Transferable key factors?


In their excellent paper [1], Graham and co-authors suggest that lessons from drinking and driving interventions can be used to develop more effective strategies to reduce intoxication at bars. The problems that arise from drunkenness at licensed premises are indeed significant, and—as the authors show—the current practices are not effective in preventing them. Suggestions for better ways to prevent intoxication at bars and related problems are therefore very welcome.

Learning from highly successful approaches in other prevention areas seems to be a good strategy, and the identification of key factors or principles that may be translated from one area to another is essential. However, the critical question is to what extent these key factors are transferable from drinking driving prevention to prevention of intoxication at bars. Building upon Norwegian experiences, it seems that two of the listed key factors are transferred less easily, and that their application to the prevention intoxication at bars may be particularly challenging.

The first of these key factors is ‘having a clear, measureable and accepted definition of when a violation has occurred’. While a blood alcohol concentration (BAC) level is fairly unambiguous in this respect, intoxication at bars seems much more problematic. Graham and co-workers suggest that research can play a role in developing a validated and standardized measure of observable intoxication that can be used in enforcement in and around bars. The development of the criteria for observable intoxication used to instruct pseudo-drunk patrons in evaluation studies seems relevant in this respect. These criteria, that usually include physical signs such as slurred speech and unsteadiness of gait [2], can probably be developed into a validated measure. Moreover, in intervention studies with pseudo-drunk patrons, the criteria for intoxication have been set so that a panel consisting police officers, bartenders, representatives for the hospitality industry and from the licensing authority has agreed that the pseudo-drunk patrons should not be served alcohol [3, 4]. It may be argued that all relevant parties have agreed on the definition of when a violation has occurred. However, when intervention studies in Norway have shown that most pseudo-drunk patrons were served alcohol, the hospitality industry has claimed that violations had not occurred because the pseudo-drunk patrons had not appeared to be intoxicated. In other words, it seems that criteria that were considered clear and that were broadly accepted in a research setting may not necessarily be accepted when used in law enforcement as a basis for sanctions.

The other key factor that is not transferred easily is ‘political will’. The drinking driving problem seems to evoke less political controversy and fewer conflicting interests than the problems of intoxicated patrons at bars. In the latter case, industry interests may well be at cross-purposes with public health and safety interests. The level of intoxication is often high at the latest serving hour at night [4, 5], when sales constitute a large fraction of the bars' turnover [6]. Sales to intoxicated patrons will therefore probably constitute a significant fraction of bar turnover. By effectively enforcing the regulations against serving intoxicated patrons in bars, the hospitality industry may suffer economic losses. The political will to enforce the regulations may thus be eroded by these other economic interests, including those of bar employees. A Norwegian politician said that, in his municipality, politicians were quite happy with the lax enforcement of regulation of intoxication in bars because there was little chance of violations being revealed. He added that there was hardly any political will to do anything about it [7]. Lack of political will is probably more pronounced when enforcement is administered at the municipality level and when there are personal connections between the enforcement staff, politicians and the hospitality industry.

Declaration of interests