When should I consider referring a patient with alcohol use disorder to specialist services?

You should consider referring a patient with alcohol use disorder to specialist services if they show signs of moderate or severe alcohol dependence ². Referral is also appropriate if the patient has failed to benefit from structured brief advice and an extended brief intervention, and wishes to receive further help for an alcohol problem ². Additionally, consider referral if the patient exhibits signs of severe alcohol-related impairment or has a related co-morbid condition, such as liver disease or alcohol-related mental health problems ².

For patients with a significant comorbid mental health disorder or those assessed to be at high risk of suicide, referral to a psychiatrist is recommended to ensure effective assessment, treatment, and risk-management plans are in place ¹. If depression or anxiety persists after 3 to 4 weeks of alcohol abstinence, assess the condition and consider referral and treatment in line with the relevant NICE guideline for that particular disorder ¹. Furthermore, if staff are not competent to initially assess the need for an intervention, they should refer the patient to a service that can provide such an assessment ¹.