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Background Counselling for Alcohol Problems (CAP), a brief intervention delivered by lay counsellors, enhanced remission and abstinence over 3 months among male primary care attendees with harmful drinking in a setting in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of CAP over 12 months, and the effects of the hypothesized mediator `readiness to change' on clinical outcomes. Methods and findings Male primary care attendees aged 18±65 years screening with harmful drinking on the Alcohol Use Disorders Identification Test (AUDIT) were randomised to either CAP plus enhanced usual care (EUC) (n = 188) or EUC alone (n = 189), of whom 89% completed assessments at 3 months, and 84% at 12 months. Primary outcomes were remission and mean standard ethanol consumed in the past 14 days, and the proposed mediating variable was readiness to change at 3 months. CAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up, with the proportion with remission (AUDIT score < 8: 54.3% versus 31.9%; adjusted prevalence ratio [aPR] 1.71 [95% CI 1.32, 2.22]; p < 0.001) and abstinence in the past 14 days (45.1% versus 26.4%; adjusted odds ratio 1.92 [95% CI 1.19, 3.10]; p = 0.008) being significantly higher in the CAP plus EUC arm than in the EUC alone arm. CAP participants also fared better on secondary outcomes including recovery (AUDIT score < 8 at 3 and 12 months: 27.4% versus 15.1%; aPR 1.90 [95% CI 1.21, 3.00]; p = 0.006) and percent of days abstinent (mean percent [SD] 71.0% [38.2] versus 55.0% [39.8]; adjusted mean difference 16.1 [95% CI 7.1, 25.0]; p = 0.001). The intervention effect for remission was higher at 12 months than at 3 months (aPR 1.50 [95% CI 1.09, 2.07]). There was no evidence of an intervention effect on Patient Health Questionnaire 9 score, suicidal behaviour, percentage of days of heavy drinking, Short Inventory of Problems score, WHO Disability Assessment Schedule 2.0 score, days unable to work, or perpetration of intimate partner violence. Economic analyses indicated that CAP plus EUC was dominant over EUC alone, with lower costs and better outcomes; uncertainty analysis showed a 99% chance of CAP being cost-effective per remission achieved from a health system perspective, using a willingness to pay threshold equivalent to 1 month's wages for an unskilled manual worker in Goa. Readiness to change level at 3 months mediated the effect of CAP on mean standard ethanol consumption at 12 months (indirect effect −6.014 [95% CI −13.99, −0.046]). Serious adverse events were infrequent, and prevalence was similar by arm. The methodological limitations of this trial are the susceptibility of self-reported drinking to social desirability bias, the modest participation rates of eligible patients, and the examination of mediation effects of only 1 mediator and in only half of our sample. Conclusions CAP's superiority over EUC at the end of treatment was largely stable over time and was mediated by readiness to change. CAP provides better outcomes at lower costs from a societal perspective.

Emerging technologies, such as the Internet and text messaging, have an ever-growing role in providing services to problem drinkers. This article summarizes selected examples of emerging technologies that have been developed and implemented as stand-alone interventions and as part of other face-to-face interventions. It provides a taste of the different opportunities available for implementing emerging technologies as a way to improve the accessibility and effectiveness of services for problem drinkers.

BACKGROUND & AIMS: To undertake the first randomised controlled trial to evaluate the effectiveness of a brief intervention delivered by community pharmacists to reduce hazardous or harmful drinking.DESIGN: This parallel group individually randomised trial, allocated participants to brief alcohol intervention (n = 205) or a leaflet-only control condition (n = 202), with follow-up study after 3 months.SETTING: 16 community pharmacies in one London borough, UK.PARTICIPANTS: 407 pharmacy customers (aged 18 or over) with AUDIT scores 8-19 inclusive.INTERVENTION: A brief motivational discussion of approximately 10 minutes duration for which 17 pharmacists received a half-day of training.MEASUREMENTS: Hazardous or harmful drinking was assessed using the Alcohol Use Disorders Identification Test (AUDIT) administered by telephone by a researcher blind to allocation status. The two primary outcomes were: 1) change in AUDIT total scores and 2) the proportions no longer hazardous or harmful drinkers (scoring FINDINGS: At 3 months 326 (80% overall; 82% intervention, 78% control) participants were followed up. The difference in reduction in total AUDIT score (intervention minus control) was -0.57 95% CI -1.59 to 0.45, p = 0.28. The odds ratio for AUDIT CONCLUSIONS: A brief intervention delivered by community pharmacists appears to have had no effect in reducing hazardous or harmful alcohol consumption.

A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.

Background: Diarrhoeal diseases are an important cause of morbidity and mortality in children under five years old in South Asia and Sub-Saharan Africa. Handwashing with soap after contact with faeces is a cost-effective way of preventing diarrhoea. However, handwashing with soap frequencies are low in many settings. Aim: The study aimed to design and evaluate two interventions to increase handwashing with soap after using the toilet, in housing compounds in Koumassi commune, Abidjan, Côte d’Ivoire. Methods: We randomly assigned 75 compounds to one of three arms in a 1:1:1 ratio. One arm received an intervention package comprising disgust-inducing handwashing messages, designed using the Theory of Normative Social Behaviour, and a handwashing station (TNSB); the second arm received only the handwashing station (HWS-only); the third arm served as a control group. The primary outcome was the proportion of occasions when hands were washed with soap after using the toilet, measured at the one-month and five-month post-intervention delivery. Results: One month post intervention, handwashing with soap somewhat increased from a baseline frequency of 3% to 9% in the HWS-only intervention group, and from 7% to 24% in the TNSB-based handwashing intervention group. In the control group, handwashing with soap changed little (from 6% at baseline to 5%). There was strong evidence (P