1. The 1998 Scottish Health Survey included questions to estimate the scale of alcohol dependence in Scotland. It recorded that 10% of male drinkers and 3-4% of female drinkers replied affirmatively to one or more of three questions designed to identify alcohol dependence. All three questions were answered affirmatively by 1% of male drinkers but less than 0.5% of female drinkers.
2. Untreated alcohol dependence results in levels of drinking, which substantially increase the risk of stroke, cirrhosis of the liver, brain damage and several forms of cancer and are associated with substantially increased mortality.
3. Following initial detoxification a longer term programme of treatment is required to prevent relapse into heavy drinking and dependence. A number of different psychosocial and pharmacological interventions are available to prevent relapse. These are the focus of this HTA.
4. The Plan for Action on Alcohol Problems was published in January 2002 (Scottish Advisory Committee on Alcohol Misuse (SACAM), 2002) and covers a wide range of social, economic and clinical aspects of the misuse of alcohol in Scotland including chronic heavy drinking. This Health Technology Assessment provides policy makers, planners and those working in the field of relapse prevention in alcohol dependence with a part of theinformation required to implement the Plan.
5. People with established alcohol dependence are likely to require treatment mainly within Tier 3 (Specialist Alcohol Problem Services) or Tier 4 (Regional Specialist Services) of the Scottish Executive’s Draft Alcohol Problems Support and Treatment Framework. Thus this HTA will be of primary interest to those concerned with these specialist tiers. However aspects of relapse prevention may happen in Tier 1 (Local Services) or Tier 2 (Specialist Support).
6. There is no agreed definition of alcohol dependence. When possible the pragmatic criterion that a process of detoxification has been undergone has been preferred. However, a range of criteria are used by investigators in clinical trials and exclusive use of any single criterion would force many studies to be discarded.