Alcohol Use Disorders

Abstract

This guideline is one of three pieces of NICE guidance addressing alcohol-use disorders. The present guideline addresses the management of alcohol dependence and harmful alcohol use in people 10 years and older including: assessment, pharmacological interventions, psychological and psychosocial interventions, and settings of assisted withdrawal and rehabilitation. The two other NICE guidelines address: 1) The prevention of alcohol-use disorders in people 10 years and older, which is public health guidance on the price of alcohol, advertising and availability of alcohol, how best to detect alcohol misuse both in and outside primary care and brief interventions to manage alcohol misuse in these settings (NICE, 2010a), and 2) The assessment and clinical management in people 10 years and older of acute alcohol withdrawal, including delirium tremens, liver damage, acute and chronic pancreatitis and the management of Wernicke's encephalopathy (NICE, 2010b). This guideline will sometimes use the term alcohol misuse, which will encompass both people with alcohol dependence and harmful alcohol use. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, lay member, service user and carer representatives, and guideline methodologists, after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for people who misuse alcohol while also emphasising the importance of the experience of care for them and their carers. Although the evidence base is expanding, there are also a number of gaps in the literature. The guideline makes a number of research recommendations specifically to address gaps in the evidence base. In the meantime, it is hoped that the guideline will assist clinicians, people who misuse alcohol and their carers by identifying the merits of particular treatment approaches where the evidence from research and clinical experience exists. National guideline 1.1.1What are clinical practice guidelines? Clinical practice guidelines are 'systematically developed statements that assist clinicians and patients in making decisions about appropriate treatment for specific conditions' (Mann, 1996). They are derived from the best available research evidence, using predetermined and systematic methods to identify and evaluate the evidence relating to the specific condition in question. Where evidence is lacking, the guidelines incorporate statements and recommendations based upon the consensus statements developed by the Guideline Development Group (GDG). Clinical guidelines are intended to improve the process and outcomes of healthcare in a number of different ways. They can: