The impact of programs for high-risk drinkers on population levels of alcohol problems.
OBJECTIVE
Historically, treatment programs and related activities for alcoholics or high-risk drinkers have been viewed as not relevant to efforts to prevent alcohol problems, and in particular population-based prevention efforts. In this review we consider evidence that high-risk programs may have an impact on population or aggregate levels of these problems.


METHODS
We first summarize recent reviews of the clinical impact of programs for high-risk drinkers, since some level of effectiveness at the individual level is necessary for these programs to have an aggregate level impact. Following that, correlational evidence on the impact of high-risk programs on aggregate problem levels is examined. Estimates of the potential impact of high-risk programs on aggregate problem levels, based on available information on the impact of these programs and the numbers of individuals affected, are then considered, as are estimations of the comparative aggregate level impact of high-risk and consumption reduction strategies.


RESULTS
There is increasing evidence that high-risk programs have beneficial effects for individuals. Available correlational evidence supports the proposal that increases in treatment and AA have contributed to the declines in alcohol-related morbidity and mortality observed in some countries in recent years. Studies estimating the recent impact of increases in levels of treatment and AA membership support that interpretation, and studies comparing estimated effects of high-risk and population strategies find similar potential for aggregate effects.


CONCLUSIONS
Programs for high-risk drinkers can have beneficial aggregate-level effects and are thus a valuable component of population-based efforts to reduce alcohol problems.
Smart
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Centre for Addiction and Mental Health, Addiction Research Foundation Division, Toronto, Ontario, Canada.
Mann
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D019973:Alcohol-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D000436:Alcoholics Anonymous; D002170:Canada / Q000453:epidemiology; D002626:Chemistry, Pharmaceutical; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015397:Program Evaluation; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology