Long-Term Effects of a Responsible Beverage Service Program: 20-Year Follow-up of the Stad-Model

Introduction:

In 1996, an alcohol prevention program in Responsible Beverage Service (RBS) targeting licensed premises was initiated by STAD (Stockholm Prevents Alcohol and Drug Problems) in Sweden. The multi-component RBS-program consists of community mobilization, training of serving staff, and improved enforcement. Evaluations of this program have shown a significant increase in the refusal rates of alcohol service to intoxicated patrons, from 5% in 1996 to 68% in 2011, and a decrease in the frequency of police-reported violence by 29%. Moreover, a cost-effectiveness analysis displayed that for every 1 Euro spent on the intervention 39 Euros were saved. The program was subsequently institutionalized and maintained by a collaborative steering group with participation from stakeholders in the local community. The purpose of this study is to evaluate the long-term effects of this institutionalized RBS-program on the frequency of refusal rates of alcohol service to obviously intoxicated patrons at licensed premises.

Methods:

The study was conducted using the same procedure as the baseline assessment in 1996 and follow-ups in 1999, 2001, and 2011. The current study was conducted during Fall 2016 and is a 20-year follow-up. Six professional male actors (i.e. pseudopatrons) were trained by an expert panel to enact a standardized scene of severe alcohol-intoxication. A total of six research teams, each consisting of two actors and one observer, visited licensed premises during Wednesday, Thursday, Friday and Saturday nights. Once inside the licensed premises, the actors approached the bar and enacted the standardized scene and attempted to order a beer. A total of 150 licensed premises located in the central part of Stockholm were randomly selected and visited.

Results:

Preliminary results indicate that the rate of refusals of alcohol service to severely intoxicated patrons has been sustained over time. At the 20-year follow-up the pseudopatrons were denied service of alcohol at about 70% of the attempts, a statistically improvement compared to 5% at the baseline study in 1996, and sustained effects relative to the previous assessments in 1999 (47%), 2001 (70%), and in 2011 (65%).

Conclusions:

The preliminary results demonstrate sustained long-term effects of the RBS-program and can be explained by the high level of institutionalization of the multi-component program.