Alcohol-related harm is not always obvious, but it is everywhere. In many countries, including Portugal, consuming alcohol is seen as part of daily life, socializing and celebrations, and little thought is given to the associated health risks. Dr Margarida Santos, a general practitioner in Lisbon, sees the effects in her patients every day. From disrupted sleep to anxiety and depression, she reports first-hand the serious toll alcohol can take on health, family life and personal relationships.
Despite its well established link to cancer, liver disease and mental health conditions, alcohol use often goes unmentioned during consultations. As a primary care provider, Dr Santos is in a position to identify patients whose drinking may put their health at risk.
However, because of how normalized alcohol use is in European societies, many medical professionals hesitate to ask patients about their drinking habits, missing key opportunities for prevention and early intervention.
“We routinely screen for conditions like blood pressure and diabetes, as well as risk factors for diseases, like smoking, but what about alcohol?” Dr Santos asks.
“In medical school, we learned about the dangers of heavy drinking, but not about the risks of regular, everyday use of alcohol, or how to talk about it with patients. That gap is dangerous because we’re the ones speaking with patients.”
Dr Santos calls for empowering medical professionals with the education and tools they need to provide patients with evidence-based information that supports informed decision-making.
Change starts with a conversation
Dr Santos believes in holistic care – getting to know and guiding her patients through every stage of life, and supporting the prevention and management of chronic conditions. She advocates for the routine use of screening and brief interventions (SBI), which consist of simple, evidence-based conversations that help both professionals and patients better assess alcohol consumption and understand drinking patterns.
Depending on the time available, SBI involves asking a few structured questions to start a conversation and providing tailored guidance when appropriate. For SBI to be truly effective, clinicians need sufficient time, proper training and strong support at the system level.
SBI is endorsed as a key part of the health-system response to alcohol harm. Featured in the WHO Global Alcohol Action Plan 2022–2030, the SAFER initiative, and the WHO European Framework for Action on Alcohol 2022–2025, SBI is backed by strong evidence showing it is an effective, cost-efficient way to identify and reduce risky drinking, especially in primary care settings.
WHO supports the widespread use of SBI because it helps to integrate assessment of alcohol risk into routine care, encourages early intervention and connects patients with further support when needed. By addressing alcohol as a health issue, SBI plays a critical role in reducing stigma, supporting families and strengthening long-term recovery pathways.
Debunking myths
Dr Santos takes the view that SBI has the potential to reduce alcohol-related harm, but only when backed by strong systems and policies. “We need policies that make healthy choices easier and support health professionals to act,” she says.
Outside the clinic, she takes her mission online, seeing social media as a powerful tool for public health. At home, Dr Santos records and edits videos to promote health literacy, hoping to reach a wider audience with clear, accessible content.
“My goal is to reach people with evidence-based information that is easy to understand,” she explains. By debunking myths and using accessible language, she hopes to help people make more informed decisions about their health.
Dr Santos believes tackling alcohol-related harm requires more than a medical intervention – it demands a societal shift and cultural change. She frequently challenges common myths, such as the belief that red wine is good for heart health, urging people to reconsider the notion of alcohol as a harmless product.
“Even light or daily drinking increases health risks – and we need to say that.”