Long-term Effects of the STAD-model: A Multi-Component Responsible Beverage Service Intervention

Background:
In 1996, an alcohol prevention program in Responsible Beverage Service (RBS) targeting the nightlife setting was co-created with stakeholders in Stockholm, Sweden. The multi-component program consists of community mobilization and collaboration, training, and enforcement. Evaluations of this RBS-program have shown a significant increase in the refusal rates of alcohol service to intoxicated guests, from 5% in 1996 to 77% in 2016, and a decrease in the frequency of police-reported violence by 29%. In addition, a cost-effectiveness analysis showed that for every Euro spent on the intervention 39 Euro were saved. The program was subsequently institutionalized and supported by a steering group with participation from stakeholders such as, the Licensing Board, the Police Authority, the County Council, the County Administration, the Organization for the hospitality industry, the Union for hotel and restaurant workers, and the nightlife industry. The aim of this study is to examine the long-term effects, over a 25-year period of this RBS-program on the frequency of refusal rates of alcohol service to obviously intoxicated guests at licensed premises.
Methods:
Data collection was conducted during the fall 2022, and the same procedure as the baseline assessment in 1996 and follow-ups in 1999, 2001, and 2016 was utilized. Eight professional male actors (i.e., pseudo-patrons) were trained by an expert panel to enact a standardized scene of obvious alcohol-intoxication. Four research teams, each consisting of one observer and two actors, visited licensed premises during Wednesday, Thursday, Friday, and Saturday nights. After entering the premises, the actors approached the bar, enacted the standardized scene, and attempted to order a beer. 240 licensed premises in central Stockholm were randomly selected for this study.   
Results:
Of the 240 selected licensed premises, 220 licensed premises were visited and tested by the research teams. At the long-term follow-up in 2022 the pseudo-patrons were refused service of alcohol at 80% of the attempts, a statistically improvement compared to 5% and 47% in 1996 and 1999 respectively, as well as sustained effects relative to the previous assessments in 2001 (70%), and 2016 (77%).
Conclusions:
This study demonstrates that the long-term effects on overserving of alcohol of a multi-component RBS-program can be sustained over a 25-year time period.