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Psychological interventions and relapse prevention medication for adults

Quality statement

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.

Quality measure

Structure

a) Evidence of local arrangements to ensure that adults who misuse alcohol are offered evidence-based psychological interventions appropriate to their circumstances, in accordance with NICE clinical guideline 115.

b) Evidence of local formal evaluation of psychological interventions within the commissioning framework, including routine review and follow-up, to ensure adherence to evidence‑based practice.

c) Evidence of local arrangements to ensure that people with moderate or severe alcohol dependence are considered for relapse prevention medication after a successful medically assisted withdrawal.

Process

a) Proportion of adults accessing specialist services for alcohol misuse who receive evidence-based psychological interventions in accordance with NICE clinical guideline 115.

Numerator - the number of adults in the denominator receiving evidence-based psychological interventions in accordance with NICE clinical guideline 115.

Denominator - the number of adults accessing specialist services for alcohol misuse.

b) Proportion of adults with moderate or severe alcohol dependence completing a successful medically assisted withdrawal who receive relapse prevention medication.

Numerator - the number of adults in the denominator receiving relapse prevention medication.

Denominator - the number of adults with moderate or severe alcohol dependence completing a successful medically assisted withdrawal.

Outcome

a) Decrease in the quantity and frequency of alcohol consumption in people who misuse alcohol.

b) Reduction in the rates of relapse to heavy drinking.

Description of what the quality statement means for each audience

Service providers ensure provision of evidence-based psychological interventions in accordance with NICE clinical guideline 115, and ensure that relapse prevention medication is offered to those with moderate or severe alcohol dependence following a successful withdrawal.

Healthcare professionals use competence frameworks developed from relevant treatment manuals to ensure they offer and deliver evidence-based psychological interventions to adults misusing alcohol and consider relapse prevention medication for those with moderate or severe alcohol dependence following a successful withdrawal.

Commissioners ensure they commission services that provide evidence-based psychological interventions in accordance with NICE clinical guideline 115, which are offered to adults accessing specialist treatment for alcohol misuse, and that relapse prevention medication is offered to those with moderate or severe alcohol dependence following a successful withdrawal.

Adults who misuse alcohol are offered psychological treatment, and those with moderate or severe alcohol dependence may also receive medication to help them stay alcohol-free following a successful withdrawal from alcohol.

Source clinical guideline references

NICE clinical guideline 115 recommendations 1.3.1.5 (key priority for implementation), 1.3.3.1 (key priority for implementation) 1.3.3.2-1.3.3.7, 1.3.4.4, 1.3.6.1 (key priority for implementation), 1.3.6.2 and 1.3.6.3.

Data source

Structure

a), b) and c) Local data collection.

Process

a) Local data collection. The National Alcohol Treatment Monitoring System (NATMS)collects data on intervention type for people in structured specialist treatment. ‘Alcohol - structured psychosocial interventions' can be recorded although the details of the intervention cannot be specified. Contained within NICE clinical guideline 115: audit support criterion 4.

b) Local data collection. The NHS Information Centre statistics on alcohol in England reports on items prescribed for the treatment of alcohol dependence, including relapse prevention medication.

Outcome

a) Local data collection. Data on the prevalence of alcohol misuse in adults is available by region from the NHS Adult Psychiatric Morbidity Survey in England.

b) Local data collection of relapse rates. See also data source for process b).

Definitions

NICE clinical guideline 115 defines moderate dependence as an SADQ score of between 15 and 30 and a need for assisted alcohol withdrawal, which can typically be managed in a community setting unless there are other risks. Severe alcohol dependence is defined as an SADQ score of more than 30 and a need for assisted alcohol withdrawal, typically in an inpatient or residential setting.

NICE clinical guideline 115 recommends the following psychological interventions for harmful drinkers and people with alcohol dependence:

  • behavioural couples therapy where people have a regular partner who is willing to participate in treatment
  • cognitive behavioural therapies
  • behavioural therapies
  • social network and environment-based therapies.

Recommendations 1.3.3.4-1.3.3.7 provide guidance on the duration and frequency of these psychological interventions.

In addition, acamprosate or oral naltrexone in combination with a psychological intervention should be considered for people with moderate and severe alcohol dependence following successful withdrawal. Disulfiram may be considered if acamprosate and oral naltrexone are not suitable for clinical reasons or if it is the informed service user's choice.

Acamprosate and oral naltrexone may also be considered for harmful drinkers and people with mild alcohol dependence who have not responded to psychological interventions alone, or who have specifically requested a pharmacological intervention.

All prescribing should be carried out in accordance with NICE clinical guideline 115. Prescribers should use each drug's summary of product characteristics (SPC) with regard to current licensed indications, contraindications and special considerations to inform their decision about a person they are prescribing for. If a drug is used at a dose or for an application that does not have UK marketing authorisation, informed consent should be obtained and documented.

Equality and diversity considerations

This statement promotes equality of access to evidence-based psychological interventions as well as relapse prevention medication for those most likely to benefit.

This page was last updated: 25 August 2011

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.