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Narasimha VL, Mukherjee D, Arya S, Parmar A. Alcohol use disorder research in India: An update. Indian J Psychiatry 2024; 66:495-515. [PMID: 39100372 PMCID: PMC11293778 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_758_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 05/10/2024] [Accepted: 05/21/2024] [Indexed: 08/06/2024] Open
Abstract
Background Despite alcohol use being a risk factor for numerous health-related conditions and alcohol use disorder (AUD) recognized as a disease, there was limited research in India until 2010. This narrative review aims to evaluate AUD-related research in India from 2010 to July 2023. Methods A PubMed search used key terms for AUD in India after 2010. Indian and international journals with regional significance that publish alcohol-related research were searched by each author individually. These were then collated, and duplicates were removed. In addition, we also conducted a gray literature search on focused areas related to AUD. Results The alcohol-related research in India after 2010 focused on diverse areas associated with alcohol use. Some areas of research have received more attention than others. Two major epidemiological surveys conducted in the past decade reveal that around 5% have a problematic alcohol use pattern. Factors associated with alcohol use, like genetic, neurobiological, psychological, and sociocultural, were studied. The studies focused on the clinical profile of AUD, including their correlates, such as craving, withdrawal, alcohol-related harm, and comorbid psychiatric and medical illnesses. During this period, minimal research was conducted to understand AUD's laboratory biomarkers, course, and prognosis. While there was a focus on generating evidence for different psychological interventions for alcohol dependence in management-related research, pharmacological studies centered on anticraving agents like baclofen. Research on noninvasive brain stimulation, such as rTMS, has shown preliminary usefulness in treating alcohol dependence. Very little research has been conducted regarding alcohol policy. Conclusion In the past decade, Indian research on alcohol has focused on diverse areas. Epidemiological and psychological management-related research received maximum attention. Considering the magnitude of the alcohol-related burden, it is essential to prioritize research to other less studied areas like pharmacological management of alcohol dependence and alcohol policy.
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Affiliation(s)
- Venkata Lakshmi Narasimha
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Sidharth Arya
- Institute of Mental Health, Pt BDS University of Health Sciences, Rohtak, Haryana, India
| | - Arpit Parmar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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Wippold GM, Garcia KA, Frary SG, Griffith DM. Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework. HEALTH EDUCATION & BEHAVIOR 2024; 51:128-143. [PMID: 37350223 DOI: 10.1177/10901981231179498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Community health workers (CHWs) are health promotion specialists who are trusted members of the community served and have a close understanding of the community's needs and values. CHWs are a cost-effective and scalable workforce to promote health among men through tailored approaches. The purpose of the present review was to use the RE-AIM Framework to assess design, implementation, and outcomes of CHW-implemented health promotion efforts tailored for men to provide recommendations for future efforts. METHODS The protocol was pre-registered with PROSPERO. The primary inclusion criteria were that the interventions were (a) implemented at least partially by CHWs, (b) conducted only among men, and (c) designed to improve a health-related outcome. PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Global Index Medicus were searched using a librarian-generated search strategy. In all, 1,437 articles were uploaded to Rayyan and two reviewers blindly reviewed each article for inclusion. A total of 24 articles met the inclusion criteria. RESULTS Most interventions (a) targeted men under 50 years, (b) were conducted among a subset of underserved men, (c) improved health outcomes, (d) community-based and informed, (e) atheoretical, and (f) had satisfactory retention rates. The roles and responsibilities of CHWs were varied. Attention was given to training of CHWs, but limited attention was given to how/if the CHWs were supervised. DISCUSSION CHW-implemented interventions can improve health outcomes among men. Opportunities exist to build on past interventions, such as addressing mental health and incorporating prosocial aspects of masculinity. The results have implications for designing similar interventions.
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Nadkarni A, Gaikwad L, Sequeira M, Velleman R, D'souza J, Hoble A, Haldankar R, Murthy P, Naughton F. Evaluation of Feasibility and Acceptability of a Text-Messaging Intervention for Tobacco Cessation in India. Nicotine Tob Res 2024; 26:72-78. [PMID: 37638548 PMCID: PMC10734385 DOI: 10.1093/ntr/ntad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/26/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION The aim of our study was to assess the feasibility and acceptability of a brief behavioral intervention for tobacco cessation delivered via mobile phone text messaging in India. AIMS AND METHODS We conducted an uncontrolled intervention cohort study in adult current users of tobacco. The participants received intervention messages on their mobile phones for eight weeks. We collected qualitative data about participants' perceptions of intervention delivery and receipt, acceptability, and feasibility of the intervention. The outcomes measured at 3 months post-recruitment were self-reported 7- and 28-day point-prevalence abstinence, and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) risk categories for tobacco-low (0-3), moderate (4-26), and high (≥27). RESULTS We recruited 26 eligible participants, and 22 completed the outcome assessments. The participants generally perceived the intervention content to be simple to access and useful in facilitating a change in tobacco use. None of the participants indicated that they wanted to discontinue receiving the intervention messages. Some suggestions for enhancing acceptability included supplementing text messaging with more intensive counseling and the use of multimedia content. Eighteen percent of participants reported abstinence in the past 7 and 28 days. A greater proportion of those who used smokeless tobacco were abstinent at follow-up compared to those who smoked (42.9% vs. 6.7%; p = .04). CONCLUSIONS If effective, simple and low-cost mobile phone text messaging can be used to deliver interventions for tobacco use, and has the potential to be scaled up so it can be delivered to populations of smokers interested in receiving cessation support. IMPLICATIONS Our study is an important step towards the development of a contextually relevant intervention suited for low- and middle-income countries and which is responsive to the needs of both those who use smoked and smokeless tobacco. If found to be effective, our intervention would be a scalable solution to overcome the human resource related barrier to accessing tobacco cessation services in low resource settings.
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Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Addictions and Related Research Group (ARG), Sangath, India
| | - Leena Gaikwad
- Addictions and Related Research Group (ARG), Sangath, India
| | | | - Richard Velleman
- Addictions and Related Research Group (ARG), Sangath, India
- Department of Psychology, University of Bath, Bath, UK
| | | | - Ankita Hoble
- Addictions and Related Research Group (ARG), Sangath, India
| | | | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
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Ertl V, Groß M, Mwaka SO, Neuner F. Treating alcohol use disorder in the absence of specialized services - evaluation of the moving inpatient Treatment Camp approach in Uganda. BMC Psychiatry 2021; 21:601. [PMID: 34852824 PMCID: PMC8638348 DOI: 10.1186/s12888-021-03593-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The gap between service need and service provision for alcohol-related disorders is highest in resource-poor countries. However, in some of these contexts, local initiatives have developed pragmatic interventions that can be carried out with limited specialized personnel. In an uncontrolled treatment study, we aimed to evaluate the feasibility, acceptability, safety, costs and potential effects of an innovative locally developed community-based program (the Treatment Camp) that is based on an inpatient clinic that moves from community to community. METHODS Out of 32 treatment-seeking individuals 25 took part in the one-week Treatment Camp that included detoxification and counseling components. Re-assessments took place 5 and 12 months after their participation. We explored the course of a wide range of alcohol-related indicators, using the Alcohol Use Disorders Identification Test (AUDIT) as primary outcome complemented by a timeline follow-back approach and the Obsessive Compulsive Drinking Scale. Additionally, we assessed impaired functioning, alcohol-related stigmatization, symptoms of common mental health disorders and indicators of family functioning as reported by participants' wives and children. RESULTS All alcohol-related measures decreased significantly after the Treatment Camp and remained stable up to the 12-month-assessment with high effect sizes ranging from 0.89 to 3.49 (Hedges's g). Although 92% of the participants had lapsed at least once during the follow-up period, 67% classified below the usually applied AUDIT cutoff for hazardous drinking (≥ 8) and no one qualified for the dependent range (≥ 20) one year after treatment. Most secondary outcomes including impaired functioning, alcohol-related stigmatization, symptoms of depression and indicators of family functioning followed the same trajectory. CONCLUSIONS We found the Treatment Camp approach to be acceptable, feasible, safe and affordable (approx. 111 USD/patient) and we could obtain preliminary evidence of its efficacy. Due to its creative combination of inpatient treatment and monitoring by medical personnel with local mobility, the Treatment Camp appears to be more accessible and inclusive than other promising interventions for alcohol dependent individuals in resource-poor contexts. Effects of the approach seem to extend to interactions within families, including a reduction of dysfunctional and violent interactions.
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Affiliation(s)
- Verena Ertl
- Clinical Psychology and Biopsychology, Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstraße 25, 85072, Eichstätt, Germany.
- vivo international (www.vivo.org), Konstanz, Germany.
| | - Melissa Groß
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Samuel Okidi Mwaka
- Program for Prevention, Awareness, Counseling and Treatment of Alcoholism (PACTA; www.pactaguluganda.org.ug), Plot 1 Burcoro Road, Wiaworanga, Gulu, Uganda
| | - Frank Neuner
- vivo international (www.vivo.org), Konstanz, Germany
- Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
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Pribék IK, Kovács I, Kádár BK, Kovács CS, Richman MJ, Janka Z, Andó B, Lázár BA. Evaluation of the course and treatment of Alcohol Withdrawal Syndrome with the Clinical Institute Withdrawal Assessment for Alcohol - Revised: A systematic review-based meta-analysis. Drug Alcohol Depend 2021; 220:108536. [PMID: 33503582 DOI: 10.1016/j.drugalcdep.2021.108536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the Clinical Institute Withdrawal Assessment for Alcohol - Revised (CIWA-Ar) is a gold standard tool for the clinical evaluation of alcohol withdrawal syndrome (AWS), a systematic analysis using the total scores of the CIWA-Ar as a means of an objective follow-up of the course and treatment of AWS is missing. The aims of the present study were to systematically evaluate scientific data using the CIWA-Ar, to reveal whether the aggregated CIWA-Ar total scores follow the course of AWS and to compare benzodiazepine (BZD) and non-benzodiazepine (nBZD) therapies in AWS. METHODS 1054 findings were identified with the keyword "ciwa" from four databases (PubMed, ScienceDirect, Web of Science, Cochrane Registry). Articles using CIWA-Ar in patients treated with AWS were incorporated and two measurement intervals (cumulative mean data of day 1-3 and day 4-9) of the CIWA-Ar total scores were compared. Subgroup analysis based on pharmacotherapy regimen was conducted to compare the effectiveness of BZD and nBZD treatments. RESULTS The random effects analysis of 423 patients showed decreased CIWA-Ar scores between the two measurement intervals (BZD: d = -1.361; CI: -1.829 < δ < -0.893; nBZD: d = -0.858; CI: -1.073 < δ < -0.643). Sampling variances were calculated for the BZD (v1 = 0.215) and the nBZD (v2 = 0.106) groups, which indicated no significant group difference (z = -1.532). CONCLUSIONS Our findings support that the CIWA-Ar follows the course of AWS. Furthermore, nBZD therapy has a similar effectiveness compared to BZD treatment based on the CIWA-Ar total scores.
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Affiliation(s)
- Ildikó Katalin Pribék
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary.
| | - Ildikó Kovács
- Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Bettina Kata Kádár
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Csenge Sára Kovács
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Mara J Richman
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa Street 8, H-1085, Budapest, Hungary; Endeavor Psychology, 10 Newbury Street, Boston, MA, 02116, USA
| | - Zoltán Janka
- Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Bálint Andó
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Bence András Lázár
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary.
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