# Infrahealth politics: Leveraging bartenders' expertise in alcohol management - An ethnography

Alix Boirot, Geraldine Cazorla, Patrizia Carrieri, Marta Lotto

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Alix Boirot, Geraldine Cazorla, Patrizia Carrieri, Marta Lotto. Infrahealth politics: Leveraging bartenders' expertise in alcohol management - An ethnography. Social Science & Medicine, 2025, 370, pp.117731. 10.1016/j.socscimed.2025.117731. inserm-05385736

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# Infrahealth politics: Leveraging bartenders' expertise in alcohol management - An ethnography

Alix Boirot* ID, Geraldine Cazorla ID, Patrizia Carrieri, Marta Lotto

Aix Marseille Univ, Inserm, IRD, SESSTIM (Economic and Social Sciences of Health and Medical Information Processing), ISSPAM, Marseille, France

<figure><img src="image_2.png" /></figure>

## ARTICLE INFO

Handling editor: Medical Sociology Office

## ABSTRACT

**Background and aims:** Despite WHO recommendations, the percentage of persons treated for Alcohol Use Disorder (AUD) is still low. The ever-increasing burden of alcohol intoxication cases on emergency services underscores the necessity for innovative approaches to treat individuals with AUD and to improve harm reduction strategies. Bars are often frequented by individuals with AUD who are not under observation by medical or social services. Recognizing that understanding the social contexts surrounding alcohol consumption is essential for harm reduction, this study examined the often overlooked yet important role of bartenders in implementing informal harm reduction strategies.

**Methods:** We conducted an ethnographic study between March and October 2023 in 33 bars in Marseille, France. Combining participant observation with semi-structured interviews, 38 bartenders (23 men and 15 women) were purposively sampled. We investigated the harm reduction strategies employed by bartenders, identified potential barriers to these professionals being able to increase harm reduction efforts, and proposed novel harm reduction strategies that these professionals and healthcare professionals could implement.

**Findings:** Bartenders skillfully manage situations of collective overindulgence to maintain a secure environment for customers. They mediate conflict through acts that sometimes go against the bar's financial interests, including moderating customers' alcohol consumption. Occasionally, they also provide support to patrons beyond commercial obligations (accommodation, finding work). In this multifaceted public health role, they balance hospitality with risk management.

**Conclusions:** Bartenders play an 'infrahealth role', reducing risks associated with alcohol consumption outside the formal framework of public health. Their harm reduction intervention ranges from adjusting beverage offerings to preventing conflicts. Acknowledging that grassroots stakeholders such as bartenders contribute to tackling AUD, and strengthening the collaboration of health professionals and local authorities with these stakeholders, could help promote safer and more responsible alcohol consumption practices.

## 1. Introduction

Alcohol use disorder (AUD) is the most prevalent of all substance use disorders worldwide, with an estimated 100.4 million cases in 2016 (Degenhardt et al., 2018). Only a small proportion of individuals with AUD receive care (i.e. any type of medical support including effective pharmacological and psychosocial interventions, whether or not abstinence is required). (Mekonen et al., 2021). Specifically, the global treatment rate for AUD is 17% (7.9% in the USA and 10% in France, our study country) (Costa et al., 2020; SAMHSA, 2023; WHO, 2018). Alcohol-related harms encompass not only health risks such as traffic

injuries, falls, cancer, and cirrhosis, but also social consequences like interpersonal and professional problems, violence, and suicide or attempted suicide (Rehm et al., 2003). Managing individuals with alcohol intoxication poses significant challenges for the medical system, particularly emergency services (Henderson et al., 2008; Raines, 2015).

Despite WHO recommendations and several efforts to address this AUD treatment gap, treatment rates have not increased in the last 15 years (Kohn et al., 2004; Mekonen et al., 2021).

AUD treatment approaches that solely focus on abstinence may discourage individuals who are not yet ready to quit consuming alcohol (Marlatt and Witkiewitz, 2002). Contemporary perspectives on AUD

<footnote>* Corresponding author.</footnote>

<footnote>E-mail addresses: alix.boirot@inserm.fr (A. Boirot), geraldine.cazorla@inserm.fr (G. Cazorla), maria-patrizia.carrieri@inserm.fr (P. Carrieri), marta.lotto@inserm.fr (M. Lotto).</footnote>
emphasize its socially negotiated nature; more specifically, they move away from the notion that it is a purely individual trajectory and highlight the importance of social support (Booth et al., 1992). It is therefore crucial to explore the social contexts of alcohol consumption, in particular, to identify elements within these contexts that could facilitate harm reduction strategies.

Various reports have demonstrated the efficacy of harm reduction strategies in managing AUD (Witkiewitz and Alan Marlatt, 2006). Harm reduction aims to help consumers minimize the negative effects of their practices (i.e. physical, psychological, and social harms). It is co-constructed, prioritizes safety of use, and may or may not involve reducing or abstaining from use (Federation Addiction, 2017).

Harm reduction applies not only to individuals suffering from AUD but also to alcohol consumers in general. In France, data from 2021 showed that 22% of adults reported exceeding lower-risk alcohol consumption guidelines (Andler, 2023a). Additionally, 16.5% of adults experienced *Heavy Episodic Drinking* (HED), which is defined by the WHO as consuming 60 g of alcohol or more on at least one occasion in the previous 30 days (Andler, 2023b).

A significant proportion of harmful drinking occurs in public places such as bars (Bellis et al., 2010; Tutenges and Bøhling, 2019). Bars are often frequented by individuals with AUD not monitored by medical or social services (Gilmore et al., 2021). The characteristics of bars, such as the atmosphere, promotions on drinks, and staff vigilance, can contribute to an increased but also a decreased risk regarding customers' health and safety (Green and Plant, 2007; Taylor et al., 2020). Bartenders play a key role in this context (Tutenges et al., 2013). For example, an innovative study showed that bartenders identified patrons who were U.S. Army veterans with mental health issues and connected them with health services (Anderson et al., 2010).

The literature often highlights the risky behaviors of young people engaging in nightlife-related binge drinking (Kuntsche et al., 2017; Miller et al., 2007); instead, contexts such as daytime drinking in bars, drinking by older persons, and less severe episodes of intoxication, all tend to be overlooked. Of the studies that focused on drinking by senior citizens, few have investigated recreational and social settings such as bars (Kelly et al., 2018). However, studying bars – and more specifically, studying different types of bars (working-class day bar, night bar, regular bar, cocktail bar, etc.) – provide researchers with a wide range of alcohol consumer profiles in terms of investigating harm reduction in the context of alcohol consumption.

Alcohol-related harm reduction is often viewed as the joint responsibility of the person with harmful alcohol use and the medical and social sectors that manage it; this vision disregards the valuable insights that grassroots stakeholders, such as bartenders, can provide in terms of strategies to implement.

Public health literature mainly focuses on evaluating legislative measures, such as compliance with and enforcement of prohibitions or recommendations against selling alcohol to minors or customers showing obvious signs of intoxication (Bolier et al., 2011; Jones et al., 2011; Nederhoff et al., 2016). A significant proportion of contemporary research on bartenders focuses on the potential adverse effects of their conduct on alcohol-related harms, including the serving of drinks to customers who are visibly intoxicated. Very little research has focused on bartender-customer dynamics and harm reduction from the bartenders' perspective.

The present study aimed to advance understanding of how bartenders implement informal harm reduction actions in their daily work, and to examine their active role in supporting individuals suffering from AUD. Specifically, we investigated how bartenders handled and cared for patrons with harmful alcohol use and intoxicated customers, to determine which of their skills could be used to systematize this role and to help other professionals confronted with persons who are intoxicated. The contribution is based on data from an ethnography conducted in 33 bars and among 38 bartenders.

## 2. Methodology and theoretical approach

Drawing on symbolic interactionism applied to the study of work (Becker, Hughes, Strauss), this paper examines bartenders' practices in situ. The work these professionals perform often goes beyond formal role descriptions (Strauss et al., 1985) of persons who serving drinks. We explore the informal tasks and implicit dimensions of bartending, highlighting how these professionals attribute meaning and value to their actions at work.

Echoing perspectives by Charles Wright Mills, 1951 and Richard Sennett (2008) on craftsmanship as a quest for quality and dedication, we show how an artisanal ethic is reflected in bartenders' work. Building on studies of 'humble occupations' (Béguin, 2013; Hughes, 1970; Ramirez et al., 2015) and specifically on their focus on the experiential knowledge of professionals working in undervalued trades, our ethnographic study uses detailed observations of professional practices to understand how bartenders see their roles and what stance they take regarding risks for customers who consume the alcohol they serve. We aim to understand the work dynamics that develop 'with' customers; in this way, we move beyond the unidirectional view of service (Strauss et al., 1985: 262). More specifically, rather than seeing interaction as a simple service relationship, we analyze the exchanges that take place at the counter between bartenders and customers, taking into account the gestures, actions and interpersonal skills used by bartenders to manage customers' drunkenness. Our study highlights an often invisible but essential skill which bartenders use at the heart of every interaction, and which contributes to a regulation of consumption and behavior that is co-produced with the customer.

These informal practices represent what we define as 'infrahealth politics', inspired by James C. Scott's concept of "infrapolitics" (Scott, 1990). Infrahealth politics encompasses the discreet, informal strategies through which individuals or groups manage, adapt, and negotiate their health conditions in contexts where institutional health infrastructures are perceived as too restrictive, insufficient, or far from their experience. These practices, rooted in daily life, revolve around local, cultural, and social dynamics. They distinguish themselves from institutionalized top-down healthcare approaches (e.g., hospitals, public health systems), as they result from actions 'from below'.

The concept of infrahealth politics is grounded in four criteria: a/ Informality: practices are developed outside formal health frameworks in everyday interactions and informal networks, such as relationships between clients and service providers; b/A community dimension: practices are anchored in community networks, blending individual autonomy with collective responsibility, and reflecting a shared framework of thought, beliefs, and specific needs within a community or a shared context. These practices often follow the community's own logics, diverging from norms imposed by public health policies; c/ Adaptability: practices address local constraints and institutional gaps through creative, flexible, and non-standardized solutions based on 'on-the-ground' pragmatism and on negotiations, while taking into account the roles and expectations of the social actors involved; d/Discretion: practices are not overtly against the order of the health system, but rather "circumspect struggles" (Scott, 1990: 183). They operate in subtle, often invisible ways, avoiding direct confrontation with institutional norms. They manifest themselves in pragmatic resistance to standardized approaches through concrete gestures and oral discussions.

The concept of infrahealth politics highlights alternative dynamics in health, and provides a framework for understanding how marginalized groups reshape their relationships with health in parallel with formal systems. These dynamics reflect community autonomy. They embody efforts to exert control over health issues; this control is based on their experience, on situated analysis, and on interpretations of health risks and possibilities for intervention. The concept of infrahealth politics may reveal how these practices fill institutional gaps, highlighting structural flaws or inadequacies in public health systems.

Empirical sociology and ethnography provide an excellent
methodology for grasping the entire process by which individuals construct their interpretation of their situation, and by extension, their actions (Chapoulie, 2020: 16). Ethnography aims to gain an in-depth understanding of the social and cultural dynamics within a particular context by directly exploring the representations and practices of the stakeholders (Adler and Adler, 1994; Fassin, 2008; Mauss, 1926). With its holistic and inductive approach, it problematizes ordinary life by changing the ordinary into something extraordinary (Dixon-Woods, 2003). Participant observations allow the researcher to integrate into the social environment. Entering into the ordinary life of the participants allows the researcher to understand, from a critical and empathetic point of view, the meanings they attach to things and the logics that guide their actions (Foley, 2016). Research data are therefore collected from informal exchanges between the researcher and the individuals involved, as well as from the observation of individuals' interactions with others and their practices.

To complement the observations, in-depth semi-structured interviews were used to help identify existing strategies that could act as levers to support prevention and to pinpoint established norms or beliefs that could act as obstacles to be deconstructed. Together, they provided a comprehensive picture of the social scene of the bars where the participants worked.

## 2.1. Study sample

The study sample comprised bartenders working in Marseille, France. We included professionals aged 18+ years who worked behind a bar in establishments serving alcohol. Restaurants, nightclubs, and bars without a counter were not included. Participants were included irrespective of their formal qualifications in hospitality and catering, and whether or not they held a legal work contract. To include a diversity of perspectives and situations, we selected participants using purposive sampling with the following relevant strategic variables: sex, age, history of alcohol consumption at work (yes/no), working status (i.e., part-time or full-time employee, team leader, owner working at the bar counter), amount of bartending experience, and type of establishment (e.g., pub, late-night bars). Purposive sampling was complemented by the snowball recruiting technique. Participants were recruited at their workplaces. Of the 50 individuals approached, 38 agreed to participate in the study. The 12 who declined cited time constraints and unavailability, despite acknowledging the importance of the research.

Of the 38 participating bartenders in the study (see Table 1 for demographic information), 15 were women and 23 were men (approximately reflecting the bartender gender distribution in France (OPCA Fafih, 2009)). Moreover, 23 were managers (i.e., owner or team leader) and 15 were regular employees. At the time of the study, nearly all the bartenders in our sample (n = 36), identified bartending as their primary occupation. Approximately half (n = 18) resided within a 15-min walk of their place of work. Of the 33 bars included in the study, three were operated by the owner alone (with an additional employee during high season), four by the owner with one additional employee, and two had more than fifteen employees (including waiters). The majority of bars (n = 24) employed between two and ten individuals.

## 2.2. Ethnography of bartenders: participant observations and interviews

In-depth semi-structured interviews and participant observations were conducted between March 2023 and October 2023 by A.B., a French female anthropologist, aged 30–39, with previous experience of ethnography in recreational establishments.

To adapt to the participants’ different work schedules and to observe various situations, A.B. was present at the bartenders’ bar counters during the day, evening, and night, on weekdays and weekends. She focused on interactions centered around alcohol, including orders, discussions about consumption preferences, comments on the effects of alcohol, jokes, and bartenders’ actions to reduce or foster customers’

<table><caption>**Table 1**
Socioeconomic and demographic characteristics of participants.</caption><thead><tr><th>Characteristics</th><th></th><th>n</th><th>%</th></tr></thead><tbody><tr><td rowspan="2">Gender</td><td>Women</td><td>15</td><td>39.5%</td></tr><tr><td>Men</td><td>23</td><td>60.5%</td></tr><tr><td rowspan="5">Age (years)</td><td>20–24</td><td>5</td><td>13.2%</td></tr><tr><td>25–29</td><td>15</td><td>39.5%</td></tr><tr><td>30–39</td><td>8</td><td>21.1%</td></tr><tr><td>40–49</td><td>8</td><td>21.1%</td></tr><tr><td>50–59</td><td>2</td><td>5.3%</td></tr><tr><td rowspan="6">Work status</td><td>Employee, part-time</td><td>2</td><td>5.3%</td></tr><tr><td>Employee, full-time</td><td>13</td><td>34.2%</td></tr><tr><td>Employee, team-leader</td><td>12</td><td>31.6%</td></tr><tr><td>Owner with multiple employees</td><td>4</td><td>10.5%</td></tr><tr><td>Owner with one employee</td><td>4</td><td>10.5%</td></tr><tr><td>Owner working alone</td><td>3</td><td>7.9%</td></tr><tr><td rowspan="5">Education Level</td><td>No Formal Education</td><td>8</td><td>21.1%</td></tr><tr><td>Vocational education certificates</td><td>10</td><td>26.3%</td></tr><tr><td>Upper secondary school Diploma</td><td>8</td><td>21.1%</td></tr><tr><td>Bachelor's Degree or higher</td><td>7</td><td>18.4%</td></tr><tr><td>Missing data</td><td>5</td><td>13.2%</td></tr><tr><td rowspan="2">Graduated in Hospitality and Catering sector</td><td>Yes</td><td>4</td><td>10.5%</td></tr><tr><td>No</td><td>34</td><td>89.5%</td></tr><tr><td rowspan="5">Years of Experience working in Bars</td><td>Less than 1</td><td>1</td><td>2.6%</td></tr><tr><td>1 to 4</td><td>12</td><td>31.6%</td></tr><tr><td>5 to 9</td><td>7</td><td>18.4%</td></tr><tr><td>10 or more</td><td>18</td><td>47.4%</td></tr><tr><td>Consumed alcohol during workshift</td><td></td><td></td><td></td></tr><tr><td></td><td>yes</td><td>28</td><td>73.7%</td></tr><tr><td></td><td>no</td><td>10</td><td>26.3%</td></tr><tr><td>Total</td><td></td><td>38</td><td></td></tr></tbody></table>

alcohol consumption. Field notes were taken during or after observations, depending on the situation.

The interview topic guide focused on bartenders’ relationships with alcohol and with individuals in states of intoxication. Interviews explored their representations of the substance and its consumers, their perceptions of the risks associated with its consumption, the measures they implemented to supervise customer consumption, their working conditions, and their perception of bartenders’ role in harm reduction. Additionally, the interviews explored the professional and consumption trajectories of the bartenders themselves, gaining insights into how their career paths and personal experiences intersected with their roles as bartenders. All interviews were audio recorded (with informed consent) and transcribed verbatim. Fieldnotes were taken to document contextual details and nonverbal expressions.

Of the 33 establishments studied, representing the 38 participating bartenders, observations only (i.e., no interview) were conducted in 13 bars, 13 had individual interviews only (i.e., no observations), while 7 had both. There were several reasons for this distribution. Some professionals expressed interest in participating but indicated they had no time for an interview. These participants allowed the researcher to observe and engage informally during their work, as long as it did not disrupt their tasks. Some employees were reluctant to seek permission from their supervisors for the researcher’s presence, but were willing to participate in interviews. In bars where at least one employee refused to participate, observations could not be conducted. However, this did not stop other employees from participating in an interview if they so wished. A total of 22 semi-structured interviews, lasting 40–120 min, were conducted, along with over 320 h of observation.

The study protocol was approved by the Aix-Marseille University Ethics Committee, reference 2022-10-20-003. All participants provided active and informed consent to participate. All identifying information, including the names of participants, as well as the names of bars or
neighborhoods, was removed during transcription. We used the
COnsolidated criteria for REporting Qualitative research (COREQ)
checklist, which provides key guidelines for reporting qualitative
research (Tong et al., 2007).

## 2.3. Analysis

NVivo 14 software was used to facilitate coding. A.B. reviewed the observation notes and transcriptions during the data collection phase, and initiated the process of taking analytical notes. The first 11 interviews and observations were analyzed before the rest of the data were collected. This was done to perform inductive coding to establish a preliminary coding framework. The research team discussed the preliminary results. New questions were added to the interview process to gather participants' perspectives on themes that emerged during this first coding phase. This iterative approach to data collection enhanced its validity and allowed for a more detailed exploration of emerging themes. New insights from this process were integrated into the interpretation, with codes reviewed and refined for coherence and relevance to the research question. Axial coding was used to link categories, explore relationships, and refine the coding structure.

# 3. Results

Bartenders, without identifying as healthcare providers or using
formal harm reduction language, often take proactive steps to address
the challenges of collective intoxication. Their approach is grounded in
careful observation, active listening, creating a low-risk environment,
and taking care of customers.

3.1. Beyond serving drinks: anticipating and managing collective intoxication

While the role of a bartender may be simplified to “the person
serving drinks behind the counter”, this definition belies a profession
that is much more complex than it appears. Many bartenders in our
study asserted that while anyone can technically perform the duties of
the job – as often no formal qualifications are required and demand for
employment is strong – bartending is not suited to everyone. Partici-
pants primarily emphasized their expertise in managing a group of
people:

It's a profession, as they say. Not everyone can do it. So, people think
serving drinks is easy. Serving a drink is easy, but then you have to
manage your customers!

(Male, 50–59, working-class bar)

A significant proportion of customers in bars are inebriated. Accordingly, bartenders must manage how much alcohol they serve them and, crucially, must deal with their reactions to alcohol. Anticipation is an essential element of bartenders' multiple responsibilities. Participants in our study did not perceive themselves as individuals merely taking orders, but rather as supervisors of a group of individuals seeking relaxation. As one participant said:

Some people handle alcohol better than others, but the context plays
a huge role. That being said, it's true that you can't run away from
your problems. When you walk into a bar with a lot on your mind,
there needs to be a lot of interactions and more than just the context
to help you forget. But the first step you take to go into the bar is also
for that. You see? It's to get your mind off all that. You enter a place
where there are alcohol professionals; so, they are people who will
guide you in how they serve you. They are people that, when you sit
at the bar, offer you a service before offering you a drink.

(Male, 30–39, pub)

This bartender nuanced the responsibility of intoxicated customers

by emphasizing the importance of fostering a favorable atmosphere.
Most bartenders interviewed believed that reactions to alcohol depend
on the context. They saw their role as promoting a pleasant environment
to control how customers behave under the influence of alcohol. In their
opinion, if customers feel comfortable in an establishment, they will be
less inclined to act aggressively or cause problems.

As a bartender, you're kind of like a conductor, you know what I
mean? Because [for] people who aren't having fun and who aren't
made to feel welcome by the staff, alcohol can affect them
differently.

(Male, 30–39, pub)

These sentiments were echoed by both managers and employees.
Moreover, the importance of the former's trust in the latter's decisions
regarding customer management was highlighted by several partici-
pants. The bartender's role of 'ambiance manager' comes with various
responsibilities, including discretionary power over serving alcohol. If a
bartender deems a customer unfit to be served any more alcohol, due to
their behaviour when intoxicated, they will generally receive support
from their manager to stop serving them. Moreover, if a bartender be-
lieves an individual should be removed from a group, they have the
authority to do so. The goal is to maintain order within the bar
collective:

We must prioritize the group over individuality.

(Female, 25–29, regular bar)

Anticipation is manifest in various dimensions of the bartender's
role. It is nourished by observation and active listening.

3.2. Observation and active listening

Bartenders must learn to identify the potential “last drink”, that is to say the final drink they can serve a customer without risking consequences such as vomiting, aggression, alcohol-induced coma, etc. The motivation for this intervention is not related to the volume of alcohol taken by the customer but to the latter’s attitude towards the substance. It is common practice among bartenders to serve alcohol to customers who appear to be intoxicated, provided that they do not exhibit overt signs of severe impairment. Manifest intoxication (slurred speech, erratic behavior, glassy-eyed gaze), as well as aggression or insistence towards other customers, especially women, are two criteria for intervening. Knowing one’s customers - typically because they are regulars - can help, as bartenders are familiar with their drinking habits and reactions so they can be attentive to any changes in these habits.

I know how much regulars drink. Often people drink the same thing, almost at the same pace, I don't know if they realize that. Anyway, there was one the other day, I got worried because he drank a lot faster than usual. So, I thought to myself, 'keep an eye out, something's not right'.

(Male, 20–24, concert bar)

Participants noted that the reaction to alcohol can vary from one
person to another, but can also vary depending on the context for the
same individual. Therefore, the bartender must be attentive to the be-
haviors of each individual in the moment:

And it really depends on the profile, and on top of the profile, it
depends on the day, on the person. Sometimes the same person holds
their liquor really well and other times no. So, it depends on a lot of
things, so that's why; but it's not about the number of drinks. You
won't see it from the number of drinks actually; it's more about the
attitude they have and how. well. whether they're drunk, you know.

(Male, 30–39, pub)

In social contexts where alcohol consumption is prevalent and where
the first round of drinks typically sets a social precedent, individuals
who prefer non-alcoholic beverages may feel hesitant to express their choice. Bartenders, attuned to this dynamic, often assist these customers in navigating societal pressures by offering support and suggesting non-alcoholic options. One participant said:

Sometimes there are people, they don't want to drink alcohol. They're at a table, everyone's drinking alcohol, and I see them looking ... you know, one's taking orders, one's getting a beer, and they look, they're like: pfff ... I don't know. 'Have a [non-alcoholic] cordial', I say! 'Have a coke, or I don't know, whatever'. 'Yeah, you're right, go for it!'. Because they feel embarrassed too. Because some of them say sorry to me, they say sorry when they order a cordial. 'Sorry, I'll have a grenadine'. But why sorry? I want to rid them of this thing of ... 'I'm sorry, it's not right not to drink alcohol.

(Male, 30-39-, regular bar)

Bartenders who do not drink alcohol are often the most attentive to this issue, as they themselves experience the pressure exerted on those who choose not to participate in drinking. However, some bartenders who do consume alcohol are also attentive. There is an implicit rhythm to the process of ordering at the bar. When customers took too much time to study the menu - from the bartender's point of view - we observed how bartenders interpreted this as customer hesitation, and as a cue to step in as an expert and offer guidance. Some bartenders initiated the conversation by directly referencing the alcoholic options, particularly in the evening, while others first sought to clarify whether the customer preferred an alcoholic or non-alcoholic option. The decision to offer non-alcoholic beverages can be influenced by certain stereotypes, such as gender stereotypes, as illustrated by the actions of one bartender in a neighborhood bar:

Around 7 p.m., a woman approached the counter, ordered a half-pint of beer—likely for a friend seated outside—and hesitated regarding her choice. The bartender spontaneously suggested sodas and lemonades, and as her indecision continued, he proposed a shandy and other low-alcohol options, one of which she eventually selected. When asked, he said he often suggested non-alcoholic drinks to un-decided women, believing they consume less alcohol but might feel hesitant to differ from their group.

(Fieldnotes, April 26th, 2023)

The importance of observation and listening skills extends beyond the immediate management of alcohol consumption to the identification of individuals who may be grappling with alcohol-related problems. Bartenders are well positioned to identify these individuals, as they have access to information such as the frequency and volume of consumption, as well as insights into the social and personal backgrounds of patrons who frequently confide in them. Our observations attested to this.

> You have to judge. When it's a little retired couple going for a gin and tonic, I won't worry, it's their little evening out, and afterward, I know they'll go home. But someone who comes in alone every day and you see they're not talking much, that's suspicious. That's when you might need to start talking to them, you know.

(Female, 25-29, pub)

Bartenders' use of observation and listening helps inform the harm reduction actions they take. These actions are generally not labeled as 'harm reduction' by them. In our study, only two of the 38 participants, both of whom were familiar with harm reduction policies for illicit drugs, adopted this terminology with the investigator; however, they did not use it in their professional practice. For others, they saw the actions they implemented as part of a framework for managing consumption that starts with creating an appropriate environment.

### 3.3. Construction of a low-risk environment

The construction of a low-risk environment involves a consideration

of the consumption offerings. Providing food, including complimentary options, helps prevent drinking on an empty stomach, which can be even more damaging to one's health. In the absence of food service, participants said they were open to customers bringing their food from outside. Some establishments, though not the majority, were contemplating the importance of highlighting an appealing, diverse, and reasonably priced non-alcoholic selection. Ginger-based drinks, original alcohol-free cocktails, and non-alcoholic beers are among the products that cater to individuals who do not drink, no longer drink, or wish to extend their social time without consuming more alcohol. Some of the managers surveyed expressed interest in developing cocktails that would allow customers to choose the same cocktail with a lower alcohol content.

I think there could be a future in that. Broadly speaking, a fairly strong cocktail is 6 cl of alcohol, so you make it [i.e., the cocktail size and strength] two, four, six, or you could make it by the centiliter [...] So that would ensure you get a good drink, with the quantity of alcohol you want ...

(Male, 30-39, regular bar)

Beyond the framework established by managers to both mitigate risks and maximize profits, bartenders implement immediate consumption management practices during their shifts, mostly preventive actions.

### 3.4. Management of intoxication

The minimum level of involvement in harm reduction by all 38 interviewed bartenders concerned anticipation during their shift. Bartenders implement a range of actions to manage their customers' consumption. These practices typically come into play once intoxication has set in. These efforts are not aimed at stopping consumption altogether, but moderating it effectively to reduce both immediate and potential next-day consequences.

Nearly all the bartenders interviewed offered water, either by bringing a pitcher alongside orders or by openly conditioning the consumption of the next alcoholic beverage on prior water intake. This service is presented as a means of pacing consumption but also as a way to mitigate the effects of dehydration caused by alcohol. We observed that some bartenders deliberately made certain customers wait before serving them. This practice was also mentioned by some bartenders in interviews. Some even steered customers towards a less alcoholic drink (e.g., a half pint of beer instead of a cocktail) or served them a less potent drink without their knowledge:

> However, I once had a situation where I kept a customer at the bar for like 20 minutes because he were too drunk, and eventually, I end up serving him something totally different to what ... the guy asks me for a rum and coke, and he gets 4 ice cubes, one cl [centilitre] of rum, and 20 cl of coke, you know. So, you realise that you can just say to him, 'Here, let me add a centiliter of rum,' and you say to him, 'Here, it's on the house. Yeah, it's the last one though' with a little smile.

(Male, 30-39, regular bar)

One bartender in particular, who was also the owner and sole worker, habitually served non-alcoholic beer instead of the ordered standard beer when she believed customers had had too much to drink. The investigator did not record any complaints from customers concerning this action. Indeed, when customers returned sober to the bar, the researcher frequently observed the barmaid trying to address the customer's previous behavior and to make them aware of their consumption. Other situations were also observed with other bartenders who openly told a returning sober customer that they had put less alcohol in their glass at the end of the previous night, for which customers often expressed their gratitude.

Despite all the preventive measures taken, situations can sometimes deteriorate. This is often linked to alcohol intoxication, as well as other
factors such as i) the blurred lines in the service-client relationship whereby customers feel bartenders are subordinate to them and that being served alcohol is their right, ii) the open layout of the venue, and iii) the presence of a crowd. A deteriorating situation can lead to physical intervention by bartenders or, as a last resort, when such personnel are employed, security personnel. However, such interventions are relatively rare. Bartenders always strive to prevent conflicts from escalating. Although a direct approach is occasionally employed (whereby a person is openly told that they have consumed too much and should leave the premises), it is not the preferred choice. Instead, mediation techniques aimed at defusing tense situations and facilitating constructive dialogue to resolve issues amicably are more common. As one bartender said:

> It's a lot about managing conflicts. Like, you also play the role of a mediator. 'Okay, you're drunk, you're getting aggressive, but let's calm down, everything's going to be okay, just leave the bar peacefully ... ' And usually, the [baseball] bat is only for extreme emergencies. Most of the time, it's all about using words to calm things down, you know, just with words. And usually, I'm all about like, 'Alright, let's calm down, let's take it easy ... '. The bat is more to scare them than to actually use it. And even for your own reassurance, like, 'I've got something.'

(Female, 25–29, regular bar)

Both men and women bartenders are susceptible to various safety concerns. In addition to the risk of physical and verbal altercations, women face issues of sexual harassment and misconduct perpetrated by some men under the influence of alcohol. Women bartenders in our study reported that certain customers made unwanted sexual propositions or remarks about their appearance; this was confirmed on several occasions in observations. When discussing such actions, participants provided anecdotes and then dismissed the issue as part of the job, "burdensome but manageable" (female, 25–29, pub). Women bartenders generally felt more in control within their place of work, where their authority behind the bar counter allowed them to serve or exclude patrons, and where they were supported by other customers and staff.

The experience of participating bartenders highlighted that confrontation with a problematic intoxicated person can quickly escalate into verbal or physical violence. To prevent this, they employ a variety of mediation techniques acquired through on-the-job training and shared experiences with colleagues. Many participants mentioned that they had developed tactics that require finesse in their implementation but are generally effective. For instance, one bartender explained that his way of getting drunk customers to leave voluntarily was by subtly guiding them into thinking that the idea was their own. Some of the participants had devised successful strategies to tactfully interrupt service when a customer was too intoxicated. For example, they adopted a playful approach by introducing games and challenges aimed at raising the customer's awareness of their level of consumption or conditioning further alcohol consumption on winning a game the customer was likely to lose.

> I'm forced to use tactics because sometimes they get offended, they don't understand right away. So, I say, 'Listen, I'll give you a pint of water; if you finish it, I'll pour you another drink.' Usually, they don't finish it, so ehm, there you go.

(Female, 25–29, pub)

This same bartender had several methods of this kind including offering a shot to a customer she feels is too intoxicated but replacing the alcohol with water without their knowledge. If the customer does not comment on the taste, she talks with them about their level of intoxication:

> It's techniques like that which ... well, it's a bit sneaky, but well, it's like: 'If you can down this shot, I'll keep serving you.' And in the end,

> they don't react; and I'm like, 'Nope, that's it for you. That was water, and you didn't even tell me 'That's water'.'

(Female, 25–29, pub)

These techniques border on manipulation and have the potential to offend certain customers who might perceive them as undervaluing their autonomy in making reasoned decisions. However, empirical observations indicated that few persons were offended. Moreover, humor emerged as a potent tool for defusing conflicts:

> When you're [emotionally] closed off, people feel stupid and get defensive. But if you joke around with them, and they can tease you back, honestly, it just happens by itself, they catch on pretty quickly.

(Female, 25–29, pub)

The consequences that this management of collective intoxication aims to prevent are not primarily legal or health-related, but rather practical and immediate. They are closely tied to the well-being of the bartender, who besides wanting to avoid any unpleasant interactions, also seeks to avoid situations such as having to clean up vomit or handle breakages. Additionally, it relates to their perception of their role, which is primarily focused on creating an enjoyable experience for the customers. One bartender said:

> When a guy is really hammered, and you give him 4 or 5 cl of rum, you've got three options. The first one: he drinks, he ends up totally wasted, he throws up. The second, he'll just sit there, he'll end up slumped in a chair, wrecked, he won't understanding anything. And the third option: he might go off the rails. You see? Because it's that one drink too many. So, it's also about observation, knowing when it's the drink that pushes him over the edge, and by doing that, we're doing him a favor. We're doing him a favor because we're steering his evening for him.

(Male, 30–39, pub)

This extract highlights that in addition to their task of managing the collective, bartenders are concerned for the well-being of their customers. This concern guides their actions and prompts them to intervene to prevent potentially dangerous situations related to excessive alcohol consumption, even those that do not directly involve their establishment.

### 3.5. Care

Many participating bartenders underscored the boundaries of their commercial role, recognizing that they are responsible for selling a potentially hazardous substance that must be managed with care:

> I've never put the cash register above customers' health. It always upsets me to cash in on someone who doesn't realize they're drinking and drinking. Just go home, it's okay, you've left me enough money!

(Male, 30–39, regular bar)

Participants listed a range of potential negative effects related to alcohol consumption, including physical symptoms such as vomiting and headaches, as well as social and behavioral consequences such as violence and interpersonal conflicts. They also mentioned that they frequently intervened with regard to road accidents. Many had confiscated customers' car keys and either subsequently arranged for a taxi, found a trusted individual to accompany them home, provided transportation themselves, or even put them up for a night in their own homes.

> Honestly, I wouldn't even dare estimate the number of people working in bars who have brought someone home [i.e., to the bar professional's home] at least once so that they could sleep ... Because after a while, you don't know what else to do, you think to yourself, 'I can't just leave them there on the sidewalk, they might get robbed ... ' For eleven years, I lived across from [the name of the bar]; I don't
know how many people slept at my place, but ... I'd say at least ten, easily.

(Male, 30–39, regular bars)

As seen in this account, complying with the law is not the main motivator for bartenders' harm reduction actions. While the threat of legal liability was occasionally acknowledged, it seldom dictated the decision to refuse serving alcohol. Instead, moral responsibility was often invoked, whether to prevent potential harm to the intoxicated customer or to others.

Because I believe it's a profession of empathy, primarily, of human interaction, and I think it's important to maintain this idea that 'well, I'm serving you alcohol, I'm here to ensure you have a good time, but I'm not here to harm you or to let you harm someone else'; so it's also my responsibility, I reckon. Because alcohol has an impact on people all the same.

(Female, 20–24, regular bar)

Even from a commercial standpoint, kindness can be advantageous. Several participants noted that customers appreciated being taken care of and were more likely to return to a particular bar precisely because the bartender had refused to serve them when they had consumed too much, and had encouraged them to go home and rest. This was confirmed by some customers during observation sessions.

Selling alcohol and making money is all well and good, but it's important to take care of the customers, and that's how we ... well, that's how we keep them too. Honestly, sometimes they really appreciate us looking out for them.

(Male, 30–39, pub)

All 38 surveyed bartenders reported offering assistance to certain customers in securing temporary accommodation, finding employment, facilitating repayment of gambling debts, extending credit, and providing money. Some bartenders also attempted to intervene with customers they identified as struggling with alcohol addiction. They were well positioned to detect excessive consumption and to build a trusting relationship with customers, as well as to support them when they choose to reduce their consumption:

> I ask him "What's up, drinking so quickly and all that?" And then he starts opening up. So, he had a friend who passed away and all that. Sometimes I don't even serve him anymore, I just go: "It's okay, drink some water", and so on. Sometimes he comes and says: "I don't know if I should have a coffee or ..." I just make him a coffee before he even asks, you know?

(Male, 30–39, regular bar)

This extract highlights that some bartenders steer customers with problematic drinking towards non-alcoholic options when they hesitate about what type of drink to order. However, this aspect of their role remains the most complex to manage, as they often feel ill-equipped to handle potential addictions in their customers. All 38 participating bartenders emphasized the psychologist-like role thrust upon them. They mentioned that just like psychologists they actively listen without judging. While this analogy elevates their importance, it has limitations in practice. Bartenders lack training in mental health care and, in any case, this is not their job. Some participants mentioned they had attempted to intervene in the consumption patterns of certain customers, but failed, with individuals disappearing or continuing their habits. Moreover, these failed attempts caused frustration and stress among some bartenders who felt powerless. One participant said:

> So, it's happened to me before, customers who say to me: "Well, honestly, I'm an alcoholic, you know." Looking me straight in the eyes. "I'm an alcoholic, you know." So then you're like, "Well, okay, dude ... that's cool, you're at the bar, right? Now you're not drunk yet, so if you want a beer, I'm here to serve you your beer, but ... it

pisses me off to serve you your beer because you just told me you're an alcoholic."

(Female, 25–29, regular bar)

### 3.6. Sales pressure and other limitations of implementing harm reduction in bars

In bars, anticipating alcohol-related risks and regulating customers' alcohol consumption have limitations, often tied to commercial pressures. Bar owners are motivated to encourage alcohol consumption to boost sales volumes and negotiate discounts from suppliers. For example, in most establishments, a pint of beer costs less than two half-pints. Furthermore, customers who consume alcohol typically spend more than those who choose non-alcoholic options. However, these sales imperatives pose moral dilemmas.

It's paradoxical because I have a business where ... people need to drink. But I don't encourage them, and I don't want to kill them either.

(Male 30–39 pub)

In the absence of support from higher management, employees may feel under pressure to continue serving alcohol even when they believe the situation requires a different response, to avoid conflict with their bosses or conflict (which could be potentially life-threatening) with customers. One participant said:

> We're here mainly to make money, of course, but we're not here to be hassled. Because we live in a time where, unfortunately, everyone's got a gun, everyone's got a knife, everyone's got this, everyone's got that, and ... and to get a ... to get punched, for what, for a drink when it's not even your bar ... it's not worth it.

(Male, 40–49, working-class bar)

Bartenders also face practical challenges related to venue monitoring. In large bars, it is more difficult for them to supervise everything; this increases the likelihood of intoxicated customers going unnoticed. In neighborhoods where foreign tourists, especially young people, go out, bars tend to be larger and more business-oriented. Extra catering staff and high employee turnover are common, and the owners do not work directly in their establishments. Service must be expeditious, and there is minimal opportunity for social interaction with customers. In these types of bars, sales pressure is elevated, and individualized care is more challenging. These specificities were observed in the two large bars included in the sample.

Furthermore, the fact that some of the surveyed bartenders normalized high-volume alcohol consumption may reflect a high level of tolerance in terms of what is considered to be an acceptable level of customer intoxication. While all 38 surveyed bartenders had a clear understanding of the social and relational (potential) risks and (visible) damage associated with alcohol, it appeared that preventing potential health problems was not a reason why they limited the volume consumed by their customers.

## 4. Discussion

This research shows that the majority of bartenders serve visibly intoxicated customers but set a limit based on the person's behavior rather than on their alcohol intake. While most bartenders did not use formal harm reduction terminology and did not perceive themselves as healthcare professionals, they still engaged in practices aimed at anticipating and managing collective intoxication. These practices included observation, active listening, creating a low-risk environment, and taking care of customers. These actions influenced their professional approach and, for some, came with significant responsibility. Participants often followed principles to reduce potential risks associated with alcohol consumption. They exercised discretion when serving alcohol by
adjusting the type of beverage offered and pacing their service based on their observations of customers' behaviors and environmental cues. The interactionist approach offers a relevant analytical framework for understanding the processes of interpretation and adjustment of actions that mark out social interactions. This framework makes it possible to observe in detail how the harm reduction strategies implemented by bartenders are based on a process of interpreting customers' behaviour and actively constructing the meanings associated with their role. These meanings constantly evolve and adjust as the customer and bartender interact, making harm reduction an intrinsically dynamic, contextual and relational process.

All 38 bartenders surveyed, irrespective of the kind of bar they worked in, had to deal with manifestations of alcohol and its management and paid attention to how intoxicated their customers were. Whether the latter were regulars or not was not a determining factor in how they acted; the following factors had a greater impact on their management: i) the level of attention paid to intoxicated customers depended on the environment (it is more challenging to manage the consumption of every customer in a large space where not everyone is visible), ii) the level of tolerance towards manifestations of intoxication is not the same in all types of establishments, iii) not all bars have a satisfactory non-alcoholic offering and, iv) bartenders face varying degrees of pressure to serve customers irrespective of the latter's condition. These findings align with Buvik's research on the motivations for supplying alcohol to intoxicated customers (Buvik, 2013).

Our study mainly focused on small, independently-owned neighborhood bars. These kinds of bars are still widespread in the towns and villages of France, although they are becoming less common, as seen elsewhere in Northern Europe (Chatterton and Hollands, 2003). They do not primarily operate as profit-driven enterprises, designed to sell the maximum of alcohol (Tutenges, 2022). They are community-anchored establishments which are more conducive to building rapport with customers and practicing informal harm reduction. Furthermore, as mentioned above, many bartenders in our study lived in the same neighborhood where they worked, sometimes just a few steps away. Some were even former customers who moved behind the bar. This territorial and local anchoring likely fosters a desire to take care of customers. Bartenders in such venues perceive their role as hosts rather than servers. Moreover, for almost all the bartenders in our sample, bartending constituted their primary occupation. Their investment and expertise were firmly grounded in a professional culture that extended beyond the mere context of sales, encompassing their significant social role (Thurnell-Read, 2021).

While the prospect of legal repercussions occasionally looms, it plays a relatively minor role in bartenders' decision-making process regarding refusal to serve alcohol. Bartenders tend to invoke the law primarily when it serves their practical interests, such as closing the establishment or evicting undesirable customers (Rapin, 2021). Moral considerations frequently take precedence, whether they stem from a desire to prevent harm to the bartenders, the customers, or others. This illustrates that beyond the legislative framework, a meticulous process of collective human management unfolds on a case-by-case basis, driven by the determined intention to fulfill the role of bartender that these professionals have chosen to take on. The scope of this role extends well past simply serving drinks; the aim is to ensure a pleasant experience for everyone in the establishment.

It is also common for bartenders to offer a great deal of assistance to regular patrons in distress. This can range from aiding them to finding housing to helping them find job opportunities, as well as offering financial support in emergencies, such as gambling debts. Access to stable employment and secure housing, together with positive social interactions play a crucial role in the physical and mental well-being of individuals, particularly those grappling with addiction issues (Austin et al., 2021; Henkel, 2011; Woodward et al., 2018). All these actions underscore the importance of community ties and the often-underestimated role of bartenders as facilitators of social support

and safety.

Today, harm reduction tends to focus primarily on diseases (cirrhosis, cancer, etc.), often at the expense of social damages, something referred to as the “forgotten dimension” (Klingemann and Gmel, 2001). This perspective sidelines a more comprehensive community health approach. Furthermore, the current harm reduction paradigm particularly targets the most vulnerable populations (e.g., those facing severe social precarity, and persons with severe dependency). However, a founding premise of harm reduction is that it be available for all. While people with alcohol dependence or harmful use constitute a high-risk group, the majority of alcohol-related problems occur among the larger population of moderate drinkers (Borges et al., 2004). This “preventive paradox” underscores the need to address alcohol consumption not only among heavy drinkers but also among the broader population, in a proportionate manner to the harms observed (Poikolainen et al., 2007).

Although harm reduction programs are usually associated with medical and social domains, it is essential to recognize the potential contribution of non-health professionals in this effort. As in the case of reducing risks associated with illicit drugs (Baker et al., 2020), ordinary social stakeholders can make a substantial contribution to mitigating alcohol-related harms.

The interactionist approach shaped our conceptualization of 'infrahealth politics'. This concept emphasizes that health practices are not limited to what is set out in official recommendations, but are part of a wider interactive and informal process in which individuals - in this case, bartenders - actively participate in the co-construction of health-care norms and practices in response to local contexts and power dynamics. In the context of alcohol management, 'infrahealth politics' could involve the sharing of knowledge and information about the harmful effects of alcohol and ways to manage them outside official channels to assist those with unmet health needs or persons marginalized by the healthcare system. It could also entail the formation of informal community networks to provide support to individuals with health needs not addressed by formal institutions and the circumvention of financial, geographical, or bureaucratic barriers that limit access to healthcare. Concerning bartenders, it is within informal interactions, often characterized by closeness and trust, that a form of organic health prevention – deeply rooted in the fabric of everyday life – manifests itself. For these professionals, this organic prevention represents an infrahealth 'role' grounded in informality and the awareness of moral responsibility inherent in their profession. By acknowledging the crucial role of stakeholders from ordinary social spheres in mitigating alcohol-related harms, we can better understand the complexity and richness of harm reduction strategies that emerge within everyday social dynamics.

Bartenders are at the forefront of observing behaviors associated with alcohol consumption and can intervene proactively to minimize potential harm. While they may not be healthcare professionals or trained social workers equipped to address addiction or mental health issues, their experience, skills, and knowledge, could serve as a valuable complementary force in the complex matter of alcohol consumption management. One caveat to this opportunity is the economic pressure faced by businesses whose primary income is from serving alcohol. A recent study indicated that introducing alcohol-free beer selections in bars in England led to a decrease in the consumption of draught alcoholic beverages, without any discernible impact on overall revenue (De-Loyde et al., 2024). This underscores the compatibility of harm reduction strategies with economic interests. Nonetheless, our study demonstrates that consumption management strategies to minimize alcohol-related harms are employed daily by these professionals. Accordingly, it would appear imperative to leverage these informal harm-reduction practices.

Confronting a customer's potential alcohol addiction is undeniably one of the most challenging aspects of a bartender's job; often they feel inadequately equipped to manage such a situation. It is imperative to provide bartenders with the necessary tools to effectively address such
challenges, including training in techniques such as motivational interviewing (Smedslund et al., 2011) and fostering partnerships with professionals specialized in addiction treatment. It is important to emphasize that such an approach should not be aimed at disproportionately assigning responsibility to bartenders, but rather at acknowledging the legitimate concerns they encounter in their daily work and providing appropriate solutions.

The existing skills and knowledge of bartenders could serve as a foundation for formalizing their role in harm-reduction efforts. Moreover, their practical expertise in managing intoxicated individuals within group settings could be valuable to other professionals working with this demographic, for example, medical and social workers. Specifically, it can help to improve patient care but also these healthcare professionals' safety. A recent French study revealed that healthcare providers first and foremost perceive harm reduction to be a means to mitigate their own risks when dealing with intoxicated patients (Martin-Fernandez, 2024). This highlights the potential for collaboration and knowledge exchange between bartenders and healthcare providers.

Establishing a network of harm reduction-certified bars could present an opportunity to promote bartenders' role in public health and enhance the commitment of hospitality professionals to customer safety. This harm-reduction label would recognize and valorize bartenders' skills in harm reduction. It would provide consumers, including those with harmful drinking (including persons with AUD) who do not want to abandon the sociability of bars, with a clear indication of places where they can expect to receive responsible and attentive service. Moreover, the creation of such a label would incentivize bar owners to invest in staff training on harm-reduction practices (Dresser et al., 2011) and to implement internal policies aimed at promoting a safe and welcoming environment. Having said that, it must be highlighted that some studies have shown that bartenders frequently present a challenge for persons advocating health initiatives and that the implementation of effective training programs for bartenders by public health stakeholders is often a challenging endeavor (Buvik and Rossow, 2017), particularly when conducted vertically. It is not uncommon for stakeholders in this sector to demonstrate a certain reticence when it comes to engaging with external actors, particularly those representing public authorities. Such training programs would be considerably more effective if conducted by peers. Peers could facilitate the presentation and exchange of harm-reduction, alcohol management, and de-escalation strategies to prevent conflict. At the same time, medical and social actors could adapt their interventions to the needs of bartenders by explaining their roles and actions to bartenders rather than prescribing standards for them to follow. For example, they could provide bartenders with information on the various existing approaches to dealing with alcohol problems and the different local support systems to which people with problematic drinking could be referred. In this way, bartenders' feelings of helplessness when faced with a customer who is suffering from alcohol problems could be mitigated. Finally, creating this kind of harm-reduction label has the potential to strengthen collaboration between bars, local health authorities, and public health organizations. It could facilitate the exchange of best practices and the dissemination of information on the latest research in harm reduction. These exchanges would be bidirectional between health organizations and bars.

### CRediT authorship contribution statement

**Alix Boirot:** Writing – original draft, Validation, Project administration, Methodology, Investigation, Formal analysis. **Geraldine Cazorla:** Writing – review & editing, Supervision. **Patrizia Carrieri:** Writing – review & editing, Supervision. **Marta Lotto:** Writing – review & editing, Validation, Methodology, Funding acquisition, Formal analysis, Conceptualization.

### Primary funding

The Bar-OH (Bartenders and alcohol; occupational risks, consumption practices and harm reduction strategies in bars) study is funded by the FFrench National Cancer Institute (INCA_16471) 'Young researchers on tobacco and/or alcohol' grant N°2022-121. INCa had no role in the study's design, implementation, analysis, or dissemination of results, and had no role in the writing of this article.

### Declaration of competing interest

None to declare.

### Acknowledgments

We would like to express our gratitude to the 38 bartenders who generously volunteered their time and insights to contribute to our research study. Their invaluable participation enriched our understanding of the complex dynamics surrounding alcohol consumption and harm reduction strategies in bar settings. Our thanks also to Jude Sweeney (Milan, Italy) who assisted in the translation from French to English of the various quotes, and who copyedited the manuscript.

### Data availability

Data will be made available on request.

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