Authors' objectives:

The objectives of this health technology assessment were to answer the following questions:

1. Which treatment or combination of treatments (pharmacological and psychosocial) will yield the maximum maintenance of recovery amongst the population of those with alcohol dependence who have undergone detoxification?

2. What is the most effective and efficient approach to delivering the individual interventions (or combination of interventions) taking into account the different risk groups, locations, durations of treatment, etc?

Authors' recommendations: 1. The following treatments are recommended because they are clinically effective and cost-effective: Coping Skills; Behavioural Self Control Training; Motivational Interviewing; Marital/Family Therapy. Suitably trained and competent professionals should administer them using standardized protocols. 2. Other therapies are less effective and are not recommended. In particular, Brief Interventions are not effective for people with established alcohol dependence. The Classical Relapse Prevention model of treatment is also unproven. 3. Specialist services must make themselves aware of non-NHS agencies (such as Councils on Alcohol and Alcoholics Anonymous) operating in their area and co-ordinate their approach, making this information available to individuals within their care. Informing people about these agencies should be part of the overall relapse prevention strategy. 4. Disulfiram (given under supervision) and acamprosate are recommended as options for treatment in addition to talking therapies. Acamprosate is the most cost effective. As these medicines work differently and have different side effects the choice of treatment should be considered carefully on an individual patient basis. 5. Naltrexone is not recommended because it does not have Marketing Authorisation in the UK for this use and is not as cost effective as acamprosate. 6. Specialist unit protocols should be available for all treatment options to ensure standardised and consistent treatment. Clear patient information leaflets should be available for each intervention. 7. Patients value group and one-to-one therapies. Certain people - such as young people, the homeless and those with other mental health problems - have special service needs and providers should ensure services are responsive and accessible to all. 8. Collection of longer-term audit data, evaluating patient outcome and resource consequences of alcohol relapse, in various Scottish settings, is needed to refine further these recommendations. Additionally, better information on the number of people in Scotland who are alcohol dependent and who would benefit from such services, and the availability of resources to meet these demands, is needed.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.htbs.co.uk/publications/htareports.asp?did=422

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Scotland, United Kingdom

Organisation Name: Health Technology Board for Scotland

Contact Address: Delta House, 50 West Nile Street Glasgow G1 2NP Scotland United Kingdom Tel: +44 141 225 6988; Fax: +44 141 221 3262

Contact Name: shtg.hcis@nhs.net

Contact Email: shtg.hcis@nhs.net

Copyright: Health Technology Board for Scotland (HTBS) (merged into NHS Quality Improvement Scotland (NHS QIS))