"They can disrupt the treatment of other patients. People can be upset or frightened by yelling and shouting. There is a history of nurses and doctors being verbally abused, spat at and assaulted."
Weekend mornings saw many more falls, cuts from punched glass, assaults and motor vehicle accidents.
ED had regular patients "presenting repeatedly with minor trauma or injuries related to the fact that they are addicted to alcohol" and diagnosing drunk people's injuries was difficult with alcohol-fuelled negative behaviour.
Long accepted as a social norm, the quantification of hazardous drinking is improving.
"The Ministry of Health is introducing mandatory data collection to try and actually quantify the extent of alcohol harm and alcohol-related presentations to emergency departments in New Zealand," Dr Barlow said.
Hawke's Bay District Health Board (HBDHB) public health physician Rachel Eyre said hazardous drinking rates were increasing - the rate went up by 10 per cent from a 2006/2007 health survey compared with a 2001/2013 survey.
Hazardous drinking is defined as an established drinking pattern that carries a risk of harming physical or mental health, or having harmful social effects to the drinker or others.
Whether someone is a hazardous drinker is determined by a 10-question Alcohol Use Disorders Identification Test.
"We know that hazardous drinking is higher in lower socio-economic groups. It doesn't mean to say that more people drink in lower socio-economic areas - that's not the case - but those that do drink are more likely to do so hazardously."
Hawke's Bay has both a poorer population than the national average and a higher percentage of Maori. In Hawke's Bay the Maori hazardous drinking rate is almost double the Pakeha rate.
Nationally men have twice the rate of women, the pattern in Hawke's Bay.
In November last year the HBDHB signed a document stating hazardous drinking was a problem and addressing alcohol-related harm was a priority.
"They acknowledged that the areas that will make the biggest of difference will be addressing issues such as marketing, price and limiting availability," De Eyre said.
The most effective changes are in the lap of central government but the HBDHB is undertaking a stocktake of what services it provides to reduce alcohol-related harm "from a prevention and treatment perspective, to identify gaps and opportunities".
The HBDHB's Population Health team already processes alcohol licensing requests - including on-licences, off-licences, special licences, and club licences - and made monitoring visits and controlled purchase operations with police and council district licensing Inspectors.
Reducing hazardous drinking was a collective responsibility and multiple agencies would be involved, she said.
"The Napier City and the Hastings district councils have a joint alcohol strategy to limit availability and promote safe, responsible drinking. We are also keen to support Wairoa and Central Hawke's Bay. They have safe community councils for a multi-agency community approach and we are part of that as well."
The fight to reduce smoking had important lessons "but what we have learnt from tobacco is that there is no single fix".
"An environment that is saturated with alcohol makes it incredibly difficult. We are creating a lot of social norms that alcohol needs to be accommodated in every setting and every event. That makes it very, very difficult for people to try and reduce their drinking."