We are all familiar with community action projects concerning alcohol, education initiatives, and innovative treatments all of which promise much, attract enthusiasm and some funding, and yet when evaluated, produce little change; many programmes will prove to have no clear cut measures by which to assess their impact. Holder is very well aware of the difficulties experienced by communities worldwide in their endeavours to minimize ‘alcohol-involved’ problems. His thesis is that preventive strategies have been too narrow in their focus and have failed to recognize the social and economic context within which drinking occurs. ‘The purpose of this book is to challenge the current implicit models used in alcohol problem prevention and to offer a perspective of the community as a complex adaptive system. Appreciating, understanding and intervening in the community system is the frontier for alcohol problem prevention in the 21st Century’.
Wise and challenging words, although some might doubt whether this represents a truly novel perspective. John Donne observed in the seventeenth century that ‘No man is an island entire of itself’. The complexity of community dynamics have been acknowledged for a long time but we have lacked a ‘handle on it’. As is often the case, it has taken a technological innovation to advance progress in this area of scientific enquiry. In this instance, it is a computer modelling approach which enables planners to enter known variables associated with alcohol misuse into a complex analysis based on evidence from research, and make predictions about the likely impact of any changes which may be introduced. Holder recognizes the debt he owes to earlier work, particularly in the USA, Canada, New Zealand, and Finland, but points out that the concepts presented in this book are a distinct departure from these traditional approaches to community prevention. The novelty of the theoretical perspectives is questionable, but there is no doubt about the benefits which flow from the use of a mathematical analysis built into a computer model. As he says, complex natural systems are by nature ‘adaptive, transformational and unpredictable’. Complex systems of this kind can never be fully understood by dismantling them into their basic components, the whole is greater than the sum of its parts. The computer model which forms the foundation for much of the content of the book is SimCom (Simulated Community), which has been developed and tested in the Prevention Research Center, Berkeley, California, USA for the past 15 years. Its capacities have been demonstrated in a variety of communities large and small and its value and validity demonstrated particularly in the USA. Hopefully, the applicability of this or other similar models will be transferred to global testing.
Within the community network, certain interacting subsystems have been identified, which are natural groupings of factors that research has shown to be important in the understanding of alcohol use. These are: (1) consumption subsystem: alcohol use as part of routine community life; (2) retail sales subsystem: alcohol availability and promotion; (3) formal regulation and control subsystem: rules, administration, and enforcement; (4) social normals subsystem: community values and social influences that affect drinking; (5) legal sanctions subsystem: prohibitive uses of alcohol; (6) social, economic, and health consequences subsystem: community identification of, and organized responses to, alcohol problems.
A chapter is dedicated to each of these subsystems. Most communities will have some data which can be fed into the analysis, while other elements will be more speculative. In the end, it should be possible for the analyst to predict the outcome of changes to any or indeed all of these subsystems. The arguments advanced are compelling and should encourage those responsible for developing alcohol strategies to look at these components and either develop their own computer model or consult with those already in existence. There are several illustrations of the SimCom simulation in action. A lingering question which remains unanswered is how to establish the credibility of this approach, so that it gains acceptance as part of the routine planning process within a community. Public and political acceptance and support for any system of intervention is crucial and may be hard to achieve particularly when pet theories or Corporate interests are being challenged or threatened. Unfortunately, it may always be easier to pursue familiar pathways, however unrewarding. In Holder's conclusions, ‘Final Thoughts from a Heretic’, he states that the field of alcohol problem prevention should abandon high risk and target group approaches. ‘We will never purposefully prevent nor substantially reduce alcohol-involved problems by simply treating heavy dependent drinkers’. Likewise identification and targeting of groups within the community, typically young people, will, he believes, result in a similar failure.
This book calls for a much wider debate. We are provided with a conceptual model of the overall community systems which should assist those responsible for alcohol problem prevention to recognize the total system, the forces that affect prevention but cannot be influenced by prevention strategy, and those factors hitherto regarded as extraneous that must be influenced in order to reduce alcohol-involved problems. It is an important step forward in our understanding of these complex issues.
This is a fascinating book and should be read by all those with responsibility for planning alcohol services at a local or national level.