Interventions for harmful, hazardous drinkers & mild alcohol dependence

interventions for harmful, hazardous drinkers & mild alcohol dependence

For persons identified as harmful, hazardous drinkers & mild alcohol dependence via screening offer a session of structured brief advice on alcohol.

• it is recommended as a first step for adults (aged 18 and over) who have been identified as drinking at hazardous or harmful levels
• can be carried out by non-alcohol specialists
• a structured episode of brief advice will take 5-15 minutes
• recognised, evidence-based resource that is based on FRAMES principals (feedback, responsibility, advice, menu, empathy, self-efficacy) should be used
• a structured advice tool can be found on http://www.alcohollearningcentre.org.uk/alcoholeLearning/learning/IBA/Module4_v2/pdf/structured_advice_tool.pdf

If structured brief advice does not lead to a reduction in harmful, hazardous & mild alcohol dependence (or if an individual wishes further input) then an extended brief intervention, has been recommended

• a structured leaflet on extended brief intervention can be found on http://www.alcohollearningcentre.org.uk/alcoholeLearning/learning/IBA/Module5_v2/extended_intervention_worksheet.pdf
• there is limited evidence on the effectiveness of brief interventions for young people under the age of 16, with some data suggesting there could be adverse outcomes.
  • the use of extended brief interventions is recommended for people aged 16-17
  • however, it is not clear from current evidence if this type of brief intervention can be adapted for younger people (1,2)

Other psychological therapies which can be offered to harmful or mildly dependent drinkers include:

• cognitive behavioural therapies - focused on alcohol-related problems should usually consist of one 60-minute session per week for 12 weeks
• behavioural therapies - focused on alcohol-related problems should usually consist of one 60-minute session per week for 12 weeks
• social network and environment-based therapies - focused on alcohol-related problems should usually consist of eight 50-minute sessions over 12 weeks.
• behavioural couples therapy - should be focused on alcohol-related problems and their impact on relationships. It should aim for abstinence, or a level of drinking predetermined and agreed by the therapist and the service user to be reasonable and safe. It should usually consist of one 60-minute session per week for 12 weeks.

Patients who do not responded to psychological interventions alone, or specifically request a pharmacological intervention, consider offering acamprosate or oral naltrexone in combination with an individual psychological intervention (such as cognitive behavioural therapies, behavioural therapies or social network and environment-based therapies) or behavioural couples therapy (3).

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
• have failed to benefit from structured brief advice and an extended brief intervention 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).

Note:

• professional judgment is needed to decide on any additional support that should be offered to vulnerable groups who are identified as being hazardous or harmful drinkers. This includes:
  • women (in particular those who are, or are thinking of becoming, pregnant)
  • younger people
  • people aged 65 and over
  • people from some black and minority ethnic groups (1)

Reference:

• (1) National Institute for Health and Clinical Excellence (NICE) 2010. Alcohol-use disorders: preventing harmful drinking
• (2) Day E, Copello A, Hull M. Assessment and management of alcohol use disorders. BMJ. 2015;350:h715
• (3) National Institute for Health and Clinical Excellence (NICE) 2011. Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence