STAD – (STockholm prevents Alcohol and Drug problems): an environmental strategy in nightlife environments focussing on the improvement of the compliance of alcohol legislation regarding overserving and age limits.
At a glance
Country of origin
- Sweden
Level(s) of intervention
- Environmental prevention
STAD uses both formal and informal control measures to address binge drinking in bars and clubs, but also underlines the need for community support of such measures. The working method, developed in Stockholm between 1995 and 2001 aims to create a better and safer bar and pub environment by reducing alcohol related problems such as violence and injuries. The STAD method is based on a structured and long-term effort, consists of three parts: Multi-agency partnership between government agencies and the industry, Two-day training Responsible Beverage Service for bar staff and bar management, and Improved (cooperative) enforcement by and with police.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
Johanna Gripenberg
STAD - Centre for Psychiatric Research | Karolinska Institutet & Region Stockholm
johanna.gripenberg[at]sll.se
Overview of results from the European studies
Studies overview
Wallin and colleagues (2003) found that the intervention was robustly effective in reducing violence in and around bars in Stockholm by means of a significant reduction in police-recorded violence (29%). The choice of control area and model specification did overall not affect this outcome. The sequels of the STAD programmes in Sweden seem to have had smaller effects than the original programme implemented in Stockholm (Trolldal, Brännström et al., 2013). One contributing factor was that not all programme components were implemented in the municipalities (Trolldal, Haggård et al., 2013). This is in line with the evidence that the pioneering versions of prevention programmes usually yield larger effects than the widely disseminated sequel programmes that operate on a more fragmentary basis.
In a cost-savings analysis, the 29% reduction in violence translated to a cost-savings ratio of 1:39 (Månsdotter et al., 2007). Furthermore, the program as implemented in Stockholm demonstrated a reduction in alcohol service to underaged using the mystery shopping method(Wallin & Andreasson, 2004) and also overserving using professional male actors (i.e., pseudo-patrons) trained to act alcohol-intoxicated while attempting to purchase alcohol (Wallin et al., 2002, 2005). An expert panel standardized the scene of obvious alcohol intoxication and each attempt was monitored by one observer.
A pre- (2003) and post (2004 and 2008) -intervention design study (Gripenberg et al. 2007, 2011) in high-risk licensed premises in central Stockholm assessed the STAD-CaD effects on the frequency of doormen intervention towards obviously drug-intoxicated guests at licensed premises. Professional male actors were trained to act impaired by cocaine/amphetamines while trying to enter licensed premises with doormen. An expert panel standardized the scene of drug intoxication and each attempt was monitored by one observer. At the follow-up study in 2008 the doormen intervened in 65.5% of the attempts, a significant improvement compared to 27.0% at the first follow-up in 2004 and to 7.5% at baseline in 2003. Within the project, it was also shown that staff at establishments reported own decreased self-reported drug use in 2007/2008 compared to 2001, and also that they observed a reduction in drug-intoxicated patrons (Gripenberg et al.2011). A study by Elgan et al. (2021) showed effects of the STAD model when applied to sports settings.
Countries where evaluated
- Sweden
Characteristics
Protective factor(s) addressed
- Environmental: Enforcement strategy in on-site alcohol-selling premise
- Environmental: Police control of surrounding areas or Hot Spots
- Environmental: RBS (Responsible Beverage Service) available
- Environmental: Regular and obvious staff surveillance and reinforcement in on-site alcohol-selling premise
Risk factor(s) addressed
- Community: laws and norms favourable to substance use and antisocial behaviour
- Community: perceived availability of drugs/alcohol
- Environmental physical: Absence of guardianship by enforcement agents in on-site alcohol-selling premise and surroundings
- Environmental physical: High density of licensed alcohol-on-site premises
- Environmental physical: High number of intoxicated patrons in on-site alcohol-selling premise
- Environmental physical: Lack of opportunities for participation in positive and prosocial development
- Environmental physical: Level of crowdedness in on-site alcohol-selling premise
- Environmental physical: Music volume in on-site alcohol-selling premise
- Environmental physical: Police underenforcement / low presence in public spaces
- Individual and peers: favourable attitude towards alcohol/drug use
- Individual and peers: favourable attitudes towards anti-social behaviour
- No defined risk factors
Outcomes targeted
- Emergency visits
- Substance use
- Alcohol use
- Use of illicit drugs
- Substance-related behaviours
- Crime
- Other behaviour outcomes
- Sexual violence
- Social behaviour (including conduct problems)
- Violence
Description of programme
The work is based on a well-developed multi-agency partnership between several authorities and service industry associations, including for instance nightclub owners, police authorities, alcohol licensing board that all contribute to steering and working groups as well as the co-creation of intervention activities. The combined expertise and commitment by bars, nightclubs and restaurants offer an interesting and well evaluated training package. RBS-training of bar staff is highly recommended by the Stockholm licensing board for licensed premises that stay open after 01:00AM. Participants pay a fee for the RBS-training that finances the coordination, administration, and execution of the training. The training covers topics such as the medical effects of alcohol, alcohol legislation, age checking, and conflict management. Part of the Stockholm approach is also an adapted enforcement strategy of the authorities (police and licensing board) that enforce the alcohol law. The strategy can be summarised by a more cooperative or coaching enforcement instead of a more controlling way of working towards the hospitality industry. As an example, the police contribute structurally to the RBS-training for bar and security staff and management, and they are encouraged to have a coaching dialogue with the staff at establishments when they perform compliance checks. This work has shown to have an effect on a number or outcomes such as violence (Wallin et al 2003; Norström, & Trolldal, 2013) and has shown to save 39 Euros for every one Euro invested in the program (Månsdotter et al, 2007). This has led to the institutionalization (Wallin, Lindewald, & Andréasson, 2004) of the program in Stockholm, and a widespread dissemination to more than 200 of Sweden’s 290 municipalities (Haggård et al., 2015). Furthermore, within the STAD in Europe project (www.stadineurope.eu), the implementation model was piloted in several other countries such as Spain (focus on Ibotellón), Netherlands (focus on big festivals), UK (focus on preloading) and Czech Republic (focus on nightlife and age-limit compliance).
During the work with the RBS-program in the Stockholm nightlife, concerns were raised about the illicit drug situation. Based on the STAD RBS-programme the multi-component illicit drug use prevention intervention, CaD, was developed. In this programme, media advocacy became one important additional intervention component. The CaD-programme has proven to have an effect on for instance increased doormen refusal or intervention rates towards obviously drug-intoxicated patrons (Gripenberg et al. 2007, 2011). This programme has been disseminated to Sweden’s municipalities and counties (Norrgård, et al., 2014), and has, as of 2019, been disseminated to more than 50 municipalities.
Implementation Experiences
Contact details
patrick.widell[a]polisen.se
Main obstacles
With respect to individual professionals
Resources and understanding.
With respect to social context
- The big turn over in staff
- Engaging the night club business
With respect to organisational and economic context
We had to show what kind of benefits one could get if working with this method
How they overcame the obstacles
With respect to individual professionals
We focused on mobilization and engaging them
With respect to social context
Worked together with our partners
With respect to organisational and economic context
We had to show what kind of benefits one could get if working with this method.
Lessons learnt
With respect to individual professionals
- Long term thinking
- Even big problems can be prevented
- Work together
- Let everyone know - What´s in it for me
With respect to social context
Don´t give up! Keep on doing what you do!
With respect to organisational and economic context
Long term funding
Written agreement
Strengths
Partnership
Community mobilization
Good results
Weaknesses
The night club industry economic reasons to join
Opportunities
Use the same strategy in different fields, that is football arenas, drugs etc
Threats
Corona pandemic
Recommendations
With respect to individual professionals
Identify the right persons
With respect to social context
Adjust the method to your own context
With respect to organisational and economic context
Write an agreement and define the specific goals for the method, your own and your common goals
Number of implementations
Country
Contact details
johanna.gripenber[a]sll.se
Main obstacles
With respect to individual professionals
Lots of effort to mobilize and developing a structure for collaboration with all the different stakeholders such as football clubs, arena corporations, licensed premises, municipality, police authority, and licensing board. Developing a good structure for collaboration is fundamental for the co-production process that was used in the program.
Another obstacle was to find training components suitable for all target groups working at the arenas. In the STAD-model implemented in the nightlife setting, staff participate in a 2-day training in responsible beverage service. At large sporting events there are a large number of extra staff working and having them taking part of a 2-day training is not feasible.
With respect to social context
In Sweden, as in many other countries, football is the most popular sport and alcohol and intoxication is often associated with football. In Sweden, all types of alcohol is sold inside the arenas at restaurants, bars, and kiosks. In fact, high levels of alcohol consumption and intoxication has been acceptable at football events in Sweden.
With respect to organisational and economic context
To develop a productive organizational structure when the stakeholders are so different from local municipalities to large international corporations that own the sport arenas and to define what roles each stakeholder have. A challenge concerning the economic context is that the alcohol industry utilizes sporting events as a marketing setting for their products. As a result, alcohol and intoxication has become normalized at football events.
How they overcame the obstacles
With respect to individual professionals
We put a lot of resources into mobilizing all stakeholders and identifying "what's in it for us" arguments for all the different stakeholders. We formed a project structure to aid collaboration and co-production. A steering group and a reference group was formed. Different working groups were formed that developed and worked with all the intervention strategies such as training, communication, and policy. In co-production, we developed a three types of training. 1. two-day responsible beverage service training for managers and full-time staff at licensed premises, 2. a brief digital training for all staff, including extra staff (e. g. entrance staff, security staff, staff at kiosks, and serving staff) working at the football events, and 3. a kick-off training that was held before the start of each season and targeted all staff in managerial positions.
With respect to social context
We conducted a baseline assessment to evaluate intoxication levels among spectators and to assess how easy it was for highly intoxicated spectators to enter the arenas and to buy alcohol inside the arenas. The figures showed poor results which were used to inform the public and all stakeholders about the situation at the arenas. We used media advocacy and different communication strategies to highlight the connection between alcohol and alcohol-related problems such as bad language, injuries, and violence. We conducted a national survey among the general public asking about their opinion on alcohol and football. The results were used to communicate the public's low acceptability for alcohol intoxication at sporting events and high support for prevention strategies.
With respect to organisational and economic context
We had meetings with all stakeholders to get to know them and to assess their motivation to engage in alcohol prevention. Based on the needs assessment we then developed strategies to increase the stakeholders' motivation and to identify "what's in it for us". By developing the strategies in co-production with the stakeholders, the stakeholders' sense of ownership was increased. We also communicated experiences from the nightlife where licensed premises have found that it is more profitable to train staff and have them sell alcohol responsibly rather than to overserve.
Lessons learnt
With respect to individual professionals
It is feasible to adapt STADs model in responsible beverage service to other settings, in this case large football events. However, it is important to stress that you need to put lots of efforts into mobilizing stakeholders, developing structures for collaboration and co-production, and nurturing the collaboration. Conducting needs assessment and baseline measurements is very helpful in the process to mobilize the community and stakeholders. In addition, media advocacy was a strategy that was used successfully in the mobilization process and also to bring attention to alcohol and intoxication at football events.
With respect to social context
It is important to conduct needs assessments and baseline measurements in order to understand the social context of the setting where the strategies are to be implemented. The results from our population survey was helpful to motivate and engage the stakeholders so that they felt that they had support for alcohol prevention work in the arenas.
With respect to organisational and economic context
It is really important to identify arguments for "what's in it for us" for all the different stakeholders in order to motivate them. We also want to stress the use of co-production to increase the stakeholders' sense of ownership. Our earlier results from research on responsible beverage service in the nightlife (eg., reduction of violence by 29% and a cost-effectiveness ratio of 1:39) have been a good marketing strategy for us to mobilize the stakeholders.
Strengths
One strength was that this intervention was an adapted version of our previously developed intervention in responsible beverage service in the nightlife setting, which has demonstrated a reduction in violence by 29% and a cost-effectiveness ratio of 1:39. The fact that STAD was already known and with a very good reputation among some of the stakeholders also facilitated the implementation. Another related, but important strength is that the intervention at the football arenas was evaluated with regard to both process and effects. The results have been published in a number of scientific peer-reviewed articles.
Weaknesses
The assessments that we have conducted requires research competence and the large data we have collected was quite costly. For instance, we collected over 10 000 breath alcohol concentration measurements. We should stress that we conducted a rigorous research project, but this is not a requirement for future implementation of the program.
Opportunities
We developed the intervention for large sporting events and implemented the multicomponent intervention at Swedish Premier League Football matches. However, the intervention can easily be implemented at other large sporting events.
Threats
One threat is that others may not realize that this is a multicomponent intervention and that all components are required, i.e. mobilization and collaboration, training, enforcement, and communication, in order to achieve the results seen in Sweden.
Recommendations
With respect to individual professionals
You need to put lots of efforts into mobilizing stakeholders, developing structures for collaboration and coproduction, and nurturing the collaboration. Conducting needs assessment and baseline measurements is very helpful in the process to mobilize the community and stakeholders. In addition, media advocacy was a strategy that was used successfully in the mobilization process and also to bring attention to alcohol and intoxication at football events.
With respect to social context
Needs assessment is crucial in order to understand the social context of the setting where the strategies are to be implemented.
With respect to organisational and economic context
It is crucial to identify arguments for "what's in it for us" for all the different stakeholders in order to motivate them. Co-production is also a crucial component of the intervention to increase the stakeholders' engagement and sense of ownership.
Note from the authors
STAD-model in Responsible Beverage Service Tailored to Large Sporting Events (Football)
Year of implementation: 2015
