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• Providing alcohol education
• Educating individuals at risk
• Educating the general public
• Conclusions
• Policy options
• References

Most people who consume beverage alcohol experience few problems as a result of their drinking. However, for some individuals, alcohol consumption is associated with harmful health and social consequences, largely as a result of their drinking patterns. Education around alcohol consumption is therefore an important tool in prevention and an essential component of health education in general.

Structured approaches to alcohol education have been developed to help share specific information and change behavior. However, much of what we know about alcohol, how we view drinking, and whether we make the decision to drink are the result of an informal process that involves learning through personal experience and is largely shaped by culture.

For policy and prevention, it is important to view alcohol education as one of several elements needed to reduce the risk for harm within a comprehensive approach to alcohol. While it may not offer all the solutions, alcohol education is an integral component of wide-ranging and balanced policies and prevention measures.

Providing alcohol education

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The aim of alcohol education is twofold:

• to raise awareness and share knowledge and skills that will enable consumers to make healthy and informed choices about their drinking;
• to help those who choose to drink avoid patterns that are associated with health and social harm to themselves and others.

Special efforts in alcohol education focus on individuals deemed at increased risk for harm (see MODULE 8: “At-risk” Populations ). However, raising awareness among the general population and ensuring that those who choose to consume alcohol do so as safely as possible is another important outcome of education efforts (International Center for Alcohol Policies, 2004).

Alcohol education may be delivered in a range of formats, whose impact and effectiveness has been closely examined.

• Mass media and information campaigns are widely used, although they are generally viewed as ineffective in changing behavior when implemented in isolation (Austin, Pinkleton, & Fujioka, 1999; Babor et al., 2003; Slater, 1999; Wechsler et al., 2003). However, there is evidence that such campaigns may be helpful in raising awareness about certain issues (Yang & Schaninger, 2010; Mallett, Ray, Turrisi, Belden, Bachrach, & Larimer, 2010; Spoth, Trudeau, Guyll, Shin, & Redmond, 2009; Clapp, Lange, Russell, Shillington, & Voas, 2003; Elder et al., 2004).
• School-based education about alcohol is another popular approach, but there is also debate around its effectiveness in changing behavior, although some initiatives show more promise than others (Foxcroft & Tsertsvadze, 2011b; Centre for Addiction and Mental Health, 1999; Foxcroft, Ireland, Lister-Sharp, Lowe, & Breen, 2003; Foxcroft, Lister-Sharp, & Lowe, 1997; Gorman, 1996, 2002, 2003; Kumpfer, Alvarado, Tait, & Turner, 2002; Marlatt, 1998; McBride, Midford, Farringdon, & Phillips, 2000; Midford & McBride, 2001).
• Targeted efforts that address particular groups of individuals are commonly used. These include programs for young people, problem drinkers, or other “at-risk” populations (Koning, van den Eijnden, Verdurmen, Engels, & Vollebergh, 2011; Schulte, Monreal, Kia-Keating, & Brown, 2010; Donohue, Allen, Maurer, Ozols, & DeStefano, 2004).
• Specific interventions have been developed to deal with drinking patterns that may be especially problematic, such as "binge" drinking or drinking and driving (Donohue et al., 2004; Eisen, Zellman, & Murray, 2003; Elder et al., 2004; McCammon, 2001; Morrison, Petticrew, & Thomson, 2003; Ziemelis, Bucknam, & Elfessi, 2002).
• Warning labels that address possible health outcomes, drinking and driving, or drinking during pregnancy may be found on containers of beverage alcohol in a number of countries (see ICAP Issues Briefing: Health Warning Labels; ICAP Table: Health Warning Labels; ICAP Table: Beverage Alcohol Labeling Requirements by Country).  While labels may raise awareness among some individuals, when used by themselves, they have been largely ineffective in changing behavior (Agostinelli & Grube, 2002; Greenfield, Graves, & Kaskutas, 1999; Greenfield & Kaskutas, 1998; Hankin et al., 1996; Kaskutas & Greenfield, 1997).
• Alcohol education may be integrated into general health education and provided through physicians, nurses, and other health or social workers (Kumpfer, Whiteside, Greene, & Allen, 2010; Pettersson, Lindén-Boström, & Eriksson, 2009; D'Onofrio et al., 2002; Giannetti, Sieppert, & Holosko, 2002; Kaner et al., 2001; Weintraub, Saitz, & Samet, 2003).
• Views, attitudes, and behaviors around drinking are largely the result of culture and environment. Parents, peers, and others who play an important role in the lives of young people, for example, can be operative in teaching youths about alcohol, and direct parental involvement is essential (Mares, van der Vorst, Lichtwarck-Aschoff, Schulten, Verdurmen, Otten, et al., 2011; Turrisi & Ray, 2010; Foxcroft et al., 2003; Houghton & Roche, 2001; Kumpfer et al., 2002; Kumpfer, Alvarado, & Whiteside, 2003).

In general, there is evidence that targeted education measures with high specificity are likely to be more effective than broad-based approaches.

Educating individuals at risk

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Young people

Young people are considered to be particularly susceptible to harm from alcohol consumption and they are a primary target group for alcohol education (see MODULE 11: Young People and Alcohol ). The developmental changes that occur in childhood and adolescence, young people’s general propensity for risk-taking, and their relative inexperience with alcohol place them at heightened risk for harm (Brown & Tapert, 2004; Centre for Addiction and Mental Health, 1999; Marlatt, 1998; Somers, 1996; Spear, 2004).

Schools offer obvious focal points for alcohol education. Curricula may include information on alcohol or lesson plans to address a range of related health and social issues. (O’Leary-Barrett, Mackie, Castellanos-Ryan, Al-Khudhairy, & Conrod, 2010).  In addition to schools, other venues where young people gather can play an important role and create opportunities for education about alcohol. These include religious and community centers, as well as clubs and discos. The home and family setting are also important for conferring information about alcohol and drinking, as are physicians’ practices and emergency rooms. (Lovecchio, Wyatt, & DeJong, 2010).

A key requirement in developing alcohol education programs and initiatives for young people is to define clearly the desired outcome. Some programs promote abstinence from alcohol until the legally mandated drinking age (see MODULE 12: Legal Age Limits ); others seek to reduce harm while acknowledging that drinking is likely to take place. Tailoring programs so that they are realistic and in keeping with society’s and young people’s expectations, behaviors, and cultural influences is important in ensuring success (Hanson, 1996; Milgram, 2001; Paglia & Room, 1999).

Social influences

Family has been shown to be the strongest single influence of all external factors on young people’s attitudes about drinking (Caria, Faggiano, Bellocco, & Galanti, 2011; Shortt, Hutchinson, Chapman, & Toumbourou, 2007; Bjarnason et al., 2003; Miller & Plant, 2003; Sanchez-Sosa & Poldrugo, 2001). This finding holds true across cultures (Halmi & Golik-Gruber, 2002; Hellandsjø Bu, Watten, Foxcroft, Ingebrigtsen, & Relling, 2002). Strong relationships between young people and their parents, family structure, communication, adult monitoring and supervision, and parental involvement may all act as positive influences on choices around alcohol consumption (Faggiano, Galanti, Bohrn, Burkhart, Vigna-Taglianti, Cuomo, et al., 2008; Smit, Verdurmen, Monshouwer, & Smit, 2008; Schinke, Schwinn, & Cole, 2006; Copello, Velleman, & Templeton, 2005; Bry, Catalano, Kumpfer, Lochman, & Szapocznik, 1998; Costa, Jessor, & Turbin, 1999; Etz, Robertson, & Ashery, 1998; Foxcroft & Lowe, 1997; Jessor, 1998; Sroufe, Cooper, & DeHart, 1996).

Programs have been developed that can play an important role in strengthening parental influence and the role of the family. Such initiatives integrate behavioral training for parents, family skills training, education, support, and brief therapy, and appear to be cross-culturally applicable (Foxcroft & Tsertsvadze, 2011a; Pettersson, Özdemir, & Eriksson, 2011; Ryan, Jorm, Kelly, Hart, Morgan, & Lubman, 2011; Coombes, Allen, Marsh, & Foxcroft, 2009; Ashery, Robertson, & Kumpfer, 1998; Foxcroft et al., 2003; Kumpfer et al., 2002; Kumpfer et al., 2003; Spoth, Redmond, & Lepper, 1999).

This suggests a need in alcohol education to include equipping the “educators”—parents, teachers, youth workers, and religious and community leaders—with the knowledge and skills for this role. It also requires training those who serve and sell alcohol to implement harm reduction measures for young people and adults alike (see MODULE 4: Responsible Hospitality ).

After parents and family, peers are another important influence on young people’s decisions about drinking and on their drinking patterns (see ICAP Issues Briefing: Determinants of Drinking; Beccaria, Amici, Bonello, Maggiorotti, & Tomaciello, 2003; Houghton & Roche, 2001). Peer relationships and attitudes have been addressed through alcohol education and specific approaches designed especially for this purpose (Moreira, Smith, & Foxcroft, 2009; see MODULE 3: Social Norms Marketing ).

Other critical elements that influence how young people learn about alcohol and how they make decisions about drinking are the prevailing drinking culture and general risk-taking behaviors. Young people’s attitudes and their personal and social skills can be developed in a way that will allow them to make responsible choices and teach them not to place themselves or others in harm’s way.  Such “life skills” training has been demonstrated to be an effective component of substance abuse prevention programs (see MODULE 2: Life Skills); Bühler, Schröder, & Silbereisen, 2008), especially for female adolescents (MacKillop, Ryabchenko, & Lisman, 2006; Vicary, Smith, Swisher, Hopkins, Elek, Bechtel, et al., 2006).

Other “at-risk” groups

Special education approaches are also developed for other populations for whom risk for harm may be increased due to their social status, personal characteristics, or behaviors and drinking patterns (see MODULE 8: “At-risk” Populations ). Such target groups include pregnant women, for whom tailored information is needed to raise awareness about drinking during pregnancy and its outcome and who may benefit from behavior changes (Andrulis & Hopkins, 2001; Drinkard et al., 2001; Hankin, 2002; Loop & Nettleman, 2002 see MODULE 10: Drinking and Pregnancy). Measures have also been developed to educate individuals who may be alcohol-dependent or unable to control their drinking (see MODULE 17: Alcohol Dependence and Treatment). Other “at-risk” groups may include socially marginalized individuals—such as indigent or homeless people—or indigenous populations who may be outside the mainstream of healthcare, among whom alcohol problems may be common, or for whom special and culturally sensitive approaches may be needed (Schinke, Cole, & Fang, 2009; Martin, Josiah-Martin, Roberts, & Henry, 2008; Moran & Reaman, 2002; Okamoto, Hurdle, & Marsiglia, 2001; Westphal, 2000; Williams & Gloster, 1999).

Educating the general public

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Alcohol education is also relevant to the public at large. This includes information about low-risk drinking through guidelines and recommendations, basic facts about the effects of alcohol, and information that can help individuals avoid harmful drinking patterns and situations. Such education also includes specific information for men and for women about the effects of alcohol consumption on each gender (see MODULE 19: Drinking Guidelines; MODULE 9: Women and Alcohol; MODULE 11: Young People and Alcohol; MODULE 15: Drinking and Driving; MODULE 16: Blood Alcohol Concentration Limits; ICAP Table: International Drinking Guidelines).

Information and education for the general public is provided by a number of sources, including governments, health agencies, or nongovernmental organizations, as well as the beverage alcohol industry and its related organizations. Responsibility messages are also part of the overall effort to educate the general public and may be found in some advertisements for beverage alcohol.

While these approaches may not always result in behavior change, they are considered necessary in informing individuals and equipping them to make decisions about their own drinking (Babor et al., 2003; Plant & Plant, 1997). In addition, some studies show that providing information about alcohol may help parents address the issue with their children (Newton, Vogl, Teesson, & Andrews, 2009; Turrisi, Larimer, Mallett, Kilmer, Ray, Mastroleo, et al., 2009; Koutakis, Stattin, & Kerr, 2008; Honik et al., 2002).

Implications for policy and prevention 

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Alcohol education efforts are a necessary and integral part of any balanced and comprehensive approach to policy. While the effectiveness of individual alcohol education programs has been questioned, there is evidence that, as part of a combined and multi-pronged strategy, it is a useful and important tool.

As a policy and prevention measure, alcohol education consists of providing information— whether for the general public or for particular groups or individuals—and of efforts to change behaviors around drinking. Both of these aspects merit attention within alcohol policy.

The provision of accurate information about alcohol can include balanced information on drinking patterns and outcomes, including health and social implications. Creating awareness about drinking guidelines and recommendations is an important part of alcohol education. Other goals also include creating awareness among the broad public about the regulations that exist around alcohol within a given country or jurisdiction. Themes to be addressed, for example, may be:

• age of legal consumption and purchase;
• alcohol availability, hours of operation;
• alcohol in the workplace;
• drinking and driving regulations.

Alcohol education can be tailored to address specific policy needs in relation to prevention and the reduction of harm:

• information about alcohol for all ages from young people to older adults;
• specific advice targeting “at-risk” populations;
• education for particular groups and circumstances, for example, alcohol and sporting events (e.g., avoiding “football hooligans”);
• appropriate training for alcohol educators, health providers, bar staff, and licensees;
• drinking and driving education;
• alcohol education for the workplace;
• alcohol education for offenders (e.g., drunk drivers).

To have its intended impact, alcohol education, like any other policy measure, must be culturally sensitive and appropriate: It should reflect a community’s culture, attitudes, and needs and be pragmatic and realistic both in its goals and approaches. It would seem unachievable (and unwarranted), for example, to develop policies to promote prohibition where alcohol is deeply embedded into a society’s culture. At the same time, it is important to educate people about making personal choices, whether these involve drinking or abstinence.

Conclusions

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Alcohol education is a popular and much used approach to reducing the potential for harm from alcohol consumption and particular drinking patterns. Although critics of alcohol education point to its shortcomings and lack of effectiveness, it is important to realize that no single policy measure or approach can change the face of problems or attitudes related to alcohol when applied in isolation.

Providing information and teaching skills represents a crucial component of an integrated approach to promoting responsible alcohol consumption and enabling individuals to make informed choices about their drinking. Alcohol education on its own cannot achieve all the results that are desirable for an effective policy. When integrated into a balanced policy approach that weighs rights and responsibilities and combines regulation with initiatives intended to minimize harm, however, alcohol education is a useful prevention tool.

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