The Department of Health recently revised the way in which it describes drinking behaviours; ‘hazardous drinkers’ are now described as being at increased risk and ‘harmful drinkers’ are now described as being at higher risk. Due to the extensive use of the terms hazardous and harmful drinking within the scientific literature, the World Health Organization International Classification of Diseases (10th revision), and many of the tools recommended in this guideline, the committee agreed that it would be helpful for methodological reasons and clarity within the clinical field to retain the terms hazardous and harmful drinking.
- Abstinence
Never drinking alcohol. People who do not drink alcohol can be described as ‘abstainers’, ‘total abstainers’ or ‘teetotallers’.
- Acute alcohol withdrawal
The physical symptoms someone can experience when they suddenly reduce the amount of alcohol they drink if they have previously been drinking excessively for prolonged periods of time.
- Alcohol
Ethanol (ethyl alcohol) is the main psychoactive ingredient in alcoholic drinks. By extension, the term ‘alcohol’ can be used interchangeably with ethanol, and to describe an alcoholic drink.
- Alcohol dependence (condition)
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. For further information, please refer to: ‘Diagnostic and statistical manual of mental disorders’ (DSM-IV) (American Psychiatric Association 2000) and ‘International statistical classification of diseases and related health problems – 10th revision’ (ICD-10) (World Health Organization 2007).
- Alcohol-use disorders
Alcohol-use disorders cover a wide range of mental health problems as recognised within the international disease classification systems (ICD-10, DSM-IV). These include hazardous and harmful drinking and alcohol dependence.
- Alcohol Use Disorders Identification Test (AUDIT)
AUDIT is an alcohol screening test designed to see if people are drinking harmful or hazardous amounts of alcohol. It can also be used to identify people who warrant further diagnostic tests for alcohol dependence (http://whqlibdoc.who.int/hq/2001/WHO_MSD_MSB_01.6a.pdf).
- Alcohol-related harm
Physical or mental harm caused either entirely or partly by alcohol. If it is entirely as a result of alcohol, it is known as ‘alcohol-specific’. If it is only partly caused by alcohol it is described as ‘alcohol-attributable’.
- ANCOVA
Analysis of covariance.
- Assisted withdrawal
See medically assisted withdrawal.
- Binge drinking
A heavy drinking session in which someone drinks at least twice the maximum recommended units of alcohol per day in one session.
- Blood alcohol concentration (BAC)
Blood alcohol concentration is the concentration of alcohol in the blood. In the UK, BAC is reported in milligrams of alcohol per 100 ml of blood (for example, 80 mg per 100 ml).
- CIWA-Ar
The Clinical Institute Withdrawal Assessment–Alcohol, revised (CIWA–Ar) scale is a validated 10-item assessment tool that can be used to quantify the severity of the alcohol withdrawal syndrome, and to monitor and medicate patients throughout withdrawal.
- CIWA-Ad
The CIWA-Ad is an 8-item version of the CIWA-Ar.
- Clinical management of people with alcohol-related problems
Any pharmacological or psychosocial intervention carried out by a clinician to manage the clinical problems caused by alcohol or any related medical or psychiatric complications. For example, support to help with withdrawal, managing liver damage and treating conditions such as Wernicke’s encephalopathy.
- Cochrane review
The Cochrane Library consists of a regularly updated collection of evidence-based medicine databases including the Cochrane Database of Systematic Reviews (reviews of randomised controlled trials prepared by the Cochrane Collaboration).
- Coeliac axis block
Pain relief by nerve block of the celiac plexus.
- Cohort study
A retrospective or prospective follow-up study. Groups of individuals to be followed up are defined on the basis of presence or absence of exposure to a suspected risk factor or intervention. A cohort study can be comparative, in which case two or more groups are selected on the basis of differences in their exposure to the agent of interest.
- Commissioning
Primary care trusts (PCTs) and drug and alcohol action teams (DAATs) may commission alcohol support services to meet patients’ needs from a range of ‘providers’. This includes GPs, hospitals, mental health trusts and voluntary and private organisations.
- Confidence interval (CI)
A range of values which contain the true value for the population with a stated ‘confidence’ (conventionally 95%). The interval is calculated from sample data, and generally straddles the sample estimate. The 95% confidence value means that if the study, and the method used to calculate the interval, is repeated many times, then 95% of the calculated intervals will actually contain the true value for the whole population.
- Cost-consequence analysis
A type of economic evaluation where, for each intervention, various health outcomes are reported in addition to cost, but there is no overall measure of health gain.
- Cost-effectiveness analysis
An economic study design in which consequences of different interventions are measured using a single outcome, usually in natural units (for example, life-years gained, deaths avoided, heart attacks avoided, cases detected). Alternative interventions are then compared in terms of cost per unit of effectiveness.
- Cost-utility analysis
A form of cost-effectiveness analysis in which the units of effectiveness are quality adjusted life-years (QALYs).
- Decompensated liver disease
Liver disease complicated by the development of jaundice, ascites, bruising or abnormal bleeding and/or hepatic encephalopathy.
- Dependence
See ‘Alcohol dependence’.
- Medically assisted alcohol withdrawal
Deliberate withdrawal from alcohol by a dependent drinker under the supervision of medical staff. Prescribed medication may be needed to relieve the symptoms. It can be carried out at home or in a hospital or other inpatient facility.
- Harmful drinking
A pattern of alcohol consumption that is causing mental or physical damage.
- Hazardous drinking
A pattern of alcohol consumption that increases someone’s risk of harm. Some would limit this definition to the physical or mental health consequences (as in harmful use). Others would include the social consequences. The term is currently used by the World Health Organization to describe this pattern of alcohol consumption. It is not a diagnostic term.
- Hepatology advice
Advice from a person trained in the management of liver conditions.
- Incremental cost
The mean cost per patient associated with an intervention minus the mean cost per patient associated with a compartor intervention.
- Incremental cost–effectiveness ratio (ICER)
The ratio of the difference in costs between two alternatives to the difference in effectiveness between the same two alternatives.
- Intoxication
A state of functional impairment caused by alcohol. For some people this can occur after drinking only a small amount.
- Malnourishment
Malnourishment is a state of nutrition in which a deficiency of energy, protein and/or other nutrients causes measurable adverse effects on tissue/body form, composition, function or clinical outcome.
- Meta-analysis
A statistical technique for combining (pooling) the results of a number of studies that address the same question and report on the same outcomes to produce a summary result.
- Methodological limitations
Features of the design or reporting of a clinical study which are known to be associated with risk of bias or lack of validity. Where a study is reported in this guideline as having significant methodological limitations, a recommendation has not been directly derived from it.
- Multivariate analysis
Analysis of more than one variable at a time. Takes into account the effects of all variables on the response of interest.
- Observational study
Retrospective or prospective study in which the investigator observes the natural course of events with or without control groups, for example cohort studies and case-control studies.
- Odds ratio
A measure of treatment effectiveness: the odds of an event happening in the intervention group, divided by the odds of it happening in the control group. The ‘odds’ is the ratio of non-events to events.
- p values
The probability that an observed difference could have occurred by chance. A p value of less than 0.05 is conventionally considered to be ‘statistically significant’.
- Quality-adjusted life-year (QALY)
A measure of health outcome which assigns to each period of time a weight, ranging from 0 to 1, corresponding to the health-related quality of life during that period, where a weight of 1 corresponds to optimal health, and a weight of 0 corresponds to a health state judged equivalent to death; these are then aggregated across time periods.
- Quality of life (QoL)
Refers to the level of comfort, enjoyment and ability to pursue daily activities.
- Randomised controlled trial (RCT)
A trial in which people are randomly assigned to two (or more) groups: one (the experimental group) receiving the treatment that is being tested, and the other (the comparison or control group) receiving an alternative treatment, a placebo (dummy treatment) or no treatment. The two groups are followed up to compare differences in outcomes to see how effective the experimental treatment was. Such trial designs help minimise experimental bias.
- Sensitivity analysis
A measure of the extent to which small changes in parameters and variables affect a result calculated from them. In this guideline, sensitivity analysis is used in health economic modelling.
- Splanchnicectomy
Surgical removal of the splanchnic nerves and celiac ganglion.
- Stakeholder
Any national organisation, including patient and carer groups, healthcare professionals and commercial companies with an interest in the guideline under development.
- Statistical significance
A result is deemed statistically significant if the probability of the result occurring by chance is less than 1 in 20 (p <0.05).
- Systematic review
Research that summarises the evidence on a clearly formulated question according to a pre-defined protocol using systematic and explicit methods to identify, select and appraise relevant studies, and to extract, collate and report their findings. It may or may not use statistical meta-analysis.
- Technology appraisal
Formal ascertainment and review of the evidence surrounding a health technology, restricted in the current document to appraisals undertaken by NICE.
- Treatment
A programme designed to reduce alcohol consumption or any related problems. It could involve a combination of counselling and medicinal solutions.
- UK drinking guidelines
Guidelines set by the UK government on how much alcohol may be consumed without a serious impact on health. The guidelines recommend that men should not regularly drink more than 3–4 units of alcohol per day, and women should not regularly drink more than 2–3 units of alcohol per day. In terms of weekly limits, men are advised to drink no more than 21 units and women no more than 14 units per week. Anyone who has drunk heavily in one session is advised to go without alcohol for 48 hours, to give their liver and other body tissues time to recover. See ‘Unit’.
- Unit
In the UK, alcoholic drinks are measured in units. Each unit corresponds to approximately 8 g or 10 ml of ethanol. The same volume of similar types of alcohol (for example, two pints of lager) can comprise a different number of units depending on the drink’s strength (that is, its percentage concentration of alcohol).
- Univariate
Analysis which separately explores each variable in a data set.
- Utility
A number between 0 and 1 that can be assigned to a particular state of health, assessing the holistic impact on quality of life and allowing states to be ranked in order of (average) patient preference.
- Withdrawal
Withdrawal from alcohol. Also see acute alcohol withdrawal and medically-assisted alcohol withdrawal.
