Alcohol Excessive Consumption: Responsible Beverage Service Training

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Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether responsible beverage service (RBS) training programs reduce excessive alcohol consumption and related harms at the community level.

Although results were generally favorable, the majority of the studies included in this review came from academic research studies that focused on individual establishments and were implemented under favorable conditions (e.g., intensive training programs, short follow-up times etc.). Further evidence is needed to assess the public health impact of sustainable, community-wide RBS training programs.

Intervention

Responsible beverage service (RBS) training programs are designed for people who own, manage, or work in establishments that serve alcohol. Programs provide information and teach participants how to serve alcohol responsibly and fulfill the legal requirements of alcohol service.

Training programs for managers and owners most often provide guidance on how to implement service policies and practices. Training programs for servers focus on knowledge and skills to help them prevent excessive alcohol consumption among patrons and minimize harms from excessive drinking that has already occurred.

Server training may address the following:

  • Checking patron identification cards
  • Using service practices that reduce the likelihood of excessive consumption
  • Identifying and responding to early signs of excessive consumption (e.g., rapid consumption)
  • Identifying intoxicated patrons and refusing service to them
  • Intervening to prevent intoxicated patrons from driving

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 11 studies (search period 1987-2009).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing excessive alcohol consumption. This finding replaces the 2001 CPSTF recommendation for Intervention Training Programs for Servers of Alcoholic Beverages to Reduce Alcohol-Impaired Driving.

Context

The context in which RBS training takes place likely plays an important role in the effectiveness of the intervention. Training programs may
  • Vary by the type of participation (e.g., state mandated, state-based incentive, voluntary research program)
  • Target establishment owners, managers, or servers
  • Be offered to groups, or delivered one-on-one
  • Be delivered by professional trainers, managers, or other staff
  • Vary in intensity and content (i.e., program can be 45 minute videotape presentations or 18 hour skill-building sessions)
  • Occur on- or off-site

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 11 studies.

  • RBS training for owners and managers led to positive changes in establishment policies, such as requiring identification checks of underage-looking customers, eliminating drink promotions, providing safe drinking information for customers, denying service to obviously intoxicated customers, conducting regular meetings with the staff, promoting food and non-alcoholic beverages, and arranging alternative transportation (4 studies).
  • RBS training for servers modestly improved observed and self-reported server practices such as offering food and water, delaying service to visibly intoxicated patrons, commenting on quantity and speed of alcohol consumption, and explaining house policies to customers (4 studies).
    • Identification checks for underage-looking patrons increased by 5 and 10 percentage points (2 studies). These results were not significant, however, and the frequency of identification checks remained low following RBS training.
    • Refusal to serve obviously intoxicated patrons (or trained actors who appeared intoxicated) increased by a median of 5 percentage points, though the frequency of service refusal remained low (4 studies).
  • RBS training generally resulted in a net decrease in the number of alcoholic drinks consumed by the patrons (2 studies with 5 study arms).
  • Researchers observed a net decrease in mean blood alcohol concentration (BAC) levels among patrons whose servers had been trained (3 studies with 6 study arms).
  • The percentage of intoxicated patrons leaving an establishment decreased by a median of 26.7% (5 studies) after being helped by trained servers.
    • The effects of RBS training on alcohol consumption and intoxication were small or in the unfavorable direction in establishments where there was a perceived lax regulatory climate, as measured in a survey of bar owners and community members.
  • Three years after a state-mandated RBS training program was introduced in Oregon, fatal single vehicle nighttime crashes decreased by an estimated 23% (1 study). Fatal single vehicle nighttime crashes are closely associated with excessive alcohol consumption.

Summary of Economic Evidence

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation are needed to answer the following questions and to fill remaining gaps in the evidence base. What are evidence gaps?
  • How do training intensity, delivery method (e.g., videotapes, lectures, role- playing), type of participation (i.e., state mandated, voluntary incentive, or research program), or type of establishment (onsite or off-site) affect outcomes of RBS training?
  • How do mandatory versus voluntary server training programs differ with respect to the following?
    • Participation level in server training programs
    • Management support to achieve program goals
    • Potential harms that can result from state offers to limit liability or sanctions in exchange for participation in training programs
    • Overall effectiveness of training programs in decreasing alcohol consumption
  • What training elements should be included in all server training programs?
  • What are the long-term effects of server training? Is one training session sufficient or ‘booster sessions’ are desired to maintain long-term intervention effectiveness?
  • How does server training affect establishment revenues, alcohol sales, and server tips?

Study Characteristics

Although included studies generally found positive results, two major limitations made it difficult to assess the potential public health impact of RBS training programs.
  • Most of the evaluated studies were academic research trials conducted in selected establishments, with high-quality, intensive training programs. This raises questions about whether programs implemented under more natural conditions would produce similar results.
  • The studies reported results for individual establishments, making it difficult to estimate the community-wide impact of RBS training programs.

Publications

Saltz RF. Why it matters: enlisting bars and restaurants in the prevention of intoxication and subsequent harms: why it matters. American Journal of Preventive Medicine. 2011;41(3):353-4.

Analytic Framework

Effectiveness Review

Analytic Framework
When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Buka SL, Birdthistle I. Long-term effects of a community-wide alcohol server training intervention. Journal of Studies on Alcohol 1999;60:27-36.

Gliksman L, McKenzie D, Single E, Douglas R, Brunet S, Moffatt K. The role of alcohol providers in prevention: an evaluation of a server intervention programme. Addiction 1993;88(9):1195-203.

Holder HD, Wagenaar AC. Mandated server training and reduced alcohol-involved traffic crashes: A time series analysis of the Oregon experience. Accident Analysis and Prevention 1994;26(1):89-97.

Johnsson KO, Berglund M. Do responsible beverage service programs reduce breath alcohol concentration among patrons: a five-month follow-up of a randomized controlled trial? Substance Use & Misuse 2009; 44(11):1592-601.

Lang E, Stockwell T, Rydon P, Beel A. Can training bar staff in responsible serving practices reduce alcohol related harm? Drug and Alcohol Review 1998 Mar;17(1):39-50.

McKnight J. Factors influencing the effectiveness of server-intervention education. Journal of Studies on Alcohol 1991;52(5):389-97.

Russ NW, Geller ES. Training bar personnel to prevent drunken driving: a field evaluation.American Journal of Public Health 1987;77(8):952-4.

Saltz RF, Hennessey M. Reducing intoxication in commercial establishments: an evaluation of responsible beverage service practices. Prevention Research Center, Berkeley (CA):1990.

Saltz RF. The roles of bars and restaurants in preventing alcohol-impaired driving: an evaluation of server intervention. Evaluation and Health Professions 1987; 10(1):5-27.

Toomey TL, Wagenaar AC, Gehan JP, Kilian G, Murray DM, Perry CL. Project ARM: alcohol risk management to prevent sales to underage and intoxicated patrons. Health Education and Behavior 2001 Apr;28(2):186-99.

Toomey TL, Erickson DJ, Lenk KM, Kilian G, Perry CL, Wagenaar AC. A randomized trial to evaluate a management training program to prevent illegal alcohol sales. Addiction 2008;103(3):405-13.

Additional Materials

Implementation Resource

Rural Health Information Hub, Prevention and Treatment of Substance Use Disorders Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of programs to prevent and treat substance use disorders in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

Search Strategies

No content is available for this section.

Considerations for Implementation

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.