People hurt while intoxicated could soon receive as much attention for their drinking as their injury.
A lot of these people wouldn't be clogging up Hawke's Bay Hospital's Emergency Department if they hadn't drunk so much, said emergency specialist Dr Paul Quigley.
The former Hawke's Bay doctor was in the region last week, outlining Wellington Hospital's programme for hazardous drinking.
He is no prohibitionist - he's a qualified beer taster - but he sees first-hand the harm alcohol does at Wellington Hospital's Emergency Department.
It is a place that no longer turns a blind eye to drink-related injuries.
"In the past years you might have had a sprained ankle treated and you wouldn't really talk about the fact that the only reason you sprained your ankle was because you were pissed," he said.
"Now you will be told, 'The reason you're here is because you are drinking - let's look at your drinking'."
A 2014 report said one in four Hawke's Bay adults was a hazardous drinker - nearly twice the national average.
The problem is growing, with hazardous drinking increasing 10 per cent between 2011 and 2014. The highest rate is among 15 to 24 year olds.
While hazardous drinking has risen, its acceptance by the medical community has fallen.
"The line has been drawn in the sand. It is actually not good enough, so you have public advocates like myself," Dr Quigley said.
The threshold for the amount of alcohol considered hazardous has also dropped. For women it is two drinks per drinking session.
"The way they are often poured means just one glass per session. The average bottle of wine is seven-and-a-half to eight units of alcohol, and most people will only get four glasses out of it."
Hawke's Bay Hospital Emergency Department acting head Dr Mark Barlow said drunk and injured people took longer to treat.
"They may have fallen over and hit their head and you have got to work out if it was just because they were drunk and fell over or they have got a more significant underlying head injury, for example.
"They can be abusive or aggressive and so it becomes difficult for staff and other patients."
Dr Quigley said in Wellington Hospital about 15 per cent of all injuries were directly related to alcohol.
"When we look at those presenting at night on the weekend with alcohol, that number rises to 75 per cent of all injuries for the whole population.
"After 10pm if you go out and hurt yourself then you're probably pissed."
The issue was a lot wider than trauma injuries - people were often unaware how alcohol increased the development of diseases such as cancer. Women who drank above recommended guidelines had a 10 per cent annual increase in developing breast cancer for every year they drank too much, he said.
A looming issue was increasing evidence that early-onset dementia was more common in drinkers.
"We are not talking about people who are alcoholics. We are talking about people whose day-to-day consumption is on the higher end. They are basically getting stupider earlier.
"For a society with a growing aged-care population then early-onset dementia is of real concern."
Dr Quigley was asked 10 years ago by Law Commission president and former prime minister Sir Geoffrey Palmer to help with a revamp of the country's alcohol laws.
Sir Geoffrey's research saw him join night patrols with police where he said he experienced "carnage".
His Sale and Supply of Alcohol Act 2012 replaced his own Sale of Liquor Act 1989, and required local government to create liquor policies informed by a report from local health bodies and a voice in all liquor licence applications.
Last year an application for a Hastings liquor licence in Raureka was withdrawn from the Hastings District Licensing Committee following police and Medical Officer of Health opposition.
"Industry had all this information about the benefits of alcohol such as the revenue earned and the employment base, but Sir Geoffrey wanted to know what the health harms were.
"We had to be honest at the time and say we don't really know - there was no national collection of data from emergency departments. It was anecdotally spoken about by a lot of them - Friday, Saturday night they see drunk patients - but a number on a piece of paper just wasn't there.
"Since then we have been steadily working to do that. Wellington has an extensive data collection model for alcohol and Dunedin would have to be one of the gold-standard places in the country now in terms of collecting that information and doing something about it," said Dr Quigley.
"We are trying to find out how much of a burden it is. Everyone has stories but we don't have any numbers."
He said in Wellington Hospital on Friday and Saturday nights there was on average 10 additional alcohol-related patients between midnight and 8am.
"We quite early recognised that it is an additional workload for staff and it needs to be acknowledged as that and requires funding."
The first trial that referred people to alcohol counselling was funded by ACC, which has a harm-prevention business model. It showed injuries associated with alcohol had more expensive and longer rehabilitation, "and are actually more likely to happen again", he said.
Hawke's Bay data would be used to present a business case to the Hawke's Bay District Health Board for extra resourcing required for alcohol-related treatment.
National data collection to be presented to the Health Ministry "was in its infancy". He said there was no need for prohibition or the complete cessation of drinking.
"Many studies support some of the positive aspects, which are not health ones, but about things like improved communication and social relaxation - all very beneficial.
"The problem is somehow getting that happy medium between appropriate safe drinking and drinking at a level that causes harm."