Prevention of alcohol-related problems - Perspectives on Current Research

Alcohol Health & Research World, Fall, 1989 by Harold D. Holder

Prevention of Alcohol-Related Problems

Prevention research, a relative newcomer to the alcohol research field, focuses on the prevention of alcohol abuse and alcohol-related problems. Substantial research in this field has been conducted only over the last 10 years. Although prevention research is a relatively new applied field, its scope already has begun to broaden considerably and efforts to increase the rigor of investigations are underway.

Prevention efforts are aimed at reducting the adverse effects of single bouts of drinking as well as the social and medical problems that arise as a result of persistent high-risk drinking by alcohol abusers and alcohol-dependent persons. Prevention activities are undertaken by legislators, law enforcement officials, health professionals, educators, business leaders, and concerned citizens. In recent years, a public health approach to prevention has emerged. A key element of this approach is the recognition that reducing alcohol use problems requires strategies that affect the environment as well as individual behavior. Efforts aimed at the prevention of alcohol use problems employ a variety of methods, including public information and education, changes in the social contexts of drinking, and limitations on the availability of alcoholic beverages (Holder and Stoil 1988). Since alcohol abuse and alcoholism per se are only a part of the full range of far-reaching social, health, and economic consequences of the misuse of alcohol, prevention efforts are now taking these into account.

The deaths and injuries that result from drinking and driving is one of these consequences. Up to 50 percent of fatal car crashes involve alcohol; alcohol-related traffic accidents result in more than 20,000 deaths annually (NIAAA 1987). On an average weekend night, I out of every 10 drivers on the road is drunk. Yet roadside surveys and arrest statistics suggest that the majority of drinking drivers are not chronic alcoholics (Wolfe 1974, 1986; Ryan and Segars 1984; Stewart et al. 1987).

Furthermore, approximately 50 percent of the 6,000 people who die as a result of fire are legally intoxicated, as are approximately 40 percent of pedestrians killed in traffic accidents (Fell and Nash 1989). Indeed, intoxicated pedestrians are three to four times more likely to be struck by automobiles than those who are not intoxicated (Irwin et al. 1983). The risk for falls increases as blood alcohol concentration (BAC) increases: persons with BACs of 0.10 to 0.15 were found to have a tenfold greater risk of falling than persons not exposed to alcohol (Honkanen et al. 1983). In addition, Roizen (1988) reviewed studies of emergency room trauma cases and found that 20 to 37 percent of all such cases involved alcohol.

What we have learned through research about the role of alcohol in these and other tragedies over the past 10 years will help legislators, community leaders, educators, and other interested individuals to develop new and perhaps more effective prevention measures, such as the following: * more stringent legal sanctions and

stricter enforcement to deter driving

under the influence of alcohol * increased minimum legal drinking

age along with stricter enforcement

of minimum drinking age limits * increased community involvement in

the reduction of alcohol problems

among the young as well as among

adults * training of servers of alcohol to

modify their serving practices and to

intervene when their customers

appear to be impaired * local zoning and other restrictions

on access to alcohol * increased alcohol retail prices

(taxes) and happy hour bans.

These measures supplement such traditional strategies as early identification and treatment, school-based education, and mass media campaigns. Evaluation of their effectiveness by prevention researchers will lead to identification of the best approaches in general, as well as of the best approaches to specific risk groups.

PREVENTION RESEARCH CENTER

The program of the Prevention Research Center (PRC) in Berkeley, California, illustrates the variety and scope of the research being done today.

Formed in October 1983, PRC currently is one of 12 National Institute on Alcohol Abuse and Alcoholism (NIAAA) Research Centers, and the only one specializing in prevention. At PRC we use a public health systems model in approaching alcohol-related problems. This model stresses reciprocal interaction among the agent (alcohol), the host (the individual drinker), and the environment (the social and physical drinking context). Of particular importance to prevention is research involving environmental influences on drinking; thus, our focus is not only on the individual, but also on the social and physical environment within which drinking occurs (Saltz 1988).

Within the context of the public health model, two types of prevention research are conducted. Basic prevention research explores factors that influence the risk of developing alcohol use problems. These factors include individual characteristics that may place one at risk (e.g., age, gender, and family history), and factors within the environment that may affect risk (e.g. family interaction, workplace factors, characteristics of drinking establishments, and alcohol beverage prices). Applied prevention research evaluates the effectiveness of purposeful actions taken to reduce problems related to alcohol use. Such actions include measures to modify the drinking environment (e.g., legislation establishing minimum drinking age, laws regarding drinking and driving, and server training programs) and measures designed to change individual behavior (e.g., educational programs). Ideally, the findings of basic prevention research contribute to the development and implementation of prevention strategies.