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Alcohol – Excessive Consumption: Maintaining Limits on Days of Sale


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 14 studies (search period through February 2008). 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.

Summary of Results

Detailed results from the systematic review are available in the CPSTF finding pdf icon [PDF - 148 KB].

All of the studies that considered the effects of changing days of sale on excessive alcohol consumption looked at limits on weekend days.

Removing limits on days of sale in off-premises settings (e.g., grocery, convenience or liquor stores)

Five studies qualified for the review.

  • A two-phase repeal of a Saturday ban was associated with a small increase in consumption, limited effects on injuries, and an increase in alcohol-impaired driving, some of which may have been due to increased surveillance (Sweden).
  • The closing of state liquor stores on Saturdays (Norway) had mixed results, with declines in consumption and in domestic violence, but increases in overall violence.
  • A 1995 repeal of a ban on Sunday sales was associated with a 30% increase in motor vehicle fatalities on Sundays compared with other days of the week (New Mexico).
  • A study of the effects of increased days of sale in multiple United States states indicated increases in the per capita consumption of spirits and beer.

Removing limits on days of sale in on-premises settings (e.g., restaurants, bars, ballparks)

Six studies qualified for the review.

  • One study found small increases in individual levels of consumption associated with new Sunday sales (Scotland).
  • Five studies found substantial increases in motor vehicle-related harms (fatal and non fatal crashes and alcohol-impaired driving arrests) associated with policies allowing new days of sale in several settings (Australia and the United States).

Imposing limits on days of sale for off-premises settings (e.g., grocery, convenience or liquor stores)

Two studies qualified for the review.

  • An experimental Saturday ban in 1981 was associated with declines in alcohol-related violence and other disturbances (Sweden).
  • Local repeal of a state-wide allowance of Sunday sales was associated with relative declines in motor vehicle fatalities (New Mexico).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF finding pdf icon [PDF - 148 KB].

Two studies qualified for the review.

  • One study modeled the cost effectiveness of restricting alcohol sales in 12 global health regions for a 24-hour period over a weekend.
    • For the region composed of the U.S., Canada, and Cuba, the model estimated an average cost-effectiveness ratio of approximately $700 (in 2007 U.S. dollars) per disability-adjusted life year (DALY) averted by the reduction in heavy or harmful drinking. This is much less than the average annual per capita income in these three countries, making it very cost effective.
  • A study in New Mexico found that lifting a Sunday ban on packaged alcohol led to an estimated increase of 41.6 alcohol-related fatalities on Sundays for the 5-year period from 1995 to 2000. This would result in an estimated additional cost of more than $6 million (in 2007 U.S. dollars) for medical care and lost productivity per year for the state.


Results of this review are likely applicable to a variety of settings and geographic locations in the U.S. and other high-income countries.

Evidence Gaps

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?

  • The research on days of sale conducted in the U.S. was primarily at the state level. However, additional research is needed to assess the effectiveness of local restrictions on days of sale in preventing excessive alcohol consumption and related harms.
  • It would be useful to better understand the effect of differential policies regarding days of sale across neighboring jurisdictions. Does more ready access in a neighboring region lead to increased travel to this region, allowing the possibility of motor vehicle crashes, especially with intoxicated drivers?
  • Additional research is also needed to more fully assess the costs and benefits of restricting the number of days of sale. From a societal perspective, these should include:
    • Intervention costs
    • Loss in sales and tax revenues and employment
    • Reductions in fatal and nonfatal injuries, crime, and violence
    • Gains in safety and public order
    • Averted loss of household and workplace productivity

Study Characteristics

  • Included studies were conducted in cities, states, and countries or large regions in the U.S., Australia, Norway, Sweden, and Scotland.
  • The policy changes that were assessed took place between 1967 and 2004.
  • Studies used a variety of methods for estimating intervention effects, including chi-square statistics, percentage change, relative risks, and auto-regressive integrated moving average (ARIMA) time series. All but one study had comparison populations or conditions.
  • To be included in the review, studies had to report on outcomes related to excessive alcohol consumption or related harms. Outcome measures included binge drinking, heavy drinking, liver cirrhosis mortality, alcohol-related medical admissions, alcohol-related motor vehicle crashes, including single-vehicle night-time crashes (which are widely used to indicate motor vehicle crashes due to drinking and driving), per capita alcohol consumption (a recognized proxy for estimating the number of heavy drinkers in a population), unintentional injuries, suicide, and crime, such as homicide and aggravated assault.