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Empirical paradigms measure and highlight that alcohol and other drugs have effects that extend beyond the person drinking or using to their social connections and produce much wider familial and societal impacts. The needs of the relatives, friends, co-workers and communities affected by the drinking or drug use of people in their social networks are often unvoiced, and few treatment systems exist to manage their specific concerns. These “Harms from substance use to social connections” or “Substances' harm to others” should be counted and responded to.