Approaching Alcohol Problems through Local Environmental Interventions

Article excerpt

One approach for reducing alcohol and other drug problems is community-based prevention programs. These programs focus on changing the environment in which a person consumes alcohol rather than the behavior of the individual drinker. Several international and U.S. programs have assessed the effectiveness of such approaches in reducing alcohol-related problems. Some of those analyses have had inconclusive results. Others, however, found reductions in alcohol-related problems such as drunk driving alcohol-related car crashes and their consequences, the sale of alcohol to underage drinkers, and assault injuries. Nevertheless, several aspects of community-based prevention programs require further study. KEY woRDS: environmental-level prevention; community-based prevention; program evaluation; prevention outcome; model prevention strategy or program; prevention of problematic alcohol or other drug use (AODU); international differences; survey of research

Workplace programs to prevent and reduce alcohol-related problems among employees have considerable potential. For example, because employees spend a lot of time at work, coworkers and supervisors may have the opportunity to notice a developing alcohol problem. In addition, employers can use their influence to motivate employees to get help for an alcohol problem. Many employers offer employee assistance programs (EAPs) as well as educational programs to reduce employees' alcohol problems. However, several risk factors for alcohol problems exist in the workplace domain. Further research is needed to develop strategies to reduce these risk factors. KEY WORDS: workplace-based prevention; Employee Assistance Program; intervention referral; relapse prevention; alcohol or other drug (AOD) education; health promotion; workplace AOD policy; identification and screening for AOD use; occupational stress; stress as an AOD cause (AODC); social detachment

For some chronic health problems, such as cardiovascular disease (CVD), community-based prevention programs have been effective in reducing those problems (Hulley and Fortmann 1981; see also Puska et al. 1985; Maccoby et al. 1977; Jacobs et al. 1986). Accordingly, researchers, community organizers, and funding agencies are examining the potential of community prevention programs for reducing alcohol and other drug (AOD)-related problems (Murray 1986). However, several important differences exist between programs aimed at reducing chronic health problems and those designed for addressing AOD problems. These differences concern philosophies and motivational strategies used in the programs and/or the characteristics of the target problems.

Comparing programs to reduce AOD and CVD as an example, the following four differences arise. First, interventions for high-risk medical conditions, such as changing dietary habits for CVD, operate under the assumption that people suffering from this condition have the power to control their behavior rationally. Conversely, efforts to reduce alcohol-related problems do not necessarily operate under this assumption.

Second, both greater needs and greater opportunities exist for regulating behaviors associated with alcoholrelated problems than for regulating behaviors associated with CVD. For example, unlike poor dietary habits and smoking, which primarily affect the person exhibiting these behaviors (with the notable exception of secondhand smoke), alcohol consumption impacts the broader community system through traffic and other injuries. At the same time, alcohol consumption occurs within a highly regulatable distribution system of bars, restaurants, and other establishments.

Third, the consumption of alcohol often is more closely linked in time and space to the resulting alcoholrelated problems (e.g., drunk driving and car crashes that occur shortly after drinking at a party) than are poor dietary habits (e.g., consumption of high-fatcontent foods) and the resulting CVD, which may develop only after years of unhealthy eating. …