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Cited by 41Substance Abuse Treatment and OutcomesAlcohol Consumption and Health EffectsHealth Policy Implementation Science

Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary

Open access
Staton, Catherine A., Vissoci, João Ricardo Nickenig, El-Gabri, Deena, Adewumi, Konyinsope, Concepcion, Tessa, Elliott, Shannon A., Evans, Daniel R., Galson, Sophie W. +10 more·2022·PLOS Medicine
DOI 10.1371/journal.pmed.1003961PMC PMC9004752
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Abstract

Background: Disease and disability from alcohol use disproportionately impact people in low- and middle-income countries (LMICs). While varied interventions have been shown to reduce alcohol use in high-income countries, their efficacy in LMICs has not been assessed. This systematic review describes current published literature on patient-level alcohol interventions in LMICs and specifically describes clinical trials evaluating interventions to reduce alcohol use in LMICs. Methods and findings: In accordance with PRISMA, we performed a systematic review using an electronic search strategy from January 1, 1995 to December 1, 2020. Title, abstract, as well as full-text screening and extraction were performed in duplicate. A meta-summary was performed on randomized controlled trials (RCTs) that evaluated alcohol-related outcomes. We searched the following electronic databases: PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO. Articles that evaluated patient-level interventions targeting alcohol use and alcohol-related harm in LMICs were eligible for inclusion. No studies were excluded based on language. After screening 5,036 articles, 117 articles fit our inclusion criteria, 75 of which were RCTs. Of these RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries. These RCTs evaluated brief interventions (24, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session up to 4 sessions), psychotherapy or counseling (15, defined as an interaction with a counselor longer than a brief intervention or that included a psychotherapeutic component), health promotion and education (20, defined as an intervention encouraged individuals’ agency of taking care of their health), or biologic treatments (19, defined as interventions where the biological function of alcohol use disorder (AUD) as the main nexus of intervention) with 3 mixing categories of intervention types. Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies. The most commonly evaluated intervention with the most consistent positive effect was a brief intervention; similarly, motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated. Conclusions: Our review demonstrated numerous patient-level interventions that have the potential to be effective in LMICs, but further research to standardize interventions, populations, and outcome measures is necessary to accurately assess their effectiveness. Brief interventions and MI techniques were the most commonly evaluated and had the most consistent positive effect on alcohol-related outcomes. Trial registration: Protocol Registry: PROSPERO CRD42017055549

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-summary found 117 patient-level alcohol intervention studies in LMICs, including 75 RCTs, with brief interventions and motivational interviewing techniques most commonly evaluated and showing the most consistent positive effects. However, evidence was heavily concentrated in middle-income countries, and heterogeneous interventions, outcomes, and follow-up times prevented meta-analysis.

Key findings

  • After screening 5,036 articles, 117 met inclusion criteria; 75 were RCTs. Of the RCTs, 93% were conducted in 13 middle-income countries and 7% in 2 low-income countries; Brazil (28%) and India (20%) contributed the most studies.
  • RCTs were categorized as brief interventions (24), psychotherapy or counseling (15), health promotion and education (20), or biologic treatments (19), with 3 studies mixing categories. Brief interventions were the most commonly evaluated and had the most consistent positive effect; motivational interviewing techniques were the most commonly utilized behavior-change technique.
  • Examples of reported effects include Babor et al., where males receiving brief or simple advice had 17% lower average daily alcohol consumption at 9 months versus control and about 10% reduction in drinking intensity; Mertens et al., where nurse-practitioner-delivered brief intervention reduced alcohol ASSIST scores at 3 months by 38% versus 21% in control; and Nadkarni et al., where the intervention group had 36% remission versus 26% in control and 42% versus 18% abstinence at 3 months.
  • Several studies found null or mixed effects, including brief interventions in tuberculosis patients and some primary care or web-based personalized normative feedback studies; biomedical trials showed mixed results across naltrexone, topiramate, gabapentin, acamprosate, baclofen, disulfiram, and transcranial direct current stimulation.

Methods

  • PRISMA-reported systematic review registered in PROSPERO (CRD42017055549); searched PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO from January 1, 1995 to December 1, 2020, with duplicate title/abstract and full-text screening and extraction; no language exclusions.
  • Eligible studies evaluated patient-level interventions targeting alcohol use or alcohol-related harm in LMICs; multiple study designs were included, but analysis was narrowed to RCTs because of their large number.
  • Due to high heterogeneity in intervention types, outcome measures, and follow-up times, the authors did not conduct meta-analysis; instead they performed a qualitative meta-summary, grouping interventions into four types and assessing risk of bias by study design using Cochrane, STROBE, ACROBAT-NRS, NOS, and EPOC tools.

Limitations

  • The paper states that no non-English manuscripts were found despite not excluding language; that meta-analysis was restricted by nonuniform outcome measurements, assessment times, and interventions; that using LMIC status at the time of search may have excluded or included countries whose income classification changed; and that grouping interventions by standard definitions rather than study-specific descriptions may limit interpretation of effect sizes.
  • The text makes evident that most evidence came from middle-income countries, leaving feasibility and effectiveness in low-income settings uncertain; all four brain stimulation studies were conducted in Brazil, no psychotherapy or counseling studies took place in a low-income country, and reliable medication availability may limit biomedical treatment feasibility in low-income settings.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pmed.1003961

Cites

97 of 97 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 145 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The brief interventions category had the greatest number of RCTs in the review, with 24 RCTs.

    “The brief interventions category had the greatest number of RCTs in our study with 24 RCTs”
    Quote in the paperNot a substantial claim
  • Findingreasoning

    The full scope of evidence-based patient-level interventions to reduce harmful alcohol use in LMICs is missing from the literature.

    “yet the full scope of the evidence-based patient-level interventions to reduce harmful alcohol use in LMICs is missing from the literature.”
    Quote in the paperSubstantial claim
  • Findingcitation

    No systematic review had been conducted focusing on alcohol interventions specifically applicable to or evaluated in LMICs.

    “While narrative reviews of global alcohol-related harms have been published, we have found no systematic review conducted focusing on alcohol interventions specifically applicable to or evaluated in LMICs [1,11].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] J Rehm, 2009, Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders, Lancet source

      Not checked in the free run.

    • cites [11] V Benegal, 2009, Packages of care for alcohol use disorders in low- and middle-income countries, PLoS Med source

      Not checked in the free run.

  • Findingown data

    Motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated.

    “similarly, motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The qualitative meta-summary can reliably determine which intervention has the most consistent positive effect despite heterogeneity.
    • Rests on an assumption: The included studies' reported alcohol-related outcomes are comparable enough to be qualitatively summarized.
  • Findingcitation

    WHO-based brief interventions were efficacious in reducing AUDIT average scores in university students.

    “and AUDIT average scores in university students [81]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [81] S Pengpid, 2013, Screening and brief interventions for hazardous and harmful alcohol use among university students in South Africa: results from a randomized controlled trial, Int J Environ Res Public Health source

      Not checked in the free run.

  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 16
  • May combine two claims. 44

  • The quote only partly states this claim.

    Findingown data

    MI techniques had the most consistent positive effect on alcohol-related outcomes.

    “Brief interventions and MI techniques were the most commonly evaluated and had the most consistent positive effect on alcohol-related outcomes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The qualitative meta-summary can reliably determine which intervention has the most consistent positive effect despite heterogeneity.
    • Rests on an assumption: The included studies' reported alcohol-related outcomes are comparable enough to be qualitatively summarized.

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    After screening 5,036 articles, 117 articles fit the inclusion criteria, 75 of which were RCTs.

    “After screening 5,036 articles, 117 articles fit our inclusion criteria, 75 of which were RCTs.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The search strategy and databases used identified all relevant patient-level alcohol intervention studies in LMICs.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Alcohol-related outcomes found included alcohol quantity or frequency measure, intention to use alcohol, use/abstinence/remission proportion or frequency, alcohol-related scores, alcohol cravings or cravings per day, or alcohol use during pregnancy or before sex.

    “Alcohol-related outcomes found included alcohol quantity or frequency measure, intention to use alcohol, use/abstinence/remission proportion or frequency, alcohol-related scores, alcohol cravings or cravings per day, or alcohol use during pregnancy or before sex.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One study by Shin and colleagues had one arm in biomedical treatments and another arm in brief intervention.

    “One study by Shin and colleagues had one arm in biomedical treatments and another arm in brief intervention [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] S Shin, 2013, Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia Addiction

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of the studies came from Brazil (28%) and India (20%).

    “The majority of the studies came from Brazil (28%) and India (20%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    High heterogeneity of intervention types, outcome measures, and follow-up times precluded meta-analysis, so a meta-summary of all 75 RCTs was performed.

    “Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The most commonly evaluated intervention with the most consistent positive effect was a brief intervention.

    “The most commonly evaluated intervention with the most consistent positive effect was a brief intervention”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The qualitative meta-summary can reliably determine which intervention has the most consistent positive effect despite heterogeneity.
    • Rests on an assumption: The included studies' reported alcohol-related outcomes are comparable enough to be qualitatively summarized.

  • May combine two claims.

    Findingown data

    Among the 75 RCTs, 24 evaluated brief interventions, 15 psychotherapy or counseling, 20 health promotion and education, and 19 biological treatments.

    “including brief interventions (24 studies) (Table 2), psychotherapy or counseling (15) (Table 3), health promotion and education (20) (Table 4), and biological treatments (19) (Table 5).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The four intervention categories (brief interventions, psychotherapy/counseling, health promotion/education, biomedical treatments) are valid and sufficiently distinct to group the included studies.

  • May combine two claims.

    Findingown data

    Of the 75 RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries.

    “Of these RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Two studies had one arm in psychotherapy or counseling and another arm in health promotion and education.

    “Two other studies had one arm in psychotherapy or counseling and another arm in health promotion and education [23,24].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [23] E Moraes, 2010, Home visits in the outpatient treatment of individuals dependent on alcohol, Addict Disord Their Treat source

      Not checked in the free run.

    • cites [24] J Ahmadi, 2004, Naltrexone for alcohol-dependent patients, Ir J Med Sci source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The 75 RCTs were performed in 15 countries: 8 upper middle-income countries (60% of studies), 5 lower middle-income countries, and 2 low-income countries (7% of studies).

    “These 75 studies were performed in 15 countries, representing 8 upper middle-income countries (60% of studies), 5 lower middle-income countries, and 2 low-income countries (7% of studies) (S2 Fig).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingcitation

    A few psychotherapy or counseling studies had null effects or found no difference between intervention and control arms.

    “A few of the studies in this subgroup had null effects or found no difference between the intervention and control arms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Sorsdahl and colleagues found a reduction in the ASSIST scale for those who received the MI with problem solving intervention compared to the control, but no difference between MI alone and control.

    “Sorsdahl and colleagues found a reduction in the ASSIST scale for those who received the MI with problem solving intervention compared to the control, yet there was no difference between the MI alone and the control group [92].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92] K Sorsdahl, 2015, The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial, Subst Abuse Treat Prev Policy source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Ng and colleagues reported significantly less alcohol cravings, drinking days, drinks per drinking day, and relapse in the BMS intervention group compared to treatment as usual at 3 months.

    “Ng and colleagues used a body–mind–spirit multidimensional intervention and reported significantly less alcohol cravings, drinking days, drinks per drinking day, and relapse in the intervention group compared to treatment as usual at 3 months [74].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] S-M Ng, 2020, Nurse-Led Body-Mind-Spirit Based Relapse Prevention Intervention for People With Diagnosis of Alcohol Use Disorder at a Mental Health Care Setting, India: A Pilot Study, J Addict Nurs source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Randomization to receive CBT, in different modalities, was associated with a higher reduction in drinking days, drinks per drinking days, and AUDIT score compared to usual care.

    “Randomization to receive CBT, in different modalities, was found to be associated with a higher reduction in drinking days, drinks per drinking days [77,78], and AUDIT score [63] in comparison to usual care”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [77] RK Papas, 2011, Treatment outcomes of a stage 1 cognitive-behavioral trial to reduce alcohol use among human immunodeficiency virus-infected out-patients in western Kenya, Addiction source

      Not checked in the free run.

    • cites [78] RK Papas, 2021, A randomized clinical trial of a group cognitive-behavioral therapy to reduce alcohol use among human immunodeficiency virus-infected outpatients in western Kenya, Addiction source

      Not checked in the free run.

    • cites [63] M Madhombiro, 2020, Effectiveness of a psychological intervention delivered by general nurses for alcohol use disorders in people living with HIV in Zimbabwe: a cluster randomized controlled trial, J Int AIDS Soc source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    L'Engle, Rendall-Mkosi, and Moraes all had significant findings for their MI interventions reducing binge drinking up to 12 months, reducing the proportion of women at risk for alcohol-exposed pregnancies, and increasing the proportion of abstinent patients.

    “L’Engle, Rendall-Mkosi, and Moraes all had significant findings for their MI interventions reducing binge drinking up to 12 months, reducing the proportion of women at risk for alcohol-exposed pregnancies and increasing the proportion of abstinent patients [23,61,83].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [23] E Moraes, 2010, Home visits in the outpatient treatment of individuals dependent on alcohol, Addict Disord Their Treat source

      Not checked in the free run.

    • cites [61] KL LʼEngle, 2014

      Not checked in the free run.

    • cites [83] K Rendall-Mkosi, 2013, A randomized controlled trial of motivational interviewing to prevent risk for an alcohol-exposed pregnancy in the Western Cape, South Africa AddictionApr

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Aira and colleagues found a reduction in drinks per day and an improvement in attitudes toward drinking, but not a reduction in the total amount of alcohol consumption.

    “For example, Aira and colleagues found a reduction in drinks per day and an improvement in attitudes toward drinking, but not a reduction in the total amount of alcohol consumption [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] T Aira, 2013, Reducing risk behaviors linked to noncommunicable diseases in Mongolia: a randomized controlled trial, Am J Public HealthSep source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Mixed effects were found by RCTs for topiramate, where Baltieri found an increase in abstinence at 4 weeks, although Likhitsathian found no differences in any drinking quantity or frequency measures up to 12 weeks.

    “Mixed effects were found by RCTs for topiramate, where Baltieri found an increase in abstinence at 4 weeks, although Likhitsathian found no differences in any drinking quantity or frequency measures up to 12 weeks [32,62].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [32] DA Baltieri, 2008, Comparing topiramate with naltrexone in the treatment of alcohol dependence, Addiction source

      Not checked in the free run.

    • cites [62] S Likhitsathian, 2013, Topiramate treatment for alcoholic outpatients recently receiving residential treatment programs: a 12-week, randomized, placebo-controlled trial, Drug Alcohol Depend source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Satyanarayan found a reduction in SADQ scores for CBT and usual care arm patients but no significant difference between intervention arms.

    “Similarly, Satyanarayan found a reduction in Severity of Alcohol Dependence Questionnaire (SADQ) scores for CBT and usual care arm patients but no significant difference between intervention arms; authors believed that this was because both intervention arms received similar alcohol reduction strategy intervention components [87].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [87] VA Satyanarayana, 2016, Integrated Cognitive Behavioral Intervention Reduces Intimate Partner Violence Among Alcohol Dependent Men, and Improves Mental Health Outcomes in their Spouses: A Clinic Based Randomized Controlled Trial from South India, J Subst Abus Treat source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Rotheram-Borus found that home visits for pre- and postnatal women were associated with a reduction in the use of alcohol during pregnancy, but this drinking resumed postpartum.

    “Similarly, Rotheram-Borus found that home visits for pre- and postnatal women were associated with a reduction in the use of alcohol during pregnancy, but this drinking resumed postpartum [84].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] MJ Rotheram-Borus, 2015, Alcohol use, partner violence, and depression: A cluster randomized controlled trial among urban south african mothers over 3 years, Am J Prev Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Furieri found that gabapentin was associated with a significant decrease in quantity and frequency of drinking and higher mean abstinent days.

    “Furieri found that gabapentin was associated with a significant decrease in quantity and frequency of drinking and higher mean abstinent days [51].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [51] FA Furieri, 2007, Gabapentin reduces alcohol consumption and craving: a randomized, double-blind, placebo-controlled trial, J Clin Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Of the health promotion and education RCTs, 2 were based in the workplace, 5 in the community, 6 in schools, and 7 in clinics, of which 1 focused on women sex workers.

    “Of these, 2 were based in the workplace [26,38], 5 in the community [23,37,43,84], 6 in schools [33,40,65,85,86], and 7 in clinics [39,55–57], of which 1 was focused on women sex workers [95].”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [26] T Aira, 2013, Reducing risk behaviors linked to noncommunicable diseases in Mongolia: a randomized controlled trial, Am J Public HealthSep source

      Not checked in the free run.

    • cites [38] NH Burnhams, 2015, Results of a cluster randomised controlled trial to reduce risky use of alcohol, alcohol-related HIV risks and improve help-seeking behaviour among safety and security employees in the Western Cape, South Africa, Subst Abuse Treat Prev Policy source

      Not checked in the free run.

    • cites [23] E Moraes, 2010, Home visits in the outpatient treatment of individuals dependent on alcohol, Addict Disord Their Treat source

      Not checked in the free run.

    • cites [37] P Bolton, 2014, A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand, PLoS Med source

      Not checked in the free run.

    • cites [43] LA Cubbins, 2012, Alcohol use and abuse among rural Zimbabwean adults: a test of a community-level intervention, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [84] MJ Rotheram-Borus, 2015, Alcohol use, partner violence, and depression: A cluster randomized controlled trial among urban south african mothers over 3 years, Am J Prev Med source

      Not checked in the free run.

    • cites [33] VC Barbosa Filho, 2019, Effect of a Multicomponent Intervention on Lifestyle Factors among Brazilian Adolescents from Low Human Development Index Areas: A Cluster-Randomized Controlled Trial. Int J Environ Res Public Health

      Not checked in the free run.

    • cites [40] R Chhabra, 2010, Adaptation of an alcohol and HIV school-based prevention program for teens, AIDS Behav source

      Not checked in the free run.

    • cites [65] FF Marsiglia, 2015, Long-term effects of the keepin’ it REAL model program in Mexico: substance use trajectories of Guadalajara middle school students, J Prim Prev source

      Not checked in the free run.

    • cites [85] ZM Sanchez, 2017, The #tamojunto drug prevention program in brazilian schools: a randomized controlled trial, Prev Sci source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The RCTs evaluating naltrexone and ondansetron found limited impact on abstinence, number of heavy drinking days or number of abstinent days, and abstinence.

    “The RCTs evaluating naltrexone and ondansetron found limited impact on abstinence, number of heavy drinking days or number of abstinent days [22,24,32], and abstinence [43].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [22] S Shin, 2013, Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia Addiction

      Not checked in the free run.

    • cites [24] J Ahmadi, 2004, Naltrexone for alcohol-dependent patients, Ir J Med Sci source

      Not checked in the free run.

    • cites [32] DA Baltieri, 2008, Comparing topiramate with naltrexone in the treatment of alcohol dependence, Addiction source

      Not checked in the free run.

    • cites [43] LA Cubbins, 2012, Alcohol use and abuse among rural Zimbabwean adults: a test of a community-level intervention, Drug Alcohol Depend source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The 14 RCTs evaluating medications looked at naltrexone (3), ondansetron (1), gabapentin (1), disulfiram (5), and topiramate (2).

    “The 14 RCTs evaluating medications looked at naltrexone (3) [22,24,32], ondansetron (1) [43], gabapentin (1) [51], disulfiram (5) [46–50], and topiramate (2) [32,62].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [22] S Shin, 2013, Effectiveness of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia Addiction

      Not checked in the free run.

    • cites [24] J Ahmadi, 2004, Naltrexone for alcohol-dependent patients, Ir J Med Sci source

      Not checked in the free run.

    • cites [32] DA Baltieri, 2008, Comparing topiramate with naltrexone in the treatment of alcohol dependence, Addiction source

      Not checked in the free run.

    • cites [43] LA Cubbins, 2012, Alcohol use and abuse among rural Zimbabwean adults: a test of a community-level intervention, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [51] FA Furieri, 2007, Gabapentin reduces alcohol consumption and craving: a randomized, double-blind, placebo-controlled trial, J Clin Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The final group of RCTs evaluated biomedical treatments and included 19 RCTs evaluating medications and brain stimulation.

    “The final group of RCTs evaluated biomedical treatments and included 19 RCTs evaluating medications and brain stimulation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Marques and colleagues found a reduction in many alcohol-related outcomes for group and individual intervention arms at 15 months, but the intervention arms were not significantly different from each other.

    “Marques and colleagues found a reduction in many of their alcohol-related outcomes for the group and individual intervention arms at 15 months, but the intervention arms were not significantly different from each other [64].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] AC Marques, 2001, Comparison of individual and group cognitive-behavioral therapy for alcohol and/or drug-dependent patients, Addiction source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Chhabra and colleagues found that students, and more specifically girls, had an immediate reduction in their intent to use alcohol, but there was no difference in the intention to use alcohol at the 10-week outcome assessment.

    “Chhabra and colleagues looked at the effectiveness of a Severity of Alcohol Dependence Questionnaire (STEP) school-based program but found that students, and more specifically girls, had an immediate reduction in their intent to use alcohol, but there was no difference in the intention to use alcohol at the 10-week outcome assessment [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] R Chhabra, 2010, Adaptation of an alcohol and HIV school-based prevention program for teens, AIDS Behav source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Cubbins and colleagues found significant alcohol reduction in both the intervention and control groups, but no difference between the groups.

    “Cubbins and colleagues evaluated a community-level intervention in which popular community individuals relayed education through casual conversations and found significant alcohol reduction in both the intervention and control groups, but no difference between the groups [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] LA Cubbins, 2012, Alcohol use and abuse among rural Zimbabwean adults: a test of a community-level intervention, Drug Alcohol Depend source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Of all the RCTs, brief interventions were the most commonly studied; MI techniques were the most prevalent behavior change technique common in both brief and psychotherapy and counseling interventions.

    “Of all the RCTs, brief interventions were the most commonly studied; similarly, MI techniques were the most prevalent behavior change technique common in both brief and psychotherapy and counseling interventions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The search strategy did not exclude studies due to language, but no non-English manuscripts were found.

    “First, our search strategy did not exclude studies due to language, and, yet, we found no manuscripts in other languages.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most studies the review found took place in middle-income countries; there was a noticeable gap of studies in the Middle East, North Africa, Europe, Central Asia, and South Asia regions.

    “Most studies we found took place in middle-income countries; there was a noticeable gap of studies in the Middle East, North Africa, Europe, Central Asia, and South Asia regions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    This is the first review, to the authors' knowledge, of alcohol harm reduction interventions evaluated in LMICs.

    “This is the first review, to our knowledge, of alcohol harm reduction interventions evaluated in LMICs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Baltieri found that acamprosate improved abstinence rates but only for those who participated in AA.

    “Baltieri found that acamprosate improved abstinence rates but only for those who participated in AA [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] DA Baltieri, 2003, Efficacy of acamprosate in the treatment of alcohol-dependent outpatients, Rev Bras Psiquiatr source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Gupta found that patients who received baclofen compared to a nutritional supplement, with a brief motivational intervention, were more likely to remain abstinent, have lower heavy drinking days, and fewer alcohol cravings.

    “Moreover, Gupta found that patients who received baclofen compared to a nutritional supplement, with a brief motivational intervention, were more likely to remain abstinent, have lower heavy drinking days, and fewer alcohol cravings [52].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] M Gupta, 2017, Randomized open-label trial of baclofen for relapse prevention in alcohol dependence, Am J Drug Alcohol Abuse source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    While 3 of the tDCS studies found a decrease in alcohol cravings compared to sham stimulation, one study found a lower relapse rate in the brain stimulation group but with no difference in alcohol cravings at 6-month follow-up.

    “While 3 of these studies found a decrease in alcohol cravings compared to sham stimulation [36,44,60], one study found a lower relapse rate in the brain stimulation group but with no difference in alcohol cravings at 6-month follow-up [59].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [36] PS Boggio, 2008, Prefrontal cortex modulation using transcranial DC stimulation reduces alcohol craving: a double-blind, sham-controlled study, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [44] MC da Silva, 2013, Behavioral effects of transcranial direct current stimulation (tDCS) induced dorsolateral prefrontal cortex plasticity in alcohol dependence, J Physiol Paris source

      Not checked in the free run.

    • cites [60] J Klauss, 2018, Multiple Sessions of Transcranial Direct Current Stimulation (tDCS) Reduced Craving and Relapses for Alcohol Use: A Randomized Placebo-Controlled Trial in Alcohol Use Disorder, Front Pharmacol source

      Not checked in the free run.

    • cites [59] J Klauss, 2014, A randomized controlled trial of targeted prefrontal cortex modulation with tDCS in patients with alcohol dependence, Int J Neuropsychopharmacol source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The review identified 4 RCTs that studied transcranial direct current stimulation, and all of them occurred at 2 institutions in Brazil.

    “We identified 4 RCTs that studied transcranial direct current stimulation, and all of them occurred at 2 institutions in Brazil.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Based on the review, brief interventions using the ASSIST or AUDIT scoring systems are the most widely used and appear to provide the best standardization among outcomes.

    “Based on our review, brief interventions using the ASSIST or AUDIT scoring systems are the most widely used and appear to provide the best standardization among outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The systematic review is reported in accordance with PRISMA and registered in PROSPERO under CRD42017055549.

    “This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement [14] (see S1 Table) and is registered in the PROSPERO database (International Prospective Register of Systematic Reviews) under the number CRD42017055549.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] PRISMA Group, 2009, Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement, PLoS Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    No manuscripts were excluded based on quality.

    “No manuscripts were excluded based on quality.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No studies were excluded based on language.

    “No studies were excluded based on language.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Compared to high-income countries, LMICs report higher rates of risky drinking behaviors, such as binge drinking and episodic drinking, as well as an earlier onset of alcohol consumption.

    “Compared to high-income countries, low- and middle-income countries (LMICs) report higher rates of risky drinking behaviors, such as binge drinking and episodic drinking, as well as an earlier onset of alcohol consumption [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] WHO | Global Status Report on Alcohol and Health 2014 [Internet]. [cited 2020 Dec 22]. Available from: https://www.who.int/substance_abuse/publications/alcohol_2014/en/

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Title, abstract, and full-text screening and data extraction were performed independently in duplicate, with disagreements resolved by a third reviewer.

    “Title, abstract, as well as full-text screening and extraction were performed in duplicate.”
    • Also stated in: § Study selection · plain
      “Six pairs of reviewers from the specified individuals (KA, TC, SE, DE, SG, CP, LR, NS, AS, CY, and AP) independently reviewed the titles and abstracts, and any inconsistencies regarding inclusion were resolved by a third reviewer (DG or CS).”
    • Also stated in: § Data extraction · plain
      “Five pairs of reviewers independently conducted the data extraction, and any disagreements were resolved by a third reviewer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Alcohol use is an important cause of chronic disease and injury and is one of the top 5 risk factors for death and disability worldwide.

    “Alcohol use is an important cause of chronic disease and injury. It is one of the top 5 risk factors for death and disability in the world [1–3].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] J Rehm, 2009, Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders, Lancet source

      Not checked in the free run.

    • cites [2] CJL Murray, 2017, Measuring global health: motivation and evolution of the Global Burden of Disease Study, Lancet source

      Not checked in the free run.

    • cites [3] J Rehm, 2016, A narrative review of alcohol consumption as a risk factor for global burden of disease, Subst Abuse Treat Prev Policy source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Risk of bias was assessed using design-specific tools, including Cochrane's revised risk-of-bias tool for randomized studies.

    “Cochrane’s revised risk-of-bias tool was used for randomized studies [18].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] JPT Higgins, 2011, The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    A majority of the health promotion and education studies that found no effect were either not adequately powered to detect the alcohol-related outcome or were compared to another intervention rather than a control.

    “Meanwhile, a majority of the studies that found no effect of their interventions either were not adequately powered to detect the alcohol-related outcome [23,43] or were compared to another intervention rather than a control, thus potentially obscuring some potential reduction in harm [95].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [23] E Moraes, 2010, Home visits in the outpatient treatment of individuals dependent on alcohol, Addict Disord Their Treat source

      Not checked in the free run.

    • cites [43] LA Cubbins, 2012, Alcohol use and abuse among rural Zimbabwean adults: a test of a community-level intervention, Drug Alcohol Depend source

      Not checked in the free run.

    • cites [95] SS Witte, 2011, Reducing sexual HIV/STI risk and harmful alcohol use among female sex workers in Mongolia: a randomized clinical trial, AIDS Behav source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The vast majority of evaluations were limited to middle-income settings, leading to feasibility and generalizability concerns for low-income settings.

    “The vast majority of evaluations were limited to middle-income settings, leading to feasibility and generalizability concerns for low-income settings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The feasibility of implementing the reviewed interventions and their effectiveness in low-income settings is uncertain.

    “Thus, the feasibility of implementing these interventions and their effectiveness in low-income settings is uncertain.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Either there is no non-English language literature on this topic or the data sets searched have limited non-English language articles.

    “Thus, either there is no non-English language literature on this topic or the data sets we searched have limited non-English language articles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Conducting the database search for only LMICs at that time might limit the findings by excluding articles from countries that have become high income since the study occurred or erroneously including countries that were high income but then reduced their status at the time of the database search.

    “Similarly, we conducted our database search for only LMICs at that time. This might limit our findings by excluding articles from countries that have become high income since the study occurred or erroneously including countries that were high income but then reduced their status at the time of the database search”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The authors rechecked the World Bank status of all countries and their intervention time periods to ensure that erroneously including countries that were high income but then reduced their status was not occurring.

    “we rechecked the World Bank status of all countries and their intervention time periods to ensure this was not occurring.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Brief interventions have been suggested to be cost-effective in high-income countries.

    “They have also been suggested to be cost-effective in high-income countries [106].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [106] C Angus, 2014, Cost-effectiveness of a programme of screening and brief interventions for alcohol in primary care in Italy, BMC Fam Pract source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    In low- and middle-income settings, brief interventions are likely to be feasible because they can be delivered by nonprofessionals requiring less training.

    “In low- and middle-income settings, brief interventions are likely to be feasible because they can be delivered by nonprofessionals requiring less training.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Brief interventions can be delivered by nonprofessionals requiring less training.

  • May combine two claims.

    Interpretationnone given

    Feasible options specific to low-income countries are most likely brief interventions and interventions that utilize motivational interviewing techniques.

    “Feasible options specific to low-income countries are most likely brief interventions and interventions that utilize motivational interviewing techniques.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Brief interventions can be delivered by nonprofessionals requiring less training.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Identifying uniform methods of implementation and assessment of alcohol harm reduction interventions can be a first step toward establishing a set of evidence-based protocols for treatment for low-income settings.

    “Identifying uniform methods of implementation and assessment of alcohol harm reduction interventions can be a first step toward establishing a set of evidence-based protocols for treatment for low-income settings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Grouping types of interventions based on standard definitions rather than study-specific descriptions might limit the interpretation of effect size and differ from the original author's description.

    “Finally, we tried to group types of interventions based on standard definitions rather than study-specific descriptions that might limit the interpretation of effect size and differ from the original author’s description.”
    Quote in the paperNot a substantial claim
55 of 55

  • The paper relies on this without support.

    The search strategy and databases used identified all relevant patient-level alcohol intervention studies in LMICs.

    “We searched electronic databases (PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO) for articles that evaluated patient-level interventions aimed at reducing an alcohol-related outcome in LMICs.”

  • The paper relies on this without support.

    The four intervention categories (brief interventions, psychotherapy/counseling, health promotion/education, biomedical treatments) are valid and sufficiently distinct to group the included studies.

    “Interventions were grouped by similarity into 4 types: brief interventions, psychotherapy and counseling, health promotion and education, and biomedical treatments.”

  • The paper relies on this without support.

    The qualitative meta-summary can reliably determine which intervention has the most consistent positive effect despite heterogeneity.

    “Therefore, we conducted a meta-synthesis for all the included manuscripts, which qualitatively aggregated findings by grouping relevant findings into categories that represent the study’s objectives (e.g., effectiveness of alcohol intervention).”

  • The paper relies on this without support.

    The included studies' reported alcohol-related outcomes are comparable enough to be qualitatively summarized.

    “Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies.”

  • The paper relies on this without support.

    The included RCTs are internally valid and their reported effect estimates are reliable enough to support the review's conclusions about intervention efficacy.

    “Overall, the majority of the studies evaluating brief interventions demonstrated evidence of efficacy in one or more of their alcohol-related outcomes, for both short- (up to 3 months) and long-term (6+ months) outcomes, comparing intervention and control”

  • The paper relies on this without support.

    The intervention categories used in the meta-summary (brief interventions, psychotherapy/counseling, health promotion/education, biomedical treatments) are valid and distinct.

    “The brief interventions category had the greatest number of RCTs in our study with 24 RCTs”

  • The paper relies on this without support.

    The studies included in the review are representative of alcohol harm reduction interventions in LMICs.

    “This is the first review, to our knowledge, of alcohol harm reduction interventions evaluated in LMICs.”

  • The paper relies on this without support.

    Low-income countries face greater barriers to implementing effective healthcare than either high- or middle-income countries.

    “Low-income countries face greater barriers (such as scarcity of medical facilities, limited training available to medical staff, infrastructural barriers to healthcare access, and effective patient communication/follow-up) to implementing effective healthcare than either high- or middle-income countries.”

  • The paper relies on this without support.

    Infrastructure in low-income settings is more limited in mental health and substance abuse facilities and professionals, with greater associated stigma.

    “Given that infrastructure in low-income settings is even more limited in mental health and substance abuse facilities and professionals, with a greater associated stigma”

  • The paper relies on this without support.

    Reliable availability of medication is essential for medication intervention to be effective.

    “reliable availability of medication is essential for this intervention to be effective”

  • The paper relies on this without support.

    Brief interventions can be delivered by nonprofessionals requiring less training.

    “they can be delivered by nonprofessionals requiring less training”
11 of 11

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Relapse conclusion reverses the reported tDCS results

    Major

    The text says three of four brain-stimulation studies found more relapses in the intervention group. Its summary of one of those studies reports the opposite: relapse was higher in the sham group (88%) than in the tDCS group (50%).

  • Study 91 is classified as both a brief intervention and psychotherapy

    Minor

    The brief-intervention summary lists reference 91 among MI interventions, but Table 1 classifies that study as psychotherapy and counseling.

  • Ondansetron study is cited under two different reference numbers

    Minor

    The narrative cites reference 43 for the ondansetron RCT, but Table 5 cites reference 42 for its ondansetron findings. Table 1 identifies reference 43 as a community-based health-promotion study.

  • Brief-intervention studies are listed as both efficacious and null

    Minor

    References 80 and 88 appear in the list of studies said to demonstrate efficacy compared with controls and also in the list said to show a null effect.

  • Reported follow-up range omits a one-month outcome

    Minor

    The discussion describes outcome measurement periods as ranging from 3 to 24 months, while Table 3 lists a one-month follow-up.

  • Reported estimate falls outside its confidence interval

    Minor

    The reported estimate of 12.16 is outside its stated 95% confidence interval of −6.10 to 1.79.

6 of 6

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. ACROBAT-NRSi (A Cochrane Risk Of Bias Assessment Tool: for Non-Randomized Studies of Interventions) for non-clinical community based studies: a participatory workshop using a worked example from public health | Colloquium Abstracts [Internet]. [cited 2020 Dec 22]. Available from: https://abstracts.cochrane.org/2015-vienna/acrobat-nrsi-cochrane-risk-bias-assessment-tool-non-randomized-studies-interventions-non
  2. JPT Higgins, 2019, Cochrane handbook for systematic reviews of interventions, Wiley
  3. 1996, A cross-national trial of brief interventions with heavy drinkers, WHO Brief Intervention Study Group. Am J Public HealthJul, 86, 948
  4. YC Baldin, 2018, Effectiveness of a web-based intervention in reducing binge drinking among nightclub patrons, Rev Saude Publica18, 52, 2
  5. K Rendall-Mkosi, 2013, A randomized controlled trial of motivational interviewing to prevent risk for an alcohol-exposed pregnancy in the Western Cape, South Africa AddictionApr, 108, 725
  6. MJ Rotheram-Borus, 2015, Alcohol use, partner violence, and depression: A cluster randomized controlled trial among urban south african mothers over 3 years, Am J Prev Med, 49, 715, 10.1016/j.amepre.2015.05.004 · DOI · Paper page

Cited by

Sorted by citations

Authors
Staton, C. A., Vissoci, J. R. N., El-Gabri, D., Adewumi, K., Concepcion, T., Elliott, S. A., Evans, D. R., Galson, S. W., Pate, C. T., Reynolds, L. M., Sanchez, N. A., Sutton, A. E., Yuan, C., Pauley, A., Andrade, L., Von Isenberg, M., Ye, J. J., & Gerardo, C. J.
Affiliations
  • Universidade Estadual de Maringá (BR)
  • Duke University (US)
Corresponding author
Staton, Catherine A.
ORCID
Venue
PLOS Medicine
Publisher
Public Library of Science (PLoS)
Published
2022-04-12
Volume
19
Issue
4
Pages
e1003961
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1003961
PMC
PMC9004752
OpenAlex
W4223492249
Semantic Scholar
a15013db5612b0e5df86c1481989f2fbf6b75464
Cited by
41
References
97
Citations by year
2026: 6 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 16
FWCI
1.39
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Fogarty International Center (TW010000-01A1)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
alcohol consumption, alcohol-related harm, low- and middle-income countries, brief intervention, motivational interviewing, psychotherapy, counseling, health promotion, biologic therapy, alcoholism, intervention effectiveness, alcohol harm reduction, harm prevention, harm reduction
MeSH terms
Alcoholism, Developing Countries, Humans, Income, Poverty, Psychotherapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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