Table of contents


Background papers: Lifestyle and wider determinants :: Alcohol [Update in progress] :: Summary

Alcohol plays an important role in society, making an important contribution to the economy.[1] However misuse of alcohol leads to a range of public health problems. Acute conditions, such as alcoholic poisoning, violence and accidents as well as the more chronic effects, such as alcohol–induced pancreatitis, chronic liver disease and stomach cancer all potentially lead to reduced health and wellbeing and at worst, loss of life. Alcohol can and does affect all of society, from the burden on the NHS in terms of hospital admission and treatment in primary care, the economic burden due to loss of employment and reduced capacity to work, through to other negative effects of alcohol on the social and behavioural welfare of communities.[2]

As alcohol has become increasingly affordable, consumption has increased by 121% between 1950 and 2000. It is estimated that alcohol misuse is now costing around £20bn a year. This is made up of alcohol–related health disorders and disease, crime and anti–social behaviour, loss of productivity in the workplace, and problems for those who misuse alcohol and their families, including domestic violence.[3] Health inequalities are clearly evident as a result of alcohol–related harm; Department of Health analysis of Office for National Statistics (ONS) data indicates that alcohol–related death rates are about 45% higher in areas of high deprivation, and liver disease represents one of the few diseases where the inequalities gap is increasing.

Key issues and gaps

  1. Post–treatment and wrap–around services provision is currently under resourced. Treatment services are commissioned but access to aftercare/recovery support is limited for alcohol users.
  2. Dual–diagnosis continues to be a service gap with adequate provision and pathways for those with both substance misuse and mental health issues.
  3. Intervention and Brief Advice (IBA), alcohol referral and pathways are not embedded in the Foundation Trust Hospital but have been shown to prove effective in reducing repeat attendances and admissions.[4]
  4. Alcohol IBA is an intervention in itself and does not necessarily need to result in a referral to treatment services—this is not fully identified by healthcare professionals. Further training in IBA to all healthcare professionals to utilise IBA as an early prevention/intervention tool is required.
  5. Increased provision of services to meet DH recommendations of 15% of dependent drinkers.


[1]   Jones L, Bellis M, Dedman D, et al. Alcohol-attributable fractions for England June, 2008; Centre for Public Health, Liverpool John Moores University.
[2]   Association of Public Health Observatories. Indications of Public Health in English Regions 8:Alcohol August, 2007; Association of Public Health Observatories.
[3]   Prime Minister's Strategy Unit. Alcohol Harm Reduction Strategy for England 2004; UK Government. .
[4]   Ryder S, Aithal G, Holmes M, et al. Effectiveness of a nurse-led alcohol liaison service in a secondary care medical unit Clin Med 2010; 10 (9): 435-40.