INTRODUCTION
I am interested in the effect employment in the food and beverage industry has upon the drinking patterns of employees. My interest stems from the fact that my family is in the liquor industry, and, with the exception of cook, I have held the majority of positions in a typical bar and full service restaurant. In my experience, off-duty alcohol and drug use among restaurant and bar employees is quite common and is almost an accepted part of employee behavior. Although I have not worked in the food and beverage industry for a number of years, I am still concerned about the potential risks of alcohol dependency and abuse faced by the employees within this industry who serve liquor on a daily basis.
It is generally known that some occupations are at higher risk of alcohol abuse than others. As I will discuss in detail later in this proposal, research has indicated that employees within the food and beverage industry are particularly at risk. It is my opinion that the state of New Mexico has a relatively unique opportunity to address addiction within a large segment of the food and beverage population with minimal difficulty, but first some background information must be discussed.
The New Mexico Alcohol Server Education Act (NMAC 15.11.31) of 1993 mandated that anyone who serves and sells alcohol, or manages a liquor licensed premise in New Mexico must become "Alcohol Server Certified". New Mexico is one of eleven states that require a statewide server certification course. The New Mexico certification course is, by law, a four and one-half hour seminar followed by an examination. An eighty percent or better on the examination is required to become certified.
The administration of the course falls under the jurisdiction of the New Mexico Department of Regulation and Licensing, Division of Alcohol and is primarily focused on serving and selling procedures, signs of intoxication among patrons, methods for checking age identification, and intoxicated person intervention techniques. The goal of the course is to prevent patrons from leaving the establishments intoxicated, thereby protecting liquor license liability and ultimately reducing the likelihood of patrons driving while intoxicated.
It is my opinion that the server certification course neglects to address issues of personal consumption. The population of liquor servers is at an elevated risk to excessive consumption for a number of reasons ranging from the mere exposure and availability of alcohol in the workplace to the culture often associated with establishments selling liquor. To determine if this is the case in Roswell, New Mexico, I propose the following question: To what extent do employees in food service positions in restaurants with liquor licenses exhibit more indicators of problematic alcohol consumption than employees in establishments without liquor licenses? I hope to demonstrate with my data that employees in food service who work in establishments with a liquor license will have higher rates of alcohol consumption measured by AUDIT score, frequency of consumption, total consumption, and other indicators of alcohol abuse than those in establishments without a liquor license. To answer this question, I will compare employees in qualifying full-service restaurants in Roswell, New Mexico with liquor licenses to employees in qualifying full-service restaurants without liquor licenses.
In addition to comparing these groups, I will outline why implementation of a personal consumption module informing liquor servers of the various etiologies of alcohol abuse and the available routes of recovery and addiction prevention is an essential and necessary addition to the certification course. To accomplish this goal, I will first give an overview of the models of alcohol consumption to illustrate the range of alcohol consumption beliefs and prevention strategies. I will then provide a literature review indicating research and evidence that liquor servers have higher rates of consumption and are therefore at high risk for alcohol abuse and dependence.
Models of alcohol consumption and prevention
In order to understand the complexity of alcohol treatment and prevention methods, it is useful to begin with a discussion of the models in which the treatment community views the use of alcohol. This overview is an important step because each model represents a different philosophy regarding the nature and the etiology of alcoholism. These philosophies range from describing the nature of alcoholism as having genetic origins to alcoholism as a learned behavior. Some of the models even suggest that alcoholism is caused by the society or dysfunctions in the family. Despite their many differences each model holds a certain truth and validity.
The treatment models discussed in the Handbook of Alcoholism Treatment Approaches, Effective Alternatives
(3rd Edition.) are summarized in the following section. The editors, Hester and Miller, are renowned experts in the field of alcohol research. The models they provide attempt to explain the development, evolution and prevention of alcohol problems. Recognizing the paradigmatic differences must be addressed before conducting any type of alcohol related research, because, due to the nature and type of intervention, specific credentials or personal belief systems are highly recommended to become an accepted interventionist within a specific model. Similarly, the manner in which an individual views alcoholism is primarily based upon the individual's learned experiences, social upbringing and belief system, and is therefore deeply rooted in personal perceptions and preconceived opinions. These individual beliefs of the etiology of alcoholism can clearly be identified within the terms of the various models.
Therefore, in order to understand the many differences and alternatives, I will discuss each model with attention to what are considered to be accepted and effective intervention strategies, and who are considered the most effective intervention agents.
Moral Model
The moral model of alcoholism can be regarded as the oldest treatment model in the United States. This view, developed in Victorian England in the mid 1800s, regards individuals who cannot drink in moderation as being weak-willed, morally deficient, and lacking character. Personal choice and individual character (or lack thereof) is the primary causal factor of the development of alcohol related problems. Once the individual develops alcohol problems, the individual becomes viewed as a willful violator of societal rules and norms. The moral model utilizes several courses of treating those with alcohol problems. The most common forms of treatments rely on clergy intervention or on moral persuasion and support from close friends and family. A more dramatic course of treatment, imprisonment, is also common due to the violation of rules and norms. In this case, incarceration serves to penalize the individual and "treatment" is in the form of learning through consequences. The moral model views alcoholism as a punishable crime because of individual responsibility. Many of those subscribing to this philosophy within the religious community view excessive use as a sin.
Intervention strategies within the moral model often include social sanctions as determined by legislative policy and the criminal justice system. A clear example of a moral model intervention strategy can be found in laws seeking to prosecute individuals arrested for driving while intoxicated, in which case, the primary agents of change would include legislators, law enforcement personnel, and the courts. In New Mexico, in addition to police officers of various agencies enforcing DWIs, the New Mexico Department of Public Safety, Special Investigations Division (NMDPS- SID) is specifically responsible for all investigations and enforcements of activities falling under the Liquor Control Act.
Spiritual Model
The spiritual model is very similar to the moral model, however a much greater emphasis is placed on spirituality. The basic premise of a spiritual model is the belief that alcoholism is a condition in which people are powerless to defeat on their own. This condition can only be resolved through spiritual growth and with the support of others.The spiritual model has its origins in the early 1930s. It came into being as the result of the repeal of Prohibition in 1933 and the founding of Alcoholics Anonymous (AA) in 1935. To this day, proponents of the spiritual model, including AA and some of the major religions, view alcoholism as a condition that arises from spiritual defects within the individual. Treatment strategies and interventions within the spiritual model are usually religious based, with the belief that alcoholism can be overcome through prayer and abstinence. Intervention specialists can include the clergy, and support groups such as Alcoholics Anonymous and other similar Twelve Step programs. The New Mexico legal system typically requires DWI offenders to attend a certain number of AA meetings as part of their sentencing.
Temperance Model
The temperance model came into being in the late 1800s and dominated the public view of alcoholism until the repeal of Prohibition in 1933. In this model, alcohol is viewed as such a hazardous substance, which no one can use it safely or in moderation. In addition, society has an obligation to protect its members from the "demonic" effects of alcohol. The cause of alcohol problems is alcohol itself, and, as such, it should be eradicated from society. The temperate view is very similar to the current popular view of drugs (and sex) in that moderation is impossible and abstinence is the only answer.Treatment strategies and interventions within this model are deceptively simple. At the micro level, an individual must be encouraged to abstain from usage. Those who are abstainers themselves set the best example and are considered to be effective treatment specialists within the model. A common phrase within the temperance model is, "Just say no". At the macro level, the strategy is to prohibit or limit the accessibility of alcohol. In this case, legislators are the most effective interventionists because they have the power to address issues concerning costs, availability, and the promotion of alcohol to the public.
Dispositional Disease Model
The dispositional disease model was the dominant treatment model in the United States through the latter part of the 20th century and today it is still one of the most common philosophies. It should be noted, however, the dispositional disease model is not as common in other countries. In this model, those who have a problem with the ability to drink in moderation have a disease that reacts to alcohol. This disease is known as alcoholism. A Swedish physician who was describing the consequences of excessive drinking first coined the term "alcoholism" in the mid-1800s. The term is still used today, perhaps encompassing a far broader description of individuals than was intended in its original meaning.The dispositional disease model is similar to the moral and temperance models in that the source of the problem is located within the individual. In this view, alcoholism is not caused by alcohol; rather, alcoholism can be found in the physical or psychological makeup of the individual. Similarly, the permanence of the disease implies a hopelessness and powerlessness similar to that found in the spiritual model. Alcoholics have a condition that differentiates them from other people. This condition prevents them from having the ability to drink in moderation.
Treatment strategies within this model require that the individual with alcohol problems identify and confront the disease of alcoholism. Once the problem is recognized, a conscious effort must be made to abstain for life because the disease is incurable. The most effective intervention strategies with the dispositional disease model involve ongoing peer support and the help of other recovering individuals.
Biological Model
The biological model, which emerged in the 1970s, is a more specific, medical version of the dispositional disease model. Biological models go one step further and emphasize genetic and physiological factors resulting in alcoholism. Genetic models have been given credence by studies determining evidence of higher levels of alcoholism among the offspring of alcoholics, even if not raised by their biological parents. This quest for the "alcoholic gene" drives alcohol related pharmacological research.The implied intervention within the biological model is risk identification by diagnosticians and the urging of caution about the use of alcohol in individuals at high risk. A gene associated with, and effected by, alcohol intake and tolerance is the assumed causal factor. The intervention specialists are physicians and the intervention strategy is generally medically oriented treatment with abstinence as the recommended goal.
Characterological Model
The characterological model considers abnormalities in the personality to be the cause of alcohol problems. Rooted initially in psychoanalysis, alcoholics were thought to be fixated at some stage in their personality development, usually the oral stage. In this case, the alcoholic is literally fixated on "sucking the bottle". Other psychoanalytic theories have considered alcoholism to be a manifestation of sex-role conflicts, latent homosexuality, or low self-esteem. Given the nature of the cause of alcoholism in the characterological model, the most appropriate treatment strategy would involve some form of psychoanalytic therapy aiming to increase social functioning and coping skills. Intervention specialists within this model are typically trained clinical professionals.
Conditioning Model
Conditioning models view excessive drinking as a pattern of learned behavior that has been reinforced. Drawing on the work of psychologist B.F. Skinner, conditioning models imply that if drinking leads to rewarding consequences, then drinking will likely continue. Treatment strategies within conditioning models are primarily a matter of counter-conditioning and relearning new ways to reduce tension or deal with the conflicts that have caused excessive drinking. Intervention specialists operating within the conditioning model are trained behavioral therapists skilled in classical conditioning or operant learning principles. General Systems Model
The general systems model focuses on the interactive relationship between the individual with alcohol problems and the larger social system to which the individual belongs. Most often, the larger social system is the family. In this view, a dysfunctional family (social system) is the primary causal factor in individual problematic consumption. Because the family system is seen as having an inherent drive to maintain the status quo, changing the individual with treatment without addressing the family dynamics has a low chance of succeeding. Consequently, the most effective intervention specialists are family therapists with a multi-systemic-orientation.Public Health Model
The public health model emphasizes the importance of three major types of causal factors in understanding and intervening with any disease, specifically concerning alcoholism, the agent (ethyl alcohol), the host (the individual), and the environment (external factors). By encompassing these three factors, the public health model attempts to incorporate key components from all of the previous philosophies into one all-inclusive treatment strategy. This model recognizes that treatment focusing only on one factor has a relatively low chance of succeeding; therefore, intervention strategies focus on addressing all three simultaneously. Appropriate intervention specialists include public health officials and epidemiologists working together to develop comprehensive public health strategies.Social Learning Model
The social learning models emerged in the 1960s. They go beyond the conditioning models by emphasizing the social context in which heavy drinking occurs. The individual and the environment are both considered. In this model, causal factors include deficits in coping skills, peer pressures and modeling of heavy drinking, positive expectancies about drinking, and psychological dependence. Heavy drinking can be seen by others as an ineffective strategy for altering psychological states or coping with problems.Treatment strategies within this model focus on changing the relationship an individual has to a surrounding detrimental environment. In these models, the appropriate intervention specialists include cognitive-behavior therapists and role models.
Sociocultural Model
The sociocultural models emphasize the roles of societal norms about drinking, the cost and availability of alcohol, and the nature of the drinking environment itself. These models overlap the temperance model in believing the cause of alcoholism lies with alcohol itself, not the individual. It has been found that per capita consumption of alcohol is strongly influenced by its cost and availability. The assumption is if alcohol were not readily available, consumption would decrease. As an example of a sociocultural intervention, the 1993 New Mexico Liquor Control Act moved to increase the liability of those who serve alcoholic beverages. As discussed previously, this act required servers to take an alcohol awareness course and learn to assume responsibility for serving intoxicated persons. In the view of the sociocultural models, the agents of intervention include legislators and makers of social policy. The implied interventions include legislation to restrict access and to increase the price of alcohol and require the training of servers of alcohol. I will discuss specific aspects of the training of severs later in this paper.
Educational Model
A central assumption in educational models is that alcohol abuse stems from a lack of knowledge about the harmful effects of alcohol and excessive drinking. The education model is widely popular within the judicial system and is becoming utilized in many public school programs. Mandatory educational programs such as lectures and films are required in many states for DWI offenders. Advertisements depicting the negative consequences of alcohol are common in the media. The purpose is to arm individuals with problematic drinking with adequate appreciation of the effects and consequences of excessive consumption. The belief is that education enables an individual to understand that alcohol abuse or alcoholism causes significant harm to themselves as well as to their families and society.Treatment strategies within the educational model encourage abstinence as being the healthy and logical choice. Appropriate role models and peer support are important, but knowledge is essential allowing the individual to become more empowered to evaluate the circumstances and available options. Therefore, within the educational model, the most significant interventions come from those skilled in educating others about the harmful effects of alcohol. The simple goal of the education model is to provide knowledge.
Integration of Models to Identify Relationship to Server
In summary, in Table A I have listed the models I have identified. The models serve to illustrate the range of philosophies on which to draw upon and can be considered as tools. | Table A: Summary of Models | ||
| Models | Belief | Interventions |
| Moral | Emphasize personal choice. Alcoholism is a moral deficit | Moral Persuasion, social legal sanctions |
| Temperance | Alcohol itself is the cause of alcohol problems | Supply side control, "Just say no" campaigns |
| Spiritual | Alcohol problems are the result of a spiritual deficit | Spiritual growth, prayer, AA |
| Dispositional Disease | Alcoholism is a progressive disease in which an individual loses control over ability to drink in moderation | Identification of risk, then abstinence |
| Biological | Alcohol problems result through heredity and specific genes | Identification of risk, then genetic counseling |
| Characterological | Alcohol problems are the result of abnormalities in the personality | Psychotherapy |
| Conditioning | Alcoholism is a learned habit developed because of the perceived rewards associated with drinking | Classical and operant conditioning |
| General Systems | Alcohol problems arise from interactions with dysfunctional social systems | Family therapy |
| Public Health | Alcohol problems arise from interactions agent (alcohol), host (individual), and environment | Multiple levels |
| Social Learning | Alcohol problems are learned through interactions in environment | Skill training and role models |
| Sociocultural | Systems of society shape individual's drinking patterns | Supply side control, role models |
| Education | Alcohol problems originate due to lack of knowledge | Education |
In light of this opinion, I will argue that liquor servers are an "at risk population", and by extension, because of this risk, the certification course needs to focus more attention on issues relating to prevention or moderation of individual server consumption rather than customer consumption.
Literature Review
The 1988 National Health Interview Survey, an ongoing, cross-sectional household interview, was the first national level survey to implement psychiatric definitions (DSM-III-R) of alcohol abuse and alcohol dependency. This survey contained a set of supplementary questions developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and these questions were asked of one randomly selected person aged 18 and older from each household in the sample. A total of 43,809 people were directly interviewed to assess alcohol consumption and dependence in certain occupations.
Alcohol consumption was derived by current drinking status and average daily consumption. Average daily consumption was measured in grams and was described as the mean daily consumption of alcohol among drinkers in each occupational category for the year preceding the interview. Current drinking status was determined by the percentage of respondents in each occupational category who reported a consumption of 12 or more drinks during the year before the interview. Alcohol abuse and dependence required self-reports of symptoms that met at least three of the nine DSM-III-R dependence criteria: (1) tolerance, (2) withdrawal, (3) drinking to relieve or avoid withdrawal symptoms; (4) drinking larger amounts than intended; (5) a great deal of time spent drinking; (6) activities given up for drinking; (7) continued drinking despite past problems; (8) neglected responsibilities or obligations; or (9) impaired control. The DSM-III dependence criteria also have a duration component. In the survey, a respondent was determined to satisfy the duration component of the criteria of two or more of the symptoms identified above have lasted over a year.
The analysis of the NHIS data by Grant et. al (1991) were the first estimates of DSM-III-R alcohol abuse and dependence to be reported at the national level. They determined that the one-year prevalence for total alcohol abuse and dependence in the 1988 NHIS sample was 8.63 percent of the total American population, representing 15,295,000 Americans, with 6.25 percent of the sample categorized as "alcohol dependent" and 2.38 percent categorized as "alcohol abusing." Stinson, Debakey, & Steffens (1992) analyzed the National Health Interview Survey and found a significant prevalence of alcohol abuse across occupations and occupational groups. Bartenders were found to be the occupational category at highest risk with 42.2 % of the bartender population exhibiting characteristics of alcohol abuse and dependency. Parker (2002) analyzed the same data set and found a high prevalence of dependence and severe dependence among specific occupations, particularly occupations in food service, farming, construction, and fishing. Parker's analysis also revealed that average daily consumption among food service workers tended to be higher than that of other occupations. Parker analyzed average daily consumption among specific types of food service occupation and found:
Bartenders had the highest average daily consumption levels (35.2 grams per day for men; 33.7 gram per day for women) than most other workers; waiters and waitresses had higher average daily consumption (17.9 grams per day for men; 11.0 grams for women) than most other occupations. (Parker, 2002)
Parker also examined the prevalence of alcohol dependence and severe alcohol dependence among found servers and found that of the bartenders, 37.6 percent could be classified as alcohol dependent and 15 percent could be classified as severely dependent. Waiters and waitresses also had a high prevalence of dependence (6.2 percent) and severely dependent (2 percent).In another study, Kjaerheim et al (1995) sampled 3,267 Norwegian waiters and cooks. A self-administered questionnaire was sent to all 7,542 retired and active waiters and cooks who had been a part of the Norwegian Hotel and Restaurant Workers Union for at least 1.5 years. The response rate was 64 percent although 265 additional respondents were eliminated due to the lack of a response on more than one key question, 1,270 were eliminated due to unemployment or retirement, and 27 were eliminated because they worked alone. The questionnaire addressed several issues including characteristics of the workplace, the work schedule, work-related social life, and the use of alcohol. Heavy drinking in this study was defined as consuming more than 40 grams of alcohol per day for men and more than 20 grams of alcohol per day for women. It should be noted that an average drink contains 12.8 grams.
The results of the study by Kjaerheim et al (1995) indicated that 6.0 percent of the men and 5.8 percent of the women could be classified as heavy drinkers, while 6.0 percent of the men and 4.4 percent of the women reported to be non-drinkers. Kjaerheim et al reported that social modeling factors and structural factors increased the probability of drinking by restaurant employees. Social modeling factors involved the frequency with which co-workers went out together after work, the frequency with which co-workers took after work drinks at the work place, and the perceived pressure to drink. Structural factors included the work-schedule, type of workplace, and the existence of a company alcohol policy. The social modeling factors, having coworkers who went out after work at least weekly, increased the odd ratio of drinking more than three times. Similarly, the structural factor of a liberal alcohol policy within the establishment allowing for drinks after the end of shifts increased the ratio two times. Their research found that the modeling factors and company alcohol policy were significantly associated with heavy drinking. Results indicated that background factors such as household type (living with adults or living with children) were the strongest predictors, but almost equally strong predictors included the variables "co-workers take an end of work drink" and "co-workers go out after work" (Kjaerheim, 1995, 1491).
The study concluded by recommending preventative factors focusing not only on the individual, but also on the aspects of the occupation that encourage and maintain heavy drinking. In addition, the study indicated that the social habits of coworkers and liberal alcohol policies should be a focal point for reducing drinking among employees. The study also recommends that the server intervention program, which primarily focuses on reducing patron drunk driving should also be expanded to include modules which address the consumption patterns of the employees themselves.
Larsen (1994) conducted another study on alcohol use and restaurant employees. Larsen reported data from two different surveys regarding alcohol use in the service industry. The goal of the two studies was to test the hypothesis that alcohol use is typically higher in the hotel and restaurant sector than in other sectors of the service industry. The first study used 84 students from three different colleges in the Stanvanger region in Norway. The respondents were recruited from campus. Thirty-seven of the respondents were from the Norwegian College of Hotel Management (NCHM), twenty-two were students from the Rogaland University and 25 were from the Stavanger Teacher Training College. These respondents were interviewed by trained professionals concerning their alcohol habits using the screening instrument AUDIT (Alcohol Use Disorders Identification Test). The results of this survey indicated that students at the Norwegian College of Hotel Management obtained significantly higher AUDIT than other students in the survey.
The second survey was given to 128 randomly selected service employees (105 responded) in the Rogaland, Norway area. The AUDIT was mailed to a number of gasoline stations, bank and insurance companies and hotel and restaurant employees in the area. The results of this study indicated that restaurant employees scored significantly higher on the AUDIT than other employees in the service industry. Both of Larsen's studies utilized one-way ANOVAS and t-tests for independent means to estimate differences in mean scores on the AUDIT between the groups in the study.
Larsen summarized his findings from the two studies into three main considerations for further research. First, the high availability of alcohol in restaurant settings may be an important factor as to the high rates of alcohol use. Second, perhaps restaurant employees had a high rate of drinking before the ever worked in the restaurant industry and therefore were attracted to the profession. Third, the working conditions of the restaurant industry, including unstable hours, work-related stress, and low level emotional support, could be promoting the high drinking levels. (Larsen, 1994, 739)
In a more recent study (2002) published in the American Journal of Drug & Alcohol Abuse, researchers Michael Nusbuamer and Denise Reiling investigated frequency of intoxication and overall alcohol consumption among licensed beverage servers in the state of Indiana. Their study sought to assess the contribution of environmental, occupational, and demographic factors that influence drinking behaviors of licensed servers. Their hypothesis was two-fold. First, in what they called the "learning hypothesis", they sought to determine the extent to which the environments of the bars represented "training grounds" that teach normal drinkers how to become heavy drinkers. Second, their "selection hypothesis" sought to determine the extent to which the bars represented environments that selectively recruit and tolerate a workforce already predisposed to heavy drinking. Their research, which included primary survey data and stepwise regression analysis, found support of the selection hypothesis. (Nusbaumer & Reiling, 2002). An important observation raised by the significant association between drinking on the job and the levels of heavy drinking identified in the study lend support to the importance of alcohol availability within the workplace as a key influence on drinking practices.
Employee Characteristics
Kjaerheim and Mykletun (1996) researched personality characteristics and the possible risk of heavy drinking among restaurant employees. This study reanalyzed the data obtained by Kjaerheim et al. in 1995. An abbreviated version of the Eysenck Personality Questionnaire was included in the survey sent to the Norwegian restaurant workers study preciously discussed. The questions included were those pertaining to neuroticism and extraversion. The results indicated that there were a large percentage of extraverts in the restaurant business. The level of extraversion is significant to note because as Eysenck and Eysenck (1985, as cited in Kjaerheim & Mykletun, 1996) state:Extraverts seek out demanding, novel situations and social contact in order to increase their level of arousal to a preferred level, while the opposite is stated for introverts…taking into account that alcohol is consumed both for its stimulant and its depressive effects, extraverts should be supposed to engage in higher consumption due to their tendency to seek out stimulation. (p. 627)
This indicates that working in an environment that provides easy access to alcohol may increase the risk of heavy drinking for employees with high extraversion scores.Katharine Henninger (2003) explored the lives of restaurant employees and their use of alcohol through qualitative interviews of eighteen restaurant employees. Issues addressed in the interviews included: Demographic information, the personal, family, and cultural backgrounds of the employees, their current alcohol use, and other aspects related to employment in the restaurant industry. The most salient result of this study was the discovery that one-third of the participants stated they drink every day and/or after every shift. Similarly, over one-half of the participants reported they drink over two drinks in a sitting. The restaurant employees reported several stressors relating to restaurant employment including difficult working hours, unpredictable income, and complaining customers. The recommendations Henninger proposed as the result of findings from the study included a recognized need for employee counseling programs, support groups, and also increasing accessibility to alcohol treatment programs. This study is somewhat limited due to the small number of restaurant employees interviewed.
Server Training Program Assessment
Toomey, Kilian, Gehan, Perry, Jones-Webb, and Wagenaar (1998) conducted a qualitative assessment of training programs for employees of establishments that serve or sell alcoholic beverages. Because not all states require or recommend server training, the researchers identified alcohol training programs across the United States by using the Internet, key informants, and research literature. They included programs that focused on bartenders, waitstaff, and retail package outlets. Three researchers then independently assessed 22 of the local and national programs they identified across ten categories. The categories used in the assessment were operationalized by identifying essential components of what they considered to be effective training modules. The categories of analysis were: Legal issues, physiological effects, policy development, social problems, preventing intoxication, preventing underage drinking, behavior change methods, realism, respectful of audience, and production quality. Each of the categories seek to address reducing problematic drinking in others and ways in which the server would be more effective in dealing with intoxicated patrons. Significant to my research is what is absent in the categorical analysis. The authors do not identify any program that seeks to address issues of personal consumption and abuse.Gehan, Toomey, Jones-Webb, Rothstien, and Wagenaar (1999) investigated significant beliefs, attitudes, and behaviors of alcohol establishment staff which may help to guide training program development. This study was conducted in a focus group format with managers, bartenders, wait staff, and security staff of on-sale, retail alcohol establishments (i.e., bars and restaurants). Their findings indicate that one of the reasons server training has been found to be ineffective in some cases is due to the fact that most training programs focus solely on the behavior of the alcohol server, largely ignoring the role played by the normative environment and the expectations communicated by the management's behaviors and practices.
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