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Review
. 2023 May 9;5(5):CD013350.
doi: 10.1002/14651858.CD013350.pub2.

Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries

M Claire Greene  1   2 , Jeremy Kane  2 , Michelle Alto  3 , Ali Giusto  4 , Kathryn Lovero  5 , Melissa Stockton  4 , Jasmine McClendon  6 , Terriann Nicholson  4 , Milton L Wainberg  4 , Renee M Johnson  2 , Wietse Anton Tol  2   7
Affiliations
Review

Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries

M Claire Greene et al. Cochrane Database Syst Rev. .

Abstract

Background: Harmful alcohol use is defined as unhealthy alcohol use that results in adverse physical, psychological, social, or societal consequences and is among the leading risk factors for disease, disability and premature mortality globally. The burden of harmful alcohol use is increasing in low- and middle-income countries (LMICs) and there remains a large unmet need for indicated prevention and treatment interventions to reduce harmful alcohol use in these settings. Evidence regarding which interventions are effective and feasible for addressing harmful and other patterns of unhealthy alcohol use in LMICs is limited, which contributes to this gap in services.

Objectives: To assess the efficacy and safety of psychosocial and pharmacologic treatment and indicated prevention interventions compared with control conditions (wait list, placebo, no treatment, standard care, or active control condition) aimed at reducing harmful alcohol use in LMICs.

Search methods: We searched for randomized controlled trials (RCTs) indexed in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, the Cochrane Clinical Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, Embase, PsycINFO, CINAHL, and the Latin American and Caribbean Health Sciences Literature (LILACS) through 12 December 2021. We searched clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, Web of Science, and Opengrey database to identify unpublished or ongoing studies. We searched the reference lists of included studies and relevant review articles for eligible studies.

Selection criteria: All RCTs comparing an indicated prevention or treatment intervention (pharmacologic or psychosocial) versus a control condition for people with harmful alcohol use in LMICs were included.

Data collection and analysis: We used standard methodological procedures expected by Cochrane.

Main results: We included 66 RCTs with 17,626 participants. Sixty-two of these trials contributed to the meta-analysis. Sixty-three studies were conducted in middle-income countries (MICs), and the remaining three studies were conducted in low-income countries (LICs). Twenty-five trials exclusively enrolled participants with alcohol use disorder. The remaining 51 trials enrolled participants with harmful alcohol use, some of which included both cases of alcohol use disorder and people reporting hazardous alcohol use patterns that did not meet criteria for disorder. Fifty-two RCTs assessed the efficacy of psychosocial interventions; 27 were brief interventions primarily based on motivational interviewing and were compared to brief advice, information, or assessment only. We are uncertain whether a reduction in harmful alcohol use is attributable to brief interventions given the high levels of heterogeneity among included studies (Studies reporting continuous outcomes: Tau² = 0.15, Q =139.64, df =16, P<.001, I² = 89%, 3913 participants, 17 trials, very low certainty; Studies reporting dichotomous outcomes: Tau²=0.18, Q=58.26, df=3, P<.001, I² =95%, 1349 participants, 4 trials, very low certainty). The other types of psychosocial interventions included a range of therapeutic approaches such as behavioral risk reduction, cognitive-behavioral therapy, contingency management, rational emotive therapy, and relapse prevention. These interventions were most commonly compared to usual care involving varying combinations of psychoeducation, counseling, and pharmacotherapy. We are uncertain whether a reduction in harmful alcohol use is attributable to psychosocial treatments due to high levels of heterogeneity among included studies (Heterogeneity: Tau² = 1.15; Q = 444.32, df = 11, P<.001; I²=98%, 2106 participants, 12 trials, very low certainty). Eight trials compared combined pharmacologic and psychosocial interventions with placebo, psychosocial intervention alone, or another pharmacologic treatment. The active pharmacologic study conditions included disulfiram, naltrexone, ondansetron, or topiramate. The psychosocial components of these interventions included counseling, encouragement to attend Alcoholics Anonymous, motivational interviewing, brief cognitive-behavioral therapy, or other psychotherapy (not specified). Analysis of studies comparing a combined pharmacologic and psychosocial intervention to psychosocial intervention alone found that the combined approach may be associated with a greater reduction in harmful alcohol use (standardized mean difference (standardized mean difference (SMD))=-0.43, 95% confidence interval (CI): -0.61 to -0.24; 475 participants; 4 trials; low certainty). Four trials compared pharmacologic intervention alone with placebo and three with another pharmacotherapy. Drugs assessed were: acamprosate, amitriptyline, baclofen disulfiram, gabapentin, mirtazapine, and naltrexone. None of these trials evaluated the primary clinical outcome of interest, harmful alcohol use. Thirty-one trials reported rates of retention in the intervention. Meta-analyses revealed that rates of retention between study conditions did not differ in any of the comparisons (pharmacologic risk ratio (RR) = 1.13, 95% CI: 0.89 to 1.44, 247 participants, 3 trials, low certainty; pharmacologic in addition to psychosocial intervention: RR = 1.15, 95% CI: 0.95 to 1.40, 363 participants, 3 trials, moderate certainty). Due to high levels of heterogeneity, we did not calculate pooled estimates comparing retention in brief (Heterogeneity: Tau² = 0.00; Q = 172.59, df = 11, P<.001; I2 = 94%; 5380 participants; 12 trials, very low certainty) or other psychosocial interventions (Heterogeneity: Tau² = 0.01; Q = 34.07, df = 8, P<.001; I2 = 77%; 1664 participants; 9 trials, very low certainty). Two pharmacologic trials and three combined pharmacologic and psychosocial trials reported on side effects. These studies found more side effects attributable to amitriptyline relative to mirtazapine, naltrexone and topiramate relative to placebo, yet no differences in side effects between placebo and either acamprosate or ondansetron. Across all intervention types there was substantial risk of bias. Primary threats to validity included lack of blinding and differential/high rates of attrition.

Authors' conclusions: In LMICs there is low-certainty evidence supporting the efficacy of combined psychosocial and pharmacologic interventions on reducing harmful alcohol use relative to psychosocial interventions alone. There is insufficient evidence to determine the efficacy of pharmacologic or psychosocial interventions on reducing harmful alcohol use largely due to the substantial heterogeneity in outcomes, comparisons, and interventions that precluded pooling of these data in meta-analyses. The majority of studies are brief interventions, primarily among men, and using measures that have not been validated in the target population. Confidence in these results is reduced by the risk of bias and significant heterogeneity among studies as well as the heterogeneity of results on different outcome measures within studies. More evidence on the efficacy of pharmacologic interventions, specific types of psychosocial interventions are needed to increase the certainty of these results.

Trial registration: ClinicalTrials.gov NCG01459068 NCT01756469 NCT01573416 NCT00483483 NCT00675961 NCT01802736.

PubMed Disclaimer

Conflict of interest statement

GMC: none.

KJ: none.

AM: none.

MCJ: none.

NT: none.

WM: none.

JRM: none.

TWA: none.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of comparison: 8 Other psychosocial intervention vs. usual care or wait list among participants with hazardous or harmful alcohol use, outcome: 8.1 Harmful alcohol use.
5
5
Funnel plot of comparison: 7 Brief psychosocial intervention vs. brief advice, information, or assessment only among participants with hazardous or harmful alcohol use, outcome: 7.1 Harmful alcohol use (continuous).
6
6
Funnel plot of comparison: 2 Any pharmacologic intervention vs. placebo given in addition to psychosocial intervention among participants with alcohol use disorder, outcome: 2.1 Harmful alcohol use (continuous).
1.1
1.1. Analysis
Comparison 1: Any pharmacologic intervention vs. placebo among participants with alcohol use disorder or dependence, Outcome 1: Remission
1.2
1.2. Analysis
Comparison 1: Any pharmacologic intervention vs. placebo among participants with alcohol use disorder or dependence, Outcome 2: Retention
2.1
2.1. Analysis
Comparison 2: Any pharmacologic intervention vs. placebo given in addition to psychosocial intervention among participants with alcohol use disorder, Outcome 1: Harmful alcohol use (continuous)
2.2
2.2. Analysis
Comparison 2: Any pharmacologic intervention vs. placebo given in addition to psychosocial intervention among participants with alcohol use disorder, Outcome 2: Harmful alcohol use (dichotomous)
2.3
2.3. Analysis
Comparison 2: Any pharmacologic intervention vs. placebo given in addition to psychosocial intervention among participants with alcohol use disorder, Outcome 3: Alcohol consumption
2.4
2.4. Analysis
Comparison 2: Any pharmacologic intervention vs. placebo given in addition to psychosocial intervention among participants with alcohol use disorder, Outcome 4: Remission
2.5
2.5. Analysis
Comparison 2: Any pharmacologic intervention vs. placebo given in addition to psychosocial intervention among participants with alcohol use disorder, Outcome 5: Retention
3.1
3.1. Analysis
Comparison 3: Any pharmacologic intervention vs. another pharmacologic intervention among participants with alcohol use disorder, Outcome 1: Remission
3.2
3.2. Analysis
Comparison 3: Any pharmacologic intervention vs. another pharmacologic intervention among participants with alcohol use disorder, Outcome 2: Retention
4.1
4.1. Analysis
Comparison 4: Any pharmacologic intervention vs. another pharmacologic intervention in addition to psychosocial intervention among participants with alcohol use disorder, Outcome 1: Remission
4.2
4.2. Analysis
Comparison 4: Any pharmacologic intervention vs. another pharmacologic intervention in addition to psychosocial intervention among participants with alcohol use disorder, Outcome 2: Retention
5.1
5.1. Analysis
Comparison 5: Brief psychosocial intervention vs. brief advice, information, or assessment only among participants with hazardous or harmful alcohol use, Outcome 1: Harmful alcohol use (continuous)
5.2
5.2. Analysis
Comparison 5: Brief psychosocial intervention vs. brief advice, information, or assessment only among participants with hazardous or harmful alcohol use, Outcome 2: Harmful alcohol use (dichotomous)
5.3
5.3. Analysis
Comparison 5: Brief psychosocial intervention vs. brief advice, information, or assessment only among participants with hazardous or harmful alcohol use, Outcome 3: Alcohol consumption
5.4
5.4. Analysis
Comparison 5: Brief psychosocial intervention vs. brief advice, information, or assessment only among participants with hazardous or harmful alcohol use, Outcome 4: Remission
5.5
5.5. Analysis
Comparison 5: Brief psychosocial intervention vs. brief advice, information, or assessment only among participants with hazardous or harmful alcohol use, Outcome 5: Retention
6.1
6.1. Analysis
Comparison 6: Other psychosocial intervention vs. usual care or wait list among participants with hazardous or harmful alcohol use, Outcome 1: Harmful alcohol use
6.2
6.2. Analysis
Comparison 6: Other psychosocial intervention vs. usual care or wait list among participants with hazardous or harmful alcohol use, Outcome 2: Alcohol consumption
6.3
6.3. Analysis
Comparison 6: Other psychosocial intervention vs. usual care or wait list among participants with hazardous or harmful alcohol use, Outcome 3: Remission
6.4
6.4. Analysis
Comparison 6: Other psychosocial intervention vs. usual care or wait list among participants with hazardous or harmful alcohol use, Outcome 4: Retention
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD013350

References

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    1. Ng SM, Rentala S, Chan CLW, Nayak RB. Nurse-led body-mind-spirit based relapse prevention intervention for people with diagnosis of alcohol use disorder at a mental health care setting, India: a pilot study. Journal of Addictions Nursing 2020;31(4):276-86. - PubMed
Noknoy 2010 {published data only}
    1. Noknoy S, Rangsin R, Saengcharnchai P, Tantibhaedhyangkul U, McCambridge J. RCT of effectiveness of motivational enhancement therapy delivered by nurses for hazardous drinkers in primary care units in Thailand. Alcohol and Alcoholism 2010;45(3):263-70. - PMC - PubMed
Omeje 2018 {published data only}
    1. Omeje JC, Otu MS, Aneke AO, Adikwu VO, Nwaubani OO, Chigbu EF, et al. Effect of rational emotive health therapy on alcohol use among community-dwelling, HIV-positive patients. Medicine 2018;97(35):1-7. - PMC - PubMed
Pal 2007 {published data only}
    1. Pal HR, Yadav D, Mehta S, Mohan I. A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months. Alcohol and Alcoholism 2007;42(4):328-32. - PubMed
Papas 2011 {published data only (unpublished sought but not used)}
    1. Papas RK, Ayuku DO, Sidle JE, Ballidawa JB, Omolo OE, Songole R, et al. Pilot results from a Stage 1 cognitive behavioral trial to reduce alcohol use among HIV-infected Kenyans. In: Alcoholism: Clinical and Experimental Research. Vol. 33. 2009:197A.
    1. Papas RK, Sidle JE, Gakinya BN, Baliddawa JB, Martino S, Mwaniki MM, et al. Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. Addiction 2011;106(12):2156-66. - PMC - PubMed
Papas 2020 {published data only (unpublished sought but not used)}
    1. Papas R, Gakinya B, Mwaniki M, Lee H, Keyer A, Martino S, et al. A randomized clinical trial of a group cognitive-behavioral therapy to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. Addiction 2020;epub:1-42. - PMC - PubMed
    1. Papas RK, Gakinya BN, Mwaniki MM, Lee H, Keter AK, Klein DA, et al. Sucessful treatment outcomes from a stage 2 randomized clinical trial of CBT to reduce alcohol use among HIV-infected outpatients in Western Kenya. Alcoholism: Clinical and Experimental Research 2017;41:253A.
Peltzer 2013 {published data only}
    1. Peltzer K, Naidoo P, Louw J, Matseke G, Zuma K, McHunu G, et al. Screening and brief interventions for hazardous and harmful alcohol use among patients with active tuberculosis attending primary public care clinics and South Africa: results from a cluster randomized controlled trial. BMC Public Health 2013;13:699. - PMC - PubMed
Pengpid 2013a {published data only}
    1. Pengpid S, Peltzer K, Van der Heever H, Skaal L. Screening and brief interventions for hazardous and harmful alcohol use among university students in South Africa: Results from a randomized controlled trial. International Journal of Environmental Research and Public Health 2013;10(5):2043-57. - PMC - PubMed
Pengpid 2013b {published data only}
    1. Pengpid S, Peltzer K, Skaal L, Van der Heever H. Screening and brief interventions for hazardous and harmful alcohol use among hospital outpatients in South Africa: results from a randomized controlled trial. BMC Public Health 2013;13:644. - PMC - PubMed
    1. Pengpid S, Peltzer K, Skaal L, Heever H, Van Hal G. Screening and brief intervention for alcohol problems in Dr George Mukhari Hospital out-patients in Gauteng, South Africa: a single-blinded randomized controlled trial protocol. BMC Public Health 2012;12:127. - PMC - PubMed
Pengpid 2015 {published data only}
    1. Pengpid S, Peltzer K, Puckpinyo A, Viripiromgool S, Thamma-Aphiphol K, Suthisukhon K, et al. Screening and concurrent brief intervention of conjoint hazardous or harmful alcohol and tobacco use in hospital out-patients in Thailand: a randomized controlled trial. Substance Abuse Treatment, Prevention, and Policy 2015;10:22. - PMC - PubMed
Poblete 2017 {published data only}
    1. Poblete F, Barticevic NA, Zuzulich MS, Portilla R, Castillo-Carniglia A, Sapag JC, et al. A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile. Addiction 2017;112(8):1462-9. - PubMed
    1. Poblete F. Effectiveness of a brief intervention for substances consumption linked to the alcohol, smoking and substance involvement screening test (ASSIST): A randomized control trial in Chilean primary care. clinicaltrials.gov/ct2/show/NCT01573416 2012. [NCT01573416]
Polshkova 2016 {published data only}
    1. Polshkova S, Voloshyna D, Cunningham RM, Zucker RA, Walton MA. Prevention of alcohol and other drug use using motivational interviewing among young adults in Ukraine. Psychosomatic Medicine and General Practice 2016;1(1):e010111.
    1. Voloshyna D, Walton MA, Zucker RA, Cunningham RM, Polshkova S. Prevention of alcohol and other drug use using motivational interviewing among youth in the Ukraine. Alcoholism: Clinical and Experimental Research 2016;40:71A.
Rendall‐Mkosi 2013 {published data only}
    1. Rendall-Mkosi K, Morojele N, London L, Moodley S, Singh C, Girdler-Brown B. A randomized controlled trial of motivational interviewing to prevent risk for an alcohol-exposed pregnancy in the Western Cape, South Africa. Addiction 2013;108(4):725-32. - PubMed
Samet 2015 {published data only}
    1. Samet JH, Raj A, Cheng DM, Blokhina E, Bridden C, Chaisson CE, et al. HERMITAGE--a randomized controlled trial to reduce sexually transmitted infections and HIV risk behaviors among HIV-infected Russian drinkers. Addiction 2015;110(1):80-90. - PMC - PubMed
    1. Tsui JI, Cheng DM, Coleman SM, Lira MC, Blokhina E, Bridden C, et al. Pain is associated with risky drinking over time among HIV-infected persons in St. Petersburg, Russia. Drug and Alcohol Dependence 2014;144:87-92. - PMC - PubMed
Satyanarayana 2016 {published data only}
    1. Satyanarayana VA, Nattala P, Selvam S, Pradeep J, Hebbani S, Hegde S, et al. Integrated cognitive behavioral intervention reduces intimate partner violence among alcohol dependent men, and improves mental health outcomes in their spouses: a clinic based randomized controlled trial from South India. Journal of Substance Abuse Treatment 2016;64:29-34. - PubMed
Schaub 2021 {published data only (unpublished sought but not used)}
    1. Formigoni M, Andrade ALM. Partial results of a web-based self-help program to reduce alcohol use in adults with harmful, hazardous or suggestive of dependence drinking patterns. Alcoholism: Clinical and Experimental Research 2018;42:204A.
    1. Schaub MP, Tiburcio M, Martinez N, Ambekar A, Balhara YP, Wenger A, et al. Alcohol e-Help: study protocol for a web-based self-help program to reduce alcohol use in adults with drinking patterns considered harmful, hazardous or suggestive of dependence in middle-income countries. Addiction 2018;113(2):346-52. - PubMed
    1. Schaub MP, Tiburcio M, Martinez-Velez N, Ambekar A, Bhad R, Wenger A, et al. The effectiveness of a web-based self-help program to reduce alcohol use among adults with drinking patterns considered harmful, hazardous, or suggestive of dependence in four low- and middle-income countries: randomized controlled trial. Journal of Medical Internet Research 2021;23(8):e21686. - PMC - PubMed
Segatto 2011 {published data only}
    1. Segatto ML, Andreoni S, Sousa e Silva R, Diehl A, Pinsky I. Brief motivational interview and educational brochure in emergency room settings for adolescents and young adults with alcohol-related problems: a randomized single-blind clinical trial. Revista Brasileira de Psiquiatria 2011;33(3):225-33. - PubMed
Sheikh 2017 {published data only}
    1. Sheikh WA, Paul R, Banda H, Agath K, Luty J. Impact of brief relapse prevention intervention in patients with alcohol dependence in Zambia. Journal of Substance Use 2017;22(1):113-7.
Shin 2013 {published data only}
    1. Shin S, Livchits V, Connery HS, Shields A, Yanov S, Yanova G, et al. Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia. Addiction 2013;108(8):1387-96. - PMC - PubMed
Signor 2013 {published data only}
    1. Signor L, Pierozan PS, Ferigolo M, Fernandes S, Moreira TC, Mazoni CG, et al. Efficacy of the telephone-based brief motivational intervention for alcohol problems in Brazil. Revista Brasileira de Psiquiatria 2013;35(3):254-61. - PubMed
Simao 2008 {published data only}
    1. Simao MO, Kerr-Correa F, Smaira SI, Trinca LA, Floripes TM, Dalben I, et al. Prevention of "risky" drinking among students at a Brazilian university. Alcohol and Alcoholism 2008;43(4):470-6. - PubMed
Thapinta 2017 {published data only}
    1. Thapinta D, Skulphan S, Kitsumban V, Longchoopol C. Cognitive behavior therapy self-help booklet to decrease depression and alcohol use among people with alcohol dependence in Thailand. Issues in Mental Health Nursing 2017;38(11):964-70. - PubMed
Thomas 2017 {published data only}
    1. Thomas B, Watson B, Senthil EK, Deepalakshmi A, Balaji G, Chandra S, et al. Alcohol intervention strategy among tuberculosis patients: a pilot study from South India. International Journal of Tuberculosis and Lung Disease 2017;21(8):947-52. - PubMed
Vlasova 2011 {published data only}
    1. Vlasova N, Schumacher J, Dumchev K, Kim Y. STEPS outpatient program demonstrates efficacy in reducing alcohol use in Ukraine. In: Proceedings of the 67th annual scientific meeting of the College on Problems of Drug Dependence. 2005.
    1. Vlasova N, Schumacher JE, Oryschhuk O, Dumchev KV, Slobodyanyuk P, Moroz VM, et al. STEPS outpatient program improves alcohol treatment outcomes in Ukrainian regional narcologic dispensary. Addictive Disorders & Their Treatment 2011;10(1):6-13.
Wandera 2017 {published data only}
    1. Wandera B, Tumwesigye NM, Nankabirwa JI, Mafigiri DK, Parkes-Ratanshi RM, Kapiga S, et al. Efficacy of a single, brief alcohol reduction intervention among men and women living with HIV/AIDS and using alcohol in Kampala, Uganda: a randomized trial. Journal of the International Association of Providers of AIDS Care 2017;16(3):276-85. - PMC - PubMed
WHO Brief Intervention Study Group 1996 {published data only}
    1. Babor TF, Grant M, Acuda W, Burns FH, Campillo C, Del Boca FK, et al. A randomized clinical trial of brief interventions in primary health care: summary of a WHO project. Addiction 1994;89(6):657-60. - PubMed
    1. Ivanets NN, Lukomskaya MI. Evaluation of early intervention strategies used in primary health care: a report on the World Health Organization (WHO) Project on Identification and Treatment of Persons with Harmful Alcohol Consumption. Alcohol and Alcoholism 1991;1:489-91. - PubMed
    1. WHO Brief Intervention Study Group. A Cross-National trial of Brief Interventions with Heavy Drinkers. American Journal of Public Health 1996;86(7):948-55. - PMC - PubMed
Witte 2011 {published data only}
    1. Carlson CE, Chen J, Chang M, Batsukh A, Toivgoo A, Riedel M, et al. Reducing intimate and paying partner violence against women who exchange sex in Mongolia: results from a randomized clinical trial. Journal of Interpersonal Violence 2012;27(10):1911-31. - PMC - PubMed
    1. Witte SS, Altantsetseg B, Aira T, Riedel M, Chen J, Potocnik K, et al. Reducing sexual HIV/STI risk and harmful alcohol use among female sex workers in Mongolia: a randomized clinical trial. AIDS and Behavior 2011;15(8):1785-94. - PMC - PubMed
Xiaolu 2017 {published data only}
    1. Xiaolu R, Wenwen W, Ali R, Xu L, Hong W, Min Z, et al. Feasibility of studying a brief intervention to help Chinese villagers with problem alcohol use after an earthquake. Alcohol and Alcoholism 2017;52(4):472-6. - PubMed

References to studies excluded from this review

Aira 2013 {published data only}
    1. Aira T, Wang W, Riedel M, Witte S. Reducing risk behaviors linked to noncommunicable diseases in Mongolia: a randomized controlled trial. American Journal of Public Health 2013;103(9):1666-74. - PMC - PubMed
Burnhams 2015 {published data only}
    1. Burnhams NH, London L, Laubscher R, Nel E, Parry C. Results of a cluster randomised controlled trial to reduce risky use of alcohol, alcohol-related HIV risks and improve help-seeking behaviour among safety and security employees in the Western Cape, South Africa. Substance Abuse Treatment, Prevention, and Policy 2015;10:18. - PMC - PubMed
Chaudhury 2016 {published data only}
    1. Chaudhury S, Brown FL, Kirk CM, Mukunzi S, Nyirandagijimana B, Mukandanga J, et al. Exploring the potential of a family-based prevention intervention to reduce alcohol use and violence within HIV-affected families in Rwanda. AIDS Care 2016;28:118-29. - PMC - PubMed
Dawson 2012 {published data only}
    1. Dawson AH, Siriwardhana P, Abeyasinge R. A randomized controlled trial of a community based alcohol education program in changing the drinking pattern in rural Sri Lanka. Clinical Toxicology 2012;50(4):350.
Holla 2020 {published data only}
    1. Holla B, Biswal J, Ramesh V, Shivakumar V, Bharath RD, Benegal V, et al. Effect of prefrontal tDCS on resting brain fMRI graph measures in Alcohol Use Disorders: A randomized, double-blind, sham-controlled study. Progress in Neuropsychopharmacology and Biological Psychiatry 2020;102:109950. - PubMed
Kalichman 2007 {published data only}
    1. Kalichman SC, Simbayi LC, Vermaak R, Cain D, Jooste S, Peltzer K. HIV/AIDS risk reduction counseling for alcohol using sexually transmitted infections clinic patients in Cape Town, South Africa. Journal of Acquired Immune Deficiency Syndromes 2007;44(5):594-600. - PubMed
Kalichman 2008 {published data only}
    1. Kalichman SC, Simbayi LC, Vermaak R, Cain D, Smith G, Mthebu J, et al. Randomized trial of a community-based alcohol-related HIV risk-reduction intervention for men and women in Cape Town South Africa. Annals of Behavioral Medicine 2008;36(3):270-9. - PubMed
Kalichman 2011 {published data only}
    1. Kalichman SC, Cain D, Eaton L, Jooste S, Simbayi LC. Randomized clinical trial of brief risk reduction counseling for sexually transmitted infection patients in Cape Town, South Africa. American Journal of Public Health 2011;101(9):e9-17. - PMC - PubMed
Mertens 2014 {published data only}
    1. Mertens JR, Ward CL, Bresick GF, Broder T, Weisner CM. Effectiveness of nurse-practitioner-delivered brief motivational intervention for young adult alcohol and drug use in primary care in South Africa. Alcohol and Alcoholism 2014;49(4):430-8. - PMC - PubMed
Myers 2016 {published data only}
    1. Myers B, Westhuizen C, Naledi T, Stein DJ, Sorsdahl K. Readiness to change is a predictor of reduced substance use involvement: findings from a randomized controlled trial of patients attending South African emergency departments. BMC Psychiatry 2016;16:35. - PMC - PubMed
Rongkavilit 2013 {published data only}
    1. Rongkavilit C, Naar-King S, Wang B, Panthong A, Bunupuradah T, Parsons JT, et al. Motivational interviewing targeting risk behaviors for youth living with HIV in Thailand. AIDS and Behavior 2013;17(6):2063-74. - PMC - PubMed
Rotheram‐Borus 2015 {published data only}
    1. Rotheram-Borus MJ, Tomlinson M, le Roux I, Stein JA. Alcohol use, partner violence, and depression: a cluster randomized controlled trial among urban South African mothers over 3 years. American Journal of Preventive Medicine 2015;49(5):715-25. - PMC - PubMed
Sorsdahl 2015 {published data only}
    1. Sorsdahl K, Stein DJ, Corrigall J, Cuijpers P, Smits N, Naledi T, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: a randomized controlled trial. Substance Abuse Treatment, Prevention, and Policy 2015;10:46. - PMC - PubMed
Thapinta 2014 {published data only}
    1. Thapinta D, Skulphan S, Kittrattanapaiboon. Brief cognitive behavioral therapy for depression among patients with alcohol dependence in Thailand. Issues in Mental Health Nursing 2014;35(9):689-93. - PubMed
Ward 2015 {published data only}
    1. Ward CL, Mertens JR, Bresick GF, Little F, Weisner CM. Screening and brief intervention for substance misuse: does it reduce aggression and HIV-related risk behaviours? Alcohol and Alcoholism 2015;50(3):302-9. - PMC - PubMed
Wechsberg 2006 {published data only}
    1. Wechsberg WM, Luseno WK, Lam WKK, Parry CDH, Morojele NK. Substance use, sexual risk, and violence: HIV prevention intervention with sex workers in pretoria. AIDS and Behavior 2006;10(2):131-7. - PubMed
Wechsberg 2008 {published data only}
    1. Wechsberg WM, Luseno WK, Karg RS, Young S, Rodman N, Myers B, et al. Alcohol, cannabis, and methamphetamine use and other risk behaviours among Black and Coloured South African women: a small randomized trial in the Western Cape. International Journal of Drug Policy 2008;19(2):130-9. - PMC - PubMed
Wechsberg 2016 {published data only}
    1. Wechsberg WM, Zule WA, El-Bassel N, Doherty IA, Minnis AM, Novak SD, et al. The male factor: Outcomes from a cluster randomized field experiment with a couples-based HIV prevention intervention in a South African township. Drug and Alcohol Dependence 2016;161:307-15. - PMC - PubMed

References to studies awaiting assessment

Balachova 2017 {published data only (unpublished sought but not used)}
    1. Balachova T, Bonner B, Chaffin M, Isurina G, Tsvetkova L, Volkova E, et al. Dual-focused brief physician intervention to reduce the risk for alcohol-exposed pregnancies: a randomized controlled trial. Alcoholism: Clinical and Experimental Research 2013;37:50A.
    1. Balachova T, Bonner B, Chaffin M, Isurina GL, Tsvetkova LA, Volkova EN. A randomized controlled trial of a dual-focused brief physician intervention in obgyn clinics in Russia. Alcoholism: Clinical and Experimental Research 2012;36:23A.
    1. Balachova T, Chaffin M, Isurina GI, Tsvetkova LA, Volkova EN, Agrawal S, et al. Efficacy of a brief intervention at women's clinics in Russia. Alcoholism: Clinical and Experimental Research 2015;39:284A.
    1. Balachova TB, Chaffin, MJ, Bonner BL, Isurina GL, Tsvetkova LA, Volkova EN. Randomized cluster trial of a brief fasd prevention intervention for Russian women in OB/GYN care. Alcoholism: Clinical and Experimental Research 2017;41:336A.
    1. Balachova TN, Chaffin MJ, Isurina GL, Tsvetkova LA, Volkova EN, Agrawal S, et al. A brief intervention to reduce the risk for an alcohol-exposed pregnancy: outcomes of a randomized clinical trial in Russia. Alcoholism: Clinical and Experimental Research 2014;38:343A.
Belokrylov 2018 {published data only}
    1. Belokrylov I, Bryukhin A, Karnozov V. Experience in the application of group psychoanalytic psychotherapy in the clinic of addictive pathology. European Psychiatry 2018;48:S544-5.
Clair 2016 {published data only (unpublished sought but not used)}
    1. Clair V, Mutiso V, Musau A, Frank E, Ndetei D. Online learning improves substance use care in Kenya: randomized control trial results and implications. Annals of Global Health 2016;82(3):320-1. [NCT02388243]
Du 2017 {published data only}
    1. Du J, Ruan X, Zhao M. Brief intervention helped individuals with problem alcohol use who experienced the Wenchuan earthquake in Sichuan, China. Journal of Neuroimmune Pharmacology 2017;12(2):S100.
Gorny 2019 {published data only}
    1. Gorny BE, Kalinina AM, Dolgova SV, Nabiullina GA, Paliy IA, Bunova AS. Organizational and functional technology for screening and preventive counseling of patients with harmful alcohol consumption and the results of testing the technology in primary health care. Profilakticheskaya Meditsina 2019;22(3):14-19.
Jin 2006 {published data only}
    1. Jin M, Li J, Yang YC. Evaluation of the clinical effect of electro-acupuncture aversion therapy of alcohol-dependence. Chinese Journal of Clinical Rehabilitation 2006;10(47):18-20.
Parry 2014 {published data only (unpublished sought but not used)}
    1. Parry C, Shuper P, Londani BM, Myers B, Nkosi S, Manda S, et al. Drinking among patients on antiretroviral therapy in South Africa: gender differences and outcomes of a clinical trial. Alcoholism: Clinical and Experimental Research 2019;43:266A.
    1. Parry CD, Morojele NK, Myers BJ, Kekwaletswe CT, Manda SO, Sorsdahl K, et al. Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes - a randomised controlled trial protocol. BMC Infectious Diseases 2014;14:500. - PMC - PubMed
Prasad 2018 {published data only}
    1. Prasad S, Basu D, Mattoo SK, Subodh BN. Brief intervention to reduce substance use in Class C male hospital employees: a randomised controlled trial. Indian Journal of Psychiatry 2018;60(5):S107. - PMC - PubMed
Rentala 2020 {published data only}
    1. Rentala S, Ng SM, Chan CLW, Bevoor P, Nayak RB, Desai M. Effect of holistic relapse prevention intervention among individuals with alcohol dependence: a prospective study at a mental health care setting in India. Journal of Ethnicity in Substance Abuse 2020;21(1):687-707. - PubMed
Siriwardhana 2013 {published data only}
    1. Siriwardhana P, Dawson AH, Abeyasinge R. Acceptability and effect of a community-based alcohol education program in rural Sri Lanka. Alcohol and Alcoholism 2013;48(2):250-6. - PMC - PubMed
Staton 2019 {published data only}
    1. Staton C, Vissoci JRN, Swann M, Hirshon JM, Bartlett J, Mmbaga B. Feasibility of a pragmatic randomized adaptive clinical trial of a brief intervention for alcohol use in Moshi, Tanzania. Alcoholism: Clinical and Experimental Research 2019;43:80A.
Yadav 2019 {published data only}
    1. Yadav P. Follow up study of effects of breathing technique and relaxation program on male patients of Alcohol Dependence Syndrome. Indian Journal of Psychiatry 2019;61(9):S591.

References to ongoing studies

Almonacid 2020 {published data only}
    1. Almonacid I, Olaya L, Cuevas V, Castillo JS, Becerra N, Delgado J, et al. Effectiveness of brief counseling in a hospital setting for smoking cessation and risky alcohol drinking reduction: randomized clinical trial protocol. Revista Colombiana de Psycquiatria 2020;20:30085-8.
Diclemente 2021 {published data only}
    1. DiClemente RJ, Brown JL, Capasso A, Revzina N, Sales JM, Boeva E, et al. Computer-based alcohol reduction intervention for alcohol-using HIV/HCV coinfected Russian women in clinical care: study protocol for a randomized controlled trial. Trials 2021;22:147. - PMC - PubMed
    1. Diclemente R. Computer-based intervention for alcohol-using HIV/HCV+ women. clinicaltrials.gov. [NCT03362476]
Fernandes 2019 {published data only}
    1. Fernandes D. Alcohol use disorders - mobile based brief intervention treatment (AMBIT): a pilot RCT. clinicaltrials.gov 2019. [NCT04078360]
Kiene 2019 {published data only}
    1. Kiene SM. Development of an intervention to reduce heavy drinking and improve HIV care engagement among fisherfolk in Uganda. clinicaltrials.gov. [NCT03919695]
Lelutiu‐Weinberger 2019 {published data only}
    1. Lelutiu-Weinberger C, Pachankis JE. Building mobile HIV prevention and mental health support in low-resource settings. clinicaltrials.gov 2019. [NCT03912753]
Liang 2020 {published data only}
    1. Liang X, Hu X, Zhang X Fu H. ASF (a compound of traditional chinese medicine) in the treatment of patients with alcohol dependence: study protocol of a randomized, double-blinded, placebo-controlled clinical trial. Medicine 2020;99(5):e23899. - PMC - PubMed
Lodi 2021 {published data only}
    1. Emenyonu N, Marson K. Drinkers' intervention to prevent tuberculosis (DIPT Study). clinicaltrials.gov. [NCT03492216] - PMC - PubMed
    1. Lodi S, Emenyonu NI, Marson K, Kwarisiima D, Fatch R, McDonell MG, et al. The Drinkers’ Intervention to Prevent Tuberculosis (DIPT) trial among heavy drinkers living with HIV in Uganda: study protocol of a 2×2 factorial trial. Trials 2021;22:355. - PMC - PubMed
Mmbaga 2021 {published data only}
    1. Mmbaga BT, Staton CA. PRACT: A pragmatic randomized adaptive clinical trial to investigate controlling alcohol related harms in a low-income setting: Emergency department brief interventions in Tanzania. ClinicalTrials.gov 2021.
Mutyambizi‐Mafu 2019 {published data only (unpublished sought but not used)}
    1. Mutyambizi-Mafunda V, Myers B, Sorsdahl K, Lund C, Naledi T, Cleary S. Integrating a brief mental health intervention into primary care services for patients with HIV and diabetes in South Africa: study protocol for a trial-based economic evaluation. BMJ Open 2019;9(5):e026973. - PMC - PubMed
Nadkarni 2019a {published data only}
    1. Nadkarni A. Alcohol use disorders- Mobile based brief intervention treatment (AMBIT): a pilot RCT. ClinicalTrials.gov 2019.
NCT02797587 {published data only}
    1. NCT02797587. Studying partial-agonists for ethanol and tobacco elimination in Russians with HIV (St PETER HIV). clinicaltrials.gov/ct2/show/record/NCT02797587 (first received 8th June 2016). [NCT02797587]
NCT03380728 {published data only}
    1. NCT03380728. Ibogaine in the treatment of alcoholism: a randomized, double-blind, placebo-controlled, escalating dose, phase 2 trial. clinicaltrials.gov/ct2/show/record/NCT03380728 (first received 15th December 2017). [NCT03380728]
NCT03610815 {published data only}
    1. NCT03610815. Community I-STAR Mozambique: Community implementation of SBIRT using technology for alcohol use reduction in Mozambique. clinicaltrials.gov/ct2/show/NCT03610815 (first received 24thJune 2018). [NCT03610815]
NCT04906616 {published data only}
    1. NCT04906616. An economic and relationship-strengthening for HIV-affected couples who drink alcohol in Malawi. clinicaltrials.gov/ct2/show/NCT04906616 2021.
Paula 2021 {published data only}
    1. Ferri CP, Paula TC. Evaluation of an intervention to reduce alcohol consumption among older adults. WHO International Clinical Trial Registry Platform 2020.
    1. Paula TC, Chagas C, Noto AR, Formigoni MLO, Pereira TV, Ferri CP. Brief interventions for older adults (BIO) delivered by non-specialist community health workers to reduce at-risk drinking in primary care: a study protocol for a randomised controlled trial. BMJ Open 2021;11:e043918. - PMC - PubMed
Sangle 2021 {published data only}
    1. Sangle S. Alcohol reduction intervention study for TB and HIV patients in India. WHO International Clinical Trials Registry Platform 2021.

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