Technical Paper 3:
Preventing Alcohol-related harm in Australia: a window of opportunity
4.1 - Current activity
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Considerable activity aiming to prevent alcohol-related harm is currently under way in Australia. The extent to which the considerable preventative desire and activity (planned or under way) is likely to be effective, and how well this activity reflects an evidence-based approach, is considered in the next section of this paper. In general, the measures that are most often called for by community members tend to be the least effective, while the most effective measures are the least popular and are thus probably the most difficult for governments to introduce, usually requiring strong leadership and well-planned implementation.
What is prevention in this area?
The stated aim of Australia’s current National Drug Strategy is to ‘prevent the uptake and minimise the harmful effects of drug use in Australian society’. Known as ‘harm minimisation’, this approach has been defined as encompassing:
- Supply reduction strategies designed to restrict the harmful supply of drugs
- Demand reduction strategies designed to prevent the uptake of harmful drug use
- Harm reduction strategies to reduce drug-related harm for individuals and communities.
The approach of harm minimisation, while complex and requiring continuing support from public advocates, is based on scientific evidence and underpins the definition of prevention adopted for the review of alcohol-related interventions in this paper. It can encompass universal as well as targeted interventions (both selective: particular high-risk sub-populations; and indicated: those with emerging problems).
Though not explored in detail in this paper, the concept of the prevention paradox
assists in understanding prevention approaches in the areas of public health and public safety. This approach suggests that more (net) harm may be prevented through universal interventions – focusing on the majority who are less seriously involved in harmful alcohol/drug use, rather than through interventions that only target the smaller proportion of high-risk users.
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What works in alcohol-related prevention?
The following discussion is informed by recent reviews of the available research evidence. This includes:
- the World Health Organization’s (WHO) international review of alcohol-related research and
- a recent Australian research monograph on the prevention of substance use, risk and harm
- a recent update of the latter, with a focus on prevention interventions targeting adolescents.
Other recent reviews have also been drawn upon, to a lesser extent, including Stockwell 2004, Loxley et al.
2005[7, 43] and NDRI 2007.
The conclusions reached in the WHO report with regard to the respective strengths and weaknesses of different types of interventions, according to the available international research evidence, are summarised in Table 6. Included in this table are Australian-authored evaluations of the equivalent interventions provided by Loxley et al.
 and Toumbourou et al.
 The scales used to rate the interventions by the respective authors are summarised in Table 5 below.
Table 5: Key to the rating scales shown in Table 6
Evidence of effectiveness
Breadth of research support
Test across cultures
Lack of effectiveness
No studies undertaken
1 well-designed study completed
Tested in 1 country
Evidence for implementation
2–4 studies completed
Tested in 2–4 countries
Evidence for outcome effectiveness
High degree of effectiveness
5+ studies completed
Tested in 5+ countries
Evidence for effective dissemination
No evidence available
Warrants further research
Evidence is contra-indicative
This rating scale applies to the WHO’s international review  and Australian reviews..
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Of the 39 interventions listed in Table 6, at least half of these are universal (targeted at the whole population) and approximately half are targeted at high-risk groups. The international review by Babor et al.
concludes that interventions targeting the whole population generally have higher effectiveness ratings and are less costly to implement and maintain, on average, than those targeting high-risk groups. In general, the types of interventions that are considered most effective according to the ratings are, in order:
- Regulating physical availability
- Taxation and pricing
- Drink-driving countermeasures
- Treatment and early intervention
The types of interventions for which there is somewhat less evidence of effectiveness are, in order:
There are differences in the ratings of some interventions between the international review and the Australian review. (for example, the treatment of alcohol problems and mass media campaigns). Also, importantly, it should be recognised that although the effectiveness of some interventions do not rate highly, in some cases this may be due to the limited research evidence that is available to inform the rating (for example, advertising content controls).
- Altering the drinking context
- Regulating promotion
- Education and persuasion
Table 6: Ratings of policy-relevant strategies and interventions
|Strategy or intervention||Effectiveness||Breadth of research||Cross-cultural testing||Cost to implement||Australian evaluation|
Regulating physical availability
|Total ban on sales||High|
|Minimum legal purchase age||Low|
|Hours and days of sale restrictions||Low|
|Restrictions on density of outlets||Low|
|Staggered closing times for bars and clubs||X|
|Server liability|| ||Low|| |
|Different availability by alcohol strength|| ||Low|
Taxation and pricing
|Hypothecated tax to pay for treatment / prevention|
|Setting floor prices / banning discounting|
|Random breath testing||Moderate|
|Low BAC limits|| ||Low|
|Administrative licence suspension||Moderate|
|Low BAC for young drivers||Low|
|Graduated licensing for novice drivers||Low|
|Designated drivers and ride services|| ||Moderate|
Treatment and early intervention
|Brief intervention in primary health settings||Moderate|
|Alcohol problems treatment|| ||High|
|Mutual help/self-help attendance||Low|
|Mandatory treatment of repeat drink drivers||Moderate|
Altering the drinking context
|Bans on serving intoxicated persons||Moderate|
|Training staff to prevent intoxication / aggression||Moderate|| |
(X if not enforced)
|Voluntary codes of bar practice||Low|| |
(X if not enforced)
|Enforcement of on-premises regulations and laws||High|
|Promoting alcohol-free events|| ||High|
|Community mobilisation|| ||High|
|Plastic or tempered-glass serving containers|| |
|Advertising content controls||Low|
Education and persuasion
|Alcohol education in schools||High|
|College student education||High|
|Public service messages / Mass media campaigns||Moderate|
|Warning labels / National drinking guidelines||Low|
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