Combining a guided self-help and brief alcohol intervention to improve mental health and reduce substance use among refugee men in Uganda: a cluster-randomized feasibility trial

In this manuscript, we describe the integration and testing of two scalable psychological interventions designed to reduce psychological distress and harmful alcohol use. In response to formative research indicating the need to incorporate alcohol-related intervention elements into mental health programs for South Sudanese refugee men in Uganda, this study integrated Self-Help Plus (SH+) and the Alcohol, Smoking and Substance Involvement Screening Test-linked Brief Intervention (ASSIST-BI). We adapted these interventions to the study context using a range of methods including qualitative interviews, cognitive interviewing, and a pilot cohort study. We then conducted a cluster randomized feasibility trial comparing the integrated intervention (SH+ and ASSIST-BI), SH+ alone, and enhanced usual care on alcohol use, other drug use, and mental health outcomes among men with elevated psychological distress in Rhino and Imvepi Refugee Settlements in northwestern Uganda. Results revealed adequate levels of attendance and reductions in symptoms of psychological distress, functional impairment, other mental health outcomes, and substance use risk levels (including alcohol use). This study demonstrates that it is feasible to integrate two scalable interventions, such as SH+ and ASSIST-BI, to address the presenting psychological and related needs in humanitarian contexts.