New guidance to tackle alcohol problems
Just 6 per cent of people in England who have an alcohol problem are receiving treatment for it, as NICE calls for screening and better access to alcohol withdrawal services.
Over one million people in England are dependent on alcohol, but every year there are over 940,000 people who are either not seeking help, do not have access to the relevant services, or whose symptoms are not being appropriately identified by healthcare professionals.
In an attempt to improve the situation, NICE has published guidance outlining how the NHS should diagnose, assess and treat the condition.
The guideline calls for all relevant health and social care professionals to be able to identify patients who could be misusing alcohol through clinical interviews and internationally recognised assessment tools, such as the Alcohol Use Disorder Identification Test (AUDIT) and the Severity of Alcohol Dependence Questionnaire (SADQ).
The tools will help healthcare professionals to make accurate diagnoses and measure the severity of their patients' dependence, on which their subsequent treatment options will be based.
Harmful drinkers and people who are mildly dependent, those who score 15 or less on the SADQ, should be offered psychological interventions, such as cognitive behavioural therapy, behavioural couples therapy or social network and environment-based therapies.
People who drink more than 15 units a day or who score 20 or more on the AUDIT should be offered a structured assisted withdrawal programme.
After completing a successful alcohol withdrawal programme, healthcare professionals should consider offering people who were moderately or severely dependent, acamprosate or oral naltrexone.
This should be offered alongside an individual psychological intervention which specifically focuses on alcohol misuse.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: “People who suffer from alcohol dependence often face much stigma and discrimination in their day to day lives which can act as a barrier to them seeking help.
“Our guideline calls for all healthcare professionals who come into contact with these people to be appropriately trained to identify those in need and be able to offer them help in a trusting, supportive and non-judgemental environment.
“Improvements must be made across the NHS so that more people can be correctly diagnosed, assessed and treated for their dependence and harmful drinking patterns. Our clinical guideline outlines the most effective ways that the NHS can do this, based on the available evidence and expert feedback.”
Dr Linda Harris, a GP and Guideline Developer said: “For far too long, poor recognition of alcohol misuse has been a major barrier to effective treatment.
“The guideline calls for GPs and other frontline healthcare professionals to be competent enough to identify those who may be drinking harmful amounts or who may be alcohol dependent, so that everyone in need can receive appropriate treatment.
“The use of structured clinical interviews and internationally recognised assessment tools like the AUDIT can greatly support this.”
Professor Colin Drummond, Professor of Addiction Psychiatry and Chair of the Guideline Development Group added: “The evidence shows that alcohol treatment can be both effective and cost effective. However the effectiveness of these are crucially dependent upon people who misuse alcohol having better access to evidence-based interventions, which are delivered by appropriately trained and skilled staff.
“With problems relating to alcohol consumption increasing steeply in the UK, I hope that this guideline provides a much needed impetus to making effective treatments more available to those who need them.”
To find out more about NICE guidance on alcohol dependence, register to attend the Royal College of Physicians' one day conference on “Alcohol Related Disorders: Towards an Integrated Care Pathway” on Tuesday 10 May 2011.
This event is aimed at all professionals who have direct contact with, and make decisions concerning, the identification and care of people who may have an alcohol use disorder.
In addition, NICE Chair Sir Michael Rawlins will deliver a keynote speech entitled “Making alcohol management NICE” at the Royal College of General Practitioners' 16th national conference on working with drug and alcohol users in primary care, on 13 May in Harrogate. Tickets can be booked on the conference website.
23 February 2011