Main findings of the literature study

The literature search identified 47 studies that examined interventions designed to reduce harm in drinking environments. Seven studies examined the effectiveness of training programmes for servers and managers, five examined specific interventions delivered in pubs and bars, eight examined the enforcement of laws related to alcohol consumption, seven examined interventions aimed at reducing underage sales and 20 examined multi-component community-based programmes. Nine of the included studies were conducted in European countries including five in Sweden and four in the UK. The remaining studies were conducted in the USA, Canada, Australia and New Zealand. The methodological quality of the included studies was variable according to the study design used, and in general the methodological quality of the included studies was weak.

Responsible server/staff training interventions

• Studies have shown that responsible server and staff training interventions can increase staff knowledge about alcohol issues and have benefits in improving staff practice.
• The impacts of staff training programmes on alcohol use and harms are generally small and short-lived, except where training is mandatory or interventions are implemented as part of broader interventions.
• Bar staff training programmes are widely used in Europe yet few have been rigorously evaluated. However some evidence of effectiveness is available from studies that have been undertaken in Scandinavia (for example the STAD project).

Interventions to reduce underage access to alcohol

• There is little evidence to support the placement of age verification devices in drinking venues as a standalone method of reducing underage sales.
• Enforcement activity to deter underage sales has shown some success, yet effects can be short lived. Enforcement needs to be applied regularly to maintain its effects and benefits from the use of real deterrents and staff training.
• There is growing concern about underage alcohol use in bars in Europe. Whilst several countries appear to be taking action to address this, the FASE literature review only identified one European study exploring the impact of an intervention.

Policing and enforcement approaches

• Studies on the effectiveness of policing and enforcement activity in reducing alcohol-related harm report mixed findings. Some have shown increased alcohol-related problems following such activity, although this may be due to better detection and reporting of such problems.
• The strongest evidence of effectiveness comes from targeted enforcement activity in high risk drinking premises.
• Policing and enforcement appears to play a key role in measures to reduce alcohol-related harm in European drinking environments.
• Few European policing and enforcement measures have been subjected to rigorous evaluation, although some evidence is available from the UK.

Interventions delivered in drinking environments

• There is limited evidence to support the effectiveness of interventions delivered in drinking environments as standalone measures.
• Brief interventions delivered in bars have been found to reduce alcohol use in heavy drinkers, but methods to combat drink driving have been less effective.
• Interventions to address alcohol-related harm are being implemented in European drinking environments. Many focus on reducing drink driving, often promoting designated driver programmes that lack evidence of effectiveness.

Community interventions in drinking environments

• Community-based programmes that combine a range of co-ordinated measures implemented through strong multi-agency partnership provide the clearest evidence of effectiveness in reducing alcohol-related harm in drinking environments.
• Studies have associated these measures to reductions in alcohol consumption, drink driving, road traffic crashes, violence and underage alcohol sales.
• Community-based multi-component approaches are being implemented in several European countries and studies from Finland and Sweden and show that they are having beneficial effects in reducing sales of alcohol to intoxicated customers and, in Sweden, reducing violence. The Swedish study has also shown cost-effectiveness.

Policy recommendations

• Although there are many interventions underway across Europe to create safer drinking environments, few of these are rigorously evaluated. Consequently there is very little information available on their effectiveness in reducing alcohol-related harm, and on their cost-effectiveness. Sharing and developing the existing evidence base is critical in protecting health in drinking environments.
• Local agencies often lack the capacity and resources required to implement rigorous evaluations of their work. Support for evaluating interventions in drinking environments should be provided at a European level. This should include evaluating both effectiveness in terms of reduced alcohol-related harm and the cost-effectiveness of programmes.
• Interventions with a clear evidence base should be promoted and tested for transferability in different settings. Authorities should be discouraged from investing in measures that have been shown to have no benefits.
• The clearest indication of effectiveness from the international evidence base comes from community-based, multi-component programmes, which combine community mobilisation, responsible beverage service training and stricter enforcement of licensing laws. Partnership approaches that enable pooled resources to be targeted at joint priorities should be promoted.
• The collection and sharing of reliable local level data on alcohol use, alcohol availability and alcohol-related harms should be encouraged and supported in order to facilitate the targeting, monitoring and evaluation of interventions to reduce alcohol-related harm.
• Evaluation and monitoring of interventions should take into account any broader impacts of interventions implemented in drinking environments. For example, measures that reduce violence in drinking environments should ensure displacement effects are not moving violence into homes and vulnerable communities, where violence is less visible.
• A major limitation of many interventions in drinking environments is their short-term approach, with the benefits of measures introduced through one-off funding often being short-lived. Support is needed to enable national and local agencies to build effective measures into routine practice. Measuring the economic benefits of interventions to health and criminal justice services, as well as the night time economy itself, is an important factor in sustaining effective practice.
• There is a major gap in knowledge of drinking behaviours in young adults in Europe, with no consistent data available on this high risk group and few studies conducted even at country level. Further, there is very little information on alcohol-related harm occurring in or because of European drinking environments and the costs this imposes on public services, communities and the alcohol industry. Developing this knowledge would greatly facilitate the creation of safer drinking settings in Europe.
• Interventions to reduce alcohol-related harm in drinking environments are often implemented as reactive rather than preventive problems. The literature suggests that high concentrations of alcohol outlets, longer opening hours and cheap alcohol prices contribute to increased alcohol-related problems. This literature should be used to inform regulatory control measures that prevent the development of drinking environments conducive to alcohol-related harm.
• Measures to reduce alcohol-related harm in drinking environments should form part of broader strategies to understand and address alcohol-related problems. Interventions should not focus solely on preventing harm, but also on reducing the drinking behaviours and other behavioural, environmental and cultural factors that contribute to such harm.

Literature Study Drinking Environments (0,99 MB)