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The experience of caring for an alcoholic woman in the family

Abstracts

This study aims at investigating the care practices developed by the family of an alcoholic woman and understanding her perception of the care she is receiving. It is a case study, developed using a qualitative approach. Data were collected through semi-structured interviews, performed in 2008 in a middle-class family home in a town in southern Brazil. The data were later submitted to analysis. The results show that the care provided by the family is centered on the needs for food, hygiene, sleep, rest and the transporting of the woman to specialized detoxification services, and that the woman views these actions as a form of control and punishment due to her addiction. We highlight the way the family cares for the woman and how this changed as her alcoholism evolved.

Women; Alcoholism; Family; Nursing care


Este estudo tem como objetivo investigar as práticas de cuidados desenvolvidas pela família à mulher alcoolista e conhecer a percepção desta em relação aos cuidados que recebe. Trata-se de um estudo de caso, desenvolvido com uma abordagem qualitativa, cujos dados foram coletados através de entrevistas semi-estruturadas, realizadas em 2008, no domicílio de uma família de classe média, residente em um município no extremo sul do Brasil e, posteriormente, submetidos à análise de conteúdo. Os resultados mostram que os cuidados desenvolvidos pela família são centrados nas necessidades de alimentação, higiene, sono, repouso, encaminhamento aos serviços especializados para a desintoxicação e que a mulher alcoolista interpreta esses esforços como sendo ações de controle sobre sua vida e punição pela sua condição de dependência. Destaca-se que a maneira da família cuidar modifica-se no mesmo compasso em que o alcoolismo evolui.

Mulheres; Alcoolismo; Família; Cuidados de enfermagem


Este estudio objetiva investigar las prácticas de cuidados desarrollados por las familia a la mujer alcohólica y conocer la percepción de ésta en relación a los cuidados que recibe. Estudio de caso, desarrollado con abordaje cualitativo, cuyos datos fueron recolectados a través de entrevistas semiestructuradas, realizadas en 2008, en el domicilio de una familia de clase media, residente en un municipio del extremo sur de Brasil y, posteriormente, sometidos a análisis de contenidos. Los resultados muestran que los cuidados desarrollados por la familia se centran en las necesidades de alimentación, higiene, sueño, reposo, derivación a los servicios especializados en desintoxicación, y que la mujer alcohólica los percibe como acciones de control sobre su vida y castigos por su condición de dependencia. Se pone en destaque que el modo de cuidar de la familia se modifica en la misma medida en que el alcoholismo evoluciona.

Mujeres; Alcoholismo; Familia; Atención en enfermería


ARTIGO ORIGINAL

The experience of caring for an alcoholic woman in the family*

La experiencia de cuidar de la mujer alcohólica en la familia

Alessandro Marques dos SantosI; Mara Regina Santos da SilvaII

IRN. Master in Nursing, Graduate Program, Federal University of Rio Grande. Rio Grande, RS, Brazil. sandromarquessan@yahoo.com.br

IIRN. Ph.D. in Nursing. Professor, College of Nursing, Federal University of Rio Grande. Rio Grande, RS, Brazil. marare@brturbo.com.br

Correspondence addressed

ABSTRACT

This study aims at investigating the care practices developed by the family of an alcoholic woman and understanding her perception of the care she is receiving. It is a case study, developed using a qualitative approach. Data were collected through semi-structured interviews, performed in 2008 in a middle-class family home in a town in southern Brazil. The data were later submitted to analysis. The results show that the care provided by the family is centered on the needs for food, hygiene, sleep, rest and the transporting of the woman to specialized detoxification services, and that the woman views these actions as a form of control and punishment due to her addiction. We highlight the way the family cares for the woman and how this changed as her alcoholism evolved.

Descriptors: Women; Alcoholism; Family; Nursing care

RESUMEN

Este estudio objetiva investigar las prácticas de cuidados desarrollados por las familia a la mujer alcohólica y conocer la percepción de ésta en relación a los cuidados que recibe. Estudio de caso, desarrollado con abordaje cualitativo, cuyos datos fueron recolectados a través de entrevistas semiestructuradas, realizadas en 2008, en el domicilio de una familia de clase media, residente en un municipio del extremo sur de Brasil y, posteriormente, sometidos a análisis de contenidos. Los resultados muestran que los cuidados desarrollados por la familia se centran en las necesidades de alimentación, higiene, sueño, reposo, derivación a los servicios especializados en desintoxicación, y que la mujer alcohólica los percibe como acciones de control sobre su vida y castigos por su condición de dependencia. Se pone en destaque que el modo de cuidar de la familia se modifica en la misma medida en que el alcoholismo evoluciona.

Descriptores: Mujeres; Alcoholismo; Familia; Atención en enfermería

INTRODUCTION

Alcoholism is a major public health problem in Brazil. The consequences of such chronic disorder are associated with the country's skyrocketing transit death rates, work absenteeism, family misunderstandings, broken relationships, and dysfunctional health status not only related to the alcoholic persons, but also to those surrounding them, especially family members. Alcoholism indistinguishably affects men and women of all ages and from all social classes(1), including children. Preventing the problem is quite a difficult task, as alcoholic beverage is freely sold everywhere, and population is not made fully aware of the damaging effects it brings about.

Although official records indicate a predominance of alcoholism among men(2), the prevalence of the illness among women has been soaring, thus demanding extra attention. Negative repercussions of alcoholism in women are usually much more intense, since physiological degenerations are identified much earlier than in men. Sexual function disorders such as dysmenorrhea, hypermenorrhea and premenstrual discomfort, menstrual cycle variations, as well as higher occurrence of gynecologic surgeries(3) have been reported. At the same time, it is important to highlight that whenever women look for a healthcare clinic or service in order to be examined or cared of, for instance, any depressive symptom, they often omit any eventual record of alcohol dependence. Such fact is a clear proof of the strong taboos concerning the alcoholic woman, both in the family circle and in the society at large(4).

From the social standpoint, we can also notice the persistence of a moral censorship that more intensely condemns certain female behaviors, including the abusive use of alcoholic beverages. Based on these biases, women are likely to be marginalized and their credibility fades away, as the alcoholic status directly interposes in their socially and culturally assigned performance roles of raising, guiding and protecting their children and family(5).

Particularly in the family scope, the negative outcomes of female alcoholism are more concretely observed. In the vast majority of the cases, the family takes a hopeful stand that the person will one day quit drinking; however, when they realize this is not happening, a rupture in the family bonds may occur and a flow of ambivalent feelings, ranging from suffering to hope, from love to hatred, from satisfaction to dissatisfaction, rise up(6). Besides, alcoholism-related illnesses are not only bound to the dependent person. In a wide variety of ways it will affect all family members. Frequently, the trust relationship between the woman and her children and husband is profoundly shaken and the mother-wife progressively loses respect and credibility within her family.

Whenever female alcoholism is to be dealt with, therefore, the focus of the process should not be restricted only to the related clinical problems, but also to the direct reverberations produced by the disease in the roles women play in the family circle. In our contemporary society, women are still assigned the greatest responsibilities in the family context(3). Whenever other people are required to take on these duties, family conflicts generally emerge from the very fact that the one who should be the caregiver is unable to do so because of the alcoholism. In such context, the woman starts being stigmatized by the whole family, which in general can not cross the line of accepting and understanding alcoholism as a disease. Therefore, she is not recognized as someone who needs to be treated.

There is a noticeable void in the related literature regarding the relevant implications of the female alcoholism issue. A major emphasis is placed upon the social, epidemiologic and clinic-psychic repercussions of the disease(7-9). In a general perspective, research neither targets the alcoholic woman in the same proportion, nor the care practices that should be developed by her family. A similar status can be seen in popular magazines, whose issues are massively centered on the clinic, social and psychic disorders manifested by the male alcoholic. References on female alcoholism and its complexities are rarely recorded.

Most of the studies do not even mention the alcoholic woman. Alcoholism is prevalently associated with men. These conditions provide enough evidence for the need of a deeper study on the female alcoholism, and more specifically on practical ways of caring for the alcoholic woman within the family context, once family tensions are commonly significant and are particularly expressed in the affection, care and protection relationship levels among its members(4,6,10).

OBJECTIVES

Based upon the above-mentioned considerations, this present study will deal with two objectives. The first focuses on the investigation of the family-centered care giving practices toward alcoholic women; the second is driven toward acknowledging the perception of women about the care provided by their families.

METHOD

This present qualitative-based study was developed with a family composed of five people: an alcoholic woman (M1) aged 51; her mother (F1) and major caregiver aged 80; M1's daughter aged 20; M1's husband; and the couple's son aged 5. The alcoholic woman started drinking at 16 and her family history points to the existence of two uncles, her mother's brothers. These two men also used to drink and were taken care of by F1 since their childhood. In adulthood, both died as a result of the abusive use of alcohol.

This is a socially and economically stable family. Their home, located at a mid-class neighborhood in a southern Brazilian town, is large and comfortable. M1 seems to be older than she really is. She is usually hostile, ironic and aggressive toward family members, pointing out tense family relationships. The family is assisted by a Psychosocial Attention Center (CAPS) where M1 gets treated and where the other family members attend to family support meetings. This CAPS is specialized in treating and caring for people under the chemical dependence of alcohol and drugs.

Data were collected between August and September 2008 by means of semi-structured interviews composed of open and closed questions, which were recorded and eventually transcribed in compliance with a script prepared to this end. Interviews were performed at the family place. Two meetings were prescheduled, one for the interview with the alcoholic woman, and the other for the interview with the care giving family. M1's interview lasted about one hour, and the care giving mother's took around two hours.

Data were submitted to a content analysis(11), in accordance with the pre-analysis steps, beginning from an exhaustive, fluctuating reading aimed to present a thorough view of the data set and to provide a deep assimilation of specificities. The activity focused on significant expressions that could identify the care giving status provided by the family and perceived by the alcoholic woman. Later on, a discussion-focused interpretation process of results was carried out, which allowed for the interaction between the study's objective and the issues and presuppositions based on the theoretical concepts that ground the research.

The study was certified by the Research Ethics Committee under registration number 2008/9. In compliance with the Ministry of Health's Resolution 196/96, which relates to research involving human beings, participants were assured utter secrecy and anonymity, as well as the right to access the research's data and quitting the process at any time. All family members signed the Free and Clarified Consent Term.

RESULTS

The care giving practices developed by the family

M1's involvement with alcoholism began in her adolescence, at around 16 years of age, when she used to skip school together with other classmates in order to drink beer in a bar in the neighborhood. At that time, her mother's type of help predominantly focused on monitoring her teenager daughter's attitudes and behaviors. The mother affirmed that she was not specifically worried about her daughter's intake of alcohol. Her major concern was centered on the girl's school performance, as she deemed the use of alcoholic beverage by her daughter only a way of drawing attention.

The mother (F1) actually started to worry with the alcohol intake when her daughter grew up. In that period – M1 was then 25 years old – she drank uncontrollably throughout the whole week, resulting in a progressive lack of interest at her personal appearance. Even so, F1 was not ready to recognize (or to admit) her daughter's alcoholism. This feature is quite common among alcoholic people's family members, who generally deny the dependence in order not to face the negative consequences of the disease.

In the above-mentioned phase of M1's vital cycle, her dependence had already grown into a public exposure to her family, and this process triggered a general uneasiness, once it represented a clear violation of predominant values. On top of it all, alcoholism for this family was considered as an exclusive male practice, as depicted by F1's speech:

I hid it in the beginning, because she had many friends in the high society. I was ashamed that my neighbors could know that my daughter was an alcoholic. It was an utter shame, because to be a drinking woman is much worse than being a drinking man (F1).

At 35, M1 got married and departed from her family to a distant place. She was now at the university, but kept drinking, even after finding out she was pregnant of her only daughter. The mother (F1) was a constant presence, visiting her frequently. As such, she could bear witness of her son-in-law's complaints about the absence of his wife regarding the home affairs, and her lack of care of herself and her daughter. M1 used to drink large amounts of alcohol during the day. It became a habit for her husband to get back home and find her completely drunk. As a result, he took control of the home issues and his newborn's needs. As expected, the marriage did not last long and M1 returned to her original family, bringing her small daughter along.

After getting back and being reinserted into the family life, the trust between F1 and M1 became fragile and all affection relationships started to collapse due to countless problems experienced by the family related to M1's dependence. F1 had to frequently rescue her drunken daughter from the streets and bring her home to sleep. In that time, this was F1's most prevalent way of providing M1 with care.

From this moment on, the care giving provided by F1 was made of being awake every night her daughter went out to have some fun, as she deemed it necessary to protect her from the father's restlessness in case he found her drunk. He definitely did not accept M1's alcoholic dependence. According to F1, she also needed to preserve her granddaughter, thus preventing the little girl to see her mother in that decaying situation. The interview with F1 clearly indicated that she made her best efforts in order to hide from the rest of the family the difficult situations unleashed by her daughter's alcoholism, such as the drunkenness condition, M1's derisive words toward her, as well as the deplorable physical status her daughter presented when she got back home. According to her point of view, this was the best way to take care no only of her daughter, but also her family. Her next words clearly depict this belief:

I did not allow her daughter to see her, because she was so small. I did not let my husband to see her, because he was very ill. I spent the whole night awake and controlling everything. You know what a mom is like: she always hushes up (F1).

F1, then, decided to take care of her alcoholic daughter and the other family members, but at the same time could not hide the social and emotional burden of experiencing M1's alcoholism and the shameful feeling before other people. This feeling seemed to be directly related to the prevalent values rooted in this family, which battled against M1 as a woman, as can be noticed in the following statement:

I was ashamed of my friends, if they came to know about it, because we used to have quite a social life. I did everything I could so that nobody came here [home] (F1).

M1's alcoholism got even worse after her father passed away. They used to be good companions, especially in tough moments. From this event onwards, M1 started ingesting other alcohol-based substances, such as perfume, gasoline and disinfectant. As a result, now at the age 75 and showing a lack of physical strength to provide her alcoholic daughter with care, F1 asked her granddaughter for help. In that moment in time her granddaughter was already married and lived with her husband and a small boy. Thus, M1's daughter started living with both her mother and grandmother, taking an active part in her mother's care, mainly those related to the control of M1's outward activities and money management. This feature strongly contributed to the intensification of the already existing family conflicts, once M1 considered these practices to be punishing and controlling.

Nonetheless, even amidst upset affection relationships, F1 was always there to provide for her daughter's basic needs, including helping her with her bath, clothe changing, feeding, and sleeping, especially when M1 returned home completely drunken. In spite of this support, M1 plainly stated she could not remember having received such care giving.

This family was clearly experiencing conflicts, inadequate situations, and was exhausted by the countless arguments and hopeless misunderstandings toward M1's recovery. A distinct evidence of this framework was the appearance of ambivalent feelings. At the same time F1 takes care of and protects M1 from a relapse, thus providing her with basic care, she also experiences a great deal of discontentment and suffering brought about by her daughter's dependence, as can be clearly observed in the next part of her speech:

On the last time, she was not able to open the door and she fell down. I dragged her in (...) I was willing to kill her, but I knelt down and asked God to help me. I got her pillow and put it below her head. I wanted to choke her. I thought: well, I'm killing her because I can't stand this anymore, I do not have a life anymore. I asked God to guide me in that hour. I let it go, but I was very willing to do it (F1).

M1's drunkenness status became a routine and the assistance provided by F1's granddaughter was not enough anymore. They then looked for the support of other family members and therefore were able to extend M1's care giving a little longer within the family context. However, M1's clinic and emotional condition evolved. The next step was to get assistance from specialized services provided by psychiatric hospitals and clinics that worked toward the rehabilitation of chemically dependent people.

Again, F1's ambivalent feelings toward M1 must be highlighted. F1 was filled with a desire of killing M1 in order to terminate both the daughter's and the family's sufferings, but she concurrently looked for the assistance of other family members in order to provide her daughter with help, which points to feelings of solidarity and affection that counteract her desire to kill. In other words, her role as a protecting, care giving mother rules at this moment.

M1's dependence and segregation within the family context was progressively exposed to other social circles surrounding the family, including their neighbors. As time went by, F1 believed, the secrecy was not necessary anymore, as all of M1's hope of recovery and cure was slowly fading away. Concurrently, F1's motivation was already undermined. She did not have the physical energy to cope with M1's dependence, and she did not mind anymore if her family was publicly exposed. She was now willingly and openly accepting other people to help her take care of M1.

One day she went out and some people brought her into their home. She said she lived here and gave them our address. They brought her here by car, because she was utterly drunk, she could barely walk (F1).

Whenever the family care giving capacity vanishes, it looks for support in the social network depicted in this present study by neighbors, relatives and community services, including psychiatric hospitals, first aid medical services, and emergency services in general hospitals. The following statements point out this feature:

I would call the fire brigade, I would call the first aid services, and they would say, "she's drunk" (...) Then she was taken to a sanatorium. She was admitted there five times (...) Now she's been treated at the CAPS. I think she is ok now...she seems to be regretting everything she did... We should not be worrying about these things (F1).

The perception of the alcoholic woman about the care giving provision.

When M1 agreed in taking part in this study she had been in an abstinence status for two months. She came to the personal conclusion that her last 34 years had been packed up of great family and individual losses. The segregation from her family seemed to be the most significant loss for her. The total collapse of all existing family bonds and the family's distrust at her were quite noticeable, and M1 recognizes that a peaceful relationship level with her relatives had been compromised by the number of problems they faced. Yet, she claims for one extra opportunity of rebuilding the lost family bonds:

I do believe they have undergone terrible moments, I know that they suffered in their way, but they need to evaluate my attitudes and acknowledge that I've been changing every day, I've been fighting to improve. They can't just throw things at my face, because instead of helping me, they bury me deeper (...) it's hard to forget (M1).

Despite the care giving practices carried on especially by her mother and daughter throughout the evolution of alcoholism, M1 states that they were only focused on her relationship with the alcohol. She realized that the care provided by her family was not directed toward herself. In her perception, they were based on punishment and control whenever her family prohibited her of leaving home, dealing with money, and every time they inquired her whether or not she had drunk as she came back home.

They cared for me in a controlling sense, time to leave, time to come back, they starred at me every time I got back home (...) Several times when I'm in my bedroom, my daughter just breaks into it, I think she wants to see whether or not I'm drinking. My daughter commands everything today. She manages my money. So, I think that in this sense it is not at all care. I mean, at least for me it's not care at all (M1).

M1 perceives the care giving carried on by her family members as controlling movements, and not as necessary actions to preserve her health in a time in her life when dependence was already resulting in social, emotional and clinic problems. For M1's family, her behaviors should have clear limits; however, there was no convergence between the family's purposes and M1's perception of their care giving. Eventually, the family slowly lost all hope that a status of utter abstinence would finally take place, which led to the inevitable weakening of every affection bond and openrf room for conflicts among family members, as well as the development of an inner culture of blaming each other for their fragile condition.

Overall, one can say that M1 does not recognize herself as cared for by her family members, as they do not provide her with affection, love and attention. From her standpoint, care is related to affection, attention, and these feelings are not present in her family. Therefore, F1's concern and involvement throughout the whole evolution of alcoholism are not recognized by M1, although her mother and her daughter have expressed their full commitment to help and support her. Again, we see a mismatch between F1's developed care giving practices and M1's perception of these practices.

Affection, attention, to be considered as a human being, as a normal person. They should leave everything I was and everything I still am behind: an alcoholic person in rehabilitation (...) They should consider me as a normal human being, and give me a trust credit, and the affection I deserve (M1).

M1 only felt affectionately and dedicatedly cared of in the relationship with her dad. However, although such relationship was perceived in a harmonious way, the drunkenness episodes were common to both of them. Father and daughter used to drink together. The mother rebuked such behavior and associated them with a sick freedom that could eventually harm her daughter. She used to play the role of advising them; but, several times she fought this practice back, although she was heard neither by her husband nor by her daughter.

I missed my father a lot. He was a real friend of mine, my companion. He cheered me up, praised me. I sat on his laps and I cried, I talked. Thank God, my father was not there to see me as an alcoholic person. He used to drink with me, we drank socially, and sometimes both of us boozed up a bit (M1).

Another action M1 perceived as a care giving practice was the search for a specialized service when the family lost all hope for her recovery and full abstinence. M1 believes she would not have survived if her family had not accessed this service. According to her own words, she crossed the borders toward utter insanity, and she could not tell how she got back home as she totally obliterated the incidents. She sort of blacked-out and when her conscience returned she was back home, or at a healthcare institution.

On these occasions, M1 only perceived the care giving provided by the healthcare professionals. She recognized her family decision to look for help in the healthcare services as a way of punishing her, instead of caring for her, even when her family members closely followed her up in detoxification periods she was submitted to. M1's statements were very broad regarding the admittance processes (around six). Throughout the interviews she tried not to show a lack of concern, suggesting that she was struggling not to be depressed at her family's decision of admitting her into a hospital.

In this last admittance I gave it a deep thought. I was ruining my whole life for things that were not worth living for, things that would take me nowhere. This would not move my family. I was the one being destroyed. Well, I felt I had reached my limit (M1).

M1's words draw a line for a moment when she started recognizing within her own self the desire to change her condition. She understands that when you are drinking you do not have any problem, everything is solved out; later, the consequences are enormous, the person is not believed, respected and cared for anymore (M1). She realizes the level of the damage she caused herself, as well as the collapse of all family bonds, but she does not recognize her family as a helping hand to cope with the alcohol dependence. However, she wants to prove her family members that she will manage to remain sober and, as recorded before, she claims for an opportunity to rebuild family relationships. Thus, M1 started her search for abstinence. When this study was brought to an end, she had been clean from any alcoholic beverage for two months.

DISCUSSION

The results of this present study show that the way M1's family understood their care giving practices was altered as her alcoholism status settled down. In other words, both the sickening and the care giving process evolved at a similar pace. In the preliminary stages, behavior monitoring and educational performance practices were prevalent, and the abusive consumption of alcohol was considered as a proper behavior of teenagers. Nonetheless, it was only the beginning of a long pathway of an unidentifiable – and consequently an unpreventable - alcoholic dependence. This study, therefore, ratifies the current literature that points out the gateway from the social habit of drinking to alcoholism, a process that can take many years and is marked by a strong interface between common drinking and dependence, during which alcohol intake processes become a priority in comparison to other activities(12).

In the same way, predominant values, beliefs, customs and biases in families, which connect alcoholism with a male practice - or an addiction instead of a disease – highly contributed so that the potential risk represented by M1's behavior could not be identified. These values permeate all family relationships and are replicated from generation to generation(13). As per the family addressed by this study, such replication is clearly observed in the hardships and conflicts experienced years later, especially between M1 and her daughter, as well as in F1's endeavors to hide M1's dependence through socially isolating her family.

This same attitude can be observed in society as a whole, particularly among some healthcare professionals who report on difficulties to care for alcoholic people and replicate the values and beliefs of the alcoholic person's family(10). Probably stirred by such values, these professionals deemed the alcoholic woman to be immoral and her behavior to be inadequate, thus heating up the suffering and the social stigma over these ill people(10).

F1's steady presence and her efforts so that M1 did not fail in her role as a mother and wife are care giving practices that can be intensified whenever the family recognizes that it is not possible to deny alcoholism anymore. In the same way, feelings of anger and shame, in addition to built-in conflicts as M1 neglects her own personal hygiene, are intensified. Finally, the family recognizes a settled down alcoholism status in a grow-up woman who depends on another woman to supply her basic needs. M1 confirms that after the identification of the advent of alcoholism, the family dynamics change, and the risk of the alcoholic woman to be abandoned by family members is quite high(5).

Several authors refer to shameful feelings toward the alcoholic person as a result of embarrassing situations he provokes in the family(4-6-14). As soon as dependence settles down, the person loses the common sense concerning his social life, disregards his most elementary needs, and experiences physical and psychic disorders. Under such conditions, the family is commonly kept at a steady alert mode, which can generate emotional and physical weariness, anguish, insecurity and discouragement regarding the recovery toward a better life condition. In a nutshell, the dialogue between family members become a difficult task and the family progressively loses any hope of levering the quality of its social life(12-15).

The care giving practices fully presented in this study ratify the purpose of family care processes pointed out by other authors, including the intention of achieving the well-being, good health and development of its members(16). Similarly, these practices provide clear evidence that the family ensures the protection of its members by means of takings steps toward providing physical, emotional and social security ranging from personal hygiene to the widest forms of healthcare(16). On the other hand, it is worth to highlight that although F1 was getting older, she kept on taking full responsibility for M1's basic needs, thus pointing out the preservation of significant elements for the definition of the understanding of care, such as commitment, support and integrity preservation, dignity, and singularity(17).

However, in spite of all the actions developed by her family throughout the evolution of alcoholism, M1 did not feel cared of. Possibly, the experiences she had for 34 years as an alcohol dependent person led her to read her family's demonstrations of affection and love as meaningless. This feature confirms the results drawn by other studies, showing the disruptive power of alcoholism over family loving ties, the difficulty to approach and to maintain trust, the sharing of experiences between the alcoholic person and the other family members, as well as the ambivalent feelings that usually generate aggressive behaviors in the domestic context(6,10,15).

A relevant aspect for Nursing pointed out by M1 is that the care giving practices carried on by her mother and her daughter were focused on the alcoholism itself, and not on her self. Care giving practices, in her perspective, should be related to demonstrations of affection, zeal, solidarity, patience and concern at people. M1 is not capable of decodifying the actions performed by her family members throughout the years as care giving practices. She considers them to be disrespectful, punishing and excluding, thus contributing to the enhancement of loneliness feelings.

Based on such comprehension, M1 feels unqualified within her own family; on the other hand, her family understands neither the woman's hardships and conflicts nor her perception of those practices as suffering. In this context, care demands become a burden to the family, thus ratifying the perception that this form of understanding is most of the times associated with the lack of knowledge about the sickening process, as well as with the recovery and social reintegration possibilities for people who develop disorders of such nature(18).

In the family scope, the care giving relationship demands responsibility, commitment and, as a matter of fact, is developed based on affection, devotion and love. The relationship between the human beings involved in the care giving process should be complimentary. Whenever this complimentary relationship is evidenced, the care giving itself is turned into a significant relationship in which a concern for the other is manifested, an engagement that is permeated with mindfulness, which is directly translated into care giving(17). However, we should not minimize the fact that the burden is heavier for those who directly cares for the person. As the other family members step back and decrease the relationship level with the sick person, the caregiver may eventually become the target for care giving(18).

Taking into account the fact that human beings do not live alone, and that the family is their closest support network(16), it is understandable why F1, after M1's long years of dependence, did not quit her care giving practices. This family has plenty of historical evidences that show this feature. Although M1's suffering triggered countless negative feelings, F1 concurrently opened ways to positive desires of helping her daughter and rescuing her from the condition she was bound to.

CONCLUSION

In spite of focusing on the care giving practices carried out by the family, the result of this present study stand out as important alerts toward the Nursing practice with alcoholic people, especially with alcoholic women. First, the results indicate that despite the constant conflicts and the long years of painful experiences, F1 always provided her alcoholic daughter with care. This is quite a significant starting point for the Nursing work, as caring for women bound to an alcoholism condition requires a planning process that needs to take into account not only the dependent person, but also the caregiver's weariness.

The results also point out the importance of identifying precocious signals of abusive consumption of alcohol, especially in our days when this behavior is very stimulated among youth. Similarly, the results should serve as an alert concerning the strong impact of the social biases related to female alcoholism over the women health status and mainly over their role as mothers and family caregivers.

Particularly, this study highlights the unbalance between the perception of the caregiver and the alcoholic woman whenever the dialogue capacity between them is compromised by the disease itself.

REFERENCES

  • 1. Laranjeira R, organizador. I Levantamento Nacional sobre Padrões de Consumo de Álcool na População Brasileira. Brasília: Secretaria Nacional Antidrogas; 2007.
  • 2
    Brasil. Ministério da Saúde. Sistema de Informação em Saúde das Principais Instituições da Saúde no Rio Grande do Sul – Brasil. Perfil da saúde do brasileiro. Porto Alegre; 2009.
  • 3. Gehrke BNC. Considerações sobre o alcoolismo. Pelotas: EDUCAT; 2001.
  • 4. César BAL. Alcoolismo feminino: um estudo de suas peculiaridades: resultados preliminares. J Bras Psiquiatr. 2006; 55(3): 208-11.
  • 5. Nóbrega MPS, Oliveira EM. Mulheres usuárias de álcool: análise qualitativa. Rev Saúde Pública. 2005;39(5):816-23.
  • 6. Silva MRS. Família de alcoolista: o retrato que emerge da literatura. Fam Saúde Desenvolv. 2003;5(1):9-18.
  • 7. Castells MA, Furlanetto LM. Validade do questionário CAGE para rastrear pacientes com dependência ao álcool internados em enfermarias clínicas. Rev Bras Psiquiatr. 2005; 27(1):54-57.
  • 8. Andrade LHSG, Viana MC, Silveira CM. Epidemiologia dos transtornos psiquiátricos na mulher. Rev Psiquiatr Clin. 2006;33(2):43-54.
  • 9. Galduróz JC, Caetano R. Epidemiologia do uso de álcool no Brasil. Rev Bras Psiquiatr. 2004;26 Supl 1:3-6.
  • 10. Nóbrega MPS, Oliveira EM. Dando voz às mulheres usuárias de álcool. Acta Paul Enferm. 2003;16(3):71-80.
  • 11. Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 10Ş ed. São Paulo: Hucitec; 2007.
  • 12. Masur J. Etiologia do alcoolismo. In: D'Albuquerque LAC, Silva AO, organizadores. Doença hepática alcoólica. São Paulo: Savier; 1990. p. 9-13.
  • 13. Leininger MM. Culture care diversity and universality: a theory of nursing. New York: Wiley; 1991.
  • 14. Filizola CLA, Perón CJ, Nascimento MMA. Compreendendo o alcoolismo na família. Esc Ana Nery Rev Enferm. 2006;10(4):660-70.
  • 15. Rossato VMD, Kirchhof ALC. Famílias alcoolistas: a busca de nexos de manutenção, acomodação e repadronização de comportamentos alcoolistas. Rev Gaúcha Enferm. 2006; 27(2):251-7.
  • 16. Elsen I. Cuidado familial: uma proposta inicial de sistematização. In: Elsen I, Marcon SS, Silva MRS, organizadoras. O viver em família e sua interface com a saúde e a doença. 2Ş ed. Maringá: Eduem; 2004. p. 19-28.
  • 17. Waldow VR. Atualização do cuidar. Chia. 2008;8(1):85-96.
  • 18. Moreno V. Familiares de portadores de transtorno mental: vivenciando o cuidado em um Centro de Atenção Psicossocial. Rev Esc Enferm USP. 2009;43(3):566-72.
  • Correspondência:
    Mara Regina Santos da Silva
    Av. Itália Km 8 – Carreiras
    CEP 96201-900 Rio Grande, RS, Brasil
  • *
    Extraído da dissertação "Práticas de cuidado no cotidiano das famílias de mulheres que vivenciam o alcoolismo", Programa de Pós Graduação em Enfermagem, Universidade Federal do Rio Grande, 2009.
  • Publication Dates

    • Publication in this collection
      07 May 2012
    • Date of issue
      Apr 2012

    History

    • Received
      14 Aug 2010
    • Accepted
      09 Aug 2011
    Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
    E-mail: reeusp@usp.br