Alcohol Excessive Consumption: Dram Shop Liability

The CPSTF finding is based on evidence from a systematic review of 11 studies (search period through October 2007).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing excessive alcohol consumption.

More details about study results are available in the CPSTF Finding and Rationale Statement.

The systematic review included 11 studies.

• Studies assessed the effects of state dram shop liability laws on different outcomes (i.e., motor vehicle deaths overall, alcohol-related motor vehicle deaths, alcohol consumption behaviors, alcohol-related violence, alcohol-related diseases).
  • Most found dram shop liability laws were associated with reductions in alcohol-related outcomes (11 studies).
  • Alcohol-related motor vehicle deaths decreased by a median of 6.4% (6 studies)
• One study assessed the effects of two high-profile dram shop liability suits in Texas. These suits led to estimated decreases of 6.6% and 5.3% in single vehicle nighttime crashes (closely associated with excessive alcohol consumption).

An economic review of this intervention did not find any relevant studies.

Most of the included studies were done before the late 1990s. Since then, some states have enacted limits on the financial liability of servers and managers, set statutes of limitation that require injured plaintiffs to sue within a specified time period, or increased the standard of evidence required to prove illegal beverage services. Such changes may limit the applicability of the findings of this review.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. What are evidence gaps?

• What is the impact, if any, of state laws that limit dram shop liability?
• How can we improve methods for identifying patrons who are intoxicated, underage, or both?
• Are there other ways to avoid overservice (serving someone too many drinks), such as counting drinks, providing food to space out drinks, or serving nonalcoholic drinks once a threshold has been achieved?
• What is the economic benefit of dram shop liability?
• What are additional benefits of dram shop liability?

All but one of the studies were panel studies of U.S. states that used econometric models.

Rammohan V, Hahn RA, Elder R, et al. Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: two Community Guide systematic reviews. American Journal of Preventive Medicine. 2011;41(3):334-43.

Task Force on Community Services. Recommendations on dram shop liability and overservice law enforcement initiatives to prevent excessive alcohol consumption and related harms. American Journal of Preventive Medicine. 2011;41(3):344-6.

Mosher JF. Dram shop liability and overservice law enforcement initiatives: a commentary. American Journal of Preventive Medicine. 2011;41(3):350-2.

O’Connor R. Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: a commentary on a New Mexico perspective. American Journal of Preventive Medicine. 2011;41(3):347-9.

Effectiveness Review

Analytic Framework
When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Effectiveness Review

Summary Evidence Table — Effectiveness Review

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Benson BL, Rasmussen DW, Mast BD. Deterring drunk driving fatalities: an economics of crime perspective. Int Rev Law Econ 1999;19:205 25.

Chaloupka FJ, Saffer H, Grossman M. Alcohol-control policies and motor-vehicle fatalities. J Legal Stud 1993;22(1):161 86.

Mast BD, Benson BL, Rasmussen DW. Beer taxation and alcohol-related traffic fatalities. S Econ J 1999;66(2):214 7.

Ruhm CJ. Alcohol policies and highway vehicle fatalities. J Health Econ 1996;15(4):435 54.

Sloan FA, Reilly BA, Schenzler C. Effects of prices, civil and criminal sanctions, and law enforcement on alcohol-related mortality. J Stud Alcohol 1994;55(4):454.

Sloan FA, Reilly BA, Schenzler C. Effects of tort liability and insurance on heavy drinking and drinking and driving. J Law Econ 1995;38(1):49 77.

Sloan FA, Reilly BA, Schenzler CM. Tort liability versus other approaches for deterring careless driving. Int Rev Law Econ 1994;14(1):53 71.

Stout EM, Sloan FA, Liang L, Davies HH. Reducing harmful alcohol-related behaviors: effective regulatory methods. J Stud Alcohol 2000;61(3):402 12.

Wagenaar AC, Holder HD. Effects of alcoholic beverage server liability on traffic crash injuries. Alcohol Clin Exp Res 2007;15(6):942 7.

Whetten-Goldstein K, Sloan FA, Stout E, Liang L. Civil liability, criminal law, and other policies and alcohol-related motor vehicle fatalities in the U.S.: 1984 1995. Accid Anal Prev 2000;32(6):723 33.

Young DJ, Likens TW. Alcohol regulation and auto fatalities. Int Rev Law Econ 2000;20(1):107 26.

Implementation Resources

Strategizer 57 – Reducing Alcohol-Related Harms Through Commercial Host Liability
Developed by the Community Anti-Drug Coalitions of America in partnership with the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health

Rural Health Information Hub, Prevention and Treatment of Substance Use Disorders Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of programs to prevent and treat substance use disorders in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

• Prevention Policies

The following outlines the search strategy used for these reviews of interventions to prevent excessive alcohol consumption: Dram Shop Liability; Increasing Alcohol Taxes; Maintaining Limits on Days of Sale; Maintaining Limits on Hours of Sale; Overservice Law Enforcement Initiatives; Regulation of Alcohol Outlet Density; Enhanced Enforcement of Laws Prohibiting Sales to Minors.

The following databases were searched from their inception up to October 2007 to identify studies assessing the impact of changes for all interventions included in the Community Guide series of alcohol reviews: Econlit, PsycInfo, Sociology Abstracts, Medline, Embase, and EtOH (not available after 2003). The search yielded 6442 articles, books, and conference abstracts, of which 5645 were unique.

1) Alcohol Keywords

• (Alcoholic drink$ OR alcoholic beverage* OR alcohol OR liquor OR beer OR wine OR spirits OR drunk OR intoxicat$ OR alcoholic binge* OR binge drinking)

2) Keywords for interventions of interest (assume ORs between bullets) {Target intervention}

• ((day$ or hour$ or sale$) and (limit$ or sale$ or extend$ or restrict$ or trading)) {Restrictions on days and hours of sale}
  • (day OR hour OR “time of day” OR time) AND (sale* OR trading OR commerce) AND (limit OR restrict OR regulate)
• (tax or taxes or taxation or cost or costs$ or prices or price) {Increased alcohol taxes}
  • (tax*) AND (increase OR raise)
• (social and (host$ or liability or provider$ or provision)) {Social host liability}
  • (“social host” OR provider* OR provision) AND (liability OR responsibility)
• ((underage or minor or youth or young or teenage$) and licens$ and (enforcement or fee$ or driver$)) {License suspension/revocation for non-MV alcohol violations among underage drinkers}
  • (underage OR minor OR youth OR adolescent OR teen*) AND (“drivers license” OR) AND (suspension OR revocation OR revoke) AND (“non-mv alcohol violation” OR (“alcohol violation” NOT (driving OR “motor vehicle”))
• (privatiz$ or monopol$ or ((sale$ or distribut$ or industry) and (ban$ or strike$ or prohibition))) {Government monopolies on off-premise outlets}
  • (“off-premise”) AND (“government monopoly” OR government OR privatiz* OR monopoly) AND (sale* OR distribut* OR industry)
• (minimum age or drinking age or purchase age or legal age or MDA or MLDA or ((teen$ or adolescen$ or young or college$ or youth$ or student$ or underage$ or minor$) and (enforce$ or deterrence$ or avail$ or access$ or crackdown or ID or identification or compliance))) {Enhanced enforcement of laws prohibiting possession or consumption of alcohol by minors}
  • (underage OR minor OR youth OR adolescent OR teen*) AND (possess* OR consum* OR access*) AND (law* OR regulat* OR enforce* OR deter* OR crackdown OR complia*) AND (“minimum age” OR “drinking age” OR “purchase age” OR “legal age” OR “MDA” OR “MLDA”)
• (advertis$ or marketing or promotion$ or internet or product placement or billboard$ or sponsorship) {Limiting advertising exposure}
  • (advertis* OR market* OR promotion* OR internet OR www OR World Wide Web OR “product placement” OR billboard* OR sponsor* OR target*) AND (underage OR minor OR youth OR adolescent OR teen*) AND (limit OR reduc* OR restrict* OR regulat*)
• (compliance check$ or sting$ or decoy$ or purchase attempt or dram shop) {Enhanced enforcement of laws prohibiting provision of alcohol to minors}
  • (“dram shop” OR “on-premise” OR provider) AND (“compliance check*” OR “purchase attempt*” OR enforce*) AND (law* OR regulat* OR prohibit*) AND (underage OR minor OR youth OR adolescent OR teen*)
• (((manager$ or management or serv$ or clerk$ or seller$) and (liabilit$ or practice$ or training or beverage$)) or liquor liability) {Responsible beverage server programs/Dram shop liability}
  • (provider OR manage* OR serv* OR “dram shop” OR “on-premise” OR sale*) AND ((liabil* OR responsib*) OR (“responsible beverage server program*” OR training OR program*)
• (gas station or self service or ((outlet$ or store$ or bar or bars or establishment) and (density or densities or on-sale or off-sale or type or types or number$ or location$ or concentration or zoning))) {Outlet density and zoning restrictions}
  • (“gas station” OR store OR bar* OR establishment* OR sale*) AND (zon* OR restriction* OR regulat* OR law*) AND (dens*)
• (happy hour$ or liquor by the drink or ladies night or (drink$ and (special$ or discount$ or pric$)) { Decreasing promotional pricing}
  • (promot* OR special OR discount OR “happy hour” OR “ladies night”) AND (pric*) AND (decrease OR restrict* OR regulat* OR limit OR reduc*)

3) Exclusionary keywords

• (air and quality) or pollution
• methanol or methyl
• solvent$

Search for (1) AND (2), NOT (3)

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

• Intervention effectiveness may be limited by state-specific caps on the financial liability of servers and managers (i.e., how much they might need to pay in a lawsuit), statutes of limitation (i.e., how long injured people have to sue), and standards for required evidence (for use in a lawsuit).
• A benefit of maintaining strong dram shop liability may be business environments that support responsible beverage service without penalizing servers and managers who try to follow liquor control laws.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce the proportion of motor vehicle crash deaths that involve a drunk driver — SU-11