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
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 nor necessarily operate under this assumption.
Second, both greater needs and greater opportunities exist for regulating behaviors associated with alcohol related 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 alcohol related 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-fat-content foods) and the resulting CVD, which may develop only after years of unhealthy eating. And fourth, societal norms associated with drinking differ dramatically from those associated with problematic dietary patterns. For example, because the decisions made by drinking drivers have consequences beyond the drinker him- or herself, the drinker's behaviors are perceived as legitimate targets for social control and regulation.
Thus, although much may be learned from the experiences of CVD prevention programs, the specific methods that effectively reduce chronic health problems may be somewhat less applicable to the reduction of alcohol-related problems. The circumstances that surround alcohol consumption and the generation of alcohol-related problems may present unique challenges and strategic opportunities for the development of community prevention programs. In fact, with these differences in mind, researchers, community stakeholders, and funding agencies have increasingly turned to so-called environmental approaches for reducing alcohol-related problems. …