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
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
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
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
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
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
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
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
Author(s): Jernigan, D., Sparks, M., Yang, E., & Schwartz, R.
Citation: Preventing Chronic Disease, 10