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，即危险饮酒(HD)(使人有可能出现健康/社会问题)、有害饮酒(已经出现健康/社会问题)和酒精依赖(已经出现严重问题)。尽管与酒精依赖(“预防悖论”)相比，HD和有害饮酒影响的人口比例更大(并造成更多问题)，但在印度，卫生政策主要侧重于为酒精依赖提供机构护理。全球广泛的证据表明，短暂干预(BIS)在减少HD患者饮酒方面是有效的。然而，在印度，提供这种以证据为基础的心理社会治疗的主要障碍是缺乏/不公平分配训练有素的医疗专业人员，以及对西方发展的心理社会干预在文化上的普遍性的担忧。克服人力资源障碍的一项创新是使用手机技术，如短信(短消息服务)和交互式语音应答(IVR)，以快速且低成本的方式向大量HDS提供BIS，如戒烟干预措施所示。此外，越来越多的证据表明，遵循系统的方法，在文化上适应心理社会干预，可以提高接受者和接生代理的接受度和接生的可行性。MOBIT的总体目标是开发一种适合背景的高清BI，可以使用移动电话技术来克服在资源不足的情况下获取的障碍。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交付的BI包；2)检查在印度环境下提供此类干预是否可接受/可行；3)进行初步测试，以确定干预是否有助于减少饮酒；以及4)微调程序，以最终测试干预的有效性。该计划的目标将通过一系列过程实现，包括识别现有证据；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；完善干预措施；以及测试其初步影响。这一治疗开发过程的输出将是在背景下可接受和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，我们希望通过使用移动电话(在印度和其他LMIC广泛拥有)和SMS(在印度和其他LMIC广泛使用)，将过去由医务人员面对面提供的帮助(BIS)方式转变为更容易获得和更广泛使用的形式，从而帮助有害饮酒者减少对他们、他们的家庭和整个社会造成的伤害。高清是一个很大的问题，而且还在不断增长，这既是因为高清本身，也是因为许多高清患者将继续开发更有问题的AUD版本。如果成功开发并被发现具有成本效益，我们的干预措施可以惠及世界各地的数百万人(因为移动电话的使用甚至在整个发展中世界都呈指数级增长)，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.