A new randomized trial offers some of the strongest evidence yet that structured alcohol-reduction care can work in humanitarian settings where specialized services are scarce. Conducted in the Mantapala refugee settlement in northern Zambia, the study reports a durable reduction in alcohol use using an approach built around SBIRT—screening, brief intervention, and referral to treatment. Results appear in The Lancet Global Health and were led by researchers at Columbia University Mailman School of Public Health with partners across six countries.
The trial addresses a critical gap: alcohol and other drug (AOD) use disorders remain largely neglected in emergency response, despite mounting evidence that armed conflict and displacement increase risk for adverse health outcomes. At the end of 2024, an estimated 123 million people were living in situations of forced displacement, including more than 36 million refugees. Within these contexts, home-brewed alcohol can be common, and cannabis or other drug use may rise as coping mechanisms for boredom, day-to-day stressors, trauma exposure, and co-occurring mental health problems.
Mantapala, established in 2018 amid an influx of people fleeing the Democratic Republic of the Congo, provided the setting for a hybrid, type 1 randomized controlled design. The intervention was delivered by non-specialist providers selected from both the refugee and Zambian host communities, working under clinical supervision. Where urgent needs were identified, participants were referred to a district-level hospital.
After baseline assessment, participants were randomized 1:1 to SBIRT or treatment as usual. The control condition relied on referral to basic counseling through primary care in the settlement’s health clinic. In the SBIRT arm, trained staff conducted a single 30–45 minute session to assess drinking patterns, evaluate impacts, and support strategies to reduce use. Participants with higher-risk alcohol use and/or co-occurring other drug use and mental health problems received 6–12 weekly cognitive behavioral therapy sessions delivered by the same non-specialists.
At follow-up, SBIRT reduced alcohol use by 64% among Congolese refugees and Zambians, with moderate treatment effects sustained for 12 months. Secondary analyses suggested improved symptoms of common mental disorders at six months, though these benefits were less evident at 12-month follow-up. Notably, there were no significant effects detected for drug use during the study period.
An accompanying economic analysis indicates the model costs less than SBIRT approaches typically implemented in high-income countries, but still requires dedicated financing and context-specific adaptation to be sustainable in resource-constrained humanitarian environments. As a result, the trial frames SBIRT not only as a clinical tool but also as an implementable system for integrated care.
“This study advances understanding of how to deliver services that address alcohol and other drug use in highly resource-constrained emergency settings,” said Claire Greene, PhD, assistant professor of population and family health and the study’s first author. With depression, anxiety, and PTSD often intertwined with unhealthy alcohol use in this population, the findings underscore the need for substance-focused interventions that also address comorbid mental health.
Subject of Research: Alcohol use reduction in humanitarian settings
Article Title: Screening, brief intervention, and referral to treatment compared with treatment as usual for alcohol use in an integrated refugee settlement in Zambia: a hybrid, type 1, randomised controlled trial
News Publication Date: 23-Jul-2026
Web References: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(26)00151-8/fulltext
References: 10.1016/j.langlo.2026.103989
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