Glossary
Source: gov.uk (2025-11-28)

An alphabetical list of technical words and terms and their meanings and definitions that are used in the UK clinical guidelines for alcohol treatment.

A

Abstinence

Completely avoiding drinking alcohol.

Acute alcohol withdrawal (or acute alcohol withdrawal syndrome)

The physical and psychological symptoms that people who are alcohol dependent can experience when they suddenly stop drinking or reduce the amount of alcohol they drink. In acute alcohol withdrawal, symptoms can be severe and can include severe complications (see annex 3 for a description of common withdrawal symptoms and severe complications).

Alcohol care teams (ACTs)

Teams of clinicians with alcohol specialist expertise, based in acute general hospitals. They provide specialist support, predominantly to alcohol-dependent inpatients admitted for any condition, whose alcohol use may be putting their health at risk.

Alcohol dependence

These guidelines use the definition of alcohol dependence from the International Classification of Diseases 11th Revision (ICD-11)](https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1580466198), which is as follows:

Alcohol dependence is a disorder of regulation of alcohol use arising from repeated or continuous use of alcohol. The characteristic feature is a strong internal drive to use alcohol, which is manifested by impaired ability to control use, increasing priority given to use over other activities and persistence of use despite harm or negative consequences. These experiences are often accompanied by a subjective sensation of urge or craving to use alcohol. Physiological features of dependence may also be present, including tolerance to the effects of alcohol, withdrawal symptoms following cessation or reduction in use of alcohol, or repeated use of alcohol or pharmacologically similar substances to prevent or alleviate withdrawal symptoms. The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if alcohol use is continuous (daily or almost daily) for at least 3 months.

An alcohol use disorder identification test (AUDIT) score of 20 and over indicates a person may possibly be alcohol dependent, but a clinical assessment is necessary to diagnose alcohol dependence.

Alcohol harm (or alcohol-related harm)

Alcohol harm is the physical health, mental health or social harm caused either entirely or partly by alcohol. This harm can be experienced by a person drinking and also by their partners, families or the wider community.

Alcohol use disorder

We use alcohol use disorder to include any pattern of alcohol use that significantly increases risks to health, either harmful (higher-risk) drinking or alcohol dependence.

B

Binge drinking

The term binge drinking in these guidelines means any drinking episode that results in acute alcohol intoxication, increasing risk of harm on that occasion.

In the AUDIT questionnaire and in some surveys, 6 or more units for women or 8 or more units for men on a single occasion is defined as binge drinking.

Brief intervention

Alcohol brief intervention is a general term used to describe a short, structured conversation that encourages and supports people with hazardous or harmful patterns of drinking to reduce their consumption towards low-risk levels.

You can find more information on brief interventions in chapter 3.

C

Care plan

See definition of ‘treatment and recovery plan (or care plan)’ in this glossary.

Carer’s assessment

Anyone who is an unpaid carer for a family member or friend has the right to have their own needs assessed by their local authority social care services (or a service the local authority commissions). This assessment is for the carer and is separate from the needs of the person they care for. The local authority uses the assessment to decide what services they can offer. The right to an assessment is underpinned by legislation and statutory guidance (see annex 1 for more information).

Child in need

A child in need is defined under the Children Act 1989 (https://www.legislation.gov.uk/ukpga/1989/41/contents) as a child:
- who is unlikely to achieve or maintain a reasonable level of health or development without the provision of services
- whose health and development is likely to be significantly or further impaired without the provision of services
- who is disabled
Local authorities have a duty to provide support to a child in need.

Child protection

Statutory guidance Working together to safeguard children (https://www.gov.uk/government/publications/working-together-to-safeguard-children--2) defines child protection as:

part of safeguarding and promoting welfare. This refers to the activity that is undertaken to protect specific children who are suffering, or are likely to suffer, significant harm.

See definition of ‘significant harm’ in this glossary. Also, see definition of ‘safeguarding (children)’.

Clinical supervision

In these guidelines, clinical supervision is defined as a collaborative, formal process between a supervisor and supervisee that takes place in a service or workplace. It is part of the overall training and development of clinicians and alcohol and drug workers.

Clinical supervision helps the supervisee to:
- develop their competencies
- ensure that they follow current ethical, organisational and professional standards in their practice
- promote their wellbeing
It is important that clinical supervision involves reflective practice (as defined in this glossary).

Clinician

In these guidelines, a clinician is a registered professional (see definition in this glossary) delivering interventions to people with problem alcohol use. For example, this includes:
- doctors
- nurses
- clinical psychologists
- counsellors
- allied registered health and care professionals
Common mental health conditions

Common mental health conditions include depression, and anxiety disorders such as:
- generalised anxiety disorder
- panic disorder
- obsessive-compulsive disorder
- social anxiety disorder
- phobias
- post-traumatic stress disorder
Complex needs

In these guidelines, complex needs refer to needs that significantly affect people’s functioning. They may be caused or made worse by alcohol use or may be independent of it. Complex needs can include but are not limited to:
- other substance use
- mental or physical health conditions
- conditions affecting cognition such as alcohol related brain damage
- domestic abuse
- sexual exploitation and violence
- homelessness
- interaction with the criminal justice system
When a person has several of these needs, this is often referred to as ‘multiple and complex needs’, ‘multiple disadvantage’ (see definition in this glossary) or ‘severe and multiple disadvantage’.

Controlled drinking

See the definition of ‘moderate drinking’ in this glossary.

Co-occurring conditions

Co-occurring conditions is when a person has more than one condition or illness at the same time. In these guidelines, this usually means when a person has problem alcohol use alongside mental or physical health conditions or problem drug use. Co-occurring conditions are also sometimes referred to as ‘comorbidities’.

You can find more information on co-occurring conditions and an alcohol use disorder in:
- chapter 18 on people with co-occurring mental health conditions
- chapter 19 on people with co-occurring physical health conditions
Controlling or coercive behaviour

Controlling or coercive behaviour is a form of domestic abuse. It is a pattern of behaviour whereby a person repeatedly controls the behaviour of another person that they are personally connected to (for example, an intimate partner, ex-partner or family member).

A perpetrator using controlling or coercive behaviour aims to make the victim feel scared, inferior and/or dependent. Controlling or coercive behaviour can include but is not limited to:
- controlling who the victim has contact with, including cutting the victim off from personal and professional support
- controlling daily aspects of the victims’ life, such as what they wear, where they go and what money they spend
- threats or humiliating and intimidating actions aimed at harming, frightening or punishing the victim
For a full legal definition of the offence of controlling or coercive behaviour, see relevant national domestic abuse legislation in annex 1.

Cultural competence

In this guideline, cultural competence means the ability of organisations and individual practitioners to effectively deliver services that meet the social, faith, cultural and linguistic needs of people from diverse communities. See section 2.3.2 for a more detailed description of cultural competence.

D

Decision in question

The ‘decision in question’ refers to the specific decision that needs to be taken (for example, consenting to proposed medical treatment), at the time it needs to be made. For more information, see the Mental Capacity Act code of practice (https://www.gov.uk/government/publications/mental-capacity-act-code-of-practice).

Domestic abuse

England, Wales, Scotland and Northern Ireland each have national legislation that defines domestic abuse. The legislation is:
- England and Wales: Domestic Abuse Act 2021 (https://www.legislation.gov.uk/ukpga/2021/17/contents)
- Wales: Violence against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015 (https://www.legislation.gov.uk/anaw/2015/3/contents)
- Scotland: Domestic Abuse (Scotland) Act 2018 (https://www.legislation.gov.uk/asp/2018/5/contents)
- Northern Ireland: Domestic Abuse and Civil Proceedings Act (Northern Ireland) 2021 (https://www.legislation.gov.uk/nia/2021/2)
You can find more details on all this legislation and related guidance in annex 1.

F

Formulation

Formulation is a framework for understanding information gathered in an assessment and helping the person to make sense of their situation. It informs treatment and recovery planning.

The formulation helps the practitioner and the person to understand:
- how the person’s alcohol problem began and developed
- the factors that maintain the person’s alcohol problem
- potential resources to address the person’s alcohol problem
There is more information on formulation in section 5.4 in the chapter on psychosocial interventions.

FRAMES

FRAMES is an acronym that identifies common components of a brief intervention. These are:
- feedback (on the person’s level of risk of alcohol use disorder)
- responsibility (change is the person’s responsibility)
- advice (identifying reasons for change, ideally using open questions)
- menu (identifying options and strategies for change, ideally using open questions)
- empathy (non-judgemental and understanding)
- self-efficacy (helping the person to be optimistic about their ability to change)
H

Harmful drinking (also called higher-risk drinking)

This guideline uses the ICD-11 definition of harmful drinking, which is outlined in the entry Harmful pattern of use of alcohol (https://icd.who.int/browse/2025-01/mms/en#714690795):

A pattern of alcohol use that has caused damage to a person’s physical or mental health or has resulted in behaviour leading to harm to the health of others. The pattern of alcohol use is evident over a period of at least 12 months if substance use is episodic or at least one month if use is continuous.

Consumption levels of 50 units and over per week for men and 35 units and over per week for women are sometimes used as proxy indicators of harmful drinking. This is because drinking at those levels risks causing harm to a person’s health or to the health of others.

Harm reduction

A harm reduction approach or philosophy sees the aim of alcohol treatment as reducing harms associated with a person’s alcohol use. Harm reduction can be understood as a continuum, with small changes at one end of the continuum and complete abstinence at the other. See chapter 8 for guidance on harm reduction.

Hazardous drinking (also called increasing-risk drinking)

A pattern of alcohol use that increases lifetime risk of harm to the physical or mental health of the person drinking or to others. Hazardous drinking has not yet reached the level of having caused harm.

You can find a more detailed definition of hazardous drinking in the ICD-11 entry Hazardous alcohol use (https://icd.who.int/browse/2025-01/mms/en#xx-xxxx-xxxx).

Consumption levels of between 15 units and 49 units per week for men and between 15 units and 34 units per week for women are sometimes used as proxy indicators of hazardous drinking. This is because drinking at those levels, increases the risk of causing lifetime harm to a person’s health or to the health of others.

I

Identification (screening)

Identification is using validated tools (such as AUDIT) to identify people who may have an alcohol use disorder. Staff can carry out identification in health, social care and community services to identify people who are not seeking alcohol treatment but may be increasing their lifetime risk of alcohol ill health or have an alcohol use disorder. Identification can also be used in alcohol treatment services as part of an initial assessment.

Identification is sometimes called screening. In this guideline, the term screening does not refer to the national screening programmes such as those recommended by the UK National Screening Committee.

Independent living

Independent living (sometimes called ‘supported living’) includes schemes that allow people with support needs to live in their own home or in alternative housing in their local community. Care and support are provided to help the person to live as independently as possible.

In-reach

In-reach are services provided within a partner service by practitioners with a specialism, often on a regular weekly basis. For example, alcohol treatment services can provide in-reach to local health, social care or community services. This can help make alcohol treatment more accessible and improve referral pathways. Local partner services can also provide in-reach within alcohol treatment services.

Intoxication (alcohol intoxication)

Alcohol intoxication is a clinically significant short-term condition that develops during or shortly after a person drinks alcohol. Intoxication is characterised by disturbances that are caused by the known pharmacological effects of alcohol on the central nervous system, including in:
- consciousness
- cognition
- perception
- affect (expression of emotional state)
- behaviour
- co-ordination
The intensity of these effects is closely related to the concentration of alcohol in the bloodstream. ICD-11 distinguishes between mild, moderate and severe intoxication. Alcohol intoxication can significantly increase the risk of suicidal ideation or behaviour.

You can find a more detailed definition of alcohol intoxication in the ICD-11 entry Alcohol intoxication (https://icd.who.int/browse/2025-01/mms/en#xx-xxxx-xxxx).

K

Keyworker

In alcohol treatment services, a keyworker is the staff member allocated to co-ordinate care and provide structured support to help the person through their treatment and initial recovery (see the definition of ‘structured support’ in this glossary). An important part of their role is to build and maintain a therapeutic relationship with the person.

L

Lived experience recovery organisations

Lived experience recovery organisations (LEROs) are autonomous projects or organisations led by people with lived experience of alcohol or drug problems and recovery. LEROs can form an important part of a recovery-oriented system of care (see definition of ‘recovery-oriented system of care’ in this glossary).

There is a more detailed description of LEROs in section 6.3.1.

M

Medically assisted (alcohol) withdrawal

Medically assisted withdrawal (often called detoxification or detox) is a treatment to help a person who is dependent on alcohol to stop drinking safely. It involves medication and clinical management to reduce withdrawal symptoms and prevent severe complications such as seizures, delirium tremens and Wernicke’s encephalopathy.

Moderate drinking (also called controlled drinking)

In this guideline, moderate drinking means drinking within the UK chief medical officers’ low risk drinking guidelines (https://www.gov.uk/government/publications/alcohol-consumption-advice-on-low-risk-drinking).

For adults who drink regularly or frequently (most weeks), the chief medical officers’ guideline says that, to keep health risks from alcohol to a low level, it is safest not to drink more than 14 units a week on a regular basis.

It also recommends that, if a person regularly drinks as much as 14 units per week, it is best to spread their drinking evenly over 3 or more days.

Multi-agency team

A multi-agency team is a group of professionals from different agencies (or services) who work together as a team to share information, co-ordinate care and deliver interventions. Multi-agency teams often work with people who have multiple needs.

Multidisciplinary team

A multidisciplinary team involves a number of professionals with clear individual responsibilities to help deliver and co-ordinate care of the person in treatment. Members of a multidisciplinary team can be staff of one organisation, or they can come from several different organisations (see definition of multi-agency team above).

Multiple disadvantage

In these guidelines, multiple disadvantage is defined as the co-occurrence and interaction of adverse circumstances leading to social exclusion, marginalisation and extreme inequality.

Complex, intersecting issues that can contribute to compounded disadvantage include:
- health inequalities
- poverty
- housing instability
- systemic discrimination
- family and individual history including adverse (traumatic) childhood experiences
As well as problem alcohol use, people can experience a range of other problems, for example:
- other substance use
- mental or physical health conditions
- conditions affecting cognitive functioning such as alcohol related brain damage
- domestic abuse
- sexual exploitation and violence
- homelessness
- interaction with the criminal justice system
N

Neurodiversity

Neurodiversity describes variations in the way people’s brains work, and the ways they think, learn and behave. It describes variations as differences, rather than deficits. The word neurodiversity refers to the diversity of all people, but it is often used in the context of autism, as well as other neurodevelopmental conditions such as attention deficit hyperactivity disorder, or dyslexia.

P

Practitioner

In this guideline, a practitioner is any person who is employed to provide care and support to people in health and care services, including alcohol treatment services. It includes both clinicians and alcohol workers.

Problem alcohol use

Problem alcohol use describes any pattern of alcohol use that causes a problem for the person who is drinking or for others. This will usually be harmful drinking or alcohol dependence. However, some people experience problems at lower levels of consumption. For some people, drinking any alcohol at all is a risk. For example, abstinence is vital for the health of people with advanced liver disease, including cirrhosis.

Psychoeducation

A psychoeducational approach involves the practitioner providing information and psychosocial support to the person so they can better understand and make changes in their alcohol use and associated problems.

R

Recovery

There are several definitions of recovery. In this guideline, we have used the definition used by Witkiewitz and others (2020):

a dynamic process of change characterized by improvements in health and social functioning, as well as increases in well-being and purpose in life.

Recovery is:
- an individual process or journey of moving on from problem alcohol and drug use
- built on hope to sustain motivation and support expectations of an individually fulfilled life
- about enabling people to gain a sense of control over their own problems, the services they receive and their lives
- about helping people to find opportunities to be active and contributing members of society
Recovery capital (also referred to as recovery resources)

Recovery capital is the range of life resources that can help a person to recover, such as:
- housing
- education
- employment
- supportive peers, family members and social networks
- health and wellbeing
Recovery-oriented system of care

A recovery-oriented system of care (ROSC) is a network of local services and community groups that help people to start and sustain recovery. A ROSC incorporates the insight and work of people with lived and living experience and their families at all levels of planning and delivery to:
- offer choice by providing a flexible and inclusive menu of services, community support and opportunities (including lived experience initiatives), recognising that there are many pathways to recovery
- provide a range of responsive and inclusive support and opportunities for people in recovery and their families
- build on the strengths and resilience of individuals, families, recovery communities and the wider community
Reflective practice

Reflective practice is a process that enables supervisees to engage in analytical thinking about a situation and understand how it has affected them and/or their practice. It enables the supervisee to identify areas for learning and development, and develop self-awareness. It also supports sharing and learning from colleagues, and offers a space for the supervisee to think about their own wellbeing.

Registered professional

As defined in the Professional Qualifications Act 2022: guidance for regulators (https://www.gov.uk/government/publications/professional-qualifications-act-2022-guidance-for-regulators), the ‘regulated workforce’ refers to roles that require an essential level of training for registration with a professional body to be able to fulfil the role.

A registered professional is a person who has completed the relevant training and has registered with the professional body for their role.

Relapse

In this guideline, relapse is when a person who has been maintaining a goal of abstinence or moderate drinking returns to a pattern of problematic drinking. Relapse is sometimes distinguished from lapse, where lapse is an occasion or short episode when a person does not maintain their drinking goal, after which they return to a pattern of abstinence or moderate drinking.

Relapse prevention

Relapse prevention is using psychosocial or pharmacological interventions to help a person maintain their drinking goals and reduce their risk of returning to a pattern of problematic alcohol use.

Psychosocial relapse prevention approaches include specific strategies to:
- help a person recognise and manage potential triggers for problematic drinking
- learn from any relapses
They also include interventions to support broader coping skills and interventions to support recovery.

Risk formulation

The Royal College of Psychiatrists’ information on formulating risk (https://www.rcpsych.ac.uk/members/supporting-your-professional-development/assessing-and-managing-risk-of-patients-causing-harm/formulating-risk) outlines that risk formulation brings together an understanding of personality, history, mental state, environment, potential causes and protective factors, or changes in any of these.

Risk formulation should aim to answer the following questions:
- how serious is the risk?
- how immediate is the risk?
- is the risk specific or general?
- how volatile is the risk?
- what are the signs of increasing risk?
- which specific treatment, and which management plan, can best reduce the risk?
S

Safeguarding (adults)

The care and support statutory guidance, available on the Care Act 2014: supporting implementation (https://www.gov.uk/government/publications/care-act-statutory-guidance) page, defines adult safeguarding as follows:

Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action.

Safeguarding (children)

Statutory guidance ‘Working together to safeguard children’ (linked under ‘Child protection’ in this glossary) defines safeguarding and promoting the welfare of children as:
- providing help and support to meet the needs of children as soon as problems emerge
- protecting children from maltreatment, whether that is within or outside the home, including online
- preventing impairment of children’s mental and physical health or development
- ensuring that children grow up in circumstances consistent with the provision of safe and effective care
- promoting the upbringing of children with their birth parents, or otherwise their family network through a kinship care arrangement, whenever possible and where this is in the best interests of the children
- taking action to enable all children to have the best outcomes in line with the outcomes set out in the Children’s social care national framework (https://www.gov.uk/government/publications/childrens-social-care-national-framework)
Severe mental health condition

In this guideline, severe mental health conditions include:
- schizophrenia, schizotypal and delusional disorders
- bipolar affective disorder
- severe depressive episodes with or without psychotic episodes
Significant harm

NSPCC child protection definitions (https://learning.nspcc.org.uk/child-protection-system/child-protection-definitions) describe significant harm as follows:

“Harm is the “ill treatment or the impairment of the health or development of the child” (Section 31, Children Act 1989 (http://www.legislation.gov.uk/ukpga/1989/41/section/31A); Article 2, Children (Northern Ireland) Order 1995 (http://www.legislation.gov.uk/nisi/1995/755/article/2/made); Scottish Government, 2023).

“Seeing or hearing the ill-treatment of another person is also a form of harm (Section 120, Adoption and Children Act 2002 (http://www.legislation.gov.uk/ukpga/2002/38/section/120); Section 28, Family Homes and Domestic Violence (Northern Ireland) Order 1998 (http://www.legislation.gov.uk/nisi/1998/1071/article/28); Scottish Government, 2023).

“Harm can be determined “significant” by “comparing a child’s health and development with what might be reasonably expected of a similar child”.

“Although there is no absolute criteria for determining whether or not harm is “significant”, local authorities such as social services, police, education and health agencies work with family members to assess the child, and a decision is made based on their professional judgement using the gathered evidence. For more information, see:
- Section 31 of the Children Act 1989 (England and Wales) (http://www.legislation.gov.uk/ukpga/1989/41/section/31A)
- Article 2 of the Children (Northern Ireland) Order 1995 (http://www.legislation.gov.uk/nisi/1995/755/article/2/made)
- The National guidance for child protection in Scotland (https://www.gov.scot/publications/national-guidance-child-protection-scotland-2021-updated-2023/documents/) (Scottish Government, 2023).”
Structured support

Structured support is the use of specific psychosocial interventions that are common in evidence-based psychological treatments for alcohol and drug use. In alcohol treatment services, the keyworker is usually responsible for offering structured support. There is a detailed description of structured support in section 5.5.

T

Tolerance

Tolerance is the need to consume more alcohol to get the same desired effect, and it develops in people who drink heavily and regularly. The effect of blood alcohol concentration on a person will decrease as tolerance develops. Tolerance decreases after a period of abstinence or reduced drinking.

Treatment and recovery plan (or care plan)

A treatment and recovery plan (or care plan) is a plan that is agreed between the assessor or allocated keyworker and the person in treatment. It is a record that specifies the person’s treatment and recovery goals, and interventions and actions to meet those goals.

The keyworker, supported by the multidisciplinary team, should regularly review the treatment and recovery plan with the person. They should adjust the plan at any time if it’s clear that it is not helping the person to meet their goals.

You can find more detailed information about treatment and recovery planning in chapter 4.

U

Unit of alcohol

The National Institute for Health and Care Excellence public health guideline Alcohol-use disorders: prevention (https://www.nice.org.uk/guidance/ph24) describes units of alcohol as follows:

In the UK, alcoholic drinks are measured in units. Each unit corresponds to approximately 8g or 10ml of ethanol. Serving volumes vary and the same volume of similar types of alcoholic drink (for example, 2 different brands of lager) can contain a different number of units, depending on the drink’s strength (that is, its percentage of alcohol by volume).

There is more information on the NHS Alcohol units (https://www.nhs.uk/live-well/alcohol-advice/calculating-alcohol-units/) page.

V

Vulnerable adult

In these guidelines, the term vulnerable adult broadly means an adult with care and support needs.

[Care and support statutory guidance (updated 2023 and linked previously under ‘Safeguarding (adults)’) says that a vulnerable adult may also be in need of safeguarding if the adult:
- has needs for care and support (whether or not the local authority is meeting any of those needs)
- is experiencing, or at risk of, abuse or neglect
- as a result of those care and support needs, is unable to protect themselves from either the risk or experience of abuse or neglect
W

Withdrawal

The physical and psychological symptoms that people who are alcohol dependent can experience when they stop drinking or reduce the amount of alcohol they drink.

Symptoms can vary in severity and how long they last. They are generally more severe in people who are severely dependent but there is wide variation among individuals. People experiencing acute withdrawal can experience serious complications. There is a list of common withdrawal symptoms and serious withdrawal complications in annex 3.