This clinical guideline on alcohol-use disorders was commissioned by NICE and developed by the National Collaborating Centre for Mental Health, and sets out the evidence for the treatment and management of harmful drinking and alcohol dependence in adults and in young people aged 10 to 17 years.

Harmful drinking leads to 2.5 million deaths annually and alcohol is the third leading risk factor globally for burden of illness. Alcohol-use disorders are an increasing problem in children and young people. Physical and psychiatric comorbidities add to the considerable burden that alcohol-use disorders can pose to the individual and to society. This guideline will enable healthcare professionals to recognise and manage these prevalent problems and offer effective treatments to their patients.

This guideline reviews the evidence for the diagnosis and assessment of alcohol-use disorders, organisation and delivery of care, settings for assisted alcohol withdrawal, psychological interventions, and pharmacological interventions for assisted withdrawal and relapse prevention. The guideline also includes health economic modelling of pharmacological interventions as an adjunctive treatment for the prevention of relapse and a chapter on the experience of care.

Contents

• GUIDELINE DEVELOPMENT GROUP MEMBERS
• ACKNOWLEDGEMENTS
• 1. PREFACE
  • 1.1. NATIONAL CLINICAL GUIDELINES
  • 1.2. THE NATIONAL ALCOHOL DEPENDENCE AND HARMFUL ALCOHOL USE GUIDELINE
• 2. ALCOHOL DEPENDENCE AND HARMFUL ALCOHOL USE
  • 2.1. INTRODUCTION
  • 2.2. DEFINITIONS
  • 2.3. EPIDEMIOLOGY OF ALCOHOL
  • 2.4. AETIOLOGY
  • 2.5. COURSE OF HARMFUL ALCOHOL USE AND DEPENDENCE
  • 2.6. PHARMACOLOGY OF ALCOHOL
  • 2.7. IDENTIFICATION AND DIAGNOSIS
  • 2.8. THE ROLE OF TREATMENT AND MANAGEMENT
  • 2.9. CURRENT CARE IN THE NATIONAL HEALTH SERVICE
  • 2.10. SERVICE USER ORGANISATIONS
  • 2.11. IMPACT ON FAMILIES
  • 2.12. SPECIAL POPULATIONS
  • 2.13. ECONOMIC IMPACT
• 3. METHODS USED TO DEVELOP THIS GUIDELINE
  • 3.1. OVERVIEW
  • 3.2. THE SCOPE
  • 3.3. THE GUIDELINE DEVELOPMENT GROUP
  • 3.4. REVIEW QUESTIONS
  • 3.5. CLINICAL EVIDENCE METHODS
  • 3.6. HEALTH ECONOMICS METHODS
  • 3.7. STAKEHOLDER CONTRIBUTIONS
  • 3.8. VALIDATION OF THE GUIDELINE
• 4. EXPERIENCE OF CARE
  • 4.1. INTRODUCTION
  • 4.2. REVIEW OF THE QUALITATIVE LITERATURE
  • 4.3. FROM EVIDENCE TO RECOMMENDATIONS
  • 4.4. RECOMMENDATIONS
• 5. ORGANISATION AND DELIVERY OF CARE
  • SECTION 1. INTRODUCTION TO THE ORGANISATION AND DELIVERY OF CARE
  • SECTION 2. EVALUATING THE ORGANISATION OF CARE FOR PEOPLE WHO MISUSE ALCOHOL
  • SECTION 3. THE ASSESSMENT OF HARMFUL DRINKING AND ALCOHOL DEPENDENCE
  • SECTION 4. DETERMINING THE APPROPRIATE SETTING FOR THE DELIVERY OF EFFECTIVE CARE
• 6. PSYCHOLOGICAL AND PSYCHOSOCIAL INTERVENTIONS
  • 6.1. INTRODUCTION
  • 6.2. THERAPIST FACTORS
  • 6.3. MATCHING EFFECTS/SEVERITY
  • 6.4. SETTING THE CONTEXT FOR 12-STEP FACILITATION AND ALCOHOLICS ANONYMOUS
  • 6.5. REVIEW OF PSYCHOLOGICAL THERAPIES
  • 6.6. OUTCOMES
  • 6.7. MOTIVATIONAL TECHNIQUES
  • 6.8. 12-STEP FACILITATION
  • 6.9. COGNITIVE BEHAVIOURAL THERAPY
  • 6.10. BEHAVIOURAL THERAPIES (EXCLUDING CONTINGENCY MANAGEMENT)
  • 6.11. CONTINGENCY MANAGEMENT
  • 6.12. SOCIAL NETWORK AND ENVIRONMENT-BASED THERAPIES
  • 6.13. COUPLES THERAPY
  • 6.14. COUNSELLING
  • 6.15. SHORT-TERM PSYCHODYNAMIC THERAPY
  • 6.16. MULTI-MODAL TREATMENT
  • 6.17. SELF-HELP-BASED TREATMENT
  • 6.18. PSYCHOEDUCATIONAL INTERVENTIONS
  • 6.19. MINDFULNESS MEDITATION
  • 6.20. CLINICAL EVIDENCE SUMMARY
  • 6.21. HEALTH ECONOMIC EVIDENCE
  • 6.22. SPECIAL POPULATIONS – CHILDREN AND YOUNG PEOPLE
  • 6.23. FROM EVIDENCE TO RECOMMENDATIONS
  • 6.24. RECOMMENDATIONS
  • 6.24.2. Research recommendation
  • 6.25. ACUPUNCTURE
  • 6.26. PSYCHOLOGICAL INTERVENTIONS FOR CARERS
• 7. PHARMACOLOGICAL INTERVENTIONS
  • 7.1. INTRODUCTION
  • 7.2. REVIEW OF PHARMACOLOGICAL INTERVENTIONS
  • 7.3. CLINICAL REVIEW PROTOCOL FOR PHARMACOLOGICAL INTERVENTIONS FOR RELAPSE PREVENTION
  • 7.4. ACAMPROSATE
  • 7.5. NALTREXONE
  • 7.6. ACAMPROSATE + NALTREXONE (COMBINED INTERVENTION)
  • 7.7. ORAL DISULFIRAM
  • 7.8. META-REGRESSION ON BASELINE ALCOHOL CONSUMPTION AND EFFECTIVENESS
  • 7.9. PREDICTORS OF EFFICACY
  • 7.10. HEALTH ECONOMIC EVIDENCE
  • 7.11. ECONOMIC MODEL
  • 7.12. CHILDREN AND YOUNG PEOPLE
  • 7.13. ASSESSMENT, MONITORING AND SIDE-EFFECT PROFILE
  • 7.14. REVIEW OF OTHER PHARMACOLOGICAL INTERVENTIONS NOT LICENSED IN THE UK FOR RELAPSE PREVENTION
  • 7.15. FROM EVIDENCE TO RECOMMENDATIONS
  • 7.16. PHARMACOTHERAPY FOR LESS SEVERE DEPENDENNCE AND NON-DEPENDENT DRINKING
  • 7.17. COMORBIDITIES
  • 7.18. WERNICKE-KORSAKOFF SYNDROME
• 8. SUMMARY OF RECOMMENDATIONS
  • 8.1. PRINCIPLES OF CARE
  • 8.2. IDENTIFICATION AND ASSESSMENT
  • 8.3. INTERVENTIONS FOR ALCOHOL MISUSE
  • 8.4. RESEARCH RECOMMENDATIONS
• APPENDICES
  • Appendix 1. Scope for the development of the clinical guideline
  • Appendix 2. Declarations of interests by Guideline Development Group members
  • Appendix 3. Special advisors to the Guideline Development Group
  • Appendix 4. Alcohol assessment tools
  • Appendix 5. Stakeholders and experts who submitted comments in response to the consultation draft of the guideline
  • Appendix 6. Researchers contacted to request information about studies
  • Appendix 7. Review questions
  • Appendix 8. Review protocols
  • Appendix 9. Search strategies for the identification of clinical studies
  • Appendix 10. Clinical study data extraction form
  • Appendix 11. Quality checklists for clinical studies and reviews
  • Appendix 12. Search strategies for the identification of health economic evidence
  • Appendix 13. Quality checklists for economic studies
  • Appendix 14. Experience of care: personal accounts and thematic analysis
  • Appendix 15. Network meta-analysis for the economic model
  • Appendix 16. Included/excluded study characteristics tables
  • Appendix 17. Clinical evidence forest plots
  • Appendix 18. GRADE evidence profiles
  • Appendix 19. Evidence tables for economic studies
• REFERENCES
• ABBREVIATIONS

The views presented in this book do not necessarily reflect those of the British Psychological Society, and the publishers are not responsible for any error of omission or fact. The British Psychological Society is a registered charity (no. 229642).