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The NHS must improve how it treats people with physical health problems caused by alcohol misuse, says the organisation responsible for setting the standards for good healthcare.

Around 1 in 4 men and women in the UK regularly drink above the recommended safe limits, which can cause them to suffer a variety of long term physical health problems such as liver disease, pancreatitis and Wernicke’s encephalopathy (a brain disorder caused by a lack of thiamine - vitamin B₁). Those who regularly drink excessive amounts of alcohol may also experience physical withdrawal symptoms (such as tremors, seizures and hallucinations) if they abruptly reduce their intake or suddenly quit - the consequences of which can be fatal.

Recognising that the NHS needs a standardised approach to treat the physical complications caused by excessive alcohol consumption, the National Institute for Health and Clinical Excellence (NICE) has published guidance today (2 June), which outlines which diagnostic tests and treatments healthcare professionals should use and when.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: “People who drink heavily over prolonged periods of time put themselves at risk of damaging almost every organ and nervous system in their bodies. There are over 800,000 people admitted to hospitals across England every year thanks to alcohol; it is a huge problem that the NHS has to deal with day-in, day-out.

“To help frontline healthcare staff ensure that they are delivering the highest possible quality of care to their patients, we have developed a guideline which outlines the procedures and tests that they should offer people with alcohol-related physical harm. This has been based on the research and clinical consensus on what is proven to work best. With around a quarter of adults regularly drinking in a hazardous or harmful way, it is essential that the NHS is fully prepared to deal with the consequences.”

Among the recommendations, NICE advises that:

• Heavy drinkers at risk of experiencing seizures and delirium tremens (e.g. profound confusion, hallucinations and severe nervous system over-activity) should be admitted into hospital immediately and assessed by an experienced healthcare professional for planned medically-assisted withdrawal. Treatment should be according to their symptoms and only administered by staff who are appropriately trained.
• All under 16s who are in acute alcohol withdrawal should be referred to hospital for physical and psychological assessment, in addition to medication.
• Healthcare professionals should continuously look out for Wernicke’s encephalopathy as the symptoms (including confusion, drowsiness and poor balance) can be overlooked, especially in patients who are still intoxicated. Those thought to be at risk should immediately be offered high doses of thiamine to prevent brain damage and death.
• People with advanced liver disease should be considered for an assessment for a liver transplant if their treatment has not been successful and if they have abstained from alcohol for at least three months.

Dr Stephen Stewart, Consultant Hepatologist and Guideline Developer said:

“Up until now, there hasn’t been a nationally-agreed approach for how the NHS should treat people with physical harm caused by heavy drinking. This has meant that access to the most effective treatments may have been dependent on where a person lives, or where they have been referred to. I hope that the NICE guideline leads to more accurate, timely and informed diagnoses of the physical health problems caused by excessive drinking, so that these vulnerable people can be given the most effective treatments available.

“Of particular importance is NICE’s recommendation that all patients with alcohol-related decompensated liver disease should be assessed for their suitability for a liver transplant if they have abstained from alcohol for at least three months and if best treatments have failed. Around 90% of people who receive a liver transplant do not go back to their former drinking habits, so it is important that all clinically suitable patients are given this opportunity for a second chance.”

Dr Lynn Owens, Nurse Consultant and Guideline Developer said:

“Traditionally, administering medication for acute alcohol withdrawal has been based on a ‘fixed-dosing’ schedule over a specific number of days. However, the evidence suggests that it is more effective for treatment to be based on the patient’s individual symptoms which can change as they go through withdrawal. As a result, there is an even greater need for specialist nurses to be skilled in the assessment and monitoring of this.

“The new NICE guideline addresses this concern by calling for all healthcare professionals that regularly come into contact with these patient groups to be appropriately trained. This will also help nurses to improve how they can identify patients that are at risk of developing Wernicke’s encephalopathy - a condition which can have devastating effects on the sufferer if it is left untreated.”

Press release: New guidance to help people with physical complications caused by alcohol misuse