ARA

Targeted Interventions

Population-Based Alcohol Policies vs. Targeted Interventions

• Many countries have attempted to address the issue of harmful drinking patterns by some people through “population-based”alcohol policies such as higher taxes, restrictions on how and where alcohol can be sold, and even outright prohibition1. These approaches, which seek to effect sweeping changes across a society as a whole, are consistent with control of consumption theories of alcohol regulation.Such policies typically are premised on the assumption that there is a relationship between the level of average per capita alcohol consumption and the incidence of problems within that population. 2 3 4
  
  
• The attraction of population-based policy measures is clear: they often are straightforward to enact through legislation or regulation, and often do not require a great deal of resources to put in place. But the fundamental assumption that per capita consumption is related to problem drinking is wrong, and such broad, blunt approaches are ineffective solutions to the complex problem of alcohol abuse. Additionally, the potential reductions in alcohol abuse associated with these types of policy measures are often very small and short-lived.
  
  
• Moreover, population-based approaches cannot differentiate between those who drink beverage alcohol to excess and cause problems for themselves and others and the much larger percentage of people who drink moderately and cause no harm (or, in some instances, are benefited by their moderate alcohol consumption). Nor can population-based approaches take into account the important cultural role that alcohol serves in different societies, and the myriad differences between cultures and groups of drinkers. There is little scientific evidence to suggest that population-based approaches will change the problematic drinking patterns that are culturally based. 5
  
  Finally, population-based approaches can produce serious unintended consequences, including encouraging the use of  potentially dangerous forms of illicit and non-commercial alcohol, increases in smuggling and other criminal activity, and even decreased tax revenue. 6 7 8 9
  
  
• Because of these limitations, there has been a shift in the alcohol policy field in recent years towards the use of targeted interventions.10 Indeed, WHO repeatedly has recognized the value of targeted approaches.
  
  Targeted interventions seek to change behaviors among specific groups in society, in certain settings, and in association with particular patterns of drinking. Targeted approaches do not treat everyone the same, and do not treat all uses of alcohol as problematic or harmful.
  
  Unlike population-based approaches, targeted interventions are not “one size fits all”solutions to the complex issue of alcohol abuse.
  
  

The Benefits of Targeted Interventions

• Targeted interventions are pragmatic. They recognize that drinking beverage alcohol is normal and accepted behavior in many cultures, and that the vastmajority of people who drink do so responsibly without causing health problems for themselves or others.
  
  
• Targeted interventions are flexible. They identify patterns of drinking or behaviors that may be associated with harmful consequences and tailor specific interventions to those problems.
  
  
• Targeted interventions can focus on certain potentially dangerous activities that may take place in conjunction with alcohol consumption. One clear example is the plethora of programs around the world addressing the important issue of driving while intoxicated, including designated driver programs.
  
  
• Targeted interventions are culturally sensitive. Because they focus on settings, situations and at-risk individuals or populations, targeted interventions can be specifically tailored to fit particular societies. This is true both between countries and even within the same country. Language, culture, social marginalization, and other factors may require crafting specific messages for the targeted population. What works in one culture may be a poor approach in another. Targeted interventions are effective and can help change potentially dangerous drinking patterns and behaviors, leading to either moderate drinking or, where appropriate, abstinence. Early Identification and Brief Intervention
  
  
• Early identification and brief intervention strategies are one important form of targeted intervention. These strategies are extremely effective in reducing harm associated with alcohol abuse and, for the majority of people, result in moderate consumption or abstention. For those individuals whose drinking is problematic, but who are not alcohol dependent, early identification and brief intervention programs offer a simple, effective and cost-efficient approach to treatment. Research has shown the importance of identifying harmful drinking patterns as early in life as possible, at a time when behavior is most amenable to change. Specific screening instruments can assist with the identification of problems and several have been adapted to meet the needs of particular populations, including young people.11 12 13 14 15
  
  Screening instruments are relatively simple and easy to administer, and can identify those whose drinking patterns have placed them at increased risk of problems. 
  
  
• Once individuals with problematic drinking patterns have been identified, brief interventions can be used to assist in modifying drinking patterns and behaviors. Brief interventions are well suited for implementation in a number of settings and 3 for a range of populations who are at risk for problems. Different interventions can be employed based on the severity of an individual’s problems.
  
  
• The benefits of such programs are well documented. Improved knowledge about drinking patterns and outcomes can help young people (and others) modify consumption or abstain. 16 17 18 Such approaches are especially effective at reaching marginalized or impoverished populations that otherwise may lack access to health care.19 20 21

Other Examples of Targeted Interventions

There are many other examples of targeted interventions that have been implemented around the world to target at-risk drinkers or populations. Some examples include:

• Information and Drinking Guidelines. In addition to providing alcohol-related health information to the population at large, specific materials can be tailored to particular high-risk segments of society. For example, many programs exist around the world to help parents teach children and adolescents about alcohol and the dangers of alcohol use by young people. Some members of the alcohol industry distribute or partner with governments and public health organizations to distribute many types of educational materials through multiple venues free of charge.
  
  
• Drink-Drive Regulations and Programs. Individual countries have important regulatory measures and laws targeting the issue of driving under the influence of alcohol, including blood alcohol content (BAC) laws. In addition to strong enforcement and harsh penalties for those who drive while intoxicated, long-term educational initiatives also are important, and special programs have been developed to inform different groups on this issue. For example, designated driver programs now exist in many parts of the world.
  
  
• Drinking and Pregnancy. Targeted interventions can be used to educate expectant mothers or women of child-bearing age about the particular risks drinking poses during pregnancy.
  
  
• "Binge Drinking". Many targeted approaches have been used to address the problem of so-called "binge drinking," particularly among secondary school and college students. As but one example, a Border-Binge Reduction Program has been developed by the U.S. and Mexico to address special problems caused by excessive cross-border drinking of young Americans (age 18-20 and not yet of legal purchase age in the U.S.) entering Mexico.
  
  
• Social Norms Programs. Social norms programs have shown promise in educating young people about actual versus perceived drinking patterns 22 23 24. These programs have been shown to be effective in reducing alcohol abuse. The objective of social norms programs is to educate populations about the acceptable attitudes about alcohol and actual drinking patterns of their peers. For example, young adults often overestimate how much others their age drink; by demonstrating that most of their peers do not drink excessively or often, social norms programs can persuade young adults to refrain from abusing alcohol and also are effective in reducing harmful consequences associated with alcohol abuse.
  
  
• Life Skills Programs. Life skills programs educate young people about various ways to promote physical and mental health. With regard to alcohol, one life skills approach relies on educating young people on the responsible of-age use of alcohol. One such program is the “Growing Up”program used with school children in South Africa and Botswana. Other programs focus on enhancing refusal skills, self esteem, and social networks.
  
  
• Responsible Hospitality. Laws prohibiting the irresponsible service of alcohol should be enforced. Additionally, targeted interventions can be used to educate and inform servers in bars, pubs, and clubs to minimize unsafe drinking practices and to avoid dangerous situations involving patrons and alcohol. The “Alcohol. Go Easy”campaign in Australia is one such program which seeks to increase the responsible service of alcohol.
  
  
• Drinking and Violence. A variety of programs have been developed to address the violence that may accompany the excessive use of alcohol in some populations. In the UK, a number of such programs have been successfully implemented, including the “Keeping the Peace” program, first published in 1993, which outlines best practices and initiatives for reducing crime on bar premises. 
  
• Technology-Based Interventions. Some creative internet and computer-based programs also have been found to be effective, especially with young people.25 Recent articles report that such programs include assessment questions and provision of personalized drinking feedback or other information that is customized to each user. Further research on these programs is necessary, but they appear to have a number of advantages and successes.26 27 28 
  
  

POLICY CONSIDERATIONS

• Targeted interventions are simple, effective and cost-effective ways of reaching specific individuals or populations with problematic drinking patterns and changing behavior.
  
  
• Targeted interventions are particularly useful where resources are limited and where access to health professionals is otherwise unavailable.
  
  
• Targeted intervention approaches are flexible and culturally sensitive ways of addressing drinking patterns, alcohol abuse, and harmful behaviors.
  
  
• Targeted intervention approaches acknowledge that alcohol plays an important role in most cultures around the world, and that the vast majority of people enjoy alcohol responsibly and in moderation.
  
  
• Targeted intervention approaches are an important way in which governments, public health organizations, and alcohol producers can partner
  together in fighting alcohol abuse and underage drinking. Each has expertise and resources that can, when combined, make powerful partnerships to combating all forms of alcohol abuse. Alcohol producers have developed and funded expert-designed programs in each of the areas described above that are implemented in communities and countries across the globe.

 

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