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www.thelancet.com Vol 389 January 14, 2017 133 Excessive alcohol consumption and depression are two of the leading causes of mortality and morbidity worldwide, impairing quality of life, social functioning, and participation in the workplace. These mental health conditions frequently co-occur in the same individuals, exacerbating the risks and burdens for individuals and their communities. Globally, excessive alcohol consumption and depression produce a huge socioeconomic burden and constitute two of the highest risk factors for disability. For individuals living in low-income and middle-income settings, the burden is particularly acute: prevalence is high, but availability of and access to adequate treatment are low. Moreover, most research evidence to support bridging of the treatment gap comes from high-income settings. In low-income and middle-income countries, primary care physicians can be ideally placed to screen patients for both conditions, classifying them according to alcohol-related risk as well as diagnosing and treating depression. For patients with alcohol use disorders, diff erent treatments should be off ered: health promotion for abstinent or low-risk drinkers, brief psychological intervention for at-risk and harmful drinkers, and referral to specialised treatment programmes (including behavioural support and pharmacotherapy) for individuals with alcohol dependence. A brief psychological intervention delivered by physicians, nurses, or psychologists can be eff ective in reduction of alcohol consumption in excessive alcohol drinkers, but most if not all studies have been done in high-income settings. For depression, patients tend to be diagnosed and managed by primary care physicians, with only a small proportion of patients being referred to specialised care. Standard treatment comprises antidepressant medication and psychotherapy. Authors of a meta-analysis found no diff erence between the eff ectiveness of these therapeutic instruments. In low-income and middle-income countries, psychotherapy is recommended as fi rst-line treatment for both excessive alcohol consumption and depression. However, because of a scarcity of time, training, and resources, most patients do not receive any treatment for excessive alcohol drinking or depression from their primary care physicians. In The Lancet, Vikram Patel and colleagues report two companion randomised controlled trials that investigate the effi cacy of a new strategy to improve treatment of excessive alcohol drinking and depression in primary care in India. Specifi cally, a brief psychological intervention was delivered to two samples of primary care patients: the fi rst comprising male harmful drinkers and the second male and female patients with depression. Although the eff ectiveness of psychological interventions in treatment of these disorders has been previously shown, the main novelty of these studies was the choice of type of counsellors who delivered the interventions. Counsellors were adult members of the local community educated to at least secondary school level but with no professional mental health training, and trained in a 3 week course in mental health delivered by specialists; the same counsellor delivered interventions for both disorders. Harmful drinkers and patients with depression were screened using two questionnaires, Alcohol Use Disorders Identifi cation Test (AUDIT) for harmful drinkers and the Patient Health Questionnaire for patients with depression, and then divided into two groups, to receive usual care delivered by their primary care physicians and usual care plus psychological intervention delivered by counsellors. Usual care received was enhanced as the primary care physicians received information about the AUDIT and Non-specialist health workers to treat excessive alcohol consumption and depression