Treating alcohol problems in Sri Lanka

An investigation into the role of alcohol in self-harm in rural Sri Lanka: a protocol for a multimethod, qualitative study

INTRODUCTION

Sri Lanka has one of the highest suicide and self-harm rates in the world and although alcohol has been found to be a risk factor for self-harm in Sri Lanka, we know little about the connection between the two. This paper comprises a protocol for a qualitative study investigating alcohol's role in self-harm in rural Sri Lanka at three levels: the individual, community and policy level. The analysis will bring new understanding of the link between alcohol and self-harm in Sri Lanka, drawing on structural, cultural and social concepts. It will equip researchers, health systems and policy makers with vital information for developing strategies to address alcohol-related problems as they relate to self-harm.

METHODS AND ANALYSIS

To capture the complexity of the link between alcohol and self-harm in the Anuradhapura district in the North Central Province in Sri Lanka, qualitative methods will be utilised. Specifically, the data will consist of serial narrative life-story interviews with up to 20 individuals who have non-fatally self-harmed and where alcohol directly or indirectly was involved in the incidence as well as with their significant others; observations in communities and families; six focus group discussions with community members; and key-informant interviews with 15-25 stakeholders who have a stake in alcohol distribution, marketing, policies, prevention and treatment as they relate to self-harm.

ETHICS AND DISSEMINATION

The study has received ethical approval from the Ethical Review Committee of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka. A sensitive data collection technique will be used and ethical issues will be considered throughout the study.

RESULTS

The results will be disseminated in scientific peer-reviewed articles in collaboration with Sri Lankan and other international research partners.

A two-year follow-up study of alcohol dependent men rehabilitated at a special unit in a developing country

Two hundred and thirty-four alcohol dependent men who had all failed to improve after previous hospital-based interventions were admitted to an intensive 6-week residential rehabilitation programme conducted at a special unit in Sri Lanka. Outcome was assessed at 2 years post-treatment, and 36% of dependent persons remained totally abstinent. During an extended period of follow-up (mean 39.2 months) a significant association was found between abstinence and having a life partner, stable family support, a higher income and regular employment. However, there was no significant association between abstinence and age, duration of alcohol dependence, level of education or type of employment. Although the majority of alcohol dependent persons did not benefit from the programme, our results compare favourably with those of similar studies done in developed countries.