There has been much recent debate and criticism of UK alcohol policy (Drummond, 2004; Hall, 2005). Over the past 20 years, per capita alcohol consumption in Britain has increased by 31%, leading to large increases in the prevalence of alcoholic cirrhosis, alcohol-related violence and heavy alcohol use. Alcohol misuse causes at least 22 000 premature deaths each year and costs the taxpayer an estimated £20 billion (Prime Minister's Strategy Unit, 2003). The key features of alcohol dependence and harmful use are listed in Box 6.1. About 5% of the UK population are dependent on alcohol (Farrell et al, 2001) and 8 million Britons drink more than recommended levels.

In their review of seven multicentre studies in the USA and Europe, involving over 8000 treatment-seeking individuals, Miller et al (2001) found that overall mortality at 1-year follow-up was about 1.5%. Clients reported an 87% reduction in alcohol consumption, with abstinence on 80% of days. Overall, 24% were abstinent for the entire year, and a similar proportion resumed controlled, problem-free drinking. These results were validated using confidants (often the client's spouse). Most relapses occurred within the first 3 months. These results are supported by other studies, including a more recent review of alcohol treatment from the Scottish Executive (Ludbrook et al, 2005). By contrast, Vaillant (1983) estimated that 2–3% of alcohol-dependent individuals in the USA abstain spontaneously each year in the community.