Risky injection practices and HCV awareness in Chiang Mai Province, Thailand: a respondent-driven sampling study of people who inject drugs.

BACKGROUND: People who inject drugs (PWID) are the most exposed to hepatitis C virus (HCV). In Thailand, drug use is highly criminalized, and harm reduction services are scarce. This study estimates risky injection practices and assesses the proportion of HCV awareness and screening in the PWID population in Northern Thailand. METHODS: We used respondent-driven sampling (RDS) to recruit PWID in Chiang Mai Province. Social and behavioural data were collected through face-to-face interviews at an addiction treatment facility. Weighted population estimates were calculated to limit biases related to the non-random sampling method. Univariate and multivariate analyses were performed to study factors associated with HCV awareness and screening. RESULTS: One hundred seventy-one PWID were recruited between April 2016 and January 2017. Median age was 33 (Interquartile range: 26-40) years, 12.2% were women, and 49.4% belonged to a minority ethnic group. Among participants, 76.8% injected heroin, 20.7% methadone, and 20.7% methamphetamine. We estimate that 22.1% [95% CI: 15.7-28.6] of the population had shared needles in the last 6 months and that 32.0% [95% CI: 23.6-40.4] had shared injection material. Only 26.6% [95% CI: 17.6-35.6] had heard of HCV. Factors independently associated with knowledge of HCV included belonging to a harm reduction organization (adjusted odds ratio (aOR) = 5.5 [95% CI: 2.0-15.3]) and voluntary participation in a drug rehabilitation programme (aOR = 4.3 [95% CI: 1.3-13.9]), while Lahu ethnicity was negatively associated (aOR = 0.3 [95% CI: 0.1-0.9]). We estimate that 5% of the PWID population were screened for HCV; the only factor independently associated with being screened was membership of a harm reduction organization (aOR = 5.7 [95% CI: 1.6-19.9]). CONCLUSION: Our study reveals that the PWID population is poorly informed and rarely screened for HCV, despite widespread risky injection practices. A public health approach aimed at reducing the incidence of HCV should target the PWID population and combine harm reduction measures with information and destigmatization campaigns. Civil society organizations working with PWID are a major asset for the success of such an approach, based on their current positive interventions promoting awareness of and screening for HCV.

Substance use among students in Thailand.

This study explored substance use prevalence, level of risk, and associated factors, especially related to binge drinking. A cross-sectional study was conducted among 306 students using questionnaires and the Alcohol, Smoking, and Substance Involvement Screening Test-Youth screening tool. The associations between binge drinking and risk factors were analyzed by generalized linear models. Our results showed current prevalence rates of alcohol, tobacco, and drugs use were 56.9%, 22.9%, and 2.3%, respectively. Multivariate analyses showed that being a binge drinker was significantly associated with low self-efficacy, high sensation seeking, moderate to high smoking risk, and low grade point average.

Translation and validation of the PACIC+ questionnaire: the Thai version.

BACKGROUND: The number of patients with chronic illness is increasing worldwide. These patients usually receive care from a primary care facility. The Patient Assessment of Chronic Illness Care (PACIC) is a tool that is increasingly used in several countries to measure how the patients perceive the care they receive. The goal of this validation study is to provide and validate an extended version of the tool, the PACIC+ questionnaire, in Thailand. METHODS: In this observational validation study, patients with type 2 diabetes from the outpatient clinic at a university hospital in Thailand completed the PACIC+ at the clinic. For follow-up, they received the questionnaire per mail after four weeks. The Thai PACIC+ comprises 26 items, which map onto 5 subscales and a summary score related to the Chronic Care Model (CCM) and 5 subscales and a summary score related to the 5A model, a counseling model for behavioral changes. Data-analysis focused on the use of most extreme answering categories (> 15%), internal consistency (Cronbach's alpha), and test-retest reliability. An exploratory factor analysis (EFA) was performed for the CCM and the 5A model separately to examine the factor structure. RESULTS: A total of 151 patients participated. The average age of the sample was 63 ± 9 years (range 29-86 years). Fifty-three percent of the respondents were female. In the Delivery System subscale, 20% of patients reported the highest possible value; in all other subscales, relative frequencies of the most extreme categories did not exceed 15%. Cronbach's alpha per subscale varied from 0.58 to 0.81, while that of the summary scores were 0.89 and 0.91. The mean difference from the test-retest varied from - 0.06 to 0.17 across subscales. The Kaiser-Meyer-Olkin criterion for sampling adequacy (KMO) was good for both models as well as the Bartlett's test for sphericity p. While the factor loadings in rotated factor solution showed good concordance with the CCM, concordance was not as good for the 5A model, especially for the subscales "Assess" and "Advice". CONCLUSION: A validated Thai version of the PACIC+ is now available to measure how the patients perceive the care they receive.

Methamphetamine use is associated with high levels of depressive symptoms in adolescents and young adults in Rural Chiang Mai Province, Thailand.

BACKGROUND: High levels of depressive symptoms often occur among individuals that use or that are dependent on methamphetamine (MA). Thailand is currently experiencing an epidemic of MA use among youth. Understanding the nature of the relationship between depressive symptoms and MA use and identifying those most at risk can further understanding of prevention and treatment options for youth who use MA and present with depressive symptoms. METHODS: In 2011, we conducted a cross sectional epidemiologic study that examined associations between MA use and high levels of depressive symptoms among adolescents and young adults aged 14-29 living in Chiang Mai province, Thailand. A combination of cluster and systematic sampling was conducted to obtain a study sample of participants actively recruited in Chiang Mai province. Depressive symptoms were measured using a Thai translation of the Centers for Epidemiologic Studies Depression scale (CES-D). The independent variables measured reported lifetime and recent MA use within the past 3 months. Multivariate logistic regression models were used to assess associations between MA use and high levels of depressive symptoms. RESULTS: Approximately 19% (n = 394) of the sample reported ever having consumed MA and 31% (n = 124) of lifetime users reported recent MA use within the past 3 months. Recent MA use was associated with high levels of depressive symptoms (aPOR recent use: 2.60, 95% CI: 1.20, 5.63). CONCLUSIONS: This is one of the first studies to examine the association between MA use and high levels of depressive symptoms in a general Thai population. The odds of having high levels of depressive symptoms was significantly greater among recent MA users compared to non-users. These findings support the need for policies, programs and interventions to prevent and treat depressive symptoms presenting among MA using Thai adolescents and young adults in rural Chiang Mai province, Thailand to aid in cessation of MA use. Furthermore, additional research is needed to investigate treatment options for adolescents and young adults in Thailand that use MA and present with high levels of depressive symptoms.

Assessment of contamination and misclassification biases in a randomized controlled trial of a social network peer education intervention to reduce HIV risk behaviors among drug users and risk partners in Philadelphia, PA and Chiang Mai, Thailand.

Controlled trials of HIV prevention and care interventions are susceptible to contamination. In a randomized controlled trial of a social network peer education intervention among people who inject drugs and their risk partners in Philadelphia, PA and Chiang Mai, Thailand, we tested a contamination measure based on recall of intervention terms. We assessed the recall of test, negative and positive control terms among intervention and control arm participants and compared the relative odds of recall of test versus negative control terms between study arms. The contamination measures showed good discriminant ability among participants in Chiang Mai. In Philadelphia there was no evidence of contamination and little evidence of diffusion. In Chiang Mai there was strong evidence of diffusion and contamination. Network structure and peer education in Chiang Mai likely led to contamination. Recall of intervention materials can be a useful method to detect contamination in experimental interventions.

Coalition formation to address structural determinants of methamphetamine use in Thailand.

Despite two recent government-sponsored 'wars on drugs', methamphetamine use continues to be a pervasive problem in Thailand. Out of concern for reported human rights abuses, there has been a call from the international community to take a different approach from the government's 'zero tolerance'. This paper describes the adaptation of the Connect to Protect® coalition formation process from urban U.S. cities to three districts in northern Thailand's Chiang Mai province, aimed to reduce methamphetamine use by altering the risk environment. Project materials, including manuals and materials (e.g. key actor maps and research staff memos), were reviewed to describe partnering procedures and selection criteria. Potential community partners were identified from various government and community sectors with a focus on including representatives from health, police, district and sub-district government officials. Of the 64 potential partners approached, 59 agreed to join one of three district-level coalitions. Partner makeup included 25% from the health sector, 22% who were sub-district government officials and 10% were representatives from the police sector. Key partners necessary for endorsement of and commitment to the coalition work included district-level governors, police chiefs and hospital directors for each district. Initial coalition strategic planning has resulted in policies and programs to address school retention, youth development initiatives and establishment of a new drug treatment and rehabilitation clinic in addition to other developing interventions. Similarities in building coalitions, such as the need to strategically develop buy-in with key constituencies, as well as differences of whom and how partners were identified are explored.

Facilitating a transition from compulsory detention of people who use drugs towards voluntary community-based drug dependence treatment and support services in Asia.

Evidence indicates that detention of people who use drugs in compulsory centers in the name of treatment is common in Cambodia, China, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, and Vietnam. The expansion of such practices has been costly, has not generated positive health outcomes, and has not reduced supply or demand for illicit drugs. United Nations agencies have convened several consultations with government and civil society stakeholders in order to facilitate a transition to voluntary evidence- and community-based drug dependence treatment and support services. In an effort to support such efforts, an informal group of experts proposes a three-step process to initiate and accelerate national-level transitions. Specifically, the working group recommends the establishment of a national multisectoral decision-making committee to oversee the development of national transition plans, drug policy reform to eliminate barriers to community-based drug dependence treatment and support services, and the integration of community-based drug dependence treatment in existing national health and social service systems.In parallel, the working group recommends that national-level transitions should be guided by overarching principles, including ethics, human rights, meaningful involvement of affected communities, and client safety, as well as good governance, transparency, and accountability. The transition also represents an opportunity to review the roles and responsibilities of various agencies across the public health and public security sectors in order to balance the workload and ensure positive results. The need to accelerate national-level transitions to voluntary community-based drug dependence treatment and support services is compelling--on economic, medical, sustainable community development, and ethical grounds--as extensively documented in the literature. In this context, the expert working group fully endorses initiation of a transition towards voluntary evidence- and community-based drug dependence treatment and support services across the region, as well as the steady scale-down of compulsory centers for drug users.Components of voluntary community-based drug dependence treatment and support services are being implemented in Cambodia, China, Indonesia, Malaysia, and Thailand. However, significant technical and financial support will be required to be allocated from national budgets and by international development agencies in order to complete the transition and reduce the reliance on detention of people who use drugs in Asia.

Risk-Minimizing Belief: Its Association with Smoking and Risk of Harm From Smoking in Northern Thailand.

Risk-minimizing beliefs refer to the underestimation of the health risks of particular behaviors. The aim of the study was to investigate the associations between risk-minimizing belief with smoking and the risk of harms from smoking in Northern Thailand (N=3,865). Adjusting for potential confounders, risk-minimizing belief was inversely associated with lifelong abstinence, positively associated with increased risk of being a current smoker, and weakly associated with increased risk of harm from smoking. Targeting risk-minimizing beliefs in current smokers and those who have never smoked may be useful in the Northern Thai population.

A comparative study of self-report, urinalysis and hair analysis in the detection of methamphetamine in Yaba users.

BACKGROUND: Three diagnostic methods have dominated drug-abuse research: self-report, urinalysis and hair analysis. Previous studies have compared detection rates for various drugs, but none has focused a three-pronged concordance study on the use of methamphetamine (MA). OBJECTIVE: To determine and compare the rates of MA detection in urine and hair of subjects who reported consuming MA in the form of Yaba. MATERIAL AND METHOD: Self-reports of Yaba use, as well as biological specimens for chemical analyses, were collected from paid volunteers participating in a larger project studying risk-taking behavior of young adults in northern Thailand. All subjects in the present study reported using Yaba within 90 days of enrollment. Hair analysis for MA followed a validated protocol that coupled solid phase microextraction (SPME) with gas chromatography-mass spectrometry (GC-MS). Preliminary urinalysis was by means of REMEDi-HS. Positive urine was confirmed for MA by the SPME/GC-MS protocol. RESULTS: The MA detection rate by hair analysis (34.3%, n = 172) was significantly higher than by urinalysis (19.1%, n = 96) (p < 0.01; McNemar's test). All subjects with MA-positive urine samples reported using Yaba within 30 days of testing, while hair analysis gave positive results for self-reports up to 90 days. Urinalysis showed greater concordance with self-report than hair analysis if testing occurred within seven days of most recent admitted Yaba use. The reverse was true after 14 days. Agreement of laboratory findings with self-reports increased if test results for the two biological matrices were combined. There was no strong agreement between hair analysis and urinalysis for subjects reporting most recent use within 30 days of testing (kappa = 0.131; 95% CI = 0.022-0.240). CONCLUSION: For the Yaba users in the present study, urinalysis for MA significantly detected more positives than hair analysis if the most recent use reportedly occurred within seven days of testing. Hair analysis yielded better results after an interval of 14 days, with its window of detection extending up to three months. There were no urine positive samples for reported use after 30 days. Combining urinalysis and hair analysis increased the probability of detecting recent MA use. Both urinalysis and hair analysis significantly under-detected MA in the biological samples collected. The combined detection rate was 44.4%. This discrepancy might have resulted from over-reporting of Yaba use due to social/psychological factors and/or insufficient MA consumption causing test results to fall below cutoff levels.

An International, Multidisciplinary Consensus Set of Patient-Centered Outcome Measures for Substance-Related and Addictive Disorders.

Background: In 1990, the United States' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018-March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer-patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.

Sexually transmitted infection risk behaviors in rural Thai adolescents and young adults: support for sex- and age-specific interventions.

Sexually transmitted infection (STI) prevalence and risks in a sample of rural Thai adolescents and young adults (14-29 years) were examined. Unprotected sex with a casual partner conferred the greatest risk for prevalent STIs, particularly for younger adolescents, and alcohol use increased the STI risk for women but not for men.

Association between kratom (Mitragyna speciosa) use and metabolic syndrome.

Background and aims: There are evidence about effects of kratom (Mitragyna speciosa) use on parameters related to metabolic syndrome (MetS). The present study aimed to determine the association between kratom use and MetS. Methods: This study is a cross-sectional study of 581 subjects (kratom users and non-users) aged 18 and over from the Nam Phu sub-district, Surat Thani province, Thailand. The association was determined using multivariate logistic regression. Results: MetS prevalence in kratom users and non-users was 11.9% (95% CI, 8.4-16.3%) and 21.6 % (95% CI, 17.1-26.8%), respectively. The use of kratom was associated with the lower odds of MetS (adjusted OR, 0.56; 95% CI, 0.33-0.96). Kratom use were associated with smaller waist circumference, lower triglycerides, and higher high-density lipoprotein. Conclusions: The current study demonstrated a potential protective effect of kratom use against MetS.

Methamphetamine dependence treatment rehabilitation in Thailand: a model assessment.

OBJECTIVE: Assess the process and outcome of the treatment rehabilitation program in Thailand by comparing out-patients and in-patients from drug dependent treatment centers (DDTCs) under Matrix and FAST Models. MATERIAL AND METHOD: In the DDTCs, male in-patient and out-patient volunteers aged 15-35 years were randomly selected to assess demographic characteristics, socio-economic status, history of substance use, and other behavior related to their health. Observations of the process of therapy and assessment of patients' improvement were made. After completing the rehabilitation, which lasted four months, trained field workers visited the patients at 1-, 3- and 6-month intervals. Analyses of rehabilitation focused on cognitive and behavioral changes at one and three months. Regarding the follow-up outcomes, comparison of Matrix and FAST Models relapse was analyzed by survival graph and Cox-regression of the days since stopping illegal substance use. RESULTS: Ninety-two in-patients and forty-three out-patients were recruited. No significant difference was found in the characteristics of the patients between the two models or in the treatment centers. After assessing patients at 1-, 3-, and 6-month, more improvement was noted among those in the FAST model than in the Matrix model. CONCLUSION: This research confirmed improvement in attendees at the in-patient treatment model and the effectiveness of rehabilitation.

Attitudes towards Kratom use, decriminalization and the development of a community-based Kratom control mechanism in Southern Thailand.

Kratom (Mitragyna speciosa Korth.) is an indigenous plant of Southeast Asia, which has been used in traditional medicine for centuries. Despite local communities in Southern Thailand viewing Kratom as a traditional remedy and not as an illicit drug, Thailand criminalized Kratom in 1943 which has led to tensions between government authorities and local communities. This study employed a mixed-method design to explore alternative ways to decriminalize Kratom, using a Participatory Action Research framework to develop a community charter to better manage Kratom in Tambon Namphu, a rural sub-district in Southern Thailand. Quantitative data consisted of face-to-face surveys with 457 Tambon Namphu residents, 104 students and teachers and on-line self-complete surveys conducted with 1,058 people outside Tambon Namphu. Qualitative data were collected using focus groups, in-depth interviews and through public forums conducted with Tambon Namphu residents. Survey results indicate that most participants agreed with decriminalization of both Kratom cultivation and consumption and typically reported positive attitudes towards people who use Kratom. The most common reasons for supporting Kratom decriminalization were Kratom's perceived benefits for work productivity and health. People had more positive attitudes towards the consumption of fresh Kratom leaves than Kratom decoctions which were deemed more harmful. Participatory action research methods were used to pilot the development of a community consensus framework for Kratom control in Donsai, a village of 127 households. Following successful piloting, the community consensus framework on Kratom control was adopted in Donsai, adapted across Tambon Namphu and then extended to cover 135 villages across Thailand.

High serum high-density lipoprotein and low serum triglycerides in Kratom users: A study of Kratom users in Thailand.

OBJECTIVE: The present study aims to examine the association between Kratom use and serum lipid level. METHOD: This study compared the serum lipid profile of Kratom users and non-users living in Nam Phu Subdistrict, a special area that allows the traditional use of Kratom. The study subjects consisted of 581 individuals aged 18 and above. Binary logistic regression was used to determine an association between Kratom use and serum lipid level. RESULTS: The findings revealed an association between Kratom use and an elevated HDL level (≥60 mg/dL) with an adjusted OR of 1.82 (95% CI, 1.17-2.8), and an association between Kratom use and a triglyceride level <90 mg/dL with an adjusted OR of 1.75 (95% CI; 1.17-2.63). There were no associations between Kratom use and LDL as well as total cholesterol level. DISCUSSION AND CONCLUSIONS: This study provided additional evidence of Kratom use and a favorable lipid profile. Prevention of coronary heart disease or cerebrovascular disease via an improvement in the lipid profile may be a future pharmaceutical application of Kratom.

Incidence of HIV and sexually transmitted infections and risk factors for acquisition among young methamphetamine users in northern Thailand.

BACKGROUND: Southeast Asia is experiencing an epidemic of methamphetamine use, a drug associated with risky sexual behaviors, putting a large segment of the population at increased risk for sexually transmitted infections (STIs) and HIV and in need of prevention efforts. Incidence estimates of STIs are rare in Southeast Asia, especially among newer risk groups. STUDY DESIGN: We enrolled methamphetamine users aged 18 to 25 years in a 12-month randomized behavioral intervention trial in Chiang Mai, Thailand in 2005. Behavioral questionnaires were administered at visits every 3 months, and biologic specimens were collected at baseline and 12 months to test for common STIs (chlamydia, gonorrhea, HSV-2, and HIV). Poisson regression with robust variance was used to determine risk factors for incident STIs. RESULTS: Overall, 12.7% of 519 participants acquired at least 1 STI. Chlamydia was the most common (10.6%), followed by HSV-2 (4.0%), gonorrhea (2.9%), and HIV (0.6%). Risk factors for both men and women included self-reported incarceration and having a casual sex partner during follow-up, and having a prevalent STI at baseline. Additionally, among women, having 2 or more heterosexual partners, and among men, having a greater frequency of drunkenness were risk factors for STI acquisition. CONCLUSIONS: Although HIV incidence is low in this population, incidence of other STIs is high compared with previous studies of young Thai adults. Risk factors for acquisition emphasize the need for new prevention strategies targeted toward current populations at risk.

Correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand.

OBJECTIVES: We examined correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand in 2005 to 2006. METHODS: We conducted a cross-sectional study among 1189 young methamphetamine users. Participants were surveyed about their recent drug use, sexual behaviors, and incarceration. Biological samples were obtained to test for sexually transmitted and viral infections. RESULTS: Twenty-two percent of participants reported ever having been incarcerated. In multivariate analysis, risk behaviors including frequent public drunkenness, starting to use illicit drugs at an early age, involvement in the drug economy, tattooing, injecting drugs, and unprotected sex were correlated with a history of incarceration. HIV, HCV, and herpes simplex virus type 2 (HSV-2) infection were also correlated with incarceration. CONCLUSIONS: Incarcerated methamphetamine users are engaging in behaviors and being exposed to environments that put them at increased risk of infection and harmful practices. Alternatives to incarceration need to be explored for youths.

Prevention of acute acoustic trauma by earmuffs during military training.

BACKGROUND: Impulse noise produced from firearms can potentially damage hearing organs resulting in sensorineural hearing loss (SNHL). In Chiang Mai during 1997, Detphithak et al reported a prevalence of acute acoustic trauma (AAT) in 22% of new military privates using an H.K.33 for shooting practice without hearing protection. The H.K.33 renders an average sound pressure level of 128 dBA. Earmuffs are claimed by their manufacturing company to attenuate noise 27 dB, and they have been recently introduced in Chiang Mai to prevent AAT. OBJECTIVE: To study the outcomes of hearing protection against AAT using earmuffs during shooting training (H.K.33) in the Military Reserve Officer Training Corps (MROTC). MATERIAL AND METHOD: A quasi - experiment study was conducted among 267 normal hearing MROTCs in the Reserve Officers Student Training Center (ROSTC) of the 33rd Military Circle, Chiang Mai, Thailand. Their condition of hearing was examined by an otolaryngologist and an audiologist using pure tone audiometry (PTA) before shooting practice, within 2 hours after the practice, 3 days after the practice at the ROSTC; and 1 month later at Fort Kawila Hospital, Chiang Mai, Thailand. RESULTS: All 267 MROTCs used earmuffs during shooting practice. Their mean age was 17.95 years. Average sound pressure level of an HK.33 was 127 dBA (range; 126.5-130 dBA). AAT was found in 4 persons (1.5%) within two hours after shooting. Repeat testing 3 days later revealed that only one person (0.37%) still had SNHL. Fortunately, this case reached complete recovery within 1 month. When comparing these findings with those of 1997, earmuffs can reduce AAT by 15 times (95% confidence interval 5.3-40.5, p-value < 0.0001) to a negligible level. CONCLUSION: Shooting training with an H.K. 33 produces a dangerous sound pressure level at the shooting site, resulting in a possible high risk of acute acoustic trauma. Earmuffs can effectively reduce this risk by approximately 15 times, and they should be widely used in all shooting training.

Drug and alcohol services in middle-income countries.

PURPOSE OF REVIEW: The present review summarizes current research in middle-income countries on drug and alcohol services for prevention, screening, treatment, care and rehabilitation between June 2006 and December 2007. RECENT FINDINGS: There is a dearth of scientific literature on prevention, treatment and rehabilitation in middle-income countries and no novel effective approaches reported during the review period. The Lancet Series on Global Mental Health showed only 0.7% of all papers reviewed were on low-income and middle-income countries. Several studies in these countries confirmed the effectiveness of brief interventions in treating alcohol use disorders at a primary care level. One study on alcohol screening in Brazil produced a promising screening tool. Other studies reported the availability of pharmacological and nonpharmacological treatments for alcohol and drug use disorders. Overall, poor accessibility to services and delayed onset of treatment persist. Political and cultural environments play a crucial role in providing services to fulfill treatment needs. SUMMARY: During the review period, reports from middle-income countries on alcohol and drug services were very limited. A few studies in some countries confirm the effectiveness of brief interventions in primary care settings. There is an obvious need for more research on alcohol and drug treatment services in middle-income countries.