Alcohol Problems and Policies: The States Have the Power, But Will They Use It?

Tags:
Early View Perspective
Topics:
Behavioral Health Population Health
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Policy Points:

  • After the repeal of National Prohibition in 1933, the federal government gave states the bulk of the regulatory power over alcohol.
  • Although states used this power early on, particularly since the 1970s state action on alcohol has largely liberalized alcohol control structures, allowed taxes’ real value to decline with inflation, expanded physical availability, and failed to limit alcohol marketing.
  • With declining federal funds for public health and health care, states have the power today to use alcohol taxes to raise much-needed revenues, and reduce alcohol problems while funding a range of needed programs and services.

Alcohol is a causal factor in more than 200 disease and injury conditions in the human body.1 The Centers for Disease Control and Prevention (CDC) define excessive drinking as binge drinking (4 or more drinks for women, 5 or more for men on one occasion in the past month), heavy drinking (8 or more drinks for women, 15 or more for men in a week), and any drinking during pregnancy or by persons younger than age 21 years.2 In the United States, excessive drinking is responsible for more than 178,000 deaths per year, which is nearly 500 deaths per day,2 and causes 1 in 8 deaths of persons of working age.3 Among persons aged 15 to 49 years old, it is the number two cause of death and disability, only outstripped by other drug use.4 Alcohol is a carcinogen, causing cancer in at least seven sites in the human body, with approximately 100,000 cases and 20,000 cancer deaths in the United States annually caused by alcohol use.5, 6 Alcohol is also a significant factor in violent deaths, including domestic violence and violent crime: the CDC estimates that 21% of suicides and 29% of homicides are alcohol-attributable, i.e., they would not have happened without alcohol use.7

References

1

World Health OrganizationGlobal Status Report on Alcohol and Health and Treatment of Substance Use Disorders. World Health Organization; 2024. Accessed July 7, 2024. iris.who.int/bitstream/handle/10665/377960/9789240096745-eng.pdf?sequence=1

2

Alcohol use and your healthCenters for Disease Control and Prevention. Accessed December 18, 2024cdc.gov/alcohol/about-alcohol-use/index.html#cdc_behavioral_basics_ty%20pes-effects-of-short-term-alcohol-useSee all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do?

3

Esser MBLeung GSherk A, et al. Estimated deaths attributable to excessive alcohol use among US adults aged 20 to 64 years, 2015 to 2019JAMA Network Open20225(11): e2239485e2239485https://doi.org/10.1001/jamanetworkopen.2022.39485

4

GBD CompareInstitute for Health Metrics and Evaluation2025. Accessed January 25, 2025. https://vizhub.healthdata.org/gbd-compare/

5

Islami FMarlow ECThomson B, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019CA Cancer J Clin 202474(5): 405432https://doi.org/10.3322/caac.21858

6

Esser MBSherk ALiu YHenley SJNaimi TSReducing alcohol use to prevent cancer deaths: estimated effects among U.S. adultsAm J Prev Med202466(4): 725729https://doi.org/10.1016/j.amepre.2023.12.003

7

Alcohol-related disease impact (ARDI) applicationCenters for Disease Control and Prevention. Accessed March 3, 2024nccd.cdc.gov/DPH_ARDI/default/default.aspx


Citation:
Jernigan DH. Alcohol Problems and Policies: the States Have the Power, But Will They Use It?. Milbank Q. 2025;103(SI):0723. https://doi.org/10.1111/1468-0009.70039.