Community-Based Harm Reduction Approaches for Alcohol Use Disorder

BackgroundEvidence shows benefits of psychological treatments in low-resource countries, yet few government health systems include psychological services.AimEvaluating the clinical value of adding psychological treatments, delivered by community-based counsellors, to primary care-based mental health services for depression and alcohol use disorder (AUD), as recommended by the Mental Health Gap Action Programme (mhGAP).MethodTwo randomised controlled trials, separately for depression and AUD, were carried out. Participants were randomly allocated (1:1) to mental healthcare delivered by mhGAP-trained primary care workers (psychoeducation and psychotropic medicines when indicated), or the same services plus individual psychological treatments (Healthy Activity Program for depression and Counselling for Alcohol Problems). Primary outcomes were symptom severity, measured using the Patient Health Questionnaire – 9 item (PHQ-9) for depression and the Alcohol Use Disorder Identification Test for AUD, and functional impairment, measured using the World Health Organization Disability Assessment Schedule (WHODAS), at 12 months post-enrolment.ResultsParticipants with depression in the intervention arm (n = 60) had greater reduction in PHQ-9 and WHODAS scores compared with participants in the control (n = 60) (PHQ-9: M = −5.90, 95% CI −7.55 to −4.25, β = −3.68, 95% CI −5.68 to −1.67, P < 0.001, Cohen's d = 0.66; WHODAS: M = −12.21, 95% CI −19.58 to −4.84, β = −10.74, 95% CI −19.96 to −1.53, P= 0.022, Cohen's d = 0.42). For the AUD trial, no significant effect was found when comparing control (n = 80) and intervention participants (n = 82).ConclusionAdding a psychological treatment delivered by community-based counsellors increases treatment effects for depression compared with only mhGAP-based services by primary health workers 12 months post-treatment.Declaration of interestNone.

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Making a bridge between general hospital and specialised community-based treatment for alcohol use disorder—A pragmatic randomised controlled trial

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2018.12.017 ◽

2019 ◽

Vol 196 ◽

pp. 51-56 ◽

Cited By ~ 2

Author(s):

Anne-Sophie Schwarz ◽

Bent Nielsen ◽

Jes Søgaard ◽

Anette Søgaard Nielsen

Keyword(s):

Randomised Controlled Trial ◽

Alcohol Use ◽

General Hospital ◽

Alcohol Use Disorder ◽

Controlled Trial ◽

Community Based ◽

Randomised Controlled ◽

Pragmatic Randomised Controlled Trial

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Harm reduction approach effective for homeless with alcohol use disorder

The Brown University Psychopharmacology Update ◽

10.1002/pu.30741 ◽

2021 ◽

Vol 32 (7) ◽

pp. 3-4

Keyword(s):

Alcohol Use ◽

Harm Reduction ◽

Alcohol Use Disorder ◽

Reduction Approach

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Magnitude and correlates of alcohol use disorder in south Gondar zone, northwest Ethiopia: A community based cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0257804 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257804

Author(s):

Getasew Legas ◽

Sintayehu Asnakew ◽

Amsalu Belete ◽

Getnet Mihretie Beyene ◽

Gashaw Mehiret Wubet ◽

...

Keyword(s):

Public Health ◽

Alcohol Use ◽

Alcohol Use Disorder ◽

Cross Sectional Study ◽

Northwest Ethiopia ◽

Sectional Study ◽

The South ◽

Community Based ◽

Cross Sectional ◽

South Gondar

Background Alcohol use disorder is the major public health problem in low- and middle-income countries that account for up to 70% of alcohol related premature mortality in the region. Therefore, the aim of this study was to assess the magnitude of alcohol use disorder and its associated factors among adult residents in south Gondar zone, Northwest Ethiopia. Methods A community-based cross-sectional study was conducted among 848 adult residents of the south Gondar zone from January 13 to February 13, 2020. A multistage sampling technique was used to recruit study participants. We assessed alcohol use disorder (AUD) using the alcohol use disorder identification test (AUDIT). A binary logistic regression model was employed to identify factors associated with AUD. Results The prevalence of alcohol use disorder over the last 12-months was found to be 23.7% (95% CI: 20.9, 26.7). Being male (AOR = 4.34, 95 CI; 2.800, 6.743), poor social support (AOR = 1.95, 95 CI: 1.098, 3.495), social phobia (AOR = 1.69, 95 CI; 1.117, 2.582), perceived high level of stress (AOR = 2.85, 95 CI; 1.829, 34.469), current cigarette smoking (AOR = 3.06, 95 CI; 1.764, 5.307) and comorbid depression (AOR = 1.81, 95 CI; 1.184, 2.778) were significantly associated with alcohol use disorder. Conclusion The prevalence of alcohol use disorder is high among adult residents of the south Gondar zone and associated with many factors. So, it needs public health attention to decrease the magnitude of alcohol use disorder in Ethiopia.

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Substance Use Disorders and Associated Factors Among Adult Psychiatric Patients in Jimma Town, Southwest Ethiopia, 2017. Community-Based Cross-Sectional Study

Clinical Medicine Insights Psychiatry ◽

10.1177/1179557321989699 ◽

2021 ◽

Vol 12 ◽

pp. 117955732198969

Author(s):

Badiru Dawud ◽

Eyerusalem Yeshigeta ◽

Alemayehu Negash ◽

Almaz Mamaru ◽

Liyew Agenagnew ◽

...

Keyword(s):

Mental Illness ◽

Substance Use ◽

Alcohol Use ◽

Nicotine Dependence ◽

Substance Use Disorders ◽

Alcohol Use Disorder ◽

Psychiatric Patients ◽

Cross Sectional Study ◽

Community Based ◽

Cross Sectional

Background: Substance use disorders are more common among people with mental illness than in the general population. It makes recovery from mental illness more difficult, leads to frequent thoughts of suicide and re-hospitalization. Objective: Aimed to assess the prevalence of substance use disorders and associated factors among adult psychiatric patients in Jimma Town, Southwest, Ethiopia, 2017. Methods: A community-based cross-sectional study was conducted on a total of 300 patients with mental illness using the case tracing method. Participants were interviewed using the alcohol use disorder identification test questionnaire to assess Alcohol Use Disorder (AUD). Fagerstrom test tool for nicotine dependence and structured questionnaires were utilized to assess the socio-demographic characteristics of participants. Data were analyzed using SPSS version 20. The variable that showed association with AUD and nicotine dependence at P < .25 in the bivariate analysis was entered into multivariable logistic regressions to control confounders for both outcome variables independently. The significance of association was determined by P < .05 and strength was described using an adjusted odds ratio at a 95% confidence level. Results: The prevalence of alcohol use disorder and nicotine dependence was 14.3% and 23.3%, respectively. Female gender (AOR 0.15, 95% CI = 0.04-0.57), starting treatment within the first month of the onset of the illness (AOR 0.20, 95% CI = 0.05-0.82) and nicotine dependence(AOR 4.84, 95% CI = 1.85-12.67) associated with AUD. Additionally, being female (AOR 0.04, 95% CI = 0.01-0.25), joblessness (AOR 3.05, 95% CI = 1.30-7.16), absence of relapse of illness (AOR 0.18, 95% CI = 0.065-0.503), no improvement in illness (AOR 5.3, 95% CI = 1.70-16.50), and current khat use (AOR 3.09, 95% CI = 1.21-7.90) were associated with nicotine dependence. Conclusion: This study revealed a high prevalence of substance use disorders among psychiatric patients in the community. Being female, experiencing a shorter duration of illness before initiating treatment, and nicotine-dependence were significantly associated with AUD. On the other hand, female sex and absence of relapse of illness were negatively associated with nicotine dependence whereas, joblessness, less improvement of illness, and khat chewing were positively associated with it. Therefore, services on substance use disorders have to be extended to the community level with wide-scale training for the town’s health care providers, including health extension workers who have direct contact with these individuals. Accordingly, comprehensive and suitable interventions were advised to be provided on factors contributing to substance use disorders in general.

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