There are high levels of alcohol in the UK population, with a particularly damaging pattern of ‘binge drinking’. Extreme alcohol use remains embedded in university culture. Since COVID and lockdown, male students, postgraduates and academic staff are likely to have increased their alcohol consumption. Starting university marks a rise in alcohol intake, to reduce social anxiety and ‘belong’ to the prevailing culture. High risk sexual behaviours rise significantly when alcohol is taken. Death by suicide, and deliberate self-harming, are associated with alcohol use. This is an important modifiable risk factor in addressing sexual violence and suicide. Mental disorders are strongly associated in complex interactions with alcohol use. Heavy alcohol use may be associated with other substance misuse and addictive behaviours. Abstaining from alcohol may result in striking improvements in mental health and academic performance. The rights and wellbeing of non-drinkers need to be acknowledged too. Information campaigns and paying lip service to disapproval do not work. The student age group tends to be less risk-averse than older groups. It falls to university authorities in partnership with local communities to control high risk alcohol intake.

Substance misuse is already widespread in UK schools, The greater freedoms of university make undergraduates particularly vulnerable to starting or increasing. Legal and medical agencies focus more on forensic consequences of established addiction. University drug use is not only recreational but may be motivated by improved performance or appearance. It is not clear whether the UK actively pursues eradication of non-medicinal drugs or prefers arrangements for safer consumption. Most universities officially ban drug use, but some student unions are permitted to provide facilities to enhance safer consumption. Lessons can be learned from the benefits and challenges of the UK smoking ‘ban’ and the history of alcohol ‘prohibition’. Drug use prevention and management need more rigorous research to discover what works and what doesn’t. Universities are ideally placed to conduct this. Meanwhile regulations need regular review by students, staff and authorities in collaboration. There is paucity of NHS treatment options for substance misuse. Confidential group-based support such as that provided by 12-step groups may provide particular advantages for students living away from home. Students and staff with drug-related concerns can also access advice from University Counselling Services and University Mental Health Advisors.