Understanding How Alcohol Policies Impact Public Health

Supporting research to inform the development and implementation of alcohol policies and to evaluate their effectiveness has been an important priority of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) for many years.

Alcohol policy represents a broad approach for intervening with alcohol misuse and related problems that can affect all individuals within a jurisdiction. Alcohol policy strategies commonly consist of federal, state, and local laws and regulations that govern a wide range of alcohol issues from the manufacture and sale of alcohol to directives about underage drinking. Alcohol policies are also set by non-governmental organizations such as colleges and universities to address alcohol consumption and access on their campuses and in their communities.

A substantial body of research has demonstrated that several types of alcohol policies are effective in reducing unsafe alcohol-associated behaviors and related harms. For example, increasing alcohol beverage taxes has been shown to reduce binge drinking, traffic crash fatalities, and other adverse outcomes.1,2,3 Increasing the minimum legal drinking age (MLDA) to 21 years, supported by a federal act established in 1984, has been studied extensively and shown to reduce mortality, crime, and other adverse consequences among the age groups affected by the law.4,5,6

Research on policy interventions to reduce driving under the influence has also demonstrated effectiveness in reducing alcohol-related consequences. A series of NIAAA-supported studies have examined the effectiveness of the 24/7 Sobriety approach, which involves frequent alcohol monitoring of individuals with DUI convictions as well as swift, certain, and modest penalties for alcohol use violations. Although implemented in a limited number of jurisdictions, evidence to date indicates the program not only contributes to reduced incidence of rearrests for impaired driving among participants but may also reduce overall death rates among program participants and in the broader community.7,8,9,10,11

Since alcohol-related behaviors and outcomes may be influenced by multiple policies at the same time, NIAAA supports research to assess the overall alcohol policy environment. Studies have found associations between the policy environment and multiple important outcomes, including binge drinking rates, traffic crash fatalities, cirrhosis death rates, cancer mortality rates, alcohol-involved suicides, and the harms that people who drink impose on others.12,13,14,15,16,17,18 More research is needed on alcohol-related public policies to understand which policies affect which behaviors or outcomes and for whom.

In addition to supporting past and ongoing policy research, NIAAA encourages new studies through a Notice of Special Interest on “Public Policy Effects on Alcohol-, Cannabis-, Tobacco-, and Other Drug-Related Behaviors and Outcomes” (NOT-AA-21-028). NIAAA also offers information resources for researchers, policymakers, and the general public. The Alcohol Policy Information System (APIS) provides detailed information on alcohol-related policies in the U.S. at both the state and federal levels, as well as policy information regarding the recreational use of cannabis. The College Alcohol Intervention Matrix (CollegeAIMhelps academic institutions address harmful and underage student drinking in their campus communities and provides information about alcohol policies relevant to college students and communities. NIAAA’s Alcohol Interventions for Young Adults extracts individual- and policy-level interventions that are described in CollegeAIM and are relevant to young adults who are not in college.

Alcohol misuse affects not only the person who drinks but also their family and communities. Alcohol policies can be effective, evidence-based strategies to improve public health by reducing alcohol misuse and related consequences within a population. Research on alcohol policies will continue to play a key role in informing the development, implementation, and assessment of policy efforts to prevent and reduce alcohol-related harms.



Elder RW, Lawrence B, Ferguson A, et al. The effectiveness of tax policy interventions for reducing excessive alcohol consumption and related harms. Am J Prev Med. 2010;38(2):217-229. PubMed PMID: 20117579

Wagenaar AC, Salois MJ, Komro KA. Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies. Addiction. 2009;104(2):179-190. PubMed PMID: 19149811

Wagenaar AC, Tobler AL, Komro KA. Effects of alcohol tax and price policies on morbidity and mortality: a systematic review. Am J Public Health. 2010;100(11):2270-2278. PubMed PMID: 20864710

Carpenter C, Dobkin C. The minimum legal drinking age and public health. J Econ Perspect. 2011;25(2):133-156. doi:10.1257/jep.25.2.133. PubMed PMID: 21595328

DeJong W, Blanchette J. Case closed: research evidence on the positive public health impact of the age 21 minimum legal drinking age in the United States. J Stud Alcohol Drugs Suppl. 2014;75 Suppl 17:108-115. PubMed PMID: 24565317

Shults RA, Elder RW, Sleet DA, et al. Reviews of evidence regarding interventions to reduce alcohol-impaired driving [published correction appears in Am J Prev Med 2002 Jul;23(1):72]. Am J Prev Med. 2001;21(4 Suppl):66-88. PubMed PMID: 11691562

Kilmer B, Nicosia N, Heaton P, Midgette G. Efficacy of frequent monitoring with swift, certain, and modest sanctions for violations: insights from South Dakota’s 24/7 Sobriety Project. Am J Public Health. 2013;103(1):e37-e43. PubMed PMID: 23153129

Midgette G, Kilmer B, Nicosia N, and Heaton P. A natural experiment to test the effect of sanction certainty and celerity on substance-impaired driving: North Dakota’s 24/7 Sobriety Program. J Quant Criminol. 2021;37(3):647-670. PubMed PMID: 34483470

Kilmer, B and Midgette, G. Criminal Deterrence: Evidence from an Individual-Level Analysis of 24/7 Sobriety. J. Pol. Anal. Manage 2020. 39: 801-834.

10 Nicosia N, Kilmer B, Heaton P. Can a criminal justice alcohol abstention programme with swift, certain, and modest sanctions (24/7 Sobriety) reduce population mortality? A retrospective observational study. Lancet Psychiatry. 2016;3(3):226-232. PubMed PMID: 26873184

11  Nicosia N, Kilmer B, Midgette G, Suttorp Booth M. Association of an alcohol abstinence program with mortality in individuals arrested for driving while alcohol impaired. [published online ahead of print, 2023 Mar 1]. JAMA Psychiatry. 2023;e230026. PubMed PMID: 36857070

12 Blanchette JG, Lira MC, Heeren TC, Naimi TS. Alcohol policies in U.S. States, 1999-2018. J Stud Alcohol Drugs. 2020;81(1):58-67. PubMed PMID: 32048602

13 Lira MC, Sarda V, Heeren TC, Miller M, and Naimi TS Lira MC, Sarda V, Heeren TC, Miller M, Naimi TS. Alcohol policies and motor vehicle crash deaths involving blood alcohol concentrations below 0.08%. Am J Prev Med. 2020;58(5):622-629. PubMed PMID: 32192802

14 Hadland SE, Xuan Z, Blanchette JG, Heeren TC, Swahn MH, Naimi TS. Alcohol policies and alcoholic cirrhosis mortality in the United States. Prev Chronic Dis. 2015;12:E177. Published 2015 Oct 15. PubMed PMID: 26469950

15 Alattas M, Ross CS, Henehan ER, Naimi TS. Alcohol policies and alcohol-attributable cancer mortality in U.S. States. Chem Biol Interact. 2020;315:108885. PubMed PMID: 31678112

16 Coleman SM, Lira MC, Blanchette J, Heeren TC, Naimi TS. Alcohol policies, firearm policies, and suicide in the United States: a lagged cross-sectional study. BMC Public Health. 2021;21(1):366. Published 2021 Mar 1. PubMed PMID: 33641667

17 Greenfield TK, Cook WK, Karriker‐Jaffe KJ, Patterson D, Kerr WC, Xuan Z, and Naimi TS. The relationship between the US state alcohol policy environment and individuals’ experience of secondhand effects: Alcohol harms due to others’ drinking. Alcohol Clin Exp Res. 2019;43(6):1234-1243. PubMed PMID: 31166048

18 Silver D, Macinko J, Giorgio M, Bae JY. Evaluating the relationship between binge drinking rates and a replicable measure of U.S. state alcohol policy environments. PLoS One. 2019;14(6):e0218718. Published 2019 Jun 25. PubMed PMID: 31237888


This article first appeared in the NIAAA Director’s Blog.

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