Management

Most of the people with alcohol-use disorders will recover without specialist treatment and many will reduce their alcohol intake following a change in circumstances e.g. - parenthood, marriage or taking on a responsible job.

For most people who are alcohol dependent the most appropriate goal in terms of alcohol consumption should be to aim for complete abstinence

• for people with significant psychiatric or physical comorbidity (for example, depressive disorder or alcoholic liver disease), abstinence is the appropriate goal.
• however, hazardous and harmful drinkers, and those with a low level of alcohol dependence, may be able to achieve a goal of moderate alcohol consumption (1)

Before initiating treatment it is essential that patients are appropriately diagnosed and assessed in order to decide on the most appropriate treatment and management.

• formal assessment tools are used to assess the nature and severity of alcohol misuse which includes:
  • Alcohol Use Disorders Identification Test (AUDIT) for identification and as a routine outcome measure
  • Severity of Alcohol Dependence Questionnaire (SADQ) or Leeds Dependency Questionnaire (LDQ)9 for severity of dependence
  • Clinical Institute Withdrawal Assessment of Alcohol Scale, revised (CIWA-Ar) for severity of withdrawal
  • Alcohol Problems Questionnaire (APQ) for the nature and extent of the problems arising from alcohol misuse.

Screening and brief intervention delivered by a non-specialist practitioner may respond hazardous and harmful drinkers while some may require the help of a mutual aid organisation, such as Alcoholics Anonymous (AA). However, many will require access to specialist treatment by virtue of having more severe or chronic alcohol problems, or a higher level of complications of their drinking (for example, social isolation, psychiatric co-morbidity and severe alcohol withdrawal) (1)

Pharmacological interventions should be administered by specialist and competent staff (1)

For all people who misuse alcohol, offer

• information on the value and availability of community support networks and self-help groups (for example, Alcoholics Anonymous or SMART recovery) and
• help to participate in community support networks and self-help groups by encouraging them to go to meetings and arranging support so that they can attend (1).

Consider stopping the treatment and review the care plan if there are signs of deterioration or no indications of improvement (1)

Reference:

• (1) NICE (February 2011). Alcohol-use disorders - Diagnosis, assessment and management of harmful drinking and alcohol dependence