Reducing Alcohol Use by OAT Patients

A pilot project was implemented by Public Health Center of the Ministry of Health of Ukraine, at opioid assisted therapy (OAT) sites in Kyiv, Lviv, and Sumy to assess and reduce alcohol use among OAT patients through psychological interventions. The initiative was part of a broader strategy to address co-occurring substance use and mental health disorders and was supported by the Global Fund. The project aimed to test the effectiveness of brief interventions and cognitive behavioural therapy (CBT) for patients with varying degrees of alcohol use problems, as identified by the AUDIT screening tool.

The preparatory phase included the selection of three pilot sites, the formation of interdisciplinary intervention teams (including a psychologist, medical nurse, and social worker), and comprehensive training sessions on the delivery of both first-line (brief intervention) and second-line (CBT) interventions. Each site developed an internal patient pathway, integrating routine alcohol use screening and stratified care responses based on AUDIT levels.

During the intervention phase from January to June 2022, OAT patients were screened for alcohol use, depression, generalised anxiety, and phobias using standardised tools (AUDIT, PHQ-9, GAD-7). Patients with mild to moderate alcohol-related issues (AUDIT levels 1–3) received brief interventions, while those who did not reduce consumption after initial support were escalated to CBT. Patients with severe alcohol use (AUDIT level 4) were directly referred for CBT and specialised support.

The results demonstrated the effectiveness of brief interventions in reducing alcohol consumption and increasing alcohol-free days, particularly among those with low to moderate risk. CBT further improved outcomes for high-risk individuals, including reductions in alcohol levels and depressive symptoms. The project also revealed a high prevalence of comorbid mental health conditions, with 70.6% of participants showing signs of depression and over 60% showing signs of phobias. Alarmingly, 24.9% of participants reported suicidal thoughts or intentions in the past two weeks.

Based on the findings, the project team recommended scaling up screening for alcohol and depression at OAT sites, developing integrated patient pathways for comorbid conditions, and institutionalising brief and CBT interventions as part of standard care. Further large-scale research was also advised to validate and expand on these results.