Home-detoxification and relapse prevention for alcohol dependence in low resource settings: An exploratory study from Goa, India

Abstract

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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.…”

“…Publications scientifically addressing the evaluation of withdrawal interventions in LMIC are scarce. A recent exception being Nadkarni et al [ 35 ], who piloted a lay counselor-delivered home-based detoxification and relapse prevention program in Goa, India. In the absence of clinics and secondary or tertiary care facilities, or them being unreachable and unaffordable for most AUD patients, task-shifting to lay workers and community-based service provision seems the only practicable solution.…”

“…In the absence of clinics and secondary or tertiary care facilities, or them being unreachable and unaffordable for most AUD patients, task-shifting to lay workers and community-based service provision seems the only practicable solution. However, in the case of the exploratory study by Nadkarni et al [ 35 ] and all other community-based detoxification programs (cf. a review by Nadkarni et al [ 14 ]) contraindications for home-detoxification were numerous and likely to apply to a significant number of AUD patients in LMIC.…”

“…Amongst others, these were a lifetime history of seizures, unexplained loss of consciousness, medical conditions (e.g. heart disease) or current conditions, such as mental health problems (psychoses, suicidality, hallucinations, depression, consuming other substances (except tobacco)) and current physical health problems from uncontrolled hypertension to liver compromise (for a full list of typical contraindications see Nadkarni et al [ 14 , 35 ]).…”

“…The Treatment Camp is continuously moving from community to community with counselors and medical staff and therefore can cover a wide range of underserved areas, while providing all necessary nutritional, medical and psychological care in one location for a predefined amount of time (usually 7 days). The inpatient nature of the approach allows for a substantial reduction of the ineligibility criteria that have been limiting other community-based detoxification approaches [ 14 , 35 ].…”