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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 2  |  Page : 131-139

Lived experiences of the wives of alcohol use disorder partners: A phenomenology study


1 Department of Gastroenterology Nursing, Institute of Liver and Biliary Sciences, New Delhi, India
2 Principal, College of Nursing, Institute of Liver and Biliary Sciences, New Delhi, India

Date of Submission29-Sep-2021
Date of Decision10-Dec-2021
Date of Acceptance31-Jan-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Dr. Mini George
Principal, College of Nursing, Institute of Liver and Biliary Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iopn.iopn_84_21

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  Abstract 


Introduction: Alcoholism, a “family disease,” is on the rise in India. Individuals who abuse alcohol affect themselves and family, especially their spouses. This study explored the lived experiences of wives of alcohol use disorder (AUD) partners within the context of phenomenology. This was essential to understand their life as they experienced it, from their perspective and the coping resources adopted by them. Materials and Methods: Interpretive phenomenology was used with a purposive sampling of wives of AUD partners attending the de-addiction clinic. After explaining the study and written consent, in-depth interviews were conducted with 11 participants, which led to data saturation. Results: Data were explicated by thematic analysis. Significant statements and meaning units were identified, and codes were assigned. Three categories namely impact on self, effect on life, and coping strategies were emerged. Two major themes namely “faced innumerable challenges and used adaptive and maladaptive coping” were generated. Conclusion: Wives faced innumerable problems of poor health, physical misery, social relations, emotional disturbances, marital discord, and financial burden. In terms of coping, most wives relied on either avoidance or tolerance which was not productive for them or their partners. The wives covered up partners' alcohol dependence, took on their responsibilities, withdrew or distanced themselves from friends and family. Many of them put on a brave front and continued to live with the constant stress.

Keywords: Alcohol use disorder partners, alcoholics, alcoholism, lived experiences of wives


How to cite this article:
Devi NB, George M. Lived experiences of the wives of alcohol use disorder partners: A phenomenology study. Indian J Psy Nsg 2022;19:131-9

How to cite this URL:
Devi NB, George M. Lived experiences of the wives of alcohol use disorder partners: A phenomenology study. Indian J Psy Nsg [serial online] 2022 [cited 2023 Jan 29];19:131-9. Available from: https://www.ijpn.in/text.asp?2022/19/2/131/365475




  Introduction Top


Well acknowledged is the fact that alcoholism is a “family disease”, as it is not only the person who is abusing alcohol but the entire family that bears its brunt. Thus, alcoholism and problems in the family are a common pairing that go hand in hand. The per capita alcohol consumption has increased.

Drinking is very common in most cultures in India. Individual alcohol use is on the rise. In 2005, Indians consumed 2.4 L of alcohol, it increased to 4.3 L by 2010 and scaled up to 5.7 L in 2016.[1] According to the National Institute of Health and Family Welfare, alcohol use varies between 23% and 74% in males across various states of India.[2] The World Health Organization estimates it to be around one-fourth to one-third among the male population.[3]

Living with an alcoholic partner can be very challenging for the spouses.[4] These partners are forced to deal with a large spectrum of immediate to long-lasting challenges. Often, de-addiction clinics involve the wives to help with husbands' progress to a sober lifestyle but overlook to explore or address the challenges faced by them.[5] Qualitative research can elicit in-depth perspectives to understand wives' experiences and inform future intervention studies. To date, very few studies have used the phenomenological design to explore wives' perspectives and experiences in-depth. The aim was to explore how wives describe their experience living with alcohol use disorder (AUD) partners within the context of phenomenology.


  Materials and Methods Top


Method of research inquiry

Rooted in a constructive ontological position, a qualitative inquiry using the phenomenological life-world approach described the richness of human experiences.[6] The life-world approach constructs the essence of a phenomenon by exploring it from the perspective of those who experienced it.[7] This approach was used to explore and describe how the wives experienced their lives and interpret how they made sense of their world in their partner's alcoholism. An in-depth literature review was not undertaken at an early stage in the research.

Role of researcher

The researcher used etic or outsider view in this study. The researcher's role first stemmed from the assertion that lived experiences of wives need to be constructed as it manifested or unfolded;[8] second, that data are mediated through the human instrument, the researcher, not through scales or inventories; and finally, acknowledging researcher's own bias, assumptions, and perceptions of alcoholics behavior, using bracketing or epoché.[9]

Research location

The De-Addiction Clinic of Institute of Liver and Biliary Sciences, New Delhi, India, which is a super-specialty hospital for liver, biliary, and pancreatic diseases.

Participant selection

Participants were wives of AUD partners and cohabitating for over 1 year. Purposive criterion sampling was used to identify wives who had experienced the phenomenon. It included wives aged above 25 years and free from substance use or psychiatric disorders. They were also screened for other stressful life events using social readjustment rating scale (SRRS) and included if scores were below 150. Wives excluded were whose husbands had a history of other substance use disorders (except smoking and tobacco chewing), medical illness (other than liver diseases), or psychiatric disorders and were recipients of the liver. Further, wives were excluded if they were liver donors to their husbands. This sampling enabled to create a homogenous sample of participants who had experienced the phenomenon.

Instruments

(1) AUD, as per the DSM-5, was identified if at least two criteria out of 11 were present;[10] (2) SRRS by Holmes-Rahe was used to check for other stressors that happened over the last 1 year on 43 life events. It assigned each event on a range of 11–100.[11] A score of less than 150 meant a low amount of life change and a score above 150 implied a major stressful change; (3) demographic profiles of wives and partners; and (4) in-depth face-to-face interview with audio-recording and field notes. The interviews were structured around a guide of open-ended questions to elicit elaborate answers in a standard sequence,[12] lasting 30–40 min each. Developed by the researcher, the guide included 7 central questions [Table 1] and a few probing questions for use when needed, reviewed by five qualitative experts, and revised. The researcher was trained in the method, use of epoché, and interview technique. Interviews with three wives were pilot tested.
Table 1: The interview guide

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Protection of human rights

Institutional ethics committee clearance was obtained by vide No.: F15 (2/2.25)/2017/HO (M)/ILBS. Participant information sheet provided details about the study, procedures, purposes, voluntary nature, and procedures to protect confidentiality. The wives signed written informed consent forms for participating in the study and audio-taping. Wives could withdraw from the study at any point in time without penalty, and all data gathered were confidential and no participants' identity was revealed in the study.

Procedures of data gathering

After administrative and ethics clearance, the researcher identified AUD patients at De-Addiction Clinic and enrolled wives who consented and met the criteria. One-to-one interviews were conducted in privacy and comfort, making participants relax and share their lived experiences. Interviews were in-depth to gain rich data, audio-taped with field notes to supplement the recordings, and lasted over 3 months. Data were gathered to saturation (11 wives) until interviews yielded no new information.

Data explication

Recordings were transcribed verbatim for an unbiased description of the experience. Transcription was done regularly after each interview and encoded with an alpha-numeral (P for the participant and numeral 1, 2, 3… for the sequence of recruits). Field notes were referred to incorporating behaviors such as smiling, sighs, stammer, crying, silence, or pausing. Transcripts were returned to wives to verify the correctness of their views (member checking) and to elaborate on their responses. With feedback incorporated, transcripts were then translated into English and validated by back-translation. Thematic analysis was done manually in six steps:[13] data familiarization, data coding, developing sub-categories and categories, theme generation, revision, and write-up. The first step was getting to know the data or immersion in data by intensive reading. Significant statements in the raw data were identified, extracted into meaning units, and labeled with short descriptors, thus generating codes (192 codes in all). Independently, two coders performed coding for the entire data set, which was compared and finalized after discussion. Codes were then examined for patterns and interrelationships and combined to develop clusters of similar challenges of alcohol use and the various forms of coping into subcategories. While working back and forth reading the data, subcategories were grouped into categories. Following the categorizing, some common features identified helped generate two themes. Audit trails, starting from coding to forming themes, were reviewed along with the log of activities and preserved. As the analysis ended, data organized into a structure where the pattern of lived experiences of wives became clear. The ultimate step, the write-up, provided a “thick description” to understand the lived experiences of wives living with alcoholics.[14]

Rigor

To enhance data quality, many strategies were used. Audio-recording ensured accuracy and back-translation of transcript language validation. Bracketing biases from data gathering and explication assured data accuracy. Member checking or respondent validation ensured the validity of data gathering and maintained the objectivity of the phenomenon. Intercoder agreement (94%) for coding enabled dependability or trustworthiness. The auditable trail of the entire process provided transparency and ensured confirmability. Transferability was ensured in the thick description.

Results

[Table 2] shows the demographic profiles of the wives of AUDs interviewed and it can be seen.
Table 2: The sociodemographic profile of the wives of alcohol use disorder interviewed

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That wives were between 30 and 46 years, belonged to both joint and nuclear families, and married for over a year to 16 years.

[Figure 1] displays the codes, subcategories, categories, and themes generated from the data. The wives' tales predominantly exhibited sadness, frustration, and hopelessness. Hence, the excerpts were grouped into two themes, “accounts of a life with an alcoholic” and “stuck at the crossroads of life.”
Figure 1: Emerging of subcategories, categories, and themes

Click here to view


The first theme faced innumerable challenges, “accounts of a life with an alcoholic,” which was developed from two categories: impact on self and effect on life. The first category was developed from subcategories such as physical misery and emotional disturbances was impact on self.

The drinking behavior of husbands brought many problems for the wives. Once drunk, husbands were not in their senses and displaced their anger on wives and children. Extracts showed that wives experienced physical discomfort such as “… pain in the hands and feet (P 1, 3, 4, 9, and 10), suffering, unable to perform daily activities “I cannot walk longer” (P 1, and 4), “… fights and arguments till late night (P 2, 3, and 4), “… felt giddiness, sickly…” (P 3), “… tired (P 2, 8, and 9), weakness (P 9)”, “… I had headaches (P 7), my health goes bad” (P 2, 7, and 8), felt anxiety, “I am tensed (P 7 and 10), cannot even eat food (P 3, 7, 8, and 9)… my weight has reduced (P 2)….” These symptoms were clustered into the code physical symptoms and poor health.

Inability to get some shut-eye was one of the major problems faced by the wives of alcoholics “I cannot sleep at night (P 2, 3, 4, 8, and 10),” late-night drinking “… disturbances (P 1, 2, 3, and 4),” “… fight late into the night (P 2 and 3),” anxiety “thinking (P 2, 4, and 10),” “… pain (P 10), and unable to wake up early (P 2).” These were clustered as sleeplessness. It affected their day-to-day lives and activities.

The wives of AUDs suffered physical violence at the hands of their husbands “… he is throwing something or other” (P 2), “… sometimes he beat me…” (P 9), and sexual abuse “he is addicted to sex… does not talk to me properly” (P 10). These above codes generated the subcategory, physical misery.

The second subcategory was emotional disturbances. Various emotional upheavals were seen in the wives. The codes that generated this subcategory included feeling sad, annoyed, no peace, worry about children, hopelessness, despair, and disturbing thoughts.

Foremost was sadness “… am so unhappy” (P 2 and 3), “… feel very upset” (P 3 and 8), “cannot do anything for children” (P 2), “… did not know his drinking habit” (P 2 and 11). Clusters that showed prolonged anguish in their life were coded as a feeling of sadness. This was coupled with frustration because “after drinks, he talks nonsense continuously (P 4, 6, and 7),” “… a lot of fights among us at home” (P 2, 3, 4, and 8), “… fights late into the night” (P 2 and 3), “… cannot even tell my parents” (P 2), and “I used to get irritated” (P 6). The code feeling of annoyance was assigned to these excerpts.

The wives worried about children as their husbands were not concerned about children or family. These extracted statements found that they worried about her children's lives and future “… worried about children (P 5, 8, and 9), I wish to buy something for children (P 2), I cannot afford (P 4 and 5).” “Children are growing up… who will take care of marriage (P 4, 8, and 9), studies (P 8 and 9), …save money for children” (P 6), “…cannot depend on relatives (P 6).” The code was named worry about children.

Every wife wished to have a peaceful life. It was reflected in these extracts “… there was no peace of mind (P 1, 4, 5, and 8)”, “… it was always struggling… daily fights” (P 4), “arguments even for small issues (P 3 and 4)” and coded as no peace. Some wives gave up their life's dream and desires, “No one understood me, not even his parents… it upsets” (P 3), “… no hope from anywhere” (P 4), “… all my desires are going away” (P 2). No hope in life was coded as hopelessness and despair.

Many thoughts were upsetting “… just thinking” (P 2), “… my mind is disturbed” (P 3 and 4), “… feel like ending life” (P 4), “his parents misunderstood me” (P 3), “… feelings are very hurt” (P 3), “feel like crying all the time” (P 4 and 7), “my family is upset too” (P 3), “… unable to do activities” (P 3), “… I keep silent” (P 7). It was coded as disturbing thoughts.

The second category that was generated is “effects on life” of wives. This was formed from subcategories such as marital discord, impaired social relations, and financial burden.

Most of the wives faced discord in their marital life due to lack of trust, abuse, and violence. They faced the insults of their husband as in “… he used to shout at me and say bad things” (P 2), “everyone is upset” (P 3) “… speaks nonsense continuously…” (P 4, 6, and 7), “… insults others… my brother rarely comes to my house” (P 3), “daily fights, arguments, threats” (P 4). These clusters of extracts were coded as verbal abuse.

Some wives of alcoholics lost faith in their husbands because they lied and hide their drinking habits. “I do not believe him… he always tells lies and hides…” (P 3), “I do not trust him” (P 10). Hence, these clusters were coded as a lack of trust in each other. Few of them felt estranged “… it has been 15 years… he lives on his terms…” (P 8), “… do not talk to each other (P 4, 7, and 10),” “… we stay separately, doing for children” (P 10). Hence, these extracts were coded as communications breakdown among spouses.

Most of the alcoholic husbands threw caution to the wind “… he never listens” (P 2, 4, 5, and 10), “… I refused to let him drink” (P 2 and 5), “… it is for his health” (P 5). Thus, it was coded as heedless to counsel. The alcoholics were indifferent to the concerns of their wives, children, or family as evident in their expressions “… never understands me” (P 4, 6, and 10), “tried many times” (P 6), “no support from him…” (P 8), “… speaks nonsense…” (P 3, 4, and 7), “… spent earnings on drinks (P 2 and 3), “… lot of expenses, wastes most of it” (P 2 and 4), “… daily fights” (P 4), “argues even for small issues (P 3 and 4)”. These statements were coded as lack of empathy or care. These codes were formed into the subcategory marital discord.

The next subcategory was impaired social relations formed by the following codes. Some wives felt embarrassed and shameful about their husbands' addiction “… feel little and ashamed, people talk, (P 2, 3, 7, and 10), now his health is bad (P 2),… others know” (P 7 and 10) and named the code as feeling ashamed. Some women had to even hide their drinking habits as expressed in extracts “Both families were happy when we got married (P 2)… I hide problems (P 2 and 10), I live a hidden life (P 7),… cannot tell my parents or neighbors (P 7 and 10) or relatives (P 10), I cry alone silently (P 7)…”. The code referred to here is hiding problems from others. Seeking help was also seen as shameful and a source of disgrace to the family “… taking any help is embarrassing (P 4 and 7),… they start talking” (P 4 and 7). Hence, it was coded as embarrassment in seeking help.

Many wives avoided interaction with others for fear of having to open up “…do not like talking to people (P 3, 7, 10, and 11)…” and “… do not talk about it… people talk at the back (P 3).” The referred code dislikes social interaction. Few of the wives had less socializing with others. As this extract reveals, “… I do not go out of my home much, rarely go to relatives (P 2, 10, and 11),” “… stay at my home mostly… not even go out with him” (P 3). P 7 said, “I eat alone.” These clusters are code-named social isolation.

Another subcategory generated was a financial burden. From the clusters of extracted statements, a large sum of money was spent “… he spent earnings on drinks (P 2 and 3)… a lot of expenses, wastes the most in it” (P 2 and 4), unable to provide for the family because of ill health “… is lying here no other means (P 1, 4, 6 and 8), does not support the family “does not give to family (P 1, 2, and 8),” “others do not pay back loans (P 4), incurs debt or loses job “there is a financial problem” (P 2, 4, 5, and 8).” The families had to fend for themselves. This code was named financial burden because of loss of income and irrational spending.

The second theme, “stuck at the crossroads in life,” was developed from various categories of coping styles used by wives in facing the alcoholism of partners. In the extracts below, the wives shared their experiences of how they cope with their husbands drinking. A few of them put their faith in God to help them, i.e., “… I trust in God (P 2 and 9)… grace and kindness of God (P 2 and 6):” the code named belief in God. Some believed in self “… confident of me (P 5),” “… can handle any problem” (P 6). This was coded as belief in self. Despite being alcoholic, some relied on a positive outlook like “I get angry but I calm down knowing that talking in that situation is useless. He does not know what he is talking about; the next morning, he forgets what happened last night” (P 8). I wish him to get well soon (P 9).” A few exhibited trust in their husbands, in that “We trust each other….” (P 5 and 11). We are in it together, in sorrow and happiness… he believes in me and I also do (P 7),” “he does not disturb others… he is good… even though he drinks, not like others who drink and beat their wives, he is not abusive…” (P 11), “… he loves me, he does everything for me (P 7),” he also earns (P 9), “I love him (P 2 and 11)… with love only make him understand, it works to improve his behavior” (P 11). This was coded trust in spouse and acceptance.

Some wives sought help from family in time of need, “Yes I am getting support” (P 2), “support from family” (P 2, 6, 7, 10, and 11). These statements have been coded as seeking support from family. Some others felt that as their husbands were not concerned about the family and children, they took over responsibilities as in these extracts “… he is not having concern regarding expenses in family, I am managing it right now…” (P 3 and 4). “I have to look after home and education of my children. If they rusticated the children from school, there will be no option…. my husband is sick” (P 2). “If there is a problem, then we have to solve it… I have the strength to handle any problem” (P 6). Here, the wives expressed their strength to handle responsibilities and solve her problems. Code given to this cluster is taking charge to help the alcoholics.

Some wives felt that there was no point in talking, had given up, or were radio silent to avoid confrontations, seen in statements such as “… there is no point of talking” (P 2 and 4). P 6 felt “It is 20 years now, it is fine…,” P 6 also said, “… we adjust to keep the family atmosphere calm”. “… given up, let him do what he feels … what else I can do?” (P 4, 5, 7, and 9). Code named tolerance. Wives said “… I avoid him…” (P 8), “… I go outside and sit alone…” (P 4 and 10), “no much energy in me to speak” (P 2 and 10), “I used to get angry… now I just keep quiet” (P 4, 7, 8, 9, and 10). P 7 and 10 expressed that “I do not want to fight… I do not have strength… to get peace” (P 9). The code assigned to the clusters is avoidance. From these statements and codes, the subcategory that was constructed is coping techniques employed by wives.

Overall essence

The wives of AUDs experienced various physical health issues, violence emotional, financial, and social challenges. Each one faced some or all of the challenges at the time of study or has been experiencing it for some time and may have to cope with it indefinitely. It led to a generation of three major categories: impact on self, effects on life, and coping strategies used. Two themes were constructed “faced innumerable challenges in life” and “used adaptive and maladaptive coping techniques” that answered the research question. Invariably, all the wives living with AUDs faced a lot of challenges and relied mostly on coping strategies that were not healthy or productive that could cause them further harm.


  Discussion Top


Partners' alcoholism posed several problems for the wives.[1] The first theme showed that wives “faced innumerable challenges in life.” Wives in this study experienced poor health marked by fatigue, pain, and sleeplessness, similar to other studies showing poor general health and quality of life.[15] Wives had an increased risk for physical abuse as also seen in other studies: 63.5% of wives sustained injured by husband;[16] 60% of alcoholics were violent to female partners as against the 12% in the comparison sample.[17] As seen in another study, wives covered up drinking habits for fear of disgrace and dishonor to the family.[18] Some faced stigma and ostracization when these habits came to light. They withdrew to themselves. Wives felt sad, lonely, frustrated, no peace and hopelessness, worried about children, and had disturbing thoughts. Alcoholics, while being preoccupied with drinking, ignored needs, did not provide for the family, and neglected expected roles and responsibilities. This placed a lot of tasks overload[18] and added a burden on the wives. The results corroborate the findings of earlier studies.[3]

Confirming the results,[19] studies found that lifetime at-risk drinking is a risk factor for psychological distress in spouse,[20] depression,[21],[22] moods, anxiety, and stress.[15],[21] Similarly, 38% reported depression and 59% reported anxiety in an other study.[23]

A well-documented association exists between financial difficulties, losses, and debts caused by husband's drinking that increased wives' burden, and suffering.[24] Marriages marred by alcoholism shook the very bedrock of the relationship, marked by violence, abuse, lack of trust, and proper communication among spouses. Physical, social, and economic abuses lead to marital discords.[16] It was stressful and confrontational.[22]

Many wives did nothing about it. Living in constant stress like this and not paying attention to problems can have long-term effects on the wives, including chronic health problems, mental illness, permanent injuries, and damaged relationships.

The wives employed both adaptive and maladaptive coping as corroborated in other studies as well.[25],[26] Wives need support and counseling to use adaptive coping for two reasons: first, for self-preservation and prevent long-lasting harms; second, coping such as acceptance, tolerance, avoidance, faith, emotional blunting, and hoping for change can damage as it ignores the real problem while it worsens. Literature abounds with evidence that wives' unhealthy relationships with alcoholics might hamper partners' recovery.[27] Marital and family therapy can help in prevention and treatment of alcoholics and wives.[17]

The present study did not explore the changes in the experience of the wives over time and their resilience. Future studies can explore these areas and test interventions to improve wives' quality of life, resolve marital problems, and help the alcoholic.[4]


  Conclusion Top


This study underscored the fact that wives faced the constant stress of living with an alcoholic, but their need for therapy as a victim of the situation often went unnoticed. Findings show the need for a therapeutic approach and support to wives of AUD partners for healthy living.

Acknowledgments

Faculty, Manipal College of Nursing, for independent coding was acknowledged.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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