Intended for healthcare professionals


Managing alcohol use in primary care

BMJ 2020; 371 doi: (Published 25 November 2020) Cite this as: BMJ 2020;371:m4129

Linked Research

Treatment interventions to maintain abstinence from alcohol in primary care

  1. Jim McCambridge, professor1,
  2. Duncan Stewart, professor2
  1. 1Addictive Behaviours and Public Health, University of York, York, UK
  2. 2Applied Health Research, London Metropolitan University, London, UK
  1. Correspondence to: J McCambridge Jim.McCambridge{at}

Recognised problem drinking is just the tip of the iceberg

People who struggle with alcohol problems are stigmatised in extraordinary ways. The UK treatment system has been partly dismantled and cheaper provision outside the National Health Service accepted.12 Predictably, much of the burden of alcohol related disease is borne by hospitals,2 not least because there is little alcohol treatment available in primary care.3

Even seemingly unremarkable drinking is implicated in a wide range of health issues.4 Usually unnoticed, alcohol interferes with the everyday work of primary care.5 This dysfunctional situation requires high level strategic planning6 to clarify the role of primary care in managing the UK’s problematic relation with alcohol.

The linked study by Cheng and colleagues (doi:10.1136/bmj.m3934) used network meta-analysis to examine the evidence underpinning mostly drug interventions for maintaining abstinence after detoxification.7 The authors found that existing evidence for drug treatments is weak. Treatment for problem drinking usually starts before detoxification, and what to do afterwards is the …

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