What all doctors should know about managing drug and alcohol misuse


All postgraduate doctors across all specialties should be aware of this new consensus paper produced by a special working group of 13 medical Colleges and Faculties. The report presents the core competencies that all postgraduate specialist trainees should have in relation to managing drug and alcohol misuse.

It’s well reported that substance misuse is a costly problem for the NHS, with £3bn spent on alcohol related hospital admissions in 2009-10 alone. Unfortunately, clinicians often miss out on opportunities to identify alcohol and drug problems in their patients, so effective treatments are rarely delivered.

The report recommends the following core competencies for all postgraduate trainees:


  • …Effects, common presentations and potential for harm of alcohol and other drugs.
  • Addictive potential of alcohol and other drugs, including prescribed and over-the counter medicines.
  • Range of interventions, treatments and prognoses for use of alcohol and other drugs.
  • Effects of alcohol and other drugs on the unborn child, children and families.
  • Recommended limits on alcohol intake.


  • …Be competent to make an assessment of alcohol and other drug use, including taking a history and using validated tools.
  • Recognise the wide range of acute and long-term presentations involving use of alcohol and other drugs (e.g. trauma, depression, hypertension)
  • Provide brief advice on use of alcohol and other drugs.
  • Provide management and/or referral where appropriate.


  • …Work in a supportive, empathic and non-judgemental manner without collusion.
  • Be confident and comfortable discussing alcohol and drug use with patients.
  • Act appropriately.

The aim of this report is that these core competencies are taken up by the Colleges’ postgraduate medical and surgical training curricula.


Alcohol and other drugs: core medical competencies. Final report of the working group of the medical Royal Colleges (PDF). Royal College of Psychiatrists (Occasional Paper OP85), June 2012.

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