Intended for healthcare professionals

Practice Guidelines

Diagnosis, assessment, and management of harmful drinking and alcohol dependence: summary of NICE guidance

BMJ 2011; 342 doi: (Published 23 February 2011) Cite this as: BMJ 2011;342:d700
  1. Stephen Pilling, director 12,
  2. Amina Yesufu-Udechuku, systematic reviewer2,
  3. Clare Taylor, editor3,
  4. Colin Drummond, professor of addiction psychiatry, honorary consultant addiction psychiatrist4
  5. on behalf of the Guideline Development Group
  1. 1Centre for Outcomes Research and Effectiveness, University College London, London WC1E 7HB, UK
  2. 2National Collaborating Centre for Mental Health, University College London
  3. 3National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London E1 8AA, UK
  4. 4National Addiction Centre, Institute of Psychiatry, King’s College London, and South London and Maudsley Foundation NHS Trust, London SE5 8AF
  1. Correspondence to: S Pilling s.pilling{at}

Alcohol dependence affects 4% of people aged between 16 and 65 years in England (6% of men and 2% of women),1 and over 26% of all adults (38% of men and 16% of women) consume alcohol in a way that is potentially or actually harmful to their health or wellbeing. Yet currently only 6% of people who are alcohol dependent receive treatment.1 Alcohol dependence is characterised by withdrawal, craving, impaired control, and tolerance of alcohol and is associated with a higher rate of mental and physical illness and a wide range of social problems. Harmful drinking is a pattern of alcohol consumption that can lead to psychological problems such as depression, accidents, injuries, and physical health problems such as pancreatitis. Alcohol misuse is also an increasing problem in children and young people, with over 24 000 treated in the NHS for alcohol related problems in 2008 and 2009.2 Hospital admissions related to alcohol consumption increased by 81% between 2003 and 2009.3 Harmful drinking and alcohol dependence therefore represent a considerable burden to individuals, their families, and wider society.

This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis, assessment, and management of harmful drinking and alcohol dependence.4


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Identification and initial assessment

  • Staff working in services provided and funded by the NHS should be competent to identify harmful drinking and alcohol dependence and to initially assess the need for an intervention; if they are not competent, they should refer people who …

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