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UK clinical guidelines for alcohol treatment: glossary

Published 16 October 2023

This was published under the 2022 to 2024 Sunak Conservative government

A

Abstinence

Completely avoiding drinking alcohol.

Acute alcohol withdrawal (or acute alcohol withdrawal syndrome)

The physical and psychological symptoms that people who are alcohol dependent can experience when they suddenly stop drinking or reduce the amount of alcohol they drink. In acute alcohol withdrawal, symptoms can be severe and can include severe complications (see annex 2 for a description of common withdrawal symptoms and severe complications).

Alcohol care teams (ACTs)

Teams of clinicians with alcohol specialist expertise, based in acute general hospitals. They provide specialist support, predominantly to alcohol-dependent inpatients admitted for any condition, whose alcohol use may be putting their health at risk.

Alcohol dependence

These guidelines use the definition of alcohol dependence from the International Classification of Diseases 11th Revision (ICD-11) which is as follows:

Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol, which is manifested by impaired ability to control use, increasing priority given to use over other activities and persistence of use despite harm or negative consequences. These experiences are often accompanied by a subjective sensation of urge or craving to use alcohol. Physiological features of dependence may also be present, including tolerance to the effects of alcohol, withdrawal symptoms following cessation or reduction in use of alcohol, or repeated use of alcohol or pharmacologically similar substances to prevent or alleviate withdrawal symptoms. The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 3 months.

You can find a more detailed definition of alcohol dependence in ICD-11.

An alcohol use disorder identification test (AUDIT) score of 20 and over indicates a person may possibly be alcohol dependent, but a clinical assessment is necessary to diagnose alcohol dependence.

Alcohol harm (or alcohol-related harm)

Alcohol harm is the physical health, mental health or social harm caused either entirely or partly by alcohol. This harm can be experienced by a person drinking and also experienced by their partners, families or the wider community.

Alcohol use disorder

Alcohol use disorder (AUD) in this guideline is used in its broadest sense to include any alcohol use that results in significant health risk or harms. So, AUD includes:

• hazardous drinking (or increasing risk drinking) (see definition of hazardous drinking below)
• harmful drinking (or high risk drinking) (see definition of harmful drinking below)
• alcohol dependence (see definition of alcohol dependence above)

B

Binge drinking

A heavy drinking episode in which someone drinks a lot of alcohol in a short period of time, increasing their risk of harm on that occasion.

Brief intervention

Alcohol brief intervention is a general term used to describe a short, structured intervention that supports hazardous or harmful drinkers to reduce their consumption towards lower risk levels.

You can find more information on brief interventions in chapter 3.

C

Care plan

See definition of ‘treatment and recovery plan’ in this glossary.

Carer’s assessment

Anyone who is an unpaid carer for a family member or friend has the right to have their own needs assessed by their local authority social care services (or a service the local authority commissions). This assessment is for the carer and is separate from the needs of the person they care for. The local authority uses the assessment to decide what services they can offer. The right to an assessment is underpinned by legislation and statutory guidance (see annex 1 for more information).

Child in need

Statutory guidance Working together to safeguard children 2018 defines a child in need as follows:

A child in need is defined under the Children Act 1989 as a child who is unlikely to achieve or maintain a reasonable level of health or development, or whose health and development is likely to be significantly or further impaired, without the provision of services; or a child who is disabled. Children in need may be assessed under section 17 of the Children Act 1989 by a social worker.

Child protection

Statutory guidance Working together to safeguard children 2018 defines child protection as follows:

Part of safeguarding and promoting welfare. This refers to the activity that is undertaken to protect specific children who are suffering, or are likely to suffer, significant harm.

See definition of significant harm in this glossary. Also, see definition of safeguarding (children).

Common mental health conditions

Common mental health conditions include depression, and anxiety disorders such as:

• generalised anxiety disorder
• panic disorder
• obsessive-compulsive disorder
• social anxiety disorder
• phobias
• post-traumatic stress disorder

Complex needs

In this guideline complex needs refer to needs that significantly affect people’s functioning. They may be caused or made worse by alcohol use or may be independent of it. Complex needs can include but are not limited to:

• mental health conditions
• physical health conditions
• drug use conditions
• conditions affecting cognitive functioning, including alcohol related brain damage
• criminal justice issues
• homelessness
• domestic abuse

When are person has several of these needs, this is often referred to as ‘multiple and complex needs’, ‘multiple disadvantage’ or ‘severe and multiple disadvantage’.

Controlled drinking

See the definition of moderate drinking in this glossary.

Co-occurring conditions

Co-occurring conditions is when a person has more than one condition or illness at the same time. In these guidelines, this usually means mental or physical health conditions and an alcohol use disorder. Co-occurring conditions are also sometimes referred to as co-morbidities.

You can find more information on co-occurring conditions and an alcohol use disorder in:

• chapter 18 on people with co-occurring mental health conditions
• chapter 19 on people with co-occurring physical health conditions

Cultural competence

In this guideline, cultural competence means the ability of organisations and individual practitioners to effectively deliver services that meet the social, faith, cultural, and linguistic needs of people from diverse communities. See section 2.3.2 for a more detailed description of cultural competence.

D

Domestic abuse

See definition of domestic abuse in section 22.2.1.

E

Extended brief interventions

Extended brief interventions go beyond simpler brief intervention approaches by including or expanding on motivational enhancement or interviewing techniques. They can be delivered in one session or over several sessions.

Extended brief interventions can be used where people have not responded to simpler brief interventions, and in settings where practitioners are adequately skilled to deliver them.

F

Formulation

Formulation is a framework for understanding information gathered in an assessment and helping the person to make sense of their situation. The formulation helps the practitioner and the person to understand:

• how the person’s alcohol problem began and developed
• the factors that maintain the person’s alcohol problem
• potential resources to address the person’s alcohol problem

Formulation is the basis for agreeing a personalised treatment and recovery plan.

FRAMES

FRAMES is an acronym that identifies common components of a brief intervention. These are:

• feedback (on the person’s level of risk of alcohol use disorder)
• responsibility (change is the person’s responsibility)
• advice (identifying reasons for change, ideally using open questions)
• menu (identifying options and strategies for change, ideally using open questions)
• empathy (non-judgemental and understanding)
• self-efficacy (helping the person to be optimistic about their capacity to change)

H

Harmful drinking (also called high risk drinking)

Harmful drinking is a pattern of alcohol use that has harmed the physical or mental health of the person who is drinking or of others.

You can read a more detailed definition of harmful drinking in ICD-11.

Drinking levels and AUDIT scores are used to indicate harmful drinking.

Drinking level: above 35 units a week for women and above 50 units a week for men.

AUDIT score: 16 to 19 (see section 3.3.2 for guidance on using AUDIT).

Harm reduction

A harm reduction approach or philosophy frames the aim of alcohol treatment as reducing harms associated with a person’s alcohol use. Harm reduction can be understood as a continuum, with small changes at one end of the continuum and complete abstinence at the other. See chapter 8 for guidance on harm reduction.

Hazardous drinking (also called increasing risk drinking)

A pattern of alcohol use that increases the risk of harm to the physical or mental health of the person drinking or to others. Hazardous drinking has not yet reached the level of having caused harm.

You can find a more detailed definition of hazardous drinking in ICD-11.

Drinking levels and AUDIT scores are used to indicate hazardous drinking.

Drinking level: 14 to 35 units a week for women and 14 to 50 units a week for men

AUDIT score: 8 to 15 (see section 3.3.2 for guidance on using AUDIT).

I

Identification (screening)

Identification is using validated tools (such as AUDIT) to identify people who may have an alcohol use disorder. Staff can carry out identification in health, social care and community services to identify people who are not seeking alcohol treatment but may have an alcohol use disorder. Identification can also be used in alcohol treatment services as part of an initial assessment.

Identification is sometimes called screening. In this guideline, the term screening does not refer to the national screening programmes such as those recommended by the UK National Screening Committee.

Independent living

Independent living (sometimes called ‘supported living’) includes schemes that allow people with support needs to live in their own home or in alternative housing in their local community. Care and support are provided to help the person to live as independently as possible.

In-reach

In-reach are services provided within a partner service by practitioners with a specialism, often on a regular weekly basis. For example, alcohol treatment services can provide in-reach to local health, social care or community services. This can help make alcohol treatment more accessible and improve referral pathways. Local partner services can also provide in-reach for their services within alcohol treatment services.

Intoxication (alcohol intoxication)

Alcohol intoxication is a clinically significant short-term condition that develops during or shortly after a person drinks alcohol. Intoxication is characterised by disturbances that are caused by the known pharmacological effects of alcohol, including in:

• consciousness
• cognition
• perception
• affect (expression of emotional state)
• behaviour
• co-ordination

The intensity of these effects is closely related to the amount of alcohol the person drinks. ICD-11 distinguishes between mild, moderate, and severe intoxication. Alcohol intoxication can increase the risk of suicidal ideation or behaviour.

There is a more detailed definition of alcohol intoxication in ICD-11.

K

Keyworker

In alcohol treatment services, a keyworker is the staff member allocated to co-ordinate care and to provide structured support to help the person through their treatment and initial recovery (see the definition of structured support in this glossary). An important part of their role is to build and maintain a therapeutic relationship with the person.

L

Lived experience recovery organisations

Lived experience recovery organisations (LEROs) are autonomous projects or organisations led by people with lived experience of alcohol or drug problems and recovery. LEROs can form an important part of a recovery-oriented system of care (see definition of ‘recovery-oriented system of care’ in this glossary).

There is a more detailed description of LEROs in section 6.3.1.

M

Medically assisted (alcohol) withdrawal

Medically assisted withdrawal (often called detoxification or detox) is a treatment to help a person who is dependent on alcohol to stop drinking safely. It involves medication and clinical management to reduce withdrawal symptoms and to prevent severe complications such as seizures, delirium tremens and Wernicke-Korsakoff syndrome.

Moderate drinking (also called controlled drinking)

In this guideline, moderate drinking means drinking within the chief medical officers’ (CMOs’) low risk drinking guidelines.

For adults who drink regularly or frequently (most weeks), the CMOs’ guideline says that to keep health risks from alcohol to a low level it is safest not to drink more than 14 units a week on a regular basis.

It also recommends that if a person regularly drinks as much as 14 units per week, it is best to spread their drinking evenly over 3 or more days.

Multi-agency team

A multi-agency team is a group of professionals from different agencies (or services) who work together as a team to share information, co-ordinate care and deliver interventions. Multi-agency teams often work with people who have multiple needs.

Multidisciplinary team

A multidisciplinary team involves a number of professionals with clear individual responsibilities to help deliver and co-ordinate care of the person in treatment. Members of a multidisciplinary team can be staff of one organisation, or they can come from several different organisations (see definition of multi-agency team above).

Multiple and complex needs

Multiple and complex needs is used to refer to people experiencing a series of simultaneous complex needs (see definition of complex needs in this glossary).

These multiple and complex needs are issues that have a profound effect on a person’s wellbeing and ability to function. The term is often used interchangeably with ‘multiple disadvantage’ or ‘severe and multiple disadvantage’ (see below).

Multiple disadvantage

See the definition of severe and multiple disadvantage in this glossary.

N

Neurodiversity

Neurodiversity describes variations in the way people’s brains work, and the ways they think, learn and behave. It describes variations as differences, rather than deficits. The word neurodiversity refers to the diversity of all people, but it is often used in the context of autism spectrum disorder, as well as other neurological or developmental conditions such as attention deficit hyperactivity disorder, or dyslexia.

P

Psychoeducation

A psychoeducational approach involves the practitioner providing information and psychosocial support to the person so they can better understand and make changes in their alcohol use and associated problems.

R

Recovery

Recovery is a process of building up positive benefits that can help the person to sustain abstinence (or moderate drinking where appropriate) and to develop broader wellbeing and a life that is meaningful to them. Recovery may involve changes in behaviour, lifestyle and identity. It may also involve developing internal and external resources to support these changes.

Recovery capital

Recovery capital is the range of life resources that can help a person to recover, such as:

• housing
• education
• employment
• social networks
• health and wellbeing

Recovery-oriented system of care

A wide range of services and organisations can contribute to a person’s treatment and recovery journey at different stages.

Structured alcohol treatment services and recovery support services are organised into a framework that incorporates the whole health and social care system and peer-based organisations. When these services and organisations work together in an integrated way, they can be considered to be part of a recovery-oriented system of care. The best system contains contributions from experts by training and from experts by experience.

Relapse

In this guideline, relapse is when a person who has been maintaining a goal of abstinence or moderate drinking returns to a pattern of problematic drinking. Relapse is sometimes distinguished from lapse, where lapse is an occasion or short episode when a person does not maintain their drinking goal, after which they return to a pattern of abstinence or moderate drinking.

Relapse prevention

Relapse prevention is psychosocial or pharmacological interventions, used to help a person maintain their drinking goals and reduce their risk of returning to a pattern of problematic alcohol use.

Psychosocial relapse prevention approaches include specific strategies to help a person recognise and manage potential triggers for problematic drinking and to learn from any relapses. They also include interventions to support broader coping skills and interventions to support recovery.

S

Safeguarding (adults)

Care and support statutory guidance (updated 2023) defines adult safeguarding as follows:

Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action.

Safeguarding (children)

Statutory guidance Working together to safeguard children 2018 defines child safeguarding as follows:

“Safeguarding and promoting the welfare of children is defined… as:

• protecting children from maltreatment
• preventing impairment of children’s mental and physical health or development
• ensuring that children are growing up in circumstances consistent with the provision of safe and effective care
• taking action to enable all children to have the best outcomes”

Severe and multiple disadvantage

The term severe and multiple disadvantage, or sometimes just multiple disadvantage, refers to adults experiencing 2 or more of:

• homelessness
• alcohol and drug problems
• criminal justice issues

They are also likely to be affected by issues such as mental health conditions, poverty and domestic abuse.

Severe mental health condition

In this guideline, severe mental health conditions include:

• schizophrenia, schizotypal and delusional disorders
• bipolar affective disorder
• severe depressive episodes with or without psychotic episodes

Significant harm

NSPCC child protection definitions describe significant harm as follows:

““Harm” is the “ill treatment or the impairment of the health or development of the child” (Section 31, Children Act 1989; Article 2, Children (Northern Ireland) Order 1995; Scottish Government, 2021).

“Seeing or hearing the ill-treatment of another person is also a form of harm (Section 120, Adoption and Children Act 2002; Section 28, Family Homes and Domestic Violence (Northern Ireland) Order 1998; Scottish Government, 2021).

“Harm can be determined “significant” by “comparing a child’s health and development with what might be reasonably expected of a similar child”.

“Although there is no absolute criteria for determining whether or not harm is “significant”, local authorities such as social services, police, education and health agencies work with family members to assess the child, and a decision is made based on their professional judgement using the gathered evidence. For more information, see:

• Section 31 of the Children Act 1989 (England and Wales)
• Article 2 of the Children (Northern Ireland) Order 1995
• the National guidance for child protection in Scotland (Scottish Government, 2021)”.

Structured support

Structured support is the use of specific psychosocial interventions that are common in evidence-based psychological treatments for alcohol and drug use. In alcohol treatment services, the keyworker is usually responsible for offering structured support. There is a detailed description of structured support in section 5.5.

T

Tolerance

Tolerance is the need to drink more alcohol to get the same desired effect, and it develops in people who drink heavily and regularly. The effect of blood alcohol concentration on a person will decrease as tolerance develops. Tolerance decreases after a period of abstinence or reduced drinking.

Treatment and recovery plan (or care plan)

A treatment and recovery plan (or care plan) is a plan that is agreed between the assessor or allocated keyworker and the person in treatment. It is a record that specifies the person’s treatment and recovery goals, and interventions and actions to meet those goals.

The keyworker, supported by the multidisciplinary team, should regularly review the treatment and recovery plan with the person. They should adjust the plan at any time if it’s clear that the plan is not helping the person to meet their goals.

You can find more detailed information about treatment and recovery planning in chapter 4.

U

Unit of alcohol

The National Institute for Health and Care Excellence public health guideline Alcohol-use disorders: prevention (PH24) describes units of alcohol as follows:

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

There is a link to a unit calculator in section 8.13.

V

Vulnerable adult

In these guidelines, the term vulnerable adult broadly means an adult with care and support needs.

Care and support statutory guidance (updated 2023) says that a vulnerable adult may also be in need of safeguarding if the adult:

• has needs for care and support (whether or not the local authority is meeting any of those needs)
• is experiencing, or at risk of, abuse or neglect
• as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect

W

Withdrawal

The physical and psychological symptoms that people who are alcohol dependent can experience when they stop drinking or reduce the amount of alcohol they drink.

Symptoms can vary in severity and how long they last. They are generally more severe in people who are severely dependent but there is wide variation among individuals. People experiencing acute withdrawal can experience serious complications. There is a list of common withdrawal symptoms and serious withdrawal complications in annex 2.