Communities That Care in Australia: a sound investment in adolescent alcohol prevention

This article is based on the research paper: Australian Communities That Care (CTC) intervention: Benefit-cost analysis of a community-based youth alcohol prevention initiative. https://doi.org/10.1371/journal.pone.0314153

Why adolescent prevention matters, and what CTC contributes

Adolescent alcohol use has been a central public-health concern in many countries for decades. Starting early can have far-reaching consequences for young people’s health and social development, and it raises the risk of problem drinking in adulthood (Griswold et al., 2018; McCambridge et al., 2011). Practitioners in prevention and health promotion are therefore constantly looking for approaches that are effective and, at the same time, economically sound. Communities That Care, a model originally developed and tested in the United States, has proved a promising strategy for preventing health and social problems among young people. A study published in PLOS ONE by Abimanyi-Ochom and colleagues (2024) now presents the first detailed benefit-cost analysis of the CTC intervention in Australia, with a specific focus on preventing alcohol use among adolescents. Its findings matter to practitioners because they speak to both sides of the question: whether a community-based approach to prevention works, and whether it pays.

CTC is a structured, community-led process for reducing the risk factors and strengthening the protective factors that shape young people’s behaviour. It mobilises local communities by bringing key people from different sectors – schools, public authorities, health services, parents, youth organisations and others – together in a coalition (Fagan et al., 2018). That coalition works through a five-phase process.

The Australian CTC study examined the implementation of this model in four communities over fifteen years (2001–2015) and compared the results with 104 non-CTC communities. Its relevance is obvious: it provides evidence for the effectiveness of CTC under Australian conditions, and it quantifies the economic value. When public money is tight, showing that prevention not only averts harm but also saves money is a decisive argument for wider implementation and stable funding.

The core results: the figures

The benefit-cost analysis by Abimanyi-Ochom et al. (2024) makes a persuasive case for using CTC to prevent adolescent alcohol use. The central findings can be summarised as follows:

• A strong return: the study concludes that the Australian CTC intervention is economically very favourable. For every Australian dollar (AUD) invested in the programme, a benefit to society of AUD 2.60 was generated. That return underlines that CTC is a sound measure from an economic as well as a health perspective, and it sends a strong signal to decision-makers and funders that investment in community-based prevention pays off over time. The analysis included the costs of organising the community coalitions, programme costs, student surveys, rent, salaries, CTC training and other administrative expenses.
• Significant savings from fewer alcohol-related problems: the cost savings attributable to the reduction in alcohol use achieved by the CTC intervention amounted to AUD 123 per adolescent over the fifteen-year observation period, or AUD 8 per adolescent per year. These savings come from costs avoided across several areas of society. The calculation is conservative and refers primarily to the direct effects during the intervention period. Longer-term benefits beyond those fifteen years could raise the return considerably.
• Crime prevention as the main source of savings: a particularly notable finding is that the bulk of the monetary savings – 93 % – came from reductions in crime and violence. Adolescent alcohol prevention has far-reaching positive effects that extend beyond the health sector and contribute substantially to public safety and to relieving the justice system. In concrete terms, AUD 5.5 million in crime-related costs were avoided (Abimanyi-Ochom et al., 2024, Table 4), including the costs of police operations, court proceedings and imprisonment. The study shows that reducing adolescent alcohol use has a direct effect on crime rates.
• Modest intervention costs: the average cost of implementing CTC was AUD 48 per adolescent over the entire fifteen years, or just AUD 3 per adolescent per year. Costs that low, especially set against the savings achieved, make CTC an attractive model for local government. Interestingly, the costs in Australia were lower than in comparable CTC implementations in the United States: AUD 3 per adolescent per year in Australia against AUD 199 per adolescent per year in the US, converted from US dollars (Kuklinski et al., 2012). The authors attribute this to the fact that in Australia existing budgets and resources were more often redeployed for CTC work rather than new budgets being created, and that Australia made greater use of low-cost interventions to reduce young people’s access to alcohol, such as test purchases and warning letters to retailers (Abimanyi-Ochom et al., 2024).

These results show that the community-based CTC approach is effective in reducing adolescent alcohol use – the study by Toumbourou et al. (2019) on which the benefit-cost analysis is built found a 28.3 % decline in alcohol use in CTC communities against 12.2 % in control communities, a reduction 16.1 percentage points greater over fifteen years – and that it produces a considerable economic benefit for society.

Practical implications for practitioners in prevention and health promotion

The findings of the Australian CTC study (Abimanyi-Ochom et al., 2024) have wide-ranging practical implications for anyone working in prevention and health promotion. They provide a scientific basis for implementing similar approaches, and concrete arguments for how prevention work should be organised and funded.

• CTC is confirmed as an evidence-based and economically sound model: the study is strong evidence that CTC is not only effective but also economically sensible. Practitioners can use these results to make the case, to political decision-makers, local administrations and potential funders, for introducing or continuing CTC or similar community-based, data-driven approaches. A demonstrated return of 2.6 to 1 is a persuasive argument that goes beyond health alone.
• Addressing risk and protective factors at community level matters: CTC rests on the systematic measurement and targeting of local risk and protective factors, and the positive results underline the importance of that approach. Prevention efforts are most successful when they are tailored to the specific needs and circumstances of a community. The study encourages investment in local data collection – a youth survey that identifies substance use and violence as well as family and school protective factors – and in the selection of evidence-based programmes that address the factors identified.
• The potential for substantial savings to society: the fact that 93 % of the savings came from reduced crime is a decisive point. Preventing adolescent alcohol use is not a task for the health sector alone; it makes an important contribution to public safety and to relieving the police and the courts. Practitioners can use this finding to initiate cooperation across departments and to put the funding of prevention on a broader footing. Investment in prevention pays off for society in many ways at once.
• Sustainability through the reallocation of resources: the Australian study suggests that the lower costs compared with the United States were partly due to existing resources and budgets being redeployed and used more efficiently (Abimanyi-Ochom et al., 2024). That is an important message for communities with limited means. Practitioners can explore how existing structures and funds – youth services, schools, health services – might be pooled and used more purposefully within a CTC strategy. That raises not only efficiency but also the durability of prevention work. It is not always a matter of “more money”; often it is a matter of using existing money more wisely.
• The long-term perspective of prevention: although the study already spans an impressive fifteen years, it suggests that the long-term benefits of CTC could be greater still if effects on educational attainment, employment and quality of life across the whole life course were taken into account (Abimanyi-Ochom et al., 2024, Discussion). Practitioners should therefore stress the importance of prevention strategies and funding that are designed for the long term. The positive effects of CTC – the build-up of prevention capacity in communities and the fall in training costs in subsequent CTC cycles, as observed in one of the Australian communities – support this argument.
• Training and capacity building matter: a significant share of the implementation costs went on staff and training. That training focused on knowledge of prevention research and on the ability to collect and interpret local data in order to select evidence-based programmes (Abimanyi-Ochom et al., 2024). It underlines the need to invest in qualifying local actors so that they can steer and implement prevention processes competently.

The study makes clear that a systematic, data-driven and cooperative approach such as CTC can have substantial positive effects. For practitioners across Europe who work with Communities That Care or comparable approaches, the Australian results offer valuable support and fresh impetus – and, as the evidence page shows, they sit alongside the US trial as the second controlled test of the model outside its country of origin.

CTC: an investment that pays

The benefit-cost analysis of the Australian CTC intervention by Abimanyi-Ochom and colleagues (2024) is a strong plea for community-based approaches to reducing adolescent alcohol use. The study shows not only that CTC works but also that it is an economically sensible strategy, returning more than two and a half times every dollar invested to society. The significant savings, particularly in crime prevention, underline the far-reaching positive effects of such interventions, which extend well beyond the health sector.

For practitioners in prevention and health promotion, these results provide a solid scientific basis for arguing for the implementation and stable funding of CTC and similar evidence-based, community-led approaches. The relatively low intervention costs, the possibility of redeploying existing resources and the potential for long-term positive effects make CTC an attractive model for communities that want to promote the wellbeing of their young people while reducing costs to society. The research from Australia is an encouragement to keep investing in community-based, cooperative and data-driven prevention strategies – an investment in a healthier and safer future for young people and for society as a whole.