A lay-counsellor delivered brief psychological treatment for men with comorbid Alcohol Use Disorder and depression in primary care: Secondary analysis of data from a randomized controlled trial

Jasper Synowski,Helen A Weiss,Richard Velleman,Vikram Patel,Abhijit Nadkarni

doi:10.1016/j.drugalcdep.2021.108961

Abstract

BackgroundWe investigated the feasibility, acceptability, safety, and preliminary effectiveness of the Counselling for Alcohol Problems (CAP) psychological intervention delivered by non-specialist health workers (NSHW) to participants with alcohol use disorder (AUD) and comorbid depression in primary care. MethodsWe used data from a single blind randomised controlled trial conducted in ten primary health care centres in Goa, India. Adult male harmful or dependent drinkers with or without depression were randomized (1:1) to receive either CAP & enhanced usual care (EUC) or EUC only. Process indicators such as the number of completed counselling sessions were assessed and compared between comorbid and non-comorbid participants. Remission from AUD and depression along with abstinence were measured at 3 and 12 months post randomisation. Analyses were on an intention-to-treat basis, employing multivariable regression analyses. Results271 participants had symptoms of comorbid depression; 241 did not. Both groups completed a similar number of counselling sessions (adjusted Mean Difference 0.05, 95 %CI −0.24–0.34;p = 0.72). Among comorbid participants, CAP did not lead to more frequent adverse events compared to EUC only (adjusted Odds Ratio [aOR] 0.84, 0.43–1.64;p = 0.62), and there was no evidence for an effect of CAP on remission from AUD or depression at 3 months (aOR 1.51, 0.84–2.74;p = 0.17 and aOR 0.74, 0.43–1.27;p = 0.28) and 12 months follow-up, respectively (aOR 1.69, 0.96–3.01;p = 0.08 and aOR 1.08, 0.62–1.87;p = 0.79). ConclusionsBrief therapies like CAP can be safely delivered by NSHWs to patients with comorbid AUD and depression, but their effectiveness may be limited and requires further investigation.

Highlights

Alcohol Use Disorder (AUD) and depression account for a substantial burden of disease worldwide (Patel et al, 2016), and have a significant impact on a person’s quality of life, resulting in a reduced ability to participate in social as well as occupational life
885 (6.0 %) participants screened positive for alcohol use disorder (AUD) (AUD≥12) overall, and 421 (2.8 %) had at least mild symptoms of comorbid depression. 512 patients (57.9 %) agreed to take part in the Counsel ling for Alcohol Problems (CAP) trial, with 257 (50.2 %) randomized to CAP + enhanced usual care (EUC) and 255 (49.8 %) randomized to EUC only
Exploratory findings from the group of comorbid patients suggest that delivering CAP does not seem to result in more frequent remission from depression compared to EUC only, it may have a positive effect on AUD-related outcomes

Summary

Introduction

Alcohol Use Disorder (AUD) and depression account for a substantial burden of disease worldwide (Patel et al, 2016), and have a significant impact on a person’s quality of life, resulting in a reduced ability to participate in social as well as occupational life. The existing evidence for this is mixed, with psychological interventions targeting alcohol use in co morbid AUD and depression leading to improved drinking outcomes but no effect on the symptoms of depression in some studies (Satre et al, 2016) and not having any effect even on the drinking outcomes in others (Grothues et al, 2008). On this background of inconclusive and con flicting evidence it is difficult to make a definitive recommendation. Conclusions: Brief therapies like CAP can be safely delivered by NSHWs to patients with comorbid AUD and depression, but their effectiveness may be limited and requires further investigation

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