<title>Jay's World of Abstracts 00010: Preventing Alcohol Abuse and Related Problems</title>

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<title>Jay's World of Abstracts 00010: Preventing Alcohol Abuse and Related Problems</title>
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Alcohol Alert From NIAAA, the National Institute on Alcohol Abuse and Alcoholism.">
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<h2 align="right">Jay's World of Abstracts 00010</h2><hr>
<div align="center"><h1>Preventing Alcohol Abuse and Related Problems</h1>
An abstract of an Alcohol Alert From NIAAA, the National Institute on Alcohol Abuse and Alcoholism. </div>
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[Standard disclaimer: The nature of abstracts are that they are pieces of something larger. Not everyone is going to be happy with my choice of abstracts from any larger work, so if you are dissatisfied, I would refer you to the original document, which should be able to be found on the Internet. I encourage others to make their own abstracts to satisfy their needs.
<h3>Jay's Introduction</h3>
Actually, this is more of an official summary than an abstract, since it is here in its entirety.
Just in case you were wondering if I wrote it.
This is here because our Substance Abuse Core Team, at one time, had the enforcement of "zero-tolerance" laws for all substances as its aim and I was reading up on this subject in their behalf.
I produced this abstract using time paid for by the Quay County Maternal Child and Community Health Council with funds from the New Mexico Department of Health.
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<h3>Abstracts</h3>
Prevention measures aim to
reduce alcohol abuse and its consequences. Such measures include
policies regulating alcohol-related behavior on the one hand and
community and educational interventions seeking to influence
drinking behavior on the other. Researchers use scientific
methods, such as randomized controlled trials, time-series analysis,
and computer simulation, to determine the effectiveness of
prevention initiatives. The resulting data may both inform policy
and guide community and educational prevention efforts. This
Alcohol Alert summarizes research on the effectiveness of
selected initiatives in each of these areas.
Policy Interventions
Alcohol Taxes. Researchers find that
alcohol taxes and prices affect alcohol consumption and associated
consequences (1). Studies demonstrate that increased beer prices
lead to reductions in the levels and frequency of drinking and heavy
drinking among youth (2,3). Higher taxes on beer are associated with
lower traffic crash fatality rates, especially among young drivers
(4,5), and with reduced incidence of some types of crime (6).
Research suggests that the heaviest-drinking 5 percent of drinkers
do not reduce their consumption significantly in response to price
increases, unlike drinkers who consume alcohol at lower levels (7).
In one study, heavy drinkers who were unaware of the adverse health
consequences of their drinking were less responsive to price changes
than either moderate drinkers or better informed heavy drinkers (8).

Raising the Minimum Legal Drinking Age (MLDA).
MLDA legislation is intended to reduce alcohol use among
those under 21, to prevent traffic deaths, and to avoid other
negative outcomes (9-11). Raising the MLDA has been accompanied by
reduced alcohol consumption, traffic crashes, and related fatalities
among those under 21 (11,12). A nationwide study found a significant
decline in single-vehicle nighttime (SVN) fatal
crashes--those most likely to involve alcohol--among drivers under
21 following increases in the MLDA (9).
Zero-Tolerance Laws. The National
Highway Systems Act provides incentives for all States to adopt
"zero-tolerance laws" that set maximum blood alcohol concentration
(BAC) limits for drivers under 21 to 0.02 percent or lower beginning
October 1, 1998 (13). An analysis of the effect of zero-tolerance
laws in the first 12 States enacting them found a 20-percent
relative reduction in the proportion of SVN fatal crashes
among drivers under 21, compared with nearby States that did not
pass zero-tolerance laws (12,14).
Other BAC Laws. Fourteen States
have lowered BAC limits from 0.10 to 0.08 percent to reduce
alcohol-related fatal motor vehicle crashes. One study found that
States with the reduced limit experienced a 16-percent decline in
the proportion of fatal crashes involving fatally injured drivers
whose BAC's were 0.08 percent or higher, compared with nearby States
that did not reduce their BAC limit. In a separate analysis, this
study found that States that lowered their BAC limit also
experienced an 18-percent decline in the proportion of fatal crashes
involving fatally injured drivers whose BAC's were 0.15 or higher,
relative to comparison States (15).
Administrative License Revocation Laws.
Laws permitting the withdrawal of driving privileges without
court action have been adopted by 38 States to prevent traffic
crashes caused by unsafe driving practices, including driving with a
BAC over the legal limit (16). These laws were associated with a
5-percent decline in nighttime fatal crashes in some studies
(17,18). Other studies observed six- to nine-percent reductions in
nighttime fatal crashes following their adoption (17).
Server Liability. Alcohol servers are
increasingly held liable for injuries and deaths from traffic
crashes following the irresponsible selling and serving of alcohol.
Researchers assessed the effect of potential server liability on the
rates of alcohol-related fatal crashes in Texas (19). SVN fatal
traffic crashes decreased 6.5 percent after the filing of a major
server-liability court case in 1983 and decreased an additional 5.3
percent after a 1984 case was filed. However, before concluding that
server liability is effective, these results need replication (19).
Warning Labels. The mandated warning
label on containers of alcoholic beverages aims to inform and remind
drinkers that alcohol consumption can result in birth defects,
impaired ability to drive a car or operate machinery, and health
problems. Research indicates that public support for warning labels
is extremely high; that awareness of the label's content has
increased substantially over time (20); that perception of the
described risks was high before the label appeared and has not
generally increased (21); and that the label has not had
important effects on hazardous behavior, although certain
effects may be indicative of the early stages of behavioral change
(20). One study of pregnant women found that after the label
appeared, alcohol consumption declined among lighter drinkers
but not among those who drank more heavily (22).
Community and Educational Interventions
The Saving Lives Program. The Saving
Lives Program in six communities in Massachusetts was designed to
reduce drinking and driving and to promote safe driving practices.
Saving Lives involved the media, businesses, schools and colleges,
citizens' advocacy groups, and the police in activities such as high
school peer-led education, college prevention programs, increased
liquor-outlet surveillance, and other efforts. Participating
communities reduced fatal crashes by 25 percent during the program
years compared with the rest of Massachusetts. The decline in
alcohol-related fatal crashes was 42 percent greater in Saving Lives
communities than in comparison cities during the program years. The
proportion of drivers under 21 who reported driving after drinking
in the month before being interviewed also declined in participating
communities (17).
Life Skills Training (LST). LST teaches
students in grades seven to nine skills to resist social influences
to use alcohol and other drugs and to enhance general competence and
self-esteem. LST has been found to increase students' knowledge of
the negative consequences of drinking and to promote realistic, not
inflated, perceptions of drinking prevalence (23). A study of LST's
long-term effects among 12th grade students who had received a
relatively complete version of the program showed significantly
lower rates of weekly drinking, heavy drinking, and getting drunk
than did control students. The full sample exposed to the program
also showed significantly lower rates of drunkenness than did the
controls (24).
Project Northland. Project Northland is
a multicomponent, school- and community-based intervention to delay,
prevent, and reduce alcohol use and related problems among
adolescents. It includes social-behavioral curricula, peer
leadership, parental involvement/education, and communitywide task
force activities (25,26). The first 3 years of intervention,
conducted in grades six through eight, resulted in significantly
lower prevalence of past-month and past-week alcohol use among
students in intervention communities compared with controls. These
beneficial effects were particularly notable among students who had
not yet begun experimenting with alcohol when the program began
(27).
Alcohol Misuse Prevention Study (AMPS).
The AMPS curriculum, for students in grades five through eight,
focuses primarily on teaching peer-resistance skills and on
clarifying students' misperceptions of their peers' alcohol use.
Among adolescents at greatest risk for escalating alcohol
misuse--those who engaged in early unsupervised use of alcohol--the
AMPS intervention had a modest, but lasting, statistically
significant effect of slowing the increase in alcohol misuse through
grade 8 (28,29) and into grade 12 (30). Replication of this research
again showed a significant effect for the highest risk subgroup
(29).
Project STAR. Project STAR--involving
schools, mass media, parents, community organizations, and health
policy components in two sites in the Midwest--attempts to delay the
onset and decrease the prevalence of alcohol and other drug use
among students beginning in sixth grade. Project STAR teaches skills
to resist alcohol use and educates students about the actual, as
opposed to the perceived, prevalence of alcohol use among their
peers. Early followup studies showed that the program had little
effect on alcohol use (31,32). However, in a 6-year followup in
Kansas City, students in program schools showed lower rates of
increase in alcohol use and episodes of drunkenness over time than
did students in control schools. Similar but smaller effects were
observed at 3.5-year followup in Indianapolis (33). 
Drug Abuse Resistance Education (DARE).
DARE, typically taught to 10- and 11-year-old students in
grades five and six by police officers, aims to inform about alcohol
and other drugs and to teach social and decisionmaking skills to
help students resist their use. Studies have found that DARE
essentially has no impact on alcohol use (34-36).
Informational Programs. Programs
attempting to persuade students not to use alcohol by arousing fear
do not work to change behavior (30,37). Emphasizing the
dangers of alcohol may attract those who tend to be
risk-takers. Programs providing information about the
pharmacological effects of alcohol may arouse curiosity and lead to
drinking (37).
Server Training. Server training,
mandatory in some States, educates alcohol servers to alter their
serving practices, particularly with underage customers and those
who show obvious signs of intoxication. Server training explains the
effects of alcohol, applicable laws, how to refuse service to
obviously intoxicated patrons, and how to assist customers in
obtaining transportation as an alternative to driving. Some, but not
all, studies report more interventions with customers after server
training than before. One evaluation of the effects of Oregon's
mandatory server-training policy indicates that it had a
statistically significant effect on reducing the incidence of SVN
traffic crashes in that State (38).
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Preventing Alcohol Abuse and Related Problems--
 A Commentary by NIAAA Director Enoch Gordis, M.D.
Prevention encompasses activities or actions ranging
from those affecting the whole population through social and
regulatory controls to those affecting specific groups, such as
adolescents, or the individual. Many of these activities overlap.
For example, health warning labels, a product of legislation (social
and regulatory control), also are educational. In this Alcohol
Alert, we have tried to give a "flavor" of this broad spectrum;
the prevention areas described are by no means exhaustive, and some
areas described in one category could well be in others.
The good news is that, using contemporary tools of
science, prevention can be rigorously studied. Currently, research
evidence shows that some prevention efforts are effective and others
have little or no effect. This knowledge will help local
communities, the States, and others who have made significant
investments in prevention activities develop or refine existing
programs to achieve their desired objectives.

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