6.1.7 Assessment and Management of Alcohol Misusers
The Assessment and Management of Alcohol Misusers, Including Symptoms and Signs of Substance Use, and Withdrawal Phenomena.
In the UK, the National Institute for Health and Care Excellence (NICE) provides guidelines for the assessment and management of alcohol misuse. These guidelines are designed to support healthcare professionals in delivering safe and effective care for individuals who may be experiencing problems related to their alcohol consumption.
The NICE guidelines recommend that healthcare professionals conduct a comprehensive assessment of individuals who present with alcohol misuse, including a detailed history of their drinking behaviour, physical examination, and laboratory tests to assess liver function and other health indicators.
In terms of management, the guidelines recommend that healthcare professionals offer brief interventions to individuals who are drinking above recommended levels but do not meet the criteria for alcohol dependence. These interventions may include advice on reducing alcohol consumption, setting goals for behaviour change, and providing information on the risks associated with excessive alcohol use.
For individuals who are dependent on alcohol, the guidelines recommend a range of pharmacological and psychosocial interventions to support recovery. Pharmacological interventions may include medications such as acamprosate, naltrexone, or disulfiram to reduce alcohol cravings or discourage drinking. Psychosocial interventions may include cognitive-behavioural therapy, motivational interviewing, or self-help groups such as Alcoholics Anonymous.
The NICE guidelines also emphasize the importance of providing ongoing support and monitoring for individuals who are in recovery from alcohol dependence. This may include regular follow-up appointments with healthcare professionals, support from peer groups or family members, and ongoing assessment of physical and psychological health.
| Assessment Guidelines | Management Guidelines |
| Conduct a comprehensive assessment, including a detailed history of drinking behaviour, physical examination, and laboratory tests. | Offer brief interventions to individuals who are drinking above recommended levels but do not meet the criteria for alcohol dependence. |
| Use standardized assessment tools to measure alcohol consumption and assess for alcohol-related problems (AUDIT – Alcohol Use Disorders Identification Test). | Provide pharmacological interventions such as acamprosate, naltrexone, or disulfiram to reduce alcohol cravings or discourage drinking for individuals who are dependent on alcohol. |
| Assess for co-occurring mental and physical health problems, including liver function and other health indicators. | Offer psychosocial interventions such as cognitive-behavioural therapy, motivational interviewing, or self-help groups such as Alcoholics Anonymous for individuals who are dependent on alcohol. |
| Consider referral to specialist services for individuals with complex needs or severe alcohol dependence. | Provide ongoing support and monitoring, including regular follow-up appointments with healthcare professionals, support from peer groups or family members, and ongoing assessment of physical and psychological health. |
Alcohol withdrawal:
The management of alcohol withdrawal is an important aspect of the overall management of alcohol misuse. In the UK, the National Institute for Health and Care Excellence (NICE) provides guidelines for the assessment and management of alcohol withdrawal.
The NICE guidelines recommend that healthcare professionals assess individuals who are at risk of alcohol withdrawal using standardized tools (Clinical Institute Withdrawal Assessment for Alcohol, commonly abbreviated as CIWA or CIWA–Ar (revised version)) to determine the severity of their symptoms. The assessment should include a physical examination and laboratory tests to assess liver function and other health indicators.
For individuals with mild or moderate withdrawal symptoms, the guidelines recommend that healthcare professionals provide oral benzodiazepines such as chlordiazepoxide or diazepam to reduce the severity of symptoms and prevent complications. The dose and duration of benzodiazepine treatment should be based on the severity of symptoms and adjusted based on individual response.
For individuals with severe withdrawal symptoms, including those who are at risk of developing delirium tremens or seizures, the guidelines recommend hospitalization for intensive monitoring and management. In these cases, intravenous benzodiazepines such as lorazepam or diazepam may be required to control symptoms.
The guidelines also recommend that healthcare professionals monitor individuals during and after withdrawal for complications such as seizures, delirium tremens, and Wernicke’s encephalopathy. Individuals who have experienced severe alcohol withdrawal may require ongoing monitoring and support to prevent relapse and manage the long-term effects of alcohol misuse.
A summary table of the UK guidelines for the management of alcohol withdrawal:
| Severity of Symptoms | Management Guidelines |
| Mild to Moderate | Provide oral benzodiazepines such as chlordiazepoxide or diazepam to reduce the severity of symptoms and prevent complications. The dose and duration of benzodiazepine treatment should be based on the severity of symptoms and adjusted based on individual response. |
| Severe | Hospitalization for intensive monitoring and management is recommended. Intravenous benzodiazepines such as lorazepam or diazepam may be required to control symptoms. |
| Complications | Monitor individuals during and after withdrawal for complications such as seizures, delirium tremens, and Wernicke’s encephalopathy. Individuals who have experienced severe alcohol withdrawal may require ongoing monitoring and support to prevent relapse and manage the long-term effects of alcohol misuse. |
Note that the severity of alcohol withdrawal symptoms can vary widely between individuals, and the management approach should be tailored to the individual’s needs and circumstances. The guidelines also recommend close monitoring and ongoing support to prevent relapse and manage the long-term effects of alcohol misuse.
Overall, the assessment and management of alcohol misuse in the UK are guided by a comprehensive and multidisciplinary approach that takes into account the individual needs and circumstances of each patient.
References:
- National Institute for Health and Care Excellence. (2018). Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. Retrieved from https://www.nice.org.uk/guidance/cg115
- National Institute for Health and Care Excellence. (2010). Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. Retrieved from https://www.nice.org.uk/guidance/cg115/chapter/1-Guidance#managing-alcohol-withdrawal.