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

Background: We 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. Methods: We 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. Results: 271 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 followup, respectively (aOR 1.69, 0.96-3.01;p = 0.08 and aOR 1.08, 0.62-1.87;p = 0.79). 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.

Automated summary

The study investigated the feasibility and safety of delivering the CAP psychological intervention to patients with comorbid AUD and depression by non-specialist health workers. The results showed that CAP can be safely delivered to patients with comorbid AUD and depression.