Alcohol use is associated with many health risks, owing to its psychoactive, toxic and dependence-producing properties. Hence, alcohol should not be recommended in any amount for health benefits, in line with WHO guidance. Clinical practice: y Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders – specifically, the module on alcohol use disorders (13) Service delivery and care pathways: y WHO package of essential noncommunicable (PEN) disease interventions for primary health care (11) Public health and policy: y WHO Global strategy to reduce the harmful use of alcohol (14) y Global alcohol action plan 2022–2030 (15) y Global status report on alcohol and health and treatment of substance use disorders (16) y The SAFER technical package: five areas of intervention at national and subnational levels (17) y Tackling NCDs: best buys and other recommended interventions for the prevention and control of noncommunicable diseases (12) y Alcohol fact sheet (18)

y No risk-free level of alcohol use can be recommended for cognitive health. Alcohol is a psychoactive, toxic and dependence-producing substance with well-established harmful effects across multiple organ systems. Even low levels of consumption increase the risk of several major health conditions, including cancer, cardiovascular disease and injuries, and population-level evidence shows no net health benefit or “protective” effect from light or moderate use (75). Although the specific causal pathways linking alcohol use to dementia are still being clarified, the broader health risks support a precautionary approach y Among the most cost-effective strategies to reduce alcohol-related harm are screening, brief interventions and access to a continuum of health services and evidence-based psychosocial and pharmacological interventions through primary care (76). Behavioural interventions are generally more acceptable and safe, with fewer adverse effects than pharmacological treatments (77). Interventions should include both individual-level behavioural strategies and population-level policies (e.g. taxation, advertising bans and reduced availability) (33,59,60,62). y Access to evidence-based treatment options should be increased, and alcohol reduction strategies should be integrated into routine primary care using screening and brief interventions, as outlined in WHO’s mhGAP guidelines (33). y Efforts focused on the individual (e.g. counselling and motivational interviewing) should be combined with population-level policies (e.g. increased taxation on alcohol, restrictions on alcohol availability and advertising, and enforcement of drink–driving laws, as per the WHO-led SAFER initiative) (62). y Nutritional support (e.g. thiamine) should be included in alcohol treatment protocols to enhance cognitive recovery; also, evidencebased psychosocial and pharmacological treatment should be provided for people with alcohol dependence (e.g. with naltrexone and acamprosate). y Alcohol reduction interventions, particularly those aimed at middleaged adults, should be framed within broader healthy lifestyle and dementia prevention strategies. y In LMIC and under-resourced settings, community health workers and non-specialist providers should be leveraged, to expand the reach of behavioural interventions.