and Janes 1987; Applebaum 1984; Mars 1991; Sonnenstuhl and Trice 1987). Others have noted factors that promote heavy drinking in executive and white-collar occupations as well (business lunches, tax deductions for entertaining, office parties), although less attention has been paid to how such factors might contribute to heavy drinking among white-collar employees (Fillmore and Caetano 1982; Roman 1982). The social control perspective attributes heavy drinking to a lack of employee supervision or to low job visibility. Jobs that have high geographic mobility or are not interdependent with others within the organization are also viewed as less likely to result in curbs on excessive drinking (see Ames and Janes 1987; Trice and Beyer 1984). In some studies, occupations with these characteristics are seen as capable of promoting excessive drinking, while in other studies, the assumption is that heavy drinkers are drawn to jobs that may protect them from detection. The two remaining perspectives both suggest the existence of environmental factors in the workplace that may directly encourage alcohol consumption. The alienation perspective postulates a direct causal link between unfulfilling work and drinking, by which the drinker seeks to relieve the sense of powerlessness resulting from the work. Research by Seeman et al. (1988) sought a possible connection between alcohol dependence and a general (subjective) alienation, powerlessness, or social isolation. Of these, only powerlessness seemed to be related to drinking behavior (Trice and Sonnenstuhl 1988). Several other studies have variously defined potentially alienating characteristics of occupations (repetitiveness, boredom, low satisfaction, low complexity) and have obtained mixed results regarding the association of these factors with drinking behavior (see Newcomb 1988). The work stress perspective also hypothesizes a direct link between certain job stressors and excessive drinking, which is engaged in to relieve induced stress. As Trice and Sonnenstuhl (1988) point out, the stress and alienation perspectives become operationally similar when one lists job characteristics that may give rise to a drinking response (e.g., boredom, low complexity, powerlessness). The stress perspective is more eclectic, however, in that it includes a wider variety of stresses, not necessarily confined to those produced by alienation and powerlessness. While there seems to be some evidence of a link between job stress and cardiovascular disease (see Karasek et al. 1988), findings about the relationship between job stress and drinking are less supportive of the stress perspective (see Harris and Fennell 1988). Recent research on the workplace and drinking has focused on blue-collar workers and their relationships to management and unions. Janes and Ames (1989) conducted a qualitative study of 30 men who had worked in a durable goods manufacturing plant that closed in 1982. Half the sample were heavy drinkers, and the others drank moderately. In comparing the two groups, the authors found that drinking was facilitated by the existence of a heavy-drinking subculture within the plant. In this subculture, heavy drinking facilitated social relationships while reducing boredom and dissatisfaction. This subculture seemed most important for those with limited attachment or involvement with people or activities outside the workplace. In a followup study at a different plant, Ames et al. (in press) describe how uncertainty and ambiguity regarding alcohol policies as well as union-management struggles over the authority to deal with alcohol-related problems can lead to an environment that enables, if not fosters, drinking in the workplace. There has been very little published research on the effectiveness of workplace prevention programs. Drug and alcohol testing in the workplace have been widely discussed, but little is known about their efficacy. In addition, existing case studies can be misleading, especially within the context of a general trend toward reduced drug use. The basic research briefly described here suggests the possibility that primary prevention in the workplace may very well need to address key structural elements of organizations and the nature of work itself. Community Prevention Research Community prevention projects typically adopt a multicomponent package of intervention strategies. This approach is partly based on the perception that no one prevention tactic is likely to make a large impact in itself and that synergistic effects might be achieved by a package of mutually supporting strategies. It is also based on the fact that real-world communities tend to adopt package approaches in which several interventions are bundled together. In theory, community interventions could focus exclusively on either individually or environmentally focused strategies. However, these projects usually contain a mix of both approaches. Harrington et al. (1989; see also Stout in press) describe a comprehensive community prevention project that they describe as a "gatekeeper training model." Gatekeepers are those whose unique role in the community can have an impact on problem drinking but who unwittingly behave as "enablers" of problem drinking. The project focused on alcohol servers in licensed establishments and law enforcement officers. Project objectives included mobilizing community support, gaining the cooperation of community leaders and the targeted gatekeepers, and training gatekeepers to understand, accept, and practice "disenabling" responses to bar patrons, drivers, and others. Although the researchers have not yet published a full impact evaluation, they have completed a highly successful effort to recruit alcoholic beverage servers and law enforcement personnel. Community support is manifested in commitment of funds to continue the interventions. An evaluation using two comparison communities and looking at hospital and police records for impact on alcoholrelated mortality and morbidity is expected (Harrington et al. 1989). Casswell and Stewart (1989) report on a community prevention program in New Zealand that used the mass media and community organizing in an effort to alter alcohol control policies and to develop support for such changes among the public. From 1982 to 1985, six cities were involved: two served as comparison sites, two had mass media interventions alone, and two others had mass media accompanied by community organizing. While the mass media campaigns were fairly traditional in aim, they were linked in the two full-program communities with events and controversies in the public forum. Targeted policy issues focused on advertising and alcohol availability (pricing was considered beyond the scope of the local community). A paid community organizer and a community coalition were active on issues dealing with licensing outlets, enforcing serving laws, and promoting nonalcoholic alternative beverages. Against a historical trend nationwide favoring liberalization of alcohol control policies, the cities with full implementation produced significantly higher support for policies restricting alcohol advertising and availability and increasing price (Casswell et al. 1989). The Tri-Community Project was conducted in one intervention and two control communities in Southern Ontario (Giesbrecht and Douglas 1990; Giesbrecht et al. 1990). The goal of the intervention was to reduce the amount of alcohol consumption among heavy consumers through education and counseling programs that taught clients to monitor and reduce their drinking. Clients were recruited through medical and legal referrals. Media campaigns, server intervention programs, and training workshops were directed at creating change in the surrounding community and supplemented the community intervention. During the program, a substantial decline in clients' drinking was observed; however, relatively few clients were attracted to the program. Pre- and postsurveys taken among community residents showed a slight shift toward more moderate drinking. However, aggregate statistics on alcohol sales, alcohol-related hospital admissions, and alcohol-related offenses recorded by the police did not show decreases in the intervention community. There have been few studies of communitywide prevention projects to date; however, several NIAAA-funded studies (some with joint funding from OSAP) are currently under way in Massachusetts, Minnesota, California, and South Carolina. As the results and program descriptions become available, it should be possible to draw some tentative conclusions about prevention effectiveness at this level. Since community prevention studies are unique in their focus on large-scale implementation, research questions should focus on implementation as well as outcome and should include such concerns as whether community coalitions are a necessary prerequisite for the programs, as is widely believed, whether resources for confronting alcohol-related problems can be mobilized from within the community itself, where unexpected sources of support or opposition will be found, and how such programs, if effective, can be maintained and institutionalized. Summary Factors influencing the development of youthful substance abuse range from individual characteristics to societal-level regulatory factors, such as enforcement of the minimum drinking age. Correspondingly, approaches to the prevention of alcohol-related problems among young people are quite broad. Curricular approaches range from those focused exclusively within schools to those that also attempt to involve families. The effects of school-based programs have been mixed, often showing small, short-term effects only. The more successful school-based approaches appear to be those that involve social influence factors, such as resistance training. Also promising are approaches that supplement classroom intervention with parent education and media campaigns. However, the impact of parent participation in programs on children's alcohol and other drug use behavior is not firmly established. Efforts aimed at transmitting a prevention message to the adult population are based, for the most part, on media campaigns. Some successes have been achieved when these campaigns are complemented by supplementary interventions such as mail contacts, dissemination of BAC charts, or community organization campaigns. A new development in transmitting prevention messages to the general public has been the placement of a warning label on alcoholic beverage containers. Early evidence indicates that a substantial proportion of the population has not noticed the existence of these labels. Studies have suggested several factors that might improve the noticeability of the label. Although the literature has recognized a need for intervention strategies tailored specifically for women, few such programs have been implemented or evaluated. One area of growing interest has been prevention efforts to reduce drinking during pregnancy. Recent studies of prevention in the workplace have concentrated on identifying work-related factors that contribute to heavy drinking rather than on evaluating work-based prevention programs. While epidemiological research has made some progress toward clarifying patterns of alcohol use and alcohol problems among minority populations, much less progress has been made in prevention research that would identify and evaluate interventions developed specifically for such groups. Modest successes have been achieved with school-based prevention programs targeted toward Native American youth. Several studies have suggested that the consumption of alcoholic beverages is related to the physical availability of those beverages. Similarly, studies of alcohol prices have generally found that the levels of consumption or of alcohol-related problems co-vary with higher prices for alcoholic beverages. Less is known about the differential effects of price and availability on heavy versus light and moderate drinkers. Studies of the minimum drinking age indicate that levels of alcohol consumption and traffic accidents among people below the age of 21 have declined in response to a higher minimum age. Initiatives to deter drinking and driving have swung away from emphasizing the severity of penalties and toward making penalties swifter and more certain. Initiatives involving random breath testing, which has demonstrated some promise, illustrate the principle of certainty of penalties. Administrative license revocation, which enjoys a growing popularity, works on the principle of making penalties swifter. Dram shop liability laws and the encouragement of responsible beverage service are also aimed at deterring drinking and driving. Recent studies have established some deterrent potential of the former, although State-by-State variations in the degree of liability make this a difficult area to study. Alcohol use appears to be involved in a high proportion of crimes. However, methodological obstacles have impeded progress toward understanding whether or how alcohol use contributes to either crime or victimization. Similarly, research on adolescents has not distinguished whether the relationship between alcohol and other drug use and delinquency is correlational or causal. Recent studies of prevention in the workplace have concentrated on identifying work-related factors that contribute to heavy drinking rather than on evaluating work-based prevention programs. A leading development in this area appears to be the refinement and clarification of theoretical perspectives on the subject. 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