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Substance abuse and dependence to alcohol, tobacco and other drugs (ATOD) is a universal public health problem extending across all borders, and including all ethnic, cultural, religious and socioeconomic boundaries. It is a condition that the nursing profession worldwide struggles to better understan. At the global level, differences in beliefs and practices regarding ATOD have resulted in a wide variation of how these problems are handled and treated.Examining and comparing those between the US and the UK can illustate an example of the differences in addictions nursing practice. Underlying assumptions of the current alcohol and drug policies in the US have been mainly based on prohibition, criminalisation and a drug‐free society ideology (Nadelmann, 1997) while the UK policies have been based on the belief of ‘harm reduction’ (Coyne & Clancy, 1996). This paper discusses some of the historical, philosophical and cultural differences between the US and the UK that have led to the respective differences in societal attitudes and treatment practices for substance abuse or ‘substance misuse’ within these two separate societies.

This paper considers future developments for Addictions Nursing. The aim of this paper is to provide a personal vision of two possible developments for Addictions Nurses, which will promote greater global working and improve the care received by service users and communities. The paper addresses the threats to public health posed by substance misuse, the wide number of diverse roles nurses undertake in addressing the problems which arise, and makes a number of suggestions about the development of nursing to maximise its impact on public health. The paper makes a number of recommendations:▪ promote international collaboration to develop the effectiveness of Addictions Nurses — by the strategic use of Work‐Based Learning and Rotation Schemes via ‘The Spiral of Excellence Model of Rotation Schemes’ (www.nurserotation.com)▪ promote international collaboration to develop Addiction Nurse prescribing using the ‘ABC Model of Addictions Nurse Prescribing’▪ Network Addictions Nurse Organisations — use the ‘AMM‐IN’ model of working, and support the work of The International Network of Nurses (TINN) Interested in Alcohol, Tobacco and Drug Misuse (www.tinnurses.org)▪ actively influence ICN, WHO, UN to promote public health approaches to substance misuse▪ promote service user and carer involvement in decision‐making▪ challenge the ‘divide and conquer’ approach to substance misuse — ‘tobacco, alcohol or drugs model of disease promotion yet again’ ie the ‘TAD‐DPY’ approach▪ actively challenge short‐termism in strategic workforce development, and in particular the ‘AM‐HRD’ model of human resource development.