Alcohol-Related Brain Damage (ARBD) remains underdiagnosed and inconsistently managed across services, despite its significant impact on individuals. Improving access to appropriate support and treatment requires the integration of stakeholder perspectives. This study aimed to co-produce a service development pathway for ARBD in Wales through a structured consensus methodology. A hybrid World Café method was used. Stakeholders from health boards, local authorities, government, and third-sector organizations participated. Discussions focused on five key themes: identification and screening; diagnosis; referral and inclusion criteria; treatment and support; and training and confidence. Data were synthesized to produce actionable recommendations for service development.Key findings included the need for clearer referral pathways, consistent diagnostic processes, early and proactive screening, and improved access to both support. Participants emphasized gaps in workforce training and confidence, as well as the necessity of cross-sector collaboration.The findings demonstrate the value of stakeholder-led consensus approaches in addressing service gaps for ARBD. Key next steps include piloting pathway trials, establishing a center of excellence to coordinate practice and define roles, and investing in data infrastructure to support outcome monitoring and research. These efforts will be critical to ensuring scalable, sustainable improvements in ARBD care.