Abstract
Problem drinking accounts for 9.6% of disability-adjusted life years worldwide. It disproportionally affects men and has disabling physical, psychological, and behavioral consequences. These can lead to a cascade of negative effects on men's families, with documented ties to intimate partner violence (IPV) and child maltreatment. These multi-level problems are often exacerbated where poverty rates are high, including low and middle-income countries (LMICs). In contexts where strong patriarchal norms place men in positions of power, family-level consequences are often even more pronounced. We conducted a systematic review of the literature on interventions in LMICs targeting men's problem drinking and any family-related outcomes. Cochrane and PRISMA procedures guided the review. The search was conducted in PsychInfo, PubMed, and Web of Science. The search yielded 1357 publications. Nine studies from four different countries met inclusion criteria. Of those, only one had the primary goal of simultaneously improving drinking and a related family-level outcome (IPV). Six of the studies documented modest improvements on both drinking and couples or family outcomes. Strategies common to these included cognitive-behavioral techniques, communication skills training, narrative therapy, and participatory learning. Gender-transformative approaches were associated with reduced IPV and more equitable gender norms, and motivational interviewing and behavioral approaches were beneficial for reducing alcohol use. Findings highlight the scarcity of interventions addressing men's drinking and its effects on families, particularly for parent-child outcomes. However, results point to strategies that, combined with other evidence-based family interventions can guide the development and rigorous evaluation of integrated programs.
Highlights
Problem drinking accounts for 9.6% of disability-adjusted life years worldwide
We systematically review interventions conducted in low and middle-income countries (LMICs) that measured both men’s alcohol use and at least one family outcome as either primary or secondary to identify intervention strategies implemented in LMICs associated with changes in these domains
Studies were included if they met the following criteria: (1) Described any intervention evaluation examining at least one alcohol-use outcome for men and at least one family-related outcome; family-related was defined as any relationship-based family variable
Summary
Problem drinking accounts for 9.6% of disability-adjusted life years worldwide It disproportionally affects men and has disabling physical, psychological, and behavioral consequences. These can lead to a cascade of negative effects on men’s families, with documented ties to intimate partner violence (IPV) and child maltreatment. The ecological-transactional model is a helpful framework for examining effects of male drinking across family systems while accounting for powerful and dynamic societal influences (Sameroff, 1975; Cicchetti & Lynch, 1993; Bronfenbrenner, 1994) This model may be especially helpful for examining and disentangling consequences of male alcohol use in low and middle-income countries (LMICs), given that it emphasizes the importance of cultural and contextual factors, including economic factors, that impact the nature and manifestation of alcoholrelated outcomes
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