Alcohol use disorder: an Australian perspective on screening, diagnosis, treatment and prevention.

This article reviews the burden of alcohol-related harm in Australia and highlights major gaps in policy and clinical practice.

Key points:

• Alcohol-related harm: Alcohol causes more death, disease and economic harm than all illicit drugs combined and contributes 4.1% of the national disease burden, yet remains relatively neglected in health policy and service planning.
• Sources of harm: Most harm arises from hazardous drinking and untreated alcohol use disorder (AUD), which is common, heavily stigmatised, under-recognised, and rarely managed with evidence-based care.
• Inequitable impact: Harms are inequitably distributed, disproportionately affecting First Nations peoples, rural communities and socioeconomically disadvantaged groups.
• Concerning trends: Concerning trends include rising hospitalisations for alcohol-related liver disease and emerging evidence linking alcohol causally to early-onset colorectal cancer, reinforcing alcohol’s role as both a hepatotoxin and multisystem carcinogen. Harm occurs at younger ages and lower consumption levels than previously appreciated.
• Public understanding: Despite strong evidence that no level of alcohol use is safe, public understanding is clouded by industry influence and inconsistent health messaging.
• Underuse of treatments: Evidence-based treatments for AUD, including approved pharmacotherapies, are substantially underutilised: only 2.9% of affected Australians receive such medications, and treatment is often delayed by nearly two decades.
• Policy measures: Population-level measures (taxation, pricing, marketing restrictions) are identified as the most effective policy tools, but implementation is weak, exemplified by the reversal of minimum unit pricing in the Northern Territory.
• Call to action: The authors argue that clinicians should reframe hazardous drinking and AUD as primary, treatable drivers of alcohol-related disease, and actively advocate for evidence-based, patient-centred treatment and stronger public policy. Addressing AUD directly is presented as the most effective strategy to reduce alcohol-related harm nationally.