Trial successfully lowers alcohol use in humanitarian setting

The first known randomized trial of an alcohol-reduction intervention in a humanitarian setting found a significant, sustained effect in lowering alcohol use. The study, which focused on the Mantapala refugee settlement in northern Zambia, was led by researchers at Columbia University Mailman School of Public Health, in collaboration with partners across six countries. The findings appear in the journal Lancet Global Health.

An estimated 123 million people were living in situations of forced displacement at the end of 2024, including over 36 million refugees. Armed conflict and displacement increase the risk of adverse health outcomes, including mental health conditions. Prominent among these are alcohol and other drug (AOD) use disorders, which remain largely neglected in humanitarian response and research.

The Ukuundapwa Chapamo randomized trial was conducted in the Mantapala refugee settlement, established in 2018 in response to the influx of refugees fleeing the Democratic Republic of the Congo. In Mantapala, like many refugee settlements, home-brewed alcohol is common, and the risk of cannabis and other drug use is high, serving as a coping mechanism for boredom, day-to-day stressors, experienced trauma, and mental health problems, which commonly co-occur with alcohol and other substance use.

As part of the study, non-specialists from the refugee and Zambian host community were trained to deliver mental health care under the supervision of mental health professionals. No other specialized mental health or substance use services were available within Mantapala. Individuals with urgent health needs were accompanied to a district-level hospital.

Following a baseline assessment, study participants were randomized 1:1 to a version of an intervention called SBIRT (Screening, Brief Intervention, and Referral to Treatment) or treatment as usual, which served as the control condition and involved referral to primary care providers for basic counseling in the Mantapala health clinic. In the SBIRT arm, staff assessed participants' current drinking patterns, the impacts of their alcohol use, and explored ways to change or reduce their alcohol use in a single 30-45-minute session. Individuals with higher risk or alcohol use or co-occurring other drug use and/or mental health problems received 6-12 weekly cognitive behavioral therapy sessions also provided by trained non-specialists from the community.

Follow-up assessments found that SBIRT significantly reduced alcohol use by 64 percent among Congolese refugees and Zambians, with moderate treatment effects sustained over 12 months. Secondary benefits included reducing symptoms of common mental disorders at six months, although these effects diminished by 12-month follow-up. No significant effects were observed for drug use.

A separate economic analysis found that while the intervention was less expensive than SBIRT models used in high-income countries, it will require dedicated financing and adaptation for sustainment in resource-constrained humanitarian settings.

This study advances understanding of how to deliver services that address alcohol and other drug use in highly resource-constrained emergency settings."

Claire Greene, PhD, assistant professor of population and family health and study's first author

The high rates of depression, anxiety, and PTSD that co-occurred with unhealthy alcohol use among this population also reinforce the need for alcohol and drug use interventions to be equipped to address comorbid mental health problems.

In all, 24 authors affiliated with universities, NGOs, and UN agencies across Australia, Denmark, the Netherlands, Switzerland, the United States, and Zambia contributed to the study. A complete list of authors and their affiliations is available online.

Several authors declare potential conflicts, including work for the World Health Organization, the institution that developed and initially validated measures used in this study, and payment for work with organizations with an interest in community health workers and/or health in humanitarian settings. The authors alone are responsible for the views expressed in this paper, and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Support for the study was provided by Elrha's Research for Health in Humanitarian Crises (R2HC) Programme.