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Packages of Care for Alcohol Use Disorders in Low- And Middle-Income Countries

  • Vivek Benegal ,

    vbenegal@gmail.com

    Affiliation Deaddiction Centre, National Institute of Mental Health and Neurosciences, Bangalore, India

  • Prabhat K. Chand,

    Affiliation Deaddiction Centre, National Institute of Mental Health and Neurosciences, Bangalore, India

  • Isidore S. Obot

    Affiliations University of Uyo, Uyo, Nigeria, Centre for Research and Information on Substance Abuse (CRISA), Uyo, Nigeria

Packages of Care for Alcohol Use Disorders in Low- And Middle-Income Countries

  • Vivek Benegal, 
  • Prabhat K. Chand, 
  • Isidore S. Obot
PLOS
x

This is the fourth in a series of articles highlighting the delivery of “packages of care” for mental health disorders in low- and middle-income countries. Packages of care are combinations of treatments aimed at improving the recognition and management of conditions to achieve optimal outcomes.

Summary Points

  • Alcohol use disorders (AUDs)—conditions that range from hazardous and harmful alcohol use to alcohol dependence—are a low priority in low- and middle-income countries (LMICs), despite causing a large health burden.
  • Most alcohol-related harm is attributable to hazardous/harmful drinkers who make disproportionate use of primary health care systems, but often go undetected and untreated for long periods, even though brief, easily delivered interventions are effective in this group of people.
  • Health care systems in LMICs currently focus on providing tertiary care services for the treatment of dependence (where there is often a poor outcome). This focus needs to shift towards the cost-effective strategy of providing brief interventions for early AUDs.
  • Effective evidence-based combinations of psychosocial and pharmacological treatments for AUDs are available in LMICs but are costly to implement. Policy makers need to ensure that people with AUDs are offered the most appropriate services using stepped-care solutions that start with simple, structured advice for risky drinkers and progress to specialist treatment services for more serious AUDs.
  • LMICs also need to improve their implementation of proven population-level preventive measures to reduce the health burden due to AUDs. An international Framework Convention on Alcohol Control may help them do this.

Introduction

Alcohol misuse is responsible for a disproportionately high health burden, accounting for almost 5% of all ill health and premature death worldwide in 2004. The impact of alcohol misuse is worst among poor populations and in low- and middle-income countries (LMICs) where the disease burden per liter of alcohol consumed is greater than in wealthy populations. In 2004, the western Pacific region, Southeast Asia, and the Americas had the highest prevalence of alcohol use disorders (AUDs) relative to the average volumes of alcohol consumed. Alcohol attributable net disability adjusted life years (DALYs) were 13,406, 7,343, and 3,392 in China, India, and Brazil, respectively, and 594 and 393 in Germany and Japan, respectively, in the same year [1][7].

Sustained, heavy alcohol exposure leads to a chronic relapsing illness with a characteristic syndromal presentation termed “dependence.” However, alcohol misuse can produce harm without the presence of dependence. The terms “hazardous drinking” and “harmful drinking” describe patterns of use likely to result in or having resulted in physical/psychological harm, respectively, without satisfying the International Classification of Disease (ICD) ten criteria for alcohol dependence (Box 1) [8],[9].

Box 1. International Classification of Disease 10 Criteria for AUDs

Hazardous use [ICD 10; Z72.1]

“A pattern of alcohol consumption that carries with it a risk of harmful consequences to the drinker. These consequences may be damage to physical or mental health, or social consequences to the drinker or others. Other potential consequences include worsening of existing medical conditions or psychiatric illnesses, injuries caused to self or others due to impaired judgment after drinking, high risk sexual behaviors while intoxicated, and worsening of personal or social interactions”. Hazardous use is often operationalized as an average consumption of 21 drinks or more per week for men and 14 drinks or more per week for women. It is recognized by the World Health Organization (WHO) as a disorder distinct from other AUDs [26].

Harmful use [ICD 10; F10.1]

“A pattern of drinking that is already causing damage to health. The damage may be either physical (e.g., liver damage from chronic drinking) or mental (e.g., depressive episodes secondary to drinking).

Harmful patterns of use are often criticized by others and are sometimes associated with adverse social consequences of various kinds. However, the fact that a family or culture disapproves of drinking is not by itself sufficient to justify a diagnosis of harmful use” [9],[26].

Alcohol dependence [ICD 10; F10.2]

“A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated alcohol use and that typically include a strong desire to take alcohol, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to alcohol use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state” [9].

Most alcohol-related harm is attributable to hazardous/harmful drinkers rather than to people with alcohol dependence [10][12]. However, this distinction is rarely made, especially in LMICs where politicians, planners, and the public discourse have focused primarily on alcohol dependence—the conventional central motif of alcohol misuse. Concentrating on the rarer presentation of dependence only serves to minimize the problem, stigmatize the condition, and marginalize affected individuals.

Studies of alcohol treatment systems across countries show that the size, extent, and character of the treatment system each country adopts depends more on its view of the importance of alcohol problems (and its reliance on alcohol excise) than on actual changes in alcohol consumption achieved by the system, the need for treatment in the country, or the economic resources available for treatment [13]. Furthermore, recent reviews of the current situation in LMICs indicate that service systems for the treatment of AUDs, where available, are mainly oriented to tertiary treatment of dependence with an emphasis on long-term residential treatment in rehabilitation centres, specialised clinics, or psychiatric hospitals [14][16]. These facilities are mainly concentrated in urban areas and are often in private settings, usually with high fee structures. Where government-funded treatment/counseling centers are available, the overall efficacy of these programmes is low [17]. Consequently, many people with AUDs in LMICs remain untreated (the median treatment gap for AUDs in LMICs is 78.1%) because they first seek help for early alcohol-related problems from primary health care providers who are not trained to recognise the problem [18][20]. Those who are finally treated often have to wait for over a decade before receiving treatment for their alcohol misuse [21]. Thus, in many LMICs, alcohol-related problems are first addressed when they are already severe and difficult to treat, secondary prevention in earlier stages of drinking problems is virtually nonexistent, and many heavy drinkers who are at risk of developing AUD in the future are not targeted by health interventions.

In this article, we focus on the effective management of AUDs in LMICs. We review the available evidence on the efficacy of treatments and the delivery of interventions derived from LMICs. Because that evidence is often limited, we also cite systematic reviews and meta-analyses based on global evidence and key randomized controlled trials (RCTs) from high income countries (HICs) where appropriate. On the basis of our review, we propose a package of care—a combination of treatments aimed at improving the recognition and management of conditions to achieve optimal outcomes—for AUDs.

The Evidence on the Treatment of AUDs

Although there is now a substantial evidence base about the relative effectiveness of different strategies for reducing the rates of alcohol-related harm, most of the evidence derives from HICs and cannot be transposed directly to LMIC settings. In Table 1, we review the existing data and in this section, we discuss some aspects of the evidence base in more detail.

Population-Level Interventions for Prevention

For populations with high rates of hazardous alcohol use, both population-wide measures (for example, taxation on alcoholic beverages) and individual-based interventions (for example, brief physician advice) have been shown to have a notable impact on reducing the global burden of alcohol misuse, although higher rates of taxation may be ineffective in countries with undocumented consumption. Other population-wide strategies, such as reduced hours of sale and advertising bans, seem to have less impact. For populations with low rates of hazardous drinking, intervention strategies targeted at particular subgroups of the drinking population, such as drivers who drink or primary-care attendees with already high levels of alcohol consumption, appear to be more cost effective than population-wide strategies like taxation [12],[22].

Early Detection and Brief Interventions for Early AUDs

The treatment gap in LMICs can be narrowed by broadening the base of treatment and by opportunistic screening and brief intervention (SBI) in primary health care settings. Several brief screening instruments have been developed in HICs and one of these—AUDIT (Alcohol Use Disorders Identification Test)—has been shown to provide an accurate measure of risk across gender, age, and cultures in several LMICs [23][29]. SBI provides a framework for stepped intervention to help risky drinkers reduce or stop alcohol consumption, which starts with simple but structured advice, progresses to extended brief interventions, and ends with referral to a specialist alcohol treatment service for those with more serious problems and those who fail to respond to brief interventions. Several reviews and meta-analyses of research evidence collected in HICs in a variety of health care settings and three RCTs in LMICs have concluded that SBI can effectively reduce alcohol consumption to low-risk levels among hazardous and harmful drinkers [30][39]. Other evidence from HICs suggests that a combination of office support programs and education of primary health care providers can increase the rate of screening and advice giving of primary-health care providers [40]. Finally, there is evidence from HICs that SBI can decrease alcohol-related mortality for up to 16 y after the intervention [41].

Psychosocial Interventions to Prevent/Delay Relapse

These interventions fall into two main categories: structured interventions and self-help groups. Two large US- and UK-based RCTs that compared psychosocial therapies differing widely in conceptual framework, intensity, duration, and location (Motivation Enhancement Therapy [MET], Cognitive Behavior Therapy [CBT], Twelve Step Facilitation [TSF] therapy, and Social Behavior and Network Therapy [SBNT]) found minimal long-term difference between inpatient/residential treatment and outpatient counseling approaches [42],[43]. These trials also found approximately equivalent (and reasonably good) outcomes with both brief, nonintensive treatments (MET) and intensive treatments (CBT, TSF, and SBNT) for moderately severe alcoholics. A systematic review that considered evidence collected in HICs concluded that manual-guided specific treatments with a theoretical base (e.g., MET, CBT) are better than nonspecific treatments (supportive therapy and social work interventions), but that among the specific therapies none was superior [44]. The same review found that marital therapy and family intervention yielded positive results. A meta-analysis of behavioral self-control training found that this intervention reduced alcohol consumption and alcohol-related difficulties [45]. Very few studies have examined psychosocial interventions in LMICs, but one RCT in dependent drinkers in Korea found that culturally modified cognitive behavioral therapy increased the drinkers' insight into their condition [46].

A Cochrane review of studies investigating the effectiveness of strategies adopted by Alcoholics Anonymous and other self-help groups to reduce alcohol dependence provided no definitive evidence that these approaches are effective in HICs; there are no data from LMICs about the effectiveness of self-help groups [47].

Pharmacotherapy for Detoxification and Relapse Prevention

Conventionally, pharmacotherapy involves the use of benzodiazepines for detoxification and disulfiram for relapse prevention. A systematic review from HICs showed that benzodiazepines remain the agents of choice for treating alcohol withdrawal during detoxification [48]. A recent RCT from India that compared lorazepam and chlordiazepoxide found that these benzodiazepines had comparable attenuating effects on uncomplicated withdrawal [49]. Thus, lorazepam can be used in LMIC settings where it is difficult to test liver function status, an essential preamble to using long-acting benzodiazepines in patients.

A multisite RCT from the US concluded that the aversive agent disulfiram might help prevent relapse in compliant patients but is ineffective at promoting continuous abstinence [50]. Outcomes were improved, however, if a supportive family member was able to monitor compliance. RCTs undertaken in LMICs where disulfiram is still the most commonly used medication for AUDs because it is cheap and easily available show that it continues to be a useful treatment particularly when compliance with the drug regimen is overseen by family members [51].

A recent systematic review of data from HICs provides substantial evidence that newer agents such as naltrexone, acamprosate, topiramate, and baclofen have modest effects on improving most outcome indicators (abstinent days, heavy drinking days, days to lapse/relapse, and work and social functioning) in alcohol-dependent individuals, although they do not guarantee abstinence. Furthermore, when accompanied by brief advice, these agents have been shown to improve overall outcome [52]. Although these newer agents are relatively costly (which limits their use in LMICs), they nevertheless offer a paradigm shift in the treatment of AUDs. Treatment with these agents can be initiated while an individual is still drinking heavily and at the point of maximum crisis and help-seeking. They can also be safely delivered in general practice and many other health care settings (unlike the scheduled drug disulfiram, which, because of its toxicity and propensity to cause severe reactions with alcohol, had to be strictly monitored and could only be prescribed by addiction specialists), thus broadening access to treatment. Although abstinence remains the ultimate goal in treating alcohol-dependent individuals, reducing the frequency of heavy drinking has the major impact of decreasing alcohol-related consequences and improving quality of life. These agents may also support effective treatment of hazardous/harmful alcohol use in primary health care settings [53].

Two systematic reviews and several RCTs that have investigated the use of the opiate antagonist naltrexone for preventing relapse in both HICs [54][57] and LMICs [58],[59] have suggested that this drug reduces the risk of relapse among recently abstinent, alcohol-dependent individuals, though the effect-size is small. The efficacy of naltrexone is greatest in people with high compliance, in those reporting high levels of craving, and in those with a family history of AUDs [60],[61].

Three large HIC-based meta-analyses of the glutamate inhibitor acamprosate reported an increased percentage of nonheavy drinking days and increased continuous abstinence rates at 6 mo when compared to placebo but the effect sizes were small [62][64]. However, both the multisite US COMBINE trial [57] and an RCT of acamprosate combined with out-patient psychosocial intervention in Korean alcohol-dependent individuals [65] failed to find any therapeutic benefit for this agent. A meta-analysis of studies that compared the efficacy profiles of naltrexone and acamprosate concluded that acamprosate was likely to be more effective in preventing a lapse, whereas naltrexone more effectively prevented a lapse becoming a relapse [66].

Table 1 also provides details of RCTs that have examined the effect of the glutamate receptor antagonist topiramate (in HICs and in India) on abstinence, relapse, and other alcohol-related outcomes [67]– and two RCTs that have examined the effect of the GABA-B receptor agonist baclofen on drinking outcomes in HICs [70],[71].

Delivery of Effective Interventions

Despite accruing evidence that medications may support effective treatment of AUDs, treatment systems in LMICs by and large continue to be dominated by psychosocial or religious models and self-help groups that generally disavow biomedical interventions [72],[73]. There is also often limited availability of these drugs in developing countries, their prices are high in the open market, and public-health systems do not supply or subsidize these medications. This last barrier to drug treatment for AUDs in LMICs is not surprising given the unacceptably low spending on health in these countries [74]. Furthermore health insurance is not readily accessible in LMICs, and even if it were present, AUDs are rarely covered by health insurance [75]. In Table 2, we propose a series of steps that might be taken to improve the delivery of care for AUDs in LMICs and in the rest of this section we provide a brief discussion of some of these steps.

Interventions to Increase Consumer Demand and Awareness

The social stigma attached to AUDs, the lack of knowledge about available treatments, and poor sensitization among primary health care providers delays treatment seeking by people with early AUDs. In turn, because of the poor outcome of advanced AUDs with conventional treatments, some health care professionals believe there is little point in trying to treat people with alcohol problems (therapeutic nihilism). These factors contribute to the large treatment gap in LMICs, and the low demand for services, coupled with the perceived economic “benefits” from alcohol-taxes, fuels official apathy towards upgrading services for the treatment of AUDs [15]. To increase consumer demand and awareness in order to get governments and planners to re-examine the status quo, stakeholders in LMICs should pro-actively disseminate the accruing evidence about the economic and social costs of alcohol misuse in their country. They should also educate their populations about the new understanding of AUDs as a treatable brain disorder and about the availability of effective treatments and use the media to influence the public discourse and to sensitize policy makers and medical professionals [73].

Interventions to Increase Access to Treatment

In LMICs, detoxification and medical treatment of mild-to-moderate alcohol withdrawal states can be safely managed in out-patient or ambulatory settings under the supervision of community nurses with medical support from local medical practitioners [76][80]. Furthermore, there is evidence that a “camp approach” in which patients with substance dependence are treated in brief residential camps in the community is clinically feasible and cost-effective compared to inpatient hospital treatment [81]. Patient access to treatment can also be greatly expanded by combining brief, standardized behavioral treatments with the newer medications. Such combinations improve overall outcome and can be delivered in general practice and other primary health care settings. Importantly, patients with chronic illnesses like AUDs benefit from the continuity of care that primary health care professionals located in the patients' community can provide—heavy drinking and alcohol addiction severity are lower in patient cohorts who receive primary care [82].

Interventions to Increase the Availability, Reduce the Costs, and Improve the Efficiency of Treatment

A greater proportion of AUDs could be effectively managed with the existing, limited health care resources available in LMICs by incorporating SBI within the normal clinical routine of primary health care doctors and nurses [77]. These practitioners would need to be trained to identify and stage AUDs and to provide a heuristic stepped-care framework of intervention [83]. SBI, which is acceptable to both patients and practitioners, is low-cost and is easily administered by medically trained clinicians with minimal training in AUD treatments [84]. Currently available training methods and manuals for SBI have already been successfully used in LMICs [85],[86].

Integration of interventions for AUDs within existing delivery systems for the care of other noncommunicable diseases would allow effective use of sparse resources. But, since primary health care personnel burdened with multiple responsibilities are often loath to take on additional tasks, AUD treatment services need to be reconceptualised, not as standalone programs, but as part of risk management strategies for other noncommunicable diseases—alcohol misuse constitutes a prominent risk factor for a wide range of noncommunicable diseases. Community level interventions organized in the workplace and by nongovernmental organizations (NGOs) working in areas of development and microfinance also merit further examination [87].

In most LMICs, NGOs and religious/social organizations (mostly unregulated) provide help for AUDs that is often not evidence based and is sometimes even inhumane [88]. The introduction of regulations to ensure minimum standards of care will be difficult because 25%–50% of LMICs do not have a national policy on treatment of AUDs, but should nevertheless be attempted [89].

Several manual-based training schemes that cover psychosocial interventions are freely available on the Internet, but more Web-based resources need to be created and used to increase the availability of treatment for AUDs [90],[91]. Finally, national addiction resource centers where available should be tasked with training, certification, and monitoring, and encouraged to engage in private-public partnerships with available treatment providers.

Packages of Care for AUDs in LMICs

Although our review suggests that effective measures for combating AUDs exist in LMICs, a degree of scaling down when prescribing care packages for LMIC settings is necessary to reflect the resource availability on the ground. In Table 3 we compare possible packages of care for AUDs in low- and high-resource countries.

More specifically, on the basis of our review, we propose that the situation in LMICs calls for the adoption of a heuristic stepped-care framework to match the needs of people with AUDs to the most appropriate services. Each step in this framework represents an increased complexity of intervention: (1) step 1 is recognition of alcohol-related problems in primary health care and general hospital settings; (2) step 2 is treatment of hazardous/harmful drinking in primary care; (3) step 3 is treatment of moderate-to-severe dependence in primary health care settings with referrals to specialized units for relapse prevention; (4) step 4 is treatment by mental-health or addiction specialists; (5) step 5 is inpatient treatment. This stepped-framework approach has been used successfully in the treatment of several mental-health problems, notably depression [92], but as yet there are few well-studied models of the approach in the field of substance abuse treatment.

However, it is important to remember that focussing on treatment alone will not reduce the huge burden of disease caused by alcohol in LMICs. Measures that target the drinking environment and the general population in these countries also need to be urgently implemented.

Finally, because the implementation of any of these packages of care or of any other measures to reduce the burden of alcohol-related disease cannot happen in LMICs without the active participation of their governments and of nongovernmental agencies, we strongly support the need for an international health policy initiative in the form of a Framework Convention on Alcohol Control, similar to that launched by the WHO for tobacco [93].

Author Contributions

ICMJE criteria for authorship read and met: VB PKC ISO. Wrote the first draft of the paper: VB PKC. Contributed to the writing of the paper: VB PKC ISO.

References

  1. 1. Beaglehole R, Bonita R (2009) Alcohol: a global health priority. Lancet 373: 2173–2174.R. BeagleholeR. Bonita2009Alcohol: a global health priority.Lancet37321732174
  2. 2. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, et al. (2009) Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 373: 2223–2233.J. RehmC. MathersS. PopovaM. ThavorncharoensapY. Teerawattananon2009Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders.Lancet37322232233
  3. 3. Gururaj G, Benegal V, Girish N, Chandra V, Pandav R (2006) Alcohol control series 2: public health problems caused by harmful use of alcohol - gaining less or losing more? New Delhi: World Health Organization, Regional Office for South East Asia. G. GururajV. BenegalN. GirishV. ChandraR. Pandav2006Alcohol control series 2: public health problems caused by harmful use of alcohol - gaining less or losing more?New DelhiWorld Health Organization, Regional Office for South East Asia
  4. 4. Bonu S, Rani M, Peters DH, Jha P, Nguyen SN (2005) Does use of tobacco or alcohol contribute to impoverishment from hospitalization costs in India? Health Policy Plan 20: 41–49.S. BonuM. RaniDH PetersP. JhaSN Nguyen2005Does use of tobacco or alcohol contribute to impoverishment from hospitalization costs in India?Health Policy Plan204149
  5. 5. Room R, Babor T, Rehm J (2005) Alcohol and public health. Lancet 365: 519–530.R. RoomT. BaborJ. Rehm2005Alcohol and public health.Lancet365519530
  6. 6. Obot IS (2006) Alcohol use and related problems in sub-Saharan Africa. African Journal of Drug and Alcohol Studies 5: 17–26.IS Obot2006Alcohol use and related problems in sub-Saharan Africa.African Journal of Drug and Alcohol Studies51726
  7. 7. Benegal V, Nayak M, Murthy P, Chandra P, Gururaj G (2005) Women and alcohol in India. Alcohol, gender and drinking problems: perspectives from low and middle income countries. In: Obot IS, Room R, editors. Geneva: World Health Organisation. pp. 89–124.V. BenegalM. NayakP. MurthyP. ChandraG. Gururaj2005Women and alcohol in India. Alcohol, gender and drinking problems: perspectives from low and middle income countries.IS ObotR. RoomGenevaWorld Health Organisation89124Available: http://www.who.int/substance_abuse/publications/alcohol_gender_drinking_ problems. pdf]. Accessed on 9 September 2009. Available: http://www.who.int/substance_abuse/publications/alcohol_gender_drinking_ problems. pdf]. Accessed on 9 September 2009.
  8. 8. Saunders JB, Aasland OG, Babor TF, De La Fuente JR, Grant M (1993) Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction 88: 791–804.JB SaundersOG AaslandTF BaborJR De La FuenteM. Grant1993Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II.Addiction88791804
  9. 9. World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization. World Health Organization1992The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic GuidelinesGenevaWorld Health Organization
  10. 10. Rehm J, Rehn N, Room R, Monteiro M, Gmel G, et al. (2003) The global distribution of average volume of alcohol consumption and patterns of drinking. Europ Addict Res 9: 147–156.J. RehmN. RehnR. RoomM. MonteiroG. Gmel2003The global distribution of average volume of alcohol consumption and patterns of drinking.Europ Addict Res9147156
  11. 11. Gururaj G, Girish N, Benegal V (2006) Alcohol Control Series 1: Burden and Socio-Economic Impact of Alcohol - The Bangalore Study. New Delhi: World health Organisation, Regional Office for South East Asia. G. GururajN. GirishV. Benegal2006Alcohol Control Series 1: Burden and Socio-Economic Impact of Alcohol - The Bangalore StudyNew DelhiWorld health Organisation, Regional Office for South East AsiaISBN 92 9022 2727. ISBN 92 9022 2727.
  12. 12. Anderson P (1991) Alcohol as a key area. BMJ 303: 766–769.P. Anderson1991Alcohol as a key area.BMJ303766769
  13. 13. Babor T, Stenius K, Romelsjo A (2008) Alcohol and drug treatment systems in public health perspective: mediators and moderators of population effects. Int J Methods Psychiatr Res 17: S50–S59.T. BaborK. SteniusA. Romelsjo2008Alcohol and drug treatment systems in public health perspective: mediators and moderators of population effects.Int J Methods Psychiatr Res17S50S59
  14. 14. Perngparn U, Assanangkornchai S, Pilley C, Aramrattana A (2008) Drug and alcohol services in middle-income countries. Curr Opin Psychiatry 21: 229–233.U. PerngparnS. AssanangkornchaiC. PilleyA. Aramrattana2008Drug and alcohol services in middle-income countries.Curr Opin Psychiatry21229233
  15. 15. Benegal V (2005) India: alcohol and public health. Addiction 100: 1051–1056.V. Benegal2005India: alcohol and public health.Addiction10010511056
  16. 16. Parry CDH (2005) Substance abuse intervention in South Africa. World Psychiatry 4: 34–35.CDH Parry2005Substance abuse intervention in South Africa.World Psychiatry43435
  17. 17. Ray R (2004) Substance abuse and the growth of de-addiction centres: the challenge of our times. In: Agarwal SP, editor. Mental health: an Indian perspective, 1946–2003. New Delhi: Elsevier. pp. 284–289.R. Ray2004Substance abuse and the growth of de-addiction centres: the challenge of our times.SP AgarwalMental health: an Indian perspective, 1946–2003.New DelhiElsevier 284289
  18. 18. Kohn R, Saxena S, Levav I, Saraceno B (2004) The treatment gap in mental health care. Bull World Health Organ 82: 858–866.R. KohnS. SaxenaI. LevavB. Saraceno2004The treatment gap in mental health care.Bull World Health Organ82858866Available: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862004001100011&lng=en. Accessed 9 September 2009. Available: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862004001100011&lng=en. Accessed 9 September 2009.
  19. 19. Peltzer K, Matseke G, Azwihangwisi M, Babor T (2008) Evaluation of alcohol screening and brief intervention in routine practice of primary care nurses in Vhembe District, South Africa. Croat Med J 49: 392–401.K. PeltzerG. MatsekeM. AzwihangwisiT. Babor2008Evaluation of alcohol screening and brief intervention in routine practice of primary care nurses in Vhembe District, South Africa.Croat Med J49392401
  20. 20. Lotrakul M, Saipanish R (2006) Psychiatric services in primary care settings: a survey of general practitioners in Thailand. BMC Fam Pract 7: 48.M. LotrakulR. Saipanish2006Psychiatric services in primary care settings: a survey of general practitioners in Thailand.BMC Fam Pract748
  21. 21. Benegal V, Gururaj G, Murthy P (2002) Project report on a WHO multi centre collaborative project: on establishing and monitoring alcohol's involvement in casualties; 2000–2001 [monograph on the Internet]. V. BenegalG. GururajP. Murthy2002Project report on a WHO multi centre collaborative project: on establishing and monitoring alcohol's involvement in casualties; 2000–2001 [monograph on the Internet].Available: http://www.nimhans.kar.nic.in/Deaddiction/lit/Alcohol%20and%20%20Injuries_WHO%20Collab.pdf. Accessed 9 September 2009. Available: http://www.nimhans.kar.nic.in/Deaddiction/lit/Alcohol%20and%20%20Injuries_WHO%20Collab.pdf. Accessed 9 September 2009.
  22. 22. Chisholm D, Rehm J, Van Ommeren M, Monteiro M (2004) Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis. J Stud Alcohol 65: 782–793.D. ChisholmJ. RehmM. Van OmmerenM. Monteiro2004Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis.J Stud Alcohol65782793
  23. 23. Ewing John A (1984) Detecting alcoholism: the CAGE questionnaire. JAMA 252: 1905–1907.A. Ewing John1984Detecting alcoholism: the CAGE questionnaire.JAMA25219051907
  24. 24. Patton R, Crawford M, Touquet R (2004) Hazardous drinkers in the accident and emergency department: who accepts advice? Emerg Med J 21: 491–492.R. PattonM. CrawfordR. Touquet2004Hazardous drinkers in the accident and emergency department: who accepts advice?Emerg Med J21491492
  25. 25. Borges A, Cherpitel CJ (2001) Selection of screening items for alcohol abuse and alcohol dependence among Mexicans and Mexican Americans in the emergency department. J Stud Alcohol 62: 277–285.A. BorgesCJ Cherpitel2001Selection of screening items for alcohol abuse and alcohol dependence among Mexicans and Mexican Americans in the emergency department.J Stud Alcohol62277285
  26. 26. Saunders J, Aasland O, Babor T, de la Fuente J, Grant M (1993) Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption – II. Addiction 88: 791–804.J. SaundersO. AaslandT. BaborJ. de la FuenteM. Grant1993Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption – II.Addiction88791804
  27. 27. Giang KB, Spak F, Dzung TV, Allebeck P (2005) The use of audit to assess level of alcohol problems in rural Vietnam. Alcohol Alcohol 40: 578–583.KB GiangF. SpakTV DzungP. Allebeck2005The use of audit to assess level of alcohol problems in rural Vietnam.Alcohol Alcohol40578583
  28. 28. Lima CT, Freire AC, Silva AP, Teixeira RM, Farrell M, et al. (2005) Concurrent and construct validity of the audit in an urban Brazilian sample. Alcohol Alcohol 40: 584–589.CT LimaAC FreireAP SilvaRM TeixeiraM. Farrell2005Concurrent and construct validity of the audit in an urban Brazilian sample.Alcohol Alcohol40584589
  29. 29. Adewuya AO (2005) Validation of the alcohol use disorders identification test (audit) as a screening tool for alcohol-related problems among Nigerian university students. Alcohol Alcohol 40: 575–577.AO Adewuya2005Validation of the alcohol use disorders identification test (audit) as a screening tool for alcohol-related problems among Nigerian university students.Alcohol Alcohol40575577
  30. 30. Kaner EFS, Dickinson HO, Beyer F, Pienaar E, Campbell F, et al. (2007) Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 18: CD004148.EFS KanerHO DickinsonF. BeyerE. PienaarF. Campbell2007Effectiveness of brief alcohol interventions in primary care populations.Cochrane Database Syst Rev18CD004148
  31. 31. Bertholet N, Daeppen J-B, Wietlisbach V, Fleming M, Burnand B (2005) Reduction of alcohol consumption by brief alcohol intervention in primary care. Arch Intern Med 165: 986–995.N. BertholetJ-B DaeppenV. WietlisbachM. FlemingB. Burnand2005Reduction of alcohol consumption by brief alcohol intervention in primary care.Arch Intern Med165986995
  32. 32. Ballesteros J, Duffy JC, Querejeta I, Arino J, Gonzalez-Pinto A (2004) Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses. Alcohol Clin Exp Res 28: 608–618.J. BallesterosJC DuffyI. QuerejetaJ. ArinoA. Gonzalez-Pinto2004Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses.Alcohol Clin Exp Res28608618
  33. 33. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J (2004) Behavioral counselling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 140: 557–568.EP WhitlockMR PolenCA GreenT. OrleansJ. Klein2004Behavioral counselling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the US Preventive Services Task Force.Ann Intern Med140557568
  34. 34. Poikolainen K (1999) Effectiveness of brief interventions to reduce alcohol intake in primary health care populations: a meta-analysis. Prev Med 28: 503–509.K. Poikolainen1999Effectiveness of brief interventions to reduce alcohol intake in primary health care populations: a meta-analysis.Prev Med28503509
  35. 35. Kahan M, Wilson L, Becker L (1995) Effectiveness of physician-based interventions with problem drinkers: a review. Can Med Assoc J 152: 851–859.M. KahanL. WilsonL. Becker1995Effectiveness of physician-based interventions with problem drinkers: a review.Can Med Assoc J152851859
  36. 36. Raistrick D, Heather N, Godfrey C (2006) Review of the effectiveness of treatment for alcohol problems. D. RaistrickN. HeatherC. Godfrey2006Review of the effectiveness of treatment for alcohol problems.London, National Treatment Agency for Substance Misuse, Available: http://www.nta.nhs.uk/publications/documents/nta_review_of_the_effectiveness_of_treatment_for_alcohol_problems_fullreport_2006_alcohol2.pdf. Accessed 9 September 2009. London, National Treatment Agency for Substance Misuse, Available: http://www.nta.nhs.uk/publications/documents/nta_review_of_the_effectiveness_of_treatment_for_alcohol_problems_fullreport_2006_alcohol2.pdf. Accessed 9 September 2009.
  37. 37. Simão MO, Kerr-Corrêa F, Smaira SI, Trinca LA, Floripes TM, et al. (2008) Prevention of “risky” drinking among students at a Brazilian university. Alcohol Alcohol 43: 470–476.MO SimãoF. Kerr-CorrêaSI SmairaLA TrincaTM Floripes2008Prevention of “risky” drinking among students at a Brazilian university.Alcohol Alcohol43470476
  38. 38. Pal HR, Yadav D, Mehta S, Mohan I (2007) A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months. Alcohol Alcohol 42: 328–332.HR PalD. YadavS. MehtaI. Mohan2007A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months.Alcohol Alcohol42328332
  39. 39. Tsai YF, Tsai MC, Lin YP, Chen CY (2009) Brief intervention for problem drinkers in a Chinese population: a randomized controlled trial in a hospital setting. Alcohol Clin Exp Res 33: 95–101.YF TsaiMC TsaiYP LinCY Chen2009Brief intervention for problem drinkers in a Chinese population: a randomized controlled trial in a hospital setting.Alcohol Clin Exp Res3395101
  40. 40. Anderson P, Chisholm D, Fuhr DC (2009) Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet 373: 2234–2246.P. AndersonD. ChisholmDC Fuhr2009Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.Lancet37322342246
  41. 41. Kristenson H, Osterling A, Nilsson JA, Lindgärde F (2002) Prevention of alcohol-related deaths in middle-aged heavy drinkers. Alcohol Clin Exp Res 26: 478–484.H. KristensonA. OsterlingJA NilssonF. Lindgärde2002Prevention of alcohol-related deaths in middle-aged heavy drinkers.Alcohol Clin Exp Res26478484
  42. 42. Babor TF, Del Boca FK, editors. (2003) Treatment matching in alcoholism. Cambridge: Cambridge University Press. TF BaborFK Del Boca2003Treatment matching in alcoholismCambridgeCambridge University Press
  43. 43. UKATT Research Team (2005) Effectiveness of treatment for alcohol problems: findings of the randomised UK Alcohol Treatment Trial (UKATT). BMJ 311: 541–544.UKATT Research Team2005Effectiveness of treatment for alcohol problems: findings of the randomised UK Alcohol Treatment Trial (UKATT).BMJ311541544
  44. 44. Berglund M, Thelander S, Salaspuro M, Franck J, Andréasson S, et al. (2003) Treatment of alcohol abuse: an evidence-based review. Alcohol Clin Exp Res 27: 1645–1656.M. BerglundS. ThelanderM. SalaspuroJ. FranckS. Andréasson2003Treatment of alcohol abuse: an evidence-based review.Alcohol Clin Exp Res2716451656
  45. 45. Walters GD (2000) Behavioural self-control training for problem drinkers: a meta-analysis of randomized control studies. Behav Ther 31: 135–149.GD Walters2000Behavioural self-control training for problem drinkers: a meta-analysis of randomized control studies.Behav Ther31135149
  46. 46. Im SB, Yoo EH, Kim JS, Kim GJ (2007) Adapting a cognitive behavioral program in treating alcohol dependence in South Korea. Perspect Psychiatr Care 43: 183–192.SB ImEH YooJS KimGJ Kim2007Adapting a cognitive behavioral program in treating alcohol dependence in South Korea.Perspect Psychiatr Care43183192
  47. 47. Ferri MMF, Amato L, Davoli M (2006) Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database Syst Rev19: CD005032.MMF FerriL. AmatoM. Davoli2006Alcoholics Anonymous and other 12-step programmes for alcohol dependence.Cochrane Database SystRev19CD005032
  48. 48. Ntais C, Pakos E, Kyzas P, Ioannidis JPA (2005) Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev 3: CD005063.C. NtaisE. PakosP. KyzasJPA Ioannidis2005Benzodiazepines for alcohol withdrawal.Cochrane Database Syst Rev3CD005063
  49. 49. Kumar CN, Andrade C, Murthy P (2009) A randomized, double-blind comparison of lorazepam and chlordiazepoxide in patients with uncomplicated alcohol withdrawal. J Stud Alcohol Drugs 70: 457–474.CN KumarC. AndradeP. Murthy2009A randomized, double-blind comparison of lorazepam and chlordiazepoxide in patients with uncomplicated alcohol withdrawal.J Stud Alcohol Drugs70457474
  50. 50. Fuller RK, Branchey L, Brightwell DR, Derman RM, Emrick CD, et al. (1986) Disulfiram treatment of alcoholism. A Veterans Administration cooperative study. JAMA 256: 1449–1455.RK FullerL. BrancheyDR BrightwellRM DermanCD Emrick1986Disulfiram treatment of alcoholism. A Veterans Administration cooperative study.JAMA25614491455
  51. 51. Grover S, Basu D (2004) The revival (or, rather, survival) of disulfiram. Addiction 99: 785.S. GroverD. Basu2004The revival (or, rather, survival) of disulfiram.Addiction99785
  52. 52. Johnson BA (2008) Update on neuropharmacological treatments for alcoholism: scientific basis and clinical findings. Biochem Pharmacol 75: 34–56.BA Johnson2008Update on neuropharmacological treatments for alcoholism: scientific basis and clinical findings.Biochem Pharmacol753456
  53. 53. Killeen TK, Brady KT, Gold PB, Simpson KN, Faldowski RA, et al. (2004) Effectiveness of naltrexone in a community treatment program. Alcohol Clin Exp Res 28: 1710–1717.TK KilleenKT BradyPB GoldKN SimpsonRA Faldowski2004Effectiveness of naltrexone in a community treatment program.Alcohol Clin Exp Res2817101717
  54. 54. Srisurapanont M, Jarusuraisin N (2005) Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev 25: CD001867.M. SrisurapanontN. Jarusuraisin2005Opioid antagonists for alcohol dependence.Cochrane Database Syst Rev25CD001867
  55. 55. Bouza C, Angeles M, Munoz A, Amate JM (2004) Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review. Addiction 99: 811–828.C. BouzaM. AngelesA. MunozJM Amate2004Efficacy and safety of naltrexone and acamprosate in the treatment of alcohol dependence: a systematic review.Addiction99811828
  56. 56. Garbutt JC, Kranzler HR, O'Malley SS, Gastfriend DR, Pettinati HM, et al. (2005) Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial. JAMA 293: 1617–1625.JC GarbuttHR KranzlerSS O'MalleyDR GastfriendHM Pettinati2005Efficacy and tolerability of long-acting injectable naltrexone for alcohol dependence: a randomized controlled trial.JAMA29316171625
  57. 57. Anton RF, O'Malley SS, Ciraulo DA, Cisler RA, Couper D, et al. (2006) Combined pharmaco-therapies and behavioral interventions for alcohol dependence — The COMBINE Study: a randomized controlled trial. JAMA 295: 2003–2017.RF AntonSS O'MalleyDA CirauloRA CislerD. Couper2006Combined pharmaco-therapies and behavioral interventions for alcohol dependence — The COMBINE Study: a randomized controlled trial.JAMA29520032017
  58. 58. Huang MC, Chen CH, Yu JM, Chen CC (2005) A double-blind, placebo-controlled study of naltrexone in the treatment of alcohol dependence in Taiwan. Addict Biol 10: 289–292.MC HuangCH ChenJM YuCC Chen2005A double-blind, placebo-controlled study of naltrexone in the treatment of alcohol dependence in Taiwan.Addict Biol10289292
  59. 59. Ahmadi J, Babaeebeigi M, Maany I, Porter J, Mohagheghzadeh M, et al. (2004) Naltrexone for alcohol-dependent patients. Ir J Med Sci 173: 34–37.J. AhmadiM. BabaeebeigiI. MaanyJ. PorterM. Mohagheghzadeh2004Naltrexone for alcohol-dependent patients.Ir J Med Sci1733437
  60. 60. Volpicelli JR, Rhines KC, Rhines JS, Volpicelli LA, Alterman AI, et al. (1997) Naltrexone and alcohol dependence: role of subject compliance. Arch Gen Psychiatry 54: 737–742.JR VolpicelliKC RhinesJS RhinesLA VolpicelliAI Alterman1997Naltrexone and alcohol dependence: role of subject compliance.Arch Gen Psychiatry54737742
  61. 61. Krishnan-Sarin S, Krystal JH, Shi J, Pittman B, O'Malley SS (2007) Family history of alcoholism influences naltrexone-induced reduction in alcohol drinking. Biol Psychiatry 62: 694–697.S. Krishnan-SarinJH KrystalJ. ShiB. PittmanSS O'Malley2007Family history of alcoholism influences naltrexone-induced reduction in alcohol drinking.Biol Psychiatry62694697
  62. 62. Mann K, Lehert P, Morgan MY (2004) The efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals: results of a meta-analysis. Alcohol Clin Exp Res 28: 51–63.K. MannP. LehertMY Morgan2004The efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals: results of a meta-analysis.Alcohol Clin Exp Res285163
  63. 63. Kranzler HR, Van Kirk J (2001) Efficacy of naltrexone and acamprosate for alcoholism treatment: a meta-analysis. Alcohol Clin Exp Res 25: 1335–1341.HR KranzlerJ. Van Kirk2001Efficacy of naltrexone and acamprosate for alcoholism treatment: a meta-analysis.Alcohol Clin Exp Res2513351341
  64. 64. Chick J, Lehert P, Landron F, Plinius Maior Society (2003) Does acamprosate improve reduction of drinking as well as aiding abstinence? J Psychopharmacol 17: 397–402.J. ChickP. LehertF. LandronPlinius Maior Society2003Does acamprosate improve reduction of drinking as well as aiding abstinence?J Psychopharmacol17397402
  65. 65. Namkoong K, Lee BO, Lee PG, Choi MJ, Lee E (2003) Acamprosate in Korean alcohol-dependent patients: a multi-centre, randomized, double-blind, placebo-controlled study. Alcohol Alcohol 38: 135–141.K. NamkoongBO LeePG LeeMJ ChoiE. Lee2003Acamprosate in Korean alcohol-dependent patients: a multi-centre, randomized, double-blind, placebo-controlled study.Alcohol Alcohol38135141
  66. 66. Rosner S, Leucht S, Lehert P, Soyka M (2008) Acamprosate supports abstinence, Naltrexone prevents excessive drinking: evidence from a meta-analysis with unreported outcomes. J Psychopharmacol 22: 11–23.S. RosnerS. LeuchtP. LehertM. Soyka2008Acamprosate supports abstinence, Naltrexone prevents excessive drinking: evidence from a meta-analysis with unreported outcomes.J Psychopharmacol221123
  67. 67. Johnson BA, Ait-Daoud N, Bowden CL, DiClemente CC, Roache JD, et al. (2003) Oral topiramate for treatment of alcohol dependence: a randomised controlled trial. Lancet 361: 1677–1685.BA JohnsonN. Ait-DaoudCL BowdenCC DiClementeJD Roache2003Oral topiramate for treatment of alcohol dependence: a randomised controlled trial.Lancet36116771685
  68. 68. Ma JZ, Ait-Daoud N, Johnson BA (2006) Topiramate reduces the harm of excessive drinking: implications for public health and primary care. Addiction 101: 1561–1568.JZ MaN. Ait-DaoudBA Johnson2006Topiramate reduces the harm of excessive drinking: implications for public health and primary care.Addiction10115611568
  69. 69. De Sousa AA, De Sousa J, Kapoor H (2008) An open randomized trial comparing disulfiram and topiramate in the treatment of alcohol dependence. J Subst Abuse Treat 34: 460–463.AA De SousaJ. De SousaH. Kapoor2008An open randomized trial comparing disulfiram and topiramate in the treatment of alcohol dependence.J Subst Abuse Treat34460463
  70. 70. Addolorato G, Caputo F, Capristo E, Domenicali M, Bernardi M, et al. (2002) Baclofen efficacy in reducing alcohol craving and intake: a preliminary double-blind randomized controlled study. Alcohol Alcohol 37: 504–508.G. AddoloratoF. CaputoE. CapristoM. DomenicaliM. Bernardi2002Baclofen efficacy in reducing alcohol craving and intake: a preliminary double-blind randomized controlled study.Alcohol Alcohol37504508
  71. 71. Addolorato G, Leggio L, Ferrulli A, Cardone S, Vonghia L, et al. (2007) Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet 370: 1915–1922.G. AddoloratoL. LeggioA. FerrulliS. CardoneL. Vonghia2007Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study.Lancet37019151922
  72. 72. Siqueira MM, Barbosa DA, Larajeira R, Hopkins K (2007) Psychoactive substances and the provision of specialized care: the case of Espirito Santo. Rev Bras Psiquiatr 29: 315–323.MM SiqueiraDA BarbosaR. LarajeiraK. Hopkins2007Psychoactive substances and the provision of specialized care: the case of Espirito Santo.Rev Bras Psiquiatr29315323
  73. 73. Benegal V, Bajpai A, Basu D, Bohra N, Chatterji S, et al. (2007) Proposal to the Indian Psychiatric Society for adopting a specialty section on addiction medicine (alcohol and other substance abuse). Indian J Psychiatry 49: 277–282.V. BenegalA. BajpaiD. BasuN. BohraS. Chatterji2007Proposal to the Indian Psychiatric Society for adopting a specialty section on addiction medicine (alcohol and other substance abuse).Indian J Psychiatry49277282
  74. 74. WHO (2001) WHO Report of the Commission on Macroeconomics and Health. Geneva: World Health Organization. WHO2001WHO Report of the Commission on Macroeconomics and HealthGenevaWorld Health Organization
  75. 75. Jutting J (2000) Social security systems in low-income countries: concepts, constraints and the need for cooperation. International Social Security Review 53: 3–25.J. Jutting2000Social security systems in low-income countries: concepts, constraints and the need for cooperation.International Social Security Review53325
  76. 76. Israel Y, Hollander O, Sanchez-Craig M, Booker S, Miller V, et al. (1996) Screening for problem drinking and counseling by the primary care physician-nurse team. Alcohol Clin Exp Res 20: 1443–1450.Y. IsraelO. HollanderM. Sanchez-CraigS. BookerV. Miller1996Screening for problem drinking and counseling by the primary care physician-nurse team.Alcohol Clin Exp Res2014431450
  77. 77. Crawford M, Patton R, Touquet R, Drummond C, Byford S, et al. (2004) Screening and referral for brief intervention of alcohol misusing patients in an Accident and Emergency Department: a pragmatic randomised controlled trial. Lancet 364: 1334–1339.M. CrawfordR. PattonR. TouquetC. DrummondS. Byford2004Screening and referral for brief intervention of alcohol misusing patients in an Accident and Emergency Department: a pragmatic randomised controlled trial.Lancet36413341339
  78. 78. Hutchings D, Cassidy P, Dallolio E, Pearson P, Heather N, et al. (2006) Implementing screening and brief alcohol interventions in primary care: views from both sides of the desk. Primary Care Research and Development 7: 221–229.D. HutchingsP. CassidyE. DallolioP. PearsonN. Heather2006Implementing screening and brief alcohol interventions in primary care: views from both sides of the desk.Primary Care Research and Development7221229
  79. 79. Hayashida M, Alterman AI, McLellan AT, O'Brien CP, Purtill JJ, et al. (1989) Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med 320: 358–365.M. HayashidaAI AltermanAT McLellanCP O'BrienJJ Purtill1989Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome.N Engl J Med320358365
  80. 80. Stockwell T, Bolt L, Milner I, Pugh P, Young I (1990) Home detoxification for problem drinkers: acceptability to clients, relatives, general practitioners and outcome after 60 days. Br J Addict 85: 61–70.T. StockwellL. BoltI. MilnerP. PughI. Young1990Home detoxification for problem drinkers: acceptability to clients, relatives, general practitioners and outcome after 60 days.Br J Addict856170
  81. 81. Chavan BS, Gupta N, Arun LRP, Chanderbala (2003) Camp Approach - an effective, alternate inpatient treatment setting for substance dependence: a report from India. German J Psychiatry 6: 17–22.BS ChavanN. GuptaLRP ArunChanderbala2003Camp Approach - an effective, alternate inpatient treatment setting for substance dependence: a report from India.German J Psychiatry61722
  82. 82. Saitz R, Horton NJ, Larson MJ, Winter M, Samet JH (2005) Primary medical care and reductions in addiction severity: a prospective cohort study. Addiction 100: 70–78.R. SaitzNJ HortonMJ LarsonM. WinterJH Samet2005Primary medical care and reductions in addiction severity: a prospective cohort study.Addiction1007078
  83. 83. Sobell MB, Sobell NC (2000) Stepped care as a heuristic approach to the treatment of alcohol problems. J Consult Clin Psychol 68: 573–579.MB SobellNC Sobell2000Stepped care as a heuristic approach to the treatment of alcohol problems.J Consult Clin Psychol68573579
  84. 84. Ernst DB, Pettinati HM, Weiss RD, Donovan DM, Longabaugh R (2008) An intervention for treating alcohol dependence: relating elements of Medical Management to patient outcomes with implications for primary care. Ann Fam Med 6: 435–440.DB ErnstHM PettinatiRD WeissDM DonovanR. Longabaugh2008An intervention for treating alcohol dependence: relating elements of Medical Management to patient outcomes with implications for primary care.Ann Fam Med6435440
  85. 85. Babor TF, Biddle-Higgins JC, Saunders JB, Monteiro MG (2001) AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Geneva: World Health Organization. TF BaborJC Biddle-HigginsJB SaundersMG Monteiro2001AUDIT: The Alcohol Use Disorders Identification Test: guidelines for use in primary health careGenevaWorld Health Organization
  86. 86. Babor T, Higgins-Biddle JC (2001) Brief intervention for hazardous and harmful drinking: a manual for primary care. Geneva: World Health Organization. T. BaborJC Higgins-Biddle2001Brief intervention for hazardous and harmful drinking: a manual for primary careGenevaWorld Health Organization
  87. 87. Cercarelli R, Allsop S, Midford R, Pidd K (2009) Workplace interventions for alcohol and other drug problems (Protocol). Cochrane Database Syst Rev CD007774.R. CercarelliS. AllsopR. MidfordK. Pidd2009Workplace interventions for alcohol and other drug problems (Protocol).Cochrane Database Syst RevCD007774
  88. 88. The Hindu (Staff reporter) (2008) Rehabilitation centres under scanner. The Hindu (Staff reporter)2008Rehabilitation centres under scanner.The Hindu. Available: http://www.hindu.com/2008/11/13/stories/2008111359620300.htm. Accessed 9 September 2009. The Hindu. Available: http://www.hindu.com/2008/11/13/stories/2008111359620300.htm. Accessed 9 September 2009.
  89. 89. World Health Organization. Mental Health Atlas (2005) World Health Organization. Mental Health Atlas2005Available: http://www.who.int/globalatlas/default.asp. Accessed 9 September 2009. Available: http://www.who.int/globalatlas/default.asp. Accessed 9 September 2009.
  90. 90. Miller WR, Zweben A, DiClemente CC, Rychtarik RGMotivational Enhancement Therapy Manual. Washington (D.C.): National Institute on Alcohol Abuse and Alcoholism. WR MillerA. ZwebenCC DiClementeRG RychtarikMotivational Enhancement Therapy ManualWashington (D.C.)National Institute on Alcohol Abuse and AlcoholismProject MATCH Monograph Series, volume 2. Available: http://casaa.unm.edu/manuals/met.pdf. Accessed 9 September 2009. Project MATCH Monograph Series, volume 2. Available: http://casaa.unm.edu/manuals/met.pdf. Accessed 9 September 2009.
  91. 91. Kadden R, Carroll K, Donovan D, Cooney N, Monti P, et al. (2004) Cognitive-behavioral coping skills therapy manual: a clinical research guide for therapists treating individuals with alcohol abuse and dependence. Washington (D.C.): National Institute on Alcohol Abuse and Alcoholism, Project MATCH Monograph Series, Volume 3. R. KaddenK. CarrollD. DonovanN. CooneyP. Monti2004Cognitive-behavioral coping skills therapy manual: a clinical research guide for therapists treating individuals with alcohol abuse and dependenceWashington (D.C.)National Institute on Alcohol Abuse and Alcoholism, Project MATCH Monograph Series, Volume 3Available: http://pubs.niaaa.nih.gov/publications/MATCHSeries3/index.htm. Accessed 9 September 2009. Available: http://pubs.niaaa.nih.gov/publications/MATCHSeries3/index.htm. Accessed 9 September 2009.
  92. 92. Patel V, Simon G, Chowdhary N, Kaaya S, Araya R (2009) Packages of care for depression in low- and middle-income countries. PLoS Med 6: e159.V. PatelG. SimonN. ChowdharyS. KaayaR. Araya2009Packages of care for depression in low- and middle-income countries.PLoS Med6e159
  93. 93. Casswell S, Thamarangsi T (2009) Reducing harm from alcohol: call to action. Lancet 373: 2247–2257.S. CasswellT. Thamarangsi2009Reducing harm from alcohol: call to action.Lancet37322472257
  94. 94. Laaksonen E, Koski-Jännes A, Salaspuro M, Ahtinen H, Alho H (2008) A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Alcohol Alcohol 43: 53–61.E. LaaksonenA. Koski-JännesM. SalaspuroH. AhtinenH. Alho2008A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence.Alcohol Alcohol435361