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Alcohol-use disorders - preventing harmful drinking [PH24]

Measuring the use of this guidance

Recommendation: Recommendation 7

Who is the target population? • Young people aged 16 and 17 years who are thought to be at risk from their use of alcohol. Who should take action? • Health and social care, criminal justice and community and voluntary professionals in both NHS and non-NHS settings who regularly come into contact with this group. What action should they take? • Complete a validated alcohol screening questionnaire with these young people. Alternatively, if they are judged to be competent enough, ask them to fill one in themselves. In most cases, AUDIT[6] (alcohol use disorders identification test) should be used. If time is limited, use an abbreviated version (such as AUDIT-C, AUDIT-PC, CRAFFT, SASQ or FAST). Screening tools should be appropriate to the setting. For instance, in an emergency department, FAST or the Paddington Alcohol Test (PAT) would be most appropriate. • Focus on key groups that may be at an increased risk of alcohol-related harm. This includes those: - who have had an accident or a minor injury - who regularly attend genito-urinary medicine (GUM) clinics or repeatedly seek emergency contraception - involved in crime or other antisocial behaviour - who truant on a regular basis - at risk of self-harm - who are looked after - involved with child safeguarding agencies. • When broaching the subject of alcohol and screening, ensure discussions are sensitive to the young person's age and their ability to understand what is involved, their emotional maturity, culture, faith and beliefs. The discussions should also take into account their particular needs (health and social) and be appropriate to the setting. • Routinely assess the young person's ability to consent to alcohol-related interventions and treatment. If there is doubt, encourage them to consider involving their parents in any alcohol counselling they receive.

What was measured: Proportion of adult acute medical admissions where the FAST alcohol screening tool was completed.
Data collection end: February 2013
37.8%
Number that met the criteria: 28 / 74
Area covered: Local
Source: Sagar N Dibor C Polson R (2013) An audit to evaluate the use of the alcohol FAST screening tool in acute medical admissions in a district general hospital. Gut: 62 (suppl 2)

Recommendation: Recommendation 9

Who is the target population? Adults. Who should take action? Health and social care, criminal justice and community and voluntary sector professionals in both NHS and non-NHS settings who regularly come into contact with people who may be at risk of harm from the amount of alcohol they drink. What action should they take? NHS professionals should routinely carry out alcohol screening as an integral part of practice. For instance, discussions should take place during new patient registrations, when screening for other conditions and when managing chronic disease or carrying out a medicine review. These discussions should also take place when promoting sexual health, when seeing someone for an antenatal appointment and when treating minor injuries. Where screening everyone is not feasible or practicable, NHS professionals should focus on groups that may be at an increased risk of harm from alcohol and those with an alcohol-related condition. This includes people: • with relevant physical conditions (such as hypertension and gastrointestinal or liver disorders) • with relevant mental health problems (such as anxiety, depression or other mood disorders) • who have been assaulted • at risk of self-harm • who regularly experience accidents or minor traumas • who regularly attend GUM clinics or repeatedly seek emergency contraception. Non-NHS professionals should focus on groups that may be at an increased risk of harm from alcohol and people who have alcohol-related problems. For example, this could include those: • at risk of self-harm • involved in crime or other antisocial behaviour • who have been assaulted • at risk of domestic abuse • whose children are involved with child safeguarding agencies • with drug problems. When broaching the subject of alcohol and screening, ensure the discussions are sensitive to people's culture and faith and tailored to their needs. Complete a validated alcohol questionnaire with the adults being screened. Alternatively, if they are competent enough, ask them to fill one in themselves. Use AUDIT to decide whether to offer them a brief intervention (and, if so, what type) or whether to make a referral. If time is limited, use an abbreviated version (such as AUDIT-C, AUDIT-PC, SASQ or FAST). Screening tools should be appropriate to the setting. For instance, in an emergency department FAST or PAT would be most appropriate. Do not offer simple brief advice to anyone who may be dependent on alcohol. Instead, refer them for specialist treatment (see recommendation 12). If someone is reluctant to accept a referral, offer an extended brief intervention (see recommendation 11). Use professional judgement as to whether to revise the AUDIT scores downwards when screening: • women, including those who are, or are planning to become, pregnant • younger people (under the age of 18) • people aged 65 and over • people from some black and minority ethnic groups. • If in doubt, consult relevant specialists. Work on the basis that offering an intervention is less likely to cause harm than failing to act where there are concerns. Consult relevant specialists when it is not appropriate to use an English language-based screening questionnaire. (For example, when dealing with people whose first language is not English or who have a learning disability.) Biochemical measures should not be used as a matter of routine to screen someone to see if they are drinking hazardously or harmfully. (This includes measures of blood alcohol concentration [BAC].) Biochemical measures may be used to assess the severity and progress of an established alcohol-related problem, or as part of a hospital assessment (including assessments carried out in emergency departments).

What was measured: Patients who attended an HIV clinic who were assessed using AUDIT-C
94.32%
Number that met the criteria: 332 / 352
Area covered: Local
Source: Ward C & Ahmad S (2012) Screening for alcohol use disorders in HIV patients. Journal of the International AIDS Society, Vol 15 suppl 4
What was measured: Emergency departments that routinely ask adults about their alcohol consumption
Data collection end: December 2006
12.7%
Number that met the criteria: / 189
Data collection end: December 2011
47.7%
Number that met the criteria: / 151
Area covered: National
Source: Patton R & O’Hara P (2013) Alcohol: signs of improvement. The 2nd national Emergency Department survey of alcohol identification and intervention activity. Emergency Medicine Journal Vol 30 pp 492–495. doi:10.1136/emermed-2012-201527
What was measured: Emergency departments that use a formal screening tool for assessment of alcohol consumption
Data collection end: December 2006
2.1%
Number that met the criteria: / 189
Data collection end: December 2011
51.7%
Number that met the criteria: / 151
Area covered: National
Source: Patton R & O’Hara P (2013) Alcohol: signs of improvement. The 2nd national Emergency Department survey of alcohol identification and intervention activity. Emergency Medicine Journal Vol 30 pp 492–495. doi:10.1136/emermed-2012-201527

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