Diagnosis and management of alcohol use disorders

doi:10.1136/bmj.39483.457708.80

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

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

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.