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Leading doctors are calling for clinical commissioning groups to support services that provide specialist care for patients with alcohol-related brain damage (ARBD).In a joint report on Alcohol and brain damage in adults: with reference to high risk groups, by the Royal College of Psychiatrists, the Royal College of Physicians, London, the Royal College of General Practitioners and the Association of British Neurologists, doctors highlight how alcohol abuse can cause changes to people’s brain function and intellect, even though many will not be aware of it. However, carers, relatives and others may notice this and it can jeopardise work, family relationships and cause domestic and financial problems.ARBD – which typically tends to affect people in their 40s and 50s, and generally affects women a decade earlier than men €“ may be difficult to diagnose. There is also a lack of awareness about ARBD within healthcare, and a stigma associated with alcohol-related diseases, all of which means little data exists relating to the scale of this €˜silent’ problem. An estimated 80-90 per cent of cases or ARBD go undiagnosed the report states. There are also no national guidelines, standards of care, or established pathways of care across most of the UK on ARBD for the longer term management of the condition.As a result, patients are unable to access the services they need and may be directed to inappropriate care -such as being placed in nursing homes designed to cater for older, frail people with dementia – or may receive no services at all. This may result in a revolving door pattern of patient presentation to emergency services, mental health services, and specialist physical healthcare.The report also draws attention to the impact of Fetal Alcohol Spectrum Disorder (FASD) where women abuse alcohol before and during pregnancy, which results in damage to the fetus or newborn baby. This can result in health problems in infants, such as difficulties in learning and problems in later life, such as anxiety and substance misuse.However, the report suggests that clinically appropriate services which provide multi-disciplinary, specialist care for the assessment and rehabilitation of patients with severe ARBD and FASD could help to address these issues, and should be commissioned. According to the authors, 75% of people with ARBD improve with the right care.