Quality standard

Quality statement 5: Interventions to prevent relapse after unplanned withdrawal from alcohol in hospital

Quality statement 5: Interventions to prevent relapse after unplanned withdrawal from alcohol in hospital

Quality statement

Adults with moderate or severe alcohol dependence are offered psychological and, if appropriate, pharmacological interventions to prevent relapse following a successful unplanned withdrawal in hospital. [2011, updated 2023]

Rationale

After a successful unplanned withdrawal from alcohol while in hospital, adults with moderate or severe alcohol dependence can benefit from a range of psychological and pharmacological interventions to help prevent relapse. Decisions about which interventions to use are made with the person, according to their needs and preferences and in line with their care plan.

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.

It is not the intention that services should achieve a score of 100% for process measure b, because not everyone will need a pharmacological intervention.

Process

a) Proportion of adults with moderate or severe alcohol dependence offered psychological interventions to prevent relapse following a successful unplanned withdrawal in hospital.

Numerator – the number in the denominator who are offered psychological interventions to prevent relapse.

Denominator – the number of adults with moderate or severe alcohol dependence who have had a successful unplanned withdrawal in hospital.

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. The Office for Health Improvement and Disparities annual substance misuse statistics reports for adults have data on adults accessing services for alcohol treatment only who receive a psychosocial intervention.

b) Proportion of adults with moderate or severe alcohol dependence offered pharmacological interventions to prevent relapse following a successful unplanned withdrawal in hospital.

Numerator – the number in the denominator who are offered pharmacological interventions to prevent relapse.

Denominator – the number of adults with moderate or severe alcohol dependence who have had a successful unplanned withdrawal in hospital.

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. The NHS Digital statistics on alcohol include data on prescription items for the treatment of alcohol dependence, prescribed in primary care and dispensed in the community, including acamprosate and disulfiram.

Outcome

Rates of relapse following unplanned withdrawal from alcohol dependence in hospital.

Data source: No routinely collected national data for this measure has been identified. 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.

What the quality statement means for different audiences

Service providers (such as primary care services, secondary care services, forensic mental health services, and community-based specialist alcohol services) ensure that systems are in place to provide psychological and, if appropriate, pharmacological interventions, aimed at preventing relapse, for adults with moderate or severe alcohol dependence who have completed an unplanned withdrawal from alcohol in hospital.

Health and social care practitioners (such as doctors, nurses and specialist alcohol service staff) offer psychological and, if appropriate, pharmacological interventions based on the needs and care plans of adults with moderate or severe alcohol dependence who have completed an unplanned withdrawal from alcohol in hospital. They offer psychological interventions as soon as appropriate after discharge and include pharmacological interventions in discharge plans. Where appropriate and with consent, they encourage families and carers to be involved in the treatment and care of the person receiving it.

Commissioners ensure that they commission services in which psychological and, if appropriate, pharmacological interventions aimed at preventing relapse are provided for adults with moderate or severe alcohol dependence that have completed an unplanned withdrawal from alcohol in hospital.

Adults with moderate or severe alcohol dependence who have completed an unplanned withdrawal from alcohol in hospital are given psychological therapy and sometimes medicines to help prevent them drinking again after they have stopped. They decide with their healthcare professional which treatments will work best for them and have these detailed in their care plan. When it is appropriate and they consent, their families and carers are encouraged to be involved in their treatment.

Definitions of terms used in this quality statement

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. [NICE's guideline on alcohol-use disorders: diagnosis and management of physical complications, terms used in this guideline]

Psychological interventions

Therapies focused specifically on alcohol misuse and given after successful withdrawal, ideally within 2 weeks, for people with moderate or severe alcohol dependence including:

  • cognitive behavioural therapies usually consisting of one 60‑minute session per week for 12 weeks

  • behavioural therapies usually consisting of one 60‑minute session per week for 12 weeks

  • behavioural couples therapy to service users who have a regular partner and whose partner is willing to participate in treatment usually consisting of one 60‑minute session per week for 12 weeks

  • social network and environment-based therapies usually consisting of eight 50‑minute sessions over 12 weeks.

[NICE's guideline on alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence, recommendations 1.3.3.1, 1.3.3.2, 1.3.3.4 to 1.3.3.7, and 1.3.6.1 to 1.3.6.3]

Pharmacological interventions

Medication prescribed after a successful withdrawal and included in discharge plans for people with moderate or severe alcohol dependence after a comprehensive medical assessment that considers any contraindications or cautions, and discussion with the person. Medicines may include:

  • acamprosate

  • oral naltrexone

  • disulfiram.

[NICE's guideline on alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence, recommendations 1.3.6.1 to 1.3.6.4]

Equality and diversity considerations

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

When offering interventions people should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with health and social care services. Information 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.

Additional support to access interventions, such as transport and access to technology, may be needed due to people's circumstances, such as people experiencing homelessness.