Latest Approaches to Preventing Alcohol Abuse and Alcoholism

Article excerpt

Scientists and policymakers have explored numerous strategies to prevent alcohol abuse and dependence as well as the adverse social, legal, and medical consequences of alcohol use. Many of these efforts have focused on reducing alcohol-impaired driving and the associated injuries and fatalities. As reported in this article, such efforts have included general deterrence laws (e.g., reduced minimum legal drinking age, administrative license revocation, and lower legal limits for blood alcohol concentrations), measures targeted at repeat offenders, and measures to control alcohol availability (e.g., increased taxes and decreased numbers of establishments selling alcohol). KEY WORDS: prevention research; impaired driver; AODR (AOD [alcohol or other drug] related) accident mortality; AOD availability; community-based prevention; AOD advertising impact; econometrics; school-based prevention; AOD laws; trend

In recent years, research on strategies to prevent alcohol abuse and alcoholism has expanded greatly and shifted in emphasis. Whereas studies 10 to 15 years ago focused almost exclusively on education-based prevention approaches, more recent research has evaluated a wider range of prevention measures, including laws and policies to reduce alcohol-related problems at local, State, and national levels. Gauging the effectiveness of such strategies can be complicated by a wide range of factors, such as cultural and economic variability in the study populations or activities at the community or Stare level that may influence the study outcomes. Using rigorous statistical methods, however, investigators are producing results that can be generalized to populations beyond the study groups, thus offering new understandings of how programs and policies can reduce the to11 of alcohol-related problems.

This article reviews the current state of prevention research in several areas. It first explores the results of various efforts to reduce alcohol-impaired driving, such as increasing the minimum legal drinking age (MLDA) to 21 and passing "Zero Tolerance" laws for young drivers. The article then reviews several community-based prevention approaches aimed at reducing alcohol consumption by young people or by all community members. Finally, the article discusses the effects of alcohol advertising on drinking behavior. For a summary of prevention issues related to feral alcohol syndrome, see the article "Prenatal Exposure to Alcohol" in this issue.

REDUCING ALCOHOL-IMPAIRED DRIVING

Alcohol-impaired driving is a major public health problem in the United States. Traffic crashes involving alcohol killed more than 16,000 people in 1997 alone (National Highway Traffic Safety Administration [NHTSA] 1998b) and injure a million more each year (Blincoe 1996). Furthermore, 40 percent of fatal traffic crashes, which are the leading cause of death for those aged 1 through 24, involve alcohol (NHTSA 1998b; U.S. Department of Health and Human Services 1997). And although annual traffic deaths related to alcohol have dropped by more than one-third since the early 1980s, the dramatic decline in fatalities seen in the early 1990s has leveled off and the number of people killed and injured each year remains staggeringly high.

Several factors have contributed to the drop in alcohol-related traffic fatalities. These include general car safety measures, such as the introduction of air bags and laws mandating the use of seat belts and child restraints, as well as alcohol-specific factors. One likely contributor to the drop in alcohol-related crashes is the reduction in drinking by nearly 20 percent since the early 1980s.

The passage of State-level legislation likely also has had an impact. This legislation includes "general deterrence laws" aimed at the population at large as well as "specific deterrence laws" aimed at persons already convicted of alcohol-impaired driving. Active enforcement and education at the community level have been critical to the success of these laws. …