Alcohol is a preventable leading cause of liver disease and over 200 other acute or chronic medical conditions. In the UK, 25% of the population drinks at an increasing risk level (ie, 15–34 units per week for women and 15–49 units per week for men) and 10% at a higher risk level (≥35 units per week for women and ≥50 units per week for men). The UK has observed a 400% rise in mortality due to liver disease in the last three decades; it is now the third most common cause of premature death. In 2020, the UK recorded 8974 deaths from an alcohol-specific cause, an 18·6% increase compared with 2019. The 2020 death rate due to wholly alcohol-attributable conditions reached 14·0 deaths per 100 000, the highest since 2001. In the same year, Dame Carol Black's independent review of drugs, treatment, and recovery, emphasised the need for an increased focus on prevention. Alcohol-related disorders are among the most common reasons for admission to hospital; in 2019–20, 5·7% of all hospital admissions in England were alcohol related. The estimated cost to the UK National Health Service (NHS) to treat alcohol-related problems is over £3·5 billion annually, with an estimated overall cost to society of £21 billion per year.

The misuse of substances is often maintained by both physical and psychological factors. Opioid-substitution medications manage physical aspects of addiction; however, difficulties with emotional regulation and avoidance perpetuate continued substance misuse. In the UK, individuals who misuse substances are often excluded from mental health services, meaning these underlying difficulties are not addressed. Acceptance and Commitment Therapy (ACT) seeks to reduce emotional avoidance. A hermeneutic single-case efficacy design was used to evaluate the effects of ACT within drugs and alcohol service. Quantitative and qualitative data was critically analysed to understand factors involved in identified changes. Analysis recognised the client progressed towards two of three of their goals, related to motivation and anxiety. Their psychological flexibility also increased. ACT processes played a key role in this; however, the therapeutic relationship and psychopharmacological factors were also noted. Study limitations and clinical and research implications are discussed.

Objectives/Aims To pilot an ARBI diagnostic service within a community substance misuse team (delivered in partnership with the NHS by a 3rd sector organisation). Background Alcohol-related brain injury (ARBI) is an umbrella term encompassing alcohol-related cognitive impairment, alcohol-related ‘dementias’, Wernicke’s encephalopathy and Korsakoff’s syndrome. It is the result of prolonged and harmful alcohol misuse, developing through direct neuronal damage from alcohol as well as chronic deficient states of vitamin B1 (thiamine). Anecdotally, it is felt that those affected by ARBI can struggle to access the necessary expertise for diagnosis and ongoing management. Methods A widespread stakeholder engagement process led to the development of a standard operating procedure for the pilot service, utilising a process mapping technique. The service received referrals between September 2018 and January 2019. During this time, assessments were carried out in line with the standard operating procedure by the authors. Referrers were also asked to complete a questionnaire for their views on the service. Results Referrals were received from several sources within the host third sector organisation. Heterogeneity was seen in presentations and diagnoses made were not limited to ARBI. Referrers spoke highly of the service and how it had positively benefitted their patients going forwards, providing clarity around diagnoses and thus being able to access appropriate support going forwards. There was a clear need demonstrated for such a service. Conclusions Anecdotally patients with ARBI are viewed as a marginalised group who struggle to access the necessary expertise for diagnosis and ongoing management. This service pilot was successful in filling that gap. Work is ongoing through discussions with local NHS healthcare system partners, including acute trusts, commissioners, mental health, the 3rd sector and Social Care, to devise a more sustainable pathway based upon this pilot service. At present, this is taking the form of an acute hospital ‘in-reach’ pathway to be trialled in an acute trust. This will provide the basis of a business case for a pathway across the STP footprint.

The present paper discusses some of the difficulties in working with people with an intellectual disability and an alcohol problem, and draws on the sparse literature about alcohol problems in people with intellectual disability. Four individuals drawn from the current clinical case loads of medical practitioners in UK community intellectual disability services are described. Some suggestions for staff training, patient education and health promotion, and therapeutic approaches are made.

This paper questions the assumption that personality disorder and dangerousness are causally linked, and suggests that insofar as a relationship between them exists, it is mediated by early-onset alcohol abuse. The latter, by impairing the function of prefrontal cortex during adolescence, a critical period of its development, putatively leads to deficits in goal-directed behaviour and emotional self-regulation that place the individual at high risk of becoming chronically antisocial in adulthood. Evidence is adduced in support of the hypothesis from the literature on: (i) the comorbidity of personality disorder and alcohol abuse; (ii) frontal lobe deficits in psychopaths; and (iii) life-course persistent offenders. Some testable predictions from the hypothesis are presented, together with its implications; most importantly, that measures to prevent serious antisocial behaviour in adulthood should target at-risk individuals prior to their commencing heavy drinking during adolescence.

In 2004, HM Prison Service launched an alcohol strategy that promotes treatment of alcohol-related problems in imprisoned offenders. In commissioning services for prisoners, the needs of any prison population must first be established. The purpose of this study was to establish the need for an alcohol intervention in a local prison and to explore whether there might be a need to address alcohol-related violence, rather than simply looking at alcohol misuse. The research identified the extent of the need for alcohol interventions in a UK prison for men, concluding that in this sample those who had also committed violent index offences might require interventions that specifically target alcohol-related violence. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Alcohol misuse is a common reason for hospital admission. While there is considerable evidence from other areas that provision of specialised alcohol services can reduce alcohol intake, there is currently less evidence for medical departments in an acute hospital setting. Nottingham hospitals initiated such a service in 2002-3 based around two nurse specialists who provided input to inpatients with alcohol-related physical disease and provided links to community-based services for alcohol misuse. This service assessed 3,632 patients over five years and has seen a reduction in hospital admissions, violent incidents against staff and primary care attendances. It is believed that this model of care is an effective means of intervening in people with alcohol-related problems.

AIMS: A single case study of alcohol withdrawal through monitored alcohol consumption in a hostel resident.

The extent and severity of alcohol problems experienced by mentally disordered patients admitted to maximum security hospitals, whilst not included in the criteria for admission, is undoubtedly of relevance and importance in planning the treatment and future disposal of these patients. The study to be described attempts to address such concerns by means of applying an extensive assessment approach with a substantial patient population drawn from three of the four Secure Hospitals within the United Kingdom (n=211). Measures utilised included semi-structured interview, standardised questionnaires and clinical reports contained in case records. Detailed information is provided on weekly consumption levels, problems related to drinking, severity of dependence on alcohol, and use of alcohol at the time of offences. Results highlighted not only the high prevalence, but the extreme severity of alcohol difficulties evident amongst the patient sample, as well as substantial use of alcohol at the time of offences. Future papers will explore further the characteristics of patients with a history of problem drinking and the possible relationship between alcohol and offending. This study represents the first major, detailed and comprehensive assessment of alcohol problems in an extensive sample of secure hospital patients. The implications of these findings for the development of therapeutic services and the future disposal of these patients is emphasised.

This editorial briefs the alcohol problems in older adults. Notwithstanding barriers and challenges in this area, there are numerous current opportunities to improve the care of older adults with alcohol use disorders. First, there is a need for coherent public health messages and awareness campaigns giving clear guidance to older adults as well as professionals about safe levels of alcohol consumption in older adults and this should be backed up by evidence and research. Second, the benefit of reducing alcohol consumption in older adults needs to be stressed so that any message is motivational and encourages individuals to change. Guidance about daily consumption and harm associated with increased frequency of heavy drinking should be provided. There is a particularly obvious need for better detection tools for specific use in older adults to identify both early and late onset drinkers and identify harmful drinking in addition to alcohol dependence. No one screening tool is adequate on its own, nor is it an adequate substitute for taking good history. Health and social care professionals need to be aware that alcohol use disorders in older adults may present in different settings. There is a need for vigilance in considering the possibility of alcohol use disorders in older adults that they are in contact with. If older adults with alcohol use disorders are identified more frequently, there will be a need for better available treatments and services. (PsycINFO Database Record (c) 2016 APA, all rights reserved)