Alcohol Excessive Consumption: Overservice Law Enforcement Initiatives

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether overservice law enforcement initiatives reduce excessive alcohol consumption and alcohol-related harms.


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.

  1. Notify alcohol beverage outlets of enforcement plans in order to foster awareness essential for effective deterrence.
  2. Provide information or training to help outlet managers and staff comply with overservice laws. Help them learn how to better recognize intoxicated customers and offer strategies to prevent overservice.

Because overservice laws are not actively enforced in many communities, these 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 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).

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

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About The Systematic Review

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

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included two studies.

  • 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). When compared with control settings
    • Service to individuals pretending to be intoxicated customers decreased 28.5%
    • People arrested for DUI who reported consuming their last drink in a bar or restaurant decreased 26.5%
  • 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 alcohol-impaired driving showed beneficial effects in both studies.

Summary of Economic Evidence

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


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

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. What are evidence gaps?

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

  • How effective is enhanced enforcement of overservice regulations in reducing excessive alcohol consumption and related harms?
  • What are barriers to effective enforcement?
  • What is the role of the media in publicizing enhanced enforcement?
  • What is the potential role of responsible beverage service training programs in reducing overservice and enhancing the effectiveness of enforcement? Multicomponent server intervention programs may prove benef cial in decreasing excessive alcohol consumption and related harms in on-premises retail alcohol settings.
  • What are the best methods for identifying patrons who are intoxicated, underage, or both?
  • Are there other methods to avoiding overservice, such as counting drinks or spacing out the frequency of drink service with food or nonalcoholic drinks?
  • What is the economic value of enforcement?

Study Characteristics

  • Studies were conducted in Washington 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.

Analytic Framework

Effectiveness Review

Analytic Framework see Figure 2 on page 338
When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

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).

Effectiveness Review

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:

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)

Considerations for Implementation

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.