Community-based psychosocial substance use disorder interventions in low-and-middle-income countries: a narrative literature review

Abstract

Background Mental health and substance use disorders (SUDs) are the world’s leading cause of years lived with disability; in low-and-middle income countries (LIMCs), the treatment gap for SUDs is at least 75%. LMICs face significant structural, resource, political, and sociocultural barriers to scale-up SUD services in community settings. Aim This article aims to identify and describe the different types and characteristics of psychosocial community-based SUD interventions in LMICs, and describe what context-specific factors (policy, resource, sociocultural) may influence such interventions in their design, implementation, and/or outcomes. Methods A narrative literature review was conducted to identify and discuss community-based SUD intervention studies from LMICs. Articles were identified via a search for abstracts on the MEDLINE, Academic Search Complete, and PsycINFO databases. A preliminary synthesis of findings was developed, which included a description of the study characteristics (such as setting, intervention, population, target SUD, etc.); thereafter, a thematic analysis was conducted to describe the themes related to the aims of this review. Results Fifteen intervention studies were included out of 908 abstracts screened. The characteristics of the included interventions varied considerably. Most of the psychosocial interventions were brief interventions. Approximately two thirds of the interventions were delivered by trained lay healthcare workers. Nearly half of the interventions targeted SUDs in addition to other health priorities (HIV, tuberculosis, intimate partner violence). All of the interventions were implemented in middle income countries (i.e. none in low-income countries). The political, resource, and/or sociocultural factors that influenced the interventions are discussed, although findings were significantly limited across studies. Conclusion Despite this review’s limitations, its findings present relevant considerations for future SUD intervention developers, researchers, and decision-makers with regards to planning, implementing and adapting community-based SUD interventions.

Treating alcohol use disorder in the absence of specialized services – evaluation of the moving inpatient Treatment Camp approach in Uganda

“…Thirdly, the Treatment Camp is set up in a way to optimally imitate an inpatient setting, where patients can concentrate on recovery without distraction. Fourthly, the inpatient nature of the Treatment Camp overcomes many of the exclusion criteria that apply to home-detoxification programs or brief interventions that are the common alternative models of alcohol-related service delivery in LMIC [ 11 , 14 , 34 , 35 ]. The combination of the inpatient setting with medical staff overseeing the provision of medication and dealing with physical concerns on the one hand and counselors or lay therapists providing sessions on psychoeducation and relapse prevention on the other hand helps to treat and monitor AUD patients intensively.…”

“…Additionally, specialized health care is not affordable for the majority of dependent drinkers in LMIC. A lack of awareness and education about alcohol-related disorders and their treatability as well as the fear of stigmatization are further contributing factors [ 14 , 16 , 34 ]. The majority of alcohol-related programs that have been scientifically evaluated in LMIC use brief interventions and target hazardous and harmful alcohol users.…”

Primary healthcare approach to substance abuse management

“…Managing substance abuse within the PHC context could improve access and the outcome of care. 12 There is growing evidence of integrated management of substance abuse in PHC settings being more cost-effective than non-integrated care. 11,13 Similar to chronic medical conditions, managing substance abuse requires long-term, continuous care, and PHC settings are well suited for these circumstances.…”

Perceived Stress, Depression and Alcohol Use Disorders in College Students During the COVID-19 Pandemic: A Socio-Economic Dimension

“…The first policy effort should therefore focus on implementing mental health into general health policy, improving public awareness of mental health and reallocating resources towards high-priority mental health needs and vulnerable groups [126]. During the COVID-19 pandemic, psychological interventions and psychosocial substance use disorder interventions are even more necessary, as psychological difficulties have increased during interpersonal isolation [127,128].…”