Whole-of-community interventions to reduce population-level harms arising from alcohol and other drug use
Whole‐of‐community interventions aim to reduce alcohol and other drug (AOD) use and harms by mobilizing community leaders, organizations and policy‐makers to respond effectively to AOD use. This review estimated the effectiveness of whole‐of‐community interventions in reducing population‐level harms arising from AOD use through a systematic review of electronic databases CENTRAL, Embase, Medline, Medline in Process and PsycINFO to August 2017. Eligible trials had a parallel comparison group, implemented interventions in two or more community settings, and reported data on AOD use or harms.
Twenty‐four trials from 63 publications were included (n = 249 125 participants). Intervention settings included schools, sporting clubs, police and law enforcement agencies, community centres, local media and retail premises. Measured outcomes included AOD consumption (quantity and frequency), AOD‐related crime and AOD‐related accidents, injuries and hospital admissions.
Findings and conclusions
Risk of bias was mostly high, due to lack of random allocation, selective reporting and significant attrition. Three trials indicated significant reductions in risky drinking but there was no impact on past‐month alcohol use (five trials), binge drinking (five trials), month marijuana use (two trials). Narrative synthesis indicated some reductions in AOD‐related assault rates and arrests, but were equivocal for quantity of alcohol consumed, 12‐month illicit drug use, assault or abuse, motor vehicle accidents and hospital admissions.
The authors conclude that existing whole‐of‐community intervention trials illustrate limited effectiveness in reducing population‐level harms arising from AOD use. There is some evidence to suggest that such interventions may be beneficial in reducing several AOD‐related outcomes. However, most evidence is limited to youth samples, and the strength of these findings is restricted by methodological constraints, which often preclude the pooling of results. Efforts should be made to standardize outcomes and measures, to target participants of all ages (not just youth) and to ensure that all data are reported in full following current reporting guidelines. Future studies may consider a greater focus on approaches known to be effective at the population level, including regulations on physical availability of alcohol, drink‐driving countermeasures, regulating alcohol advertising and other promotional activities, and conducting screening and brief interventions in health‐care and work‐place setting.