NICE public health guidance
Issued: June 2010
PH24

Alcohol-use disorders: preventing harmful drinking

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This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/ph24

8 Glossary

Alcohol dependence

A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use. Someone who is alcohol-dependent may persist in drinking, despite harmful consequences. They will also give alcohol a higher priority than other activities and obligations. For further information, please refer to: 'Diagnostic and statistical manual of mental disorders' (DSM-IV) (American Psychiatric Association 2000) and 'International statistical classification of diseases and related health problems – 10th revision' (ICD-10) (World Health Organization 2007).

Alcohol-related harm

Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as 'alcohol-specific'. If it is only partly caused by alcohol it is described as 'alcohol-attributable'.

Alcohol-use disorders

Alcohol-use disorders cover a wide range of mental health problems as recognised within the international disease classification systems (ICD-10, DSM-IV). These include hazardous and harmful drinking and alcohol dependence. See 'Harmful' and 'Hazardous' drinking and 'Alcohol dependence'.

Alcohol-use disorders identification test (AUDIT)

AUDIT is an alcohol screening test designed to see if people are drinking harmful or hazardous amounts of alcohol. It can also be used to identify people who warrant further diagnostic tests for alcohol dependence.

Brief intervention

This can comprise either a short session of structured brief advice or a longer, more motivationally-based session (that is, an extended brief intervention – see also below). Both aim to help someone reduce their alcohol consumption (sometimes even to abstain) and can be carried out by non-alcohol specialists.

Clinical management of people with alcohol-related disorders

Any pharmacological or psychosocial intervention carried out by a clinician to manage the clinical problems caused by alcohol or any related medical or psychiatric complications. For example, support to help with withdrawal, managing liver damage and treating conditions such as Wernicke's encephalopathy.

Commissioning

Primary care trusts (PCTs) and drug and alcohol action teams (DAATs) may commission alcohol support services from a range of 'providers'. This includes GPs, hospitals, mental health trusts and voluntary and private organisations.

Dependence

See Alcohol dependence.

Extended brief intervention

This is motivationally-based and can take the form of motivational-enhancement therapy or motivational interviewing. The aim is to motivate people to change their behaviour by exploring with them why they behave the way they do and identifying positive reasons for making change. In this guidance, all motivationally-based interventions are referred to as 'extended brief interventions'.

FRAMES

FRAMES is an acronym summarising the components of a brief intervention. Feedback (on the client's risk of having alcohol problems), responsibility (change is the client's responsibility), advice (provision of clear advice when requested), menu (what are the options for change?), empathy (an approach that is warm, reflective and understanding) and self-efficacy (optimism about the behaviour change).

Harmful drinking

A pattern of alcohol consumption that is causing mental or physical damage.

Hazardous drinking

A pattern of alcohol consumption that increases someone's risk of harm. Some would limit this definition to the physical or mental health consequences (as in harmful use). Others would include the social consequences. The term is currently used by WHO to describe this pattern of alcohol consumption. It is not a diagnostic term.

Higher-risk drinking

Regularly consuming over 50 alcohol units per week (adult men) or over 35 units per week (adult women).

Increasing-risk drinking

Regularly consuming between 22 and 50 units per week (adult men) or between 15 and 35 units per week (adult women).

Looked after children

The term 'looked after' has a specific legal meaning. It refers to children and young people who are provided with accommodation on a voluntary basis for more than 24 hours. This compares with the term 'in care' which refers to those who are compulsorily removed from home and placed in care under a court order.

Lower-risk drinking

Regularly consuming 21 units per week or less (adult men) or 14 units per week or less (adult women). It is also known as 'sensible' or 'responsible' drinking.

Responsible authority

Responsible authorities have to be notified of all licence variations and new applications and can make representations regarding them. The Licensing Act 2003 lists responsible authorities. They include the police, environmental health and child protection services, fire and rescue and trading standards.

Saturated (in relation to licensed premises)

Describes a specific geographical area where there are already a lot of premises selling alcohol – and where the awarding of any new licences to sell alcohol may contribute to an increase in alcohol-related disorder.

Screening

For the purposes of this guidance, screening involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. The term is not used here to refer to national screening programmes such as those recommended by the UK National Screening Committee (UK NSC).

Structured brief advice

A brief intervention that takes only a few minutes to deliver.

Treatment

A programme designed to reduce alcohol consumption or any related problems. It could involve a combination of counselling and medicinal solutions.

UK government drinking guidelines

Guidelines set by the UK government on how much alcohol may be consumed without a serious impact on health. The guidelines recommend that men should not regularly drink more than 3–4 units of alcohol per day, and women should not regularly drink more than 2–3 units of alcohol per day. In terms of weekly limits, men are advised to drink no more than 21 units and women no more than 14 units per week. Anyone who has drunk heavily in one session is advised to go without alcohol for 48 hours, to give their liver and other body tissues time to recover. See 'Unit'.

Unit

In the UK, alcoholic drinks are measured in units. Each unit corresponds to approximately 8 g or 10 ml of ethanol. The same volume of similar types of alcohol (for example, 2 pints of lager) can comprise a different number of units depending on the drink's strength (that is, its percentage concentration of alcohol).