Universal school-based alcohol prevention programs

Evidence Rating  
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Decision Makers
Date last updated

Universal school-based alcohol prevention programs provide all students with the information and skills needed to prevent underage alcohol use, without screening for risk level. Such programs can be delivered as a specific curriculum that is part of school lessons or as a component of classroom behavior management. Programs can focus on raising awareness of the potential dangers of alcohol use, development of norm setting and peer resistance skills, or a combination of these approaches1.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Reduced underage drinking

What does the research say about effectiveness?

There is some evidence that universal school-based alcohol prevention programs reduce alcohol use among adolescents1, 2, 3, 4; such programs appear more effective for younger adolescents than older adolescents2. Additional evidence is needed to confirm effects and determine the characteristics of the most effective programs1, 2.

Individually-delivered brief interventions that last fewer than 5 hours have been shown to reduce alcohol use among adolescents4, 5. Classroom-based programs that target alcohol use and other risk behaviors such as tobacco use, illicit drug use, sexual risk, and antisocial behavior may also reduce adolescent alcohol use1, 6, 7; such programs may be more effective than programs that focus on alcohol alone1. Web- or computer-based universal programs can be effective in reducing adolescents’ alcohol use when they focus on alcohol problems alone8, but may not be effective when they target multiple risk behaviors9. A web-based program providing normative feedback about alcohol use can reduce binge drinking and intensity of drinking in the short term among high school athletes who are heavy drinkers10. Programs that focus on developing peer resistance and other skills (i.e., psychosocial programs) appear more likely to have positive effects than alcohol-focused programs alone1.

Universal school-based alcohol prevention programs that combine student and parent interventions may reduce students’ alcohol use11. Researchers suggest that program content consider adolescents’ psychological and cognitive developmental stage for different age groups2

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

There are also many universal school-based alcohol prevention programs, such as LifeSkills Training program12, the Unplugged program13, SPORT Prevention Plus Wellness program14, Project ALERT15, and the PAX Good Behavior Game16. The Washington State Health Care Authority maintains the Athena Forum, a resource center for substance use disorder prevention, that provides a list of evidence-based alcohol prevention programs and strategies for students17.

Implementation Resources

LST - Botvin LifeSkills Training (LST). LST overview.

Unplugged - European Drug Addiction Prevention trial (EU-Dap). Unplugged: Curriculum and workbook.

PAX GBG - Paxis Institute. PAX Good Behavior Game (PAX GBG).

NIDA-Preventing drug use - Robertson EB, David SL, Rao SA. Preventing drug use among children and adolescents. Bethesda: National Institutes of Health (NIH), U.S. Department of Health and Human Services (U.S. DHHS); 2003.

WA ATHENA-Alcohol - Washington State Health Care Authority, ATHENA Forum. Excellence in prevention strategy list: Alcohol.


* Journal subscription may be required for access.

1 Cochrane-Foxcroft 2011 - Foxcroft DR, Tsertsvadze A. Universal school-based prevention programs for alcohol misuse in young people. Cochrane Database of Systematic Reviews. 2011;(5):CD009113.

2 Onrust 2016 - Onrust SA, Otten R, Lammers J, Smit F. School-based programmes to reduce and prevent substance use in different age groups: What works for whom? Systematic review and meta-regression analysis. Clinical Psychology Review. 2016;44:45-59.

3 Strom 2014 - Strom KK, Adolfsen F, Fossum S, Kaiser S, Martinussen M. Effectiveness of school-based preventive interventions on adolescent alcohol use: A meta-analysis of randomized controlled trials. Substance Abuse: Treatment, Prevention, and Policy. 2014;9:48.

4 Hennessy 2015 - Hennessy EA, Tanner-Smith EE. Effectiveness of brief school-based interventions for adolescents: A meta-analysis of alcohol use prevention programs. Prevention Science. 2015;16(3):463-474.

5 Mogro-Wilson 2017 - Mogro-Wilson C, Allen E, Cavallucci C. A brief high school prevention program to decrease alcohol usage and change social norms. Social Work Research. 2017;41(1):53-62.

6 Cochrane-MacArthur 2018 - MacArthur G, Caldwell DM, Redmore J, et al. Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people. Cochrane Database of Systematic Reviews. 2018;10(10):CD009927.

7 Hale 2014a - Hale DR, Fitzgerald-Yau N, Viner RM. A systematic review of effective interventions for reducing multiple health risk behaviors in adolescence. American Journal of Public Health. 2014;104(5):19-41.

8 Champion 2013 - Champion KE, Newton NC, Barrett EL, Teesson M. A systematic review of school-based alcohol and other drug prevention programs facilitated by computers or the internet. Drug and Alcohol Review. 2013;32(2):115-23.

9 Champion 2019 - Champion KE, Parmenter B, McGowan C, et al. Effectiveness of school-based eHealth interventions to prevent multiple lifestyle risk behaviours among adolescents: A systematic review and meta-analysis. The Lancet Digital Health. 2009;1(5):e206-e221.

10 Doumas 2021 - Doumas DM, Mastroleo NR. Reducing alcohol use among high school athletes: A randomized controlled trial of a brief, web-based personalized normative feedback intervention. Sport Psychologist. 2021;35(1):55-63.

11 Newton 2017 - Newton NC, Champion KE, Slade T, et al. A systematic review of combined student- and parent-based programs to prevent alcohol and other drug use among adolescents. Drug and Alcohol Review. 2017;36(3):337-351.

12 LST - Botvin LifeSkills Training (LST). LST overview.

13 Unplugged - European Drug Addiction Prevention trial (EU-Dap). Unplugged: Curriculum and workbook.

14 SPORT PPW - Prevention Plus Wellness. SPORT Prevention Plus Wellness (SPORT PPW).

15 Project ALERT - Project ALERT. Substance abuse prevention for grades 7 & 8.

16 PAX GBG - Paxis Institute. PAX Good Behavior Game (PAX GBG).

17 WA ATHENA-Alcohol - Washington State Health Care Authority, ATHENA Forum. Excellence in prevention strategy list: Alcohol.