20 years of success: Effects of the Responsible Beverage Service program in Stockholm

In the mid-1990s, Stockholm was struggling with high levels of alcohol-related problems in nightlife settings. As a response, a pioneering program was co-created by STAD (Stockholm Prevents Alcohol and Drug Problems) and relevant stakeholders. As a result, the Responsible Beverage Service (RBS) program was launched in 1996 aiming to prevent alcohol overservice to obviously intoxicated patrons in licensed premises.

This community-based intervention was built on three essential pillars :

1. mobilizing and collaborating with key stakeholders, including the municipal licensing board, police, and nightlife venue owners;
2. providing targeted training for staff at licensed establishments; and
3. enhancing enforcement efforts.

Early successes

Following the baseline assessment in 1996, follow-up assessments in 1999 and 2001 revealed impressive results. Before the RBS program’s implementation, only 5 per cent of serving staff in Stockholm refused to serve alcohol to obviously intoxicated patrons. However, by 1999, this rate had risen to 47 per cent, and by 2001, it reached 70 per cent, marking a significant shift in serving practices from liberal to more restrictive. The program’s impact extended beyond serving practices; it also contributed to a 29 per cent reduction in police-reported violence over the same period. A cost-effectiveness analysis further highlighted the program’s value, showing a cost-saving ratio of 1:39—

indicating that for every euro invested in the program, 39 euros were saved in reduced health and policing expenses.

Evidence of sustained success at the 20-year follow-up

Two decades later, in 2016, a third follow-up study was conducted to assess whether the positive outcomes of the RBS program had been sustained. The study found that the refusal rate for serving alcohol to intoxicated patrons remained high at 77 per cent, demonstrating the program’s long-term effectiveness. This consistency is particularly noteworthy given the challenges associated with maintaining the success of such programs over time.

A key factor in the program’s sustained success has been its high degree of institutionalization. Under STAD’s coordination, key community stakeholders have remained actively involved, and ongoing training for serving staff has been maintained. Further, as a proxy for enforcement, the yearly number of inspections by the licensing board in Stockholm saw an increase from approximately 1600 in 1997 to more than 4000 in 2016.

Lessons for the future

The enduring success of STAD’s RBS program provide valuable lessons for other cities and countries facing alcohol-related problems in nightlife settings. The program’s success led to its nationwide dissemination in Sweden and its adaptation to other contexts, such as large sporting events. Research in these new settings has supported the positive outcomes observed in Stockholm. Additionally, in an EU-funded project, the RBS program was extended to six other European countries, including Netherlands, UK, Germany, Slovenia, Czech Republic, and Spain. Results from Spain demonstrated that the program was successful in reducing alcohol sales to minors in supermarkets.

The long-term success of the program in Stockholm underscores the enduring impact that community-based interventions can have on reducing alcohol-related harm. By maintaining high standards of alcohol service and fostering collaboration among stakeholders, the program not only improved public safety but also served as a model for initiatives in other countries. These results emphasize the importance of institutionalizing such programs, ensuring they continue to benefit society by reducing violence and promoting responsible alcohol consumption. The 20-year follow-up of the RBS program is a powerful reminder that with commitment from all key stakeholders, collaboration, and training, meaningful change is possible.

This article is written by:

Tobias Elgán, Associate professor at Karolinska Institutet and researcher at STAD

Sven Andréasson, Professor at Karolinska Institutet

Johanna Gripenberg, Associate professor at Karolinska Institutet and director of STAD

on the request by PopNAD.

Related publications:

• Elgán, T.H., Andréasson, S., & Gripenberg, J. Long-term effects of an alcohol prevention program at licensed premises: a Swedish 20-year follow-up study. Frontiers in Public Health. 2024; 12:1423708.
• Elgán. T.H., Durbeej, N., Holder, H.D., & Gripenberg, J. Effects of a multi-component alcohol prevention intervention at sporting events: a quasi-experimental control group study. Addiction, 2021; 116(10):2663-2672.
• Duch, M., Gervilla, E. Juan, M., Guimarães, C., Kefauver, M, Elgán, T.H., Gripenberg, J., & Quigg, Z. Effectiveness of a community-based intervention to increase supermarket vendors’ compliance with age restrictions for alcohol sales in Spain: a pilot study. International Journal of Environmental Research and Public Health, 2020; 17(16):5991.
• Möhle, M., Nijkamp, L., de Greeff, J., & Mulder, J. STAD in Europe – A manual for communities preventing alcohol related harm. STAD in Europe (2019). http://stadineurope.eu/resources/sie-manual/
• Brännström, L., Trolldal, B., & Menke, M. Spatial spillover effects of a community action programme targeting on-licensed premises on violent assaults: evidence from a natural experiment. Journal of Epidemiology and Community Health, 2016; 70(3):226-230.
• Månsdotter, A.M., Rydberg, M.K., Wallin, E., Lindholm, L.A., and Andréasson, S. A cost-effectiveness analysis of alcohol prevention targeting licensed premises.European Journal of Public Health, 2007; 17(6):618-623.
• Wallin, E., Gripenberg, J., and Andréasson, S. Overserving at licensed premises in Stockholm: Effects of a community action program.Journal of Studies on Alcohol, 2005; 66(6):806-814.
• Wallin, E., Lindewald, B., and Andréasson, S. Institutionalization of a community action program targeting licensed premises in Stockholm, Sweden.Evaluation Review, 2004; 28(5):396-419.
• Wallin, E., Norström, T., and Andréasson, S. Alcohol prevention targeting licensed premises: A study of effects on violence.Journal of Studies on Alcohol, 2003; 64(2):270-277.