Case presentation

Dr. Brian Wwesige

 Demographic Data
Name: BBK
Age: 30yrs
Sex: Male
Tribe: Munyankole
Religion: Protestant
Address: Kyamukama, Sheema
Level Of Education: Certificate in plumbing
Occupation: Farmer.
Marital Status: Married
Informant & N.O.K: K.L (Wife)
Date of admission: 15/10/2025
Source of referral: Home
Presenting Complaints

• Excessive alcohol drinking - 1/52

• Hearing voices of unseen people - 3/7
• Seeing things not seen by others -1/7
 History of Presenting Complaints (HPC)
• BBK, an old client of the department since 2023, has been using
alcohol for over 17 years, modeling his father and brother.
• BBK was admitted following excessive alcohol intake for a week.
• 3/7 prior to admission, he abruptly reduced the amount taken due
to financial constraint.
• He experienced generalized body jerky movements which lasted
approximately 2 minutes associated with urine and fecal
incontinence.
• Previously, the wife reported that he was taking between 3 – 5
glasses of local waragi every evening but suddenly cut it to 1
glass.
 HPC cont…
• BBK also reported to hear voices unheard by others. Was hearing a
European voice, promising to buy his land for large sums of money
(70-100 million Uganda shillings).
• Later on, he started asking his wife and other people around him
for the money, to which they were refused. This made him agitated
and aggressive towards them.
• He chased his wife with a Panga who ran to the relatives for help.
• Upon the arrival of the relatives, he confused them for the police
and tried fleeing. However, he was apprehended and brought to the
hospital.
• He doesn’t smoke or use of any other illicit substances apart from
alcohol. No history of suicidal behaviors.
 Past Psychiatric History
• An old client of the unit in his 4th episode, but 3rd admission,
• 1st episode was in 2015 where he presented with similar
symptoms. He was managed by traditional healers where he
regained full functionality.
• 2nd episode was in 2022, presented with similar symptoms and
was admitted and managed at Kabwohe HC1V for 2 weeks.
• He was fine for 1 year on medication but due to poor adherence
got 3rd episode in 2023 where he was admitted and managed at
MRRH for 5 days before discharge.
Past Medical History

• Reportedly HIV sero-negative.

• No known history of chronic illness, food or drug allergies.
• Surgical history
• Unremarkable.
 Family and social history
• He is 5th out of 6 children in his family.
• 5 are men and are alive, (only sister passed on 15years ago due
to HIV complications)
• There is excessive alcohol consumption in family. Mother died
in 2006 (cardiac complications) and father died of unknown
causes.
• No family history of mental illness reported on either side
Personal & Forensic history

• Had an uneventful childhood, attained milestones normally.

• He related well with his siblings and friends.
• Studied up to S.4 and joined an institute for a certificate in
plumbing
• Married one wife and have 2 children.
• Arrested in 2019 after being involved in a mob incident
related to the assault of a suspected goat thief; detained for
one month before being released
 Mental Status Exams(MSE)
• Appearance and behaviors: Middle aged male, well dressed
and kempt with bruises around the mouth. Maintained
appropriate eye contact with normal posture.
• Patient was cooperative and readily engaging in assessment
process.
• Speech: Normal rate, volume and tone with relevant content.
• Mood and Affect:
• Mood: reported to feel happy
• Affect: looked happy (mood-affect congruent)
 MSE cont…
• Thought: Was logical, able to provide clear and relevant
responses. Denied suicidal ideation. No delusions.
• Perception: Had visual and auditory hallucinations.
• Cognition: Patient was fully oriented in person, place and time
with intact immediate, short and long term memory; attention
and concentration were elicited and sustained; Abstract thinking
was also intact.
• Judgement: Intact
• Insight: Had insight and knew he needed help.
 Impression
Severe Alcohol Use Disorder (AUD) in Withdrawal.

DDX
- Hypoglycemia
- Brief psychotic disorder
Investigations.
1. RBG - 5.7mmol/l
2. RCT - Negative, TPHA – Negative
3. CBC - Unremarkable
4. LFT’s - Not done.
Management Plan
Biological management
1. Inj. Diazepam 20mg start
2. Inj. Haloperidol 50mg start
3. PO Haloperidol 5mg bd
4. PO Diazepam 5mg bd
5. PO Neuroton I od x 1/12
Psychological management
1. Motivational interviewing
2. Cognitive Behavioral Therapy

3. Social management
Linked him to addiction clinic.
 ALCOHOL USE,
DRIVERS AND
CONSEQUENCES
DATE: 28TH OCT 2025
PRESENTER: DR. MARJORIE M.KABATOORO
PSYCHIATRY RESIDENT YEAR II
PRESENTATION OUTLINE
Introduction & definitions

Epidemiology of alcohol use

Drivers of alcohol use

Myths and realities about alcohol use

Red flags and early warning signs

Consequences of alcohol use

 WHAT IS A SUBSTANCE?

Any chemical altering brain function, mood,

or behavior

Categories:
 Legal: Alcohol, tobacco, caffeine
 Prescription: Sedatives, opioids
 Illegal: Cannabis, cocaine, heroin
 WHAT IS ADDICTION?

Characterized by the
“A state of
compulsion to seek
dependence
or take a substance,
produced either by
or engage in a
the habitual taking of
behaviour, and the
drugs or by regularly
loss of control
engaging in certain
relating to that
activities
substance or
(e.g., gambling)”
behaviour
 WHAT IS ADDICTION?
It is possible to become addicted to almost anything, including:
Substances – Heroin, stimulants, sedatives, alcohol,
cannabis and tobacco
Gambling – Involves repeated problematic gambling
behaviour
Work – Obsession with work to the extent that other
aspects of life are affected
The internet – Spending hours surfing the internet or
gaming, to the detriment of other aspects of life
Shopping – The ‘high’ from buying unnecessary
things can be followed by feelings of guilt and shame
 TYPES OF ADDICTION
Two types of addiction
Substance-use Behavioural
disorders addictions
Addiction to a psychoactive Behaviours that develop as
substance (e.g., alcohol-use a result of specific
disorder) repetitive rewarding and
reinforcing behaviours (e.g.,
Core features: Impaired control gambling disorder)
Core feature: Failure to resist
over drug-taking, social
impairment, risky drug use, and an impulse to perform an act,
the pharmacological the repetition of which
consequences of tolerance and interferes with the individual’s
withdrawal functioning
 TYPES OF PSYCHOACTIVE
SUBSTANCES
Depressants – Alcohol, benzodiazepines
(slow brain)
Stimulants – Cocaine, caffeine (increase
alertness)
Hallucinogens – LSD, cannabis (alter
perception)
Opioids – Heroin, morphine (pain relief,
euphoria)
Inhalants/Nicotine – Varying effects
 EPIDEMIOLOGY
Global prevalence: 5.1% of adults have AUD (~283
million people)

Africa: Increasing trend, especially in males aged

20–40

Uganda: Linked to domestic

High consumption
9–10% of adults violence,
of locally brewed
meet AUD criteria accidents, and HIV
alcohol
 WHY DO WE DRINK?
Peer & social influence
Youth often drink to fit in, conform to peer norms,
or because of peer pressure
Perceived norms (believing “everyone else is
drinking”) increase use
Shift in gender patterns: in some contexts more
girls now report binge‐drinking
 WHY DO WE DRINK?

Family and home environment

Parental alcohol use or permissive

attitudes toward alcohol increase risk
Easy access to alcohol at home or via
older siblings/friends
 WHY DO WE DRINK?

Psychosocial stress, mental health & coping

Youth may use alcohol to relieve stress,

anxiety, trauma, familial or social
problems
Risk‐taking behavior, novelty seeking in
adolescence ties into alcohol use
 WHY DO WE DRINK?
Environmental, regulatory and cultural factors
Low enforcement of minimum drinking age, ease of
purchase, aggressive alcohol marketing
The “modern” driver: digital/social media influence (drinking
portrayed as glamorous), though less well quantified in the
literature
Urbanization/transition: changing social norms, more
disposable income, more unsupervised time may increase
risk
 WHY DO WE DRINK?

Biological/developmental vulnerability
Adolescence is a period of brain development; alcohol
may have more impact (so young people are more
vulnerable)
Genetic/family history predisposition also plays a role
MYTHS AND REALITIES
ABOUT ALCOHOL
Myth: 'Alcohol
makes me
Myth: 'Everyone
confident' →
drinks' → Reality:
Reality:
Many youths
Temporary;
abstain
impairs
judgment
Myth: 'I can
Myth: 'It helps control it
me sleep' → anytime' →
Reality: Disrupts Reality:
sleep cycles Addiction is a
brain disease
RED FLAGS & EARLY
WARNING SIGNS
Mood
Neglecting Changes in swings,
studies or sleep or secrecy,
work hygiene withdrawa
l
Smell of
Financial Accidents
alcohol or
problems or injuries
tremors
CONSEQUENCES OF
ALCOHOL ABUSE
 WHAT HAPPENS AS A RESULT OF YOUTH
ALCOHOL USE

Short‐term harms
Injuries, accidents (including road traffic crashes), falls,
drownings
Risky sexual behavior, unplanned pregnancies, sexually
transmitted infections
Aggressive/violent behavior, involvement in assaults (both
victim and perpetrator)
Legal/disciplinary problems (underage drinking, driving
under influence, trouble at school)
 WHAT HAPPENS AS A RESULT OF YOUTH
ALCOHOL USE

Academic/social consequences
Poor school attendance, lower grades, drop-outs
Social problems: family conflict, isolation, reduced
opportunities for positive social development
Wider public‐health/societal consequences
Underage drinking contributes to overall morbidity and
mortality (lost life years)
Economic/social cost (health care, law enforcement, lost
productivity)
 WHAT HAPPENS AS A RESULT OF YOUTH
ALCOHOL USE

Developmental & health consequences

Impaired brain development, memory and cognitive

function deficits (since adolescent brain still maturing)
 Increased risk of developing an alcohol use disorder in
adulthood – starting early increases lifetime risk
Chronic health issues: although more long‐term evidence
tends to be from adulthood, early heavy use sets the
stage
 Emotional
Speech control Physical
Becomes weakens, responses
Slurred As with mood include
Alcohol swings, nausea,
SHORT TERM Disrupts agitation, vomiting,
EFFECTS Brain Areas
Controlling
and
impulsive
blood
pressure and
Language behavior breathing
And Muscle increasing irregularities,
Coordination risks with alcohol
poisoning
risking
unconscious
ness or coma
 Chronic alcohol use damages the heart,
causing cardiomyopathy, arrhythmias,
hypertension, increasing risks for heart
failure and stroke

LONG-TERM The liver suffers fatty changes, cirrhosis,

and cancer, impairing toxin filtration with
ORGAN broad systemic impacts
DAMAGE
The pancreas inflames (pancreatitis),
disrupting blood sugar control and
heightening risk for diabetes and
metabolic disorders
 PSYCHOLOGICAL AND COGNITIVE EFFECTS
Alcohol disrupts brain communication, impairing memory,
concentration, and learning, causing difficulty with decision-making
and multitasking
Prolonged use causes emotional dysregulation—severe mood swings,
anxiety, and depression arise from altered brain neurotransmitters
Alcohol use strongly correlates with mental health disorders, doubling
the risk of alcohol use disorder in those with common mental
illnesses
Addiction develops through brain reward system changes, leading to
cravings, withdrawal distress, and compulsive drinking
 PSYCHOLOGICAL AND COGNITIVE EFFECTS

Behavioral disinhibition lowers social restraints and impulse control,

increasing risky or irresponsible actions

Alcohol use strongly correlates with mental health disorders,

doubling the risk of alcohol use disorder in those with common
mental illnesses

Addiction develops through brain reward system changes, leading

to cravings, withdrawal distress, and compulsive drinking
 SEXUAL AND HORMONAL EFFECTS

Alcohol depresses impairs sexual arousal, performance, and desire with

larger or chronic use
 Alcohol decreases testosterone and estrogen levels, reducing
sexual desire
 It impairs blood flow and nerve function to the genital organs
 Because of sedation and loss of coordination, sexual satisfaction is
reduced
Chronic drinking disrupts hormone regulation and damages sperm
or eggs
 CONCLUSION
Modern youth alcohol use reflects a complex interplay between
psychosocial, cultural, economic, and technological factors
Interventions must go beyond individual education to address
structural and cultural determinants, including regulation of
alcohol marketing, youth-friendly mental-health services, school-
based prevention, and parental engagement
Policymakers, educators, and mental-health practitioners must
work collaboratively to design context-sensitive prevention and
treatment strategies
THANK YOU FOR
LISTENING
Challenges and Barriers to Care
for People with Alcohol Use
Disorders
Presenter: Dr Twinamatsiko Wilberforce
 Individual-Level Barriers

Denial and Lack of Insight:

Many individuals with AUD do not perceive their drinking as
problematic, often minimizing or rationalizing consumption.
Alcohol impairs judgment and insight, reducing motivation to seek
help, while neurobiological changes in the reward and prefrontal
control systems further impair self-awareness.

Stigma and Shame:

AUD is often viewed as a moral failing rather than a medical
condition. Patients fear being labeled or discriminated against,
leading to secrecy and avoidance of care.
Stigma may also exist among healthcare providers, impacting the
quality of care.
 Individual-Level Barriers
Comorbid Psychiatric and Cognitive Disorders:
Conditions such as depression, anxiety, bipolar disorder, and
psychosis often coexist with AUD, complicating diagnosis and
treatment. Cognitive impairments hinder adherence to treatment
and engagement in therapy.

Low Motivation and Readiness to Change:

Many patients remain in the 'precontemplation' stage of change,
lacking readiness or hope for abstinence. Relapse may reinforce
feelings of futility.

Physical Dependence and Withdrawal:

Fear of withdrawal symptoms, including tremors, seizures, or
delirium, discourages cessation or treatment-seeking, especially
when past withdrawal was poorly managed.
 Family and Interpersonal Barriers

Family Denial and Enabling Behaviors:

Families may normalize or hide the problem to avoid social
embarrassment. Enabling—providing money, alcohol, or excuses—
perpetuates Alcohol use.

Lack of Family Support:

Effective treatment often requires family engagement. Emotional
detachment, blame, or lack of understanding can undermine
recovery efforts.

Cultural and Religious Influences:

Cultural norms that encourage alcohol use or, conversely, religious
condemnation of drinking both create obstacles. In permissive
cultures, help-seeking is delayed; in punitive cultures, it is hidden.
 Health System Barriers
• Limited Availability of Specialized Services:
Few trained addiction professionals and limited treatment centers,
particularly in low- and middle-income regions, make access
difficult.

Poor Integration into Primary Care:

AUD screening is often absent from routine health care, leading to
missed early interventions.

Fragmentation of Care:
Lack of coordination among psychiatry, general medicine, and
community services results in poor continuity of care and high
dropout rates.
Health System Barriers
• Cost and Insurance Limitations:
Treatment costs and inadequate insurance coverage make
care unaffordable for many, deterring engagement.

Provider Attitudes and Training Gaps:

Clinicians may hold stigmatizing beliefs about substance users
and lack training in managing AUDs, reducing quality of care.

Inadequate Diagnostic and Treatment Tools:

Limited use of standardized screening tools (AUDIT, CAGE) and
restricted access to pharmacotherapy compromise evidence-
based care.
 Societal and Structural Barriers
• Policy and Regulatory Gaps:
Weak alcohol control laws, poor regulation of sales and advertising,
and absence of coherent national substance use policies contribute to
widespread harm.

Socioeconomic Factors:
Poverty, unemployment, and unstable housing increase vulnerability
and reduce capacity to access and adhere to care.

Alcohol Industry Influence:

The alcohol industry lobbies against effective regulation, framing
alcohol problems as individual rather than structural.

Media and Public Perception:

Alcohol is glamorized in the media, while people with AUD are
portrayed as irresponsible or dangerous, reinforcing stigma.
Legal and Ethical Barriers
• Involuntary Treatment and Human Rights Concerns:
Some jurisdictions enforce coercive treatment, raising ethical
concerns about autonomy and consent. Fear of detention or job
loss deters voluntary treatment.

Confidentiality and Privacy Issues:

Concerns about confidentiality, especially in small communities,
deter individuals from seeking psychiatric help due to fear of
social or occupational consequences.
Barriers in Low- and Middle-Income
Countries (LMICs)
• Resource Constraints:
Mental health and addiction services are underfunded, with few
inpatient detoxification centers and minimal access to
medications.

Workforce Shortages:
A severe shortage of psychiatrists, addiction specialists, and
psychologists limits service delivery, leaving primary care
workers underprepared.

Competing Health Priorities:

Government focus on infectious diseases such as HIV, TB, and
malaria diverts funding and attention away from mental health
and substance use disorders.
Intersectional Barriers
Gender Barriers:
Women face heightened stigma, reduced social support, and lack
of gender-sensitive services, deterring treatment-seeking.

Youth Barriers:
Adolescents often fall through gaps between child and adult
psychiatric services, limiting appropriate interventions.

Marginalized Populations:
Homeless individuals, prisoners, and LGBTQ+ persons experience
compounded stigma, social exclusion, and lack of tailored services.
Summary

• Barriers to care for individuals with AUD occur across

multiple levels: individual, family, health system, and
societal.
• Central challenges include stigma, poor service
integration, inadequate resources, and policy
deficiencies.
• Addressing these requires multisectoral collaboration,
health system strengthening, and evidence-based,
patient-centered interventions.
THANK YOU
 Alcohol and the Family System:
Family Functioning and Recovery
in the Ugandan Context

Presenter: Dr Piex Uwiragiye

Supervisor: Dr Ashaba
 The Family System Perspective
• The family operates as an interconnected system  A
change in one member affects all others.(Family
systems theory , Bowen, 1978),

In the context of alcohol use disorder:

• The individual with Alcohol Use Disorder (AUD)
becomes a “symptom bearer,” reflecting underlying
stress or dysfunction within the family.
• Alcohol use alters roles, communication patterns,
and emotional boundaries among family members.
Alcohol and Family Functioning
Emotional aspect
• Frequent drinking leads to emotional instability,
fear, and resentment.
• Family members experience psychological
distress, including anxiety, depression, and
trauma (Mehus et al, 2021).

• Emotional communication becomes distorted

(denial, blame, and secrecy… being common
coping patterns).
Alcohol & In Uganda, parenting is often shared by
extended families.
Parental  alcohol misuse can lead to neglect,
Roles and inconsistent discipline, and financial
insecurity. (Swahn et al, 2017)
Child
Outcomes Children from such families may show
school dropout, behavioural
problems, or early substance use
initiation.

Domestic violence, often alcohol-

related, disrupts the sense of safety and
belonging. (Tumwesigye et al, 2012)
Alcohol and Economic Functioning

• Alcohol misuse drains household income through

spending on drinks, healthcare costs, or job
loss. (Tumwesigye et al, 2012)

• In rural Uganda, where subsistence farming is

common, alcohol use during working hours (e.g.,
after local brew production or boda boda earnings)
can reduce productivity and family food security.
 Alcohol, • Men’s drinking is often culturally
tolerated, but women’s alcohol use
Gender carries stronger stigma. (why?)
and
Power • Wives of heavy drinkers may
Dynamics experience economic dependency,
intimate partner violence (IPV), or
social isolation.

• In some cases, alcohol-related conflict

is a leading cause of family
breakdown and divorce.
 Extended families sometimes
normalize or enable alcohol use
(e.g., social drinking at funerals or
Alcohol and ceremonies).
the Extended
Family in Conversely, they may also serve as
Uganda protective networks, offering
informal care, counseling, or
temporary accommodation during
crises.
Clan elders and religious leaders
often mediate in alcohol-related
conflicts, reflecting the communal
approach to problem-solving.
 Family-Based Recovery and Resilience

Family Involvement in Treatment

• Evidence suggests that family-inclusive interventions enhance

recovery outcomes.
• In Uganda, community-based rehabilitation programs (e.g., Butabika
National Referral Hospital’s community outreach, TASO, or Faith-
Based Organizations) have piloted family education and
counselling sessions.
• Involving spouses and children helps address enabling behaviors,
improves communication, and restores trust.
 Family Collective coping (extended family
Strength and sharing responsibilities)
Resilience
Factors Spiritual reliance and prayer

Community support networks

(neighbors, churches, women’s
savings groups)
Open communication during the
recovery phase
Barriers to Family
Recovery
• Stigma toward both drinkers
and their families
• Limited access to addiction
services, especially in rural
districts
• Gender-based violence
perpetuating cycles of trauma
• Poverty and unemployment
undermining recovery stability
• Inadequate family therapy
programs in public health
facilities
Recommendations for Strengthening Family Recovery

• Integrate family therapy and psychoeducation in alcohol

treatment services.
• Train community health workers in basic family-based
interventions.
• Promote gender-sensitive programs addressing alcohol-
related domestic violence.
• Leverage faith and cultural structures for prevention
and recovery support.
• Conduct public health campaigns to reduce stigma and
promote responsible drinking.
• Implement school-based programs to support children
from alcohol-affected homes.
 Alcohol misuse disrupts the core
fabric of family functioning (in
Uganda and elsewhere)

Conclusio Families hold the key to

n recovery, offering the social and
emotional scaffolding for
sustainable change.

An integrated, culturally

responsive, and family-centered
approach can transform alcohol
recovery from an individual
journey into a collective process
of healing and resilience.
Thank you for
listening!
 Clinical
Management
Dr. David Kamya
H.E: John Pombe
Magufuli (1959 - 2021)
Quote: “Pombe is not
soup”
Actual Interpretation:
“Beer can’t replace
good governance”
Ugandans: “Alcohol not
for the weak”
Introduction

• Alcohol dependence is characterized by;

• Inability to stop or control alcohol use despite negative
social, occupational, or health consequences
• In Uganda, alcohol is deeply interwoven into the social and
cultural fabric, which makes addressing AUD both complex
and sensitive
 History taking (Alcohol Use History)

• Age of onset, Triggers, Frequency, other

Manageme substances, course

nt of Examination (Mental state + Physical)

Alcohol use Investigations

disorder • Biological: Liver function tests, renal, drug screen,
HIV test
• Psychological: CAGE score, AUDIT
• Social: Further inquiry from community (spouse,
friends)
Treatment

• Biological, Psychological, Social

Treatment
• Follows the Bio-Psycho-
Social model
A. BIO-logical
(Pharmacotherapy)

• Applicable when presenting with

mental health complications
• Intoxication, Withdrawal
• Immediate management
• Admission (to ensure safety)
• Vitamin B1 replacement
(Thiamine-IM, Multivitamins)
• Glucose after Thiamine
• Benzodiazepines (for
withdrawal)
• Antipsychotics (for psychosis)
BIO-logical
(Pharmacotherapy) cont…

• If the patient gets

alcohol withdrawal
seizures (Ram fits);
• Use Benzodiazepines
• Antiseizure drugs
are helpful
• Support
treatment
• Disulfram [Aversion
therapy]
• Naltrexone
• Acamprosate
• Gabapentin
B. Psychological
management
Psychotherapy
• Evokes behavioral change
1. Motivational interviewing
2. Cognitive behavioral therapy
3. Group therapy
4. Couple/Family therapies
5. Skills building
6. Psychodynamic therapy
 Socioeconomic Support
• Vocational training, livelihood programs
Family and Community
C. Social Involvement
manageme • Repair relationships and educate
families
nt Support Groups (Alcoholic
Anonymous)
Policy and Enforcement
• Enforce the Alcohol Control Act (age
restrictions, licensing, marketing
regulations
Alcohol Use
Prevention
• Prevention of alcohol use
and misuse can be
categorized into primary,
secondary, and tertiary
levels, each targeting a
different stage of the
problem.
 Summary of Clinical
Management for BBK

• The management plan is divided into

immediate stabilization (acute care)
and long-term relapse prevention.
• 1. Acute Pharmacological
Management (Stabilization)
• The immediate goal is to control the
central nervous system (CNS)
hyperexcitability, which is manifesting
as seizures and psychosis, and to
manage associated symptoms.
 2. Long-Term Recovery and Psychosocial Care

Once the patient is medically stable and the acute psychosis has resolved, the focus
must shift to preventing relapse, as BBK has a history of poor medication adherence
and multiple past episodes.

Psychotherapy: The plan includes psychotherapy to address the underlying

psychological and behavioral factors contributing to the Alcohol Use Disorder.
Motivational Interviewing (MI): To enhance the patient's internal motivation for
abstinence, leveraging the fact that he currently has good insight 11.
Cognitive Behavioral Therapy (CBT): To identify and change learned behaviors
and thoughts associated with drinking (e.g., drinking as a coping mechanism for
stress).
2. Long-Term Recovery and Psychosocial Care

Adherence Monitoring:
Given the history of relapse Social Support: Counseling
due to poor adherence12, a for the wife (informant) and
robust plan must be put in the family is necessary to help
place to ensure he continues them manage the current
taking prescribed long-term strained relationship (due to
medication (such as anti- his aggression) and establish a
craving agents, once supportive, sober home
appropriate) and attends environment13131313.
follow-up appointments.
Thank You
Prevention and Intervention
strategies
Presenter: Dr. Esther Murungi
Introduction
Alcohol misuse prevention and
intervention use multilevel strategies to
reduce initiation, hazardous use, and
alcohol use disorders.
Strategies are grouped
into Primary, Secondary, and Tertiary
Prevention.
Primary Prevention

Primary prevention aims to stop alcohol

misuse before it starts by addressing
root causes and risk factors.

It targets the entire population or high-

risk groups with no current alcohol
problems.
Education and Awareness
• School-based education programs:
Teach young people about the risks of alcohol,
decision-making, assertiveness, and resisting peer
pressure.
• Media and social campaigns:
Use radio, TV, and social media to spread anti-alcohol
messages in youth-friendly language.
• Incorporate life skills training:
Encourage emotional regulation, stress management,
and problem-solving skills to build resilience.
Family Based Prevention
• Parental supervision and communication:
Parents should talk openly about alcohol and set clear
rules against underage drinking.
• Positive role modeling:
Parents and adults should demonstrate responsible
behavior by avoiding excessive drinking.
• Family bonding activities:
Promote shared leisure time and open discussions to
reduce secrecy and peer-driven experimentation.
 Peer and Community-
Based
• Peer Programs
education initiatives:
Train youth leaders to influence
peers positively through clubs,
debates, and community
outreach.
• Youth clubs and safe
recreation:
Provide alternatives like sports,
music, and art to replace idle time
that could lead to drinking.
• Religious and cultural groups:
Use moral and cultural teachings
to discourage substance misuse
 Policy and Environmental Measures
Regulate access:
Regulate Enforce minimum drinking age laws and prohibit
sales to minors.
Taxation and pricing:
Increase Increase alcohol prices to reduce youth
affordability.
Control advertising:
Advertising Restrict alcohol marketing targeting young
audiences on radio, billboards, and social media.
Limit availability:
Limit Ban alcohol sales near schools and youth
gathering places; regulate hours of sale.
Secondary Prevention
Secondary prevention targets individuals
who have begun risky or hazardous
alcohol use but do not yet meet criteria
for an alcohol use disorder. ,
The goal is to intervene early to prevent
progression and secondary harms.
Common approaches include:
Screening and Early identification
Identification
• Routine screening:
• Ask simple questions to see if someone drinks too much
and can be done in schools or clinics. Easy tools such as
:
• AUDIT – short questionnaire about drinking habits
• CAGE – 4 quick questions to spot alcohol problems
• School counselors and teachers:
Should be trained to identify behavioral or academic
changes linked to alcohol use
Brief Interventions
Motivational interviewing:
Helps youth explore reasons for drinking and set personal
goals to reduce or quit.

Peer or mentor support:

Older youth or mentors can guide peers toward healthier
coping methods.

Referral systems:
Schools and community health workers should have links
to health centers or psychologists for further care.
Tertiary Prevention

Tertiary prevention focuses on people

with established alcohol use disorders or
dependence.

Its aim is to manage and reduce harms,

prevent relapse, and improve quality of
life.
 Counseling and Therapy
Cognitive Behavioral Therapy (CBT):
Addresses underlying thoughts and behaviors that
sustain alcohol use.

Family therapy:
Engages family members to improve relationships and
support recovery.

Group therapy and peer support:

Offers encouragement and accountability among
recovering youth.
Rehabilitation Programs

Youth-friendly rehabilitation
centers:
Provide safe spaces for detoxification,
counseling, and skill-building.
Aftercare services:
Continuous follow-up to prevent relapse
and help reintegration into school or
work.
Pharmacological Therapies for Alcohol
Dependence
Purpose: Reduce cravings and prevent relapse in alcohol-
dependent youth

Role: Complements psychological and social interventions

Key Medications:
• Naltrexone: Reduces cravings.
• Acamprosate: Helps maintain abstinence.
• Disulfiram: Causes unpleasant reactions if alcohol is consumed.
Community
Reintegration
• Vocational training:
Empower recovered youth with
job skills to promote
independence.
• Support groups:
Alcoholics Anonymous (AA) or
youth-led recovery networks for
sustained sobriety.
 Cross-cutting Strategies
Decentralization of Services:
Integrating alcohol misuse prevention and treatment into
primary healthcare to increase accessibility, especially in
rural areas.
Community Mobilization:
Engaging local leaders, youth clubs, and faith-based
organizations to reinforce positive behaviors.

Policy & Advocacy:

Enforcing laws against drunk driving, public drinking, and
underage sales.