International research consistently demonstrates that alcohol and tobacco use routinely rank at the top of modifiable risk factor league tables as contributing to global morbidity and mortality, with illicit drug use also often a feature of top ten lists.Reference Degenhardt, Charlson, Ferrari, Santomauro, Erskine and Mantilla-Herrara1 Despite alcohol- and drug-related pathology affecting almost every organ system, and being frequent features of presentations to medical, surgical and psychiatric specialties, there is often a perception that management of an individual’s underlying drug or alcohol use is not the purview of the current treating professional.Reference Van Boekel, Brouwers, Van Weeghel and Garretsen2 This situation appears unfortunately paralleled within many areas of healthcare research, with typically low numbers of studies recruiting participants with comorbid drug and alcohol problems.
Alcohol, tobacco and/or other drug use may have material and lasting impacts on both individual- and population-level physical and mental health. As academic journals remain trusted sources of evidence and research, provisioning a wide array of clinicians, researchers and policy makers, this article argues that encouragement, support and publication of research in this area are vital and may have a substantial and positive impact on reducing the record levels of preventable substance-related harm currently manifest across the globe.Reference Degenhardt, Charlson, Ferrari, Santomauro, Erskine and Mantilla-Herrara1,3,4 The British Journal of Psychiatry (BJPsych) editorial board acknowledges the clinical importance of these issues, recognises that more needs to be done and seeks to reaffirm BJPsych’s commitment to publish drug- and alcohol-related research. This Editorial serves as a prompt and a reminder to all that BJPsych is keen to publish high-quality research in this field.
Why is the British Journal of Psychiatry currently acutely aware of these issues?
Over the past decade the UK has experienced record levels of drug- and alcohol-related harm, with simultaneously observed declines in the numbers of both people accessing drug and alcohol treatment services and researchers active in this area.5 In 2024, the Drug and Alcohol Treatment and Recovery Workforce Census in England reported that less than 0.2% (n = 59) of staff were medically trained specialists, the number of full-time equivalent consultant posts having more than halved over the previous decade.6 Contemporaneous legislative changes also resulted in substantial reductions in funding and changes to the commissioning structure of community drug and alcohol services, with most English service contracts now subject to competitive tendering. Notably, over two-thirds of services are now provided by the voluntary, community and social enterprise sector as opposed to the National Health Service (NHS).5 This has led to a significant reduction in the ability to train registered professionals, and in the availability and integration of the drug and alcohol workforce within healthcare settings, during a period over which the number of national drug- and alcohol-related deaths has continued to set tragic new records with each passing year.3,4 Given the ubiquity of ill health attributable to drug and alcohol use, as evidenced by the staggering statistic that over a third of patients entering UK hospitals are estimated to harmfully use alcohol,Reference Roberts, Morse, Epstein, Hotopf, Leon and Drummond7 models of both healthcare delivery and research that artificially separate and silo the treatment and understanding of problematic drug and alcohol use inevitably result in systems that are inefficient and hinder the provision of holistic, person-centred care.
Given the currently observed extreme levels of drug- and alcohol-related harm, one might assume that the orientation of healthcare and research ecosystems may shift in response. However, ongoing stigma, and the persistent commercial framing of problematic drug and alcohol use as an individual moral failure, continue to contribute to these modifiable risk factors being afforded Cinderella status.Reference Van Boekel, Brouwers, Van Weeghel and Garretsen2 The recent Independent Review of Drugs noted the parlous state of the national drug and alcohol treatment system following over a decade of sustained funding cuts, with the review’s recommendations paving the way for renewed investment in both treatment delivery and research infrastructure.5 Multiple organisations have subsequently led initiatives seeking to specifically improve integration between drug and alcohol and wider mental health provision, with a focus on the management of individuals with co-occurring substance use and mental health disorders.8 Given the high number of individuals presenting with these disorders, it is vital that funding agencies support calls that acknowledge this comorbidity, and that the content of BJPsych and other, non-specialist, mental health journals reflects the clinical realities faced by a general psychiatric audience. We would hope that authors of any future research outputs, including those that may be generated via this renewed energy and funding, will now consider BJPsych a receptive and suitable home.
A commitment to champion and publish relevant research
The BJPsych recently published an editorial pledging its commitment to publish science that is conducted with integrity and rigour and, equally importantly, that concerns the provision of care to vulnerable populations.Reference Malhi, Adlington, Al-Diwani, Ali, Arya and Baldwin9 In the current international landscape, changes to research priorities and funding structures that may restrict the study of marginalised communities who may have experienced trauma and/or interpersonal violence are likely to disproportionally, and indeed negatively, affect individuals who use drugs and alcohol.
The ultimate goal of professions working across public health and the psychological, psychiatric and neuroscientific landscape is to alleviate the distress and suffering caused and conferred by mental and behavioural disorders. The harms related to alcohol and drug use should not be subject to assumptions, such as the oft-quoted assertion that they fall outside the remit of the sphere of influence of these professions, or that they are somehow different or less important than other modifiable risk factors. We are acutely aware as an editorial board that, when discussing drug and alcohol use, BJPsych affiliates often anecdotally report hearing colleagues state that the journal ‘doesn’t publish that kind of research’ or that they ‘only care about cannabis’. While it would be presumptuous of BJPsych to think that we might be able to reorient the field entirely, what is perhaps in our power is to recommit to publishing research that aims to improve the lives of the millions of individuals who experience harm following the use of drugs and alcohol. Put another way, we are renewing our vows, and we encourage editors of non-specialist journals worldwide to join us and do the same so that we can jointly ensure that the modifiable risk factors causing the highest levels of morbidity and mortality globally are tackled with the urgency they merit.
Data availability
Data availability is not applicable to this article as no new data were created or analysed in this study.
Author contributions
All authors meet all criteria for authorship in the International Committee of Medical Journal Editors recommendations. Contribution of article co-authors as per the Contributor Roles Taxonomy author statement: E.R.: conceptualisation, investigation, writing – original draft, review and editing, project administration. E.F.: writing – review and editing, supervision. A.L.-H.: writing – review and editing, supervision.
Funding
This work is supported by the corresponding author’s National Institute for Health and Care Research (NIHR) Advanced Fellowship (no. NIHR302215). The views presented here are those of the authors and should not be attributed to the National Health Service, NIHR, the Department of Health and Social Care or the Office for Life Sciences. The funders had no contribution to the study design; to the collection, analysis and interpretation of data; to the writing of the report; and to the decision to submit the article for publication.
Declaration of interest
E.R. is a member of the BJPsych editorial board. He did not take part in the review or decision-making process of this paper. The authors declare no other competing interests and acknowledge the comments and feedback from the editor-in-chief on an earlier draft of this editorial.
Transparency declaration
E.R. affirms that the manuscript is an honest, accurate and transparent account and that no important aspects have been omitted.
Emmert Roberts is a senior clinical lecturer in addiction psychiatry at King’s College London and a consultant addiction psychiatrist at the South London and Maudsley NHS Foundation Trust.
eLetters
No eLetters have been published for this article.