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UK clinical guidelines for alcohol treatment: annexes

Published 16 October 2023

This was published under the 2022 to 2024 Sunak Conservative government

Annex 1: relevant legislation and guidance

Safeguarding children and adults

Overview

Across the 4 countries of the UK, the protection of children and adults at risk sits within different legislative and implementation frameworks. Each UK nation is responsible for its own policies and laws around education, health and social welfare. This covers most aspects of safeguarding and child protection. However, similar basic principles apply.

Relevant legislation, guidance and practice resources supporting the application of the basic principles in service delivery are detailed below.

Child safeguarding

England and Wales

allocates duties to local authorities, courts, parents, and other agencies, to ensure children are safeguarded and their welfare is promoted.

is a development from the 1989 Children Act. It reinforces the idea that all people and organisations working with children have a responsibility to help safeguard children and promote their welfare.

Working together to safeguard children 2018 is statutory guidance on inter-agency working to safeguard and promote the welfare of children.

amended the 2004 act replacing Local Safeguarding Children바카라 사이트™s Boards with new local arrangements for safeguarding and promoting the welfare of children.

Wales

provides the legal framework for improving the wellbeing of people who need care and support, and carers who need support, and for transforming social services in Wales.

is statutory guidance relating to Part 7 of the Social Services and Well-being (Wales) Act 2014. It covers the protection of adults and children. The volumes that cover safeguarding children are:

• volume 1: introduction and overview
• volume 2: child practice reviews
• volume 5: handling individual cases to protect children at risk
• volume 7: safeguarding children from child sexual exploitation

sets out expectations about the ways in which agencies and practitioners should work together to safeguard children. And it provides advice on what should happen if a person has concerns about the wellbeing of a child.

, together with the , provides advice to promote consistent safeguarding practice across agencies and across Wales.

focuses on improving social, cultural, environmental and economic wellbeing. It also requires public bodies in Wales to:

• think about the long term impact of their decisions
• work better with people, communities and each other
• prevent persistent problems, such as poverty, health inequalities and climate change

provides the statutory framework for the regulations on workforce registration and regulation, as well as service provider standards in various settings.

Northern Ireland

The Northern Ireland Executive, through the Department of Health, is responsible for child protection in Northern Ireland. They set out policy, legislation and statutory guidance on how the child protection system should work.

The Safeguarding Board for Northern Ireland (SBNI) co-ordinates and ensures the effectiveness of work to protect and promote the welfare of children.

is the principal statute governing the care, upbringing and protection of children in Northern Ireland.

regulates the provision for checking persons seeking to work with children or vulnerable adults, and for barring those considered to be unsuitable for such posts.

is the legislative framework for the creation of the regional SBNI and the establishment of safeguarding panels to support the SBNI바카라 사이트™s work at a health and social care trust level.

places a duty on children바카라 사이트™s authorities, as defined by the act, to co-operate where appropriate as they deliver services aimed at improving the wellbeing of children and young people.

makes it an offence not to report a 바카라 사이트˜relevant offence바카라 사이트™ to the police. This includes offences against children.

provides the overarching policy framework for safeguarding children and young people in the statutory, private, independent, community, voluntary and faith sectors.

(Safeguarding Board for Northern Ireland, revised 2018) provides detailed operational guidance and explains the actions that must be taken when there are concerns about the welfare of a child or young person.

sets out the strategic framework to improve the wellbeing of all children and young people in Northern Ireland.

is used to assess a child바카라 사이트™s needs and the most appropriate forms of intervention to meet the identified needs of the child or young person and prevent problems from escalating.

It also provides guidance about when and how to refer a child to children바카라 사이트™s social services when it has been assessed that their needs warrant this.

sets out high level principles and guidance that staff in children바카라 사이트™s social services should follow when sharing information for child protection purposes.

Scotland

The Scottish 바카라 사이트 is responsible for child protection in Scotland. It sets out policy, legislation and statutory guidance on how the child protection system should work.

Child protection committees are responsible for multi-agency child protection policy, procedure, guidance and practice.

regulates the provision for promoting social welfare in Scotland, including the care and protection of children, and the supervision and care of persons put on probation or released from prison.

outlines the legislative framework for Scotland바카라 사이트™s child protection system. It covers parental responsibilities and rights, and the duties and powers local public authorities have for supporting and promoting the safety and welfare of children.

protects the rights of children and young people in Scotland.

established a new national body, under the leadership of the National Convener, to protect the safety and wellbeing of infants, children and young people.

restates and amends the law relating to adoption in Scotland and makes other provisions relating to the care of children.

helps social workers, police, health professionals and others protect vulnerable children, including areas of practice such as keeping children safe online and child trafficking.

provides a framework for people working with children and their families ensuring children get earlier, effective and integrated support from all agencies to prevent problems escalating. It also provides .

UK

The legislation and guidance adopted in each of the 4 nations needs to be understood in the context of international conventions that have been incorporated into UK legislation. This includes the following.

is the most widely ratified human rights treaty in history, protecting human rights for under 18s.

incorporates the European Convention on Human Rights into UK legislation. Public authorities, like a local authority or the NHS, must follow the act. It includes the:

• right to life
• right to respect for private and family life
• right to freedom of religion and belief

Adult safeguarding

England

relates to care and support for adults and the law relating to support for carers, and makes provision about:

• safeguarding adults from abuse or neglect
• care standards
• integrating care and support with health services

This legislation is supported by the Care and support statutory guidance, which includes information on:

• safeguarding
• person-centred care
• partnership working
• moving between areas
• the role of the principal social worker

Wales

provides the legal framework for improving the wellbeing of people who need care and support, and carers who need support, and for transforming social services in Wales.

is issued under the Social Services and Well-being Act 2014. It sets out clear expectations about the ways in which agencies and professionals should work together to safeguard adults at risk. It also provides an overview of effective safeguarding systems and advice on carrying out assessments and care and support plans.

is issued under the Social Services and Well-being Act 2014. This guidance provides a single point of reference on adult protection and support orders (APSOs), including when and how they can be used.

covers the regulatory processes applying to social care services, and covers the regulation of the social care workforce, as well as providing for information sharing and joint working.

Northern Ireland

aims to improve safeguarding arrangements for adults who are at risk of harm from abuse, exploitation or neglect for the purpose of reducing the prevalence of harm.

Northern Ireland is currently developing an Adult Protection Bill. New statutory guidance will accompany this legislation.

Scotland

deals with the protection of adults at risk of harm, including:

• duties on local authorities
• a requirement for specified bodies to co-operate on adult protection investigations
• a range of protection orders
• the establishment of multidisciplinary adult protection committees

This is supported by the , which provides guidance about the performance of functions by councils and other professionals under the Adult Support and Protection Act.

Mental capacity

Capacity legislation exists to allow legally valid decisions to be made about finances, welfare or medical treatment where the individual lacks mental capacity.

England and Wales

provides a legal framework for making decisions relating to persons who lack capacity.

This is supported by the Mental Capacity Act Code of Practice, which provides guidance to anyone who is working with or caring for adults who may lack capacity to make particular decisions. It focuses on people who have a duty of care to someone who lacks the capacity to agree to the care that is being provided.

Northern Ireland

provides a statutory framework for people who lack capacity and for those who now have capacity but wish to make preparations for a time in the future when they lack capacity.

This is supported by the guidance , which provides practical information for how the Mental Capacity Act (NI) works. It also explains the legal obligations for specific agencies and professionals to have regard to when working with people who lack, or may lack, capacity.

Scotland

sets out the principles that must be applied when making decisions about the needs of adults who lack capacity.

This is supported by , which is a collection of forms and guidance relating to adults with incapacity.

Carers

There바카라 사이트™s an entitlement to a carer바카라 사이트™s assessment in each of the devolved nations, but the process for this is slightly different and it바카라 사이트™s a different legislative framework in each nation.

England

relates to care and support for adults and the law relating to support for carers.

Wales

provides the legal framework for improving the well-being of people who need care and support, and carers who need support, and for transforming social services in Wales.

This is supported by the following guidance:

sets out the requirement of local authorities to assess the needs of individuals for care and support.

provides for the circumstances in which needs for care and support, or support for carers, may or must be met by local authorities.

sets out national priorities for unpaid carers, including on education and employment.

Northern Ireland

gives carers the right to an assessment and to be considered for services to meet their assessed needs.

This is supported by the , which provides a framework for assessing the support needs of family carers, designed to capture information required for holistic, person-centred assessment of the older person.

Scotland

supports carers바카라 사이트™ health and wellbeing and help make caring more sustainable, with specific duties for local authorities to support carers.

This is supported by the for local authorities, health boards and integration authorities on effectively implementing the provisions of the Carers (Scotland) Act 2016.

Domestic abuse

England and Wales

outlines provisions to:

• promote awareness of domestic abuse
• protect and support victims and their families
• prioritise victim safety
• encourage co-ordinated responses to domestic abuse across all local areas, agencies and sectors

The act is supported by Domestic abuse: statutory guidance. This guidance aims to increase awareness and inform the response to domestic abuse. It sets out standards and good practice for organisations and individuals that work with victims or perpetrators of domestic abuse.

sets out provision for law enforcement agencies to address serious and organised crime. It also introduces measures to enhance the protection of vulnerable children, including by strengthening the law to tackle female genital mutilation (FGM) and domestic abuse.

Wales

focuses on preventing these issues, protecting victims and supporting those people affected by these issues.

Northern Ireland

deals with domestic abuse as an offence, and with civil proceedings, including cross-examination and special measures in civil and family proceedings.

This is supported by . This guidance is to be used by agencies investigating domestic abuse offences, and to assist the work of non-governmental organisations and voluntary organisations and to raise awareness of the new domestic abuse offence.

Scotland

creates a specific statutory offence of domestic abuse and makes a number of associated changes to criminal procedure, evidence and sentencing in domestic abuse cases.

introduces additional protective measures for victims of domestic abuse and also additional police powers.

Annex 2: alcohol withdrawal symptoms

Alcohol treatment staff should be able to understand and recognise the signs of alcohol withdrawal. This is so they can accurately diagnose a person with alcohol dependence. They should know how alcohol withdrawal symptoms differ from other clinical characteristics and conditions that may appear similar.

Common alcohol withdrawal symptoms

People who are mildly dependent may experience some milder symptoms of alcohol withdrawal including:

• sweating
• nausea
• shaking (mild tremor)

Generally, people experiencing these milder symptoms do not require medical treatment. However, those who are moderately or severely alcohol dependent will develop acute alcohol withdrawal syndrome when they abruptly stop or substantially reduce their alcohol consumption. This can lead to severe complications requiring an urgent pharmacological response.

The National Institute for Health and Care Excellence clinical guideline (PDF, 10.7MB) notes that common symptoms of alcohol withdrawal include:

• tremor
• nausea
• sweating
• headache
• mood disturbance including anxiety and agitation
• disturbed sleep pattern
• hyperacusis (sensitivity to sound)
• hyperthermia (increased body temperature)
• tachycardia (increased pulse rate)
• increased respiratory rate
• tactile and visual disturbances (itching, burning, double or blurry vision)

Serious complications of alcohol withdrawal

The alcohol guidelines development group notes that serious complications of alcohol withdrawal include:

• seizures (fits)
• auditory and visual hallucinations
• delirium tremens (severe shaking, agitation, fever, tachycardia, profound confusion, delusions and hallucinations)
• Wernicke-Korsakoff syndrome (short and long term memory problems, impaired eye movements or unsteady walking)

Alcohol withdrawal symptoms can be life threatening in severe cases requiring urgent medical attention.

You can find guidance on managing the symptoms and complications of alcohol withdrawal in the chapter 10 on pharmacological interventions.

Annex 3: fitness to drive

Reporting responsibilities

Some medical conditions can affect a person바카라 사이트™s fitness to drive safely so these should be reported to the Driver and Vehicle Licensing Agency (DVLA) in Great Britain or to the Driver and Vehicle Agency (DVA) in Northern Ireland. This includes persistent alcohol misuse and dependence.

DVLA has published general information for medical professionals about assessing fitness to drive to help healthcare professionals and doctors understand their roles and responsibilities for assessing fitness to drive.

The guidance says that applicants and licence holders have a legal duty to:

• notify DVLA (or DVA) of any injury or illness that would have a likely impact on safe driving ability
• respond fully and accurately to any requests for information from either DVLA (DVA) or healthcare professionals

It also says that doctors and other healthcare professionals should:

• advise the person on the impact of their medical condition for safe driving ability
• advise the person on their legal requirement to notify DVLA (or DVA) of any relevant condition
• notify DVLA directly of a person바카라 사이트™s medical condition or fitness to drive, where they cannot or will not notify DVLA themselves

This guidance explains that persistent drug or alcohol misuse or dependence, when confirmed by medical enquiry, are included in the list of medical conditions affecting fitness to drive that should be reported to the DVLA (or DVA).

Reporting concerns to DVLA or DVA

The DVLA guidance acknowledges the challenge for healthcare professionals on issues of consent and to the relationship with their patient when notifying DVLA (or DVA) themselves (if a person cannot or will not notify DVLA themselves). It directs healthcare professionals to General Medical Council (GMC) guidance .

The GMC guidance sets out the steps a doctor should take to inform decisions about disclosing relevant medical information directly to the DVLA or DVA when a person바카라 사이트™s failure or refusal to stop driving exposes others to a risk of death or serious harm. The guidance recognises the duty of confidentiality doctors owe to their patients, but also acknowledges their wider duty to protect and promote the health of patients and the public.

Drug or alcohol use or dependence guidance

The DVLA has also produced guidance on assessing fitness to drive in people with drug or alcohol misuse or dependence.

This guidance:

• defines the main terms DVLA use
• says who should not drive
• sets out the minimum periods of licence revocation
• details the circumstances in which a licence may be re-issued

It will help clinicians to give appropriate advice to people who are drinking harmfully or dependently.

Annex 4: development group and other contributors

Alcohol clinical guidelines development group

Chair

Dr Louise Sell MRCP(UK) FRCPsych, Consultant Psychiatrist, Pennine Care NHS Foundation Trust, Non-Executive Director, Stockport NHS Foundation Trust and Trustee, Early Break

Members

Dr Seonaid Anderson, Consultant Addictions Psychiatrist, NHS Tayside

Mary Bailey (chair of the alcohol assertive outreach working group), Addictive Behaviours Programme Manager, Sandwell Council

Dr Prun Bijral (chair of the ethnic minority groups working group), Medical Director, Change Grow Live

Annabel Bouteloup, expert through experience

Dr Chris Daly (chair of the specialist inpatient medically assisted withdrawal working group), Consultant Addiction Psychiatrist and Deputy Medical Director, Greater Manchester Mental Health Foundation Trust

Dr Liz Davies, Senior Medical Officer for Mental Health, Substance Misuse, Learning Disabilities and Vulnerable Groups Division, Primary Care and Mental Health Group, Welsh 바카라 사이트

Dr Ed Day (chair of the experts through experience group), Consultant Addiction Psychiatrist and Clinical Reader in Addiction Psychiatry, Solihull Integrated Addiction Service and the University of Birmingham, UK Recovery Champion

Monica Desai, Consultant Public Health Adviser, National Institute for Health and Care Excellence (NICE)

Dr Jonathan Dewhurst FRCPsych MSc MBChB, Consultant Psychiatrist and Clinical Lead of Addiction Services, Greater Manchester Mental Health NHS Foundation Trust

Will Digan, expert through experience

Professor Colin Drummond, MB ChB, MD, FRCP, FRCPsych, FFPH, FRCGP(Hon) Professor of Addiction Psychiatry, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King바카라 사이트™s College London

Professor Eilish Gilvarry (chair of the young people working group), Consultant Psychiatrist in Addictions, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle Treatment and Recovery (NTaR), Deputy Medical Director for Revalidation and Appraisal, Central Access Services CBU, and Professor of Addiction psychiatry, Newcastle University

Angela Hall, Public Health Manager, North Yorkshire County Council

Mathis Heydtmann MD, FRCP, PhD, Consultant Hepatologist, Vice Chair of SHAAP (Scottish Health Action on Alcohol Problems), Specialist Advisor to the Scottish Chief Medical Officer (Hepatology)

Mark Holmes, Viral hepatology Clinical Nurse Specialist, Royal Cornwall Hospital NHS Trust

Dr Nicky Kalk MBChB MRCPsych PhD (chair of the acute hospitals working group), Consultant Addiction Psychiatrist, Kings College Hospital Alcohol Care Team, South London and Maudsley NHS Foundation Trust, and Visiting Clinical Lecturer, Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London

Dr Mike Kelleher, Consultant Addictions Psychiatrist and Clinical Lead, Lambeth Addictions, South London and Maudsley NHS Foundation Trust, and National Clinical Advisor Addiction and Inclusion directorate, Office for Health Improvement and Disparities

Jan Larkin (chair of the psychosocial interventions working group), Consultant Clinical Psychologist, Head of Psychology, Turning Point

Tim Leighton PhD, Strategic Consultant, Recovery Models, Forward Trust

Dr Julia Lewis, MBBS, MRCGP, MRCPsych, MSc, MD (chair of the alcohol-related brain damage working group), Consultant Addiction Psychiatrist, Aneurin Bevan University Health Board and Visiting Professor, University of South Wales

Professor Anne Lingford-Hughes, Consultant Psychiatrist, Central and North West London NHS Foundation Trust and Division of Psychiatry, Imperial College London

Dr Steven Masson, Consultant Hepatologist, Freeman Hospital, Newcastle, and Alcohol Lead, British Society of Gastroenterology

Tim Meynen (representing the British Psychological Society) Consultant Clinical Psychologist, Addiction Psychology, South London and Maudsley NHS Foundation Trust, and Clinical Director, Doctorate in Clinical Psychology, King바카라 사이트™s College London

Zulfiquar Mirza, Consultant in Emergency Medicine, Chelsea and Westminster Hospital NHS Foundation Trust

Dr Luke Mitcheson DCLinPSy, Consultant Clinical Psychologist, Lambeth Drug and Alcohol Team, South London and Maudsley NHS Foundation Trust, and National Clinical Advisor Addiction and Inclusion directorate, Office for Health Improvement and Disparities

Graham Parsons, Lead Pharmacist for Hepatology, University Hospitals Plymouth NHS Trust and South West Peninsula Hepatitis C Operational Delivery Network

Professor Thomas Phillips, Professor of Nursing in Addiction, Institute for Clinical and Applied Health Research, University of Hull

Julia Sinclair MB BS FRCPsych DPhil FHEA, Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Honorary Consultant in Alcohol Liaison, University Hospital Southampton, and National Specialty Advisor for Alcohol Dependence, NHS England

Dr Helen Toal, Consultant Psychiatrist in Addictions and Clinical Director, Belfast Health and Social Care Trust

Dr Roya Vaziri MBBS DRCOG DFFP MRCGP, (chair of the community services and inclusive services working group), Executive Medical Director, Humankind

Ruth Wallbank, Making Every Adult Matter Partnerships Manager, Mind UK

Tassie Weaver, Head of Networks and Operations (Homeless Link), Making Every Adult Matter

Dr Sarah Welch, MA BM BCh DPhil FRCPsych (chair of the pharmacological interventions working group), addiction psychiatrist

Ariella Williams, Associate Director of Nursing, North West, Change, Grow, Live

Experts through experience group

Annabel Bouteloup

Donna Campbell

Devon Clarke

Dermot Craig

Will Digan

Justin Greenwood

Michaela Jones

Javed Rehman

Additional contributors to working groups

Dr Neil Aiton, Consultant Neonatologist, Honorary Senior Lecturer Brighton and Sussex Medical School, Trevor Mann Baby Unit, One Stop Clinic

Lisa Barnfield, Substance Misuse Team Leader (South), GDAS, Newport

Julie Breslin, Head of Programme, Drink Wise, Age Well, With You

Dr Steve Brinksman, Clinical Director, Addiction Professionals

Devon Clark, expert through experience

Dermot Craig, expert through experience

Dr Mark Crowe, Research and Development Coordinator, Humankind

Janine Day, Operations Director, Early Break

Dr Arun Dhandayudham, MBBS, FRCPsych, CCT (Addictions Psychiatry), PgDip (Mental Health Law) PgCert (Med Ed), MBA (Henley Business School), MFMLM Medical Director Westminster Drug Project

Andrew Docherty, Ministry of Defence Rachel Fance, Service Manager, Change Grow Live

Colin Fearns, Medical Director, Delphi

Mike Flanagan, Consultant Nurse and Clinical Lead, i-access Drug and Alcohol Service, Surrey and Borders Partnership NHS Foundation Trust

Dr Linda Harris, OBE FRCGP, Chief Executive Officer, Spectrum Community Health Community Interest Company (CIC)

Greta Hayward, Lead Nurse, Maternity and Early Years, Public Health England

Dr Stephen Kaar, MBChB BSc(Hons) MRCPsych PGCert (Clin Ed.), Consultant Addictions Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust

Shaun Kennedy, Head of Equality, Diversity and Inclusion, Change Grow Live

Cathy Lovatt, Service Manager, Greater Manchester Mental Health NHS Foundation Trust

Squadron Leader Ian Matthews, BSc(Hons) MPH RAF

Dr Andrea Morris FRCGP Senior Medical Officer, Defence Primary Healthcare, Stonehouse Group Medical Practice

James Morris PhD, Research Fellow

Pam Menzies Banton, Area Manager, Lewisham, Tower Hamlets and Bexley, Humankind

Monty Moncrieff, Chief Executive, London Friend

Rachael Nielsen, Project Manager, Alcohol Exposed Pregnancy Programme, NHS Greater Manchester Integrated Care

Adrian Perks, Health and Justice Public Health Implementation Lead, NHS England

Javed Rehman, expert through experience

Roisin Reynolds, Senior Advisor, Alcohol Exposed Pregnancy Programme, NHS Greater Manchester Integrated Care

Emmert Roberts, Consultant Addiction Psychiatrist, South London and the Maudsley NHS Foundation Trust and Clinical Research Fellow at the National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London

John Reynolds Warrant Officer Class 2, Headquarters 4 Brigade, SMART Facilitator, Lived experience

Ruth Rushton (chair of the armed forces working group) Consultant Clinical Psychologist, Defence Specialist Addictions Post

Sohan Sahota, Managing Director Bac-in, Accredited Psychotherapist, Addiction Recovery Specialist, National Recovery Advocate

Soya Sherkat, Advanced Specialist Pharmacist Addiction, Central and North West London NHS Foundation Trust

Hannah Todman, PhD Researcher, Department of Social Care and Social Work, Manchester Metropolitan University

Dr Derek Tracy, Medical Director, West London NHS Trust, and Senior Lecturer, King바카라 사이트™s College London and University College London

Gill Turner, Lead Nurse for Children, Young People and Families, World Health Organization Collaborating Centre and Nurse Advisor, Chief Public Health Nurse Directorate, Office for Health Improvement and Disparities

Sarah Tyndall, Nurse Consultant, Family Nurse Partnership National Unit, Chief Public Health Nurse Directorate, Office for Health Improvement and Disparities

Naim Vali, Community Harm Minimisation Team Leader, CHART Kirklees

Mike Ward, Senior Consultant, Alcohol Change UK

Dr Kenneth Wilson, MB ChB MPHIL MD FRCPsch, Director, Alcohol Related Brain Damage Network

Nat Wright, (chair of the criminal justice services working group), NIHR Primary Care Specialty Lead, Yorkshire and Humber, Honorary Research Adjunct Fellow, West Sydney University, General Practitioner Armley Medical Practice