At a glance
STAD uses both formal and informal control measures to address binge drinking in bars and clubs, but also underlines the need for community support of such measures. The working method, developed in Stockholm between 1995 and 2001 aims to create a better and safer bar and pub environment by reducing alcohol related problems such as violence and injuries. The STAD method is based on a structured and long-term effort, consists of three parts: Multi-agency partnership between government agencies and the industry, Two-day training Responsible Beverage Service for bar staff and bar management, and Improved (cooperative) enforcement by and with police.
Johanna Gripenberg
STAD - Centre for Psychiatric Research | Karolinska Institutet & Region Stockholm
johanna.gripenberg[at]sll.se
Overview of results from the European studies
Studies overview
Wallin and colleagues (2003) found that the intervention was robustly effective in reducing violence in and around bars in Stockholm by means of a significant reduction in police-recorded violence (29%). The choice of control area and model specification did overall not affect this outcome. The sequels of the STAD programmes in Sweden seem to have had smaller effects than the original programme implemented in Stockholm (Trolldal, Brännström et al., 2013). One contributing factor was that not all programme components were implemented in the municipalities (Trolldal, Haggård et al., 2013). This is in line with the evidence that the pioneering versions of prevention programmes usually yield larger effects than the widely disseminated sequel programmes that operate on a more fragmentary basis.
In a cost-savings analysis, the 29% reduction in violence translated to a cost-savings ratio of 1:39 (Månsdotter et al., 2007). Furthermore, the program as implemented in Stockholm demonstrated a reduction in alcohol service to underaged using the mystery shopping method(Wallin & Andreasson, 2004) and also overserving using professional male actors (i.e., pseudo-patrons) trained to act alcohol-intoxicated while attempting to purchase alcohol (Wallin et al., 2002, 2005). An expert panel standardized the scene of obvious alcohol intoxication and each attempt was monitored by one observer.
A pre- (2003) and post (2004 and 2008) -intervention design study (Gripenberg et al. 2007, 2011) in high-risk licensed premises in central Stockholm assessed the STAD-CaD effects on the frequency of doormen intervention towards obviously drug-intoxicated guests at licensed premises. Professional male actors were trained to act impaired by cocaine/amphetamines while trying to enter licensed premises with doormen. An expert panel standardized the scene of drug intoxication and each attempt was monitored by one observer. At the follow-up study in 2008 the doormen intervened in 65.5% of the attempts, a significant improvement compared to 27.0% at the first follow-up in 2004 and to 7.5% at baseline in 2003. Within the project, it was also shown that staff at establishments reported own decreased self-reported drug use in 2007/2008 compared to 2001, and also that they observed a reduction in drug-intoxicated patrons (Gripenberg et al.2011). A study by Elgan et al. (2021) showed effects of the STAD model when applied to sports settings.
Countries where evaluated
Characteristics
Description of programme
The work is based on a well-developed multi-agency partnership between several authorities and service industry associations, including for instance nightclub owners, police authorities, alcohol licensing board that all contribute to steering and working groups as well as the co-creation of intervention activities. The combined expertise and commitment by bars, nightclubs and restaurants offer an interesting and well evaluated training package. RBS-training of bar staff is highly recommended by the Stockholm licensing board for licensed premises that stay open after 01:00AM. Participants pay a fee for the RBS-training that finances the coordination, administration, and execution of the training. The training covers topics such as the medical effects of alcohol, alcohol legislation, age checking, and conflict management. Part of the Stockholm approach is also an adapted enforcement strategy of the authorities (police and licensing board) that enforce the alcohol law. The strategy can be summarised by a more cooperative or coaching enforcement instead of a more controlling way of working towards the hospitality industry. As an example, the police contribute structurally to the RBS-training for bar and security staff and management, and they are encouraged to have a coaching dialogue with the staff at establishments when they perform compliance checks. This work has shown to have an effect on a number or outcomes such as violence (Wallin et al 2003; Norström, & Trolldal, 2013) and has shown to save 39 Euros for every one Euro invested in the program (Månsdotter et al, 2007). This has led to the institutionalization (Wallin, Lindewald, & Andréasson, 2004) of the program in Stockholm, and a widespread dissemination to more than 200 of Sweden’s 290 municipalities (Haggård et al., 2015). Furthermore, within the STAD in Europe project (www.stadineurope.eu), the implementation model was piloted in several other countries such as Spain (focus on Ibotellón), Netherlands (focus on big festivals), UK (focus on preloading) and Czech Republic (focus on nightlife and age-limit compliance).
During the work with the RBS-program in the Stockholm nightlife, concerns were raised about the illicit drug situation. Based on the STAD RBS-programme the multi-component illicit drug use prevention intervention, CaD, was developed. In this programme, media advocacy became one important additional intervention component. The CaD-programme has proven to have an effect on for instance increased doormen refusal or intervention rates towards obviously drug-intoxicated patrons (Gripenberg et al. 2007, 2011). This programme has been disseminated to Sweden’s municipalities and counties (Norrgård, et al., 2014), and has, as of 2019, been disseminated to more than 50 municipalities.
