Reviews of evidence regarding interventions to reduce alcohol-impaired driving

Alcohol in Europe: a public health persepctive. A report for the European Commission.

Background It is unclear whether psychiatric morbidity contributes to the small proportion of the population responsible for a large percentage of antisocial behaviour, including violence.

Aims To measure associations between psychiatric morbidity and severity, chronicity and types of victims of violence in the national household population of Britain.

Method Cross-sectional survey of persons in households ( n =8397).Data included self-reported location, victims and outcome of violence over the previous 5 years. Diagnoses were determined by computer-assisted interviews.

Results Hazardous drinking was associated with over half of all incidents involving injury. Antisocial personality disorder conveyed an attributable risk of 24% of respondents reporting victim injuries, but screening positive for psychosis conveyed an attributable risk of only 1.2%.

Conclusions The burden of care resulting from violence associated with hazardous drinking supports population interventions. Despite exceptional risks, half of respondents with antisocial personality disorder were not violent, indicating limitations in targeted interventions to detain high-risk individuals.

Violence and psychiatric morbidity in the national household population of Britain: public health implications

The criteria for causation of alcohol in violent injuries based on emergency room data from six countries.

Objective: This research studied the effects of a commu- nity alcohol prevention program on violent crimes. Starting in 1996, a 10-year multicomponent program based on community mobilization, training in responsible beverage service for servers and stricter enforce- ment of existing alcohol laws has been conducted in Stockholm, Swe- den. The project has been led by an action group consisting of members from the hospitality industry and the authorities. Method: We used a time-series quasi-experimental design that included a control area. Data on police-reported violence during the period of January 1994 to Sep- tember 2000 were analyzed through ARIMA modeling. Results: Dur- ing the intervention period, violent crimes decreased significantly by 29% in the intervention area, controlled for the development in the con- trol area. Conclusions: The intervention seems to have been successful in reducing violent crimes. This effect is most likely due to a combina- tion of various policy changes initiated by the project. The findings sup- port the notion that community action projects working on a local basis can be effective in decreasing alcohol-related problems at licensed prem- ises. (J. Stud. Alcohol 64: 270-277, 2003)

Alcohol prevention targeting licensed premises: a study of effects on violence.

Server intervention is a relatively new approach in the attempt to reduce the incidence of drinking and driving. Although a number of evaluations have suggested that the approach may be effective, there have been few comprehensive evaluations of such programmes. The present study utilized process evaluation techniques to assess reactions to a programme developed by the Addiction Research Foundation, and a quasi-experimental design to determine the impact of the programme on the serving practices of servers. Actors portrayed behaviours often faced by servers, and observers rated the reactions of the servers, who were unaware of the simulations, to these situations. The programme appears to have been effective in changing behaviour, in that trained servers exhibited less inappropriate responses than did untrained servers. In addition the results suggested that the programme increased servers' knowledge about their obligations and potential strategies for dealing with these situations. The implications of these findings for future implementations of such programmes are discussed.

Diane McKenzie

Papers

The role of alcohol providers in prevention: an evaluation of a server intervention programme