Introduction and overview

Introduction and overview

This quality standard covers the care of children (aged 10–15 years), young people (aged 16–17 years) and adults (aged 18 years and over) drinking in a harmful way and those with alcohol dependence in all NHS-funded settings. It also includes opportunistic screening and brief interventions for hazardous (increasing risk) and harmful (high-risk) drinkers. The quality standard addresses the prevention and management of Wernicke's encephalopathy but does not cover the separate management of other physical and mental health disorders associated with alcohol use.

Introduction

Alcohol dependence and harmful (high-risk) alcohol use are associated with increased risk of physical and mental health comorbidities including gastrointestinal disorders (in particular liver disease), neurological and cardiovascular disease, depression and anxiety disorders and ultimately, premature death. It is estimated that 24% of people aged between 16 and 65 in England consume alcohol in a way that is potentially or actually harmful to their health or well-being. Depending on the diagnostic criteria used, alcohol dependence affects between 3% and 6% of people. Brief interventions can be effective in reducing drinking in hazardous (increasing risk) and harmful (high-risk) drinkers, but people with alcohol dependence and some harmful drinkers will require more specialist alcohol services. Alcohol misuse is also an increasing problem in children and young people, with over 24,000 treated in the NHS for alcohol-related problems in 2008 and 2009. Current practice across the country is varied and access to a range of specialist alcohol services varies as a consequence.

Alcohol dependence and harmful alcohol use are associated with increased risk of physical and mental health comorbidities including gastrointestinal disorders (in particular liver disease), neurological and cardiovascular disease, depression and anxiety disorders and, ultimately, premature death.

This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for harmful drinkers and people with alcohol dependence in the following ways:

  • Preventing people from dying prematurely.

  • Enhancing quality of life for people with long-term conditions.

  • Ensuring that people have a positive experience of care.

  • Treating and caring for people in a safe environment and protecting them from avoidable harm.

The 2011/12 Adult Social Care Outcome Framework is available.

It is also expected that this quality standard will contribute to reducing alcohol-related hospital admissions and readmissions to hospital.

Overview

This quality standard refers to harmful (high-risk) drinking and alcohol dependence collectively as 'alcohol misuse'. Where a statement refers exclusively to harmful drinking, alcohol dependence or hazardous (increasing risk) drinking, this is explicitly stated. Definitions of these terms can be found in the development sources. The term 'alcohol misuse' is a working definition taken from NICE's guideline on alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence and is not used as a diagnostic term or to imply intentionality.

The quality standard for alcohol dependence and harmful alcohol use requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole care pathway. An integrated, multidisciplinary approach to provision of services is fundamental to the delivery of high-quality care to people who misuse alcohol. A specialist alcohol service is one in which the primary role is the assessment and management of alcohol misuse, including both psychological and physical effects. Some specialist addiction services will have this role for both drug and alcohol misuse.

NICE quality standards are for use by the NHS in England and do not have formal status in the social care sector. However, the NHS will not be able to provide a comprehensive service for all without working with social care communities. In this quality standard, care has been taken to make sure that any quality statements that refer to the social care sector are relevant and evidence-based. Social care commissioners and providers may therefore wish to use them, both to improve the quality of their services and support their colleagues in the NHS.