Clinical Review

Diagnosis and management of alcohol use disorders

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39483.457708.80 (Published 28 February 2008) Cite this as: BMJ 2008;336:496
  1. Andrew J R Parker, specialist registrar1,
  2. E Jane Marshall, consultant psychiatrist and senior lecturer2,
  3. David M Ball, honorary consultant psychiatrist and senior lecturer3
  1. 1South London and Maudsley NHS Trust, Maudsley Hospital, London SE5 8AZ
  2. 2Kings College London, Institute of Psychiatry, Addiction Research Unit, London SE5 8AF
  3. 3Kings College London, Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London SE5 8AF
  1. Correspondence to: A J R Parker andrew.parker{at}iop.kcl.ac.uk
  • Accepted 26 January 2008

Alcohol use disorders account for 4% of the global burden of disease and cause 1.8 million deaths (3.2% of total) each year.1 The overall economic cost to society is huge—around £20bn (€26.7bn; $39bn) each year in the United Kingdom—mostly as a result of lost productivity and alcohol related crime.2 Healthcare professionals have a vital role to play in implementing secondary prevention, and in identifying those who need specialist treatment. Well validated screening tools have recently become available, and the effectiveness of early brief interventions and more intensive treatments, together with the cost effectiveness of intensive treatments provide a strong impetus for improving the identification and management of disorders of alcohol misuse.3

Summary points

  • Alcohol use disorders account for 4% of the global burden of disease

  • Most alcohol use disorders go undetected in primary care

  • The fast alcohol screening test (FAST) is the best screening tool in busy settings

  • Brief interventions are effective for hazardous and harmful drinking

  • Specialist interventions are effective in people with alcohol dependence

  • Most people with alcohol dependence can undergo medically assisted withdrawal safely at home, after risk assessment

Methods

We used the term “alcohol” to search the online electronic databases of the World Health Organization (WHO), the Cochrane Library, the National Treatment Agency for Substance Misuse, the National Institute for Health and Clinical Excellence (NICE), and the UK Department of Health for suitable evidence based material and policy documents.

How are alcohol use disorders defined?

Box 1 lists the categories of alcohol use disorders used by WHO and in an important UK review of treatment for alcohol problems.3 The pattern of drinking and the total weekly consumption of alcohol are important determinants of alcohol related harm, so “binge drinkers” are included in the categories of hazardous drinking and harmful drinking.

Box 1 Classification of alcohol use disorders

Hazardous drinking

A level or pattern of alcohol consumption that will probably eventually …

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