Ghosh Abhishek, Singh Pranshu, Das Nileswar, Pandit Prabhat Mani, Das Sauvik, Sarkar Siddharth
Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, India.
Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, India.
Addiction. 2022 Mar;117(3):545-558. doi: 10.1111/add.15613. Epub 2021 Jul 27.
Low and middle-income countries (LMIC) have a disproportionately higher alcohol-attributable disease burden, in conjunction with a minimal focus on primary prevention. Screening and brief interventions can be a promising approach to address this problem. This systematic review aimed to perform a qualitative and quantitative synthesis of studies of brief interventions for harmful and hazardous alcohol use in LMIC.
Systematic review of randomized controlled trials of brief interventions for harmful and hazardous alcohol identified from four electronic databases, conducted in any country identified as LMIC as per the World Bank. We measured differences in intervention and control groups on risk-scores using standard screening instruments, the frequency of heavy drinking, the drinking risk-level, or quality of life and other mental health-related outcomes.
A total of 14 studies were included, seven of them from South Africa. On standardized screening instruments, the brief intervention (BI) group had significantly lower scores than controls at 3 months (Hedges' g = - 0.34, P = 0.04), but the effects did not persist at 6- and 12-month follow-up (g = - 0.06, P = 0.68 and g = 0.15, P = 0.41, respectively). There was little evidence to suggest that BIs led to changes in the frequency of heavy drinking or change in the risk level of alcohol use. Surprisingly, a single session (g = -0.55, P < 0.001) fared better than multiple sessions (g = -0.03, P = 0.85). A nurse delivered brief intervention (g = -0.44, P = 0.02) showed better results than BIs delivered by others (g = -0.14, P = 0.66), whereas the outcomes were similar for young adults and middle-age people.
Brief interventions for alcohol use show some promise in low- and middle-income countries. Specifically, a single session, nurse-delivered brief intervention for harmful and hazardous alcohol use appears to show a small but significant positive effect in low- and middle-income countries.
低收入和中等收入国家（LMIC）的酒精所致疾病负担 disproportionately 更高，且对一级预防的关注极少。筛查和简短干预可能是解决这一问题的有效方法。本系统评价旨在对低收入和中等收入国家针对有害及危险饮酒的简短干预研究进行定性和定量综合分析。
对从四个电子数据库中识别出的针对有害及危险饮酒的简短干预随机对照试验进行系统评价，研究在世界银行认定的任何低收入和中等收入国家开展。我们使用标准筛查工具、重度饮酒频率、饮酒风险水平或生活质量及其他与心理健康相关的结局指标，测量干预组和对照组在风险评分上的差异。
共纳入14项研究，其中7项来自南非。在标准化筛查工具上，简短干预（BI）组在3个月时的得分显著低于对照组（Hedges' g = - 0.34，P = 0.04），但在6个月和12个月随访时效果未持续（g = - 0.06，P = 0.68和g = 0.15，P = 0.41）。几乎没有证据表明简短干预会导致重度饮酒频率或饮酒风险水平的变化。令人惊讶的是，单次干预（g = -0.55，P < 0.001）的效果优于多次干预（g = -0.03，P = 0.85）。由护士提供的简短干预（g = -0.44，P = 0.02）比其他人提供的简短干预效果更好（g = -0.14，P = 0.66），而年轻人和中年人的结局相似。
针对饮酒的简短干预在低收入和中等收入国家显示出一定前景。具体而言，针对有害及危险饮酒的单次、由护士提供的简短干预在低收入和中等收入国家似乎显示出虽小但显著的积极效果。
