The landscape of substance misuse in the UK is depressingly familiar to most clinicians. It includes high levels of alcohol misuse, particularly binge drinking by younger people and steady heavy drinking among the affluent retired. Almost 300 000 people use heroin and crack cocaine, and a heavy health burden of morbidity and premature mortality is associated with drugs, alcohol, and tobacco. The struggles to get to grips with these last two are highlighted in articles in this month’s BJGP. Jamie Brown and colleagues found that smokers in England who reported visiting their GP appeared more likely to receive advice on their smoking than those drinking excessively were to be advised about their alcohol consumption: 50% of smokers recalled receiving a brief intervention on smoking whereas less than 10% of those drinking excessively recalled having …