Alcohol dependence and harmful alcohol use quality standard

1. Health and social care staff receive alcohol awareness training that promotes respectful, non-judgmental care of people who misuse alcohol.

2. Health and social care staff opportunistically carry out screening and brief interventions for hazardous and harmful drinking as an integral part of practice.

3. People who may benefit from specialist assessment or treatment for alcohol misuse are offered referral to specialist alcohol services and are able to access specialist alcohol treatment.

4. People accessing specialist alcohol services receive assessments and interventions delivered by appropriately trained and competent specialist staff.

5. Adults accessing specialist alcohol services for alcohol misuse receive a comprehensive assessment that includes the use of validated measures.

6. Children and young people accessing specialist services for alcohol use receive a comprehensive assessment that includes the use of validated measures.

7. Families and carers of people who misuse alcohol have their own needs identified, including those associated with risk of harm, and are offered information and support.

8. People needing medically assisted alcohol withdrawal are offered treatment within the setting most appropriate to their age, the severity of alcohol dependence, their social support and the presence of any physical or psychiatric comorbidities.

9. People needing medically assisted alcohol withdrawal receive medication using drug regimens appropriate to the setting in which the withdrawal is managed in accordance with NICE guidance.

10. People with suspected, or at high risk of developing, Wernicke´s encephalopathy are offered thiamine in accordance with NICE guidance.

11. Adults who misuse alcohol are offered evidence-based psychological interventions, and those with alcohol dependence that is moderate or severe can in addition access relapse prevention medication in accordance with NICE guidance.

12. Children and young people accessing specialist services for alcohol use are offered individual cognitive behavioural therapy, or if they have significant comorbidities or limited social support, a multicomponent programme of care including family or systems therapy.

13. People receiving specialist treatment for alcohol misuse have regular treatment outcome reviews, which are used to plan subsequent care.

Full alcohol dependence and harmful alcohol use quality standard (PDF format)

This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

Scope of the quality standard

This quality standard covers the care of children (aged 10-15 years), young people (aged 16-17 years) and adults (aged 18 years and over) drinking in a harmful way and those with alcohol dependence in all NHS-funded settings. It also includes opportunistic screening and brief interventions for hazardous and harmful drinkers. The quality standard addresses the prevention and management of Wernicke's encephalopathy but does not cover the separate management of other physical and mental health disorders associated with alcohol use.

Alcohol dependence and harmful alcohol use quality statements

This quality standard refers to harmful drinking and alcohol dependence collectively as ‘alcohol misuse'. Where a statement refers exclusively to harmful drinking, alcohol dependence or hazardous drinking, this is explicitly stated. Definitions of these terms can be found in appendix 1. The term ‘alcohol misuse' is a working definition taken from NICE clinical guideline 115 and is not used as a diagnostic term or to imply intentionality.

The quality standard requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole care pathway. An integrated, multidisciplinary approach to provision of services is fundamental to the delivery of high-quality care to people who misuse alcohol. A specialist alcohol service is one in which the primary role is the assessment and management of alcohol misuse, including both psychological and physical effects. Some specialist addiction services will have this role for both drug and alcohol misuse.

NICE quality standards are for use by the NHS in England and do not have formal status in the social care sector. However, the NHS will not be able to provide a comprehensive service for all without working with social care communities. In this quality standard, care has been taken to make sure that any quality statements that refer to the social care sector are relevant and evidence-based. Social care commissioners and providers may therefore wish to use them, both to improve the quality of their services and support their colleagues in the NHS.

Subject to legislation currently before Parliament, NICE will be given a brief to produce quality standards for social care. These standards will link with corresponding topics published for the NHS. They will be developed in full consultation with the social care sector and will be presented and disseminated in ways that meet the needs of the social care community. As we develop this library of social care standards, we will review and adapt any published NICE quality standards for the NHS that make reference to social care.

NICE has produced a support documentto help commissioners and others consider the commissioning implications and potential resource impact of this quality standard. A full commissioning guide on services for the identification and treatment of hazardous drinking, harmful drinking and alcohol dependence in children, young people and adults, that supports the local implementation of NICE guidance is also available.

It is also noted that service user preference and choice need to be taken into account, and practitioners should offer appropriate evidence-based interventions in their consultations with individuals. Reflecting this choice will be particularly important when measuring achievement against statements using the process measures. However, the quality standard uses the term 'receive' so as to facilitate measurability, audit and reporting.

Download the alcohol dependence and harmful alcohol use areas of care mapto see the quality statements mapped against the areas of Alcohol dependence and harmful alcohol use care.

Rationale for developing this quality standard

Alcohol dependence and harmful alcohol use are associated with increased risk of physical and mental health comorbidities including gastrointestinal disorders (in particular liver disease), neurological and cardiovascular disease, depression and anxiety disorders and ultimately, premature death. It is estimated that 24% of people aged between 16 and 65 in England consume alcohol in a way that is potentially or actually harmful to their health or well-being. Depending on the diagnostic criteria used, alcohol dependence affects between 3% and 6% of people¹. Brief interventions can be effective in reducing drinking in hazardous and harmful drinkers, but people with alcohol dependence and some harmful drinkers will require more specialist alcohol services. Alcohol misuse is also an increasing problem in children and young people, with over 24,000 treated in the NHS for alcohol-related problems in 2008 and 2009. Current practice across the country is varied and access to a range of specialist alcohol services varies as a consequence. This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for harmful drinkers and people with alcohol dependence.

Policy context

Department of Health (2011) Transparency in outcomes - a framework for quality in adult social care
Department of Health (2010) The NHS Outcomes Framework 2011/12
Department of Health (2009) Local routes: Guidance for developing alcohol treatment pathways
National Audit Office (2008) Reducing alcohol harm: health services in England for alcohol misuse
Department of Health (2007) Safe. Sensible. Social. The next steps in the National Alcohol Strategy
Department of Health (2006) Signs for improvement - commissioning interventions to reduce alcohol-related harm
Department of Health and National Treatment Agency for Substance Misuse (2006) Models of care for alcohol misusers (MoCAM)
National Treatment Agency for Substance Misuse (2006) Review of the effectiveness of treatment for alcohol problems
Department of Health (2005) Alcohol needs assessment project (ANARP).

Key development sources

Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE clinical guideline 115 (2011; NHS Evidence accredited).

Alcohol-use disorders - diagnosis and clinical management of alcohol-related physical complications. NICE clinical guideline 100 (2010; NHS Evidence accredited).

Alcohol-use disorders: preventing the development of hazardous and harmful drinking. NICE public health guidance 24 (2010; NHS Evidence accredited).

Development team

Director

Fergus Macbeth

Associate Director

Lorraine Taylor

Consultant Clinical Adviser

Tim Stokes

Lead Analyst

Charlotte Bee

Topic Expert Group: alcohol dependence and harmful alcohol use

Consultation feedback

Consultation on the alcohol dependence and harmful alcohol use quality standard took place from 19 January 2011 to 16 February 2011. In total, 612 stakeholders were contacted during consultation. All eligible comments were reviewed by the Topic Expert Group and the standard was updated accordingly.

Alcohol dependence and harmful alcohol use consultation report

Implementation support materials

Publication partners

Many organisations share NICE's commitment to improve quality by making it clear what quality care is for patients and the public, health and social care professionals, commissioners and service providers.

So that these standards reach the widest possible audience, some of the organisations who have been involved in the development process, and who endorse the alcohol dependence and harmful alcohol use quality standard, have become partners in its publication.

These organisations are:

Alcohol Concern
British Psychological Society
European Association for the Treatment of Addiction UK (EATA)
Medical Council on Alcohol
Royal College of Nursing
Royal College of Physicians
Royal Pharmaceutical Society
Specialist Clinical Addiction Network