Implementation of evidence-based alcohol policies to reduce alcohol-related harm and liver disease to advance public health in Europe. [Review]

Abstract

Alcohol-related liver disease (ALD) remains a leading cause of preventable morbidity and mortality in Europe. Despite robust evidence that alcohol-related population-level policies delay use initiation and reduce associated harms, their implementation in Europe has been inconsistent and frequently undermined by alcohol industry interference, fragmented governance, and policy inertia. The burden of ALD as well as combined metabolic dysfunction and alcohol-associated liver disease (MetALD) has grown steadily, driven by increased alcohol intake, widespread metabolic risk factors, delayed diagnosis, and poor integration between primary care, substance use services, endocrinology, and hepatology. In this Series paper, we combine epidemiology, policy evaluations, and clinical evidence to examine these findings through the lenses of policy, system preparedness, education, and stigma. We highlight screening strategies for alcohol use and liver disease and describe models of multidisciplinary and digital care. Finally, we outline priorities for policy reform, stigma reduction, youth-focused prevention, and research on biomarkers, pharmacotherapies, and digital/artificial intelligence tools.