Background:
Globally, unhealthy alcohol use remains a major public health concern, contributing significantly to premature death and disability. The World Health Organization ranks South Africa among the countries with the riskiest patterns of alcohol consumption. Given these trends, there is a growing need for scalable, community-based strategies to prevent and reduce alcohol-related harm.


Methods:
This study explored a two-pronged, community-centred approach that combined screening and early intervention. Using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), lay counsellors identified individuals with moderate-risk (scores 5-7) and high-risk (scores 8+) drinking patterns. The intervention incorporated screening, brief advice, and referral pathways to assess their potential in reducing alcohol-related risk.


Results:
Among 54,187 participants screened, 42.97% reported moderate-risk and 22.11% high-risk alcohol consumption. While screening successfully identified individuals at risk, the uptake of further support remained limited. Fewer than 10% of high-risk participants accepted referrals, and men were significantly less likely to engage with treatment options despite higher rates of risky drinking. Participants who accepted brief advice often showed limited motivation to modify their behaviour.


Conclusions:
These findings highlight the challenges of shifting entrenched alcohol-use behaviours in low-resource settings. While community-based screening and brief interventions offer valuable entry points for prevention, sustainable impact requires addressing structural, gendered, and motivational barriers. Strengthening the role of community networks and integrating trauma-informed, culturally grounded interventions could enhance future