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Prevention interventions for partygoers

 

This page refers to the current evidence available on the effectiveness of prevention interventions for partygoers. Information on the methodology used and the definition of terms can be found on the methodology page.

Date of last update: 06.2016      Next update: 12.2016

Available evidence for prevention interventions for partygoers

Summary: Drink-driving programmes, media campaigns and multicomponent interventions involving the community are effective in reducing car accidents, public nuisance and violence related to alcohol consumption. Police supervision can reduce public disorders and training of alcohol servers reduces clients’ alcohol consumption and intoxication.

Beneficial

Drink-driving programmes to reduce alcohol-related injury in car crashes

Drink-driving service (free transport home - ‘Tipsy Taxi’ service (operated 24 hours a day, 365 days a year) providing a free ride home for persons too intoxicated to drive. Service offered by bar employee or request made to bar employee by patron. Control areas had no such service.) for intoxicated drinkers was found to be effective in a systematic review ( Ker and Chinnock, 2008) in:

  • reducing injury in car crashes: 15 % reduction in the experimental area (reported as ‘highly significant’), with no change in the control.
  • reducing fatal crashes (ratio reduced from 0.78 to 0.60, P = 0.29 – not statistically significant). 

Mass media campaigns to reduce traffic accidents targeting recreational settings

According to three narrative reviews (Calafat, 2010; Calafat, Juan and Duch, 2009; Faggiano and Vigna-Taglianti, 2008) and one systematic review (Tay 2005), drink-driving mass media campaigns have proven:

  • to reduce alcohol-related crashes in the period during or after the campaign resulting in injury, by a median of 10 % (IQR 6 % to 15 %).

Multicomponent programme based on community mobilisation to reduce crimes and irresponsible use of alcohol in recreational premises

The project STAD (Stockholm Prevents Alcohol and Drug Problems), a multicomponent programme that has been active for ten years based on community mobilisation, training in RBS for servers and stricter enforcement of existing alcohol laws, was found in two narrative reviews (Calafat, 2010; Calafat, Juan and Duch, 2009) to be effective in:

  • decreasing police-reported violent crimes by 29 % in the intervention area, compared with the control area.
  • decreasing alcohol-related problems at licensed premises (only narrative results).
  • increasing refusal of alcohol to intoxicated clients (from 5 % in 1996 to 47 % in 1999 and 70 % in 2001) in licensed premises and in increasing refusal to serve minors (from 55 % in 1996 to 59 % in 1999 and 68 % in 2001).

Multicomponent programme based on community mobilisation to reduce night time traffic injuries

The Community Trials project including community mobilisation, media advocacy, RBS training, and enhanced enforcement efforts against drink-driving and under-age drinking was found to be effective in two narrative reviews (Calafat, 2010; Calafat, Juan and Duch, 2009) in:

  • reducing the rate of night time traffic injuries and the number of hospital admissions due to traffic accidents (116 fewer injury accidents in 38 months in the experimental site compared with the control community) .

Multicomponent programmes combining community mobilisation, Responsible Beverage Service (RBS) training, house policies and stricter enforcement of licensing laws to reduce accidents and alcohol consumption

The Sacramento Neighbourhood Alcohol Prevention Project was found effective in a narrative review (EMCDDA, 2012) and in two systematic reviews (Jones, Hughes, Atkinson and Bellis, 2010; Bolier, Voorham, Monshouwer, van Hasselt and Bellis, 2011) in:

  • significantly reducing assaults and motor vehicle accidents (based on police and emergency medical service reports);

The 'A Matter of Degree' programme was found effective in a narrative review (EMCDDA, 2012) and in two systematic reviews (Jones, Hughes, Atkinson and Bellis, 2010; Bolier, Voorham, Monshouwer, van Hasselt and Bellis, 2011) in:

  • significantly reducing alcohol consumption, alcohol-related harms and drink-driving at follow-up, based on self-reported outcomes (but only at five sites with the highest implementation of environmental programming).

Police interventions to reduce public disorders

Police interventions in licensed premises, with uniformed police officers visiting pubs two to three times a week was found in a narrative review (Calafat, Juan and Duch, 2009) to lead to:

  • a 20 % reduction in recorded public disorders offences in the intervention area, compared with no reduction in the control area.

Police intervention in high-risk premises was found in a systematic review (Jones, Hughes, Atkinson and Bellis, 2010) and in a narrative review (EMCDDA, 2012) to be a more effective strategy than ‘low level’ policing in:

  • reducing alcohol-related incidents (narrative results only).

Police interventions to reduce crime

Police interventions aimed at reducing the movement of clients between bars, the overall alcohol consumption of clients and contain that consumption within safer settings was found to be effective in a systematic review (Ker and Chinnock, 2008) in:

  • reducing assault rates: pre-intervention serious assault rate in the experimental area was 52 % higher than the rate in the control area. After intervention, the serious assault rate in the experimental area was 37 % lower than in the control area.

Police and law enforcement measures to increase responsible serving behaviours

Police interventions encompassing regular enforcement and visits by plain clothes officers aimed at promoting responsible alcohol service and at preventing driving while under the influence, and targeting servers in nightlife settings and licensed premises were found in a systematic review (Bolier, Voorham, Monshouwer, van Hasselt and Bellis, 2011) to lead to:

  • Bar tenders serving alcohol less often to pseudo-clients acting as though they were intoxicated (variation of results across three studies ranging from significant to not statistically significant results).

Combined enforcement checks and management training to reduce under-age serving

Combined enforcement checks and management training programmes were found in one study included in a systematic review (Bolier, Voorham, Monshouwer, van Hasselt and Bellis, 2011) to be effective in:

  • reducing the service to under-age clients (relatively non-significant decrease in intervention group, from 46 % to 42 %).

Interventions to increase adoption of responsible serving policies by recreational premises

Policy interventions focused on implementation evaluated in a systematic review (Bolier, Voorham, Monshouwer, van Hasselt and Bellis, 2011) were found to lead to:

  • more alcohol policies being written by the club owners and being used after club owners underwent intensive management training but in multivariate models we observed no significant differences at follow-up in reported policies/practices across establishments.
  • a higher number of licensed premises adopting a responsible service policy (increases in the 239 participating premises ranged between 11 % and 59 % for alcohol-related initiatives).

Training for alcohol servers and owners/managers to reduce night-time traffic accidents

Drink-driving programmes targeting recreational settings encompassing compulsory training for all alcohol servers and owners/managers were found in a narrative review (Calafat, Juan and Duch, 2009) to lead to:

  • statistically significant reductions in single-vehicle night-time traffic accidents (those with high percentages of alcohol involvement).

Mandated server training was found in two systematic reviews (Jones, Hughes, Atkinson and Bellis, 2010; Ker and Chinnock, 2008) and in a narrative review (EMCDDA, 2012), to lead to:

  • reductions in Single Vehicle Night crashes and alcohol-related crashes (23 % by the end of the third year).

Alcohol server interventions were found in a systematic review (Bolier, Voorham, Monshouwer, van Hasselt and Bellis, 2011) to have significant effects in:

  • reduction of road accidents (narrative results).

Promotion of sensible alcohol consumption to reduce traffic accidents

Promotion of sensible alcohol consumption and/or prevention injuries policy were found in narrative review (Calafat Juan and Duch, 2009) and in a systematic review (Ker and Chinnock, 2008) including 23 studies (RCT, 10 non-randomised controlled trials and 5 CBA) to be more effective than no intervention in:

  • reducing Single Vehicle Night crashes 4 % after six months, 11 % after 12 months, 18 % after 24 months, and 23 % after 36 months.

Training for alcohol servers to reduce the level of patron’s intoxication

Face to face server training, when accompanied by strong and active management support, assessed in two narrative and two systematic review (Calafat, Juan and Duch, 2009; EMCDDA, 2012; Bolier, Voorham, Monshouwer, van Hasselt, and Bellis, 2011; Jones, Hughes, Atkinson and Bellis, 2010) was found effective in:

  • reducing the level of intoxication in bar clients (only narrative results).
  • reducing the percentage of clients with BALs ≥ 0.08 (reported by the authors as significant, only narrative results).  

Likely to be beneficial

Drink-driving programmes to prevent drinking related harms

Multi-component programmes combining: community mobilisation, responsible behaviour service training, house policies and stricter enforcement of licensing laws, were studied in a systematic review of studies (Jones, Hughes, Atkinson and Bellis, 2010), and were found to be potentially effective in:

  • reducing assaults (narrative results).
  • traffic crashes (narrative results).
  • under-age sales (narrative results).  

Pub-watching schemes to reduce alcohol-related crime against property

A narrative review (Calafat, Juan and Duch, 2009) found some evidence suggesting that pub-watching schemes have a significant desirable effect on:

  • crime reduction (only narrative results).

Trade-off between benefits and harms

No interventions met the criteria for this category.

Unknown effectiveness

Dedicated driving programmes to reduce drinking and driving harms

‘Designated driver’ programmes were found to have little evidence supporting their efficacy in two narrative reviews (Calafat, 2010; Calafat, Juan and Duch, 2009) in:

  • reducing drink-driving.

Dedicated drink-driving programmes to change clients behaviours in relation to travel in a car with an intoxicated driver

Programmes targeting drink-driving were found to have no impact on client behaviours in a systematic review (Jones, Hughes, Atkinson and Bellis, 2010), namely:

  • community programmes targeting drivers and resorting to media campaigns and promotions revealed no change in frequency of being in a car with a driver with .05 BAL (1 low quality study UCBA).

Dedicated drink-driving programmes to change alcohol consumption

Programmes targeting drink-driving were found to have no impact on client behaviours in a systematic review (Jones, Hughes, Atkinson and Bellis, 2010), namely:

  • programmes promoting responsible drinking, targeting seventeen licensed premises, eight intervention premises and nine control premises (n = 575 clients) and aimed at promoting responsible drinking and at placing breath analysis machines, revealed no significant differences in alcohol consumption based on BAL measurements (one low quality RCT study).

Interlocks mechanism to prevent alcohol impaired driving in long term

The effectiveness of interventions placing interlocks (mechanism that automatically prevents the car from launching under certain conditions) on the ignition to prevent an alcohol-impaired driver from operating the car (used with drink-driving offenders), was limited according to two narrative reviews (Calafat, 2010; Calafat, Juan and Duch, 2009):

  • it showed good results during the period of time they were using the interlock but the effects disappeared when the interlock was removed.  

Restricting opening hours to reduce alcohol related injuries

Restricting opening hours was found to have no effect in a narrative review (Calafat, Juan and Duch, 2009) in:

  • reducing the numbers of alcohol- or assault-related visits to emergency rooms.

Multicomponent programmes to control alcohol sales

The Sacramento Neighbourhood Alcohol Prevention Project (CCT focused on community mobilisation, community awareness, RBS and law enforcement in relation to under-age access to alcohol and intoxicated clients) showed no effects in a narrative review (EMCDDA, 2012) and in a systematic review (Jones, Hughes, Atkinson and Bellis, 2010) in:

  • sales to under-age and pseudo-intoxicated clients.

Police and law enforcement measures to reduce alcohol sales

Evidence for the effectiveness of police intervention or increased enforcement of licensing laws in reducing alcohol-related incidents was found in two systematic reviews (Jones, Hughes, Atkinson and Bellis, 2010; Bolier, Voorham, Monshouwer, van Hasselt and Bellis, 2011) and in a narrative review (EMCDDA, 2012) to be inconclusive regarding:

  • under-age sales (narrative results).
  • sales to intoxicated clients (narrative results).  

Evidence of ineffectiveness

 

Information provision to prevent drug- and alcohol-related problems

Information provision (e.g. prevention or harm reduction information material, such as brochures and pamphlets on intoxication and related harm) was not found to be an effective measure in a narrative review (EMCDDA, 2012) in:

  • reducing drug- and alcohol-related problems.

Educational interventions in recreational settings to influence attitudes and drinking behaviour

Educational interventions were found in a systematic review (Bolier, Voorham, Monshouwer, van Hasselt and Bellis, 2011) to have no effects on:

  • risky behaviours (use of drugs such as ecstasy, GHB and alcohol).

Replacement of glassware in recreational settings aimed at preventing injuries among servers

Replacement of pint glasses with toughened glassware was found in two systematic reviews (Jones, Hughes, Atkinson and Bellis, 2010; Ker and Chinnock, 2008) to cause even more harm:

  • experimental glass caused more injury than the control (only narrative results).

Electronic Age Verification (EAV) devices to increase the frequency of age verification at recreational premises

Electronic Age Verification devices (EAVs) were found not effective according to a narrative review (Calafat, Juan and Duch, 2009) in: 

  •  increasing the frequency of age verification in recreational settings.

References and definitions

References

Explanation of terms used

Below you can find definitions and further explanation for some of the terms used in this section of the Best practice portal. A more general glossary for the best practice portal is also available.

Affective-focused prevention intervention

A type of prevention intervention which aims to they aim to modify inner qualities (personality traits such as self-esteem and self-efficacy, and motivational aspects such as the intention to use drugs).

BA

Before-after (BA) study design

BAL

Blood alcohol level (BAL)

Beneficial

Interventions for which precise measures of the effects in favour of the type of intervention were found in systematic reviews of relevant studies. An intervention ranked as ‘beneficial’ is suitable for most patients/contexts. See the relevant module methodology page for further information.

CBA

Controlled before-after (CBA) study design. UCBA stands for Uncontrolled before-after study design.

CBT

Cognitive behavioral therapy is an individual based intervention occurring in three stages. Phase 1 is aimed at determining and prioritizing the patient’s problems and constructing the treatment contract. Phase 2 is aimed at increasing coping competence and reducing risky behaviors. Phase 3 focuses on relapse prevention. Each session is administered once per week over a period of 4-6 months with 60- to 90-minute sessions (Beck AT, Wright FW, Newman CF, Liese B. Cognitive Therapy of substance abuse. New York: Guilford Press, 1993).

CCT

Controlled clinical trials (CCT)

Cohort study

A cohort study is a type of observational study that follows a group of people (i.e. a cohort) over time. In a prospective cohort study, the cohort is formed and then followed over time. In a retrospective cohort study, data is gathered for a cohort that was formed sometime in the past.

Confidence Interval (CI)

The Confidence Interval (CI) is a measure of the precision (or uncertainty) of study results. It is the interval that most likely includes the true value of the parameter we are calculating, where 'most likely' is taken by common usage to be a 95% probability. Thus the current expression of '95 % CI'. A wide CI indicates less precise estimates of effect and vice versa.

Practical interpretation

  • If the RR (the relative risk) = 1, or the CI (the confidence interval) = 1, then there is no significant difference between treatment and control groups
  • If the RR > 1, and the CI does not include 1, events are significantly more likely in the treatment than the control group
  • If the RR < 1, and the CI does not include 1, events are significantly less likely in the treatment than the control group
CPS

Current population survey (CPS)

Cross-sectional study

A cross-sectional study is a study employing a single point of data collection for each participant or system being studied.They are usually conducted to estimate the prevalence of the outcome of interest for a given population at a given point in time.

Evidence of ineffectiveness

Interventions that gave negative results if compared with a standard intervention or no intervention, for example. See the relevant module methodology page for further information.

Additional information for prevention
For ethical reasons this category in prevention should be considered as interventions with negative and undesired (iatrogenic) effect.

IP

Individual psychotherapy is a standard individual treatment based on counseling and motivational interviewing and focused on substance use triggers and strategies for relapse prevention. It includes elements of cognitive-behavioral therapy (CBT).

IQR

Interquartile range (IQR) - also called the midspread or middle fifty - is a measure of statistical dispersion. It is a trimmed estimator, defined as the 25% trimmed mid-range, and is the most significant basic robust measure of scale.

ITS

Intermittent time series design (ITS)

Knowledge-focused prevention intervention

A type of prevention intervention which aims to to enhance knowledge of drugs, and drug effects, and consequences.

Likely to be beneficial

Interventions that were shown to have limited measures of effect, that are likely to be effective but for which evidence is limited. An intervention ranked as ‘likely to be beneficial’ is suitable for most contexts/patients, with some discretion. See the relevant module methodology page for further information.

Number Needed to Treat (NNT)

The Number Needed to Treat (NNT)indicates the number of patients that needs to be treated to obtain one respondent patient. Numerically the NNT is the reciprocal of the difference between the proportion of events in the experimental and the comparison group (absolute risk reduction). Taking into consideration that the ideal NNT would be 1 (the unreal situation in which every single patient succeeded) it is easily understood that a NNT value close to 3 or 4 would be very good.

Adjusted Odds Ratio (AOR)

The Adjusted Odds Ratio is a way of comparing whether the probability of a certain event is the same between two groups, yet they are calculated adjusting for or controlling for other possible contributions from other variables (tipically demographic variables) in the model. An AOR equal to 1 implies that the the event is equally probable in both groups. An AOR greater than 1 implies that the event is more likely in the first group. An AOR less than 1 implies that the event is less likely in the first group.

Odds Ratio (OR)

The Odds Ratio is a way of comparing whether the probability of a certain event is the same between two groups. Like the Relative Risk, an OR equal to 1 implies that the the event is equally probable in both groups. A OR greater than 1 implies that the event is more likely in the first group. A OR less than 1 implies that the event is less likely in the first group. In medical research, the odds ratio is commonly used for case-control studies, as odds, but not probabilities, are usually estimated. Relative risk is used in randomized controlled trials and cohort studies.

p value

A p-value is a measure of how much evidence we have against the null hypothesis. The null hypothesis represents the hypothesis of no change or no effect. The smaller the p-value, the more evidence we have against the null hypothesis thus it is more likely that our sample result is true. Traditionally, researchers will reject a null hypothesis if the p-value is less than 0.05.

RBS

Responsible beverage service (RBS)

RCT

Randomised controlled trial (RCT)

Relative Risk (RR)

The Relative Risk (RR) is used to compare the risk in the two different groups of people, i.e. treated and control groups to see if belonging to one group or another increases or decreases the risk of developing certain outcomes. This measure of effect will tell us the number of times an outcome is more likely (RR > 1) or less likely (RR < 1) to happen in the treatment group compared with the control group.

Practical interpretation

  • If the RR (the relative risk) = 1, or the CI (the confidence interval) = 1, then there is no significant difference between treatment and control groups
  • If the RR > 1, and the CI does not include 1, events are significantly more likely in the treatment than the control group
  • If the RR < 1, and the CI does not include 1, events are significantly less likely in the treatment than the control group
Trade-off between benefits and harms

Interventions that obtained measures of effects in favour of the intervention, but that showed some limitations or unintended effects that need to be assessed before providing them. See the relevant module methodology page for further information.

 
Unknown effectiveness

Interventions for which there are not enough studies or where available studies are of low quality (with few patients or with uncertain methodological rigour), making it difficult to assess if they are effective or not. Interventions for which more research should be undertaken are also grouped in this category.

Additional information for prevention
For prevention interventions,  this  is also known as 'zero effect'.

Skill-focused prevention intervention

A type of prevention intervention which aims to enhance students’ abilities in generic skills, refusal skills and safety skills.

Standardised Mean Difference (SMD)

The Standardised Mean Difference (SMD) is the difference in means divided by a standard deviation. Note that it is not the standard error of the difference in means (a common confusion). The standardized mean difference has the important property that its value does not depend on the measurement scale. It may be useful if there are several trials assessing the same outcome, but using different scales.

z score (Standard Score)

The z-score (aka, a standard score) indicates how many standard deviations an element is from the mean of the population.

Case definition

Prevention interventions can target patrons of bars, pubs, nightclubs, discotheques, music festivals, rave parties and other recreational settings, as well as staff and other relevant stakeholders. Attending recreational settings has an effect on the networking and social life of young people and data indicate that recreational venues are risk enhancing settings.

Risks

The increased mobility and globalisation of the entertainment industry makes it necessary to address potential substance abuse (e.g., alcohol, illicit drugs) in recreational settings, both at national and international level.

Interventions

Interventions can be designed to tackle the problem at different levels

  • user level (patron education through brochures and pamphlets)
  • staff and management of recreational premises level (‘responsible serving’ training)
  • community level (community mobilisation, including campaigns to raise awareness). These interventions may involve a broader set of stakeholders, such as the police and law enforcement officers (police visits to high-risk nightlife venues, age verification, and the use of sanctions)
  • environmental aspects such as context, environment and neighbourhood (crowd management, clear house rules preventing access by minors as well as ‘drink and driving’ programmes)

Different approaches can be combined together into multi-component programmes.

Outcomes

The main aim of prevention interventions targeting recreational settings is to reduce the health and social risks (including driving harms) associated with the potential use of alcohol and illicit drugs in such settings.

Primary outcomes, measures

  • Reduction of substance use
  • Reduction of risky behaviours, namely:
    • alcohol intoxication
    • vehicular and non-vehicular injuries
    • drinking and driving
  • Reduction of underage drinking
  • Reduction of public disorders and crime

References

EMCDDA

Other

Page last updated: Thursday, 23 June 2016