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'Referral advice' recommendation details

Alcohol dependence and harmful alcohol use

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG115 Staff working in services provided and funded by the NHS who care for people who potentially misuse alcohol should be competent to identify harmful drinking and alcohol dependence. They should be competent to initially assess the need for an intervention or, if they are not competent, they should refer people who misuse alcohol to a service that can provide an assessment of need. Time frame not specified
CG115 For service users whose comorbid mental health problems do not significantly improve after abstinence from alcohol (typically after 3?4 weeks), consider providing or referring for specific treatment. Time frame not specified
CG115 Refer all children and young people aged 10?15 years to a specialist child and adolescent mental health service (CAMHS) for a comprehensive assessment of their needs, if their alcohol misuse is associated with physical, psychological, educational and social problems and/or comorbid drug misuse. Time frame not specified
CG115 Refer people who misuse alcohol and have a significant comorbid mental health disorder, and those assessed to be at high risk of suicide, to a psychiatrist to make sure that effective assessment, treatment and risk-management plans are in place. Time frame not specified
CG115 For service users who typically drink over 15 units of alcohol per day and/or who score 20 or more on the Alcohol Use Disorders Identification Test (AUDIT), consider offering: ? an assessment for and delivery of a community-based assisted withdrawal, or ? assessment and management in specialist alcohol services if there are safety concerns about a community-based assisted withdrawal. Consider inpatient or residential assisted withdrawal if a service user meets one or more of the following criteria. They: ? drink over 30 units of alcohol per day ? have a score of more than 30 on the Severity of Alcohol Dependence Questionnaire (SADQ) ? have a history of epilepsy, or experience of withdrawal-related seizures or delirium tremens during previous assisted withdrawal programmes ? need concurrent withdrawal from alcohol and benzodiazepines ? regularly drink between 15 and 20 units of alcohol per day and have: ? significant psychiatric or physical comorbidities (for example, chronic severe depression, psychosis, malnutrition, congestive cardiac failure, unstable angina, chronic liver disease) or ? a significant learning disability or cognitive impairment. Time frame not specified
CG115 For people who misuse alcohol and have comorbid depression or anxiety disorders, treat the alcohol misuse first as this may lead to significant improvement in the depression and anxiety. If depression or anxiety continues after 3 to 4 weeks of abstinence from alcohol, assess the depression or anxiety and consider referral and treatment in line with the relevant NICE guideline for the particular disorder. Time frame not specified
CG115 Service users who need assisted withdrawal should usually be offered a community-based programme, which should vary in intensity according to the severity of the dependence, available social support and the presence of comorbidities. ? For people with mild to moderate dependence, offer an outpatient-based assisted withdrawal programme in which contact between staff and the service user averages 2?4 meetings per week over the first week. ? For people with mild to moderate dependence and complex needs (for example, psychiatric comorbidity, poor social support or homelessness), or severe dependence, offer an intensive community programme following assisted withdrawal in which the service user may attend a day programme lasting between 4 and 7 days per week over a 3-week period. Time frame not specified

This page was last updated: 22 August 2012

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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.