Addressing Alcohol Use Before It Causes Harm

Alcohol consumption is an often-overlooked global health threat, causing around 2.6 million deaths each year, according to the World Health Organization. But one reason it can be so hard to address – especially in low- and middle-income countries – is that problems with alcohol use rarely occur on their own. 

It’s common for someone with an alcohol use disorder to be dealing with other health issues, such as anxiety, depression or another form of substance abuse. In fact, in one year at Moi Teaching and Referral Hospital in Eldoret, Kenya, 100 percent of the patients being treated for drug or alcohol disorders had such comorbidities, says Florence Jaguga, MBChb, a psychiatrist who oversees the alcohol and drug abuse rehabilitation services department at the hospital.

Alcohol use and mental health issues “are like sisters and brothers that walk together,” Jaguga said during a Think Global event on Jan. 22 hosted by the Duke Global Health Institute. 

During the virtual event, speakers echoed the challenges low- and middle-income countries face in addressing alcohol use disorders, which affect around 400 million people globally and even children as young as 15. But they also shared success stories of interventions that are helping health facilities identify and intervene in cases where alcohol use may lead to other health problems, including injuries, road accidents and domestic violence. 

The event was moderated by Catherine Staton, M.D., Director of the Duke Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center. Staton has been researching interventions to combat alcohol related harm and injuries in Tanzania for more than a decade with partners at Kilimanjaro Christian Medical Centre. They’ve found success with a screening and brief intervention (SBI), which is now being implemented regionally. 

“We have a significant amount of data about what works – an interdisciplinary approach to reduce the use of alcohol and impact on lives,” said Staton, a professor of emergency medicine, neurosurgery and global health.

Panelists talked about the cultural influences that can underlie alcohol use in many African countries. “One of the biggest challenges to alcohol awareness is it’s embedded in our cultural fabric,”  said David Kalema, PhD, a consultant on addiction studies at Uganda Martyrs University. He noted that alcohol is common during celebrations and a part of everyday living. “The alcohol industry sees us as a market for their products now and in the future.”

Although underage drinking is stigmatized in many African cultures, adolescents still often begin drinking alcohol early in life, increasing the risks for abuse, said Kim Madundo, PhD, a psychiatrist and lecturer at Kilimanjaro Christian Medical University College. 

“Prolonged use of alcohol on an adolescent’s brain can cause harm later in life,” Madundo said. He noted that its consumption correlates with unplanned pregnancies, sexually transmitted infections and violence seen in youth. “We need to reach these populations at an earlier age.” 

Kenneth Kalani, PhD, a psychiatrist and senior medical officer in the mental health division of Uganda’s Ministry of Health, said when alcohol use issues go undetected, it can lead to alcohol-related injuries and deaths, often from road accidents. 

“In my country, we only have one alcohol rehab center, and by the time patients [are seen] at tertiary hospitals, they have severe alcohol problems,” he said. “It can be hard to manage alcohol disorders with limited resources.”

But João Vissoci, PhD, said tools such as Artificial Intelligence and ChatGPT can help  fill in the gaps where there are shortages of trained specialists, giving health providers more ways to spot alcohol use disorders and direct patients toward help. 

“With our ability to model complex data from different modes such as voice, text and raw data, we can try to understand alcohol [use] from a multi-level perspective,” says Vissoci, co-director of GEMINI. “There’s a large role to play in how we tackle these harms in low- and middle-income countries.”