The impact of programs for high-risk drinkers on population levels of alcohol problems

Aims. Historically, treatment programs and related activities for alcoholic s or high-risk drinkers have been viewed as not relevant to efforts to prev ent alcohol problems, and in particular population-based prevention efforts . In this review we consider evidence that high-risk programs may have an i mpact on population or aggregate levels of these problems. Design. 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 nece ssary for these programs to have an aggregate level impact. Following that, correlational evidence on the impact of high-risk programs on aggregate pr oblem levels is examined. Estimates of the potential impact of high-risk pr ograms on aggregate problem levels, based on available information on the i mpact of these programs and the numbers of individuals affected, are then c onsidered, as are estimations of the comparative aggregate level impact of high-risk and consumption reduction strategies. Findings. There is increasi ng 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 morbid ity and mortality observed in some countries in recent years. Studies estim ating the recent impact of increases in levels of treatment and AA membersh ip support that interpretation, and studies comparing estimated effects of high-risk and population strategies find similar potential for aggregate ef fects. Conclusions. Programs for high-risk drinkers can have beneficial agg regate-level effects and are thus a valuable component of population-based efforts to reduce alcohol problems.