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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 19  |  Issue : 2  |  Page : 111-114

A study to assess the knowledge of psychiatric aspects of alcohol use disorders in medical students


1 Assistant in Department of Psychiatry, Kakatiya Medical College, Warangal, Telangana, India
2 Associate Professor, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
3 Professor, HOD, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
4 Professor, Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Raghuram Macharapu
Department of Psychiatry, Mamata Medical College, Khammam, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMH.AMH_31_18

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  Abstract 


Aims and Objectives: The aim of this study was to assess the knowledge of psychiatric aspects of alcohol use disorders (AUDs) in medical students.
Materials and Methods: A cross-sectional study conducted in Mamata Medical College, Khammam, Telangana, from June 2014 to May 2015. The study sample consisted of 180 medical students (115 final year and 65 interns), who agreed to answer the Knowledge of Psychiatric Aspects of Alcohol Questionnaire (KPAAQ) anonymously, indicating their gender, year of study and whether they had attended any lecture or workshop on alcohol. KPAAQ consists of 50 questions of 6 clinically relevant categories. Each response to 50 questions of the KPAAQ was assessed. Each correct response was awarded 2 points, thereby, yielding a possible range from 0 to 100 points.
Results: The mean knowledge score in medical students was 44.53 (standard deviation = 11.23) without any significant differences (t = 1.171; P > 0.05) between final year students and interns, while the mean knowledge score was significantly more in 74 male students when compared to 106 female students (46.62 ± 10.58; 43.07 ± 11.49) (t = 2.103; P < 0.037).
Conclusions: Irrespective of their year of study. Knowledge of psychiatric aspects of AUDs in medical students was inadequate.

Keywords: Alcohol use disorders, knowledge, medical students


How to cite this article:
Tialam G, Macharapu R, Reddy PK, Babu RS. A study to assess the knowledge of psychiatric aspects of alcohol use disorders in medical students. Arch Ment Health 2018;19:111-4

How to cite this URL:
Tialam G, Macharapu R, Reddy PK, Babu RS. A study to assess the knowledge of psychiatric aspects of alcohol use disorders in medical students. Arch Ment Health [serial online] 2018 [cited 2019 Sep 18];19:111-4. Available from: http://www.amhonline.org/text.asp?2018/19/2/111/248886




  Introduction Top


According to the WHO, Global Status Report on alcohol and health,[1] 2014, around 30% of the total population of India consumed alcohol in the year 2010. The per capita consumption of alcohol in India had increased from 1.6 L from the period of 2003 to 2005 to 2.2 L from the period of 2010 to 2012. An average individual over the age of 15 years consumed 8 L of alcohol per annum in Kerala followed by Maharashtra and Punjab.

Worldwide consumption in 2010 was equal to 6.2 L of pure alcohol consumed per person aged 15 years or older, which translates into 13.5 g of pure alcohol per day. A quarter of this consumption (24.8%) was unrecorded, that is, homemade alcohol, illegally produced, or sold outside normal government controls. In 2012, about 3.3 million deaths, or 5.9% of all global deaths, were attributable to alcohol consumption. In 2012, 7.6% of deaths among males and 4.0% of deaths among females were attributable to alcohol.

A substantial proportion of alcoholics seek medical treatment for their physical complications rather than seek treatment for alcoholism.[2] Referral to an emergency department or admission to a general hospital, therefore, provides a window of opportunity for intervention for these patients.[3] Regrettably, however, there is evidence that doctors are not effective in detecting alcohol use disorder (AUD) in the hospital setting and elsewhere.[2],[4] Lack of appropriate training has been highlighted as a critical barrier for medical practitioners confronted by patients with alcohol problems.[5],[6]

The National Institute on Alcohol Abuse and Alcoholism[7] has recommended that the impact of changing the medical curriculum should be examined with experimental or quasi-experimental designs. The International Center for Drug Policy described the core aims and learning outcomes in medical undergraduate curricula and good practice on delivery.[8]

There is little research that addresses the baseline knowledge of the medical student and the retention of this knowledge following an educational intervention. Alcohol withdrawal syndromes in the general hospital[3] and AUD in pregnancy[9] have been identified as areas in which doctors need more training in recognition and assessment. The limited awareness of AUD by medical staff may relate to the view that alcohol morbidity has not been a serious problem in certain cultures.[2]

A study[10] recommended that there was an urgent need for further in-service training programs and the development of standard protocols/guidelines for the identification and management of substance using patients who present in the emergency department. Results also indicated that participants' current level of knowledge of about alcohol and drug misuse in general was satisfactory but a particular deficit in relation to intervention strategies and other substances was identified.

A number of interventions to improve detection rates of AUD in the hospital have been described, including a single screening question,[11] individual feedback to junior medical officers,[4] and the establishment of a drug and alcohol unit with a drug and alcohol education program.[12]

Medical students have been surveyed about their knowledge, skills, and attitudes regarding alcohol and drugs, but the validity and reliability of the survey instrument is unclear.[13],[14],[15],[16],[17] Low levels of knowledge were demonstrated in the areas of psychiatric complications of alcohol abuse, screening and low-risk drinking guidelines, problem drinking, and physician impairment.[17] Thus, the aim of the present study was to assess the knowledge of psychiatric aspects of alcohol- and alcoholism-related issues in medical students.


  Materials and Methods Top


A cross-sectional study was undertaken at Mamata Medical College, Khammam, Telangana, from June 2014 to May 2015. The study sample (180) consisted of 115 final year students and 65 interns who had given verbal consent.

The knowledge of psychiatric aspects of AUDs in medical students was assessed using the Knowledge of Psychiatric Aspects of Alcohol Questionnaire[18] (KPAAQ) with an internal consistency of each category (metabolism of alcohol [0.71], short-term effects of alcohol [0.60], long-term effects of alcohol [0.70], AUD [0.70], alcohol withdrawal [0.85], and alcohol use in pregnancy [0.42]) and also for the whole questionnaire (0.92), yielding Cronbach's alpha[19] values.

KPAAQ consists of 50 questions of 6 clinically relevant categories. Twenty questions from the Student Alcohol Questionnaire knowledge of alcohol subscale (consisting of 35 questions)[20] were adapted as a basis for the KPAAQ and 30 questions were adapted from the Kaplan and Sadock textbook synopsis chapter on alcohol-related disorders.[21] Each response to 50 questions of the KPAAQ was assessed as to whether it was correct or not. Each correct response was awarded 2 points, thereby, yielding a possible range from 0 to 100 points.

All the medical students were requested to answer the questionnaire anonymously, indicating their gender, year of study and whether they had attended any lecture or workshop on alcohol previously. Taking prior history of attending any lecture or workshop on alcohol, irrespective of when, where, and how many times each student had attended, was thought to have some effect on the individual knowledge score on alcohol.

Students were requested not to guess the answers, but rather, to indicate if they did know whether a statement was true or false.

Statistical analysis

Data obtained were analyzed using the Statistical Package for the Social Sciences, Version 20 (IBM Corp., IBM SPSS Statistics for Windows, Armonk, NY, USA).[22] The Student's t-test and Pearson's correlation were used.


  Results Top


Psychiatric aspects of AUDs in both final year medical students and interns was inadequate and the mean knowledge score of male students was found to be statistically significant when compared to female students.


  Discussion Top


[Table 1] shows the statistical analysis had depicted the mean knowledge score of final year students as 45.26 ± 10.90 and interns 43.23 ± 11.76 without any statistically significant difference between them (t = 1.171; P > 0.05). However, when the mean knowledge score of 74 male students (46.62 ± 10.58) was compared with 106 female students (43.07 ± 11.49), the difference was found to be statistically significant (t = 2.103; P < 0.037). The above finding of our study might be due to multiple reasons such as sociocultural differences between males and females about alcohol and related issues, open discussions on alcohol and its effects among male students, individual experiences with the substance and its effects, individual interests, priorities, and restrictions and also the sample size.
Table 1: Mean knowledge score of final year students and interns

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[Table 2] shows among final yr students 48 were males and 67 were females. Among interns 26 were males and 39 were females.
Table 2: Distribution of the study sample based on sex

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No statistically significant differences were observed between the knowledge scores of the medical students who had attended any lecture (27) or workshop (3) on alcohol to those who did not attend a lecture (153) or workshop (177). This result may be because of the very small sample size who had attended any lecture or workshop on alcohol.

[Table 3] shows the study findings showed that there was significant difference in the mean knowledge score of male and female medical students (t = 2.103; P < 0.037), [Table 4] shows no significant difference in the mean knowledge scores of final year students and interns irrespective of whether they had previously attended any lecture (t = 1.333; P > 0.05) on alcohol. [Table 5] shows no significant difference in the mean knowledge scores of final year students and interns irrespective of whether they had previously attended any workshop (t = 0.021; P > 0.05) on alcohol.
Table 3: Mean knowledge score of male and female medical students

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Table 4: Mean knowledge score of medical students who had attended and not attended a lecture on alcohol

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Table 5: Mean knowledge score of medical students who had attended and not attended a workshop on alcohol

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Previous studies that assessed the knowledge of psychiatric aspects of AUDs in medical students reported that adequate knowledge was lacking in the medical students, the results were confirmed in this study too. A study[23] demonstrated that a brief, structured, educational intervention for emergency medicine residents contributed to a significant improvement in knowledge and practice with regard to patients with alcohol problems.

The difference in the mean knowledge score of final year students and interns was not statistically significant (t = 1.171; P > 0.05), but the mean knowledge score of the medical students was near to the findings of a study conducted by Jaworowski et al.[18] at the Shaare Zedek Medical Centre, Jerusalem, Israel.

The statistically significant difference (t = 2.103; P < 0.037) in the mean knowledge score of male and female medical students is in accordance with the findings of a study of a sample of specialized services in Brazil nurses personal knowledge and their attitudes toward alcoholism issues by Vargas[24] where male participants provided more correct answers on the knowledge questionnaire than female participants.

Our study demonstrated that only a few number of medical students had previously attended lecture (n = 27) or workshop (n = 3) on alcohol, and in spite of this experience, there was no significant difference in the knowledge acquired. The reason for this might be multifactorial like few numbers of medical students with additional academic exposure, lack of continuous lectures, training programs, or allotment of adequate teaching hours of psychiatric and mental health subjects.


  Conclusion Top


Overall knowledge of psychiatric aspects of AUDs in both final year medical students and interns was inadequate (44.53 ± 11.23) and the mean knowledge score of male students was found to be statistically significant when compared to female students (t = 2.103; P < 0.037). Our study findings might be influenced by various factors such as potential differences in didactic teaching regarding alcohol and its effects, differences in individual as well as clinical exposure, sociocultural background of the medical students.

Limitations

  • Cross-sectional study design
  • Small sample size
  • Results cannot be generalized.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Global Status Report on Alcohol and Health. Geneva, IL, Switzerland: World Health Organization; 2014.  Back to cited text no. 1
    
2.
Chen CH, Chen W, Cheng AT. Prevalence and identification of alcohol use disorders among non psychiatric patients in one general hospital. Gen Hosp Psychiatry 2004;26:219-25.  Back to cited text no. 2
    
3.
Jaworowski S, Raveh D, Golmard Gropp C, Mergui J. Alcohol use disorder in an Israeli general hospital: Sociodemographic, ethnic and clinical characteristics. Isr Med Assoc J 2012;14:294-8.  Back to cited text no. 3
    
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Proude EM, Conigrave KM, Britton A, Haber PS. Improving alcohol and tobacco history taking by junior medical officers. Alcohol Alcohol 2008;43:320-5.  Back to cited text no. 4
    
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Fassler D. Views of medical students and residents on education in alcohol and drug abuse. J Med Educ 1985;60:562-4.  Back to cited text no. 5
    
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Glass IB. Undergraduate training in substance abuse in the United Kingdom. Br J Addict 1989;84:197-202.  Back to cited text no. 6
    
7.
National Institute on Alcohol Abuse and Alcoholism. Resource Guide to the Evaluation of the Faculty Development Program in Alcohol and Other Drug Abuse. Part 1: Overview of the Evaluation Model. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism; 1990.  Back to cited text no. 7
    
8.
Ghodse H. Substance misuse in the undergraduate medical curriculum. London: International Centre on Drug Policy. Google Scholar. 2007.  Back to cited text no. 8
    
9.
Neumark Y. Alcohol consumption in Israel: A public health and medical problem. Isr Med Assoc J 2012;14:315-7.  Back to cited text no. 9
    
10.
Kelleher S, Cotter P. A descriptive study on emergency department doctors' and nurses' knowledge and attitudes concerning substance use and substance users. Int Emerg Nurs 2009;17:3-14.  Back to cited text no. 10
    
11.
Massey SH, Norris L, Lausin M, Nwaneri C, Lieberman DZ. Identifying harmful drinking using a single screening question in a psychiatric consultation-liaison population. Psychosomatics 2011;52:362-6.  Back to cited text no. 11
    
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Gaughwin M, Dodding J, White JM, Ryan P. Changes in alcohol history taking and management of alcohol dependence by interns at the Royal Adelaide hospital. Med Educ 2000;34:170-4.  Back to cited text no. 12
    
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Cape G, Hannah A, Sellman D. A longitudinal evaluation of medical student knowledge, skills and attitudes to alcohol and drugs. Addiction 2006;101:841-9.  Back to cited text no. 13
    
14.
Roche AM, Parle MD, Saunders JB. Managing alcohol and drug problems in general practice: A survey of trainees' knowledge, attitudes and educational requirements. Aust N Z J Public Health 1996;20:401-8.  Back to cited text no. 14
    
15.
Yi PH, Kim JS, Hussein KI, Saitz R. Behavior, knowledge, and attitudes towards khat among Yemeni medical students and effects of a seminar. Subst Abus 2012;33:373-7.  Back to cited text no. 15
    
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Stack KM, Fore Arcand LG, Briscoe G. Use of alcoholics anonymous as part of medical school education: Students' and educators' perspectives. Subst Abus 2012;33:387-91.  Back to cited text no. 16
    
17.
Kahan M, Midmer D, Wilson L, Borsoi D. Medical students' knowledge about alcohol and drug problems: Results of the medical council of Canada examination. Subst Abus 2006;27:1-7.  Back to cited text no. 17
    
18.
Jaworowski S, Walter G, Soh N, Freier Dror Y, Mergui J, Gropp C, et al. Avalidated questionnaire to assess the knowledge of psychiatric aspects of alcohol use disorder. Subst Abus 2014;35:147-52.  Back to cited text no. 18
    
19.
Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16:297-334.  Back to cited text no. 19
    
20.
Engs RC, Hanson DJ. The student alcohol questionnaire: An updated reliability of the drinking patterns, problems, knowledge, and attitude subscales. Psychol Rep 1994;74:12-4.  Back to cited text no. 20
    
21.
Sadock BJ, Sadock VA. Alcohol related disorders. Synopsis of Psychiatry. 10th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams and Wilkins; 2007. p. 390-407.  Back to cited text no. 21
    
22.
Nie Norman H, Dale H, Bent C. Hadlai Hull. “SPSS: Statistical package for the social sciences.” 1975;249.  Back to cited text no. 22
    
23.
D'Onofrio G, Nadel ES, Degutis LC, Sullivan LM, Casper K, Bernstein E, et al. Improving emergency medicine residents' approach to patients with alcohol problems: A controlled educational trial. Ann Emerg Med 2002;40:50-62.  Back to cited text no. 23
    
24.
Vargas D. Nurses personal knowledge and their attitudes toward alcoholism issues. A study of a sample of specialized services in Brazil. J Nurs Educ Pract 2014;4:123.  Back to cited text no. 24
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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