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

世界卫生组织（世卫组织）将有问题的酒精消费定义为三个级别，即有害饮酒（使人面临发展健康/社会问题的风险）、有害饮酒（健康/社会问题已经发生）和酒精依赖（已经发生严重问题）。尽管多动症和有害饮酒对人口的影响比酒精依赖（“预防悖论”）更大（造成的问题也更多），但印度的卫生政策主要侧重于为酒精依赖提供制度性护理。全球广泛的证据表明，短期干预措施（BIs）在减少HD患者饮酒方面是有效的。然而，在印度，提供这种循证心理治疗的主要障碍是训练有素的保健专业人员缺乏/分配不均，以及对西方发展的社会心理干预的文化普遍性的担忧。克服人力资源障碍的一项创新是使用移动电话技术，如SMS（短消息服务）和交互式语音应答（IVR），以快速和低成本向大量hd提供bi，如戒烟干预措施所示。此外，越来越多的证据表明，遵循一种系统的方法来适应文化上的社会心理干预，可以提高接受者和提供方的可接受性，以及提供的可行性。AMBIT的总体目标是开发一种适合高清环境的BI，可以使用移动电话技术来克服资源匮乏环境下的访问障碍。AMBIT的具体目标是：1)与我们的技术合作伙伴合作，开发使用移动电话技术的BI软件包；2)检查在印度环境中提供这样的干预是否可以接受/可行；3)进行初步测试，看看干预是否有助于减少饮酒；4)微调程序，以确定干预措施的有效性。该规划的目标将通过一系列进程来实现，包括确定现有证据；与我们的技术合作伙伴合作开发干预措施，并利用包括危险饮酒者在内的一系列个人和团体的反馈；改进干预措施；并测试其初步影响。该处理开发过程的输出将是一个上下文可接受且可行的移动技术交付的BI包，然后可以在更大的试验中进行测试。总而言之，我们希望通过使用手机（在印度和其他中低收入国家广泛拥有）和短信（在印度和其他中低收入国家广泛使用），将过去由卫生保健工作者面对面提供的帮助方式（BIs）转变为更容易获得和广泛使用的形式，从而帮助危险饮酒者减少对他们、他们的家庭和整个社会造成的伤害程度。HD是一个日益严重的大问题，不仅因为它本身，而且因为许多HD患者会继续发展出更有问题的AUD版本。如果开发成功并具有成本效益，我们的干预措施可以惠及全世界数百万人（因为移动电话的使用即使在发展中国家也呈指数增长），并可能真正改变公共卫生领域的游戏规则。

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.