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Alcohol – Excessive Consumption: Dram Shop Liability


What the CPSTF Found

About The Systematic Review

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.


There is no information for this section.

Summary of Results

Eleven studies qualified for the review.

  • Studies assessed the effects of state dram shop liability laws on diverse outcomes, including motor vehicle fatalities overall, alcohol-related motor vehicle fatalities, alcohol consumption behaviors, alcohol-related violence, and alcohol-related diseases.
    • Most found reductions in alcohol-related outcomes associated with the presence of dram shop liability (11 studies).
      • Alcohol-related motor vehicle fatalities: median decrease of 6.4%(interquartile interval: 3.7%  to  11.3%; 6 studies)
  • One study assessed the effects of two high-profile dram shop liability suits in Texas.
    • Estimated effects on single vehicle nighttime crashes (closely associated with excessive alcohol consumption)
      • 6.6% decrease as a result of one suit
      • 5.3% decrease as a result of the other


Summary of Economic Evidence

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


Most of the included studies were conducted before the late 1990s, when various caps were enacted on the financial liability of servers and managers in dram shop cases. In addition, some states have instituted statutes of limitation that require injured plaintiffs to sue within a specified time period. And the standards of evidence required in dram shop liability cases have also grown more stringent, making it increasingly difficult to prove illegal beverage service. These changes may limit the applicability of this review to current circumstances.

Evidence Gaps

Each Community Preventive Services Task Force (CPSTF) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the CPSTF finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the CPSTF recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the CPSTF recommendation is based.

Identified Evidence Gaps

The following outlines evidence gaps for dram shop liability and overservice law enforcement initiatives.

As noted, many of the studies included in this review were conducted prior to the enactment in the late 1990s of various caps on financial liability of servers and managers in dram shop cases, in addition to statutes of limitation and increased legal evidence requirements. Further research is needed to assess what impact, if any, these limits on liability have had on the effectiveness of dram shop laws in reducing excessive alcohol consumption and related harms.

Additional studies are needed to assess how effective enhanced enforcement of overservice regulations is in reducing excessive alcohol consumption and related harms. It would be useful to ascertain barriers to effective enforcement. In addition, research is needed to assess the role of the media in publicizing enhanced enforcement and enhancing its effectiveness and the potential role of responsible beverage service training programs in reducing overservice and thus enhancing the effectiveness of enforcement. The latter is important as these multicomponent server intervention programs may prove benefıcial in decreasing excessive alcohol consumption and related harms in on-premises retail alcohol settings. The potential cost savings to owners of on-premises retail alcohol outlets through the promotion of responsible beverage service will be useful in assessing economic benefits.

The signs of intoxication that a patron exhibits may be difficult for servers or law enforcement officials to identify. To help servers avoid engaging in illegal service, additional research is needed to improve methods for identifying patrons who are intoxicated, underage, or both. Other methods for avoiding overservice can also be explored, such as counting drinks and spacing out the frequency of drink service through the use of food or nonalcoholic drinks after a predetermined threshold has been achieved.

Although enforcement of existing laws and regulations prohibiting service of alcohol to intoxicated patrons appears to be cost-benefıcial based on the estimated findings from Washtenaw County, additional studies are needed for a more reliable estimate of the economic value of enforcement.

Finally, additional research is needed to assess the effectiveness of both dram shop liability and enhanced enforcement in achieving these broader societal impacts, but if further research corroborates these findings, dram shop liability and enhanced enforcement of overservice laws could provide many collateral benefits.

Study Characteristics

All studies but one were panel studies of U.S. states using econometric models to assess the effects of dram shop liability and other interventions on diverse outcomes.