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These services should be properly resourced to support the stepped care approach recommended in 'Models of care for alcohol misusers' [ 4 ]. Commissioners should ensure at least 1 in 7 dependent drinkers can get treatment locally, in line with 'Signs for improvement' [ 5 ]. Commissioners should include formal evaluation within the commissioning framework so that alcohol interventions and treatment are routinely evaluated and followed up. The aim is to ensure adherence to evidence-based practice and to ensure interventions are cost effective.
Managers of NHS-commissioned services must ensure an appropriately trained nurse or medical consultant, with dedicated time, is available to provide strategic direction, governance structures and clinical supervision to alcohol specialist nurses and care givers. Managers of NHS-commissioned services must ensure community and voluntary sector providers have an appropriately trained professional who can provide strategic direction, governance structures and supervision to those providing screening and brief interventions.
Managers of NHS-commissioned services must ensure staff have enough time and resources to carry out screening and brief intervention work effectively. Staff should have access to recognised, evidence-based packs. These should include: a short guide on how to deliver a brief intervention, a validated screening questionnaire, a visual presentation to compare the person's drinking levels with the average , practical advice on how to reduce alcohol consumption, a self-help leaflet and possibly a poster for display in waiting rooms. Managers of NHS-commissioned services must ensure staff are trained to provide alcohol screening and structured brief advice.
If there is local demand, staff should also be trained to deliver extended brief interventions. Children and young people aged 10 to 15 years who are thought to be at risk from their use of alcohol. Any professional with a safeguarding responsibility for children and young people and who regularly comes into contact with this age group. Use professional judgement to routinely assess the ability of these children and young people to consent to alcohol-related interventions and treatment.
Some will require parental or carer involvement. Obtain a detailed history of their alcohol use for example, using the Common Assessment Framework as a guide. Include background factors such as family problems and instances of child abuse or under-achievement at school. Use professional judgement to decide on the appropriate course of action. In some cases, it may be sufficient to empathise and give an opinion about the significance of their drinking and other related issues that may arise. In other cases, more intensive counselling and support may be needed.
If there is a reason to believe that there is a significant risk of alcohol-related harm, consider referral to child and adolescent mental health services, social care or to young people's alcohol services for treatment, as appropriate and available. Ensure discussions are sensitive to the child or young person's age and their ability to understand what is involved, their emotional maturity, culture, faith and beliefs.
The discussions and tools used should also take into account their particular needs health and social and be appropriate to the setting. Health and social care, criminal justice and community and voluntary professionals in both NHS and non-NHS settings who regularly come into contact with this group.
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Complete a validated alcohol screening questionnaire with these young people. Alternatively, if they are judged to be competent enough, ask them to fill 1 in themselves. Screening tools should be appropriate to the setting. Focus on key groups that may be at an increased risk of alcohol-related harm. This includes those:. When broaching the subject of alcohol and screening, ensure discussions are sensitive to the young person's age and their ability to understand what is involved, their emotional maturity, culture, faith and beliefs.
The discussions should also take into account their particular needs health and social and be appropriate to the setting. Routinely assess the young person's ability to consent to alcohol-related interventions and treatment. If there is doubt, encourage them to consider involving their parents in any alcohol counselling they receive. Young people aged 16 and 17 years who have been identified via screening as drinking hazardously or harmfully. Health and social care, criminal justice and community and voluntary sector professionals in both NHS and non-NHS settings who regularly come into contact with this group.
Provide information on local specialist addiction services to those who do not respond well to discussion but who want further help. Refer them to these services if this is what they want. Referral must be made to services that deal with young people. Give those who are actively seeking treatment for an alcohol problem a physical and mental assessment and offer, or refer them for, appropriate treatment and care. Health and social care, criminal justice and community and voluntary sector professionals in both NHS and non-NHS settings who regularly come into contact with people who may be at risk of harm from the amount of alcohol they drink.
NHS professionals should routinely carry out alcohol screening as an integral part of practice. For instance, discussions should take place during new patient registrations, when screening for other conditions and when managing chronic disease or carrying out a medicine review. These discussions should also take place when promoting sexual health, when seeing someone for an antenatal appointment and when treating minor injuries. Where screening everyone is not feasible or practicable, NHS professionals should focus on groups that may be at an increased risk of harm from alcohol and those with an alcohol-related condition.
This includes people:. Non-NHS professionals should focus on groups that may be at an increased risk of harm from alcohol and people who have alcohol-related problems. For example, this could include those:. When broaching the subject of alcohol and screening, ensure the discussions are sensitive to people's culture and faith and tailored to their needs.
Complete a validated alcohol questionnaire with the adults being screened. Alternatively, if they are competent enough, ask them to fill 1 in themselves. Use AUDIT to decide whether to offer them a brief intervention and, if so, what type or whether to make a referral. Do not offer simple brief advice to anyone who may be dependent on alcohol. Instead, refer them for specialist treatment see recommendation If someone is reluctant to accept a referral, offer an extended brief intervention see recommendation If in doubt, consult relevant specialists.
Work on the basis that offering an intervention is less likely to cause harm than failing to act where there are concerns. Consult relevant specialists when it is not appropriate to use an English language-based screening questionnaire. For example, when dealing with people whose first language is not English or who have a learning disability.
Treatment of young people with alcohol and other drug problems
Biochemical measures should not be used as a matter of routine to screen someone to see if they are drinking hazardously or harmfully. This includes measures of blood alcohol concentration [BAC]. Biochemical measures may be used to assess the severity and progress of an established alcohol-related problem, or as part of a hospital assessment including assessments carried out in emergency departments.
Adults who have been identified via screening as drinking a hazardous or harmful amount of alcohol and who are attending NHS or NHS-commissioned services or services offered by other public institutions. Offer a session of structured brief advice on alcohol.
If this cannot be offered immediately, offer an appointment as soon as possible thereafter. Use a recognised, evidence-based resource that is based on FRAMES principles feedback, responsibility, advice, menu, empathy, self-efficacy. It should take 5—15 minutes and should:.
Where there is an ongoing relationship with the patient or client, routinely monitor their progress in reducing their alcohol consumption to a low-risk level. Where required, offer an additional session of structured brief advice or, if there has been no response, offer an extended brief intervention. Adults who have not responded to brief structured advice on alcohol and require an extended brief intervention or would benefit from an extended brief intervention for other reasons. NHS and other professionals in the public, private, community and voluntary sector who are in contact with adults and have received training in extended brief intervention techniques.
Offer an extended brief intervention to help people address their alcohol use. This could take the form of motivational interviewing or motivational-enhancement therapy. Sessions should last from 20 to 30 minutes. They should aim to help people to reduce the amount they drink to low risk levels, reduce risk-taking behaviour as a result of drinking alcohol or to consider abstinence. Follow up and assess people who have received an extended brief intervention. Where necessary, offer up to 4 additional sessions or referral to a specialist alcohol treatment service see recommendation Those aged 16 years and over who attend NHS or other public services and may be alcohol-dependent.
For those under 16 see recommendation 6. NHS and other professionals in the public, private, community and voluntary sector who have contact with anyone aged 16 and over. Consider making a referral for specialist treatment if 1 or more of the following has occurred. The next steps in the national alcohol strategy. London: Department of Health. London: The Stationery Office. Geneva: World Health Organization. Guidance Tools and resources Evidence History Overview.
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Next 1 Recommendations Population versus individual approach Policy and practice Recommendations for policy Recommendations for practice. Population versus individual approach A combination of interventions are needed to reduce alcohol-related harm — to the benefit of society as a whole. They can help: those who are not in regular contact with the relevant services those who have been specifically advised to reduce their alcohol intake, by creating an environment that supports lower-risk drinking.
Policy and practice This guidance makes the case that alcohol-related harm is a major public health problem. Recommendations for policy Who should take action? Recommendation 1: price Making alcohol less affordable is the most effective way of reducing alcohol-related harm. What action could be taken? Regularly review alcohol duties to make sure alcohol does not become more affordable over time.
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