The systematic development and pilot randomized evaluation of counselling for alcohol problems, a lay counselor-delivered psychological treatment for harmful drinking in primary care in India: the PREMIUM study

Abhijit Nadkarni, Richard Velleman, Hamid Dabholkar, Sachin Shinde, Bhargav Bhat, Jim Mccambridge, Pratima Murthy, Terry Wilson, Benedict Weobong, Vikram Patel

Research output: Contribution to journalArticle

26 Citations (Scopus)
145 Downloads (Pure)

Abstract

Background: Despite harmful drinking causing a significant burden on global health, there is a large treatment gap, especially in low- and middle-income countries. A major barrier to care is the lack of adequately skilled human resources to deliver contextually appropriate treatments. This paper describes the systematic process used to develop Counselling for Alcohol Problems (CAP), a brief psychological treatment (PT) for delivery by lay counselors in routine primary care settings to men with harmful drinking in India. Methods: CAP was developed using a methodology involving 3 sequential steps: (i) identifying potential treatment strategies; (ii) developing a theoretical framework for the treatment; and (iii) evaluating the acceptability and feasibility of the treatment. Results: CAP is a 3-phase treatment delivered over 1 to 4 sessions based on a motivational interviewing (MI) stance and involves the following strategies: assessment and personalized feedback, family engagement, drink refusal skills, skills to address drinking urges, problem-solving skills and handling difficult emotions, and relapse prevention and management. Data from a case series were used to inform several adaptations to enhance the acceptability of CAP to the recipients and feasibility of delivery by lay counselors of the treatment, for example expansion of the target group to include alcohol-dependent patients and the extension of the delivery settings to include home-based delivery. There was preliminary evidence of the effectiveness of CAP. Conclusions: CAP is an acceptable brief PT for harmful drinking delivered by lay counselors in primary care whose effectiveness is currently being tested in a randomized controlled trial based in primary care in Goa, India.

Original languageEnglish
Pages (from-to)522-531
Number of pages10
JournalAlcoholism: Clinical and Experimental Research
Volume39
Issue number3
DOIs
Publication statusPublished - Mar 2015

Keywords

  • Harmful Drinking
  • India
  • Lay Counselors
  • Primary Care
  • Psychological Treatment

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