Interactive Educational programs demonstrated to reduce alcohol use and abuse have all been highly interactive. That is, they did not rely on didactically presented messages, but used teaching techniques that encouraged participants to be actively engaged in the process of forming social norms. Meta-analyses (Gottfredson and Wilson, 2003; Tobler et al., 2000) revealed that interactive programs that delivered more hours of programming were more effective than interactive programs that delivered fewer hours. This trend was not evident among noninteractive programs.

Implemented with Fidelity There is strong evidence that the quality of program delivery is highly related to successful outcome (Dusenbury et al., 2003). Training for providers is crucial. It is also essential for providers to have sufficient time to become fluent in delivering the program. On their initial attempt, program providers typically focus on understanding the mechanics of a program. It is only after they have mastered the mechanics of program delivery that they are able to focus on underlying psychological and sociological constructs that define quality implementation.

Access Limitations Family and community interventions that have been shown to be effective included a focus on limiting youth access to alcohol (see also Chapter 9). Such approaches need to include not only the adoption of laws and ordinances, but also their enforcement and the development of a strong social norm that supports the intent of such legislation. For example, Project Northland (Komro et al., 1994), Day One Community Partnership (Rohrbach et al., 1997), Communities Mobilizing for Change (CSAP model program), and Community Trials Intervention to Reduce High-Risk Drinking (a model program of the Substance Abuse and Mental Health Services Administration [SAMHSA]) all included efforts to reduce underage access to alcohol, and in each case these efforts were found to have significant effects on reducing drinking (see also Chapter 11).

Institutionalized Institutionalization is crucial for prevention to realize its full potential. It can ensure that new social norms in a community are perpetuated by exposing new community members (e.g., every fifth grade class in a school) to the norms, that well-trained professionals facilitate the intervention, and that programs are regularly evaluated and adjusted to meet the changing needs of the community. This kind of consistency and rigor has the potential to ensure that programs shown to reduce underage drinking can have long-lasting effects. However, schools and communities are often funded to implement these programs through temporary mechanisms and often at a level that does not allow sustained implementation.