The Systematic Development of the Counselling for Alcohol Problems (CAP): A Lay Counsellor Delivered Psychosocial Intervention for Harmful Drinking in Primary Care

Harmful drinking adversely affects the drinkers’ health, social, and occupational functioning, leads to immense societal costs, and causes a significant burden on global health. Despite this, policy makers, and consequently health systems, are disproportionately focused on providing care for dependent drinking, the more severe end of the alcohol use disorders spectrum. Consequently there is a large treatment gap for harmful drinking, especially in lowS and middleSincome countries where only a small proportion of those with harmful drinking receive appropriate psychosocial care. Two major barriers to providing care for harmful drinking are the shortage of adequately skilled specialist human resources and the lack of contextually appropriate psychosocial treatments suitable for low resource settings. The aim of my thesis is to describe the systematic process used to develop Counselling for Alcohol Problems (CAP), a brief psychosocial intervention for delivery by lay counsellors in routine primary care settings to men with harmful drinking in India. In my thesis I have described each step of the intervention development process which is broadly divided three sequential stages viz (i) identifying potential psychosocial intervention strategiesZ (ii) developing a theoretical framework for the new interventionZ and (iii) evaluating the acceptability, feasibility, and preliminary impact of the new intervention. These three stages have nine steps that utilise a range of quantitative and qualitative participatory research methods to achieve the aims of the study. The outcome of the intervention development process is CAP a threeSphase treatment delivered over one to four sessions based on a Motivational Interviewing stance and includes other strategies as follows: assessment and personalised feedback, family engagement, drink refusal skills, skills to address drinking urges, problemSsolving skills and handling difficult emotions, and relapse prevention and management. To conclude, the outputs of the intervention development process were a) a contextually appropriate brief psychosocial intervention for harmful drinking designed to overcome specialist manpower shortages as it can be delivered by lay counsellors in primary care, and b) a structured framework to guide the development of contextually appropriate psychosocial interventions in low resource settings.