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Adolescent alcohol consumption has declined in most high-income countries over the last decade; however, the prevalence of drinking under the legal age of 18 years remains high. There are several confounding factors related to alcohol use inclusive of gender, poverty, parental education, parental alcohol use and parental mental health difficulties. In addition, young people placed under the care of the state are disproportionately affected by alcohol misuse.

Longitudinal research has shown a linear risk between alcohol consumption and educational performance. Adolescents that have heavy alcohol consumption are associated with lower enrolment in post-secondary education, potentially reduced earnings and heightened job instability.

Universal interventions are one potential way to provide education regarding problematic alcohol use and its consequences. A recent Cochrane review identified that school-based interventions have potential to provide adolescents with the necessary knowledge, skills and opportunities for young people to remain alcohol free and decrease the risk of multiple risk-taking behaviours.

This is the second of a two‐part article on cultural aspects of alcohol use. Part I introduced the primary and secondary characteristics of culture and the current information on drinking patterns of selected ethnocultural groups. Part 2 includes other selected primary and secondary characteristics of culture such as age, gender, religious affiliation, education, socioeconomic status, and sexual orientation. The article concludes with measures whose effectiveness has been questionable in promoting responsible alcohol use and includes some proven and new recommendations.

It has come to be generally accepted that alcohol use — sometimes excessive — is “de rigeur” on the college campus. Occasionally this acceptance has blossomed into concern — witness the flurry of activity by many states to raise the legal drinking age after having lowered it to 18 in the early 1970s. Attention has subsequently focused on the age group particularly affected, the 18 to 21‐year‐olds caught in the public and legislative tug‐of‐war over what should constitute the legal drinking age. The inherent implication is that the legal drinking age should be the age at which most individuals are “adult enough” (i.e., emotionally mature) to make responsible decisions about alcohol use. However, since the majority of alcoholics and problem drinkers are over 21 years of age, it would seem that age alone is not enough to deter irresponsible alcohol use. Consequently, a renewed effort at alcohol education has arisen, with particular focus on the college campus where large numbers of 18–21‐year‐olds are concentrated.

The primary alcohol, ethanol, and its effects in man have been of considerable interest since ancient times. In recent years, for social, scientific, medical and legal reasons, even greater attention has been focused on the problems of alcohol drinking, its metabolism, pathology, and effects on physical and mental behaviour.

The adverse effects of alcohol consumption are massive. Alcohol is deemed to be the major factor in four per cent of the global burden of disease mortality (World Health Organisation, 2004). It has been suggested that there are two quite separate approaches to alcohol control policies. These supposedly different approaches are called the ‘public health approach’ and ‘harm minimisation’ or ‘harm reduction’. In fact, while there has been a clear difference in emphasis between some expressions of these two approaches, so much of what their exponents advocate is the same that there would appear to be no merit in continuing to regard them as mutually exclusive or in conflict. The public health approach emphasises curbing the level of alcohol‐related problems by reducing the per capita alcohol consumption (eg. Bruun et al, 1975; Edwards et al, 1995; Babor et al, 2003). Harm minimisation or harm reduction is intended to reduce the level of alcohol's adverse effects without necessarily reducing per capita alcohol consumption (Plant et al, 1997).

Alcohol Concern decided to develop the service for several reasons. Primary care is the main contact people have with the health service ‐ in any year 70% of the population will visit their general practitioner (GP). This makes primary care an ideal setting in which to detect and identify hazardous and dependent drinkers. While people experiencing difficulties or ill health because of their drinking will not necessarily attend a specialist alcohol service, they will probably visit their GP. Problem drinkers are known to consult their GPs twice as often as the average patient, the most common complaints are gastrointestinal, psychiatric and accidents (Heather & Kaner, in press).

Shaw et al. identified the need for alcohol counsellors to have “therapeutic commitment” when working with clients or patients with alcohol problems. Studies building on this work have focussed on how such commitment can be increased. In addition, as helping agencies have increasingly offered support services to people with drug related problems, attention has also been given to staff “therapeutic commitment” when working with both alcohol and drug using populations. This study aims to report on the evaluation of the impact of an alcohol and drugs awareness training programme which was provided for personal advisors (PAs) for young vulnerable people based in a government funded criminal justice project in London.

A three‐day alcohol and drug awareness programme was provided for 38 personal advisors. Participants completed an adapted version of the alcohol and alcohol problems perception questionnaire (AAPPQ) assessment instrument, previously developed by Shaw et al., immediately before and then again three weeks after the programme ended. This self‐completion instrument is designed to measure the alcohol and drugs knowledge, attitudes and confidence of the PAs in working with service users experiencing alcohol and drug related difficulties. Components of the AAPPQ are specifically designed to assess staff in relation to their role legitimacy, role adequacy, role support, and role satisfaction. In total, 38 participants completed the AAPPQ at Time 1. However, AAPPQ data for the pre‐and post training programme were only obtained for 16. Time 1 and Time 2 responses for these 16 were entered into SPSS and analysed using five‐paired samples t‐tests.

Participants significantly improved their attitudes to working with, and having confidence in the engagement of young people with alcohol and drug problems. Positive changes were also observed in relation to participants' role legitimacy, role adequacy, role support, and role satisfaction. A positive but non‐significant change in participant motivation was identified.

Alcohol and drugs awareness training programmes have a demonstrable and positive impact on the confidence, perceived role, and confidence of personal advisors working with service users with addiction issues.

During the past few years public concern in Britain has periodically moved from one health or social problem to another. Topics such as youthful heroin use, child abuse, and the upsurge of AIDS have, quite rightly, received a considerable amount of interest. Although media — popular and political — interest tends to single out particular ‘topical’ issues for attention, the sad fact is that, although health and social problems ebb and flow, they exist concurrently and some of the oldest and greatest problems often receive relatively scant concern. This is certainly true in relation to the misuse of alcohol and of the massive mortality attributable to tobacco smoking. The latter exceeds the health damage due to all other drugs (both legal and illegal) and it has been estimated that over 100,000 people in the United Kingdom die of tobacco‐related diseases each year. Fortunately, although tobacco is the cause of a horrifying toll of health damage, the use of this drug has declined dramatically and smokers are now a beleaguered and dwindling minority, roughly a third of the adult population.

Problem drinking includes a spectrum of drinking habits ranging from excessive alcohol intake to alcohol dependence. Numerous risk factors are thought to increase the susceptibility to such drinking patterns ‐ genetic, environmental and constitutional. Although alcohol misusers are frequently stereotyped, from interviewing numerous patients it is evident that there is no ‘typical alcoholic’. Alcohol consumption screening is widely used; however, it is important for healthcare professionals to understand the social and psychological aspects of problem drinking before advising abstinence. With this understanding, it is clear that governmental legislation with regards to alcohol is more likely to cut down the number of social binge drinkers than the number dependent on alcohol. The onus of reducing the number of individuals developing diseases as a result of chronic alcohol misuse, therefore, lies with the healthcare profession; early screening of alcohol consumption and early psychological intervention for susceptible individuals is key in this prevention.

Treating people with alcohol problems can be very expensive. Hospital‐based community focused treatment has been a traditional response. However, treatment for this client group has developed into a very cost effective treatment option. Alcohol is exacting a heavy financial burden upon the limited resources within health care provision (Royal College of Physicians, 2001). The heavy burden placed upon primary care is reflected in the data. General practitioners make the highest number of referrals to the Specialist Alcohol Service (72%). The link to policy is clear with the Welsh Assembly placing greater focus on a condition specific specialist response (Welsh Assembly, 2001). Comparison with patients presenting to a 24‐hour emergency psychiatric assessment service at the district general hospital help define the alcohol service user group. Data confirms that a community‐focused response by specialist community psychiatric nurses is a cost effective and appropriate alternative to hospital admission.