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NICE recommends minimum price for alcohol to curb high risk drinking

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2927 (Published 02 June 2010) Cite this as: BMJ 2010;340:c2927
  1. Zosia Kmietowicz
  1. 1London

    The government should consider increasing the price of alcohol, making it more difficult to buy, and banning advertising if it wants to create a sensible drinking culture, the National Institute for Health and Clinical Excellence (NICE) has said.

    In its evidence based guidance on preventing harmful drinking, NICE recommends a minimum price per unit of alcohol, which, it says, should be regularly reviewed so that alcohol does not become more affordable over time. It also says limits should be put on how much alcohol people can import from abroad, the number of outlets selling alcohol in a given area, and the days and hours that alcohol can be purchased.

    Health professionals are also being asked to question routinely their teenage and adult patients about how much they drink to identify those who are drinking too much.

    Mike Kelly, director of pubic health at NICE said: “It is NICE’s job to improve the health of the population, and there is no doubt that if these measures are taken forward, they will significantly decrease alcohol consumption and thereby offset some of the serious social, economic, and physical health problems that arise as a consequence of drinking too much.”

    Around one in four adults in England are currently drinking dangerous amounts of alcohol that are causing, or have the potential to cause, physical and mental damage. Alcohol costs the NHS £2.7bn (€3.1bn; $3.9bn) a year and causes 17 million days of sick leave a year and half a million crimes. It was also responsible for nearly 15 000 deaths in 2005.

    Anne Ludbrook, guidance developer and a health economist said: “There is a strong body of evidence from around the world to show that making alcohol less affordable will reduce its consumption. This will in turn, improve the overall health of the population.”

    “NICE’s recommendation to introduce a minimum price per alcohol unit is a very targeted measure as it is most likely to affect heavy drinkers who typically purchase ‘cheaper’ alcohol products,” she added.

    In separate guidance NICE said that the NHS needed to improve its treatment of health problems caused by alcohol misuse.

    Among the recommendations, NICE advises that heavy drinkers at risk of seizures and delirium tremens should be admitted to hospital and assessed by an experienced healthcare professional for planned medically assisted withdrawal.

    Lynn Owens, a nurse consultant and guideline developer, said: “Traditionally, administering medication for acute alcohol withdrawal has been based on a ‘fixed dosing’ schedule over a specific number of days. However, the evidence suggests that it is more effective for treatment to be based on the patient’s individual symptoms which can change as they go through withdrawal.”

    The guideline says that young people under 16 who are in acute alcohol withdrawal should also be referred to hospital for physical and psychological assessment, in addition to medication.

    Healthcare professionals are advised to continuously look out for Wernicke’s encephalopathy among patients—“a condition which can have devastating effects on the sufferer if it is left untreated,” said Dr Owens, and the symptoms of which can be overlooked, especially in patients who are still intoxicated. Anyone thought to be at risk should immediately be offered high doses of thiamine to prevent brain damage and death, says the guideline.

    People with advanced liver disease should be considered for a liver transplant if their treatment has not been successful and if they have abstained from alcohol for at least three months.

    Stephen Stewart, consultant hepatologist and guideline developer, said,Around 90% of people who receive a liver transplant do not go back to their former drinking habits, so it is important that all clinically suitable patients are given this opportunity for a second chance.”

    Alcohol-use disorders: preventing the development of hazardous and harmful drinking, is at www.nice.org.uk/PH24, and Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications is at www.nice.org.uk/CG100.

    Notes

    Cite this as: BMJ 2010;340:c2927

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