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Alcohol - problem drinking - Management
Basis for recommendation
These recommendations are in line with those made by the National Treatment Agency for Substance Misuse [Raistrick et al, 2006] and the Scottish Intercollegiate Guidelines Network (SIGN) [Raistrick et al, 2006], and are largely based on expert and consensus opinion. Drinking targets are beyond the scope of current guidelines from the National Institute for Health and Clinical Excellence (NICE) concerning alcohol misuse [NICE, 2010a; NICE, 2010c]. However, this issue will be addressed in the forthcoming NICE clinical guideline Alcohol-use disorders: diagnosis and clinical management of harmful drinking and alcohol dependence, due to be published in January 2011 [NICE, 2010e].
- Treatment goals (whether to aim for lifelong abstinence or responsible drinking at non-harmful levels) are contentious, but increasingly in the UK drinking in moderation is seen as an acceptable target for most hazardous and many harmful drinkers:
- The target selected is essentially a clinical choice and depends on the individual's characteristics and wishes.
- A persons acceptance of the goal is an important indicator of how likely it is to be achieved.
- Many hazardous and harmful drinkers are likely to be deterred by the prospect of lifelong abstinence, and this may put them off seeking help in the first place.
- The decision to aim for abstinence or drinking in moderation should be negotiated with the person, with defined drinking targets where appropriate (usually in line with national recommendations; see Safer drinking limits). The most suitable course of action will depend on individual circumstances [SIGN, 2003; Raistrick et al, 2006].
- Moderation is a reasonable goal for most hazardous drinkers. However, if drinking is heavy, a period of abstinence may be advisable before attempting moderation.
- People who have physical or mental conditions that would be worsened by continued alcohol use (for example liver damage or severe depression) should aim for abstinence. Abstinence may also be necessary if the person is using particular medication that interacts with alcohol, or if they are pregnant or are planning a pregnancy.
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