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Recent attempts to approach drug and alcohol problems as a public health issue in the UK and globally have begun to achieve some success. Yet, in historical terms, the idea that the use of psychoactive substances should be regarded as a public health problem is a relatively new one. In the UK, it was only in the latter half of the 20th century that what were termed “public health” approaches to alcohol and drugs began to gain purchase. Moreover, what was meant by a “public health” framing of psychoactive substance use changed over time and between substances. This article examines the development of public health approaches to drugs and alcohol in Britain since the 19th century. It suggests that a public health view of substance use existed alongside, and interacted with, other approaches to drug and alcohol use. To understand the meaning of a “public health” framing of drugs and alcohol we need to locate this in historical and geographical context.

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