Server intervention: An overview

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1 Server intervention: An overview D r. R obin E. K ayser D epartm ent o f C ontinuing E ducation, U niversity o f N ijm egen, P.O.B ox 9104, 6500 H E N ijm egen, T he N etherlands, A B ST R A C T S erver intervention trainings for bar personnel have a lot o f potential in preventing drunkenness and im paired driving. Servers o f alcohol are a logical starting place for m ounting a program m e or training to change drinking behaviour. T he first server intervention program m es are originally developed in the U nited States o f A m erica in the eighties. E valuation studies are indicating that server intervention results in m ore interventions by trained bar personnel, custom ers w ith a low er blood alcohol level and less alcoholrelated traffic accidents. B ut for a real effective approach an integral approach is needed, in w hich server intervention is ju st part o f it. IN T R O D U C T IO N M ost alcoholrelated traffic accidents do occur in w eekends at night. In T he N etherlands each year around 200 people die and around 4000 people are injured because o f alcoholrelated traffic accidents. It can be concluded from national and international research that a great part o f intoxicated drivers com es from bars, cafes, discotheques or restaurants (Soder, 1990; M e K night, 1991). M ost part o f all alcohol is consum ed at hom e, but the later the tim e o f day the g reater the chance that alcohol is consum ed outdoors. F ifty percent o f the drivers w ith a blood alcohol level above 0,7 prom ille in w eekends com es from a bar. T his increases up to 60% if w e are talking about the drivers w ith a blood alcohol level above 1,3 prom ille (M attijssen, 1995). T he total num ber o f intoxicated drivers in w eekends at night, that is above the D utch legal lim it o f 0,5 prom ille, is 4-5%. T hose w ho are at greatest risk o f driving w hile under the influence are relatively m ore violating the (traffic) laws, relatively drinking m ore alcoholic beverages and are m ore often

2 visiting bars, cafes or discotheques (M ek night & Streff, 1994; M cm illen et al, 1992). An A ustralian study (Peberdy, 1991) show s us that 59% o f the people w ho died in an alcoholrelated traffic accident had their last drink, ju st before the accident, in a bar and 33% w ith friends at hom e. It is evident that servers o f alcohol are a logical starting place for m ounting a program or training to change drinking behaviour o f their patrons or their friends. Servers o f alcohol prom ote the im m ediate environm ent conducive to responsible drinking. T he m ost significant factor influencing the decision to drink (and drive) or not to drink (and drive) is the social environm ent. M oreover, places o f public resort such as bars are m ore easily to approach than people at hom e. A nd, not only as a prevention strategy for driving w hile intoxicated but also as a prevention strategy for other alcoholrelated crim inality such as violence and vandalism. B ars w ith high risk for alcoholrelated crim inality can be characterised by: serving alcohol to obviously intoxicated custom ers; organising happy hours; perm itting crow ding (Stockw ell et al., 1993). T his relevant kind o f inform ation can be included in server intervention program m es. M oreover, prevention strategies should be directed at those high risk drinking settings. T he first server intervention program m es to prevent unresponsible drinking are originally developed in the U nited States o f A m erica in the eighties. N ow adays server intervention program m es are also im plem ented in other countries such as C anada, A ustralia and the N etherlands (K ayser, 1992). M ost o f these program m es are training program m es directed at transfer o f relevant know ledge and training o f skills (recognising people w ho are under the influence or w ho are ju st about to drink too m uch; prevention techniques) using textbooks, instruction books, videotapes and role plays. R E SE A R C H R E SU L T S W ithout any scientific proof for the efficacy o f it, server intervention training program m es w ere initiated in the early eighties. O nly one relevant study is done in these early years. L angenbucher and N atahan (1983) show ed that police officers are in som e degree able to estim ate diverse levels o f being under the influence w hile a group o f professional servers o f alcohol and social drinkers w ere not able to do that. They also show ed that m any intoxicated

3 drivers cam e from bars. T his study does not tell us anything about the efficacy but supports the need o f server intervention. In the late eighties a few evaluation studies are done. T he study o f R uss and G eller (1987) and G liksm an and Single (1988) w ere indicating that trained bar personnel initiated substantially m ore interventions than did untrained bar personnel. E xam ples o f interventions are: slow ing dow n service, provide (not salty) snacks, offer non-alcoholic beverages, m ake driving related com m ent, deter buying o f rounds w hen there is m ore than one drin k per person on the bar. Studies o f M ck night (1987), Saltz (1987) and Saltz and H ennesy (1991) dem onstrated that patrons o f trained b ar personnel show ed less signs o f being under the influence, reported drinking less glasses o f alcohol and reached low er levels o f blood alcohol concentration (BA C). E specially w hen there w as m anagem ent support from the establishm ents the level o f being under the influence o f the custom ers w as reduced. T he studies o f W agenaar and H older (1991) and H older en W agenaar (1994) dem onstrated that server intervention can eventually have positive effects on alcoholrelated traffic accidents as w ell. T he 1991 study show ed that, directly after the im plem entation o f the D ram Shop Law in T exas, single-vehicle nighttim e traffic accidents (assum ed alcoholrelated) reduced significantly, corrected for other influences such as increasing the m inim um drinking age and m aking w earing seat bells m andatory. It seem s that alcoholic beverage server liability (including being legally responsible for the behaviour o f your custom ers) frightened ow ners o f establishm ents that m uch that it resulted in behaviour change o f both them selves and their personnel. U nfortunately, long term results are not known. T he 1994 study gives even harder evidence o f the efficacy o f server intervention. T his study w as executed in the State o f O regon w here server intervention training fo r people w orking in licensed bars w as m andated in T his offered a unique opportunity to investigate the efficacy o f server intervention. T hree m onths after m andating these trainings the num ber o f single-vehicle nighttim e night accidents reduced w ith 4%. A fter one y ear these accidents decreased 11%, after tw o years it decreased 18% and three years after m andating these

4 trainings it decreased significantly 25%. In that period o f % o f all licensed bars w ere trained. C onclusion: server intervention can have positive effects. It leads to m ore in terventions by trained bar personnel and custom ers drink less alcohol resulting in low er BA C. M oreover, m andating server intervention training program m es for servers o f alcohol can result in less alcoholrelated traffic accidents. C O N C E P T U A L M O D E L R esearch dem onstrated that server intervention can w ork, but w hy and under w hat conditions does it w ork? It is assum ed that drinking behaviour is directly influenced by the social environm ent. T he risk to drive w hile under the influence w ill be reduced by m odification o f the drinking environm ent. It is also know n that situational factors such as the num ber o f heavy drinkers and the volum e o f m usic on the prem ises is influencing the drinking b ehaviour o f custom ers. E specially the drinking behaviour o f young people is determ ined by the actual drinking situation (V an de G oor, 1991). T he server o f alcohol has a unique position to influence drinking behaviour o f his or her patrons. The server creates the im m ediate environm ent conducive to responsible drinking. T his com m unity position o f gatekeeper or interm ediary brings servers o f alcohol into strategic contact w ith all persons w ho could cause alcoholrelated problem s. T hey are a success factor in the design o f effective prevention program m es. T he problem is how to im plem ent server intervention. In the N etherlands server intervention training is not m andated. B ar personnel can participate in these trainings on a voluntary basis. T hat w ay, one w ill only reach a few m otivated people. H ow ever, starting January 1996 it is m andated that all bar staff m ust have certain know ledge about the effects o f alcohol on the behaviour o f people. T herefore all ow ners o f establishm ents m ust pass a new exam social hygiene in w hich elem ents o f the server intervention training is included. But it is all too theoretical, no skills are practised. A lcohol legislation including m andating server intervention trainings for all bar sta ff is the first determ ining factor for a successful im plem entation o f server intervention. T he study o f H older en W agenaar (1994) proved that Dram Shop Law s and m andating server intervention

5 trainings can be successful in preventing alcoholrelated accidents. N evertheless, even w ithout a stim ulating alcohol legislation it is clear that server intervention is a useful strategy to influence the behaviour o f bar personnel and the policy o f ow ners o f establishm ents in a positive w ay and through them the drinking behaviour o f custom ers and the alcoholrelated problem s such as vandalism, driving w hile intoxicated and traffic accidents caused by them. How server intervention can influence alcoholrelated problem s can be seen in figure 1. L egislation gives the opportunity to penalise unresponsible serving. In the U SA the law ( D ram S hop L iability ) is a strong m otivation for people to participate in server intervention training. If a custom er causes an accident the server o f alcohol has to prove he did everything he could have done to prevent the accident. R eferring to participation in a server intervention training w ill support the server and m ay lead to discharge o f prosecution. A s the U SA can be considered as a judicial society w here everyone can be sued for the least little thing, the D utch situation is different. In T he N etherlands one appeals m ore to the m oral responsibility o f servers o f alcohol and the responsibility o f the drinker him self. A s a result a policy o f se lf regulation is agreed betw een the governm ent and the H oreca (H otel R estaurant C afe) organisations. T hese organisations, represented by STIV A (Foundation for M oderate D rinking), developed a Code, actualised in Septem ber 1996 (ST IV A, 1996), in w hich is stated that all their m em bers act upon the existing alcohol law s w ith the utm ost exertion. A lthough D utch legislation is not as severe as the A m erican legislation, it is for exam ple p rohibited to serve alcohol to a drunken custom er, to a person under the age o f sixteen (eighteen if it concerns spirits) and to have drunken custom ers on the prem ises. A s w ith other law s the problem is controlling these law s. T here is hardly any control, although by the m entioned C ode there is som e kind o f social control w ithin the group o f bar staff. Still, the governm ent m ay use the legislation to w ithdraw o n e s license to run a bar. U ntil now this is only done in cases o f serious disturbance o f the peace or in cases o f repeatedly drugs dealing. It m ust be told here that the D utch governm ent intends to im plem ent a new alcohol legislation to stim ulate responsible selling and serving o f alcohol

6 So participation in server intervention trainings can be stim ulated by legislation, by social control (developing a Code) and by integrating it into relevant curricula. A nother im petus m ay be incentives. F or exam ple in the U SA m any insurance com panies offer low er insurance rates to ow ners o f establishm ents and restaurants w here 75% or m ore o f the em ployees are trained in server intervention procedures. A D utch exam ple is that participants o f server intervention in the F ig.l : conceptual m odel for influencing alcohol related problem s by server intervention alcohol related problems Province o f G elderland got a shield on w hich is w ritten "R esponsible H ospitality". H anging the shield on the w all w ill prom ote their business and is good publicity. C ustom ers can recognise those establishm ents and know that there will be responsible and good service. A lthough server intervention m ay have positive effects it depends on the culture o f the country under w hat conditions im plem entation w ill be successful. D rinking and server culture is different in each country, even regional and local differences exists. A nd m eeting the specific needs o f a (sub)culture is an im portant condition for an effective program m e. IN T E G R A L A P PR O A C H Server intervention itself can have positive effects on drinking behaviour o f custom ers and alcoholrelated problem s such as driving while under the influence. B ut it will not be

7 sufficient for a perm anent and m eaningful change. T he approach to the problem o f alcohol m isuse and driving w hile intoxicated dem ands an integral approach. T he strategy to develop exerts influence on several risk factors (the m ulti factor approach), acts upon the sam e factor through several channels and m ethods (the m ulti m ethod approach) and involves different social system s around the target groups (the m ulti system approach). T his concentration o f intervention forces enhances the chance that the form ulated objectives for preventing a certain problem w ill be realised (H osm an & M ollem an, 1994). Selling beer in a bar is influenced by m any factors such as governm ental policy concerning alcohol trade, taxes and licenses, the local policy concerning controlling legislation, rules and values w ithin subcultures, the type o f establishm ent and the chosen m eans o f transport o f the drinker. It is evident that bar personnel can not influence all these factors, but they are a crucial factor in m odifying a drinking environm ent discouraging unresponsible drinking and stim ulating responsible drinking. It is recom m ended that server intervention program m es should be part o f an integral approach. T hough server intervention is w idespread in countries such as the U SA, C anada and A ustralia, it still is im plem ented very lim ited o r not at all in E uropean countries. R E F E R E N C E S G liksm an, L., & Single, E. (1988). A field evaluation o f a server intervention program : A ccom m odating reality P aper presented at the C anadian E valuation Society M eeting, M ontreal, Canada, M ay G oor, L.A.M. van de. (1991). Situational aspects o f adolescent drinking behaviour. M aastricht: D issertation Rijksuniversiteit Lim burg, Faculteit der G ezondheidsw etenschappen. H older, H.D., & W agenaar, A.C. (1994). M andated server training and reduced alcoholinvolved traffic crashes: A tim e series analysis o f the O regon experience. A ccident A nalysis and Prevention, 26:1, H osm an, C.M.H., & M ollem an, G.R.M. (1994). P reventie van rijden onder invloed: Een integrate aanpak. In: B uism an, W.R. e.a. (red.) H andboek V erslaving. H outen: B ohn Stafleu Van Loghum, pag. 2100/3-2100/35. K ayser, R.E. (1992). A server intervention training to prevent alcohol abuse. In: H.D. U tzelm ann, G. B erghaus & G. Kroj. Proceedings o f the 12th International C onference on A lcohol, Drugs and Traffic Safety. Koln: V erlag TuV Rheinland

8 L agenbucher, J., N athan, P. (1983). Psychology, public policy, and the evidence for alcohol intoxication. A m erican Psychologist, 10, M athijssen, M.P.M. (1995). R ijden onder invloed in N ederland, L eidschendam : Stichting W etenschappelijk O nderzoek V erkeersveiligheid (SW OV). M cm illen, D.L., Pang, M.G., W ells-parker, E., & A nderson, B.J. (1992). A lcohol, personality traits, and high risk driving: A com parison o f young, drinking driver groups. A ddictive Behaviors, 17, M e K night, A.J. (1987). D evelopm ent and field test o f a responsible alcohol service program. V olum e I: R esearch findings, report no. D O T -H S W ashington DC: N ational H ighw ay Traffic Safety Adm inistration. M ck night, A.J. (1991). Factors influencing the effectiveness o f server-intervention education. Journal o f Studies on A lcohol, 52:5, M ck night, A.J., & Streff, F.M. (1994). T he effect o f enforcem ent upon service o f alcohol to intoxicated patrons o f bars and restaurants. A ccident A nalysis and Prevention, 26:1, Peberdy, J.R. (1991). P rior drinking locations o f drivers killed in V ictoria. In: T. Stockw ell, E. L ang, & P. R ydon (eds). T he licensed drinking environm ent: C urrent research in A ustralia and N ew Z ealand. Perth: N ational C entre for R esearch into the P revention o f D rug A buse, Curtin U niversity o f Technology. R uss, N.W., & G eller, E.S. (1987). T raining bar personnel to prevent drunking driving: A field evaluation. A m erican Journal o f Public H ealth, 77:8, Saltz, R.F. (1987). T he role o f bars and restaurants in preventing alcohol-im paired driving: An evaluation o f server intervention. E valuation and the H ealth Professions, 10:1, Saltz, R.F., H ennessy, M. (1991). R educing intoxication in com m ercial establishm ents: A n evaluation o f responsible beverage service practices. B erkeley, CA: P revention R esearch Center. Soder, J.C.M. (1990). A lcoholgebruik van autom obilisten H aren: V erkeerskundig Studiecentrum, Rijksuniversiteit G roningen. S tichting V erantw oord A lcoholgebruik (ST IV A ). (1996). D e C ode voor A lcoholhoudende D ranken. Rotterdam : STIVA. Stockw ell, T., L ang, E., & R ydon, P. (1993). H igh risk drinking settings: T he association o f serving and prom otional practices w ith harm ful drinking. A ddiction, 88, W agenaar, A.C., & H older, H.D. (1991). E ffects o f alcoholic beverage server liability on traffic crash injuries. A lcoholism : Clinical and Experim ental R esearch, 15:6,

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