Closing the treatment gap for alcohol use disorders in low- and middle-income countries

The impacts of policies controlling the spatial availability of take-away alcohol on consumption and harms: A systematic narrative review

AIM

To systematically review the evidence on the impacts of policies regulating the spatial availability of off-premises alcohol on consumption and harms.

METHODS

Narrative review that examined peer-reviewed studies published from 2016 to 2024 on policy changes affecting the spatial availability of off-premises alcohol. Outcomes of interest were alcohol consumption, alcohol-related harms and mortality.

RESULTS

The review identified 20 observational studies, primarily natural experiments, examining four policy types: malt liquor restrictions, sales expansion to retail outlets, privatization and changes to allowable alcohol content. Across studies, there was a suggestion that allowing alcohol sales in gas station convenience stores was associated with increased consumption and harms, whereas expanding to grocery stores was not. There was no clear evidence that restricting malt liquor reduces crime. Similarly, privatization was not associated with crime or health outcomes, though it was accompanied by price increases. Increases in allowable alcohol content were not associated with higher consumption, but decreases were associated with fewer alcohol-related emergency visits and hospitalizations.

CONCLUSIONS

The impact of policy changes in spatial alcohol availability depends on the policy details and retail outlet types. To mitigate public health impacts, policymakers should consider comprehensive alcohol control measures, such as regulating convenience store sales and accompanying grocery store expansions with minimum unit pricing, taxation and marketing restrictions. High-quality natural experiments with pre-post designs, control groups and confounder adjustments are needed to better understand how these policies impact both the general population and high-risk subgroups.

Exploring Cultural Adaptations: A Scoping Review on Adolescent Mental Health and Substance Use Prevention Programs

Adolescence is a critical period for developing risk behaviors such as substance use, which can impact health in adulthood. Culturally adapted evidence-based programs (EBPs) are promising for prevention. This review explores the processes for culturally adapting EBPs targeting alcohol, tobacco, or cannabis use, and/or anxiety or depression in adolescents. We searched multiple databases, grey literature, and relevant websites for studies detailing the cultural adaptation process of EBPs. We then categorized common adaptation steps, classified adaptations using the cultural sensitivity model, identified prevalent adaptation techniques, and determined effectiveness assessment methods. We reviewed the cultural adaptation processes of 43 EBPs. These programs were implemented in schools (51%), followed by family settings (30%), community settings (14%), and multi-component settings (5%). Eleven key steps were identified across the documents: local needs assessment, program selection, understanding of the program's curriculum, advisory group establishment, first draft of initial adaptation changes, staff selection and training, pilot study, enhanced cultural adaptation, implementation, evaluation and monitoring, and dissemination. Most programs integrated both surface (e.g., use of local images, material translation) and deep adaptations (e.g., incorporation of cultural values like "familismo"). Despite the common use of the cultural sensitivity model, detailed adaptation frameworks were often lacking. The field has advanced, but clearer documentation is needed to improve research and practical application.

Digital interventions for alcohol use and alcohol use disorders in low- and-middle-income countries: a systematic review

Background

Despite the high burden of alcohol use and alcohol use disorders (AUDs) in low-and-middle-income countries (LMICs), access to health care is poor. Digital interventions (DIs) have recently emerged as promising avenues for addressing substance use. Such interventions could potentially address barriers to help-seeking in LMICs, such as travel costs, shortage of professionals, stigma, etc.

Aim

To synthesize evidence on the effectiveness and implementation of DIs for AUDs in LMICs.

Methods

The systematic review had a comprehensive search strategy that combined search terms for DIs (e.g. SMS, eHealth), alcohol use (e.g. hazardous drinking) and LMICs (e.g. India). Studies presenting primary data that reported effectiveness (e.g. relapse) and/or implementation or intervention-related outcomes (e.g. feasibility) of DIs for AUDs in LMICs were eligible. Three databases (EMBASE, MEDLINE and PsycINFO) were searched from their inception till June 2023. Data was extracted in relevant categories and analysed.

Results

Twenty-one reports from 19 studies were included. Types of DIs ranged from standalone mobile applications and web portals to human-delivered interventions via digital platforms. 12 studies reported positive or partially positive alcohol use outcomes (e.g. number of drinking days, abstinence). DIs with human involvement were found to be more effective than standalone DIs. Additionally, high levels of acceptability, feasibility and satisfaction were reported across interventions.

Conclusion

DIs are acceptable and feasible in LMICs and broadly effective in improving alcohol use outcomes. Firm conclusions could not be drawn because of methodological issues such as small sample sizes, short follow-up periods and limited generalisability. Adequate investment, improved research methodology and increased focus on implementation outcomes are required for determining the role that DIs can play in addressing AUDs in LMICs.

Changes in tobacco and alcohol consumption during the COVID-19 pandemic in India: a propensity score matching approach

OBJECTIVES

The COVID-19 pandemic may have influenced alcohol and tobacco consumption in low-income and middle-income countries, yet the effects are relatively unknown. In this study, we estimated the medium-term effects of the pandemic on tobacco and alcohol consumption in India.

METHODS

We used data from the fifth round of the National Family Health Survey 2019-2021, a nationally representative survey conducted between June 2019 and April 2021. We employed propensity score matching to evaluate the change in tobacco and alcohol consumption patterns by exploiting the gap in survey activities due to the pandemic lockdown-no data collection took place from April to October 2020. Individuals surveyed after the lockdown were considered COVID-19-affected, while those surveyed before were considered as unaffected.

RESULTS

The tobacco use rate was 1.4% lower and alcohol consumption was 0.3% lower for COVID-19-affected individuals relative to non-affected individuals. By tobacco product, there was a 0.9%, 0.6% and 0.4% decrease in the use of smokeless tobacco, cigarettes and bidi, respectively. Recent initiation decreased by 2.3%, 1.6% and 1.4%, for cigarettes, smokeless tobacco and alcohol, respectively. Tobacco use declined to a greater extent in low-wealth and rural populations, and in male and older subsamples. Alcohol use decreased in urban households, and among male and young subsamples, relative to their counterparts. Secondhand smoke exposure decreased by 4.6%.

CONCLUSION

Tobacco and alcohol consumption, including recent initiation, decreased during the pandemic in India. Varying effects by subgroups suggest the need for targeted future control policies that support cessation and limit consumption.

Pathways to community living in practice: Local development and adaptation within an older peoples mental health service

OBJECTIVE

To describe the local adaptation of the Pathways to Community Living (PCLI) program in an Older Peoples Mental Health (OPMH) service to guide other services.

METHOD

A retrospective observational study was conducted. Data were obtained from service planning meetings and newly developed documents, Clinical Advisory Committee meetings, and OPMH PCLI database.

RESULTS

The PCLI program was adapted for the local OPMH service through development of an assessment template, creating a Memorandum of Understanding with a partner Residential Aged Care Facility (RACF) and establishing processes for collaboration and regular review. Between 2019 and March 2023, 20 mental health consumers were referred to the OPMH PCLI program. Their demographic and clinical characteristics are described.

CONCLUSIONS

Adaptation of the PCLI program for OPMH consumers required consideration of specific older adult needs to develop a bespoke plan for assessment and partnership with the PCLI-funded RACF. The development phase and ongoing processes for review facilitated engagement of key stakeholders across health and RACF sectors, highlighting issues with consumer engagement. Similar models could be used by other health services to implement the PCLI in their local context.