BMJ  2008;336:496-501 (1 March), doi:10.1136/bmj.39483.457708.80

Clinical Review

Diagnosis and management of alcohol use disorders

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

The first 150 words of the full text of this article appear below.

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 . . . [Full text of this article]

Methods

How are alcohol use disorders defined?

Box 1 Classification of alcohol use disorders
Hazardous drinking
Harmful drinking
Dependent drinking

How common are alcohol use disorders?

How are alcohol use disorders identified and diagnosed?

Box 2 Improving identification of alcohol use disorders
Tips
Suggested questions⁸
What screening tools are helpful?

What should further assessment entail?

How are alcohol use disorders managed?

Box 3 Managing withdrawal in the community
What are brief interventions?
Box 4 Brief advice and extended brief interventions
Brief advice: few minutes only
Extended brief intervention (20-30 minutes; follow-up optional)
The FRAMES acronym is useful for both forms of advice¹⁴
How is medically assisted withdrawal managed?
Box 5 Medical management of assisted withdrawal
Mild dependence
Moderate dependence
Wernicke’s encephalopathy
Box 6 Preventing and treating Wernicke’s encephalopathy^{19 20 21}
Community setting
Inpatient setting
Prophylactic treatment
Therapeutic treatment of suspected Wernicke’s encephalopathy
What psychosocial interventions are effective?
What is the role of mutual self help groups?
What is the role of drugs to prevent relapse?
Additional educational resources
Resources for healthcare professionals
Resources for patients

What is the long term outcome of alcohol use disorders?

Ongoing research

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