Exploring effective coping strategies for wives living with spouses who have alcohol dependence: Insights from focus group discussions

Abstract

BACKGROUND:

Alcohol dependence is a prevalent issue worldwide. The wives of persons with alcohol dependence (WPAD) often experience several psychological, physical, and social problems, and it is essential to identify their coping strategies. This study aims to explore the coping strategies employed by WPAD by conducting a focus group discussion (FGD).

MATERIALS AND METHODS:

This study was conducted among wives of persons with alcohol dependence during their husband’s admission in the departments of Psychiatry and gastroenterology of St. John’s Medical College Hospital, Bangalore, India, using qualitative research with phenomenological design. The inclusion criteria were being married and living with a person with alcohol dependence for more than three years and free from major psychiatric disorders and recruited through purposive sampling for six FGDs, which were conducted using a FGD guide and lasted approximately 60 to 90 minutes. The discussions were audio-recorded and transcribed verbatim. Thematic analysis was used to analyze the data.

RESULTS:

The study revealed that the WPAD adhered to various coping strategies to face the challenges of living with their husbands with alcohol dependence. It is observed that WPAD used emotion-focused coping, problem-focused coping and avoidance coping.

CONCLUSIONS:

This study highlighted the effective coping strategies adapted by WPAD to tackle the hardships related to their husband’s alcoholic behavior and most of the WPAD used emotion-focused coping. This study provided valuable insights into the coping strategies used by wives of alcoholics and the challenges they faced in managing their spouse’s addiction.

Introduction

Alcohol dependence is a complex behavior with far reaching harmful effects on the work, family, and society. The prevalence of alcohol use disorders (AUDs) among adults is 3.6%. In India, alcohol use is more common among men,[1] which creates ongoing stress for families.

The problem of alcoholism is not just related to the alcoholics but also the lives of those around them are adversely affected, the spouses of individuals struggling with alcohol addiction often express a range of negative emotions, such as guilt, shame, anger, fear, grief, and isolation.[2] WPADs undergo social, occupational and psychological damage.[3] Alcoholism has a significant impact on the functioning of a marital family.[4,5] They suffer from high levels of anxiety, depression, neuroticism, and low self-esteem, among other issues.[2] Alcoholism leads to strained relationships, communication breakdown, domestic violence, and a lack of trust and intimacy between partners.[6] Domestic violence, emotional abuse, and financial difficulties are common and well-recognized problems faced by wives of individuals with alcohol addiction.[7]

Wives who cohabit with persons with alcohol use disorder face a range of difficulties in the short term and long term. However, these challenges can result in enduring problems that individuals must manage over an extended period. The coping strategies employed by wives of individuals with alcohol addiction refer to the collective attempts, both behavioral and psychological, to manage, endure, lessen, or limit the stress caused by their spouse’s drinking. These coping mechanisms are typically categorized into two major approaches: problem-focused and emotion-focused. Problem-focused coping involves taking active measures to alleviate stressful situations, while emotion-focused coping involves attempting to regulate the emotional effects of stressful events.[8] The most frequently observed coping strategies among wives of alcoholics were avoidance, conflict, withdrawal due to fear, and withdrawal from sexual intimacy.[9] There is vast literature on coping strategies of wives of persons with alcohol dependence but those are mainly conducted in a quantitative way using coping tools.[7,8,9,10,11] A study was conducted on 30 wives of alcoholics using an Orford – Guthrie – ‘Coping with drinking questionnaire’. The commonest coping behavior reported was discord, avoidance, indulgence and fearful withdrawal while marital breakdown, taking special action, assertion and sexual withdrawal were least frequently used.[10]

In the context of coping strategies of WPAD’s a qualitative study may be more appropriate for exploring the complexity and diversity of coping strategies and their effectiveness. The coping strategies used by WPAD can be complex and varied as it involve psychological, social and behavioral strategies.[12,13] FGD provides a platform for WPAD to share their life experiences, challenges and coping strategies in a supportive and non-judgmental environment and this may help in the development of planning the effective interventions and support services that are tailored to the specific needs of WPAD. Hence the researchers planned to conduct a study on coping strategies of WPAD using FGD which can provide valuable insights into the coping mechanisms used by WPAD and can inform the development of effective interventions specific to WPAD.

Materials and Methods

Study design and setting

This study used a qualitative research design with a phenomenological approach and employed Focus Group Discussions (FGDs) to collect data from the subjects.

Study participants and sampling

The subjects of the study were wives of persons with alcohol dependence aged between 25 to 55 years and accompanied their husbands during the admission to Psychiatry and gastroenterology ward of St. John’s Medical College Hospital, Bangalore, India. The inclusion criteria for the participants were, being married and living with a person with alcohol dependence for more than five years and free from major psychiatric disorders screened through Modified Mini Screen tool (MMS). Exclusion criteria used were subjects who are suffering from chronic physical problems, divorced or separated for more than 3 years. The sampling technique used was purposive sampling, and the sample size was determined based on data saturation.

Procedure

The researcher, after obtaining permission from authority and ethical clearance, screened the subjects through Modified Mini Screen and informed consent was obtained from all the subjects who met the inclusion criteria before the start of each focus group discussion. Subjects were informed that their participation was voluntary and that they could withdraw from the study at any time. Confidentiality and anonymity were maintained throughout the study. To protect the subjects’ privacy, pseudonyms were used to refer to them in the analysis and reporting of the results. Six FGDs were conducted, each comprising 7-9 participants, which resulted in a total of 48 participants. The discussions were conducted in a private setting, lasted for 60 to 90 minutes each and were audio-recorded with the participants’ consent. During the FGDs, participants were encouraged to share their thoughts, emotions, and actions in response to the difficulties they faced. The discussions were facilitated by an experienced moderator who used a semi-structured interview guide to explore various aspects related to coping strategies. The interview guide included prompts and probing questions to elicit rich and detailed responses from the participants. Through thematic analysis of the transcribed FGDs, we identified and categorized the coping mechanisms utilized by the wives. Thematic analysis involves the systematic identification, organization, and interpretation of patterns or themes within qualitative data. We examined the transcripts carefully, identifying recurring patterns and themes related to coping strategies. The identified coping mechanisms were then further analyzed and classified into different categories, such as emotion-focused coping, problem-focused coping, and avoidance coping. This classification allowed us to gain a comprehensive understanding of the various approaches used by the wives to cope with the challenges they faced in their marital relationships and daily lives.

Focus group discussions (FGDs) guide

The interview guide comprised of open-ended questions to explore the coping mechanisms employed by the wives of persons with alcohol dependence [Table 1].

Table 1.

Focus group discussion (FGD) guide

Questions/prompters
What coping strategies have you used to deal with the challenges of living with a spouse who has alcoholism?
How do you manage stress and emotional turmoil related to your spouse’s alcoholism?
How do you communicate with your spouse about their alcoholism and its impact on your relationship and family?
Have you sought support from friends, family, or professional resources? If so, what has been helpful?
What self-care strategies have you found helpful in coping with the challenges of living with a spouse who has alcoholism?

Results

The wives of persons with alcoholism shared their experiences and coping strategies that they have used to manage the challenges of living with their spouses.

Section I: Description of demographic variables [Table 2]

Table 2.

Description of demographic variables of wives of persons with alcohol dependence

Demographic variables		Frequency	Percentage (%)
Age in years	25-35 years	9	18
	36-45 years	21	44
	46-55 years	18	38
Educational Status	Illiterate	7	15
	Primary school education	12	25
	High school education	13	27
	Graduate/Post graduate	16	33
Occupation	Home maker	33	69
	Professional	15	31
Religion	Hindu	33	69
	Muslim	11	23
	Christian	4	8
Family monthly income	Rs. 5000-10,000	8	17
	Rs. 10,000-20,000	17	35
	Rs. Above 20,000	23	48
Place of Residence	Urban	27	56
	Rural	21	44
Age at marriage	<20 years	13	27
	21-25 years	17	35
	>25 years	18	38
Duration of marriage	5-10 years	14	29
	11-20 years	34	71
Type of family	Nuclear family	32	67
	Joint family	16	33

Section II: Thematic analysis of coping strategies developed by wives of persons with alcohol dependence [Figure 1].

Figure 1.

Themes of coping strategies of wives of persons with alcohol dependence

The audio recordings were transcribed verbatim and a thematic analysis approach was used for data analysis, involving the identification of themes and categories through the process of coding. Two independent researchers coded the data to ensure reliability, and the disagreements were resolved through discussions. Thematic analysis revealed five major coping strategies: Emotion-focused coping, Problem-focused coping, Avoidance coping and self-care. The final themes were presented using direct quotes from the participants to ensure credibility.

Emotion-focused coping

Emotion-focused coping refers to efforts to manage the negative emotions associated with stressful situations.

The present study revealed that some of the WPAD used emotion-focused coping strategies such as praying or turning to religion and expressing their emotions, seeking emotional support from family and friends, and engaging in hobbies or activities.

Praying and Expressing emotions: A few wives of persons with alcohol dependence verbalized that sometimes they cannot tolerate the behavior due to his alcoholism. “I cry silently”, “I do not speak to anyone”, “I place my trust in God and I keep praying.”, “When he is out of the influence of alcohol, I express my feelings.”, “I just break down and cry”, “I talk to my husband and express my feelings, hoping that he will understand.”, “I pray a lot and go to church. It gives me comfort and strength to keep going.”. Crying and expressing their feelings helped them to release all the emotions that were built up inside.

Seeking emotional support from family and friends: Participants expressed coping strategy of turning to loved ones for comfort, advice, and encouragement during times of stress or difficulty related to living with their husband with alcohol dependence. This involved reaching out to family members or close friends to talk about their feelings, share experiences, or receive practical assistance, when necessary, with tasks or responsibilities. Seeking emotional support can help individuals feel less isolated, build a sense of community, and provide a safe space to express emotions and discuss coping strategies. Following are the few verbatim expressed by subjects.

“I talk to my sister and my close friends”, “I speak to my close friends”, “My parents are old, so I do not tell them my problems”, I do not have anyone to express my feelings or problems”, “I call my mother and express my feelings”, “I talk to my sister and cry on the phone with her.”, “I use humor.”.

Engaging in hobbies or activities to distract one-self

Participants verbalized that they participate in leisure activities or hobbies that they enjoy taking their minds off the stress or difficulties caused due to their husband’s alcoholism. By engaging in such activities, temporarily they can forget about their problems and reduce the negative impact of stress on their mental health. This coping strategy helped them to improve their mood, boost self-esteem, and increase their sense of control over their lives. This was evident from their expressions; “I try to keep myself busy with my hobbies and reading books.”, “I listen to music that uplifts my mood”, “I try to think positively.”, I spend my time with my children.”, “I practice deep breathing and meditation to stay calm”,“I distract myself by watching Television.”

Problem-focused coping

This theme was derived from following codes that are persuasive to alcohol abstinence, financial control and professional help. The researcher arrived at this code through the following verbatim from the subject “I accept his alcoholism.”, “I try to find ways to help him to reduce his stress.”, “I confront to him.”, “I try to manage his drinking by not allowing him to drink at home.” “I try to set boundaries about his drinking.”, “I manage the financial matters by running his business.”, “I encourage him for de-addiction treatment.”, “I do not argue with him while he is drunk.”, “I try to speak to him and explain the impact of his drinking on our family and finance.”

Avoidance coping

Avoidance coping is a strategy used by wives of persons with alcohol dependence to avoid confronting or dealing with the problem of alcohol-related behavior. Some of the WPAD used avoidance coping strategies such as avoiding arguments with their spouse, Ignoring or avoiding the issue altogether and focusing on their own work or activities to avoid thinking about the problem to manage the stress and negative consequences associated with their husband’s alcohol-related behavior.[5,7] “I just try to ignore his drinking and pretend everything is fine.”, “I don’t want to deal with the fights and arguments so I just stay quiet and try to keep the peace.”, “I distract myself with other things while he is intoxicated”, “I avoid social situations, where he might drink and create a scene”. This strategy involved immersing themselves in work or other activities to distract themselves from their husband’s alcoholism.

Self-care

Self-care involves wives taking care of their physical and emotional well-being. This theme emerged from three codes such as taking care of their own health, seeking professional help and setting boundaries. This included engaging in activities such as exercise, meditation, and spending time with friends and family. However, the subjects realized the importance of self-care to maintain their mental and physical health which was evident through the following verbatim; “I’ve realized that I can’t take care of my husband if I don’t take care of myself first.”, “At first, I was so focused on taking care of my husband that I neglected my own needs. But now I give importance to my needs.”, “At first, I didn’t want anyone to know about my husband’s drinking because I was ashamed. But eventually, I realized that I needed support.”, “Connecting with other people who are going through similar situations gave me little relief. I felt less alone and more understood.”, “I’m seeing a therapist myself to help me work through my emotions and develop healthy coping strategies.”, “I go for a walk with my friends.”, etc.

Discussion

The coping strategies employed by the wives of persons with alcoholism vary widely and are influenced by various factors, including individual circumstances, experiences, cultural backgrounds, and available support systems.[8] This study contributes to the existing literature by highlighting the coping strategies utilized by wives of persons with alcoholism, including emotion-focused coping, problem-focused coping, avoidance coping, and practicing self-care.[14] This study adds to the literature by highlighting the importance of positive thinking and developing coping strategies to manage emotions.

Emotion-focused coping

The findings of our study indicate that wives of persons with alcohol dependence (WPAD) employ emotion-focused coping strategies to manage the negative emotions associated with their husband’s alcoholism.[15] Prayer and expressing emotions emerged as prominent coping mechanisms utilized by some WPAD. Participants mentioned that they turned to religion and prayer as a source of comfort and strength during challenging times. Praying and expressing their emotions, either privately or to their husband, allowed them to release pent-up emotions and find solace. Crying and expressing emotions emerged as important mechanisms for releasing pent-up emotions and finding solace. Seeking emotional support from family and friends played a significant role in alleviating feelings of isolation and gaining strength to cope with the challenges posed by their husband’s alcoholism. Engaging in hobbies and activities provided a temporary respite from stressors and helped improve participants’ mood and self-esteem.[16,17] These strategies helped them navigate the emotional turmoil caused by their spouse’s alcohol dependence. These findings are consistent with previous research highlighting the role of religion and emotional expression as coping mechanisms among individuals facing various stressors.

Problem–focused coping

Problem-focused coping strategies were also evident in the participants’ responses. In the present study, WPAD sought help from family members, friends, and support groups, and took practical steps to address the underlying issues associated with their husband’s alcohol dependence. Setting boundaries, managing finances, and encouraging professional help were common strategies employed by the participants. Participants recognized the need to confront the problem directly and take practical steps to mitigate its impact on their lives and relationships. These findings are supported by previous studies emphasizing problem-solving approaches as effective coping strategies for individuals dealing with substance use disorders.[17] However, the effectiveness of these strategies may vary depending on the severity of the alcohol dependence and the willingness of the husband to seek help. Financial constraints and social stigma can also pose challenges in implementing problem-focused coping strategies.

Avoidance coping

The use of avoidance coping strategies was also observed among some WPAD in our study. The present study, found that few WPAD used avoidance coping strategies which included avoiding arguments with their spouse, ignoring or avoiding the issue altogether, and focusing on their own work or activities to avoid thinking about the problem.[9] Few of the WPAD reported that they avoided arguments with their husband’s while they were intoxicated. Other WPADs reported that they avoided or ignored the issues of their spouse’s drinking behavior altogether. Very few of the WPAD verbalized having consumed alcohol and distanced emotionally from their husband’s alcohol-related behavior to protect themselves from the negative consequences of their husband’s alcoholism.[15] This coping strategy helped them to temporarily forget about their problems and reduce the negative impact of stress on their mental health.[18] These findings are consistent with previous research highlighting the limitations and potential negative outcomes of avoidance coping strategies.

Self-care

The subjects recognized the importance of taking care of themselves, both physically and emotionally. Recognizing the importance of their own physical and emotional well-being, the wives prioritized self-care activities such as exercise, meditation, and spending time with friends and family. This realization enabled them to strike a balance between taking care of their husbands and attending to their own needs. Self-care is crucial for maintaining mental and physical health, and previous research has emphasized its role in promoting emotional well-being.[19]

Limitations of the study: This study included the small sample size and the fact that only wives were included in the study.

Recommendations: Future research could explore the coping strategies used by husbands who live with spouses who have alcoholism or include both husbands and wives in the study to provide a more comprehensive understanding of coping strategies employed by couples dealing with addiction.

Conclusion

The themes that emerged from the data suggest that wives of persons with alcohol dependence experience a range of negative emotions and engage in both helpful and unhelpful coping strategies to manage their spouse’s addiction. This study provided valuable insights into the coping strategies used by wives of alcoholics and the challenges they faced in managing their spouse’s addiction also gives the healthcare providers insight to consider these coping strategies when providing support to wives of individuals with alcohol dependence. Additionally, counseling can help wives develop new coping skills and manage their emotions effectively. Further research is needed to identify the most effective coping strategies for this population and to determine the long-term outcomes of these coping strategies.

Key message

The study findings highlight the diverse coping strategies employed by wives of individuals with alcohol dependence (WPAD) to confront the challenges they face. The WPADs utilized a combination of coping mechanisms to navigate their circumstances. This comprehensive understanding sheds light on the adaptive strategies adopted by WPAD and their potential implications for interventions and support programs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.