A neglected health problem in displacement settings has new evidence behind a workable response
A randomized trial conducted in the Mantapala refugee settlement in northern Zambia found that a structured alcohol-reduction intervention produced a significant and sustained drop in alcohol use among participants, according to researchers led by Columbia University Mailman School of Public Health. The study, published in Lancet Global Health, is described as the first known randomized trial of an alcohol-reduction intervention in a humanitarian setting.
That matters because the health burden is large and often under-addressed. The source article notes that an estimated 123 million people were living in situations of forced displacement at the end of 2024, including more than 36 million refugees. Conflict and displacement are associated with a higher risk of adverse health outcomes, including mental health conditions. Alcohol and other drug use disorders are among those risks, but humanitarian systems have historically devoted limited attention and research capacity to them.
The Mantapala settlement offers a clear example of why this gap matters. Established in 2018 in response to refugees fleeing the Democratic Republic of the Congo, the settlement faces pressures common in prolonged displacement settings: trauma exposure, chronic stress, boredom, and limited specialized services. In that environment, the study authors say, home-brewed alcohol is common and the risk of cannabis and other drug use is high. These substances can become coping mechanisms for distress that is social, economic, and psychological all at once.
How the trial was structured
The trial, called Ukuundapwa Chapamo, compared a version of SBIRT, or Screening, Brief Intervention, and Referral to Treatment, against treatment as usual. After a baseline assessment, participants were randomized one-to-one into one of the two groups. In the control condition, treatment as usual meant referral to primary care providers for basic counseling at the Mantapala health center.
The intervention model is notable not only for what it delivered, but for who delivered it. Non-specialists from the refugee settlement and the surrounding Zambian host community were trained to provide mental health care under the supervision of mental health professionals. That detail is central to the significance of the result. Mantapala did not have other specialized mental health or substance use services available inside the settlement, and people with urgent health needs were instead accompanied to a district-level hospital.
In other words, the trial was not testing a solution dependent on a large specialist workforce that most humanitarian operations do not have. It was testing whether a supervised, community-based model could produce measurable benefit where formal services are scarce. According to the source text, it did.
Why the findings could travel beyond one settlement
Humanitarian health systems frequently struggle with a structural mismatch: needs are broad and persistent, but specialist resources are thin, mobile, or absent. Interventions that rely on psychiatrists, psychologists, or addiction specialists at scale can be difficult to maintain in refugee settings. A model that trains non-specialists drawn from affected and host communities fits better with how many real-world responses are staffed.
The Mantapala findings therefore point to more than one successful program. They suggest a service design that may be adaptable across refugee settlements and other displacement contexts where alcohol and other drug use are present but formal treatment pathways are minimal. If the core components can be taught, supervised, and integrated into primary or community health systems, humanitarian agencies may have a more realistic pathway to addressing substance use than waiting for specialist capacity that never fully arrives.
The result also reinforces a broader shift in global mental health: carefully designed task-sharing can extend care into places where conventional service models fall short. In this study, the intervention was delivered by people embedded in the community rather than imported as a narrow outside service. That can improve reach and operational feasibility, especially in settlements where transport, workforce recruitment, language, and trust all complicate clinical delivery.
Limits that remain important
The source material does not provide detailed outcome measures, subgroup results, or the precise duration of follow-up beyond describing the effect as significant and sustained. It also does not offer comparative data on cannabis or other drug use outcomes, even though the article frames alcohol and other drugs as a linked challenge in Mantapala. Those missing details do not negate the headline result, but they do limit how far the findings can be generalized from the summary alone.
There is also a practical distinction between showing that an intervention works in a trial and proving that it can be scaled consistently across humanitarian systems with different funding levels, security conditions, and public health infrastructure. Training, supervision, referral capacity, and continuity of care remain operational requirements. Even a low-resource model is not a no-resource model.
Still, those caveats should not obscure the main development. Humanitarian care has often treated substance use as secondary to other emergencies, or as a problem too specialized to address meaningfully inside refugee responses. This trial challenges that assumption with evidence from the setting itself.
What this means for humanitarian health planning
The policy implication is straightforward. Alcohol and drug use disorders in displacement settings can no longer be dismissed as issues with too little evidence to support structured intervention. The Mantapala trial indicates that a brief, supervised, non-specialist approach can reduce harmful alcohol use even in a context marked by conflict displacement, limited formal services, and overlapping mental health stressors.
For governments, aid agencies, and public health planners, that creates a more concrete choice. Screening and brief intervention for alcohol use can be treated as part of humanitarian health system design rather than an optional add-on. Training local non-specialists from both refugee and host communities may also offer a way to build services that are more resilient and more locally grounded.
As displacement numbers remain high globally, evidence that practical care models can work under humanitarian constraints is unusually valuable. The Mantapala study does not solve the broader neglect of substance use in refugee settings. But it does establish something essential: intervention is possible, and the absence of specialist-heavy infrastructure does not have to mean the absence of treatment.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
