The NHS is failing to get a grip on the growing alcohol problems in England, a watchdog says.
The National Audit Office said local health bosses did not have a clear idea of the scale of the problem and as a result were not co-ordinating services.
In particular, the report called on GPs to take more responsibility as the NHS was struggling to reach those at the early stages of alcohol abuse.
But the government said it was doing "more than ever" to tackle the problem.
The criticism comes after the number of alcohol-related deaths has doubled since the early 1990s to nearly 9,000 a year.
Hospital admissions for conditions such as liver disease have also soared, leaving the NHS bill for alcohol abuse at £2.7bn a year.
The NAO quizzed primary care trusts (PCTs), which are in charge of local services, GPs and a host of experts providing alcohol services.
It found that a quarter of PCTs had not carried out assessments of the problem locally, four in 10 did not have a strategy in place and a third did not know what they were spending on the problem.
Where evidence on investment was available, just £600,000 a year - or 0.1% of the budget - was spent on average.
The report said, because of the lack of co-ordination, the services were not providing value for money.
It said most of the responsibility was being placed on drug and alcohol action teams, which were often run jointly with councils, but these tended to focus on the most serious cases that required detox and counselling programmes.
It meant that too little was being done for the estimated 7m hazardous drinkers - those drinking above the recommended limits but who were not yet seeing their health affected.
The NAO said GPs were in the ideal position to help these groups of people through the use of brief advice during consultations on how to reduce drinking levels.
But the report added that currently this only happened sporadically.
Mark Davies, who oversees health at the NAO, said: "The NHS is just not getting to grips with the issue. It needs to take a much wider approach and improve the way it is delivering it services."
Don Shenker, chief executive of Alcohol Concern, added: "There is a clear case for urgent improvement to treatment services, if we want to see an end to spiralling costs of alcohol misuse to the NHS."
But a Department of Health spokesman said the government was doing "more than ever" to tackle alcohol-related problems.
He added: "Most PCTs with high levels of hospital admissions have already decided to tackle this as a local NHS priority.
"We have appointed regional alcohol managers to support the local NHS and develop regional strategies to reduce alcohol misuse."
Dr Hamish Meldrum, chairman of the British Medical Association, said there were moves to encourage more brief interventions.
But he added: "Patients often tend to underestimate their consumption and underplay any problems."