Guideline 74: The management of harmful drinking and alcohol dependence in primary care

The management of harmful drinking and alcohol dependence in primary care
Annex 8

The NHS Quality Improvement Scotland recommendations on the prevention of relapse in alcohol dependence ¹¹⁵

Psychosocial interventions

Behavioural Self Control Training (BSCT), Motivational Enhancement Therapy (MET), Marital/Family Therapy and Coping/Social Skills Training are clinically and cost effective psychosocial interventions and are recommended treatment options for the prevention of relapse in alcohol dependence.
Brief Interventions are not recommended, as trials in alcohol dependent people have failed to show any benefit. However, this guideline recommends Brief Interventions for hazardous drinkers (a less severely affected group than those who are considered to be alcohol dependent).
Other psychosocial interventions are not recommended as their clinical effectiveness is unproven.

Pharmacological interventions

Acamprosate and supervised oral disulfiram are treatment options recommended as adjuncts to psychosocial interventions. Naltrexone does not have a Marketing Authorisation for the treatment of alcohol dependence in the UK and is not recommended for routine use in NHSScotland.

Delivery of services

Alcohol services should aim to reduce the delay between detoxification and interventions for the prevention of relapse. This would be facilitated by joint working between specialist mental health services, primary care, social work addiction services and non-statutory agencies, as recommended by the Joint Futures Group.
Acamprosate or supervised oral disulfiram should usually be initiated by a specialist service. The specialist service will: ensure that the patient meets the criteria for suitability; ensure the assessment of the motivation and ability of the patient to use the medication correctly; monitor efficacy; and ensure that adjunctive psychosocial treatment is organised. Usage should be in accordance with the Summary of Product Characteristics and reviewed regularly during the first 12 weeks after initiation of treatment, at which stage transfer of prescribing to the general practitioner may be appropriate, even though specialist care may continue (shared care).
Introduction to AA and non-statutory agencies such as local Councils on Alcohol (Alcohol Focus Scotland) should be part of the overall strategy of specialist NHS services for the prevention of relapse. As with other psychosocial treatments, attendance is most likely to be beneficial if it is an informed voluntary decision.
People who are alcohol dependent should be informed about treatment choices. Their needs, preferences and social circumstances should be considered. As a result, the choice of interventions should be a shared decision between the health professional and the patient.
NHS specialist services should contact people who drop out of treatment programmes and offer them another appointment.

Communication with patients

Health professionals should provide patient information, including leaflets, which should be used to support discussion between health professionals and patients about the most appropriate treatment option.
Written information about the range of available services should be readily accessible to people with alcohol problems, their families, carers and to health professionals, especially GPs. Alternative formats such as cartoons or audiovisual material should be used to support discussions with people who have low reading skills or poor concentration. Alcohol Action Teams could coordinate information requirements.
A regularly updated comprehensive directory of alcohol services and accommodation should be developed for the benefit of NHSScotland staff, patients and their families, friends and carers.