Universal school-based alcohol prevention programs

Evidence Rating

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Disparity Rating

No impact on disparities likely

Community Conditions

Alcohol and drug use

Authors

Lead: Bomi Kim Hirsch

Contributor(s): Ben Case

Acknowledgements: Kate Austin Stanford, Alison Bergum, Jessica Rubenstein, Jane Sachs

Date Last Updated

August 12, 2021

Universal school-based alcohol prevention programs provide all students with the information and skills needed to prevent underage alcohol use, without screening for risk level. Such programs can be delivered as a specific curriculum that is part of school lessons or as a component of classroom behavior management. Programs can focus on raising awareness of the potential dangers of alcohol use, development of norm setting and peer resistance skills, or a combination of these approaches (Cochrane-Foxcroft 2011).

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

Reduced underage drinking

What does the research say about effectiveness? -+

There is some evidence that universal school-based alcohol prevention programs reduce alcohol use among adolescents (Cochrane-Foxcroft 2011, Onrust 2016, Strom 2014, Hennessy 2015); such programs appear more effective for younger adolescents than older adolescents (Onrust 2016). Additional evidence is needed to confirm effects and determine the characteristics of the most effective programs (Cochrane-Foxcroft 2011, Onrust 2016).

Individually-delivered brief interventions that last fewer than 5 hours have been shown to reduce alcohol use among adolescents (Hennessy 2015, Mogro-Wilson 2017). Classroom-based programs that target alcohol use and other risk behaviors such as tobacco use, illicit drug use, sexual risk, and antisocial behavior may also reduce adolescent alcohol use (Cochrane-MacArthur 2018, Cochrane-Foxcroft 2011, Hale 2014a); such programs may be more effective than programs that focus on alcohol alone (Cochrane-Foxcroft 2011). Web- or computer-based universal programs can be effective in reducing adolescents’ alcohol use when they focus on alcohol problems alone (Champion 2013), but may not be effective when they target multiple risk behaviors (Champion 2019). A web-based program providing normative feedback about alcohol use can reduce binge drinking and intensity of drinking in the short term among high school athletes who are heavy drinkers (Doumas 2021). Programs that focus on developing peer resistance and other skills (i.e., psychosocial programs) appear more likely to have positive effects than alcohol-focused programs alone (Cochrane-Foxcroft 2011).

Universal school-based alcohol prevention programs that combine student and parent interventions may reduce students’ alcohol use (Newton 2017). Researchers suggest that program content consider adolescents’ psychological and cognitive developmental stage for different age groups (Onrust 2016).

Implementation Examples -+

There are also many universal school-based alcohol prevention programs, such as LifeSkills Training program (LST), the Unplugged program (Unplugged), SPORT Prevention Plus Wellness program (SPORT PPW), Project ALERT (Project ALERT), and the PAX Good Behavior Game (PAX GBG). The Washington State Health Care Authority maintains the Athena Forum, a resource center for substance use disorder prevention, that provides a list of evidence-based alcohol prevention programs and strategies for students (WA ATHENA-Alcohol).

Implementation Resources -+

LST - Botvin LifeSkills Training (LST). LST overview.

NIDA-Preventing drug use - Robertson EB, David SL, Rao SA. Preventing drug use among children and adolescents. Bethesda: National Institutes of Health (NIH), U.S. Department of Health and Human Services (U.S. DHHS); 2003.

PAX GBG - Paxis Institute. PAX Good Behavior Game (PAX GBG).

Unplugged - European Drug Addiction Prevention trial (EU-Dap). Unplugged: Curriculum and workbook.

WA ATHENA-Alcohol - Washington State Health Care Authority, ATHENA Forum. Excellence in prevention strategy list: Alcohol.

Citations -+

* Journal subscription may be required for access.

Champion 2013* - Champion KE, Newton NC, Barrett EL, Teesson M. A systematic review of school-based alcohol and other drug prevention programs facilitated by computers or the internet. Drug and Alcohol Review. 2013;32(2):115-23.

Champion 2019* - Champion KE, Parmenter B, McGowan C, et al. Effectiveness of school-based eHealth interventions to prevent multiple lifestyle risk behaviours among adolescents: A systematic review and meta-analysis. The Lancet Digital Health. 2009;1(5):e206-e221.

Cochrane-Foxcroft 2011* - Foxcroft DR, Tsertsvadze A. Universal school-based prevention programs for alcohol misuse in young people. Cochrane Database of Systematic Reviews. 2011;(5):CD009113.

Cochrane-MacArthur 2018 - MacArthur G, Caldwell DM, Redmore J, et al. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database of Systematic Reviews. 2018;10(10):CD009927.

Doumas 2021* - Doumas DM, Mastroleo NR. Reducing alcohol use among high school athletes: A randomized controlled trial of a brief, web-based personalized normative feedback intervention. Sport Psychologist. 2021;35(1):55-63.

Hale 2014a - Hale DR, Fitzgerald-Yau N, Viner RM. A systematic review of effective interventions for reducing multiple health risk behaviors in adolescence. American Journal of Public Health. 2014;104(5):19-41.

Hennessy 2015 - Hennessy EA, Tanner-Smith EE. Effectiveness of brief school-based interventions for adolescents: A meta-analysis of alcohol use prevention programs. Prevention Science. 2015;16(3):463-474.

LST - Botvin LifeSkills Training (LST). LST overview.

Mogro-Wilson 2017* - Mogro-Wilson C, Allen E, Cavallucci C. A brief high school prevention program to decrease alcohol usage and change social norms. Social Work Research. 2017;41(1):53-62.

Newton 2017* - Newton NC, Champion KE, Slade T, et al. A systematic review of combined student- and parent-based programs to prevent alcohol and other drug use among adolescents. Drug and Alcohol Review. 2017;36(3):337-351.

Onrust 2016* - Onrust SA, Otten R, Lammers J, Smit F. School-based programmes to reduce and prevent substance use in different age groups: What works for whom? Systematic review and meta-regression analysis. Clinical Psychology Review. 2016;44:45-59.

PAX GBG - Paxis Institute. PAX Good Behavior Game (PAX GBG).

Project ALERT - Project ALERT. Substance abuse prevention for grades 7 & 8.

SPORT PPW - Prevention Plus Wellness. SPORT Prevention Plus Wellness (SPORT PPW).

Strom 2014 - Strom KK, Adolfsen F, Fossum S, Kaiser S, Martinussen M. Effectiveness of school-based preventive interventions on adolescent alcohol use: A meta-analysis of randomized controlled trials. Substance Abuse: Treatment, Prevention, and Policy. 2014;9:48.

Unplugged - European Drug Addiction Prevention trial (EU-Dap). Unplugged: Curriculum and workbook.

WA ATHENA-Alcohol - Washington State Health Care Authority, ATHENA Forum. Excellence in prevention strategy list: Alcohol.

WI DPI-AODA program - Wisconsin Department of Public Instruction (WI DPI). Alcohol and other drug abuse (AODA) program.

WISH-AODA - Wisconsin Safe and Healthy (WISH) Schools Center. Alcohol and other drugs: AODA learning modules.