Brief interventions for alcohol use disorders in low- and middle-income countries: barriers and potential solutions.
Brief interventions for alcohol use disorders in low- and middle-income countries: barriers and potential solutions.
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DOI：
10.1186/s13033-022-00548-5
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发表时间：
2022-08-08
影响因子：
3.6
通讯作者：
Andreasson, Sven
中科院分区：
文献类型：
--
作者：
Nadkarni, Abhijit;Bhatia, Urvita;Bedendo, Andre;de Paula, Tassiane Cristine Santos;de Andrade Tostes, Joanna Goncalves;Segura-Garcia, Lidia;Tiburcio, Marcela;Andreasson, Sven
预计未来几十年全球酒精消费和有害使用酒精将增加，其中大部分将发生在低收入和中等收入国家;这就要求采取具有成本效益的措施，减少这些国家的酒精暴露。其中一个基于证据的措施是酒精问题的筛查和简短干预（BI）。BI的一些特点使其成为资源匮乏环境中特别有吸引力的干预选择。然而，尽管有证据表明BI有效，但在中低收入国家实施BI的情况很少。在本文中，我们讨论了在中低收入国家实施BI的障碍，从拉丁美洲和印度的例子。在中低收入国家实施商业智能的主要障碍是缺乏财政和结构资源。针对酒精使用障碍的专门服务有限或根本不存在。因此，初级保健往往是实施BI的唯一可能的替代方案。然而，在这种情况下，卫生专业人员普遍缺乏处理这些疾病的培训。在我们对这些国家的BI研究的回顾中，我们发现了一些有希望的结果，主要是在拉丁美洲的国家，但到目前为止，对有效性的研究有限。BI疗效和有效性的适当评价因缺乏普遍性和方法学局限性而受到影响。在印度，没有系统和科学的努力来探索BI在初级和社区护理平台中的实施和评估。需要采取创新战略，克服与中低收入国家专家人力短缺有关的供应方障碍。越来越多的证据表明，非专业卫生工作者，包括非专业咨询人员，在为中低收入国家的一系列疾病，包括酒精使用障碍提供一线心理干预方面是有效的。本文旨在激发研究人员，从业人员和政策制定者在中低收入国家的讨论，因为增加获得循证护理的酒精使用障碍的中低收入国家将需要所有这些利益相关者的共同努力。
Global alcohol consumption and harmful use of alcohol is projected to increase in the coming decades, and most of the increase will occur in low- and middle-income countries (LMICs); which calls for cost-effective measures to reduce alcohol exposure in these countries. One such evidence based measure is screening and brief intervention (BI) for alcohol problems. Some of the characteristics of BI make them a particularly appealing choice of interventions in low-resource settings. However, despite evidence of effectiveness, implementation of BI in LMICs is rare. In this paper we discuss barriers to implementation of BI in LMICs, with examples from Latin America and India. Key barriers to implementation of BI in LMICs are the lack of financial and structural resources. Specialized services for alcohol use disorders are limited or non-existent. Hence primary care is often the only possible alternative to implement BI. However, health professionals in such settings generally lack training to deal with these disorders. In our review of BI research in these countries, we find some promising results, primarily in countries from Latin America, but so far there is limited research on effectiveness. Appropriate evaluation of efficacy and effectiveness of BI is undermined by lack of generalisability and methodological limitations. No systematic and scientific efforts to explore the implementation and evaluation of BI in primary and community platforms of care have been published in India. Innovative strategies need to be deployed to overcome supply side barriers related to specialist manpower shortages in LMICs. There is a growing evidence on the effectiveness of non-specialist health workers, including lay counsellors, in delivering frontline psychological interventions for a range of disorders including alcohol use disorders in LMICs. This paper is intended to stimulate discussion among researchers, practitioners and policy-makers in LMICs because increasing access to evidence based care for alcohol use disorders in LMICs would need a concerted effort from all these stakeholders.
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影响因子：
3.2
作者：
Elliott, Jennifer C.;Delker, Erin;Hasin, Deborah S.
通讯作者：
Hasin, Deborah S.
影响因子：
2.6
作者：
Hanpatchaiyakul, Kulnaree;Eriksson, Henrik;Ostlund, Gunnel
通讯作者：
Ostlund, Gunnel
影响因子：
105.7
作者：
Kaner, Eileen;Bland, Martin;Drummond, Colin
通讯作者：
Drummond, Colin
DOI：
10.1177/1455072520954325
发表时间：
2020-10
期刊：
Nordisk alkohol- & narkotikatidskrift : NAT
影响因子：
--
作者：
Bye EK;Moan IS
通讯作者：
Moan IS
影响因子：
3.7
作者：
Glass, Joseph E.;Andreasson, Sven;Saitz, Richard
通讯作者：
Saitz, Richard