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

Abstract

The alcohol-attributable disease burden is greater in low- and middle-income countries (LMICs) as compared to high-income countries. Despite the effectiveness of interventions such as health promotion and education, brief interventions, psychological treatments, family-focused interventions, and biomedical treatments, access to evidence-based care for alcohol use disorders (AUDs) in LMICs is limited. This can be explained by poor access to general health and mental health care, limited availability of relevant clinical skills among health care providers, lack of political will and/or financial resources, historical stigma and discrimination against people with AUDs, and poor planning and implementation of policies. Access to care for AUDs in LMICs could be improved through evidence-based strategies such as designing innovative, local and culturally acceptable solutions, health system strengthening by adopting a collaborative stepped care approach, horizontal integration of care into existing models of care (e.g., HIV care), task sharing to optimise limited human resources, working with families of individuals with AUD, and leveraging technology-enabled interventions. Moving ahead, research, policy and practice in LMICs need to focus on evidence-based decision-making, responsiveness to context and culture, working collaboratively with a range of stakeholders to design and implement interventions, identifying upstream social determinants of AUDs, developing and evaluating policy interventions such as increased taxation on alcohol, and developing services for special populations (e.g., adolescents) with AUDs.

Inertia or unanticipated bottlenecks? Exploring the implementation determinants of the national alcohol policy five years post-enactment in Zambia

“…This issue is common in many SSA countries, where inadequate budget allocation to alcohol control demonstrates a lack of government commitment [26]. Similarly, key services for the treatment and rehabilitation of alcohol use disorders are often absent in SSA [27][28][29],…”

Using Theory of Change to Plan for the Implementation of a Psychological Intervention Addressing Alcohol Use Disorder and Psychological Distress in Uganda

“…Literature on AUDs demonstrates an increased risk for mental health disorders (Grant et al, 2004 ; Lo et al, 2017a ), noncommunicable diseases (Hammer et al, 2018 ; Nadkarni et al, 2023a ), gender-based violence (Shiva et al, 2021 ) and wider social and economic risks (Hammer et al, 2018 ). People with AUDs often experience barriers to treatment which can reduce health seeking behavior and underutilization of services (Probst et al, 2015 ; Mellinger et al, 2018 ; McCrady et al, 2020 ).…”

Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia

“…Previous studies reported that attitudinal barriers were more critical in high-income settings and structural barriers were more likely in LMICs (Sareen et al, 2007 ; Roberts et al, 2018 ). However, available evidence suggested that both attitudinal and structural barriers are important in hindering or delaying treatment in low-resource settings (Andrade et al, 2014 ; Nadkarni et al, 2023 ). For example, a previous Ethiopian study reported that major barriers to seeking treatment for alcohol use disorder included low perceived need and a lack of knowledge about where to seek help (Zewdu et al, 2019 ).…”