Alcohol plays an important role in many societies. Over 90% of adults in the UK – nearly 40 million people – consume alcohol, and it is widely associated with pleasure and relaxation. Drinking in moderation can also confer some health benefits (Cabinet Office Strategy Unit, 2003). Sensible drinking may:

Alcohol makes a substantial contribution to the UK economy, with the drinks market generating approximately one million jobs and excise duties on alcohol raising about £7 billion per year (Cabinet Office Strategy Unit, 2003).

However, alcohol contributes 4% to the total disease burden worldwide, as measured by disability-adjusted life years (DALYs) (Rehm et al, 2003). This burden is greater in high-income countries (9% DALYs), where alcohol ranks third after smoking and hypertension among the leading causes of morbidity and premature death.

The costs of alcohol misuse in the UK are around £20 billion a year (Cabinet Office Strategy Unit, 2003), with £1.7 billion directly related to health costs. In the UK, alcohol-related disease accounts for 1 in 26 hospital bed days and up to 35% of all attendances at accident and emergency departments and ambulance costs. Up to 150 000 hospital admissions are related to alcohol misuse. It has also been estimated that 1 in 15 doctors may, at some time, experience problems with drugs or alcohol (British Medical Association, 1998) (see Chapter 32 for further discussion of this issue).

The World Health Organization (WHO) has been committed to reducing the burden of alcohol-related problems for over three decades (Brunn et al, 1975). The first WHO European Alcohol Action Plan was introduced in 1992. It aimed to reduce consumption by 25% and had a particular focus on reducing harmful use, although in fact only three countries (Italy, Poland and Spain) achieved this target (Institute of Alcohol Studies, 2003).