Diagnosis and management of alcohol use disorders

doi:10.1136/bmj.39483.457708.80

BMJ 2008;336:496-501 (1 March), doi:10.1136/bmj.39483.457708.80

Clinical Review

Diagnosis and management of alcohol use disorders

Andrew J R Parker, specialist registrar¹, E Jane Marshall, consultant psychiatrist and senior lecturer², David M Ball, honorary consultant psychiatrist and senior lecturer³

¹ South London and Maudsley NHS Trust, Maudsley Hospital, London SE5 8AZ, ² Kings College London, Institute of Psychiatry, Addiction Research Unit, London SE5 8AF, ³ Kings College London, Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London SE5 8AF

Correspondence to: A J R Parker andrew.parker@iop.kcl.ac.uk

The first 150 words of the full text of this article appear below.

Alcohol use disorders account for 4% of the global burden ofdisease and cause 1.8 million deaths (3.2% of total) each year.¹The overall economic cost to society is huge—around £20bn( ${euro}$ 26.7bn; $39bn) each year in the United Kingdom—mostlyas a result of lost productivity and alcohol related crime.²Healthcare professionals have a vital role to play in implementingsecondary prevention, and in identifying those who need specialisttreatment. Well validated screening tools have recently becomeavailable, and the effectiveness of early brief interventionsand more intensive treatments, together with the cost effectivenessof intensive treatments provide a strong impetus for improvingthe identification and management of disorders of alcohol misuse.³

Alcohol use disorders account for 4% of theglobal burden of disease

Most alcohol use disorders go undetectedin primary care

The fast alcohol screening test (FAST) is thebest screening tool in busy settings

Brief interventions are. . . [Full text of this article]

Brief advice:few minutes only
Extendedbrief intervention (20-30 minutes; follow-up optional)
TheFRAMES acronym is useful for both forms of advice¹⁴
Mild dependence
Moderate dependence
Community setting
Inpatient setting
Prophylactictreatment
Therapeutic treatment of suspected Wernicke’s encephalopathy
Resources for healthcare professionals
Resources for patients

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