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Alcohol-use disorders: Preventing the development of hazardous and harmful drinking.
National Institute for Health and Clinical Excellence
National Institute for Health and Clinical Excellence, 2010.
In these UK national prevention guidelines, experts prioritised population-wide changes like price rises and outlet restrictions which affect everyone, independent of the choices they make. But in England government prefers to target what they see as the troublesome minority, not the responsible majority.
Summary The UK Department of Health asked the National Institute for Health and Clinical Excellence (NICE) to produce public health guidance on the prevention and early identification of alcohol-use disorders Alcohol-use disorders cover a wide range of mental health problems as recognised within the international disease classification systems (ICD-10, DSM-IV). These include hazardous and harmful drinking and alcohol dependence. among adults and adolescents. The guidance is for government, industry and commerce, the NHS and all those whose actions affect the population’s attitude to – and use of – alcohol. This includes commissioners, managers and practitioners working in local authorities, education and the wider public, private, voluntary and community sectors.
When writing the recommendations, the Programme Development Group considered evidence of effectiveness (including cost-effectiveness), fieldwork data and comments from stakeholders and experts.
A combination of interventions are needed to reduce alcohol-related harm Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’. – to the benefit of society as a whole.
Population-level approaches are important because they can help reduce the aggregate level of alcohol consumed and therefore lower the whole population’s risk of
alcohol-related harm.
Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’.
They can help:
• those who are not in regular contact with the relevant services;
• those who have been specifically advised to reduce their alcohol intake, by creating an environment that supports
lower-risk
Regularly consuming 21 UK units (8g alcohol per unit) per week or less (adult men) or 14 units per week or less (adult women).
drinking.
They can also help prevent people from drinking harmful A pattern of alcohol consumption that is causing mental or physical damage. or hazardous 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. amounts in the first place.
Interventions aimed at individuals can help make people aware of the potential risks they are taking (or harm they may be doing) at an early stage. This is important, as they are most likely to change their behaviour if it is tackled early. In addition, an early intervention could prevent extensive damage.
This NICE guidance provides authoritative recommendations, based on a robust analysis of the evidence, which support current government activities. The recommendations could form part of a national framework for action. National-level action to reduce the population’s alcohol consumption requires coordinated government policy. It also needs government, industry and key non-governmental organisations to work together.
This guidance makes the case that alcohol-related harm Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’. is a major public health problem. On the basis of the best available evidence, it also identifies the policy options that are most likely to be successful in combating such harm. Policy recommendations (recommendations 1 to 3) are based on extensive and consistent evidence which suggests that the issues identified deserve close attention. This evidence also suggests that policy change is likely to be a more effective – and more cost-effective – way of reducing alcohol-related harm Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’. among the population than actions undertaken by local health professionals. Practice recommendations (4 to 12) support, complement – and are reinforced by – these policy options. They include screening For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. and brief interventions. This can comprise either a short session of structured brief advice or a longer, more motivationally-based session (that is, an extended brief intervention). Both aim to help someone reduce their alcohol consumption (sometimes even to abstain) and can be carried out by non-alcohol specialists.
The Chief Medical Officer should coordinate the alcohol harm-reduction strategy for England across government, supported by the Department of Health.
The following departments and national agencies should also be involved:Organisations that should be consulted include:
• advertisers;
• alcohol producers;
• national non-governmental organisations (for example, Alcohol Concern and the Royal Medical Colleges);
• off- and on-sale retailers.
Making alcohol less affordable is the most effective way of reducing alcohol-related harm. Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’. The current excise duty varies for different alcoholic products (for historical reasons and under EU legislation). This means that the duty does not always relate directly to the amount of alcohol in the product. In addition, an increase in the duty levied does not necessarily translate into a price increase as retailers or producers may absorb the cost. There is extensive international and national evidence (within the published literature and from economic analyses) to justify reviewing policies on pricing to reduce the affordability of alcohol.
Consider introducing a minimum price per unit. A UK unit is 8g alcohol. Set the level by taking into account the health and social costs of alcohol-related harm Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’. and its impact on alcohol consumption. Consider initiating a review of the excise duty regime with fellow EU member states. The aim would be to obtain a pan-EU agreement on harmonisation which links alcohol duty to the strength of each product.
Regularly review the minimum price per unit A UK unit is 8g alcohol. and alcohol duties to ensure alcohol does not become more affordable over time.
International evidence suggests that making it less easy to buy alcohol, by reducing the number of outlets selling it in a given area and the days and hours when it can be sold, is another effective way of reducing alcohol-related harm. Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’. In Scotland, protection of the public’s health is among the objectives of licensing decisions.
Consider revising legislation on licensing to ensure:
• protection of the public’s health is one of its objectives;
• health bodies are
responsible authorities;
Responsible authorities have to be notified of all licence variations and new applications and can make representations regarding them. The Licensing Act 2003 lists responsible authorities. They include the police, environmental health and child protection services, fire and rescue and trading standards.
• licensing departments can take into account the links between the availability of alcohol and
alcohol-related harm
Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’.
when considering a licence application (that is, they can take into account the number of alcohol outlets in a given area and times when it is on sale and the potential links to local crime and disorder and alcohol-related illnesses and deaths);
• immediate sanctions can be imposed on any premises in breach of their licence, following review proceedings.
Consider reducing personal import allowances to support the introduction of a minimum price per unit A UK unit is 8g alcohol. of alcohol.
There is evidence that alcohol advertising does affect children and young people. It shows that exposure to alcohol advertising is associated with the onset of drinking among young people and increased consumption among those who already drink. All of the evidence suggests that children and young people should be protected as much as is possible by strengthening the current regulations.
Ensure children and young people’s exposure to alcohol advertising is as low as possible by considering a review of the current advertising codes. This review would ensure:
• the limits set by the Advertising Standards Authority for the proportion of the audience under age 18 are appropriate;
• where alcohol advertising is permitted there is adequate protection for children and young people;
• all alcohol marketing, particularly when it involves new media (for example, web-based channels and mobile phones) and product placement, is covered by a stringent regulatory system which includes ongoing monitoring of practice.
Ofcom, the Advertising Standards Authority and the government should keep the current regulatory structure under review.
Assess the potential costs and benefits of a complete alcohol advertising ban to protect children and young people from exposure to alcohol marketing.
Alcohol licence-holders and designated supervisors of licensed premises.
• Local authorities;
• Trading standards officers;
• The police;
• Magistrates;
• Revenue and customs.
Use local crime and related trauma data to map the extent of alcohol-related problems before developing or reviewing a licensing policy. If an area is ‘saturated’ Describes a specific geographical area where there are already a lot of premises selling alcohol – and where the awarding of any new licences to sell alcohol may contribute to an increase in alcohol-related disorder. with licensed premises and the evidence suggests that additional premises may affect the licensing objectives, adopt a ‘cumulative impact’ policy. If necessary, limit the number of new licensed premises in a given area.
Ensure sufficient resources are available to prevent under-age sales, sales to people who are intoxicated, proxy sales (that is, illegal purchases for someone who is under-age or intoxicated), non-compliance with any other alcohol licence condition and illegal imports of alcohol.
Work in partnership with the appropriate authorities to identify and take action against premises that regularly sell alcohol to people who are under-age, intoxicated or making illegal purchases for others.
Undertake test purchases (using ‘mystery’ shoppers) to ensure compliance with the law on under-age sales. Test purchases should also be used to identify and take action against premises where sales are made to people who are intoxicated or to those illegally purchasing alcohol for others.
Ensure sanctions are fully applied to businesses that break the law on under-age sales, sales to those who are intoxicated and proxy purchases. This includes fixed penalty and closure notices (the latter should be applied to establishments that persistently sell alcohol to children and young people).
Professionals who have contact with those aged 16 and over.
• Chief executives of NHS and local authorities;
• Commissioners of NHS healthcare services;
• Commissioners from multi-agency joint commissioning groups;
• Managers of NHS-commissioned services.
Chief executives of NHS and local authorities should prioritise alcohol-use disorder Alcohol-use disorders cover a wide range of mental health problems as recognised within the international disease classification systems (ICD-10, DSM-IV). These include hazardous and harmful drinking and alcohol dependence. prevention as an ‘invest to save’ measure.
Commissioners should ensure a local joint alcohol needs assessment is carried out in accordance with World class commissioning and Signs for improvement. They should also ensure locally defined integrated care pathways for alcohol treatment are reviewed.
Commissioners should ensure their plans include screening For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. and brief interventions This can comprise either a short session of structured brief advice or a longer, more motivationally-based session (that is, an extended brief intervention). Both aim to help someone reduce their alcohol consumption (sometimes even to abstain) and can be carried out by non-alcohol specialists. for people at risk of an alcohol-related problem – hazardous 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. drinkers – and those whose health is being damaged by alcohol – harmful A pattern of alcohol consumption that is causing mental or physical damage. drinkers. This includes people from disadvantaged groups.
Commissioners should make provision for the likely increase in the number of referrals to services providing tier two, three and four structured alcohol treatments as a result of screening. For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. These services should be properly resourced to support the stepped care approach recommended in Models of care for alcohol misusers.
Commissioners should ensure at least one in seven dependent drinkers can get treatment locally, in line with Signs for improvement.
Commissioners should include formal evaluation within the commissioning framework so that alcohol interventions and treatment are routinely evaluated and followed up. The aim is to ensure adherence to evidence-based practice and to ensure interventions are cost effective.
Managers of NHS-commissioned services must ensure an appropriately trained nurse or medical consultant, with dedicated time, is available to provide strategic direction, governance structures and clinical supervision to alcohol specialist nurses and care givers.
Managers of NHS-commissioned services must ensure community and voluntary sector providers have an appropriately trained professional who can provide strategic direction, governance structures and supervision to those providing screening For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. and brief interventions. This can comprise either a short session of structured brief advice or a longer, more motivationally-based session (that is, an extended brief intervention). Both aim to help someone reduce their alcohol consumption (sometimes even to abstain) and can be carried out by non-alcohol specialists.
Managers of NHS-commissioned services must ensure staff have enough time and resources to carry out screening For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. and brief intervention This can comprise either a short session of structured brief advice or a longer, more motivationally-based session (that is, an extended brief intervention). Both aim to help someone reduce their alcohol consumption (sometimes even to abstain) and can be carried out by non-alcohol specialists. work effectively. Staff should have access to recognised, evidence-based packs. These should include: a short guide on how to deliver a brief intervention, This can comprise either a short session of structured brief advice or a longer, more motivationally-based session (that is, an extended brief intervention). Both aim to help someone reduce their alcohol consumption (sometimes even to abstain) and can be carried out by non-alcohol specialists. a validated screening For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. questionnaire, a visual presentation (to compare the person’s drinking levels with the average), practical advice on how to reduce alcohol consumption, a self-help leaflet and possibly a poster for display in waiting rooms.
Managers of NHS-commissioned services must ensure staff are trained to provide alcohol screening For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. and structured brief advice. A brief intervention that takes only a few minutes to deliver. If there is local demand, staff should also be trained to deliver extended brief interventions. This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’.
Children and young people aged 10 to 15 years who are thought to be at risk from their use of alcohol.
Any professional with a safeguarding responsibility for children and young people and who regularly comes into contact with this age group.
Use professional judgement to routinely assess the ability of these children and young people to consent to alcohol-related interventions and treatment. Some will require parental or carer involvement.
Obtain a detailed history of their alcohol use (for example, using the Common Assessment Framework as a guide). Include background factors such as family problems and instances of child abuse or under-achievement at school.
Use professional judgement to decide on the appropriate course of action. In some cases, it may be sufficient to empathise and give an opinion about the significance of their drinking and other related issues that may arise. In other cases, more intensive counselling and support may be needed.
If there is a reason to believe that there is a significant risk of alcohol-related harm, Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’. consider referral to child and adolescent mental health services, social care or to young people’s alcohol services for treatment, as appropriate and available.
Ensure discussions are sensitive to the child or young person’s age and their ability to understand what is involved, their emotional maturity, culture, faith and beliefs. The discussions (and tools used) should also take into account their particular needs (health and social) and be appropriate to the setting.
Young people aged 16 and 17 years who are thought to be at risk from their use of alcohol.
Health and social care, criminal justice and community and voluntary professionals in both NHS and non-NHS settings who regularly come into contact with this group.
Complete a validated alcohol screening For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. questionnaire with these young people. Alternatively, if they are judged to be competent enough, ask them to fill one in themselves. In most cases, AUDIT should be used. If time is limited, use an abbreviated version (such as AUDIT-C, AUDIT-PC, CRAFFT, SASQ or FAST). Screening tools should be appropriate to the setting. For instance, in an emergency department, FAST or the Paddington Alcohol Test (PAT) would be most appropriate.
Focus on key groups that may be at an increased risk of
alcohol-related harm.
Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’.
This includes those:
• who have had an accident or a minor injury;
• who regularly attend genito-urinary medicine (GUM) clinics or repeatedly seek emergency contraception;
• involved in crime or other antisocial behaviour;
• who truant on a regular basis;
• at risk of self-harm;
• who are looked after;
• involved with child safeguarding agencies.
When broaching the subject of alcohol and screening, For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. ensure discussions are sensitive to the young person’s age and their ability to understand what is involved, their emotional maturity, culture, faith and beliefs. The discussions should also take into account their particular needs (health and social) and be appropriate to the setting.
Routinely assess the young person’s ability to consent to alcohol-related interventions and treatment. If there is doubt, encourage them to consider involving their parents in any alcohol counselling they receive.
Young people aged 16 and 17 years who have been identified via screening For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. as drinking hazardously 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. or harmfully. A pattern of alcohol consumption that is causing mental or physical damage.
Health and social care, criminal justice and community and voluntary sector professionals in both NHS and non-NHS settings who regularly come into contact with this group.
Ask the young person’s permission to arrange an extended brief intervention This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’. for them.
Appropriately trained staff should offer the young person an extended brief intervention. This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’.
Provide information on local specialist addiction services to those who do not respond well to discussion but who want further help. Refer them to these services if this is what they want. Referral must be made to services that deal with young people.
Give those who are actively seeking treatment for an alcohol problem a physical and mental assessment and offer, or refer them for, appropriate treatment and care.
Adults.
Health and social care, criminal justice and community and voluntary sector professionals in both NHS and non-NHS settings who regularly come into contact with people who may be at risk of harm from the amount of alcohol they drink.
NHS professionals should routinely carry out alcohol screening For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. as an integral part of practice. For instance, discussions should take place during new patient registrations, when screening for other conditions and when managing chronic disease or carrying out a medicine review. These discussions should also take place when promoting sexual health, when seeing someone for an antenatal appointment and when treating minor injuries.
Where
screening
For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening.
everyone is not feasible or practicable, NHS professionals should focus on groups that may be at an increased risk of harm from alcohol and those with an alcohol-related condition. This includes people:
• with relevant physical conditions (such as hypertension and gastrointestinal or liver disorders);
• with relevant mental health problems (such as anxiety, depression or other mood disorders);
• who have been assaulted;
• at risk of self-harm;
• who regularly experience accidents or minor traumas;
• who regularly attend GUM clinics or repeatedly seek emergency contraception.
Non-NHS professionals should focus on groups that may be at an increased risk of harm from alcohol and people who have alcohol-related problems. For example, this could include those:
• at risk of self-harm;
• involved in crime or other antisocial behaviour;
• who have been assaulted;
• at risk of domestic abuse;
• whose children are involved with child safeguarding agencies;
• with drug problems.
When broaching the subject of alcohol and screening, For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. ensure the discussions are sensitive to people’s culture and faith and tailored to their needs.
Complete a validated alcohol questionnaire with the adults being screened. For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. Alternatively, if they are competent enough, ask them to fill one in themselves. Use AUDIT to decide whether to offer them a brief intervention This can comprise either a short session of structured brief advice or a longer, more motivationally-based session (that is, an extended brief intervention). Both aim to help someone reduce their alcohol consumption (sometimes even to abstain) and can be carried out by non-alcohol specialists. (and, if so, what type) or whether to make a referral. If time is limited, use an abbreviated version (such as AUDIT-C, AUDIT-PC, SASQ or FAST). Screening tools should be appropriate to the setting. For instance, in an emergency department FAST or PAT would be most appropriate.
Do not offer simple brief advice to anyone who may be dependent on alcohol. Instead, refer them for specialist treatment (see recommendation 12). If someone is reluctant to accept a referral, offer an extended brief intervention This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’. (see recommendation 11).
Use professional judgement as to whether to revise the AUDIT scores downwards when screening:
• women, including those who are, or are planning to become, pregnant;
• younger people (under the age of 18);
• people aged 65 and over;
• people from some black and minority ethnic groups.
If in doubt, consult relevant specialists. Work on the basis that offering an intervention is less likely to cause harm than failing to act where there are concerns.
Consult relevant specialists when it is not appropriate to use an English language-based screening questionnaire, for example, when dealing with people whose first language is not English or who have a learning disability.
Biochemical measures including of blood alcohol concentration should not be used as a matter of routine to screen For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. someone to see if they are drinking hazardously 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. or harmfully. A pattern of alcohol consumption that is causing mental or physical damage. Biochemical measures may be used to assess the severity and progress of an established alcohol-related problem, or as part of a hospital assessment, including assessments carried out in emergency departments.
Professionals who have received the necessary training and work in:
• primary healthcare;
• emergency departments;
• other healthcare services (hospital wards, outpatient departments, occupational health, sexual health, needle and syringe exchange programmes, pharmacies, dental surgeries, antenatal clinics and those commissioned from the voluntary, community and private sectors);
• the criminal justice system;
• social services;
• higher education;
• other public services.
Offer a session of structured brief advice A brief intervention that takes only a few minutes to deliver. on alcohol. If this cannot be offered immediately, offer an appointment as soon as possible thereafter.
Use a recognised, evidence-based resource that is based on
FRAMES
Feedback (on the client’s risk of having alcohol problems), responsibility (change is the client’s responsibility), advice (provision of clear advice when requested), menu (what are the options for change?), empathy (an approach that is warm, reflective and understanding) and self-efficacy (optimism about the behaviour change).
principles. It should take 5–15 minutes and should:
• cover the potential harm caused by their level of drinking and reasons for changing the behaviour, including the health and wellbeing benefits;
• cover the barriers to change;
• outline practical strategies to help reduce alcohol consumption, to address the ‘menu’ component of the
FRAMES
Feedback (on the client’s risk of having alcohol problems), responsibility (change is the client’s responsibility), advice (provision of clear advice when requested), menu (what are the options for change?), empathy (an approach that is warm, reflective and understanding) and self-efficacy (optimism about the behaviour change).
model;
• lead to a set of goals.
Where there is an ongoing relationship with the patient or client, routinely monitor their progress in reducing their alcohol consumption to a low-risk level. Where required, offer an additional session of structured brief advice. A brief intervention that takes only a few minutes to deliver. or, if there has been no response, offer an extended brief intervention. This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’.
Adults who have not responded to structured brief advice. A brief intervention that takes only a few minutes to deliver. on alcohol and require an extended brief intervention This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’. or would benefit from this for other reasons.
NHS and other professionals in the public, private, community and voluntary sectors who are in contact with adults and have received training in extended brief intervention This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’. techniques.
Offer an extended brief intervention This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’. to help people address their alcohol use. This could take the form of motivational interviewing or motivational-enhancement therapy. Sessions should last from 20 to 30 minutes. They should aim to help people to reduce the amount they drink to low risk levels, reduce risk-taking behaviour as a result of drinking, or to consider abstinence.
Follow up and assess people who have received an extended brief intervention. This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’. Where necessary, offer up to four additional sessions or referral to a specialist alcohol treatment service (see recommendation 12).
Those aged 16 years and over who attend NHS or other public services and may be alcohol-dependent. (For those under 16 see recommendation 6.)
NHS and other professionals in the public, private, community and voluntary sectors who have contact with anyone aged 16 and over.
Consider making a referral for specialist treatment if one or more of the following has occurred. They:
• show signs of moderate or severe
alcohol dependence;
A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use. Someone who is alcohol dependent may persist in drinking, despite harmful consequences. They will also give alcohol a higher priority than other activities and obligations.
• have failed to benefit from
structured brief advice
A brief intervention that takes only a few minutes to deliver.
and an
extended brief intervention
This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as ‘extended brief interventions’.
and wish to receive further help for an alcohol problem;
• show signs of severe alcohol-related impairment or have a related co-morbid condition (for example, liver disease or alcohol-related mental health problems).
An update on the evidence behind the report was published in March 2014. None of the new findings were considered to possibly requires changes to the original guidance. Among these, new studies on alcohol pricing were considered to strengthen the original recommendations and in particular the call for a minimum unit price. Similarly considered strengthened were calls for controls on availability and in particular restricting the concentration of alcohol outlets and controlling marketing. ‘No effect’ findings from the English SIPS trial of primary care screening and brief interventions were considered unlikely to have an impact on the original recommendations. The positive implications of a cost-effectiveness study for England were taken to strengthen the original guidance’s recommendations in favour of implementing such programmes.