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Rural Health Information Hub

Prevention Policies

Most prevention policies related to substance use disorders (SUDs) 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 also describes evidence-based findings related to tobacco and excessive alcohol consumption, but does not address other commonly misused substances. The Rural Tobacco Control and Prevention Toolkit provides additional examples of tobacco-related policies.

Policies to Limit Access to Substances

  • Maintaining Limits on 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 Preventive Services Task Force (CPSTF) and County Health Rankings and Roadmaps have found evidence that limiting times for selling alcoholic beverages is effective for reducing excessive alcohol consumption and other related harms. The Surgeon General's Report on Alcohol, Drugs, and Health also describes evidence that limiting the sale of alcohol is associated with reduced alcohol-related harms.
  • Regulating Alcohol Outlet Density – A positive association exists between alcohol outlet density and excessive alcohol consumption and alcohol-related harms, such as violence, crime, and injuries. Limiting the number of alcohol outlets in a designated area can reduce the overall frequency of alcohol sales. The Community Preventive Services Task Force (CPSTF) recommends regulating alcohol outlet density as an effective strategy for reducing harms from excessive alcohol consumption.
  • Increasing Alcohol Taxes – Increasing the price of alcohol can influence purchasing behavior and ultimately decrease alcohol misuse, including underage and binge drinking. 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. Alcohol taxes are effective at reducing excessive drinking, underage drinking, and alcohol-related harms. The Community Preventive Services Task Force (CPSTF) recommends increasing alcohol taxes as a strategy for reducing harms from excessive alcohol consumption.

Policies to Limit Consumption of Substances

  • Drink Special Restrictions – Placing limits on drink specials can 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. Conversely, lower alcohol prices are associated with increased underage and binge drinking.
  • Public Alcohol Availability Restrictions – The County Health Rankings and Roadmaps suggest public alcohol availability restrictions reduce excessive and underage drinking and alcohol-related harms. Restricting the availability of alcohol at 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.

Policies to Limit Advertising to Youth

  • 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. Restrictions often focus on placement and ad content. For example, 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 alcohol advertisements.

Policies to Raise Awareness about SUD

  • 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 information. The County Health Rankings and Roadmaps suggest using mass media campaigns against underage drinking to reduce underage and excessive drinking.

Policies to Support Enforcement of Existing Laws

  • Dram Shop Liability Laws – Dram shop liability laws hold commercial hosts (dram shops) responsible for harms resulting from serving alcoholic beverages to intoxicated or underage customers. Examples of harm include instances of death and injury or other damages due to alcohol-related accidents. Most states have implemented dram shop laws in some form, but laws vary across states. The Community Preventive Services Task Force (CPSTF) recommends dram shop liability laws for preventing and reducing harms from excessive alcohol consumption. More information on 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.
  • 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 by state and can take the form of criminal or civil actions. This class of laws is associated with the reduction of drunk driving, heavy episodic drinking, and underage drinking. The County Health Rankings and Roadmaps recommend social host liability laws.
  • 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. The Community Preventive Services Task Force (CPSTF) recommends enhanced enforcement of alcohol sales laws for limiting underage alcohol purchases.
  • Responsible Beverage Server Training (RBST) – Includes education efforts to prevent servers from illegally providing 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 also referred to as server training and RBS. The 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. Rural 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, rural communities may need to consider that community members or youth may circumvent local policies by travelling to another state or locality.

Resources to Learn More

Best Practices in Responsible Alcoholic Beverage Sales and Service Training: with Model, Ordinance, Commentary and Resources
Describes the minimum components of responsible beverage sales programs and includes a model ordinance and discussion on the role of law enforcement.
Organization(s): Ventura County Behavioral Health, Center for the Study of Law and Enforcement Policy, Pacific Institute for Research and Evaluation
Date: 4/2008

Talk. They Hear You.
A resource for parents and caregivers to help them talk to children about the dangers of underage drinking and substance use. Offers a variety of resources including downloadable public service announcements and customizable posters and brochures.
Organization(s): Substance Abuse and Mental Health Services Administration (SAMHSA)

Underage Drinking: Prohibitions Against Hosting Underage Drinking Parties
A database of state laws that enforce liability against social hosts for underage drinking.
Organization(s): Alcohol Policy Information System

Using Public Health and Community Partnerships to Reduce Density of Alcohol Outlets
Reviews the literature discussing the relationship between alcohol outlet density, and alcohol consumption and related harm. Describes the role of state and local public health agencies and communities in reducing alcohol outlet density, and offers key steps to help them influence policy makers.
Author(s): Jernigan, D., Sparks, M., Yang, E., & Schwartz, R.
Citation: Preventing Chronic Disease, 10
Date: 4/2013