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New NICE guidance on alcohol misuse

"Alcohol is the third leading cause of disease burden in developed countries".  This month the National Institute for Health and Clinical Excellence (NICE) published the first two parts of a three-part guidance on alcohol-related problems.  The first section is "Alcohol-use disorders: preventing the development of hazardous and harmful drinking" which covers public health guidance on the price, advertising and availability of alcohol, how best to detect alcohol misuse in and outside primary care, and brief interventions to manage it in these settings.  The second part is "Alcohol-use disorders: diagnosis and clinical management of alcohol-related physical complications" which covers acute alcohol withdrawal including delirium tremens, alcohol-related liver damage, alcohol-related pancreatitis and management of Wernicke's encephalopathy.  The third part is "Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence" covering identification, assessment, pharmacological and psychological/psychosocial interventions, and the prevention and management of neuropsychiatric complications.  For the good 20 page quick reference guide to the prevention section click here.

I've written a number of previous blog posts on alcohol.  See, for example, "The demon drink - social costs and social responsibilities" with its comment that "Alcohol causes major health problems - the Cabinet Office reported up to 150,000 hospital admissions and 15,000-22,000 deaths overall in 2003. Between 1991 and 2005, deaths directly attributed to alcohol almost doubled. More people are dying from alcohol related causes than from breast cancer, cervical cancer, and infection with methicillin resistant Staphylococcus aureus combined." Additionally "The turning point in a similar debate over tobacco control was the effect of passive smoking, yet damage to third parties from exposure to alcohol misuse is far greater. Drinking alcohol is a factor in more than half of violent crimes and a third of domestic violence. Between 780 000 and 1.3 million children are affected by their parents' use of alcohol - 30 to 60% of child protection cases and 23% of calls to the National Society for the Prevention of Cruelty to Children about child abuse or child neglect involved drunken adults. This seems justification enough for society to debate what reasonable and evidence based means could reduce the harm caused by alcohol."

See too "Alcohol: know your limits and increase the price" which points out "Although alcohol consumption has fallen in many European countries since 1970 it has increased by 40% in England ... The average adult in the UK consumes the equivalent of 120 bottles of wine a year.  Crime and antisocial behaviour associated with alcohol costs £7.3bn a year in emergency and criminal justice services. Costs to the NHS are estimated at £2.7bn a year.  Adopting his (the Chief Medical Officer) recommendation on alcohol pricing (a minimum price of 50 pence per unit) would result in 3,393 fewer deaths, 97,900 fewer hospital admissions, 45,800 fewer crimes, 296,900 fewer sick days, and a total benefit of over £1bn".  As the excellent self-help NHS website "Know your limits" points out "Most people who have health problems from drinking aren't alcoholics - they're just people who've regularly been drinking more than the NHS advises for some years".  The World Cancer Research Fund puts out an even tougher line stating "For cancer prevention, we recommend not to drink alcohol at all. But we recognise that modest amounts of alcohol may have a protective effect on heart disease. But the benefits of small amounts of alcohol only outweigh the risk in those particularly at risk of heart disease, such as men aged over 40 or postmenopausal women". 

With my work often involving helping people who are both stressed and also drink too much, I was very interested by last year's paper "Tests of causal links between alcohol abuse or dependence and major depression" which followed up over 1,000 people for up to 8 years and concluded "The findings suggest that the associations between AAD (alcohol abuse or dependence) and MD (major depression) were best explained by a causal model in which problems with alcohol led to increased risk of MD as opposed to a self-medication model in which MD led to increased risk of AAD".  For more on assessment of alcohol problems, information handouts, and advice on cutting down, see too the "Alcohol and food" page on the Good Knowledge section of this website.


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