Innovating Care of Addictions in Low-Resource Settings

  • Abhijit NadkarniEmail author
  • Urvita Bhatia
Living reference work entry


The entire range of addictions is increasingly being acknowledged as an area of public health concern. Substance use disorders and behavioral addictions are associated with a range of adverse health, lifestyle, social, and economic outcomes. Despite the availability of evidence-based interventions, low-resource settings are ridden with challenges of demand-side and supply-side barriers to effective health care, including care for addictions. There is a need for a well conceptualized and integrated response to the growing epidemic of a range of addictions, especially in low-resource settings. Some innovative approaches such as task-sharing and technology-based care, which are highlighted as case studies in this chapter, have shown promise for use across low-resource and even high-resource settings. The future calls for strengthening of the evidence base for addictions care in low-resource settings, focus on the less-researched addictions, cross-setting implementation of existing solutions, and further evaluation and development of existing and alternative innovative approaches. These actions need to be supplemented by robust monitoring and evaluation systems, and a concerted focus from key actors in the health care sector.


  1. Araya R, Rojas G, Fritsch R, Gaete J, Rojas M, Simon G, et al. Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Lancet. 2003;361:995.CrossRefGoogle Scholar
  2. Benegal V, Chand PK, Obot IS. Packages of care for alcohol use disorders in low- and middle-income countries. PLoS Med. 2009;6(10):e1000170.CrossRefGoogle Scholar
  3. Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty KF, Wickramaratne P, et al. Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA. 2003;289:3117.CrossRefGoogle Scholar
  4. Brosan L, Reynolds S, Moore RG. Factors associated with competence in cognitive therapists. Behav Cogn Psychother. 2007;35(2):179–90.CrossRefGoogle Scholar
  5. Calado F, Griffiths MD. Problem gambling worldwide: an update and systematic review of empirical research (2000–2015). J Behav Addict. 2016;5(4):592–613.CrossRefGoogle Scholar
  6. Chand P, Murthy P, Gupta V, Kandasamy A, Jayarajan D, Sethu L, et al. editors. Technology enhanced learning in addiction mental health: developing a virtual knowledge network: NIMHANS ECHO. Technology for Education (T4E), 2014 IEEE sixth international conference on; 2014: IEEE.Google Scholar
  7. Charlson FJ, Baxter AJ, Cheng HG, Shidhaye R, Whiteford HA. The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies. Lancet. 2016;388(10042):376–89.CrossRefGoogle Scholar
  8. GBD 2015 Tobacco Collaborators Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet. 2017;389(10082):1885–906.Google Scholar
  9. CONTAD. Available from:
  10. De Silva MJ, Lee L, Fuhr DC, Rathod S, Chisholm D, Schellenberg J, et al. Estimating the coverage of mental health programmes: a systematic review. Int J Epidemiol. 2014;43(2):341–53.CrossRefGoogle Scholar
  11. Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet. 2012;379(9810):55–70.CrossRefGoogle Scholar
  12. Dias A, Dewey ME, D’Souza J, Dhume R, Motghare DD, Shaji KS, et al. The effectiveness of a home care program for supporting caregivers of persons with dementia in developing countries: a randomised controlled trial from Goa, India. PLoS One. 2008;3:e2333.CrossRefGoogle Scholar
  13. Dickson-Gillespie L, Rugle L, Rosenthal R, Fong T. Preventing the incidence and harm of gambling problems. J Prim Prev. 2008;29(1):37–55.CrossRefGoogle Scholar
  14. Dmitrieva E, Frolov SA, Kresina TF, Slater W. A model for retention and continuity of care and treatment for opioid dependent injection drug users in the Russian Federation. Health. 2012;4(08):457.CrossRefGoogle Scholar
  15. Eng E, Parker E, Harlan C. Lay health advisor intervention strategies: a continuum from natural helping to paraprofessional helping. Thousand Oaks: Sage; 1997.Google Scholar
  16. Fleeman ND. Alcohol home detoxification: a literature review. Alcohol Alcohol. 1997;32(6):649–56.CrossRefGoogle Scholar
  17. Griffiths M. Betting your life on it: problem gambling has clear health related consequences. BMJ. 2004;329(7474):1055.CrossRefGoogle Scholar
  18. Hadley M, Maher D. Community involvement in tuberculosis control: lessons from other health care programmes. Int J Tuberc Lung Dis. 2000;4(5):401–8.PubMedGoogle Scholar
  19. National Collaborating Centre for Mental Health Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. Great Britain; 2011.Google Scholar
  20. Heather N, Raistrick D, Godfrey CA. Summary of the review of the effectiveness of treatment for alcohol problems. London: National Treatment Agency for Substance Misuse; 2006.Google Scholar
  21. Ibrahim F, Gilvarry E. Alcohol dependence and treatment strategies. Br J Hosp Med. 2005;66(8):462–5.CrossRefGoogle Scholar
  22. Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, et al. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378(9803):1654–63.CrossRefGoogle Scholar
  23. Kalischuk RG, Nowatzki N, Cardwell K, Klein K, Solowoniuk J. Problem gambling and its impact on families: a literature review. Int Gambl Stud. 2006;6(1):31–60.CrossRefGoogle Scholar
  24. Knapp M, Funk M, Curran C, Prince M, Grigg M, McDaid D. Economic barriers to better mental health practice and policy. Health Policy Plan. 2006;21(3):157–70.CrossRefGoogle Scholar
  25. Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82(11):858–66.PubMedPubMedCentralGoogle Scholar
  26. Kuss DJ, Griffiths MD, Karila L, Billieux J. Internet addiction: a systematic review of epidemiological research for the last decade. Curr Pharm Des. 2014;20(25):4026–52.CrossRefGoogle Scholar
  27. Lehmann U, Van Damme W, Barten F, Sanders D. Task shifting: the answer to the human resources crisis in Africa? Hum Resour Health. 2009;7(1):49.CrossRefGoogle Scholar
  28. Levy DT, Chaloupka F, Gitchell J. The effects of tobacco control policies on smoking rates: a tobacco control scorecard. J Public Health Manag Pract. 2004;10(4):338–53.CrossRefGoogle Scholar
  29. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Libr. 2010. Issue 3Google Scholar
  30. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2224–60.CrossRefGoogle Scholar
  31. Maher D, Van Gorkom J, Gondrie P, Raviglione M. Community contribution to tuberculosis care in countries with high tuberculosis prevalence: past, present and future. Int J Tuberc Lung Dis. 1999;3(9):762–8.PubMedGoogle Scholar
  32. McManus F, Rakovshik S, Kennerley H, Fennell M, Westbrook D. An investigation of the accuracy of therapists’ self-assessment of cognitive-behaviour therapy skills. Br J Clin Psychol. 2012;51(3):292–306.CrossRefGoogle Scholar
  33. Muñoz RF, Aguilera A, Schueller SM, Leykin Y, Pérez-Stable EJ. From online randomized controlled trials to participant preference studies: morphing the San Francisco stop smoking site into a worldwide smoking cessation resource. J Med Internet Res. 2012;14(3):e64.CrossRefGoogle Scholar
  34. Nadkarni A, Weobong B, Weiss HA, McCambridge J, Bhat B, Katti B, et al. Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial. Lancet. 2017;389(10065):186–95.CrossRefGoogle Scholar
  35. Naslund JA, Aschbrenner KA, Araya R, Marsch LA, Unützer J, Patel V, et al. Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. Lancet Psychiatry. 2017;4(6):486–500.CrossRefGoogle Scholar
  36. Noknoy S, Rangsin R, Saengcharnchai P, Tantibhaedhyangkul U, McCambridge J. RCT of effectiveness of motivational enhancement therapy delivered by nurses for hazardous drinkers in primary care units in Thailand. Alcohol Alcohol. 2010;45(3):263–70.CrossRefGoogle Scholar
  37. Padmanathan P, De Silva M. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med. 2013;97:82–6.CrossRefGoogle Scholar
  38. Papas RK, Sidle JE, Gakinya BN, Baliddawa JB, Martino S, Mwaniki MM, et al. Treatment outcomes of a stage 1 cognitive–behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya. Addiction. 2011;106(12):2156–66.CrossRefGoogle Scholar
  39. Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376:2086–95.CrossRefGoogle Scholar
  40. Petry NM, Ginley MK, Rash CJ. A systematic review of treatments for problem gambling. Psychol Addict Behav. 2017;31(8):951.CrossRefGoogle Scholar
  41. Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, et al. Needle and syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane Review and meta-analysis. Addiction. 2018;113(3):545–63.CrossRefGoogle Scholar
  42. Prasad KM, Angothu H, Mathews MM, Chaturvedi SK. How are social changes in the twenty first century relevant to mental health? Indian Journal of Social Psychiatry. 2016;32(3):227.CrossRefGoogle Scholar
  43. Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet. 2008;372:902.CrossRefGoogle Scholar
  44. Ran M-S, Xiang M-Z, Chan CL-W, Leff J, Simpson P, Huang M-S, et al. Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2003;38(2):69–75.CrossRefGoogle Scholar
  45. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009;373(9682):2223–33.CrossRefGoogle Scholar
  46. Rehm J, Gmel GE Sr, Gmel G, Hasan OS, Imtiaz S, Popova S, et al. The relationship between different dimensions of alcohol use and the burden of disease – an update. Addiction. 2017;112(6):968–1001.CrossRefGoogle Scholar
  47. Rojas G, Fritsch R, Solis J, Jadresic E, Castillo C, González M, et al. Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial. Lancet. 2007;370(9599):1629–37.CrossRefGoogle Scholar
  48. Room R, Babor T, Rehm J. Alcohol and public health. Lancet. 2005;365(9458):519–30.CrossRefGoogle Scholar
  49. Singla DR, Weobong B, Nadkarni A, Chowdhary N, Shinde S, Anand A, et al. Improving the scalability of psychological treatments in developing countries: an evaluation of peer-led therapy quality assessment in Goa, India. Behav Res Ther. 2014;60:53–9.CrossRefGoogle Scholar
  50. Spooner C, Hetherington K. Social determinants of drug use. National Drug and Alcohol Research Centre. University of New South Wales. Technical report; 2004.Google Scholar
  51. Su W, Fang X, Miller JK, Wang Y. Internet-based intervention for the treatment of online addiction for college students in China: a pilot study of the Healthy Online Self-helping Center. Cyberpsychol Behav Soc Netw. 2011;14(9):497–503.CrossRefGoogle Scholar
  52. Swider SM. Outcome effectiveness of community health workers: an integrative literature review. Public Health Nurs. 2002;19(1):11–20.CrossRefGoogle Scholar
  53. Townend M, Iannetta L, Freeston MH. Clinical supervision in practice: A survey of UK cognitive behavioural psychotherapists accredited by the BABCP. Behav Cogn Psychother. 2002;30(4):485–500.CrossRefGoogle Scholar
  54. van Ginneken NTP, Lewin S, Rao GN, Meera SM, Pian J, Chandrashekar S, et al. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database Syst Rev. 2013;19(11):CD009149.Google Scholar
  55. Viswanathan M, Kraschnewski JL, Nishikawa B, Morgan LC, Honeycutt AA, Thieda P, et al. Outcomes and costs of community health worker interventions: a systematic review. Med Care. 2010;48:792–808.CrossRefGoogle Scholar
  56. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575–86.CrossRefGoogle Scholar
  57. Xiang M, Ran M, Li S. A controlled evaluation of psychoeducational family intervention in a rural Chinese community. Br J Psychiatry. 1994;165(4):544–8.CrossRefGoogle Scholar
  58. Yang L, Sung H-Y, Mao Z, Hu T-w, Rao K. Economic costs attributable to smoking in China: update and an 8-year comparison, 2000–2008. In: Economics of tobacco control in China: from policy research to practice. Singapore: World Scientific; 2016. p. 9–28.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.London School of Hygiene & Tropical MedicineLondonUK
  2. 2.SangathGoaIndia

Personalised recommendations