Research

The Impact of State-Level Alcohol Policies on Reduced Health Consequences

It is also important to investigate whether policies that reduce hazardous forms of alcohol use, such as binge drinking, can impact downstream alcohol-related health outcomes.

 WHAT PROBLEM DOES THIS STUDY ADDRESS?

Researchers that examined the Alcohol Policy Scale and its relationship to binge drinking also analyzed whether alcohol policies may also be related to a particularly noteworthy alcohol-related health problem – death due to alcohol-related cirrhosis.

Cirrhosis is a disease where healthy liver tissue is replaced with scar tissue and impairs the liver’s ability to function properly (e.g., digestion, energy storage, and breakdown of potentially harmful substances like alcohol and other drugs).

HOW WAS THIS STUDY CONDUCTED?

Hadland and colleagues analyzed the relationship between a summary measure of a state’s alcohol policies, the Alcohol Policy Scale, and rates of death due to alcohol-related cirrhosis 3 years later.

The time periods examined were 1999-2008 for alcohol policies and 2002-2011 for deaths due to alcohol-related cirrhosis (relationships were examined for policies in 1999 and deaths in 2002, policies in 2000 and deaths in 2003, policies in 2001 and deaths in 2004, and so on), obtained from the Center for Disease Control’s Wide Ranging Online Data for Epidemiological Research (WONDER). The scale measures the extent to which a state has policies in place that have been shown to reduce harmful and hazardous alcohol use (e.g., higher taxes on each alcohol purchase, also called an excise tax). These analyses were adjusted statistically for the year studied as well as state-level race/ethnicity, proportion that were “college educated”, health insurance status, household income, religiosity, density of police force, and proportion living in rural/urban areas.

WHAT DID THIS STUDY FIND?

Authors found that, overall, men have higher rates of death due to alcohol-related cirrhosis than women, and Western states have greater rates than states in the Northeast, Midwest, and South (e.g., New Mexico has the highest rates of cirrhosis deaths and Maryland the lowest).

 

Regarding whether policies were related to death caused by cirrhosis, the influence of the Alcohol Policy Scale on deaths due to alcohol-related cirrhosis varied by gender, the region in which the state was located, and the proportion of American Indian/Alaskan Natives in the state.

In general, alcohol policies were more likely to positively impact cirrhosis deaths among women as well as in states that have low proportions of American Indian/Alaska Natives (less than 2.5%), and those located in the Northeast and South.

 

Even with a lag time of only 3 years, in contrast to the lengthier period of time it takes to develop cirrhosis, if states have more effective and widely implemented policies to reduce drinking it may have a fairly immediate impact on reduced health consequences among its residents. It is possible that one pathway through which this might happen is reduced binge drinking, which data show is responsible for half of the deaths and two-thirds of healthy life years lost due to all forms of excessive drinking.

WHY IS THIS STUDY IMPORTANT

This research examines the impact of alcohol policies on health outcomes in the U.S. and could inform policy changes at a state level, which might yield improvements in public health and reductions in alcohol-related disease, disability, and deaths.

 

This public health study suggests state-specific alcohol policies, on their own, could reduce the harm associated with hazardous and harmful alcohol use.

This study’s findings add to several others similar in nature that show strong associations between such things as the availability and price of alcohol and related harms (i.e., lower availability is related to less harm). Because there is an association between state policies and drinking, treatment/recovery research might be improved by including in analyses the state in which a person lives.

LIMITATIONS
  1. Studies that use population data (for example, analyzing data at the level of individual states) may be subject to the “ecological fallacy”, where analyses control for potential alternative explanations of the results using population data, but are applying the study conclusions to individuals.
  2. One limitation that may increase the effect authors observed was the 3-year lag between the alcohol policies and the incidence of alcoholic cirrhosis. Indeed, it often takes decades for alcohol to cause cirrhosis.
  3. While this study showed that better policies may improve mortality even over a short period, it would be interesting to see if the effects were even larger if associations were examined between policies and health outcomes over a 10-15 year period.

NEXT STEPS

Given lower impact of state alcohol policies for American Indian/Alaska Natives, more research is needed to understand how we can leverage alcohol related policies to reduce drinking and improve health outcomes specifically in this more vulnerable ethnic group.

BOTTOM LINE

  • For individuals & families seeking recovery: This study was focused on how state alcohol policies can reduce death due to alcohol-related cirrhosis. More research is needed to determine whether individual treatment and recovery outcomes are affected by the alcohol policies of the states in which you live.
  • For scientists: State alcohol policies may have substantial public health implications for alcohol related morbidity and mortality. These policies appear to have greatest influence on women, individuals in the Northeast, and non-American Indian/Alaska Natives. Future studies may examine why certain groups benefit more or less from the presence of alcohol policies. Also, if conducting research on health effects of hazardous alcohol use, strongly consider including an individual’s state or region of residence in your models if not already doing so (using multi-level analyses for example).
  • For policy makers: Strongly consider evidence-based policies shown to reduce alcohol consumption and binge drinking; they are likely to save lives, lower crime, reduce the financial burden of hazardous and harmful alcohol use, and improve the public health of your constituency.
  • For treatment professionals and treatment systems: It may be helpful to think about alcohol policies in your state and how they could affect your patients’ recovery context and alcohol-related behaviors and outcomes. For example, patients living in communities without restrictions on alcohol outlet density may need more help in coping with greater exposure to alcohol cues that can elicit more cravings than those living in communities with greater restrictions.

CITATIONS

Hadland, S. E., Xuan, Z., Blanchette, J. G., Heeren, T. C., Swahn, M. H., & Naimi, T. S. (2015). Alcohol Policies and Alcoholic Cirrhosis Mortality in the United States. Preventing Chronic Disease, 12, E177. doi:10.5888/pcd12.150200

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