Alcohol is the most widely used psychotropic drug in the industrialised world; it has been used for thousands of years as a social lubricant and anxiolytic. In the UK, it is estimated that 24% of adult men and 13% of adult women drink in a hazardous or harmful way³. Levels of hazardous and harmful drinking are lowest in the central and eastern regions of England (21–24% of men and 10–14% of women). They are highest in the north (26–28% of men, 16–18% of women)³. Hazardous and harmful drinking are commonly encountered amongst hospital attendees; 12% of emergency department attendances are directly related to alcohol⁴ whilst 20% of patients admitted to hospital for illnesses unrelated to alcohol are drinking at potentially hazardous levels⁵. Continued hazardous and harmful drinking can result in dependence and tolerance with the consequence that an abrupt reduction in intake might result in development of a withdrawal syndrome. In addition, persistent drinking at hazardous and harmful levels can also result in damage to almost every organ or system of the body. Alcohol-attributable conditions include liver damage, pancreatitis and the Wernicke’s encephalopathy. Key areas in the investigation and management of these conditions are covered in this guideline.

Many other and diverse conditions are associated with chronic alcohol misuse, which will not be covered in the guideline. There are examples listed in Table 1-1 below. As well as these physical problems there are the social consequences of harmful and hazardous drinking. These vary according to age group, but can be devastating. Antisocial behaiour and teenage pregnancy in the young, domestic violence and employment issues in the middle aged and social isolation in the elderly. Again, these are not covered in this particular guideline.

Table 1-1

Conditions associated with chronic alcohol misuse.

During the writing of the guideline, the GDG has given consideration to the management of patients according to their gender, age and ethnic origin. Where evidence is age-specific, this is reflected in the recommendations. Among ethnic groups there is variability in the dose and pattern of alcohol consumption ⁶ and possibly also in the susceptibility to develop alcohol-related cirrhosis⁷. This evidence may have an impact on the recommended sensible limits of alcohol consumption (see public health guideline) for specific ethnic groups. In general, however, regardless of susceptibility, the management of the alcohol use disorder is largely the same across ethnic groups. Where the evidence suggests otherwise, this has been reflected in the recommendation.