Mental health policy and practice across Europe: an overview

Addiction and alcohol 265
College student
education
Public service
messages
0 + + + TG = HR; may increase
knowledge and change
attitudes but has no effect
on drinking
0 +++ ++ ++ TG = GP; refers to messages
to the drinker about
limiting drinking; messages
to strengthen policy
support untested
Warning labels + + 0 +++ TG = GP; effect on message
awareness, none shown on
behaviour
Promotion of
alternatives
Alcohol-free
activities
? + ? ? TG = GP; not enough
research to draw
conclusions about this
strategy
0 ++ ++ ++ TG = GP; evidence mostly
from youth alternative
programmes
1 Evidence of effectiveness – This criterion refers the scientific evidence demonstrating whether
a particular strategy is effective in reducing alcohol consumption, alcohol-related problems or
their costs to society. To be considered in this compendium, at a minimum the strategy had to
be carefully investigated in at least one well designed study which accounted for alternative and
competing explanations. The following rating scale was used as a guide:
0 Evidence indicates a lack of effectiveness
+ Evidence for limited effectiveness
++ Evidence for moderate effectiveness
+++ Evidence of a high degree of effectiveness
? No studies have been undertaken or there is insufficient evidence upon which to make a
judgement
2 Breadth of research support. The highest rating was influenced by the availability of integrative
reviews and meta-analyses. Breadth of research support was evaluated independent of the rating
of effectiveness (i.e. it is possible for a strategy to be rated low in effectiveness but to also have a
high rating on the breadth of research supporting this evaluation). The following scale was used:
0 No studies of effectiveness have been undertaken
+ Only one well designed study of effectiveness completed
++ From two to four studies of effectiveness have been completed
+++ Five or more studies of effectiveness have been completed
? There is insufficient evidence on which to make a judgement
3 Tested across cultures. This criterion is concerned with the diversity of geography and culture
in which each strategy has actually been applied and tested. It refers to the robustness of
international or multinational testing of a strategy as well as the extent to which a strategy
applies to multiple countries and cultures. The following scale was used:
0 The strategy has not been tested adequately
+ The strategy has been studied in only one country or appears to be unique to one country
++ The strategy has been studied in two to four countries or appears relevant to more than one
country but perhaps is culturally bounded
+++ The strategy has been studied in five or more countries or appears to be relevant to a large
number of countries
? There is inadequate information on which to make a judgement
4 Cost efficiency. This criterion seeks to estimate the relative monetary cost to the state to
implement, operate and sustain this strategy, regardless of effectiveness. For instance, increasing
alcohol excise duties does not cost much to the state but may be costly to alcohol consumers. In
this criterion, the lowest possible cost is the highest standard. Therefore, the higher the rating,
the lower the relative cost to implement and sustain this strategy. The following scale was used:
0 Very high cost to implement and sustain
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