Is adapted brief intervention more effective compared to either educating on low risk drinking or usual care in men admitted with alcohol related problems to a tertiary care hospital and does this outcome correlate with childhood adversities?

Study setting: Teaching Hospital Peradeniya. Method of randomisation: Participants will be randomized according to ABC, BCA, CAB order. Intervention: Adapted Brief Intervention (ABI): The World Health Organization (WHO) has introduced a brief intervention to be used among those with alcohol used disorders. Brief interventions (BIs) are ‘short conversations aiming in a non-confrontational way to motivate individuals to think about and/or plan a change in their drinking behaviour in order to reduce their consumption and/or their risk of harm’. The manual given by the WHO is already adapted by the principal investigator, and comments from five experts were amalgamated. This was repeated until a desired outcome was reached. The adapted brief intervention has taken the cultural aspects of Sri Lanka to consideration, hoping that this will improve the acceptability and effectiveness of the intervention. The manual which the principal investigator has prepared gives guidance to the research assistant on how to proceed with the patient depending on his individual circumstances, level of motivation and what his choice is. The 3 arms are as follows:

1. Care as usual (CAU arm) (The control arm): The participant will be told about their Alcohol Use Disorders Identification Test (AUDIT) score and that his consumption is likely to have caused problems already or is likely to cause him problems in the future. The alcohol information leaflet (AIL) will be given to him. This group of participants will not get any follow up calls. The same research assistants (RA) who talked to the patient will approach a family member (FM) and 'Short Questionnaire for Family Members' (SQFM) will be filled. This will take about 20-30 minutes. The patient is requested to present to THP, with the same family member a RA had contacted with at the recruitment, 4 weeks after the initial contact. It will take 15-20 minutes with the patient and 20-30 minutes with the FM.

2. Adapted Brief Intervention (ABI) arm The RA responsible to this arm will carry out the ABI according to the instructions given in the manual (prepared by the principal investigator). The RAs who do the screening will do the intervention, so that they will have better rapport with the patients. It will take about 60 minutes for the screening and the intervention. After the ABI the patients will receive the AIL as well. The same RA who does the intervention will approach a FM and SQFM will be filled. This will take about 20-30 minutes. The patient is requested to present to THP, with the same family member a RA had contacted with at the recruitment, 4 weeks after the initial contact. It will take 15-20 minutes with the patient and 20-30 minutes with the FM. This arm will receive a text message 2 weeks after the intervention; ‘How are you going with your plan?’ to which the patient does not have to respond to, and this is just to remind them of the plan.

3. Educating about the concept of ‘Unit of alcohol’ and instances where taking alcohol is risky (UOA arm): Prepared information cards and diagrams which shows what is meant by a ‘unit of alcohol’ and the volume of liquor (in glasses, cans, packets, bottles) in each type of commonly used alcoholic beverage containing a ‘unit of alcohol (UOA)’ will be used. The participant will be educated that he can take only 2 UOA for a day (emphasizing not per occasion) (expressing in the measure in the type of liquor he frequently takes) and about the things that he should avoid doing after taking even this amount of alcohol. They will also be educated that the risks will increase if he takes more than 4 UOA a day. The participants will receive the AIL. This group of participants will not get any follow up messages. The same RA who talked to the patient will approach a family member (FM) and SQFM will be filled. This will take about 20-30 minutes. The patient is requested to present to THP, with the same family member a RA had contacted with at the recruitment, 4 weeks after the initial contact. It will take 15-20 minutes with the patient and 20-30 minutes with the FM.

1. All consenting male patients who are 18 years or above admitted to wards 1,8,12,16 and 17 of Teaching Hospital Peradeniya
2. All male patients who score 5 or more for Alcohol Use Disorders Identification Test-C (AUDIT-C) which is a screening tool.

1. The patients who have ongoing serious physical or mental illness, making them incapable of following the directions given
2. The patients who are already on therapy/ intervention to reduce alcohol related harms
3. The patients who choose to go for specialized psychiatry care due to the severity of their ARPs (Others in this category will be chosen since BI could be helpful in some such patients (WHO 2017)
4. If the patient has been recruited in the current study in a previous admission
5. Patients who are not able to communicate adequately in Sinhala