Assessment and management of alcohol dependence and withdrawal in the acute hospital: concise guidance

Abstract

Alcohol dependence is common among patients attending acute hospitals. It can be the major reason for attendance or a significant cofactor. Assessment of these patients in the acute setting can be challenging owing to the multidisciplinary approach required. Doctors in acute hospitals are often inexperienced in managing dependence, a mental health problem. They might focus on the physical harms or the withdrawal, a consequence of the dependence. For this reason, assessment of dependence and prevention and management of acute alcohol withdrawal are often suboptimal. There is little existing guidance on how to manage this patient population, especially in non-specialist settings. With recently published National Institute for Health and Clinical Excellence (NICE) guidance on the management of dependence and withdrawal, now is the perfect time to produce concise guidelines in the hope that a more succinct suite of guidance can reach a larger audience.

Fig. 1.

The Alcohol Use Disorders Identification Test (AUDIT) questionnaire. Scoring the questionnaire: scores for each question range from 0 to 4, with the first response for each question (eg never) scoring 0, the second (eg less than monthly) scoring 1, the third (eg monthly) scoring 2, the fourth (eg weekly) scoring 3, and the last response (eg daily or almost daily) scoring 4. For questions 9 and 10, which only have three responses, the scoring is 0, 2 and 4. A score of 8 to 15 is associated with harmful or hazardous drinking. A score of 16 to 19 is harmful, mild or moderate dependence; ≥20 is severe dependence. Copyright World Health Organisation 2001.

Fig. 2.

Severity of Alcohol Dependence Questionnaire (SADQ-C). Scoring the questionnaire: a score of 15 or less indicates mild dependence; a score of 16–30 indicates moderate dependence; and a score of 31 or more indicates severe dependence.

Fig. 3.

Clinical Institute Withdrawal Assessment of Alcohol Scale, revised (CIWA-Ar). Scoring ranges from 0 to 9 for minimal absent withdrawal; 10 to 19 for mild/moderate withdrawal; and ≤20 severe withdrawal.