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Health condition · Clinically reviewed

Alcohol use disorder, screening, safe detox and staying well.

A treatable condition with a clear UK pathway. AUDIT screening, community or inpatient detox and a mix of medication and psychology - stepped to the severity in front of us.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CG115, NICE TA325 and Royal College of Psychiatrists standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including AUDIT screening, community detox pathways and MHRA-approved pharmacotherapy.

Key facts

AUD at a glance.

The essentials, in plain English - how it is defined, how it is screened and how the UK treats it in 2026.

  • What it is

    A DSM-5 diagnosis of impaired control over alcohol use with 11 criteria. Mild is 2 to 3, moderate 4 to 5 and severe 6 or more.

  • Screening

    AUDIT (10 items) or AUDIT-C (3 items) is the standard UK screen. A score of 8 or more on AUDIT signals harmful drinking.

  • Withdrawal risk

    Tolerance and physical dependence carry a real risk of seizures, delirium tremens and Wernicke encephalopathy on abrupt cessation.

  • Community detox

    For mild-to-moderate dependence a chlordiazepoxide-tapered regimen with Pabrinex and daily reviews works well at home.

  • Inpatient detox

    Severe dependence, past seizures, delirium tremens or serious medical comorbidity warrants a supervised inpatient admission.

  • Relapse prevention

    NICE CG115 supports acamprosate or oral naltrexone alongside psychological therapy after successful detox.

Why this guide matters

A stepped plan, not willpower alone.

AUD is a diagnosable, treatable condition. The three points below shape everything else on this page.

  • Screening finds it early

    AUDIT and AUDIT-C are validated tools used in primary care, A&E and antenatal clinics - a short questionnaire can change a life.

  • Detox has to be planned

    Abrupt cessation carries a real risk of seizures and delirium tremens - safe detox is medically managed with benzodiazepines and thiamine.

  • Medication plus psychology works

    Acamprosate, naltrexone or nalmefene combined with CBT and community support gives the best long-term outcomes.

How the diagnosis is made

From first conversation to a safe plan.

The steps a UK GP, community addiction service or liaison psychiatrist will normally follow - so you know what to expect and why.

  1. 01

    Assessing

    AUDIT and AUDIT-C screening

    A structured self-report scored 0 to 40. AUDIT-C is the quick 3-item version used in primary care and A&E.

  2. 02

    Assessing

    DSM-5 criteria count

    Eleven criteria covering tolerance, withdrawal, craving, control, roles, social life, hazardous use and consequences.

  3. 03

    Assessing

    Stage of change and motivation

    Motivational interviewing places you on the pre-contemplation to maintenance ladder and shapes the plan.

  4. 04

    Confirming

    LFTs, GGT, MCV and CDT

    Liver enzymes plus MCV and carbohydrate-deficient transferrin give an objective picture of recent drinking.

  5. 05

    Confirming

    Nutrition and haematology

    FBC for anaemia, plus vitamin D, folate and B12 - dependence commonly depletes them.

  6. 06

    Confirming

    Thyroid and comorbidity screen

    TFTs and a review for depression, anxiety and PTSD - conditions that both drive and follow harmful drinking.

  7. 07

    Preparing

    Detox setting decision

    Severity, seizure history, delirium tremens risk, home support and physical health decide community versus inpatient care.

Typical timeline: first assessment to a settled detox plan usually within one to two weeks.

Symptoms

What AUD actually looks like.

The DSM-5 criteria in real life - tolerance, withdrawal, craving, control, roles, social life and continued use despite harm.

  • Tolerance

    Needing more alcohol for the same effect, or feeling less effect at the same amount - a core DSM-5 criterion.

  • Withdrawal symptoms

    Tremor, sweating, nausea, anxiety, tachycardia and insomnia within hours of the last drink.

  • Loss of control

    Drinking larger amounts or over longer periods than intended, with unsuccessful attempts to cut down.

  • Craving

    A strong urge or compulsion to drink - increasingly recognised as a driver of relapse and a treatment target.

  • Time and roles

    A lot of time spent obtaining, using or recovering. Work, study, family and household roles start to slip.

  • Social and interpersonal problems

    Continued drinking despite arguments, breakdowns and social withdrawal - and giving up activities that once mattered.

  • Hazardous and continued use

    Drinking in physically risky situations, and continuing despite a clear physical or psychological consequence.

  • Red flag - seizure or delirium tremens

    A history of alcohol-related seizures, confusion, hallucinations or autonomic instability needs urgent medical review before any detox.

Treatment

How AUD is treated in the UK.

Brief intervention and community detox first for milder cases, inpatient detox for severe or high-risk cases, then relapse-prevention medication with structured psychology and community support.

  • Brief intervention (FRAMES)

    Feedback, Responsibility, Advice, Menu, Empathy and Self-efficacy - a short primary-care conversation with real evidence for hazardous drinkers.

  • Community detox

    A tapered chlordiazepoxide regimen with Pabrinex, hydration and daily reviews for mild-to-moderate dependence and safe home support.

  • Inpatient detox

    Supervised detox for severe dependence, past seizures, delirium tremens risk, Wernicke concerns or serious medical or psychiatric comorbidity.

  • Relapse-prevention psychology

    CBT, motivational enhancement therapy and behavioural couples work - the psychological backbone of staying well after detox.

  • 12-step and SMART recovery

    Alcoholics Anonymous, SMART Recovery and community peer support - free, widely available and a strong predictor of long-term outcomes.

  • Acamprosate

    First-line NICE CG115 option to maintain abstinence after detox. Started within days of the last drink and continued for 6 to 12 months.

  • Naltrexone or nalmefene

    Oral naltrexone reduces heavy drinking and craving. Nalmefene (NICE TA325) supports harm reduction in moderate-severe AUD without needing full abstinence.

  • Disulfiram - supervised

    An aversive option - produces an unpleasant reaction with alcohol. Typically supervised and reserved for motivated patients when other agents fail.

MDT working

Addiction psychiatry, hepatology, primary care and family.

The best outcomes come from a coordinated team - addiction psychiatry, hepatology where the liver is involved, GP, social work and, where possible, partners and family in the plan.

Long-term health

Liver, brain, heart and cancer follow-up.

AUD raises the risk of liver disease, cognitive decline, cardiomyopathy, hypertension, arrhythmias and several cancers. Ongoing screening, blood-pressure control and cardiovascular risk management are part of the plan.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, addiction service or liaison psychiatrist knows your history and can tell you which parts apply to you. If you are drinking heavily, please do not stop suddenly without medical advice.

  • NICE. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence (CG115).

  • NICE. Nalmefene for reducing alcohol consumption in people with alcohol dependence (TA325).

  • NICE. Alcohol-use disorders: diagnosis and management of physical complications (CG100).

  • Royal College of Psychiatrists. Position statement on alcohol and mental health.

  • MHRA. Safety information on chlordiazepoxide, acamprosate, naltrexone and disulfiram.

Red flags

When AUD needs urgent attention.

Most AUD can be managed with planned outpatient care. These are the situations where a same-day or hospital-based response is needed.

  • Delirium tremens

    Confusion, hallucinations, tremor and autonomic instability 48 to 72 hours after the last drink - a medical emergency needing hospital admission.

  • Alcohol withdrawal seizures

    Generalised tonic-clonic seizures in the first 48 hours. Any past history means a supervised detox with benzodiazepine cover.

  • Wernicke encephalopathy

    Confusion, ataxia and eye-movement changes - treat empirically with parenteral thiamine (Pabrinex) before it becomes Korsakoff syndrome.

  • Decompensated liver disease

    Jaundice, ascites, encephalopathy or variceal bleeding - urgent hepatology input alongside the addiction pathway.

  • Self-harm or suicidal ideation

    AUD sharply raises suicide risk. Any active ideation or plan needs same-day mental-health assessment.

  • Pregnancy and the perinatal period

    No safe amount of alcohol in pregnancy. Specialist perinatal addiction and obstetric input is essential.

  • Drug interactions and polysubstance use

    Benzodiazepines, opioids and stimulants alongside alcohol raise the risk of overdose and complicate detox - be honest about everything you take.

  • Head injury while intoxicated

    A low threshold for imaging - subdural haematoma is easily missed and coagulation may be impaired.

  • New confusion or falls

    Consider Wernicke, hepatic encephalopathy, subdural bleed, hypoglycaemia or intoxication - all need urgent assessment.

Living with it

A treatable condition, one day at a time.

Four things that make the biggest difference day to day - a steady structure, real community support, a plan for triggers and asking for medication early.

A quiet reminder

Relapse is a step, not the end of the story.

Most people who recover have setbacks. What matters is getting back in touch with your team quickly - the plan can be adjusted, not scrapped.

  1. 01 Structure

    Anchor the day

    Sleep, meals and exercise at regular times take the edge off craving and low mood - especially in the first 90 days.

  2. 02 Support

    Use the community

    AA, SMART Recovery and local NHS or third-sector services help. Consistent attendance is one of the strongest predictors of staying well.

  3. 03 Triggers

    Map your high-risk moments

    Stress, low mood, boredom, certain people and places - name them, plan for them and rehearse a response.

  4. 04 Escalate

    Ask for medication early

    Acamprosate, naltrexone or nalmefene can be added at any point. They work best alongside psychology, not as a substitute.

Frequently asked

Everything we get asked about AUD.

Quick answers on assessment, detox setting, medication and treating the conditions that so often go with it.

  • What is alcohol use disorder?

    A DSM-5 diagnosis of impaired control over alcohol despite consequences. There are 11 criteria across tolerance, withdrawal, craving, control, roles, social life, hazardous use and continued use despite harm. Two to three is mild, four to five is moderate, six or more is severe.

  • How is drinking assessed in the UK?

    The AUDIT questionnaire (10 items) or its shorter AUDIT-C is the standard screen. Bloods often include LFTs, GGT, MCV and sometimes carbohydrate-deficient transferrin, alongside FBC, folate, B12, vitamin D and thyroid tests.

  • Can I detox at home?

    For mild-to-moderate dependence with safe home support and no history of seizures or delirium tremens, a community detox on tapered chlordiazepoxide with Pabrinex and daily reviews is usually possible. Severe dependence needs inpatient care.

  • Which medication is first-line after detox?

    NICE CG115 recommends acamprosate or oral naltrexone alongside psychological therapy. Nalmefene (NICE TA325) is licensed for people who want to reduce heavy drinking rather than stop completely, and disulfiram is reserved for motivated patients when other agents have not worked.

  • What is the risk of not treating it?

    Untreated AUD raises the risk of alcohol-related liver disease, cardiomyopathy, arrhythmias, hypertension, several cancers, cognitive decline (Korsakoff), accidents, self-harm and suicide. Early treatment substantially reduces every one of these.

  • What about depression, anxiety or PTSD alongside drinking?

    Very common and treated concurrently. Antidepressants, trauma-focused psychology and medication for AUD work well together - waiting to treat one until the other is fixed rarely helps and often prolongs both.

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