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Strategic Plan: Fiscal Years 2024-2028

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Goal 3: Prevent and Reduce Alcohol Misuse, Alcohol Use Disorder, and Associated Consequences

NIAAA encourages the development, evaluation, and implementation of culturally appropriate individual, family, school, community, and policy-based strategies to prevent alcohol misuse, alcohol use disorder, and related consequences.

NIAAA’s Long-Term Vision

Develop and implement effective and targeted prevention strategies to prevent all alcohol-related problems.

Evidence-based strategies to prevent and reduce alcohol misuse and the associated consequences are critical for lessening the resulting individual, social, and public health impact. Research is revealing opportunities for developing novel prevention interventions and improving the effectiveness of existing ones.

Alcohol use commonly begins during adolescence, and the earlier a person starts to drink the more likely they are to escalate to alcohol misuse, develop alcohol use disorder (AUD), harm themselves and others while intoxicated, and misuse other substances. As such, prevention strategies that seek to delay and prevent alcohol use among adolescents are a major focus of the NIAAA research portfolio.

Similarly, integration of prevention across a variety of health, community, justice, and social service settings can increase the reach among underserved populations. These interventions typically occur at the individual, family, school, community, and policy levels, and focus on preventing or delaying the initiation of alcohol use or preventing escalation to more serious problems.

Additionally, promoting awareness of fetal alcohol spectrum disorders (FASD), adopting culturally informed prevention strategies, and evaluating policies that also reduce stigma around seeking treatment can support efforts to prevent alcohol use and reduce consequences among individuals who are or may become pregnant. The Cross-Cutting Research Program on FASD explores this research area.

Goal 3 research topics are integrally linked to the Cross-Cutting Research Themes. Examples of NIAAA research priorities in this area include the following objectives.

Objective 1: Increase Utilization of Alcohol Screening and Brief Intervention in Different Settings

The U.S. Preventive Services Task Force recommends alcohol screening and brief intervention (SBI) in primary care settings for adults ages 18 and older. A data analysis from the National Survey on Drug Use and Health showed that although alcohol screening often occurs among people with AUD who have utilized health care in the last year, there is still insufficient use of brief intervention or referral to alcohol treatment. Research also indicates that not all groups of people are equally likely to be screened or receive advice about risks associated with drinking, a practice that may contribute to health disparities.

Barriers to SBI are significant but surmountable. The barriers include lack of health care provider time to ask questions and respond to harmful drinking behaviors, need for health care provider training for efficient and effective alcohol SBI, lack of treatment resources for referral (especially among adolescent and minority populations), and impediments to reimbursement of alcohol SBI and referral to treatment.

For both adolescents and adults, there are relationships between patterns of alcohol use and other risk factors for health. Evidence-based screening tools can uncover these risks. For instance, among adolescents, certain drinking behaviors are related to the likelihood of having depression and misusing opioid pain medications. Thus, in addition to identifying alcohol misuse, alcohol SBI can also help health care providers uncover other issues that impact health and well-being. Studies have also suggested that training health care providers to conduct SBI reduces stigma toward patients with AUD.

NIAAA encourages research to promote improvements in alcohol SBI, including increased utilization and a better understanding of outcomes—for example:

  • Collecting additional evidence of the effectiveness of SBI for alcohol misuse among adolescents and older adults
  • Assessing the effectiveness of SBI for prevention of alcohol and co-occurring cannabis and other drug use, liver disease, atrial fibrillation, and other conditions caused or exacerbated by alcohol misuse
  • Continuing to investigate digital technologies for SBI, evaluate their effectiveness, and assess their impact on uptake of alcohol SBI in various settings
  • Identifying barriers and effective strategies for increasing real-world adoption (scaling up) of alcohol SBI and evidence-based preventive interventions among all populations
  • Measuring the long-term health care cost savings based on the utilization of SBI in the prevention or exacerbation of alcohol-related conditions

Objective 2: Develop and Improve Targeted Interventions to Prevent and Reduce Alcohol Misuse Across the Life Course and in Different Settings

Patterns of alcohol use and misuse vary over the life course. Typically, alcohol use is initiated in adolescence, peaks in young adulthood, and then gradually declines over the course of adulthood. Binge drinking (for a typical adult, this corresponds to consuming five or more drinks for men and four or more drinks for women in about two hours) and high-intensity drinking (defined as alcohol intake at levels twice or more the gender-specific threshold for binge drinking) often begins or escalates in late adolescence or early adulthood.

Binge drinking in the US; in 2022, 23.5% of people ages 18 and older reported that they engaged in binge drinking in the past month.

The earlier in life a person begins to use and misuse alcohol, the greater the likelihood they will go on to develop significant problems with alcohol. Furthermore, early alcohol use has the potential to negatively impact brain development and increases the likelihood of cognitive impairments and AUD. For these reasons, adolescents and young adults remain a central focus of prevention research.

Social and environmental factors contribute to decisions about alcohol use throughout life and offer opportunities for prevention. As young people progress through adolescence and into adulthood, there is considerable variation in life experiences that can increase or decrease the likelihood of alcohol misuse. Examples are related to factors such as home and school environment, social experiences (online and in person), and opportunities and choices related to education and career.

Each of these factors provides opportunities for prevention efforts tailored to connect in meaningful ways with young people who have diverse experiences, beliefs, and access to resources.

Examples of research in this area that NIAAA encourages include:

  • Creating and tailoring interventions for alcohol misuse for life stage and environment
  • Improving prevention and early intervention through the use of validated biosensors and biomarkers, including risk predictions of alcohol-associated disease development and progression using biomarker signatures
  • Developing or modifying underage drinking prevention strategies to integrate prevention of combined use of other substances
  • Evaluating strategies to prevent and reduce high-intensity drinking
  • Evaluating the impact of social media on alcohol use and associated behaviors as well as the use of social media and other digital technologies in the development of “in-the-moment” and other innovative prevention interventions
  • Using social media to counter misinformation about alcohol and provide evidence-based information for prevention
  • Developing prevention models to reduce family and cross-generational effects of alcohol misuse, such as violence, child maltreatment, and other harms
  • Designing and evaluating interventions to mitigate the effects of trauma and childhood adversity on alcohol misuse and alcohol-related conditions, such as AUD
  • Evaluating the impact of general health promotion strategies (whole person health, including effective stress management and coping strategies) on alcohol misuse and AUD
  • Creating culturally informed interventions to reduce adverse alcohol-related outcomes among different populations
  • Creating interventions for people in specific work environments who are at higher risk for alcohol misuse due to work-related stress and trauma, such as first responders and health care providers

Objective 3: Determine the Impacts of Policies on Alcohol Misuse, Health Effects, and Acute Harms

Alcohol-related policies represent a population-level strategy that can affect all individuals within a jurisdiction (e.g., federal, state, local, or institutional). A well-known example of an impactful alcohol policy is the 1984 U.S. National Minimum Drinking Age Act, which led to the adoption of 21 as the legal age to purchase or publicly possess alcohol in all states in the United States. The change in drinking age was associated with reductions in underage alcohol use and related traffic fatalities among young people. Policy research has revealed several other effective environmental-level interventions that reduce alcohol-related harms (see box).

Environmental-level interventions include:

  • Administrative license suspension
  • 0.08% blood alcohol concentration law, with zero tolerance for youth
  • “Use and lose” laws to suspend or revoke driver licenses for alcohol violations
  • Restriction of adult provision of alcohol to underage individuals
  • Mandatory assessment for drivers with alcohol-related traffic citations
  • Dram shop and social host laws
  • Increased alcohol taxes
  • Reduced alcohol outlet density
  • Responsible beverage service laws
  • Laws restricting hours and days of alcohol sales

NIAAA encourages ongoing and new efforts to determine the impact of policies on alcohol misuse and harms, such as:

  • Examining effects of alcohol policies on alcohol-related morbidity, mortality, and risk behaviors, including but not limited to intentional and unintentional injuries, child and maternal health outcomes, and chronic conditions
  • Determining the differential effects of alcohol policies, including across population subgroups
  • Characterizing the effects of cannabis legalization on alcohol misuse, co-use with other substances, and related risk behaviors
  • Evaluating the impact of new policies related to alcohol on alcohol-related behaviors or outcomes—these include additional labeling of alcohol containing products and other policies adopted during the COVID-19 pandemic
  • Evaluating the effects of social media marketing on underage drinking and related consequences, such as motor vehicle crashes, intentional and unintentional injuries, and other alcohol-related consequences (e.g., poor academic and work performance among youth)
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