INTRODUCTION

How then can we learn? In trying to reduce alcohol problems, as in other such endeavors, we must have models to test and improve or discard. Models should be based on a strategy. Often models are strategy. This book intended as a base for developing and refining strategy. The refined strategies must, of course, still be continually burnished.

Here we look at strategy for global, national and local community needs. Taking on such a sweep involves the risk that the effort will be dismissed as foolhardy.  But this risk is deliberately taken. We must, when planning at one level, take into account the influence of what happens at others. So these very difficult levels of organization are addressed here, despite the focus then becoming blurred. To compensate, the material is presented in a way that allows each chapter to be read independently. Someone interested in getting community action started can, for instance, start with the section on “Practical implementation” in chapter 5(community action) directly.

A brief overview of selected studies is provided. But useful knowledge is found outside of the learned scientific literature too. To tap this, one has constantly to be on the lookout for snippets and comments from those working in this field and follow these up. Such snippets related mostly to action taken at community level, not rigorously ‘scientific’ enough to merit publication in the learned journal.

The section on developing a strategy takes into account verifiable report of community action not reported formally. These are mostly from Asia. The proposed elements of strategy flow from all of these assorted experiences. But strategy, as I said, has to keep an eye at all levels-from the WTO and the global multinational alcohol industry giants to the man who gulps a drink of illicit brew in a remote village in Sierra Leone. Actions of the global alcohol trade do impact even on the behavior of this man. But, for convenience, the strategy section treats community, national and global realities separately.

The easiest way to understand the foundation on which strategy should rest is to look at a small community. The forces that work on the individual, family and local groups are then easier to understand. And interventions to reduce alcohol problems are more easily tested at these smaller levels. At the national level, more gas to be added. But the fundamental requirements for community progress must be strengthened through national action. There are necessary global responses too, which should always keep in mind the needs for national or community level progress.

A fair amount of evidence exists on what has worked and what has failed at each of these levels. A mechanism to build on these is essential. At the same time, fresh ideas must be put to test. New ideas must not be whim. Some basic underlying hypotheses should guide experimentation. The results then help underlying principles and strategies to be recognized, refined or discarded. A set of desired outcomes is suggested here for community strategy, as the starting point. Most attention is paid to this aspect as this is the most proximal determinant of drinking individual behavior.

Different imperatives guide national and global strategy. These are dealt with briefly. At these complex levels of organization, it is more difficult to test out what works. Despite the difficulties, accumulated knowledge has grown enough to provide impartial practitioners with solid recommendations on what a country can do to reduce alcohol problems. Global measures have less of an evidence base to support them. They can however be worked out through a clear understanding what must be done to facilitate the results sought within countries and in communities.

Interventions should help in amending or refining a basic framework, such as that proposed here for community action. We should continually improve our guiding principles to make them increasingly robust. The attempt in this booklet is simply to fit together into one framework. There may be pieces redundant, awry or missing. But we need a base from which to start testing what the essentials are.