Experts call for national strategy to address alcohol-related harms in the UK

The UK needs an overarching national strategy to tackle alcohol related harms, argue experts in The BMJ today, as deaths from alcohol in England reach their highest level on record.

Julia Sinclair at the University of Southampton and colleagues warn that successive government cuts have led to reduced provision and quality of alcohol treatment, and say sustained funding is needed for screening and care, while industry must also shoulder some of the costs.

Alcohol is widely available and drunk by around 80% of adults in the UK and is now well established as a leading preventable cause of cancer and a significant contributor to health inequalities and premature death, they explain. 

Deaths from alcohol specific causes in England rose by 42% between 2019 and 2023, the highest number on record, most of them from alcohol related liver disease.

Yet they argue that successive government budget cuts have led to reduced provision and quality of alcohol treatment since the Health and Social Care Act 2013.

For instance, in 2020-21, less than 1% of people being treated for alcohol dependence in England and Wales received treatment in a residential rehabilitation setting, compared with the European average of 11%, and only 15-18% of people who are alcohol dependent access alcohol services.

As a result, unscheduled hospital admissions for alcohol withdrawal have increased substantially, highlighting a missed opportunity for early intervention and saving NHS resources.

A national strategy to tackle the harms caused by alcohol is long overdue and important for reducing health inequalities, they say.

This includes routine screening in primary care, acute hospitals, and mental health services to help clinicians identify higher risk alcohol use and related harms, such as liver disease, at an earlier stage. This, in turn, would improve outcomes, better target treatment where it is most effective, and generate data to facilitate quality improvements.

Sustained funding is also needed to develop and deliver integrated alcohol care pathways across health and social care, they say. 

For instance, between 2010 and 2020, 48% of people who died by suicide while under the care of mental health services had a history of problematic alcohol use. Yet despite numerous policy recommendations, few mental health trusts have a crisis care pathway in place to respond to the needs of suicidal people who are also alcohol dependent.

A national strategy would also help frame a more consistent response to the tobacco, gambling, and alcohol industries, they add, noting that whereas the gambling industry is subject to a "polluter pays" levy for associated health and social harms, alcohol producers have received a decade of cuts or freezes to alcohol duty, widening rather than limiting their market. 

They point to Scotland's alcohol strategy, which established national data systems on hospital admissions for alcohol harm by levels of deprivation, introduced public health measures (including a minimum unit pricing) and evaluated its impact.

"The costs of alcohol harms to individuals and society are well documented, at over £27bn in England alone, but, as the progress made in Scotland shows, much can be done when there is the government will to do it," they conclude.