Intended for healthcare professionals


Alcohol—who is paying the price?

BMJ 2015; 350 doi: (Published 05 June 2015) Cite this as: BMJ 2015;350:h2974

Re: Alcohol—who is paying the price?

In a purely business sense the UK alcohol industry is a tremendous success. Production and sales make a major contribution to the economy and future global sales are predicted by many to increase. Alcohol use has been firmly embedded in our society for centuries and is likely to remain so in the future. Nevertheless, we do agree with Gilmore and many others, alcohol is a major public health problem and effective action is needed.(1-4)

Alcohol is a significant cause of mortality, morbidity and disability internationally and in the UK. (2-4) It is associated with more than 60 adverse health consequences.(2) Some doctors and nurses have to face the consequences of alcohol misuse every day, for example, supporting patients suffering from long term ill health as a result of sustained alcohol abuse or dealing with aggressive and violent patients in A&E departments. Alcohol misuse is also associated with a wide range of anti-social behaviors and crimes, and it can significantly impact on relationships and family life.(2)

Some of the issues related to this public health problem include: low cost and availability; over consumption by certain groups; excessive drinking seen as norm by certain sections of society; considerable budgets used for advertising and promotion; the political power of the pro alcohol lobby; and, the lack of resources dedicated to solving this public health problem.

There are known evidence based solutions available.(2,4-6) However, in the past there has been an over-reliance on information campaigns and these on their own are usually ineffective.(2) Educational measures need to be complimented by environmental measures.(7) Action is needed in relation to availability, pricing, advertising and social norms. So that when individuals are making decisions it will be easier for them to choose a more positive option. In relation to social norms there is clear evidence from past public health successes that these can be changed, for example, not drinking and driving and, no smoking in enclosed areas.

Schools have an important role in providing education about alcohol though Personal, Social and Health Education programmes. The Alcohol Education Trust (AET) provides peer reviewed and piloted resources for teachers, young people and their parents. Their Talk About Alcohol interventions take a harm minimisation approach and give teachers free tools to encourage students to make informed decisions, and tactics to help them manage difficult situations.(8) The National Foundation for Educational Research undertook an independent evaluation of the impact of the interventions, by comparing the knowledge, awareness, attitudes and behaviour of students age 11-16 who use the AET resources.(9) The evaluation showed the intervention had a statistically significant impact on the age at which teenagers start to drink. There was also a significant association between the Talk About Alcohol intervention and increased knowledge of alcohol and its effects.

The work of AET is consistent with advice from NICE which states that children and young people should learn about keeping healthy and safe, and about alcohol use and its effects. NICE recommend that this should be done by giving young people the chance to talk about the issues involved as it would help them to develop knowledge, attitudes and skills needed to support their health and wellbeing.(10)

Doctors and nurses have crucial roles to play in tackling this important public health problem, including prevention and treatment. To assist them there are now clear guidelines in relation to prevention, diagnosis, assessment and management of harmful drinking.(5,6) But there are missed opportunities to provide effective interventions, as alcohol misuse is under-identified by health and social care professionals.(6,11) Although improved training is one issue the lack of resources in primary care is also very important.(12)

There are now evidence-based alcohol interventions available to serve the public good.(2, 4-6,10) Overall, reduced consumption by certain groups and a targeted approach are needed. This will require a coordinated, systematic response involving a wide range of players including doctors, nurses, teachers, police, legislators, retailers and industry. However, the government must take a lead and there are key actions that are needed.(4) As a country we have an alcohol industry that in a business sense is a great success, we should be building on this and creating a country that in relation to alcohol is also a health success?


1) Gilmore I. Alcohol—who is paying the price? Britain can’t afford to foot the £21bn bill that alcohol delivers annually to the economy. BMJ 2015;350:h2974

2) BMA. Alcohol misuse: tackling the UK epidemic. London: BMA, 2008.

3) Rehm J, Mathers C, Popova S, et al. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol use disorders. Lancet 2009;373:2223-33.

4) World Health Organization. Global status report on alcohol and health. Geneva: World Health Organization, 2014.

5) NICE. Alcohol-use disorders: preventing harmful drinking. NICE guidelines [PH24]. London: NICE, 2010.

6) NICE. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. NICE guidelines [115]. London: NICE, 2011.

7) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.

8) Alcohol Education Trust. TALK ABOUT ALCOHOL! 2015 [viewed 16 June 2015]. Available from:

9) Lynch, S., Styles, B., Dawson, A., Worth, J., Kerr, D. and Lloyd, J. Talk About Alcohol: an Evaluation of the Alcohol Education Trust’s Intervention in Secondary Schools. Slough: NFER, 2013. [viewed 14 June 2015]. Available from:

10) NICE. School-based interventions on alcohol. NICE guidelines [PH7]. London: NICE, 2007.

11) European Alcohol Policy Alliance. EUROCARE RECOMMENDATIONS FOR A FUTURE EU ALCOHOL STRATEGY. Brussels: Eurocare, 2014.

12) Royal College of General Practitioners. New league table reveals GP shortages across England, as patients set to wait week or more to see family doctor on 67m occasions. 2015 [viewed 16 June 2015]. Available from:

Competing interests: No competing interests

17 June 2015
Michael Craig Watson
Associate Professor of Public Health
Dr John Lloyd (Immediate Past President, Institute of Health Promotion and Education).
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA