Preusse Melissa, Neuner Frank, Ertl Verena
Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Bielefeld, Germany.
vivo international, Konstanz, Germany.
Front Psychiatry. 2020 Aug 7;11:768. doi: 10.3389/fpsyt.2020.00768. eCollection 2020.
In low- and middle-income countries (LMIC), the mismatch between the number of individuals needing and those receiving treatment for alcohol use disorders (AUD) is substantial. In order to provide suggestions for the scaling up of effective service provision we systematically reviewed the current evidence on the effectiveness of AUD-focused psychosocial interventions in LMIC.
We used a systematic review methodology following the PRISMA guidelines. Twelve electronic databases listing published and grey literature were searched and only randomized-controlled trials (RCTs) were included. Where possible, effect sizes were calculated using Hedges' indices.
Twenty-one RCTs conducted in 15 different LMIC between 1992 and 2018 fulfilled inclusion criteria. Most studies employed brief one-on-one interventions facilitated by trained primary care staff. Eighty-six percent of RCTs based their interventions on the principles of motivational interviewing (MI) with the majority supplementing MI-based interventions with alcohol-tailored elements of cognitive-behavioral therapy (CBT). The remaining RCTs employed CBT-components exclusively. Just over 40% of studies included in quantitative analyses (n=17) yielded an at least medium-sized effect (≥.50) of the respective intervention compared to alcohol-related and unrelated control conditions or waiting list. Only half of the trials implementing the widely applied MI-based approaches (or MI-based approaches blended with CBT-elements) were superior to their respective control conditions.
To date, a relatively small number of RCTs investigating AUD-focused treatments has been conducted in LMIC. The majority of between condition effect size estimates were small and no type of intervention can clearly be recommended over another. No RCTs were conducted in conflict-affected areas in LMIC although they would merit particular attention since AUD is often linked to trauma-related mental health disorders. More RCTs in LMIC are required and alternatives to MI-based approaches should be investigated. This systematic review summarizes properties of effective interventions and provides implications for future research.
在低收入和中等收入国家（LMIC），酒精使用障碍（AUD）患者的治疗需求与实际接受治疗的人数之间存在巨大差距。为了为扩大有效服务提供提供建议，我们系统地回顾了当前关于低收入和中等收入国家以AUD为重点的心理社会干预效果的证据。
我们采用了遵循PRISMA指南的系统回顾方法。检索了列出已发表和灰色文献的12个电子数据库，仅纳入随机对照试验（RCT）。在可能的情况下，使用Hedges指数计算效应量。
1992年至2018年期间在15个不同的低收入和中等收入国家进行的21项随机对照试验符合纳入标准。大多数研究采用由经过培训的初级保健人员提供的简短一对一干预。86%的随机对照试验的干预基于动机性访谈（MI）原则，大多数在基于MI的干预中补充了针对酒精的认知行为疗法（CBT）元素。其余的随机对照试验仅采用CBT组件。与酒精相关和不相关的对照条件或等待名单相比，定量分析中纳入的研究（n = 17）中略多于40%产生了各自干预的至少中等大小的效应（≥.50）。实施广泛应用的基于MI的方法（或与CBT元素混合的基于MI的方法）的试验中，只有一半优于各自的对照条件。
迄今为止，在低收入和中等收入国家进行的调查以AUD为重点的治疗的随机对照试验数量相对较少。大多数组间效应量估计值较小，没有一种干预类型能明显优于另一种。低收入和中等收入国家受冲突影响地区尚未进行随机对照试验，尽管这些地区值得特别关注，因为AUD通常与创伤相关的心理健康障碍有关。低收入和中等收入国家需要更多的随机对照试验，应研究基于MI方法的替代方案。本系统回顾总结了有效干预的特性，并为未来研究提供了启示。
