How to manage alcohol dependence and harmful drinking: NICE opens public consultation on draft guideline

In draft guidance out today (24 June), NICE is calling for improvements to be made across the NHS in the diagnosis, assessment and management of people who are alcohol dependent or drinking harmful amounts of alcohol.

Alcohol dependence affects around 4% of the population in England aged 16-65 years old - that's around 1.1 million people. It is characterised by craving, tolerance, a preoccupation with alcohol and continued drinking in spite of its harmful consequences, such as liver disease and depression.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: “Of the one million people who suffer from alcohol dependence in England, only around 6% a year receive treatment. This means that 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.

“Improvements must be made across the NHS so that more people who are in need can be correctly diagnosed, assessed and treated for their dependence and harmful drinking patterns. Our draft guideline outlines ways that the NHS can do this, based on the best available evidence of what is proven to be good clinical practice.”

Among the draft recommendations out for consultation, NICE is advising that:

  • All healthcare professionals in non-specialist settings should be able to correctly identify alcohol dependence and harmful drinking patterns and provide an initial assessment using formal assessment tools.
  • Adults who are referred to specialist alcohol services should be assessed for their history of alcohol and other drug misuse, their need for urgent treatment (including assisted withdrawal), their associated risk to themselves and others as well as any known health conditions that they may have.
  • Most people with alcohol dependence should be provided with withdrawal treatment in community-based settings; the duration and intensity of which should vary with the severity and complexity of the person's problems.
  • Adults with mild dependence should be offered a psychological intervention such as cognitive behavioural or behavioural couple's therapies, which specifically focuses on alcohol misuse.
  • Adults with moderate dependence (e.g. those who drink more than 15 units of alcohol a day) should be considered for planned withdrawal in a community-based setting. They should be offered a pharmacological intervention (such as naltraxcone or acamprostate) together with a psychological intervention. When managing alcohol withdrawal in the community, healthcare professionals should avoid prescribing large quantities of medication in order to prevent overdose or diversion.
  • Adults with severe dependence (e.g. those who drink more than 30 units a day), all children and young people who are dependent on alcohol, as well as people who are homeless and also suffer from alcohol dependence should be considered for hospital-based or residential withdrawal treatment.

The draft guideline follows two pieces of final guidance published by NICE earlier this month which outlined how the NHS should treat the physical complications caused by prolonged alcohol misuse and how the government and public services can prevent people from drinking dangerous amounts of alcohol in the first place.

Dr Macbeth added: “We are now inviting our stakeholders and the public to review our provisional recommendations so that we can ensure our final version is of greatest benefit to the NHS and importantly to those who are drinking harmful amounts of alcohol.”

Stakeholders wishing to submit their comments on the draft guideline are invited to do so via the NICE website by 19th August 2010. NICE will then publish its final guideline in February 2011.


Notes to Editors

Key facts about alcohol misuse (taken from the draft guideline)

  • Alcohol dependence affects 4% of the population in England aged 16-65 years old - this is approximately 1.1 million people.
  • Of the 1.1 million people who are alcohol dependent, only about 6% receive treatment a year.
  • Over 26% of adults in the UK consume alcohol in a way that is potentially or actually harmful to their health or wellbeing.
  • Alcohol misuse is an increasing problem in children and young people, with over 24,000 treated in the NHS for alcohol-related problems in 2008 and 2009.

Definitions of alcohol dependence and harmful drinking

1. Alcohol dependence is characterised by craving, tolerance, a pre-occupation with alcohol and continued drinking in spite of its harmful consequences, such as liver disease or depression. Alcohol dependence is also associated with increased criminal activity and domestic violence and an increased rate of significant mental and physical disorders.

2. Harmful drinking is defined as drinking over the recommended weekly amount and experiencing health problems directly related to alcohol. This could include psychological problems such as depression, alcohol-related accidents or physical illness such as acute pancreatitis. In the longer term, harmful drinkers may go on to develop high blood pressure, cirrhosis, heart disease and mouth, liver, bowel or breast cancers.

About the clinical guideline

3. On 2nd June 2010, NICE published two pieces of final guidance which addressed alcohol-related problems in adults and young people aged 10 years and older.

a. “Alcohol-use disorders: preventing the development of harmful and hazardous drinking - public health guidance on the price, marketing and availability of alcohol, how best to detect alcohol misuse in and outside of primary care, and brief interventions to manage it in these settings. For more information visit:

b. “Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications - a clinical guideline covering acute alcohol withdrawal (including delirium tremens), alcohol-related liver damage, alcohol-related pancreatitis and Wernicke's encephalopathy. For more information visit:

4. The draft guideline was developed for NICE by the National Collaborating Centre for Mental Health.

5. Read more information about the draft NICE clinical guideline on “Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence” visit: cg115.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

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This page was last updated: 24 June 2010