Comparing Family Burden in Alcohol Dependence Syndrome with Dual Diagnosis of Alcohol Dependence and Bipolar Affective Disorder: A Cross-sectional Study from South India

Background: The burden on family is substantial for individuals diagnosed with Alcohol Dependence Syndrome (ADS), and it is hypothesized that caring for an individual with a dual diagnosis of ADS with Bipolar Affective Disorder (BPAD) can be more complex. This study compared the family burden of caregivers of individuals with ADS with and without comorbid BPAD. Methods: This cross-sectional comparative study was conducted in a tertiary care psychiatric centre in Kerala, India. A total of 160 primary caregivers were enrolled using purposive sampling divided equally between two groups: Family caregivers of patients with ADS (n=80) and those of patients with a dual diagnosis (n=80). Data on socio-demographic and clinical variables were collected using a structured proforma. The measurement tools used included Family Burden Interview Schedule (FBIS), Severity of Alcohol Dependence Questionnaire (SADQ), Young Mania Rating Scale (YMRS), and Hamilton Depression Scale (HAM-D). Statistical analyses involved chi-square test, Fisher’s exact test, and Mann-Whitney U test. Results: Among caregivers of patients with a dual diagnosis, 71.3% (n = 57) reported severe burden, compared with 61.3% (n = 49) of caregivers of patients with ADS alone; this difference was not statistically significant ( P = 0.181). The mean FBIS score was 27.24 in the dual diagnosis group and 26.18 in the ADS group. In the ADS group, severe caregiver burden was significantly associated with greater severity of alcohol dependence ( P < 0.001), history of tobacco use ( P = 0.002), and daily alcohol use frequency ( P = 0.021). In the dual diagnosis group, severe burden was significantly associated with the patient’s occupational status ( P < 0.0001), nuclear family structure ( P = 0.041), pattern of alcohol use ( P = 0.009), and frequency of alcohol use ( P = 0.032). Conclusions: Severe family burden was common in both groups, caregivers of individuals with ADS and those with ADS and BPAD associated with differing clinical factors in the two groups. These findings highlight the critical need for family-centered interventions for families of patients with alcohol use disorders, tailored to the unique challenges posed by a single diagnosis versus a dual diagnosis.