the global scenario, but recent reports show an alarming increase in alcohol consumption.^{[2],[3],[4],[5],[6],[7],[8],[9],[10],[11]} Furthermore, evidence suggests that workplace alcohol screening has the potential in reducing the harmful drinking pattern and plays a major role in preventing its progression into serious diseases.^[12],[13] However, epidemiological research on substance use screening linked to ASSIST in Indian populations is limited.^[14]

Aims and Objectives

There is a lacuna of evidence on screening for harmful alcohol use linked to ASSIST in Indian workplace settings. This prompted the investigators to explore this area to generate an evidence base while planning for workplace alcohol interventions.

Subjects and Methods

This cross-sectional study is a part of ASSIST linked brief intervention study. An earlier publication from this study explored the acceptability and feasibility of conducting a brief intervention in the Indian workplace setting.^[15]

The study randomly screened 162 semi-skilled male manual laborers of the hospital (hospital and sanitary attendants, i.e., Class C employees) between the age group of 20–50 years in order to identify subjects with moderate risk and high-risk on WHO ASSIST V3.0 questionnaire scores. The criteria for detection as moderate and high-risk alcohol use were based on the ASSIST score of 11–26 (moderate risk) and 27 and above (high-risk). Clients scoring between 11 and 26 are at moderate risk of health and other problems due to alcohol use and may be experiencing some of the problems at the same time. A score of “27 or higher” for any substance suggests that the client is at high risk of dependence or is dependent on that substance and is probably experiencing health, social, financial, legal, and relationship problems as a result of their substance use. Ethical approval was obtained from the authorities, and informed consent was obtained from the subjects.

The analysis was done using the (Version 16.0; SPSS Inc, Chicago, IL, USA). Frequencies with percentages were calculated for categorical variables and mean, and standard deviation were calculated for continuous variables. Chi-square test was used for inferential statistics.

Results

Magnitude of harmful use of alcohol

Nearly one-fourth of the 162 screened participants (24.06%, n = 39) were moderate and high-risk users of alcohol. Among them, a major proportion were in high-risk level category (14.19%, n = 23) and 9.87% (n = 16) were moderate alcohol risk users on ASSIST scores. Almost all of the remaining subjects were “low risk” or nonproblematic drinkers and expressed that they use alcohol occasionally and does not have any problems with the same.

[Table 1] shows that a major proportion of subjects in the high-risk use category were young, that is, in the age group of 20–35 (78.9%, n = 15), whereas more than half of the subjects in the moderate risk use category were in the age group of 36–50 (60%, n = 12). The difference in this distribution was significant (Chi-squared value: 6.11; P = 0.031).

Table 1: Moderate and high risk alcohol use as per age groups

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Patterns of substance use with alcohol

Around one-fifth of the total participants (19.74%, n = 32) used tobacco in moderate and high-risk level along with alcohol on ASSIST scores. More than half of the subjects of the comorbid users of alcohol and tobacco were alcohol high-risk users or heavy drinkers (59.4%, n = 19), whereas a major portion were tobacco moderate risk users (75%, n = 24). This reveals that excessive alcohol consumption can be seen with the concurrent use of both alcohol and tobacco. Although a small proportion of subjects (3.08%, n = 5) used alcohol, tobacco, and cannabis in a comorbid manner, all the subjects (n = 5) were the high-risk users of cannabis on ASSIST scores. Many subjects verbalized that they had used other substances such as sedatives, opioids (”afeem”) in a lifetime, however, alcohol was the major substance used in a harmful manner by class C employees.

Discussion

This study used ASSIST to identify harmful drinking in a randomly drawn sample of male Class C workers in the workplace settings of Indian population and found that nearly one-fourth (24.06%, n = 39) of the total participants were moderate and high-risk users of alcohol as per ASSIST scores. Many screening instruments, such as the Addiction Severity Index, and expanded Substance Abuse Module of the Composite International Diagnostic Interview although comprehensive, are time-consuming to administer in primary care settings. On the other hand, some of the briefer instruments available, such as the CAGE adapted to include drugs, have a focus on dependence, which is less useful for detecting harmful or hazardous use in nondependent persons.^[16] Most of the previous studies conducted in working populations on the rates of harmful drinking used the WHO developed instrument – Alcohol Use Disorders Identification Test.^{[17],[18],[19]} However, there is little epidemiological research on ASSIST linked screening in Indian populations, and the present study found that ASSIST was very useful as a screening tool in this workplace setting. However, the study also identified an over or under estimation while calculating ASSIST risks score (both score 11 and 26 are considered as moderate drinkers). The results of the study further corroborate the findings of earlier studies with a vivid emphasis on the increasing magnitude of the harmful users of alcohol in the workplace population.^[20],[21]

One-fifth of the total participants (19.74%) of the study were comorbid users of alcohol and tobacco and more than half of them used alcohol in a high-risk manner (59.4%). An increase in the harmful drinking pattern of the comorbid users of alcohol and tobacco in the present study provides a tangible support for the association of smoking and drinking in the general population.^{[22],[23],[24]}

The current study shows that high-risk drinkers were more in the age group of 20–35 years than above 35 years. This may be interpreted as harmful drinking can be more in young adults (20–35 years) than middle adults (36–50 years). The result of the study is consistent with the similar studies in the Indian population.^[25]

Limitations of the current study are its small sample size, cross-sectional design, and reliance on self-reported alcohol consumption. Despite these limitations, the present study opens an area that deserves further research in India with larger samples focusing on the prevalence as well as specific interventions for harmful use of alcohol.

Conclusion

The results of the study indicate the alarming magnitude of harmful alcohol use in workplace settings and advocate that ASSIST is an important screening tool for detecting harmful substance use in this population. Furthermore, it corroborates the findings of previous studies – a reveille on harmful use of alcohol to forecast for early intervention strategies for alcohol problems.

Acknowledgment

The authors are truly grateful to Mrs. Manju Dandapani, Lecturer, National Institute of Nursing Education, PGIMER, Chandigarh for her insightful opinions throughout the study period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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