Pilot trial of a transdiagnostic intervention for war-affected men with alcohol misuse in Ukraine

Background

Despite the significant burden of alcohol use disorders in Ukraine, access to appropriate care among conflict-affected people remains inadequate. A major barrier is the lack of contextually appropriate interventions suited for conflict-affected settings. This feasibility trial aimed to test the trial procedures, examine early implementation outcomes and preliminary effectiveness of a new brief psychological intervention (“CHANGE”) targeting both alcohol misuse and psychosocial distress among war-affected men in Ukraine.

Methods

Parallel two-arm single blind individually randomized controlled pilot trial with a nested qualitative study was conducted in the two Ukrainian cities – Kyiv and Dnipro. Participants included adult male hazardous or harmful drinkers with elevated levels of psychological distress that were randomised 1:1 to receive either the CHANGE intervention & enhanced usual care (EUC) or EUC only. A mixed-methods approach was used to assess trial procedures (recruitment, retention, randomisation, and data collection), implementation outcomes (acceptability, feasibility of delivery and safety), and perceived effectiveness.

Results

62 participants were randomised and 41 (66%) completed the outcome assessments. Recruitment targets were met over a seven-month period. Key obstacles to recruitment included normalization of alcohol use, stigma surrounding help-seeking, low intrinsic motivation, competing responsibilities, and war-related logistical barriers. Both participants and facilitators reported overall satisfaction with intervention content, structure, and delivery approach. All stakeholders perceived the intervention to be useful for reducing alcohol misuse and improving well-being.

Conclusions

The findings show overall acceptability, feasibility, and perceived effectiveness of CHANGE delivered under ongoing war conditions, laying the foundation for a fully powered RCT to assess its effectiveness.

Key messages

• CHANGE was feasible and acceptable brief psychological intervention for war-affected men who misuse alcohol in Ukraine, despite active recruitment and delivery challenges.

• CHANGE shows promise for reducing alcohol misuse and improving well-being, supporting a full-scale randomised trial.