Alcoholic Beverage Outlet Density Regulation to Reduce Excessive Alcohol Consumption

The following definitions are used for the purposes of this systematic review:

• An outlet is a place where alcohol may be legally sold for the buyer to drink either there or elsewhere.
• Density refers to the number of alcohol outlets in a given area.
• Related harms include those listed in the background section, as well as many other adverse health and societal outcomes.

While no studies looked at the effects of local interventions to limit outlet density, results from several types of studies consistently indicated that alcoholic beverage outlet density and policy changes that affect outlet density were associated with excessive alcohol consumption and related harms. Findings from these various types of studies are described below.

• Policy changes that increase outlet density have been found to result in increased excessive alcohol consumption and related harms. This finding is based on:
  • Four studies of such policy changes (e.g., the decision in some North Carolina counties to allow serving liquor by the drink).

• Alcoholic beverage retail privatization---when governments relinquish monopoly control over the retail sale of alcoholic beverages---commonly results in increased alcohol outlet density, among other changes.
  • Eight studies of privatization in the U.S., Canada, and Scandinavia showed that privatization of alcohol sales was associated with increased alcohol consumption and related harms.
  • One study of government re-monopolization indicated that re-monopolization may reduce these harms.

• Bans against alcoholic beverages can reduce excessive alcohol consumption and related harms, particularly in isolated environments without other sources of alcohol. This finding is based on:
  • Seven studies of bans and lifting of bans, mainly among American Indian, Alaska Native, and Inuit communities in Canada.
• Nine studies of the association between outlet density change and alcohol-related harms, in which the cause of density change was not assessed, generally indicated that increased outlet density was associated with increases in alcohol-related harms. One possible exception was alcohol-related motor vehicle crashes for which evidence was mixed.

Excessive alcohol consumption in the United States is responsible for approximately 75,000 deaths per year, making it the third leading cause of preventable death:

• Nearly 47% of homicides, 23% of suicides, and 40% of fatal motor vehicle crashes are directly attributable to excessive drinking.
• More than 600,000 retail alcohol outlets are licensed in the United States. In 2005, this meant 2.7 outlets per 1,000 people aged >18 years. 
• One of the widely recognized approaches to reducing the harms associated with excessive alcohol consumption is local regulation of the density and location of outlets that sell alcoholic beverages.

The findings and conclusions in this report have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Alcoholic Beverage Outlet Density Regulation to Reduce Excessive Alcohol Consumption. Guide to Community Preventive Services Website. Centers for Disease Control and Prevention. www.thecommunityguide.org/alcohol. Accessed on: MM/DD/YYYY.

Review completed: February 2007