Public discourse on alcohol increasingly emphasises declining average consumption, particularly among younger cohorts. While per-capita consumption has fallen to its lowest figure since data collection began², hospital admissions for alcohol-specific conditions remain at 339,916 annually (2023/24)¹, indicating that population-level trends may obscure persistent concentrations of harm. Drawing on nationally representative polling of 2,037 UK adults conducted in December 2025, this white paper identifies five empirical findings (Sections 2-6) with direct implications for policy design, service commissioning, and clinical pathway development.

First, clinical risk and self-identification are systematically misaligned. Among the 25.8% of adults meeting AUDIT-C criteria for increasing or higher risk of alcohol dependence, 90% do not self-identify as heavy drinkers. Among self-identified “moderate” drinkers, 58.6% meet clinical criteria for at least increasing risk. This disconnect is structural, not confined to individuals in denial, and has significant implications for service access models predicated on self-referral.

Second, alcohol harm has substantial reach beyond the index population. Nearly half of UK adults (49.3%) report knowing someone they consider a heavy drinker. Of these, 25.1% identify a close family member, 18.1% a colleague, and 10.8% a partner. Among higher-risk drinkers themselves, 70% know someone they consider a heavy drinker. This diffuse social exposure suggests that families and colleagues may recognise escalating risk before formal services engage, yet current pathways offer limited mechanisms for family-supported intervention.

Third, the primary barriers to accessing support are system capacity and stigma, not information deficit. Among higher-risk drinkers, the most frequently cited barriers are long NHS wait times (24.5%), fear of stigma (24.1%), and cost of private healthcare (19.4%). “Not knowing where to go for help” ranks sixth at 16.9%, suggesting that awareness campaigns alone are unlikely to address the structural impediments preventing help-seeking behaviour.

Fourth, workplace prevalence is significant and associated with identifiable stressors. Among full-time workers, 30.8% meet AUDIT-C criteria for increasing or higher risk, with 40% of this cohort earning £50,000 per annum or more. Among higher-risk full-time workers, 58.2% attribute their drinking to specific life stressors, with work pressures cited at 1.8 times the general rate (25.7% vs 14.3%). This pattern suggests a stress-response dynamic rather than individual pathology, with implications for upstream workplace interventions.

Fifth, higher-risk drinking is cross-political and geographically distributed. All major political constituencies show 22-34% higher-risk drinking prevalence (a range of 11.9 percentage points), and no statistically significant regional variation was observed. This distribution indicates that targeted geographic or demographic commissioning strategies may systematically exclude substantial affected populations.

These findings challenge several assumptions embedded in current policy frameworks: that declining average consumption correlates with declining harm; that self-identification is a reliable service access mechanism; that information provision addresses the primary barriers; that workplace alcohol issues reflect individual pathology rather than systemic stress; and that demographic or geographic targeting efficiently captures affected populations. 

The paper concludes with four evidence-linked recommendations: create alternative pathways that reduce NHS wait times and stigma barriers, including digitally-enabled home-based detoxification models; implement objective AUDIT-C screening and identity-neutral service framing; address upstream work stressors as a preventive strategy; and enable family-inclusive pathways with appropriate safeguards. These proposals are grounded in the empirical findings presented but require further testing, economic evaluation, and implementation research to establish effectiveness and cost-efficiency.