Changes in the Provision of Institutionalized Mental Health Care in Post-Communist Countries

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Alcohol e-Help: study protocol for a web-based self-help program to reduce alcohol use in adults with drinking patterns considered harmful, hazardous or suggestive of dependence in middle-income countries

Background and aimsGiven the scarcity of alcohol prevention and alcohol use disorder treatments in many low and middle-income countries, the World Health Organization launched an e-health portal on alcohol and health that includes a Web-based self-help program. This paper presents the protocol for a multicentre randomized controlled trial (RCT) to test the efficacy of the internet-based self-help intervention to reduce alcohol use. DesignTwo-arm randomized controlled trial (RCT) with follow-up 6 months after randomization. SettingCommunity samples in middle-income countries. ParticipantsPeople aged 18+, with Alcohol Use Disorders Identification Test (AUDIT) scores of 8+ indicating hazardous alcohol consumption. Intervention and comparatorOffer of an internet-based self-help intervention, Alcohol e-Health', compared with a waiting list' control group. The intervention, adapted from a previous program with evidence of effectiveness in a high-income country, consists of modules to reduce or entirely stop drinking. MeasurementsThe primary outcome measure is change in the Alcohol Use Disorders Identification Test (AUDIT) score assessed at 6-month follow-up. Secondary outcomes include self-reported the numbers of standard drinks and alcohol-free days in a typical week during the past 6 months, and cessation of harmful or hazardous drinking (AUDIT < 8). AnalysisData analysis will be by intention-to-treat, using analysis of covariance to test if program participants will experience a greater reduction in their AUDIT score than controls at follow-up. Secondary outcomes will be analysed by (generalized) linear mixed models. Complier average causal effect and baseline observations carried forward will be used in sensitivity analyses. CommentsIf the Alcohol e-Health program is found to be effective, the potential public health impact of its expansion into countries with underdeveloped alcohol prevention and alcohol use disorder treatment systems world-wide is considerable.World Health OrganizationUniv Zurich, Swiss Res Inst Publ Hlth & Addict ISGF, Konradstr 32, CH-8031 Zurich, SwitzerlandRamon Fuente Muniz, Natl Inst Psychiat, Mexico City, DF, MexicoRamon Fuente Muniz, Natl Inst Psychiat, Dept Social Sci Hlth, Mexico City, DF, MexicoAll India Inst Med Sci, Natl Drug Dependence Treatment Ctr, New Delhi, IndiaAll India Inst Med Sci, Dept Psychiat, New Delhi, IndiaUniv Fed Sao Paulo, Dept Psicobiol, Escola Paulista Med, Sao Paulo, BrazilBelarusian Psychiat Assoc, Informat & Training Ctr, Minsk, ByelarusRepublican Res & Practice Ctr Mental Hlth, Minsk, ByelarusWHO Dept Mental Hlth & Subst Abuse Geneva, Geneva, SwitzerlandUniv Fed Sao Paulo, Dept Psicobiol, Escola Paulista Med, Sao Paulo, BrazilWorld Health Organization: 001Web of Scienc