Definitions of community-level approaches to address substance-related harms and lessons learned: A systematic overview of reviews.

Community action focused on sociocultural and environmental influences to prevent alcohol and other drug (AOD) use and related harms is a global priority. Despite this recognition, understanding of effective community-level approaches is limited. This umbrella review aimed to develop a unifying term to define and describe community-level AOD approaches and summarize lessons learned from implementation. We searched Embase/MEDLINE, PsycINFO, the Cochrane Database of Systematic Reviews, two online registries and reference lists of included studies. Eligible reviews focused on community-level approaches addressing AOD use or harms. Two authors independently screened articles and completed full-text review and data extraction. We identified 87 reviews, spanning three decades. We propose the term Comprehensive Community Initiatives (CCI) to define community-level AOD approaches. CCIs involve multiple coordinated initiatives implemented across a community and are categorised into four types and eleven subtypes. School-based activities, the most common initiative subtype, were reported by reviews to be most effective when interactive and peer-focused, while fear-based approaches reportedly lack impact. Meaningful community engagement was central across recommendations to improve effectiveness. We summarize lessons learned for each initiative subtype, including recommendations, barriers, facilitators, and moderators of impact to guide future implementation.