Community
coalitions have a lot to accomplish. Resources are tight and expectations
high for coalitions to impact changes within communities. Since a plethora
of information about prevention programs and strategies are available
to community coalitions, where do coalitions put their energies to have
the greatest effect for changing their communities? They look to researchers
to help us understand what works in prevention to guide our efforts. Dr.
Harold Holder provides direction from his review of prevention research
and stresses that to be effective, coalition leaders must understand how
community systems affect alcohol and other
drug
abuse.
Historically, prevention efforts have focused on high-risk individuals
or groups through education, service or interventions to reduce individual
risk. Dr. Holder’s article states that the potential for greater
impact will be made from a community systems approach. A community systems
approach influences the community population rather than the individual.
It considers the wide range of problem behaviors rather than looking at
one problem behavior. Targeting high-risk individuals is unlikely to have
a long-term effect. The fact is that problems and people keep coming.
There is little evidence that education and targeting high-risk groups
alone will impact a significant reduction in alcohol and/or other drug
problems in the community. No single prevention program can make an impact.
A community is dynamic and complex and requires thinking in the larger
systems approach to affect the larger population.
Prevention has the challenge to change the context in which people behave
to have the a greater impact within a community. Coalitions that engage
in a systems approach understand that alcohol and other drug use and abuse
problems are often influenced by public policies and practices. Clean
indoor air policies and ordinances are the classic example of a strategy
directed at the larger population. Let’s say a coalition is concerned
with drinking and driving and they have data on alcohol related car crashes.
Where should the coalition direct their energies? Dr. Holder’s article
tells us that the greater impact is to change DUI enforcement policy.
We know that perceived risk is a highly effective deterrent to drunk driving.
Coalitions will have the greatest impact by lobbying for enforcement policy
which commits agency follow-through and is therefore sustained. A coalition
could sponsor media campaigns since the news media plays an important
role by reporting and carrying the message to the community as a whole.
Policy changes at the community level:
Community policies can produce the structural change more likely to reduce
alcohol problems. Policies that are implemented and maintained by governmental
structures have a greater opportunity to achieve long-term effects. Local
policies are likely to be lower in cost. Such as raising the retail price
of alcohol at the local level and generating revenue from special purpose
taxes at the same time is a low-cost prevention strategy.
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Consider also that policies
have a longer life. A prevention program must be maintained and funded.
A mass media campaign must be planned, funded and implemented each year.
There is also scientific evidence that local policies that were developed
and implemented reduced alcohol-involved injuries and death at the community
level. The following two policy examples were implemented by local communities:
- Establishment of highly visible drinking and driving enforcement.
The evidence is clear that perceived risk of being caught deters drunk
driving. A local policy requires commitment for law enforcement to carry
out frequent and highly visible DUI enforcement. Encouraging news media
to report is also encouraged.
- Establish retail sales practices and limit youthful social events
to reduce underage drinking. Local policies can be reinforced with business
license or zoning, training of sales clerks, serving and sales policies
of local establishments, and enforcement checks. Another is parent and
law enforcements checks on alcohol availability at youthful social events.
This can be reinforced by keg registration, community mobilization and
training, enforcing drinking practices where underage persons are present
such as limiting alcohol to a fenced area at a community event or allowing
one individual to buy several alcoholic beverages at once.
Examples of local policies that impact alcohol and drug use and abuse
include but are not limited to:
- Restricting alcohol advertising,
- Warning labels,
- Zoning to reduce alcohol outlet density,
- Server/seller training,
- Increasing the price of alcohol,
- Enforcement and compliance checks to reduce illegal access
- Limiting hours of alcohol sales,
- DUI enforcement,
- Increased fines and penalties of DUI convictions,
- Limiting purchase of pseudophedrine.
While research around the effectiveness
of environmental approaches is not new, Dr. Holder is telling us that
to get sustained population level changes, we need to approach change
from take a systems perspective of the community. For a long time coalition
leaders have espoused two fundamental prevention principles. First, our
belief that skilled, knowledgeable local people are in the best position
to solve local problems. And second, that people will support and become
invested in what they help create. Dr. Holder’s review of the research
reminds us that community excitement and enthusiasm is necessary but not
enough. He is expanding our view and asking us to pay attention to the
community as a complex, dynamic system. Prevention strategies are most
effective when focused on the community at large rather than only those
at risk. Local policy is an effective means to produce systems changes.
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