Preventing Excessive Alcohol Consumption: Privatization of Retail Sales

Research Gaps

What are Research Gaps?

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as "research gaps." Research gaps can be pulled together in the form of a basic set of questions to inform a research agenda for those in the field.

Identified Research Gaps

Results from the Community Guide review indicate generally consistent evidence that the privatization of retail alcohol sales is associated with an increase in total alcohol sales, which is considered a useful proxy for excessive alcohol consumption due to their strong relationship. There is also some evidence that remonopolization is associated with a reduction in excessive alcohol consumption and related harms.  However, the limited available evidence of effects of privatization on alcohol-related harms (i.e., motor vehicle crashes and cirrhosis) in North American settings is not consistent with findings on consumption (i.e., while the increased consumption associated with privatization would be expected to lead to increased motor vehicle crashes and alcohol-related diseases, a tendency toward the opposite has been observed).  Further research is needed to resolve these inconsistencies. 

Thus, both because most studies do not directly address impacts on excessive consumption and because of inconsistent findings on related harms, there is insufficient evidence to determine the effects of privatization on excessive alcohol consumption and related harms. Due to differences in implementation, there is also substantial variability in the effects of privatization on the intermediate outcomes (e.g., outlet density and beverage price) through which privatization is presumed to affect alcohol consumption. Future research should directly evaluate the effects of privatization on excessive consumption and alcohol-related harms. 

Most useful would be studies in the U.S. similar to the one conducted by Makela, et al.⁽¹⁾ in Finland, assessing the effects of privatization (or monopolization) on patterns of alcohol consumption (e.g., binge drinking) and alcohol-related harms.  Such studies might be conducted using self-reported data on alcohol consumption from large population-based risk factor surveys, such as the CDC’s Behavioral Risk Factor Surveillance System (BRFSS). 

Privatization has assumed different forms in different states and localities.  Thus, it would be useful to determine whether the effects of privatization observed here and in individual-specific analyses vary by the degree of government regulation and other specific parameters of the privatization. Although in general government monopolies impose a greater degree of regulation over retail alcohol sales than systems where sales have been privatized, Stockwell and Gruenewald⁽²⁾ have noted that, “Some private systems were heavily regulated and some government monopolies were highly commercially orientated in their operation.”

Government control of the retail sale of alcoholic beverages may provide a source of government income.  It would be useful to assess the effects of privatization in differing circumstances on state revenues associated with sales and taxes on alcoholic beverages. 

 

(1) Makela P. Whose drinking does the liberalization of alcohol policy increase? Change in alcohol consumption by the initial level in the Finnish panel survey in 1968 and 1969. Addiction 2002; 97(6):701-706.

(2) Stockwell T, Gruenewald P. Controls on the Physical Availability of Alcohol. In: Heather N, Peters TJ, Stockwell T, editors. International handbook of alcohol dependence and problems. Chichester, England: Wiley, 2001: 699-719.