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

Date Published: October 27, 2009

Publisher: Public Library of Science

Author(s): Vivek Benegal, Prabhat K. Chand, Isidore S. Obot, Vikram Patel

Abstract: In the fourth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Vivek Benegal and colleagues discuss the treatment of alcohol use disorders.

Partial Text: 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].

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.

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.

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.



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