New treatment guidelines for alcohol dependence subject to UK-wide consultation

20th October 2023

A consultation on UK-wide guidelines for the clinical treatment of harmful drinking and alcohol dependence has been launched by the Department of Health and Social Care (DHSC).

Developed in partnership with the UK‘s devolved administrations, the guidelines include advice for alcohol care in acute hospitals as well as other settings such as primary care, community health services and the criminal justice system.

‘Patients with alcohol use disorder present to acute hospitals with a wide range of primary diagnoses and the presence of alcohol use disorder may not always be obvious to the patient or to clinical staff,‘ the guidance states.

It therefore emphasises the need for hospitals to have staff with appropriate skills to identify alcohol use disorders, assess risk and provide specialist treatment interventions.

The importance of implementing a system for identifying health risk from alcohol and gauging the severity of alcohol use disorder among all hospital inpatients is also highlighted as this may impact a patient‘s treatment, recovery and risk of complications.

The guidelines also outline key factors in dealing with acute or medically assisted alcohol withdrawal, managing associated complications and treating patients with co-occurring physical and mental health conditions, including those in crisis.

The need for a seamless transition to ongoing treatment in mental health and community services when discharged is also detailed, with integrated planning identified as a priority to ensure effective wrap-around care.

According to the DHSC, the main aim of the guidelines is to develop a ‘clearer consensus’ on good practice and how to implement NICE-recommended interventions.

The consultation will be open for eight weeks, inviting views from people working in alcohol treatment, the wider health and care sector and those with lived experience of alcohol dependence across the UK.

Neil O’Brien, minister for public health, said: ’This consultation will help us develop guidance to ensure alcohol treatment services are of consistently high quality, providing stronger pathways to recovery for those in need of treatment for alcohol dependence.’

In May, ministers were accused of not taking alcohol harm seriously enough after a new report revealed that over the last two decades the number of alcohol-related deaths rose by 89% and was continuing to rise sharply since the start of the pandemic.

Despite this, the report found that a ‘staggering’ 82% of dependent drinkers were not in treatment despite success rates of 60% and evidence that treatment delivers £3 of benefit for every £1 invested.

A version of this story was originally published by our sister publication Nursing in Practice.

Psilocybin-assisted therapy in alcohol use disorder reduces heavy drinking days

30th August 2022

Psilocybin-assisted psychotherapy has been found to reduce the proportion of heavy drinking days in adults with alcohol use disorder

Psilocybin-assisted psychotherapy reduces the proportion of heavy drinking days as well as the mean number of drinks consumed per day, among adults with alcohol use disorder according to the findings of a randomised, placebo-controlled trial by a team of US and Mexican researchers.

The psychedelic compound psilocybin occurs naturally in the psychoactive psilocybe genus of mushrooms. It is one of a number of psychedelic drugs, together with lysergic acid diethylamide and mescaline, that were used extensively in the past for psychiatric patients, in particular, those with psychoneurotic’ disorders.

In recent years, some evidence has emerged to suggest a potential role for psilocybin to help smokers quit and psilocybin-assisted therapy is efficacious in treating major depressive disorder. Alcohol use disorder (AUD) could be amenable to treatment with psychedelics given that a meta-analysis of 6 trials found that a single dose of lysergic acid diethylamide is associated with a decrease in alcohol misuse.

To date, only a single, proof-of-concept’ study has shown that psilocybin-assisted treatment in combination with motivational enhancement therapy, found that abstinence increased significantly following psilocybin administration (p < 0.05).

For the present study, researchers decided to build upon the ‘proof-of-concept’ study and undertook a randomised, placebo-controlled trial, to evaluate whether 2 administered high-doses of psilocybin reduced the percentage of heavy drinking days (PHDD) in adults with AUD who underwent psychotherapy compared to placebo.

In the trial, participants were offered 12 weeks of psychotherapy and randomised to receive psilocybin or diphenhydramine (which served as the placebo) during two day long medication sessions after 4 and 8 weeks. Diphenhydramine was used as a placebo because the drug has noticeable subjective effects and therefore could possibly be mistaken for psilocybin by psychedelic-naïve participants.

After 38 weeks, individuals could continue and receive 4 additional psychotherapy sessions and assessment took place for a further 18 weeks. Psilocybin was given as a single oral capsule at a dose of 25 mg/70 kg and was increased to 30 mg/70 kg if there were no dose limiting adverse events and if the participants were happy for the increased dosage.

The dose of diphenhydramine was 50 mg at the first session but increased to 100 mg regardless of subjective response and all doses were administered by staff. The primary drinking outcome was the percentage of heavy drinking days during weeks 5 to 32 and which were assessed at weeks 8, 12, 24 and 36.

Psilocybin-assisted therapy and heavy drinking days

A total of 95 participants with a mean age of 45.8 years (44.2% female) were included and randomised to psilocybin (49) or placebo and individuals had been alcohol dependent for a mean of 14.2 years.

The PHHDs during weeks 5 to 36 were 9.7% for the psilocybin-assisted group and 23.6% for the placebo group (mean difference = 13.9%, 95% CI 3 – 24.7, p = 0.01). In other words, the PHDD in psilocybin-assisted treatment group was 41% of that observed for the diphenhydramine group.

At the 32-week follow-up, the mean number of drinks per day was 2.26 for the diphenhydramine group and 1.17 for the psilocybin group and this mean difference (1.09) was significant (p = 0.01).

The authors concluded that among individuals with AUD, psilocybin-assisted psychotherapy was associated with a reduction in both daily and heavy drinking. They called for future studies to support these findings in patients with AUD.

Citation
Bogenschutz MP et al. Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial JAMA Psychiatry 2022