Engs, Ruth C., Medical, Nursing, and Pharmacy Students' Attitudes Towards Alcoholism in Queensland, Australia Alcoholism: Clinical and Experimental Research, Vol. 6, No. 2, Spring 1982.

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Medical, Nursing, and Pharmacy Students' Attitudes Towards Alcoholism in Queensland, Australia

Ruth C. Engs, RN, EdD

Numerous studies in the United States and a few in the British Isles have indicated that there are differences between helping professionals (physicians, nurses, social workers, psychiatrists, etc.) in their attitudes towards alcoholics and the nature of alcoholism. (1-15) Studies have also indicated that there are differences between beginning and more advanced students in attitudes towards alcoholics and alcoholism and that attitudes sometimes become more negative as individuals acquire more education. (16-19)

However, few studies have been carried out in Australia with helping professionals or students as to their attitudes towards alcoholics or alcoholism. It would be interesting to determine if attitudinal differences are cross-cultural among medical-related helping professional students and whether or not there are differences due to course of study or year in school.

Tolor and Tamerin have found that attitudes towards alcoholics and alcoholism can be gathered in a short questionnaire of 24 questions with six scales. The scales include: 'Psychological Etiology,' which refers to statements that embrace the notion that the cause of alcoholism is psychological; Physical-Genetic Etiology,' which applies to statements concerning the idea that alcoholism has physical or inherited causes; 'Moral Weakness,' which consists of assertions embracing the view that the alcoholic has weak moral character; 'Medical Illness' which refers to propositions articulating the notion that the alcoholic is sick and that alcoholism can be treated as an illness; 'Humanism,' which contains assertions supporting a kind, fair, and humanistic treatment of the alcoholic; and 'Social Rejection,' which refers to statements that support the view that the alcoholic should be avoided or rejected. The higher the score on a particular scale the more the individual agrees with the concept.

The reliability of the six scales range from 0.62 to 0.77 and they are only minimally related to sex, age, and education of the respondent(20). The normative sample for this questionnaire was composed of 135 American students in education and other professional courses according to these authors. It must be kept in mind when comparing this norm to the Australian sample that it was not composed of medical-related helping professional students. However, this scale has been used in previous studies with helping professionals whose educational backgrounds were also different from the norm(21).

Thus, the purpose of this study was to investigate the attitudes towards alcoholics and alcoholism of medical, nursing, and pharmacy students in Queensland, Australia. The purpose was also to compare the attitude of these students to the American norm for the instrument, to determine if differences in attitudes between the courses of study existed, and to examine possible attitudinal changes due to educational experiences. This present report forms part of a larger study of alcohol and drug-taking behaviors and attitudes towards alcoholics and alcoholism of pre-professional students(22,23).

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MATERIALS AND METHODS

Sample

All first and final year students from the pharmacy school, the first and fourth year students at the medical school (the last year for which medical students are together in large lecture classes) at the University of Queensland, and the first and final year students in four nursing schools representing a large and a small public and private institution in Brisbane, were asked to participate in this project.

Before administration of the questionnaire, the purpose of the study, procedures used to safeguard students' anonymity, and the fact that participation was voluntary were discussed. From the total possible number of medical, nursing, and pharmacy students, 32 individuals either did not wish to participate in the study or returned questionnaires with most of the data missing. This percentage ranged from 4% for medical and 9% for the pharmacy and nursing students. The final sample included 791 students, of which 431 were medical, 213 nursing, and 147 pharmacy students. Of these students, 51.3% were first year students and 48.7% were last year students.

The Questionnaire

Items to obtain demographic information such as year in school were constructed based on WHO recommendations for standardization of research in the areas of drugs and alcohol(24). 'The Attitudes Toward Alcoholism Questionnaire' described in the introduction to gather information about attitudes towards alcoholism was used(20).

Calculations

The Statistical Package for the Social Science program was used to calculate t and F scores to determine possible differences between the groups and their attitudes towards alcoholism.

RESULTS

Attitudes Compared to the Norm

Table 1 shows the results of the attitude scores for the different courses. On all of the attitude scales except medical weakness, there is a significant difference between the norm and the groups studied here. For 'psychological etiology' of alcoholism, medical (t = -2.8; df = 564; p < 0.05) and pharmacy students (t = 2.4; df = 280; p < 0.05) scored significantly lower than the norm. There was no significant difference for nursing students. For 'social rejection,' medical (t = 3.05; df = 564; p < 0.05), nursing (t = 3.50; df = 346; p < 0.05), and pharmacy (t = 1.8; df = 280; p < 0.05) students all scored significantly higher than the norm. A significantly lower score was found for medical (t = -8.1; df = 564; p < 0.001), nursing (t = -2.98; df = 346; p < 0.05), and pharmacy (t = 3.33; df = 280; p < 0.05) students compared to the norm for 'physical-genetic etiology' of alcoholism. Likewise, on the 'moral weakness' scale, medical (t = 5.67; df = 564; p < 0.001), nursing (t = 5.19; df = 346; p < 0.001), and pharmacy (t = 5.5; df = 280; p < 0.001) students had significantly more negative feelings compared to the norm. The medical (t = 4.5; df = 564; p < 0.001), nursing (t = -2.52; df = 346; p < 0.05), and pharmacy (t = -5.51; df = 280; p < 0.001) students scored lower in 'humanitarian' feelings towards the alcoholic compared to the norm.

Attitudes by Course

Analysis of variance of the mean scores for each of the attitude scales showed no significant difference on any of the attitude scales due to course.* (See Table 2). This appears to be in contrast with other studies which have shown that nurses are more likely to view alcoholism as a psychological or physical illness compared to psychiatrists(8,17) or that physicians are less apt to view alcoholism as a physical illness(15), are more humanistic(11), and tend to have more negative attitudes(13) than nurses toward alcoholics.
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Table 1. Comparison of American norm to medical, nursing and pharmacy students' attitudes towards alcoholism
Psychological Social Rejection Physical-
Genetic
Humanitarian Moral 
Weakness
Medical Illness
Course of Study
  Medicine(431)§  12.2 ± 1.9*  10.1 ± 2.3   9.2 ± 2.2  12.3 ± 1.9   7.5 ± 2.5  10.1 ± 2.1
  Nursing (213)  12.7 ± 1.9  10.1 ± 2.4   9.9 ± 2.3  12.5 ± 1.8   7.5 ± 2.5  10.3 ± 2.1
  Pharmacy (147)  12.2 ± 1.9  10.4 ± 2.2   9.8 ± 2.0  12.1 ± 1.9   7.7 ± 2.4  10.2 ± 1.9
American Norm  12.6 ± 2.1   9.6 ± 2.1  10.4 ± 2.5  12.9± 1.8   6.7 ± 1.9  10.5 ± 2.4
* Mean` ±  SD
§ Numbers in parentheses, maximum number of students

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Attitudes by Year in School

When the year in school variable was examined (Table 2), it was found that first year students score significantly higher on the scales which ascribes alcoholism to a 'physical-genetic' illness (t = 5.4; df = 758; p < 0.01) and 'moral weakness' (t = 2.4; df = 772; p < 0.05). Table 3 shows that both first year medical (t = 4.0; df = 413; p < .001) and nursing students (t = 7.4; df = 210; p < 0.001) also scored higher on the belief that alcoholism is a 'physical-genetic' illness, and the first year medical students score higher in the belief that alcoholism is a 'medical illness' (t = 3.4; df = 428; p < 0.05) and 'moral weakness' = 2.1; df = 419; p < 0.05) compared to last year students. Last year pharmacy students (t = 3.2; df = 144; p < 0.05) were more apt to see alcoholism as a psychological problem.

When first year students in all three courses were compared, nursing students were found to score the highest in the belief that alcoholism is caused by 'psychological' problems (F = 4.5; df = 2; p < 0.05),* and pharmacy students scored the lowest. Among last year students, medical students (F = 8.4; df = 2; p < 0.001)* scored the lowest on this scale. Last year medical students compared to the other last year students also scored the lowest (F = 18.0; df = 2; p < 0.001)* on the 'physical-genetic' causes of alcoholism.

SUMMARY AND CONCLUSIONS

On the whole, the medical, nursing, and pharmacy students in this sample had more negative feelings towards alcoholics and the cause of alcoholism compared to the American students who were the norm for the instrument. Medical and pharmacy students were less apt to ascribe a psychological etiology to alcoholism and all groups were more socially rejecting and less humanistic towards the alcoholic compared to the norm. They also felt that alcoholism was more of a moral weakness and less of a physical-
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Table 2. Comparison of Course of Study and Year in School on Attitudes Towards Alcoholism
Psychological Social Rejection Physical-
Genetic
Humanitarian Moral 
Weakness
Medical Illness
Course of Study
  Medicine(431)§ 12.2 ± 1.9* 10.1 ± 2.3 9.2 ± 2.2 12.3 ± 1.9 7.5 ± 2.5 10.1 ± 2.1
  Nursing (213) 12.7 ± 1.9 10.1 ± 2.4 9.9 ± 2.3 12.5 ± 1.8 7.5 ± 2.5 10.3 ± 2.1
  Pharmacy (147) 12.2 ± 1.9 10.4 ± 2.2 9.8 ± 2.0 12.1 ± 1.9 7.7 ± 2.4 10.2 ± 1.9
Year in School
  First (406) 12.3 ± 1.9 10.2 ± 2.4  9.9 ± 2.2  12.2 ± 2.0  7.8 ± 2.6 10.5 ± 2.1
  Last (385) 12.3 ± 1.9  10.2 ± 2.1  9.0 ± 2.0 12.4 ± 2.0 7.3 ± 2.3  10.1 ± 2.0
Total (791) 12.3 ±1.9  10.2 ± 2.3 9.5 ± 2.2 12.3 ± 1.9 7.6 ± 2.4  10.2 ± 2.0 
* Mean` ±  SD
§ Numbers in parentheses, maximum number of students

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Table 3. Year in School, Medical, Nursing, and Pharmacy Students in Relation to Attitudes Towards Alcoholism
Psychological Social Rejection Physical-
Genetic
Humanitarian Moral
Weakness
Medical Illness
Course of Study
 (Year in School)

 Medical

  First 12.3 ± 1.8* 10.1 ± 2.4  9.6 ± 2.3 12.1 ± 2.0 7.9 ± 2.7 10.5 ± 2.0
  Last 11.9 ±  1.9 10.1 ± 2.1 8.7 ± 1.9 12.3 ± 1.7 7.1 ± 7.7 9.5 ± 2.1
 Nursing
  First 12.9 ± 1.8 10.1 ± 2.1 10.6 ± 2.2 12.4 ± 1.8 7.5 ± 2.4 10.6 ± 2.3
  Last 12.6 ± 1.7 10.2 ± 2.1 9.2 ± 1.9 12.6 ± 1.7 7.5 ± 2.3 10. ± 1.7
 Pharmacy
  Fist 11.7 ± 1.7 10.4 ± 2.1 9.9 ± 1.9 11.9 ± 1.7 7.8 ± 2.3 10.2 ± 1.7
  Last 12.7 ± 1.7 10.3 ± 2.1 9.7 ± 1.9 12.3 ± 1.7 7.6 ± 2.3 10.3 ± 1.7
Total (791)§ 12.3 ± 1.9 10.2 ± 2.3 9.5 ± 2.2 12.3 ± 1.9 7.6 ± 2.4 10.2 ± 2.0

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genetic problem compared to the norm. Though the differences were statistically significant for most of the groups, they were under one scale point which might not have practical significance in terms of interaction on the part of these individuals with alcoholic persons. However, the results could indicate that these students have attitudes towards alcoholics which could cause them problems with referrals and treatment interactions in their professional capacity.

It was interesting that no significant differences between the different courses of study was found. This appers to be contrary to other reports from other countries(1-15). Perhaps medical-related students in Australia are more homogeneous due to similar backgrounds arising from living in a small country with less divergent ethnic backgrounds compared to larger nations.

Final year students tended to be more negativistic on several scales compared to first year students which appers to support other studies which have also reported that students become more negativistic towards alcohol-dependent persons as they go through their course of study(16-18). Last year medical and nursing student were less likely to see alcoholism as having a physical-genetic basis, and last year medical students were less apt to view it as a treatable illness compared to the first year students in these groups. However, pharmacy students in their final year of school were more apt to envision alcoholism as a psychological problem, and final year medical students less likely to view alcoholism as a moral weakness. There was no change for any group on being less socially rejecting or more humanistic towards alcoholic persons due to the existing course curriculum for individuals in their last year of study.

RECOMMENDATIONS

In view of the fact that there appears to be a difference in these Australian students towards alcoholism compared to the American norm, it is recommended that more cross-cultural studies be carried out to determine if differences in attitudes among the medical-related professions exist in other cultures and if ther is relationship to referral and treatment outcomes for alcoholic persons in different cultures which might reflect attitudes towards alcoholism. Due to the fact that last year medical students in this sample were less apt to view alcoholism as a treatable condition, compared to the first year group, it is recommended tht they be given exposure to alcoholic persons who have high probability of recovering and have the opportunity for close interactions with successful recovering individuals, including recovering physicians and nurses.

REFERENCES

          1. Ferneau E: What student nurses think about alcoholic patients and alcoholism. Nurs Outlook 15:40-41, 1968.

          2. Gray RM, Moody PM, Sellars M, Ward JR: Physician authoritarianism and the treatment of alcoholics. Q J Stud Alcohol 30:981-983, 1969.

          3. Gurel M, Spain MD: Differences in attitudes toward alcoholism in graduates of two schools of nursing. Psychol Rep 41:1285-1286, 1977.

          4. Kilty KM: Attitudes towards alcohol and alcoholism among professionals and non-professionals. J Stud Alcohol 36:327-347, 1975.

          5. Knox WJ: Attitudes of social workers and other professional groups towards alcoholism. Q J Stud Alcohol 34:1270-1278, 1973.

          6. Knox WJ: Attitudes of psychiatrists and psychologists towards alcoholism. Am J Psychiatry 127:1675-1679, 1971.

          7. Knox WJ: Attitudes of psychologists towards alcoholism. J Clin Psychol 29:446-450, 1969

         8. Lemos AV, Moral J: Veterans administration hospital staff attitudes toward alcoholism. Drug Alcohol Depend 3:77-83, 1978.

          9. MacDonald EB, Patel AR: Attitudes towards alcoholism. Br Med J 2:430-431, 1975.

        10. Mendelson JH, Wexler D, Dubzansky PE, Harrison R, Liederman G, Solomon P: Physicians' attitudes toward alcoholic patients. Arch Gen Psychiatry 11:392-399, 1964.

        11. Pittman DJ, Sterne MW: National Clearinghouse for Mental Health Information Report On Alcoholism: Community agency attitudes and their impact on treatment services (Public Health Series Publication No. 1273). Washington, D.C., HEW, 1965.

        12. Schmid N, Schmid DT: Nursing students' attitude toward alcoholics. Nurs Res 22:246-248, 1973.

        13. Sowa RA, Cutter HS: Attitudes of hospital staff towards alcoholics and drug addicts. Q J Stud Alcohol 35:210-214, 1974.

        14. Wallston KA, Wallston BS, DeVellis MB: Effect of a negative stereotype on nurses' attitudes toward an alcoholic patient. J Stud Alcohol 37:659-665, 1976.

        15. Wolf I, chafetz ME, Blane HT, Hill MJ: Social factors in the diagnosis of alcoholism. II. Attitudes of physicians. Q J Stud Alcohol 26:72-79, 1965.

        16. Eron LD: The effect of medical education on attitudes: A follow-up study. 10:25-33, 1958.

        17. Ferneau EW, Morton EL: Attitudes of nursing personnel regarding alcoholism and alcoholics. Nurs Res 19:446-448, 1969.

        18. Ferneau E, Gertler R: Attitudes regarding alcoholism: Effect of the first year of the psychiatry residency. Br J Addict 66:257-160, 1971.

         19. Moody PM: Attitudes of nurses and nursing students toward alcoholism treatment. Q J Stud Alcohol 32:172-175, 1971.

         20. Tolor A, Tamerin JS: The attitudes toward alcoholism instrument: A measure of attitudes toward alcoholics and the nature and causes of alcoholism. Br j Addict 70:223-231, 1975.

         21. Berger-Gross V, Lisman S: Attitudes of paraprofessionals toward alcoholism; setting effects. J Stud Alcohol 5:514-516, 1979.

         22. Engs RC: The drinking patterns and attitudes towards alcoholism of human service students in Brisbane, Australia. J Stud Alcohol (in press)

         23. Engs RC: The drug use patterns on helping professional students in Brisbane, Australia. Drug Alcohol Depend 6:231-240, 1980.

         24. World Health Organization Draft Report: Working group on encouraging comparability of drug use surveys. Geneva, WHO, 1976.

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This project was completed while the author was on Sabbatical leave at the University of Queensland, Australia, January to June 1980.

Received for publication May 22, 1981; accepted January 21, 1982.

Appreciation is expressed to the Department of Human Movement Studies, the Department of Social Medicine, and to the Queensland Drug and Alcohol Education Project for assistance and support in this study.

Reprint requests: Ruth C. Engs, Professor, Department of Applied Health Science, Poplars 615, Indiana University, Bloomington, IN 47405-3085.

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Copyright © 1982 by The American Medical Society on Alcoholism, The Research Society on Alcoholism, and The National Council on Alcoholism.