Abhijit Nadkarni|Benedict Weobong|Helen A. Weiss|Jim McCambridge|Bhargav Bhat|Basavaraj Katti|Pratima Murthy|Michael King|David McDaid|A?La Park|G. Terence Wilson|Betty Kirkwood|Christopher G. Fairburn|Richard Velleman|Vikram Patel
Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial
London School of Hygiene & Tropical Medicine|Sangath|London School of Hygiene & Tropical Medicine|London School of Hygiene & Tropical Medicine|University of York|Sangath|Sangath|National Institute of Mental Health and Neurosciences|University College London|London School of Economics and Political Science|London School of Economics and Political Science|Rutgers, The State University of New Jersey|London School of Hygiene & Tropical Medicine|University of Oxford|Sangath|University of Bath|London School of Hygiene & Tropical Medicine|Sangath
although structured psychological treatments recommended firstline interventions harmful drinking small fraction people globally receive treatments poor access routine primary care assessed effectiveness costeffectiveness counselling alcohol problems cap brief psychological treatment delivered lay counsellors patients harmful drinking attending routine primary healthcare settingsin randomised controlled trial recruited male harmful drinkers defined alcohol use disorders identification test audit score 1219 aged 1865 years ten primary health centres goa india excluded patients needed emergency medical treatment inpatient admission unable communicate clearly intoxicated time screening participants randomly allocated 11 trained health assistants based primary health centres enhanced usual care euc alone euc combined cap randomly sized blocks four six stratified primary health centre allocation concealed use sequential numbered opaque envelopes physicians providing euc assessing outcomes masked primary outcomes remission audit score 8 mean daily alcohol consumed past 14 days 3 months secondary outcomes effect drinking disability score days unable work suicide attempts intimate partner violence resource use costs illness analyses intentiontotreat basis used logistic regression analysis remission zeroinflated negative binomial regression analysis alcohol consumption assessed serious adverse events perprotocol population trial registered iscrtn registry number isrctn76465238between oct 28 2013 july 29 2015 enrolled randomly allocated 377 participants 188 50 euc plus cap group 190 50 euc alone group one subsequently excluded protocol violation 336 89 completed 3 month primary outcome assessment 164 87 euc plus cap group 172 91 euc alone group proportion remission 59 36 164 euc plus cap group vs 44 26 172 euc alone group adjusted prevalence ratio 150 95 ci 109207 p001 proportion abstinent past 14 days 68 42 vs 31 18 adjusted odds ratio 300 176513 p00001 significantly higher euc plus cap group euc alone group noted effect mean daily alcohol consumed past 14 days among reported drinking period 370 g sd 442 vs 310 g 278 count ratio 108 079149 p062 noted effect percentage days abstinent past 14 days adjusted mean difference amd 160 81241 p00001 effect percentage days heavy drinking amd 04 57 49 p088 effect drinking short inventory problems score amd003 193 186 p097 disability score disability assessment schedule score amd 062 062 187 p032 days unable work days unable work adjusted odds ratio 102 061169 p095 suicide attempts adjusted prevalence ratio 18 24 60 p025 intimate partner violence adjusted prevalence ratio 30 104 44 p057 incremental cost per additional remission 217 95 ci 501073 85 chance costeffective study setting noted significant difference number serious adverse events two groups six 4 euc plus cap group vs 13 8 euc alone group p011cap delivered lay counsellors plus euc better euc alone harmful drinkers routine primary healthcare settings might costeffective cap could key strategy reduce treatment gap alcohol use disorders one leading causes global burden among men worldwidewellcome trust