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

PLoS Med 6(10): e1000170.

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.

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