Alcohol - Removes Everything you Value
STRATEGIES FOR ACTION - ANALYSIS
Preventing Alcohol Abuse and Related Problems
Prevention measures aim to reduce alcohol abuse and its consequences. Such measures include policies regulating alcohol-related
behavior on the one hand and community and educational interventions seeking to influence drinking behavior on the other.
Researchers use scientific methods, such as randomized controlled trials, time-series analysis, and computer simulation, to
determine the effectiveness of prevention initiatives. The resulting data may both inform policy and guide community and educational
prevention efforts. This Alcohol Alert summarizes research on the effectiveness of selected initiatives in each of these areas.
Researchers find that alcohol taxes and prices affect alcohol consumption and associated consequences (1). Studies demonstrate
that increased beer prices lead to reductions in the levels and frequency of drinking and heavy drinking among youth (2,3).
Higher taxes on beer are associated with lower traffic crash fatality rates, especially among young drivers (4,5), and with
reduced incidence of some types of crime (6). Research suggests that the heaviest-drinking 5 percent of drinkers do not reduce
their consumption significantly in response to price increases, unlike drinkers who consume alcohol at lower levels (7). In
one study, heavy drinkers who were unaware of the adverse health consequences of their drinking were less responsive to price
changes than either moderate drinkers or better informed heavy drinkers.
RAISING THE MINIMUM LEGAL DRINKING AGE (MLDA).
MLDA legislation is intended to reduce alcohol use among those under 21, to prevent traffic deaths, and to avoid other
negative outcomes. Raising the MLDA has been accompanied by reduced alcohol consumption, traffic crashes, and related fatalities
among those under 21. A nationwide US study found a significant decline in single-vehicle nighttime (SVN) fatal crashes--those
most likely to involve alcohol--among drivers under 21 following increases in the MLDA.
ZERO TOLERANCE LAWS
A National Highway Systems Act would provide incentives for adoption of a "zero-tolerance law" that set maximum
blood alcohol concentration (BAC) limits for drivers under 21 to 0.02 percent or lower.
An analysis of the effect of zero-tolerance laws in the first 12 US States enacting them found a 20-percent relative reduction
in the proportion of SVN fatal crashes among drivers under 21, compared with nearby States that did not pass zero-tolerance
OTHER BAC LAWS
Fourteen US States have lowered BAC limits from 0.10 to 0.08 percent to reduce alcohol-related fatal motor vehicle crashes.
One study found that States with the reduced limit experienced a 16-percent decline in the proportion of fatal crashes involving
fatally injured drivers whose BAC's were 0.08 percent or higher, compared with nearby States that did not reduce their BAC
limit. In a separate analysis, this study found that States that lowered their BAC limit also experienced an 18-percent decline
in the proportion of fatal crashes involving fatally injured drivers whose BAC's were 0.15 or higher, relative to comparison
ADMINISTRATIVE LICENSE REVOCATION LAWS
Laws permitting the withdrawal of driving privileges without court action have been adopted by 38 US States to prevent
traffic crashes caused by unsafe driving practices, including driving with a BAC over the legal limit (16). These laws were
associated with a 5-percent decline in nighttime fatal crashes in some studies. Other studies observed six- to nine-percent
reductions in nighttime fatal crashes following their adoption.
Alcohol servers are increasingly held liable for injuries and deaths from traffic crashes following the irresponsible
selling and serving of alcohol. Researchers assessed the effect of potential server liability on the rates of alcohol-related
fatal crashes in Texas. SVN fatal traffic crashes decreased 6.5 percent after the filing of a major server-liability court
case in 1983 and decreased an additional 5.3 percent after a 1984 case was filed. However, before concluding that server liability
is effective, these results need replication.
Server training, mandatory in some States, educates alcohol servers to alter their serving practices, particularly with
underage customers and those who show obvious signs of intoxication. Server training explains the effects of alcohol, applicable
laws, how to refuse service to obviously intoxicated patrons, and how to assist customers in obtaining transportation as an
alternative to driving. Some, but not all, studies report more interventions with customers after server training than before.
One evaluation of the effects of Oregon's mandatory server-training policy indicates that it had a statistically significant
effect on reducing the incidence of SVN traffic crashes in that State.
The mandated warning label on containers of alcoholic beverages aims to inform and remind drinkers that alcohol consumption
can result in birth defects, impaired ability to drive a car or operate machinery, and health problems. Research indicates
that public support for warning labels is extremely high; that awareness of the label's content has increased substantially
over time; that perception of the described risks was high before the label appeared and has not generally increased; and
that the label has not had important effects on hazardous behavior, although certain effects may be indicative of the early
stages of behavioral change. One study of pregnant women found that after the label appeared, alcohol consumption declined
among lighter drinkers but not among those who drank more heavily (22).
Community and Educational Interventions
THE SAVING LIVES PROGRAM
The Saving Lives Program in six communities in Massachusetts was designed to reduce drinking and driving and to promote
safe driving practices. Saving Lives involved the media, businesses, schools and colleges, citizens' advocacy groups, and
the police in activities such as high school peer-led education, college prevention programs, increased liquor-outlet surveillance,
and other efforts. Participating communities reduced fatal crashes by 25 percent during the program years compared with the
rest of Massachusetts. The decline in alcohol-related fatal crashes was 42 percent greater in Saving Lives communities than
in comparison cities during the program years. The proportion of drivers under 21 who reported driving after drinking in the
month before being interviewed also declined in participating communities.
LIFE SKILLS TRAINING
LST teaches students in grades seven to nine skills to resist social influences to use alcohol and other drugs and to
enhance general competence and self-esteem. LST has been found to increase students' knowledge of the negative consequences
of drinking and to promote realistic, not inflated, perceptions of drinking prevalence. A study of LST's long-term effects
among 12th grade students who had received a relatively complete version of the program showed significantly lower rates of
weekly drinking, heavy drinking, and getting drunk than did control students. The full sample exposed to the program also
showed significantly lower rates of drunkenness than did the controls.
Project Northland is a multicomponent, school- and community-based intervention to delay, prevent, and reduce alcohol
use and related problems among adolescents. It includes social-behavioral curricula, peer leadership, parental involvement/education,
and communitywide task force activities. The first 3 years of intervention, conducted in grades six through eight, resulted
in significantly lower prevalence of past-month and past-week alcohol use among students in intervention communities compared
with controls. These beneficial effects were particularly notable among students who had not yet begun experimenting with
alcohol when the program began.
ALCOHOL MISUSE PREVENTION STUDY (AMPS)
The AMPS curriculum, for students in grades five through eight, focuses primarily on teaching peer-resistance skills and
on clarifying students' misperceptions of their peers' alcohol use. Among adolescents at greatest risk for escalating alcohol
misuse--those who engaged in early unsupervised use of alcohol--the AMPS intervention had a modest, but lasting, statistically
significant effect of slowing the increase in alcohol misuse through grade 8 and into grade 12. Replication of this research
again showed a significant effect for the highest risk subgroup.
Project STAR--involving schools, mass media, parents, community organizations, and health policy components in two sites
in the Midwest--attempts to delay the onset and decrease the prevalence of alcohol and other drug use among students beginning
in sixth grade. Project STAR teaches skills to resist alcohol use and educates students about the actual, as opposed to the
perceived, prevalence of alcohol use among their peers. Early followup studies showed that the program had little effect on
alcohol use. However, in a 6-year followup in Kansas City, students in program schools showed lower rates of increase in alcohol
use and episodes of drunkenness over time than did students in control schools. Similar but smaller effects were observed
at 3.5-year followup in Indianapolis.
DRUG ABUSE RESISTANCE EDUCATION (DARE)
DARE, typically taught to 10- and 11-year-old students in grades five and six by police officers, aims to inform about
alcohol and other drugs and to teach social and decisionmaking skills to help students resist their use. Studies have found
that DARE essentially has no impact on alcohol use.
Programs attempting to persuade students not to use alcohol by arousing fear do not work to change behavior. Emphasizing
the dangers of alcohol may attract those who tend to be risk-takers. Programs providing information about the pharmacological
effects of alcohol may arouse curiosity and lead to drinking.
Preventing Alcohol Abuse and Related Problems--A Commentary by NIAAA Director Enoch Gordis, M.D.
Prevention encompasses activities or actions ranging from those affecting the whole population through social and regulatory
controls to those affecting specific groups, such as adolescents, or the individual. Many of these activities overlap. For
example, health warning labels, a product of legislation (social and regulatory control), also are educational. In this Alcohol
Alert, we have tried to give a "flavor" of this broad spectrum; the prevention areas described are by no means exhaustive,
and some areas described in one category could well be in others.
The good news is that, using contemporary tools of science, prevention can be rigorously studied. Currently, research
evidence shows that some prevention efforts are effective and others have little or no effect. This knowledge will help local
communities, the States, and others who have made significant investments in prevention activities develop or refine existing
programs to achieve their desired objectives.