Alcohol use disorders-Mobile based Brief Intervention Treatment (AMBIT): Technological innovation to bridge the treatment gap for hazardous drinking.

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The World Health Organization (WHO) defines three levels of problematic alcohol consumption, namely hazardous drinking (HD) (which puts a person at risk of developing health/social problems), harmful drinking (where health/social problems are already occurring), and alcohol dependence (where serious problems have already occurred). Although HD and harmful drinking affects a larger proportion of the population (and causes many more problems) than alcohol dependence (the 'prevention paradox'), in India health policy focuses mainly on institutional delivery of care for alcohol dependence. Extensive evidence globally demonstrates the effectiveness of Brief Interventions (BIs) in reducing drinking in HD. However, in India, the major barriers to providing such evidence-based psychosocial treatments are the lack/inequitable distribution of trained healthcare professionals and concerns about the cultural generalisability of psychosocial interventions developed in the West. One innovation to overcome the human resource barrier is to use mobile phone technology like SMS (Short Messaging Service) and interactive voice response (IVR) to deliver BIs to large numbers of HDs, quickly and at low cost, as demonstrated in interventions for smoking cessation. Furthermore, a growing body of evidence demonstrates that following a systematic methodology to culturally adapt psychosocial interventions increases acceptability by recipients and delivery agents, and feasibility of delivery.The overall objective of AMBIT is to develop a contextually appropriate BI for HD that can be delivered using mobile phone technology to overcome barriers to access in low resource settings. The specific aims of AMBIT are to 1) Develop a BI package delivered using mobile phone technology, in partnership with our technology partner; 2) Examine if it is acceptable/feasible to deliver such an intervention in an Indian setting; 3) Conduct preliminary testing to see if the intervention helps in reducing drinking; and 4) Fine-tune procedures for the definitive testing of the effectiveness of the intervention. The aims of the programme will be achieved through a range of processes including identification of the existing evidence; development of the intervention in partnership with our technology partner and utilising feedback from a range of individuals and groups including Hazardous Drinkers; refinement of the intervention; and testing of its preliminary impact. The output of this treatment development process would be a contextually acceptable and feasible mobile-technology-delivered BI package which can then be tested in a larger trial. To summarise, we want to help hazardous drinkers to reduce levels of harm caused to them, their families and society in general, by transforming a way of helping (BIs) which has in the past been delivered face-to-face by healthcare workers into a much more accessible and widely available form, by using mobile phones (widely owned across India and other LMICs) and SMSs (widely used across India and other LMICs). HD is a big and growing problem, both in itself, and also because many people with HD will go on to develop even more problematic versions of AUD. If successfully developed and found to be cost-effective, our intervention can reach millions of people across the world (as mobile phone use has increased exponentially even across the developing world) and could be a real game changer in the field of public health.