The present study was a descriptive observational study, conducted in Department of Psychiatry, Sri Ramachandra Medical College and Research Institute (SRMC & RI), Chennai, Tamil Nadu, India from December 2013 to July 2014, for a period of eight months.

All the assessments in this study were carried out only once. The patients who attended the outpatient clinic or were admitted to the inpatient de-addiction unit of the Department of Psychiatry at SRMC &RI, Chennai, Tamil Nadu, India were recruited for the study. The sample comprised of 50 patients with DSM-IV [12] diagnosis of alcohol dependence syndrome. After getting the approval of Institutional Ethics Committee (CSP-MED/13/OCT/09/98), the study was commenced. All patients fulfilling the selection criteria were approached and explained about the purpose of the study. Written informed consent was obtained from all potential participants.

Inclusion Criteria:

Exclusion Criteria:

Following parameters were assessed in the study:

1. Socio-demographic profile sheet: It was developed for the purpose of study. Consisted of a semi structured proforma to record the following variables regarding the patient such as age, marital status, level of education, socio-economic class, employment and residence (urban/rural). The socio-demographic profile sheet and the scales sheet were given as a hard copy to each patient and made to fill.

2. FACIT Sp-12-spiritual well-being scale (FACIT Sp-12) [13]: It has three subscales with four items in each: 1) Meaning subscale; 2) Peace subscale; and 3) Faith subscale. Each item was rated in Likert format from 0 to 4 (0=Not at all; 1=A little bit; 2=Somewhat; 3=Quite a bit; and 4=Very much) and each subscale scores ranges from 0 to 16. Each subscale score was obtained by summing up individual scores which was then multiplied by four and divide by the number of items answered [13]. The total score is obtained by summing up of three subscale scores which ranges from 0 to 48. The higher the score the better the spiritual well-being.

3. AASE scale [14]: It has four subscales with five items in each: 1) Negative effect subscale; 2) Social/positive subscale; 3) Physical and other concerns sub scale; 4) Craving and urges subscale. Each item rated in Likert format from 1 to 5 (1=Not at all, 2=Not very, 3=Moderately, 4=Very, 5=Extremely) and each subscale scores ranges from 5 to 25. Mean scores for each subscale, was obtained by summing up of item scores for each subscale and divided by the number of items [14]. The higher the score, the more efficacy to remain abstinent from alcohol.

The data was entered in a Microsoft excel sheet and analysed by using the Statistical Package for the Social Sciences 15^th version (SPSS version 15) under ‘descriptive’ and ‘inferential’ statistics.

Descriptive Statistics: Frequency counts were obtained for socio-demographic details. Mean and standard deviation were computed for all continuous variables e.g., age, income, subscale scores.

Inferential Statistics: Pearson’s product moment correlation coefficient was used to examine the association between spiritual well-being and AASE scales.

As shown in [Table/Fig-1], mean age of the male patients was 36.96±6.957 years, 76% were married, 42% were graduates, 76% were employed, patients belonging to, middle, lower middle and lower socio economic classes were 54%, 20% and 16% respectively; 72% hailed from urban locality.

Meaning, faith and peace subscales values are shown in [Table/Fig-2]. The total score of FACIT Sp-12 scale was 36±5.2. This indicates that patients had more spiritual belief in faith and meaning subscales, whereas low belief in peace subscale.

Negative effect, social/positive, physical and other concerns and craving and urges subscales values are shown in [Table/Fig-3]. The total score of AASE scale was 78.2±17.2. This showed that patients had more abstinence self-efficacy.

As shown in [Table/Fig-4], there was a positive correlation between meaning and faith subscales of FACIT Sp-12 scale with AASE scale at r-value 0.799 and 0.825, respectively. There was negative correlation between peace subscale of FACIT Sp-12 scale with AASE scale at r-value – 0.026.

The current study aimed at correlating FACIT Sp-12 scale with AASE scale in alcohol dependent patients. Majority of the patients in present study were middle aged males, married, had completed their graduation, belonged to middle socio-economic class and resided in urban localities. In a study done by Martins ME et al., patients were middle aged males, studied upto high school, married and active workers [15]. This can be compared with present study except that patients were well educated.

In present study, we found that Meaning and Faith subscales of FACIT Sp–12 scale had higher mean scores 12 and 14.5, respectively whereas Peace subscale which had a lower mean score of 9.4. In a study done by Jafari N et al., Meaning and Faith subscales had higher scores 10.97, 11.03 respectively, whereas peace subscale had a lower score 10.30 [16]. In another study done by Fradelos EC et al., Meaning and Faith subscales had higher scores 12.49, 9.49, respectively, whereas Peace subscale had lower score 8.64 [17]. This shows that present study can be comparable to previous studies which had similar results. This indicates that spirituality has positive role in maintaining abstinence in alcohol dependent patients. Similarly, in a study conducted by Miller WR, there was a strong evidence of spiritual involvement as a protective factor against alcohol abuse [18]. Vice versa, a study by Robinson EA et al., showed that alcohol abuse can have negative effect on spirituality [19]. So, it clearly indicates that spirituality plays a role in maintaining abstinence in alcohol dependence patients.

In present study, the total AASE score was 78.2±17.2, this higher score indicates that patients had more efficacy to remain abstinent from alcohol. Similar study in the past has shown that self-efficacy has been found to predict the alcohol use [20]. However, in a study done by Stephens RS et al., they found that self-efficacy was related to occurrence or frequency of drinking or drug use [21]. They observed Predictive validity was stronger for frequency of post-treatment substance use than for abstinence [21]. From this, it is clear that, self-efficacy helps in abstinence in alcohol dependence patients.

In present study, we found a positive correlation of Meaning and Faith subscales of FACIT Sp- 12 scale with subscales of AASE scale, pearson’s correlation values (r) 0.799 and 0.825 respectively. There was a negative correlation with Peace component of FACIT Sp-12 scale with components of AASE scale r-value -0.026. This clearly indicates that patients with greater spiritual beliefs will have more self-efficacy to remain abstinent from alcohol. Similar to present study results, a study done by Piderman KM et al., concluded that significant association exists between spiritual well-being and alcohol abstinence self-efficacy (r=0.56) [10]. In another study done by Kim MY and Byun EK a positive correlation (r=0.23) was observed between spiritual well-being with abstinence self-efficacy and it was statistically significant [22]. However, in a study conducted by Bluma L, there were no significant differences in scores obtained for FACIT Sp-12 and AASE scales with p value being 0.74 [23]. There was no difference in high or low spiritual beliefs and their abilities to remain abstinent from alcohol.

Strengths of this study included the subject’s common diagnosis of alcohol dependence, power of spirituality to remain abstinent and instruments used in the study have been used in published research. However, similar studies must be carried out for further replication and to comprehend its significance.

The sample size was relatively small. The study sample had no control group to find the impact of spiritual variables. Depressive and anxiety symptoms were not measured which are the diagnostic indicators of a mental health disorder.

Spiritual belief and AASE were found to be higher in index study. Also, spiritual variables (Meaning and Faith) had a positive correlation with AASE, which suggests that patients with high spiritual belief may have better capability to remain abstinent from alcohol and good long term recovery.