Most prevention policies related to substance use disorders focus on alcohol and tobacco use. The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute's County Health Rankings and Roadmaps database has collected effective and promising policies related to alcohol and drug use. The Community Guide has collected evidence-based findings related to tobacco and excessive alcohol consumption, but does not address other commonly misused substances. The Community Guide defines excessive drinking as including: heavy drinking, binge drinking, drinking by pregnant women, and drinking by people under age 21.
Dram Shop Liability Laws: Dram shop liability laws are scientifically supported as effective methods for reducing alcohol-related harms by The Community Guide's Alcohol – Excessive Consumption: Dram Shop Liability and County Health Rankings and Roadmaps' Dram Shop Liability Laws. The term dram shop liability refers to commercial hosts (dram shops) being held liable for harms resulting from illegal beverage service to intoxicated or underage customers. Examples of harm include instances of death and injury or other damages due to alcohol-related accidents. The Task Force found dram shop liability laws encouraged more responsible beverage serving by managers and servers. Most states have implemented dram shop laws in some form, but the laws vary across states. More information on the illegal service to minors related to dram shop laws can be found in the U.S. Department of Health and Human Services' Report to Congress on the Prevention and Reduction of Underage Drinking.
Maintaining Limits on Days and Hours of Alcohol Sales: Reducing the days and hours alcohol sales are allowed can result in a decrease in alcohol related injuries and instances. Both The Community Guide and County Health Rankings and Roadmaps have found evidence supporting limits on the days and hours alcoholic beverages are sold is an effective mechanism to reduce excessive alcohol consumption and other related harms. The Surgeon General's Report on Alcohol, Drugs, and Health highlights that a review of 11 studies focused on changing days of sale indicated that increasing the numbers of days alcohol can be sold was associated with an increase in alcohol use and alcohol-related harms.
Regulating Alcohol Outlet Density: A positive association exists between alcohol outlet density and excessive alcohol consumption along with its harmful effects such as violence, crime, and injuries. Regulations controlling the number of alcohol outlets in a designated area has the potential to reduce the overall frequency of alcohol sales. Regulations are implemented by zoning or licensing efforts and limits the numbers of outlets allowed to sell alcohol in a given area. The regulation of alcohol outlet density is recommended in The Community Guide's Alcohol – Excessive Consumption: Regulation of Alcohol Outlet Density and County Health Rankings and Roadmaps' Alcohol Outlet Density Restrictions for reducing excessive drinking and reducing alcohol-related harms.
Increasing Alcohol Taxes: Increasing the prices of alcohol can influence purchasing behavior. Taxes on alcohol are created with the intention of reducing sales or increasing revenue and therefore reducing alcohol consumption and its related problems. Taxes on alcohol are mandated on a federal, state, and local level and differ by beverage type (such as wine, beer, liquors). As of January 2019, state taxes varied from $0.02 (WY) to $1.29 (TN) per gallon of beer, $0.20 (CA and TX) to $3.26 (KY) per gallon of wine, and $2.00 (MO) to $32.52 (WA) per gallon of spirits. Overall, taxes are intended to decrease alcohol misuse including underage and binge drinking rates. This intervention is effective at reducing excessive drinking, underage drinking, and alcohol-related harms. Increasing alcohol taxes is recommended by both The Community Guide's Alcohol – Excessive Consumption: Increasing Alcohol Taxes and County Health Rankings and Roadmaps' Alcohol Excise Tax for reducing excessive alcohol consumption and related harms.
Enhanced Enforcement of Laws Prohibiting Alcohol Sales to Minors: Increasing efforts to monitor sales to minors is an evidence-based approach to limiting underage alcohol purchases and drinking. Local law enforcement or alcohol beverage control (ABC) agencies work with retailers on regular checks to ensure their compliance with the prohibition of underage alcohol sales. Also known as “sting operations,” regular compliance checks help to ensure sales are not ongoing to minors at the targeted establishment. Often, all local alcohol retailers are targeted and sent letters or mass media to warn them of the consequences related to underage sales. This intervention is effective for limiting underage alcohol purchases and cited in The Community Guide's Alcohol – Excessive Consumption: Enhanced Enforcement of Laws Prohibiting Sales to Minors and County Health Rankings and Roadmaps' Enhanced Enforcement of Laws Prohibiting Alcohol Sales to Minors.
Alcohol Advertising Restrictions: There is some evidence that changing the content and placement of alcohol advertisements may help to reduce underage and excessive drinking. Efforts for advertisement restrictions include local ordinances, state laws, and self-regulation by the alcohol industry. Placement and ad content are two major areas that restrictions focus upon. An example of alcohol ad restriction can be seen in Virginia. Virginia's youth presence law prohibits all type of alcohol advertising within 500 feet of areas frequented by children such as schools, public playgrounds, and churches. Ohio, Indiana, Kentucky, Pennsylvania, and Washington are also leading efforts to restrict these types of advertisements.
Drink Special Restrictions: There is evidence for laws placing limits on drink specials in order to reduce excessive drinking, underage drinking, and reduce alcohol related harms. Studies show that overall alcohol consumption and its related problems decrease when alcohol prices increase whereas lower alcohol prices are associated with increased underage and binge drinking.
Social Host Laws: These laws hold private property owners liable for injuries or deaths that may arise due to providing minors or obviously intoxicated individuals with alcohol. Social host liability laws vary on a state basis and can take the form of criminal or civil actions. This class of laws are associated with the reduction of drunk driving, heavy episodic drinking, and underage drinking. Social host liability laws have been rated as an expert opinion in County Health Rankings and Roadmaps.
Mass Media Campaigns against Underage and Binge Drinking: In order to help decrease underage
drinking rates, mass media campaigns use television, radio, print, and social media to increase awareness among
young adults of the consequences associated with underage drinking. There is evidence that national
media campaigns are effective in disseminating
media campaigns against underage and binge drinking has been rated
Expert Opinion in County
Health Rankings and Roadmaps for reducing underage and excessive drinking.
Public Alcohol Availability Restrictions: Public alcohol availability restrictions are considered an expert opinion in County Health Rankings and Roadmaps for reducing excessive and underage drinking and alcohol-related harms. Alcohol availability restrictions for large events can result in a decline in the availability and use of alcohol at public venues. Events may include concerts, street fairs, and sporting events. This strategy can be implemented voluntarily by event organizers or through local legislation.
Responsible Beverage Server Training (RBST): Includes education efforts regarding strategies to avoid illegally serving alcohol to underage youth or intoxicated customers. Some strategies include offering customers food along with drinks and delaying service to intoxicated customers. Additional efforts aim to discourage intoxicated customers from driving. RBST is known by multiple names and is also referred to as server training and RBS. County Health Rankings and Roadmaps notes that this strategy can reduce excessive drinking and violence.
Considerations for Implementation
Some policy interventions are determined at the state-level and may be beyond the scope of local influence. Communities should be aware of state preemption laws (laws that prevent implementing or enforcing local laws that are more restrictive than state laws) when considering local policy. Additionally, when considering new policies, it is important to consider that community members or youth may travel out of state or to another locality in order to circumvent local policies.
Resources to Learn More
Drinking: Prohibitions Against Hosting Underage Drinking Parties
Database of state laws that enforce liability against social hosts for underage drinking.
Organization(s): Alcohol Policy Information System
Practices in Responsible Alcoholic Beverage Sales and Service Training
Report covering minimum components of responsible beverage sales programs, including the role of enforcement and a model ordinance.
Organization(s): Ventura County Behavioral Health, Center for the Study of Law and Enforcement Policy, Pacific Institute for Research and Evaluation
Talk. They Hear You.
Includes customizable materials, parent resources, and PSAs on SAMHSA's “Talk. They Hear You.” campaign for prevention of underage alcohol consumption.
Organization(s): Substance Abuse and Mental Health Services Administration
Using Public Health and Community Partnerships to
Reduce Density of Alcohol Outlets
Describes the role of public health agencies and localities to influence alcohol outlet density.
Author(s): Jernigan, D., Sparks, M., Yang, E., and Schwartz, R.
Citation: Preventing Chronic Disease, 10