Nadkarni Abhijit, Massazza Alessandro, Tol Wietse A, Bogdanov Sergiy, Andersen Lena S, Moore Quincy, Roberts Bayard, Weiss Helen A, Singh Soumya, Neuman Melissa, May Carl, Fuhr Daniela C
Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK WC1E 7HT, UK.
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Int J Ment Health Syst. 2025 Jan 8;19(1):2. doi: 10.1186/s13033-024-00656-4.
Despite the significant burden of alcohol use disorders (AUD), there is a large treatment gap, especially in settings and populations affected by armed conflict. A key barrier to care is the lack of contextually relevant interventions and adequately skilled human resources to deliver them. This paper describes the systematic development of the CHANGE intervention, a potentially scalable psychological intervention for people with co-existing AUD and psychological distress in conflict-affected populations, delivered by non-specialist workers (NSWs).
CHANGE was developed in sequential steps: (1) identifying potential treatment strategies through a meta-review and Delphi survey with international experts; (2) in-depth interviews (IDIs) with key stakeholders from the study settings in Uganda and Ukraine; and (3) three consultative workshops with international experts and experts from Uganda and Ukraine to develop a theoretical framework for the intervention informed by outputs of the Delphi and IDIs.
In the Delphi survey, experts reached agreement on the acceptability, feasibility and potential effectiveness of the following components: identify high-risk situations, problem solving skills, assessment, handling drinking urges, communication skills, pros and cons of drinking, and identifying high-risk situations. From the IDIs we identified (a) causal attributions for using alcohol e.g., psychosocial stressors; (b) cultural norms related to alcohol consumption such as patriarchal stereotypes; and (c) coping strategies to deal with drinking problems such as distraction. The CHANGE intervention developed through the consultative workshops can be delivered in three sequential phases focussed on assessment, feedback, and information (Phase 1); providing the client with need-based skills for dealing with high-risk situations related to alcohol use (Phase 2), and relapse prevention and management (Phase 3).
CHANGE is a contextually relevant and potentially scalable treatment for co-existing AUD and psychological distress to be delivered by NSWs to conflict-affected populations. Effectiveness and cost-effectiveness of CHANGE will be tested in Uganda and Ukraine.
尽管酒精使用障碍（AUD）造成了巨大负担，但治疗缺口很大，尤其是在受武装冲突影响的地区和人群中。护理的一个关键障碍是缺乏与具体情况相关的干预措施以及提供这些措施的足够专业人力资源。本文描述了CHANGE干预措施的系统开发过程，这是一种针对受冲突影响人群中同时患有酒精使用障碍和心理困扰的人群的、可能具有可扩展性的心理干预措施，由非专业工作人员（NSWs）提供。
CHANGE分以下几个步骤开发：（1）通过与国际专家进行的元综述和德尔菲调查确定潜在的治疗策略；（2）对来自乌干达和乌克兰研究地点的关键利益相关者进行深入访谈（IDI）；（3）与国际专家以及来自乌干达和乌克兰的专家举办三次协商研讨会，根据德尔菲调查和深入访谈的结果为干预措施制定理论框架。
在德尔菲调查中，专家们就以下组成部分的可接受性、可行性和潜在有效性达成了一致：识别高风险情况、解决问题的技能、评估、应对饮酒冲动、沟通技巧、饮酒的利弊以及识别高风险情况。从深入访谈中我们确定了：（a）饮酒的因果归因，例如心理社会压力源；（b）与饮酒相关的文化规范，如父权制刻板印象；（c）应对饮酒问题的策略，如分散注意力。通过协商研讨会开发的CHANGE干预措施可以分三个连续阶段实施，重点是评估、反馈和信息（第一阶段）；为客户提供基于需求的技能，以应对与酒精使用相关的高风险情况（第二阶段），以及预防和管理复发（第三阶段）。
CHANGE是一种与具体情况相关的、可能具有可扩展性的治疗方法，用于同时治疗酒精使用障碍和心理困扰，由非专业工作人员提供给受冲突影响的人群。CHANGE的有效性和成本效益将在乌干达和乌克兰进行测试。
