Assessment and management of alcohol use disorders (2015)

Alcohol can impact on both the incidence and the course of many health conditions, and nearly 6% of all global deaths in 2012 were estimated to be attributable to its consumption. A quarter of the UK adult population drinks alcohol in a way that is potentially or actually harmful to health. Between 2002 and 2012 in England the number of episodes where an alcohol related disease, injury, or condition was the primary reason for hospital admission or a secondary diagnosis doubled. Despite the large numbers of people drinking alcohol at higher risk levels, a relatively low number access treatment. Possible causes for this include missed opportunities to identify problems, limited access to specialist services, and underdeveloped care pathways. International studies have shown that more than 20% of patients presenting to primary care are higher risk or dependent drinkers, yet the problem of alcohol is inadequately addressed. This review focuses on practical aspects of the assessment and treatment of alcohol use disorders from the perspective of the non-specialist hospital doctor or general practitioner.
The bottom line:
- Alcohol use disorders exist across a spectrum, and public health measures to reduce the drinking of a whole population have considerable health benefits.
- All front line clinicians should be aware of the potential effects of alcohol consumption and be able to screen for alcohol use disorders using the alcohol use disorders questionnaire test.
- Brief interventions are quick and easy to deliver and have a potentially large impact on reducing hazardous and harmful drinking.
- Benzodiazepines are the drug of choice for medically assisted alcohol withdrawal.
- Relapse to drinking is common in the first year after stopping drinking, but psychological treatments, mutual aid groups, and relapse prevention drugs increase the likelihood of remaining abstinent.