Technical Paper 3:
Preventing Alcohol-related harm in Australia: a window of opportunity
4.6 - Altering the drinking context
Because drinking takes place in a social, cultural and community context, it follows that the harmful consumption of alcohol or the harmful consequences of this may be prevented or ameliorated though strategies that modify this context.[13] Such harm-reduction measures are important elements of an overall alcohol policy, as they are generally more socially and politically palatable. However, harm-reduction measures should not be considered as an equal substitute for the measures known to be most effective, as measures that aim to alter the drinking context are comparatively under-evaluated and generally possess less potential for reducing alcohol-related harm.[13]
It is clear that effective law enforcement is the key ingredient to ensure the efficacy of strategies that aim to alter drinking contexts as a way of preventing the harmful consumption of alcohol. While all Australian jurisdictions do have bans on serving intoxicated persons and underage persons, it is the extent to which these laws are adequately enforced that determines their effectiveness. Similarly, although very popular, the effectiveness of responsible service of alcohol (RSA) programs (also referred to as responsible beverage service, RBS) is also contingent on proper enforcement.[36] Without concerted efforts by police and/or liquor licensing authorities to enforce existing liquor laws, the imposition of RSA policies and/or training, while potentially raising awareness of relevant issues, has limited impact on the behaviour of servers or intoxication levels of patrons.[36] When highly publicised, the threat of substantial financial penalty has been shown to be particularly effective at motivating behaviour change among licensees, which has in turn resulted in reduced levels of alcohol-related harms, but it is not clear whether such financial penalties remain effective in the long term without frequent and highly visible examples of enforcement.[36] There is evidence of RSA programs being effective when they include a mandatory component combined with effective enforcement.[13] While mandatory server training has led to an increase in the number of servers undertaking training, program quality and content differ significantly between jurisdictions, and the high mobility of the workforce makes it difficult to sustain and monitor.
Mosher et al. assessed training programs offered by states and territories that have either mandatory or incentive-based laws, and found that the quality of programs is generally low, with only two jurisdictions meeting minimum standards.[81] A further criticism of RSA training programs has been that they focus solely on training servers, and do not include a more comprehensive community plan to address wider environmental issues, a factor that limits their potential.[82] To date, only a limited number of RSA training programs have been evaluated in Australia.[36] In addition to training bar staff in the responsible service of alcohol, there have also been programs designed to train staff in managing aggressive behaviour, given the reality that some patrons may have become already intoxicated elsewhere and that some aggressive behaviour may not be necessarily alcohol-related at all.[13] There have been very few evaluations of such programs, although there is evidence that they can improve staff and patron interactions generally, but the long-term sustainability of these improvements relies on maintaining training and standards of practice.[13]
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Proactive policing or intelligence-led policing has been successful in some parts of the world and has been partially adopted in some Australian jurisdictions.[13] It involves monitoring alcohol-related incidents in and around licensed premises, combined with regular police visits to the licensed premises that are most often linked to alcohol problems. For example, the New South Wales police have adopted a system of enforcing liquor laws through the collection of data such as feedback to police about alcohol-related crimes that have followed drinking at a specific licensed premises.[83] Known as the ‘Alcohol Linking Program’, the intelligence-led enforcement system has been shown to reduce alcohol-related crime, and similar approaches are now being trialled and implemented in other jurisdictions.
Voluntary codes of bar practice typically take the form of ‘liquor accords’ in Australia. The emergence of liquor accords as a means of reducing alcohol-related problems in late-night entertainment centres began in Victoria in the early 1990s, and since then there has been a rapid proliferation throughout several states.[36] Accords are local, community-based initiatives to involve licensees, other businesses, local government authorities, community representatives and police, but which are implemented and largely coordinated by the latter to reduce alcohol-related harm in the late-night drinking environment.[36]
There are many possible components of accords, such as RSA, drink discounting bans, trained security personnel, provisions of food, use of safe glassware and alcohol containers, and environmental modifications to reduce conflict and thereby reduce the risk of violence.[7] Few accords have been formally evaluated, and among those that have, most have been unable to demonstrate effectiveness in either the short- or (particularly) long-term reduction of alcohol-related harms.[36] The appeal of accords probably rests more on the development of local communication networks, the facilitation of local input, a sense of local ‘control’ and improving public relations through open negotiations than in the actual reduction of harm. Even so, improved communication and participation may also be perceived as desirable and worthwhile outcomes in some circumstances. Loxley et al. acknowledge that there is no doubt that accords can be an effective vehicle for introducing some harm-reducing practices into licensed drinking venues; however, it is recommended that voluntary regulation such as this is accompanied by effective law enforcement.[7]
The promotion of alcohol-free events, while popular in many countries, including Australia, has not been found on its own to be effective in reducing alcohol problems.[36] Alcohol restrictions for large sporting and leisure events have usually been implemented as part of a range of initiatives, making it difficult to determine their specific impact.[36] Based on evidence that some injuries from alcohol-related violence were linked to the use of drinking glasses and bottles as weapons, a number of licensed premises around the world now serve alcohol only in toughened glass or plastic containers.[13] However, the soundness of this approach has been called into question by a study that found that injuries to bar staff actually increased when toughened glass was used.[13]
Providing food service on premises that serve alcohol, as a way of encouraging eating while drinking and hence reducing the effects of alcohol, is a popular element in liquor accords.[7]
However, the specific contribution of making food available on licensed premises as a way of preventing intoxication has not been determined, and in the case of certain foods (for example, salty snacks) there may actually be a risk of the opposite effect on alcohol consumption.[7]
Community mobilisation has been used to raise awareness of problems associated with on-premises drinking, develop specific solutions to problems and pressure licensees to take responsibility for some of the impacts on the local community, such as noise, litter and anti-social behaviour.[13] There is no set formula by which community action projects operate, as each project has differing aims and objectives, often in response to localised problems.[36] Studies overseas support the view that when community mobilisations are implemented as comprehensive, evidence-based strategies and are well funded, they can influence server behaviour, drinking behaviour and levels of alcohol-related harms associated with licensed premises.[36] Although some relatively small community mobilisation projects are currently under way in Australia, results from evaluative studies are yet to be published.[36] In general, community mobilisation approaches have at least a temporary effect on licensed premises in terms of serving practices and patron behaviour but in the longer term they often tend not to be implemented in a systematic way, and prove to be expensive and difficult to sustain.[13]