A joint problem drinking clinic: the King's College and Maudsley hospitals initiative.

We describe the establishment of a joint alcohol misuse clinic, staffed by both a psychiatrist and a physician, in a London Teaching Hospital providing general as well as specialist medical services. The demographic and medicopsychiatric problems of the first 100 referrals (60% attendance rate) are described. The clinic provides an assessment and re-education role for most patients referred with alcohol misuse problems: the need for specialist alcohol treatment facilities, especially for in-patients, remains essential. In addition, the clinic provides a valuable training and research resource.

Alcohol misuse as challenge to medical education: a belated remedy.

Substance misuse contributes directly or indirectly to each of the 5 key targets outlined in the Health of the Nation strategy: coronary heart disease and stroke, cancers, mental illness, HIV/AIDS and accidents. More specifically, the risk factor targets include a 30% reduction in the prevalence of cigarette smoking to no more than 20% in both men and women by the year 2000; a 30% reduction in the proportion of men drinking more than 21 units of alcohol per week and women drinking more than 14 units per week to 18% and 7% respectively, and reduction in the percentage of drug misusers sharing equipment to no more than 5% in the year 2000. The Tomlinson report repeatedly underscores the problems of drug misuse, alcohol problems and mental illness in Inner London. Both these recent reports admit to a 'lack of trained professionals' (p17) and to 'ensuring that professionals ... are adequately and appropriately educated' (p97). Furthermore, Health of the Nation declares that 'Professional bodies in health and social work will continue to design training to promote the early identification of alcohol misuse, and appropriate referral skills' (p16).