The experience collected across countries has shown that sometimes it is hard to convince policy and decision makers at local level of the importance of an initiative like the STAD intervention, unless they have a good understanding of what a community and environmental approach means and entitles. This is particularly true in those countries where, unlike Sweden, there is lower local governmental control and/or higher influence of the alcohol and recreational industry.
With this idea in mind, we have prepared an introduction to community and environmental interventions to reduce binge drinking, that is illustrated by a short description of the work undertaken in each pilot site of the STAD in Europe project. Hopefully this piece will provide a better understanding of the STAD intervention and give indications of its adaptation in different settings.

Community and Environmental Interventions to reduce binge drinking and its associated harms

Mark A. Bellis & Karen Hughes

Especially on a night out, people may decide to drink considerably more alcohol than on other occasions for a variety of reasons. They may feel they need to drink to reduce their inhibitions to help them socialise, flirt or adopt other behaviours they would typically feel uncomfortable displaying. Some may drink to forget their problems or stresses. It may be a celebration of a birthday or other event where consuming large amounts of alcohol is almost an expectation. For some drinking on a night out can be a form of competition with peers about who can consume most or even a rebellion against parental or other socially constructed mores. For many young people getting drunk on a night out is simply considered fun and a normal part of socialising with friends.

Unfortunately, the harms associated with intense periods of alcohol consumption (i.e. binges) can be substantive. Some of the immediate effects include problems with coordination, disorientation and nausea (and subsequent vomiting) as well as memory loss. Falls associated intoxication can leave people seriously injured and on occasion can be fatal. Drunk individuals can pass out either while out or after returning home and subsequently choke on their vomit and are also at increased risk of harms such as fire; if they pass out while smoking or cooking. Poor judgement and other effects of alcohol on individuals’ mental capacities leave people prone to being assaulted and assaulting others. Gender issues also play a role and drunk women in particular are more vulnerable to sexual assault. However, any individual can make sexual choices which increase risks of sexually transmitted infections, unplanned pregnancy and negative social consequences. Alcohol-related disinhibition can also facilitate the use of illegal drugs which themselves carry a range of criminal justice, physical and mental health risks.
While there is a substantive literature on these shorter-term harms associated with heavy alcohol binges, studies are also identifying long-term harms associated with repeated binges including brain damage, cardio-vascular disease and cancer. In fact, alcohol consumption is associated with increased risks of over 200 health conditions. Critically, harms from binge drinking do not only affect drinkers – they also affect those around them including their family and friends, other nightlife users and local communities, who may suffer effects such as injury, violence, noise, property damage, financial difficulties and stress, as well as exclusion from participation in a night time economy focused on alcohol. The societal costs of alcohol misuse on health services, judicial services, local authorities, education, business and employment can be immense.

Judging an appropriate level of alcohol use on a night out can be difficult for people who want to experience the perceived benefits of drinking but also wish to minimise risks to their health or that of those around them. Many people misjudge how much those around them are drinking and consequently may feel they need to drink more to conform to social norms. Those who have already drank enough alcohol can be vulnerable to the alcohol promotions in drinking environments – often through the use of imagery linking drinking with sexuality, social success and cultural and sporting icons. Those working in the alcohol industry can price alcohol to encourage greater consumption (e.g. 2 for 1 offers), up sell (why not have a double measure instead of a single?) and flaunt rules intended to protect those who have already consumed enough alcohol (e.g. no alcohol sales or admission for those who are drunk). Practices that promote excessive and potentially harmful alcohol use are not limited to town and city centres but can also be part of festivals, sporting and music events. Further, it is not just the actions of the alcohol industry that can tip social drinking into harmful bingeing.
Relaxed attitudes from local authorities and police to public drunkenness, alcohol related disturbances and excessive or illegal alcohol advertising as well as the design and management of town and city centres (e.g. high concentration of drinking venues, relaxed opening hours) can all encourage environments in which binge drinking is both accepted and expected. Even when parties are held in private/residential settings the approach of public services to noise, wider messaging about the acceptability of bingeing and drunkenness from educational and public settings and the pricing and promotion of alcohol may all still impact the behaviours individuals express.

Interventions that alter these community and environmental aspects of nightlife can reduce binge drinking and reduce the risks of harm to drinkers and those around them. However, their successful development and adoption requires broad partnerships working together to create sustainable nightlife environments focusing on enjoyment and socialising rather than on maximising alcohol sales and profits. Multi-agency programmes to improve town and city centres typically involve: local authorities, police, inspectorates of nightlife settings, health services, family and young people’s organisations, bar and club owners and managers, bar and door staff as well as town and city centre designers. Such groups may be supported by other organisations providing resources such as: intelligence on evidence-based approaches; data collection, processing and distribution functions (e.g. understanding were most assaults occur and targeting activity appropriately); and broader community alcohol messaging through schools and community groups.
Whilst there have been a range of multi-agency initiatives targeting alcohol-related problems in drinking environments, one of the most successful and well established is the STAD (Stockholm prevents alcohol and drug problems) programme in Sweden. STAD began in 1996 with a central aim of reducing alcohol-related problems in licensed premises. The initiative established a community partnership between the licensing board, police, the county administration, the national health board and Stockholm city council, with support also from the academic Karolinska Institute. Using research to understand the extent and drivers of alcohol-related problems in nightlife, the partnership worked together to develop and implement solutions using a coordinated approach. The range of interventions delivered through the project included responsible service training for bar staff, training of door supervisors in issues such as conflict management, clear house policies for licensed premises, increased enforcement of licensing legislation and media awareness-raising. Evaluation of STAD suggests it was highly effective at tackling issues such as nightlife violence and was also cost-effective, saving 39 euros for every one invested.

Based on the success of STAD in Sweden, the STAD in Europe (SiE) project aims to tackle heavy episodic drinking across multiple European settings whilst also developing tools to help others to adopt a STAD approach. SiE aims to improve the management of alcohol sales and consumption in four drinking environments: licensed premises in nightlife settings; festivals; public environments (e.g. streets, parks and beaches); and in private settings (e.g. the home). In this newsletter, project partners outline how they are adopting techniques such as multi-agency planning, training bar staff in responsible beverage service (i.e. not selling alcohol to people who are drunk), examining the better use of existing enforcement powers and enhancing provision of information to the public and professional in order to achieve behaviour change.


Trimbos Institute
The Netherlands
Festival setting
+ info
The National Institute
of Public Health
Czech Republic
Licensed premises in nightlife settings
+ info
IREFREA · European Institute of Studies on Prevention
Hot spots in public settings (streets, parks and beaches)
+ info
Public Health
Institute · LJMU
United Kingdom
Private settings: Home drinking before a night out (preloading)
+ info
Institute for Therapy and Health Research
Private settings: Home (parents as law enforcers)
+ info
Institute · STAD
Festival setting
+ info
Utrip Institute
Licensed premises in nightlife settings
+ info

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