Alcohol – Excessive Consumption: Overservice Law Enforcement Initiatives

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Snapshot

Summary of Task Force Finding

The Community Preventive Services Task Force finds insufficient evidence to determine the effectiveness of overservice law enforcement initiatives as a means to reduce excessive alcohol consumption and alcohol-related harms, because of the small number of available studies and inconsistent findings.

Intervention

Overservice law enforcement initiatives are proactive community efforts to increase the enforcement of laws that prohibit the service of alcoholic beverages to intoxicated customers. Alcohol Beverage Control personnel or plainclothes or uniformed police carry out enforcement, which may include fines or licensing actions.

Overservice law enforcement initiatives often involve two more components. The first is to notify alcohol beverage outlets of enforcement plans in order to foster the awareness essential for effective deterrence. The second is to provide information or training to help outlet managers and staff comply with overservice laws by learning how to better recognize intoxicated customers and by providing strategies to prevent overservice. Because overservice laws are not actively enforced in many communities, overservice law enforcement initiatives often involve increases in enforcement from low baseline levels.

Not all U.S. states provide definitions of intoxication in their overservice regulations, and the definitions in use are inconsistent. Law enforcement officers and servers may recognize patron intoxication by tracking the number of alcoholic beverages served or by looking for physiological and behavioral characteristics that become more apparent as alcohol consumption increases (e.g., bloodshot eyes, flushed face, slurred speech, lack of balance and coordination).

Task Force Finding and Rationale Statement

Read the full Task Force Finding and Rationale Statement [PDF - 153 kB] for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

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What the Task Force Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review of 2 studies (search period through October 2007). The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing excessive alcohol consumption.

Context

There is no information for this section.

Summary of Results

Two studies qualified for the review.

One study (with a greater intensity of enhanced enforcement) found substantial and statistically significant benefits of the overservice enforcement initiative on all of the outcomes assessed (Michigan).
- Service to individuals pretending to be intoxicated customers: decrease of 28.5% in intervention settings, compared with control settings.
- People arrested for DUI who reported consuming their last drink in a bar or restaurant: decrease of 26.5% in intervention settings, compared with control settings.
The other study found inconsistent and statistically nonsignificant results for outcomes assessing overservice and alcohol-impaired driving (Washington state).
Overall, several results pointed in a comparable direction. The estimated effects on the most reliable health outcomes—those related to DUI—showed beneficial effects in both studies.

Summary of Economic Evidence

An economic review of this intervention was not conducted because the Task Force did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because the Task Force did not have enough information to determine if the intervention works.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) 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 Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force 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 Task Force 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 fınancial 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 benefıts.

The signs of intoxication that a patron exhibits may be diffıcult for servers or law enforcement offıcials 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 fındings 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 fındings, dram shop liability and enhanced enforcement of overservice laws could provide many collateral benefıts.

Study Characteristics

Studies were conducted in Washington state and Michigan.
Both studies provided information about efforts to raise awareness about the initiative and its enforcement.
The studies used pre–post designs, with concurrent comparisons.

Publications

Rammohan V, Hahn RA, Elder R, et al. Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: two Community Guide systematic reviews. American Journal of Preventive Medicine. 2011;41(3):334-43.

Task Force on Community Services. Recommendations on dram shop liability and overservice law enforcement initiatives to prevent excessive alcohol consumption and related harms. American Journal of Preventive Medicine. 2011;41(3):344-6.

O’Connor R. Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: a commentary on a New Mexico perspective. American Journal of Preventive Medicine. 2011;41(3):347-9.

Supporting Materials

Analytic Framework

Analytic Framework [PDF - 582 kB] – see Figure 2 on page 338

Summary Evidence Table

Summary Evidence Table - - Effectiveness Review [PDF - 105 kB]

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

McKnight AJ, Streff FM. The effect of enforcement upon service of alcohol to intoxicated patrons of bars and restaurants. Accid Anal Prev 1994;26(1):79–88.

Ramirez R, Nguyen D, Cannon C, Carmona M, Freisthler BA. A campaign to reduce impaired driving through retail-oriented enforcement in Washington State. National Highway Safety Administration, Washington (DC): 2008. Available at URL: http://trid.trb.org/view.aspx?id=863884 External Web Site Icon .

Search Strategies

The following outlines the search strategy used for these reviews of interventions to prevent excessive alcohol consumption: Dram Shop Liability; Increasing Alcohol Taxes; Maintaining Limits on Days of Sale; Maintaining Limits on Hours of Sale; Overservice Law Enforcement Initiatives; Regulation of Alcohol Outlet Density; Enhanced Enforcement of Laws Prohibiting Sales to Minors.

The following databases were searched from their inception up to October 2007 to identify studies assessing the impact of changes for all interventions included in the Community Guide series of alcohol reviews: Econlit, PsycInfo, Sociology Abstracts, Medline, Embase, and EtOH (not available after 2003). The search yielded 6442 articles, books, and conference abstracts, of which 5645 were unique.

1) Alcohol Keywords

(Alcoholic drink$ OR alcoholic beverage* OR alcohol OR liquor OR beer OR wine OR spirits OR drunk OR intoxicat$ OR alcoholic binge* OR binge drinking)

2) Keywords for interventions of interest (assume ORs between bullets) {Target intervention}

((day$ or hour$ or sale$) and (limit$ or sale$ or extend$ or restrict$ or trading)) {Restrictions on days and hours of sale}
- (day OR hour OR “time of day” OR time) AND (sale* OR trading OR commerce) AND (limit OR restrict OR regulate)
(tax or taxes or taxation or cost or costs$ or prices or price) {Increased alcohol taxes}
- (tax*) AND (increase OR raise)
(social and (host$ or liability or provider$ or provision)) {Social host liability}
- (“social host” OR provider* OR provision) AND (liability OR responsibility)
((underage or minor or youth or young or teenage$) and licens$ and (enforcement or fee$ or driver$)) {License suspension/revocation for non-MV alcohol violations among underage drinkers}
- (underage OR minor OR youth OR adolescent OR teen*) AND (“drivers license” OR) AND (suspension OR revocation OR revoke) AND (“non-mv alcohol violation” OR (“alcohol violation” NOT (driving OR “motor vehicle”))
(privatiz$ or monopol$ or ((sale$ or distribut$ or industry) and (ban$ or strike$ or prohibition))) {Government monopolies on off-premise outlets}
- (“off-premise”) AND (“government monopoly” OR government OR privatiz* OR monopoly) AND (sale* OR distribut* OR industry)
(minimum age or drinking age or purchase age or legal age or MDA or MLDA or ((teen$ or adolescen$ or young or college$ or youth$ or student$ or underage$ or minor$) and (enforce$ or deterrence$ or avail$ or access$ or crackdown or ID or identification or compliance))) {Enhanced enforcement of laws prohibiting possession or consumption of alcohol by minors}
- (underage OR minor OR youth OR adolescent OR teen*) AND (possess* OR consum* OR access*) AND (law* OR regulat* OR enforce* OR deter* OR crackdown OR complia*) AND (“minimum age” OR “drinking age” OR “purchase age” OR “legal age” OR “MDA” OR “MLDA”)
(advertis$ or marketing or promotion$ or internet or product placement or billboard$ or sponsorship) {Limiting advertising exposure}
- (advertis* OR market* OR promotion* OR internet OR www OR World Wide Web OR “product placement” OR billboard* OR sponsor* OR target*) AND (underage OR minor OR youth OR adolescent OR teen*) AND (limit OR reduc* OR restrict* OR regulat*)
(compliance check$ or sting$ or decoy$ or purchase attempt or dram shop) {Enhanced enforcement of laws prohibiting provision of alcohol to minors}
- (“dram shop” OR “on-premise” OR provider) AND (“compliance check*” OR “purchase attempt*” OR enforce*) AND (law* OR regulat* OR prohibit*) AND (underage OR minor OR youth OR adolescent OR teen*)
(((manager$ or management or serv$ or clerk$ or seller$) and (liabilit$ or practice$ or training or beverage$)) or liquor liability) {Responsible beverage server programs/Dram shop liability}
- (provider OR manage* OR serv* OR “dram shop” OR “on-premise” OR sale*) AND ((liabil* OR responsib*) OR (“responsible beverage server program*” OR training OR program*)
(gas station or self service or ((outlet$ or store$ or bar or bars or establishment) and (density or densities or on-sale or off-sale or type or types or number$ or location$ or concentration or zoning))) {Outlet density and zoning restrictions}
- (“gas station” OR store OR bar* OR establishment* OR sale*) AND (zon* OR restriction* OR regulat* OR law*) AND (dens*)
(happy hour$ or liquor by the drink or ladies night or (drink$ and (special$ or discount$ or pric$)) { Decreasing promotional pricing}
- (promot* OR special OR discount OR “happy hour” OR “ladies night”) AND (pric*) AND (decrease OR restrict* OR regulat* OR limit OR reduc*)

3) Exclusionary keywords

(air and quality) or pollution
methanol or methyl
solvent$

Search for (1) AND (2), NOT (3)

Review References