title: The systematic development and pilot randomized evaluation of counselling for alcohol problems, a lay counselor-delivered psychological treatment for harmful drinking in primary care in India: the PREMIUM study.
abstract: BACKGROUND
  Despite harmful drinking causing a significant burden on global health, there is a large treatment gap, especially in low- and middle-income countries. A major barrier to care is the lack of adequately skilled human resources to deliver contextually appropriate treatments. This paper describes the systematic process used to develop Counselling for Alcohol Problems (CAP), a brief psychological treatment (PT) for delivery by lay counselors in routine primary care settings to men with harmful drinking in India.
  
  
  METHODS
  CAP was developed using a methodology involving 3 sequential steps: (i) identifying potential treatment strategies; (ii) developing a theoretical framework for the treatment; and (iii) evaluating the acceptability and feasibility of the treatment.
  
  
  RESULTS
  CAP is a 3-phase treatment delivered over 1 to 4 sessions based on a motivational interviewing (MI) stance and involves the following strategies: assessment and personalized feedback, family engagement, drink refusal skills, skills to address drinking urges, problem-solving skills and handling difficult emotions, and relapse prevention and management. Data from a case series were used to inform several adaptations to enhance the acceptability of CAP to the recipients and feasibility of delivery by lay counselors of the treatment, for example expansion of the target group to include alcohol-dependent patients and the extension of the delivery settings to include home-based delivery. There was preliminary evidence of the effectiveness of CAP.
  
  
  CONCLUSIONS
  CAP is an acceptable brief PT for harmful drinking delivered by lay counselors in primary care whose effectiveness is currently being tested in a randomized controlled trial based in primary care in Goa, India.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, United Kingdom; Sangath, Goa, India.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Nadkarni
authors.forename: Richard
authors.initials: R
authors.lastname: Velleman
authors.forename: Hamid
authors.initials: H
authors.lastname: Dabholkar
authors.forename: Sachin
authors.initials: S
authors.lastname: Shinde
authors.forename: Bhargav
authors.initials: B
authors.lastname: Bhat
authors.forename: Jim
authors.initials: J
authors.lastname: McCambridge
authors.forename: Pratima
authors.initials: P
authors.lastname: Murthy
authors.forename: Terry
authors.initials: T
authors.lastname: Wilson
authors.forename: Benedict
authors.initials: B
authors.lastname: Weobong
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology / Q000628:therapy; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003376:Counseling / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011897:Random Allocation; D016896:Treatment Outcome
keywords: Harmful Drinking; India; Lay Counselors; Primary Care; Psychological Treatment