Alcohol dependence and harmful alcohol use quality standard

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Alcohol dependence and harmful alcohol use quality standard.

National Institute for Health and Clinical Excellence.
National Institute for Health and Clinical Excellence, 2011.

From the UK health service standard-setting agency, a concise statement of 13 practices which constitute high quality health care for problem drinkers and good practice in identifying and advising hazardous drinkers - standards which may be used to assess and reward providers and health service commissioning authorities.

Summary Quality standards set by expert groups convened by the UK National Institute for Health and Clinical Excellence (NICE) are intended to represent concise aspirational, but achievable, markers of high-quality, cost-effective patient care, derived from the best available evidence. They will be used to assess the performance of health services and will inform associated payment mechanisms and incentive schemes.

The featured set of standards cover the care in all NHS-funded settings of people aged 10 or older dependent on alcohol or drinking in a harmful way. They also include opportunistic screening and brief interventions for hazardous and harmful drinkers and address the prevention and management of Wernicke's encephalopathy, A brain and nervous system disorder caused by a lack of thiamine (vitamin B1). but not the management of other disorders associated with drinking. Also available is an associated guide for commissioners of services.

The standards

Below verbatim are the agreed quality standards sometimes with explanatory notes drawn from the standards. The meaning, assessment and practice implications of each is expanded on in the source documents.

1 Health and social care staff receive alcohol awareness training that promotes respectful, non-judgmental care of people who misuse alcohol.

2 Health and social care staff opportunistically NHS professionals should consider discussing alcohol consumption during new patient registrations at a GP practice, when screening for other conditions, and when managing chronic disease or carrying out a medicine review. Discussions should also take place when promoting sexual health, when seeing someone for an antenatal appointment and when treating minor injuries.
Social care professionals should focus on people who may be at an increased risk of harm and people who have alcohol-related problems.
carry out screening and brief interventions for hazardous and harmful drinking as an integral part of practice.

3 People NICE public health guidance 24 recommends that referral for specialist treatment is considered for people aged 16 years and older if they: show signs of moderate or severe alcohol dependence; or fail to benefit from structured brief advice and an extended brief intervention and desire to receive further help for an alcohol problem; or show signs of severe alcohol-related impairment or related comorbid condition (for example, liver disease or alcohol-related mental health problems). who may benefit from specialist assessment or treatment for alcohol misuse are offered referral to specialist alcohol services and are able to access Access to specialist alcohol services for those who might benefit from specialist treatment requires a responsive treatment system. A responsive treatment system is a pathway that ensures appropriate case identification and subsequent referral to specialist services, which respond appropriately to referrals and provide ease of access to treatment. Treatment access should include appropriate arrangements for self-referral. People who are likely to benefit from specialist alcohol treatment who accept a referral to specialist alcohol services should expect the service to make contact with them as soon as possible. specialist alcohol treatment.

4 People accessing specialist alcohol services receive assessments and interventions delivered by appropriately DANOS should be considered a minimum requirement for practitioners in specialist alcohol services. In addition, relevant specialists will be required for some assessments and interventions, such as mental health assessments and delivery of cognitive behavioural therapy. trained and competent specialist staff.

5 Adults accessing specialist alcohol services for alcohol misuse receive a comprehensive assessment that includes the use of validated measures.

6 Children and young people accessing specialist services for alcohol use receive a comprehensive assessment that includes the use of validated measures.

7 Families and carers of people who misuse alcohol have their own needs NICE clinical guideline 115 recommends that families and carers involved in supporting a person who misuses alcohol should have the opportunity to discuss concerns about the impact of alcohol misuse on themselves and other family members ... All staff in contact with parents who misuse alcohol and who have care of or regular contact with their children, should take account of the impact of the parent's drinking on the parentchild relationship and the child's development, education, mental and physical health, own alcohol use, safety, and social network and be aware of and comply with the requirements of the Children Act (2004). identified, including those associated with risk of harm, and are offered information and support.

8 People needing medically assisted alcohol withdrawal are offered treatment within the setting most appropriate For people with mild to moderate dependence, offer an outpatient-based assisted withdrawal programme in which contact between staff and the service user averages 2–4 meetings per week over the first week. For people with mild to moderate dependence and complex needs ... or severe dependence, offer an intensive community programme following assisted withdrawal in which the service user may attend a day programme lasting between 4 and 7 days per week over a 3-week period.
Consider inpatient or residential assisted withdrawal if a service user meets one or more of the following criteria. They: drink over 30 units of alcohol per day; have a score of more than 30 on the SADQ; have a history of epilepsy, or experience of withdrawal-related seizures or delirium tremens during previous assisted withdrawal programmes; need concurrent withdrawal from alcohol and benzodiazepines; regularly drink between 15 and 20 units of alcohol per day and have significant psychiatric or physical comorbidities ... or a significant learning disability or cognitive impairment. Also consider a lower threshold for inpatient or residential assisted withdrawal in vulnerable groups, for example, homeless and older people.
Offer inpatient care to children and young people aged 10–17 years who need assisted withdrawal.
NICE clinical guideline 100 recommends that people in acute withdrawal with, or assessed to be at high risk of developing, alcohol withdrawal seizures or delirium tremens, should be offered admission to hospital for medically assisted alcohol withdrawal. A lower threshold for admission to hospital for medically assisted withdrawal should also be considered in certain vulnerable people ... Young people under 16 years who are in acute alcohol withdrawal should be offered admission to hospital for physical and psychosocial assessment, in addition to medically assisted alcohol withdrawal.
to their age, the severity of alcohol dependence, their social support and the presence of any physical or psychiatric comorbidities.

9 People needing medically assisted alcohol withdrawal receive medication using drug regimens appropriate to the setting in which the withdrawal is managed in accordance with NICE guidance.

10 People with suspected, or at high risk of developing, Wernicke's encephalopathy are offered thiamine in accordance with NICE guidance.

11 Adults who misuse alcohol are offered evidence-based psychological interventions, NICE clinical guideline 115 recommends the following psychological interventions for harmful drinkers and people with alcohol dependence: behavioural couples therapy where people have a regular partner who is willing to participate in treatment; cognitive behavioural therapies; behavioural therapies; social network and environment-based therapies. and those with alcohol dependence that is moderate or severe can in addition access relapse prevention medication Acamprosate or oral naltrexone in combination with a psychological intervention should be considered for people with moderate and severe alcohol dependence following successful withdrawal. Disulfiram may be considered if acamprosate and oral naltrexone are not suitable for clinical reasons or if it is the informed service user's choice. Acamprosate and oral naltrexone may also be considered for harmful drinkers and people with mild alcohol dependence who have not responded to psychological interventions alone, or who have specifically requested a pharmacological intervention. in accordance with NICE guidance.

12 Children and young people accessing specialist services for alcohol use are offered individual cognitive behavioural therapy, or if they have significant comorbidities or limited social support, a multicomponent Multicomponent treatment programmes may include multidimensional family therapy, brief strategic family therapy, functional family therapy or multisystemic therapy. NICE clinical guideline 115 makes recommendations about the content, structure and duration of these therapies ... programme of care including family or systems therapy.

13 People receiving specialist treatment for alcohol misuse have regular treatment outcome reviews, which are used to plan subsequent care.

Findings logo commentary Other related NICE guidance documents are listed below.

Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Assessment of what evaluation research means for alcohol dependence treatment in Britain, featuring reviews of the literature on the topics it covers.

Alcohol-use disorders: preventing the development of hazardous and harmful drinking Prevention guidelines which prioritised population-wide changes like price rises and outlet restrictions which affect everyone, independent of the choices they make.

Alcohol use disorders: diagnosis and clinical management of alcohol-related physical complications Clinical guidelines on the medical care of people suffering acute alcohol withdrawal or alcohol-related lack of thiamine, liver disease, or inflammation of the pancreas.

Services for the identification and treatment of hazardous drinking, harmful drinking and alcohol dependence in children, young people and adults Guidance for commissioners on how to organise and procure alcohol treatment and brief intervention services in an area which implement related national clinical guidance and satisfy policy requirements.

Last revised 02 March 2012. First uploaded

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