In this blog and accompanying video, Dr Kieran Moriarty CBE, Non-Alcoholic Trustee, Alcoholics Anonymous and Consultant Gastroenterologist, reflects on more than 35 years of pioneering work to transform the way hospitals support people with alcohol use disorders. From identifying gaps in care in Bolton in the early 1990s to helping establish Alcohol Care Teams as a recognised model across the UK, he shares the story of how a commitment to compassionate, integrated and person-centred care has improved outcomes for patients across the country. He also discusses how members of Alcoholics Anonymous can cooperate with members of Alcohol Care Teams, especially alcohol specialist nurses and ward nurses, to help people with alcohol use disorders achieve abstinence and lifelong remission, remove stigma and guilt and be reunited with their families and loved ones.

Link to Video

When I arrived at Bolton NHS Foundation Trust (NHSFT) in 1990 as its first Consultant Gastroenterologist, I kept seeing the same painful pattern repeat itself. Patients would be admitted over a weekend in acute alcohol withdrawal. They’d be detoxified over several days, discharged with no follow-up, and then readmitted weeks later under a different consultant. Didn’t these patients deserve better?

That question drove everything else that followed.

Building a different model of care

The first step was simple: I wrote to my consultant colleagues and local GPs asking them to refer all patients with alcohol and liver problems to me. Working alongside Dr Stephen Liversedge, the General Practice lead in Public Health, we built an integrated primary and secondary alcohol and liver care service.

I established a multidisciplinary team (MDT) that brought together ward and endoscopy nurses, doctors, physiotherapists, an occupational therapist, a pharmacist, and a social worker, who could find accommodation for patients on discharge.

I also received inspiration and guidance from the superb alcohol care teams being developed by Sir Ian Gilmore and Lynn Owens in Liverpool, Professor Steve Ryder in Nottingham, Professor Colin Drummond at King’s College, London and Professor Robin Touquet at Saint Mary’s Hospital, London.

My inpatient numbers grew from 1,300 to 2,200 per year — 500 more than any other consultant physician I’ve encountered — but far more importantly, outcomes began to improve.

Evolution of the Bolton NHSFT Alcohol Care Team

In 1993, Dr Wendy Darling was appointed as a Consultant Liaison Psychiatrist. Together, we pioneered internationally-recognised, collaborative, integrated care for people with alcohol-use disorders. This was ground-breaking, as historically patients with alcohol-related liver disease (ARLD) were admitted to liver units and those with mental health problems to psychiatry units, with little or no joined-up care.

In essence, we had established our Alcohol Care Team (ACT). We provided person-centred care, which was holistic, timely and responsive to the needs of patients and their families.

Our aim was quality improvement and to unify patient care, with a non-judgmental approach and to empower our patients to make lifestyle changes. Our mission statement, inspired by one of our own patients, said it best: “We never give up on anyone, even if they give up on themselves.”

The Power of the Alcohol Specialist Nurse

If I had to identify the single most transformative element of what we built, it would be the Alcohol Specialist Nurse (ASN). We appointed our first in 1994. By 2012, we had four ASNs and a hospital-based, seven-day ASN service running 365 days a year.

The ASNs — trained in both liver disease and mental health — assessed every alcohol-related admission across the hospital. They conducted comprehensive physical and mental health assessments, provided brief advice, supervised care plans and connected patients rapidly with community alcohol services. They identified vulnerable children and adults and addressed safeguarding concerns. The impact was remarkable. An estimated 2000 bed days were saved per year, with readmission rates falling by 3%.

Taking It National

In my role as the British Society of Gastroenterology (BSG) Alcohol Lead, I began to share what we’d learned in Bolton with the rest of the country. A major 2010 publication — produced with the Alcohol Health Alliance and the British Association for Study of the Liver — set out the key components of an Alcohol Care Team (ACT) and kickstarted the implementation across UK hospitals. The term resonated immediately with clinicians, managers and policymakers alike.

The core of what makes an ACT work comes down to four essentials:

• A clinician-led, multidisciplinary team providing integrated, person-centred care across primary, secondary and community settings
• A seven-day Alcohol Specialist Nurse service, based at the hospital
• Specialist consultant gastroenterologists, hepatologists and psychiatrists

• An alcohol assertive outreach team dedicated to reaching frequent hospital attenders — the patients most at risk and most in need

In 2011, with updates in 2012, 2014 and 2016, NHS Evidence and the National Institute for Health and Care Excellence (NICE) invited me, on behalf of the BSG and Bolton NHSFT, to write the “Quality and Productivity: Proven Case Study” (QIPP) entitled “Alcohol care teams: reducing acute hospital admissions and improving quality of care”. This scored highly on ‘Savings’, ‘Quality’, ‘Evidence of Change’ and ‘Implementation’.

By 2016, 83% of UK hospitals had at least one ASN in post — a transformation from the 42% recorded just a few years earlier.

Tackling stigma and health inequalities

Alcohol use disorders remain heavily stigmatised — too often dismissed as a self-inflicted lifestyle choice rather than recognised as the complex diseases they are. This stigma has real consequences: inferior treatment, denial of intensive care, and exclusion from liver transplantation. ACTs can push back against this, not just through clinical care, but by restoring dignity, removing shame, and helping patients reconnect with their families.

We also cannot ignore who carries the heaviest burden. The alcohol-harm paradox tells us that people from lower socioeconomic backgrounds suffer disproportionately more alcohol-related illness, disability and death — despite consuming the same or even lower amounts of alcohol than their more affluent counterparts. A 2026 Health Foundation report confirmed that healthy life expectancy in the UK is falling, with the wealthiest areas enjoying roughly 20 more years of good health than the poorest. At a time when inequalities are widening, ACTs have an increasingly important role to play in improving outcomes for our disadvantaged and vulnerable communities.

Evidence for peer-support approaches like Alcoholics Anonymous (AA) is growing. Working alongside Alcohol Care Teams, they can both help people maintain recovery after discharge from inpatient care. A 2020 Cochrane Review found that AA and 12-Step programmes were superior to all other treatments in achieving continuous abstinence and remission. AA support is accessible, free to all and continues long after time-limited NHS treatment has ended.

I have been highlighting the value of AA members cooperating with ACTs, especially ASNs and ward nurses, to facilitate patients attending AA meetings in hospital and at discharge — the major risk period for relapse. The bond, once established, can lead to lifelong remission and peer support.

Thirty-Five Years On and looking ahead

Public Health England calculated that the Return on Investment from the 2000 bed days saved annually by the Bolton 7-Day ASN service was around £3 for every £1 spent on ASN salaries. Consequently, from 2020-2024, NHS England implemented fully-resourced ACTs in 25% of English hospitals. This growth represents one of the most important advances in alcohol treatment over the past three decades.

However, implementation remains uneven, with variation in staffing, training, leadership and service models. A lack of national funding means that ACTs are not available in every major UK hospital. Standardising and implementing the service at a national level would ensure every patient, wherever they live, has access to the same quality of care.

The core principles, however, remain unchanged from the earliest days in Bolton: to treat people with alcohol problems with the same compassion, rigour and ambition we would bring to any other serious illness.

Alcohol Care Teams save lives. They reduce pressure on hospitals. They improve quality of care. And perhaps most importantly, they remind people experiencing alcohol harm that they are worthy of dignity, support and hope. Because we should never give up on anyone, even when they give up on themselves.

Written by Dr Kieran Moriarty CBE, MD, FRCP, FRCPI, KSG, Consultant Gastroenterologist, Alcohol Lead, British Society of Gastroenterology 2009-2020, Government Alcohol Adviser 2000-2020, Non-Alcoholic Trustee, Alcoholics Anonymous

This video was recorded by Dr Vasiliki Thanopoulou and the technical team at the Royal College of Physicians of London.

This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of Alcoholics Anonymous or its members.