Quality standard

Quality statement 1: Use of validated alcohol questionnaires

Quality statement 1: Use of validated alcohol questionnaires

Quality statement

Adults who are being asked about their alcohol use have a validated alcohol questionnaire completed to identify any need for a brief intervention or referral to specialist alcohol services. [new 2023]

Rationale

Using an appropriate validated alcohol questionnaire when asking adults about their alcohol use will identify if they should receive a suitable brief intervention (structured brief advice or extended brief intervention) or referral to specialist alcohol services, according to their needs and their identified level of risk.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Adults who are asked about their alcohol use who have a validated alcohol questionnaire completed.

Numerator – the number in the denominator who have a validated alcohol questionnaire completed.

Denominator – adults who are asked about their alcohol use.

Data source: Data can be collected from information recorded locally by health and social care practitioners and provider organisations, for example from patient and service user records including new patient registrations, hospital admissions and records from other services such as criminal justice services. Records should use existing coding to identify if the person was asked about their alcohol use and if a validated alcohol questionnaire was completed.

Outcome

a) Rates of brief intervention for alcohol use in adults asked about their alcohol use.

Data source: Data can be collected from information recorded locally by health and social care professionals and provider organisations, for example from patient and service user records.

b) Rates of referral to specialist alcohol services in adults asked about their alcohol use.

Data source: The Office for Health Improvement and Disparities annual substance misuse statistics reports for adults include data on the number of adults referred to and starting substance misuse treatment for alcohol only.

What the quality statement means for different audiences

Service providers (such as primary care services, secondary care services, social care services, criminal justice services, and community and voluntary services) ensure that systems are in place for the use of validated alcohol questionnaires when asking adults about their alcohol use. They ensure that staff are trained to use validated alcohol questionnaires used within the service. They ensure that there are a range of questionnaires available that are appropriate to the setting, including abbreviated versions for when time is limited.

Health and social care practitioners (such as doctors, nurses, social workers, staff working in the criminal justice system, and community and voluntary sector workers) use a validated alcohol questionnaire, appropriate to the setting, when asking adults about their alcohol use. They use the questionnaire to decide if the person is at risk of harm and if a brief intervention (and if so, what kind) or referral to specialist alcohol services is needed. They explain the score from the validated alcohol questionnaire and what it means to the person.

Commissioners ensure that they commission services in which validated alcohol questionnaires are used when asking adults about their alcohol use to make decisions about offering brief interventions or referral to specialist alcohol services.

Adults who are being asked about their alcohol use complete an appropriate validated questionnaire about their alcohol use. This may be completed by a member of staff, or by themselves if they are able. It is used to check if they are at risk because of their alcohol use and decide if they need any advice and support, or a referral, according to their needs. The score from the completed questionnaire and what it means should be explained by a member of staff.

Source guidance

Alcohol-use disorders: prevention. NICE guideline PH24 (2010), recommendations 7 and 9

Definitions of terms used in this quality statement

Brief intervention

This includes structured brief advice and extended brief interventions.

Structured brief advice comprises a 5‑minute to 15‑minute session of structured advice aimed at helping someone reduce their alcohol consumption or to stop drinking alcohol. It is offered immediately or by appointment as soon as possible. The advice should use a recognised, evidence-based resource based on FRAMES principles (feedback, responsibility, advice, menu, empathy and self-efficacy) and should cover:

  • the potential harm caused by the person's level of drinking and reasons for changing their behaviour, including the health and wellbeing benefits

  • the barriers to change

  • practical strategies to help reduce alcohol consumption (to address the 'menu' component of FRAMES)

  • identification of goals.

Extended brief intervention is for someone who is reluctant to accept a referral. It is aimed at motivating them to reduce their alcohol consumption to low risk levels and reduce risk-taking behaviour as a result of drinking alcohol, or to consider stopping drinking alcohol. The intervention should explore with the person why they behave the way they do and identify positive reasons for making change, taking the form of 20 to 30 minutes of motivational interviewing or motivational enhancement therapy. [NICE's guideline on alcohol-use disorders: prevention, recommendations 9 to 12]

Validated alcohol questionnaire

For example:

  • Alcohol-use disorders identification test (AUDIT) or

  • when time is limited, an abbreviated version such as:

    • AUDIT for consumption (AUDIT-C)

    • AUDIT for primary care (AUDIT-PC)

    • Single alcohol screening questionnaire (SASQ)

    • Fast alcohol screening test (FAST)

    • Paddington Alcohol Test (PAT).

Questionnaires used should be appropriate to the setting. For instance, in an emergency department FAST or PAT would be most appropriate. [Adapted from NICE's guideline on alcohol-use disorders: prevention, recommendation 9]

Equality and diversity considerations

The presence of stigma in healthcare settings towards people with an alcohol-use disorder in general should be considered when asking about alcohol use, as well as the effect of cultural factors on openly discussing alcohol use for people from some faith groups.

People should be provided with a validated alcohol questionnaire that they can easily read, understand and complete themselves, or with support. The validated alcohol questionnaire should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. People should have access to an interpreter, or advocate in accordance with NICE's guideline on advocacy services for adults with health and social care needs, if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.

Professional judgement should be used as to whether to adjust thresholds for brief intervention and referral when screening due to factors that may make some people more vulnerable to alcohol than others, including:

  • sex

  • people who are, or are planning to become, pregnant

  • younger people

  • people aged 65 and over

  • people from some minority ethnic family backgrounds that are less able to metabolise alcohol.