Substance misuse harms impact the vulnerable and disadvantaged most and are not inevitable

by Penelope Toff

This is part 1 of our blog series for Road Safety Week. Read part 2 exploring how the impact that alcohol and drugs, including prescription medicine, can impair safe driving and the role that government and doctors can play to reduce impaired driving

Location: UK
Published: Sunday 12 November 2023
car park

National Road Safety Week (19-23 November) provides a timely opportunity to raise awareness of the personal and societal impact of road traffic accidents (RTAs) caused by impaired driving due to alcohol or drugs.

In 2021, in the UK, there were 260 people killed and 6,740 injured by drink-driving and almost 2,500 injured by drug-driving – up by 260% since 2012. Worldwide, RTAs are the leading cause of death for children and young adults, more than half affect vulnerable road users: pedestrians, cyclists and motorcyclists and 73% are among men under the age of 25 years. In the UK, over a quarter of casualties caused by drink driving are under the age of 25. Moreover, the risk of being a victim of a drink or drug driving RTA represents only a fraction of the damage these substances cause; the wider harms include other accidental injury, physical illness, mental ill-health and domestic violence.

Alcohol and drugs do the most harm to the most vulnerable and in the most deprived communities

The wider harms of alcohol and drugs are estimated to cost UK society over £30 billion a year and central to a call for action, is acknowledging and addressing the inequalities in who is most impacted. The evidence shows that those from vulnerable and disadvantaged groups are more likely to be affected by the harmful impacts of alcohol and drugs.

People living in the most deprived areas of England are twice as likely to die from the direct effects of drinking alcohol – for example from alcoholic liver disease. They are also nearly twice as likely than those living in the least deprived areas, to die from causes related to alcohol intake, such as chronic kidney disease and some cancers. The term “alcohol harm paradox” describes how, despite people on lower incomes drink less on average than those on higher incomes, people living in deprived areas are more likely to experience alcohol-related harm or death. There is also a close association between the use and harms from some illicit drugs, particularly opiates and crack/cocaine and poverty and deprivation.

Funding cuts mean a lack of prevention and specialist treatment services

Drug driving statistics show that almost 1 in 4 are repeat offenders and since 2010, more than 1 in 6 drink drive offences in England were charged to repeat offenders, suggesting deeper dependence issues. However, the vast majority (82%) of those dependent on alcohol in England do not receive treatment, with a lack of access to and awareness of support being the main reasons.

Community treatment services are frequently not available because of the drastic funding cuts to local public health services in England. The Public Health Grant has been cut by 26% in real-terms since 2015-16, resulting in a particularly large reduction in the availability of drug and alcohol treatment services and these service cuts have tended to be greater in more deprived areas

A decade of austerity has resulted in a worsening of the underlying socio-economic causes of substance abuse and a lack of capacity to engage in preventative measures for individuals and communities, as well as under-staffing in specialist healthcare services. For example, already dwindling Addiction Psychiatry training posts – a specialty which makes up a mere 1% of the workforce in this sector - could be wiped out in the next decade.

Addressing alcohol and drug driving harms is important but must be alongside decisive action on wider harms and inequalities

A holistic approach, which includes legislation but also addresses inequalities is necessary to reduce alcohol and drug-related harm. Over the past decade, government policies of austerity and a failure to prioritise prevention, have led to greater poverty and ill-health, including harms resulting from substance use. To reverse this direction of travel, a public health approach is required focusing on reducing underlying inequalities, by improving and mitigating disadvantageous socio-economic circumstances.

Decisive cross-government action is also needed on all the drivers of substance abuse. The last UK alcohol strategy was published in 2012 but many of its commitments, such as minimum unit pricing, are not yet implemented across the UK. An updated alcohol strategy is needed, like that announced by Government for smoking and drugs, with the political will and investment to carry out recommendations in full.

So, as well as campaigning for a reduction in the legal blood alcohol content for driving, the BMA is calling for initiatives to raise public and professional awareness of the risks of impaired driving, investment to increase the availability of community and specialist treatment services and action on health inequalities and the social determinants of health. Ultimately this approach is essential to reduce the health, social and economic harms caused by alcohol and drugs and allow individuals, communities and our society to thrive.


Penelope Toff is co-chair of the BMA public health medicine committee and UK council deputy chair, south central regional council