Alcohol

Recommended Guidelines

Guidance by the Chief Medical Officer (CMO) from January 2016 indicates that adults should not drink more than 14 units of alcohol a week on a regular basis and that those drinking as much as this should spread the drinking out evenly over at least three days as well as having alcohol-free days.[1]

Evidence-based population-level interventions

NICE states that 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.[2] NICE have published recommendations for policy and practice that should be considered to tackle alcohol-related harm. These include considering price, availability and marketing in policy. In practice recommendations link to licensing, resources for screening, supporting children and young people, screening and brief intervention with young people, brief advice for adults and referrals.[5]

Screening tools

NICE recommends that NHS professionals include alcohol screening as an integral part of their practice. Other non-NHS professionals such as social services and higher education teams should also screen for alcohol misuse where possible.

Screening should use a validated alcohol questionnaire, AUDIT, or an abbreviated version of it e.g., AUDIT-C. This screening tool guides professionals as to whether the individual should be offered a brief intervention or whether they need onward referral for specialist treatment.[5]

Identification and Brief Advice (IBA)

Identification and Brief Advice (IBA) aims to facilitate behaviour change for those drinking above the CMO guidelines of 14 units per week. IBA has been proven to be an effective method of supporting people to drink less and is supported by a large body of evidence, including the PHE Evidence Review and a Cochrane Collaboration review.[3] 

Identification would be done via screening with the AUDIT tool and the brief intervention would typically give feedback on the individual’s alcohol use; give advice about how to cut down their drinking and change their drinking behaviour; and help to develop a personal plan to reduce their drinking.[3]

An extended brief intervention is required for adults who have not responded to brief structured advice. Sessions typically last 20 to 30 minutes and involve motivational interviewing or enhancement therapy to help the individual to reduce their drinking or consider abstinence. These individuals should be followed-up for further sessions or onward referral to a specialist alcohol treatment service.[4]

Interventions for harmful drinking or alcohol dependence

Referral to specialist treatment should be considered for those with alcohol dependence or those with harmful drinking patterns who have failed to benefit from extended brief intervention but would like to receive further help.30 Specialist treatment should involve offering the individual a psychological intervention, such as cognitive behavioural therapy (CBT) or behavioural couples therapy if a regular partner is willing to participate. Some individuals, particularly those with more severe dependence may benefit from this in combination with a pharmacological intervention. Prior to these interventions, some individuals may also require assisted withdrawal which should usually be offered via a community-based programme.[5]

Alcohol Misuse in Children and Young People

Children and young people aged 10 to 17 years who have alcohol misuse may need to be referred to a specialist child and adolescent mental health service (CAMHS) for a comprehensive assessment of their needs. Inpatient care should be offered to those who need assisted withdrawal with the goal of treatment being complete abstinence and individual cognitive behavioural therapy or family therapy can help to achieve this.[5]

Parents with Alcohol and Drug Problems

Governmental guidance from 2021 outlines the key issues for families affected by parental drug or alcohol misuse. It reports that therapeutic services for children and families are essential and that a ‘whole family’ approach will often be required. The guidance highlights some key requirements to help support families affected by substance misuse including:

• Senior leadership to help develop a whole-system response.
• Confident frontline staff to identify and refer affected parents and children to support services.
• Clear pathways between systems to identify affected families and ensure they receive prompt support.[6] 

[1] GOV.UK. Alcohol consumption: advice on low-risk drinking. 25th August 2016. Available from: https://www.gov.uk/government/publications/alcohol-consumption-advice-on-low-risk-drinking

[2] National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. Available from: https://www.nice.org.uk/guidance/ph24/chapter/Recommendations

[3] Kaner E et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews. 2018; 2: 1465-1858. doi: https://doi.org/10.1002/14651858.CD004148.pub4

[4] National Institute for Health and Care Excellence (NICE). Guideline – Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence. [CG115]. 23rd February 2011. Available from:  https://www.nice.org.uk/guidance/cg115/chapter/Recommendations

[5] National Institute for Health and Care Excellence (NICE). Guideline – Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence. [CG115]. 23rd February 2011. Available from:  https://www.nice.org.uk/guidance/cg115/chapter/Recommendations

[6] Public Health England. Parents with alcohol and drug problems: adult treatment and children and family services. 10th May 2021. Available from: https://www.gov.uk/government/publications/parents-with-alcohol-and-drug-problems-support-resources/parents-with-alcohol-and-drug-problems-guidance-for-adult-treatment-and-children-and-family-services