Effective Policies to Prevent Excessive Alcohol Use

Minimum legal drinking age (MLDA) laws of 21 in the U.S. refer to a minimum age required to purchase alcohol in a state and measures aimed at preventing people under the minimum age from accessing alcohol. MLDA laws have significantly reduced drinking and drinking-related problems among adolescents and young adults, including education drop-out rates, car crashes, crime, injuries, assaults and suicides. There is also evidence that the relaxation of age restrictions contributes to heavier use later in life.  

Alcohol taxes and mark-ups in control states, are a way for governments to raise money to offset the societal cost and harm of alcohol use and are generally well-supported by the public. Minimum unit pricing and setting the price floor in control states has also been found to be an effective public health intervention when applied along with taxes, but this policy has not been tried in the U.S. Such strategies are found to increase alcohol prices, lower consumption and reduce alcohol-related harms such as drinking and driving, crime, violence and premature deaths.

Restrictions imposed through licensing and regulation to limit alcohol availability can curb consumption by reducing the number, types and locations of alcohol outlets, and limiting hours and days of sale for both off-premise (e.g., liquor stores) and on-premise (e.g., bars and restaurants) sales. Privatization of alcohol sales, the process of giving the private sector the responsibility for selling alcohol, tends to result in significantly more off-premise outlets, higher prices for the consumer and increased rates of consumption compared to state government monopolies where the state is a market participant and sells the product. A major challenge in this literature is defining accessibility in a way that is relevant to both urban and rural areas and understanding contextual factors (e.g., socioeconomic factors, population, crime, type of product sold, type of outlet) that may contribute to the alcohol outlet environment.

The impacts of advertising and marketing on drinking and related problems have been difficult to estimate; however, recent research has indicated a need to strengthen regulations. Targeted approaches, such as promotions aimed at college students, have been found to be much more problematic, and vulnerable groups (underage youth), are more susceptible. Legal or government restrictions on alcohol marketing range from moderate to considerable and vary across different alcohol types and media formats. Warning labels, product content labeling, and counter-messaging to increase awareness of alcohol’s harms may help offset industry promotions. 

Given beer, wine and spirits have different ethanol content, sales volume and drinker type preferences (e.g., heavy, moderate, underage), and thereby have differential health effects, governments often apply distinct regulations to each beverage type to help control their use. Such control measures include differences in where and when beverage types can be sold, advertising restrictions, tax rates and labeling requirements. While historically the U.S. has adopted more stringent regulations for spirits, and research supports the more stringent treatment of spirits, harms related to beverage type, particularly those higher alcohol content products, such as spirits, remains an understudied area.