Regulating availability: how access to alcohol affects drinking and problems in youth and adults

Regulations on the availability of alcohol have been used to moderate alcohol problems in communities throughout the world for thousands of years. In the latter half of the 20th century, quantitative studies of the effects of these regulations on drinking and related problems began in earnest as public health practitioners began to recognize the full extent of the harmful consequences related to drinking. This article briefly outlines the history of this work over four areas, focusing on the minimum legal drinking age, the privatization of alcohol control systems, outlet densities, and hours and days of sale. Some historical background is provided to emphasize the theoretical and empirical roots of this work and to highlight the substantial progress that has been made in each area. In general, this assessment suggests that higher minimum legal drinking ages, greater monopoly controls over alcohol sales, lower outlet numbers and reduced outlet densities, and limited hours and days of sale can effectively reduce alcohol sales, use, and problems. There are, however, substantial gaps in the research literature and a near absence of the quantitative theoretical work needed to direct alcohol-control efforts. Local community responses to alcohol policies are complex and heterogeneous, sometimes reinforcing and sometimes mitigating the effects of availability regulations. Quantitative models of policy effects are essential to accelerate progress toward the formulation and testing of optimal control strategies for the reduction of alcohol problems.

Long-term effects of minimum drinking age laws on past-year alcohol and drug use disorders

BACKGROUND

Many studies have found that earlier drinking initiation predicts higher risk of later alcohol and substance use problems, but the causal relationship between age of initiation and later risk of substance use disorder remains unknown.

METHOD

We use a "natural experiment" study design to compare the 12-month prevalence of Diagnostic and Statistical Manual, Fourth Edition, alcohol and substance use disorders among adult subjects exposed to different minimum legal drinking age laws minimum legal drinking age in the 1970s and 1980s. The sample pools 33,869 respondents born in the United States 1948 to 1970, drawn from 2 nationally representative cross-sectional surveys: the 1991 National Longitudinal Alcohol Epidemiological Survey (NLAES) and the 2001 National Epidemiological Study of Alcohol and Related Conditions. Analyses control for state and birth year fixed effects, age at assessment, alcohol taxes, and other demographic and social background factors.

RESULTS

Adults who had been legally allowed to purchase alcohol before age 21 were more likely to meet criteria for an alcohol use disorder [odds ratio (OR) 1.31, 95% confidence intervals (95% CI) 1.15 to 1.46, p < 0.0001] or another drug use disorder (OR 1.70, 95% CI 1.19 to 2.44, p = 0.003) within the past-year, even among subjects in their 40s and 50s. There were no significant differences in effect estimates by respondent gender, black or Hispanic ethnicity, age, birth cohort, or self-reported age of initiation of regular drinking; furthermore, the effect estimates were little changed by inclusion of age of initiation as a potential mediating variable in the multiple regression models.

CONCLUSION

Exposure to a lower minimum legal purchase age was associated with a significantly higher risk of a past-year alcohol or other substance use disorder, even among respondents in their 40s or 50s. However, this association does not seem to be explained by age of initiation of drinking, per se. Instead, it seems plausible that frequency or intensity of drinking in late adolescence may have long-term effects on adult substance use patterns.

Environmental and contextual considerations

A number of environmental factors can influence an adolescent's risk for drinking, including parenting styles, an adolescent's choice of peer groups, and even whether he or she is active in after-school activities. Alcohol advertising, the price of alcohol, and the degree to which underage drinking laws are enforced also play a role. It is difficult to establish the degree to which alcohol use is influenced by environmental factors. This article describes some of the environmental influences that may increase the risk for underage drinking.

Community Prevention of Young Adult Drinking and Associated Problems

This article briefly summarizes three evidence-based community intervention trials sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Designed to reduce alcohol use among youth and young adults, these trials demonstrate the potency of community interventions that can influence the price, availability, drinking context, and perceived risks of heavy drinking among young people. The effectiveness of comprehensive, research-based local prevention efforts is confirmed by research examining other programs to reduce alcohol sales to youth as well as the harm caused by alcohol use among youth and young adults, including alcohol-related traffic accidents and assaults. By restructuring the total alcohol environment in a way that can be self-sustaining, these interventions are more likely to be effective than one-time interventions.

International Perspectives on Adolescent and Young Adult Drinking

Alcohol consumption by adolescents and young adults varies greatly in different countries and cultures, in different population groups within a country, and over time. Analyses of per capita consumption in different countries provide some information on drinking patterns of young people in various countries. School-based surveys conducted in a variety of European countries and in the United States offer more specific insight into the drinking behavior of this age group. Such surveys have analyzed variables such as age of onset of drinking; lifetime frequency of drinking; drinking to intoxication; frequency, amount, and timing of current drinking; and drinking consequences. These studies have demonstrated that drinking patterns of young people in, for example, Scandinavian, Anglo-Saxon, and Mediterranean countries vary greatly. Further analyses have explored the influence of social norms and related factors as well as alcohol availability and pricing on alcohol consumption among adolescents and young adults. The generalizability of the findings is limited, however, by the fact that most studies have been conducted in the United States and Europe.

Environmental Influences on Young Adult Drinking

Policy measures intended to control alcohol use and related problems have seldom been specifically targeted toward the entire group of young people between the ages of 18 and 25. Research evaluating these policies also tends not to focus on the 18–25 age group but, rather, on 18- to 20-year-olds or the adult population as a whole. Furthermore, some studies of alcohol control policies are cross-sectional and thus can offer only tentative information about the causes of results observed. Despite these limitations, the current literature does offer evidence for the effectiveness of particular alcohol control measures deserving of trials and further study among young adults. These measures affect the availability of alcohol, social messages about alcohol, and enforcement of current laws.

The Minimum Legal Drinking Age: History, Effectiveness, and Ongoing Debate

Minimum legal drinking age (MLDA) laws provide an example of how scientific research can support effective public policies. Between 1970 and 1975, 29 States lowered their MLDAs; subsequently, scientists found that traffic crashes increased significantly among teenagers. Alcohol use among youth is related to many problems, including traffic crashes, drownings, vandalism, assaults, homicides, suicides, teenage pregnancies, and sexually transmitted diseases. Research has demonstrated the effectiveness of a higher MLDA in preventing injuries and deaths among youth. Despite laws prohibiting the sale or provision of alcohol to people under age 21, minors can easily obtain alcohol from many sources. Increased MLDA enforcement levels and deterrents for adults who might sell or provide alcohol to minors can help prevent additional injuries and deaths among youth.

Prevention of Drinking and Driving

Since the early 1980's, legislative initiatives, such as the minimum legal drinking age of 21, administrative license revocation, and lower legal blood alcohol concentration limits for youth and adults, have significantly decreased alcohol-related traffic fatalities. General deterrence legislation is aimed at dissuading the general public from driving after drinking, whereas specific deterrence laws seek to prevent people who have been convicted for driving under the influence from repeating their offense. Education, enforcement, and comprehensive community programs, combined with legislation, can substantially reduce alcohol-related traffic deaths.

Alcohol Research and Social Policy: An Overview

Science can facilitate the task of choosing among complex social policies, although it rarely serves as the only basis for policy development. Science's role in policy formation can be decisive when public support already exists, as with the passage of the Federal Uniform Drinking Age Act. Science can assess a policy after it has been implemented, as in the scientific evaluation of the health warning labels on alcoholic beverage containers. In addition, science can investigate the short- and long-term benefits and risks of areas where the development of policies is likely. An example is the current scientific examination of the tradeoffs involved in moderate alcohol consumption.