Quality standard
Development sources
Evidence sources
The documents below contain clinical guideline recommendations or other recommendations that were used by the TEG to develop the quality standard statements and measures.
Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE clinical guideline 115 (2011; NHS Evidence accredited).
Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications. NICE clinical guideline 100 (2010; NHS Evidence accredited).
Alcohol-use disorders: preventing the development of hazardous and harmful drinking. NICE public health guidance 24 (2010; NHS Evidence accredited).
Policy context
It is important that the quality standard is considered alongside current policy documents, including:
Department of Health (2011) Transparency in outcomes – a framework for quality in adult social care.
Department of Health (2010) The NHS Outcomes Framework 2011/12.
Department of Health (2009) Local routes: Guidance for developing alcohol treatment pathways.
National Audit Office (2008) Reducing alcohol harm: health services in England for alcohol misuse.
Department of Health (2007) Safe. Sensible. Social. The next steps in the National Alcohol Strategy.
Department of Health (2006) Signs for improvement – commissioning interventions to reduce alcohol-related harm.
Department of Health and National Treatment Agency for Substance Misuse (2006) Models of care for alcohol misusers (MoCAM).
National Treatment Agency for Substance Misuse (2006) Review of the effectiveness of treatment for alcohol problems.
Department of Health (2005) Alcohol needs assessment project (ANARP).
Definitions and data sources
The definition of harmful alcohol use in this quality standard is that of the World Health Organisation (WHO) The International statistical classification of diseases and related health problems (ICD-10): "a pattern of psychoactive substance use that is causing damage to health. The damage may be physical (for example, hepatitis) or mental (for example, depressive episodes secondary to heavy alcohol intake). Harmful use commonly, but not invariably, has adverse social consequences; social consequences in themselves, however, are not sufficient to justify a diagnosis of harmful use".
In ICD-10 the 'dependence syndrome' is defined as: "a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state".
The term hazardous drinking indicates a pattern of alcohol consumption that increases someone's risk of harm. Some would limit this definition to the physical or mental health consequences (as in harmful use). Others would include the social consequences. The term is currently used by WHO to describe this pattern of alcohol consumption. It is not a diagnostic term.
References included in the definitions and data sources sections can be found below:
Care Quality Commission and Picker Institute (2008) National survey of local health services.
Children Act (2004).
Department of Health (2010) The Primary Medical Services (Directed Enhanced Services) (England) Directions 2010.
Department of Health (2009) Signs for improvement – commissioning interventions to reduce alcohol-related harm.
National Treatment Agency for Substance Misuse. The National Drug Treatment Monitoring System (NDTMS) and the National Alcohol Treatment Monitoring System (NATMS).
NHS Information Centre (2011) Statistics on alcohol: England 2011.
NHS Information Centre (2010) Smoking, drinking and drug use among young people in England 2009.
NHS Information Centre (2009) Adult psychiatric morbidity in England, 2007: results of a household survey.
NICE (2011) Alcohol dependence and harmful alcohol use – audit support. NICE clinical guideline 115.
NICE (2010) Alcohol-use disorders: physical complications – audit support. NICE clinical guideline 100.
NICE (2010) Alcohol-use disorders: preventing harmful drinking – audit support. NICE public health guidance 24.
Office for National Statistics (2010) Drinking: adults' behaviour and knowledge in 2009 (Opinions Survey Report No. 42).
Royal College of Psychiatrists and Royal College of GPs (2005) Roles and responsibilities of doctors in the provision of treatment for drug and alcohol misusers.
Skills for Health (2010) Drugs and Alcohol National Occupational Standards (DANOS).
World Health Organisation (2007) The International statistical classification of diseases and related health problems (ICD-10).