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Two years ago, the American Journal of Preventive Medicine published results of a study that estimated how much money excessive alcohol consumption costs the United States each year. The tab came to $223.5 billion—a sobering statistic. While a national estimate can inform federal funding decisions about alcohol research and programing, however, the real legal authority to regulate alcohol consumption—and most health behaviors, for that matter—exists at the state level.

This week, another study in the same journal provided estimates of how much excessive alcohol consumption costs in each state—underscoring the economic imperative for individual states to take action. The tri-state area total: $15 billion.

Drawing from national standards, the study defined “excessive” alcohol consumption as having: 4 (woman) or 5 (man) drinks or more on at least one occasion in the previous 30 days or 1 (woman) or 2 (man) drink(s) per day, on average, or any drinks for someone who is under the age of 21 or pregnant. The researchers pulled from various data sources to estimate the numbers of adverse events (e.g., drunk driving accidents, fetal alcohol syndrome, alcohol-attributable deaths) caused by “excesses” in the amount of alcohol consumed in each state per year and multiplied them by estimates of the financial cost associated with each. The researchers then divided the totals by estimates, based on surveys of retail sales, of the number of alcoholic beverages consumed in each state. This yielded the “cost per drink”—an indication of how much the price of every drink would need to be increased to offset the economic consequences of excessive alcohol consumption.

Here’s what the study found locally:

  • Pennsylvania: $1 billion in health care costs, $5.9 billion in lost productivity costs, $1.4 billion in other costs for things like property damage, criminal justice, and special education for kids with fetal alcohol syndrome—a total of $1.81 per drink.
  • New Jersey: $570.9 million in health care cost, $4.5 billion in lost productivity, $840 million in other costs—$1.69 per drink.
  • Delaware: $86.6 million in health care costs, 477.9 million in lost productivity, $122.5 million in other costs—$1.40 per drink.

So, short of bringing back prohibition, what can states do to prevent the harms of excessive alcohol consumption and its accompanying costs? The U.S. Community Preventive Services Task Force (CPSTF)—an independent body, appointed by the Centers for Disease Control and Prevention (CDC), that synthesizes research to make evidence-based recommendations about what programs and policies keep people healthy—has identified more than half-a-dozen strategies that have proven effective. Here are a few:

  • Dram shop liability laws: Gaining its name from an ole’ fashion word for a unit of alcohol (“Bartender, give me another dram of whiskey!”), state dram shop liability laws allow bars and restaurants to be held legally responsible for damage caused by consumers after they drink too much at their establishment. The CPSTF concluded that state dram shop liability laws are effective in preventing alcohol-related harms. Overall, the task force found that the laws decreased drunk driving fatalities by 6.4%. (“Sorry Sir, I will not—you’re quite drunk. If I give you another dram of whiskey, I will be sued and lose the bar, the house, and my wife.”)

  • Alcohol excise taxes: On average, people drink less when it costs more. In their review of 73 studies, the CPSTF concluded that there was an inverse relationship between the price of alcohol and its excessive consumption and/or adverse outcomes (e.g., drunk driving, liver cirrhosis). States can prevent some of these outcomes by taxing alcohol at a rate higher than other goods.

  • Not privatizing retail alcohol sales: While it can be a hassle to get booze in states like Pennsylvania where government is both regulator and retailer, the evidence suggests that it’s good for the public’s health. The CPSTF “recommends against the further privatization of alcohol sales in settings with current government control of retail sales” as there is “strong evidence that privatization results in increased per capita alcohol consumption, a well-established proxy for excessive consumption.”

As I discussed in a previous post, the decision about whether Pennsylvania should privatize liquor sales should be informed by evidence about the impact it’s likely to have on the state’s health—not just its economy. The recent study offers a compelling example of how health and the economy are often linked. Pennsylvania lawmakers—and the residents who elected them to watch out for their interests—should be mindful that short-term economic gains of liquor privatization might well be offset by costs to both the public's health and the treasury in Harrisburg down the line.

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