Prevention
of Alcohol-Related Problems
The prevention of alcohol-related problems is a huge topic, as can
be seen by browsing through PREVLINE
(DHS and SAMSHA's clearinghouse for alcohol and drug information). As
this page is being written, San Francisco is in the midst of two large
planning processes that will influence the way that alcohol-related
problems might be prevented. The first of these planning processes is
the work of the prevention subcommittee of the Mental
Health Services Act (California Proposition 63), which will be completed
during the Fall of 2005. The second is the development of a Substance
Abuse Prevention Strategic Plan, which will take place between August
2005 and July 2006. Both of these planning processes will be informed
and guided by the San Francisco Department of Public Health's Prevention
Strategic Plan.
Accordingly, the comments below emphasize environmental approaches,
recognizing, as Geoffrey Rose pointed out in his classic paper "Sick
Individuals and Sick Populations," that the "high risk"
approach to prevention, carried out in clinical settings, and the "population
approach," which seeks to control the causes of incidence, are
complementary. In short, there is a spectrum
of prevention.
Environmental
Approaches
San Francisco's Board of Supervisors recently passed an ordinance
that will hold liquor store owners responsible for alcoholic-beverage-related
problems on the sidewalks in front of their stores [see
article].
SAMSHA maintains an inventory of model
programs (as well as evidence-based and promising programs). These
vary widely in their focus and approach. One of these programs, Communities
Mobilizing for Change on Alcohol (CMCA), is similar to the San
Francisco Department of Public Health's Community
Action Model, which is currently under review for SAMSHA recognition.
The Community Action Model is being employed in the SAMSHA-funded
YouthPower
project, which utilizes environmental prevention strategies to reduce
alcohol and marijuana use among middle and high school-age youth in
San Francisco’s Bayview Hunters Point. The Community Action Model
was recently described in the American
Journal of Public Health.
Small grants to community organizations are often a useful means
means of preventing alcohol and other drug problems [PDF].
Youth
Leadership Institute is employing environmental strategies to
prevent alcohol problems among youth in San Francisco, and the Marin
Institute is a great resource for technical assistance.
Prevention by Design's Taking Charge: Managing Community Alcohol
& Drug Risk Environments: An Action Guide to Help California Cities
Reduce Risk in Alcohol and Drug Problem Environments is evidence-based,
and Prevention
by Design has been contracted by the California Department of
Alcohol and Drug Programs to assist us in this process. This guide
employs sound public health practices and is compatible with the Department's
Prevention Strategic Plan.
Clinical
Approaches
The U.S. Preventive Services Services Task Force found that there
is good evidence to support screening of adult patients by doctors
in primary care settings to identify risky drinking practices. [PubMed
with Link to Full Clinical Guidelines from Annals of Internal Medicine]
[Summary
for Patients]
Brief alcohol interventions in trauma centers have been found to
be cost effective [PubMed].
The American College of Emergency Physicians has recently issued guidelines
on screening [PubMed].
Expert Guidelines
From the World Bank's Priorities in Health, Chapter 5. "Cost-Effective Strategies for Noncommunicable Diseases, Risk Factors, and Behaviors," the section on alcohol.
