Download PROFORMA FOR REGISTRATION OF SUBJECT FOR

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
Mr. Janarthanan.I
1St Year M.Sc (Nursing)
Psychiatric Nursing
Year 2011 -2013
SUSHRUTHA COLLEGE OF NURSING
BANGALORE 560 085
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE. KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1.
NAME OF THE CANDIDATE
AND ADDRESS
2.
NAME OF THE INSTITUTION SUSHRUTHA COLLEGE of
Nursing
3.
COURSE OF THE STUDY
AND SUBJECT
1St Year M.Sc (Nursing)
Psychiatric Nursing
4.
DATE OF ADMISSION TO
THE COURSE
03-06 - 2011
5.
TITLE OF THE STUDY
Mr.JANARTHANAN.I
1St Year M.Sc (Nursing)
#23, PAPAIAH GARDEN,
DIAGONAL RD,,BSK,IIISTAGE,
CHANAMANKERE
ACHAKATTU, BENGALURU 560085
A STUDY TO EVALUATE THE
EFFECTIVENESS OF
MOTIVATIONAL
ENHANCEMENT THERAPY ON
ALCOHOLIC PATIENT IN
SELECTED DE ADDICTION
CENTER AT BANGALORE
BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Alcoholism is chronic progressive and often fatal disease. It is a primary disorder and not
a symptom of other disease or emotional problems. The chemistry of alcohol allow it to effect
nearly every type of Cell in the body, including those in the central nervous system.1
Chronic alcoholism causes severe health problem like liver disorder, gastrointestinal
problem, diabetes, skin, muscle, bone disorder and reproductive problem. Prolonged heavy use
of alcohol can lead to addiction.
Extensive alcohol intake is likely to produce withdrawal symptoms including severe
anxiety, tremor, hallucination and convulsion. In addiction Mother who drinks alcohol during
pregnancy may give birth to infant with fetal alcohol syndrome. These infant may suffer from
mental retardation and other irreversible physical abnormalities.2
Moderate drinking is defined as equal to or less than two drinks a day for men and one
drink a day for women. Hazardous drinking puts people at risk for adverse health events. People
who are heavy drinkers consume more than 14 drinks per week.3
Drinking is considered harmful when alcohol consumption has actually caused physical
or psychological harm. People with alcohol abuse have one or more of the alcohol-related
problems over a period of 1 year like Failure to fulfill work or personal obligations, recurrent use
in potentially dangerous situations.4
When a person drinks alcohol, the alcohol is absorbed by the stomach, enters the blood
stream, and goes all the tissues. The effect of alcohol are dependent on a variety of factors ,
including a person’s Size, weight, age, and sex, as well as the amount of food and alcohol
consumed . The effect of alcohol Intake include dizziness and talkativeness; the immediate effect
of a larger amount of alcohol Includes slurred speech, disturbed sleep, nausea, and vomiting.
Alcohol even at low doses may significantly have impair the judgment and coordination required
to drive a car safely. Low to moderate doses of alcohol can also increase the incidence of variety
of aggressive acts, including domestic violence and child abuse.5
Depending on the scope of the program, motivational enhancement therapy refers to the
medical, psychotherapeutic, educational, and/or social treatment processes required for
alcoholism recovery.
Motivational Enhancement Therapy (MET)
attempts to enhance a patient’s desire to
change by asking about the pros and cons of the patient’s behaviors, by considering the patient’s
goals and the ambivalence associated with reaching those goals, and by attentively listening to
the patient. As would be expected, this form of treatment may be of benefit primarily to patients
who are not already highly motivated to change.6
Motivational enhancement therapy uses reflective listening techniques and a nonjudgmental stance, both of which facilitate an empathetic environment for therapy. Motivational
enhancement therapy is usually a relatively short-term intervention; one that is gaining in
popularity partly because it can be tailored to the needs of the recipient, it can be readily learned,
and it is widely thought to be efficacious.7
NEED FOR THE STUDY
Drug and alcohol dependence are becoming more and more prevalent all over the world.
From the last ten years, an invariable rise has been seen in the amount of alcohol related deaths.
The statistics reveal that one in six people aimed the age of 13- 20 is a binge drinker. About 52
% of college boys have binged drunk and 40% girls have binged drunk.8
Estimates of the economic costs of alcohol abuse collected by WHO, vary from 1-6% of a
country’s GDP (Gross Domestic Product).9
Alcohol consumption and related problems have risen substantially in many Asian
countries, over the last several years. Alcohol consumption has been steadily increasing in
developing countries like India. 62.5 million alcohol users estimated in India .Approximately one
in ten adolescents are abusers of alcohol. 22.6% of the 15-19 age group have been using alcohol
for three or more years.8In Karnataka, is a significant lowering of age of initiation of drinking
from the mean age of 28 years to 18 years.10
According to the International classification of diseases-10 (ICD-10) Dependence
syndrome is defined as a cluster of physiological, behavioral and cognitive phenomenon in
which the use of the use of a substance (in the present context alcohol) takes on a much higher
priority for an individual than other behaviors that once had great value. A definite diagnosis of
the syndrome requires that at least 3 or more of the criteria –viz: A strong desire for the
substance, difficulty in controlling substance taking behavior, withdrawal state, tolerance,
salience and persisting with the substance use despite harmful consequences have been present
together at some during the previous year.
In recent years the use of alcohol has increased in both quantity and frequency results
from 2005 national survey on drug use and health SAMHSA (Substance abuse and mental health
services administration north Carolina) have shown that slightly more than half of Americans
aged 12 or older reported being current drinkers of alcohol in the 2005 survey(51.8%). This
translated to an estimated 126 million people, which was higher than the 2004 estimate of 121
million people also heavy drinking (defined as binge drinking on at least 5 days in the last 30
days) was reported by 6.6% of the population aged 12 or older are 16 million people.11
Although the prevalence of alcohol use in India has been calculated at 30 per cent, there
has been a rapid and noticeable increase in the rates of alcohol use in the Indian population as
awhole.113 patients admitted to a special deaddiction service for alcohol dependence were
assessed. The average individual earned a mean of Rs 1660.95 , spent Rs 1938.40 per month on
alcohol and incurred personal loans of Rs 8388.29. 94.7% had two or more admissions in the
previous two years and did not work for 13.53 days in a month. This amounted to a loss of Rs
13823.62 per person per year in terms of foregone productivity. 18.1per cent had lost jobs in the
previous year. 59.4 per cent of families were supported by income from other family members
and 9.7 per cent sent children under 15 years to work to supplement family incomes. While the
state recovered Rs 581.5 crores through taxation on alcohol and Rs18.09 crores as individual
health payments, it spent Rs 1147.48 crores in hospital costs alone.The social costs of alcoholism
far outweigh the benefits accrued from the sale and taxation ofalcohol.12
Motivating clients to make behavioral changes is an important nursing task and
promising work has been done in developing and evaluating methods of promoting treatment
adherence. While giving motivational enhancement therapy to clients regarding alcoholism , the
nurse give knowledge and respect the client’s autonomy and works collaboratively with the
clients, making the nurse- client relationship, more like a partnership which is the spirit of
motivational enhancement therapy.13
There is growing evidence of the effectiveness of motivational enhancement therapy to
treat everything from alcoholism to breast cancer. Motivation offers on effective way to help
alleviate alcoholism. Residents of alcoholics who participate in motivation enhancement therapy
showed increased levels of physical and cognitive functioning which in turn lowered their effect.
The basic premise behind motivational enhancement therapy
is that bring about positive
psychological and physical changes that improve the quality of life for the individual.
Hence the researcher is interested to find the effectiveness of motivational enhancement
therapy on alcoholics.
Summary: The chapter has dealt with background and need for undertaking this study
REVIEW OF LITERATURE
Review of literature is a systematic identification location, scrutiny and summary of
written materials that contain information on research problem.
The research presents the review of related literature, which helps to study the
problem in depth. It also serves as a valuable guide to understand what has been done. And what
is still unknown and untested.
This chapter presents a review of select literature relevant to the present study.
 Studies related to common problems experienced by alcoholic patients.
 Studies related to motivational enhancement therapy on alcoholic patients.
STUDIES RELATED TO COMMON PROBLEMS EXPERIENCED BY ALCOHOLIC
PATIENTS.
A study was conducted on adolescents aged between 13 and 18 years both. The pattern of
result suggests that family history of alcohol dependence and adolescent substances are separate
risk factors for proper neuropsychological performance in youth. Non abusers with negative
family history performed better than other adolescents.14
A cross sectional study conducted on survey using snowballing technique to explore the
relation between young people of psycho active substance of alcohol, perceived function for
using, the experience of negative effect and influence of these variables on their intention to use
alcohol again in an informal community setting. The results showed that lifetime experience of
negative effects from using the alcohol was not found to correlate with current consumption
patterns. Statistically significant associations were observed between the reported frequency of
taking alcohol and the perceived social/contextual and / or mood altering function cited for their
consumption. The alcohol use function measures together with the reported extent of peer use
were significant predictors of intervention use again.15
A cross sectional study was conducted in India to find the magnitude of licit and illicit
substance use among students and to find out the association between socio economic and
demographic characteristics of the students and habits of use. In a multistage random sampling
among all the districts and colleges in West Bengal, India , 416 college students from two
colleges were selected. To them pre-tested close ended anonymous self administered
questionnaire related to pattern, frequency and correlates of alcohol use were administered. The
result showed that the ultimate response rate was 87.02%.The over all prevalence rates among
rural and urban adolescent students were 6.14% and 0.6% for illicit drug use, and 7.37% and
5.23% for tobacco and 8.6% and 11.04% for alcohol consumption respectively. Both licit and
illicit substance abuse was associated more with male students.16
STUDIES
RELATED
TO
MOTIVATIONAL
ENHANCEMENT
THERAPY
ON ALCOHOLIC PATIENTS
A study was conducted on a randomized controlled trial of motivational enhancement
therapy (MET) with two control conditions: nondirective reflective listening (NDRL) and no
further counseling (NFC); and a sample of patients with a primary diagnosis of mild to moderate
alcohol dependence, in a clinical setting. All patients received a feedback
session before
randomization to either four sessions of MET, four sessions of NDRL, or NFC. Global
assessment scale (GAS) measured general personal/social functioning. The result concluded that
patients treated with MET, 42.9% showed were heavy drinking compared with 62.5% of the
NDRL and 65.0% of the NFC groups (p = .04).. MET can be considered an effective "value
added" counseling intervention in a real-life clinical setting.17
A study on Motivational Interviewing Skills Code Version 2.0 was used to code 106
audiotaped MET sessions from 28 participants who received 3-4 sessions. Client Language was
analyzed within sessions and across sessions, and in relation to six month drinking outcomeThe
result reveled that unremitted Drinkers uttered a significantly higher frequency of Sustain Talk,
lower Ability Language strength, and lower Commitment Language strength .18
A study was made to investigate the treatment effectiveness, during treatment, of a
second-generation cognitive-behavioral therapy for alcoholism--broad-spectrum treatment
(BST)--compared with motivational-enhancement therapy (MET), with a therapeutic dose of
naltrexone .One hundred forty-nine alcohol-dependent patients completed a 3-month
randomized, controlled trial of BST and naltrexone versus MET and naltrexone.The result shows
that patients receiving BST had a significantly higher percentage of days abstinent than patients
receiving MET.19
A study was made on multisite randomized trial comparing the effectiveness of 3
individual sessions of motivational enhancement therapy with that of 3 individual sessions of
counseling as usual on treatment retention and frequency of substance use; among 405
individuals seeking treatment for any type of current substance use. Results suggest that the
individual treatments delivered were both attractive to and effective with this heterogeneous
group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy
may be limited to those whose primary substance use problem is alcohol and may be fairly
modest in magnitude.20
A study was conducted on Randomized clinical trials on the effectiveness of
naltrexone (NTX) in the treatment of alcohol dependence have produced conflicting results. One
hundred and seventy-four alcohol-dependent outpatients participated in a double-blind trial
where they were randomly assigned to 12 vs. 24 weeks NTX duration and to one of two
psychosocial treatments: motivational enhancement therapy (MET) and broad spectrum
treatment (BST), a cognitive behavioral therapy tailored to the patient's specific needs. After an
initial 12-week period of NTX and psychosocial treatment, half of each psychotherapy condition
was assigned to continue NTX for an additional 12 weeks while the other half was assigned to
placebo. The result states that median time to first drink and time to first heavy drinking day
were found to be significantly longer for patients who received BST and extended NTX than for
patients in the other three groups.21
A study was made on randomized controlled trial was conducted in eight PCUs. Of 117
eligible participants , 59 were randomized to the intervention group to receive MET in three
individual appointments with a trained nurse and 58 to an assessment-only control group.
Outcome evaluations were carried out after 6 weeks, 3 months and 6 months. The outcome
reports that Self-reported drinks per drinking day, frequency of hazardous drinking assessed
either on a daily or weekly basis, and of binge drinking sessions were reduced in the intervention
group more than in the control group (P < 0.05) after both 3 and 6 months.22
A study was conducted on any given day, more than 700,000 people receive alcoholism
treatment in either inpatient or outpatient settings. For many of those patients, detoxification-with or without pharmacotherapy--is the first step of treatment. The major behavioral approaches
currently used in alcoholism treatment include cognitive-behavioral therapy, motivational
enhancement therapy, and Alcoholics Anonymous (AA) or related 12-step programs. Clinical
studies, such as the Project MATCH trial, have compared the effectiveness of these approaches.
Overall, that study detected no significant differences among the three treatments in patient
outcome, although certain treatment methodologies may be most appropriate for patients with
certain characteristics. Pharmacotherapy with aversive or anticraving medications may
supplement behavioral treatment approaches. Briefly result shows that are delivered by primary
health care providers also have been shown to reduce drinking levels, particularly in
nondependent drinkers.23
A evaluator study has been made on two strategies to facilitate involvement in Alcoholics
Anonymous (AA)--a 12-Step-based directive approach and a motivational enhancement
approach--during skills-focused individual treatment. Randomized controlled trial with
assessments at baseline, end of treatment and 3, 6, 9 and 12 months after treatment. participants,
setting and intervention: A total of 169 alcoholic out-patients (57 women) assigned randomly to
one of three conditions: a directive approach to facilitating AA, a motivational enhancement
approach to facilitating AA or treatment as usual, with no special emphasis on AA.Self-report of
AA meeting attendance and involvement, alcohol consumption (percentage of days abstinent,
percentage of days heavy drinking) and negative alcohol consequences.Participants exposed to
the 12-Step directive condition for facilitating AA involvement reported more AA meeting
attendance, more evidence of active involvement in AA and a higher percentage of days
abstinent relative to participants in the treatment-as-usual comparison group. Evidence also
suggested that the effect of the directive strategy on abstinent days was mediated partially
through AA involvement. The motivational enhancement approach to facilitating AA had no
effect on outcome measures. These results suggest that treatment providers can use a 12-Stepbased directive approach to effectively facilitate involvement in AA and thereby improve client
outcome.24
A descriptive study was done on "training of soft skills", "motivational enhancement
therapy",
"couple/family
therapy",
"cognitive
behavioural
treatment"
and
"relapse
prevention"..The examination based on a representative sample of 5540 alcohol dependent
patients completed inpatient alcohol rehabilitation in a clinic for drug addiction. The highest
utilisation rate resulted for the treatments "information/schooling" with 93.3 %. The utilisation
rate of "cognitive behavioural treatment" was 85.4 %, and of "soft skill training" 79.1 %. Low
utilisation rates resulted for "relapse prevention" with 29.6 %, "nutrient schooling" (28.9 %),
"non-smoker training" (17.3 %), "motivational enhancement therapy" (14.8 %), and the therapy
element "groups of mental comorbidity" (11.2 %). 39.5 % of the patients received services from
the therapy element "psychoanalytic therapy". On the average, patients took part in 18 treatment
offers (SD = 6.8). This were treatment offers of 9 from a total of 14 evidence based treatment
categories, on the average. The result suggested that scientifically based therapy realization of
some treatments, e. g. "soft skill training" and "cognitive behavioural treatment", was at a high
level, the low level of utilisation for "relapse prevention" and "motivational enhancement
therapy" is surprising on account of their proven effectiveness. 25
A study has been conducted on naltrexone and the effectiveness in the treatment of
alcohol dependence. The naltrexone works when combined with cognitive behavioral therapy
(CBT) or a motivational enhancement therapy. Outpatient alcoholics (N = 160) were randomly
assigned to either naltrexone (50 mg/d) or placebo and either CBT or motivational enhancement
therapy, and treated over a 12-week period.. The result shows that the combination of
motivational enhancement therapy and naltrexone is effective. Because MET and naltrexone
share common mechanisms of action, such as craving reduction and relapse prevention, these
therapies are likely to be well suited to use in combination.26
STATEMENT OF THE PROBLEM:
“A
STUDY
TO
EVALUATE
THE
EFFECTIVENESS
ENHANCEMENT THERAPY ON ALCOHOLIC
PATIENT
OF
IN
MOTIVATIONAL
SELECTED
DE
ADDICTION CENTER AT BANGALORE.”
6.3 OBJECTIVES OF THE STUDY:

To assess the existing level of motivation among control and experimental group on
alcoholic patient.

To administer the motivational enhancement therapy among alcoholic patient.

To evaluate the effectiveness of motivational enhancement therapy on alcoholic patient.

To determine association between level of motivation with selected demographic
variables.
6.4 HYPOTHESIS:
H1: There will be significant differences in the level of motivation among alcoholic
patient before and after motivational enhancement therapy
H2: There will be significant association between the level of motivation among
alcoholics with selected demographic variables.
6.5 VARIABLES:
Research variables are the concepts at various levels of abstraction that are entered
manipulated and collected in a study.
Extraneous Variable: - Age, education, religion, occupation , marital status, income, family
background ,history of illness,
Independent Variable:-Motivational enhancement therapy.
Dependent Variable:- Level of motivation
6.6. OPERATIONAL DEFINITION
1.EVALUATE
In this study evaluate means the identification of motivational enhancement therapy on its
effect to produce changes in alcohol addiction as per
Motivation Scale developed by Neeliyara T.(1990)
2.MOTIVATIONAL ENHANCEMENT THERAPY
In this study motivational enhancement therapy refers to motivation process semidirective 5-15 minute individualized guiding style to engage with alcoholics, clarify their
strengths and aspirations, evoke their own motivations for change, and promote autonomy of
decision making on alcoholism.
3.ALCOHOLICS
In this study alcoholics means excessive consumption of and dependence on alcoholic
beverages leading to physical and psychological harm and impaired social functioning.
4.DEADDICTION CENTER
In this study deaddiction means the alcoholics who are admitted in the hospital and for
whom the treatment modalities are been carried out.
6.7 ASSUMPTION:Alcoholic patient will have less motivation,

Motivational enhancement therapy may help the alcoholic people to increase
the level of motivation.

Motivational therapy
will provide opportunity for active learning among
participants
6.8 DELIMITATION:

The study is delimitated to 60 samples,

The study is delimited in selected de addiction centers

The study is delimited to alcoholic people who are willing to participate in the study.
7.0. MATERIALS & METHOD:7.1. SOURCES OF DATA
Data will be collected from alcoholic people in selected de addiction center, Bangalore.
7.2. METHOD OF COLLECTION OF DATA
7.2.1. RESEARCH DESIGN:
The research design used in this study will be experimental, non equivalent control group design.
R O1
R O1
X
O2
O2
R=Random assignment
O1=Assessment of level of motivation towards alcoholism by a self completion base line
questionnaire on the 1st day.
X=3sessions of individualized motivational enhancement therapy will be conducted for the
experimental group from 2nd -10th day.
O2=Assessment of behavior modification by a self completion follow up questionnaire on the
25th day
7.2.2. RESEARCH APPROACH
An Evaluative Research approach.
7.2.3. SETTING OF STUDY:
The study will be conducted in selected de addiction center at Bangalore.
7.2.4. POPULATION:
All the inmates of the alcohol addicts who were willing to participate and who were
present during the period of data collection.
7.2.5. SAMPLE SIZE:
All alcoholic people residing in de addiction center who fulfill inclusion criteria and
sample size (N=60) 30 subjects in control groups (n=30) and 30 subject in experimental group
(n=30)
7.2.6. SAMPLE TECHNIQUE:
Probability sampling method: Simple random sampling technique by lottery method
7.2.7. SAMPLING CRITERIA.
INCLUSIVE CRITERIA
1. People who are staying in de addiction centers
2. People who are willing to participate in the study.
3. People who are available during data collection.
4. People who are able to speak and read English, kannada.
5. Both male and female gender.
EXCLUSION CRITERIA
1. People who are not willing to participate during data collection.
2. People who are not able to speak and read English , kannada.
3. people who have chronic medical problems
7.2.8. TOOLS FOR DATA COLLECTION
A structured questionnaire will be drafted for this purpose and relevant data will be
collected from the sample unit. The tool consists of two parts, Part – I and Part – II.
PART – I :Selected demographic variables such as age, , education, religion, family background,.
Economic condition, marital status, history of illness.
PART – II:Questionnaire related to motivational enhancement therapy.
PROCEDURE FOR DATA COLLECTION
Formal Permission will be obtained from the head of institution. After obtaining the
informed consent from the alcohol addiction people and assuring about confidentiality of the
information obtained, the investigators will administer the questionnaire to assess the level of
motivation for about 30 minutes.
7.2.9. DATA ANALYSIS METHOD
Data collected on level of motivation will be recorded and analyzed through the
following statistical techniques.
DESCRIPTIVE STATISTICS:The basic statistical technique such as mean, standard deviation, correlation, range and
mean score percentage of described demographic variables will be computed and interpreted
suitably.
INFERENTIAL STATISTICS:Statistical Paired’ test to compare the pre and posttest motivation for statistical analysis.
Chi-square test will be used to find out the association between demographic variables.
7.3. DOES THE STUDY REQUIRE ANY INTERVENTION TO BE CONDUCTED ON
PATIENTS OR OTHER HUMANS OR ANIMALS?
Yes
7.4. ETHICAL CLEARANCE
Permission will be obtained from
 The authorities of selected de addiction centers in Bangalore.
 The ethicalcommittee of Sushrutha college of Nursing.
 Informed consent will be obtained from the alcoholics who are willing to participate in
the study.
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publication; 2003.
2.Bimla Kapoor.,“Textbook of Psychiatric Nursing”., New Delhi: Kumar publishing house.,
2004.
3.Sreevani.R. A Guide to Mental health and Psychiatric nursing. New Delhi. jaypee
publication. 2007.
4.Gail W.Stuart, Michele T.Laraia. Principles and practice of Psychiatric Nursing. Missouri.
Mosby Publication; 2005.
5.B.T. Basavanthappa. Textbook of Nursing Research. Review of Literature, Jaypee
Brothers.New Delhi;2007.
6 .Principal Investigator: WilliamR.Miller ,Ph.D .Funding Agencies: National Institute on
Alcoho lAbuseand Alcoholism(NIAAA)National Institute on Drug Abuse (NIDA).
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Counseling, National Institute on Drug Abuse, 2000, pp. 89–93.
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psychiatry. 2010; 52(7):189-199
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http//oas.samhsa.gov.
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Perspective. NIMHANS Journal; 18 (1&2); 67
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Journal of studies on alcohol.1997;58(1):728-729.
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research in psychiatry.2010; 2(1):76-81.
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Psychological
Medicine,
Christchurch
School
of
Medicine,
New
Zealand.
[email protected]. Sellman JD, Sullivan PF, Dore GM, Adamson SJ, MacEwan I, J
Stud Alcohol. 2001 May;62(3):389-96.
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[email protected], Campbell SD, Adamson SJ, Carter JD, Behav Cogn
Psychother. 2010 Jul;38(4):399-415. Epub 2010 Jun 3
19 Department of Psychiatry, Veterans Affairs Boston Healthcare System, 150 South
Huntington Avenue, Boston, Massachusetts 02130, USA. Davidson D, Gulliver SB, Longabaugh
R, Wirtz PW, Swift R, J Stud Alcohol Drugs. 2007 Mar;68(2):238-47.
20. Department of Psychiatry, Yale University School of Medicine, West Haven, CT 06519,
USA. [email protected], Carroll KM, Martino S, Ball SA, Nich C, Frankforter T, Anez
LM etol, J Consult Clin Psychol. 2009 Oct;77(5):993-9.
21. Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
Longabaugh R, Wirtz PW, Gulliver SB, Davidson D, Psychopharmacology (Berl). 2009
Oct;206(3):367-76. Epub 2009 Jul 29.
22. Department of Social Medicine, Chonburi Hospital and Medical Education Center,
Chonburi, 20000, Thailand. [email protected], Noknoy S, Rangsin R, Saengcharnchai P,
Tantibhaedhyangkul U, McCambridge J, Alcohol Alcohol. 2010 May-Jun;45(3):263-70. Epub
2010 Mar 17.
23. Division of Clinical and Prevention Research, National Institute on Alcohol Abuse and
Alcoholism, Bethesda, Maryland, USA, Fuller RK, Hiller-Sturmhöfel S, Alcohol Res Health.
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24.Journal Article Randomized Controlled Trial Research Support, N.I.H., Extramural,
Walitzer KS, Dermen KH, Barrick C, Addiction 2009 Mar; 104(3):391-401.
25. Fortschritte der Neurologie-Psychiatrie [Fortschr Neurol Psychiatr], Schmidt P, Köhler J,
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76(2):86-90.
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9. Signature of the candidate
10. Remarks of the guide
:
:
11. Name and Designation of
11.1 Guide
:
11.2 Signature
:
11.3 Co-guide (if any)
:
11.4 Signature
:
11.5 Head of the Department
:
11.6 Signature
:
12.1 Remarks of the Chairman &
Principal
:
12.2 Signature
:
.
.