Principal Investigators: Jeremy Kane and Claire Greene, Columbia University Mailman School of Public Health
Refugees are at risk for unhealthy alcohol and other drug (AOD) use, yet few receive treatment. This research will evaluate the effectiveness and implementation of stepped-care AOD services (screening, brief intervention, and referral to evidence-based psychotherapy) for Congolese refugees and host community members in Mantapala, an integrated settlement in northern Zambia. We will first explore the types, correlates, and patterns of AOD use, validate measures for AOD use, and adapt the interventions and research procedures to be locally relevant and acceptable in the study context. Refugee incentive workers will be trained to deliver the intervention to 200 persons reporting unhealthy AOD use. Using a hybrid effectiveness-implementation trial and mixed-methods data collection, we will evaluate the feasibility, cost, barriers and facilitators to implementation of the intervention, as well as its effectiveness in reducing unhealthy AOD use and co-occurring mental health problems 12-months after baseline relative to those receiving treatment-as-usual.
Alcohol and other drugs are responsible for substantial physical, psychological, and social harms, including in humanitarian settings. This research will aid us in identifying which interventions are effective for reducing this burden and how we need to adapt services so they are relevant, acceptable, and feasible in humanitarian contexts
There is an absence of information on how to effectively treat unhealthy alcohol and other drug use in humanitarian settings. Results from this study will be among the first to provide critical evidence regarding whether a stepped-care system including evidence-based intervention components is effective and feasible within humanitarian settings.
Anticipated clinical and public health outcomes include reduced alcohol and other drug use, improved mental health, and reductions in substance-related consequences (e.g., gender-based violence). We also anticipate discovering unique considerations for adapting evidence-based interventions tested in non-humanitarian contexts to complex humanitarian settings. Furthermore, this research provides an opportunity to examine the implementation of a public health intervention through an integrated governmental and non-governmental system to both refugees and host community members. We will produce and disseminate study outcomes, intervention manuals, screening tools, and implementation plans to researchers, practitioners, and policymakers through our study partners, webinars, publications, and dissemination meetings.
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