Publication Date: 
Monday, September 21, 2015

The Problem: Especially when used in excess, alcohol increases one’s risk for a host of health conditions including injury, heart disease, liver disease, mental health issues, and certain types of cancer. Excessive alcohol use results in approximately 88,000 deaths each year in the United States. On average, these deaths occur 30 years earlier than the typical American life expectancy, representing a total of 2.5 million years of potential life lost. CDC: Alcohol Use and Your Health. Further, impaired driving is one of the largest contributors to motor vehicle crashes. It is estimated that roughly 30 people per day are killed in motor vehicle crashes involving an alcohol-impaired drivers. In 2013, these crashes accounted for almost one third of all U.S. traffic-related deaths. CDC: Impaired Driving Factsheet. One established risk factor for excessive alcohol consumption is high density of outlets that sell alcohol.

The Law: Sale of alcohol is regulated by states and localities. In some jurisdictions, the state maintains a monopoly over the sale of off-premises alcohol, preventing private entities from selling alcohol not consumed at the place of sale (such as restaurants and bars). Periodically, states have created and dissolved such government monopolies. Some state alcohol monopolies apply to all intoxicating beverages while others apply only to wines or liquor. For examples of state laws that create alcohol monopolies, see Pa. Code Title 40, Chapter 11 (Pennsylvania) and Michigan Constitution, § 40.

The Evidence: An expert panel at the Community Guide systematically reviewed studies assessing the effect of privatization of alcohol sales on alcohol consumption. Hahn, Robert A. et al. "Effects of alcohol retail privatization on excessive alcohol consumption and related harms: a Community Guide systematic review." American Journal of Preventive Medicine 42, no. 4 (2012): 418-427. The reviewers identified 17 studies that fit their criteria of evaluating either the privatization or re-monopolization of the sale of alcohol consumed off-premises. According to the reviewers, the weight of the evidence across the studies suggests that privatization of off-premises alcohol sales increases consumption and contributes to excessive drinking and alcohol-related harms. The median increase in the sale of privatized beverages was 44.4 percent. Reviewers found that re-monopolization caused a significant decrease in the number of alcohol outlets. Evidence also showed that re-monopolization had a positive impact on a number of health related outcomes.

The Bottom Line: According to the authors of a Community Guide systematic review, there is sufficient evidence to suggest that privatization of off-premises alcohol sale is associated with increases in alcohol consumption and other alcohol-related harms.

Impact: Effective


Originally published June 29, 2012. Updated September 21, 2015.