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Alcohol – Excessive Consumption: Increasing Alcohol Taxes


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 73 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.


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Summary of Results

Seventy-three studies qualified for the review.

  • The studies looked at the relationship between either tax rates or total price on measures related to excessive alcohol consumption or its related harms.
  • The effects of prices on consumption or other outcomes are often expressed as “elasticities,” that are defined as the expected percentage change in the outcome when the price increases by 1%. For example, an alcohol price elasticity of -0.50 would mean that the outcome of interest (e.g., alcohol consumption) would be expected to decrease by 5% for every 10% increase in price.

Alcohol price and per capita consumption

  • Price elasticity of alcohol consumption (i.e., the expected percentage change in alcohol consumption when the price increases by 1%)
    • Beer consumption: -0.50 (interquartile interval [IQI]: -0.91 to -0.36; 18 studies)
    • Wine consumption: -0.64 (IQI: -1.03 to -0.38; 22 studies)
    • Spirits consumption: -0.79 (IQI: -0.90 to -0.24; 21 studies)
    • Total alcohol (ethanol) consumption: -0.77 (IQI: -2.00 to -0.50; 11 studies)
  • Price and consumption by high school or college age youth
    • Six studies found consistent evidence that higher alcohol prices were associated with less youth drinking; 3 studies found mixed results (9 studies).

Alcohol price and alcohol-related harms

  • Higher alcohol prices or taxes were consistently related to:
    • Fewer motor vehicle crashes and fatalities (10 of 11 studies)
    • Less alcohol-impaired driving (3 of 3 studies)
    • Less mortality from liver cirrhosis (5 of 5 studies)
    • Less all-cause mortality (1 study)
  • Effects also were demonstrated for measures of violence (3 studies), sexually transmitted diseases (1 study), and alcohol dependence (1 study).


Summary of Economic Evidence

Two studies assessed the economic costs and benefits of alcohol tax intervention. All monetary values are reported in 2007 U.S. dollars.

  • Cost-effectiveness was measured using disability-adjusted life-years (DALYs) which express both time lost due to premature death and time spent disabled by disease or accident.
  • Alcohol tax of 20% of the pretax retail price offered net cost savings (one study).
  • Intervention costs were $482,956 per 1 million people per year and the average cost-effectiveness ratio was approximately $395 per DALYs averted, a good value for money based on the per capita income of included countries (one study).


Review findings are likely applicable across high-income countries.

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 volume and consistency of the evidence reviewed suggests little need for additional research on the basic questions of whether changes in alcohol taxes and price affect excessive alcohol consumption and related harms. Nonetheless, studies published subsequent to the 2005 cutoff date for this review continue to indicate the public health benefits that accrue from increasing alcohol taxes. For example, a 2009 meta-analysis found very similar mean price elasticities for alcohol consumption as were found in this review (Wagenaar et al., 2009a).

Similarly, a study of alcohol-related disease mortality published in 2009 found that substantial alcohol tax increases in Alaska in 1983 and 2002 resulted in estimated reductions of 29% and 11%, respectively (Wagenaar et al., 2009b).

However, additional research is needed to assess:

  • Whether changes in alcohol prices differentially affect drinking behavior and health outcomes for important subgroups of the population, such as underage young people.
  • The relative benefits of increasing taxes on all alcoholic beverages simultaneously, versus selectively increasing taxes on specific beverage types. This evaluation should be considered in light of known differences in the beverage preferences of binge drinkers, historic changes in tax rates across beverage types, and the effect of inflation on real tax rates by beverage type.
  • The impact of different approaches to taxing alcoholic beverages on excessive alcohol consumption and related harms. Specific emphasis should be placed on the impact of alcohol sales taxes, where taxes are calculated as a proportion of the total beverage price; the potential impact of standardizing alcohol taxes across beverage types based on alcohol content; and the potential impact of alcohol taxes levied by local governments on a per-drink basis in on-premise, retail alcohol outlets (i.e., tippler taxes).


Wagenaar AC, Salois MJ, Komro KA. Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies. Addiction 2009a;104:179–90.

Wagenaar AC, Maldonado-Molina MM, Wagenaar BH. Effects of alcohol tax increases on alcohol-related disease mortality in Alaska: time–series analyses from 1976 to 2004. Am J Public Health 2009b;99:1464–70.

Study Characteristics

  • Most studies assessed total alcohol consumption at the societal level (i.e., per capita alcohol consumption). The design of these studies varied across countries.
    • Most studies conducted outside the U.S. used interrupted time–series designs, because alcohol taxes in other countries tend to be set at the national level, and as such, it is generally not possible to do intra-country comparisons.
    • In contrast, most of the U.S. studies used a panel study design, in which multiple states were assessed over time, allowing each to serve as a comparison for the others.
  • The remaining studies assessed measures related to excessive drinking (e.g., the prevalence of underage or binge drinking) or alcohol-related harms, the most common being outcomes related to motor-vehicle crashes.