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Alcohol – Excessive Consumption: Responsible Beverage Service Training


What the CPSTF Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review of 11 studies (search period 1987-2009). The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing excessive alcohol consumption. This finding replaces the 2001 Task Force recommendation for Intervention Training Programs for Servers of Alcoholic Beverages to Reduce Alcohol-Impaired Driving [PDF - 257 kB].


The context in which RBS training takes place likely plays an important role in the effectiveness of the intervention. Training programs may:

  • Vary by the type of participation (e.g., state mandated, state-based incentive, voluntary research program)
  • Be targeted at establishment owners, managers, or servers
  • Be offered to groups, or delivered one-on-one
  • Be delivered by professional trainers, managers, or other staff
  • Vary in intensity and content (i.e. program can be 45 minute videotape presentations or 18 hour skill- building sessions)
  • Be offered at on-site or off-site locations

Summary of Results

Eleven studies published between 1987 and 2009 qualified for the review.

Results show that effects were favorable for the following outcomes:

  • Service policies: RBS training for owners and managers led to positive changes in establishment policies, such as requiring identification checks of underage-looking customers, eliminating drink promotions, providing safe drinking information for customers, denying service to obviously intoxicated customers, conducting regular meetings with the staff, promotions of food and non alcoholic beverages, and arrangement of alternative transportation (4 studies).
  • Server practices: RBS training for servers was associated with positive and consistent evidence of modest changes in observed and self-reported server practices, meaning the frequency of appropriate server practices increased (7 studies).
    • Overall server practices: server training was associated with a moderate increase in appropriate server practices , such as offering food and water, delaying service to visibly intoxicated patrons, commenting on quantity and speed of alcohol consumption, and explaining house policies to customers (4 studies).
    • ID checks for underage-looking patrons: non-significant increases of 5 and 10 percentage points (2 studies)
    • Refusal to serve obviously intoxicated patrons (or trained actors who appeared intoxicated): median increase of 5 percentage points (interquartile interval [IQI]: 3 to 14 percentage points; (4 studies)

    Even after RBS training, however, the frequency of ID checks and service refusal remained low.

  • Alcohol consumption:
    • RBS training generally resulted in a net decrease in the number of alcoholic drinks consumed by the patrons (2 studies, 5 study arms).
    • Overall, a net decrease in mean blood alcohol concentration (BAC) levels was observed among patrons leaving establishments where they were served by trained servers (3 studies, 6 study arms).
  • Percentage of intoxicated patrons leaving an establishment: there was a median decrease of 26.7% (IQI: -58.2% to -9.5%; 5 studies) in the percentage of intoxicated patrons leaving the establishment after being helped by trained servers.
    • However, the effects of RBS training on alcohol consumption and intoxication were small or in the unfavorable direction in establishments where there was a perceived lax regulatory climate, as measured in a survey of bar owners and community members.
  • Alcohol-related harms: three years after a state-mandated RBS training program was introduced in Oregon, fatal single vehicle nighttime crashes decreased by an estimated 23% (1 study).

Summary of Economic Evidence

An economic review of this intervention was not conducted because the Task Force did not have enough information to determine if the intervention works.


Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

The effectiveness of responsible beverage service (RBS) training at the community level depends on the context in which training takes place; factors such as training intensity, delivery method (e.g., videotapes, lectures, role- playing), type of participation (i.e., state mandated, voluntary incentive, or research program), type of establishment (onsite or off-site) play an important role.

The majority of the studies included in this review came from academic research studies that focused on individual establishments and were implemented under favorable conditions (e.g., intensive training programs, short follow-up times etc.). Further research is needed to address the following questions related to the effectiveness of RBS training programs:

  • How do mandatory versus voluntary server training programs differ with respect to the following?
    • Participation level in server training programs
    • Management support to achieve program goals
    • Potential harms that can result from state offers to limit liability or sanctions in exchange for participation in training programs
    • Overall effectiveness of training programs in decreasing alcohol consumption
  • What effective training elements should be included in all server training programs?
  • How do different training delivery methods (e.g., videotapes, lectures, role- playing) affect the effectiveness of intervention?
  • What are the long-term effects of server training? Is one training session sufficient or 'booster sessions' are desired to maintain long-term intervention effectiveness?
  • How does server training affect establishment revenues, alcohol sales, and server tips?

Study Characteristics

Although included studies generally found positive results, two major limitations make it difficult to assess the potential public health impact of RBS training programs:

  1. Most of the evaluated studies were academic research trials conducted in selected establishments, with high-quality, intensive training programs. This raises questions about whether programs implemented under more natural conditions would produce similar results.
  2. The studies reported results for individual establishments, making it difficult to estimate the community-wide impact of the RBS training programs.